[The effectiveness of Braun's anastomosis in Billroth II surgery. The role of hepatobiliary sequence scintigraphy (HBSS) in the diagnosis of bile flow following stomach resection]. / Zur Effektivität der Braunschen Fusspunktanastomose bei der Operation nach Billroth II. Stellenwert der hepatobiliären Sequenzszintigraphie (HBSS) bei der Diagnostik des Galleflusses nach Magenresektion.

After resection of the stomach the alkaline reflux of the duodenal contents into the residual stomach is a major factor to be taken into consideration when assessing the causes leading to irregularities of the mucosal barrier. Illnesses that may arise subsequent to gastric surgery are gastritis of the resected stomach, inflammation of the anastomosis, anastomotic ulcers and--with reservations--anastomotic carcinoma. In view of these clinical pictures, a protective function for the biliary system is ascribed to Braun's entero-anastomosis. With the aid of hepatobiliary sequence scintigraphy (HBSS) a functional analysis was obtained from 30 patients, subsequent to gastric surgery--after Billroth II with entero-anastomosis--which showed a surprisingly high rate of reflux into the residual stomach, in 16 out of these 30 patients. The high-grade HBSS data with regard to the biliary reflux proportions after gastric surgery and the low-grade effectiveness of Braun's entero-anastomosis are clearly evidenced.

[Computed tomographic findings in portal hypertension secondary to liver cirrhosis. 3. Hemodynamic changes--angio-CT]. / Computertomographische Befunde bei portaler Hypertension infolge Leberzirrhose. Teil 3: Hämodynamische Veränderungen - Angio-CT.

Contrast injection for angio-CT shows kinetic changes in patients with portal hypertension due to cirrhosis of the liver when compared with normals. Contrast-duration diagrams show a higher aortic peak, low contrast and delayed contrast maximum in the liver and portal vein in patients with liver cirrhosis and portal hypertension. On these criteria it is possible to distinguish patients with cirrhosis (n = 18) from normals (n = 16).

[Animal experiments in electrophysiology of the canine stomach in reference to esophageal substitution with a tubal stomach in man]. / Tierexperimentelle Studie zur Elektrophysiologie des Hundemagens im Hinblick auf den Ersatz der Speiseröhre durch den Schlauchmagen beim Menschen.

In an effort to demonstrate and explain the peristalsis and intact pylorus-function of an oesophagus substituted by a transformed stomach-tube and despite total vagotomy, acute tests were undertaken on 14 dogs of mixed breed in the form of electromyographic examinations on the normal stomach, the stomach after vagotomy and with transformed stomach-tubes. Apart form slight frequency-decreases it was found that extracellular phasic bipolar contractions, traced an independent, individual current curve both after vagotomy and after transformation into a stomach-tube. The clinically observed intact function of the isoperistaltic stomach is to be explained with synergism after biomechanical changes and by the autonomy of the smooth stomach-musculature.

[Function-preserving interventions in metastatic fractures]. / Funktionserhaltende Eingriffe bei metastatischen Frakturen.

A report on combined osteosynthesis (plate and bone cement) in 11 metastatic fractures of arms and legs is presented. Fractures in the aged and high risk patients with osteoporosis are other indications for this method. Normal use of the affected limb and mobilization are possible one day after operation. Already existing visceral metastases are no contraindication.

[Esophageal function scintigraphy following sclerosing therapy]. / Osophagus-Funktionsszintigraphie nach Sklerosierungsbehandlung.

Sclerotherapy in oesophageal variceal bleeding and portal hypertension is a standardized method. Gastro-oesophageal reflux-scintigraphy was performed in 18 from 90 patients. Augmented reflux of gastric acid and signs of insufficiency could not be shown. Our results indicate that a general treatment for avoiding a relapse of variceal bleeding by reflux is not necessary.

[Pedicle torsion, hemorrhagic ovarian infarct. A rare cause of pediatric acute abdomen]. / Stielgedrehtes, hämorrhagisch infarziertes Ovar. Eine seltene Ursache des kindlichen akuten Abdomens.

The most common cause of acute abdomen in a child is acute appendicitis followed by mesenteric lymphadenitis, invagination, strangulation-ileus as a result of volvulus and more rarely perforated Meckel's diverticulum. However even with a child, from a differential diagnosis' aspect, a gynaecological cause should be taken in account too. From time to time one comes across a polycystic-alterated, with twisted lig. ovarii, haemorrhagic and infarctioned ovary without any endocrinological or other pathological irregularities which produces these complaints and symptoms. In the following casuistic such an instance is described.

[Esophagus replacement by an isoperistaltic gastric tube (author's transl)]. / Die Funktion des Magens als Speiseröhrenersatz.

In 20 patients the esophagus was replaced by an isoperistaltic gastric tube. Cervical esophagogastrostomy was performed. Postoperatively motility, histology, gastric secretion, and emptying time of the gastric tube were investigated. The esophageal replacement showed residual motility, pyloric motility, atrophic gastritis, decreased basal and stimulated secretion and normal emptying time, except in two patients. There were no essential drawbacks in function of the intrathoracic gastric tube. Patients with esophagectomy are comparable to patients with partial gastrectomy.

Acute non-calculous cholecystitis.

Shock gall-bladder is a complication that can arise following trauma or after an operation. The sex distribution, disease frequency and mortality rate associated with this condition are presented and possible pathophysiology is discussed. Post-traumatic cholecystitis seems to occur most often in the second to fourth decade of life. The aetiology remains unknown and may be multifactorial. An awareness of this complication and a resort to early surgery can largely protect the patient from severe consequences.

[Densitometric follow-up of algodystrophy using computerized tomography]. / Densitometrische Verlaufskontrolle der Algodystrophie mit Hilfe der Computertomographie.

Clinical and radiological findings obtained from diagnosis and follow-up examination of post-traumatic algodystrophy (Morbus Sudeck) are very much open to subjective interpretation. Decisive importance is attributed not only to alteration of soft tissue but also to typical distribution patterns and severity of bone demineralisation. No objectifiable and quantifiable have so far become available for proper assessment but are urgently desirable in view of the great number of therapeutic approaches. Densitometry integrated with computed tomography was applied to nine patients with algodystrophy of hand or foot in the region of spongy bones to determine absorption values which were then compared with those on the clinically intact side. Significant differences between sides proved to be objectifiable and were quantifiable measures by which demineralisation of the effected extremity could be assessed. Repeated examinations were undertaken for follow-up through a period up to nine months.

[Surgical treatment of acromioclavicular dislocation using the Balser hookplate]. / Zur operativen Behandlung der akromioklavikulären Luxation mit der Hakenplatte nach Balser.

The surgical technique applied to 17 patients for acromioclavicular separation is described in this paper. Ligament repair and Balser's hookplate were used. Advantages over surgical joint fixation were recorded from twelve patients in clinical and radiological follow-up checks. No major complications were recordable from implants. Postoperative immobilisation of the patients was not necessary. Timing of plate removal is variable. In follow-up examinations, ten of the twelve patients were satisfied with the therapeutic result.

[Quantifying mineralization processes in post-traumatic algodystrophy using computerized tomography densitometry]. / Quantifizierung von Mineralisationsprozessen bei posttraumatischer Algodystrophie mittels computertomographischer Densitometrie.

Computed tomography examinations have been made in 12 patients with posttraumatic algodystrophy. Significant differences of sides were found to be a measure of demineralisation by CT densitometry. 7 patients could be repeatedly examined during up to 60 weeks after the trauma. CT-integrated densitometry enables to quantify the process of de- and remineralisation and to objectify the disease according to the spongiosa bone. It seems to be possible to value the process of mineralisation by this method.

[B II-Y-Roux anastomosis--resection procedure of choice in complicated ulcer?]. / B II-Y-Roux-Anastomose--Resektionsverfahren der Wahl bei der komplizierten Ulcuskrankheit?

43 patients with complicated gastric, duodenal or anastomotic ulcers resected according to Billroth II-Roux were controlled clinically, by endoscopy and X-ray. Little amounts of bile acid were found in only one case. Two groups with different pH-values were verified: 6 patients with pH from 1.2 to 2.2; three of them had recurrent ulcers. In the other group of the remaining 37 patients pH was higher than 5.5; there was only one recurrence in a patient with HPT. According to the Visick grading system results were good or excellent in 86%. The study shows that under conditions of no bile reflux and maintained vagal stimulation recurrence of ulcer is probable. In the acid ulcer type (Johnson II and III), duodenal ulcer and anastomotic ulcer supplementary vagotomy is recommendable.

[Possibilities of surgical and drug therapy of parasitic cholestasis]. / Möglichkeiten chirurgischer und medikamentöser Therapie bei parasitärer Cholostase.

Out of 123 patients with hydatid-disease of the liver in 15 patients biliary engorgement by compression from cysts or parasites in the biliary system were observed. Diagnosis can be established by serology, sonography, scintigraphy, ERCP and CT. Invasive diagnostic procedures are not indicated. Surgical therapy of echinococcosis is in the first place; long-term adjuvant chemotherapy by Mebendazole is indicated if the resection of the cysts is not complete.

[Transjugular vena cava umbrella placement (author's transl)]. / Die transjuguläre Kava-Schirm-Implantation. Indikation, Technik, Komplikationen durch Migration.

In order to prevent venous emboli originating from the veins of the lower extremities to pass through the inferior V. cava, its passage can be blocked without interrupting the blood stream. This is done by inserting an umbrella filter in the inferior V. cava above the entrance of the renal veins. 55 transjugular umbrella filters were inserted in the period from 1.8. 1972 to 31. 10. 1979. There were 4 cases of dislocation among them, which are described in detail.

[Ischemia of the cecum caused by glycylpressin]. / Ischämie des Zökums nach Glyzylpressin.

A case report is given of a patient with severe upper gastrointestinal bleeding, the source of which could not be localized immediately. Glycylpressin (GP) was applied since bleeding from esophageal varices was suspected. During surgery a gastric ulcer was found penetrating into the pancreas and eroding the splenic artery. A segmental ischemic necrosis of the coecum was found as well, - a complication not yet reported after use of GP. Problems of using GP as a therapeutic agent and especially intestinal necrosis as a complication are discussed. The patient had gastrectomy, splenectomy and hemicolectomy and recovered well.

[Electromyography studies of gastrointestinal obstruction zones. An animal experiment study]. / Elektromyographische Untersuchungen an gastrointestinalen Verschlusszonen. Tierexperimentelle Untersuchung.

In experiments on animals the function of cardia, pylorus and ileocecal valve was characterized electromyographically. Under non-pathologic conditions a reflux in the cardia and ileocecal region cannot be expected; the pylorus permits a physiological reflux between duodenum and stomach. A connection to other reflux-dependent pathological processes is discussed.

Disposition of antipyrine in patients with extensive metastatic liver disease.

In the present study the effect of metastatic liver disease on hepatic drug metabolism has been examined by studying the pharmacokinetics of antipyrine and the urinary excretion of antipyrine and its three major metabolites (4-hydroxyantipyrine, norantipyrine, and 3-hydroxymethylantipyrine) in 12 patients with extensive metastatic liver disease, and in 12 matched healthy controls. In the patients total liver volume, the volume of the liver parenchyma, and the volume of the liver metastases were determined by computed tomography. The volume of liver metastases always exceeded 35% of the total liver volume. There were no significant differences between the patients and controls in plasma half-life, plasma clearance, or apparent volume of distribution of antipyrine. The cumulative urinary excretion of antipyrine and its three major metabolites was significantly lower in patients [44 (18) %] than in controls [71 (8) %]. The excretion of antipyrine itself was unchanged and the decrease in cumulative excretion was due to reduced excretion of the three metabolites. The results show that the activity of the hepatic mixed function oxidases was not impaired even in patients with extensive metastatic liver disease. This may be because liver metastases do not cause a corresponding reduction in the volume of normal hepatic parenchyma. The decreased urinary excretion of the three major metabolites of antipyrine, which are mainly glucuronidated, may have been due to an alteration in the process of conjugation.