Adjuvant 5-fluorouracil and BCNU chemotherapy in gastric cancer: 3-year results.

One hundred-three patients with a potentially curative operation of a histologically proven gastric cancer were randomly assigned to a control and chemotherapy group after stratification according to tumor stage II and III. Chemotherapy courses with 5-fluorouracil (10 mg/kg/day) and BCNU (40 mg/m2/day) for 5 days were administered eight times in 6-8 week intervals. Age, sex, and tumor location were matched in the chemotherapy and control groups. Five patients declined treatment after randomization. Three years after initiating the study, the tumor has recurred in 38 of the 103 patients. There were 21 recurrences of 54 controls and 14 recurrences of 44 patients who received chemotherapy, and 17 and ten deaths, respectively, due to tumor relapse. The results of our study to data show a high degree of statistical probability that adjuvant chemotherapy with the regime used has no influence on the recurrence-free interval and survival time in gastric cancer.

[The Mannheim peritonitis index. An instrument for the intraoperative prognosis of peritonitis]. / Der Mannheimer Peritonitis-Index. Ein Instrument zur intraoperativen Prognose der Peritonitis.

Based on the experience with 1243 patients suffering from purulent peritonitis 255 patients of two surgical departments were studied prospectively in a cohort study. Lethality was 24%. For intraabdominal infection an index is established that allows for the first time to predict lethal outcome of the disease in the individual patient. For each index-score the expected mortality is given by a modern mathematical calculation. The 'Mannheim Peritonitis Index' includes only clinical risk-factors that are routinely documented pre- and intraoperatively. Methods of evaluation, validation and the comparison with other prognostic indices are presented.

[Postoperative peritonitis]. / Postoperative Peritonitis.

In a 5-year-period (1986-1990), 7818 patients underwent abdominal operations. 40 developed diffuse peritonitis postoperatively, of whom 14 (35%) died. Postoperative peritonitis is best subgrouped according to primary surgery (operations on colon, duodenum, small intestine, biliary tract and pancreas; gynecological surgery; interventional operations). Diagnosis relies mainly on clinical signs and laboratory parameters (e.g. serum endotoxin level); imaging techniques may present additional hints. Reoperation should be initiated early. Scheduled relaparotomy was successful in six patients.

[The effectiveness ot thyroid-hormone therapy following goiter-resection]. / Die Wirkung einer Rezidivprophylaxe nach Strumaresektion

The effectiveness of a postoperative thyroid-hormone therapy in preventing a goiter-recidiv was investigated two years after goiter-resection. Of 3381 patients with goiter, who were operated on in the years 1964 to 1973 in the Surgical Department of the Krankenhaus Nordwest in Frankfurt/Main, Germany, 129 patients who were operated on in the first six months of 1969, were questioned and examined in a follow-up study. A rezidiv-goiter was found in 4, 6 p.c. of patients. If only palpable recidiv-goiters are taken into consideration 2, 3 p.c.), patients without postoperative thyroid-hormone therapy developed a recidiv goiter twice as often as patients with thyroid-hormone therapy.

Common wrist injuries.

Patients with wrist injuries often present to primary care physicians. Many times, mild clinical injury involves significant damage to carpal bones and soft tissue elements. The long-term outcome of these injuries depends on prompt diagnosis and appropriate therapy. Familiarity with the functional anatomy and physical examination of the wrist, accompanied by radiologic evaluation, may aid the physician in differentiating simple sprains from potentially debilitating wrist injuries.

[Drug therapy of peritonitis. 6-year experience with the chemotherapeutic agent and anti-endotoxin taurolin]. / Medikamentöse Therapie der Peritonitis. 6 Jahre Erfahrung mit dem Chemotherapeutikum und Anti-Endotoxin Taurolin.

Since 1976 Taurolin is applied in clinical trials in several European states. The results being submitted show a very good activity of this substance against bacteria and endotoxin. Evaluating all clinical and experimental studies in our opinion the use of antibiotics postoperatively together with Taurolin seems to be an effective treatment of peritonitis. In our hospital taurolin has become an important part of the surgical management of severe forms of peritonitis. A development of resistant bacteria is not known up to now.

[An index of peritonitis originating in the biliary tract: correlation with the postoperative course (author's transl)]. / Ein Peritonitis-Index bei der von den Gallenwegen ausgehenden Bauchfellentzündung: Korrelation mit dem postoperativen Verlauf.

Peritonitis originating in the biliary tract is analyzed in 41 patients (1973--1977). Cholelithiasis was the underlying disease in 90% of the cases, and one patient suffered from carcinoma of the biliary tree. Early cholecystectomy was performed in 95% of the patients. Peritonitis was localized in two-thirds and diffuse in one-third of the patients. A perforation was present in 63%. The grade and extent of peritonitis could be correlated with the postoperative course. One-half of the patients with turbid or purulent exudate developed postoperative fever; one fifth showed secondary wound healing. The diffuse form of peritonitis was followed more often by postoperative fever than the localized form. Although the presence or absence of perforation did not influence this parameter in the diffuse form, it did influence cases of localized peritonitis. Only the diffuse forms of peritonitis were followed by secondary wound healing. A peritonitis index was established from age, risk factors, and several preoperative and intraoperative findings. It could also be correlated with the postoperative course. The peritonitis index may classify the disease state of patients with peritonitis and may be found useful in evaluating prognosis at the time of the operation.

Measurements of oxygen tension from the canine gastric mucosa under the influence of vasoactive and acid stimulating agents and following vagotomy. Implications on the pathophysiology of peptic ulceration.

By the use of a multiwire platinum electrode mucosal tissue pO2 from the canine gastric antrum is continuously recorded. Injection of norepinephrine causes a short, steep fall of mucosal pO2, naftidrofuryl elevates mucosal pO2 for several minutes in spite of reduced arterial blood pressure, pentagastrin produces a biphasic response, a temporary rise of mucosal pO2 is followed by a longer lasting decrease, vagotomy causes a considerable and more persistent drop of mucosal pO2. These experimental findings are discussed in their possible relations to the clinical problem of ulcer formation and therapy of gastroduodenal bleeding.

[The recurrent ulcer patient following selective proximal vagotomy in the treatment of duodenal ulcer (author's transl)]. / Der Rezidivulcuspatient nach selektiv-proximaler Vagotomie beim Zwölffingerdarmgeschwür.

Selective proximal vagotomy (SPV) in the treatment of duodenal ulcer shows a lethality of 0% in this series. The recurrence rate is 12.4% when 60% of the patients are examined by endoscopy at a mean postoperative interval of 27 months. If only the patients with complaints had been examined by gastroscopy then ulcer recurrence would have been diagnosed in 7.1%. One-third of the recurrences are in the stomach. There is no significant difference in the recurrence rate in male or female patients, whether the ulcer is uncomplicated or complicated or SPV is done with or without pyloroplasty. Ulcers heal under further surveillance in one-third of recurrent ulcer patients; one-half of the rest have to be reoperated upon.

[Antibacterial therapy of purulent peritonitis: a prospective randomized study on the effects of antibiotics and taurolin, a new chemotherapeutic and antiendotoxic agent (author's transl)]. / Die antibakterielle Behandlung der eitrigen Peritonitis: Prospektiver randomisierter Vergleich von Antibiotica mit dem neuen Chemotherapeuticum und Antiendotoxin Taurolin.

A prospective randomized study on the value of additional antibacterial therapy in surgically treated, purulent peritonitis (69 patients) is presented. A new chemotherapeutic agent Taurolin with antiendotoxin activity is tested against conventional antibiotic therapy. There was an increased rate of secondary wound healing and overall complications in the Taurolin group (especially bronchopneumonia). Local complications and lethality due to peritonitis occur similarly frequently in both groups. The bactericidal and antiendotoxic effects of Taurolin, its lacking toxicity (possibility of higher dosage), and the choice of combination with antibiotics make it a most interesting substance for additional antibacterial therapy for purulent peritonitis following surgical treatment.

[Peritonitis in acute appendicitis: prognostic aspects, personal results]. / Peritonitis bei akuter Appendizitis: Prognostische Faktoren, eigene Ergebnisse.

One of the most frequent causes for peritonitis is acute appendicitis. Extent and degree of peritonitis determine the further course of the disease. A retrospective analysis of acute appendicitis with concomitant peritonitis relates pre- and intraoperative findings to the postoperative development. Resulting aspects may simplify therapy in special cases and permit a more reliable prognosis.

[Acute ischemic gastric mucosal and duodenal lesions in dogs: "stress ulcer" after experimental disseminated intravascular coagulation]. / Akute ischämische Schleimhauntläsionen des Magens und Zwölffingerdarms am Hund: "Stressulkus" auf dem Boden experimenteller intravasaler Gerinnung.

Experimental disseminated intravascular coagulation (DIC) without considerable effect on blood pressure is shown to produce within 80 min acute mucosal bleeding in stomach and duodenum. A documented high degree of tissue hypoxia caused by mucosal microthrombosis is necessary for the genesis of mucosal lesions. These results stress the necessity to look for DIC in patients with upper gastrointestinal "stress ulcers".

[Significance of scores for therapy planning and evaluation of individual intensive care patients from the viewpoint of general surgery]. / Die Bedeutung von Scores für die Therapieplanung und -beurteilung beim individuellen Intensivpatienten aus der Sicht der Allgemeinchirurgie.

Thirty-six postoperative patients of the department for general, thoracic and vascular surgery were treated in the ICU during November 1995. APACHE-II-Scores were prospectively monitored daily. All three patients with considerable deterioration (> = 2) of this score succumbed. During 6 weeks starting in January 1996 the Hannover-Intensive-Score was documented in all 14 patients requiring ICU-treatment for 3 days or more: three patients died; two without considerable change, one with improvement of this score. Numerical changes of both scores did not precede clinical changes. Thus neither score system replaces or even significantly supports clinical judgement in a field like general surgery with an inhomogenous group of patients.

[Standardized ulcer surgery. Results of 10 years' experience]. / Standardisierte Ulcus-Chirurgie. Ergebnisse zehnjähriger Erfahrung.

In ten years a total of 1207 operations for gastroduodenal ulcer were performed, using a standardizing treatment scheme. The number of operations has markedly decreased since 1978, probably due to the introduction of H2-receptor blockers in the treatment of peptic ulcers. The results of operations suggest elective surgical treatment for ulcer patients at risk of complications. This is the only way of decreasing the adverse effect of emergency operations on the total surgical mortality of ulcer patients.

[Therapy of purulent peritonitis. Documentation of 78 cases and experience with taurolin (author's transl)]. / Die Behandlung der eitrigen Bauchfellentzündung. Untersuchungen des Krankengutes und Erfahrung mit dem neuen Chemotherapeuticum und Antiendotoxin taurolin.

From three different surgical departments 78 patients with purulent peritonitis are analyzed according to cause, origin, and extent of peritonitis. Operative therapy is presented. As additional antibacterial therapy the new chemotherapeutic agent, Taurolin, with antiendotoxin-effect is used. The postoperative course (temperature exceeding 38 degrees C, secondary wound healing, day of discharge, and serious complications) is correlated with pre- and intraoperative parameters; for instance, 1. postoperative fever occurs in one half of the patients, more frequently following perforation of stomach and duodenum; 2. every second patient shows secondary wound healing, this happens even more often in peritonitis arising from biliary disease or appendicitis; 3. in 29.5% of the patients serious complications arise, especially in patients with peritonitis originating in stomach, small intestine or large bowel; 4. overall mortality of 11.5% is surpassed in patients with peritonitis originating from small intestine or large bowel. The so-called peritonitis-index (calculated on the basis of pre- and intraoperative factors) shows a significant difference between survivors and patients dying during the postoperative course. In 80% of the 78 patients with purulent peritonitis taurolin was effective as a substitute for the usual antibiotics.

[Stomach movement following selective gastric vagotomy: correlation of roentgen contrast studies and electromyography in the conscious dog]. / Dei Magenmotorik nach selektiv gastraler Vagotomie: Korrelation von Röntgenkontrastuntersuchung und Elektromyographie am wachen Hund.

Electrical gastric activity in the alert dog was continuously registered by bipolar steel electrodes simultaneously with contrast x-ray studies. Delayed gastric emptying in the postoperative period following selective gastric vagotomy and pyloroplasty can be attributed to specific changes of electrical activity: 1. Electrical potential units become irregular in amplitude and frequency; 2. electrical activity of antrum is no longer synchronized with the corpus; 3. appearance of high frequency, atypical electrical activity in the antrum is associated with gastric motor inactivity; 4. peristalsis and emptying are linked to the de novo appearance of action-potential bursts.

[Prophylaxis of gastroduodenal complications after renal transplantation (author's transl)]. / Zur Prophylaxe gastroduodenaler Komplikationen nach Nierentransplantation.

Gastroduodenal bleeding or perforation following renal transplantation constitute a serious complication with a high lethality. 82 patients with terminal renal insufficiency were grouped in 4 categories with increasing gastroduodenal risk factors. Parameters for judging gastroduodenal risk consisted of gastric acid secretion, history and endoscopic demonstration of acute or chronic ulcer disease. 33 transplant candidates of groups I (hypochlorhydria, no ulcer) and II (normochlorhydria, no ulcer) were treated by medical prophylaxis alone. 23/33 were transplanted without prophylactic surgery, 1 patient in group II with erosive duodenitis before transplantation died from bleeding duodenal ulcer. Patients of group III (hyperchlorhydria up to 40 mval/h, MAO, no ulcer) received selective proximal vagomty, patients of group IV (hyperchlorhydria, 40 mval/h MAO and/or ulcer) underwent selective gastric vagotomy and 50% gastric resection. In 25 of 49 patients of group III and IV prophylactic operations were performed without serious complications. In 16 later on transplantated patients no gastrointestinal bleeding occurred. 2 patients of group III without gastric operation had minor bleedings out of erosive lesions in the gastric antrum and duodenal bulb, that could be managed by medical treatment. The positive experience with prophylactic gastric surgery in this limited number of patients seems to advocate a broader application of such a protocol. A considerable rise in gastric secretion was demonstrated in 19/21 patients during the first 3 years following the commencement of dialysis, BAO rose by an average of 72,2%, MAO by 41%. Thus, gastric analysis should be repeated once a year. Erosive gastritis and duodenitis seem to predispose for bleeding episodes after renal transplantation, this diagnosis should prompt prophylactic SPV.

[Intraoperating measuring of tissue oxygen pressure on the surface of the gastric mucosa. A new method for the control of complete vagotomy of the stomach]. / Intraoperative Messung des Sauerstoff-Gewebsdruckes an der Magenschleimhaut. Eine neue Methode zur Kontrolle der kompletten Vagotomie des Magens

A new method for the control of complete gastric vagotomy. Anew method is presented to control the completeness of gastric vagotomy. The procedure is based on measuring of gastric mucosa tissue oxygen pressure as an equivalent for the diminished perfusion of gastric mucosa after vagotomy. The results up to now proved the method reliable. Since we practice this method in quite a number of vagotomies primarily not severed vagal branches could be found and cut later.

[Recognition and management of perforation of the gastro-intestinal tract during endoscopy (author's transl)]. / Erkennung und Versorgung endoskopischer Perforationen am Gastrointestinaltrakt.

In the course of 71/2 years there occurred 37 cases of perforation of the gastro-intestinal tract after endoscopic investigation or operation in the abdominal region. Analysis of the therapeutic results indicates that immediate laparotomy in case of confirmed perforation provides the best survival chance. In individual cases with pneumoperitoneum and no symptoms careful supervision in a surgical intensive care unit before surgical intervention can be justified.

[O2 pressure on liver surface following portacaval anastomosis and administration of vasoactive substances in dogs with normal livers]. / Der O2-Druck an der Leberoberfläche nach portocavaler Anastomose und nach Gabe vasoaktiver Substanzen beim lebergesunden Hund

1) Following acute portocaval anastomosis in healthy dog liver tissue - pO2 drops by 23%, an extent regulary occuring in hour long laparotomy. 2) Intravenous octapressin lowers splanchnic blood flow, concomitantly liver blood-flow and tissue -pO2 is decreased. 3) In contrast to octapressin orciprenalin improves liver blood-flow and tissue-pO2. 4) By shunting of arterial blood through the gut norepinephrine causes a rapid and lasting elevation of liver tissue-pO2.