[Malignant hemangioendothelioma of the thyroid gland]. / Zum malignen Hämangioendotheliom der Schilddrüse.

Between 1969-1984 (16 years) 17 patients with "malignant haemangioendothelioma" of the thyroid were admitted to our services. This type of cancer is usually found in patients with a long history of goiter and is a very aggressive tumor. Infiltration of surrounding tissues is mostly responsible for death by asphyxia or uncontrollable bleeding. Some patients die also from metastases, which were seen frequently in the lungs. A precise preoperative diagnosis of the disease can be achieved rarely, histological classification has improved using immunohistochemical assays of Factor-VIII antigen in tumor tissue. No "prescription" for therapy can be given: results of surgery, radiotherapy and chemotherapy do not show significant differences (also in a variety of combinations). If the diagnosis is properly established, palliation will be the only therapeutic goal.

[Local excision of rectal tumors: Y. Mason's operation]. / Escissione locale dei tumori del retto: l'operazione di Y. Mason.

Twenty-nine patients with cancer of the low rectum were treated by local excision performed by a transsphincteric approach (Mason's operation). Patient's selection requires a careful digital examination, biopsy, CT or MR and intraluminal ultrasound. In our series an accurate and strictly selection provides low recurrence rates with no mortality and low postoperative complications. Mason's operation, when criteria for appropriate patients selection are followed, is a valid alternative to mayor surgical procedures as APR.

[No acid, no ulcer: such a simple axiom?]. / No ácido, no úlcera: un axioma tan simple?

According to the traditional view gastric acid and pepsin are a sine qua non for ulcer development. Acid suppression, however, is far from being the only successful therapeutic approach, and similar healing rates are achieved by drugs with substantially different mechanisms of action--antacids, H2-antagonists, antimuscarinics, cytoprotective and site-protective agents--thus denoting a multifactorial pathogenesis. Even with the antisecretory compounds, the relationship between gastric acid and ulcer healing gives rise to perplexity: antacids prove effective at widely varying doses; pirenzipine and H2-blockers, which are clinically equieffective, differ considerably in antisecretory efficacy; H2-antagonist studies on early vs late postprandial dosing yield contradictory clinical results; morning and bedtime single administrations of H2-antagonists prove equiactive on ulcer healing, leading to a reappraisal of the alleged importance of nocturnal acidity. Ulcer sealants such as colloidal bismuth and sucralfate prove as effective as H2-antagonists despite their total lack of antisecretory activity, thereby apparently undermining the primary pathogenetic role of acid. However, with the spectacular 100% healing rates achieved by the protonpump blocker, omeprazole, the wheel has come full circle, and gastric acid appears to re-emerge as a primary element in pathogenesis. Specific therapy, based on the predominant pathogenetic factor involved, is likely to be a feasible proposition, but, at present, remains little more than a remote possibility.

[Sonography of the thyroid gland in surgery]. / Schilddrüsensonographie in der Chirurgie.

50 patients were sonographically examined by the surgeon prior to thyroidectomy. The sonographic findings were then compared with the intra-operative situation and with the goitre removed. Complete agreement was recorded from 80 per cent of the cases. Sonography was found to be superior to traditional thyroid diagnosis for its higher accuracy in indicating the positions of adenomas, cysts, and calcareous nodules as well as the relationship between goitre and vessels of the neck.

[Boerhaave syndrome]. / Zum Boerhaave-Syndrom.

Among the different types of esophageal wall injuries Boerhaave's syndrome is associated with the highest morbidity and mortality. The classical history of retching or vomiting and retrosternal splitting pain is indicative. Roentgenograms of the chest and esophagogram with a water soluble contrast medium are able to reveal the perforation in most cases. Esophagoscopy has been recommended for diagnosis, but its use is unnecessary and frequently contraindicated. Spontaneous perforation of the esophagus should be treated by prompt surgical intervention: left side thoracotomy, direct closure of the perforation by monolayer suture, and adequate mediastinal and pleural drainage. The treatment of esophageal perforation after late diagnosis is considerably more complicated and may consist in a drainage only.

[Reflections on the significance of detecting Campylobacter pylori in a biopsy of the stomach mucosa]. / Uberlegungen zur Bedeutung des Nachweises von Campylobacter pylori in der Magenschleimhautbiopsie.

The inevitable confrontation with Campylobacter pyloridis implicates the surgeon to take into consideration this germ. For that reason we have examinated Campylobacter-positive patients with regard to histological changes of the gastric mucosa and to clinical symptoms. Apart from the fact, that there was no Campylobacter colonisation in the healthy gastric mucosa, there were not found specific features for the germ.

Assessment of splanchnic tissue oxygenation by gastric tonometry in patients undergoing laparoscopic and open cholecystectomy.

This experimental study compared the effects of laparoscopic (n = 31) and open (n = 32) cholecystectomy on gastric intramucosal pH (pHi). For this purpose, pHi was measured tonometrically before induction of anaesthesia, at 30-min intervals during surgery, and 1, 2 and 4 h after operation in otherwise healthy patients undergoing elective cholecystectomy. Additionally, perioperative arterial pH (pHa), arterial carbon dioxide tension (PaCO2), intramucosal carbon dioxide tension, arterial bicarbonate concentration, end-tidal carbon dioxide pressure (PECO2), levels of serum lactate, lactate dehydrogenase (LDH) and gamma-glutamyl transferase (GGT), haematocrit and arterial blood pressure were recorded. In the two groups no significantly different changes occurred in pHi, pHa, serum lactate concentration or haematocrit at any of the observation times. PECO2 and PaCO2 were significantly raised during the laparoscopic procedure, whereas levels of LDH and GGT and arterial blood pressure rose during and after open cholecystectomy. In spite of the increased intra-abdominal pressure and the peritoneal carbon dioxide absorption related to the creation of a pneumoperitoneum, no decrease in pHi was detectable during laparoscopic cholecystectomy.

[Results of studies in 165 patients following selective proximal vagotomy]. / Untersuchungsergebnisse von 165 Patienten nach selektiver proximaler Vagotomie.

Selective proximal vagotomy was performed on 165 patients at the I. Surgical Clinic of Innsbruck University, between 1970 and 1984. Results of 90 patients were retrospectively evaluated. Lethality was 0.6 per cent, while the rate of recurrence amounted to 14.4 per cent and average acid reduction to 50 per cent. 65 per cent of the above 90 patients were almost without any postoperative complaint, when rated by the I. and II. degree according to Visick. Results were particularly favourable in cases of perforated ulcer, combined ulcer (Type II according to Johnson), hyperacid gastroduodenitis, and in cases of duodenal ulcer of women.

Amyloidosis--an unusual case of recurrent intestinal bleeding and sigmoid perforation: case report with review of the literature.

We describe a patient with recurrent intestinal bleeding and sigmoid perforation due to amyloidosis. Hartmann's procedure was carried out with resection of the diseased sigmoid colon and by performing a terminal colostomy. The postoperative course was uneventful, but the patient died 3 months later of lobar pneumonia and multiple organ system failure.

The pattern of rejection after combined stomach, small bowel, and pancreas transplantation in the rat.

This study was designed to investigate whether in combined stomach, small bowel, and pancreas transplantation allograft rejection occurs in the individual organs concomitantly and with the same intensity. Heterotopic en-bloc transplantation of the stomach, small bowel, and pancreas was performed in a Lewis-to-Brown Norway rat combination. Group 1 animals received no immunosuppressive therapy while animals in group 2 were treated with cyclosporin (10 mg/kg body weight, orally) daily. Grafts were histologically evaluated on the 5th (subgroups 1a and 2a) and 10th (subgroups 1b and 2b) postoperative days. The degree of rejection was defined as moderate, intermediate, or severe according to predefined criteria. The results indicate that the small bowel is more susceptible to rejection than either the stomach or the pancreas. Mucosal biopsies of the stomach are unlikely to provide a reliable guide to rejection in the small bowel.

Preservation of small bowel grafts--a comparison with two standard solutions.

This study investigates the use of EuroCollins (EC) and University of Wisconsin (UW) solution, two major preservation fluids, for small bowel preservation. After in situ flushing, grafts were cold-stored at 4 degrees C with either EC for 30 min (group 1a), 6 h (group 1b) and 12 h (group 1c) or with UW for 30 min (group 2a), 6 h (group 2b) and 12 h (group 2c). Using UW, cold ischemia was extended to up to 18 h (group 2d). As a control, small intestines were flushed and stored for the same time periods in cold saline (group 3a-c). Survival in group 1b was 66% versus 100% in group 2b. After 12 h 80% survived in group 2c, but there were not survivors in group 1c. After 18 h of cold storage, survival was only observed in group 2d (25%). Saline was ineffective after 6 h of preservation. Histology at the end of preservation revealed characteristic changes for EC (intracellular vacuoles) and UW (amorphic granules). We conclude that with UW small bowel can be preserved for up to 12 h.