[Primary hypertrophic pyloric stenosis. A are form and stomach outlet stenosis in the adult]. / Primäre hypertrophe Pylorusstenose. Eine seltene Form der Magenausgangsstenose beim Erwachsenen.

A 38-year-old white female with primary hypertrophic pyloric stenosis is presented. The patient was admitted to our service with a history of upper digestive tract pain and postprandial vomiting since her 17th year of life. Diagnosis of benign pyloric stenosis was made preoperatively and the patient was successfully treated by Finney pyloroplasty. Primary hypertrophic pyloric stenosis in adults is a rare condition of unknown etiology. Only about 200 cases of primary hypertrophic pyloric stenosis in adults have been reported in the literature.

Microsatellite alterations in serum DNA of patients with colorectal cancer.

Cell-free DNA in the blood of cancer patients has been shown to harbor microsatellite alterations frequently matching those of the primary tumors. The aim of this study was to assess the prevalence of allelic loss and instability of serum DNA microsatellites in colorectal cancers. DNA extracted from preoperative sera and microdissected tumors of 27 patients with colorectal adenocarcinoma were allelotyped for nine markers on chromosome arms 1p, 5q, 8p, 12p, 15q, 17p, 17q, and 18q. In all tumors, expression of MLH1 and MSH2 was explored immunohistochemically. Microsatellite alterations comprising loss of heterozygosity (LOH) or microsatellite instability (MSI) were present in 26 of 27 (96%) tumors and in 16 of 27 (59%) serum samples. Using stringent criteria, serum MSI was significantly (p < 0.02) more detectable than serum LOH. Of the three patients with high-grade MSI (more than two unstable loci) present in tumor and serum DNA, two had MSH2-negative tumors on immunohistochemical testing. No significant association of tumor stage or clinical outcome with serum microsatellite alterations of LOH or MSI type could be demonstrated. Although the DNA-shedding phenotype of tumors remains to be elucidated, its detection by serum DNA microsatellite analysis seems to be useful for the diagnosis and monitoring of neoplasms, including colorectal cancers with and without MSI.

Microsatellite instability analysis: a multicenter study for reliability and quality control.

The molecular biology section of the Hereditary Non-Polyposis Colorectal Cancer study group-Germany, instituted a multicenter study to test the reliability and quality of microsatellite instability (MSI) analysis. Eight laboratories compared MSI analyses performed on 10 matched pairs of normal and tumor DNA from patients with colorectal carcinomas. A variety of techniques were applied to the detection of microsatellite changes: (a) silver and ethidium bromide staining of polyacrylamide gels; (b) radioactive labeling; and (c) automated fluorescence detection. The identification of highly unstable tumors and tumors without MSI was achieved in high concordance. However, the interpretation of the band patterns resulted in divergent classifications at several microsatellite marker loci for a large fraction of this tumor/normal panel. The data on more than 30 primers per case suggest that the enlargement of the microsatellite panel to more than 10 loci does not influence the results. In this study, cases with MSI in less than 10% of loci were classified as microsatellite stable, whereas MSI was diagnosed in cases with more than 40% of all markers unstable. We propose that a panel of five microsatellite loci consisting of repeats with different lengths should be analyzed in an initial analysis. When less than two marker loci display shifts in the microsatellite bands from tumor DNA, the panel should be enlarged to include an additional set of five marker loci. The number of marker loci analyzed as well as the number of unstable marker loci found should always be identified. These criteria should result in reports of MSI that are more comparable between studies.

[Current treatment strategies in acute distal aortic occlusion]. / Aktuelle Behandlungsstrategien beim akuten distalen Aortenverschluss.

Forty-eight acute distal aortic occlusions were treated on an inpatient basis from January 1973 to December 1993. The mean age was 66 years. Twenty-seven patients had an acute thrombotic occlusion of the distal aorta, and a cardiogenic embolism was the cause of occlusion in 21 cases. The 43 operated patients evidenced a hospital mortality of 32.6% (14/43) and an amputation rate of 7% (3/43). Reperfusion was achieved in 20 patients solely by remote thromboembolectomy with the aid of a Fogarty catheter. A TEA and patch graft were performed in six patients; an extra-anatomic bypass was established in 9 cases and an aortobifemoral bypass in 8. Severe accompanying cardiac diseases were predominant in the patients with an embolic occlusion, whereas severe arteriosclerotic risk factors prevailed in all those with thrombotic occlusions. The mortality among our patients showed a statistically significant (p < 0.05) correlation only with the preoperative ischemia time.

[Surgical treatment of bleeding stomach and duodenal ulcer--retrospective analysis of a five-year period]. / Die chirurgische Behandlung des blutenden Magen- und Duodenalulkus--Retrospektive Analyse über einen Fünfjahreszeitraum.

94 patients have been operated upon for haemorrhagic gastroduodenal ulcer disease in the Wenckebach-Krankenhaus during the years 1986-1990. In all but 6 patients the ulcer has been controlled by an emergency gastroscopy. 25 of these patients had to undergo emergency operation at once for persistent bleeding after gastroscopy. From the other patients, another 31 suffered rebleeding and had to be laparotomised in an emergency procedure, too. Only in 38 cases an interval-operation was possible. No one of these 38 patients died. The overall mortality-rate was 14.9% (14 patients). The mean age of our patients was 68 (26-90) years, none of the patients under 60 years died, whereas the mortality-rate of the elder was as high as 20%. The operative procedures were ulcer excision and suturing of the bleeding vessel and distal gastrectomy. There was no difference in mortality-rates between resective and non resective procedures. Our aim to operate upon the patients in an elective way could be achieved in about one third only. Many patients refused an operation after primary control of bleeding.

[Multivisceral and extended resection in tumor surgery: stomach cancer]. / Multiviszerale und erweiterte Resektionen in der Tumorchirurgie: Magenkarzinom.

The aim of curative surgery in gastric cancer is the complete removal of all tumour bulk both macroscopically and microscopically (R0 resection). The operative strategy should consider the location of tumor, its histological character (Laurén classification), and the stage of disease according to the TNM-classification. Lymphadenectomy of compartments I and II does not increase operative morbidity and mortality if performed routinely, but seems to increase long-term survival in patients with stages II and IIIa disease. Routine removal of the spleen does not lead to better results. Gastrectomy in locally advanced gastric cancer with combined resection of adjacent organs can prolong survival in absence of peritoneal disseminating or distant metastases if R0 resection is achieved. The indication for gastrectomy of patients with an incurable stage of disease (peritoneal dissemination, distant metastases) should be determined after considering the individual status of the patient and surgical risk and can be performed as a so-called ultima ratio resection with the aim of palliation.