Palliative and curative surgical therapy of malignant stenoses of the esophagus and cardia.

Between January 1967 and July 1986, 171 patients with malignant stenosis of the esophagus and cardia were subjected to curative or palliative surgical treatment. Specifically, there were 84 primary esophageal carcinomas, 5 cases of malignant esophageal stenosis caused by an extra-esophageal malignant tumor (inter alia bronchial carcinoma), and 82 primary carcinomas of the cardia. The average age of the patients as a whole was 63.7 years, and the sex ratio (male:female) was 4.0:1. In 18 esophageal carcinoma patients and 21 patients with carcinoma of the cardia curative resection was possible, but in 132 patients merely palliative surgery was performed, most frequently esophageal intubation and gastrostomy. The specific operations with a curative objective performed upon the esophageal carcinoma patients were abdominothoracic esophageal resection with upward displacement of the stomach (n = 16) or interposition of a colonic segment (n = 2), whereas in the patients with carcinoma of the cardia, proximal resection was performed in 13 cases, either subtotally or as a cardiofundectomy, and total gastrectomy in 8 cases. For the subsequent reconstruction of the passage the interposition of a jejunal segment was most frequently used. The clinical mortality for the curative resections was 33% for the 18 esophageal carcinoma patients and 9.5% for the 20 patients with carcinoma of the cardia. The long-term survival rates are depressing: of the patients who underwent curative resection 47.6% were still alive after one year, 28.6% after 2 years and 14.3% after 5 years. Of the patients treated only palliatively on account of an already advanced stage of the tumor, 91.5% died within the first year; only 4.9% of patients from this group were still alive after 2 years.

[Results of surgical treatment of chronic pancreatitis]. / Ergebnisse nach chirurgischer Behandlung der chronischen Pankreatitis.

On the basis of a group of 67 patients studied by the authors, the various techniques for the surgical treatment of chronic pancreatitis are discussed. The average age of the patients covered by this study was 45.7 years, and the male:female ratio was 2.9:1. In more than 82% of the cases a history of chronic alcohol abuse was definitely established. For the drainage operations performed the preferred operative techniques were the pancreaticojejunal anastomosis and, where pancreatic pseudocysts were present, the cystojejunostomy. Resection of the pancreas was performed in a total of 18 patients, the clinical mortality here being 5.6%. In our study also the long-term prognosis for patients with chronic pancreatitis depended, on the whole, less upon the operative technique chosen than upon the subsequent degree of alcoholism.

[Results following the surgical treatment of pancreatic cancer]. / Ergebnisse nach chirurgischer Behandlung des Pankreaskarzinoms.

A retrospective study was conducted into clinical data recorded from 152 patients who had been operated on for carcinoma of the pancreas, between 1967 and July 1986. Tumours could be removed only in 25 cases (16.5 per cent). Non-removing, purely palliative operations had to be performed on 127 patients (83.5 per cent), because of too advanced tumour stages. In most of these cases, surgical action was taken with the view to eliminating obstructive jaundice or pyloric stenosis. The surgical approaches to 22 cases (14.5 per cent) even had to be completed as exploratory laparotomy. Cumulative survival rates revealed extremely unfavourable long-term prognosis of pancreas carcinoma. Five-year survival has proved to be achievable only through radical removal of the carcinoma but was found to be restricted to few cases.

[How far are our patients educable?]. / Wie weit sind unsere Patienten aufklärbar?

Only 10-20% of all patients could be made to understand in depths the medical information supplied to them regarding their illness and the therapeutic risks involved. 30-40% of patients did not understand the medical information at all. The resulting consequences of the above facts are discussed and suggestions for improvement of medical information of patients are made.

[On informing patients: a study of doctor-surgical patient interaction (author's transl)]. / Patientenaufklärung. Untersuchungen zur Interaktion an chirurgischen Patienten.

Test questions were given to almost 500 patients at regular intervals after their condition and surgical treatment had been discussed with them. Only 18% were able to reproduce the contents of the discussion, while 49% knew merely that the operation had been necessary and carried some danger. The remainder had no recollection of the content of the doctor's information. Because of these results, the technique of information giving was exactly analysed in 50 cases, both the doctor and the patient being given the same set of questions. Both doctor and patient in general took it as a matter of course that the other one had the same opinions; but this was frequently not the case. Patients who more than others stressed their physical complaints had a significantly higher rate of difference between the answers by the doctor and that by the patient. The study demonstrates that the technique of information giving needs to be more defined so that the patient both understands and accepts the information given. Thise can only be done in a talk in which the doctor can assess the patient's response and modify his explanations.

[Hemangiopericytoma of the stomach]. / Das Hämangiopericytom des Magens.

The case is reported of a 46-year-old man who was succesfully operated for a tumor that had its origin in the greater curvature of the stomach and grew into the gastrocolic ligament. After two false diagnoses (pancreatitis and retroperitoneal tumor) this tumor was histologically identified as a hemangiopericytoma. The possibility of recurrence and its prevention are discussed.

[Congenital bronchoesophageal fistula--a case study (author's transl)]. / Zum Krankheitsbild der kongenitalen Osophago-Bronchialfistel

This report deals with a patient with a congenital bronchoesophageal fistula, type "H", which was diagnosed only at age 43. This is an extremely rare defect and, if not recognized shortly after birth, it usually will stay unrecognized despite the fact that it causes recurrent pneumonias or localized bronchiectasis. The diagnosis of such a case is difficult and usually only possible with the help of a variety of diagnostic tests. The deciding factor is the recognition of the congenital defect. The subsequent surgical treatment including resection of the canal and closure of the fistula is a relatively simple operative procedure.