[Anorectal continence following manual and mechanical anastomosis suture. Results of a controlled study of rectal surgery]. / Die anorectale Kontinenz nach manueller und maschineller Anastomosennaht. Ergebnisse einer kontrollierten Studie in der Rectumchirurgie.

In a controlled clinical trial-manual vs. stapler anastomosis in rectal surgery-it was found that both suture techniques per se made no difference in the function of anal continence. The anal pressures at rest and sphincter contraction remained unchanged. A linear reduction of functional reservoir of the "neorectum" could be shown, which depended on the level and healing of the anastomosis. An anastomosis level at 6 cm from anocutaneous line is important for functional reasons. Anastomoses above this level do not cause any consequences for anal continence. Anastomoses below this level result in a reduced functional reservoir for at least 6 months. Within this period a decrease in anal continence is possible, especially in cases of disturbed healing of the anastomosis.

[Modification of the oxygen supply of the small intestine demonstrated on the ileus model]. / Die Beeinflussung der Sauerstoffversorgung des Dünndarmes im Ileusmodell

Elevation of the intraluminar pressure of rabbit ileum lowers the oxygen supply of the bowel wall in a pressure dependent manner. After decompression local PO2 exceeds the initial values. The infusion of Rheomacrodex-Sorbit induces an increase of local PO2 in the nondistended ileum. The reaction is enhanced in the distended bowel. The application of glucagon does not influence tissue PO2 significantly in either the distended or the undistended bowel. The infusion of Rheomacrodex-Sorbit as well as decompression of the distended bowel are recommended to improve oxygen supply of bowel wall in ileus.

[Technic of rectum anastomoses in rectum resection. A controlled study: instrumental suture versus hand suture]. / Zur Technik der Rectumanastomosen bei Rectumresektionen. Eine kontrollierte Studie: Instrumentelle Naht versus Handnaht.

Stapler and manual sutures in rectal end-to-end anastomoses were compared in a controlled trial. The following results were obtained: For the analysis the cases naturally separated into three groups, A (manual suture), B (planned stapler suture) and WD ("withdrawn" cases, from both groups, in which continence could be maintained only with a stapler suture). The distribution of the WD cases in dependence on localization and sex varied significantly from groups A and B, while A and B remained comparable, in spite of the WD cases. The analysis of the date showed no, or only slight, clinical differences. In a comparison of the two stapler groups B and WD, significantly more suture dehiscences, colocutaneous fistulae and post-operative disturbances in bladder function were found in group WD. As a general conclusion we can state that: In comparable anastomosis localizations it is possible to achieve almost the same clinical results with both suture techniques. With a circular stapler it is, however, technically possible to perform rectum resections in cases in which this was not previously possible, particularly in men with a narrow pelvis and a stale pelvic floor. To what extent this still is an advantage after the local recurrences are taken into consideration remains to be seen.

[Controlled experimental histological and microbiological studies on the inhibitory effect of polyglycolic acid sutures in infections]. / Kontrollierte experimentelle histologische und mikrobiologische Untersuchungen zur Hemmwirkung von Polyglycolsäurefäden bei Infektionen.

In the first experimental series, 3-0 PGS sutures which had been contaminated with staphylococcus aureus were situated in rat muscle in vivo. After periods of 20, 30, 40, 50, and 60 days, these sutures were removed and investigated histologically. After 20 days, the tissue surrounding the suture surface was much inflamed, showing inflammation cells and bacteriae, whereas after 60 days no signs of inflammation were to be seen. By hydrolysis of the PGS thread to the monomere glycolic acid, a bacteriostatic and bactericidal milieu seems to develop. In the second experimental series, purely in vitro, the fungicidal and bactericidal properties of glycolic acid were proved microbiologically. Furthermore, in two investigations PGS did not show fungicidal or bactericidal properties. When using PGS sutures, inhibition of the growth of fungi and bacteriae is based on the hydrolysis of PGS to glycolic acid.

[Systemic antibiotic prophylaxis in elective colon surgery. Results of a controlled study]. / Die systemische Antibioticumprophylaxe in der elektiven Colonchirurgie. Ergebnisse einer kontrollierten Studie.

A prospective controlled, randomized trial was carried out among 70 patients undergoing elective colonic surgery; 31 patients received a systemic prophylaxis with cefotaxime (3 h) before surgery for 4 days and 29 patients were controls. The large bowel preparation consisted of whole gut irrigation with 0.9% NaCl and Paromomycin 1 g/l. Both groups were well matched after randomization. The rate wound infections in the control group was 28% and, in the test group, 6.4% (p less than 0.05, chi2-test). A trend toward a lower rate of urinary tract infections, an astomosic dehiscences and septicemic complications was recognizable in the test group, but not significant.

[Value of circular mechanical colon and rectum anastomosis. Prospective study of 91 patients]. / Der Wert der zirkulären maschinellen Colon- und Rectumanastomose (EEA). Eine prospektive Studie an 91 Patienten.

A prospective study was carried out on 91 patients to evaluate colonic and rectal anastomoses constructed with an EEA stapling gun. The concept comprises the following: orthograde lavage, cecal fistula or colostomy, intraoperative sufficiency control of the anastomosis, intraoperative direct measurement of the height of the anastomosis, postoperative X-ray control of the anastomosis using standardized techniques, classification of the cases into three groups according to the height of the anastomosis: 3-5 cm, and over 9 cm. Characterization of the patients was accomplished biostatistically using the Median-Quartil system. Primary hospital letality of 2% was due to heart failure. Imparied wound healing occurred in 11%. Secondary suture dehiscence was roentgenologically identified in a total of 18% of which only 7% showed clinical symptoms. Stenosis was determined by X-ray in 11% with only 1% demonstrating a temporary clinical correlation. For especially low rectal anastomoses at 3-5 cm the EEA stapling gun appears to have a great technical advantage over hand-placed sutures, allowing extension of indications for low anastomoses.

[Significance of manometry in the functional diagnosis of anal continence]. / Die Bedeutung der Manometrie in der Funktionsdiagnostik der analen Kontinenz.

Using small size catheters with perfusion of 2 ml water/min. quantitative and reproductive measurements are possible without irritation of the anal canal. With our technique of measurement we could characterize the anal function both for physiological and pathological conditions of continence. The influences of sphincter saving operations on the anal continence in the rectal surgery were analysed.

[Functional results after continuity resection of the rectum]. / Funktionsergebnisse nach Kontinuitätsresektion des Rektums.

Disturbances of anal continence and bladder and sexual functions are frequently a consequence of low anterior resection. In a prospective study of 60 patients anal continence and bladder control were examined for objective results in function. Within the first 3 months after surgery 50% of the patients had a deficiency in anal continence due to reduced reservoir function. This was not evident in cases with good anastomosis healing in the second postoperative half-year. Especially male patients (46%) developed a dysfunction in micturition which required urologic treatment.

[Interpretation of results of clinical studies for practical colon and rectum surgery]. / Interpretation der Ergebnisse klinischer Studien für die praktische Kolon- und Rektumchirurgie.

Systemic antibiotic prophylaxis in surgery of the colon and rectum is principally useful. It should be administered only on the day of surgery. Stapling makes it possible to enlarge the indication for deeper rectal resection. In cases of deep rectal anastomoses in men bladder dysfunction has to be expected in a considerable percentage. Anal continence does not depend on the anastomotic technique but on the anastomotic level in relation to its distance from the ano-cutaneous line and in consequence on the loss of reservoir capacity.

[Pathogenesis and morphology of anal fistulas]. / Pathogenese und Morphologie der analen Fistelerkrankung.

In a prospective consecutive study in 80 patients with anal fistulous disease we found characteristics in the morphology of the fistulous tracks, which correspond to the structure of anal glands. The theory of a cryptoglandular infection as the cause of anal fistulous disease seems to be realistic for this reason. The chronic fissure in ano represents likewise a pathogenetic factor in the genesis of anal fistula, especially in the posterior part of the anal canal. In this region we found trans- and suprasphincteric tracks with abscesses in the fossa ischiorectalis. Anal fistulas as a consequence of specific intestinal infections could be found only in 6%, whereas unspecific fistulas with inter- and transsphincteric tracks amounted to 90%.

[Significance of the suture technic and anastomosis sites for continence following deep rectum resection]. / Die Bedeutung von Nahttechnik und Anastomosenlokalisation für die Kontinenzfunktion nach tiefer Rektumresektion.

In a controlled clinical trial of 60 patients who underwent low anterior resection we found no influence of anal continence due to suture technique. Continence depends on the level and healing of anastomosis. Below a level of 6 cm from the anocutaneous line we more frequently found a reduction of functional reservoir in the 'neorectum', especially in cases with suture line leakage at anastomosis. Usually, the weakness of continence due to reduced functional reservoir was a temporary situation which lasted not longer than 6 months, if anastomosis healed without insufficiency.

Hemodynamic parameters and blood gas analyses in the normal and the cirrhotic rat.

Thioacetamide-fed rats developed cirrhosis with portal hypertension (P portal=23.0 +/- 5.2 cm H2O, controls: 14.4 +/- 1.0 cm H2O). The PO2 of liver tissue was markedly reduced in cirrhosis (PO2=7.6 +/- 3.4 torr, controls 22.3 +/- 5.8 torr), and the aortal pH was significantly lower as well. No correlation was found between portal hypertension, development of large--nodular cirrhosis, and ascites.

[Effects of intraluminal pressure increase on oxygen consumption of the rabbit ileum and its possible pharmacological modification]. / Auswirkungen der intraluminären Druckerhöhung auf die Sauerstoffversorgung des Kaninchenileums und ihre pharmakologische Beeinflussbarkeit.

Elevated intraluminal pressure of rabbit small bowel induces a decrease of tissue pO2 of the bowel wall dependent on the applied pressure. After decompression local pO2 exceeds the initial pO2 values. While the i.v. application of 25 microgram/kg glucagon is not able to improve local oxygen supply of the distended bowel, local pO2 increases considerably after infusion of 7.5 ml/kg dextran 40. Decompression by operation or intestinal tube as well as application of dextran 40 are recommended in the treatment of ileus.

[Oxygen supply of the human small intestine in mechanical ileus]. / Die Sauerstoffversorgung des menschlichen Dünndarmes im mechanischen Ileus.

In 16 patients operated on for mechanically caused ileus and in 12 control patients (cholecystectomy) local PO2 of the small bower wall was determined by means of a multiwire Pt surface electrode constructed by Kessler and Lübbers. The ileus patients showed an increased pulse rate of 110 (90-115) vs 90 (80-110) beats/min and creatinine levels of 1.06 (0.79-1.45) vs 0.80 (0.70-0.88) mg%. (mean, 1.-3. quartile, P less than 0.05). Local PO2 values of the serosal site of the small bowel were significantly reduced in patients with ileus compared to the control group [22.5 (12.5-35) vvs 61.2 (53.0-71.0) torr.] Hypoxia of the bower in mechanically caused ileus could be demonstrated by local PO2 determination and underlines the demand of early decompression.

[Functional pathomechanisms of anal fissure]. / Funktionelle Pathomechanismen der Analfissur.

In a prospective consecutive study of 40 patients with anal fissure we analysed the anal sphincter function at rest and rectal distension. Healthy persons with comparable age and sex distribution were controls. The anal pressures were registered with thin water perfused catheters (2 ml/min). Our patients with anal fissure showed significant elevation of anal pressures at rest along the whole length of anal canal. During rectal distension only the distal part of anal sphincter (up to a level of 2 cm from the anocutaneous line) showed a spasm with reduced relaxation. Our results are useful for operative therapy, since lateral internal sphincterotomy corresponds very well to functional pathomechanism of anal fissure.

[Early or delayed operation in patients with acute cholecystitis. Results of a prospective randomized controlled clinical trial (author's transl)]. / Früh- oder Intervalloperation bei der "akuten Galle". Ergebnisse einer prospektiven kontrollierten randomisierten klinischen Studie.

In a prospective controlled randomized clinical trial, 60 patients with acute cholecystitis (diagnosed according to well defined criteria) were allocated randomly to early operation (n=28) or conservative treatment followed by delayed operation (n=30). The formed groups were well balanced. Total duration of hospitalization was 12 days for the early and 22 days for the delayed operation group. One case of death in the second group appeared to be due to pancreatic necrosis. From other complications recorded, only stitch sinus seemed to occur more frequently in the early operation group. For the first time the success of the two therapeutic procedures was evaluated by means of a systematic follow-up 6 weeks and 6 months after operation. The outcome was the same in both groups and "very good" and "good" for all patients. From these results early operation as the routine method for acute cholecystitis can be recommended unconditionally.

[Auto-suture stapler EEA in surgery of the colon and rectum [author's transl)]. / Prospektive Studie zum Auto-Suture-Klammernahtgerät für Kolon- und Rektumanastomosen.

The increasing use of auto-suture staplers for gastrointestinal anastomoses makes it necessary to test the value of this new method of suturing. In a "pilot study" the practicability, the tightness and permeability of the anastomosis and complications were tested and analysed in a total of 30 colon and rectal anastomoses using the EEA-suture gun. The results of 14 colon resections and 16 low anterior resections justify the further use of the EEA auto-suture apparatus and raise the question of a prospective controlled random study in which manual and mechanical machine sutured anastomoses are compared.

[Plasma histamine level during and following kidney allotransplantation in man]. / Plasmahistaminspiegel während und nach Neirenallotransplantationen beim Menschen.

In human kidney allotransplantation, elevated plasma histamine levels were measured before surgery, following revascularization, and in single cases also several days after surgery. The maximum extent of this histamine release must be tested with respect to time and to localization. Its significance must be established. The intermittently increasing plasma histamine levels (greater than 1 ng/ml) must be considered as a possible risk regarding stress ulcer pathogenesis.

Studies on the oxygen supply of heterotopic auxiliary liver grafts in rats.

Heterotopic auxiliary liver transplantations were performed in rats using the method of Hess et. al. [6]. Oxygen pressure of liver tissue was measured with a Pt-surface electrode of Kessler and Lübbers [10]. After ligation of the hepatic artery, liver tissue PO2 decreased and remained low during further preparation. Only two of the seven lobes of the rat liver (= 30% of the parenchyma) were used as a graft. After revascularization and application of a gelatine plasma substitute, tissue PO2 of the graft increased to values of normal rat liver, although the graft was supplied with portal blood only. We suggest that one reason for this is the increase of portal perfusion rate, for the whole amount of portal blood perfuses only 30% of liver parenchyma. In the first month after transplantation PO2 of the graft parenchyma was low, but increased continually in the following months, reaching PO2 values of normal rat livers after 1 year.

[CA-50 in serum of patients with carcinoma. Clinical experiences with a new tumor marker]. / CA-50 im Serum von Karzinom-Patienten. Klinische Erfahrungen mit einem neuen Tumormarker.

Quantitative radioimmunological demonstration of carbohydrate antigen CA-50 in serum achieved a sensitivity of 62.3% for colorectal carcinoma (n = 53), of 64.7% for gastric carcinoma (n = 34), of 33.9% for lung carcinoma (n = 56), and 19.8% for lymphoproliferative diseases (n = 91). The positive results for the latter probably correspond to the immunohistological demonstration of the antigen in dendritic reticulum cells. Occasionally an increased CA-50 level in inflammatory disease presents difficulties in differential diagnosis, but it returns to normal when the inflammatory process has subsided. Methodological scatter of the CA-50 system is satisfactory, with a coefficient of variation of +/- 11%, but unsatisfactory at low values (less than or equal to 10 U/ml) and high ones (greater than or equal to 50 U/ml) with a coefficient of variation of +/- 19%. Further development with the IMRA technique may significantly reduce methodological scatter (coefficient of variation +/- 5%).