[Endoscopic and surgical therapy of malignant colorectal polyps]. / Endoskopische und chirurgische Therapie maligner kolorektaler Polypen.

87 malignant colorectal polyps were removed in 81 patients by endoscopic polypectomy from 1972 until 1987. Thereafter 34 of these patients had a surgical resection of the colon. Surgical resection was performed for incomplete excision of the polyp (20 x), for tumor invasion of the lymphics in the polyp stalk and for moderately/poor differentiated carcinoma. In 6 patients a residual carcinoma was detected in the removed colon specimen, but lymph-node metastasis only in one with moderate-differentiated carcinoma. Our results demonstrate that colorectal polyps with invasive well-differentiated carcinoma and tumor free base do not need a surgical resection. Patients of the high-risk-group (moderately/poor-differentiated carcinoma, invasion of blood vessels and lymphatics, incomplete excision), should be referred to further surgical resection. With regard to the low rate of metastatic spread even in patients with high-risk-polyps accurate differentiation seems to be necessary. In 19 out of 52 (36.5%) patients endoscopic control examinations after surgical or endoscopic resection revealed recurrent pathological findings. On the base of the presented data we conclude that there is a need for short-term endoscopic controls over a period of five years.

[Esophagus perforation--treatment and results]. / Die Oesophagusperforation--Behandlung und Ergebnisse.

Esophageal perforation is most often caused by instrumental lesion during endoscopy. Mortality is still high; underlying malignant disease, septic complications and cardiopulmonary problems are endangering the patient. In small perforation with poor clinical symptoms, conservative treatment (i.e. antibiotics, gastric suction, parenteral nutrition) should be considered. We could treat in this way more than 50% of our cases. On the other hand, some patients require agressive surgical procedures, e.g. cervical esophagostomy gastrostomy and disconnection of esophageal continuity.

[Instrumental esophageal perforation--its treatment and results]. / Die instrumentelle Oesophagusperforation--ihre Behandlung und Ergebnisse.

The number of oesophagus perforations has increased considerably with the increase in endoscopic, diagnostic and therapeutic procedures. 46 instrumental oesophagus perforations have been observed between 1973 and 1984. The youngest patient was a 2-year-old girl with a benign oesophagus stenosis and the eldest was an 89-year-old man with a neoplasm of the cardia. The average age was 62 years. 26 patients were treated conservatively; 20 patients were treated surgically. In 2 cases the oesophagus was diverted at the cervical level and the cardia detached. 8 months later this was successfully reconstructed. 9 out of 43 patients died. In every case, the cause of death were cardio-pulmonal complications accompanying general sepsis.

[Experiences with ileoanal anastomosis and ileal pouch formation following colectomy and proctomucosectomy]. / Erfahrungen mit der ileoanalen Anastomose und Ileum-Pouch-Bildung nach Colektomie und Proktomucosektomie.

Since 1981 12 patients (11 adenomatosis coli = AC/1 ulcerative colitis = CU) had a colectomy and mucosal proctectomy with ileo-anal anastomosis (IA) and formation of an ileal-S-pouch (IP). The mean age of 7 men and 5 women was 33 years (21-46 yrs). We preferred the synchronous abdomino-peranal operation. Protective ileostomy was closed after a mean of 4.6 months in 11 patients. Postoperative complications: IA-insufficiency = 4, sacral abscess = 1, stenosis = 3, ileus and reoperation = 2). Late results: spontaneous defecation: 11/11, continence 10/11, evacuation 6-8/day. This operative procedure seems to be good for AC and CU.

[Ranitidine and cimetidine in the prevention of stress: ulcer hemorrhage a prospective comparative multicenter study]. / Ranitidin und Cimetidin in der Prophylaxe der Stressulcus-Blutung: Eine prospektive Multicenter-Vergleichsstudie.

In a multicentre single-blind study, ranitidine was compared to cimetidine as prophylactic treatment against stress-induced upper gastrointestinal bleeding in seriously ill patients in the intensive care unit (ICU). 380 patients entered the study. 192 patients were treated with ranitidine 50 mg q.i.d. as i.v. bolus followed by 150 mg orally twice daily. 188 patients received cimetidine 400 mg q.i.d. intravenously and 1,000 mg daily orally in divided doses. Five patients in the ranitidine group (2.6%) and 12 in the cimetidine group (6.4%) developed gastrointestinal bleeding definitely or possibly due to stress lesions. This difference was not significant. The incidence of stress erosions or ulcerations developing during the study was 11.8% for the ranitidine group and 18.3% for the cimetidine group (non-significant difference). Adverse events in the ranitidine group were nausea, tachycardia or vomiting in 4 patients. 5 cimetidine-treated patients developed cholestasis, and 5 additional central nervous system problems. The high degree of efficacy of both drugs compared very favourably with the high incidence of stress ulceration and hemorrhage in similar untreated populations.

Lack of correlation between carcinoembryonic antigen content of tumor extracts and leukocyte migration reactivity of tumor patients.

Tumor extracts varying in carcinoembryonic antigen (CEA) content (0.4--2,280 ng/mg protein) did not affect the reactivity of cancer patients' leukocytes in the leukocyte migration inhibition test (LMIT). In addition, variations in the plasma CEA levels of tumor-bearing leukocyte donors did not influence the frequency of significant LMIT reactivity.

Isolation and characterization of lipoprotein-X from the pig.

In vitro incubation of pig bile with pig whole serum resulted in the formation of "LP-X like" material migrating towards the cathode on agar-gel electrophoresis. As in all other species studied so far, LP-X occurred also in the serum of bile duct ligated pigs, however, relatively late (48-72h) after the operation. In parallel, alterations of some serum parameters and of the protein-lipid composition of the different lipoporotein fractions were observed. While the electrophoretic behaviour, the protein-lipid and apoprotein composition of pig LP-X were comparable to those found in man, dog and rat, it sedimated in most instances at the density 1.063 g/ml.