[Nutritional status in esophageal cancer: assessment and significance for preoperative risk assessment]. / Ernährungsstatus beim Oesophaguscarcinom: Erfassung und Bedeutung für eine präoperative Risikoabschätzung.

In a prospective study including 60 patients with esophageal carcinoma the nutritional status was evaluated by means of anthropometric, biochemical and immunological data. As a first measure of malnutrition the diminuation of each single parameter was estimated in a 10%-scale, according to this a linear rising number of points given and the sum for all 11 parameters expressed as a score (Gofferje and Fekl). Second the nutritional status was judged by the prognostic nutritional index (Buzby and Mullen). Both score and index were correlated with serious postoperative complications (wound infection, anastomotic leakage, sepsis, organ failure, death). The results show that it was not possible to assess the risk of esophagectomy preoperatively on the ground of nutritional parameters solely. The reason could be that the nutritional status was rather normal in most cases and its risk burden therefore low. In conclusion performing preoperative nutritional therapy routinely seems not to be justified.

[Postoperative energy requirements following large abdominal surgery interventions: comparison of measuring by indirect calorimetry with estimated values]. / Der postoperative Energiebedarf nach grossen abdominal-chirurgischen Eingriffen: Vergleich der Messung durch indirekte Calorimetrie mit rechnerischer Schätzung.

Energy requirement after major abdominal operations, as calculated according to the formula for basic energy expenditure by Harris-Benedict, was increased by 30% in the early and by 50% in the late postoperative period. Correlation of these calculated values to measurements by indirect calorimetry was good. Even more simply a good estimation of caloric requirements can be obtained by multiplication of the body weight with a factor 30. The development of septic complications does not increase considerably postoperative energy expenditure, however, the correlation between measured and estimated values becomes poor. As supposed from isotope studies measuring gas exchange for indirect calorimetry for one hour provides sufficiently stable results.

[Experiences with 3151 central venous catheters at a surgical clinic]. / Erfahrungen mit 3151 zentralen Venenkathetern an einer Chirurgischen Klinik.

The incidence of infection among over 3,000 central venous catheters, placed over a period of 18 months, was analysed, 1,570 retrospectively and 1,581 prospectively. The Shaldon catheter had the highest infection rate of the various catheter types. Taking the findings of 983 catheters of one type, Cavafix, the infection rate was significantly higher when the internal jugular vein was the site of puncture instead of the cubital or subclavian veins. Signs of inflammation at the site of catheter entry were a further risk factor for infection. Although the clinical suspicion of catheter-induced sepsis proved groundless in nearly half the cases, early catheter removal is at present the most effective prophylactic means, while routine weekly catheter replacement did not reduce the infection rate. Catheter colonization and catheter sepsis are predominantly problems of nursing and hygiene. The infection rate was reduced through nursing and supervision by personnel specially trained in infectious precautions.

[Early postoperative enteral feeding following esophageal resection]. / Frühe postoperative enterale Ernährung nach Oesophagusresektion.

In a prospective randomized study, total parenteral alimentation was compared with early postoperative enteral alimentation in a group of patients who had undergone esophageal resection. In addition to mechanical problems with the jejunal catheter abdominal complications arose during enteral alimentation (meteorism, distension), leading to discontinuation in one-third of cases. The limited prognostic value of ultrasound examination of the abdomen - now often used postoperatively as a decisive aid to diagnosis - is a further serious disadvantage; overall, since there are no particulars in which enteral alimentation can be shown to be superior to parenteral alimentation, it no longer seems justified in the early postoperative phase. The jejunal catheter has, however, proved its worth as a means of direct access to the intestine that can be exploited any time after the initial postoperative period (a week to some months after surgery). For this reason we now insert a jejunal catheter routinely following esophagectomy or gastrectomy.

[First experience with diagnostic nuclear medicine in gastrointestinal hemorrhage]. / Erste Erfahrungen mit der nuklearmedizinischen Diagnostik gastrointestinaler Blutungen.

The search for the source of intraabdominal bleeding in the small intestine from Treitz' ligament to Bauhin's valve and in the large intestine up to the left flexure provides major difficulties: On the one hand angiographic examinations often were disappointing, on the other hand emergency endoscopy without time-consuming preparations is impossible. Therefore 14 patients during the period of January 1981 till September 1982 were examined with nuclear medicine in order to detect the localization of previously unidentified intestinal hemorrhage. The examination is conducted with the patient's own erythrocytes marked with technetium and requires comparison of early and late scintigraphies. The actual process of in-vitro tracing can be performed rapidly. In case the hemorrhage has stopped at the time of this examination, a later-date scintigraphy is possible without renewed injection up to 12 hours later. In 14 patients examined this way, the localization of hemorrhage could be identified in 50%. The 7 patients without recognizable source of hemorrhage showed no persistency of bleeding later on. The nuclear medical examination for identification of unknown intraabdominal hemorrhage does not burden the patient and requires no preparation. Therefore this technique serves as a valuable expansion to the existing range of diagnostic tools.

[Finger replantation in children]. / Fingerreplantationen bei Kindern.

The possibility of replantation is discussed for children's amputation injuries. The use of this technique is also indicated for multiple amputations and severe crush injuries. More than half of the replanted fingers healed successfully. Since the existence of the Replantation centre of the Klinikum Rechts der Isar, over 600 operations of separated limbs were performed. The healing rate of totally and subtotally separated limbs of adults was 87%. The attempt was made to replant separated digits of 14 children, aged from 1 to 8 years, with microvascular anastomoses. The grade of injuries and the minimal size of anatomic structures demand a particularly high standard of the operative standard. Replantation was also indicated for badly squashed and contaminated limbs.

[Results of surgical treatment of bronchiogenic carcinoma and nonsurgical treatment of oat cell carcinoma (author's transl)]. / Ergebnisse der Behandlung des operierten Bronchuscarcinoms und des nicht operierten kleinzellig anaplastischen Carcinoms.

Of 1732 patients, 95% were followed up. The proportion of men to women was 7:1, most patients being about 70 years old. Eighty percent of the patients smoked, 64% were considered inoperable when first seen, and 4% were found to be incurable at the time of surgery. Postoperative deaths were 8.2%; 3 bronchopleural fistulas and 17 pleural empyemas complicated recovery. Of those patients operated on without lymph node involvement, the 5-year survival rate was 45.4%, with lymph node metastasis 14.7%. Of 242 patients with oat cell carcinoma who were not operated on, 85% died within the first year after hospital discharge. Only 1.2% survived 5 years.