[Chronic anaemia in a patient with hereditary haemorrhagic telangiectasia and juvenile gastric polyposis]. / Chronische Anämie bei hereditärer hämorrhagischer Teleangiektasie und juveniler Polyposis des Magens.

HISTORY: A 52-year-old woman with chronic anaemia presented with recurrent epistaxis, telangiectasias and haemangiomas, suggesting the presence of hereditary haemorrhagic telangiectasia (Osler-Rendu-Weber disease). Moreover, previous investigations had also shown multiple polyps of the stomach. INVESTIGATIONS: A severe microcytic iron deficiency anaemia in combination with hepatic haemangiomas and duodenal angio-dysplasia were detected. Gastrointestinal endoscopy revealed multiple juvenile polyps in the gastric fundus and body, indicating the diagnosis of hereditary haemorrhagic telangiectasia in combination with juvenile polyposis. THERAPY AND COURSE: A gastrectomy was performed because of recurrent gastrointestinal bleeding and the malignant potential of juvenile gastric polyposis. Histopathology confirmed the diagnosis and did not reveal any malignancy. CONCLUSION: The association of hereditary haemorrhagic telangiectasia and juvenile polyposis, as seen in this patient, has been reported repeatedly. A diagnosis of one of the described entities should initiate the screening for evidence of the other one to prevent (life-threatening) complications.

[Lipoma of the small bowel]. / Dünndarmlipom - Seltene Ursache von Abdominalschmerzen und chronischen, blutigen Diarrhöen.

CLINICAL FEATURES: A 40-year-old female presented with chronic diarrhoea, intermittent abdominal pain, and melena. She reported of a 7 kg loss of weight within the preceding 6 weeks and showed signs of mild abdominal pain upon palpation of the right lower quadrant. Our clinical diagnosis was Crohn's disease or infectious gastro-enteritis as a CT scan showed thickening of the colonic wall in the right lower quadrant. However a previously performed ileocolonoscopy was normal. TECHNICAL EXAMINATIONS: Magnetic resonance imaging showed a thickened terminal ileum with extensive narrowing of the bowel lumen, in addition a polyp obstructing the lumen of the terminal ileum at 30 cm was detected during colonoscopy. THERAPY: The involved portion of ileum was resected. Intraoperatively an intussusception with the polyp forming the leading edge was found. Histological analysis led to the diagnosis "lipoma". Postoperatively the patient is now feeling well without any abdominal pain. CONCLUSION: Tumours of the small bowel are rare and are therefore often forgotten in the list of differential diagnoses of abdominal pain. If symptomatic, these tumours present mainly with uncharacteristic and unspecific signs, often leading to a delay in correct diagnosis as in the presented case. We therefore suggest that small bowel tumours should be considered at earlier stages in the differential diagnosis of unexplained abdominal pain in the middle-aged patient with signs of intestinal obstruction.

[Effect of perioperative donor blood transfusion on prognosis of bronchial cancer]. / Der Einfluss der perioperativen Fremdblutgabe auf die Prognose des Bronchialkarzinoms.

Immunological research and experimental animal studies have shown that allogeneic blood has an immunosuppressive effect. Several clinical investigations have demonstrated the negative influence of blood transfusions on the prognosis after curative resection of colorectal carcinoma. However, there are only a few studies about the influence after complete removal of lung cancer, and the results are contradictory. In our retrospective study we analyzed the follow-up results of 224 patients (192 men, 32 women; average age 57 years) on whom we had performed a curative resection of their bronchogenic carcinoma. A total of 119 patients had received nonspecific random blood transfusions. The survival rate for patients with blood transfusions was significantly worse in comparison to the non-transfused group 2 years after the operation (74% vs 59%, P = 0.019); after 5 years, however, no difference could be seen (43% vs 43%). Even when we subdivided our patients according to tumor cell type, tumor stage, differentiation and method of resection, the negative influence of transfused blood was confirmed for the 2-year survival rate, but again had disappeared 5 years after the operation.

Surgical treatment of nesidioblastosis in childhood.

A review of the literature on the surgical treatment of nesidioblastosis in childhood was made to answer the following questions: age at operation, surgical procedure, pathohistological findings, incidence of recurrence and its treatment, as well as mortality. Primary subtotal pancreatectomy appears to be the method of choice. It should be performed as early as possible following exact diagnosis. Total pancreatectomy is reserved for treatment of a recurrence.

[Effect of perioperative allogenic blood transfusion on prognosis of colorectal cancer]. / Der Einfluss der perioperativen Fremdblutgabe auf die Prognose des kolorektalen Karzinoms.

In 1973 the observation was published that in patients who had received non specific blood transfusions before kidney transplantation graft survival was improved. An immunosuppressive effect of blood transfusion was suggested. Indeed, modulation on the cellular and humoral immunologic system has been demonstrated during the last decade. But this immunomodulation effect might worsen the prognosis after cancer surgery. Whereas in several experimental studies in animals the negative influence was confirmed, clinical investigations on the other hand are contradictive. In our retrospective study we analysed the follow-up of 273 patients (158 men, 115 women; average age 66 years) on which we had performed a curative resection of their colorectal carcinoma. 182 patients had received nonspecific random blood transfusions. The survival rate for patients with blood transfusions was significantly worse in comparison to the non-transfused group (43% versus 73%, respectively). Even when we subdivided our patients into tumor stage, differentiation and localisation, the negative influence of transfused blood was confirmed. We conclude that beside the risk of transmitting hepatitis or HIV the immunosuppressive effect is a strong argument to restrict the indication for blood transfusion.

Tumor cells in intraoperative pleural lavage. An indicator for the poor prognosis of bronchogenic carcinoma.

Fifty-nine patients with bronchogenic carcinoma and 21 patients with nonneoplastic lung diseases underwent intraoperative pleural lavage with 300-ml physiologic saline before (Lavage I) and after resection (Lavage II). The presence of tumor cells in the lavage fluid was established cytologically in 29 patients with bronchogenic carcinoma. Twenty-seven had positive findings in Lavage I and 23 of these also in Lavage II. Two patients had positive findings in Lavage II only. All controls were negative. In all 40% of patients with Stage I bronchogenic carcinoma had positive lavage results. The cumulative two-year survival rate of this group is 40%, which differs significantly (P less than 0.01) from the 97% survival rate of the patients with the same tumor stage whose lavage findings were negative. Detection of tumor cells in pleural cavity washings before resection proves that tumor cells have spread into the pleural cavity. Cytologic examination of an intraoperative pleural lavage should be done when assessing the tumor stage.

[Determining the prognosis in bronchial carcinoma by intraoperative pleural lavage]. / Prognosebestimmung beim Bronchialkarzinom durch die intraoperative Pleuralavage.

Pleural lavage with 300 ml physiological saline was undertaken at thoracotomy (before and after resection) in a prospective study of 59 patients (49 males and 10 females; average age 59.7 years, range 41-76 years) with first manifestations of a bronchial carcinoma. The aim was to find out whether, even at an early stage of the tumour, there are tumour deposits in the pleural cavity. The lavage fluid was centrifuged and the sediment then embedded in paraffin and prepared for cytological examination. Tumour cells were demonstrated before resection in 27 patients (45.8%), in 23 of them also after the resection. Among 38 patients, previously classified as being in stage I, the lavage material was positive in 15 (39.5%); tumour cells were demonstrated in 5 of 18 patients in stage pT1. The cumulative two-year survival rate of non-small-cell bronchial carcinoma in stage I (n = 32) was 39.9% if the lavage was positive, 97.4% if negative (P less than 0.01). The results indicate that a positive finding on pleural lavage corresponds to a pT4 stage with a poor life expectancy.

[Cold struma nodule--enucleation or resection]. / Kalter Strumaknoten--Enucleation oder Resektion.

During 1969-1984 2,408 patients underwent thyroid surgery at the Dept. of General Surgery, Giessen University. In 72.5% cold nodules have been diagnosed. However, a cold nodule has been in less than 50% of all cases with cold nodules the causal indication for operation. Inspecting closely the whole thyroid gland, the operating surgeon removes the nodule with a segmental resection if there are no further regressions or suspicion of malignancy. This technique facilitates the histological detection of a possible highly differentiated carcinoma because of its invasion into the capsule.

Allotransplantation of neonatal pancreas-microfragments in man.

We report of an allotransplantation of neonatal pancreatic tissue. The donor was a three-week-old girl with nesidioblastosis, in which a subtotal pancreas resection had to be performed. The pancreas microfragments were injected transcapsularly into the spleen of a patient with juvenile diabetes. During the postoperative course only a short-termed improvement of the diabetic condition was seen.

[Somatostatin in the medical treatment of fistula of the pancreas and the small intestine]. / La somatostatine dans le traitement médical des fistules du pancréas et de l'intestin grêle.

Somatostatin is a peptide hormone which inhibits the secretion of the growth hormone and certain gastrointestinal hormones. Its main effect is to reduce the gastric acid output and inhibit the exocrine function of the pancreas. It was therefore used as an adjuvant therapy in the conservative treatment of ten patients presenting with fistulas of the small intestine or pancreas. The treatment was successful in eight cases. The short halflife of the hormone makes continuous application of the somatostatin as important as the carrying on of the conservative treatment itself.

[Technic of delayed skin flap transplantation]. / Technik der verzögerten Spalthauttransplantation.

In 38 patients a "delayed skin flap transplantation" was performed after excision of malignant melanomas. The skin graft can be stored in a refrigerator at 4 degrees C for 2 weeks without damage to the transplant. The transplantation was usually done 4 days postoperatively. Advantages of this method seem to be a decreased risk of local infection, early mobilisation of the patient, and generally good cosmetic results.

[Reimplantation of splenic tissue after neonatal abdominal trauma (author's transl)]. / Reimplantation von Milzgewebe nach geburtstraumatischer Milzruptur.

Loss of the spleen in children frequently results in overwhelming infection caused by pneumococci. In order to preserve splenic function the reimplantation of splenic tissue into the abdominal wall and the greater omentum was performed in a newborn child and six other children up to the age of thirteen. Postoperatively the complete absence of Jolly's bodies could be observed, while a continuous increase of IgM was noted. The otherwise mandatory antibiotic prophylaxis over 2 years could be reduced to 5 months in the newborn.

[Advantages of a new thoracic drainage unit with double sealing]. / Vorteile einer neuen Thoraxdrainageeinheit mit Doppelabdichtung.

The paper deals with the application of a new 'Four-Compartment Drainage System' with double-sealing in 20 patients having lung parenchyma resections, explorative thoracotomies, and pneumothorax. This drainage system has an advantage over conventional intercostal drainage in as much as it prevents tension pneumothorax in leakage of the lung and suction failure. The closed system avoids bacterial contamination of the pleural space.