[Gastrointestinal stroma tumor: a surgical oncology problem child?]. / Gastrointestinaler Stromatumor: ein chirurgisch-onkologisches Sorgenkind?

Retrospectively analyzing the history of three patients with gastrointestinal stromal tumors (GIST) treated over a period of 1 year in the surgical department of our regional hospital, we tried to answer the following questions: using the current recommendations in the literature, how are the macro- and microscopic features and clinical presentation to be interpreted? Which prognostic and therapeutic conclusions should we draw, giving special consideration to practice-orientated management of such cases. The patients were 65, 75 and 88 years old respectively, and in each case the GIST manifested as recurrent gastrointestinal bleeding. During surgical treatment four gastric tumors ranging in cross section between 2.5 and 8 cm were found. The GIST diagnosis was established after light microscopic and immunohistochemical examinations. Going through the current literature, a large number of structural and immunohistochemical criteria have come to light for determining its classification and potential malignancy. On the other hand, very few subsequent recommendations concerning therapy and prognosis can be found and follow-up recommendations are almost unavailable. We conclude that GISTs are difficult to diagnose because of their locality and that their clinical behavior is uncertain. The potential malignancy, on the other hand, requires a well-founded diagnostic procedure in the form of the best possible pre-therapeutic staging. Furthermore, initially radical surgical treatment should be adopted and the follow-up should be adapted to the risk involved. The latter is arbitrary and further clinical studies are required.

[Herniation of the cecum and ascending colon through the Winslowi foramen in the bursa omentalis]. / Herniation des Zökums und Colon ascendens durch das Foramen Winslowi in die Bursa omentalis.

Herniation through the foramen of Winslow (HFW) is exceedingly rare, the ileum, coecum or ascending colon is involved mostly. One new case is presented here to illustrate the clinical findings, which are often discreet, and the characteristical radiographic features, which can lead to definitive preoperative diagnosis. Treatment is by surgical reduction of the hernia, resection of non-viable bowel or fixation of coecum and ascending colon. Closure of the foramen is generally considered unnecessary. Without delay in diagnosis and treatment, the former high letality rate of the condition is now nearly zero.

[Cystic lymphangioma of the transverse mesocolon]. / Cystisches Lymphangiom im Mesocolon transversum.

Intraabdominal cystic lymphangiomas are very rare. One new case of the disease is presented here: a 10-year-old boy undergoes laparotomy because of suspected appendicitis acuta, a cystic tumor in the transverse mesocolon is found and a segmental colon resection with primary anastomosis performed. Histologic examination of the tumor leads to the diagnosis of cystic lymphangioma. The postoperative course is uneventful. History, clinical features, diagnosis, therapy and pathologic-anatomical findings are discussed and the literature is reviewed.

[Pneumococcal peritonitis in an adult. Report of a case]. / Pneumokokkenperitonitis beim Erwachsenen. Ein kasuistischer Beitrag.

A case report is presented of primary pneumococcal peritonitis, a disease rare in the adult. The etiology, differential diagnosis and therapy are discussed and the literature is reviewed. The authors believe that laparotomy should be performed in the case of acute abdomen with diffuse peritonitis, even if pneumococcal peritonitis is suspected.

[Therapy of breast cancer. Results and prognosis after treatment with different surgical methods]. / Zur Therapie des Mammakarzinoms. Behandlungsergebnisse und Prognose bei verschiedenen chirurgischen Behandlungsmethoden.

Breast carcinoma is the most frequent form of cancer in women. In Switzerland 1265 women died of it in 1975, the mortality rate is rising slowly, the cause of this being unclear. There is no uniformity about the best treatment of breast cancer. We analyzed 454 carcinomas, operated in the years 1961--1971 according to Halsted, Patey and McWhirter. We found similar 5- and 10-year survival rates with the Halsted and the Patey method of operation, however, decidedly worse results with the simple mastectomy. Today we recommend the modified radical excision of the breast after Patey at all stages; in addition we treat all patients with postoperative X-ray therapy or prescribe an adjuvant cytostatic therapy based on the experimental study of the SAKK (Swis Therapy Group for Clincal Cancer Research).

[Prognosis with different therapeutic methods and therapeutic recommendations in operable breast cancers]. / Prognose bei verschiedenen Behandlungsmethoden und therapeutische Empfehlungen beim operablen Mammakarzinom.

Breast carcinoma is the most frequent form of cancer in women. In Switzerland 1265 women died of it in 1975, the mortality rate is rising slowly, the cause of this fact being unclear. There is no uniformity about the best treatment of breast cancer. We analyzed 454 carcinomas, operated in the years 1961--1971 after Halsted, Patey and McWhirter. We found similar 5- and 10-year survival rates with the Halsted and the Patey method of operation, however, decidedly worse results with the simple mastectomy. Nowadays we recommend the modified radical excision of the breast after Patey at all stages; in addition we treat all patients with postoperative X-ray therapy or prescribe an adjuvant cytostatic therapy based on the experimental study of the SAKK (Swiss Therapy Group for Clinical Cancer Research).

[Mammographic and thermographic diagnosis of breast cancer]. / Zur mammographischen und thermographischen Diagnostik des Mammakarzinoms.

2731 mammography and thermography results were analyzed. The radiological examination could be histologically verified 468 times. The diagnosis made by means of mammography was wrong in 42%, by thermography in 52%. In this group only 3 occult carcinomas were discovered mammographically. A wide range of indications of mammography applied hitherto therefore becomes doubtful. It is recommended to assign all palpable tumours of the female breast directly to the surgeon without mammography.

[Surgical therapy of severe chronic constipation]. / Die chirurgische Therapie der schweren chronischen Obstipation

Primary chronic constipation is an ailment of modern civilisation. Severe forms can seldom be treated satisfactorily by conservative methods, and in these cases surgical intervention must be considered. This consists of subtotal colectomy with ileosigmoidostomy. Partial resection and hemicolectomy do not afford the desired result. A report is presented on 28 patients who had subtotal colectomy for chronic constipation during the period 1959 to 1976. Immediate and long-term results have proved to be surprisingly good. Unsatisfactory conditions are to be expected in patients with strong complementary psychoneurotic symptoms. Preoperative investigations must be carried out with precision, morphological changes accurately identified and treated by differentiated surgical methods. The indication for colectomy in cases of chronic constipation must be strictly established, if possible in collaboration with a gastroenterologist.