Impact of overall treatment time on local control of anal cancer treated with radiochemotherapy.

Between 1987 and 2000, 111 patients with epidermoid anal cancer (T1-T4 Nx M0) were assigned to primary simultaneous radiochemotherapy (RCT) with a radiation dose of 45 Gy, performed either as a split course with 2-Gy single fractions (schedule A, 1987-1996, n = 65 patients) or continuously with fractions of 1.8 Gy (schedule B, 1996-2000; n = 38 patients). The chemotherapy consisted of continuous infusions of 5-fluorouracil (5-FU; 800/1,000 mg/m(2)/day, on 4/5 consecutive days, during weeks 1 and 5) together with one (schedule A) or two (schedule B) short infusions of mitomycin C (10 mg/m(2)) during the first course of 5-FU. Associations between clinical outcome and various prognostic factors were assessed in 103 patients who completed these schedules. For both patient groups combined, 5-year local control rate was 67% and 5-year survival rate 71%. Advanced tumor stage, size, and nodal status significantly decreased the 5-year local control rate as well as the overall treatment time (OTT) >41 days (58% for OTT >41 days vs. 79% for OTT < or =41 days; p = 0.04). However, we did not find a correlation with the prescribed radiotherapy schedule (A or B). In conclusion, in patients with anal carcinomas treated with RCT with a radiation dose of 45 Gy, the predominant determinant of local control is the resulting OTT and not the administration schedule (split course or continuous radiotherapy).

[Congenital choledochus cyst in adulthood]. / Die kongenitale Choledochuszyste im Erwachsenenalter.

New methods of visualisation of the cysts like ultrasonography, computertomography and endoscopy make a praeoperative diagnosis possible. Because of the malignant potential of the cyst resection is now the treatment of choice instead of cystenterostomy which was formerly used.

[Surgical therapy of severe acne conglobata]. / Zur chirurgischen Therapie der schweren Akne conglobata.

Thirty-six patients were treated for severe acne conglobata. Wide and deep excision of the affected area should be followed by wound closure, primary or secondary, depending on the body region involved.

[Endotoxin in experimental mesenteric infarction]. / Endotoxin beim experimentellen Mesenterialinfarkt.

After ligation of the mesenteric arteries an intestinal ischaemia was obtained. Endotoxin was measured from the peritoneal cavity, the portal und the peripheral blood. The limulus test for Endotoxin was used after phenol-water-extraction of the plasma. Microbiological investigations were done simultaneously. The endotoxin concentrations correlated to the clinical state of gram negative sepsis.

[Peritonitis, septic shock and endotoxin--an animal experiment study]. / Peritonitis, septischer Schock und Endotoxin--eine tierexperimentelle Studie.

Fecal peritonitis was produced by a sphincter-system leading to intestinal perforation. In 10 beagle dogs endotoxin was measured with the Limulus test. There was a correlation between endotoxin appearance and microbiological findings in the peritoneal cavity and in the blood. Endotoxinaemia correlated with the clinical severity of peritonitis.

[Corrosive burns of the upper gastrointestinal tract in adults]. / Verätzungen des oberen Gastrointestinaltraktes beim Erwachsenen.

Experience obtained from acid burns in 60 adult patients is reported in this paper. Twelve of them died, while 48 received conservative treatment, and twelve underwent surgery. Attempted suicide accounted for the highest number and severity of those accidental injuries. The therapeutic approach should be chosen on earliest possible endoscopy. Trends towards exploratory laparotomy and blind oesophagus stripping are described, and the problem of conservative therapy is discussed.

[Therapy of anal incontinence with a Schmidt free-muscle transplant]. / Therapie der analen Inkontinenz mit dem freien Muskeltransplantat nach Schmidt.

Between 1980 to 1985 in ten patients with complete anal incontinence the autologous muscle graft introduced by Schmidt has been used. The operative results obtained were good for satisfactory in nine patients whereas in one patient the operation failed.

[Endotoxin in diffuse suppurative peritonitis]. / Endotoxin bei diffus-eitriger Peritonitis.

Endotoxin has been measured in the blood and peritoneal fluid from 28 patients with diffuse peritonitis after intestinal perforation, intestinal obstruction or mesenteric infarction. Phenol-Water-Extraction for plasma preparation has been used. Endotoxin in correlated with the clinical state in these patients.

[Model for producing a reversible ileus state in conscious experimental animals]. / Ein Modell zur Erzeugung eines reversiblen Ileuszustandes am wachen Versuchstier.

A sphincter system for intermittent intestinal occlusion in conscious dogs is presented. The system consists of a hydropneumatic system and a percutaneous lead implanted in the neck of the animal. In 14 long-time experiments (24-40 days) the system was well tolerated by the dogs and no failure was accounted.

[Endotoxins in bacterial peritonitis]. / Endotoxin bei bakterieller Peritonitis.

Tests for the presence of endotoxin in blood and peritoneal fluid were performed at short intervals in 19 patients with peritonitis, 9 following gastric perforation, and 10 with perforation of the large bowel. A highly sensitive precipitation technique (LAL test) was used. Endotoxin was demonstrated in peritoneal fluid during the early stage of peritonitis in 15 of 19 patients (79%), while blood determination revealed endotoxin in 7 of 19 cases within the first 48 h. During the clinical course circulating endotoxin was recovered in 12 of 19 patients, which implies endotoxinemia in 63% of the cases. The prognostic significance of endotoxin determinations was high, since circulating endotoxin was demonstrated within the first 72 h in 8 of 9 patients with a fatal course. Demonstration of circulating endotoxin is a time-consuming and complicated procedure with great clinical significance in patients with gram-negative peritonitis.

Fatal cervical dislocation related to wearing a seat belt: a case report.

A case of fatal cervical dislocation in a front seat passenger restrained by a retractable three-point belt is described. A biomechanical and technical analysis is given.

[Postoperative disturbance in insulin secretion: studies on the altered secretion mode]. / Die postoperative Insulinsekretionsstörung: Untersuchung zum veränderten Sekretionsmodus.

1. Depending on the operative trauma, insulin secretion is decreased until the 10th day after abdominal surgery. 2. The decreased insulin release is caused by a diminished discharge from the pancreatic beta cell during the second phase of insulin secretion (partially newly synthesized insulin). Insulin release during the early phase of insulin secretion (prestored insulin) is unchanged or even accelerated. 3. The glucose tolerance level is pathologically diminished until the 10th postoperative day.

[Surgery of gastric cancer in patients older than 70 years (author's transl)]. / Magencarcinomchirurgie auch bei über 70 jährigen?

In this study it is reported about operative mortality and long-term results of surgery of gastric carcinoma in patients over the age of 70 years. The operative mortality in 50 patients with a distal partial gastrectomy was 16%, the mortality in 24 patients with total gastrectomy was 33.3% and in 14 patients with a proximal gastrectomy the mortality was 28%. The main cause of death (40%) was a pneumonia. There was no correlation between frequency of pneumonia and preoperative results of measurement of lung function. Only advanced arteriosclerotic disease in the heart and brain has a fatal influence on mortality rate. In the old patients the long-term results are determined by the staging of the tumor at the time of operation, too. In the 60 patients, who had left the hospital and who are in our control, the half year survival rate was 78.3%, the 1-year survival rate was 58.3% and the 2-years survival rate is exceeding 41.6%. 14 patients of the 17, who are still alive and who are after 2 1/2 years again explored, are in a very good condition. In comparison with the literature it is to conclude that for the indication to surgery of gastric carcinoma there is important not only the real age of the patient but rather the biological and mental condition of the patient.

[Focal nodular hyperplasia of the liver and oral contraceptives]. / Fokale noduläre Hyperplasie der Leber und orale Kontrazeptiva.

Three cases of benign liver tumors in young women are reported in addition to 58 cases in the literature. Uncharacteristic pains in the upper abdomen and general weakness were the main symptoms. The most valuable diagnostic examination is selective angiography. Liver resection was successful in these cases. Elective surgery is advocated because massive bleeding with high lethality may occur. Histologically focal nodular hyperplasia was found and all three had taken oral contraceptives.