The cancer risk in the stomach subjected to nonresecting procedures. An experimental long-term study.

Whereas there is no longer any significant controversy regarding whether the resected stomach is subject to an increased risk of cancer, this question remains of great importance in terms of the cancer risk of nonresecting procedures performed on the stomach. Attention was given in particular to investigating with respect to carcinogenic potential the influence of gastrotomy. Heineke-Mikulicz pyloroplasty, gastrotomy plus pyloroplasty, vagotomy plus pyloroplasty, and gastroenterostomy without resection. As with resecting procedures, the carcinomas were also first observed in larger numbers following the nonresecting procedures without application of carcinogen. Of the 227 animals surviving the prescribed period 16 developed carcinomas of the stomach following application of carcinogen. 20 developed gastric carcinomas without carcinogen. Which individual factors in this multifactorial process might be the main contributors to carcinogenesis cannot be ascertained from our study.

When is a corrective procedure indicated for the operated stomach?

Disease occurring as a direct consequence of the surgical treatment of ulcers is not infrequently an indication for remedial surgical intervention. Most frequently it is necessary, on the one hand, to refer to objective information such as the histological findings as well as a gastric function analysis, and, on the other hand, to the clinical picture of the illness. Therefore, we have attempted to summarize the symptoms, the morphology, and the function into a synopsis, which would make it possible t match the severity of gastric disease with a particular mode of therapy. The sum of the three parameters provides a point value between three and twelve. It is our belief that surgical intervention is to be seriously considered above a point score of seven (SFM-Index).

Cell-kinetic investigations in the operated rat stomach to show the influence of duodenogastric reflux. An experimental long-term study.

In has been proven in our own studies that the frequency of carcinoma is closely correlated with the varying intensity of duodenogastric reflux occurring as a result of surgery. Now it was our objective to provide information regarding the changes in cell proliferation kinetics in support of the already established relation, toward which end we conducted an additional autoradiographic study on the gastric mucosa of the same operated animals. Five different operative procedures were performed on the stomachs of 265 female Wistar rats. 3H-Thymidine was used for labeling. Comparison of the labeling rates with the type of operative procedure used revealed an average labeling value typical for each particular procedure. It became evident that increased reflux quite obviously leads to an increase in cell proliferation.

Operation-sequel carcinoma--an experimental study.

Gastric-stump carcinoma, a special form of gastric carcinoma, is seen as a late complication of gastric surgery performed on the carcinoma-free stomach. In the present experimental series a considerable number of carcinomas were observed, for the first time, in rats after gastric surgery without additional application of a carcinogen. The rate of malignancies arising in the gastric stump correlates closely with the intensity of the duodenogastric reflux provoked by different surgical procedures. The important role of duodenogastric reflux for the development and growth of gastric stump carcinoma is thus established beyond doubt. While bearing in mind the need for caution in translating experimental results to man, this study does suggest the value of reflux-preventing techniques in the surgical management of gastric diseases. Patients who have undergone an operation are at increased risk of developing carcinoma, and therefore require consequent and regular follow-up examination. The introduction of surgical prophylaxis and careful postoperative surveillance are the only effective methods for the prevention of gastric stump carcinoma.

Gastric stump carcinoma--new aspects deduced from experimental results.

The actual influence of surgical technique on the pathogenesis of gastric stump carcinoma has not been fully explained, even under experimental conditions. We attempted to elucidate the problem by a series of experiments with Wistar rats assessing the postoperative consequences of Billroth I resection, B II resection with Roux-en-Y gastroenterostomy, B II resection with Braun's anastomosis, and plain gastroenterostomy without resection, and defining their influence on the development of carcinoma in the gastric remnant. Based on general clinical observations and randomized endoscopic and radiologic examinations, the date for killing and autopsy was fixed on the 56th after the surgical intervention. The number of malignant neoplasms was found to rise in proportion with the intensity of duodenogastric reflux resulting from the respective operative procedures: No tumors were found after B II resection with Roux-en-Y gastroenterostomy, but tumor incidence in the other groups rose from 10% in the animals subjected to B I resection, to 23.1% in those with B II resection plus Braun's anastomosis, and finally to 30% in animals with B II resection only, but no Braun's anastomosis. Gastroenterostomy without any resection even produced a tumors incidence of 70.8%. The present paper is presumably the first to report about gastric carcinomas that arose after surgery alone, without additional carcinogen exposure.

[Asymmetrical macrodactyly]. / Asymmetrische Makrodaktylie.

A case of asymmetrical macrodactyly is reported with special regard to the conservation of the remaining function. It is shown that partial resection of the metacarpal bones, performed for functional reasons, leads to a satisfying result, while the amputation of the fingers, proposed for cosmetic reasons, is not recommended.

[Multiple gastric carcinoid, its diagnosis in gastric polyposis (author's transl)]. / Das multiple Magenkarzinoid in der Differentialdiagnose polypöser Magenveränderungen

Carcinoid of the stomach, hormonally inactive, is diagnosed with MDP, gastroscopy and biopsy. Solitary carcinoids are treated with excision in toto with immediate histology of the edges. Multiple gastric carcinoids require gastrectomy.

[Diverticula of the stomach - diagnosis of their importance (author's transl)]. / Das magendivertikel - diagnostische Möglichkeiten zur Beurteilung der Dignität

Gastric diverticula may be due to dilatation or traction. 75% are found in the fundus, 15% in the prepyloric antrum. In 10% they were situated elsewhere. Symptoms are unspecific. Radiography has to be combined with endoscopic investigation of their nature. Smaller diverticula are mainly treated conservatively, the larger ones will require surgery because of chronic symptoms and complications.

[Lymphogenic osteomyelitis of the foot (author's transl)]. / Das Bagatelltrauma - Ursache lymphogener Vorfussosteomyelitis

The special way of infection of the lymphogenic osteomyelitis caused by trivial trauma is demonstrated in 4 cases. Germ ascension is done by lymphatics or fissures in the tissue, as it is well known in the panaritium ossale. The treatment consists in removing the focus of infection, irrigation-suction drainage and specific antibiotic therapy. Trivial trauma of the lower extremity should be treated according to the principles of asepsis.