[Adenomatosis of the bile ducts as a rare cause of cholestasis]. / Adenomatose der Gallenwege als seltene Ursache einer Cholestase.

Biliary obstruction of uncertain aetiology in a 69-year-old women led to a cholecystectomy and exploration of the bile tract: a nearly complete cast of the hepatic ducts and intrahepatic bile ducts was extracted. Histological examination of the gall bladder and liver biopsy failed to provide a diagnosis, but a bile duct biopsy taken at the time of an endoscopic retrograde cholangiography revealed the diagnosis of papillomatosis. This disease has a poor prognosis because there is no known cure.

[The biliary excretion of azlocillin]. / Die biliäre Exkretion von Azlocillin.

The excretion of azlocillin into the human biliary tract was investigated in 8 patients with a T-tube in the common bile duct after intravenous injection of 2 g. Samples of serum and common duct bile were assayed from 15 min to 12 hours after injection. Biliary tract levels generally run parallel to serum levels but were about 15 times higher than those. Peak levels in T-tube bile averaged 1137 mg/l 60 to 90 min after administration. 12 hours after administration there were still mean concentrations of 13 mg/l to be found. It is concluded that azlocillin concentrations in bile exceed for a long time the minimum inhibitory concentrations for gram-negative and gram-positive causative organisms (above all E. coli, enterococci, Klebsiella spp., Proteus spp., staphylococci) of biliary tract-infections.

[Mezlocillin: tissue concentration and efficacy (author's transl)]. / Mezlocillin: Zur Gewebekonzentration und Wirksamkeit.

Studies on serum and tissue (cutis, muscle and liver) concentrations were carried out with mezlocillin (Baypen), a semi-synthetic new acyl ureidopenicillin, in 51 patients. Serum half life was 59 minutes. The highest concentrations were measured in the cutis, the lowest in the muscles. Concentrations in the liver were found to be relatively constant and persistent.--The efficacy and tolerance of mezlocillin were examined in 48 patients affected by 56 mostly severe infections, which were treated with a dose of 5 g twice or three times daily. The indications for antibiotic treatment were bronchopulmonary infections, peritonitis, soft tissue infections, biliary and urinary tract infections and postoperative febrile conditions of unknown origin. Clinical cure was achieved in 78.5% and an improvement of symptoms in 5.4% of infections. 76% of the causative microorganisms were eliminated. Mezlocillin was locally and systemically well tolerated.

[Emptying of the stomach after selective proximal vagotomy (author's transl)]. / Untersuchungen zur Magenentleerung nach selektiver proximaler Vagotomie.

Cream cheese containing 14C-labelled glutaminic acid was given to patients after proximal selective vagotomy and 14CO2 measured in the expired air in order to test the gastric emptying process. Results do not allow exact quantitative evaluation, however definite changes of gastric emptying for up to 6 month after surgery could be demonstrated.

[Surgical problems of diverticulosis of the small intestine (author's transl)]. / Chirurgische Probleme der Divertikulose des Dünndarms.

Two patients are reported which were operated for complications of small bowel diverticula. One was operated for a retroperitoneal tumor caused by a perforated diverticulum, which led to an inflammatory mass of the mesentery. In another patient adhesions produced acute intestinal obstruction.

[Postpyloric resection of a complicated ulcer on the posterior wall of the duodenum within the scope of form-and function-preserving gastric surgery. Technic and 1st results]. / Postpylorische Resektion des komplizierten Ulcus der Duodenalhinterwand im Rahmen form- und funktionsgerechter Magenchirurgie.

By combining different methods available in modern gastric surgery, we have developed a new procedure in surgical treatment of the complicated ulcer of the posterior duodenal wall. Our new technique allows the radical resectioning of the ulcer and includes all the advantages of nonresectioning operations in form- and function-preserving surgery. The technique of open anastomosis with an one-row, one-layer suture only slightly injures the gut that is to be anastomosed and thus eliminates complications in the healing process. The pylorus is completely preserved. The great advantages of avoiding gall reflux into the stomach, of preserving its total capacity, and of preserving the possibility of a portioned evacuating of the stomach can not yet be fully estimated.

[Collecting methods for pancreatic juice in long-term research in the non-anesthesized dog]. / Zur Methodik der Gewinnung von Pankreassaft im Langzeitversuch am nicht narkotisierten Hund.

Comparison of various methods of collecting pancreatic juice in long-term experiments shows that there is no ideal procedure. The authors themselves obtained the best results by help of the duodenal cannula according to Tuckermann and Thomas, which is implanted in the duodenum opposite to the duodenal papilla. Using this cannula it is often possible with sufficient skill and patience to cannulate the duodenal papilla from the outside and to gain pancreatic juice from the awake dog in an exact manner. Among the pouch techniques the best is the method according to Herrera.

[Increased kidney cell proliferation caused by folic acid treatment after dichromate induced renal failure (author's transl)]. / Proliferationssteigerung im Nierengewebe durch Folsäure nach induziertem Nierenversagen mit Dichromat.

Folic acid is given intravenously to rats 5 to 10 days after a dichromate induced damage of the kidneys. These injection cause an additional damage in the function and structure of the kidneys, but on the other hand, they induce a cell proliferation detected by the increased uptake of thymidine. This cell proliferation in the kidney-tissue seems to be a part of specific reactions to the folic acid.

[Symptoms, signs and therapy of the septate gallbladder (author's transl)]. / Klinik und Therapie der septierten Gallenblase.

The septate gallbladder probably represents a congenital anomaly of form, that can be proven by X-ray in 3,8% of hospitalized patients. Only in 25% of these cases it has an own symptomatic significance. Here it does lead though, more or less distinctly, to the typical painful discomfort, comparable to the cholelithiasis, especially augmented by dietary sins, up to the state of colics. The symptoms intensify during the clinical course. Because the gallbladder remains in most cases without the finding of concrements, the misjudgement in these cases often leads to an unnecessary prolongation of the interval between diagnosis and operative treatment.

[Experimental longterm cannulation of the stomach (author's transl)]. / Langzeitfistelung des Magens im Tierexperiment.

The construction and use of a new cannula for the long-term cannulation of the stomach in experimental surgery is described. The major attribute of the gastric fistula is the simplicity of technical management and the advantage to avoid irritation of the animals as much as possible.

[Duodenal fistula for long term animal studies]. / Duodenalfisteln für Langzeituntersuchungen im Tierexperiment

The author modified the duodenal cannula -- first described by Tuckermann in 1883 -- obtaining a safe long-term access to the duodenum with almost no complications in animal experiments. This technique reveals the possibility to obtain duodenal fluid from the animal without anesthesia, or pancreatic juice by cannulating the duodenal papilla.

[Persistent duodenal septum in an adult]. / Persistierendes Duodenalseptum im Erwachsenenalter

A case of duodenal obstruction by a congenital duodenal web in a 34-year-old woman is presented. A mucosal diaphragm obstructed the duodenum. It showed an excentric opening of 0.8 cm diameter, but the dilated diaphragm caused a total stop during the last months. Despite a typical history, exact X-ray, and endoscopic examination, the correct preoperative diagnosis was not found, because nobody thought it possible, that a mucosal diapharm of the duodenum could persist for 34 years.

[Hemothorax after abdominal vagotomy. Diagnostic problem]. / Hämatothorax nach abdominaler Vagotomie. Ein diagnostisches Problem

Selective or selective-proximal vagotomy has increased in preference as surgical treatment for uncomplicated duodenal ulcer disease. An unusual immediate complication of transabdominal vagotomy is the hemothorax. Few cases of this complication have been reported in literature. Our case represents a variation with simultaneous presence of a both-sided hemothorax. Although the exact etiology of this complication remains obscure, we try to explain this spontaneous hemothorax by operative injuries of subpleural vessels.

[Influence of various forms of vagotomy on the exocrine function of the pancres]. / Auswirkungen verschiedener Vagotomieformen auf die exokrine Pankreasfunktion

In surgical treatment of the duodenal ulcer a selective proximal vagotomy is the only method to vagotomize parietal cell area of the stomach alone and to let the motoric and endocrine function of the antrum, as well as the vagal innervation of the liver, the pancreas and the gut indisturbed. Our experimental investigations on dogs with total and selective proximal vagotomy show, that an intact vagal innervation of the pancreas is important for its normal function and that selective proximal vagotomy does not change the exocrine pancreatic secretion. Otherwise a total vagotomy diminishes significantly the pancreatic production of volume and enzymes after insulin stimulation. In respect of the vagal innervation and normal function of the pancreas, a selective proximal vagotomy therefore seems to be the best method in surgical treatment of the duodenal ulcer.