[Right-sided pneumothorax in laparoscopic cholecystectomy]. / Rechtsseitiger Pneumothorax bei laparoskopischer Cholecystekomie.

In a 28-year-old woman right-sided pneumothorax developed during a laparoscopic cholecystectomy. The authors believe that the pneumothorax was caused by in the inflow of carbon dioxide into the thoracic cavity without injury to the diaphragm. So far, only a few reports of this complication exist, but in the future it will probably occur more frequently, since the number of laparoscopic operations is increasing. The symptoms are alterations in capnography, subcutaneous emphysema and diminished respiratory sounds.

[Significance of CEA and CA 19-9 for after care of curatively resected colorectal cancers]. / Die Bedeutung von CEA und CA 19-9 für die Nachsorge kurativ resezierter kolorektaler Karzinome.

The monitoring of CEA is valuable in the follow-up after curative resection of colorectal cancer and contributes to the early detection of local recurrence and distant metastases. The simultaneous detection of the CA 19-9 does not lead to a substantial advantage. The recurrences and especially the metastases detected by the monitoring of the tumour markers frequently are unresectable. In patients with elevated tumour markers without other evidences of recurrence or metastases the indication for a second-look operation should be considered cautious because elevated tumour markers are found in patients with benign diseases also.

[Measurement of serum protein-bound hexose--an aid in the diagnosis and after-care of colorectal cancers?]. / Die Messung der Proteingebundenen Hexose im Serum--ein Hilfsmittel bei Diagnose und Nachsorge von kolorektalen Karzinomen?

In a group of 80 patients with colorectal carcinoma and a control group of 103 persons Protein-bound Hexose (PHex) was measured in the serum. The level was, as reported previously by other authors, significantly elevated in the tumour group. The aim of this study was to compare the sensitivity of PHex with that of the oncofetal antigens CEA and CA 19/9. The sensitivity of PHex turned out to be clearly lower than that of CEA. It was about as high as the sensitivity of CA 19/9 in colorectal carcinoma. In view of these results there is no benefit to be expected from an introduction of the PHex determination into clinical practice.

[Ender nailing versus dynamic hip screw--a comparison of early postoperative results]. / Ender-Nagelung versus Dynamische Hüftschraube (DHS)--Ein Vergleich früh postoperativer Verläufe.

Proximal fractures of femur may be alternatively treated by implantation of dynamic hip screws or Ender-nails. Estimation of the value of both measures is to be done by analysis of the early postoperative course. Full load bearing capability was obtained in 83% of all cases with Ender-nails as against 68% of all cases after implantation of hip screws. Duration of operation was clearly shorter and the need for blood transfusions was reduced by implantation of Ender-nails. The amount of specific technical complications was equal in both procedures. There were no differences in the postoperative ability to walk.

[The activity of serum cholinesterases following experimental choledochus ligation in the rat]. / Die Aktivität der Serumcholinesterase nach experimenteller Choledochusligatur an der Ratte.

The activity of serum cholinesterase was measured over three days after ligature of the common bile duct in female Wistar rats. A specific effect of the ligature was observed on the third day postop.: the activity decreased. The delayed reaction can be explained by the long half-life of the enzyme. Further, in all operated rats (sham-operated, too) a decrease of activity on the first postop. day was noticed. Possible causes are an influence of the anesthetics or sequels of the operative trauma.

[Obstructive jaundice in proximal pancreatitis after sclerosing of a bleeding duodenal ulcer]. / Verschlussikterus bei Kopfpankreatitis nach Sklerosierung eines blutenden Duodenalulkus.

Two weeks after successful endoscopic sclerotherapy of a bleeding duodenal ulcer a fifty-year old male patient developed a benign enlargement of the head of the pancreas and obstructive jaundice. He underwent exploratory laparotomy with choledocho-jejunostomy because there was no evidence of malignant disease. The enlargement of the head of the pancreas and obstructive jaundice are considered to be symptoms of a pancreatitis as a complication of the endoscopic sclerotherapy.

[Evaluating histologic findings after appendectomy]. / Zur Bewertung histologischer Befunde nach Appendektomie.

The results of the histopathologic examination of 262 appendices after incidental appendectomy were reviewed. Only 17.5% of the histologies were regarded as normal. Fibrosis, obliteration and chronic appendicitis were described frequently. It is discussed whether these findings belong only to the normal histologic appearance of appendices in more advanced age.

[Sensitivity and specificity of alpha-1-antitrypsin and acid alpha-1-glycoprotein in colorectal carcinoma]. / Sensitivität und Spezifität von Alpha-1-Antitrypsin und saurem Alpha-1-Glykoprotein beim kolorektalen Karzinom.

In a group of 80 patients with colorectal cancer and a control group of 91 persons and in 15 patients with acute diverticulitis of the sigmoid colon acid alpha-1-glycoprotein (AGP) and alpha-1-antitrypsin (AAT) were measured. The median of AAT in the carcinoma group was 3.34 g/l, in the control group 2.39 g/l. AGP was in the carcinoma group 1.19 g/l, in the control group 0.79 g/l. Both differences are significant. The sensitivities of AGP and AAT were compared with the sensitivities of CEA and CA 19/9 using ROC-curves. AAT and AGP have a distinctly lower sensitivity than CEA, but only on the basis of a high specificity of 95%. In the region of lower specificities AAT has the highest sensitivity. Therefore, the sensitivity of CEA for colorectal carcinoma is not reached by AAT and AGP, when a high specificity of the test is required. The relevance of AAT and AGP determinations is further reduced because in the diverticulitis group the levels were as high as in the carcinoma group.

Activities of APh, gamma-GT, GlDH and GPT and bile acid concentrations in serum after bile duct obstruction and cycloheximide in the rat.

The aim of this study was to investigate the effect of the protein synthesis inhibitor cycloheximide on the serum activities of gamma-Glutamyltransferase, Glutamate dehydrogenase and Glutamate pyruvate transaminase after bile duct obstruction in rats. The results showed that the increase of these enzyme activities after bile duct obstruction is further augmented by cycloheximide. Determinations of total bile acids in serum and liver showed that also the bile acid concentrations rise to a higher level after bile duct obstruction + cycloheximide than after bile duct obstruction alone. It is concluded that the effect of cycloheximide on the serum enzyme activities in extrahepatic cholestasis is produced via an influence on the metabolism of bile acids. This stresses the central role of bile acids for alterations of enzyme activities in extrahepatic cholestasis. Further, the effect of cycloheximide on bile acids after bile duct obstruction has not been reported before.

Serum activities of AP, gamma-GT, G1DH and GPT in the first four days after bile duct obstruction and ethionine in the rat.

Following sham operation and bile duct obstruction (BDO), Wistar rats received ethionine, which inhibits protein synthesis in the liver. Earlier studies revealed, that the increase of activity of AP after BDO is the result of a de novo-synthesis of enzyme protein in the liver. With regard to serum activities of the enzymes G1DH, GPT and gamma-GT, no influence of de novo-synthesis after BDO has so far been certified, but these enzymes have only been investigated in the early phase after BDO, for up to 24 h under protein synthesis inhibition. In the present study, the protein synthesis inhibition was extended up to the fourth day after BDO. Signs of de novo-synthesis after BDO could also be detected in G1DH, GPT and gamma-GT.

[Retinol-binding protein, haptoglobin and ceruloplasmin--tumor markers in colorectal cancer?]. / Retinolbindendes Protein, Haptoglobin und Coeruloplasmin--Tumormarker beim kolorektalen Karzinom?

Retinol-binding protein, haptoglobin and ceruloplasmin were determined in the plasma of patients with colorectal carcinoma. The comparison with a control group shows that retinol-binding is significantly decreased in colorectal carcinoma and that haptoglobin and ceruloplasmin are significantly elevated. The ROC-curves of the three parameters, however, display a sensitivity distinctly lower than that of CEA, so that any use in the clinical treatment of colorectal carcinoma cannot be expected from the determination of these substances.

The serum activities of AP, gamma-GT, GlDH and GPT after bile duct obstruction and ethionine in the rat.

The increase of activity of the enzymes AP, Gamma-GT, GlDH and GPT was investigated in this study with regard to its pathomechanism. The increase of AP is known to be caused by a de novo-protein synthesis in the liver, as several investigators have demonstrated using protein synthesis inhibitors. In this study female Wistar rats were partly sham-operated, partly bile duct-obstructed. One half of each group received the protein synthesis inhibitor ethionine, 24 h after bile duct obstruction in the group with ethionine the following enzyme activities were measured in the serum: AP 216 +/- 80 U/l; gamma-GT 4.5 +/- 1.9 U/l; GlDH 85 +/- 26 U/l; GPT 375 +/- 163 U/l. In the group without ethionine the activities were: AP 459 +/- 69 U/l; gamma-GT 4 +/- 0.9 U/l; GlDH 120 +/- 81 U/l; GPT 417 +/- 191 U/l. Because the differences between the groups with and without ethionine were not significant with the exception of AP, it is concluded that in the early phase of bile duct obstruction up to 24 h no influence of de novo-protein synthesis can be demonstrated in the elevation of the activities of gamma-GT, GlDH and GPT.

[The behavior of mixed function oxidases in the liver of the rat on the first day after ligation of the ductus choledochus]. / Das Verhalten der mischfunktionellen Oxidasen in der Leber der Ratte in den ersten Tagen nach Ligatur des Ductus choledochus.

The aim of this study was to investigate the activity of the mixed function oxidases in the liver of the rat during the first days of extrahepatic cholestasis. In particular, contradictory results of previous studies of the metabolism of type I- and type II-substrates should be examined. The activities of the aminopyrine demethylase, aniline hydroxylase and nitroanisole-O-desalkylase were measured in the liver microsomes after sham operation and on the first and third day after ligature of the common bile duct. On the first day of cholestasis both the metabolism of the type I-substrate (aminopyrine) and of the type II-substrates (aniline, nitroanisole) was significantly reduced. On the third day the metabolism of type II-substrates reached nearly normal levels, whereas the metabolism of aminopyrine was even further reduced. Contradictory results of previous studies seem to be due to different times of measurement.

The serum activities of AP, gamma-GT, GLDH, GPT and CHE after complete biliary obstruction and choledochocaval fistula in the rat.

The activities in serum of alkaline phosphatase, gamma-glutamyltransferase, glutamate dehydrogenase, glutamic pyruvic transaminase and cholinesterase were compared after complete biliary obstruction (CBO) and choledochocaval fistula (CCF) in the rat. CCF was used as a model of complete biliary retention without bile stasis and without increased pressure in the biliary tract. The increases in AP, GLDH and gamma-GT within 24-h post-op. show no difference between the two experimental groups. The conclusion is that the retention of biliary constituents alone is responsible for the increase in the levels of serum activity and that other conditions like bile stasis and increased pressure in the biliary tract do not play an important role in the pathogenesis of these alterations. The rise of GPT activity in CCF is of a lesser degree than in CBO.

[Non-traumatic perforations of the small intestine]. / Nichttraumatische Perforationen des Dünndarmes.

A series of 23 patients is reviewed admitted to our hospital for non traumatic perforation of the small intestine, a condition found very rarely as a cause of acute abdominal disease. The causes were primary small bowel neoplasia (four patients), adhesions (five patients), intraluminal foreign bodies (two patients), small bowel metastases (two patients), diverticulum (two patients). In seven patients a perforation was found that was neither related to any gross alterations of the bowel wall nor was specifically distinguished in histology. For the latter group, the possible role of local drug toxicity, especially of potassium chloride, is discussed.

Tumor markers carcinoembryonic antigen, tissue polypeptide antigen, and carbohydrate antigen 19/9 in liver diseases.

The tumor markers carcinoembryonic antigen (CEA), tissue polypeptide antigen (TPA), and carbohydrate antigen 19/9 (CA19/9) have been compared with regard to their sensitivity to liver diseases. All three markers have been found to be sensitive to liver diseases, but to a different degree: TPA rises the most; CEA the least. The sensitivities of TPA and CA19/9 are higher in a group of liver diseases than, for comparison, in a group of colorectal carcinomas.

[Does measuring axillo-rectal temperature difference help in the diagnosis of acute appendicitis?]. / Hilft die Messung der axillorectalen Temperaturdifferenz bei der Diagnosestellung der akuten Appendicitis?

The value of the axillorectal temperature difference in the diagnosis of acute appendicitis was estimated with the aid of statistical methods. The axillorectal temperature difference turned out to be of very low discriminant ability between acute appendicitis and non-acute conditions.