[A very rare submucosal tumour of the rectum - primary endometrioid adenocarcinoma of the rectum wall]. / Ein sehr seltener submuköser Tumor des Rektums - primäres endometrioides Adenokarzinom der Rektumwand.

A 56-year-old female, with a past history of hysterectomy 13 years previously due to uterine myomata, presented with complaints of pain around the anus of a few months duration. Three years previously she underwent a colonoscopy, which was found to be unremarkable. A high suspicion of a submucosal tumour of the rectum in endoscopic examinations was confirmed by endoscopic ultrasound. The biopsy could not specify the tumour characteristics. Based on the diagnosis of a 4 cm submucosal tumour with infiltration of bowel wall and regional lymph nodes the affected segment was resected. Histolopathology revealed an adenocarcinoma involving tissue from the outer bowel wall to the submucosa. However, immunohistochemistry revealed an endometrioid adenocarcinoma, suspicious for primary endometrioid adenocarcinoma of the ovary with rectum metastasis in the absence of a uterus. But this assumption could not be confirmed in the excised ovary. The tumour cells were immunopositive for cytokeratin 7, CA 12 - 5, vimentin and oestrogen receptor, but negative for cytokeratin 20 and CDX-2. Ultimately, we report a very rare case of primary endometrioid adenocarcinoma arising in endometriosis in the rectum wall and presenting as a submucosal tumour.

Benign and malignant cells in effusions: diagnostic value of image DNA cytometry in comparison to cytological analysis.

Identifying tumor cells in body cavity fluids reliably is a well-known diagnostic problem. Since cytometric quantitation of nuclear DNA content appears to be a promising new tool in the diagnosis and prognostic evaluation of many solid human tumors, we examined its validity in detecting malignant cells in cytologically positive effusions. For this purpose, image DNA cytometric measurements, including the evaluation of DNA-ploidy and the calculation of the DNA index (DI), were performed in 80 body cavity fluids. The results were correlated with cytology, clinical course and final histological diagnoses. We used aneuploidy, as shown by interactive image DNA cytometry, as a marker for the malignancy of cells that occur in body cavity fluids with a 100% specificity and 94.8% sensitivity. Cytological investigation showed a 92.3% specificity and 95.4% sensitivity. Combining both methods raised the specificity to 100% and the sensitivity to 98.5% and had a positive predictive value of 100% and a negative predictive value of 93.8%. The DNA-index (DI) was significantly higher in malignant effusions than in benign effusions: 1.5 +/- 0.74 (mean +/- SD) versus 1.11 +/- 0.26 (p < 0.05). Along with the difficult cytological evaluation of malignant cells in body cavity fluids, image DNA cytometry can be a helpful additional method for evaluating these cells. Combining the two techniques results in a highly specific and sensitive prediction of malignant cells. We, therefore, suggest using these methods for the reliable identification of tumor cells in effusions.

[Diagnosis and therapy of ergotism following the use of heparin-DHE in thrombosis prevention]. / Diagnostik und Therapie des Ergotismus nach Heparin-DHE-Thromboseprophylaxe.

Vasospastic complications have been reported in five patients following the use of heparin-dihydroergotamine for thrombo-embolic prophylaxis. The most important diagnostic procedure is angiography, which shows characteristic findings. Intraarterial prostaglandin is a promising form of treatment. Experience with two patients is reported.

[Angiospasm and dihydroergotamine--dangers in thromboprevention]. / Der Angiospasmus und Dihydroergotamin--Gefahren der Thromboseprophylaxe.

The advantages of perioperative low dose heparinization as well known. Angiospastic reactions of Heparin-DHE have been described. In some cases additional factors such as interruption of blood flow and application of sympathicomimetics, are supposed to be decisive for the course. In cases where the application of sympathicomimetics might be necessary, perioperative treatment with DHE should therefore be avoided. Consequent observation of the peripheric blood flow is required in traumatized patients. In addition to other vasodilating agents the intraarterial application of Prostaglandin E1 is of advantage in case of angiospastic reactions.

[Control of low-dose heparin therapy using photometry to detect biologically active heparin]. / Kontrolle der low dose-Heparintherapie durch photometrischen Nachweis biologische aktiven Heparins.

The low-dose heparin prophylaxis depends upon a low-level activation of antithrombin III to prevent thrombin generation. For the routine regiment, the application of 5000 units twice daily seems sufficient to reduce fatal lung embolism. By comparing three commercially available heparins (Thrombophob, Thrombo-Vetren, Heparin-Dihydergot) the effectiveness of the so-called low-dose heparin application was controlled with a chromogenic substrate assay (Coatest, Kabivitrum). Only twice-daily Heparin-Dihydergot resulted in an average heparin level of 0.12 +/- 0.78 m/ml plasma, which was sufficient to provide an effective thrombosis prophylaxis.

[Theoretical and clinical aspects of fibrin stabilization in the post-operative phase]. / Theoretische und klinische Aspekte der Fibrinvernetzung in der postoperativen Phase.

The level of factor XIII circulating in the blood plasma was determined with a commercially available screening method of the Behringwerke, Marburg, Germany. In a randomized study, the blood of 76 of both sexes and different ages was analyzed before and after surgery. In most extensive laparotomies, factor XIII declined as an expression of the vascular processes during and after the operation. The same effect was demonstrated after surgical excision of stomach or of colon carcinomas. Concurrent with the factor XIII level, fibrinogen concentration was also reduced. While the replenishment of factor XIII extended over a period of several days postoperatively, the fibrinogen synthesis was increased and exceeded normal levels after 2 to 3 days. Inspite the operational activities, factor XIII was never so low that a substitution was indicated.

[Surgical therapy of achalasia for prevention of reflux esophagitis]. / Chirurgische Therapie der Achalasie zur Vermeidung einer Refluxösophagitis.

Not only the conservative dilatation treatment achalasia is at disposal, but also the operative cardiomyotomy. The former treatment followed often by recurrent danger of perforation as well as both methods lead in a definite percentage of cases to refluxesophagitis. Therefore, in our department since 1973 a combination of cardiomyotomy and fundoplication are performed consecutively. By using this method the reflux is surely, according to our experiences, avoidable. The indication of conservative treatment is to be performed by inoperable patients.

[Pathology of the anal region and its care in proctologic practice]. / Pathologie de la région anale et les soins en pratique proctologique.

The anal dermis, with its sensitive receptors, is an important part of the anorectal apparatus. Anal fissures and perianal phlebothrombosis can cause considerable pain. According to anatomical diagnostics, there are three clear stages in the development of an anal fissure. At the first stage, a treatment using a glass dilator gives good results. The subsequent two stages, however, require surgery. In current practice there are two types of operation: the association of a fissurectomy with dorsal sphincterotomy under local or general anaesthetic; or fissurectomy associated with an inferior lateral sphincterotomy, a technique improved by Notaras. A comparison between the two types of treatment shows that fissurectomy associated with lateral sphincterotomy constitutes the more effective method. As the rate of recidivism and complications is the same, the operation can be performed on an ambulatory basis during hours of consultation. Thrombectomy under local anaesthetic may be used for the treatment of perianal phlebothrombosis in its most critical phases. This always relieves the patient's pain, and it, too, may be performed on an ambulatory basis.

[On the relationship between the return blood circulation and sports]. / A propos des rapports entre la circulation sanguine de retour et les sports.

The authors discuss the consequences of various kinds of sport such as canoeing, the numerous forms of jumping, football and cycling on the venous system and go on to consider the treatment of varicose veins and to recommend fairly broad indications for surgery based on stripping along the length of the internal saphenous vein, completed if necessary, by phlebosclerosis. The importance of keeping the leg in a sterile state during the post operative period is emphasised. Some easy precautions to be carried out while practicing various sports are described.

[The Caroli syndrome]. / Das Caroli-Syndrom.

Caroli's disease is characterized by congenital pseudocystic dilatation of the biliary tree. Inflammation and stone formation lead to clinical manifestation in the second decade. ERC and computed tomography are main diagnostic procedures. In cases, where the alterations are limited partial hepatectomy has been recommended. If dilatations are diffuse, the aim of surgical treatment is the performance of a choledochojejunostomy to realize drainage and prevent recurrent ascending cholangitis.

[Clinical symptoms and morphology of ischemic proctitis (author's transl)]. / Klinik und Morphologie der ischämischen Proktitis.

Obliterating arteriosclerotic lesions of pelvic vessels may induce inflammation and fibrosis of the rectum and subsequently ischemic proctitis. This may lead to damage of the sphincter muscle and to complete incontinence. Clinical symptoms are pain and bloody stools, as in ischemic colitis. The combination of periproctitis and perianal necrosis may be misinterpreted as anal fistulas. An anus praeter sigmoideus is to be recommended for palliation. A case report of this particular disease is given including clinical, angiographic and morphological data.