Ancient Mammalian and Plant DNA from Late Quaternary Stalagmite Layers at Solkota Cave, Georgia.

Metagenomic analysis is a highly promising technique in paleogenetic research that allows analysis of the complete genomic make-up of a sample. This technique has successfully been employed to archaeological sediments, but possible leaching of DNA through the sequence limits interpretation. We applied this technique to the analysis of ancient DNA (aDNA) from Late Quaternary stalagmites from two caves in Western Georgia, Melouri Cave and Solkota. Stalagmites form closed systems, limiting the effect of leaching, and can be securely dated with U-series. The analyses of the sequence data from the Melouri Cave stalagmite revealed potential contamination and low preservation of DNA. However, the two Solkota stalagmites preserved ancient DNA molecules of mammals (bear, roe deer, bats) and plants (chestnut, hazelnut, flax). The aDNA bearing layers from one of the two Solkota stalagmites were dated to between ~84 ka and ~56 ka BP by U-series. The second Solkota stalagmite contained excessive detrital clay obstructing U-series dating, but it also contained bear bones with a minimum age of ~50 BP uncalibrated years and ancient DNA molecules. The preservation of authentic ancient DNA molecules in Late Quaternary speleothems opens up a new paleogenetic archive for archaeological, paleontological and paleoenvironmental research.

[Obligatory intraoperative cholangiography in laparoscopic cholecystectomy]. / Die obligatorische intraoperative Cholangiographie bei der laparoskopischen Cholecystektomie.

Despite growing experience with laparoscopic cholecystectomy in up to now 1100 operations lesions of the bile ducts sometimes occur. We therefore decided to perform intraoperative cholangiography obligatorily and increased our rate of intraoperative X-ray control from 30% in the first 500 operations to 98.2% in the last 500 operations. The mean operation time in the radiography group was 44.8 min. After introduction of intraoperative cholangiography no bile duct lesions were encountered, but in 4.6% of all patients with this examination previously unknown choledocholithiasis was diagnosed.

[Results of conventional and laparoscopic cholecystectomy]. / Ergebnisse der konventionellen und laparoskopischen Cholezystektomie.

We report about a retrospective study of 861 conventional and 812 laparoscopic cholecystectomies (including one coelioscopic choledocholithotomy). In the conventionally operated group reoperation was required in 2.7% (1.4% relaparotomy, 1.3% secondary suture), mortality was 0.5%. After laparoscopic treatment the reoperation rate was 2% (10 relaparoscopies, 5 laparotomies, 2 secondary sutures), no mortality. Growing experience and better definition of contraindications for endoscopic cholecystectomy might improve our results in the future.

Intra-abdominal bleeding after rupture of hepatic cyst.

We have described the successful surgical management of intra-abdominal bleeding after rupture of a hepatic cyst. In cases of acute arterial hemorrhage, operation is the treatment of choice, whereas unruptured hepatic cysts seldom cause symptoms and rarely need treatment.

[Incidence of complications in elective colon resections at various ages]. / Komplikationsdichte elektiver Kolonresektionen in verschiedenen Lebensaltern.

A retrospective analysis was made of 235 cases of colectomy, subdivided by age groups, with emphasis being laid on preoperative risk factors and postoperative complications. Lethality accounted for 2.5 per cent, with disorders of wound healing being the most common complications. Advanced age per se does not imply unfavourable prognosis.

[Effectiveness of after-care in colonic cancer]. / Die Effektivität der Nachsorge beim Coloncarcinom.

52% of recurrences of the group with regular check-up after curative surgery for colonic carcinoma were diagnosed within the first postoperative year compared to 38% of the patients without medical control. Diagnosis of recurrent disease was made in 75% during a regular check-up, i.e. in state of asymptomatic relapse. Patients without postoperative control attended a physician in 96% because of symptomatic recurrence. 31% of the controlled group were free of lymph node involvement or metastases at the time of secondary procedure as compared to 20% of the group without check-up. 37% of secondary operations could be performed curatively for the patients with examinations compared to 17% of the patients without control. Five-year-survival-rate after secondary procedure was 11% for the group with check-up and 0% for the patients without control. Therefore the high personal, financial and temporal expense and the handicap of patients by a regular postoperative check-up seems justified in case of colonic carcinoma.

[The problem of recurrence in colonic cancer]. / Das Rezidivproblem beim Coloncarcinom.

In this study the incidence of recurrence in radical procedure for carcinoma of colon is more than 37.4%. Of 100 patients undergoing second laparotomy because of recurrence 33% could be resected curatively. The rate of recurrence was independent on sex, negatively correlated with age and positively correlated with tumor stage of former operations. Curative operations located at the ascending colon and hepatic flexure had less recurrences than others. Second operations in curative aims were twice as successful in men than in woman and equally possible in all decades. Results of recurrences of splenic flexure and transverse colon were better than other locations. Tumors of early stages relapsed later. The probability of a radical procedure in recurrence related operations was better in those cases with a long recurrence-free interval. The resectability +/- rate and tumor stage of second-look operation were depending on tumor stage in the first operation. This means further history of tumor disease is determined closely by tumor stage in the first operation.

[Motility of the jejunal replacement stomach]. / Zur Motorik des jejunalen Ersatzmagens.

The food retaining and reservoir-function of the intestinal pouch seems to be characterized by the following mechanism: After being filled with a few foodboli arriving from the oesophagus, segmentary contractions arise and thus continuously propulse the food into the duodenum. In other words the interposed jejunal-loop, due to its decreased motility, rather represents a physiological restraint to the chyme passage, than a real food reservoir. For mixing, predigestion and food-storage the duodenum is more apt, as clinical studies could demonstrate. Furthermore we have shown that any type of surgical manipulation concerning the intestine has severe effects regarding its mechanical activity. This should always be kept in mind when performing Roux-en-Y-anastomosis, correctly intestinal atresia or planning a jejunal by-pass.

[Non-alcoholic Wernicke's encephalopathy as a cause of death in 3 surgical patients]. / Nicht alkoholbedingte Wernickesche Enzephalopathie als Todesursache bei drei chirurgischen Patienten.

3 cases of Wernicke's encephalopathy are reported with consecutive death in surgery patients. A long period of vomiting caused by tumors or inflammation in the upper intestinal tract, preceded. This probably causes a deficiency of thiamin. The deficiency was reinforced by high calorie parenteral nourishment. Caused by non-reversible shock and severe destruction of metabolism, only a period of 1-2 days lays between first neurological symptoms and death. in similar cases a sufficient supply of thiamine should be considered.

[Investigation of the oral-anal frequency gradient of the slow waves in the reversed intestinal segment]. / Untersuchung des oral-analen Frequenzgradienten der slow waves im gegengeschalteten Dünndarmsegment.

Slow waves on small intestine are recognized by decreasing frequency from oral to anal direction. By means of an unipolar recording we found in 65,7 percent of our probes the higher frequency on oral side, in 15,7 percent on anal side and 18,6 percent no remarkable difference between both. After the reverse of a segment of small intestine we still found a reverse of the gradient of the frequences in that way, that nearly in the same percentage the higher frequency was now to be found on the anal side. The mechanical activity of the reversed segment remains also permanently reversed. These indicate that the oral-anal frequency gradient is bound causally to the direction of mechanical activity of the small intestinal wall. They further indicate the permanent antiperistalsis of the reversed small intestinal segment.

[Implantable measuring device for simultaneous pressure and potential recording in the conscious experimental animal]. / Implantierbares Messpult zur simultanen Druck- und Potentialregistrierung am wachen Versuchstier.

The construction and application of a recording desk is described, which is to implant chronically in the abdominal wall of an experimental animal. Potential- und pressure changes can be recorded by this contraction at two different points. Motility can be studied by this method with conscious animals over weeks and month.

[Pathology, clinical appearance and therapy of Ménétrier's disease (author's transl)]. / Zur Pathologie, Klinik und Therapie des Morbus Ménétrier

Clinical pathology of Ménétrier's disease is reviewed and 3 own cases are presented. All symptoms are unspecific exception made for the enteral protein loss. Roentgenologic and endoscopic appearance contribute to the diagnostic but only histologic examination is decisive. Gastrointestinal bleeding, acute pyloric stenosis, profuse albumin loss are all clear indications for an operation, but also the possibility of malignancy should be kept in mind. Resection should include all abnormal parts of the stomach. Recurrency of the Ménétrier's disease is only known after incomplete resection.

[Delayed rupture of the spleen]. / Zweizeitige Milzruptur

From 1964 to 1974 14 patients affected with a delayed rupture of the spleen, were operated in the Surgical Clinic of the University of Mainz. 12 of these 14 patients had a polytrauma. Head-, brain- and thorax injuries were prevalent. Because of the risk of a delayed spleen rupture each blunt trauma has to be hospitalized and observed under clinical conditions. In unconscious patients and in all doubtful cases a peritoneal lavage should be done. If a spleen rupture is caused by an intraabdominal bleeding, Splenectomy is the therapy of choice as further complications can be avoided by this measure.