[Effectiveness, population-level effects, and heath economics of measles and rubella vaccination]. / Effektivität, Populationseffekte und Gesundheitsökonomie der Impfungen gegen Masern und Röteln.

Vaccination against measles and rubella has been included in national immunization programs worldwide for several decades. In this article, we present the evidence related to the effectiveness of measles and rubella vaccination based on published systematic reviews, and we describe the epidemiological and health economic effects of vaccination at a population level. Several observational studies demonstrate the high effectiveness (> 90 %) of both measles and rubella vaccination. The global measles mortality reduction and the dramatic decrease in rubella and measles incidences after introduction of routine immunization contribute to the very high quality of evidence. The countries of the Americas have proved that it is feasible to eliminate measles and rubella by strengthening infant immunization through routine vaccination services and by conducting supplemental immunization activities in other childhood age groups so as to close immunity gaps. An economic evaluation of measles and rubella vaccination specifically for the healthcare system in Germany does not exist. However, we conducted a systematic review and identified 11 health-economic studies from other industrialized countries and one for a hypothetical industrialized country. Results indicate that vaccination against measles and rubella had either a cost-effective or even a cost-saving potential, which could be assumed with some limitations also for the German setting. In conclusion, there is compelling evidence that the available vaccines are very effective and that measles and rubella elimination is feasible if adequate vaccination strategies are implemented. In Germany, catch-up vaccination programs are urgently needed for children, adolescents, and young adults specifically in the western federal states.

Palliative treatment of malignant stenoses of the upper gastrointestinal tract using a combination of laser and afterloading therapy.

Forty-eight patients with malignant stenoses of the esophagus and cardio-esophageal junction were submitted to endocavitary afterloading treatment after prior endoscopic recanalization with the laser. An intraluminal reduction in tumor mass, and rapid elimination of dysphagia proved possible. This technique represents an alternative to the endoscopic implantation of an endoprosthesis. The afterloading tube is placed endoscopically under direct vision. Using a 192Iridium radiation source, 7 Gy were applied at a distance from the tube of 1 cm. Dysphagia was permanently relieved in 77%, while re-stenosis occurred in 23%. The mean survival time was 5.9 months. This procedure is associated with a low incidence of complications, and can be employed on an outpatient basis, and in combination with percutaneous radiotherapy given as boost radiation.

[Esophageal function following sclerotherapy of esophageal varices]. / Oesophagusfunktion nach Oesophagusvaricensklerosierungstherapie.

Functional disorders of the esophagus were evaluated in 24 patients 4 +/- 2 months after sclerotherapy following the first hemorrhage. The mean volume of polidocanol required per patient was 181 +/- 111 ml. 9 patients complained of dysphagia and/or reflux symptoms; strictures were found in two cases; 4 patients had esophagitis. Manometrically the lower esophageal sphincter was completely insufficient in 14 patients; only 7 patients still had a competent cardia. The first group had received significantly more polidocanol than the latter. Tubular motility was disturbed by nonpropulsive (18%) and repetitive (7%) contractions. By longterm-pH-metry the percentage of oesophageal reflux was elevated in all patients.

[Endocavitary radiotherapy in an after-loading technic in malignant stenoses of the upper gastrointestinal tract and bile ducts]. / Endokavitäre Strahlentherapie in After-loading-Technik bei malignen Stenosen des oberen Gastrointestinaltraktes und der Gallenwege.

Palliative brachytherapy with 192iridium in high dose rate technique was applied until August 1985 in 44 patients: 40 suffering from an inoperable malignant stenoses of the esophagus or cardia, and 4 from bile duct carcinomas located in the upper part of the duct. The patients with malignant stenoses of the upper gastrointestinal tract underwent laser therapy until an endoscope could be passed beyond this stenoses. Then an after-loading tube was placed endoscopically and the stenoses irradiated endocavitarily (7/Gray/session in 1 cm distance). In the patients with malignant bile duct obstruction a PTCD-catheter served to guide the iridium wire up to the stenotic region.

Intragastral provocation under endoscopic control (IPEC) in food allergy: mast cell and histamine changes in gastric mucosa.

In fourteen patients with food allergy, intragastral provocation under endoscopical control (IPEC) was performed. In all patients positive immediate-type reactions of the gastric mucosa were observed consisting of oedema, erythema and petechial bleeding. Microscopically, mast cell degranulation was observed and measured by mast cell counts using the o-phthaldialdehyde technique. Concomitantly, tissue histamine content in gastric mucosa decreased significantly after allergen provocation, while there was no change in normal volunteers. Plasma histamine concentration increased in most patients; the increases were most evident in four patients showing mild systemic reactions (urticaria and bronchospasm). The technique described might prove to be useful in establishing the diagnosis in doubtful cases of food allergy.

[Surgical therapy of hemorrhaging gastroduodenal ulcer]. / Chirurgische Therapie des blutenden gastroduodenalen Ulkus.

By using the literature important facts of the spontaneous course of ulcer bleeding are presented. Patient groups with a high risk for early rebleeding are characterized. The indication for operation is discussed regarding intensity and activity of bleeding and endoscopic findings. The operative technique of haemostasis in duodenal and gastric ulcer is described. The own cases are analysed with special respect to endoscopic haemostasis.

[Self-healing cecal fistulas for securing anastomoses of the colon and rectum--is this still indicated?]. / Selbstheilende Coecalfisteln zur Sicherung der Anastomosen mit dem Colon und Rectum--noch indiziert?

UNLABELLED: During a period of 2.5 years self-healing coecostomies according to Stelzner (1970) were applied in 48 elective procedures to the left colon. The following operations were done by 16 different surgeons: left side hemicolectomy 5, sigma resection 24, anterior resection of the rectum 19, 13 of which had anastomoses less than 8 cm. RESULTS: Mean postoperative hospital care 25.3 days, no clinical manifestation of anastomotic leaks, first passing of stool after a mean of 8.5 days. Lethality of 4.2% independent of anastomoses, spontaneous occlusion of fistulae after 42 +/- 26 days. 21% local not life-endangering complications occurred.

[Intraluminal irradiation with iridium 192--a new method for the treatment of inoperable esophageal cancers?]. / Intraluminale Bestrahlung mit Iridium 192--ein neuer Weg zur Behandlung inoperabler Oesophaguscarcinome?

In inoperable esophageal carcinoma the intraluminal high dose afterloading therapy with Iridium 192 was employed as an alternative to the palliative resection. Prerequisite for this treatment, which was used in 19 patients during the last year, is the preceding passage restoration of the tumor stenosis by endoscopic laser therapy. Every two weeks the patients are endocavitarily irradiated up to 3 times with a dose of 7 Gy. Observing the patients by endoscopic means the implantation of a tubus is avoidable achieving better quality of life and comparable survival times.

Action of FPL 52694 on gastric acid secretion in the healthy human stomach.

In a double blind crossover experiment in 16 healthy male volunteers, the effects of oral FPL 52694 and a matching placebo upon pentagastrin stimulated gastric acid secretion, gastric mucosal histamine content, and gastric mucosal mast cell count were compared. There was a significant increase in acid secretion, and a fall in tissue histamine and the mast cell count after treatment with the placebo. All these changes were inhibited by FPL 52694, and there was a significant difference between the effects of this compound and the placebo in all three parameters. It is concluded that FPL 52694 caused significant inhibition of acid secretion, and that the likely mechanism of action is by stabilisation of mast cells and inhibition of histamine release.

[The effect pf antacids on the tissue histamine and prostaglandin (PGE2) content of the gastric mucosa]. / Die Wirkung von Antazida auf den Gehalt von Gewebshistamin und Prostaglandinen (PGE2) in der Magenmukosa.

Stimulation tests (pentagastrin) induced significant changes in tissue histamine levels in the gastric mucosa within 30 minutes. Acid secretion and a decrease of histamine after application of antacids containing calcium could not be observed in our study; neither was application of antacids over a period of eight days followed by a change in gastric mucosal tissue histamine concentrations. Patients under non-steroidal antiphlogistic medication showed diminished histamine levels. Administration of antacids did not produce changes in histamine levels, but induced a rise of PGE2 levels in the fundal and corpus area of the stomach. This may be due to a cytoprotective effect of antacids containing calcium on the gastric mucosa.

[Palliative intrabronchial laser treatment of malignant bronchial stenosis using the fiberbronchoscope]. / Palliative intrabronchiale Laser-Behandlung maligner Bronchusstenosen mit dem Fiberbronchoskop.

During a period of 15 months we performed a laser therapy of bronchi stenosis due to malignant tumors in 28 patients. We used a Neodym-YAG-Laser (MBB-AT, Munich), guided through a fiberbronchoscope (Olympus BF-1 TR). 59% of total-stenoses and 83% of the partly occluded bronchi could be opened sufficiently. During a follow-up period of 12 months (mean 4.7 m) 83% of the bronchi remained open. According to our experience, fractional tissue removal is the method of choice rather than all-at-once coagulation since tissue edema may cause bronchial occlusion 1 to 3 days after treatment. We think, if surgical treatment is ruled out, intrabronchial laser coagulation is an alternative with little impairment of the patient to prevent hypoventilation and repair functional conditions.

The use of CT in monitoring cryosurgery.

One of the main problems encountered in cryosurgery is that of controlling the amount of tissue that is irreversibly destroyed by cooling. In vitro-experiments in which the homogeneous cooling of various substances, as well as "ice-ball" propagation within different tissues of animals via a cryotip were evaluated. In vivo experiments, on an anaesthetized pig, indicate CT to be a useful continuous-monitoring technique with a high spatial resolution. Using CT simultaneous localization of pathological tissue and measurement of temperature distribution is possible. The density changes induced by cooling were visualized on CT and the corresponding temperature changes were measured using thermocouples. The greatest decrease in density was observed as a change of phase took place. The speed of ice-ball propagation as well as the diameter of the ice ball generated varied considerably depending on the type of tissue. Construction of cryoprobes of a very small diameter could facilitate the percutaneous treatment of lesions within the body.

[Computerized tomography and traumatology of the musculoskeletal system]. / Computertomographie und Traumatologie des Haltungs- und Bewegungsapparates.

Value and indication of computerized tomography in diagnostic procedures after trauma of the musculoskeletal system is shown analyzing the case material with CT in traumatized patients. In general CT is not to take place of conventional X-ray methods. We feel CT is indicated in evaluation of: intraarticular fragments, congruity of joints, lesions of the cruciate ligaments and osteocartilagineous fractures, if conventional X-ray procedures prove insufficient.

Release of gastric histamine in patients with urticaria and food allergy.

In a clinical study the participation of histamine in the allergenic response of patients with food allergy was investigated. The resting levels of gastric tissue and plasma histamines of 10 patients were slightly higher than the respective values of normal volunteers. 5 minutes after local intragastral allergenic provocation a decline of the mucosal histamine content of the allergen-treated area was noticed. Parallel investigations on the mast cell content of the stomach mucosa revealed a parallel decrease of the o-phthaldialdehyde stained cells, whereas the number of toluidine blue stained cells remained unchanged. These data are in accordance with an antigen-induced IgE-dependent liberation of the mast cell histamine stores.

[Autologous replacement of the cervical esophagus. Free jejunal interposition in a microsurgical technic as a replacement of the esophagus with function studies in an experiment]. / Autologer Ersatz des Halsösophagus. Freies Jejunuminterponat in mikrochirurgischer Technik als Ersatz des Halsösophagus mit Funktionsstudien im Experiment.

The replacement of the esophagus using multiple-stage procedures and requiring a double cavitary approach has been burdened with a high post-operative lethality rate. A replacement of the esophagus using a free autogenous jejunal interponate by avoiding a double-cavitary approach has a lower lethality rate. The hitherto grafting procedures using macrosurgical vascular transplantation techniques were burdened with such a high thrombosis rate that no competitive alternative has ensued. Furthermore, different publications did not clarify whether or not the autogenous intestinal graft retained its peristaltic or, as Nakayama et al. (1964) reported, changed into a rigid and inflexible conduit composed of connective tissue. In a collective of 18 Beagles the esophagus was replaced using a autogenous jejunum graft. The vascular anastomoses between the interponate and neck vessels prepared using microsurgical techniques and the esophago-jejunal anastomoses were prepared using a one-row multiple layer suture. No animal died as a result of the operation. Necrosis of the interponate due to microthrombosis in the vascular anastomoses did not occur. The peristalsis began after opening the arterial vessel. Peristalsis remained even after one year. Histological investigations showed that the intestinal villi degenerate but the musculature and ganglion cells from the myenteric plexus remain intact. The interponate does not become fibrous. In approximately 1/3 of the cases, periluminal scar-tissue growth caused a stenosis of the interponate. This complication was resolved by surgical revision.