[Use of ofloxacin in infections which do not readily respond to treatment]. / Primenenie ofloksatsina pri infektsiiakh, trudno poddaiushchikhsia lecheniiu.

The properties of ofloxacin such as a new mechanism of action, broad spectrum and high antimicrobial activity, 100-percent bioavailability and rapid penetration to the body tissues, etc. which defined the antibiotic high efficacy in the therapy of infections difficult for the treatment with other antibacterial drugs are presented. The intensive use of ofloxacin within the last years was no accompanied by an increase in the resistance of the main pathogens to it. High concentrations of ofloxacin provided in the nasa sinuses and the antibiotic broad spectrum including the majority of gram-positive and gram-negative microbes conditioned its high therapeutic efficacy in the treatment of chronic sinusitis and otitis. Successful treatment of tuberculosis resistant of other drugs with ofloxacin supplementing the standard 3-component combination of rifampicin, isoniazid and pyrazinamide was shown possible. By its bioavailability ofloxacin proved to be superior to ciprofloxacin and its oral dose of 200 mg was equivalent by the efficacy to the oral dose of 500 mg of ciprofloxacin. The usual regimen of the ofloxacin use in the treatment of severe infections was 400 mg intravenously twice a day. The further oral use in a dose of 400 mg once a day was possible after the infectious process stabilization.

[Primary malignant tumors of the small intestine. A review with demonstration of a case]. / Die primären malignen Tumoren des Dünndarmes. Eine Ubersicht mit Demonstration eines Falles.

Malign tumours in the small bowel are rarely found. A survey is given on appearance, symptoms, diagnosis and therapy of these tumours (by exclusion of the tumours of the duodenum and the tumours derived from Meckel's diverticulum). By means of a case report and a number of observed patients it is demonstrated, how the non-characteristic symptoms cause a late diagnosis and therefore late therapy.

Pseudotumorous pancreatitis.

Chronic pancreatitis can occasionally present as a focal, noncalcified mass, indistinguishable from carcinoma. Radiologic studies in 21 such patients were considered to show carcinoma in 16 and an islet cell tumor in 5 patients. Seventeen of the patients came to laparotomy when a palpable mass was found in each; 9 of the patients had a partial pancreatectomy, and multiple biopsy specimens were taken in 8 patients. Four patients did not come to surgery; in them the diagnosis was based on examination of percutaneous biopsy specimens and follow-up. In all patients the histologic diagnosis was chronic relapsing pancreatitis.

[Pancreas cancer: staging with dynamic computerized tomography]. / Pankreaskarzinom: Staging mittels dynamischer CT.

Carcinoma of the pancreas continues to present a most unfavorable prognosis. 90% of the tumours cannot be operated on and the survival time of these patients is 2-6 months. In a prospective study based on 23 patients it was investigated whether comprehensive staging of the carcinoma of the pancreas can be performed via computed tomography so that operable carcinomas alone must be presented for laparotomy. Results of CT were compared with those of angiography and laparotomy. Differentiation between stage 1 (tumour restricted to organ) and stage 2 (limited lymph node metastasising) is limited if effected via CT. However, it was possible to differentiate between the non-operable stages 3 and 4 with a sensitivity of 88% and a specificity of 78%. CT showed particularly high sensitivity in patients with vascular involvement.

[Hyperbaric oxygen therapy in experimental necrotising pancreatitis (author's transl)]. / Hyperbare Sauerstofftherapie bei experimenteller Pankreasnekrose.

In the last years non operative and surgical efforts could not diminish the high lethality of severe acute haemorrhagic necrotising pancreatitis. While majority of patient die in consequence of pancreatitis-shock, hyperbaric oxygen therapy (HBO) can improve all hypoxic circulation situations. Therefore the value in treatment of experimental necrotising pancreatitis in pig is examined. 5 pigs were treated with, 5 without HBO and 5 served as control. With HBO liquid sequestration was diminished and total protein loss prevented significantly, but foremost survival time was significantly prolonged. In consequence demarcation of necrosis with connective tissue was possible, but nevertheless operative treatment remain necessary. Without HBO all pigs and with HBO only 2 pigs died in consequence of necrotising pancreatitis. It is demonstrated, that HBO as additive therapy can improve the prognosis of necrotising pancreatitis.

[Computer tomographic diagnosis of pancreatitis and pancreatic cancer]. / Computertomographische Diagnostik der Pankreatitis und des Pankreaskarzinoms.

The article reports on 78 CT scans of surgically verified diseases of the pancreas, namely, 30 cases of chronic pancreatitis, 12 cases of haemorrhagic-necrotizing pancreatitis, and 36 cases of carcinoma of the pancreas. 12 of these cases were operable, whereas 234 were inoperable. The operable carcinomas were so small that proper diagnosis was effected in 50% only, whereas the inoperable carcinomas eluded CT identification in 17% of the cases only. The most important signs of an operable carcinoma of the pancreas are a well-defined enlargement and inhomogeneity of the parenchyma with reduced contrast, especially on bolus injection, as well as dilatation of the bile duct system. The most essential criteria for inoperability are absence of boundaries, especially towards the dorsal side, with infiltration of the retroperitoneal fatty tissue, and lack of delineation of the large vessels. According to the present state of the art, CT does not supply definite criteria for differentiating between an operable carcinoma of the pancreas and chronic fibrotic pancreatitis. Overstepping of the marginal contours is a reliably distinctive feature between carcinoma and pancreatitis, but it also points to the inoperable nature of the disease. Haemorrhagic-necrotizing pancreatitis is characterized by definite CT criteria, so that diagnosis is easy.

[Effect of hyperbaric oxygenation on experimental pancreas necrosis in pigs]. / Einfluss der hyperbaren Sauerstoffoxygenation auf die experimentelle Pankreasnekrose beim Schwein.

A pancreatic necrosis was produced in 7 piglets by means of a sodiumdesoxycholacid trypsin mixture. 4 animals served as control. All animals get a basis-infusion therapy. Hyperbaric oxygen therapy (HBO) was applied additionally in 3 animals. All control animals survived. The three animals with HBO deceased in average after 22 days, those without HBO deceased already after 4.25 days. Laboratory and circulatory measures show no significant differences. The autopsy statements were different from the age of necrosis. The conclusion by the extension of the average survival time in experimental pancreatic necrosis by means of HBO is that the high lethality of the pancreatic necrosis can be reduced by means of HBO.

[Clinical experience in a case of orthotopic liver transplantation by use of an atypical caval vein anastomosis (author's transl)]. / Klinische Erfahrung mit einer atypischen Hohlvenenanastomose bei einem Fall von orthotoper Lebertransplantation.

The two main indications for liver grafting are primary malignancy and parenchymatous liver disease. In both cases orthotopic transplantation remains the preferred technique. Since graft rejection was considered not to be the main problem in clinical liver transplantation, recent improved survival rates were reported to be due to a more aggressive diagnostic management and consequent treatment of postoperative complications nonrelated to graft rejection. Because of the limited number of organs available for organ grafting sometimes technical modifications may become necessary. This was the case in a 40-year old male patient suffering from primary malignant hepatoma. The donor was a child, and during operation a great difference between organ size and length and diameter of the hepatic vessels became evident. Orthotopic transplantation was performed using an unusual method of caval vein anastomosis. Initially the patient did very well, but later on liver function deteriorated and the patient died in the eighth postoperative week because of hepatic artery thrombosis. The autopsy showed that all other vascular anastomosis were patent and no signs of portal hypertension were evident. The surgical technique used in this case is described in detail and some interesting aspects are discussed.

[Endoscopic retrograde cholangio-pancreaticography (ERCP) and computer tomography in the diagnosis of chronic pancreatitis, pseudocysts and carcinoma of the pancreas--a comparison (author's transl)]. / ERCP und CT in der Diagnostik von chronischer Pankreatitis, Pseudozysten und Pankreaskarzinom--ein Vergleich.

In 107 patients, endoscopic retrograde cholangiopancreaticography (ERCP) and computer tomography (CT) were performed at a short time interval. The combined use of ERCP and CT yielded a correct diagnosis in chronic pancreatitis in 92% of the patients; pseudocysts were diagnosed correctly in 100% of the cases, whereas the rate of accuracy in carcinomas was 94%. In chronic pancreatitis, ERCP usually gave clear and comprehensive information. CT proved a valuable additional examination method wherever the findings did not supply a clear answer. Both examination method were ideally complementary in pseudocysts, so that ERCP and CT were found to be appropriate in each case. In carcinoma, ERCP proved superior to primary diagnosis, whereas CT served to confirm the findings and to assess the volume occupied by the tumor.

[Surgical therapy of acute pancreatitis (author's transl)]. / Chirurgische Therapie der akuten Pankreatitis.

Surgical therapy of acute pancreatitis is indicated only in necrotising inflammation. The indication, moment and choice of operation are discussed. The results of surgery in 71 patients treated because of acute necrotising pancreatitis are demonstrated. In cases of necrotising lethality was 26.5%; in total necrotising 86.5%.

[Traffic accidents and seat belts: thorax injuries (author's transl)]. / Verkehrsunfall und Anschnallgurt: Thoraxverletzungen.

The types of injuries to 313 automobile accident victims, especially thorax injuries, are compared. Independent of seat belt use (42%), there was in general a higher degree of injury. Those wearing seat belts had a markedly less severe AISm (median degree of injury of body region) and less severe thorax injury. Severe thorax injury was first found at speeds greater than 24 km/h above average. Severer thorax injury is to be expected with defective seat belts (AISm = 1.25) than with properly functioning belts (AISm = 0.32).

[Experiences with cephradine (Sefril) in septical-surgery (author's transl)]. / Erfahrungen mit Cefradin (Sefril) in der septischen Chirurgie

100 patients with septic-surgical diseases were treated with the cephalosporine-derivate Cephradine (Sefril). 79 patients were treated by surgical intervention in advance of the antibiotic therapy, 21 by Sefril in combination with conservative therapy only. The continuance of medication amounted to two weeks in 94%. A complete healing of the pyogenic infection was obtained in 86 patients. Complications occured in 6%.