[Gallstone ileus. A report of 104 cases]. / Der Gallensteinileus. Ein Bericht über 104 Beobachtungen.

An analysis of 104 cases of gallstone ileus in 102 patients is presented. Biliary stones reach the intestinal tract through a biliodigestive fistula in 80-85% and on natural way in 15-20%. Clinical symptoms depend on mechanism of obstruction. It shows 3 forms of course: peritonitical form (20%), remittent form (30%) and typical intestinal obturation (50%). Roentgenological findings show aerobilia in 36%, dystope radiopaque stones in 8% and signs of obstruction in 97% of investigations. The main concern in gallstone ileus should be to relieve the intestinal obstruction and not cholelithiasis. The mortality rate declined during reported time from 40-50% to 25%.

[Gastroscopy before cholecystectomy]. / Die Gastroskopie vor der Cholecystektomie.

In a prospective study the routine endoscopy of the upper gastrointestinal tract was carried out in 100 patients before they underwent elective cholecystectomy for gallstones. In 31/100 patients we detected abnormalities which changed the plan of therapy. In 18/100 patients the cholecystectomy was performed 4 to 8 weeks later, after additional medical treatment. 7 patients were discharged from the cholecystectomy. The preoperative endoscopy of the upper gastrointestinal tract should be used in patients undergoing cholecystectomy to exclude other gastrointestinal disorders.

[Surgical therapy of acute cholecystitis]. / Chirurgische Therapie der akuten Cholezystitis.

The active surgical approach obtains more and more importance in the therapy of acute cholecystitis. On the basis of an own retrospective examination over 10 years (1978 to 1987) with 342 cases of treatment and of the literature the various possibilities of the surgical therapy are described and assessed. On account of the possibilities of complication the treatment of the acute cholecystitis should on principle be performed at a hospital. According to the treatment of acute cholecystitis is differed between the immediate and early operation in the acute phase and the interval operation 2-3 months after the beginning of the disease. The early operation can further be subdivided into the principal early operation and the early operation for necessity in which the indication for the operation is made dependent on the development of the findings. The advantages of the early operation in contrast to the interval operation do not result from a smaller lethality, but among others from the avoidance of further complications, shorter times of complaint and treatment and lower costs. The interval operation and the only conservative therapy are still justified only in motivated exceptional cases.

[Intubation of the small intestine in ileus. Technic, results, complications]. / Die Dünndarmschienung beim Ileus. Technik, Ergebnisse, Komplikationen.

Operative intestinal intubation with Miller-Abbott-tube was performed on 188 patients from 1974 to 1988 in the Surgical Department of Dresden Academy of Medicine. In a retrospective analysis, the advantages and disadvantages of the method in treating the adhesion ileus are described and complications and lethality after predominantly orthograde nasal intestinal intubation are discussed. Exact indications and various operational details may help to reduce complications due to the tube-method to a minimum. The relatively high postoperative lethality (22.3%) was mainly caused by cardiopulmonary illness and peritonitis and does not result from the operative procedure. The fact that no early recurrent bowel obstruction was observed may be stated as an essential result, even though a relaparotomy due to late recurrence had to be made within 1 to 5 years after the first operation in 4% (8 patients) of 188 intestinal intubations.

[Modern mechanical antibiotic preparation in colorectal operations. Results of a prospective study]. / Moderne mechanisch-antibiotische Vorbereitung bei kolorektalen Operationen. Ergebnisse einer prospektiven Studie.

A prospective clinical study was made to compare the effectiveness of a short-term oral antibiotic prophylaxis (neomycin) and a longacting oral-parenteral aerobically and anaerobically effective combination (neomycin, metronidazol, chloramphenicol) on the incidence of wound infections. All patients had orthograde lavage as a mechanical bowel preparation. Preoperative administration of the antibiotic combination before lavage could not reduce the relative aerobic bacterial count of the faeces. The incidence of wound infections was nearly identical with 4/89 in the neomycin group and 5/114 in the combination group. In the neomycin group there occurred 2/44 anastomotic dehiscences, but none in the combination group (0/65). Lethal complications were significantly higher in the neomycin group (7/89 to 2/114), whereas nonlethal complications were not significantly higher in the combination group. These data suggest that long-term, oral-parenteral prophylaxis with an antibiotic combination was not superior to a short-term, sole neomycin prophylaxis applied after orthograde lavage. Cleansing the bowel as completely as possible is a fundamental prerequisite for an effective antibiotic prophylaxis.

[Intestinal injuries in rectosigmoidoscopy in expert opinion]. / Darmverletzungen während der Rektosigmoidoskopie im Gutachten.

Based on criteria of evaluation in the field of rectoscopy, questions are derived which concern expert opinions on rectal lesions during rectoscopy. Excluding a dereliction, the authors take the view that, owing to the rare occurrence of rectal perforations in the course of an instrumental examination of the rectum, criteria can now be given in each case for applying the law on the extended material support of persons in the case of lesions due to surgical operations.

Concentration behavior of carbamazepine in bile and plasma of man.

The concentration in plasma and bile of carbamazepine was determined in four humans with Kerr's T-tube drain after an oral administration of a single dose of 400 mg of Finlepsin (carbamazepine). The mean plasma half-life time was 25 (15-31) hr. The concentration time curves in bile and plasma were parallel with the bile to plasma concentration ratio of 0.62 (0.24-0.82). A negative linear correlation between the lithogenic index and the bile plasma concentration ratio was found. It is suggested that the concentration of carbamazepine in bile is influenced by the saturation of biliary micelles with cholesterol. The amount of carbamazepine eliminated by bile within 72 hr was 4.1 +/- 1.9 mg, i.e., 1% of the administered dose. It is concluded that there is no significant enterohepatic circulation of carbamazepine.

[The reconstruction of inflammatory biliary duct stenoses by using a ring-drainage (author's transl)]. / Rekonstruktion von entzündlichen Gallengangsstenosen unter Verwendung einer Ringdrainage

In treating the inflammatory closures and stenoses of the biliary ducts surgically, the bilio-biliary and bilio-digestive anastomoses were splinted by inserting an annular drainage. In this way it was possible to ensure the bileflow into the intestine and to prevent recurrent stenoses. The ring-drainage is suggested to be kept for 2 years at least. In our experience this method has been validated in 13 patients. Therefore it is recommended for use in reconstructive operations with inflammatory obstructions of the biliary tract.