Early post-operative endoscopy after biliary tract surgery.

Immediate post-operative complications such as obstructive jaundice, biliary fistulae or gastrointestinal hemorrhage, occurring after biliary tract surgery can be diagnosed endoscopically. The causes of bile flow obstruction and leakage from the common bile duct can be identified using ERC. In many cases the diagnosis can be followed by endoscopic treatment, therefore obviating re-laparotomy. Between 1972 and 1979 we carried out early post-operative ERC or esophago-gastro-duodenoscopy in a total of 94 patients after biliary tract surgery. In 75 patients with residual gallstones and 4 cases with overlooked stenoses of the papilla, successful papillotomies were carried out. The procedure was unsuccessful in one case with an extremely narrow papilla. Complete removal of stones was achieved in 72 cases. In two other patients with gastroduodenal stress ulcers, bleeding was stopped by submucosal infiltration.

[Fiberscopic obliteration of esophageal varices (author's transl)]. / Fiberendoskopische Verödung von Oesophagusvaricen.

We are reporting our 2 years experience in the fiberscopic sclerotherapy of esophageal varices. 170 patients from 15-83 years of age were treated (61 females and 109 males), the majority being around 50 years of age. In 162 cases, the cause of the portal hypertension was cirrhosis of the liver and in 8 cases thrombosis of the splenic or portal vein. 47 patients were treated during acute bleeding, 101 in the interval, and 22 prophylactically. Using the modified intravascular technique, most varices could be sclerosed after a maximum of three treatments. In 83%, acute hemorrhages were stopped. The hospital mortality amounted to 30%, while in the interval group only it was 5%. None of the prophylactically treated patients died during their stay in hospital. The mortality after an average of 11.2 months amounted to 11.8%: The main cause was liver failure. Bleeding reoccurred in 11.2% and resulted in death in every fifth case. The most common complication, namely stenosis, arose in 16 cases and 4 of these necessitated dilation therapy. Esophagothoracic fistulae occurred in 2 cases and could be cured by siphon drainage. The rate of complication amounted to 10.6%, without any lethal outcome.

[Benign stenosis of the papilla (author's transl)]. / Benigne papillenstenose.

The diagnostics of benign stenosis of the papilla is based on the preoperative endoscopic retrograde cholangiopancreatography (ERCP) and preoperative cholangiography and debimetry with diagnostic dilatation of the papilla. The high rate of positive results achieved with these difficult procedures necessitate their use. The therapy of reversible stenosis consists of the eradication of the responsible inflammatory focus (cholecystolithiasis and choledocholithiasis). Irreversible stenoses of the papilla are without exception successfully treated with sphincterotomy or papillotomy.

Effect of intraperitoneal aprotinin treatment in acute and chronic peritonitis.

Our results demonstrate that peritoneal absorption even of large amounts of fluid is not restricted in either acute or chronic peritonitis. According to investigations reported elsewhere, antibiotics administered intraperitonealy can be found quantitatively in the serum, if peritoneal absorption is not impaired. The retardation effect of proteinase inhibitor TRASYLOL on peritoneal absorption in peritonitis may indicate that proteolytic processes are necessary to break up the protein binding of antibiotics which only then are able to permeate the peritoneal wall. This may also pertain to other substances of pharmacologic activity, like toxins -lipoproteins, lipopolysaccharides- and medicaments. With respect to the clinical relevance of this effect it should be regarded as beneficial. Alternatively, the role of kallikrein/kinin-system for transmembranous absorption of proteins and protein split products has to be considered.

[Haemodynamics and shock prevention in acute haemorrhage from the upper intestinal tract (author's transl)]. / Hämodynamik und Schockprophylaxe bei der akuten Blutung im oberen Intestinaltrakt.

Acute haemorrhages in the upper intestinal tract derive mainly from smaller low-pressure vessels. Bleeding is generally protracted and is often clinically occult. The clinical signs are a more reliable indicator of the severity of the haemorrhage than are measurements of the central venous pressure, shock index and cardiac output. The considerable tolerance of man to blood loss is probably attributable to the erect standing position. It has the advantage that it provides a large measure of counter-regulatory possibilities; but has the disadvantage that there is only a very narrow margin of safety as regards the development of irreversible shock. Close and consistent co-ordination of diagnosis and therapy is essential in all cases of gastro-intestinal haemorrhage.

[Transperitoneal resorption in acute and chronic peritonitis (author's transl)]. / Transperitoneale Resorption des Peritoneums bei der akuten und chronischen Peritonitis. Experimentelle Untersuchungen an der Ratte.

Two forms of peritonitis have been examined on 60 rats (Wistar) in three groups. Group 1 = acute peritonitis, group 2 = chronic peritonitis and group 3 = control. All animals have had an injection of an aminoglycosid antibiotic and a proteinase inhibitor into the peritoneal cavity. One intended to measure the influence of the proteinase inhibitor for different kinds of inflammation of the function of resorption of the peritoneum. Serum concentration of the antibiotic after 30, 60, and 90 min was measured. In clinical dosage the resorption of protein-bonded aminoglycosid antibiotics was decreased. The healthy control animals didn't show any effects. Connections concerning molecule size of protein-bonded substances and proteolytic ferments are in discussion. The practical relevance of these results could be found in an retarding effect of the resorption of protein-bonded toxines.

[The thoracic stomach. Etiology--diagnosis--therapy]. / Der Thoraxmagen. Atiologie - Diagnostik - Therapie.

Congenital, acquired, and traumatic defects of the diaphragm are reported. Special consideration is given to positional changes of the stomach due to the above lesions. Clinical examples are used to point out the diagnostics and surgical possibilities of reparation.