Recurrence of peptic ulcer after selective proximal vagotomy and pyloroplasty in relation to changes in clinical signs and symptoms between 1969 and 1983.

Only those patients who were examined endoscopically were evaluated. Concomitant examinations, such as biopsy, histologic studies, roentgenograms, scintiscanning, acid secretion, serum gastrin and review of the operative reports, were done. Duodenal ulcers (1,219) and gastric ulcers (421) were examined preoperatively. Of these, selective proximal vagotomy and pyloroplasty and excision of the ulcer were performed for 1,018 duodenal ulcers. Forty-three per cent were examined postoperatively. Selective proximal vagotomy and pyloroplasty and excision of ulcer were performed for 315 gastric ulcers. Thirty-nine per cent were examined postoperatively. Recurrence was calculated in relation with the patients examined postoperatively. Recurrence of duodenal ulcer occurred in 6.3 per cent; of these, 0.9 per cent had duodenal ulcers develop into gastric ulcers. The recurrence rate of gastric ulcer is 8.1 per cent; of these, 0.8 per cent developed into duodenal ulcers, and 0.8 per cent to carcinoma of the stomach. Data of recurrent ulcers were compared with the data for the total number of patients who underwent surgical treatment. The possible causes for a recurrence are demonstrated. In duodenal ulcers, 79 per cent of recurrences are due to technical error (inadequate vagotomy and incomplete drainage); in gastric ulcers, 90 per cent of recurrences are due to technical error. In both duodenal and gastric ulcers, causes are partly based on advanced clinical symptoms. Recurrence rates showed a tendency to increase between 1969 and 1975 and 1976 and 1983. This correlated directly with the deterioration of the clinical signs and symptoms between 1969 and 1983, shown in increased acid secretion, increase and shift of ulcers and stenoses, increase in bleeding and changed epidemiologic findings.

An evaluation of stage II vaginal clear cell adenocarcinoma according to substages.

Of the 76 cases of stage II vaginal clear cell adenocarcinoma reviewed, the lesion involved the vesicovaginal and/or rectovaginal septa (IIc) in 19, the paravaginal/parametrial tissues without extension onto the pelvic sidewall (IIb) in 8, and the subvaginal tissue without paravaginal/parametrial or septal infiltration (IIa) in 36; the substage could not be determined in 13 cases. The three substage groups were similar with regard to maternal hormone history, greatest tumor diameter, depth of invasion, cross-sectional tumor area, location of the lesion in the vagina, predominant histologic pattern and cell type, mitoses, grade, lymph node status, and treatment modality. Actuarial survival rates at 5 and 10 years for all patients with stage II vaginal clear cell adenocarcinoma were 83 and 62%, respectively. The recurrence and survival experiences for the three substage groups were similar. The data available do not suggest any clinical benefit to categorizing cases of stage II vaginal clear cell adenocarcinoma into substages.

Local therapy in stage I clear cell adenocarcinoma of the vagina.

Of the 219 cases of Stage I vaginal clear cell adenocarcinoma reviewed, 176 had conventional therapy and 43 underwent local therapy. The two groups appear to be similar with respect to symptoms, stage, location of the lesion in the vagina, greatest tumor diameter, surface area, depth of invasion, predominant histologic pattern, grade, and number of mitoses; nonetheless, firm conclusions cannot be drawn because of missing data. Actuarial survival rates at 5 and 10 years for the local therapy group (92% and 88%, respectively) were essentially equivalent to those for the conventional therapy group (92% and 90%, respectively), however, the recurrence experience after local therapy was less favorable. Local therapy consisted of vaginectomy in nine cases, local excision alone in 17 cases, and local irradiation (with or without local excision) in 17 cases. The subgroup of patients receiving local irradiation had a recurrence experience as favorable as that of the conventional therapy group and more favorable than that of either the subgroup treated with vaginectomy or local excision alone. The data suggest that when employed, local therapy should include local irradiation.

On secondary hyperparathyroidism in orang-utans, Pongo satyrus (Linnaeus, 1758).

Orang-utan crania with alterations in bone structure which could be determined morphologically were studied and evaluated. The alterations in bone structure were referred to in the literature up to about 1939 as "rickets"; when vitamin D was given to the animals, the alterations diminished, until they were almost unnoticeable. From about 1941/52, the alterations were diagnosed as "Morbus Paget". Research on orang-utan crania has become possible through comparison of a larger number of single symptoms, occurring in a number of individuals. Out of a larger sample, the study was carried out on 5 individuals, showing these alterations in varying degrees. The individuals also covered various age groups, both sexes and both subspecies of orang-utans. The findings permit a diagnosis of secondary (or tertiary) hyperparathyroidism (= Morbus Engel-von Recklinghausen = fibrous cystic osteitis). The study also showed that orang-utans fall prey to Morbus Engel-von Recklinghausen in a shorter period and suffer more severely than humans. The frequency of orang-utans suffering from this disease, which are kept captive in zoos, is statistically far higher than the occurrence in humans. Orang-utans living under natural conditions do not suffer from the disease at all; according to the study of 500 animals. The authors also believe that there is a psychogenic basis for the occurrence of Morbus Engel-von Recklinghausen in zoo animals; psychological conditions such as apathy, disinterest, etc. are part of the illness, and these symptoms are also shown by animals having no outward signs of fibrous cystic osteitis. The authors believe that improved prophylaxis of orang-utans in zoos would lead to discovery of Morbus Engel-von Recklinghausen in early stages, and allow early therapy to arrest the disease. This is necessary for preservation of the species.

[Two cases of homicide from the pre-ceramic neolithic era of Arabia Petraea]. / Zwei Fälle von Homicid aus dem Praekeramischen Neolithicum der Arabia Petraea.

Human remains from Basta 1 (P PN B, 6. Mill. B.C.) and Sabra 1 (Khiamian, 7. Mill. B.C.) were prepared and studied; the results show that Basta 1 was a permanent settlement and Sabra 1 was a temporary summer camp. Both settlements are located in Arabia Petraea. Basta 1, No. 3477: The calvarium of a boy, aged 8 to 9 a, from Basta 1 was studied. The race can be determined as orientalide, according v. Eickstedt's classification. The boy was killed; as evidence by 2 blows to the skull occurring while he was alive. The cause of death has been reconstructed, using parallels taken from ethnological and forensic medical research. First, the boy received a light blow on the left forehead, with a sharp weapon. The authors present as a working hypothesis that the motivation for the death was rape, taking place as the boy was (probably) in a semi-conscious state. After recovering and rising to his feet, the boy suffered a deadly blow on the back of the skull (rabbit punch). A blunt instrument was used for the second blow. The body lay where it fell over 1 a or more; afterwards it was found by members of his own group. They removed the calvarium and buried it in their permanent settlement. The manner in which burial took place, would seem to indicate, that no further religious or ritual ceremony was involved. This type of crime has been observed e.g. as occurring among purely male groups-such as temporary herdsmen. In case of the boy from Basta 1, this would the earliest evidence for the occurrence of this type of sexual delinquency in prehistoric times. Sabra 1, No. 4088: Skull fragments of 2 individuals were recovered from a camp fire shifted by humans, in Sabra 1. Individual I is a male, aged 25 to 30 a; Individual II is a female of 25 to 30 a (or perhaps even younger). The examination showed that the bone fragments had been subjected to temperatures less than or equal to 200 degrees C (examination of bone material) and around 100 degrees C (evidence of charcoal material), when they were still fresh. The bones were not burned but grilled (or roasted). The evidence would indicate a case of antropophagy. The parallels in ethnological studies show that anthropophagy occurs only in farming societies, as religious rites; up to now, there is no evidence for this type of rites among the hunting and collecting groups.(ABSTRACT TRUNCATED AT 400 WORDS)

Effect of selective proximal vagotomy without and with pyloroplasty on gastroduodenal motility.

The effect of selective proximal vagotomy (SPV) was examined in six dogs on the gastric emptying of solid food and the motility of the antrum and duodenum (basic rhythm, motility index, and contractile activity percentage). Emptying and motility were also examined in three dogs after additional submucosal pyloroplasty (SMP). Electrical and motor activities were tested in fasted and fed states. The meal consisted of 300 g of standard protein-mixed meal. Determination of gastric emptying by X ray were conducted with the same meal mixed with barium sulfate. All animals showed delayed emptying of solid food after SPV. Antral motility increased nonsignificantly in the digestive state, whereas duodenal motility decreased, resulting in an increased antroduodenal motor gradient. In the interdigestive state the motility of the antrum decreased significantly. Additional SMP normalized the emptying delay, but decreased digestive and interdigestive motility below the normal values. In conclusion, the emptying delay after SPV is caused at least in part by the altered functional condition of the immediate pyloric region.

[Experimental studies on the accuracy of mineral content assessment in spongiosa bone using quantitative CT (single energy measurement)]. / Experimentelle Untersuchungen zur Genauigkeit der Mineralsalzgehaltsbestimmung spongiöser Knochen mit Hilfe der quantitativen CT (Einenergiemessung).

The mineral content of 42 lumbar vertebral bodies (using a phantom to simulate living conditions) and of 30 calcanea was measured by quantitative CT. The bones were subsequently ashed and the calcium and fat content determined chemically. The mineral concentration (calibrated against a K2HPO4 solution) showed good correlation with the calcium content (for the lumbar vertebrae, r = 0.963 and for the calcanea r = 0.94. The fat content of the bone marrow leads to a systematic under-estimation of the mineral content, if one uses single energy CT measurements. The experimental findings can be satisfactorily treated in a quantitative way with the help of a model which contains the three components of spongy bone (mineral, fat and fat-free connective tissue.

[Pathogenesis and clinical significance of Mönckeberg medial calcinosis]. / Zur Pathogenese und klinischen Bedeutung der Mönckebergschen Mediaverkalkung.

Medial calcinosis of Mönckeberg is frequently observed in peripheral arteries of diabetics with neuropathy. The cause of this vessel alteration is unknown and the clinical significance has been questioned. Six to eight years after uni- or bilateral lumbar sympathectomy 60 patients were investigated radiologically for medial calcinosis of foot arteries. Of 60 patients, 55 had Mönckeberg's sclerosis. In 93% of the patients who had undergone bilateral operation medial calcification was seen in both feet. After unilateral sympathectomy the incidence of medial calcinosis on the operated side was significantly higher than on the non-operated side (88% versus 18%, p less than 0.01). There was no significant difference between diabetics and non-diabetics. These findings suggest that medial calcification is related to autonomic neuropathy of peripheral vessels. Fifty-two of 160 patients (32.5%) with severe arterial occlusive disease of the lower limbs showed medial calcification of foot arteries. Mönckeberg's sclerosis was significantly associated with the peripheral type of vascular disease (p less than 0.025). Two groups of patients with the same stage of occlusive vascular disease but without (group A) and with (group B) medial calcification were examined by Doppler ultrasound. In group A the mean ankle pressure (pD) was 51 mm Hg lower than the Riva-Rocci pressure (pRR). In spite of the severe ischemia mean pD in group B exceeded pRR by 14 mm Hg. Of the patients of group B 63% had a pD-pRR value greater than or equal to 0 mm Hg. In group A no positive difference pD-pRR could be shown.(ABSTRACT TRUNCATED AT 250 WORDS)

[Effect of artificial skull deformation in vitro on sensory performance in the human. Morphologic and tomographic study based on the calvarium E2 of Tell es Sultan/Jericho (7th millenium b.c.)]. / Uber den Einfluss der künstlichen Schädeldeformation in vivo auf die Sinnesleistungen beim Menschen. Morphologische und tomographische Studie an Hand des Calvariums E2 vom Tell es Sultan/Jericho (7. Jahrtausend v. u. Z.).

The question of an influence of artificial skull deformations on sensory performances in man has been discussed since Torquemada (1615). It was inquired into by means of the individual E2 of the Tell es Sultan/Jericho (7th millenium B.C.). At first a morphological expert evidence and then an ear tomography (Mündnich and Frey's method) were carried out. Hereby abnormal displacements of all head organs or their parts could be seen. Evaluable pathological findings, however, did not result. Thus an influence of artificial skull deformation on sensory performance in man has to be refused in the same way as the connection of the same with infant mortality invented by Torquemada (in this case political reasons were probably responsible for it). The functional thesis of Toldt for the formation of Arcus superciliares etc. was confirmed.

Angiographic control of renal artery stenoses 6 months following percutaneous transluminal angioplasty.

Twenty-eight patients with a total of 32 stenoses of the renal artery were examined by angiography 6 months following percutaneous transluminal angioplasty (PTA). The angiograms were obtained: (1) prior to PTA; (2) immediately following PTA; and (3) 6 months later. These angiograms were compared and the relationship of diameter of the stenosis (A) to the poststenotic region (B) was evaluated. In 22 cases (78.5%), 6 months post-PTA, the stenoses were no longer demonstrated; stenosis diameter (A) showed an average increase from 2.1 to 5.1 mm, while the poststenotic region (B) decreased from 7.7 to 5.6 mm on average. Five cases of partial stenoses (17.8%) seen on angiograms 6 months after PTA still showed a marked difference between A and B, with only a minimal reduction in area of B. In five patients with restenosis (17.8%), nearly the same results were obtained as in the pre-PTA state. Neither aneurysms nor renal arterial obstruction was found in our patient group. Rather, in most of our patients normalization of the renal vessels could be demonstrated on angiograms, supporting the choice of PTA as the preferred method of treatment of renal artery stenosis.

[X-ray tomography in fractures of the temporal bone and injuries of the ossicula (author's transl)]. / Röntgen-Schichtaufnahmen bei Schläfenbeinfrakturen und Verletzungen der Gehörknöchelchen.

Since a high percentage of cross-fractures of the temporal bone cannot be verified in standard projections, tomography is indicated under clinical aspects. With this technique even small fractures concerning the meatus acusticus internus, the labyrinth, and the proximal part of the canalis facialis can be diagnosed. Experimental data concerning longitudinal fractures with facial palsy show the course of the fracture but not the exact point of the lesion. Additional information will be given to verify luxations or displacement of the ossicula.

[Mineral content of the peripheral skeleton in patients with diabetes mellitus ]. / Ergebnisse der Bestimmung des Mineralsalzgehaltes am peripheren Skelett bei Patienten mit Diabetes mellitus.

In order to determine the effect of diabetes mellitus on bone mineral content, measurements with the iodine 125 isotope method of Cameron were carried out in the distal ulna and calcaneus of 40 patients. 38% of female and 20% of male diabetic patients showed abnormally low values. The most severe changes were found in patients with complications of diabetes. There was a correlation between the duration of the diabetes and the severity of the mineral loss.

[Scintigraphy and tomography in inflammations and non-malignant tumors in head and neck (author's transl)]. / Szintigraphie und Tomographie bei Entzündungen und gutartigen Tumoren im Kopf-Hals-Bereich.

Scintigraphy is a non-invasive technically simple tool for diagnostic in the head and neck. Using nuclides with a short life time the irradiation of the skeleton is less than 1 rd. Scintigraphy in addition to X-ray examination is useful in diagnosis and surveillance of different osteoplastic tumors (like osteoma, osteoplastoma, cementoma, meningioma) and in systemic diseases of the bones (fibrotic dysplasia, Morbus Paget). Concerning inflammatory diseases osteomyelitis is the main indication for scintigraphy, but it is as well usefull in the diagnosis of complications of inflammatory diseases of the sinuses, like mucocelia or non resorbed antibiotics which provoked an inflammatory reaction of the mucosa. There is no indication for scintigraphy regarding its low specificity in common acute or chronic sinusitis.

[Bone scintigraphy in the diagnosis and follow up care of malignant head and neck neoplasms]. / Die Skelettszintigraphie in der Diagnostik und Nachsorge von malignen Geschwülsten im Kopf-Hals-Bereich.

In diagnosis and localisation of malignant tumors with destruction of the bone, scintigraphy has its special importance in diagnosis as an addition to X-ray tomography. When carcinoma are localized in the middle or dorsal part of the base of the skull scintigraphy may help to calculate the chance for an operation. The exact knowledge of the dimension of the tumor is a valuable help in radiotherapy. In primary diagnosis of destructions of the base of the skull scintigraphy might give an earlier information than X-ray. Malignant tumors of the ear however are sufficiently detected by means of X-rays alone. The main field of scintigraphy is the observation of irradiated and operated malignoma. We recommend 6 or 12 months controls in combination with a clinical observation and with tomographic controls. Scintigraphy became a most valuable tool in the search and diagnosis of metastases in primary malignoma of the mammae, the lungs or the kidneys. In case of metastases in the skull scintigraphy is most helpful to detect them often earlier than by means of X-rays.

[Transluminal dilatation of the distal abdominal aorta and of the common and external iliac arteries (author's transl)]. / Transluminale Gefässdilatation der distalen Bauchaorta, der Arteria iliaca communis und externa.

Percutaneous transluminal angioplasty (PTA), a radiological procedure for dilating stenosed or occluded vessels, was carried out for 67 stenoses and three occlusions of the abdominal aorta or of the common or external iliac arteries. Seventy procedures were carried out; of these, 65 showed satisfactory primary results (observation period 15 days) ie, the clinical situation was improved. On four occasions the procedure had to be abandoned for technical reasons and, in one case, there was an early recurrence. Subsequently there were two late recurrences (after six and 24 months) during an observation period of three to 24 months. In the successfully dilated stenoses or occlusions there was a highly significant increase in the vessel diameter, with a highly significant reduction in the pressure gradient across the stenosis. The results are discussed. The authors conclude that in the presence of stenoses of the distal aorta or common or external iliac arteries PTA, which carries little risk and can be repeated, should be considered and attempted before surgical intervention.

[Excretion urogram with angiotomography sensitivity and specificity in the diagnosis of renal artery stenosis; a comparison with differences in renal size and contrast density on early films (author's transl)]. / Ausscheidungsurogramm mit Angiotomographie. Sensitivität und Spezifität in der Diagnostik von Nierenarterienstenosen im Vergleich zur Seitendifferenz von Nierengrösse und Kontrastmittelausscheidung (Frühserienurogramm).

Intravenous bolus injection of contrast material with angiotomography permits direct demonstration and evaluation of the renal arteries during an excretion urogram. Angiotomography was carried out in 71 patients with suspected reno-vascular hypertension; the results were compared with contrast excretion and renal size on the two sides, and with the findings of catheter angiography. In the presence of haemodynamically significant stenosis the sensitivity of angiotomography was 87% and its specificity was 99%. The sensitivity of renal size differential was only 20% and of contrast excretion differential 47%. A combination of all three methods resulted in a sensitivity of 93%. The advantages of demonstrating the renal arteries as a part of an excretion urogram are discussed, particularly with respect to possible treatment.