[Cystic echinococcosis of the spleen]. / Cystische Echinokokkose der Milz.

Based on the portal infection root, the hydatid disease of the spleen represents a rarity. Because of a lack of prospective studies, spleen-preserving procedures and splenectomies were published as surgical therapy in case reports. In this report, the case of a 72-year-old woman with symptomatic hydatid disease of the spleen will be reported. Surgical and pharmaceutical strategy to minimize the risk of an OPSI syndrome as well as the value of adjuvant therapy with Albendazole will be discussed.

[Technic of real-time ultrasonic examination of the adrenal glands and adrenal gland tumors]. / Technik der real-time-Ultraschalluntersuchung von Nebenniere und Nebennierentumoren.

A prospective examination was carried out to determine the optimum technique for demonstrating the adrenal glands; there were 60 normal persons, 16 with small adrenal tumours (average size 13 mm.) and 10 with large adrenal tumours (average size 38 mm.). A normal adrenal gland was identified only once amongst the 60 patients as a hypoechoic structure. Fifteen of the 16 small, and eight of nine large tumours could be demonstrated sonographically. An intercostal approach was particularly suitable for showing the suprarenal region and for small tumours. Large tumours could be shown by a ventral, lateral or dorsal approach.

Real-time ultrasound of normal adrenal glands and small tumors.

The adrenals were studied prospectively with real-time ultrasound in a series of 60 healthy individuals and 13 patients with small adrenal masses sized 8-20 mm in diameter. In only one of the 60 healthy subjects was a normal adrenal gland delineated as a distinct hypoechoic structure. In all other instances only the highly echogenic suprarenal fat could be displayed. Visualization of small tumors was successful in 12 of 13 patients. The suprarenal area and small lesions were best demonstrated by a lateral intercostal approach using longitudinal and transverse scanning planes. The best access was through the 9th/10th intercostal space at the junction with the anterior and middle axillary lines on the right and the posterior axillary line on the left.

[Imaging adrenergic tumours with 131J-meta-benzylguanidine]. / Szintigraphie adrenerger Tumoren mit 131J-meta-Benzylguanidin.

Pheochromocytoma scanning using 131J-meta-benzylguanidine was done in one patient with metastasizing paraganglioma, one patient with multiple endocrine neoplasia type IIb. No activity of tumour tissue could be demonstrated in the patient with metastasizing paraganglioma, whereas the pheochromocytoma could be clearly defined in the patient with multiple endocrine neoplasia type IIa. The female with multiple endocrine neoplasia type IIb showed a suspect space-occupying lesion of the left adrenal using computed tomography. Pheochromocytoma could be excluded by 131J-benzylguanidine scanning, selective estimation of catecholamines in adrenal venous blood as well as the glucagon stimulation and clonidine suppression.

[Motility of the small intestine in dogs before and after total colectomy, proctomucosectomy and endorectal ileal pull-through]. / Die Dünndarmmotilität des Hundes vor und nach totaler Kolektomie, Proktomukosektomie und endorektalem Ileumdurchzug.

In healthy dogs the parameters (amplitude and frequency) of small intestinal motility of segmental and propulsive contractions demonstrate a pressure-gradient directed from oral to aboral. The frequency of segmental contractions in the colo-rectal region shows a vector in the opposite direction. One rarely finds propulsive activity in this area. Following on colectomy, proctomucosectomy and ileum pull-through a distinct increase in segmental small intestinal activity is noticed, while the frequency of propulsive movements simultaneously decrease. Thus it comes to a slowing of the passage of intestinal contents, and to increased water resorption. From these findings we conclude that the small intestine plays an essential part in the regaining of fecal continence in these animals.

[Gardner's syndrome. Diagnosis and surgical treatment (author's transl)]. / Das Gardner-Syndrom. Diagnose und chirurgische Therapie.

The early appearance of "hard" and "soft" tumors should give cause to search regularly for intestinal polyposis. Once the diagnosis is made prophylactic total colectomy with ileorectal anastomosis is justified. With regard to a polyposis of the upper gastrointestinal tract, there is room for observation. The possibility of a peripapillary carcinoma with or without simultaneous involvement of stomach and duodenum must be reckoned with even years after a colectomy. Postoperative mesenteric fibroses and widespread adhesions are responsible for subileus and ileus. Because of their tendency to recur, desmoid tumors should only be treated operatively when this appears unavoidable by reason of local symptoms.

[Long stump of the cystic duct causing trouble after cholecystectomy (author's transl)]. / Langer Zystikusstumpf als Ursache der Restbeschwerden nach Cholezystektomie.

Of 4,058 patients who had had surgery in the years 1964-1977 because of disease of the extrahepatic biliary system 232 had to be operated upon again; in 9% of these the remaining stump of the cystic duct was found to be too long. In one third of these cases a causal relationship between long stump and clinical trouble could be suspected. From analysing these cases it became clear, that complications arising in the long stump e.g. inflammation or formation of new stones, involving in some cases extended parts of the hepatic biliary system,--caused the troubles. Reoperation should be performed early; a long stump should be shortened and the biliary duct system should be investigated intraoperatively in order to exclude other pathological conditions. Three fourths of our patients became symptom-free after the second operation; in the other patients secondary changes of the hepatic biliary system had already become autonomous and were responsible for the further course of the disease.

[Surgery of the adrenals: result of 154 operations (author's transl)]. / Nebennierenchirurgie. Bericht über 154 operative Eingriffe.

Biochemical and radiological results, surgical technique and its results were critically analysed in a retrospective study of 154 operations on the adrenals in 127 patients, operated on between 1957 and 1980. There were no complications in 95 patients. In the remaining 32, both intra- and postoperative complication rate was greater after extraperitoneal than transabdominal approach to the adrenals. Postoperative mortality was 6%, but since 1967 only two patients have died in the postoperative period. Thromboembolic phenomena were the main cause of death, patients with Cushing's disease most commonly having this complication.

[Small intestine plication by the Noble method. Critical evaluation with reference to its results]. / Die Dünndarmplikation nach Noble. Kritische Wertung unter Berücksichtigung eigener Ergebnisse.

Based on our own cases (1964-1979) the indications for and the surgical technique of small intestine-plication (Noble-procedure) are discussed. The mean follow-up period was 10.3 years. Utilizing this surgical procedure 87% of 15 patients treated for chronically recurring adhesive ileus experienced good results. These statistics correlate with other publications that propose recurrent adhesive ileus as the 'indicatio causalis' for Noble-procedure. Possible major complications and the problem of symptoms from adhesions occurring or persisting after small intestine-plication are demonstrated with reference to our own cases.

[Modern methods in localization of pheochromocytomas (author's transl)]. / Wertigkeit moderner Verfahren zur Lokalisation von Phäochromocytomen.

In six patients with adrenal pheochromocytoma the tumors were localized by ultrasonography, phlebography of the adrenal glands and by estimation of plasma catecholamines selectively obtained from the vena cava and the adrenal gland veins. All tumors were localized by selective catecholamine estimation, five by ultrasonography, and four by phlebography. The smallest pheochromocytoma of 1.5 g weight was only localized by selective catecholamine estimation but not by ultrasonography or phlebography. This tumor, however, had been visualized by computed tomography. To avoid diagnostic errors by selective catecholamine estimation, it is important to withdraw blood from the adrenal gland veins prior to the injection of any radiographic contrast media, since this may result in an extremely enhanced secretion of catecholamines from the adrenal medulla.

The phlebographic diagnosis of phaeochromocytomas. / Phlebographische Diagnostik des Phäochromozytoms.

The diagnosis of phaeochromocytomas is based on the clinical features and on the hormone findings in the peripheral blood. Localisation, however, depends on radiological methods. Pneumoperitoneum was abandoned, because of its low accuracy, in favour of arteriography; lately, suprarenal phlebography has been available for the localisation of phaeochromocytomas. Our experience in nine patients with operatively confirmed phaeochromocytomas is described. Together with venous sampling from the caval system and the suprarenal veins for catecholamine estimations, it was possible to localise all tumours correctly. One tumour lying in the sympathetic chain in the thorax was correctly localised by hormone estimation. Our experience suggests that suprarenal phlebography represents a reliable method for localising phaeochromocytomas which carries a low risk and is to be preferred to arteriography.

[Clinical signs and therapy of familial polyposis of the colon and recutum (author's transl)]. / Klinik und Therapie der familiaären Polyposis coli et recti

Familial polyposis of the colon and rectum does always present an absolute indication for immediate total colectomy because of the predictable malignant degeneration. The patient concerned as well as his family have to be examined and treated if necessary. 12 such cases have been operated upon in the surgical Department of the University of Mainz Medical School. In 4 cases proctocolectomy with terminal ileostomy were performed, in 7 cases ileorectostomies. The procedure of mucosectomy with subsequent pulling of the terminal ileum through the colon (Hochen-egg and Reifferscheid) has been tried by us so far only in animals. Since a terminal, life-long ileostoma does present a considerable disadvantage for the mostly younger patients we did perform in most cases an ileo-rectal end-to-end anastomosis. This procedure can be looked upon as adequate cancer prophylaxis if control rectoscopies are performed regularly in cooperative patients.

[Clinics and management of radiation injuries of small bowel and colon(author's transl)]. / Der Strahlenschaden des Dünn- und Dickdarms

In the Surgical and Gynecological Departments of the University of Mainz, Medical School, 50 patients were operated between 1964-1976 for mechanical and paralytical ileus and intestinal bleeding caused by radiation injury of the bowel. Diagnosis depends on the history of radiation therapy. At operation we have seen a recurrence of gynecological and other malignant growths only two times. Intestinal resection with anastomosis is the preferred method for the management of such radiation injuries. The postoperative dehiscence of the intestine was noticed only five times. In order to prevent higher mortality rates, operation should be carried out as soon as possible.

[Pathology, clinical appearance and therapy of Ménétrier's disease (author's transl)]. / Zur Pathologie, Klinik und Therapie des Morbus Ménétrier

Clinical pathology of Ménétrier's disease is reviewed and 3 own cases are presented. All symptoms are unspecific exception made for the enteral protein loss. Roentgenologic and endoscopic appearance contribute to the diagnostic but only histologic examination is decisive. Gastrointestinal bleeding, acute pyloric stenosis, profuse albumin loss are all clear indications for an operation, but also the possibility of malignancy should be kept in mind. Resection should include all abnormal parts of the stomach. Recurrency of the Ménétrier's disease is only known after incomplete resection.