[Endoscopic and surgical therapy of malignant colorectal polyps]. / Endoskopische und chirurgische Therapie maligner kolorektaler Polypen.

87 malignant colorectal polyps were removed in 81 patients by endoscopic polypectomy from 1972 until 1987. Thereafter 34 of these patients had a surgical resection of the colon. Surgical resection was performed for incomplete excision of the polyp (20 x), for tumor invasion of the lymphics in the polyp stalk and for moderately/poor differentiated carcinoma. In 6 patients a residual carcinoma was detected in the removed colon specimen, but lymph-node metastasis only in one with moderate-differentiated carcinoma. Our results demonstrate that colorectal polyps with invasive well-differentiated carcinoma and tumor free base do not need a surgical resection. Patients of the high-risk-group (moderately/poor-differentiated carcinoma, invasion of blood vessels and lymphatics, incomplete excision), should be referred to further surgical resection. With regard to the low rate of metastatic spread even in patients with high-risk-polyps accurate differentiation seems to be necessary. In 19 out of 52 (36.5%) patients endoscopic control examinations after surgical or endoscopic resection revealed recurrent pathological findings. On the base of the presented data we conclude that there is a need for short-term endoscopic controls over a period of five years.

[New aspects of early gastric carcinoma]. / Neue Aspekte beim Magenfrühkarzinom.

Between 1st January 1970 and 31st December 1984, 910 total or subtotal resections for gastric cancer were carried out in the Department of Surgery of the University Clinic Mannheim. A work-up of operative specimens showed that 146 patients (16%) had early gastric carcinoma. The patients comprised 97 men and 49 women; the youngest was 31, the oldest 86 years. The following trends were apparent when the 58 patients operated on between 1970 and 1976 were compared with the 68 patients operated on between 1977 and 1982: An increase in early gastric carcinoma is also detectable in younger patients. The previously seen tendency for localisation in the antrum appears to have changed in favour of the upper segments of the stomach. The proportion of the diffuse type rose from 26% in the first group to 44% in the second. The 5-year survival of all patients with early gastric carcinoma was 78.8%. No significant difference could be found between the diffuse and intestinal type. The prognosis of early gastric carcinoma appears to be dependent on the depth of invasion and involvement of the lymph nodes.

[Vagino-cytological studies in prostitutes]. / Vaginalzytologische Untersuchugen an Prostituierten.

Numerous papers on the high incidence of precancerous lesions of the uterine cervix in prostitutes have been published mainly in Anglo-American literature. The reported data were compared with those of prostitutes in a South German city. In a retrospective study on 239 prostitutes and a control group of 502 patients of the same age distribution the data regarding the vaginal flora and the obtained cytologic groups (modified Papanicolaou classification "M unchner Nomenklatur ") were compared. The prostitutes showed a higher rate of cocci in otherwise "comparably clean" smears. The incidence of trichomonas vaginalis was five times higher among the prostitutes. In contradiction to American and British publication there was no higher incidence of smears pointing to precancerous lesions among the prostitutes. It seems that the characteristic "low socioeconomic status" does not apply to prostitutes in our region.

Treatment of ruptured kidney by gluing with highly concentrated human fibrinogen.

A complete transverse rupture of the kidney diagnosed preoperatively by IV pyelogram and selective renal angiography is reported. It could be conserved by tissue gluing with highly concentrated human fibrinogen. An IV pyelogram should always be performed, especially since immediate aortography and renal arteriography is indicated by visible extravasation of contrast medium in every case. The lesion is exactly determined in the early stage and an organ-conserving operation becomes possible. Without the availability of angiography, nephrectomy was most frequently performed.

[Injuries of the ligaments of the knee joint; follow-up results (author's transl)]. / Operativ behandelte Kapselbandverletzungen am Kniegelenk-klinische Ergebnisse.

From 1978 to 1979 87 patients with singular and combined injuries of the ligaments of the kneejoint underwent surgery at the Department for Traumatic Surgery of Mannheim. 62 (71.3%) patients could be examined one to two years after operation. In uncomplicated cases of instability of the kneejoint a good to excellent result could be achieved in 62%. In combined instability only 40% good to excellent results were achieved, due to the higher severity of the injury. The classification was measured according to a modified scheme of Gotzen and co-workers [2a].

[The recurrent ulcer patient following selective proximal vagotomy in the treatment of duodenal ulcer (author's transl)]. / Der Rezidivulcuspatient nach selektiv-proximaler Vagotomie beim Zwölffingerdarmgeschwür.

Selective proximal vagotomy (SPV) in the treatment of duodenal ulcer shows a lethality of 0% in this series. The recurrence rate is 12.4% when 60% of the patients are examined by endoscopy at a mean postoperative interval of 27 months. If only the patients with complaints had been examined by gastroscopy then ulcer recurrence would have been diagnosed in 7.1%. One-third of the recurrences are in the stomach. There is no significant difference in the recurrence rate in male or female patients, whether the ulcer is uncomplicated or complicated or SPV is done with or without pyloroplasty. Ulcers heal under further surveillance in one-third of recurrent ulcer patients; one-half of the rest have to be reoperated upon.

[Surgical therapy of early gastric carcinoma (author's transl]. / Die chirurgische Behandlung des Magenfrühkarzinoms.

From January 1970 to September 1980 101 patients with early gastric carcinoma were operated. The youngest patient was 33 years, the oldest 83 years old. The incidence was highest in the 7th decade. Two thirds of all early gastric carcinomas were localized in the prepyloric region. 4 of these tumours were found in the gastric stump after previous B II resection. 3 multifocal carcinomas were found in our series. According to Laurën's classification 70 early gastric carcinomas were of the intestinal type, 28 of the diffuse type, in three cases a correct classification could not be performed. The predominant operative procedure was the B II resection in 71 patients. Further methods were total gastrectomy 15, B I resection 4, proximal resection 4, endoscopic polypectomy 3, Maki-resection 2, local excision 2. In the postoperative period complications occurred in 9 patients; four of them died. The 5-years survival rate was 72%. In 4 patients a recurrence of the malignancy was detected, in 3 of them another early gastric carcinoma and in 1 an advanced gastric carcinoma.

[Endoscopic papillotomy (EPT) (author's transl)]. / Die endoskopische Papillotomie; Methodik - Indikationen - Ergebnisse.

From August 1974 to December 1977 a total of 155 endoscopic papillotomies were performed. Endoscopic papillotomy (EPT) has proven to be an acceptable alternative to surgical reintervention at the biliary tree especially in aged and cholecystectomized patients where obstructive jaundice is caused by a concrement. The rate of all complications (9%) is comparatively low. In our own series 3 patients died after endoscopic papillotomy. EPT may be justified in jaundiced patients without previous cholecystectomy when there is a high risk for laparotomy. Preoperative drainage of massive hyperbilirubinaemia caused by a carcinoma of the papilla of Vater and treatment of the blind sack syndrome in cases of choledochoduodenostomy are further indications of this method. Late complications after EPT are not known until now.