[Costs in the hospital (in the diagnosis of liver and pancreatic tumors using imaging procedures)]. / Kosten in der Klinik (bei der Diagnostik von Leber- und Pankreastumoren mit bildgebenden Verfahren).

The proportion of inpatients with tumours of the liver and pancreas is rather small, being only 0.25% of all the patients. Nevertheless, imaging methods may still be employed to an extent that is out of proportion to the small number of such patients. Although it is not possible at present to assess the cost arising from using the imaging methods for the diagnosis of these particular patients, an analysis of the performance data stated in the annual balance sheets of hospitals definitely shows an upward trend in respect of the use of imaging methods in diagnostic procedures in general. Despite the reductions in individual methods, such as, for example, roentgenoscopic screening or fluoroscopy, there are disproportionate increases in the total number of x-rayed patients while at the same time other imaging methods such as sonography, computed tomography and endoscopy show steep increases. It can be assumed that this applies likewise to patients with tumours of the liver and pancreas. Side by side with the tendency to extend the spectrum of use there is also an individual cost increase per case. Whereas the total cost for all Hamburg hospitals increased by 5.2% between 1985 and 1986, cost of materials and equipment rose by 6.8% and specifically in the x-ray sector by 10.2%. Seen from this point of view, the x-ray sector has become a growing cost factor. Of course that does not mean that the multitude of procedures to which the patient is subjected is always meaningful and mandatory.(ABSTRACT TRUNCATED AT 250 WORDS)

Delaying effect of cyclophosphamide on bone fracture healing chemical analyses of rat femora.

Hydroxyproline, calcium and inorganic phosphate contents of osteotomised rat femora were compared with those from rats treated with cyclophosphamide. The treatment consisted of 10 mg/kg/body weight injected intraperitoneally daily for 14 days after (group II) and before (group III) operation. The obtained results indicated a reduction in the hydroxyproline content of the callus and a diminution of the calcium and phosphate deposition upon it, thus inhibiting collagen formation and delaying mineralisation, retarding the healing process of the fraction. The degree of inhibition was decreased when the cyclophosphamide treatment discontinued before osteotomy was performed (group III). We would like to draw attention to these results, and suggest that cyclophosphamide treatment should not coincide with the healing of bone fracture.

[The modification of fracture healing by the cytostatic agent cyclophosphamide - an experimental interdisciplinary study]. / Die Beeinflussung der Knochenbruchheilung durch das Zytostatikum Zyklophosphamid -- eine tierexperimentelle, interdisziplinäre Untersuchung.

The influence of the cytotoxic agent cyclophosphamide (Endoxan) on the course of fracture healing has been investigated in rats. -- In 200 rats the right femur was osteotomized and stabilized by intramedullar nailing. The rats were distributed to 4 groups (n = 50) and submitted to the following scheme of treatment: group I had no further treatment after operation, group II was injected intraperitoneally daily for 14 days with 10 mg cyclophosphamide per kg body-weight beginning at the 3rd day after operation, group III was treated the same dose as group II but until 2 days before operation, group IV was injected the same dose as group II but beginning 20 days after operation. Beside continuous check of body weight and white blood cells as well as x-ray of the hind-limbs, 10, 20, 30, 50 and 70 days after operation both femora were excised and investigated by means of radiologic, scintigraphic, biomechanic as well as histomorphologic methods. The results obtained indicate that cyclophosphamide significantly retards the course of fracture reparation. The degree of retardation was directly depended on the phase of fracture healing process during cyclophosphamide treatment. The retarding effect was supreme in case of coincidence of the beginning of fracture healing and cytotoxic treatment (group II) and diminished relatively in case of cyclophosphamide treatment before (group III) or after (group IV) operation.

[Collagen fiber texture and injury pattern of the epiphyseal groove]. / Kollagenfasertextur und Verletzungsmuster der Epiphysenfuge.

Injuries of the epiphyseal plate seem to follow the course of the collagenous fibres in the epiphyseal plate. Studies using polarized light and scanning electron microscopy show the relationship between the collagenous fibres and the direction of fractures of the epiphyseal plates.

[Therapy and prognosis of severe soft tissue injuries in children]. / Therapie und Prognose schwerer Weichteilverletzungen im Kindesalter.

In consequence of "run-over" road accidents of children there has been a marked increase in severe soft tissue injuries. --The prophylaxis of bacterial contamination, the immediate reduction of compound fractures as well as the consequent debridement of devitalized soft tissue are shown to be essential components of the acute traumatic wound care. Primary closure of the wound must not be forced. The definite procedure includes reconstruction of vessels, nerves and last but not least osteosynthesis of fractures. Special attention is given to the fixateur externe, which is getting increasingly important in childhood injuries. The follow-up results of 17 multiple injured children with 3rd-degree open fractures and/or severe soft tissue injuries demonstrate that in childhood the results are generally better than in grown-up patients with corresponding injuries. 80% of the children showed very good results. No osteomyelitis was observed.

[The influence of cyclophosphamide upon the healing of fractures in the rabbit (author's transl)]. / Der Einfluss von Cyclophosphamid auf die Knochenbruchheilung am Kaninchenfemur.

The influence of cyclophosphamide (Ctx) upon the healing of fractures in the femur of the rabbit is reported. During treatment with Ctx the x-ray shows a reduced callus-formation; the fluorescence-microscopy reveals a decreased apposition of bone. Fracture-load, fracture-energy and mineral content of the intact bone are not influenced by Ctx. Four weeks after an operation fracture-load and fracture-energy are reduced almost by one half and the mineral content is decreased significantly.

[The connecting osteosynthesis and its problems in unstable pertrochanteric fractures of the femur (author's transl)]. / Die Verbund-Osteosynthese und ihre Problematik bei instabilen pertrochanteren Femurfrakturen.

In unstable pertrochanteric fractures of the femur a high bending strain and much load lies on the medial part of the bone. The connecting osteosynthesis takes off this load and immediately guarantees a high stability. Clinical experiences with 44 cases of connecting osteosynthesis - among them 35 per-and subtrochanteric fractures of the femur-show, that in 11 cases complications due to the fractures occurred (breaking of the implant, pseudarthrosis etc.) These complications are probably due to a delayed healing caused by bone cement penetrating into the area of the fracture. It is recommended to use an autologous cancellous bone graft. Indications for the compound osteosynthesis are only unstable pertrochanteric fractures in old patients in poor general condition and a short life-expectancy, and fractures in patients with diffuse metastases.

[Protective effect of cholestyramine in the hepatocarcinogenesis of the rat (author's transl)]. / Die tumorhemmende Wirkung von Cholestyramin in der Hepatocarcinogenese. Eine Tierexperimentelle Beobachtung (Vorläufige Mitteilung).

The influence of cholestyramine on hepatocarcinogenesis was investigated in the Wistar rat. After 14 weekly gastric instillation of 50 mg diethylnitrosamine/kg and simultaneous administration of diet supplement with 1.3% cholestyramine, half of the animals developed hepatic tumors. In contrast, nearly all the animals in the control group under similar experimental conditions, but without the cholestyramine supplement in their diet, developed hepatic tumors. The sequestration of bile acids and the reduction of the noxious lithocholic acid could be considered as an explanation for the modification of hepatic tumors induced by diethylnitrosamine in the Wistar rat.

Protective effects of cholestyramine on liver cirrhosis induced by carbon tetrachloride in the rat.

The influence of cholestyramine and chenodeoxycholic acid on the induction of liver cirrhosis by carbon tetrachloride was investigated in the Wistar rat. The addition of 1.3% cholestyramine to the diet of the experimental animals inhibited to a large extent the induction of cirrhosis. While all the animals subjected to carbon tetrachloride exposure plus basal diet and those to carbon tetrachloride intoxication plus chenodeoxycholic acid diet developed cirrhosis, the morphological manifestation of cirrhosis occurred in the livers of only two out of 18 rats under carbon tetrachloride treatment plus cholestyramine diet. The administration of cholestryamine induces reactions which correspond to the physiological protective mechanisms of the liver. These are the bile acid binding, bacteriostatic, and microsomal enzymatic stimulating properties of cholestyramine.

[Fractures of the proximal and middle-third of the lower arm in childhood (author's transl)]. / Der Vorderarmschaftbruch des mittleren und proximalen Unterarmdrittels im Kindesalter.

53 children with fractures of the proximal or middle third of the lower arm and who were treated conservatively have been reviewed between 5 and 13 years after the accident. In 23% of the patients with fractures of the middle third of the arm, the results were unsatisfactory or poor. As the spontaneous ability correct in the intermediate third of the forearm is apparently less than in the proximal and distal thirds close to the epiphysis an axially corrected reduction should be aimed at in all cases. If this cannot be achieved by conservative means, then surgical intervention is necessary even in children.

[Effect of cholestyramine and chenodesoxycholic acid on liver cirrhosis. An experimental study in rats]. / Einfluss von Cholestyramin und Chenodesxycholsäure auf die Leberzirrhose--Experimentelle Studie mit Ratten.

The influence of cholestyramine and chenodeoxycholic acid on the induction of cirrhosis of the liver of the male Wistar strain rats was studied. The simultaneous dietary exposure of 1 g cholestyramine in 100 g diet prevented the development of cirrhosis induced by carbon tetrachloride. Whereas all the animals in the control group (CCl4-Exposure plus normal diet) developed cirrhosis, histologic examination showed cirrhosis in only 2 of 9 rats fed with diet containing cholestyramine. On the contrary, the exposure to chenodeoxycholic acid at a concentration of 1 g in 300 g diet potentiated the induction of cirrhosis. The experimental results support the clinical findings in which the administration of cholestyramine caused an improvement of liver function tests by cirrhosis.

[The significance of low-frequency magnetotherapy for local treatment of burns. An experimental comparative approach (author's transl)]. / Die Bedeutung des nieder-frequenten Magnetfeldes in der lokalen Verbrennungsbehandlung.

Under standardized experimental conditions 3rd degree burns were produced on the neck of 241 Wistar-rats. The process of wound-healing was documented by means of planimetric, histologic and microbiologic methods. In comparison to an untreated control-group the effectiveness of low-frequency magnetotherapy (system magnetodyn 5 by W. Krauss) as well as coagulation of necrosis according to Grob and autologous skin-transplantation were studied. The results obtained indicate that only early debridement of necrosis and subsequent autologous skin-grafting guarantees sufficient acceleration of wound healing. The low-frequency magnetotherapy according to Krauss showed no effect of therapeutic value. With the coagulation of necrosis, as described by Grob, a germfree status under the necrosis was obtained for nearly 2 weeks.

[Fractures of the head of the radius in childhood (author's transl)]. / Der Bruch des proximalen Radius im Kindesalter.

In childhood fractures of the head of the radius are typical and frequent. Generally these fractures are in the metaphysis, but a few cases are in the epiphysis. In the follow-up of conservatively treated fractures of the radial head in childhood, the therapeutic alternatives are discussed. The therapeutic procedure must take into account the degree of fragment displacement. Fractures of type I and II according to Judet are treated conservatively, predominantly by means of exact reduction and fixation in a plaster cast. If reduction fails for type III, however, type III and type IV fractures must be operated on at once for sufficient results.

[Promotion of adenocarcinomas at the preternatural anus by bile acids in rats (author's transl)]. / Carcinompromotion am Anus praeter durch Gallensäuren. Eine tierexperimentelle Beobachtung.

Wistar rats spontaneously develop adenomatous polyps with cell dysplasia (Figs. 2 and 3) and finally, adenocarcinomas (Fig. 1) at the preternatural anus 120-200 days after the formation of a double loop colostomy. With respect to the potential significance of bile acid metabolites in the pathogenesis of colonic cancer, the effect of continuous oral administration of chenodeoxycholic acid (CDCA) on the rate of carcinomas at the preternatural anus was examined. This animal model gained special interest because until now the possible cocarcinogenic rule of bile metabolites was generally demonstrated only after additional administration of chemical carcinogens like dimethylhydracin or nitrosoguanidin. Of ten rats in the CDCA-treated group, three already showed a malignant transformatin to adenocarcinomas at the preternatural anus 60 days after a colostomy (Fig. 4). Apparently the alteration of natural ecologic conditions diminishes the resistance against external and internal carcinogenic or coarcinogenic agents. The role of bile acid metabolites is discussed under these circumstances.

The stability of osteosyntheses bridging defects.

Segmental defects of 2 cm in the femoral midshaft of dogs were bridged with either single, double or a single plate and cortical bone graft. The massive bone transplant was fixed with screws opposite the plate in order to diminish harmful bending loads. The biomechanical behavior was tested under continuous increasing axial stress. The combined osteosynthesis of internal plate and contralateral cortical bone graft fixation increased the stability in the defect region significantly (see Figs. 3 and 4). The results of our tests are discussed with respect to the basic problem that the biological behavior of transplanted cortical bone depends mainly on absolute stability in the transplanted area. We think--although the transplantation of autologous cancellous bone should be favoured--the transplantation of massive bone grafts still has its indications under well defined conditions particularly when good mechanical stability is present.

[Chenodeoxycholic acid therapy and colorectal carcinoma--an experimental approach (author's transl)]. / Orale Chenodesoxycholsäuretherapie und kolorektales Karzinom--eine experimentelle Studie.

With respect to the potential significance of bile acids in the pathogenesis of colorectal cancer the effect of continuous oral administration of chenodeoxycholic acid--which is used for conservative therapy of radiolucent gallstones--on the rate of colonic tumors was examined. In rats treated with chenodeoxycholic acid a higher incidence of 1,2-dimethylhydrazine induced adenocarcinomas was detected. On the basis of these results it is postulated that all patients treated with chenodeoxycholic acid due to gallstones are registered systematically in order to gain definite information about its possible role as tumor promoter.