[Cryotherapy in rectal cancer. A palliative local tumor treatment]. / Kryotherapie beim Rectumcarcinom. Eine palliative lokale Tumorbehandlung.

Cryotherapy was applied to 182 rectal cancer patients in the Department of General Surgery, University of Ulm, between 4/1982 and 4/1991. Recipients of this tumor freezing therapy were patients whose general condition was bad, patients with an advanced inoperable carcinoma, patients with tumor recurrence and patients refusing operation. Rectal carcinomas, mostly in an advanced stage, were usually freezed several times. Only 4 patients with general inoperability reached the survival time margin of 5 years. In 18 patients local tumor destruction was possible by application of cryotherapy. In 80% of cases disagreeable tumor symptoms like tenesma, mucous discharge and oozing hemorrhages could be reduced or completely removed. Perianal pain and intense tumor bleeding could be relieved temporarily or definitely in only 50% of patients. An artificial anus could be avoided in 80% of cases by local tumor destruction/reduction or arrest of tumor growth. The mean survival time of patients with tumor recidivation was 11 months after onset of the recurrence. Tumor progression, incontinence and iatrogenic rectal perforation made an artificial anus necessary in 14 patients.

[Effect of tumor size and lymph node status on the prognosis of pancreatic cancer]. / Der Einfluss von Tumorgrösse und Lymphknotenstatus auf die Prognose des Pankreascarcinoms.

Between 1982 and 1987 186 patients with a carcinoma of the pancreas underwent surgery. In 69 patients (37%) a resective surgical procedure was performed. In these patients, lymph node staging was conducted intraoperatively. The operative mortality of the resection was 4.3%. The median survival of the resected patients with papillary carcinoma was 21 months and of the patients with ductal pancreatic carcinoma 7 months. A correlation between survival time and frequency as well as localization of the lymph node attack could be established. Only patients in the TNM stage I of a ductal carcinoma appeared to have profited significantly from the resection compared to the palliative procedure.

[Cephalic pancreatectomy with conservation of the duodenum in chronic pancreatitis with inflammatory lesions of the head of pancreas. Results of 15 years' experience]. / La pancréatectomie céphalique avec conservation du duodénum pour pancréatite chronique dans les lésions inflammatoires de la tête du pancréas. Résultats d'une expérience de 15 ans.

In 122 patients with severe chronic pancreatitis and inflammatory enlargement of the head of the pancreas a duodenum-preserving resection of the pancreatic head was performed. Postoperative hospitalization was 16 days in median, the frequency of re-operation was 4.9%. In the early postoperative phase one patient died and hospital mortality amounted to 0.8%. Following a medium follow-up period of 4.2 years (min. 6 months, max. 15 years) 7 patients died (late mortality 4.9%). 77% of the patients were completely free of abdominal pain, 84% went back to their previous occupation. During the follow-up period in 81% of the patients the glucose metabolism was unchanged, in 13% it deteriorated, and in 5% it improved permanently; 80% of the patients had a marked increase in weight averaging 8.7 kg. Compared to the Whipple procedure the duodenum-preserving resection of the head of the pancreas spares the patient with chronic pancreatitis a gastric resection, the duodenectomy, and the resection of the extrahepatic bile ducts. The limited operative intervention at the head of the pancreas in terms of a subtotal resection and the preservation of the duodenum explains the low early and late postoperative morbidity and mortality.

[Mesenterial infarct. New aspects of diagnosis and therapy]. / Der Mesenterialinfarkt. Neue Aspekte der Diagnostik und Therapie.

Based on a retrospective analysis of 38 patients with mesenteric ischemia treated from 1981-1987, the current diagnostic and therapeutic concepts are presented. Embolic or thrombotic occlusions of the superior mesenteric artery prevailed (34 patients); venous thrombosis (4 patients) and non-occlusive disease (2 patients) occurred less frequent. Old age (70.6 years in average) and a long time interval between onset of symptoms and therapy (25.8 h in average) are responsible for the still high operative mortality (52.9% in the reported series). Of crucial importance is the early diagnosis within the first 6-12 hours, in which the ischemic bowel may mostly retain its viability. Since the application of transfemoral selective angiography or primary laparotomy however far more patients can be cured, compared to the results in earlier days. Especially in case of primary laparotomy the operative strategy aims in the exposition and inspection of the main trunk of the superior mesenteric artery and vein. Extensive ischemia of the intestines mandates, first of all, revascularization of the bowels. By means of exclusive vascular reconstruction or in combination with limited bowel resection (15 patients) the operative mortality could be reduced to 20%. For the intraoperative determination of intestinal viability the fluorescein test is of high reliability. New concepts in the management of mesenteric ischemia such as local arterial application of thrombolytics or spasmolytics open new approaches to improve the therapeutic results. Post-operative monitoring of serum-lactate in combination with clinical findings obviates routinely performed second-look operation.

[Cryotherapy in rectal cancer (author's transl)]. / Klinik und Morphologie des Mastdarmkrebses bei Kryotherapie.

From 1972 to 1979 151 carcinomas of the rectum were treated by cryotherapy. Radical tumour destruction was observed in 19 cases. The other cases showed good palliation after multiple cryotherapy. In 48 biopsies the local effect of cryotherapy has been studied by SEM. Local tumour destruction was followed by tissue inflammation and nonspecific phagocytosis of tumour cells. Immunological reaction and epithelialization was noted only after radical destruction of the tumour.

[Biotransformation of vascular prostheses]. / Die Biotransformation von Gefässprothesen.

Fifty arterial implants in animals and sixteen arterial implants in man have been examined with the scanner electronic microscope. After these examinations it appears to be that the form of biological reaction of the vessel graft is mostly determined by the condition of the host artery. If the host artery is healthy, even a synthetic prothesis will undergo a kind of revitalisation. However, if the host artery shows arteriosclerotic changes, even a healthy implant will be changed into a fibrotic tube.

[Scanning electron microscopy study of autologous vein and fascia lata before and one year after implantation into the arterial blood stream]. / Rasterelektronenmikroskopische Bilder von autologer Vene und Fascia lata vor und ein Jahr nach Implantation in die arterielle Strombahn.

The present communication deals with scanning electronmicroscopical changes of autologous vein and autologous fascia lata, which were used as arterial implants. We examined material, which could be removed during reoperation for vascular occlusion. After one year, the surface exposed to the blood stream shows a homogenous layer of fibrin. Whilst the elastic fibers of fascia lata-transplants have nearly completely disappeared, we can still find them in the vein. This might be the essential reason for the longer survival of venous implants into the arterial blood stream.

[Comparative endoscopic, light microscopy and scanning electron microscopy studies of the gastric mucosa in patients with chronic uremia]. / Vergleichende endoskopische, lichtmikroskopische und rasterelektronenmikroskopische Untersuchungen der Magenschleimhaut bei Patienten mit chronischer Urämie.

Ten patients suffering from chronic uremia were selected for comparison studies of gastric mucosa. With endoscopy erosive gastritis was seen in the corpus and antrum of five patients and in the fundus of two patients. Conventional microscopy (nine patients) revealed chronic gastritis I three times in the fundus and five times in the corpus. Gastritis II was localized once in the corpus and twice in the antrum. Gastritis III was present in the antrum of four patients. Under the scanning electron microscope lesions of gastric mucosa were present in all ten cases. Single cell necrosis (A), mucosal defects involving basal membrane (B), destruction of tunica propria (C), and muscularis mucosae with bleeding (D) were seen. Mucosal lesions A and B are early stages of gastric erosions. The most severe lesions were seen in the antrum mucosa with all three methods.

[Revitalization of bovine xenografts used for experimental arterial replacement in dogs (author's transl)]. / Die Revitalisierung des bovinen Xenograft als Gefässersatz beim Hund.

In 16 mongrel dogs bovine xenografts of 4 to 12 cm of length were used for arterial replacement. The grafts were removed after 30 minutes and up to 13 months for electronmicroscopic examination. The graft was shown to be significantly thrombogenic during the first six weeks after implantation. After 8 to 10 weeks an increasing revitalization of the graft is found starting from the ends of the canine artery. A cover of endothelial cells is formed in the graft lumen. The graft wall is enforced by formation of collagen and elastic fibers originating from capillaries and fibroblasts. Revitalization of the graft is limited to a rim of 2 to 3,5 cm next to the anastomoses with the canine artery. The remaining graft segment shows revitalization only on the outside wall. Degenerative changes take place in the inner layer of the graft with time passing.

[Revitalization of bovine xenograft used for repair of experimental tracheal defects (author's transl)]. / Die Revitalisierung des bovinen Xenograft als Tracheaersatz beim Hund.

In 12 mongrel dogs tracheal defects of different size were covered by bovine xenografts. The grafts were subjected to electronmicroscopic examination 2 to 19 months after implantation. Following the ingrowht of fibroblasts and capillaries a basal membrane is formed on the side of the previous graft lumen. After 4 to 5 months this membrane is covered from the tracheal margins by microvillous cells. After 8 months ciliated epithelia and goblet cells are developed by cell metaplasia. Although the graft becomes revitalized and integrated into the tracheal wall, the layer of ciliated epithelia is interrupted by less differentiated cells. The possible causes for this phenomenon are discussed. Thus bovine xenograft used for the repair of tracheal defects has the following advantages: total revitalization, no shrinkage, less prone to infection and formations of ciliated epithelia.

[Pancreatitis following kidney transplantation]. / Pankreatitis nach Nierentransplantation.

Follow-up of 249 recipients of cadaver renal allografts revealed 14 cases of pancreatitis. The minimum follow-up time was 2 1/2 years and the maximum 12 1/2 years. In 9 patients acute pancreatitis occurred within 4 months, 5 died from hemorrhagic-necrotizing disease. Later, 2 lethal cases of abscess-forming pancreatitis, 1 benign acute and 2 chronic forms were observed. The mortality in post-transplant pancreatitis is 7 out of 14, which corresponds to 7% of all fatalities after transplantation. Many different factors contribute to the development of pancreatitis, the most important being steroid medication.

[Various blood-foreign body reactions in the heart-lung machine in heart valve replacement and aortocoronary bypass operations]. / Unterschiedliche Blutfremdkörperreaktion in der Herzlungenmaschine bei Herzklappenersatz- und aortocoronaren Bypass-Operationen.

Blood-foreign material interaction in the pump oxygenator was studied by means of scanning electron microscopy in 3 patients undergoing heart valve replacement (HVR) and 3 patients undergoing coronary bypass operation (CBO). While polyvinyl tubes show an average deposit of 60 thrombi/mm2 with 20--40 microns in size in CBO, bloodgas interface during HVR causes increasing thrombotic deposits (375 Mcthr/nm2, 25--50 microns in size). Distal to the pump the volume of particles may rise up 250 micrometer in HVR and up to 80 micrometer in CBO. In a 35 micrometer pore arterial-line-filter (Pall-Corporation) platelet clumps up to 1 mm in size are removed from circulating blood in HVR, and up to 300 micrometer thrombi in CBO. According to different platelet deposit proximal to the filter, more and larger thrombi can pass through the filter in HVR. Distal to the pump thromboemboli of 30--60 (maximum 90) micrometer in size can be observed in HVR. Particles of 20--35 (maximum 60) micrometer in size may pass through the filter and enter into the patient's circulation in CBO. As the results suggest, extracorporal circulation is more harmful for patients undergoing HVR than for those undergoing CBO.

[Animal experiments with a new intracardial pacemaker electrode]. / Tierexperimentelle Erfahrungen mit einer neuen intrakardialen Pacemkaer-Elektrode.

In order to reduce the rate of dislocation of intracardiac pacemaker electrodes, a new electrode was developed. The tip of this new electrode is helical and can be fixed between the trabecles of the right ventricle by clockwise rotation. Since the tip of this new electrode has no sharp hooks the myocard cannot be damaged by fixation.

[Evaluation of the interaction between blood and foreign material in the pump oxygenator during open-heart surgery in infants by scanning electron microscopy (author's transl)]. / Rasterelektronenmikroskopische Evaluation des Blut-Fremdkörperkontaktes in der Säuglings-Herz-Lungen-Maschine

Scanning electron microscopy was used to elucidate the interaction between blood and foreign material in the pump oxygenator during open-heart surgery in 7 infants. The loss of platelets upstream of the blood pump is caused by thrombogenicity. The pump itself causes massive destruction of platelets and red blood cells; thromboembolie up to 100 mu and foreign body particles up to 200 mu are being detached from the wall of the tubing to a large extent. The particulate matter is trapped in arterial line filter. Particles up to 40 mu and cellular aggregates up to 60 mu can pass through the filter and enter the patient's systemic circulation.

Pancreatitis after renal transplantation.

Pancreatitis is seldom seen as a severe complication of renal transplantation. In a review on 1321 renal transplants, 23 cases with 12 deaths are reported (Johnson and Nabseth, 1970). Single case reports may be added. In our departments pancreatitis has proved to be a fairly frequent complication. It developed in 10 (7 percent) of 147 patients with renal transplantation one week to seven and a half years after transplantation (patients with primary hyperparathyroidism excluded). Three of the eight acute cases had haemorrhagic pancreatitis, in two of them leading to death. Two patients had chronic calcifying pancreatitis. Pancreatitis was complicated in one case by abscess formation and in two by severe haemorrhage into a pseudo-cyst. In two patients the diagnosis was made at necropsy only and death was probably not related to the acute pancreatitis. The exact pathogenesis of pancreatitis after renal transplantation cannot be precisely assessed. Possible contributing factors are treatment with corticosteroids, azathioprin, and L-asparaginase, early hypercalcaemia after transplantation, surgery, infections of bacterial or viral origin, and unknown immunological processes.