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Biomedical subjects

H Bünte

Publications and source records attributed to H Bünte.

At least 73 records · Page 4Linked to original sources
PubMed1981

Gastric stump carcinoma--new aspects deduced from experimental results.

The actual influence of surgical technique on the pathogenesis of gastric stump carcinoma has not been fully explained, even under experimental conditions. We attempted to elucidate the problem by a series of experiments with Wistar rats assessing the postoperative consequences of Billroth I resection, B II resection with Roux-en-Y gastroenterostomy, B II resection with Braun's anastomosis, and plain gastroenterostomy without resection, and defining their influence on the development of carcinoma in the gastric remnant. Based on general clinical observations and randomized endoscopic and radiologic examinations, the date for killing and autopsy was fixed on the 56th after the surgical intervention. The number of malignant neoplasms was found to rise in proportion with the intensity of duodenogastric reflux resulting from the respective operative procedures: No tumors were found after B II resection with Roux-en-Y gastroenterostomy, but tumor incidence in the other groups rose from 10% in the animals subjected to B I resection, to 23.1% in those with B II resection plus Braun's anastomosis, and finally to 30% in animals with B II resection only, but no Braun's anastomosis. Gastroenterostomy without any resection even produced a tumors incidence of 70.8%. The present paper is presumably the first to report about gastric carcinomas that arose after surgery alone, without additional carcinogen exposure.

Animals↗
PubMed1981

The routine use of Roux-en-Y anastomosis in gastric surgery.

In the Surgical Clinic of the University of Münster Billroth II resection with Roux-en-Y gastroenterostomy was introduced 1974--with a specific modification-- and has now been performed in every case where primary or additional resections of the stomach were indicated. The main advantage is seen in the tensionless gastroenteral anastomosis even in cases with high resection. In ulcer surgery, the method permits to remove safely the main gastrin-producing parts of the stomach, and to reduce the mass of acid-producing parietal cells. At the same time it is possible to avoid duodeno-gastric reflux which is held responsible for promoting carcinomas in the gastric remnant. The use of the Roux loop guarantees reflux-free resection and provides an effective prophylaxis of gastric stump carcinoma. After this type of operation bile reflux is never seen on endoscopy.

Gastroenterostomy↗
PubMed1981

Operation-sequel carcinoma--an experimental study.

Gastric-stump carcinoma, a special form of gastric carcinoma, is seen as a late complication of gastric surgery performed on the carcinoma-free stomach. In the present experimental series a considerable number of carcinomas were observed, for the first time, in rats after gastric surgery without additional application of a carcinogen. The rate of malignancies arising in the gastric stump correlates closely with the intensity of the duodenogastric reflux provoked by different surgical procedures. The important role of duodenogastric reflux for the development and growth of gastric stump carcinoma is thus established beyond doubt. While bearing in mind the need for caution in translating experimental results to man, this study does suggest the value of reflux-preventing techniques in the surgical management of gastric diseases. Patients who have undergone an operation are at increased risk of developing carcinoma, and therefore require consequent and regular follow-up examination. The introduction of surgical prophylaxis and careful postoperative surveillance are the only effective methods for the prevention of gastric stump carcinoma.

Adenocarcinoma↗
PubMed1980

[(The behaviour of dacron grafts in porta-caval interposition-shunts)].

After the successful completion of experiments with animals, 7 patients with portal hypertension were implanted with porta caval interposition grafts, using 12 mm gauge, 3-4 cm long, Dacron double velour. In 6 patients after 6-8 month the oesophageal varices were again seen, there we must assume that the porta caval shunts had closed. In view of this we must state that this material is not suitable, and until we have a more efficient alternative the latero-lateral shunt is the method of choice.

Blood Vessel Prosthesis↗
PubMed1979

[Surgical or endoscopic papillotomy? (author's transl)].

Endoscopic papillotomy has become a competitive method to the surgical technique. Endoscopy took over many cases formerly treated surgically. The indications to either procedure are defined. The alterations of papilla and peripapillary region of choledochus are treated by endoscopy. The surgical method is indicated in gallbladder diseases, in further accessory operations and in failing of endoscopic proceeding. The complication rate of endoscopic papillotomy is 6.7 p.c. and about 20 p.c. under the rate of the surgical method. The relation of mortality rate is given with 1.5 p.c.: 3.8 p.c. in favour of endoscopy. Indications, advantages, disadvantages and complications of both methods are discussed, using the own case material of 211 surgical and 714 endoscopic papillotomies.

Aged↗
PubMed1979

Endodermal germ cell carcinoma (endodermal sinus tumor) of the vagina in infant girls.

An endodermal sinus tumor (endodermal germ cell carcinoma) was diagnosed in a 1-year-old girl in the vagina after hemorrhage; the tumor was completely removed by radical abdominal surgery. Postoperative polychemotherapy was performed for two years with Actinomycin D, Adriamycin, Vincristin, and Cyclophosphamide. The infant is now tumor-free for 26 months, showing almost normal somatic and psychic development. The characteristic histological patterns and clinical course of this strongly malignant tumor are demonstrated, based on 25 published case reports of endodermal sinus tumors in the vagina of little girls (aged 5-26 months). This neoplasm in early infancy has to be separated from the clear-cell adenocarcinoma of the vagina which occurs after puberty in adolescent girls and young women, and is induced by stilbestrol therapy to the mother during early pregnancy.

Adenocarcinoma↗
PubMed1979

Gastric stump carcinoma -- carcinogenic factors and possible preventive measures.

Cancer in the resected stomach has a very poor prognosis unless it is detected at the "early gastric cancer" stage. The development of gastric stump carcinoma is probably dependent on the procedure chosen for primary surgery (resection). Local irritation accompanying the execution of anastomosis is also discussed as a possible cause of malignant transformation. Surgical precautions should include the choice of methods avoiding reflux, and the use of resorbable suture material for performing an exact and well-matched anastomosis. Periodic postoperative control is essential; in addition to radiological methods, endoscopy and biopsy are indicated for adequate identification of local abnormalities and mucosal changes. Patients whose high risk was stated in previous examinations, must be re-examined at shorter intervals. Identification of changes at the early cancer stage requires close cooperation of surgeon and pathologist.

Duodenum↗
PubMed1978

[Surgical management of achalasia].

As long as its etiology is uncertain, achalasia can only be treated symptomatically. Basically, conservative dilation treatment and operative cardiomyotomy can be performed. Although dilation treatment can save the patient the operative procedure, it has relative disadvantages. For this reason since 1973 we treat achalasia through cardiomyotomy with Nissen's fundoplication method. We have operated on 25 cases using this method. These are examined and the results reported.

Adult↗
PubMed1978

[Interdisciplinary cooperation between anaesthesiology and surgery from the surgeon's point of view (author's transl)].

The development of anaesthesiology has brought about a great variety of problems e.g. unforeseen capacities, money, vacancies and equipment. The patients welfare, of course necessitates the establishment of anaesthesiological departments wherever operations are being performed. We believe that in hospitals without anaesthesiologists an experienced physician should devote himself to the above mentioned duties, which should not be allowed to be of less quality. This is the only way to avoid serious complications. Furthermore, the type of operation and selection of patients have to consider these factors. Risky patients should not be operated on in hospitals without an anaesthesiologist. In a single-man-anaesthesia department the surgical colleagues should be temporarily transferred to assist in the anaesthesiologic department. If there is no possibility of using modern anaesthesia, neither through an anaesthesiologist nor an experienced surgeon, the range of surgery should be limited to the more riskless areas of the body or to operations that can be done in local anaesthesia.

Anesthesiology↗
PubMed1977

Oxygen tension in different tissues.

Our findings of studies in critically ill patients can be summarized as follows: 1) Adequacy of tissue oxygenation cannot be predicted solely from measurement of arterial blood Po2 since normal values may be associated with an inadequate tissue oxygen supply. 2) Measurements of global blood flow are in no way indicative of the distribution of blood flow within an organ and point to need for more specific monitoring within organs of both low distribution and metabolic activity.

Humans↗
PubMed1976

[Control of intensive care through the measurement of microcirculation and 02 consumption].

The pO2-multiwire electrode measures the intercapillary oxygen tension. The pO2 histogram, which results from such measurements gives precise information about the question as to whether microcirculation is disturbed or not. Thus, pathological changes in respiration and volume can be recognized earlier than with classical methods. The latter registers the mainly central variables which are compensated for a longer period of time. The local pO2 measurement allows individual regulation of respiratory therapy and monitors the response of oxygen therapy. Using this method oxygen deficiency as well as overdosage of oxygen supply can be averted. Thus, important diagnostic and therapeutic indications can be identified.

Central Venous Pressure↗
PubMed1976

[The so-called spontaneous nodular panniculitis (Weber-Christian lipodystrophy)].

Enlarged lymph nodes and a tumor, the size of a man's fist, were found in the abdomen of a female patient of 63. Histologic diagnosis determined a non-suppurative panniculitis with typical proliferation of foam cells and reactive inflammatory infiltration attaining the stage of granulomatosis. The disease is seen as granulomatous histiocytosis; a sure explanation of its pathogenesis is not yet possible.

Female↗