Biomedical subjects
Publications and source records attributed to H Brünner.
A 63-year-old man developed a carcinoid tumor of the cardia with unusual metastases of the brain and a rapid lethal course. Clinical aspects of these tumors, their attachment to apudomas and their new morphologic respectively functional--morphologic aspects are discussed.
Mean duration from symptoms to diagnosis in 87 patients with primary retroperitoneal tumour was 4.8 months for malignant tumour (67 patients), 18.1 months for benign tumour (20). The cardinal symptoms were palpable abdominal mass (68%), feeling of fullness and nausea (64%), as well as ill-defined abdominal pain (55%). Radiological diagnosis, especially selective angiography, provided important pointers to the global diagnosis of "retroperitoneal tumour". Small-needle biopsy, guided by ultrasound, has now become available in the pre-operative diagnosis of the type and malignancy of these tumours. After radical resection of 30 malignant tumours there was a mean survival time of, so far, 30.2 months. Results were worse with palliative malignant-tumour removal in 25 patients, at an average of 17.3 months. Survival time was only 4.8 months for 29 patients declared inoperable. In individual instances cytostatic treatment achieved an increase in survival time of up to 12 years.
Total gastrectomy was performed on purebred beagle dogs and a 30--40 cm jejunal segment was grafted isoperistaltically between oesophagus and duodenum. Histological and histoautoradiographical examinations were carried out and the wall-thickness and the cell-transformation rate in the interponate determined. Despite the isoperistaltic substitute-stomach a muscular wall-hypertrophy of 140% of the interponated jejunum was found. The reason for this hypertrophy is thought to be the result of adhesions and the functional mechanical demands. Histoautoradiographical examinations confirmed that the regeneration time in the substitute-stomach decreased by 70% compared with the normal jejunum. The distinct reduction of cell regeneration in the regeneration in the interponated jejunum could be attributed to the considerable regression of the absorbent performance and to the increase in its mechanical exercises.
In 68 patients arterial and portal blood flow were measured by angiodensitometry in the course of routine, indirect splenoportography. Results were compared with those already published, with investigations of a model and with animal experiments. It was shown that, given certain underlying conditions, reliable results can be obtained even in the presence of a pulsatile flow and incomplete contrast mixing. Compared with other procedures, the method has the advantage of providing a complete picture of liver haemodynamics in the course of routine splenoportography in a simple way and without affecting the patient further. As a result the indications for performing a shunt and the choice of the shunt technique can be more accurately determined.
The classical splenorenal shunt of Linton modified by Clatworthy is definitely superior to portocaval anastomosis. Between 1968 and 1976 in 225 patients with bleeding oesophageal varices a splenorenal anastomosis was performed in 47 cases, a portocaval in 30 cases and a mesentericocaval in 2 cases. There were 55 palliative operations as compared with 91 conservative therapeutic approaches. Over the last five years central termino-lateral splenorenal anastomses have been performed almost exclusively.
Explore the source record for details and available documents.
By chronic recidivating ileus with massive extensive adhesions, small intestine plications according to Noble or Childs and Philipps, respectively, have stood the test of time. In view of the total lethality rate of 5%, no plication should be attempted for acute ileus syndrome or for local or diffuse peritonitis. Serious complications include fistulization, intestinal perforation, recurring ileus, and peritonitis. Prophylactic plication is not recommended. The cases treated by the surgical department of the university clinic in Mainz, which include a total of 233 laparotomies for chronic adhesions of the ileus, reflect strict adherence to indications for small intestine plication. Among our own cases, we had no postoperative lethality.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Diagnostic and therapeutic possibilities for esophageal varices hemorrhage in portal hypertension are indicated with reference to 149 patients. In the acute phase, operative measures are to be rejected because the lethality is too high. Conservative treatment with a Blakemore-Sengstaken probe should always be introduced at first. After confirmation of the conditions in the liver, a pressure-reducing anastomosis operation (delayed emergency shunt) must be performed. For this purpose we prefer the terminolateral splenorenal anastomosis.
14 cases of carcinoid tumors over a period of 16 years are reported. There are 7 carcinoids of the vermiforme appendix, 3 of the small bowel, 1 of the rectum, and 2 carcinoids of the bronchus. No carcinoid syndrom was observed. Three patients with carcinoid tumors, localized in the small intestine died immediately post operationem. All others are still alife and followed up between 6 month and 13 years, are free of symptoms or rezidives. Poor prognosis of the carcinoids of the small intestine seems to depend on late diagnosis, complications already occured at the moment of operation, and advanced age of these patients. Different malignance is not considered to be an important factor of prognosis.
The classical splenorenal shunt of Linton modified by Clatworthy is definitely superior to portocaval anastomosis. Between 1968 and 1976 in 225 patients with bleeding oesophageal varices a splenorenal anastomosis was performed in 47 cases, a portocaval in 30 cases and a mesentericocaval in 2 cases. There were 55 palliative operations as compared with 91 conservative therapeutic approaches. Over the last five years central termino-lateral splenorenal anastomoses have been performed almost exclusively.
Preliminary results were evaluated in patients with carcinoma of the rectum of whom 33 had preoperative radiotherapy and 23 were treated by operation only. The tumour stage was T2-4 NX MO in all patients. There was no significant difference between the groups as to postoperative mortality, would healing, and postoperative admission time. However, the recurrence rate was significantly lower in pre-irradiated patients than in those treated by operation only. The combination of radiotherapy and radical operation appears to be a possible means of significantly improving the survival rate of patients with carcinoma of the rectum.
Anal and perianal lesions in Crohn's disease such as fistulae, fissures, abscesses and proliferative ulcerous proctitis are often misinterpreted and consequently unsatisfactorily treated. They always indicate a florid intestinal attack or a relapse after previous intestinal resection. Out of 153 patients with Crohn's disease in the last 11 years we have had 59 cases (= 38.6%) with a history of anal changes or such changes were demonstrable on admission to hospital. Only after subtle diagnosis in which the nature and extent of these complications and the location of the intestinal disease focus are determined, the most promising therapy, after all possibilities of conservative treatment have been exhausted, is intestinal resection. Local surgical measures which would often endanger continence, are reserved for the individual case.
In 12 anesthetized beagle dogs breathing spontaneously flow in the hepatic artery (168 ml/min + 10 SEM) and portal vein (576 ml/min +/- 20 SEM) was measured by means of angiodensitometry. Total hepatic blood flow (THBF) was 185 ml/100 g/min +/- 11 SEM. In our opinion this relatively high THBF depends upon the method used.
The recurrence of Crohn's disease often presents problems in the indication for surgery. Reoperation is indicated in all recurrent complicated cases and in postoperative complication not specific for Crohn's disease. However relaparotomy should be performed only after conservative measures have proved unavoiding. In the Department of Surgery at the University Hospital in Mainz 153 patients with Crohn's diseases were treated over an 11-year-period. Of 310 patients operated for Crohn's disease 153 reoperations were performed in 73 patients. The aim of reoperation should be the prevention of further complications. In view of the individually differing courses of the disease no general guidelines can be laid down for the indications for laparotomy.
424 patients with malignant jaundice were treated from 1964 to 1976. 152 carcinomas of the extrahepatic biliary tract and 272 carcinomas of the duodenopancreatic region were reported. Initial symptoms of cancer of this region are often vague, so that physicians must employ a high index of suspicion if earlier diagnosis is to be effected. Most of the carcinomas of pancreas and the biliary tract are unresectable because of the early dissemination. The dismal of the malignant tumors of the biliary tract is unchanged during the last 50 years but survival rates are better in carcinoma of the duodeno-pancreatic region.
Regional enteritis does present therapeutical problems because of the unpredictable course of this disease. 162 patients were operated upon in the Surgical Department of the University of Mainz Medical School between 1964 and 1976. Medical and surgical treatment of these patients has been rather different due to the heterogenity of the patient group. Curative therapy of regional enteritis does not exist. Medical treatment is aimed at converting the active form of the disease into an inactive, 'burnt out' form. One therapeutic regimen widely used is the combination of salazosulfapyridin and corticosteroids, another regimen is the combination of azathioprine and prednisolone. Surgery is indicated when complications arise and after medical treatment has failed. The optimal approach is resection of the afflicted part of the intestine. Even after surgery prognosis is doubtful and depends upon the activity of the disease in each individual case.