Biomedical subjects
Publications and source records attributed to H Gögler.
Thirty-six patients were treated for severe acne conglobata. Wide and deep excision of the affected area should be followed by wound closure, primary or secondary, depending on the body region involved.
New methods of visualisation of the cysts like ultrasonography, computertomography and endoscopy make a praeoperative diagnosis possible. Because of the malignant potential of the cyst resection is now the treatment of choice instead of cystenterostomy which was formerly used.
After ligation of the mesenteric arteries an intestinal ischaemia was obtained. Endotoxin was measured from the peritoneal cavity, the portal und the peripheral blood. The limulus test for Endotoxin was used after phenol-water-extraction of the plasma. Microbiological investigations were done simultaneously. The endotoxin concentrations correlated to the clinical state of gram negative sepsis.
Fecal peritonitis was produced by a sphincter-system leading to intestinal perforation. In 10 beagle dogs endotoxin was measured with the Limulus test. There was a correlation between endotoxin appearance and microbiological findings in the peritoneal cavity and in the blood. Endotoxinaemia correlated with the clinical severity of peritonitis.
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Experience obtained from acid burns in 60 adult patients is reported in this paper. Twelve of them died, while 48 received conservative treatment, and twelve underwent surgery. Attempted suicide accounted for the highest number and severity of those accidental injuries. The therapeutic approach should be chosen on earliest possible endoscopy. Trends towards exploratory laparotomy and blind oesophagus stripping are described, and the problem of conservative therapy is discussed.
Between 1980 to 1985 in ten patients with complete anal incontinence the autologous muscle graft introduced by Schmidt has been used. The operative results obtained were good for satisfactory in nine patients whereas in one patient the operation failed.
Endotoxin has been measured in the blood and peritoneal fluid from 28 patients with diffuse peritonitis after intestinal perforation, intestinal obstruction or mesenteric infarction. Phenol-Water-Extraction for plasma preparation has been used. Endotoxin in correlated with the clinical state in these patients.
A case of fatal cervical dislocation in a front seat passenger restrained by a retractable three-point belt is described. A biomechanical and technical analysis is given.
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1. Depending on the operative trauma, insulin secretion is decreased until the 10th day after abdominal surgery. 2. The decreased insulin release is caused by a diminished discharge from the pancreatic beta cell during the second phase of insulin secretion (partially newly synthesized insulin). Insulin release during the early phase of insulin secretion (prestored insulin) is unchanged or even accelerated. 3. The glucose tolerance level is pathologically diminished until the 10th postoperative day.
In this study it is reported about operative mortality and long-term results of surgery of gastric carcinoma in patients over the age of 70 years. The operative mortality in 50 patients with a distal partial gastrectomy was 16%, the mortality in 24 patients with total gastrectomy was 33.3% and in 14 patients with a proximal gastrectomy the mortality was 28%. The main cause of death (40%) was a pneumonia. There was no correlation between frequency of pneumonia and preoperative results of measurement of lung function. Only advanced arteriosclerotic disease in the heart and brain has a fatal influence on mortality rate. In the old patients the long-term results are determined by the staging of the tumor at the time of operation, too. In the 60 patients, who had left the hospital and who are in our control, the half year survival rate was 78.3%, the 1-year survival rate was 58.3% and the 2-years survival rate is exceeding 41.6%. 14 patients of the 17, who are still alive and who are after 2 1/2 years again explored, are in a very good condition. In comparison with the literature it is to conclude that for the indication to surgery of gastric carcinoma there is important not only the real age of the patient but rather the biological and mental condition of the patient.
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Three cases of benign liver tumors in young women are reported in addition to 58 cases in the literature. Uncharacteristic pains in the upper abdomen and general weakness were the main symptoms. The most valuable diagnostic examination is selective angiography. Liver resection was successful in these cases. Elective surgery is advocated because massive bleeding with high lethality may occur. Histologically focal nodular hyperplasia was found and all three had taken oral contraceptives.
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1005 case histories of patients, older than 70 years, were studied retrospectively: 496 abdominal interventions (lethality - 29%), 509 extraabdominal interventions (lethality - 14%). In each patient 75 preoperative data are compared to 50 data of the intraoperative and postoperative period. There is a correlation between preoperative findings and postoperative complications and lethality. The main factors of risk are: Hb less than 10 g%, Creatinine greater than 1,5 mg%. The analysis implies the necessity of intensive preoperative therapy as well as the immediate correction of even slight post-operative deviations of the "norm".
Experience of two African and one German Surgical Units on abdominal operations in a two-years period are reported. Appendicitis, gall-stones, cancer of the colon and intestinal diverticulosis are rare in Africa, but frequent in Europe. Possible relations to dietry habits are discussed.