[CT symptomatology of cavernous hemangioma of the liver].
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Biomedical subjects
Publications and source records attributed to H Wolff.
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This is a progress report on work carried out to draft a coherent system for documentation and quality assurance in surgery. Methods and value of the system are described, with particular reference being made to results obtained from pilot studies in the Region of Suhl.
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Up to now we registered all over the world 485 transplantations of the pancreas. The partial donation of organs of relatives was performed in forty cases. On August 1st 1984 297 patients (70%) survived after a transplantation of the pancreas; of them 131 had a functioning transplant (30%). 54 transplanted organs (13%) had a good function for longer than 1 year. The most frequent complications were the thrombosis of the transplant, the pancreatitis, the fistulae of the pancreas and the rejection. Of 166 human allogenic islet transplantations at present none is functioning. Early rejections were the causes for the short function times. There were no cases of death by an islet transplantation. The present research concentrates to new methods of the islet isolation from the human pancreas and the immunological influence on the isolated islets.
The paper gives a survey of indication, technique, immunosuppression as well as results of the isolated heart transplantation. The isolated heart transplantation represents a genuine therapeutic alternative for many hopeless patients with heart disease who cannot be helped neither with medicamentous nor with the usual cardiosurgical methods. In future the combined heart-lung transplantation might be an essential enlargement of the treatment of patients with terminal heart diseases and with a pulmonary hypertension or of patients with a terminal pulmonary disease.
The importance of the liver transplantation for the treatment of infaust liver diseases is nowadays regarded as undisputed. The results could be improved during the last years: on an average 40% of the patients still live one year after the transplantation. The control of the transplant rejection and the diminution of the ischaemic liver damage are preeminent pathophysiological problems. Clinical routine and experience essentially further the optimization of the results.
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For the evaluation of a possible relationship between antisperm antibodies and LAV/HTLV-III antibodies, both markers were determined in the sera of 89 homosexual men. Thirty-one of 89 men (35%) had sperm antibodies in their sera, and 21 of 89 men (24%) had LAV/HTLV-III antibodies. There was no significant relationship between the occurrence of both kinds of antibodies, so that infection with the LAV/HTLV-III retrovirus in homosexual men seems not be influenced by the presence of antisperm antibodies.
The paper analyses the findings of a CT study of 21 lesions of focal nodular hyperplasia in 17 patients. In addition to subjective valuatin of the dynamic studies, densitometric measurements on a time basis were carried out (gamma-fit curves) and a density profile was obtained. These tumour-like lesions show typical density changes with rapid enhancement in the arterial phase and rapid fall in density after one or two minutes. Various patterns of the hyperdense lesions (non-homogeneous, those resembling vessels or homogeneous lesions) may be of significance in differential diagnosis. Atypical density patterns were found particularly in foci projecting from the liver.
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Liver preservation and transplantation was performed in pigs. For flush perfusion cold (2 degrees C) and warm (15 degrees C) lactated Ringer's solution were compared. Administration of cold Ringer's resulted in a severe endothelial damage of sinusoids that was aggravated after recirculation, as shown by electron microscopic examination. Using warm Ringer's solution this alteration was limited. Liver parenchymal cells are impaired mainly during reflow as a consequence of microcirculatory disturbance. After cold flushing animals died within a few hours, whereas after flushing with warm Ringer's solution pigs survived definitively.
An account is given in this paper of surgical treatment of malignant tumors of the liver of patients in the Surgical Department of Charité over the past six years, with reference being made to both indications for surgery and therapeutic results. - In the period under review, treatment was applied to 335 patients with malignant tumors of the liver, among them 168 with liver metastases. Thirty-eight per cent of all tumours treated were localised in the right lobe and 19 per cent in the left. The portal hilum was affected in 15 per cent of all cases and the entire liver in 28 per cent. Promising curative therapy was considered practicable for 67 patients, whereas three underwent palliative surgery. Liver transplantation was performed on 21 patients with malignant tumours not accessible to meaningful surgical approach. The resection rate in cases of liver malignoma was 14.6 per cent. The record included 14 hemihepatectomies on the right side and eleven on the left as well as 24 instances of atypical or segment removal, primarily in cases of liver metastasation. Surgical lethality amounted to 6.1 per cent, while the three-year survival rate was 55 per cent, with the most favourable results being recorded from hepatocellular carcinoma with 81 per cent. Only seven per cent of 265 patients with inoperable malignant liver tumours were left alive after one year. Impaired wound healing, the most common postoperative complication, had to be coped with in 21 per cent of all cases. The rate of complications proved to be substantially controllable by pre-operative conditioning and careful postoperative intensive care.
Reported in this paper are studies conducted into oestrogen receptor levels of 103 patients with mammary carcinoma, with the dextran-carbon method being used. The findings thus recorded are discussed for their clinical relevance. Recorded were correlations between quantitative oestrogen receptor levels, on the one hand, and menopausal status, grading, histological typing, and tumour size, on the other.
Preservation of B-cells, following organ collection and cold ischaemia, was defined on 19 donor organs by means of histological tests and testing for insulin content in pancreatic tissue. The degree of preservation declined by 50 per cent after two hours of cold ischaemia. The Velcro technique and uncrushed organ digestion were used for isolation. Islet yield was calculated by determination of insulin levels in isolated tissue (nmol/ml) and in the islet (pmol/islet). The average islet yield was 2 076 islets to one gram pancreas, that is ten per cent of the original amount. Studies conducted into in-vitro insulin secretion from isolated islets have revealed damage to organs due to handling, especially to organs which had undergone extended cold ischaemia.
Pancreatic autotransplantation is a necessary requirement for studies on the technical aspects of pancreatic grafting. In the allograft model immunological problems influences the graft survival. In 25 mongrel dogs the left limb of the pancreas was transplanted into the grain with end to side vascular anastomosis. The body and right limb of the pancreas was removed and discarded. We have compared various technique for management the exocrine pancreas section (Neoprene-injected duct; open duct technique). Currently the rate of complications in segmental pancreas autotransplantation was high especially in Neoprene injected dogs. Reasons for this result from technical failures like venous thrombosis and pancreatitis. In every case it was possible to ameliorate the diabetes mellitus up to the 7th day. Histological we found dilated interlobe space up to 7 days after transplantation with open ducts and there were no signs of disturbance in the endocrine tissue. In the Neoprene-injected group we found a severe intraacinous oedema and 5 days after transplantation already a beginning fibrosis with destroyed islets of Langerhans.
A survey is given on 23 patients (10 of our own, 13 reported in personal communications and in the literature) suffering from lymphoproliferative diseases and treated with acyclovir (ACV). In 5 patients (3 of 18 with cutaneous T-cell lymphomas, 2 of 5 with lymphomatoid papulosis) partial remission could be achieved. Since herpes simplex virus, cytomegalovirus and viruses like Epstein-Barr and varicella-zoster do not play an etiologic role and since HTLV-I virus, due to its lack of thymidine kinase, cannot activate ACV, the following mechanisms should be discussed regarding the possible effectiveness of ACV in lymphoproliferative diseases: a direct cytopathic effect; activation of ACV by the thymidine kinase of viruses not yet detected in cutaneous lymphoproliferative disorders; ACV activation by cellular thymidine kinase, which has been found to be elevated in lymphoproliferative disorders. Preliminary clinical observations suggest that ACV may exhibit an antiproliferative effect intravenously in some patients with lymphomatoid papulosis.
Since 1979, 174 patients with histopathologically proven adenocarcinoma of the rectum have undergone abdomino-perineal extirpation (Quenu) or anterior resection for cure. In 86% patients in Dukes stage B were undergone anterior resection and in 92.2% patients in Dukes stage C undergone extirpation. The recurrence rate was lower than 7%, 25% of them were local recurrences and 75% recurrence of the tumor in general. Anastomoic leak was not found after anterior resection. The three-years-survival rate was significantly higher in patients with adeno carcinoma of the rectum in the middle and upper part of the rectum. The three-years-survival rate was after anterior resection 87.6%. After abdominal extirpation, in most cases Dukes C, the three-years-survival time was 58.6%. For curative surgery a "curative" cancer resection involves resection of the cancer bearing rectal segment with its adjacent fat, blood vessels, nerves and lymph nodes. Specially in cases of mid rectal cancer involves resection of mesentery and utilizing high ligation of the inferior mesenteric artery and vein.
Examinations were applied to 101 patients with simple fibrocystic mastopathy (15 cases), proliferative mastopathy (52 cases), invasive ductal carcinoma in concomitance with mastopathy (21 cases), and normal mammary glands (13 probands) in a prospective clinico-morphological pilot study. The use of Robotron A 6471/AMBA-R, a system for automated microscopic image analysis, together with improved methods, has opened up new possibilities for early detection of precancerous changes of the mammary gland. Significant differences were identified between the two clinically relevant groups, II and III, of proliferative mastopathy by quantitative analysis of ductal epithelial proliferations through reproducible measuring data were obtained together with highly distinctive karyometric and histometric parameters. Multiparametrical analysis also provided suggestions to the effect that cases of proliferative mastopathy III, probably, break down into two groups with presumedly differentiated carcinoma risks. Hence, it may well be possible that the biological importance of atypical ductal epithelial proliferations differs from case to case.