Biomedical subjects
Publications and source records attributed to L Ulatowski.
601 low anterior anastomoses of the rectum are analysed concerning suture techniques, leakage rate and operative mortality. None of the patients who developed a dehiscence (9.3%) died due to the extraperitoneal position of the anastomosis and the continuous sump-suction drainage of the retroperitoneum. The operative mortality was 1.5%.
Preliminary results of sonographically controlled alcohol injection into the region of the coeliacal ganglion for treatment of medically intractable pain in inoperable pancreas carcinoma (6 patients) are compared with results of a similar treatment using a surgical approach (10 patients). Both procedures resulted in up to total pain relief and marked reduction of consumption of analgetics. Neurolysis of the coeliacal ganglion by means of sonographically guided alcohol injection seems to be a useful treatment to reduce pain in inoperable pancreas carcinoma.
After comparing our own experience with previous publications in using the American EEA suture gun for esophagojejunostomies it has to be discussed, whether the use of such suturing apparatus in this type of anastomosis is really valuable. After performing 29 mechanical esophagojejunostomies we observed a low suture insufficiency rate: 3.5% (an average rate of 12,6% is found in the available literature). We try to explain this significant difference by the use of special technical procedures, respecting the anatomy of this area.
Based on the experiences of our own with two papillary disconnections during partial gastric resection and 105 reports of the world literature (1916-1980), the cause, diagnosis and management of the injury is described. The most important factor favouring the operative accident is the foreshortening of the duodenum caused by the scarring of a chronic postbulbar ulcer. The ampulla of Vater may, therefore, be brought closer to the pylorus. The prognosis of the injury is not determined by the time of discovery, but it depends on the complete diagnosis of both severed ducts and adequate treatment. On delayed recognition the lesion may masquerade leaking of the duodenal stump. Successful repair can be achieved by reimplantation or invagination of the transsected common bile and pancreatic duct into the duodenal stump or an isolated Roux-en-Y-loop.
It is reported on experimental experiences in the use of a biological adhesive system--highly concentrated native fibrinogen, thrombin and clotting factor XIII--in conjunction with local antibiotics. The results in animals are: Antibiotics in conjunction with the mentioned adhesive system give a high local concentration for a short time. The activity of the antibiotics decreases quickly within some activity of the antibiotics decreases quickly within some hours, there is no more antibiotic effect after 36 hours.
A case of liposarcoma of the mediastinum in reported and a review of the literature is given. To our knowledge 53 cases have been described in the literature. The most common symptoms are dyspnea, chest-pain, a cough and loss of weight. There is no relation between operability, the duration of clinical symptoms and the size of the tumor. The final diagnosis was made by histological examination in all cases. A clinical classification of the tumor is not possible, because there are no characteristic clinical findings. The prognosis in general depends on the histological type of the malignant. Although recurrence of the tumor appears in more than 40% of cases, radical surgical resection is the only method of successful treatment. The significance of the five-year survival rate is doubtful, because recurrent tumors were reported up to 14 years after the initial surgical procedure.
In a 62-year-old patient diffuse polypoid lipomatosis of the colon and hypertrophy of the appendices epiploicae was found together with subcutaneous lipomata and bone changes. Out of the five cases of diffuse lipomatosis coli published so far certain parallels can be drawn in only one case. The clinical picture and course indicate that it is either a pathogenetically uniform form of mesenchymal dysplasia or a syndrome.
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