Biomedical subjects
Publications and source records attributed to P Dohrmann.
A nationwide limitation of the total health care budget requires the shutdown of certain departments or complete hospitals in order to increase the budget for the surviving hospitals. This development involves surgical departments as well, which have to be re-designed for an economic future.
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Homologous recombination between DNA molecules injected into Xenopus oocyte nuclei was investigated by examining the recovery of information from differentially marked parental sequences. The injected recombination substrate was a linear DNA with terminal direct repeats of 1246 bp; one repeat differed from the other by eight single base-pair substitutions, distributed throughout the region of homology, each of which created or destroyed a restriction enzyme site. Recombination products were recovered and analyzed for their content of the diagnostic sites, either directly by Southern blot-hybridization or after cloning in bacteria. The majority (76%) of the cloned products appeared to be the result of simple exchanges-i.e., there was one sharp transition from sequences derived from one parent to sequences derived from the other. These simple exchanges were concentrated near the ends of the homologous interval and, thus, near the sites of the original molecular ends. Placing marked sites on only one side of the homologous overlap showed that marker recovery was governed largely by the positions of the molecular ends and not by the markers themselves. When a terminal nonhomology was present at one end of the substrate, the yield of recombinants was sharply decreased, but the pattern of exchanges was not affected, suggesting that products from end-blocked substrates arise by the same recombination pathway. Because of considerable evidence supporting a nonconservative, resection-annealing mechanism for recombination in oocytes, we interpret the distribution of exchanges as resulting from long-patch repair of extensive heteroduplex intermediates.
Hypoglycemia with hyperinsulinism persisted in a newborn weighing 6410 g despite treatment with high doses of diazoxide and glucagon, as well as infusions of glucose and somatostatin. A subtotal pancreatectomy was performed after nesidioblastosis had been diagnosed on the basis of the laboratory findings. Due to the persistence of therapy-resistant hypoglycemia, a total pancreatectomy preserving the duodenum and the bile duct was done 6 weeks later. With insulin and pancreatic enzyme substitution the now 6-year, 9-month-old child has shown normal, age, appropriate development.
This prospective study included 80 patients in routine follow-up examinations after rectal cancer treatment. We performed anamnesis, clinical examination, total colonoscopy and endorectal sonography and tested the level of tumour markers CEA and CA 19-9. In 10 cases we detected local cancer recurrence of the rectal tumour. In 8 cases tumour markers were pathologically raised. Endoscopy detected the local recurrence in 4 patients only. Endorectal US was able to detect all of the recurrence cases. A histological confirmation was possible by EUS-guided needle biopsy in all cases. We were able to perform R 0-re-resection with the hope of curing in 4 patients out of 10 recurrence cases. Only endorectal US was able to detect two of those 4 recurrent tumours. In the follow-up of rectal cancer endorectal US seems to be a highly sensitive examination that may raise the number of re-resection with the hope of curing after rectal cancer treatment.
This report deals with instrumental suture in the deep anterior rectum resection when treating Hirschsprung's disease. The concept includes: ensuring diagnosis, cleaning the intestines, antibiotic prophylaxis, intraoperative testing of the anastomosis and postoperative X-ray by a standardized technique. Our first experience in the use of the stapler was gained with ten patients. One case of anastomosis insufficiency occurred. With the stapler apparatus, safe anastomosis was possible. The stapler facilitates anastomoses in deep resections. Therefore, a deep resection of the pathological segment in Hirschsprung's disease is possible. The practicality of the stapler and the favourable clinical experience justify the continued application of the instrumental suture technique in children's surgery.
There is no definite cure for the loss of oesophageal peristalsis and incomplete relaxation of the lower oesophageal sphincter associated with achalasia. Pneumatic dilatation is a simple and safe method of achieving symptomatic improvement of the oesophageal passage. By this means five young patients became free of complaints within an average observation period of 6 3/4 years.
The extent of intraabdominal adhesions can be limited by reducing the degree of operative trauma. This may be achieved by: prevention of ischaemia, moistening of the peritoneal surface, gentle handling of tissue, and the use of thin atraumatic suture material. The most recent development, minimally invasive surgery, reduces the actual area of operative trauma, and possibly lessens the risk of postoperative adhesions. Should a re-laparotomy be indicated for complaints due to adhesions, the laparoscopic approach to adhesiolysis has increased in importance.
In view of the favorable properties of the amniotic membranes as a peritoneal substitute, the following questions were posed: (1) Can the vitality of the amniotic epithelium be preserved by cryoconservation? (2) Which reactive changes occur in an intraabdominal amniotic graft? Animal studies gave the following findings. The vitality of the amniotic cells was not impaired by cryoconservation. A histiocytic demarcation zone developed on the membrane.
From 1980-1983 the funnel chest of 29 patients (age range 6-40 years) was surgically corrected using Ravitch's method. In 25 patients clinical and cosmetic follow-up investigations were possible. The psychological investigation consisted of standardised interviews with special questions concerning the problems that patients with funnel chest have to deal with. In 16 cases the result of the operation was good, in 7 cases satisfying, 2 patients had a poor result. The presence of a funnel chest did have a psychological impact on most of the patients, who were inhibited in their psychosocial activities. Surgical correction changed these restrictions in most of the patients in a positive way. We conclude that the psychosocial indication for surgical correction of the funnel chest is justified, since our results strongly support this indication.
Orthograde whole-gut irrigation proved a simply applicable method for bowel cleansing also in infants and small children. It could be demonstrated that the use of saline-lavage solution is well tolerated by these patients, accompanied only by minor changes of electrolyte and pH balance. Orthograde whole-gut irrigation is indicated in operations for small and gross bowel surgery. It is contraindicated, however, in marked bowel stenoses and also, to a lesser degree, in functional bowel stenoses.
Adhesions are a leading cause of bowel obstruction and infertility. The coverage of peritoneal defects, as in gastroschisis, is still a crucial problem. Despite biodegradable substitutes and synthetic implants such as PTFE membrane, a satisfactory replacement for gastroschisis has not been identified. The amniotic membrane, which is available at birth with a low antigenicity, was evaluated as a peritoneal substitute. Viable, partially viable, and inversed-used amniotic membranes were compared in a rat model. A full-thickness abdominal wall defect was made and the amniotic membrane sutured into this defect. The skin was closed over the amniotic membrane. Reoperation was performed 3 weeks after initial surgery, and the adhesion formation was measured by computerized area calculation. Viable amniotic membrane showed 0 to 3% area adhesion formation, while partially viable (50%) amniotic membrane demonstrated 33% area adhesion formation. Inversed-used amniotic membrane, with the stromal side directed toward the abdominal cavity, showed 70% of the amniotic membrane area to be covered with adhesions. The same amount was found in the control group, in which no substitute was sutured into the defect. This animal model is suitable for the straightforward evaluation of peritoneal substitutes with regard to adhesion formation. It is easy to perform and mimics surgical needs. Viable amniotic membrane proved to be an excellent antiadhesive tissue.