Biomedical subjects
W Thaler
Publications and source records attributed to W Thaler.
Problems and controversies in endoscopic survey of the resected stomach.
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Pattern of rejection after multivisceral transplantation in stomach, small bowel, and pancreas.
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Small bowel transplantation in the rat: impact of various immunosuppressive regimens on graft-versus-host reaction.
The effect of ciclosporin (CS) and methotrexate (MTX) on the development of graft-versus-host (GvH) disease was examined after small bowel allotransplantation in the rat. The drugs were tested either alone or in combination. Lewis small bowel allografts were transplantated into Brown Norway recipients in a heterotopic position. The native small bowel, spleen, liver, skin, mesenteric lymph nodes and the kidney of the recipients were examined histologically 5, 10 and 20 days after allotransplantation. Intraepithelial lymphocyte numbers were determined quantitatively in the native small bowel. The relative spleen weight of the host was determined after sacrifice for estimation of the severity of GvH disease. Grade I GvH reaction of the native small bowel occurred in the animals without immunosuppression, but graft rejection predominated in this group. Treatment with CS was effective in the early postoperative periods; after 10 and 20 days GvH lesions in the native small bowel were comparable to those observed in the allogeneic combinations. MTX had a detrimental effect on the allografts and the GvH reaction was augmented. When CS and MTX were combined, GvH lesions were comparable to those in the animals treated solely with CS. Animals, however, suffered from heavy side effects. The spleen, liver, lymph nodes and kidney exhibited only unspecific histologic changes, which could not unequivocally be recognized as a GvH reaction. This was true for all groups. As a conclusion it can be said that GvH reaction occurs in the early postoperative period in a fully allogeneic model and cannot be prevented by CS in the dosae used. MTX was not seen to be of any value in this regard.
[No acid, no ulcer: such a simple axiom?].
According to the traditional view gastric acid and pepsin are a sine qua non for ulcer development. Acid suppression, however, is far from being the only successful therapeutic approach, and similar healing rates are achieved by drugs with substantially different mechanisms of action--antacids, H2-antagonists, antimuscarinics, cytoprotective and site-protective agents--thus denoting a multifactorial pathogenesis. Even with the antisecretory compounds, the relationship between gastric acid and ulcer healing gives rise to perplexity: antacids prove effective at widely varying doses; pirenzipine and H2-blockers, which are clinically equieffective, differ considerably in antisecretory efficacy; H2-antagonist studies on early vs late postprandial dosing yield contradictory clinical results; morning and bedtime single administrations of H2-antagonists prove equiactive on ulcer healing, leading to a reappraisal of the alleged importance of nocturnal acidity. Ulcer sealants such as colloidal bismuth and sucralfate prove as effective as H2-antagonists despite their total lack of antisecretory activity, thereby apparently undermining the primary pathogenetic role of acid. However, with the spectacular 100% healing rates achieved by the protonpump blocker, omeprazole, the wheel has come full circle, and gastric acid appears to re-emerge as a primary element in pathogenesis. Specific therapy, based on the predominant pathogenetic factor involved, is likely to be a feasible proposition, but, at present, remains little more than a remote possibility.
Increased number of intraepithelial lymphocytes in rejected small-bowel allografts: an analysis of subpopulations involved.
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Endoscopic decompression in "toxic megacolon".
Endoscopic decompression of the bowel in "toxic megacolon" is presented in two cases as an alternative procedure to Turnbull's technique using multiple bowel fistulas. In our opinion this technique seems to be a substantial improvement in the treatment of "toxic megacolon" and may even help to prevent ileotomy-colotomy in some cases.
[Reflections on the significance of detecting Campylobacter pylori in a biopsy of the stomach mucosa].
The inevitable confrontation with Campylobacter pyloridis implicates the surgeon to take into consideration this germ. For that reason we have examinated Campylobacter-positive patients with regard to histological changes of the gastric mucosa and to clinical symptoms. Apart from the fact, that there was no Campylobacter colonisation in the healthy gastric mucosa, there were not found specific features for the germ.
[Boerhaave syndrome].
Among the different types of esophageal wall injuries Boerhaave's syndrome is associated with the highest morbidity and mortality. The classical history of retching or vomiting and retrosternal splitting pain is indicative. Roentgenograms of the chest and esophagogram with a water soluble contrast medium are able to reveal the perforation in most cases. Esophagoscopy has been recommended for diagnosis, but its use is unnecessary and frequently contraindicated. Spontaneous perforation of the esophagus should be treated by prompt surgical intervention: left side thoracotomy, direct closure of the perforation by monolayer suture, and adequate mediastinal and pleural drainage. The treatment of esophageal perforation after late diagnosis is considerably more complicated and may consist in a drainage only.
[Sonography of the thyroid gland in surgery].
50 patients were sonographically examined by the surgeon prior to thyroidectomy. The sonographic findings were then compared with the intra-operative situation and with the goitre removed. Complete agreement was recorded from 80 per cent of the cases. Sonography was found to be superior to traditional thyroid diagnosis for its higher accuracy in indicating the positions of adenomas, cysts, and calcareous nodules as well as the relationship between goitre and vessels of the neck.
[Development of stomach cancers following vagotomy].
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[Malignant hemangioendothelioma of the thyroid gland].
Between 1969-1984 (16 years) 17 patients with "malignant haemangioendothelioma" of the thyroid were admitted to our services. This type of cancer is usually found in patients with a long history of goiter and is a very aggressive tumor. Infiltration of surrounding tissues is mostly responsible for death by asphyxia or uncontrollable bleeding. Some patients die also from metastases, which were seen frequently in the lungs. A precise preoperative diagnosis of the disease can be achieved rarely, histological classification has improved using immunohistochemical assays of Factor-VIII antigen in tumor tissue. No "prescription" for therapy can be given: results of surgery, radiotherapy and chemotherapy do not show significant differences (also in a variety of combinations). If the diagnosis is properly established, palliation will be the only therapeutic goal.
[Results of studies in 165 patients following selective proximal vagotomy].
Selective proximal vagotomy was performed on 165 patients at the I. Surgical Clinic of Innsbruck University, between 1970 and 1984. Results of 90 patients were retrospectively evaluated. Lethality was 0.6 per cent, while the rate of recurrence amounted to 14.4 per cent and average acid reduction to 50 per cent. 65 per cent of the above 90 patients were almost without any postoperative complaint, when rated by the I. and II. degree according to Visick. Results were particularly favourable in cases of perforated ulcer, combined ulcer (Type II according to Johnson), hyperacid gastroduodenitis, and in cases of duodenal ulcer of women.
[Non-Hodgkin lymphoma of the rectum].
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Sonography in the diagnosis of colon carcinoma.
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Hemorrhage from fistula between duodenal cap and hepatic artery aneurysm.
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Preservation of small bowel grafts--a comparison with two standard solutions.
This study investigates the use of EuroCollins (EC) and University of Wisconsin (UW) solution, two major preservation fluids, for small bowel preservation. After in situ flushing, grafts were cold-stored at 4 degrees C with either EC for 30 min (group 1a), 6 h (group 1b) and 12 h (group 1c) or with UW for 30 min (group 2a), 6 h (group 2b) and 12 h (group 2c). Using UW, cold ischemia was extended to up to 18 h (group 2d). As a control, small intestines were flushed and stored for the same time periods in cold saline (group 3a-c). Survival in group 1b was 66% versus 100% in group 2b. After 12 h 80% survived in group 2c, but there were not survivors in group 1c. After 18 h of cold storage, survival was only observed in group 2d (25%). Saline was ineffective after 6 h of preservation. Histology at the end of preservation revealed characteristic changes for EC (intracellular vacuoles) and UW (amorphic granules). We conclude that with UW small bowel can be preserved for up to 12 h.