J. Scheele

Use of immunoscintigraphy in the diagnosis of fever of unknown origin

Fever of unknown origin (FUO) has been defined as an elevation in temperature (38°C) for at least 2–3 weeks despite intensive investigation. The value of immunoscintigraphy with the technetium-99m-labelled anti-granulocyte antibody anti-NCA-95 (BW 250/183, IgG1) was studied retrospectively in 34 consecutive patients with FUO. Every effort was made to confirm a diagnosis, including methods such as ultrasonography, computed tomography, magnetic resonance imaging, bacteriological tests, surgical intervention and clinical follow-up. In 58.8% of the patients, an infectious cause for the fever was found, in 30.2% of the patients, a benign or malignant haematological disease, pancreatitis or thyrotoxicosis was found. No cause for fever could be found in 11%. The overall diagnostic sensitivity and specificity of immunoscintigraphy for infection were 40% and 92% respectively. The positive predictive value was calculated to be 88% and the negative predictive value was calculated to be 52%. False-negative scans were especially noted in patients with endocarditis, pneumonia and small brain abscesses, where the lesions did not exceed a diameter of 0.5 cm. If patients with endocarditis were excluded, the imaging sensitivity and specificity were increased to 57% and 95%. This study demonstrates that 99mTc-anti-NCA-95 scanning is able to localize infectious causes of FUO, other than endocarditis.

Significance of Serum Phosphohexose Isomerase in Gastrointestinal Cancer at Different Stages

The purpose of this study was to reevaluate the significance of serum PHI in gastrointestinal cancer at histopathologically defined stages prior to primary treatment. A total of 248 patients with malignant tumors of the gastrointestinal tract and a collective of 42 patients with noncancerous diseases were studied. The results are compared with those obtained with the established markers tissue polypeptide antigen (TPA) and carcinoembryonic antigen (CEA). Phosphohexose isomerase (PHI) revealed an overall diagnostic sensitivity of 69%, combined with a specificity of 74%. The corresponding data for TPA were found to be 73 and 47% while for CEA 26 and 95% respectively were determined. Even in the early stages of colorectal and esophageal carcinoma, PHI showed a sensitivity of about 60%. A continuous rise of PHI serum levels, correlating well with the extent of the tumor disease, could be detected. In contrast to TPA and CEA, PHI assay can be carried out with a minimum of laboratory efforts, in a short time and at low costs. These findings suggest that serum PHI assay is a useful aid for screening of gastrointestinal cancer, especially esophageal and gastric carcinoma, and a reliable marker for treatment control and follow-up.

Die gefäßorientierte Segmentresektion der Leber

SummaryComplete surgical resection represents the only treatment for malignant tumors of the liver which offers the chance of long-term tumor-free survival. From this oncological perspective the segment orientated approach appears to be a valuable supplement of traditional hepatic surgery. It minimizes incomplete tumour removal, and prevents a waste of non-involved hepatic tissue. This combination of optimum local radicality and maximum parenchyma preservation also reduces operative risk. Various modern diagnostic and surgical aids such as intraoperative ultrasound, liver transection using the ultrasonic aspirator, and control of bleeding by means of infrared coagulation or fibrin tissue adhesive, all do considerably support this individualized surgical approach. However, the practical application is essentially based on the intrahepatic vasculature and the thereby defined segmental anatomy. The sequence of the operative proceeding will be illustrated for different mono- and polysegmentectomies.ZusammenfassungDie komplette chirurgische Resektion bietet als einziges Behandlungsverfahren bei malignen Lebertumoren die Chance eines langfristigen tumorfreien Überlebens. Unter diesem onkologischen Blickwinkel erscheint die Einbeziehung segmentorientierter Resektionsverfahren als wesentliche Bereicherung der traditionellen Leberchirurgie. Sie reduziert das Risiko unradikaler Tumorentfernungen, vermeidet jedoch andererseits die unökonomische Entfernung nicht-betroffener Areale. Dank dieser Kombination optimaler lokaler Radikalität and ökonomischer Parenchymreduktion wird auch das Operationsrisiko gesenkt. Verschiedene diagnostische und operative Hilfsmittel wie: Intraoperative Sonographie, Parenchymdurchtrennung mit dem Ultraschalldissektor oder Blutstillung mittels Infrarot-Kontaktkoagulation bzw. Fibrinklebung unterstützen dieses individualisierte operative Vorgehen. Die praktische Umsetzung basiert entscheidend auf der Festlegung der intrahepatischen Gefäßaufzweigung and der hierdurch definierten segmentalen Leberanatomie. Die einzelnen Schritte des operativen Vorgehens werden fur die verschiedenen Mono- and Polysegmentektomien dargestellt.Complete surgical resection represents the only treatment for malignant tumors of the liver which offers the chance of long-term tumor-free survival. From this oncological perspective the segment orientated approach appears to be a valuable supplement of traditional hepatic surgery. It minimizes incomplete tumour removal, and prevents a waste of non-involved hepatic tissue. This combination of optimum local radicality and maximum parenchyma preservation also reduces operative risk. Various modern diagnostic and surgical aids such as intraoperative ultrasound, liver transection using the ultrasonic aspirator, and control of bleeding by means of infrared coagulation or fibrin tissue adhesive, all do considerably support this individualized surgical approach. However, the practical application is essentially based on the intrahepatic vasculature and the thereby defined segmental anatomy. The sequence of the operative proceeding will be illustrated for different mono- and polysegmentectomies.

Fibrinklebung an parenchymatösen Oberbauchorganen

In rabbits and dogs standardized lesions of the liver, kidney, and spleen were treated by application of human fibrinogen tissue adhesive. In all cases this procedure resulted in a complete control of bleeding as well as a stable and lasting closure of the wounds. During the postoperative observation time of one month, the fibrinogen tissue adhesive was initially infiltrated by leucocytes and macrophages and subsequently resorbed by a granulating tissue, characterized by the early appearance of numerous fibroblasts. Our clinical experience, until now, confirms these promising experimental results.SummaryIn rabbits and dogs standardized lesions of the liver, kidney, and spleen were treated by application of human fibrinogen tissue adhesive. In all cases this procedure resulted in a complete control of bleeding as well as a stable and lasting closure of the wounds. During the postoperative observation time of one month, the fibrinogen tissue adhesive was initially infiltrated by leucocytes and macrophages and subsequently resorbed by a granulating tissue, characterized by the early appearance of numerous fibroblasts. Our clinical experience, until now, confirms these promising experimental results.ZusammenfassungAn Kaninchen und Hunden wurden standardisierte Verletzungen von Leber, Niere und Milz mit humanem Fibrinkleber versorgt. Hierbei ließ sich stets eine vollständige Blutstillung und eine feste, dauerhafte Wundadaptation erzielen. Während der einmonatigen postoperativen Beobachtungszeit zeigte sich initial eine celluläre Infiltration, nachfolgend eine gewebliche Resorption des Fibrinklebers durch ein fibroblastenreiches Granulationsgewebe unter Ausbildung zarter Narben. Erste klinische Erfahrungen bestätigen diese günstigen tierexperimentellen Befunde.

Typical and Atypical Resection Techniques of Hepatic Metastases

This report deals exclusively with liver metastases from colorectal cancer, since our experience with hepatic metastases from other primary tumors is very limited.

76. Differentialindikationen der konservativen und operativen Behandlungsmöglichkeiten der Milzruptur

SummaryConservative therapy of splenic trauma in the adult cannot be recommended, since 2/3 of patients with polytrauma will prove to have additional abdominal organ lacerations. The new methods of local haemostasis, suture and partial resection and their application and contraindications according to Barretts classification of splenic trauma are discussed. Our own salvage rate has been 50% (70/140) in trauma and 77% (116/151) in iatrogenic lacerations during the past 5 years.ZusammenfassungBeim Erwachsenen kann das rein konservative Vorgehen beim Milztrauma nicht empfohlen werden, da polytraumatisierte Patienten in 2/3 der Fälle zusätzliche abdominale Mehrfachverletzungen aufweisen. Die neuen Methoden der lokalen Blutstillung, Naht und Teilresektion sowie ihre Anwendung und Kontraindikationen beim Milztrauma, werden anhand der Barrett-Klassifikation dargestellt. Beim Milztrauma betrug die eigene Milzerhaltungsrate 50 % (70/140) und bei iatrogener Milzverletzung 77% (116/151) in den letzten 5 Jahren.

Vergleichende morphologische Untersuchungen verschiedener Anastomosentechniken bei transthorakalen Oesophagogastrostomien am Hund

SummaryIn 27 dogs esophagogastric anastomoses were performed in a single-layered end-on, a three-layered end-on and a double-layered inverting technique The anastomoses were reinvestigated on the 2., 4., 7., 15. and 30. postoperative . day. Suture line leakages were not observed. The inverted suture resulted in considerable anastomosic stenosis, ulceration of the mucosa, disordered and initially incomplete revascularisation, and widespread granulomatous inflammatory reaction. In contrast, the end-on technique led to almost no stenosis, ordered revascularisation, and narrow and delicate scar tissue formation while maintaining a normally layered structure. The single-layered methode was superior to the three-layered one. The best results were obtained by the extramucous technique.ZusammenfassungBei 27 Hunden wurden einreihig-auf Stoß, dreireihig-auf Stoß und zweireihig-invertierend genähte transthorakale Oesophagogastrostomien am 2., 4., 7., 15. und 30. postoperativen Tag untersucht. Anastomoseninsuffizienzen wurden nicht nachgewiesen. Invertierende Anastomosen zeigten Stenosierung, Schleimhautulcerationen, unruhigen Gefäßdurchbau mit anfänglichen avasculären Bezirken und ausgedehnte granulierende Entzündung. Bei schichtgerechten Anastomosen fanden sich nur geringe Stenosierung, schichtgerecht geordneter Gefäßdurchbau und niveaugleiche zarte Vernarbung. Die einreihige Naht war der dreireihigen überlegen, wobei die extramuköse Technik das günstigste Resultat zeigte.

321. Fibrinklebung@@@The use of fibrin glue

SummaryIn animal experiments fibrin glue proved useful in the protection of colonic and tracheal anastomoses, reconstruction of tracheal defects using cartelage grafts, and repair of hepatic, splenic, and renal wounds. The absorption of the glue in tissue is identical to that of physiological fibrin. Our positive clinical experience includes: Protection of digestive anastomoses, fibrin pleurodesis of persistent or recurrent spontaneous pneumothorax, topical haemostasis and sealing of dacron grafts in cardiac surgery, management of cerebrospinal fluid rhinorrhea, and fixation of transplants in ENT surgery. An increased risk of postoperative hepatitis has not been found.ZusammenfassungTierexperimentell bewährte sich die Fibrinklebung bei der Absicherung von Colon- und Tracheaanastomosen, der Deckung von Tracheadefekten mit Knorpeltransplantaten und der Wundverklebung an parenchymatösen Oberbauchorganen. Der gewebliche Abbau des Fibrinklebers entspricht dem körpereigenen Fibrins. Positive klinische Erfahrungen betreffen: Absicherung von Anastomosen am Verdauungstrakt, Fibrinpleurodese bei persistierendem oder rezidivierendem Spontanpneumothorax, Blutstillung und Prothesenabdichtung in der Herzchirurgie, plastische Deckung frontobasaler Liquorfisteln sowie Transplantatfixation im HNO-Rereich. Ein erhöhtes Hepatitisrisiko ließ sich nicht nachweisen.

164. Anastomosensicherung mit Fibrinkleber Experimentelle ErgebniBe und klinische Erfahrungen

SummaryIn animal experiments the additional sealing of digestive anastomoses with fibrin glue results in an especially fast healing of the intestinal wound with formation of a narrow scar. Between April 1, 1976 and March 31, 1977 we used this method of anastomotic protection in 118 out of 355 patients undergoing extensive abdominal procedures. The two groups were matched regarding age, sex, underlying disease, and preoperative albumin level. Use of the fibrin glue resulted in a considerable decrease of postoperative mortality and incidence of ileus. Leakage of the suture line was seven times leB frequent than in the control group.ZusammenfaBungIm Tierexperiment führt die ergänzende Fibrinklebung digestiver Anastomosen zu einer besonders zügigen Abheilung der Darmwunde mit zarter Narbenbildung. Im klinischen Bereich kam die Methode vom 1.4.1976 bis 31.3.1977 bei 118 von 355 groBen abdominalchirurgischen Eingriffen zur Anwendung. Beide Patientengruppen waren hinsichtlich Alter, Geschlecht, Grundkrankheit und präoperativem Albuminwert ausgeglichen. Die zusätzliche Fibrinklebung führte zu einer erheblichen Senkung von postoperativer Letalität und Ileushäufigkeit. Anastomoseninsuffizienzen wurden 7 mal seltener beobachtet als in der Kontrollgruppe.

140. Vergleichende Untersuchungen verschiedener Anastomosentechniken am Verdauungstrakt des Hundes

Summary104 anastomoses of the gastrointestinal tract were constructed in dogs, with 3 different suturing techniques: single-layered inverting, double-layered inverting and single-layered edge-to-edge. Macroscopic, microangiographic and histologic examinations and tension testing were carried out 4, 8 and 18 days after operation, The edge-to-edge anastomosis proved to be superior in all respects. Healing took place without bulges or stenosis. The resulting scar was narrow and delicate in appearance, with earlier and more regular vascularization. It showed a higher tensile strength throughout testing. Re-epithelization was accelerated.ZusammenfassungAn 104 Anastomosen des Hunde-Magendarmtraktes wurden ein- und zweireihig invertierende und einreihig auf Stosß adaptierende Nahttechniken 4, 8 und 18 Tage p. O. makroskopisch, im Zugversuch, mikroangiographisch und histologisch untersucht. Bei allen Kriterien erwies sich die schichtgerechte Anastomose überlegen; sie heilte ohne Wulstbildung oder Stenosierung, zeigte während des gesamten Verlaufes höhere mechanische Belastbarkeit und bildet unter früherem und geordneterem Gefäßdurchbau sowie frühzeitiger Reepithelisierung eine eng-umschriebene zarte Narbe.