Wolfgang Krautzberger

CA 19‐9 and pancreatic adenocarcinoma

The diagnostic place value of CA 19‐9, a tumor‐associated antigen, was tested in 611 patients. This group of patients included 273 patients who suffered from a malignant disease (48 patients with pancreatic carcinomas and 225 patients with extrapancreatic malignant growths) and 338 patients with benign diseases (66 patients with chronic pancreatitis, 36 patients with acute pancreatitis, and 236 patients with general surgical diseases). In 93% of the patients with pancreatic carcinoma (median value, 528 U/ml), in 37% and 19% of the patients with carcinoma of the stomach and colorectal carcinomas (median value 8 U/ml), respectively, the CA 19‐9 value was estimated as being above the normal limits of 6 to 37 U/ml. A sensitivity of 93% and a specificity of 85%, as well as a total accuracy of 82%, were established in pancreatic carcinoma during preoperative observation. The preoperatively raised CA 19‐9 concentration in patients with pancreatic carcinomas dropped after curative resection of the carcinoma to within normal limits. However, a serum concentration of less than 37 U/ml was not recorded in any CA 19‐9 estimation after a palliative surgical intervention, or in any case of inoperable carcinomas.

A Metastatic Endocrine-Neurogenic Tumor of the Ampulla of Vater with Multiple Endocrine Immunoreaction Malignant Paraganglioma?

The present case report demonstrates the history of a 50-year-old man with a mixed endocrine-neurogenous tumor of the ampulla of Vater. The tumor was localized endoscopically after an attack of melena. There were no signs of endocrinopathy. A local resection with suturing of the pancreatic duct was performed. Morphologically, there were two different tissue types (neurogenous and carcinoid-like) with numerous cells and nerve fibers reacting immunohistochemically with somatostatin and neurotensin antisera: some immunoreactivity to PP-antibodies was observed. Still, after 20 months, the patient seems to have been cured by local resection.

Thromboembolieprophylaxe in der operativen Medizin: Heparin oder Heparin-Dihydroergotamin?

This review summarizes clinical studies on prevention of venous thromboembolism by heparin or heparin and dihydroergotamine. Advantages and disadvantages of both drugs are described. The value of low-dose-heparin can no longer be seriously disputed. Up to now, however, there is no clear evidence that heparin-dihydroergotamine improves the efficacy and reduces the frequency of complications. The later drug is a new approach still under investigation.SummaryThis review summarizes clinical studies on prevention of venous thromboembolism by heparin or heparin and dihydroergotamine. Advantages and disadvantages of both drugs are described. The value of low-dose-heparin can no longer be seriously disputed. Up to now, however, there is no clear evidence that heparin-dihydroergotamine improves the efficacy and reduces the frequency of complications. The later drug is a new approach still under investigation.ZusammenfassungIn dieser Übersichtsarbeit werden die Vor- und Nachteile der medikamentösen Thromboembolieprophylaxe mit Heparin bzw. Heparin-Dihydroergotamin dargestellt. Auf der Basis klinischer Studien und Literaturmitteilungen wird über Wirkungen und Nebenwirkungen berichtet. Es ist feststellbar, daß Wirkungsunterschiede zwischen beiden Prophylaxeformen hinsichtlich der Verhütung postoperativer tödlicher Lungenarterienembolien und tiefer Venenthrombosen bisher nicht zweifelsfrei dokumentiert sind. Wegen spezifischer Nebenwirkungen (Ergotismus) der Kombinationsprophylaxe sind weitere Untersuchungen zur Festlegung der Nutzen-Schaden-Relation erforderlich.

111. Behandlungsergebnisse des axillo-femoralen Bypass beim Risikopatienten in einem zehnjährigen Beobachtungszeitraum

SummaryIn 95 high-risk patients (average age of 68.28 years), 114 axillofemoral bypass operations were performed: 84.48 % of the 116 extremities were in stages III and IV. In elective operations, the operative mortality was 6.3 %. The unilateral bypass showed a cumulative 5-year patency rate of 51.60 %, the bifemoral bypass of 77.14 %. Graft thrombosis was the most common complication (47.37 %); successful revision was possible only in 53.75 %. Therefore we recommend a more strict indication: an operation should be performed only in cases in stages III and IV and only in a “real” high-risk patient.ZusammenfassungAn 95 Risikopatienten (Durchschnittsalter 68,28 Jahre) wurden 1970–1979 114 axillo femorale Bypassoperationen durchgeführt: in 84,48 % der 116 Extremitäten im Stadium III und IV. Derelektive Eingriff war mit einer Operationsletalität von 6,3 % belastet. Die kumulative 5-Jahres-Durchgängigkeit betrug für den unilateralen Bypass 51,60 % und für den bifemoralen Bypass 77,14 %. Häufigste Komplikation war mit 47,37 % die Transplantatthrombose, nur in 53,75 % gelang eine erfolgreiche Revision. Vorrangig erscheint daher eine strengere Indikationsstellung: Operation nur im Stadium III und IV sowie nur beim ßechten” Risikopatienten.