Biomedical subjects
Publications and source records attributed to A Hollinger.
Mammography-screening contributes new diagnostic problems. In spite of sophisticated diagnostic procedures, surgical excision is the only way to diagnosis in microcalcifications. Triple-diagnosis may lead to the correct diagnosis of a carcinoma, but in most cases a tumor has to be excised if present. Specialists in senology tend to expensive and complicated diagnosis.
An unusual tumor of the pancreas occurred in a 42-year-old man who presented with a gradually enlarging abdominal mass and weight loss. The mass was a 2 kg/25 cm diameter encapsulated multicystic tumor closely attached to the body and tail of the pancreas. On light microscopy it showed a predominantly tubular architecture and ultrastructurally numerous zymogen granules could be demonstrated in the tumor cells. It is therefore presumed to be of acinar cell origin. This tumor has features similar to the so-called acinar cell cystadenocarcinoma described in 1981 by Cantrell et al. Sixteen months after resection of the primary tumor a solitary liver metastasis was removed at a second operation.
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Intraabdominal pseudotumor of the plasma cell granuloma type in a 19-year-old man is reported. The patient presented with fever and weight loss lasting months, and the laboratory findings revealed high sedimentation rate, hypochromic, microcytic anemia, thrombocytosis, elevated alkaline phosphatase, decreased thromboplastin time and polyclonal hypergammaglobulinemia. When the plasma cell granuloma was removed, all laboratory findings returned to normal within 3 months and the patient remained asymptomatic during the two-year follow-up.
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Pulmonary varices are dilated pulmonary veins with normal anatomy of pulmonary venous return. Etiology, diagnostic procedures nd different forms of pulmonary varices are discussed. Surgery is indicated for thromboembolic or hemorrhagic complications, or, as in the case of our patient, for suspected malignoma.
207 patients curatively resected for colorectal cancer have been followed up in a prospective, controlled study using serial CEA, ultrasound, colonoscopy and clinical examination for early detection of recurrent tumor. After a median follow-up of 2.5 years, 52 recurrences (25%) have been detected, rising CEA value being the most sensitive indicator (86%) among the diagnostic procedures. 26 patients were reoperated for recurrent disease; in 10 out of 19 patients with local and 3 out of 7 patients with distant recurrence a potentially curative resection was possible. Median survival of patients not operated upon (n = 26) or incompletely resected (n = 13) is 8.5 months, whereas median survival for the 13 patients reoperated for cure has not yet been reached at 2 1/2 years. With respect to resectability, thorough clinical examination and endoscopy have been the most sensitive examinations (both 44%). Aggressive follow-up for suitable patients with colorectal cancer will detect most of the recurrences in an early asymptomatic phase, increase the rate of resectability and prolong survival in selected, curatively reresected cases.
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In 1981, the surgical departments of the 5 Universities of Switzerland and 5 departments of Cantonal Hospitals and City Hospitals performed a total of 77 liver resections. The most prominent indication was liver metastases (especially from colorectal carcinomas), and lobectomy (hemihepatectomy) was the most commonly performed operative procedure. These data are in agreement with the experience of Zurich University Hospital from 1961-1981: 26 out of 45 liver resections were indicated by liver metastases. The overall postoperative lethality was 6.6%; lethality for resection of metastases was zero.
Complications were observed in 19 out of 250 patients undergoing endoscopic papillotomy. In 215 patients in whom papillotomy was successful the frequency of complications was 2.8%, in contrast to 37% in 35 patients with failed therapy (p less than 0.0001). Furthermore, the complications of successful papillotomy were observed immediately, except in one patient with gallstone ileus. The following 19 complications were observed: cholangitis (5), pancreatitis (5), bleeding (5), perforation (2), impaction of the Dormia basket (1), and gallstone ileus (1). Three patients died, all as a result of cholangitis (mortality 1.2%). All patients with pancreatitis had previously had a precutting.
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A two-marker technique avoiding transpyloric intubation was used to measure the volume of gastric secretion, the rate of gastric emptying and the degree of postprandial duodenogastric reflux in 8 dogs, 5 without and 3 with Heineke-Mikulicz pyloroplasties. The stomach emptied after a liquid fatty meal at an overall rate of 4.9 ml/min +/- 0.2 s.e.m. in animals with a normal pylorus and 5.7 +/- 0.2 ml/min in those with pyloroplasties (P less than 0.05). Though mean fractional emptying rates were similar, the fractional emptying rate was greater in animals with pyloroplasties than in those without in the first 10 and in the last 20 minutes. The rate of duodenogastric reflux was likewise greater in animals with pyloroplasties than in those without (1.8 +/- 0.2 ml/min and 0.7 +/- 0.2 ml/min respectively, P less than 0.05). The rates of gastric secretion did not differ materially (2.2 +/- 0.3 ml/min and 2.1 +/- 0.2 ml/min), but a greater proportion of the gastric contents was emptied more than once in animals with pyloroplasties than in those without (7.7 +/- 1.5 per cent and 2.3 +/- 1.0 per cent, P less than 0.05).
A modified Komarov-Marks esophagostomy is described. It was the aim of our experiments to show that this procedure does not harm the vagal innervation of the stomach. The vagal function was assessed by testing (1) basal secretion, (2) 2-deoxy-D-glucose-stimulated secretion, (3) pentagastrin-stimulated secretion, and (4) serum gastrin levels in five mongrel dogs. Each test was performed at least three times in each dog before and after the esophagostomy procedure, respectively. The secretion rates were not affected by surgery. It is concluded that cervical esophagostomy in dogs does not affect vagal stimulation of gastric acid secretion. For the application of tracer substances into the duodenum, two types of conduits are described: (1) a short jejunal segment and (2) a jejunal segment with an invagination valve. The pros and cons of these procedures are discussed.