[Surgical therapy of primary reflux disease of the esophagus].
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Biomedical subjects
Publications and source records attributed to B Husemann.
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Experiments were conducted on Wistar rats for the purpose of finding out, whether peroral vitamin C application is capable of inhibiting carcinogenesis through subcutaneous injection of nitrosamine. One group of animals received injections of N-nitrosodiethylamine, while high doses of vitamin C were additionally administered to a second group in drinking water. Vitamin C only was given to a third group (control). Numerous liver carcinomas developed in response to nitrosamine application. No numerical difference was found to exist between the groups with and without vitamin C.
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High 10-year recurrence rates following proximal gastric vagotomy (PGV) for pyloric/prepyloric ulcer (31.6%, European trial) result from antral stasis (Dragstedt-mechanism). Additional pyloroplasty reduces the recurrence rate to 16.6%. General causes of recurrence following PGV are primarily incomplete vagotomy and smoking: For incomplete vagotomy (Burge-test) 24.4% recurrences, for complete vagotomy 13.6% (10-year results); in smokers 38%, non-smokers 12%. Therapy is conservative in 80%. Selective gastric revagotomy and antrectomy as reoperation shows lowest recurrence rate (1.2%). The major cause of recurrence after partial gastrectomy is inadequate resection. Conservative therapy is successful in 76%. Reoperation should be transthoracic vagotomy with no mortality in 11 centers.
In a 14-years period (1970-1984) eight-three patients were operated on for primary hyperparathyroidism (pHPT) at the University Hospital of Erlangen. Special attention was paid to associated diseases, symptoms, preoperative diagnostic parameters were serum calcium, parathyroid hormone in venous blood, cyclic AMP in 24 h-urine. In 15.7% only borderline increased serum calcium values were measured. Ulcer incidence in pHPT was 19% as compared with approx. 7% in the general population. There was no increased incidence of pancreatitis in pHPT. The possibility of an association of pHPT with the Multiple Endocrine Neoplasia (MEN) syndrome was emphasized and measures of early diagnosis proposed.
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An absolute indication for thymectomy exists in all cases with tumors of the thymus gland, however, preoperative differentiation between benign and malignant lesions is not always possible even with modern imaging methods. In extensive tumors of questionable operability preoperative transthoracic needle biopsy (guided by CAT-scan) is recommended. After establishing the histological diagnosis, preoperative radio- and/or chemotherapy can be considered. Certain immunological diseases are a relative indication for thymectomy. Its value is proven in myasthenia gravis, questionable however in ulcerative colitis and erythroblastopenia. Systemic lupus erythematosus is a contraindication.
From 1977 to 1984 esophageal resection and reconstruction by stomach due to squamous cell cancer of the esophagus was carried out by an abdomino-thoracic approach in 53 (A) and through a left-transthoracic approach in 57 (B) patients. Localisation and safety margins were practically identical: median orally A = 24, B = 29 mm, aborally A = 71, B = 49 mm. The overall lethality is significantly different: A = 41.5%, B = 22.8%. Without preoperative radiation or chemotherapy the mortality reaches in group A 39.5% and B 19.0%. Leakage rate in both groups is still high (A = 20.8%, B = 8.8%). However, the lethal respiratory insufficiency rate dropped from 15% (A) to 5% (B).
Squamous epithelium carcinoma of the esophagus occurs seldom in the Federal Republic of Germany and is not usually discovered until it is in an advanced stage. Surgical therapy is full of complications due to the high rate of accompanying illnesses. In the last few years the results could be considerably improved by the use of the stomach as a substitute organ. In spite of this, the five-year survival rate of 5-12% is extremely unfavourable.
The urinary excretion of calcium, oxalate, citrate and magnesium, and the relative saturation products in urine of either calcium oxalate or calcium phosphate, were determined in male duodenal ulcer (DU) patients preoperatively (n = 60), and 1 and 5 years following highly selective vagotomy (HSV), and in male healthy controls (n = 30). In DU before HSV citrate and magnesium were lowered, oxalate was in the low normal range and calcium was normal. The calcium oxalate product was lower than in controls, while the calcium phosphate product was unchanged. Within 5 years HSV normalized urinary citrate and oxalate, but not urinary magnesium, and the median urinary pH was lower than pre-operatively. There thus results a normal product for calcium oxalate, but a reduced one for calcium phosphate. It is suggested that: (1) unoperated DU patients have a urine composition similar to that exhibited in normocalciuric recurrent calcium urolithiasis; (2) this spectrum of urinary constituents may be changed by HSV.
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Only 125 of 287 cases of carcinoma of the esophagus (43%), diagnosed between 1. 1. 1967 and 31. 12. 1980, were resectable. "Curative" resection was possible in only 40 patients. Preferred surgical technique was a one-session resection and pedicle reconstruction of the stomach supplied by the right gastroepiploic artery (99 cases). Post-operative mortality was due largely to pulmonary complications, 60% of all cases by the abdominal-thoracic approach, 7% when thoracotomy only had been performed. Five-year survival rate after "curative" resection was 10%.
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