[So-called fetal form of the vermiform appendix].
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Biomedical subjects
Publications and source records attributed to G Schindler.
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Quantitative hepato-biliary functional scintigraphy (HBFS) determines the post-hepatic, ie. biliary, passage of diethyl-IDA through the liver and bile ducts. Time-activity curves of representative regions of the liver parenchyma and hilum are obtained. Subtraction of the parenchymal curve from the hilum curve produces a hilum flow curve, which provides an accurate measure of flow through the main biliary ducts. It allows one to differentiate the dynamic effects of various post-hepatic forms of obstruction. Dyskinesia and retention can be defined as pathological phenomena in a new way; dyskinesia is defined as intermittent flow, retention as delayed flow of bile into the duodenum. The method is only useful after removal of the gall bladder. The information provided is independent of the shape and size of the selected regions.
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Following oral cholecystography in 100 patients, the conventional "fatty meal" was replaced by an intramuscular injection of Ceruletid in a dose of 0.4 microgram/kg body weight. The synthetic decapetide Ceruletid is a substance with a hormone-like effect on the gastro-intestinal tract. It contracts smooth muscle in the gut and stimulates secretion in the stomach and the exocrine pancreas. Compared with other substances producing contraction which are given orally, Ceruletid acts more quickly and more powerfully in producing contraction of the gall bladder muscle. In 86% of positive cholecystograms, this resulted in satisfactory demonstration of the bile duct, 66% better than for oral substances. Many abnormalities, particularly localised adenomyomatosis, can only be diagnosed after good contraction of the gall bladder. Side effects, such as nausea, dizziness and a feeling of heat were transitory. In three patients it led to vomiting. The rapid and certain effect of Ceruletid during oral cholecystography requires reassessment of the role of intravenous cholangiography in diagnosis. Particularly amongst out-patients, with a high proportion of normal gall bladders, it is possible to complete the examination in one stage by demonstrating the bile duct with Ceruletid.
Local tumour recurrences at colonic anastomoses in an early, curable stage are rarely missed by double contrast enema. On the other hand, the variable appearances caused by inflammatory lesions, which delay healing of the anastomosis, are often misinterpreted as recurrences. Early post-operative investigation with a water-soluble contrast medium is therefore important. Small and transient leaks at the suture line may cause intramural inflammatory lesions with a variety of symptoms and may be confused with local recurrences. They are due to delayed healing at the anastomosis and will only be interpreted correctly if there is regular radiological follow-up.
Following resection of carcinoma of the colon, local recurrence at the site of the anastomosis must be expected in about 10%. Recurrence diagnosed early can be resected in 50%. Double contrast technique has proven to be most helpful in early diagnosis of recurrence. Therefore, radiographic follow-up examination, in adequate time intravals permit an early differentiation between lesions due to recurrence and due to the surgical procedure or prolonged healing of the anastomosis. Close cooperation with clinical follow-up, especially by endoscopy and biopsy, guarantees reliably good care of patients after resection of cancer of the colon or rectum.
1. Substance P (SP) could be extracted from brain homogenates with chloroform-methanol by a method which extracts all lipids. 2. SP could be transferred form this total lipid extract (TLE) into an aqueous solution at low pH values (2.0--3.0). 3. At higher pH values (5.5) SP could be transferred from an aqueous phase into an organic phase (chloroform:methanol, 2:1) and recombined with TLE (which was previously freed from endogenous SP) contained in this phase. The binding capacity of TLE for SP exceeded by far the amount of endogenous SP bound originally in the brain extracts. 4. Among the lipids present in TLE, phosphatidylserine was able to bind and release SP in a pH dependent manner. 5. It is suggested that SP bound to phosphatidylserine is the storage form of SP in the brain. The mechanisms by which it is released are still unknown. The possibility that the SP-receptor is also a phospholipid is considered.
Multiple phaeochromocytomas represent a polytopic form of chromaffin tumours. The tumours may arise simultaneously or sequentially in chromaffin tissue, particularly in the retroperitoneal space. Malignancy can only be assumed if there are metastases to organs which do not contain chromaffin tissue. Their origin may be regarded as a dysontogenetic event. The clinical picture is dominated by the excretion of catecholamines. Laboratory tests are therefore used to determine the suspicion of the presence of a chromaffin tumour. A patient with an eight-year history is described, who had had four operations and in whom, by radiology or surgery, seven phaeochromocytomas had been found. The value of various radiological methods is discussed. The most informative method is arteriography; in view of the possibility of multiple tumours, aortography should be carried out in the first instance.
1. Rat brain synaptosomes were incubated under different conditions to study the release of substance P (SP). 2. Potassium ions and electrical field stimulation induced a loss of SP from synaptosomes. The release of SP by potassium in high concentrations (23.8 mM) was shown to be calcium dependent. 3. Substance P was retained in synaptosomes during incubation in 0.32 M sucrose at +4 degrees C up to 120 min. During incubation at 30 degrees C the SP content fell initially (30 min) but was gradually restored (120 min). 4. If these pre-incubated synaptosomes were reincubated for 45 min at 30 degrees C in potassium free Krebs-Ringer-phosphate buffer a further rise in their SP content occurred which was taken as indication that SP is being synthesized in synaptosomes. 5. The newly synthesized SP is presumably stored by binding to phosphatidyl serine until a sudden release is initiated by depolarization.
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In a joint retrospective study by 17 radiotherapy clinics in German-speaking countries the results of treatment of bronchial carcinoma after radiotherapy were analysed in 7503 cases. The age peak was between the 60th and 70th year. Squamous-cell carcinoma was the most frequent histological type, followed by anaplastic carcinoma, with adenocarcinoma being rare. There was a high proportion of histologically not clearly identified cases (27% in central and 35% in peripheral carcinomas). Survival rate at one year was 31% for central (3662 patients) and peripheral (961 patients) tumours, but only 2% at five years. Prognostically there was no difference between histological types and kind of radiotherapy or technique, but total dose affected survival rate. At a total dose of less than 5000 rd the survival rate at five years was minimal. The prognosis of combined surgical and radiotherapeutic measures was slightly better than with a radiotherapy alone, but results were unpredictable for the individual case. It is concluded that radiotherapy aiming at cure should be used in imoperable bronchial carcinoma if the tumour state and general condition of the patient appear to make a cure possible. But if this is not the case, radiotherapy should be used only palliatively, i.e. only to ameliorate symptoms.
The evaluation of spleen length from routine x-ray films of the left epigastrium of 97 healthy patients suggested a close correlation to the height of the 12th thoracic and the first three lumbar vertebral bodies. The normal ratio of spleen length to the vertebral height Th 12- L 3 is 0,82 +/- 0,09, two standard deviations are represented by ratios from 0,64 to 1,0. Spleen length over vertebral height Th 12 -L 3 indicates pathologic enlargment of the spleen. 54 patients with diseases which may cause splenomegaly showed spleen lengths mostly over the heights Th 12 - L 3.
The skip-technique may be used either for screening or lessening the radiation load to sensitive sound organs or for an adjusted formation of the isodoses or for both. To show the possibilities of application of this elegant and quite practicable method, some examples are reported concerning spondylous processes, para-aortic lymph nodes and tumors in the small pelvis. The loss of radiation dose because of the additional opening and closing procedure of the diaphragm demands a correction of the duration of irradiation.
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