Biomedical subjects
Publications and source records attributed to H Albert.
At present the technique of selective proximal vagotomy (SVP) seems to be standardized. Nevertheless, the surgical procedure is practiced by many authors in a different way concerning the proximal and distal borderline of denervation. In our opinion pylorplasty should only be performed in those patients suffering from retention or stenoses.
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After surgery for gastric or duodenal ulcer the resorption of amino acids is changed due to alteration of morphology and function of stomach, bile system, pancreas and small bowel. We used the stable isotope labelled amino acid 15N-glycine in patients after partial gastrectomy (B II), truncal vagotomy with pylorplasty as well as antrectomy and in healthy persons. It could be shown that in contrast to the control group the absorption of the amino acid in the surgical group took place more rapid and more intensive.
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By use of stable isotope labeled amin acid 15N-glycine the effects of truncular subdiaphragmatic vagotomy and of pyloroplasty, which are comprised in the method of bionomic gastric operations, were studied separately. The assessment of nitrogen equilibrium in rats after only truncular vagotomy, only pyloroplasty, truncular vagotomy combined with pyloroplasty, and without surgery serving as controls yielded results as following: After truncular vagotomy the 15N equilibrium was worse than in the control animals or after pyloroplasty only. The cause of that is an enhanced nitrogen loss in urine. After truncular vagotomy with pyloroplasty, though, 15N excretion in feces was significantly higher than after only pyloroplasty. It may be concluded from these results that truncular vagotomy is primarily responsible for the disturbances in protein metabolism. Pyloroplasty in combination with truncular subdiaphragmatic vagotomy also causes a higher nitrogen excretion in the feces indeed.
In the era of selective vagotomy the gastric motility is increasingly important. Measuring methods are demonstrated as to electromyography, intraluminal pressure measuring, measuring of emptying using isotope labeled food, and serial X-ray technique with amplifier photography. Measurings were performed in 12 patients, before and 4 months after selective proximal vagotomy. The bioelectric gastric activity is hardly influenced by selective proximal vagotomy. Enhanced antral peristalsis (tonic and peristaltic contraction) and delayed emptying are observed in cases without pyloroplasty. The authors therefore recommend that preoperative examination of motility in combination with intraoperative findings should indicate the pyloroplasty.
In preparation for surgery of the colon and rectum 50 patients were fed an oral balanced synthetic diet. Additionally, antibiotics were administered. With the exception of 4 patients the bowel was completely free from faeces. During the preoperative period, averaging 5 days, no pathological laboratory findings were observed. On the 5th day of the oral diet feeding there was a total N-retention rate of +2,8 +/- 1,2 N/day.
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In different intervals 220 patients were examined after a resection of the stomach with Billroth's second operation. 179 of them spoke about complaints of different degrees of severity. The cases in question were an early dumping syndrome in 83 patients, which, with the exception of 7 patients, could be removed by simple dietetic measures, such as the elimination of incompatible foodstuff. Again and again the symptoms could be evoked by provocation with it. The method described by Henley proved as correcting operation. Apart from a few exception the fitness for work was not restricted by Billroth's second operation. In shift work or severe physical work a change of the working place was striven for. The body-weight which was reduced already before the operation again increased after operation in 50%, but reached the normal only in 20%. Recidivation ulcera and anastomositis of a suture were rare findings. Stump gastritis is no own clinical picture. Also in this case in histologically still normal mucous membrane earlier histochemical changes develop in the sense of a chronic gastritis with a reduction of the adenosin triphosphatase, the acid tissue phosphatase and succinodehydrogenase.
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The nowadays best treatment of the hypernephroid carcinoma of the kidneys is the radical tumornephrectomy with following supervoltage-radiation. Recently before any surgical treatment a short radiation with a dose of 1 500 up to 2 000 R is recommended. Hereby a preoperative devitalization of tumor-cells should be achieved. An application of cytostatica would be useless. Sometimes in generalized cancers a recession of the metastases and a stagnation of the growth of the tumor for a long time can be achieved by the application of gestagens. The statistical analysis of results won in a clinic or by some defined modalities of treatment respectively the comparison of these results with the ones won by other authors is rather difficult. This would demand comparable collectives of patients. With the relative rarity of kidney cancers this would be only possible if many clinics would co-operate on a national and international base and if the modalities of treatment were equal. Not before the question for the best therapy of the hypernephroid carcinoma of the kidneys can be answered.
Brine aerosol inhalations cause reactions of the nasal mucous membrane and the submucousal vascular bed as is shown by rhinomanometric examinations of healthy persons and patients suffering from various kinds of rhinitis. Changes in the resistance as a whole differ from those in partial resistances. The reactions are depending on the form of inhalation, the spectrum and concentration of the aerosol, climatic parameters and the pathophysiologic condition of the nasal mucosa.
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