Biomedical subjects
Publications and source records attributed to H Bünte.
The contradictions implied in any effort to differentiate from each other postoperative loop syndromes following partial gastrectomy were found to call for systematisation. Reference is made in this paper to syndromes of afferent and efferent loops. The authors present their own modification developed to prevent the Roux-Y syndrome.
Posttransplant renal artery stenosis (TRAS) as a cause of secondary hypertension is reported with an incidence of 1 to 10%. Early diagnosis of TRAS should be made by non-nephrotoxic and non-invasive means to lower the risk of hypertension. One to 66 months after kidney transplantation 335 patients underwent Duplex-scanning, 38 of cases for clinical tentative diagnosis of TRAS. Parameters for clinical diagnosis of TRAS were diastolic hypertension greater than 100 mm Hg with resistance to therapy (A), an abdominal bruit over the transplant (B), disturbance of renal function (serum-creatinine greater than 2 mg/dl) (C). Admission to study followed the parameter-combination A + B. A + C, B + C. Rejection crisis was excluded in 18/38 cases by fine needle biopsy, cyclosporine over-dosage was negative in 38/38 cases, 20/38 cases had normal renal function. Duplex-/Doppler-ultrasound criteria for TRAS were systolic peak velocity greater than 100 cm/s-1 and broadening of the diastolic frequency spectra with a smooth decline in diastole to an elevated diastolic level. In 32/38 cases (84.2%, n = 38) diagnosis of TRAS was made by duplex-scanning, angiography confirmed the result in 30/32 cases (93.75%, n = 32); sensitivity was 88.2% with a specificity of 66.6%. Duplex-scanning as a primary diagnostic means for TRAS seems a promising method compared to e.g. radionuclide imaging or angiography. Duplex-scanning is a non-nephrotoxic and non-invasive procedure repeatable at any time with only few preliminary conditions.(ABSTRACT TRUNCATED AT 250 WORDS)
The results of endoscopic therapeutic methods (EST, TPCD), which changed the therapy of the frequent biliary duct and of the diseases of the pancreas, are discussed and the literature and treatment of our own patients are discussed. The choice of optimal therapy for the patient is possible only if endoscopic methods are part of a combined endoscopic-surgical concept of therapy selected in close cooperation with the surgeon. The therapy of cholelithiasis and acute pancreatitis are used as examples.
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From January 1, 1973 to October 31, 1987 we treated 271 patients suffering from acute pancreatitis at the Department of General Surgery at the University Münster, Westphalia. 159 (58.7%) presented with stage I, 75 (27.7%) with stage II, and 39 (13.6%) with stage III disease according to the Mainz classification for acute pancreatitis. In 147 cases an endoscopic sphincterotomy (EST) was performed. At a low method-specific morbidity (5.4%) we observed a mortality rate of 0% for stage I, 8% for stage II, and 22% for stage III. Altogether, a mortality rate of 13.3% was calculated for the necrotizing forms of acute pancreatitis after EST, compared to 36.5% for a conventionally (conservative therapy, operation) treated group.
The place of endoscopic sphincterotomy (EST) as primary and sole invasive treatment was retrospectively analysed in 185 patients who had the procedure performed because of choledocholithiasis and/or stenosis of the papilla. EST was successful in 99.5%, with an early complication rate of 3.8%, an early mortality rate of 0.5% and an emergency operation rate of 0.5%. Freedom from stone in the choledochal duct or adequate bile flow was achieved in 94.1%. Late complications, on average 36.5 (6-75) months after the procedure, was 16.9%, late mortality 2.8% and operation rate for complications 5.6%. Even without stones in it the gallbladder was the cause of late complications in over 60% of cases. Comparison of results between operative treatment and EST indicated advantages of the former up to the age of 60 years, combined cholecystectomy and EST up to 70 years, while EST alone seems justified in older patients.
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The Caroli syndrome is a rare autosomal-recessively inherited disease with cystic dilatation of the intrahepatic bile ducts. Cystic bile duct dilatations are usually accompanied by cholelithiasis and subsequent cholangitis. This is the most substantial danger implied in the Caroli syndrome. It has often been left unconsidered as a cause in differential diagnosis of cholangitis, resulting in undetected protracted course of the disease. Once an unambiguous diagnosis has been established, the authors, by their own experience from three cases and with reference to the literature, recommend subtotal hepatectomy as optional therapy.
The platinum-multiwire-surface electrode after Kessler and Lübbers gives the opportunity of direct measuring of the local tissue-pO2-pressure; this 8-wire electrode with a Pt-wire-diameter of 15 microns operates on the polarographic principle. Each Pt-wire has a hemispheric collecting area of about 30 microns. Pressure ischemia by compression of capillaries is prevented by proportioning the weight (2.1 g) of the electrode. Data output is done by continuous pO2 measuring; pO2 histograms. During the continuous pO2 measurement the electrode stays on the tissue measuring point thus enabling the direct record of quickly proceeding reactions. The pO2-histogram exhibits the statistical distribution of the local partial oxygen pressures in a studied organ, a quasi sample inquiry is performed in the tissue, based on minimum 100 single values that are obtained by repeated manual repositioning of the electrode. By this, values are obtained on the level and distribution of local pO2 in the tissue so that condition and function of the microcirculation can be objectively assessed. Immediate alterations in the local tissue pO2 suggest regulatory adjustment after hemodynamic changes. Technical problems connected with pO2 measurement in clinical use (sterilization, data acquisition and presentation) are described. The presented technique gives the chance to exactly assess the effects of vasoactive drugs on the microcirculation and to quantify the results of operations, for example after bypass-surgery.
Hypoxic and ischemic states are the main problem makers in angiology and vascular surgery. It is therefore suggestive to employ the technique of tissue-pO2 measurement for the verification and support of diagnostic and therapeutic measures. Two forms of registration are possible: continuous monitoring of partial oxygen pressures in eight different places and registration in the form of pO2-histograms, which represents a kind of "representative opinion poll" held in the tissue. The effects of a surgical intervention (endarterectomy, bypass operation) and the efficacy of blood flow-promoting drugs were studied in several series. In 9 patients the effect of the blood flow-promoting agent pentoxifylline (3,7-dimethyl-1-(5-oxohexyl)-xanthine) was studied. The pO2-histograms exhibited a shift to the right by an average of 7 mmHg after administration of this drug. Moreover, findings obtained with sodium nitroprusside and nitroglycerin during induced hypotension indicate that the continuous measuring of tissue-pO2 and recording of oxygen pressure distribution curves (pO2-histogram) provide the clinician with essential guidance data for the improvement of diagnostics and therapeutic control.
At the Surgical Department of Münster University in-patient treatment was applied to 320 patients for pancreas carcinoma, between 1977 and 1984. These cases were concomitantly studied for informative potentials of computed tomography (CT), sonography (Sono), and endoscopic retrograde cholangiopancreatography (ERCP). CT was performed on 163 patients (50.3 per cent), Sono on 180 (56.3 per cent), and ERCP on 90 (28.1 per cent). Highest sensitivity was recorded from ERCP, with 91.1 per cent of correctly positive diagnoses. CT gave correct positive findings in 70.5 per cent of all cases and Sono in 61.1 per cent. Resection rates were not increased by introduction of these new techniques, but the rate rather stayed at 14.8 per cent. While the period between hospitalisation and operation was slightly reduced, surgical intervention was too late for curative resection in most cases. In some highly advanced cases with distant metastases but absence of symptoms on the basis of CT findings, exploratory laparotomy was abandoned. The new methods have improved diagnostic accuracy rather than prognosis of pancreas carcinoma.
In-patient treatment was applied to 64 patients for carcinoma of Vater's papilla at the Surgical Department of Münster University, between 1974 and 1985. Their average age was 57.3 years. Most of the tumours investigated were highly or moderately differentiated. The average time that passed from the first symptoms was 2.4 months, before most of the patients sought medical consultation for jaundice and loss of weight. Tumours were removed from 54 patients (84.4 per cent). No curative therapy was possible in ten cases. Lymph node or distant metastases were recorded at the time of treatment from 16 of all 64 patients or from six of those who had undergone radical resection. Five-year survival probability after curative surgery was attributed to 42.1 per cent of all patients concerned.
Thirty-three patients with malignant melanoma and regional lymph node metastases who underwent lymph node dissection were additionally given polychemotherapy with carmustine, hydroxycarbamide and dacarbazine immediately before surgery and up to five times postoperatively. Twenty-nine patients were only treated surgically. These two groups were comparable as regards prognostic criteria, in particular tumour size, ulceration and the number of lymph nodes affected, although the individual follow-up periods varied considerably. The group given chemotherapy showed better results than the control group undergoing surgery alone. The log rank test yielded a significant difference (P less than 0.05) with respect to the probability of relapse-free survival but not as regards probability of survival time. Patients with ulcerated primary melanomas and with a large number of affected lymph nodes had a less favourable prognosis. The major side effects of chemotherapy were transient nausea and bone marrow depression.
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Criteria of indication for operative treatment of ileus have not very much changed through the last years. Operation as soon as possible will bring the best results. Hence in most of the cases a temporary stoma can be avoided in favour of primary anastomosis. In case of recurrent ileus careful enterolysis is of great importance. Affixiation of the small intestine and application of tubes have not proved to be of value. They do not prevent relapse, are attended with complications and render every future operation difficult.
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