Biomedical subjects
Publications and source records attributed to H J Peiper.
From 1972 to 1981, 806 patients suffering from diseases of the bile ducts were seen at our Dept. 20% of them were over 70 years of age. Mortality rate, types of surgery, complications and causes of death are dealt with in detail. All the facts given demonstrate the necessity of early surgical intervention in case of surgical diseases of the bile ducts.
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Early gastric cancer, i.e., a tumor of intestinal or diffuse cell type confined to the mucosa or submucosa, has so far been found in only 6% of all cases of gastric carcinoma in Europe, whereas the Japanese report a percentage of 30%. This tumor stage has a very good prognosis with a survival rate of 95% or 87%. If the tumor lies in the distal half of the stomach, a subtotal gastrectomy is justified, whereas we recommend total gastrectomy in a more proximal localization. In exceptional cases such as a polypous tumor situated near the cardia, an endoscopic resection or local excision may be considered.
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Endocrine tumors of the pancreas apparently develop from a premature stem-cell, possibly originating from the ectodermal neural crest. These tumors belong to the APUD-cell system, which is identical with the "Helle-Zellen-system". Following a description of the various forms of appearance there is a discussion of the different syndromes. The present-day differentiated diagnostic procedures are described. Finally, details and problems of treatment, especially regarding surgical intervention, are discussed. Cases from the author's own clinic are considered.
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Circumscribed or diffuse non-puerperal mastitis is usually associated with local signs of inflammation. In two-thirds of these cases it is possible to demonstrate the radiological features of mastitis. Mammography is an important diagnostic procedure in the demonstration of acute mastitis and its differentiation from an inflammatory carcinoma; it is also valuable in the control of treatment. The success of intensive antibiotic therapy with recovery of normal appearances in the chest can be observed objectively by mammography. In distinguishing mastitis from an inflammatory carcinoma, radiological evidence of regression under the influence of antibiotics is evidence in favour of mastitis.
The columnar epithelium lined esophagus is usually the result of a chronic reflux disease. In the literature one can find more and more references to a malignant transformation of this columnar epithelium. Our own observations of 14 patients with an adenocarcinoma in a columnar-lined esophagus support this suspicion. Because the adenocarcinoma of the esophagus has therapeutic consequences other than a squamous carcinoma of the esophagus, the surgery has to give attention to this malignant transformation of the columnar-lined esophagus.
This paper deals with the basic surgical principles in inoperable tumours. In case of inoperability the possibilities of palliative surgery should be examined: palliative resection, quantitative tumour reduction, different bypassing procedures in the G.I-tract, amputation, exarticulatoan. It is most decisive to keep the balance between intended effect and operative risk or prognosis of the underlying disease respectively, Additional conservative measures enlarge the indications of palliative surgery.
Of 51 patients with primary hyperparathyroidism (2 patients with MEN, Type 1 clinical symptomatology, diagnostic procedures, differential diagnosis, operative strategy and long-term results are being reported. Aside from clinical findings and radiologic signs in our hands determination of the ionized serum calcium fraction, results of chrest bone biopsies and parathormone determinations are best parameters to substantiate the diagnosis of PHPT. Parathormone radioimmunassay determination is very helpful in localizing the adenoma, especially in cases of reoperations. Five patients were seen in acute hypercalcemic crises, in which emergency operations are absolutely indicated. Postoperative hypercalcemia and recurrencies were observed in 3.9%. Successful extirpation of parathyroid adenomas (15% multiple adenomas were found) is the therapy of choice in PHPT, only in cases with hyperplasia subtotal parathyroidectomy is indicated.
During long-term dialysis of patients in chronic renal failure disorders of mineral metabolism in the sense of renal osteodystrophy occur increasingly with time. Quite separate from these patients with renal osteopathy (osteomalacia and osteopenia) as a result of dialysis there is a group of patients in whom, despite appropriate dialysate composition, a full-blown picture of renal osteodystrophy due to secondary hyperparathyroidism develops. Subtotal parathyroidectomy will significantly improve them. Experience in 12 patients has demonstrated that, in addition to the clinical signs, biochemical findings and radiological changes, the quantitative evaluation of iliac crest biopsy and determination of parathormone and ionised serum-calcium fraction are decisive as indications for surgery. In these patients subtotal parathyroidectomy gave satisfactory results, but the treatment of renal osteopathy in the sense of osteopenia is often unsatisfactory and the full clinical picture can often be improved only by early renal transplantation.
Improvement of the results of treatment was achieved only when an increased number of patients were diagnosed in stage I. The prerequisite for limitation of radical surgery is histomorphologic classification of the stages. The central axillary group of lymph nodes appears to be representative of lymph node involvement. Differentiated methods of operations range from local excision to mastectomy in case of precancer. In histologic stage I, modified radical mastectomy; is the treatment of choices; operations with further limitations are recommended only within the scope of controlled studies. In stage II, the classical ablation is still the safest procedure.
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On the basis of four cases from our own clinic and three outside cases, we describe a so-called, "telescope phenomenon". This involves a specific complication that may arise after fundoplication. The characteristic of this postoperative complication is the slipping down of the fundus cuff, accompanied by a telescopic pushing upwards of the cardia. Recurrent reflux and occasionally new manifestations of dysphagia are the clinical results of this. This paper describes the diagnostic procedure and therapy of the telescope phenomenon.
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