Biomedical subjects
Publications and source records attributed to H J Schubert.
Gallstone ileus may complicate biliary disease in 0.3 to 4.0%. The incidence of mechanical obstruction of the small intestine due to gallstones is between 0.1 and 7.7%. This being an illness of the elderly patient, the prognosis is most unfavorable. The mortality lies between 10 and 50%. Further lowering of the mortality rate is only possible by early surgery.
Similar to the high pressure zone of the lower esophageal segment (LES) gastric emptying results from alternating intraluminal pressure in the antrum, pylorus and duodenum. Alterations of this antro-duodenal pressure zone depend on hormonal and nervous control mechanisms and are regulated by intraduodenal localized pH-, osmo- and fat-receptors. Experimental investigations in partially gastrectomized dogs emphasize the important role of the duodenum for gastric emptying. After resection of the lower half of the stomach and reconstruction of the orthograde passage between the gastric remnant and the duodenum by gastroduodenostomy (b i-anastomosis), a hormonally controlled gastric emptying comparable to that of the intact organ can be noticed.
Early cancer of the stomach is defined as a carcinomatous degeneration restricted to gastric mucosa and/or submucosa. The size of extension as well as the mode of perhaps previously spread metastases are not taken into account. The addition early is correct as far as the pathologic-anatomical localized findings are concerned. The clinician however associates early besides the idea of timely recognition and therapy with a better prognosis, e.g. real recovery for the patient. Yet, so-called early gastric cancer does by no means imply absolute curing. Therefore it seems to be more pregnant to speak mucosal and/or submucosal cancer of the stomach.
Benign neoplasms of the esophagus are rare. According to Linder and Grözinger (1968) they come up to about 0,5-2% of all esophageal tumors. Among new growths of mesenchymal origin leiomyomas are dominant in 75-85%. In nearly the half of the concerned patients symptoms occur, indicating operative intervention. At the Surgical Department of the RWTH Aachen besides 58 patients with esophageal cancer only 4 patients suffering from benign tumors have been operated on between 1967 and 1975. Histologically three times the diagnosis of a leiomyoma could be established. In one female, a preoperatively simulated leiomyoma was verified as an intramural cyst of bronchogenic origin. Thoracotomy and enucleation or extirpation are the preferable methods of treatment. Postoperatively no essential complications were seen. A clinically silent fistula healed up spontaneously.
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There is a provable correlation between the housing conditions of elderly persons and their being attached to a network of aid they can rely on in cases of emergency and strain. The elderly living in one or two-family houses, for example, have several options of being supported. The elderly living in big city tenements on the other hand often lack such an abundance of relations. Integration into the circle of family members and relatives plays the major role for these quantitative framework conditions as well as for the immediate availability of assistance. Having a house of one's own increases the possibility of developing a well-functioning cross-generation support system within the family. If promotion of house construction was further adapted to this operating mechanism, support effects for social policy could be reached. At the same time it is imperative to encourage the development of informal support systems within the framework of socio-political initiatives. With the number of childless elderly persons increasing, such systems would partially compensate for the lack of family assistance through neighbourhood and other forms of self-support.
This study presents the results of an investigation of the reasons for the elderly people being cared for as residents of nursing homes or as outpatients. With regard to the reasons for being outpatients or being residents of nursing homes it can be pointed out: elderly people as outpatients can only be cared for as long as there are intact social relations. If services for outpatients are not supplemented by social relations the stay in a nursing home cannot be avoided.