Biomedical subjects
Publications and source records attributed to K Jaeger.
148 patients with malignant melanoma are presented. Localization, prognosis and clinical stadium are summarized. The surgical procedure is still three-dimensional excision. The latitude of defects asks for a specialists surgeon.
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To investigate the immunological status of hepatic grafts we transplanted livers from different inbred rats orthotopically on 58 LEW rats; rearterialization of the grafts was achieved with an hepatico aortal segment of the donor. Survival time depended on the donor strain; LBNF1-allografts survived in 67% (n = 12), WiS- in 60% (n = 20) and BUF- in 43% (n = 14) indefinitely. In the DA-to-LEW-combination we found no long-term survivor. Liver perfusates (LP) were prepared from 10 BDE and 10 LEW; after keeping the livers for 6 h at room temperature we perfused via portal vein with 2 ml/g Ringer's solution five times. The treatment of BDE-kidney recipients (LEW) with LP showed prolonged survival; at 5 days application 10.2 +/- 1.3 d (control: 6.5 +/- 0.5 d; P less than 0.001), at 10 days treatment 15.3 +/- 7.3 d. In vitro LP inhibited the PHA-stimulation of LEW lymphoid cells in more than 90% and the ConA-stimulation of LEW spleen cells in more than 95%. In MLC LP showed strong inhibitory effect (inhibition rate greater than 97%) even when different combinations of responding and stimulating cells were used. We assume that an unspecific immunosuppressive hepatic factor is released from ischemic damaged liver grafts which is able to prevent rejection in the induction phase. In WiS-liver recipients surviving for more than 4 months GvHR was tested after splenectomy with spleen cells. All tests showed a grade III reaction. Donor-specific skin grafts which were transplanted on these recipients survived indefinitely while third party skin grafts were regularly rejected (7.6 +/- 0.5 d). We therefore can conclude that the cellular immunosurveillance is intact, but the immunological response against donor-specific antigens is reduced. With transfer of serum from long-term-surviving WiS-liver recipients (greater than 6 months) WiS-kidney grafted LEW were able to survive also prolonged (20.7 +/- 3.4 d, control 6.2 +/- 1.0 d; P less than 0.001). Lymphoid cell transfer (1 X 10(8)) did did not result in significant prolongation of survival time (8.0 +/- 2.0 d). These observations suggest that in the steady phase specific humoral transfer factors are responsible for prolonged survival of hepatic grafts.
This paper describes a situation where an alteration in the final-year assessment scheme led to changes in student learning activities which were the exact opposite of those intended. Students were seen to be spending a disproportionate amount of time studying the theoretical components of the course relative to the practical and clinical aspects. The paramount importance of the assessments and examinations in influencing student learning behaviour led the departments concerned to develop a new clinical examination which more clearly reflected the objectives of the course. A questionnaire survey was undertaken to determine how the different sections of the final assessment affected the students' approach to studying. The questionnaire was administered to graduates during their intern year for the 3 years following the introduction of the new clinical examination. Results were also obtained for the year preceding the change. The survey showed that the students developed a high regard for the new examination and its validity as a test of clinical competence. The students found that an increase in ward-based learning activities was essential for success in the final examinations. The new clinical examination has thus influenced students' learning and successfully restored the balance of their learning activities between the clinical and theoretical components of the course.
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Twenty two latissimus dorsi free flaps transplanted with microsurgical techniques in infected regions are presented. The guarants of success are the end-end anastomosis, the venous drainage over the deep veins, the muscle with its skin coverage. The indications are: soft tissue infections, early infections after fractures, and the chronic osteitis. The economic, social and psychological effects of microsurgical tissue transfer elevate this technique to the procedure of choice.
A group of 114 colorectal resections was investigated for preoperative haemoglobin and haematocrit in relation to postoperative septic complications. The group subdivided in men and women with and without complications were comparable in respect of their age and their diseases. There were significant differences in the preoperative levels of Hb and Ht in the groups with and without postoperative septic complications (p less than 0.05). The mean values were 14.7 g/dl for men with postoperative complications and 13.7 g/dl for those without any complications. The corresponding Ht-values were 45% vs. 42%. The mean values of Hb for women were 13.9 g/dl in the groups with postoperative complications and 12.9 g/dl in those without any complications (Ht-values 43% resp. 39%).
125 patients suffering from hiatal hernia were seen at the Surgical Clinic of Bonn-University between 1963 and 1977. 76 patients underwent surgery and could be followed-up. Our treatment of choice is gastropexy.
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Radical operative treatment of ulcerative colitis and regional granulomatous enteritis leads to satisfactory short-term results. The high mortality of one-stage proctocolectomy in the acute case can be markedly reduced by a staged operation. The same applies for surgery in toxic megacolon. Preservation of continence in ulcerative colitis is rarely possible without endangering long-term results. Chances of evading life-long ileostoma in granulomatous enteritis are very much better. The prominent ileostoma represents a great step forwards. Conservatively treated patients with ulcerative colitis are by no means free from the risk of dangerous complications. 10% had to undergo surgery in the end and only 36% were symptom-free according to their own evaluation. Out of patients with ulcerative colitis treated with procto-colectomy and ileostoma 75% were completely symptom-free. Patients with symptoms had not obtained a prominent ileostoma or it was unsuccessful. Acute ileitis should not be treated operatively. Surgical treatment of chronic granulomatous enteritis need seldom be urgently performed and should be carefully evaluated. Late mortality in operated patients occurs only in the young, in a small percentage due to relapse.
In treatment of malignant lymphomas exploratory laparotomy with splenectomy, liver and lymphnodes biopsy is necessary in order to individualize appropriate management. The surgeon must make maximal effort to obtain lymphnodes for histological examination. The surgical anatomy of the retroperitoneum in space of abdominal aorta and the biopsy procedure of paraaortic lymphnodes were described. The literature was reviewed.
A case of esophageal Crohn's disease occurring in a 40-year-old woman with proctocolitis and oral manifestation is reported. A possible connection between Crohn's disease and Behçet's syndrome is discussed. A survey of the literature indicates that comparable lesions occur very rarely.
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