Biomedical subjects
P C Alnor
Publications and source records attributed to P C Alnor.
[Combination of a hiatal hernia and a transpyloric prolapse of gastric mucosa].
During the past 5 years we operated 13 cases of combination of a hiatal hernia and a transpyloric prolapse of the gastric mucosa. These represent ca. 7% of all operated hiatal herniae. In addition we treated 9 cases conservatively, at that the combination of a loose cardia and a labile pylorus was diagnosed through endoscope. Results of these both treatments are satisfactory. 12% of operated hiatal herniae are combined with duodenal ulcer but only 4% with gastric ulcer. It may be concluded that gastric entrance (cardia) and exit (pylorus) have a close connection.
[C. Controversial technical and methodological problems in abdominal surgery. 1. Bile: a) Procedures in intraoperative actualization of papillary stenosis. Papillotomy in principle].
A critical comment on the question of papillotomy en principe is made, based on results from more than 7000 gallbladder operations and over 500 papillotomies, performed at the surgical departments of the municipal hospitals in Braunschweig and Lüneburg. In principle, too few papillotomies are carried out in many hospitals. The duration and seriousness of the cholecystitis is to a large degree responsible for the frequency of the formation of a papilla stenosis. Out of 232 multiple gallbladder operations performed at the Braunschweiger Hospital, 130 were necessary because of an incorrect opinion about the indication at the time of the first operation, in most cases due to an overlooked stenosis of the papilla.
[The significance of the duodenal papilla within the framework of diseases of gallbladder and bile ducts].
On the basis of 3185 biliary tract operations performed at the city hospitals of Braunschweig and Lüneburg, 12% of which included papillotomies, the frequency and pathogenesis of Vater's papilla stenosis is discussed. About 5% of all stenoses of Vater's papilla do not appear in connection with lithiasis in the biliary tract; these are defined as primary stenoses. 95% of Vater's papilla stenoses occur with lithiasis and inflammatory diseases of biliary tract. Stenosis of Vater's papilla is most often seen in connection with severe cholecystitis and pericholecystitis. There exists in most cases a purely inflammatory swelling of papillas mucosa which decreases following sanitation of the biliary tract. Intraoperative findings show good dilatation through catheterization and Vater's papilla should therefore not be discised. In opposite the concommitant stenoses of Vater's papilla caused by choledocholithiasis, chiefly in case of calculus near the papilla, are signed by severe deforming alterations even concerning deeper layers of papilla wall. The high grade destruction of muscle tissue leads to a not retrogressive stenosis, even after sanitation of biliary tract, which principally should be discised. 211 biopsies of papilla were taken and histologically analyzed. A specific pathologic-anatomic substrate of stenosis of Vater's papilla could not be found.
[Operations of the gall-system (papillectomy) (author's transl)].
The last 14 years around 4000 operations of the gall-bladder and the gall-system were performed at the surgical hospital in Braunschweig. All cases were benign. A papillectomy was performed in more than 500 cases. Because of better intraoperative diagnostic and routine radiomanometry of nearly all the patients the contingent of papillotomy, which was usually 25% to 30%, decreased to 10% to 12%. Our statistic shows that there was no increase of complications or of the postoperative lethality due to the papillotomy. On the other hand we had to performe a second operation in 82 cases, who had no papillotomy at the first surgical approach. 14 of these patients had a biliodigestive anastomosis and later a bad polycystectomy syndrom. On the other side we had a group of patients who got ailments years after the cholecystectomy. These patients had a stenosis of the papilla as a real second disease and needed to undergo a second operation.
[Shunt operations of the small intestine in cases of extreme adiposity (author's transl)].
Report is made about 15 patients suffering from most serious adiposity; owing to complete inefficiency of conservative methods of therapy whatsoever, a shunt operation of the small intestine according to Payne Dewind, modified after Baden, was carried out in these patients. After a period of observation, weight decrease amounted to 40 to 50 p.c. of the starting weight. Side effects having manifested immediately after operation, such as weariness, giddy sensations, nausea, flatulence, sweating stages, etc., disappeared after about six months. The highly increased frequency of stools was reduced--after two years--to one to two defectations per day. Increased blood pressure values returned to normal.
[Simultaneous occurrence of hiatal hernia and transpyloric prolapse of the gastric mucosa].
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[Proceedings: Indications for papillotomy and papillary plastic surgery, and surgical technique (author's transl)].
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[Stenosing papillitis of Vater's ampulla].
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[Diverticula of the stomach and the small intestine].
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[The pure papilla stenosis as an indication for repeated surgery on the efferent biliary ducts].
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[The problem of papillotomy within the scope of efferent bile duct diseases].
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[Pregnancy after treatment of obesity using jejuno-ileal anastomosis].
The authors report on 5 cases of pregnancy in women who had previously received a jejunoileal bypass for obesity. In two patients, menstruation had normalized after the operation. None of the patients changed her eating habits during the time of pregnancy and both their antenatal courses and births revealed no complications. All the babies were healthy and well developed. Conception occurred 6 to 18 months after the operation, which proved to be sufficient to avoid a fatal fatty metamorphosis of the liver. It can therefore be said that a weight reduction due to the jejunoileal bypass represents no contraindication for pregnancy; sometimes extremely obese women could even become pregnant after the operation. With a careful supervision of the electrolyte balance and the albumen and iron concentration, a jejunoileal bypass means no increased risk for mother and child, neither during delivery nor during the ante- or postnatal period.