Biomedical subjects
Publications and source records attributed to P Merkle.
A report is given about the clinical picture, the course and therapy of spontaneous perforation of the bile duct. In adults perforations may be caused by necrotic lesions of the bile duct due to thrombosis of very small vessels supplying the wall. Increase of bile pressure due to various causes then may induce perforation.
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The results of treatment of early gastric carcinoma were analysed in 65 patients. In 33 patients the operation was performed 5 years ago. The 5-year-survival rate was 70%. Prognosis was predominantly influenced by the histology of the tumour. Signet ring cell and anaplastic early carcinomas (diffuse type) had a worse prognosis than intestinal (differentiated) forms. Carcinomas localised wholly in the mucosa had no better prognosis than those penetrating into the submucosa. There is no choice of surgical method according to prognostic criteria as the diagnosis "early gastric carcinoma" can be made only postoperatively from the resection material. Bioptic proof of carcinomatous gastric mucosal changes requires full observation of the rules of cancer surgery.
Measurements of the rate of incorporation of radioactively labeled nucleic acid precursors into the DNA and RNA of gastric carcinoma cell suspensions indicated variable rates of proliferation for the tumors. The rate of incorporation generally correlates to the cytological level of differentiation of the carcinoma. Reduced differentiation of the tumors showed a corresponding increase in the rate of proliferation. Knowing the proliferation-dependent effect of most cytostatica, this results in a resistance to cytostatica of highly differentiated gastric cancers. The nucleic acid synthesis of proliferatively active tumors could only be partially inhibited by the cytostatica tested (5-fluorouracil, adriamycin). Carcinomas with metabolic possibility for compensation of the active mechanism of the cytostatica were biochemically resistant. Due to the resulting methodical problems and unaccountable patient-dependent causes of resistance, a conclusive statement about cytostatica-sensitive tumors is difficult to make in incorporation studies.
A fat-free diet produces a deficiency of essential fatty acids in Wistar rats. This is associated with disturbances of wound healing in the colon and skin due to an impaired collagen metabolism, since hydroxyproline content in the wound area is decreased. The results are of clinical significance with regard to total parenteral nutrition in surgical patients.
Basis and current possibilities of adjuvant therapy in gastric cancer are discussed. The response rate with 5-FU und nitrosoureas for advanced gastric cancer is significantly superior to all other regimens. Based on Japanese experiences a higher survival rate is observed in the curatively resected patients treated with postoperative prophylactic chemotherapy. The drawing of reliable conclusions must await the results of further studies. Efforts for individual chemotherapy by measurement of cell production of recurrences and the necessity of aftercare in gastric cancer patients are explained.
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Using the perfusion technique, the absorption of water, sodium, and glucose was studied in a partial occlusion of the intestine. In this study we investigated the mucosal enzyme, the metabolic changes of the small bowel wall, and the morphology of the mucosa. The reason for the decreased absorption of glucose, sodium, and water in the prestenotic phase may be the increased proliferation of the mucosa. The decreased absorption of the glucose, sodium and water in the poststenotic phase may be caused by an atrophy of the mucosa.
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The poor prognosis of gastric carcinoma can be improved by intensification of early diagnostics and adequate surgical measures. To avoid local recurrent tumour growth at the resection lines total gastrectomy is necessary if the tumour is located in the upper and middle third of the stomach as well in the case of diffusely infiltrating tumours in the distal third. To prevent relapses in the regional lymphatics radical lymph node dissection should be performed. Remission rates in advanced gastric cancer are high after combination chemotherapy with 5-fluorouracil and nitrosourea. Postoperative adjuvant chemotherapy seems to be successful according to newer communications. Basic problems of adjuvant chemotherapy in gastric cancer are discussed.
Serum-zinc-levels were evaluated in patients with breast cancer in relation to the various stages. Patients with metastatic breast cancer had significantly depressed zinc-levels, wereas patients with disease apparently localized to the breast and draining lymphnodes had nearly normal serumzinc levels. It appears that the determination of serumzinc in breast cancer patients may be of value in discriminating between localized and metastatic disease.
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Among 947 patients operated on for gastric carcinoma between 1961 and 1976 there were 60 with early (superficial) gastric carcinoma. All but two patients consulted their doctor for diverse complaints. In one third of them treatment was delayed for a year or longer. In 26 of the 64 cancer foci it was limited to the mucosa. The correct diagnosis was made radiologically in 60%, gastroscopically in 70%. Selective endoscopic biopsy increased accuracy to 90%. The remaining false-negative findings occurred in the ulcerative form, which was the most frequent one. Improved radiological techniques (double-contrast) and obligatory gastroscopy with biopsy increased the relative proportion of early (superficial) carcinoma from under 4% in 1961 to 15%. The diagnosis of this type of carcinoma can be made only by careful histological study of the surgical specimens. Here as elsewhere in the surgery of carcinoma, multicentricity (in 5%) and possible lymph node metastases (10-20%) must be taken consideration in the surgical management.
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The cancerogenic effect of continous duodenal reflux on the gastric mucosa has been investigated in male Wistar-rats after gastrointestinal anastomosis. Groups of animals with gastroenterostomy without enteroenteral anastomosis and with Roux-en-y-anastomosis preventing duodenal reflux were treated with lower dosages of the cancerogenic Nitrosoguanidine. Proliferative mucosal alterations near the gastroenteral anastomosis were observed. In addition the gastric mucosa was characterized by adenomatous lesions caused by duodenal reflux. The changes detected were not influenced by Nitrosoguanidine and did not appear in cases of Roux-en-y-anastomosis.
A gastroenterostomy without enteroanastomosis leads to a change in the bacterial flora of the stomach, where-by in particular the proportion of nitrite-decomposing bacteria, is enhanced. This results in an increase of nitrite concentration in the gastric fluid, which may possibly be accompanied by an augmented production of carcinogenic nitrosoamine. This latter aspect is considered with respect to the origin of carcinoma in the operated stomach. Since the reported changes will be largely prevented by a Roux-Y-gastroenterostomy, this should be taken into consideration for reconstruction of the alimentary tract after gastric surgery.