[Leiomyoma in the B II stomach remnant].
Following Billroth II surgery carcinomas of the stomach stump are the most common tumours. A rare case of a benign mesenchymal tumour is reported.
Aged↗
Biomedical subjects
R Grüssner
Publications and source records attributed to R Grüssner.
[Ultrasonics and lavage in polytraumatized patients with blunt abdominal trauma].
The reliability of sonography and peritoneal lavage in assessing the need for immediate surgical intervention in blunt abdominal trauma was examined in a controlled prospective and retrospective study. Whereas no false results occurred using peritoneal lavage, false negative findings in sonography were 9.8% and false positive findings 3.9%. A significant difference was also found on retrospective evaluation of all cases with diagnostic peritoneal lavage (2.2% false results) and ultrasound investigations (14.9% false results). This demonstrates that sonography cannot fully replace peritoneal lavage as a diagnostic method in blunt abdominal trauma.
Abdominal Injuries↗
[Appendicitis in childhood].
Appendectomy was performed on 1,059 children at the University Clinic of Paediatric Surgery in Mainz from 1. 1. 1975 to 31. 6. 1983. For the retrospective examination of the indication for appendectomy histopathological and intraoperative findings were analysed and evaluated. Histologically five types of appendicitis were differentiated: 1. acute appendicitis (two forms: acute ulcero-phlegmonous appendicitis with or without perforation and acute superficial appendicitis), 2. chronic appendicitis, 3. lymphatic hyperplasia, 4. submucosal fibrosis, 5. rare diseases. In 618 cases (= 58.3%) acute appendicitis was diagnosed histologically. In another 203 cases (= 19.2%) intraoperative findings (e.g. Lymphadenitis mesenterialis, Meckel's diverticulum) were retrospectively collected; they caused symptoms similar to those of appendicitis. However, there remain retrospectively 22% of all appendectomised children with no indication for laparotomy. The statistical analysis of postoperative complications showed a significant dependance from the histopathological findings. The highest rate of complications was seen in cases with perforated (34%) or non-perforated (10%) ulcero-phlegmonous appendicitis. Children with acute superficial appendicitis had a complication-rate of 5%; those with lymphatic hyperplasia and submucosal fibrosis of 6% each. Relaparotomies were almost exclusively necessary in cases with acute appendicitis; septic and pulmonary complications were mostly seen either in infants with malformations or other perinatal risks, or in children with additional severe diseases. Therefore non-acute appendicitis justifies a wide indication for appendectomy because of a low complication-rate; this, however, is not valid for high-risk children (e.g. malformations). In these cases sonography might be useful for preoperative diagnosis.
Adolescent↗
[Importance of infection following laparotomy in childhood].
Laparotomy was performed on 579 children at the University Clinic of Paediatric Surgery in Mainz from 1.1.1975 to 31.12.1982. The children were up to 15 years of age; appendicitis or inguinal and umbilical hernia cases were not included. Postoperative sepsis occurred in 74 patients (12.8% of all children with laparotomy); in 51 cases positive bacteriological findings were seen besides the clinical and clinicochemical ones. Sepsis morbidity was particularly high in children who had not yet completed their first year of life (postoperative sepsis occurring in approximately every fourth infant); among the disease patterns, the following were particularly prominent: Defects of the abdominal wall (23 out of 50 children developed postoperative sepsis); intestinal atresia (18 out of 59 children); intestinal perforation (11 out of 39 children). In addition, sepsis morbidity was enhanced after relaparotomies. Gram-negative bacteria were most frequent among the 51 patients with bacteriologically positive findings; these bacteria consisted mostly of representatives of the group of enterogenous pathogens. These groups of bacteria were also the most frequently occurring pathogens in mixed and secondary infections. 33 out of 74 children with postoperative sepsis died. The mortality rate was 68% in prematurely born infants compared with mature newborns. Lethality was highest among children with congenital defects of the abdominal wall and intestinal perforations. Among the patients with bacteriologically positive findings the lethality was particularly high with multiple attacks of sepsis, in case of septitides caused by multiple pathogens, by Candida albicans and after relaparotomy.
Adolescent↗
[The significance of the surgical treatment of neuroblastoma].
Results of surgical treatment of 29 neuroblastoma patients between 1968 and 1980 are presented. 13 of these children have remained free from relapses and complaints for more than 2 years. Despite the progress in (immuno)chemotherapy and (immuno)radiotherapy the prognosis depends on the kind of surgery performed, also and especially in stages III and IV (after Evans). Among the author's own patients it became evident that both the survival rate and the survival period were increased in the prognostically unfavourable cases by subtotal resection. No representative collective statistics are known and it will probably take quite some time before these can be compiled, since it is extremely difficult to evaluate the disease pattern. However, it appears meaningful to establish postoperative prognosis in accordance with the possibilities of surgical procedure. Hence we are offering a classification of postoperative prognoses which, in our opinion, is superior to that proposed by Evans.
Abdominal Neoplasms↗