Biomedical subjects
Publications and source records attributed to U Blum.
Since the introduction in the Federal Republic of Germany of free routine screening for colorectal carcinoma (digital examination of the rectum in 1971; test for occult blood in the faeces in 1977), the number of Dukes' stage A cases diagnosed at one hospital has increased by 30%. The average interval between onset of symptoms and diagnosis has shortened from 5 to 3.8 months, and the proportion of inoperable carcinomas has decreased by 10%.
Since screening for colorectal carcinoma was started in Germany (rectal digital palpation 1971, test for occult blood in stool 1977) the rate of early stage Dukes A in more than 3600 cases of colorectal carcinoma has increased significantly by 30%. The history of the disease has shortened and the number of inoperable patients has diminished by 10%.
The lack of symptoms in lung cancer is the main reason for its late diagnosis and therapy. In the surgical clinic of Northwest Hospital, Frankfurt/Main, only 32,5% of 1494 bronchogenic carcinomas (1970-1980) were operable. 40% of these lung cancers were detected by routine examination, 45,7% of the operable carcinomas and 25% of the inoperable carcinomas. Peripherally located carcinomas showed very few symptoms; even at an early stage, centrally located carcinomas showed as many symptoms as inoperable carcinomas.
Cosmetic aspects often are the indication for operation in funnel chest or pigeon breast. Cardial or respiratory symptoms are only noticed in a few patients. The operative procedure according to Brunner is technically a simple method with low risk, which reaches good cosmetic and long-term results (the recurrence rate is 16,6%). Because of the higher recidivation liability after surgery in early childhood, we recommend surgical correction of the chest wall deformities after the age of 12.
Based on own results, general negation of operation in small cell carcinoma of the lung does not appear warranted. Surgical treatment is indicated when a non-metastasizing tumour is present. Small cell bronchial carcinoma operated in tumour stage I has a clearly better prognosis than a carcinoma of the same stage treated by chemo- or radiotherapy. A certain response of these carcinomas to cytostatic or radiotherapy has not been established. Should tumour metastases be demonstrable, i.e. lymph node metastases in the mediastinum or distant metastases, as is the case in the majority of these rapidly metastasizing carcinomas, chemo- or radiotherapy has been shown to be superior to operative treatment.
Congenital pulmonary cysts should be treated surgically at an early stage. An analysis of our cases shows the high risk of conservative therapy, the risk of operation increases with the complication rate.
In a retrospective study (1969--1979) of 530 resections performed because of bronchial carcinoma, there were 70 patients older than 70 years (13.2%). Two-thirds of their resections were carried out on T 1--2 N0M0 and one-third on T 1--2-N1M0. For 22 central and 48 peripheral carcinomas, 25 pneumonectomies, 40 lobectomies, and 5 bilobectomies were performed. The mortality was 14.2% (lung embolism, pneumonia, apoplexia, and one insufficiency of the bronchial resection stump). Postoperative complications were atelectasis (28.5%), pneumonia (4%), lung embolism (6%), and two pleura empyemas. Of the patients operated on from 1976 to 1978, 40% (T1N0M0) and 30% (T2N0M0) and 30% (T2N0M0) are alive after 2.5 years.
The high risk of peritonitis following a perforation of the gall bladder is discussed in a short review of the literature. In 15 years 9084 operations of the bile ducts were performed at Nord-West-Hospital, Franfurt/M., among these were 36 cases of free gall bladder perforation. Our experiences with abdominal drainage only, without perfusion of the abdomen following cholecystectomy and revision of the bile ducts with simultaneous systemic appliance of antibiotics are reported.
Between 1964 and 1978 9084 patients had been operated because of benign diseases of the gall bladder and the gall tract, out of these 64 because of iatrogenic lesion in primary surgery. As a criterion for our long-term results 48 patients were reviewed by a written questionnaire and 41 responded to it. Out of these 5 complained about persisting symptoms, which in 3 cases could be traced back to biliary cirrhosis and in one case to a thrombosis of the vena portae. Ine on case no pathological changings could be found. A good long-term result was seen in 36 of all operations because of iatrogenic gall tract lesion.
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The report concerns two female patients who had taken contraceptives for a period of eight to ten years and were found to have benign liver-cell-tumor. The possibility of liver-cell-tumor induced by oral contraceptives is discussed with regard to the literature.
Between 1964 and 1978 8748 operations had been performed because of benign diseases of the extrahepatic biliary tract, 413 cases of mechanical intestinal obstruction had been operated, out of these 30 patients with gallstone ileus. The frequency, pathogenesis, symptomatology, diagnostic procedure and therapy are described, the own results are discussed.
The divalent cation ionophore A23187 was found to produce a dose-dependent release of histamine from isolated mesenteric mast cells of the guinea pig. The process showed a specific requirement for calcium ions and was blocked by inhibitors of glycolysis. The effect of cAMP, theophylline, sympathomimetic amines and DSCG on the histamine release induced by the ionophore or by the antigen-antibody reaction was compared. In both cases, the release was inhibited by Bu2cAMP and by theophylline but higher concentrations were required with the ionophore. Adrenaline, isoprenaline and DSCG were effective only in the anaphylactic system. These results are compared with those previously reported for human leucocytes and rat peritoneal mast cells in which the release produced by the ionophore was found not to be inhibited by cAMP and its analogues. On the basis of these findings, the possible role of cAMP in the modulation of histamine release is discussed.
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A method is described for the dissociation of guinea pig lung and mesentery into their component cells. The method comprises incubation of the tissues with the enzyme pronase in Ca++- and Mg++-free saline followed by mechanical dispersion and yields on average 3-8% free mast cells. These cells are morphologically intact and viable. They retain an active sensitization or can be passively sensitized. The levels of cAMP and cGMP in the whole cell suspension respond to catecholamine, histamine or cholinergic stimulation in a way similar to that observed in the corresponding undispersed tissue. Although the separation of guinea pig mast cells from other cells proved to be more difficult than the purification of rat mast cells, an inrichment of greater than 50% has been achieved. The mast cells isolated by this method proliferate in vitro and have been cultured successfully for several months.
Basing on the fact that in adult articular cartilage there is an equilibrium of anabolic and catabolic processes, we developed a hypothesis that an experimentally induced reduction of anabolic reactions will lead to degenerative alterations in joint cartilage. In our experiments using monoiodine acetate, a potent inhibitory substance, we could confirm that 6-8 weeks after intraarticular injection into the knee joint of hen arthrotic processes can be observed in cartilage. By macroscopical, histological and biochemical criteria these arthrotic degenerations are in good correlation with human osteoarthrosis. Our new experimental model of osteoarthrosis in laboratory animals appears to be very sutiable for the study of degenerative articular processes and for pharmacological tests of new antiarthrotic drugs.
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