0000000000490260
AUTHOR
K. Rückert
Localization of small islet-cell tumors. Preoperative and intraoperative ultrasound, computed tomography, arteriography, digital subtraction angiography, and pancreatic venous sampling
A total of 42 islet-cell tumors were examined between 1972 and 1984. Problems of localization were only encountered in 31 tumors less than 2 cm in diameter. Of 31 small tumors, 27 were correctly localized using a combined diagnostic approach: ultrasound was successful in 12/20 tumors, CT in 9/21, angiography in 20/31, intraarterial digital subtraction angiography in 1/2, and pancreatic venous sampling in 13/16. The smallest tumor found by ultrasound and CT was 7 mm in diameter. Intraoperative ultrasound demonstrated all 9 insulinomas examined. Currently, the most useful techniques for localizing small islet-cell tumors are ultrasound, CT, and angiography. CT is particularly useful for tumor…
Anwendungsm�glichkeiten der intraoperativen Sonographie
Sonographie, Computertomographie, Angiographie und endoskopisch retrograde Cholangiopancreaticographie haben sich in der Allgemein- und Gefaschirurgie als wertvolle Untersuchungsmethoden etabliert. Schwierigkeiten bestehen jedoch manchmal in der Korrelation der Praoperativen Befunde mit dem intraoperativen Befund. Hier ist das Anwendungsgebiet der intraoperativen Sonographie (IOS) zu sehen. Sie bietet dem Chirurgen eine zusatzliche Information durch Darstellung von pathologischen Gefasprozessen, Kontrolle von Gefasanastomosen, intraoperative FlowMessung in Gefasen, Lokalisationsdiagnostik in parenchymatosen Organen. Die intraoperative Sonographie ist somit ein neues Instrument des Chirurgen…
Die Therapie der veralteten Schulterluxation
Eine Schulterluxation, die langer als vier Wochen besteht, gilt als veraltet. Die Diagnose ist klinisch-radiologisch einfach zu stellen. Therapeutisch ist die Reposition auch nach Monaten noch anzustreben. Gelingt die Reposition nicht, ist lediglich bei jungen Patienten die blutige Reposition angezeigt. Bei alteren Patienten sollte der Zustand belassen und die eintretende Gebrauchsminderung in Kauf genommen werden.
Ergebnisse und Komplikationen von 616 perkutanen transhepatischen Gallenwegsdrainagen
During nine years, percutaneous transhepatic biliary drainage was carried out 616 times on 563 patients in the Department of Radiology, University of Mainz Medical School. 50.3% were pre-operative and 39% were palliative. More than 80% were necessitated by malignant lesions. Subsequent improvements in biochemical measurements were observed in 82.4% of patients. Complications of the procedure led to the death of five patients (0.8%) and required surgery in nine patients (1.5%). The following complications were observed: biliary peritonitis in 0.6%, sepsis in 1.9%, bleeding in 1.9% and fever higher than 38 degrees C in 16.2%.
Surgical treatment of pancreatic cancer
From 1964 to 1982, there were 782 patients treated for carcinoma of the pancreas. In 174 patients pancreaticoduodenal resection was possible (22%). Until 1977 we performed Whipple procedures, while from 1978 to 1982 total pancreatectomy was preferred. Comparing the results of both methods, we did not find any advantages of total pancreatectomy. Operative mortality did not decrease, survival time did not extend, and the higher resection rates (up to 26%) for more advanced tumor stages were accompanied by greater morbidity. With respect to the patients with inoperable cancer of the pancreas, we found over the last 5 years that the rate of those not undergoing surgery has climbed from 8% to 25…
Sonography versus peritoneal lavage in 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 prospective study (n = 71). Statistical analysis revealed a sensitivity of 100% for peritoneal lavage compared to 84% for sonography; the accuracy was 99% versus 86%, the predictive value 97% vs. 89%. The statistical difference was significant (p less than 0.05). The results demonstrate that sonography cannot replace peritoneal lavage in the diagnosis of blunt abdominal trauma. The discussion of the advantages and disadvantages of both methods shows that sonography and peritoneal lavage are not competing, but rather, are complementary exam…
Intraductal proliferation in the pancreas and its relationship to human and experimental carcinogenesis
In 21 patients who had undergone total pancreatectomy for pancreatic head carcinoma, the uninvolved pancreas was examined with regard to the type, incidence and regional distribution of duct epithelial proliferation. The results were compared with those in 37 operative specimens from patients with chronic pancreatitis, in 46 normal pancreases from autopsies and with findings in experimental pancreatic carcinogenesis. While the incidence of squamous metaplasia and non-papillary epithelial hypertrophy varied little in the different groups, papillary epithelial hyperplasia was found three times more often in cases of carcinoma, with associated mild duct obstruction. Atypical epithelial prolife…