Langenbecks Archiv für Chirurgie
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Langenbecks Arch Chir · Jan 1996
[Tumor cell dissemination in bone marrow and peritoneal cavity. An immunocytochemical study of patients with stomach or colorectal carcinoma].
The tumor spread and the radicality of surgical resection are the most important facts in a patient's prognosis. In spite of curative tumor resection many patients die from metastases or local tumor recurrence. One possible reason is early dissemination of tumor cells which cannot be detected with clinical methods of examination. ⋯ In bone marrow there was a good correlation of tumor cells with staging, but in peritoneal lavage fluid this was not so. Finally, we detected tumor cells more often in bone marrow and peritoneal lavage fluid of patients with poorly differentiated tumors (G3) or diffuse Lauren type than in patients with moderately differentiated tumors (G2) or intestinal Lauren type. After a median follow-up period of 12.5 months patients with disseminated tumor cells had a lower survival rate than patients without tumor cells.
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Langenbecks Arch Chir · Jan 1996
Review[Cystic bone changes. Etiology, diagnosis, therapeutic principles and personal results of treatment].
Various bone disorders become manifest as cystic lesions. The differential diagnosis must include benign and malignant tumors and also non-tumorous lesions, such as osteomyelitis. The most important and most frequent types of genuine bone cyst are juvenile bone cyst and aneurysmal bone cyst. ⋯ For this reason, operative treatment should not be performed until after that age if possible. Newer methods, such as steorid injections and continuous decompression by means of perforated screws, had better results in some studies, but only according to a few authors. Further research is needed to show whether our method will yield good results in the long term when applied in larger patient collectives.
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Differential diagnosis of solitary calcaneal cysts extends from benign cysts to malignant tumours. In all, 10-50% of these cysts are located at the centre of the calcaneal body in the form of intraosseous lipomas. ⋯ It should also be remarked that all four patients came from a region in which mining was of central economic importance. Our experience has shown that such cysts should be surgically removed and filled with plastic spongiosa material in order both to check whether the cysts are benign or malignant and to avoid an imminent spontaneous fracture of the heel bone.
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Langenbecks Arch Chir · Jan 1996
Randomized Controlled Trial Comparative Study Clinical Trial[Effect of orthograde intestinal irrigation with Prepacol and polyethyleneglycol solution on duration of postoperative ileus after colorectal resections].
In a prospective randomized study in 100 patients undergoing conventional (n = 66) or laparoscopic (n = 34) colorectal resection, mechanical lavage with 2 l of a polyethylene glycol (PEG) solution (group A, n = 50) combined with a laxative was compared with lavage with 4 l of PEG alone (group B, n = 50). The influence of bowel preparation on postoperative ileus was investigated. The efficacy of bowel preparation was determined intraoperatively by a surgeon blind to the type of preparation. ⋯ The first bowel movement occurred 3.2 +/- 1.1 days after conventional surgery and 4.3 +/- 1.2 days (P < 0.001) after laparoscopic surgery. The type of preoperative bowel preparation had no influence on the duration of postoperative ileus. The postoperative interval before the first bowel movement was shorter after laparoscopic surgery.
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Between 1972 and 1993 a total of 90 patients were operated on for acute mesenteric ischemia at Hanover Medical School, Department of Abdominal- and Transplantation Surgery. As causes of mesenteric ischemia, arterial embolism (23%), arterial thrombosis (30%), venous thrombosis (33%), and non-occlusive disease (14%) were differentiated. The overall hospital mortality was 66%. ⋯ While hospital mortality was dependent on the type of mesenteric ischemia, long-term survival after exclusion of hospital deaths proved independent of the original pathogenesis. Of the patients who survived the acute attack of mesenteric ischemia, 70% were alive 2 years later and 50% 5 years later. The survival probability of these patients was not determined by recurrence of mesenteric ischemia, but was mainly related to their cardiovascular comorbidity and a high incidence and prevalence of malignancies.