C. Herfarth – författare

The concept of immunologic responses against tumors is currently under intense scrutiny throughout the world. The evidence for the existence of tumor-specific transplantation antigens (TSTA) and specific immune reactions to them in experimental animals is overwhelming. The available data concerning human tumors are controversial. The reason for this is partially that antigens detectable on human tumors by in vitro assays have not been biologically characterized. In other words, we do not know if the antigens on human tumors are acting as the targets for immunologically mediated rejection processes in vivo. It was the purpose of this workshop to bring experimental tumor immunologists and clinical oncologists together in order to disclose facts and limits in tumor immunology. Clinicians were to learn how shaky the ground becomes once the experimentalist looks beyond the edge of the mouse cage. Tumor biologists heard the clinicians' urgent cry for controlled randomized trials of immunotherapy which thus reflects clearly that immunotherapy in its present form without knowledge of dose-effect-relationship does not work. Nobody would deny that the problem of human cancer smells of immunology, but since we are just about to taste it the essential ingredient might be different. In other words one might look at present rather at immunological epiphenomena than at mechanisms of tumor immul1lty operating in vivo. This problem was among others a central issue of this workshop.

Im Chirurgischen Forum werden ausgewählte Beiträge vorab veröffentlicht, die auf dem Kongreß der Deutschen Gesellschaft für Chirurgie vorgetragen werden. Der Forumsausschuß achtet dabei auf höchste Qualität der Beiträge. Der Leser findet hier die neuesten Ergebnisse aus Forschung und Klinik übersichtlich in einem Band.

The concept of immunologic responses against tumors is currently under intense scrutiny throughout the world. The evidence for the existence of tumor-specific transplantation antigens (TSTA) and specific immune reactions to them in experimental animals is overwhelming. The available data concerning human tumors are controversial. The reason for this is partially that antigens detectable on human tumors by in vitro assays have not been biologically characterized. In other words, we do not know if the antigens on human tumors are acting as the targets for immunologically mediated rejection processes in vivo. It was the purpose of this workshop to bring experimental tumor immunologists and clinical oncologists together in order to disclose facts and limits in tumor immunology. Clinicians were to learn how shaky the ground becomes once the experimentalist looks beyond the edge of the mouse cage. Tumor biologists heard the clinicians'' urgent cry for controlled randomized trials of immunotherapy which thus reflects clearly that immunotherapy in its present form without knowledge of dose-effect-relationship does not work. Nobody would deny that the problem of human cancer smells of immunology, but since we are just about to taste it the essential ingredient might be different. In other words one might look at present rather at immunological epiphenomena than at mechanisms of tumor immul1lty operating in vivo. This problem was among others a central issue of this workshop.

The problem of gastric cancer, with its multifaceted aspects, offers an example of diversified oncological research, which includes epidemiology, pathogenesis, histo­ morphology, surgical and conservative therapy in its spectrum. This disease not only constitutes an interesting and important subject for research, but it is also a challenge for the practitioner due to its inordinately poor prognosis. It therefore appeared a rewarding task to the editors to collect information from individual experts, in order to gain a topical summary of the problems pertaining to gastric cancer, as well as to provide a survey of the progress and the therapeutic possibilities in this field. This task was particularly enticing, as gastric cancer has lately come to belong to those tumors somewhat relegated to the shadows, although it is, despite its decreased fre­ quency in some western countries, still one of the most prevalent malignant diseases. This collection should emphasize the need for broadly based knowledge of individual problems as a prerequisite for any satisfactory therapy of an organ tumor. It is therefore the primary concern of this book to furnish anyone with an interest in oncology with this necessary survey. The editors thank Mrs. Karin Dohmeier and Mrs. Karin Kluge from Springer-Verlag for their cooperation in preparing this monograph. We extend our thanks to Mrs. Susanne Schenk and Mrs. Marga Wild, who contributed so much by her secretarial experience for the success of this volume. lJIm,September1979 Ch. Herfarth P. Schlag Table of Contents 1 Epidemiology and Pathogenesis . . . . . . . . . . .

The problem of gastric cancer, with its multifaceted aspects, offers an example of diversified oncological research, which includes epidemiology, pathogenesis, histo­ morphology, surgical and conservative therapy in its spectrum. This disease not only constitutes an interesting and important subject for research, but it is also a challenge for the practitioner due to its inordinately poor prognosis. It therefore appeared a rewarding task to the editors to collect information from individual experts, in order to gain a topical summary of the problems pertaining to gastric cancer, as well as to provide a survey of the progress and the therapeutic possibilities in this field. This task was particularly enticing, as gastric cancer has lately come to belong to those tumors somewhat relegated to the shadows, although it is, despite its decreased fre­ quency in some western countries, still one of the most prevalent malignant diseases. This collection should emphasize the need for broadly based knowledge of individual problems as a prerequisite for any satisfactory therapy of an organ tumor. It is therefore the primary concern of this book to furnish anyone with an interest in oncology with this necessary survey. The editors thank Mrs. Karin Dohmeier and Mrs. Karin Kluge from Springer-Verlag for their cooperation in preparing this monograph. We extend our thanks to Mrs. Susanne Schenk and Mrs. Marga Wild, who contributed so much by her secretarial experience for the success of this volume. lJIm,September1979 Ch. Herfarth P. Schlag Table of Contents 1 Epidemiology and Pathogenesis . . . . . . . . . . .

Im Chirurgischen Forum werden ausgewählte Beiträge vorab veröffentlicht, die auf dem Kongreß der Deutschen Gesellschaft für Chirurgie vorgetragen werden. Der Forumsausschuß achtet dabei auf höchste Qualität der Beiträge. Der Leser findet hier die neuesten Ergebnisse aus Forschung und Klinik übersichtlich in einem Band.

Die Lebensqualitat der an Colitis ulcerosa und Adenomatosis coli (Prakanzerosen des Dickdarms) erkrankten, meist jungen Patienten kann heute durch den gezielten Einsatz der neuen kontinenzerhaltenden Operationstechniken fundamental verbessert werden. Erstmals wird das Verfahren der ileoanalen Pouchtechnik in dieser Monographie detailliert beschrieben. Es wird in den Kontext der exakten Indikationskriterien fur den funktionellen Organersatz (Enddarm-Pouch statt kunstlichem Darmausgang), der moglichen Komplikationen und der besonderen Aufgabe der Nachsorge gestellt. Das ausgezeichnete Abbildungsmaterial setzt einen optischen Akzent und veranschaulicht die Technik. Von Bedeutung auch fur den Pathologen: die auf einmalige Weise zusammengestellten "Pouchhistologie"-Abbildungen. Somit kann der Leser die grossen Erfahrungen des Heidelberger Teams in dieser zeitgemassen Technik optimal fur die eigene Patientenversorgung nutzen. Internisten erhalten grundlegendes Wissen fur die Abstimmung der Behandlung mit dem Chirurgen und der Operateur wichtige Hinweise und Daten fur die Therapieplanung bei seinen Patienten.

Dieses Buch hat sich die Aufgabe gestellt, die gastroenterologi­ Erkrankungen systematisch zu beschreiben, wobei auf alle schen pathophysiologischen Ausführungen verzichtet wurde, obwohl diese zum Verständnis der Erkrankungen und des Ablaufes an sich notwendig wären. Begründet wird das damit, daß diese Buchreihe dem praktisch tätigen Kollegen für eine erste unmittelbare Information zur Verfügung gestellt wird, um ihm durch Über­ sichts-Tabellen einen möglichst raschen Weg zu Diagnose und Therapie aufzuzeigen. Daß Diagnostik und Therapie stets im Wandel begriffen sind und deswegen ständig neue Informationen eingeholt werden müssen, ergibt sich aus der raschen Entwicklung der Medizin. Autoren und Herausgeber hoffen, daß das Buch dem praktisch tätigen Arzt bei seiner täglichen schweren und ver­ antwortungsvollen Arbeit Hilfe leistet. Linz, im Sommer 1976 P.H. Clodi v Inhalt Vonvort .......................................... V Zeichenerklärung .. . . . . . . . . . . . . . . . . . . . . .. . . XVII . . . . . . . . Abkürzungen ...................................... XVIII Verzeichnis der Mitarbeiter ... . . . . . . . . . . . . . . . . . X . . X . . . . P. H. Clodi Übersichtstabellen I-V ............................... . Ch. Herfarth und J. Horn Das akute Abdomen ... . . . . . . . . . . . . . . . . . . . . . . 7 . . . . . . . . . 1. Definition. . . . . . .. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 7 2. Allgemeine Symptomatologie . . . . . . . . . . . . . . . . . . . . . . . 7 3. Allgemeine diagnostische Hinweise .................. 8 3.1. Anamnese. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 8 3.2. Klinische Untersuchung. . . . . . . . . . . . . . . . . . . . . 8 3.2.1. Allgemeininspektion ....................... 83.2.2. Inspektion des Abdomens ................... 9 3.2.3. Der Schmerz .............................. 9 3.2.4. Palpation.................................. 9 3.2.5. Auskultation.... . . . . . . . . . . . . . . . . . . . 10 . . . . . . . 3.2.6. Perkussion................................ 10 3.2.7. Rektale Untersuchung... . ... . ... . ... . .... .. 10 3.2.8. Gynäkologische Untersuchung.. . . ... . ....... 10 3.3. Laboruntersuchungen. . . . . . . . . . . . . . .. . . 10 . . . . 3.4. Röntgenuntersuchungen. . . . . . . . . . . . . .. . . 11 . . . 4. Ätiologie und Differentialdiagnose .................. 11 Weiterführende Literatur . . . . . . . . . . . . . . . . . . . . . 21 . . . . . . . . F. H. Franken Funktionelle Beschwerden des Magen-Darmtrakts (Reizmagen, irritables Colon, habituelle Obstipation, funktionelle Diarrhoe) ................................ 22 1. Definition. . . . . . . . . . . . . . . . . . . . . . . . . . . . 22 . . . . . . . . . . . .