Langenbecks Archiv fur Chirurgie. Supplement II, Verhandlungen der Deutschen Gesellschaft fur Chirurgie. Deutsche Gesellschaft fur Chirurgie. Kongress最新文献

In view of the lack of representative clinical studies indication and potential value of neo-/adjuvant chemotherapy of pancreatic cancer has still to be discussed on the basis of palliative treatment results, prognostic and pathohistological data, theoretical considerations and experimental data. A critical analysis, however, indicates that the widespread therapeutical nihilism at least with regard to adjuvant trials should be obsolete today. On the contrary, adjuvant chemotherapeutic trials should be recommended, alone or in combination with radiation or immunotherapy.

Endoscopic Nd:YAG laser therapy (lambda = 1.06 microns; 80-100 W) of colorectal neoplasia is indicated in: 1. Premalignant, sessile adenoma. After snare resection for histologic estimation of dignity laser ablation is curative when it is benign. 2. Obstructed colorectal cancer can be recanalized preoperatively to perform orthograde bowel lavage, total colonoscopy and elective primary tumour resection. 3. Inoperable colorectal cancer can be irradiated palliatively by the laser to arrest bleeding, to avoid obstruction and to reduce protein and electrolyte secretion.

Clinical and radiological features of Sudeck's dystrophy following radius fracture are described. Peripheral and endogenous factors are pointed out. Therapy consists in preventing and alleviating pain by primary immobilisation combined with gentle physical therapy of the non-involved parts of both upper extremities. Calcitonin, non-steroid antirheumatic and anxiolytic drugs should be administered simultaneously. The physician's care and tolerance of the mentally upset and labile patient are essential. Physiotherapy plays a major role in the long-standing rehabilitation process.

In an open, randomized, controlled and prospective study we compared the efficacy of LMWH with unfractionated heparin (UFH) and the effects of both heparin preparations on haemostatic and fibrinolytic parameters. We also stratified subgroups which received HES intra- and postoperatively. The study groups were well matched with regard to baseline characteristics. With LMWH 4 patients (4.1%) displayed a positive fibrinogen uptake test (1 patient with HES). With UFH 5 patients (5%) demonstrated a positive uptake (3 patients with HES). Antifactor Xa levels were significant higher in the LMWH groups; all other fibrinolytic and haemostatic factors, bleeding and local wound complications did not differ. These data suggest that LMWH in equally effective and safe as UFH in general surgery. HES may have and additive effect.

Bile duct stones can be treated by conventional operative endoscopy in up to 90%. Stones with a diameter of up to 10 mm may be treated without endoscopic sphincterotomy (EST), larger stones require EST and subsequent mechanical lithotripsy. Extracorporeally generated shock-wave lithotripsy (ESWL) is indicated in huge (phi greater than 15 mm), hard, and intrahepatic calculi. High risk patients are palliatively treated with transpapillary stent. Symptomatic gallbladder stones require surgical therapy in up to 85%. Only selected patients are candidates for oral litholytic therapy (phi less than 10 mm) or ESWL (1-3 radiolucent stones, phi 10-30 mm). Percutaneous transhepatic litholysis is not yet established as therapeutic alternative.

From 1975 to 1987, 44 of 230 patients with cystic fibrosis under our care underwent a total of 66 operations. There were no direct intra- or postoperative complications. If an optimal and aggressive adjuvant treatment is given postoperatively, there are no increased risks associated with surgical procedures in cystic fibrosis patients. Treatment of spontaneous pneumothorax remains a problem. An alternative treatment for pneumothorax using transcutaneous fibrin pleurodesis is presented.

Between 1980 and 1989, 69 children underwent lung resection in our department. 45 of them (25 boys, 20 girls, age 0-9 years) presented with atelectatic areas of the lung parenchyma, which had been demonstrated preoperatively in only 76%. Resections were performed for bronchial malformations (n = 7), sequestration (6), cysts (6), aspiration (1), pyocele following pulmonary artery ligation (1), upper lobe torsion (1), chronic pneumonia and/or bronchiectasis (14) and lobar emphysema with lung compression (10). The overall mortality was 4/45. Indications are discussed with special reference to the persistent or recurrent atelectasis.

Airway obstruction, dysphagia and mediastinal masses are the most common causes for surgery of the mediastinum in the pediatric age group. From 1976-1990, 82 children underwent such surgery: 7 tracheoplasties, 4 endotracheal resection of a membrane, 6 stenoses due to haemangioma or lymphangioma, 2 papillomatosis of the trachea, 8 pexes of the aorta or the innominate artery due to tracheomalacia, 7 vascular rings (4 right descendent aorta, 3 double aortic arch), 4 congenital esophageal stenoses, 44 mediastinal tumors (20 malignant, 24 benign lesions).

During the last fifteen years, endoscopic sclerotherapy has been established for the treatment of bleeding esophageal varices. However, many technical questions such as the type of sclerosing agent and the site and schedule of injection still exist and require analysis by controlled trials. Endoscopic sclerotherapy has been proven effective for the treatment of acute bleeding and for the prevention of variceal rebleeding. Improvement of survival by sclerotherapy for the prevention of rebleeding, however, is debated. Several controlled trials demonstrate that there is no indication whatsoever for the use of endoscopic sclerotherapy as primary prophylaxis of variceal bleeding in patients who have not bled before.

1944 patients with 2418 lacerations of extensor tendons in the hand were treated since 1966. Follow up study was possible in 1031 (53%) patients. The discussion about the best method to evaluate the results of treatment lead to a better scheme for critical examination. The preoperative status was taken into consideration as well as the subjective meaning and brought into harmony with the objective results.