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

A retrospective examination involved 414 patients (260 m, 154 w, mean 60 y) with pleural metastasis/pleural effusion of the following primary tumors: 37.2% bronchogenic (23.2% malignant pl. mesothelioma), 14.5% breast, 8.7% adeno-ca (unknown primary) 2.4% gastrointestinal, 2.2% uterus/ovar, and 11.8% others. Thoracoscopy with histologic confirmation played a central role in our diagnostic procedures in 97% of the cases. Malignancy was defined by CEA (less than 5 mg/ml) (71.9%) and cytology (76.9%) in 90.4%. Our strategy had the following success rate: desiccation by pleural drainage (greater than 26 Charr) alone 74%, in combination with pleurodesis 81%, pleurectomy/decortication 95%, and extended pleuropneumonectomy (in 80% mesothelioma) 96%.

Thoracic surgical emergencies in early childhood refer mainly to congenital malformation. To enable a successful treatment, disclosing of provable malformations by prenatal ultrasound screening and gradual sonographic diagnostics are necessary. Management of thoracic emergency situations should take place within an interdisciplinary team. Progress can only be expected by improved ultrasonographic examinations, planning of dilivery, intrapartum management, post partal differentiated diagnostic and therapy. As those prerequisits are not provided everywhere, medical care of those newborns effected in qualified centers is to be recommended.

Cholecystectomy, hitherto the "golden standard" in gallstone treatment, and all the other alternative methods must pass the test of applicability, morbidity, mortality, rate of success and recurrence. According to these criteria, cholecystectomy (removing not only the stones but also the offending gallbladder)--in particular with the advent of the laparoscopic approach--is the therapy of choice.

Experimental surgery in german various forms of organisation and different aims as regards cooperation between experimental and clinical surgery. The best and most effective form is that of an institute with good personnel, adequate finances and sufficient space. An essential prerequisite for good cooperation between experimental and clinical surgeons is that the scientific aims be initiated by both. Success is possible only, if continuity can be guaranteed over a longer period. This is possible only in well established institutes of experimental surgery.

For aortic aneurysms type A operative treatment is the method of choice. During the past 15 years 128 patients with this diagnosis have been operated on. Early mortality was 22%, 77% of all dissections were emergencies. Main causes of death were multiorgan failure. Up to 117 months 8 patients died late in part due to additional ruptures. 17% of the survivors required reoperation up to 154 months. The probability of survival after 10 years is 0.78, in the group with dissections only 0.4. Therefore close follow-up of this patient group is necessary in order to recognize progression of the disease and induce elective operative treatment.

Unlabelled: Between 4/78 und 9/89 44 patients (pts.) underwent primary repair of CADA. 3 pts. died early postoperatively. 36 pts. were followed-up 3 months to 9.7 years (means = 3.1 years) postoperatively with CT, DSA and echocardiography. 8 pts. underwent 12 aortic reoperations, in 10 cases due to persistent or recurrent aneurysms.

Conclusions: In CADA radical replacement of the Ascending Aorta is advisable to prevent recurrent aneurysms formation. Systematic follow-up facilitates early recognition and repair of progressively chronic or new downstream aortic pathology.

In a prospective study 50 patients who reported regular ethanol consumption and who underwent neck dissection were evaluated by clinical examination and the Munich alcohol test (MALT). 31 patients were not classified as alcohol abusers and none of them developed withdrawal symptoms (WS) postoperatively. 19 patients were diagnosed as alcohol abusers; 9 of them (group 1) received symptomatic therapy with clomethiazol and haloperidol, 10 patients (group 2) received continuous ethanol infusions (2-4 g/h) postoperatively as prophylaxis for WS. 6 patients in group 1 developed WS; none of group 2 developed WS. Thus the period of intensive care therapy of group 2 was significantly shorter (3.0 versus 11.5 days). It was concluded that postoperative continuous ethanol infusions prevent the occurrence of WS and should be administered to severely alcoholic patients.

From Jan 1, 1982 to Jan 1, 1990 692 patients were admitted because of acute or recurrent hemorrhage from esophagogastric varices. Initial management was endoscopic sclerotherapy. 14 pat. were excluded. In 26 of 311 Child-Pugh C-patients a gastroesophageal disconnection and in 5 because of a portal pressure over 30 mmHg a narrow-lumen mesocaval interposition shunt (NLMCS) were performed because of uncontrollable hemorrhage. Hospital mortality was 31%. 182 pat. belonged to Child-Pugh class A and 185 to B. In 194 long-term injection sclerotherapy was successful; 173 were sclerotherapy failures and selected for shunt operation at the end of the selection analysis. 85 refused shunt operation or did not fulfill selection criteria. Thus, 88 pat. were shunted mainly by NLMCS and distal splenorenal shunt. Sclerotherapy and shunt group were comparable. Hospital mortality showed no difference. Five year life-expectancy was significantly higher in shunted patients. Thus, in sclerotherapy failures early a shunt-indication should be discussed.

By the X-ray Cineradiografie we are able to examine and to judge the dynamic of the wrist bones by 50 pictures/sec. in comparison to one another and also depending on their ligaments. We did an investigation of 170 patients with painful wrist. With the method we were able to make up a clear diagnosis and to propose the therapy. I.e.: If consecutive shortening of the radius after distal radius fracture resulting ingruency of the wrist joint is relevant, or a scaphoid pseudarthrosis is fixed elastically, or a scaphoic dissociation is effective. The variations were shown in comparison to normal circumstances.

Only early diagnosis and vascular surgery during the period of ischemic tolerance (about 12 hours) will improve the results of treatment of acute splanchnic artery occlusion. From 1966 to 1989, 98 patients were treated: 81 underwent operations (65 emboli of the SMA, 16 arteriosclerotic obstructions). Of the 47 patients who were treated at the stage of reversible acute mesenteric ischaemia 12 died (25.5%). Of the 34 patients undergoing surgery at the stage of small bowel infarction 24 died postoperatively (70.6%).