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

Report about harmonization of surgical training in the E.C. countries. Responsibility of the U.E.M.S. (European Union of Medical Specialists), in particular of the section of surgery. Each country is represented by two members. Annual meetings. A harmonization committee has been founded under direction of Prof. Gruwez, Leuwen/Belgium. A first report on the harmonization of surgical training in the E.C. countries is available. Standards of quality shall be reached. Consideration to found a European Board of Surgery.

Aneurysmectomy was performed in 37 patients with a traumatic aneurysm the aorta in segment III. 34 "cross-clamping" without bypass was used, 6 after preliminary transposition of the subclavian artery. 3 patients died after surgery, two of whom were more than 70 years old. 2 patients developed a paraparesis, which has in the meantime considerably improved. Hesitation to operate is justified only in older asymtomatic patients at high cardiac risk. Cross-clamping is preferable to more elaborate procedures. Preliminary transposition of the subclavian artery simplifies the proximal anastomosis and may contribute to spinal-cord protection.

The necessity of closing a hemodynamically significant patent ductus arteriosus (PDA) in a premature neonate is unequivocal. Until 12/86 the PDA was disected and ligated and a chest tube was inserted (127 pts.) Since 1/87 45 pts. (weight less than 1500 g) underwent PDA-closure using a metal-clip and no chest tube. Simplified surgical technique in closure of PDA in the premature neonate has led to a marked reduction of operating time (mean from 36 to 18 min) and has decreased the incidence of perioperative complications.

IORT can be part of an oncologic treatment plan for patients with pancreatic or advanced stomach cancers that can be potentially cured by surgery. When used palliatively IORT can relieve symptoms. Used curatively IORT allows the administration of irradiation boost which complements percutaneous irradiation of the tumor region and the regional lymph nodes. External radiotherapy may also include irradiation of the liver which is performed simultaneously with chemotherapy. IORT also permits the application of oncolytic doses for adenocarcinomas of the upper gastrointestinal tract.

Endobronchial afterloading irradiation by remote control was administered to 304 patients with lung cancer. The use of a highly active 192-Iridium source (740 GBq) is possible; irradiation time lasts only a few minutes. A combined treatment modality with laser was employed in 24%, with chemotherapy in 2%. The response rate of all patients amounted to 67%. There was an improvement in 81% of patients with retrostenotic complications.

Local recurrences of intraperitoneal malignancies are mainly localized at the primary tumor site and the peritoneal surface. Surgical procedures alone are neither able to further reduce the development of local recurrence nor to treat the already established recurrent disease. In this situation intraperitoneal chemotherapy as an "adjuvant" treatment modality could be thought helpful. Experimental and clinical trials have shown that high doses of cytotoxic agents can be applied to the abdominal cavity with less systemic side effects. While the recent published data are not promising for gastrointestinal malignancies, they seem to be more encouraging for ovarian cancer.

At the University of Frankfurt/M. we perform chemoembolization of the liver in patients with inoperable liver cell carcinoma. Before application of embolization material vasoconstriction of healthy blood vessels is achieved by intraarterial injection of norepinephrine. This procedure improves selectivity of tumor embolization. Methods, indications, contraindications and results are presented.

The clinical manifestation of wounds of the heart is determined by the mode, site and size of the injury as well as the structure of the pericardial and myocardial lesion. Diagnosis can be confirmed by ECG and echocardiography. Only 20% of the patients with penetrating wounds of the heart live for more than 30 minutes. Pericardio-centesis should be used only to gain time for a safe sternotomy, cardiac decompression and suture of the wound of the heart. An aggressive surgical approach is mandatory. Cardiopulmonary bypass is necessary only to correct of concomitant lesions.

Venous thrombectomy was performed on 123 patients with phlegmasia coerulea dolens (blue phlebitis). Best results are obtained if treatment is initiated at the earliest stage. Arterial involvement must be closely monitored. A fasciotomy, which in some cases may involve the fascia lata, must be performed in case of compartment compression. Palma's bypass procedure and Av-fistula are indicated in some cases.

Exudative pleural carcinosis may remain the only localisation of generalized disease for months. Exudation and total distension of the lung must be prevented. Since sclerosis is not effective in cases of tapered lung, parietal pleurectomy and decortication are indicated. This ensures patient survival and fitness for work for several years.