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

From 1979 through 1988, 215 patients with pulmonary metastases were treated in our department. Surgery was possible in 112 patients. Eighty-two patients were resected curatively, whereas 30 had only palliative surgery. The operation mortality was 1.8%. The essential prognostic factors were the complete removal of all pulmonary metastases, the portal or caval path of metastasis, involvement of the hilus lymph nodes and presence of clinical symptoms upon hospital admission. The 5-year-survival rate of patients undergoing potentially curative operations was 31%. This was significantly higher than in patients who underwent palliative operations (9%).

In the palliative treatment of malignant esophageal stenosis endoscopic laser therapy and intracavitary radiation currently represent the best alternative. The results achieved with elimination of dysphagia, duration of the complaint-free interval, survival period, and complications are presented from a group of 167 patients. Referring to the quality of life, an evolving tendency towards the use of laser therapy instead of endoscopic intubation is reported.

Oncologic surgery still is the fundamental principle of cancer therapy. This is only useful when leading to a complete tumor extirpation (so-called R0-resection). Under these conditions an improvement of prognosis can be achieved. Unfortunately this aim can only be reached in some 50-70% of our patients. For all the other patients non-surgical therapy in surgery has to be secured by oncologic surgery. A most interesting development takes at present the preoperative chemotherapy or radiation therapy respectively. The aim is down-staging of the tumor to make a final R0-resection possible after all.

Thoracic aneurysms are classified according to the nomenclature of De Bakey (1-3b) or Daily (Stanford A-B). Our early and late results refer to dissections of the ascending aorta with and without aneurysms as well as with and without aortic valve involvement. The distal extension of the dissections was different. Since 1979 45 patients (mean age 48 years, range 23-70 years) were operated, the acute dissections mostly as emergencies after secured diagnosis. The preferred technique was reconstruction of the ascending aorta. However, also other techniques as prosthetic replacement or implantation of an conduit were used. The hospital lethality was 12.5% (n = 6); the late letality 24% (n = 7). The cumulative survival rate after 8 years was 74%.

The triadic system of psychiatry according to Kurt Schneider (1887-1967) is considered the systematic framework. The main forms of alcoholic poisoning, medication abuse and defective cerebral circulation are examined with regard to the unspecificity of psychopathological syndromes. Despite a considerable convergence there are quite a few differential diagnostic criteria, which are helpful in solving the perioperative problems of alcoholics and persons with medication dependency or defective cerebral circulation. All participants in the treatment of such patients must expand their knowledge of psychopathology and psychiatry.

Prophylaxis and treatment of alcohol withdrawal syndrome following esophagectomy consists of substitution with alcohol (1-2 g/kg/d), monotherapy with Midazolam (0.2-0.4 mg/kg/h) und Clonidin (1-2 mg/d). Out of 218 patients undergoing esophagectomy from X/86 till III/90 52 were classified as alcoholics and divided in 3 comparable groups. The Midazolamgroup showed the best results as far as withdrawal symptoms, time at the ICU, ventilation time, respiratory complications, delirium tremens and mortality are concerned. Patients in the Clonidin-group needed extensive supplimentary sedation.

The most important pathophysiological and pathogenetic facts are: The lower autoregulation threshold of cerebral blood flow and hypoxidosis, blood pressure in bradycardia, cerebral fits and stroke marks in CT, carotid atherosclerosis; reduced cerebral metabolism in chronic alcoholism and Wernicke. Reversible hypoglycemic induced hemiplegia. Multiinfarct syndrome and cerebral degenerative process Alzheimer. Effect of treatment by Piracetam.

In 1988 and 1989 4581 patients had been hospitalized in the surgical department of the Stadtkrankenhaus Neuwied. These patients were treated prophylactically with a combination of low molecular weight heparin and dihydroergotamine in order to prevent deep vein thrombosis. The observed incidence of DVT and pulmonary embolism was extremely low. In patients who died during hospitalization, death was mainly caused by cancer or multimorbidity. Although some risk factors for developing DVT are recognized, we are at present not able to calculate the individual risk of a patient. Therefore, we need an effective and safe prophylaxis regimen for all patients undergoing surgical operations.

Up to 80% of patients with liver cirrhosis develop esophageal variceal bleeding which is lethal in up to 30% after the first bleeding episode. Parameters suitable to identify patients being on risk to bleed from their varices are severe liver disease (Child's C), large varices with red color sign and red wall markings and high intra-variceal pressure above 12 mmHg.

Imaging procedures in patients suffering from portal hypertension and the problems arising from this condition are limited to the demonstration of the morphology of the collateral circulation towards the superior and the inferior vena cava. Imaging is essential prior to elective and emergency treatment of bleeding varices. Non-invasive and invasive imaging procedures are available. Acute hemorrhage of varices usually can not be demonstrated with any of the methods. Important is the preoperative evaluation of the portal system and the angiographic demonstration of the anatomy.