[Detection of an insulinoma in pregnancy--a rare cause of hypoglycemia]. / Nachweis eines Insulinoms in der Schwangerschaft--eine seltene Hypoglykämieursache.

An insulinoma was diagnosed in a 26 year-old woman who suddenly went into hypoglycemic coma in the 38th week of an apparently uncomplicated pregnancy. On review of the history it became apparent that symptoms due to hypoglycemia had been present since the 16th week of pregnancy. Continuous intravenous infusion of glucose was administered and the patient was delivered of a healthy child 5 days later. Investigations revealed 2 insulinoma nodules in the tail of the pancreas which were successfully removed 2 weeks post partum.

[The use of disposable draping materials in the operating room and its effect on the postoperative wound infection rate]. / Der Einsatz von Einwegabdeckung im Operationssaal und sein Einfluss auf die postoperative Wundinfektionsrate.

In a consecutive study we analyzed the influence of gown and drape material on the postoperative wound infection rate. 1033 operations were included in this study. In 354 operations conventional cotton gowns and drapes were used, while in 679 operations, a disposable gown and drape system was utilized. The use of disposable gown and drape material reduced the postoperative wound infection rate in our surgical department. The greatest reduction -43% - was seen in clean wounds. Within this group gallbladder operations showed a reduction of 59% and hernia operations showed a reduction of 46%. A slight reduction was also seen in clean-contaminated and contaminated wounds, while in dirty wounds there was no difference. However, due to the relatively low numbers involved the results were not of statistical significance. An analysis of the costs over a 12-month period showed a reduction of 7.5% when the disposable gown and drape system was used. With respect to ease of handling and wear the disposable material was preferred by the operating-staff, both doctors and nurses.

[Treatment of advanced ovarian cancer as an interdisciplinary task: surgery, histopathology, radiotherapy, and chemotherapy]. / Die Behandlung fortgeschrittener Ovarialkarzinome als interdisziplinäre Aufgabe: Chirurgie, Histopathologie, Strahlentherapie, Chemotherapie.

From February 1977 to February 1981 we treated 55 patients with ovarian cancer (45 stage III and 10 stage IV) with simultaneous radio-chemotherapy; 34 of these patients underwent a therapeutic second-look operation. The overall response rate was 94%, comprising 63% complete and 31% partial remissions. In the group with residual tumours exceeding 2 cm in diameter after primary operation 52% complete remissions were observed. In the stage III group there were 74% complete and 26% partial remissions. Cytoreductive surgery to less than 2 cm was achieved by means of an early second-look operation in 74% of these cases. These patients have as good a prognosis as those with an equivalent residual tumour after primary resection. Unlike the cases with tumour spread to the retroperitoneal area, macroscopic tumour spread to the surface of the liver or diaphragm indicated a worse prognosis. The survival time of patients who prove to be tumour-free at the time of the diagnostic operation is significantly longer than of those with residual tumours. Neither the age of the patients nor the histological findings after primary operation have any significant influence on survival time. Late intestinal complications made us change the therapeutic strategy employed since March 1981 to sequential radio-chemotherapy. Possible cure for stage III patients can be achieved only by way of interdisciplinary cooperation. In stage IV patients the prognosis is so bad that local therapy is possible only in selected cases.

[Circular staple anastomoses in the gastrointestinal tract with the staplers SPTU and EEA]. / Zirkuläre Klammeranastomosen im Magen-Darm-Trakt mit den Klammernahtgeräten SPTU and EEA.

In 72 patients, 80 circular stapler anastomoses have been performed in the whole gastrointestinal tract of them, 39 were created by means of the Russian SPTU stapler with a single row of staples and 41 were performed with the American Auto-Suture EEA stapler, which employs a double row of staples. Three patients died because of anastomotic leakage (4.17%) and one myocardial infarction (overall mortality: 5.56%). The use of circular staplers lowers the incidence of anastomotic dehiscence, shortens the operating time and enlarges the operative possibilities, particularly in esophageal and rectal surgery. Since application of these staplers may be difficult, this, like any other surgical technique, must be trained.

[Carcino-embryonic antigen as screening protein in the follow-up of patients with surgically-treated gastrointestinal cancer (author's transl)]. / Das karzinoembryonale Antigen als Screeningprotein in der Nachkontrolle chirurgisch behandelter Patienten mit gastrointestinalem Karzinom.

Carcino-embryonic antigen (CEA) was determined in 206 patients with gastrointestinal cancer (131 colonic and 75 stomach) at the 2nd Department of Surgery of the University of Vienna. The value of CEA in predicting tumour recurrence and/or metastatic spread has been assessed within the framework of regular follow-up control examinations after surgery. A postoperative rise in CEA titre corresponded with cancer recurrence or metastasis both in patients with stomach (91%), as well as colonic cancer (86%), whilst low postoperative CEA values correlated with a negative clinical report only in patients with carcinome of the colon to any degree of accuracy (91%). The correspondence was much lower in patients with stomach cancer (67%).

[The contribution made by the 2nd Department of Surgery, Vienna University, to the treatment of colorectal cancer (author's transl)]. / Der Beitrag der II. Chirurgischen Universitätsklinik Wien zur Behandlung des kolorektalen Karzinoms.

The treatment of colorectal cancer was chosen as a significant example for the history of the second department of surgery of Vienna University. Not only was a considerable part of relevant surgical techniques developed here, but also the problem of cancer has always been one of the traditional fields of activity of this institution. After the foundation of modern abdominal surgery by Billroth, his pupil Czerny performed the first combined abdomino-perineal resection of the rectum, whilst Gussenbauer, his successor, carried out the first curative resection of a carcinoma of the colon. Hochenegg performed the first sphincter-saving resection of the rectum and devised his pull-through procedure. Moreover, he started to organize the general fight against cancer by a campaign to enlighten the public. Denk continued these activities. He founded the cancer research centre and initiated the present activities in the prevention and therapy of cancer in this country.

[The research programme "Artificial Heart" at the 2nd Department of Surgery, University of Vienna: a ten year review (author's transl)]. / Das Forschungsprojekt "Künstliches Herz" an der II. Chirurgischen Universitätsklinik Wien. Ein 10-Jahres-Bericht.

The experimental and clinical results are presented of the research programme "Artificial Heart" carried out by the 2nd Department of Surgery, University of Vienna. In particular, an assessment of the clinical experience in 177 patients with the intra-aortic balloon pump is documented and it is concluded that only limited cardiac support is possible by this pump. In view of this fact more efficient methods of mechanical circulatory support, such as the interaortic auxilliary ventricle, the aortic "Windkessel" ventricle with guiding balloon, and two types of ventriculo-aortic bypass ventricle were tested with regard to their haemodynamic and long-time efficacy. The transatrio-aortic auxilliary ventricle (E-LVAD) was also clinically tested in 11 patients. In conclusion the problems of total mechanical heart replacement are discussed.

[About the angiographic diagnosis of intestinal carcinoids (author's transl)]. / Zur angiographischen Diagnose von Darmkarzinoiden.

Using two angiographically well documented cases the angiomorphological features of intestinal carcinoid tumors are described. One case is a carcinoid of the terminal ileum with hepatic metastases, the other case a cecal carcinoid without distant metastases. The primary tumor of the second case is strikingly hypervascular--most primary carcinoid tumors heretofore described in literature were hypovascular. In both cases is the mesentery afflicted in the typical manner indicating spread to local lymph nodes. By reviewing the literature the pathophysiologic mechanisms causing the anatomic changes are explained.

The Windkesselventricle with guiding balloon as a new approach for assisted circulation.

A simple method was developed to aid the patient with low cardiac output syndrome following cardiac surgery. The concept was shown to be feasible in electric circulatory analog studies and verified in 20 dog experiments. A Dacron graft (end-to-side) through the right second intercostal space connects the ascending aorta to the subcutaneously implanted, ellipsoidal-shaped artifical ventricle. A spherical polyurethane balloon is positioned in the aorta distal to the Dacron graft via the femoral artery. The ventricle and balloon are pneumatically driven synchronously with the ECG. In natural systole the balloon is inflated, occluding the aorta, and the artificial ventricle sucks the entire stroke volume. In natural diastole the balloon deflates and the artificial ventricle ejects the blood into the peripheral arteries. With this system it is possible to maintain a normal systemic pressure and have high hemodynamic efficiency. The left ventricular systolic pressure is 85 percent unloaded. The systolic wave is turned 180 degrees to the natural. After treatment, the device can be removed without thoracotomy.

[A new design for a totally artificial heart: the ellipsoid heart (author's transl)]. / Eine neue Konstruktion für ein total künstliches Herz: Das Ellipsoidherz

Thromboembolic complications represent the main limiting factor in cardiac replacement by totally artificial hearts in calves at present. Thrombus formation within artificial hearts is caused by the appearance of stagnation areas. The ellipsoid heart eliminates stagnation areas by virtue of its production as a one-piece membrane. The heart is driven pneumatically and functions as a diaphragmatic blood pump. The stroke volume is 178 cm3 and the maximal cardiac output 15.8l/Min. Three acute experiments demonstrated a high degree of haemodynamic efficiency without compression of, or interference with surrounding structures, especially the inferior vena cava or the right atrium.

[Functional replacement of the left heart with an intrathoracally implantable ventricular-aortic blood pump (author's transl)]. / Funktioneller Linksherzersatz mit einer intrathorakal implantierbaren ventrikulo-aortalen Blutpumpe

An implantable ventricular-aortic blood pump was employed for the functional replacement of the left heart. Pilot studies were performed in 12 dogs to test new materials and manufacturing innovations used in the production of the blood pumps. Further pilot studies were undertaken to evaluate prophylactic measures against infection along percutaneous driving lines. A skin button made from biomaterials and covered with antibiotics was subcutaneously implanted in 2 dogs and 5 calves. No infection was seen along the percutaneous lines for up to 6 months later. After the implantation technique had been worked out in 15 calves acute haemodynamic studies were undertaken. The implanted pump took over, on average, 88% of the cardiac output. The peak systolic ventricular pressure was decreased from 106 to 18 mm Hg. The myocardial oxygen consumption was thereby decreased by 21% in respect to the control value. A ventricular-aortic blood pump was implanted in 12 calves for long-term studies. The longest duration of pump experimentation was 73 days. The laboratory examinations show that all body functions return to normal within 10 days and that the pumping device is completely integrated into the living organism.

[Partial replacement of the heart]. / Zum Teilersatz des Herzens

A ventricular-aortic blood pump was constructed for the functional replacement of the left heart. Hemodynamic experiments showed that the device was able to pump the total cardiac output in calves with a body weight under 85 kg. In these cases the myocardial oxygen consumption decreased to 40%. Laboratory findings in 5 longterm experiments revealed a complete adaptation of the body to the artificial organ up to 73 days.