Analysis of 274 Omniflow Vascular Prostheses implanted over an eight-year period.

BACKGROUND: Polytetrafluoroethylene (PTFE), dacron, and, more recently, collagen prostheses are finding increasing use for femoropopliteal reconstruction when a suitable vein is not available. The main factors to be considered when choosing a prosthesis are patency, susceptibility to infection and formation of aneurysms. METHODS: Sheep collagen prostheses were implanted on 274 occasions in the femoropopliteal or crural regions. RESULTS: The patency rate for supragenual bypass after 3 years was 61.9% with good vascular periphery and 44% with poor vascular periphery. If the prosthesis extended below the knee, the patency rate was 55.4% with good and 35.3% with unfavourable vascular periphery. Patency for the femorocrural bypass was 28.7% after 2 years. The rate of infection was 0% and an aneurysm occurred in three patients (1.1%). CONCLUSIONS: With this low infection rate and very slight danger of aneurysm, the long-term results suggest that the ovine collagen prosthesis can be recommended for use when no suitable vein is available.

Posttraumatic extracranial aneurysm of the internal carotid artery: combined endovascular treatment with coils and stents.

We report a case of a posttraumatic extracranial pseudoaneurysm of the internal carotid artery that was treated successfully via embolization with Guglielmi detachable coils and placement of a Wallstent after surgical repair failed.

Cystic retroperitoneal lymphangiomas in adults.

Lymphangioma (LA) is a rare benign tumour of the lymphatic tissue, most common in the neck and head, and clinically manifests itself mostly in childhood. Within this group, intra-abdominal and retroperitonal LA are the rarest tumours, especially when occurring in adults. We report four LAs localized in the retroperitoneum of patients aged between 28 and 72 years. One of these tumours infiltrated the transverse mesocolon and greater omentum, others were situated in the left retroperitoneum and retroperitoneally at the duodeno-jejunal flexure, and in the retrosplenal and retropancreatic area. Diagnosis was made by light microscopy supported by immunohistochemistry. In three cases the tumour could be removed by radical surgery and none of these patients had a recurrence (median follow-up time: 4 years). The tumour could not be removed completely from one patient with pre-operative chylascos. Six months after diagnosis of LA this patient died of cardiopulmonary failure due to progressive tumour chylascos. Isolation and ligation of the cystic LA's peduncle as well as ligation of lymph channels can prevent recurrences and chylascos.

Male breast cancer: Austrian experience.

Data were collected on 169 men treated for breast cancer at 36 surgical departments in Austria between 1970 and 1991. We report here several of their clinical features and assess the importance of established prognostic factors. After a median observation period of 51 months 60 patients (35%) suffered a recurrence. The estimated 5-year recurrence-free survival for the entire group was 55%, and the estimated 5-year overall survival was 62%. Although stage-adjusted data are comparable to those for female breast cancer, the outcome in this series may be attributed to a relatively high frequency of advanced tumor stages. Tumor size (recurrence-free survival p = 0.00001; overall survival p = 0.03) and axillary lymph node status (recurrence-free survival p = 0.0001; overall survival p = 0.0001) proved to have a prognostic impact. Using a multivariate analysis, axillary lymph node status (recurrence-free survival p = 0.001; overall survival p = 0.01) still had prognostic influence. The various procedures used had no effect on local recurrence.

Malignant fibrous histiocytoma of the mesentery--a rare cause of abdominal pain. Case report with a review of literature.

Malignant fibrous histiocytoma (MFH) is a tumor most frequently occurring in lower and upper extremities and in retroperitoneum. This paper presents the extremely rare case of a 55-year-old male patient with a MFH of storiform pleomorphic subtype originating from the mesentery. Sonography, computed tomography as well as endoscopy and ERCP did not reveal the diagnosis. Finally the tumor was diagnosed by laparoscopy with biopsy and histological examination. Two months after diagnosis of the tumor the patient died of bronchopneumony and heart failure contracted during a generalisation of MFH.

[The clinical importance of protein C and S deficiency for surgical patients]. / Die klinische Bedeutung von Protein-C- und -S-Mangelzuständen für das chirurgische Patientenkollektiv.

Protein C and S are important factors in blood coagulation reported in many papers about people who suffered from thromboembolic diseases related to inherited or acquired deficiencies. Homozygous protein C/S deficiency is lethal in most cases without therapy. Heterozygous deficiency is moderate and complications occur between the 20.-50. year of age. Acquired protein C/S deficiency is a strong parameter for liver function. The typical clinical manifestations of protein C/S deficiencies are superficial and deep leg vein thrombosis, thrombosis of the mesenterial, cerebral, renal and axillary veins, portal vein thrombosis and pulmonary embolism. Most of the affected people live disease free over a longer period and develop thromboembolic complications during and after trauma, surgical interventions, pregnancy and puerperium. We report our experience with a 60 years old male who had developed a severe bilateral iliofemoral vein thrombosis with signs of pulmonary embolism after total hip replacement. An extended functional protein C deficiency (type II) was investigated by coagulation tests (Protein C Reagent, coagulometric from Behring Institute). A second female patient developed a descending iliofemoral vein thrombosis during pregnancy. Venous thrombectomy with arteriovenous fistula was performed, but reocclusion occurred after delivery. Redo-surgery was undertaken and a second reocclusion took place 10 days later. Further lysis therapy was not able to reopen the venous system. Whereas immunological and functional protein C levels showed normal ranges, the functional protein S level was markedly reduced (IL-Instrumentation Laboratory Protein S-Test).

[Breast cancer in the catchment area of the Graz Institute of Pathology. Evaluation of morphologic parameters based on 1,510 cases]. / Das Mammakarzinom im Einzugsgebiet des Grazer Instituts für Pathologie. Evaluierung morphologischer Parameter an Hand von 1510 Fällen.

The patient's age, tumour size, histological type and degree of differentiation as well as involvement of axillary lymph nodes are decisive for prognosis and therapy of breast cancer. Moreover these parameters reflect the achievement of early diagnosis and the surgical standard of treatment of breast carcinomas. Therefore we retrospectively reviewed 1510 cases diagnosed from 1984-1987. Non-invasive carcinomas were diagnosed in 4%. 75% of them were classified as intraductal carcinoma and 25% as lobular carcinoma in situ. 96% of the tumours were invasive at time of diagnosis. Invasive ductal carcinoma (NOS-type) was found in 70.2%, invasive lobular carcinoma in 12.3%. 3.2% of the tumours showed both ductal and lobular differentiation and 2.3% corresponded to invasive ductal carcinoma with a predominantly intraductal component. Medullary and mucinous carcinomas were detected in 2.1% and 2% of cases, respectively. Papillary carcinomas were observed in 0.9%, the frequency of other histological types was less than 1%. 44% of the tumours corresponded to UICC-category pT1, 38% to pT2, 6% to pT3 and 8% to pT4. A meaningful correlation of tumour size and axillary lymph node involvement was possible in only 906 cases, in which 10 or more lymph nodes were verified histologically. Lymph node metastases were detected in 23% of tumour category pT1 and in 47% of category pT2. PT3- and pT4-tumours metastasized to axillary lymph nodes in 77 and 86% of cases, respectively.