[The modified Kleinsasser tube: the ideal in difficult intubation]. / Das modifizierte Kleinsasser-Rohr: Ideal für die schwierige Intubation.

The modified Kleinsasser tube is commonly used for laryngeal tumour diagnosis. The tube has a semilunar cross-section with a radius of 2.5 cm and a diameter of 3 cm. Its lower third contains a cold light lamp placed so that it cannot become covered by blood or tumour masses. After insertion of the endotracheal tube into the patient the Kleinsasser tube is placed at the entrance of the larynx. Operations are done through the inner lumen of the Kleinsasser tube. The Kleinsasser tube has proved a reliable instrument for insertion of endotracheal tubes in patients whose vocal cords could not be seen by ordinary laryngoscopy, e.g. patients with a short neck and unable to recline, with severe hypopharyngeal haemorrhage, with obstruction at the base of the tongue and partial occlusion of the laryngeal entrance by tumour. After introduction the vocal cords may be inspected in their entire length and under bright light the endotracheal tube may be brought safely through the Kleinsasser tube into endotracheal position using Magill forceps as an auxiliary instrument.

[Selective proximal vagotomy in stenosing and penetrating duodenal ulcer]. / Die selektiv-proximale Vagotomie beim stenosierenden und penetrierenden Ulcus duodeni.

In duodenal ulcer with complete pyloric stenosis selective proximal vagotomy in connection with either pyloric dilatation or duodenoplasty is generally indicated. Pyloroplasty may still be considered as an acceptable alternative drainage procedure. In high risk patients with pyloric stenosis, especially in the very old, truncular vagotomy with an adequate drainage is the operation of choice because of its low operative trauma. Penetrating ulcers are treated by selective proximal vagotomy only. Postoperative pyloric stenosis occurs rarely and should be managed by secondary pyloroplasty or pyloric dilatation.

[Revision operations following vagotomy]. / Revisionsoperationen nach Vagotomie.

Recurrent duodenal ulceration after highly selective vagotomy is best managed by antral gastric resection and gastroduodenostomy (BI). In cases of gastral localisation of the recurrent ulcer and in cases with high postoperative acidity a 2/3 partial gastrectomy (BI) should be performed. Revagotomy after highly selective vagotomy is not feasable in most cases. Pyloric stenosis after highly selective vagotomy occurs in about a percentage of 2 and can be easily corrected by secondary pyloroplasty or duodenoplasty. In very rare cases of severe postvagotomy dumping and postvagotomy diarrhoea the interposition of an antiperistaltic jejunal segment can be practised. Persisting postvagotomy dysphagia may require pneumatic dilatation of the cardia or operative revision of the oesophago-cardiac region. A case of ulcerocancer in a pyloric ulcer primarily treated by truncal vagotomy and pyloroplasty is reported.

[Injury of the interorbital space: II. Therapy. Pathology and therapy of the traumatic telecanthus]. / Das Trauma des interorbitalen Raumes: II. Teil: Therapie. Pathologie und Therapie des traumatischen Telekanthus.

The surgical treatment of lesions of the interorbital area belongs to the field of the rhinologist. Treatment options have been extended in recent years by technical advances. These include the extension of microsurgery to the base of the skull and the use of fibrin tissue glue. We have also had experience of an osteosynthetic material. Stable fixation of the antero-lateral walls of the interorbital space have esthetic advantages and functions as compared with interosseous wiring. An abutment is formed to support the upper jaw, and, with this, circular periorbital bony reconstruction is achieved.

[Unilateral blindness following intranasal aethoxysklerol injection]. / Einseitige Erblindung nach Intranasaler Aethoxysklerol-Injektion.

In spite of extensive experience based on animal experiments and human treatment, a unilateral, irreversible amaurosis occurred in one case of paravascular sclerotherapy of epistaxis with Aethoxysklerol. The strict submucosal application of Aethoxysklerol does not cause a mural thrombosis but leads to narrowing of the vessels (e.g., in the region of the Locus Kiesselbachii) due to gradual subepithelial sclerosis of the mesenchymal tissue. Temporary or permanent amaurosis has also been described in cases of injection of local anesthetics or glucocorticoid crystalline suspensions in the facial and neck region. From the pathophysiological point of view, allergic reactions, neuroreflex vascular spasm, or micro embolism of the central retinal artery have to be considered. The incident on which this paper is based led to a liability lawsuit. Judgement was given against the attending doctor because of severe bodily injury.

[Trauma of the interorbital space. Pathology and therapy of traumatic telecanthus. 1. Pathology]. / Das Trauma des interorbitalen Raumes. Pathologie und Therapie des traumatischen Telekanthus. 1. Teil Pathologie.

Converse is using the term "interorbital space" for the ethmoid bone, especially its lateral wall. We added the frontal process of the upper jaw including spongy substance ("trajector"). Pathophysiology and clinical points of view of comminuted fractures are demonstrated.

[One-stage reconstruction of intraorbital fractures by means of plate osteosynthesis (author's transl)]. / Die Primärversorgung des zentralen Mittelgesichtspfeilers mit stabiler Plattenosteosynthese.

Considering the multiplicity of sequelae of central midface fractures (rhinoliquorrhea, anosmia, impediment to the drainage of the superior sinuses and to the lacrimal fluid, traumatic telecanthus, dish-face etc.) the importance of rhinosurgical treatment as the foremost procedure is shown. The small-fragment sets according to Champy as stabilizing elements in operations of the interorbital space (Converse) and its osseous supports are mentioned. Both the technical and the functional advantage of establishing a stable osseous trajectory in the rhinobasis after fractures is emphasized. Stable osteosynthesis as a primary therapeutic procedure enables the rhinosurgeon to find a remarkable synthesis of both functional and aesthetic tasks in this problematic area. The stable fixation makes the rhinosurgical treatment a preliminary one for other surgical procedure to follow.

[Vascular functional disorders in insulin-dependent diabetes]. / Vaskuläre Funktionsstörungen beim insulinabhängigen Diabetes.

In 60 patients with manifest diabetes mellitus of juvenile onset type in whom no peripheral macroangiopathy was present for objectifying disturbances of the vascular function angiological measurements in rest and after pedal-ergometric load were performed in the region of the lower extremity. In comparison to test persons with healthy metabolism diabetes showed significantly shorter pulse were times due to decreased elasticity of arteries. The behaviour of the rheographic and doppler-sonographic parameters corresponded to a larger and longer lasting dilatation of the muscular arterioles after load. Correlations between these functional changes and the severity of a microangiopathy (retinopathy) or their ascertained influence factors could not be proved in the examined number of patients. Disturbances of the haemodynamic vasomotor function are in diabetes above all to be evaluated as signs of the autonomous neuropathy. Moreover, the regulation of the blood supply changed under muscle work is connected with an increased catecholamine-conditioned stimulation of adrenergic beta 2-receptors of the vascular wall and further local metabolic as well as haemorheologic deviations.

[Metabolism of 32P-butonate and formation of vinylbutonate metabolite in warm-blooded animals]. / Zum Metabolismus von 32P-Butonat und zur Bildung des Metaboliten Vinylbutonat im Warmblüter.

The metabolic fate of butonate, a 32P-labelled organophosphorus insecticide (0.0-dimethyl-l-n-butyryloxy-2.2.2-trichloro-ethyl phosphonate) was investigated in blood serum of cattle in vitro and in mice in vivo, following intraperitoneal and oral administration of 200 mg/kg. Metabolites were separates by thin-layer chromatography, using two solvent systems, acetonitrile-water = 85:15 and ethyl ether, for polar or non-polar metabolites. The Rf-values as well as the partition coefficients for chloroform and water and ethyl ether to ten per cent H2SO4 and for n-hexane and acetonitrile are given for butonate and the metabolites together with the amounts of metabolite, following in vivo metabolic degradation. The blood level as well as residues in milk are given by the following graduation: trichlorphone greater than vinylbutonate greater than butonate greater than dichlorvos. The formation of the new metabolite vinylbutonate is discussed.

[The immediate reconstruction of a large lip-chin defect with two muscular pedicled and innervated island flaps (author's transl)]. / Die sofortige Rekonstruktion eines grossen Lippen-Kinn-Defektes mit zwei muskulär gestielten und innervierten Hautinsellappen.

Different methods of defect closure in the lipchin region through lateral advancement-flaps have been described by Bernard, Fries, Hertig, Meyer and others. Is there not enough material available, can neck-, breast-or forehead flaps cover the defect, although they do not fulfill the demands for a satisfactory restoration of specific function. In the following work is the possibility of covering of a three layered facial defect with a combined skin muscle flap taken into consideration in view of the disadvantages of a simple or doubled skin flap. By this operation method the procedure consists of preparing various sized cervical island flaps which are connected with on the mastoid pedicled M. sternocleidomastoideus. We are describing a case of extensive tumorresection in the lip-chin area with neurofibromatosis Recklinghausen, whereby we have closed a large defect with two separately laid on muscle-pedicled, innervated island flaps from the fossa supraclavicularis. These bilateral compound flaps fulfill the demands of an immediate restoration of contour and prominence in this area. Apart from this they allow satisfactory voluntary activity, unpleasant dribbling of saliva is prevented.

[The process of manufacturing splints for the nose after nasal tip surgery (author's transl)]. / Erfahrungen mit Kunststoffstabilisatoren der Nase, hergestellt im Tiefziehverfahren.

The process of manufacturing splints for the nose after nasal tip surgery falls into three catagories: impressions, moulding and insertion. The plastic ware is carried out in a dental laboratory, so as to help the surgeon who is less familiar with the preparation of the material. The special procedure of moulding is suitable for this purpose. The splints are favourable in regard of cosmetics and tissue compatibility.

[Experiences with the postoperative intranasal long term splinting of the septum (author's transl)]. / Erfahrungen mit der postoperativen intranasalen Langzeitschienung des Septums.

Reference is made to the stabilizing function of the septal cartilage and the incalculability of its reaction after injury or surgical treatment. Apart from various forms of tampons particularly the use of cut polyethylen splints for long term splinting of the septum has to be mentioned. We emphasize their stabilizing effect in the healing phase, the compatability with the patient, the application possibilities and finally surgical details. Even after a period of 3 weeks observation, we can see active ciliated epithelium by microscopic examination, a transformation into inferior squamous epithelium does not take place.

[The double chisel--a new nasal osteotome (author's transl)]. / Der Doppelmeissel, ein neues Osteotom zur medianen Osteotomie.

A new chisel for performing osteotomy in rhinoplasty is described. It is double barrelled and consists of two flat chisels jointed together. Its advantage is that it permits clean division of the nasal bones and in combination with "in and out fracturing" contour irregularities are almost completely avoided.

[A contribution for conservative septal surgery (author's transl)]. / Ein Beitrag zur konservativen Septumchirurgie.

The correction of the lower part of the septum serves the operation principle after Cottle. In the following work is a simplification shown to help discover the "Premaxilla-Area". Because of the possibility of mucous membrane perforation and irritation of the nasopalatinus nerve the building of an isolated inferior tunnel is purposely avoided. In any case the main aim is the least traumatical exposure of structures.

[Experimental research to carry out a contralateral anastomosis of the arteria carotis (author's transl)]. / Experimentelle Untersuchungen über die Anlage einer kontralateralen Carotisanastomose.

The contribution is presenting a procedure for reconstruction of cerebral blood flow after resection of the A. carotis communis and the A. carotis externa in animal experiments. The preparation in human corps will demonstrate the possibilities on anatomical points. The surgical intervention is based on the fact that we can tie up the A. carotis externa on both sides without disadvantage. On the healthy side, without formation of metastasis, we prepare the A. carotis externa from the bifurcation up to the region of the Mm. pterygoidei. There we will tie up the vessel. The vessel can be transplanted to the contralateral side via a retropharyngeal "tunnel". On this side we dissect the big vessels of the neck. There the suture will be applied to the transplanted A. carotis externa and to the stump of the A. carotis interna by end-to-end or end-to-side anastomosis. The results are documentated by angiographies and local pressure measurements during the operation.

[The hydrodynamic mucosa-cytology by means of ultrastructures filters in upper respiratory tract and oesophagus]. / Die hydrodynamische Filtrationszytologie an Schleimhäuten der oberen Luft-und Speisewege

A rinse-and-suck-sound is presented, which conveys cytological material to a special filter mechanism. The heart of the system is a well-known filter, an electric pump, and a new constructed vacuum chamber. After Papanicolaou staining the filters are being cleared and allow a light-microscopical judgement. A reduction of possibilities of error in exfoliative cytology can be noticed.