[Acute diverticulitis of the jejunum. A rarely diagnosed cause of peritonitis]. / Die akute Divertikulitis des Jejunum. Eine selten diagnostizierte Ursache der Peritonitis.

A 77 year old man was treated for duodenal ulcer and obstipation for 2 years; the diagnosis was not confirmed by endoscopy. Because of recurrent and increasing abdominal pain the patient was admitted to hospital as recurrent duodenal ulcer; this was excluded by emergency endoscopy. At laparotomy a sealed-off perforation of an inflamed jejunal diverticulum was identified complicating the jejunal diverticulosis. The entire jejunal segment involved by diverticulosis was removed. The patient made an uneventful recovery and is well 15 months after surgery. Jejunal diverticulosis may be associated with a variety of complications; it should be considered, especially in the elderly patient, with recurrent gastrointestinal symptoms of obscure origin.

[Mediastinal lymphadenectomy. Anatomical basis and its surgical relevance in central bronchus carcinoma]. / Die mediastinale Lymphadenektomie. Anatomische Grundlagen und ihre chirurgische Relevanz beim zentralen Bronchuskarzinom.

102 patients with potentially curable bronchial carcinoma were subjected to pneumonectomy and mediastinal lymph node dissection regardless of gross appearance of the mediastinum at the time of surgery. 83 of these patients were analysed retrospectively. In 34 patients (41%) enlarged mediastinal lymph nodes were found; in 19 of these (56%) malignant invasion was verified histologically, whereas in 15 of these 34 patients (44%) the enlarged lymph nodes revealed only inflammatory changes. On the other hand, in 49 patients (59%) the mediastinum was grossly inconspicuous, yet in 2 of these patients (4.1%) microscopic invasion by carcinoma was found. This confirms that the assessment of the mediastinum by gross appearance is unreliable. As a consequence, mediastinal lymph node dissection should be performed routinely in all patients in order to detect occult metastases since only patients who had a complete resection have a change of cure. This approach is justified as in our experience mediastinal lymph node dissection does not impose an additional operative risk and long-term survival or even cure may be achieved in individual patients. Estimated 5-year survival in our patients with histologically proven mediastinal lymph node metastases was 22%; 3 of 21 patients with N 2 carcinoma are alive 8, 10 and 13 years p.o., without evidence of recurrence. The operative strategy and technical aspects based on anatomical knowledge of pathways of lymphatic spread of carcinoma of the lung are presented.

[Rapid transesophageal and transvenous atrial stimulation]. / Transösophageale und transvenöse rasche Vorhofstimulation.

Rapid atrial stimulation (RAS) is a very effective method of treatment of paroxysmal supraventricular tachycardia (PSVT). Substained AV nodal reentrant PSVT could not be terminated by administration of different antiarrhythmic drugs in 19 patients. Transesophageal pacing was performed in 10 patients successfully - in 2 patients following verapamil intravenous administration. In the remaining 7 patients in whom this procedure failed the PSVT could be terminated by transvenous RAS - in 3 patients following the intravenous injection of verapamil.

[Prognostically unfavorable factors in esophagus cancer. II. Value of diagnostic significance]. / Prognostisch ungünstige Faktoren beim Oesophaguscarcinom. II. Der Wert diagnostischer Aussagen.

The analysis of data of 121 patients with esophageal carcinoma treated at the Department of Surgery, Landeskrankenhaus Klagenfurt, between 1969 and 1982 revealed that neither histological type nor tumor grading had any significant influence on survival time (p = greater than 0,158). However, tumor localization and length influenced the chance of survival; the more proximal the tumor the poorer the chance to survive more than one year (p = 0,0008); patients with tumors less than 6 cm in length had a better chance of survival (p = 0,031). Cures were achieved only after resection for stage I. Resections for stage II and III did not show any difference in prognosis (p = 0,879). Although no cures could be achieved by surgery, the 1-year survival chance was increased threefold (p = 0,041). In the absence of contraindications, resection should be carried out even when mediastinal lymphnodes are involved by tumor.

[Prognostically unfavorable factors in esophagus cancer. III. Operative therapy of esophagus cancer--effect of preoperative measures on prognosis in curative resection]. / Prognostisch ungünstige Faktoren beim Oesophaguscarcinom. III. Operative Therapie des Oesophaguscarcinoms--Einfluss präoperativer Massnahmen auf die Prognose bei kurativer Resektion.

Between 1969 and 1982, 121 patients were treated for esophageal carcinoma at the Department of Surgery, Landeskrankenhaus Klagenfurt. 38 patients (31.4%) had palliative surgery, 23 patients underwent a curative resection. Hospital mortality after resection was 39%, overall adjusted survival rate at 7 years was 11.2%. An analysis of data shows that a higher resection rate (p = 0.0045) will not improve long-term results. A preoperative parenteral nutrition seems to decrease postoperative mortality (p = 0.069). Preoperative radiotherapy does not improve long-term results (p = 0.788).

[Operative therapy of esophageal cancer. Palliative surgical methods and results]. / Operative Therapie des Osophaguskarzinoms. Palliative Operationsmethoden und ihr Ergebnis.

Between 1969 and 1982, 38 out of 121 patients with oesophageal carcinoma underwent palliative surgery. Operatively in 22 patients a Celestin- or Häring-tube was inserted, gastrostomy was performed 10 times, palliative resection two times. Four times the obstruction was bypassed. 17 patient achieved additional radiation therapy. An analysis of data showed, that all operative palliative procedures had nearly the same bad prognosis (p greater than 0.265). A longer survival could be achieved by additional radiation therapy (p = 0.044). Postoperative mortality rate was higher in patients with additional diseases (p = 0.018). Lethal aspiration-pneumonitis was a common (30%) and typical (p = 0.031) complication, when gastrostomy was performed. Because oft the high mortality rate of the first and because of the missing crude palliation of the second operation, palliative resection and gastrostomy were considered to be not indicated in most cases.

[Prognosticly unfavorable factors in esophageal carcinoma. I. The importance of anamnestic data]. / Prognostisch ungünstige Faktoren beim Oesophaguscarcinom. I. Die Bedeutung anamnestischer Angaben.

The analysis of data of 121 patients with esophageal carcinoma treated at the Department of Surgery, Landeskrankenhaus Klagenfurt, between 1969 and 1982 revealed that neither sex nor age, environment, delay of treatment or additional disease had any significant influence on survival time. Weight loss, however, significantly shortened survival time (p = 0.0002). In addition, weight loss suggests an advanced tumor stage (p = 0.0279). After curative resection, rate of survival was significantly lower in patients with weight loss (p = 0.042). In the presence of weight loss and additional risk factors resection is probably not indicated.

[Massive pulmonary embolism: case report of successful embolectomy with transatrial vena cava blockade]. / Die massive Lungenembolie: Kasuistik einer erfolgreichen Embolektomie mit transatrialer Kavablockade.

Massive pulmonary embolism occurred in a 42-year-old man 7 days after repair of a torn patellar ligament. Because of progressive deterioration in spite of full heparinization and supportive measures, and more than 60% occlusion of the pulmonary vascular bed on angiogram, partial cardiopulmonary bypass was instituted under local anesthesia by femoral artery and vein canulation. After improvement of hemodynamics and tissue oxygenation, general anesthesia was induced, the patient intubated and a longitudinal sternotomy carried out. The superior vena cava was canulated, the inferior vena cava occluded with a tourniquet and the pulmonary artery incised during temporary aortic occlusion. The left main pulmonary artery and its branches were nearly completely occluded, in addition, a large embolus was expressed into the right pulmonary artery by massaging the right lung. Finally, transatrial infrarenal caval interruption with a Mobin-Uddin umbrella filter was carried out. After 48 hours of mechanical ventilation, the patient was extubated; he made an essentially uneventful recovery.

[The effect of intra-aortic balloon pumping in experimental ischemic heart disease]. / Die Wirkung der intraaortalen Ballon-Gegenpulsation nach experimenteller ischämischer Herzschädigung.

The effect of intraaortic balloon counterpulsation (IABP) was investigated in normal dogs and after production of ischemic myocardial damage of various extent. Pharmacologic isolation of the heart and ligation of the left anterior descending coronary artery at different levels produced ischemia of the distal third (preparation type 1), distal half (preparation type 2), and distal two-thirds (preparation type 3) of the left ventricular fee wall. The degree of left heart failure (LVF 1 - 3) correlated with the extent of the ischemic damage and was defined by characteristic hemodynamic and metabolic parameters. IABP was most effective when the ischemic damage of the left ventricle was limited and counterpulsation was instituted before significant heart failure developed. When the distal half of the left ventricular free wall became nonfunctional hemodynamic stabilisation remained pump-dependent; to improve survival immediate revascularization of the ischemic area is required. With extensive loss of functional myocardium IABP could merely delay irreversible cardiogenic shock. The experimental data suggest that IABP should be instituted before the blood pressure fall exceeds 25% of its original level. At the stage of profound cardiogenic shock IABP cannot improve survival significantly.

[Levels of sulfametrole-trimethoprim in blood and lung-tissue during treatment of respiratory tract infection (author's transl)]. / Blutspiegel und Spiegel im Lungengewebe von Sulfametrol-Trimethoprim während der Behandlung bronchopulmonaler Erkrankungen.

A report is given on the examination of the levels of sulfametrole and trimethoprim in blood and lung tissue of 29 patients with pulmonary tumours of various origin, who were subjected to a pre-operative treatment with 2 tablets 2 times daily of the sulfametrole-trimethoprim combination Lidaprim for an average period of one week because of concurrent bronchopulmonary infections. About 14 hours after the last tablet dose samples of tumour-free lung tissue and blood were removed during the operation and subjected to a chemical analysis of sulfametrole and trimethoprim. The mean blood level of sulfametrole was 30.3 micrograms/ml and of trimethoprim 2.0 micrograms/ml; the mean levels in the lung tissue was 19.2 micrograms/g of sulfametrole and 9.2 micrograms/g of trimethoprim. Trimethoprim via the blood is stored in the lung tissue. The relationship of these results to the good clinical activity of the combination sulfametrole/trimethoprim in the treatment of infections of bacterial origin in the upper and lower airways is discussed.

[Unusual cause of an arteriovenous coronary fistula (author's transl)]. / Ungewöhnliche Ursache einer arteriovenösen Koronarfistel.

Shortly after a febrile "flu" a systolo-diastolic murmur was heard in a 25-year-old female. Clinically a ruptured sinus-Valsalva aneurysm was assumed. Coronary angiography revealed a fistula between the right coronary artery and the right atrium. A density on X-ray along a rib led to a biopsy and the specimen showed an angiosarcoma. Very fast growing and spreading into the lungs, liver and many bones caused death 6 months after onset. Autopsy showed many metastases from an angiosarcoma and a fistula between the right coronary artery and the right atrium due to sarcomatous masses.

[Percutaneous implantation of permanent pacemakers (author's transl)]. / Zur perkutanen Implantation permanenter Herzschrittmacher.

2 methods for the implantation of permanent pacemakers with percutaneous puncture of the subclavian vein are described. The first one was used in 44 patients with the aid of an introducing catheter-set Desilets-Hoffman consisting of guide-wire, inner Teflon dummy catheter and outer thin-walled sheath; through this a shoulder-less electrode catheter no. 8 could be inserted for permanent pacing. The other technique was applied to 20 patients and used thinner special electrodes no. 6F, which could be introduced directly through a plastic cannula inserted with a puncture-needle. The advantages are: diminished risk of infections, local anesthesia instead of general anesthesia, applicability by the cardiologist in the catheterization-laboratory or under a simple fluoroscopy-unit, short stay of patients in the hospital without transfers to other departments, few personnel (1 scrubbed doctor, 1 non-scrubbed nurse), recognition of venous anomalies (singular left superior caval vein) without useless incisions for the patient. Complications such as pneumothorax, puncture of the subclavian artery, and dislocations of the electrodes have also been encountered.