[Venous bypass: gold standard with excellent results]. / Der Venenbypass: Goldstandard mit überragenden Ergebnissen.

Since 1974 we have performed 1104 in situ vein bypasses for the reconstruction of femoropopliteal or femorotibial occlusions. The venous valves were made incompetent by using our Insitucut. An intraoperative completion angiography is mandatory. The primary cumulative patency rate is 93.5% at one year and 64.9% at five years. The permeability is depending on the quality of the outflow tract. The patency of femoropopliteal in situ bypasses with a three vessel runoff is 82.2% at five years, whereas bypasses with a single vessel runoff show a patency of 56%. The own results are comparable with the results of reversed and non-reversed vein bypasses given in the literature.

Femoropopliteal and femorotibial greater saphenous vein "in situ" reconstructions in non selected patients. Life table analysis.

594 non selected "in situ" reconstructions were analyzed retrospectively using the life table method. Especially after immediate occlusion the cumulative patency rate is unsatisfactory (33.1% vs 62.3% after 6 years). Patency rates are influenced by the anastomotic site and mainly by run off conditions. The number of patent tibial arteries seems to be the most important determinant. These results prove to be statistically significant.

Results of femoropopliteal and femorotibial greater saphenous vein in situ bypass. Life table analysis.

Five-hundred-ninety-four nonselected "in situ" reconstructions were analysed retrospectively using the life table method. Especially after immediate occlusion cumulative patency is very unsatisfactory. After 5 years cumulative patency rate in these cases is 39.5% vs. 64.9% in all cases. Patency rates are influenced by the anastomotic site and the run-off quality. While statistically not significant, popliteal anastomoses perform a little better after 5 years than peripheral anastomoses (67% vs. 51% cumulative patency rate). The number of patent tibial arteries seems to be the most important determinant. In non-occluded run-off cases (three patent tibial vessels) the cumulative patency rate after 5 years is 82.2% vs. 56% in cases with only one patent tibial artery. The difference is statistically significant.

[17 years experience with saphenous vein in situ bypass]. / 17 Jahre Erfahrungen mit dem Vena saphena magna in situ Bypass.

Long-term results of femorodistal in situ vein bypasses depend on the quality of the outflow tract. The cumulative patency of in situ bypasses to the third popliteal segment with a three-vessel runoff is 82.2% at 5 years, compared to 56% for bypasses to a single tibial artery. Immediate occlusions during the first 3 postoperative days are fatal for long-term permeability. After successful revision, the cumulative patency is only 39.5% at 5 years, compared to 64.9% for the whole group. A prospective randomized trial could show that an adjunct intra-arterial treatment with PGE 1 over 10 days can statistically significantly reduce the rate of fatal immediate occlusions.

[Thoracic outlet syndrome and tumor embolism]. / Thoracic outlet Syndrom und Tumorembolie.

This is probably the first report of a rare tumor-embolization from a leiomyosarcoma into the brachial artery simultaneously linked with a thoracic outlet syndrome. After transaxillary rib resection and thromboembolectomy only histological examination of the resected specimen allowed the final diagnosis: leimyosarcomatous embolus.

[Experiences with adjuvant prostaglandin therapy in vascular surgery interventions]. / Erfahrungen mit der adjuvanten Prostaglandin-Therapie bei gefässchirurgischen Eingriffen.

Two prospective randomized trials were referred. In the first study 50 patients with femorotibial greater saphenous vein in situ bypasses were treated intraarterially with 0.2 ng PGE 1/kg body weight/min and 15,000 i.U. of heparine continuously. The control group of 50 patients also got 15,000 i.U. of heparine and 3 x 0.5 g of Aspirin. We observed 2 (4%) immediate occlusions in the PGE 1 group and 7 (14%) immediate occlusions in the control group. This difference proved to be statistically significant. In the second study 83 patients with three level occlusions (ilio-femoro-tibial) in stage III and IV were treated with a profundaplasty. 42 patients received 60 micrograms PGE 1 in 250 ml saline twice daily. The control group of 41 patients only got twice 250 ml saline over a period of three weeks. In the PGE 1 group 26 patients (61%) showed disappearance of rest pain and healing of necrotic lesions, whereas in the control group this could only be achieved in 15 patients (35%). The difference proved to be statistically significant.

[Functional treatment of extra-articular calcaneus fractures in childhood]. / Funktionelle Behandlung von Fersenbeinfrakturen ohne Gelenkbeteiligung im Kindesalter.

Fractures of the calcaneus are rare in childhood. They occur by considerable force or in preliminary defect of the calcaneus. The classification by Vidal has regard to the treatment. According to our cases the early functional treatment results in complete restitution.

[Biliary peritonitis without perforation and idiopathic biliary peritonitis]. / Die gallige Peritonitis ohne Perforation und die idiopathische gallige Peritonitis.

This is a report about an uncommon disease. Three forms of biliary peritonitis without demonstrable perforation are differentiated due to etiology as far as known. While the causes of biliary diffusion in the course of acute cholecystitis or pancreatogenic necrosis of the gall bladder are well known, there is still no information about the genesis of idiopathic biliary peritonitis, which never shows lesions or inflammation of the extrahepatic bile tract or gall bladder. Two cases are reported.

[Treatment of pancreas lesions in childhood]. / Zur Therapie von Pankreasverletzungen im Kindesalter.

Although lesions of the pancreas are rare injuries in childhood, serious pancreatic lesions should be considered after blunt abdominal trauma initially. The typical feature of rupture of the pancreas is characterized by fall on a bicycle handlebar and a round circumscript sign in the upper abdomen. The management is determined by the situation: Nasogastric suction and i.v. alimentation in case of pancreatic contusion. Surgical intervention and local external drainage in case of parenchymal rupture and Roux'enteroanastomosis in the event of injury of the pancreatic duct are recommended. The implantation of a pancreatico-cutaneous fistula into the duodenum is reported.

[The "Perthes-Braun-syndrome". A sign of severe blunt thoracic trauma in childhood]. / Das Perthes-Braun-Syndrom als Symptom des schweren stumpfen Thoraxtraumas im Kindesalter.

"Perthes-Braun-Syndrom" is told to be sign of severe blunt thoracic trauma. We report about 7 patients up to the age of 14 years, who showed symptoms of thoracic compression. The syndrome appears in different expression with main symptoms as subconjunctival bleedings and petechias of the upper part of the body. In 6 of the described cases the syndrome was associated with severe intrathoracic lesions. In is concluded that intensive supervision is indicated in patients with "Perthes-Braun-Syndrome" because of delayed appearance of cardial and pulmonary symptoms.

[The topical treatment of large second degree burns in childhood by tanning with silvernitrate and mebromide (author's transl)]. / Die lokale antiseptische Behandlung grossflächiger Verbrühungen im Kindesalter mit der Gerbungsmethode auf Silbernitratbasis.

The tanning method using 7% silvernitrate and 2% mebromide solution for second degree burns in childhood is demonstrated. The advantages of this method are described as singular and painless application of the agent, little annoyance of the patient, bactericidal effect in second degree burns, low expenses and easy medical care. The procedure of tanning is preferred in treating burn injuries of the trunk and non mobile areas of the extremities. We report on indication, procedure of tanning and results in the treatment of 129 burned children.

[Percutaneous osteosynthesis of supracondylar humerus fractures with Kirschner wires in childhood (author's transl)]. / Perkutane Bohrdrahtosteosynthese bei der suprakondylären Humerusfraktur beim kind.

Percutaneous fixation with Kirschner wires is recommended for supracondylar fractures of the humerus with displacement in children. The advantages of this easy technique are demonstrated.

[Operative treatment of femoral shaft fractures in infancy by Küntscher nailing (author's transl)]. / Die operative Behandlung der Oberschenkelschaftfraktur im Kindesalter durch Marknagelung nach Küntscher.

Considering our own results with treating 96 children by Küntscher nailing we cannot agree with other authors who prefer conservative treatment of femoral shaft fractures in infancy. Using a special technique which avoids injuries of the epiphyseal zone, we neither found unphysiological differences in legs length nor varus or valgus displacements three months to five years after nail removal. Bacterial infections are extremely rare. Healing mostly follows without complications. In well defined cases we think operative treatment has the following advantages: short period of hospitalization, early mobilization, easy medical care, little x-ray exposition and lowering of costs.