Special compression sutures: a new surgical technique to achieve a quick decrease in shunt volume caused by diffuse hemangiomatosis of the liver.

A new surgical technique for the management of shunting liver hemangiomas that otherwise would rapidly lead to intractable cardiac failure is presented. Rapid, significant reduction of shunt volume was achieved surgically by transhepatic compression sutures using PTFE pledgets and selective ligation of a large feeding vessel from the right hepatic artery.

Repair of incisional hernias with expanded polytetrafluoroethylene.

OBJECTIVE: To find out the rates of recurrence after repair of incisional hernias with or without the implantation of a PTFE-patch. DESIGN: Open and retrospective study. SETTING: University hospital, Austria. SUBJECTS: 26 patients who had their incisional hernias repaired with a polytetrafluoroethylene (PTFE) patch and 70 for whom conventional methods were used. MAIN OUTCOME MEASURES: Absolute recurrence rate and the Kaplan-Meier estimate 24 months after the operation. Presence of risk factors. RESULTS: Three patients developed recurrences by 24 months in the PTFE group and 41 in the conventional group. The Kaplan-Meier estimate for the PTFE group was 13% and for the conservative group 63%. Women had significantly fewer recurrences than men (p < 0.05). Age, body mass index, and diameter of the defect were not significantly associated with an increased risk of failure. CONCLUSIONS: Insertion of a prosthesis can improve the results of surgical repair of incisional hernias.

[Results of occlusion of large or recurrent incisional hernias with polytetrafluoroethylene]. / Ergebnisse nach Verschluss grosser oder rezidivierender Narbenhernien durch Polytetrafluorethylen.

In 48 patients who were suffering from recurrent or large abdominal incisional hernias the defect in the abdominal wall was closed by the implantation of a patch of polytetrafluoroethylene. Patients were examined 22 months postoperatively on the average. In 5 cases recurrence had occurred (10.4%). The estimated rate of recurrence two years postoperatively amounted to 14%. As this is significantly lower than after conventional techniques without alloplastic materials, the closure of incisional hernias by PTFE is an important alternative for the management of difficult abdominal incisional hernias.

Prognostic factors in adenocarcinoma of the cardia.

BACKGROUND: The optimal extent of resection for adenocarcinomas of the gastroesophageal junction is controversial. This study was conducted to examine whether the extent of resection is an independent prognostic factor in cardia cancer. METHODS: The records and survival data of 125 patients who underwent resection for cancer of the cardia were retrospectively analyzed. Multiple regression was used to evaluate prognostic factors in patients who underwent proximal gastric resection (PR) or total gastrectomy (TG) for cancer of the cardia. RESULTS: Seventy-five patients underwent PR and 50 TG. The 5-year survival was 40% for tumors confined to the esophageal wall (T1, T2), and 13% in more advanced cases (T1, T2; P = 0.0001). Twenty-two percent of the patients with tumor-free margins, 10% of those with microscopic residual tumor, and none with macroscopic residual tumor survived longer than 5 years (P = 0.0001 for any residual tumor versus no residual tumor). Lymph node involvement (P = 0.002) and stage (P = 0.0001) were also significant in the univariate analysis. Five-year survival was 18% after TG, and 17% after PR (P = NS). CONCLUSION: Multiple regression identified residual tumor and penetration depth as independent predictors of survival (P = 0.0002, and P = 0.0001, respectively). After correction for these factors, none of the following variables were of additional significance: extent of resection (TG versus PR), lymph node involvement, age, or Lauren's classification. In 19 of 20 cases with microscopic incomplete resection, it was the oral margin that was positive. We conclude that the extent of resection (TG versus PR) does not influence survival in adenocarcinoma of the gastroesophageal junction.

Sonographic detection of internal jugular vein thrombosis after central venous catheterization in the newborn period.

We sonographically investigated the internal jugular veins of 40 children who had undergone catheterization of the vein (group A: silastic catheter, n = 24; group B: polyurethane catheter, n = 16) in the neonatal period. The average age at catheter implantation was 43 +/- 73 days, the average birthweight 2414 +/- 1145 g, and the average gestational age 34.8 +/- 5.0 weeks. We performed follow-up longitudinal and transverse high resolution sonographic scans including routine examination of the contralateral jugular vein at a mean age of 3.7 +/- 1.5 years. In group A thrombotic alterations were detected in 8 aut of 24 patients. In three of these patients we found mild clinical symptoms. In group B thrombotic alterations were detected in 1 aut of 16 patients without clinical symptoms. Mean birthweight (1815 versus 3313 g) and mean gestational age (32.3 versus 38 weeks) were significantly lower and indwelling time of the catheters (18 versus 11 days) was significantly longer in group A. Our results indicate that jugular vein thrombosis is a frequent long-term complication in neonates after jugular vein catheterization. High resolution ultrasonography is an adequate method for detecting jugular vein thrombosis and should therefore routinely be performed for long-term follow-up.