[Recurrent varicose veins. Surgical procedure--results]. / Rezidiv-Varikose. Operatives Vorgehen--Ergebnisse.

We report 96 patients (107 legs) with recurrence after varicose vein surgery. We define a recurrent varicose vein as a new transfascial insufficiency after incomplete interruption of the saphenofemoral as well as popliteal junction with reflux in the epifascial venous system. 92 patients underwent external primary surgery. Morphologically an insufficient high ligation of the V. saphena magna (Moszkowicz's operation) led in 30 cases to a recurrent varicose vein. In 47 cases an incomplete isolated, in 29 cases an incomplete saphenofemoral ligation during a Babcock procedure and in one case an incomplete saphenopopliteal ligation for V. saphena parva insufficiency were the reasons for the recurrence. As recurrent surgery we performed 106 ligations of the saphenofemoral junction. In 38 of these cases an isolated saphenofemoral ligation and in 68 cases an additional stage-adjusted ligation of the V. saphena magna were carried out. In one case of recurrent saphenopopliteal insufficiency a repeated ligation of the V. saphena parva was performed. The recurrence is an avoidable complication of a not perfect primary surgery. The main cause is an inadequate access with incomplete saphenofemoral or -popliteal ligation.

[Salmonella enteritidis infected false aneurysm of the superficial femoral artery in an HIV seropositive patient]. / Salmonella enteritidis infiziertes falsches Aneurysma der Arteria femoralis superficialis bei einem HIV-seropositiven Patienten.

In the course of an infection with human immunodeficiency virus, a large variety of complications affecting all organ systems can occur. However, complications affecting the vascular system demanding surgical intervention are rare. In the case presented we report a 67-year-old HIV-seropositive patient who underwent surgery for a huge abscess in the thigh. Intraoperatively unexpectedly we found a mycotic aneurysm of the femoral superficial artery and the causactive bacterium proved to be Salmonella enteritidis. Because of the rising number of HIV-infected patients we suspect that the amount of complications involving the vascular system and demanding surgical intervention will also increase. Therefore, when diagnosing and deciding on therapy for patients with AIDS, the physician must be aware that vascular complications due as a result of HIV infection might occur more frequently in the future.

[Varicose and ascending thrombophlebitis--surgical planning for emergency crossectomy by duplex ultrasound]. / Varikose und ascendierende Thrombophlebitis--Operationsplanung zur Notfallcrossektomie durch Duplexsonographie.

Ascending thrombophlebitis of the superficial leg veins is known to pass into the deep veins, causing an embolism to develop. Duplex ultrasonography has been shown to be a reliable technique for the evaluation of superficial venous thrombosis. If progression is noted, crossectomy proved to be effective in preventing passage of thrombi into the deep veins.

[Acute compartment syndrome of the tibia--complication of popliteal artery aneurysm]. / Das akute Compartmentsyndrom des Unterschenkels--Komplikation eines Aneurysma der A. poplitea.

The compartment syndrome is a common complication in the traumatology of the lower limb. In vascular surgery it is observed following emergency revascularisation. It is a rare condition as an initial symptom of a peripheral clotted aneurysm. By means of a case with a complicated popliteal aneurysm the differential diagnosis of the non-traumatologic compartment syndrome is discussed.

[Acceptance and effectiveness of surgical vascular consultation--is it worthwhile?]. / Akzeptanz und Effektivität der chirurgischen Gefässsprechstunde--lohnt sich der Aufwand?

In a retrospective analysis the meaning of the vascular outpatient clinic and the follow-up after vascular reconstructive surgery were investigated. 6889 patients were checked within 8 1/2 years in the vascular consultant hour of the Marien-Hospital Düsseldorf with a fixed diagnostic schedule related to the vascular surgery. More than 40% of the patients did not have any vascular disease. Only 6.5% of the 276 patients with aortoiliac reconstructive surgery visited the follow-up terms regularly. The additional vascular training group was visited by only 1.2%. While 93 patients (33.7%) were hospitalized to further treatment because of new clinical findings, 54 patients got another vascular reconstruction and 12 patients were operated because of secondary disease. In 12 cases (10.5%) we found a clinical asymptomatic deterioration of the vascular status. The vascular consultant hour is time-consuming and expensive. The important task is the differentiation of vascular clinical findings. Although the acceptance and the effectiveness are disappointing the vascular outpatient clinic and the long-term follow-up after reconstructive vascular surgery is necessary for the improvement of the quality of care of the department and for acquiring new knowledge.

[Bouveret syndrome--a rare form of pyloric obstruction]. / Das Bouveret-Syndrom--eine seltene Form der Magenausgangsstenose.

Gallstone ileus represents a severe complication of cholelithiasis. The incidence of serious disease concomitant with gallstone ileus is high; it is most often seen in elderly patients and contributes to its high morbidity and mortality rates. Bouveret's syndrome is a rare form of gallstone ileus, characterized by its duodenal site after migration through a cholecysto-duodenal fistula in almost all cases. We report on a patient with Bouveret's syndrome. The etiology, pathogenesis, diagnosis and therapeutic approach with literature review are presented and discussed.

[Transient paraplegia of the legs after sigmoid resection--late complication after implantation of an aortic bifurcation prosthesis in arterial occlusive disease?]. / Passagere Paraplegie der Beine nach Sigmaresektion--Spätkomplikation nach Implantation einer Aorten-Bifurkationsprothese bei arterieller Verschlusserkrankung?

Ischemic spinal lesions following graft replacement of an infrarenal aortic aneurysm are rare complications. Even more rare is the development of this complication in case of aortoiliac occlusive disease. We report one further case who developed transient paraplegia following sigma resection six years after implantation of an aortobifemoral bifurcation graft because of aortoiliac occlusive disease. The abdominal vessel and the collateral situation of this site of the caudal aorta is discussed and the possibility of late ischemic spinal lesions is pointed out.

[Incidence of peptic ulcers in patients with arterial occlusive diseases--a further risk factor?]. / Inzidenz peptischer Ulzera bei Patienten mit arterillen Verschlusserkrankungen--ein weiterer Risikofaktor?

Acute bleeding of the upper gastrointestinal tract found in patients with arterial occlusive disease lead us to analyse the coincidence of arterial occlusive disease and pathological changes of the upper gastrointestinal tract. While waiting for reconstructive vascular surgery between 1986 and 1992 420 patients underwent esophago-gastro-duodenoscopy for preoperative risk assessment. In 59% endoscopy revealed pathological findings in the upper gastrointestinal tract. Inflammation was found in 61.6% of the patients, in 15% gastric ulcer. Patients with gastrointestinal symptoms had no significant more pathological findings in gastroscopy (p = 0.1). We excluded 9.3% patients from primary elective vascular surgery because of their severe pathological findings. 19 patients were operated on their gastrointestinal disease at first. In 7 patients we found an unknown carcinoma of the stomach. 5 patients got a resection of the stomach, in 2 patients an operation was unable. The diagnosis and therapy of risk factors are a major objective in the treatment of arterial occlusive disease. The results of the study stress the necessity of routinely performed endoscopy in patients awaiting vascular surgery. Beside a preoperative risk assessment this will lead to a lower incidence of serious gastrointestinal complications postoperatively.

[Dislocation of the knee joint with lesion of the popliteal artery. A case report]. / Kniegelenkluxation mit Läsion der Arteria poplitea. Ein Fallbericht.

Complete dislocation of the knee is rare but frequently associated with popliteal artery disruption. Prompt recognition and early revascularisation are paramount for a successful and functional result. We report on a case of anterior dislocation of the knee complicated by concomitant popliteal artery injury. The value of pre-operative diagnostic methods including pre-operative arteriography and Doppler-sonography is discussed. Review of literature is presented.

[Rational EDP-basic documentation in the surgical clinic]. / Rationelle EDV-Basisdokumentation in der Chirurgischen Klinik.

The establishment of a clinical basis documentation has approved because of the co-operation with the service-computer-centre of the clinical administration by linking the administrative and clinical data of the patients. The most essential data like diagnosis, operation, complication, operating surgeon as well as the eventual case of death will be registered in a protocol by the ward physician. These data will be registered by a documentary assistant according to the international keys. The evaluation of the data is done by a SPSS-program. The present results demonstrate that this kind of computer assisted clinical documentation has been successful.