[Phytobezoars: case report and review of the literature]. / Phytobezoare: Kasuistik und Literaturübersicht.

We report on the case of a 40-year-old woman with a long year history of vegetarian lifestyle, who experienced a phytobezoar induced acute abdomen due to a mechanic small bowel ileus. After uncomplicated surgical treatment and post-OP course the patient could be discharged on post-OP day 10. Beside a description of the historical background, relevant diagnostic and therapeutic aspects are mentioned as well as a review of the relevant literature.

[Behavior of postoperative adhesions after intraperitoneal administration of fibrinolytic drugs in a rat model]. / Verhalten postoperativer Adhäsionen nach intraperitonealer Applikation von Fibrinolytika in einem Rattenmodell.

In a rat model, the effect of the intraperitoneal application of fibrinolytic agents on the development of adhesions was examined. Streptokinase and TPA reduced sero-serosal adhesions significantly, whereas urokinase did not reduce them. Intravascular coagulation was not affected.

[Advantages and disadvantages of ultrasound dissection of benign struma. A report of experiences after 2 years clinical use]. / Vor- und Nachteile der Ultraschalldissektion der benignen Struma. Ein Erfahrungsbericht nach 2jähriger klinischer Anwendung.

Ultrasonic dissection of goitre allows a controlled resection. This method saves time and diminuishes risk of operation. Not suturing the remnants of thyroid gland, optimal blood supply is obtained and hazard for the recurrent laryngeal nerve is decreased. Loss of blood is insignificant. To increase acceptance of this method, handling of apparatus has to be improved.

[Results of cryosurgery in the treatment of inoperable tumor stenoses of the anus and rectum]. / Ergebnisse der Kryochirurgie bei der Behandlung inoperabler Tumorstenosen des Anus und Rektums.

Inoperable tumor stenosis of anus and rectum may be treated surgically only by implantation of artificial anus. Cryosurgery proves to be a feasible alternative in order to maintain free passage of the gut. The cryoprobe is introduced through a rectoscopy under direct view. Visible tumor is touched with the tip of the cryoprobe and subsequently temperature is lowered to approximately -19 degrees C. Usually anesthesia is not required. From 1976 to 1989, 213 patients had been treated by cryosurgery in our department. In 23 cases the use of an artificial anus became inevitable afterwards.

[Experience with the ultrasonic aspirator in surgery of benign goiter]. / Erfahrungen mit dem Ultraschallsauger in der Chirurgie der Struma benigna.

In 60 cases intracapsular resection of goiter was performed by using ultrasonic aspirator. The superior pole vessels and the inferior thyroid artery were not touched, the recurrent laryngeal nerve was not identified. Minimal hemorrhage in the intra- and postoperative period, operation time saving in comparison with conventional subtotal thyroidectomy, no temporary and no permanent damage to the recurrent laryngeal nerve and no wound infection were observed. Not suturing the remnants of thyroid optimal blood supply was obtained. There were no hypoparathyroidism and but one case of hypothyroidism.

[New aspects of surgical therapy of acute gastroduodenal hemorrhage]. / Neue Aspekte der chirurgischen Therapie der akuten gastroduodenalen Blutung.

The chances for conservative treatment of bleeding ulcers have been expanded by progress in endoscopic haemostasis. Surgery, nowadays, is in many cases applied only to patients with uncontrollable recurrent haemorrhage, after the internist's efforts have failed. This has increased lethality from 20 to 44 percent. To improve results, elective operation is recommended in the no-bleeding interval, following endoscopic haemostasis.

Repair of complete acromioclavicular dislocation (Tossy stage III) using Balser's hook plate combined with ligament sutures.

A total of 57 consecutive cases of complete acromioclavicular dislocations are reported. They were treated by open reduction and Balser's hook plate fixation supplemented by ligament suture.

[Results of percutaneous transluminal embolization therapy in severe hemorrhages in the pelvis]. / Ergebnisse der perkutanen transkatheteralen Embolotherapie bei schweren Blutungen im Becken.

Percutaneous transluminal embolisation technique (PTE) is used to an increasing extent in preference to surgical operations for treatment of severe haemorrhages of surgical, gynaecological, and urological tumours of the pelvic region which are difficult to control. Based on a study of 35 patients (19 female and 16 male) with an average of 71 (32-87) years the indication of embolisation, the technique, the choice of material for embolisation, the rate of success, and the complications of this therapeutic method are discussed. In 34 of the 35 patients bleeding stopped after embolisation therapy. Only in one patient major side effects were seen. Our own experience has shown that an exact pretherapeutic angiogram of the pelvic vessels with selective or subselective catheterisation of tumour feeders is necessary for an effective embolisation.

[Spontaneous splenic rupture as a cause of postoperative hemorrhage]. / Spontane Milzruptur als Ursache einer postoperativen Blutung.

Following a vaginal hysterectomy without complications, intraperitoneal after bleeding from an adnexal stump occurred, making a laparotomy necessary. On the following day a second laparotomy had to be performed because of a recurrence of hemorrhage in the abdominal cavity. The source of the bleeding could not be found. A third laparotomy the next day revealed a splenic rupture, which had evidently occurred spontaneously. Spontaneous ruptures of a normal spleen are considered rare. In cases of intraperitoneal hemorrhage where the source of bleeding cannot be found, the possibility of splenic rupture should be considered, even if there is no history of trauma.

[Massive hemorrhage following multiple epidural punctures as a late complication in thrombocythemia]. / Massive Blutung nach multiplen epiduralen Punktionen als Spätkomplikation bei Thrombozythämie.

We present a female patient in whom numerous lumbar punctures for epidural anaesthesia were followed by a delayed development of a large subcutaneous haematoma in the lumbar region. The outcome was fatal. The patient's basic disease was found to be chronic myeloic leukaemia that had caused an excessive elevation of platelet count. We, therefore, suggest that lumbar punctures for epidural anaesthesia should be approached with extreme care in cases of thrombocytaemia. If possible, repeated punctures for the placement of epidural catheters should be avoided.

Nontraumatic perforations of the small intestine.

Nontraumatic perforation of the small intestine is very rarely found as a cause of acute abdominal disease. A series of 15 adult patients admitted to our hospital from 1973 to 1983 is reviewed. Underlying conditions were primary neoplasia (three patients), adhesions (three patients), intraluminal foreign bodies (two patients), metastases (two patients) and diverticulum (one patient). In four patients, the pathogenesis remained unclear (idiopathic perforations). As surgical therapy, resection and anastomosis is preferred in order to make a thorough histologic examination of the perforated bowel possible. A possible role of local drug toxicity in the pathogenesis of perforations has been discussed herein. No anastomotic leakage was observed. Four patients died (27 percent).

[Ileus in the aged]. / Der Ileus beim alten Menschen.

From 1973 to June 1982, 218 patients older than 70 years (148 women, 70 men) suffering from acute bowel obstruction were seen at our Dept. The mortality rate came up to 33%. Main causes of the ileus were incarcerated hernias and colonic obstruction (25% each). In case of an incarcerated hernia the authors emphasize early operation and colostomy in case of colonic obstruction due to tumour stenosis.