[Long-term prognosis of conservative or surgical treatment of peripheral arterial occlusive disease--critical evaluation]. / Langzeitprognose nach konservativer oder operativer Behandlung der peripheren arteriellen Verschlusskrankheit--kritisch betrachtet.

The spectrum of therapeutic measures for PAOD (peripheral arterial occlusive disease) has increased substantially. A combination of therapeutic measures is therefore applied more frequently. It makes sense to evaluate the patients individually. This is increasingly recommended. Some therapeutic guidelines are shown. It has to be stressed that there are no more clear-cut borders between conservative and operative measures. It is a fact, that the treatment of PAOD improves the quality of life and the morbidity.

[Percutaneous endoscopic gastrostomy--a possibility for enteral feeding of patients with severe cerebral dysfunctions]. / Perkutane endoskopische Gastrostomie--eine Möglichkeit der enteralen Ernährung von Patienten mit schweren zerebralen Funktionsstörungen.

Patients who are unable to be adequately nourished owing to cerebral dysfunction do not tolerate nasogastric tubes for enteral nutrition well. They are threatened by active or passive dislocation of the tube into the oesophagus with subsequent aspiration. Although these risks are minimized by percutaneous gastrostomy (PEG), aspiration cannot be completely prevented even when this method of feeding is employed. Enteral nutrition was provided by PEG in 33 patients with different cerebral disorders. PEG was indicated when adequate oral intake of food and fluids proved impossible 8 to 12 days after an acute hypoxaemic cerebrovascular event. 3 of 23 patients who had suffered a stroke, 2 of 8 patients with hypoxaemic brain damage and 3 of 5 patients with decompensated cerebral sclerosis regained the ability to eat between the 21st and 50th day of treatment, so that the gastrostomy could be dispensed with. The other patients died of their severe underlying disease. 6 patients aspirated. In 2 cases this complication occurred during acute aggravation of the underlying disease after several weeks of satisfactory enteral tube feeding. 2 patients aspirated after returning to oral nutrition, whereby feeding was certainly implicated in 1 patient and probable in the other patient. PEG enables adequate enteral nutrition of patients with severe neurological impairment. The advantages of PEG over parenteral nutrition are fewer complications, lower costs and, above all, its superiority in meeting physiological requirements.

[Early clinical diagnosis of stomach and large intestine cancer]. / Klinische Frühdiagnose des Magen- und Dickdarmkarzinoms.

Gastric and colonic cancer, which affect alarmingly also younger age groups to a growing extent, are developing into a serious problem of public health. Not recognized in time, the survival probability is low. The 5-year survival time is 10% with a manifest gastric carcinoma, with colonic cancer it is 30%. If these neoplasias are recognized in a stage in which they correspond to the criteria of an early carcinoma, the chance of recovery will be 90% for the patients. The early gastric carcinoma does not occur without any symptoms, but in more than 80% of the cases it causes differently intensely pronounced symptoms in the epigastric region, with pain, dyspepsia, haemorrhage and loss of weight prevailing. Therefore, epigastric, complaint for more than 4 weeks should give reason for a thorough gastroenterological examination, with endoscopy being superior to radiological examination, even when using advanced methods of examination. Special control is needed for patients of the various risk groups. Patients with a morbus Ménétrie, a pernicious anaemia and a chronic-atrophic gastritis with intestinal metaplasia of the colonic type are exposed to a particularly high risk of carcinoma. Of a special practical importance is the circumstance that a peptic ulcus of the stomach may develop in an already carcinomatously changed mucosa and thus the carcinoma continues growing below a healed peptic lesion. Thus, a gastric ulcer requires a regular and short-term endoscopic control until its final macroscopic and histological healing. The malignant diseases of stomach and large intestine show an inverse behaviour over the past 20 years. The colonic carcinoma develops from an adenoma in 90% of the cases. In most of the cases, this development from the precursors is without any symptoms. Symptoms such as blood in the stools, abdominal pain, change in the action of the bowels, loss of weight, decrease in power and the like indicate already an advanced carcinoma. Among the laboratory tests, only the examination of the faeces for concealed haemorrhage is of some importance as a diagnostic test. The CEA test in not suitable therefore. As also larger adenomas bleed intermittently, there is the chance of recognizing also these prestages of carcinomas by regular examinations of the faeces. In contrast to the simple barium enema, the radiological examination in double contrast reveals changes of the mucosa of the colon up to a size of 1 cm in more than 80% of the cases. Coloscopy, however, is superior to X-ray examination, regarding both expressiveness and efficiency.(ABSTRACT TRUNCATED AT 400 WORDS)