[Late results of Childs-Phillips mesenteric plication for therapy and prevention of small intestine ileus]. / Spätresultate der Mesenterialplikatur nach Childs-Phillips zur Therapie und Prophylaxe des Dünndarmileus.

During the past 7 years 45 patients have been operated upon using the Childs-Phillips method. Of those, 37 were subsequently examined for the study--7 patients had died in the meantime. None of the deaths occurred as a direct result of transmesenteric small-bowel plication. An early recurrence of intestinal obstruction occurred in 4.4% and a laparotomy was repeated. During the most recent examinations 86.5% of those patients checked had (virtually) no complaints--91.9% based upon the Visick classification. A subtotal intestinal obstruction occurred during the period of the study in 8.1% of cases, but could be conservatively treated. Up until the most recent examination there were still no instances of a late recurrence. Most intestinal obstruction recurrences are due to errors specific to the technique and are early recurrences. On the basis of our results, we are of the opinion that plication in the presence of existing peritonitis, as well as partial plication, is acceptable.

[Degenerative spinal canal stenosis in lumbar spine: clinical view and treatment.]. / Die degenerative lumbale Spinalstenose: Klinik und Behandlung.

Radicular leg pain, combined with numbness and intermittent radicular paresis while walking or standing are typical symptoms of a narrow spinal canal of the lumbar spine. Medical history and lumbar myelogram are usually sufficient to localize the source of pain. We prefer the myelogram to CT-scan or MRI because it gives a longitudinal view of the whole lumbar spine, is easy to read and is also possible in the presence of a scoliotic deformity or claustrophobia. Between 1987 and 1993, 76 patients with symptomatic lumbar spinal stenosis were treated operatively by the same surgeon. Results are available for 74 patients. In all patiens, a decompression was performed, a fusion was performed in 64 patients. The follow-up ranges from 1 to 5.7 years (average 2.7 years). 59 patients (80 %) were happy with the result and would like to be operated again in the same conditions. 8 of the 15 unhappy patients had, objectively, a good result but were unsatisfied for other reasons. Our results show, that operative treatment of the lumbar spinal stenosis is a rewarding task. Decompression usually results in a dramatic decrease of the leg pain and improvement of the walking distance. Advanced age in not a contraindication for this kind of surgery. Decompression combined with fusion results in a longer operative time and greater blood loss and is only indicated in the presence of an instability in a younger patient or massive preoperative back pain. Key words: spinal stenosis, claudication, lumbar spine, decompression, fusion.

[Early results of percutaneous transluminal coronary vessel dilatation in single vessel disease. Comparison with drug treated or surgically treated patients, retrospective for dilatation suited patients]. / Frühresultate der perkutanen transluminalen Koronargefässdilatation bei Ein-Gefäss-Erkrankung. Vergleich mit medikamentös oder chirurgisch behandelten, retrospektiv für Dilatation geeigneten Patienten.

The shortterm results (mean follow-up 0.9 years) in 61 patients with single vessel disease (1-VD) who had undergone percutaneous transluminal coronary angioplasty (PTCA) were compared with those in 33 patients with 1-VD treated medically and in 36 patients with 1-VD treated by bypass surgery. All medically and surgically treated patients had coronary artery stenoses which were classified in a retrospective analysis as suitable for PTCA. Initially there were no significant differences between the three groups with respect to functional impairment (NYHA class), incidence of prior myocardial infarction, left ventricular ejection fraction and localization of the coronary stenoses. Comparison of follow-up results at the end of the first year showed (1) that the NYHA class was reduced to a similar extent both in patients treated surgically and in those treated by PTCA, (2) that the NYHA class in the medically treated group was significantly greater than in the other two groups, and (3), that there was no difference among the three groups with respect to infarct and mortality rate.