[Continuous intestinal suture with polydioxanone]. / Fortlaufende Darmnaht mit Polydioxanon.

Within five years a total of 264 anastomoses were performed on 241 patients in a continuous extramucosal single-layer end-on suture technique with polydioxanone. In 133 small bowel, and 131 colonic anastomoses there were no leakages as the only complications attributable to the procedure. Both anastomotic failures occurred after colonic resections, for a 1.5% dehiscence rate. Small bowel anastomoses healed without complications.

[Choledocholithiasis: risk factors and their significance for pre- and intraoperative diagnosis]. / Choledocholithiasis: Risikofaktoren und ihre Bedeutung für die prä- und intraoperative Diagnostik.

In 19% of the cholecystectomies done for acute cholecystitis, cholangitis and/or jaundice, an operative cholangiogram could not be obtained, usually because of considerable local inflammatory changes. This was the case in only 1.7% of the operations for uncomplicated cholelithiasis. Surprisingly high was the 31% rate of choledocholithiasis among the patients with complicated cholelithiasis, when compared to the 8% rate for operations in the complication-free interval. If a cholangiogram could not be obtained, exploration of the choledochal duct also was renounced. So patients with residual choledochal stones had to be expected, and in fact became symptomatically within the five years of follow-up.

[The small intestine as a source of hemorrhage. A graduated protocol for diagnosis and therapy]. / Der Dünndarm als Blutungsquelle. Ein Stufenschema für Diagnostik und Therapie.

Within 21 years, 18 patients with acute small bowel hemorrhage were treated. Our results of pre- and intraoperative diagnostic procedures are reviewed critically. Based on bleeding activity and patient age, a decision tree for efficient diagnosis and therapy is proposed.

[Actinomycosis of the bladder]. / Aktinomykose der Harnblase.

A palpable tumour was discovered in the left lower abdomen of a 66-year-old woman with uncharacteristic lower-abdominal pain and treatment-resistant pollakisuria and stress incontinence. On ultrasound examination the tumour was about 6.0 x 2.5 x 2.5 cm in size and was located between bladder roof and anterior abdominal wall. Ultrasound-guided fine-needle biopsy failed to produce any cytologically interpretable material, and there was no bacterial growth from the aspirate. All clinical and biochemical findings were normal, except for a raised blood-sedimentation rate (15/43 mm). The tumour, completely removed at laparotomy, was diagnosed to be actinomycosis of the bladder. No long-term postoperative antibiotic treatment was undertaken. Nine months after the operation the patient was without symptoms and there were no abnormal clinical findings.

[The prevalence and significance of pseudodiverticulosis of the small intestine]. / Häufigkeit und Bedeutung der Pseudodivertikulose des Dünndarmes.

Diverticula of the small intestine were found in four among 358 consecutive major abdominal surgical procedures (1.1%). The prevalence rate was 4% among patients over the age of 70 years. All of the discovered diverticula were located in the proximal jejunum. Two patients had single, two had multiple diverticula. All patients were women (aged 73, 78, 81 and 86 years). In three the finding was by chance: in one the operation had been done for a perforating duodenal ulcer, in two because of ileus. The 86-year-old woman was operated for lower intestinal bleeding. During the operation a solitary diverticulum, the cause of the bleeding, was excised.

[Atrial versus ventricular cardiac pacing in the elderly with respect to hemodynamic data (author's transl)]. / Differentialtherapie bradykarder Herzrhythmusstörungen mit permanenter atrialer oder ventrikulärer Schrittmacherstimulation unter Berüchsichtigung der Hämodynamik.

The importance of synchronized atrial and ventricular action is well known. Especially in elderly patients the circulation of the brain, the kidneys and the coronary arteries may be diminished by ventricular stimulation. Permanent atrial, atrial triggered ventricular, and bifocal stimulation increases cardiac output by 20-30 percent. From the hemodynamic data the best results during atrial stimulation are obtained at a frequency of 80 to 85 bpm.

[Effect of fractures on the juvenile epiphysis]. / Auswirkung von Frakturen auf die kindliche Wachstumsfuge.

In a clinical and experimental study two factors have been found to be most important for the increase of growth after fractures in childhood: 1. Trauma leads to changes of blood circulation in the epiphysis. Changes in oxygen tension cause morphometric alterations of cellular and intercellular constituents of the plate as well as measurable changes in thickness of the plate and length of the cartilage columns. These changes are relatively uniform and nearly independent of the kind of fracture and its treatment. Growth stimulation by fracture alone is moderate, limited to the time of fracture healing and hardly influenced by implantation of metallic material for osteosynthesis. 2. Angular deformity stimulates the epiphyseal plate to spontaneous correction. This correction is mostly stimulated by the change of pressure caused by the muscular coat and only minimally by static load. Correction of angular deformity can only happen under simultaneous increase in longitudinal growth, as long as pressure in the plate is changed. If angular deformity does not lead to changes in pressure by muscular tension on the concavity of the fracture (e.g. recurvation of tibia, varus in supracondylar fracture of humerus, torsion deformity of long bones) no stimulation of the epiphyseal plate will occur. In these cases the increase of growth is insignificant.

[Pseudotumor of the urinary bladder and intestino-vesical fistula in ileitis regionalis (Crohn's disease) and diverticulitis. Surgical tactic and technic]. / Harnblasen-Pseudotumor und Darm-Blasen-Fistel bei Ileitis regionalis (M. Crohn) und Divertikulitis. Operative Taktik und Technik.

Pseudotumor of the urinary bladder and intestino-vesical fistula caused by regional ileitis (Crohn's disease) and diverticulitis require radical en bloc resection. The authors present their own procedure.

[Bleeding from hiatal hernia (author's transl)]. / Blutung aus der Hiatushernie

Report on 7 cases of massive hemorrhage from hiatal hernias. In all cases diagnosis was made before operation by oesophago-gastroscopy and/or by selective angiography. Early operation is the only successful therapy. The procedure depends on the kind of lesion and the type of hernia. In sliding hernia a Nissen fundoplication, in the paraesophageal type a fundoplication combined with gastropexy is performed. In cases of hyperacidity a combination with vagotomy and pylorplasty is necessary. Ulcers should be excised or resected by a Billroth-I-type gastrectomy. All seven patients could be cured.