[Anterior lumbar interbody fusion. Indications, technique, advantages and disadvantages]. / Die ventrale lumbale interkorporelle Fusion. Indikation, Technik, Vor- und Nachteile.

BACKGROUND: Anterior lumbar interbody fusion (ALIF) for lumbar interbody fusion from L2 to the sacrum has been an established technique for decades. OBJECTIVES: The advantages and disadvantages of ALIF compared to posterior interbody fusion techniques are discussed. The operative technique is described in detail. Complications and avoidance strategies are discussed. MATERIAL AND METHODS: This article is based on a selective literature search using PubMed and the experience of the authors in this medical field. RESULTS: The advantages of ALIF compared to posterior fusion techniques are the free approach to the anterior disc space without opening of the spinal canal or the neural foramina. This gives the possibility of an extensive anterior release and placement of the largest possible cages without the risk of neural structure damage. The disadvantages of ALIF are the additional anterior approach and the related complications. The most frequent complication is due to damage of vessels. The rate of complications is significantly increased in revision surgery. CONCLUSION: The ALIF technique meaningfully expands the repertoire of the spinal surgeon especially for the treatment of non-union after interbody fusion, in patients with epidural scar tissue at the index level and spinal infections. Advantages and disadvantages should be considered when evaluating the indications for ALIF.

[Endovascular implantation of stent-grafts in the thoracic aorta -mid-term results of a prospective controlled study]. / Endovaskuläre Implantation von Stent-Grafts in die Aorta thoracica - Mittelfristige Ergebnisse einerprospektiven kontrollierten Studie.

PURPOSE: To evaluate the effectiveness and safety of endovascular treatment of various descending thoracic aortic pathologies with covered stent-grafts as an alternative to open surgery. METHODS: Among 16 patients (5 type B dissections, 5 contained ruptures, 3 aneurysms of the descending aorta, 1 thoraco-abdominal aneurysm, 1 mural thrombosis, 1 patch aneurysm) treated between November 1997 and November 2000, eight patients received Talent stent-grafts and another 8 patients underwent a Gore-TAG stent-graft implantation. A clinical follow-up and control CT scans were obtained after the procedure and then at six-month intervals. RESULTS: Deployment of the stent-grafts was technically successful in all cases. Sufficient aortic reconstruction was achieved in all but one patient who needed surgical treatment. One patient died two days after the procedure from aortic rupture due to retrograde type A dissection. Another patient died 19 months after the procedure from an unknown cause. There was no occurrence of distal embolization, paralysis or infection. During follow-up, all patients remained free from recurrence or late complications of their disease. CONCLUSION: Endoluminal treatment of thoracic aortic pathologies with covered stent-grafts appears to be a safe and feasible method with at least mid-term efficacy.

A patient with five primary tumours of the aerodigestive tract and the kidney. The Interdisciplinary Tumour Board, Tübingen.

We report the case of a 65-year-old male who developed an oropharyngeal carcinoma, an oesophageal carcinoma and two primary bronchial carcinomas in combination with a renal cell carcinoma as an additional primary entity. By means of an aggressive diagnostic regimen including radiological and nuclear imaging techniques all carcinomas were detected early and could be treated with curative intention.

Minimally invasive aortic valve replacement without sternotomy. Experience with the first 50 cases.

OBJECTIVE: The method of replacing the aortic valve via a mini-thoracotomy has been reported in the recent literature. Although this strategy has clear advantages, further refinements of the process make the procedure even less invasive. METHODS: Aortic valve replacement was performed in 50 patients whose age ranged between 49 and 82 years, averaging 68+/-8.3 years. As access route, a right parasternal mini-thoracotomy of about 8 cm, without rib resection was used. Cardiopulmonary bypass was connected through the same access. Standard surgical techniques and equipment were employed. In all patients a mechanical prosthesis was implanted. RESULTS: There were neither intraoperative complications nor hospital death. All patients could be discharged home at an average of 10+/-3 days postoperatively. Cardiopulmonary bypass time, aortic cross-clamp time, total operation time averaged 118+/-32, 70+/-21, 180+/-45 min, respectively. Four patients could be extubated in the operative theater, the others on the intensive care units at an average of 12+/-6 h, postoperatively. One patient with a very thin aortic wall sustained a severe bleeding from the aortic cannulation site during an hypertensive crisis, just after extubation. He had to be re-entered immediately via a median sternotomy. A second patient, who was initially operated on because of a floride aortitis, had a limited periprosthetic leak 2 months postoperatively. The leak was repaired via a median sternotomy. Drainage lost and blood substitution averaged 751+/-400 and 274+/-390, respectively. CONCLUSIONS: The advantages of the present method include further reduction of hospital trauma, preservation of chest wall integrity, early mobilization and rehabilitation of the patient. Surgical technical improvements include avoidance of groin cannulation, simpler equipment, and an easy access in case of reoperation.

Single access for minimally invasive aortic valve replacement.

BACKGROUND: The method of replacing the aortic valve via a minithoracotomy has been reported in the recent literature. Although this strategy has clear advantages, further refinements of the process make the procedure even less invasive. METHODS: Aortic valve replacement was performed in 27 patients via a right parasternal minithoracotomy without rib resection. Cardiopulmonary bypass was connected through the same access site. Standard surgical technique and equipment were employed. RESULTS: There were no intraoperative complications. All patients survived and could be discharged home within 1 week, except 1. Cardiopulmonary bypass time, aortic cross-clamp time, and total operating time averaged 114 +/- 26, 76 +/- 19, and 190 +/- 40 minutes, respectively. Three patients could be extubated in the operative theater, the others in the intensive care unit at an average of 10 +/- 7 hours postoperatively. Chest drainage lost averaged 430 +/- 380 mL. CONCLUSIONS: The advantages of this method include further reduction of surgical trauma, early mobilization, and rehabilitation of the patient. Surgical technical improvements include avoidance of groin cannulation, simpler equipment, safe venting of the left ventricle, and preservation of chest wall integrity.

Early results of minimally invasive aortic valve replacement. Experience with the first 34 cases.

BACKGROUND: The method of replacing the aortic valve via a minithoracotomy has been reported in the recent literature. This strategy has clear advantages. However, further refinements of the process make the procedure even less invasive. METHODS: Aortic valve replacement was performed in 34 patients whose age ranged from 49 to 82 years, averaging 69 +/- 8 years. As access route, a right parasternal minithoracotomy about eight cm long and without rib resection was used. Cardiopulmonary bypass was connected through the same access. The standard surgical technique and equipment were employed. RESULTS: There were neither intraoperative complications nor hospital death. All patients, except two could be discharged home within one week. Cardiopulmonary bypass time, aortic cross-clamp time, and total operation time averaged 110 +/- 25, 73 +/- 19, and 183 +/- 38 minutes, respectively. Three patients could be extubated in the operating theater, and the others on the intensive care units at an average of 9 +/- 7 hours postoperatively. One patient had to be re-entered immediately after extubation because of a bleeding from the aortic cannulation site. A second patient, who was initially operated because of a florid aortitis, had a limited periprosthetic leak two months postoperatively which was repaired thereafter. CONCLUSIONS: The advantages of the present method include further reduction of surgical trauma, preservation of chest wall integrity, early mobilization, recovery and rehabilitation of the patient. Improvements in the surgical technique include avoidance of groin cannulation, simpler equipment, and an easy access through a mid-sternotomy in case of reoperation.