[Endoscopic removal of an ingested foreign body--indications and choice of procedure]. / Die endoskoipische Entfernung ingestierter Fremdkörper--Indikation und Verfahrenswahl.

The majority of ingested foreign bodies does not cause problems for the patients and leaves the gastrointestinal tract spontaneously without complications. However the low risk of modern fiberendoscopy allows a safe approach of endoscopic extraction. In children and all other cases, where general anesthesia is required for the extraction procedure, indication for endoscopic extraction should be limited. From 1980-1986 we followed a concept, which differentiated for emergency, early-elective or elective extraction, depending on localisation and nature of the foreign bodies as well as the necessity for general anesthesia. In 88 endoscopic extractions (22 emergency, 66 elective) no complications were observed.

[Roux-Y reconstruction following distal stomach resection using only staplers]. / Roux-Y-Rekonstruktion nach distaler Magenresektion durch alleinige Verwendung von Staplern.

The spreading of stapled suture techniques has also entailed the utilization of staplers in gastric surgery. A functional, up-to-date, and exclusively stapled reconstruction procedure, Roux-Y-reconstruction, after subtotal gastrectomy was established and analyzed in a pilot study (n = 25). In doing so, one proceeded as follows after subtotal gastrectomy and systematic lymphadenectomy in cases of carcinoma: duodenal closure (GIA or TA30), gastric resection (TA90), jejunojejunostomy (EEA25), gastrojejunostomy (EEA25/28), closure of the projecting efferent loop (GIA). This study intended to achieve the following advantages: increased suture safety, saving of time, reduction of complications, and especially the extension of indications regarding age and localization of the tumor. A special program to eliminate mistakes in handling is required for the sole and systematic application of staplers in the upper gastrointestinal tract. Every complication occurring during and after surgery was carefully recorded in this study and the attainable quality of life after subtotal gastrectomy was assessed.

[Ulceration of large leiomyoma of the stomach]. / Ulzerationen auf grossen Leiomyomen des Magens.

Two case reports are given of patients harboring big gastric leiomyoma with central ulceration. X-ray, endoscopic and intraoperative findings are described; the surgical procedure is discussed.

[Hemorrhage of esophageal varices in child B and C patients. Results of sclerosing therapy]. / Osophagusvarizenblutung bei Child-B- und -C-Patienten. Ergebnisse der Sklerosierungstherapie.

In a 3-years period 51 patients with acute bleeding oesophageal varices with Child-stadium B and C were admitted to our department. Endoscopic sclerosing therapy was performed during emergency endoscopy. --The analysis of these patients indicates, that unsuccessful conservative treatment before endoscopic sclerosing therapy has a negative influence on the outcome of our patients. This fact should be kept in mind when results of this study are compared with other studies. Fatal prognostic criteria are early recurrent bleeding within the first 24 h after emergency endoscopy, thrombocytopenia and a deficiency of fibrinogen. The latter is an indication for ballon tamponade of the varices in the distal oesophagus even after successful endoscopic hemostasis.

[Operation or conservative therapy? New aspects based on further differentiation of emergency endoscopy findings in hemorrhage of gastrointestinal ulcers]. / Operation oder konservative Therapie? Neue Gesichtspunkte durch weitere Differenzierung des notfallendoskopischen Befundes bei Blutungen gastroduodenaler Ulcera.

In a retrospective study the clinical courses of 121 patients with bleeding peptic ulcers were reviewed. The possibility for endoscopic prediction of recurrent bleeding was evaluated. The criteria specific to recurrent hemorrhage, which we found in bleeding ulcers during emergency endoscopy, led us to a modification of the Forrest-classification. All spurting arterial bleedings, which could be stopped by endoscopic means and all lesions with a big visible vessel in the ulcer crater had a high risk of recurrent bleeding. Therefore early surgical treatment should be performed soon after stabilisation of all vital functions and compensation of the blood loss. The emergency endoscopy enables not only an accurate diagnosis, but also a prediction and prognostic judgement of recurrent bleeding. This will give the surgeon valuable informations on deciding an operative or conservative treatment.

[The injection method for hemostasis in gastroduodenal lesions. Indications and possibilities]. / Die Injektionsmethode zur Blutstillung bei gastroduodenalen Läsionen. Indikationen und Möglichkeiten.

Endoscopic injection of polidocanol was used in a prospective study of 88 patients with gastroduodenal bleeding. Active bleeding by injecting polidocanol (1%) in 54 patients achieved initial haemostasis in 51 (94%); lasting arrest of bleeding was achieved in 39 (72%). This injection treatment was also used to prevent recurrence of bleeding where there had been signs of previous bleeding: this proved successful in 25 of 34 patients (74%). The endoscopic injection method thus gave results equivalent to other endoscopic methods of achieving haemostasis.

[The concept of endoscopy-related therapy in gastroduodenal ulcer hemorrhage]. / Endoskopie-abhängiges Therapiekonzept bei der gastroduodenalen Ulkusblutung.

In a prospective study a new therapeutic concept was tested on 76 patients with bleeding gastroduodenal ulcers. During emergency endoscopic an exact inspection of the ulcercrater helped to determine the possibility of recurrent bleeding of the ulcer. This possibility was expressed in a modified Forrest-classification. Endoscopic hemostasis has been performed in all cases of active bleeding. Ulcers with a big visible vessel stump should be operated early elective after an intervall of intensive care, because definitive endoscopic hemostasis seemed not to be sufficient with this bleeding type. The new concept decreased the operation frequency of bleeding gastroduodenal ulcers from 51% in 1981/82 to 34% in 1983. Mortality of bleeding duodenal ulcers decreased from 18% to 8,6%, in bleeding stomach ulcers from 24% to 18%. Endoscopic hemostasis with injection therapy has proved to be most successfull in the F1b bleeding type.

[Clinical experiences with induced preoperative haemodilution in vascular surgery (author's transl)]. / Klinische Erfahrungen beim Einsatz der induzierten präoperativen Hämodilution in der Gefässchirurgie

A procedure of haemodilution modified for the particular requirements of vascular surgery has been used on 90 hospital patients. 61% of the operations have been performed without using homologous blood. The method applied being clinically well tolerable, it the object of this study to find to what extent a measurable reduction of the loss of blood during the operation with consequently a reduction of the amount of homologous blood administered can be attained. If the tolerable loss of blood is estimated to be 600 ml, in 22% of the cases operated on the administration of homologous blood has been avoided. The improvement in rheology by the infusion of low molecular weight dextran is considered an additional advantage in the special field of vascular surgery.