[Acute diverticulitis of the jejunum. A rarely diagnosed cause of peritonitis]. / Die akute Divertikulitis des Jejunum. Eine selten diagnostizierte Ursache der Peritonitis.

A 77 year old man was treated for duodenal ulcer and obstipation for 2 years; the diagnosis was not confirmed by endoscopy. Because of recurrent and increasing abdominal pain the patient was admitted to hospital as recurrent duodenal ulcer; this was excluded by emergency endoscopy. At laparotomy a sealed-off perforation of an inflamed jejunal diverticulum was identified complicating the jejunal diverticulosis. The entire jejunal segment involved by diverticulosis was removed. The patient made an uneventful recovery and is well 15 months after surgery. Jejunal diverticulosis may be associated with a variety of complications; it should be considered, especially in the elderly patient, with recurrent gastrointestinal symptoms of obscure origin.

[Mediastinal lymphadenectomy. Anatomical basis and its surgical relevance in central bronchus carcinoma]. / Die mediastinale Lymphadenektomie. Anatomische Grundlagen und ihre chirurgische Relevanz beim zentralen Bronchuskarzinom.

102 patients with potentially curable bronchial carcinoma were subjected to pneumonectomy and mediastinal lymph node dissection regardless of gross appearance of the mediastinum at the time of surgery. 83 of these patients were analysed retrospectively. In 34 patients (41%) enlarged mediastinal lymph nodes were found; in 19 of these (56%) malignant invasion was verified histologically, whereas in 15 of these 34 patients (44%) the enlarged lymph nodes revealed only inflammatory changes. On the other hand, in 49 patients (59%) the mediastinum was grossly inconspicuous, yet in 2 of these patients (4.1%) microscopic invasion by carcinoma was found. This confirms that the assessment of the mediastinum by gross appearance is unreliable. As a consequence, mediastinal lymph node dissection should be performed routinely in all patients in order to detect occult metastases since only patients who had a complete resection have a change of cure. This approach is justified as in our experience mediastinal lymph node dissection does not impose an additional operative risk and long-term survival or even cure may be achieved in individual patients. Estimated 5-year survival in our patients with histologically proven mediastinal lymph node metastases was 22%; 3 of 21 patients with N 2 carcinoma are alive 8, 10 and 13 years p.o., without evidence of recurrence. The operative strategy and technical aspects based on anatomical knowledge of pathways of lymphatic spread of carcinoma of the lung are presented.

[Hepatitis A: antibody conversion under gamma globulin (author's transl)]. / Hepatitis A: Antikörperkonversion unter dem Schutz von Gammaglobulin.

55 soldiers of the Austrian UNO contingent to the Near East, stationed on the Golan Heights for 6 months were examined before and after their period of duty for hepatitis A antibodies and the liver specific enzymes GOT, GTP and gamma-GT were determined. All received prophylactic gamma globulin to prevent infectious hepatitis at a dosage of 0.05 ml/kg body weight before flying out and after three months. No cases of hepatitis occurred, but 4 sero-negative subjects displayed antibody conversion. No concomitant changes in the liver enzyme values were recorded, however. These findings are discussed.