[Guidance of the severely ill patient following detailed information about his disease]. / Die Führung des schwerkranken Patienten nach eingehender Information über seine Krankheit.

The ability to guide serious sick patients and to help in terminal cases depends on the helpers personal attitude to death and questions of eschatalogy. The concept of truth means not only correct information about findings of examinations but rather veracious relationship based on mutual trust between patient and doctor. All coworkers especially the nurses participate process of helping the patient. There is no model program for the talk with serious sick patients nor for the inter-action with patient. Each situation of terminal cases is absolutely singular and unique. All our behaviour towards our patients is influenced by personal experiences.

Stricter selection criteria improve the results of shunt surgery.

Between October, 1976 and December, 1982, 176 patients with full-blown liver cirrhosis were referred to us either with Acute oesophageal variceal bleeding, or after having had such a haemorrhage. Eight of these patients died of a haemorrhage that did not respond to conservative treatment, or of hepatic failure after emergency surgery. After receiving initial conservative treatment, 168 patients were classified in accordance with clinical, biochemical and haemodynamic selection criteria, particular importance being attached to the haemodynamic criteria. One-hundred-and-one of these patients in whom a shunt operation was not justifiable, were treated conservatively by means of repeated sclerotherapy. In the cases of acute bleeding, a balloon tamponade was performed in 3, an emergency shunt procedure in 1 and palliative dissection surgery in 4. Twenty-three patients in a non-bleeding state were treated conservatively without sclerotherapy. Shunt surgery was performed in 44 patients; out of the 42 patients shown by our selection criteria to be suitable for shunt surgery, only 1 patient died, 5 days after the operation, of cardiac failure with underlying toxic cardiomyopathy. In view of the low early mortality rate in selectively operated patients, a major argument against the use of the shunt for the treatment of portal hypertension is no longer valid, and it should again be considered whether the surgical procedure might not provide better long-term results than does conservative sclerotherapy alone.

[Surgical treatment of varices (author's transl)]. / Die chirurgische Behandlung der Varizen

Basically three possibilities are available for the treatment of the varicose symptom complex: 1. Varicosclerozation, 2. Surgery, 3. Compression. Dermatologists and internists understandably prefer varicosclerozation; surgeons, surgery. The best success, in my opinion, is achieved with all three possibilities of treatment are used in combination and adjusted individually to the vascular findings of each case. There is no effective varicosclerozation and no surgical treatment without subsequent compression. In no case, can treatment by medication be more than supportive for other effective measures. The goal of this article is to provide information regarding the present status of surgical treatment. Unavoidably, the indication for the other methods of treatment was also established.

[Catheterization of the umbilical vein, diagnostic and therapeutic relevance (author's transl)]. / Der Nabelvenenkatheterismus - diagnostische Bedeutung und therapeutische Möglichkeiten

Catheterization of the umbilical vein does allow direct access to the portal system, thus yielding information about the pathophysiology of the hepatic and splanchnic vessel system. Mesurement of the portal vein pressure in conditions of portal hypertension can be performed in the portal vein. A special, three-compartment ballon catheter is available for mesurement of intrahepatic wedge pressure. Angiography of the umbilical vein allows earlier diagnosis of metastases within the liver than other diagnostic procedures. Intraportal application of cytostatic drugs using a long term indwelling umbilical vein catheter is feasible as well. Own experiences are as yet rather limited. Three patients have been treated up to now this way; evaluation of the therapeutic results is not yet possible, because of the short duration of therapy and because of the low number of patients. The technique of umbilical vein catheterization does not seem to present any problems. Complications are rare and did not occur in our series.