Embolization therapy in patients with severe arterial bleeding after hysterectomy.

The case history of a patient aged 41 years, who suffered recurrent hemorrhages following vaginal hysterectomy is reported. After several surgical interventions complete hemostasis was finally achieved by selective embolization of the internal iliacal artery. The application of this procedure is recommended in case of recurrent bleeding complications caused by pelvic surgery or neoplasms.

[Clinical use of the Bretschneider HTK cardioplegic solution for in situ protection of the kidney]. / Klinische Anwendung der kardioplegischen Lösung HTK nach Bretschneider zur in-situ-Protektion der Niere.

The first clinical use of Bretschneider's HTK-solution for in-situ-protection of the kidney in mild hypothermia is reported. By means of this protective method renal surgery can be performed in a bloodless field without permanent loss of renal function. After initial protective perfusion of the kidney no repeated perfusions or additional surface cooling must be done. There are no systemic side effects when the HTK-solution is applied appropriately.

Hepatic artery embolization for treatment of endocrine gastrointestinal tumors with liver metastases.

We report about six patients with endocrine gastrointestinal tumors and liver metastases (four insulinomas, one carcinoidtumor, one paraganglioma), who were treated with a transluminal embolization of the hepatic artery when cytostatic therapy was ineffective. In two patients a second embolization was necessary after recurrence of clinical symptoms. All patients tolerated the procedure without severe side-effects and improved clinically. Serum insulin levels and HIAA-secretion rapidly decreased. Survival lasted from 3 to 32 months (median 15 months). Five additional patients with metastatic endocrine gastrointestinal tumors, observed during the same time period, were regarded as not suitable for hepatic artery embolization. In selected patients, hepatic artery embolization may become an effective therapy for treatment of metastasing endocrine gastrointestinal tumors when conventional medication with cytostatic drugs has become ineffective.

Intra-arterial perfusion therapy with 5-fluorouracil in patients with metastatic colorectal carcinoma and intractable pelvic pain.

In a phase-II trial, 18 patients with intractable pelvic and perineal pain caused by local recurrent and/or metastatic colorectal carcinoma resistant to combinations of analgesics, systemic cytostatic chemotherapy and/or radiation were treated with intra-arterial perfusion therapy using 15-30 mg 5-FU/kg body wt./day for 1-5 days. Of 18 patients, ten achieved complete pain relief for 3-32 weeks (mean, 15.7 weeks); after the perfusion therapy eight used less than 50% of the amount of analgesics required before treatment; one patient had only a minor response; two patients were treated unsuccessfully. Side effects were mild and controllable. One patient died subsequent to arterial embolism in the leg where the catheter was placed; pelvic perfusion therefore appears risky in patients with severe arteriosclerosis.

[Criteria for diagnostic and therapeutic methods of vascular embolization (kidneys, spleen, liver) (author's transl)]. / Kriterien diagnostischer und therapeutischer Verfahren zur Organgefässembolisation (Niere, Milz, Leber).

Basing on the findings in patients with extensive carcinomas of the kidneys, the article reports on the various possibilities of application of occlusion spirals (Gianturco's method), of injectable occlusion materials and a combinations of both methods. In the authors' own experience, the spiral technique has mostly proved successful in achieving embolization of the arteries of the kidney 24 hours before surgery. Both the spiral technique as well as the use of injectable emblizates and a combination of both are used in the treatment of macrohaematurias in non-operable kidney tumours. The article reports on the technical conditions, indication and methodical limitations of embolization of the splenic artery, basing on three actual cases. The conditions and technique of embolization of branches of the hepatic artery are discussed by means of the findings obtained in two patients with liver metastases of an insulinoma.

[Quality criteria of phlebography examination methods. Technically conditioned possibilities of error prediction (author's transl)]. / Qualitätskriterien phlebographischer Untersuchungsverfahren--Technisch bedingte Fehlaussagemöglichkeiten.

The article describes the technical and anatomical limitations of information supplied by phlebography. Injection of contrast medium into the v. mediana hallucis enables optimal contrast medium distribution. The more proximal the site of injection, the greater the uncertainty of achieving continuous filling of the deep veins with contrast medium. Obstructions during compression (ulcer, oedema) may prove an obstacle to the assessment of insufficient v. perforantes due to overfilling of superficial veins with contrast medium. Even without any abnormal finding it is not possible to stain muscle veins and the v. femoris profunda in about 50% of the examinations. Muscular traction can result in deformation of mainly the v. poplitea and hence results in discontinuous filling with contrast medium if the musculature is not properly relaxed. The veins of the thigh and pelvis must be stained with high contrast in a continuous manner, since otherwise occlusions and collaterals are overlooked in an otherwise normal distal phlebogram. Valve motility can be assessed without additional examination measures directly after ascending phlebography during recumbency of the patient.