Endoscopic sclerotherapy--personal experience.

Over the last 12 years, treatment of bleeding esophageal and gastric varices has improved considerably. By the use of new techniques and with increased experience the results of endoscopic sclerotherapy have been optimized. Acute variceal bleeding, esophageal or gastric, can now be reliably and definitively stopped using the tissue adhesive Histoacryl Blau. This is also applicable to all patients irrespective of their liver status at presentation. As expected, the mortality of acute variceal bleeders has decreased considerably, no death from bleeding occurring in the last 5 years. This has obviated the need for emergency surgery, balloon tamponade or vasopressin infusion. Using an aggressive sclerotherapy technique in the bleeding-free interval, varices of all grades can now be effectively eliminated within an average of 3 sessions covering 3-4 weeks. With the intra- cum peri-variceal injection technique not only are the visible veins eradicated, but also fibrosis of the inner esophageal wall is achieved at the same time. If careful attention is paid to certain details of the technique and instruments, and with close follow-up, patients of portal hypertension can now live well in terms of liver function, without the danger of further variceal bleeding.

A new technique for replacing an obstructed biliary endoprosthesis.

We report on a new method of stent exchange using a threaded device that enables removal of the clogged stent while simultaneously maintaining the original pathway without withdrawing the endoscope. With this method stent replacement has become more reliable, safer, simpler and quicker. This technique is also suitable for removal of stents dislodged inside the duct.

ESWL and gallstone dissolution with MTBE via a naso-vesicular catheter.

Endoscopic placement of a naso-vesicular catheter was successful in 90% (45/50) of patients with cholecystolithiasis. The first 7 patients were treated by MTBE dissolution alone. Dissolution was discontinued after a maximum of 14 days, as only two patients were rendered stone free. In one patient, 3 tiny pigment stones were sucked out through the catheter, and in another inoperable patient a pigtail endoprosthesis was finally inserted into the gallbladder. In the remaining 36 patients, combined ESWL and MTBE dissolution therapy was carried out. Treatment was broken off by one patient after one week, and interrupted in another due to catheter dislodgement. After an average of 10 days with 1-9 ESWL sessions (average: 3) complete stone clearance was achieved in 60% (20/34) of patients. Fourteen of the patients who completed treatment, and the one with catheter dislodgement still have sludge in the gallbladder, which is being treated with oral bile acids. The procedure-related complication rate was 10% (3 pancreatitis, 1 cystic duct perforation and 1 guidewire impaction). The mortality rate was zero. There was no evident complication due to either ESWL or MTBE dissolution.

[Endoscopic injection treatment]. / Endoskopische Injektionsbehandlung.

Nowadays injection treatment is not only used for sclerosing esophageal varices but also for stopping hemorrhage from mucosal lesions. This method is equally effective for treatment of hemorrhages after polypectomies and papillotomies. New indications for this method are benign and malignant stenoses of the esophagus. Good results in sclerosing of varices and of stopping hemorrhage have been confirmed very often; however further experience is needed in the treatment of stenoses.

[The surface of the greater omentum in the human and its vulnerability in intra-abdominal surgical interventions]. / Die Oberfläche des grossen Netzes beim Menschen und seine Verletzlichkeit bei chirurgischen intraabdominellen Eingriffen.

From five patients of the Department of General Surgery of the University Hospital of Hamburg-Eppendorf, who underwent laparotomy because of different indications, small pieces of tissue of the greater omentum were taken intraoperatively. The surface morphology of the greater omentum was studied by means of light, transmission electron and scanning electron microscopy. It became obvious that intact tissue only was obtained when the procedure of taking out material was accomplished most carefully. Consequently, during normal surgical manipulations the greater omentum usually will be damaged. In undamaged tissue specimen the normal surface of the greater omentum in man is described. The findings basically confirm the results of previous investigations. Injuries at the surface of the greater omentum after surgical treatment are, however, much more severe than they are noticeable by the naked eye. Lifting up of the mesothelium, ruptures of the submesothelial structures of connective tissue, squashing of fat cells and ruptures of blood vessels can be observed. During these processes lipid droplets are squeezed into the submesothelial connective tissues or even pressed up to the surface of the mesothelium. Large quantities of erythrocytes are found in the interstitium in between the adipose cells. To what extent milky spots and free nerve endings at the surface of the greater omentum are damaged during intraoperative manipulations cannot be unequivocally estimated on the basis of the material studied here.

[Qualitative and quantitative investigations on testicular tissue using the semithin slide technic in patients with oligozoospermia. II. Results]. / Qualitative und quantitative Untersuchungen am Hodengewebe mittels der Semidünnschnitt-Technik bei Patienten mit Oligozoospermie. II. Ergebnisse.

In 150 patients with oligozoospermia a testis biopsy of both testes was performed. In 76% the patients were 25-35 years old. Most of them had a sperm count less than or equal to 8.1 million/ml ejaculate (in the group of 0.3-1.1 million spermatozoa/ml ejaculate 32%, in the group of 1.2-8.1 million spermatozoa/ml ejaculate 43.3%, and in the group of 8.2-20.0 million spermatozoa/ml ejaculate 26.5%). The tissue of the testis was examined by the semithin slide technique. This method was preferred instead of the routinely used paraffin slide technique, because is semithin slides the different cells of the spermatogenesis as well as its pathological forms can be classified nearly to the limit of resolving power under a light microscope. Examples of histological pictures were given. In a statistical study especially the connection between tubules wall and cells of the spermatogenesis was examined. The tubule diameter which might influence the relation of the number of cells/tubule wall was connected. For all germ cells it could be observed, that the number of patients with the various germ cells decreased with thickening of the tubule wall. In this collective the high number of patients with a reduced number of spermatogonia was remarkable, as well as the number of patients with degenerating spermatocytes I degree and with pathological spermatids. These spermatids had especially abnormalities of the acrosom and of the nucleus. Furthermore the investigations revealed that the number of the germ cells in the tubules increase with higher spermatozoa density. But in the all cases the various numbers of this material showed only tendencies but no statistical significances.