Stab injury of the superior mesenteric artery with life threatening bleeding - endovascular treatment with an unusual technique.

Endovascular microcoil embolization of the superior mesenteric artery (SMA) main trunk is not currently employed as a treatment for penetrating injury to the SMA in hemodynamically instable patients. Immediate laparotomy is the initial gold standard therapy. We report a case of successful SMA microcoil embolization with preservation of mesenteric perfusion by an unusual endovascular technique.

[Combination of endovascular procedures with open vascular surgery]. / Kombination endovaskulärer Eingriffe mit offenen gefässchirurgischen Operationen.

The combination of open surgery with endoluminal catheter techniques offers new chances in the treatment of multi-staged arterial occlusive disease. We report our experiences in 205 patients. In n = 125 patients TEA or bypass were undertaken in the groin with simultaneous catheter intervention proximally or distally. In 31 patients the operation was carried out above knee and in 49 cases below knee. 94 patients with an open operation in the groin and simultaneous iliac catheter interventions are in the follow up. For these interventions the combined secondary patency rate was 77 % after three years.

[Solitary primary amyloid tumor of the rectum]. / Solitärer primärer Amyloidtumor des Rektums.

Solitary primary amyloidtumor of the rectum. Gastrointestinal involvement of AL and AA amyloidosis is common and shows a broad variety of clinical appearance. We report a case of amyloidosis manifestated as a sole large rectum tumor and discuss the therapeutic procedure.

[Gallbladder tuberculosis. Review and case report of a patient with advanced renal failure]. / Gallenblasentuberkulose. Ubersicht und Kasuistik eines Patienten mit fortgeschrittener Niereninsuffizienz.

Tuberculosis of the gallbladder is a rare disease, which mostly is diagnosed by histological examination after cholecystectomy. Less than 60 cases are published. Four different manifestations are described by Weitz: The gallbladder infection by miliary tuberculosis in children or in adults, the disseminated abdominal tuberculosis including the biliary tract or the isolated infection of the gallbladder. Our case report outlines the progress of an isolated tuberculosis of the gallbladder wall in a patient with chronic renal failure. The uremic immunological anergy may have favoured the infection.

[Percutaneous drainage of abdominal abscesses. I. Technic and results]. / Die percutane Drainage abdominaler Abscesse. I. Technik und Ergebnisse.

88 intraabdominal abscesses in 77 patients were treated by percutaneous drainage. Patients were cured in 63 percent. Complications were observed in 11 percent followed by surgery in two instances. Ten out of 75 patients (13 percent) died in the postprocedural course from multiple organ failure or postoperative complications. A fatal outcome, however, was never attributable to the percutaneous procedure. Technical considerations of percutaneous abscess drainage are described in detail. Its similarities with open drainage and advantages over septic surgery are discussed.

[Percutaneous drainage of abdominal abscesses. II. Value in comparison with septic surgery]. / Die percutane Drainage abdominaler Abscesse. II. Stellenwert im Vergleich zur septischen Chirurgie.

Based on the review of the literature and experience with own cases the current status of the therapy of abdominal abscesses by percutaneous catheter drainage is described. Indications, reasons for failure, complications, and mortality are presented in detail. Compared with surgery percutaneous abscess drainage (PAD) seems to have better results; however, this statement should be viewed with caution since the input of modern imaging techniques might have improved current surgical success rates. A trial of PAD can be recommended in all feasible cases because it offers high curability with little morbidity.

[Echinococcus cysticus of the pancreas in the clinical picture of acute pancreatitis]. / Echinococcus cysticus des Pankreas unter dem klinischen Bild einer akuten Pankreatitis.

A 30-year-old Italian male was admitted to the hospital showing all clinical signs of acute pancreatitis. With the help of computerized tomography, ultrasonic and angiographic methods multiple cysts in pancreatic body and tail as well as close to the hilus of the spleen could be shown. Positive serological tests made the diagnosis "echinococcus granulosus" likely. Resection of the left part of the pancreas as well as resection of the spleen eliminated the parasite. Histologically hydatid cyst was traceable in the pancreatic duct.

[Intraoperative sonography following endarterectomy of the carotid artery]. / Intraoperative Sonographie nach Endarteriektomie der Arteria carotis.

The application of intraoperative sonography during carotid endarterectomy will give additional information in vascular diseases, in control of vascular anastomoses in localization of residual arterioma, intima flaps and instrumental damage. Intraoperative sonography is a new device for the vascular surgeon, and should be used to reduce the risk of early restenosis after carotid endarterectomy.

[Significance of the esophagogram compared to computed tomography in esophageal cancer]. / Aussagekraft des Osophagogramms im Vergleich zur Computertomographie beim Osophaguskarzinom.

A comparison of the oesophagogram and computed tomography has shown that there is angulation of the axis of the oesophagus in 75% of patients with perioesophageal tumour spread. This angulation is more common due to tumour in the younger patient. Longer tumours tend to show deeper infiltration into the peri-oesophageal tissue, although its frequency is not necessarily increased. Tumours longer than 8 cm. show infiltration in about 80% of cases.

[Standardized surgery of esophageal cancer]. / Standardisierte Chirurgie des Osophaguskarzinoms.

Surgery was performed in 63 out of 143 patients admitted with oesophageal carcinoma (44%) between 1977 and 1983. The tumour-affected oesophagus was resected in 47 patients (33%). For resection the abdomino-thoracic approach with removal of the oesophagus under sight was done in 26 patients, blunt transmediastinal oesophageal dissection in 21 and palliative gastric bypass without tumour removal in 16 patients. The mortality in the group with abdomino-thoracic resection was 31%, in blunt resection 10%, and in gastric bypass 12,5%. The main cause of mortality was pulmonary complications. As the mean survival time after blunt dissection is not different from the one after abdomino-thoracic resection the former is considered as method of choice due to the lower mortality. Abdomino-thoracic resection should be reserved only for a few patients with stringent indication.

[Palliative surgical therapy of incurable esophagus cancer by stomach bypass and endotube]. / Die palliative chirurgische Therapie des inkurablen Osophaguskarzinoms durch Magenbypass und Endotubus. Indikation und Ergebnisse.

Palliative treatment plays an important role in the management of esophageal carcinoma. On the whole there are more than 50% of the patients where the tumour is already inoperable at the time of diagnosis. From 1977 to 1983 we treated a total of 132 patients affected with esophageal carcinoma. It was only in 44 patients that the tumour could be resected. In 26 cases the approach was thoraco-abdominal, in 18 patients thoracotomy was unnecessary. Only palliative measures were possible for the rest. In recent years we have favoured gastric bypass or endoscopically and radiologically guided intubation for palliative treatment of esophageal carcinomas. In 17 patients a Celestin tube was placed surgically. During the last 2 years we exclusively inserted the tube endoscopically using the Nottingham introducer (n = 32). According to our results the best palliative treatment could be achieved by gastric bypass, restoring normal swallowing. Only 1 of 16 patients died postoperatively. Endoscopic insertion of an esophageal tube should be considered as a second choice treatment. A review of our mortality statistics and complication rate suggest that the Celestin tube should rather not be introduced by open surgery. Radiological and endoscopic investigation preoperatively is strictly advised. Furthermore, the indication for a Celestin tube depends on the localisation of the obstruction. In our view, the commercially available tubes (Medoc, Medinex Ltd.) supplied in 3 standard lengths are perfectly satisfying.

[Computed tomography and preoperative staging of esophageal cancers]. / Computertomographie und präoperatives Staging des Osophaguskarzinoms.

Fifty-two patients with proven esophageal carcinoma underwent thoracic and abdominal computed tomography (CT) prior to treatment. The mediastinum, lungs and abdomen were studied for evidence of direct invasion or metastases. Correlation with surgical findings were available in 15 thoracic and 29 abdominal CT-scans. Results indicate that experience of the radiologist is the most important factor in evaluation and in accuracy of CT-scanning. The extent of mediastinal spread in 13 of 15 and intraabdominal metastases in 23 of 29 patients were correctly identified. All errors were caused by false-negative diagnoses. The ability of CT to reliably predict the extent of disease can help the surgeon to plan an optimal therapy.

[Results of percutaneous abscess drainage]. / Ergebnisse der perkutanen Abszessdrainagetherapie.

Between 1978 and 1983 fifty-two abdominal abscesses in 44 patients were drained percutaneously. 79% of the abscesses occurred as postoperative complications. The overall success rate was 60%, whereas only 42% of left subphrenic abscesses were cured. Complications were encountered in 4.5%. Reasons for drainage failures were: liver sequestration, loculation, fistulae and recurrences. Percutaneous abscess drainage is an alternative, and valuable addition, to surgery.

[Gastric bypass in incurable esophageal cancer]. / Magen-Bypass beim inkurablen Oesophaguscarcinom.

Between 1977 and 1981, 70 patients were treated for esophageal carcinoma; 45 carcinomas were considered to be unresectable. In 11 of the 45, the site and stage of the tumor and the physical condition of the patient permitted palliative treatment with retrosternal gastric bypass. One patient died postoperatively. A gastric bypass enabled the remaining 10 patients to swallow normally and therefore led to significantly better quality of life. Only two patients survived for more than 1 year, the longest survival time being 15 months till now.

[Surgical treatment of oesophageal carcinoma (author's transl)]. / Chirurgische Behandlung des Osophaguskarzinomas.

Between 1977 and 1980 55 in-patients were treated for oesophageal carcinoma. Tumour stage and general state permitted curatively aimed treatment in only 19 patients. Combined pre-irradiation and operation were the treatment of choice in these cases. Subtotal oesophageal resection and reconstruction were performed in one session. The stomach was used as replacement organ in all cases. In five cases with cervical or immediate supracardial tumour localisation the oesophagus could be extirpated by bimanual dissection without thoracotomy. Fourteen patients required surgery in both cavities. In nine out of the remaining patients, in whom only palliative surgery could be performed, retrosternal tumour bypass with the stomach was performed. During admission, lasting on average 17 days after the operation in 28 patients, three patients with resection and one with bypass died. In the other 24 patients operation led to normal ability to swallow.

[Ultrasonic diagnosis and control of an amebic obscess of the liver (author's transl)]. / Sonografische Diagnose und Verlaufskontrolle eines Amöbenab-szesses der Leber.

A case report is given of a patient, who suffered from relapsing fever, loss of weight, and right-sided upper abdominal colicky pain. A tentative diagnosis of amebic abscess was established on clinical grounds and after ultrasonography. Metronidazol was given and body temperature normalized within 24 hours; 6 weeks later only scarring of the liver remained. Sonographic controls were performed once weekly during the course of the disease, showing that the central parts of the abscess were liquified increasingly; at the same time a marginal zone about 1 cm broad was formed. This type of marginal zone could be demonstrated in another patient with amebic abscess of the liver as well by ultrasonography, whereas it could never be shown in patients with purulant abscesses of the liver.

[Mesenteric venous thrombosis and oral contraceptives (author's transl)]. / Mesenterialvenenthrombose und orale Ovulationshemmer.

Primary mesenteric venous thrombosis seldom occurs in young women. As a complication of oral contraceptives it is uncommon as well. Based on an own observation (39 year old female patient) pathogenesis and problems in diagnosis of this aspect of thrombosis are discussed. Involvement of the veins being segmentary and peripheral, small bowel resection is the effective treatment.