[Improving anal continence by selective stimulation of the external anal sphincter muscle]. / Verbesserung der analen Kontinenz durch selektive Stimulation des M. sphincter ani externus.

Using the pig as a model, it was shown that stimulation of the distal nerve ending of the pudendal nerve leads to the isolated stimulation of the external anal sphincter muscle. No difference in pressure response was noted after application of between 0.5 and 1.5 mA unilateral or bilateral stimulation. Major advantages observed using between 1.5 and 2.5 mA bilateral stimulation; with a stimulation between 2.0 and 2.5 mA the pressure response was twice as high compared to unilateral stimulation. Continuous stimulation of the striated anal sphincter muscle leads to fatigue, reaching 50% fatigue after a median time between 40-90 s. In cyclic stimulation (alternation every 15 s, duration 20 min) a fatigue reaction was also seen. The peak pressure decreased after 20 min for a median of 11%, the final pressure was lowered in 15% following a logarithmic curve pattern. The experimental application of variable impulse ranges also caused pressure differences. Increasing the impulse range from 200 to 450 microseconds (peak pressure) vs. 400 microseconds (final pressure) resulted in a statistically significant pressure increase. Therefore, it was proven that selective stimulation of the external anal sphincter muscle can lead to a transient pressure increase, which possibly improves fecal continence.

[Peripheral vascular injuries in polytrauma]. / Periphere Gefässverletzungen beim Polytrauma.

Between 1972 und 1993 a total of 68 patients were treated at the Department of Surgery of the University Clinic of Mannheim for peripheral vascular injury resulting from multiple trauma. The average age of these patients was 31.3 years, and most of them were male (88.2%; n = 60). The injured vessels were localized evenly in all the extremities: 31 patients (45.5%) presented with arterial damage of the upper extremity, and 37 (54.5%) showed lesions along the femoro-popliteal arteries. The most frequent location of injured vessels in the multiply traumatized patient was the popliteal artery (n = 18, 26.5%), the distal part of the superficial femoral artery (n = 12, 17.6%), the brachial artery (n = 14, 20.6%) and the axillary artery (n = 10, 14.6%). The dominant cause, of trauma was road traffic accidents (72%), and 20 patients (29%) acquired their vascular injuries as motorcyclists. There were also 13 occupational accidents (19%) involving vascular injuries. In addition to a vascular trauma 34 patients (50%) had complicated fractures, and a further 34 patients (50%) had multiple fractures: 12 (17.6%) had head and brain damage, 5 (7.3%) had blunt abdominal trauma and 6 (8.8%) had blunt thoracic injury. The general amputation rate was 2.9% (n = 2). One patient died on the table of a torn off subclavian artery combined with multiple other injuries. Paresis of the plexus is a particular problem after vascular lesions of the upper extremity: in 22 patients (71%) paresis of the plexus persisted after successful vascular reconstruction (follow-up period between 3 months and 16 years, median time 3.45 years).(ABSTRACT TRUNCATED AT 250 WORDS)

[Results of a prospective study of laparoscopic appendectomy]. / Ergebnisse einer prospektiven Studie zur laparoskopischen Appendektomie.

Laparoscopic appendicectomy for acute appendicitis is being increasingly criticized, because of the possible complications, the technical effort required and the high costs. The results of the present prospective study performed between May 1992 and March 1994 on 222 appendectomies (110 conventional and 112 laparoscopic) are intended to serve as a tentative guide. The use of endoscopic stapling and cutting devices, as well as the observance of exclusion criteria make laparoscopic appendicectomy a safe operation. It can be employed routinely and shows certain advantages for the patient e.g. fewer disturbances of wound healing and shorter postoperative hospitalization. Although laparoscopic appendicectomy has brought us valuable experience, it is by no means the method of choice and for the time being, it is unlikely to replace conventional appendicectomy.