[Restenosis of carotid artery after stenting associated bleeding in the vascular wall]. / Karotis-Restenose durch Stent-assoziierte Einblutung in einen atheromatös-fibrösen Herd.

Stenting is an alternative procedure to the endarterectomy in patients with severe (> 70 %) symptomatic stenosis of the carotid artery. Its value is actually tested in large controlled randomised multicenter studies. Many vascular surgeons postulate no benefits for the patients but a higher complication rate for the stenting procedure. Especially the possibility of mechanical irritations of the endothel caused by the stent itself seems to be a major problem. Despite thousands of stenting procedures of the carotid artery, there exist no reports of patients with direct mechanical irritation of the carotid artery through the stent itself. It is only published a higher risk of embolisation. This case of a 71-years old patient, who had a irradiation of the head and neck region 5 years ago for cancer therapy, is presented here. After the irradiation (60 gr) the stent was not so fixed in the carotid wall as usually. Therefore the stent caused a mechanical irritation of the sclerotic plaque with a bleeding in the carotid wall and subsequent severe stenosis at the end of the stent with higher level of infarction volume. This case demonstrates the risk of the theoretical postulated irritation of the endothel through the stent itself in a high movement region.

[Automated data processing of special reimbursements and case fees in general surgery]. / Automatisierte Ermittlung von Sonderentgelten und Fallpauschalen in der Allgemeinchirurgie.

Based on the algorithm of defined combinations between diagnosis and surgical procedures due to the Gesundheitsstrukturgesetz an automatical detection of reimbursement with an electronic hospital information system is presented.

[Differential diagnostic evaluation of a dysfunctional kidney transplant by magnetic resonance tomography]. / Differentialdiagnostische Abklärung des dysfunktionellen Nierentransplantats durch die Kernspintomographie.

Immediate diagnosis of rejection is essential for the prognosis of a renal transplant. To differentiate between rejection and acute tubular necrosis, 48 examinations (31 patients) were evaluated by Magnetic Resonance Imagining and Duplex Doppler ultrasound, and compared to the clinical outcome and histology. Sensitivity of MRI and Duplex Doppler was 82% (14/17), specificity was 77% (24/31) and 84% (26/31), respectively. Even when the results of both methods matched well, due to the extensive financial and technical efforts MRI may only be used as an additional tool for diagnosis.

[Color velocity imaging for diagnosis in kidney transplants. Methods for interpretation of color coding]. / "Color velocity imaging" in der Diagnostik von Nierentransplantaten. Methoden zur Interpretation der Farbkodierung.

Colour velocity imaging is a new technique in the field of colour-coded sonographic flow measurement. It measures blood flow directly by analysing ultrasound pulses' running time and has advantages over colour Doppler systems. Colour velocity imaging's colour code detects changes in arterial blood flow. Therefore it can be used in the diagnosis of kidney allografts in the same way as duplex ultrasound. Using the presented methods of colour interpretation, sensitivity of 66.6-100% and specificity of 72.7-91.7% are attained. Thus colour velocity imaging combines the attributes of duplex ultrasound and colour Doppler ultrasound.

[Laparoscopic Kader fistula]. / Die laparoskopische Kader-Fistel.

A laparoscopic modification of a gastrostomy by a catheter following the method first described by Kader is presented. Characteristic features are large luminal catheters being introduced into the stomach over a guide-wire and a special trocar under laparoscopic control. The gastric wall is additionally attached to the abdominal wall by laparoscopically applied sutures. Advantages and disadvantages of the presented method are compared and discussed to alternative and established procedures.

[Progress in kidney transplantation]. / Fortschritte der Nierentransplantation.

The introduction of immunosuppression with cyclosporine A in 1983 compared to conventional immunosuppression has clearly improved early results within the first year post transplant. In contrast, the rate of graft failure per year in the following course has not changed essentially. Still HLA histocompatibility is a predominant prognostic factor which can be influenced by organ sharing. On the other hand, donor factors like sex and age are becoming more important and should be taken into account for organ allocation. This furthermore requires strict attention to future exchange rules within the transplant community.