[Alloplastic replacement of the proximal femur--indications, results and experiences]. / Alloplastischer Ersatz des proximalen Femurendes--Indikationen, Ergebnisse und Erfahrungen.

The aim of this follow-up study was to see if, by the application of a special endoprosthesis for the replacement of the proximal femur, a radical tumour resection could be achieved and/or the function of the lower limb could be preserved or restored respectively. Between 11/1986 and 12/1992 a proximal femoral endoprosthesis was implanted in 9 patients with metastases in the proximal femur. In 21 cases this special endoprosthesis was used in the revision of conventional cemented total hip arthroplasties with loosening of the implant and extreme bone loss at the proximal femur. Twenty-three patients were seen for a follow-up examination with an average follow-up period of 20 months. In all cases the walking ability was preserved or restored respectively. The majority (22/23) of the patients had complete or, nearly complete pain relief. In those patients with skeletal metastases, were no cases of local reoccurrence. The majority problem of this endoprosthesis was the increased risk of dislocation. There is a clear indication for such a special endoprosthesis in the treatment of primary and secondary bone tumours in the proximal femur. For revision of cemented total hip prostheses with loosening and bony defects a revision prosthesis with uncemented distal fixation should be used.

[Secondary achalasia in non-Hodgkin's lymphoma of low malignancy and leiomyomatosis of the cardia]. / Sekundäre Achalasie bei niedrigmalignem Non-Hodgkin-Lymphom und Leiomyomatose der Kardia.

A 28-year-old man had been dysphagic for 9 months with a weight loss of 4 kg. A preliminary diagnosis of primary achalasia was made on the basis of typical radiological and manometric findings. Despite balloon dilatation of the cardia the symptoms did not improve and further diagnostic tests were performed. Ultrasound demonstrated a 4 cm tumour below the cardia. But its type and possible malignancy remained uncertain even at laparotomy. But as a malignant tumour was suspected a gastrectomy and omentectomy with removal of the local and regional lymph nodes were performed. After this the symptoms regressed and postoperative food intake was without problem. Histological examination of the surgical specimen revealed leiomyomatosis of the cardia and the gastric fundus, combined with a low-malignant B-cell lymphoma of the mucosa-associated lymphatic tissue. Oesophagus manometry 4 months postoperatively gave normal results. The patient has been free of symptoms and without evidence of recurrence for by now 18 months postoperatively.

[Surgical therapy of achalasia after prior pneumatic dilatation]. / Operative Therapie der Achalasie nach vorausgegangener pneumatischer Dilatation.

Of 15 patients operated on for achalasia in the Department of General and Abdominal Surgery at the University of Mainz between September 1985 and April 1990, 14 were followed-up. All the patients had received an extramucous myotomy combined with Dor's semifundoplication; in twelve, one or more preoperative balloon dilatations had been performed. The results are reported in this study. The average age of the patients was 55.3 years (18 to 76 years), and the average follow-up period 21 months (six to 53 months). No postoperative complications were seen in any of the case. All patients reported appreciable improvements in their symptoms, six being completely symptom-free. Occasional dysphagia was reported in six cases, one patient had occasional, another frequent, nocturnal heartburn, which however had already presented preoperatively. In all seven cases submitted to postoperative radiological examination, the diameter of the esophagogastric junction was increased, and the diameter of the middle-third of the esophagus decreased. No gastroesophageal reflux or signs of inflammation were seen in any of the cases. The low complication rate and the high success rate despite prior balloon dilatation or bougienage support the use of Heller's operation combined with Dor's semifundoplication for the surgical treatment of achalasia after failed balloon dilatation.

[Results of surgical therapy of cervical diverticulum]. / Ergebnisse der operativen Therapie des cervicalen Divertikels.

Eighteen patients with a pharyngoesophageal diverticulum were operated on at the University Department of Surgery, Mainz, between September 1985 and July 1990. Results are based on follow-up studies of 15 patients. Three patients were operated upon less than six months ago. All patients underwent excision of the diverticulum and a cricopharyngeal myotomy. The mean age was 69 (49-84) years and the average follow-up interval was 30 (6-52) months. Twelve of the fifteen patients are free of symptoms concerning the esophagus since the operation. Two patients who died 17 resp. 22 months after the operation were also free of symptoms concerning the esophagus. In all 11 patients who had a barium contrast, swallowing was normal and no recurrence was found. The results show excision of the diverticulum combined with a cricopharyngeal myotomy to be an effective method with low risk for the long-term removal of pharyngoesophageal diverticulum.