[Peri- and postoperative pain therapy with mechanical patient-controlled disposable analgesia pumps in general surgery. Report of initial trial]. / Peri- und postoperative Schmerztherapie mit mechanischen PCA-Einmal-Pumpen in der Allgemeinchirurgie. Ein erster Anwendungsbericht.

The patient-controlled analgesia (PCA) or "ondemand analgesia" is a pain-relieving therapy, which is regulated and monitored by the patient himself. Postoperative pain therapy is the main approach for PCA, which facilitates a long-term, individually controlled pain relief. In certain situations we use mechanical PCA-pumps filled with piritramid (Dipidolor) as an opioid-analgetic for reducing postoperative pain. This kind of therapy needs the acceptance and understanding of the patient as a main condition for the success. Beside an increase of patients' comfort and patients' independence of analgetic demand from the medical staff a reduction in postoperative complications can be expected, the time of hospitalisation might be decreased.

[Percutaneous transluminal angioplasty (PTA) of the arteries of the arm in brachial and cerebral ischemia]. / Perkutane transluminale Angioplastie (PTA) der armversorgenden Arterien bei brachialer und zerebraler Ischämie.

35 patients with brachial and/or cerebral ischemia underwent 37 PTA's. Indications for PTA were stenosis (n = 31) or occlusion (n = 1) of the subclavian artery, stenosis of the brachiocephalic trunk (n = 2), stenosis of the axillary artery (n = 2) and stenosis of the brachial artery (n = 1). 23 patients demonstrated a subclavian steal phenomenon. However, the minority of patients (n = 10) presented with neurologic symptoms, which could be provoked by brachial exercise in only 3 patients. 7 of the 10 patients with cerebral ischaemia demonstrated additional significant stenosis of the extracranial arteries. The technical success rate for PTA was 89.2%. Two patients showed relapse of the stenosis. The clinical success rate regarding brachial ischaemia was 94.4% (follow-up: 6-37 months). Neurologic symptoms disappeared after treatment in 72.7%. Minor complications without clinical sequelae occurred in 8.6%.

PTA of the subclavian and innominate artery: short- and long-term results.

Twelve patients with brachial ischemia and/or subclavian steal syndrome underwent PTA of the subclavian, innominate and axillary artery. One technical failure occurred in a patient with a high grade stenosis of the subclavian artery. All other patients were successfully dilated. On long-term follow-up (mean: 12 months) only one patient had a recurrent stenosis which was successfully recanalized by PTA. This patient is asymptomatic since 12 months. The only severe complication was a transient amaurosis which occurred during catheterization. Balloon angioplasty was, therefore, not performed. In summary, PTA is an effective therapy for patients with brachial ischemia and/or subclavian steal syndrome. The long- and short-term results compare favorably with results obtained by surgery.

[The "ideal" cholecystectomy. A prospective, randomized study]. / Die "ideale" Cholecystektomie. Eine prospektive, randomisierte Studie.

200 patients undergoing elective cholecystectomy were studied in a prospective randomized manner. This study suggests that the nasogastric tube and postoperative iv-infusions are unnecessary. We continue to use a subhepatic drain. Exception: the senior surgeon in a straightforward case.

[Angiographic detection of focal changes in the liver]. / Angiographischer Nachweis herdförmiger Veränderungen der Leber.

CT and ultrasound have completely replaced angiography in the diagnosis of focal liver lesions. However, angiography of the liver is still important for delineation of the vascular anatomy and enhancing diagnostic specificity, especially prior to hepatic surgery. CT angiography using water-soluble or oily contrast materials improves the diagnostic accuracy with regard to the number of lesions detected in patients with liver metastases or hepatoma. Both techniques reveal more lesions than do standard angiographic methods.

[Diagnosis and therapy of bleeding aneurysms of the peripancreatic arteries]. / Diagnostik und Therapie blutender Aneurysmen peripankreatischer Arterien.

Aneurysms of the pancreatic arteries are a rare complication of pancreatitis. Most usually they are observed with pancreatic pseudocysts or pancreatic abscesses. In view of the danger of haemorrhage, the diagnosis and treatment of these aneurysms is of considerable clinical significance. Angiography plays a dominant role, since it can demonstrate the source of bleeding and, at the same time, provides effective treatment by means of vascular embolisation. This is illustrated by three examples.

[Acute infrarenal aortic and bilateral pelvic artery occlusion]. / Der akute infrarenale Aorten- und beidseitige Beckenarterienverschluss.

Operations were performed on 75 cases of acute occlusion of the aorta and bilateral iliac arteries, between 1972 and 1987. The occlusions had been caused by embolisation in 48.6 per cent of these cases and by thrombosis in 31.4 per cent. Amputations had to be performed on 22 per cent, while the mortality rate at hospital amounted to 42.8 per cent. Surgical and anaesthetic risks were extremely high in 71 per cent of all patients. Complete ischaemia lasted more than six hours in 48 per cent. Intraoperative angioplasty was applied to twelve patients to control occlusion-induced stenoses and is believed to be capable of reducing hospital mortality.

[Acute aortic and iliac artery occlusion: a banality in vascular surgery?]. / Der akute Aorten- und Beckenarterienverschluss: eine gefässchirurgische Banalität?

From 1972 to 1986 70 acute occlusions of the aorta or bilateral iliac arteries were operated in our clinic. The occlusion was caused in 41 cases by embolisation, in 29 cases by thrombosis. Amputation rate was 22.8%, the mortality rate 42.8%. 71% of the patients were of extreme high risk regarding the operation as well as the anesthesia. In 44% of the patients the duration of complete ischemia was more than 6 h. Performance of intraoperative angioplasty (n = 10 patients) for dilatation of stenoses leading to thrombotic occlusions may lower the mortality rate.

[Intra-arterial DSA of the pelvic/leg vasculature using a 57 cm image intensifier]. / Intraarterielle DSA der Becken-/Beingefässe mit einem 57-cm-Bildverstärker.

100 consecutive intraarterial DSA's of the lower extremities obtained with a 57 cm image intensifier were evaluated retrospectively by 2 radiologists and 3 surgeons. The studies were considered diagnostic in 95% of the cases. The results, advantages and possible disadvantages are presented and compared to those associated with conventional film angiography and with i.v. DSA.

[Fibrin gluing of congenital esophageal malformations]. / Die Fibrinklebung angeborener Osophagusmissbildungen.

Gluing of oesophageal anastomoses in atresia effected by means of three or four sutures will definitely produce better results than suturing alone. The results of endoscopic closure of tracheo-oesophageal fistulas by gluing with fibrin are excellent. Furthermore, it is possible with fibrin gluing alone to treat iatrogenic perforations of the oesophagus in the newborn, following a false passage of nasogastric tubes from the hypopharynx into the mediastinum or pleural cavity.

Cerebral toxoplasmosis in the adult.

We report a case of cerebral toxoplasmosis in an adult patient. The diagnosis was established by demonstration of Toxoplasma gondii in the cerebrospinal fluid, and the patient was evaluated by computed tomography.