[Post-traumatic aneurysm of the thoracic aorta; the results of surgical repair (author's transl)]. / Posttraumatische Aneurysmen der thorakalen Aorta Ergebnisse nach chirurgischer Therapie.

29 patients aged 11-55 years underwent surgery an aneurysm of the descending part of the thoracic aorta that had developed after a blunt chest trauma. In all patients continuity of the vessel was restored by interposition of a prosthesis. Surgery was performed during the acute stage in 5 patients, two of whom died postoperatively due to infection of the prosthesis and shock lung respectively. One of the 24 patients who were operated on during the chronic stage died on the 16th postoperative day of apoplexy. One of the 26 patients who were discharged from hospital after the operation died of a spurious aneurysm that had developed at the site of the prosthesis. Follow-up examinations of 21 patients showed normal postoperative function. In 5 cases there was an angiographically demonstrable slight narrowing at the site of the anastomosis; the pressure gradient, measured intravascularly, did not exceed 30 mm Hg.

[Results of endarterectomy in coronary artery surgery (author's transl)]. / Resultate der Endarteriektomie im Rahmen der Koronarchirurgie.

In a series of 432 aortocoronary bypass procedures endarterectomies were performed in 58 patients (13.4%) on 60 coronary arteries. Except of two vein patch grafts all endarterectomized arteries were bypassed with a saphenous vein graft. The majority of the patients had an endarterectomy of the right coronary artery. Clinical control investigations were performed in 43 out of 47 survivors including 30 with coronary angiograms 5.2 months (mean) after surgery. 26 out of 31 endarterectomized arteries (83.9%) were open angiographically whereas the patency rate to non-endarterectomized arteries of the same patients was 86.4%. The hospital mortality was high; 11 out of 58 patients (19%) deceased. All patients who died postoperatively had a three vessel disease with diffuse coronary sclerosis. Only three had no myodardial infarction prior to surgery, seven had one to four infarctions before surgery. The relatively high mortality intends for the future a more strict revision of the indications for coronary surgical procedures. But not in all cases the preoperative coronary angiograms and ventriculograms allow a clear estimation of the local arterial conditions.

[Diagnosis and therapy of acute penetrating myocardial injury (author's transl)]. / Zur Diagnose und Therapie der akuten penetrierenden Herzverletzung.

Clinical signs of an acute penetrating wound of the heart not always are clear. Because of hemorrhage and reduced cardiac output during heart tamponade venous pressure not necessarily must be increased. If by pericardiocentesis an aspiration of blood is possible, diagnosis of a penetrating heart wound is of high probability; otherwise there is no diagnostic value of a negative pericardiocentesis. Only in a case of a very small cardiac wound pericardial drainage can be used as a sole therapeutic proceeding; clinical observation is mandatory and an emergency operation at all time must be possible. In most cases immediately thoracotomy with suture of the cardiac wound should be performed. Attention is necessary because of an injury of a coronary artery. Following this principle prognosis is good if the patient is reaching clinical treatment alive. Lethal outcome in 2 of our 12 reported cases in one of them is caused by refusing immediate surgical intervention by the patient himself, in the other by development of ischemic cardiac necrosis involving a papillary muscle after suturing a cardiac wound.

[Pancreatic pseudocysts--clinical picture and surgical treatment]. / Pankreaspseudozysten - Klinik und chirurgische Behandlung

Report about 98 cases of pancreatic pseudocysts and also elaboration on the etiology, pathogenesis and details of this disease. The operative method of choice is to establish the internal anastomosis. As long as the anatomic conditions and especially the structure of the cyst permit it, such anastomosis should be performed. We applied this method in 57.2 p.c. of the cases altogether. Y-anastomosis (Roux) proved to be the best. We applied it in 35.9 p.c. of our patients. For patients in bad general condition, outside drainage operation in the sense of marsupialisation is often the only possible and at the same time life-saving intervention. We performed this operation in 42.8 p.c. of our cases. Because of the clear increase in number of pancreas diseases in the last years, there is also a higher frequency of pancreatic pseudocysts. Their diagnosis and therapy are therefore important.

[Clinical indications for pacemaker exchange and functional studies of the explanted aggregates (author's transl)]. / Klinische Austauschindikation bei Herzschrittmacher- patienten und technische Funktionskontrolle der explantierten Aggregate

For the purpose of examining the clinical exchange indication 96 removed Demand-pacemakers (type Medtronic 5842, 5843, 5942, 5943) had been sujected to a functional test by the manufacturers. After a service-life from 31-45 months 71% (i.e. 42 out of 59 units) and, in the group with a service-life from 31-35 months, 66% (i.e. 33 out of 51 units) of pacemaker units removed at that time were still working regularly. The mean energy loss exceeded 70% with a simultaneous mean drop of the output voltage down to 2.5 Volts. After the 25th month of the implantation date the number of battery failure increased spasmodically. Under the suspicion diagnosis of "battery exhaustion" a prophylactic "selective" exchange operation of the pace-maker units implied does not appear justifiable to us but in cases with stable AV-Block III. Providing reliable supervision of patients with sufficient self-rhythm, the exchange may be delayed up to about the 40th month after the implantation.