[Effects of social change on surgery]. / Auswirkungen von Gesellschaftsveränderungen auf die Chirurgie.

The main social changes that have influenced medicine and surgery since the Second World War are growing criticism directed against science and technology, the understanding of the limits of economic growth, the institution of a system of social security for all, the loss of faith in the omnipotence of science and technology following numerous serious technical accidents and, last but not least, the invasion of economic ideas into the domain of medical thinking.

[Surgical indications in the asymptomatic gallstone]. / Operationsindikationen beim symptomlosen Gallenstein.

As long as long-term observations of operated and nonoperated patients with silent gallstones are missing, the question of general, differentiated or absent indication for operation in such cases cannot be answered by facts. To day only by 20% of people with gallstones are operated. 50-70% of those with silent gallstones probably remain free of complaints and symptoms during life. Each case of symptomatic cholelithiasis must be operated as soon as possible, but a general indication for operation of really silent gallstones cannot be advocated.

[Duodenal stenosis in coincidence with annular pancreas and cancer of the papilla]. / Duodenalstenose bei Koinzidenz von Pancreas anulare und Papillenkarzinom.

We report on a case of annular pancreas complicated by the development of a carcinoma of the papilla causing secondary chronic obstructive pancreatitis. Eventually, a high-grade stenosis of the duodenum developed, leading to symptoms of gastric outlet obstruction. The stenosis was proved by endoscopic and radiologic diagnosis, but the exact anatomical condition was only revealed by an operation. Efficient diagnostic and therapeutic procedures in annular pancreas with its potential complications are discussed in detail.

[Blunt and penetrating abdominal injuries]. / Stumpfe und offene Bauchverletzungen.

During the last 10 years 0.45% of all our patients were operated on because of blunt (92) or penetrating (22) abdominal trauma. In the acute phase, diagnosis can be made on clinical symptoms alone. Of the early diagnostic procedures, peritoneal lavage is most reliable. Laparoscopy, ultrasonography, computed tomography, and arteriography are procedures used later, but only when the patient's circulation is stable. The most frequent injury encountered is splenic rupture, followed by rupture of the liver and gastrointestinal tract. When one single organ is injured, lethality is under 10% and grows to more than 30% when several organs are injured.

[Retroperitoneal injuries: introduction (author's transl)]. / Retroperitonealverletzungen: Einführung (Anatomie, Frequenz und Statistik).

Injuries of the retroperitoneal organs occur mainly in patients with multiple traumas. Spine and spinal muscle provide an effective protection against blunt trauma from behind. In the front the thin peritoneal layer is just a biological border. Therefore injuries of the abdominal and retroperitoneal organs frequently occur together. Direct clinical examinations are limited by the specific anatomical situation; further invasive diagnostic procedures deal mainly with indirect effects of retroperitoneal injuries. Massive hemorrhage with consequent retroperitoneal hematoma is the dominant pathophysiologic course; mortality is high.