Palliative portal vein stent placement for lymphatic recurrence of gastric cancer.

INTRODUCTION: Percutaneous transhepatic stenting of the main portal vein is a rare intervention. CASE REPORT: In the current patient, percutaneous angioplasty and stenting of a main portal vein stenosis due to lymphatic recurrence of gastric cancer ameliorated the progressing therapeutic restriction. The wall stent achieved portal venous patency that enabled ongoing chemotherapy. The stent remained patent for the entire subsequent survival period.

[Retrospective view of the development of surgical therapy of gallstones]. / Rückblick zur Entwicklung der chirurgischen Therapie des Gallensteinleidens.

This paper gives a short historical overview of the evolution of biliary surgery from John Stough Bobbs (1867) until the present day. The development of different diagnostic methods (from cholangiography to sonography) are described also, as well as the different therapeutic methods including laparoscopic cholecystectomy. Hans Kehr (1862-1916) was a distinguished pioneer in the development of biliary surgery.

[Value and sensitivity of abdominal ultrasound in preoperative histologic diagnosis before laparoscopic cholecystectomy]. / Die Wertigkeit und Treffsicherheit der abdominellen Sonographie in der präoperativen Feindiagnostik vor laparoskopischer Cholezystektomie.

In a retrospective study we compared the findings of our abdominal ultra-sound diagnostic of the gallbladder and the common bile duct with the results ot preoperative ERCP, intraoperative findings and the histological results. The test parameters were the size of the gallbladder, the number and the size of biliary calculi, the thickness and the constitution of the wall of the gallbladder and the consecutive grade of inflammation, the wideness of the common bile duct and the suspicion of a choledocholithiasis, respectively. In acute cholecystitis we performed laparoscopic cholecystectomy within 24 hours, in symtomatic cholecystolithiasis without cholecystitis an elective laparoscopic cholecystectomy. If there was suspicion of a choledocholithiasis we performed a preoperative ERCP. Altogether we had correct findings of the common bile duct in our ultrasound diagnostic in 133 of 136 cases (97.8%), only in 3 of 136 cases (2.2%) we had false negative ultrasound findings. With a generous indication to ERCP caused by anamnestic and/or laboratory findings the obstruction of the bile duct could be diagnosted and eliminated in 2 of these 3 cases preoperatively. In all cases of bile duct dilatation (7 mm and more) we found an obstruction of the common bile duct. Our results demonstrate that abdominal ultrasound is a high-efficiency method in the preoperative diagnostic of gallbladder and common bile duct stones.

[Transthoracic-transabdominal resection of esophageal carcinoma]. / Ein Beitrag zur transthorakalen-transabdominalen Resektion des Oesophaguskarzinoms.

54 patients suffering from esophageal cancer have been treated in a period from 1990 to 1994. In 29 cases curative resection was possible, corresponding to a resection rate of 54%. Average age of resected patients was 62 years. According to pTNM-classification the stages T1 and T2 amounted to 45%, T3 and T4 to 55%. Lymphatic node metastases were discovered with an incidence of 55%. In patients treated conservatively more unfavourable stage distributions and increased rates of lymphatic node metastasis were shown. Transthoracal-transabdominal esophageal resection was preferred as curative management. Lethality amounted to 13.8%. In 3 of 4 lethal cases after resection autopsy confirmed absence of tumor. Lethal complications were two respiratory insufficiencies, one suture line dehiscence and one alcoholic delirium. Survival rates were calculated by life-table-method. We consider the transthoracal-transabdominal esophageal resection as an acceptable therapeutic option in esophageal cancer offering a real chance of enduring curing.

[Encounter of the Ernst von Bergmann and Erwin Payrs surgical schools at the Jena University Clinic]. / Die Begegnung der Chirurgenschulen Ernst von Bergmanns und Erwin Payrs an der Universitätsklinik in Jena.

This paper gives a short historical overview on the work of distinguished Professors such as Erich Lexer, Nikolai Guleke, Heinrich Kuntzen and Theo Becker, who worked in the Surgical University Hospital in Jena from 1911 to 1981. The main areas of their clinical and scientific activities are described, as well as the private and human qualities of these well-known personalities.

[Results of correction of benign bile duct obstructions by bilio-jejunal anastomosis]. / Ergebnisse nach Korrektur benigner Gallenpassagestörungen durch bilio-jejunale Anastomose.

In 27 patients with disorders of the bile ducts we performed a bilio-jejunal anastomosis to eliminate the stenosis. The letality rate was 3.7%, the rate of complications following operation was 30%. After a period of 3 to 15 years 15 patients agreed to an inpatient follow-up examination. 80% of them regarded the postoperative results as subjectively good or very good. 60% were again completely able to work. Biochemical examinations, ultrasonography and sequencescintigraphy of the liver showed a higher rate of irregular findings despite missing symptoms. These findings were due to icteric or cholangitic predamages before surgical treatment. The determination of Gamma-Glutamyl-Transferase and alcaline Phosphatase as well as ultrasonography and sequencescintigraphy of the liver proved to be the most sensitive methods for evaluation of the late results.