Separating different contributions to the crystal-field parameters using Wannier functions.

We discuss the calculation of crystal-field splittings using Wannier functions and show how contributions to the crystal-field splitting that are due to hybridization with different ligand states can be separated from the bare Coulomb contribution by constructing sets of Wannier functions incorporating different levels of hybridization. We demonstrate this method using SrVO3 as a generic example of a transition metal oxide. We then calculate trends in the crystal-field splitting for two series of hypothetical tetragonally distorted perovskite oxides and discuss the relation between the calculated 'electrostatic' contribution to the crystal field and the simple point charge model. Finally, we apply our method to the charge disproportionated 5d electron system CsAuCl3. The proposed procedure elucidates the way in which the negative charge transfer energy in this material leads to a reversal of the p-d ligand contribution to the crystal-field splitting such that the eg states of the nominally Au(3+) cation are energetically lower than the corresponding t2g states.

Adjuvant chemoimmunotherapy with LMF plus BCG in node-negative and node-positive breast cancer - intermediate report at 4 years.

A randomized surgical adjuvant trial in 242 evaluable patients with T1-3a, N0-1, and M0 breast cancer was initiated 4 years ago. The well-tolerated, oral combination chemotherapy with six cycles of Leukeran plus methotrexate plus fluorouracil (LMF) plus repeated BCG skin scarifications was used. After 4 years, the following results were seen: (1) significant increase of relapse-free (RFS) and also overall survival (S) in both pre- and postmenopausal node-negative patients versus surgical controls (RFS 91.1 vs. 701%, P = 0.003; S 96 vs. 88%, P = 0.03); (2) no significant increase of RFS or S in pre- and postmenopausal node-positive patients versus surgical controls (RFS 50.1 versus 44%, P = 0.49; S 70 versus 68 %, P = 0.9, respectively); (3) Patients receiving greater than 90% of the planned LMF dose showed significantly better survival after 4 years; and (4) Nonrandomized comparison with concurrent Swiss adjuvant studies with LMF alone indicate no beneficial or harmful effect of BCG skin scarifications in addition to the six-cycle LMF.

Three-dimensional reconstruction of fracture surfaces: area matching algorithms for automatic parallax measurements.

This paper describes two solutions for systematic measurement of surface elevation that can be used for both profile and surface reconstructions for quantitative fractography case studies. The first one is developed under Khoros graphical interface environment. It consists of an adaption of the almost classical area matching algorithm, that is based on cross-correlation operations, to the well-known method of parallax measurements from stereo pairs. A normalization function was created to avoid false cross-correlation peaks, driving to the true window best matching solution at each region analyzed on both stereo projections. Some limitations to the use of scanning electron microscopy and the types of surface patterns are also discussed. The second algorithm is based on a spatial correlation function. This solution is implemented under the NIH Image macro programming, combining a good representation for low contrast regions and many improvements on overall user interface and performance. Its advantages and limitations are also presented.

[Surgical treatment of varices at the stage of trophic disorders in chronic venous insufficiency]. / Le traitement chirurgical des varices au stade des troubles trophiques lors d'insuffisance veineuse chronique.

Most ulcers of the lower limbs are caused by existing chronic venous insufficiency. Later on, true social and professional problems will arise, with serious economic and psychological consequences not only for the patient himself, but for the community as well, such as huge medical costs--hence the importance of prevention and treatment, which must in no case be purely symptomatic. The ligation of the arch and of the perforating veins and stripping of the affected vein are part of the classical management of varices. These procedures can may prove to be virtually impossible in case of chronic venous insufficiency, if the patient also presents with subcutaneous liposclerosis or atrophy in an already pregangrenous skin. This preulcerous stage can be aggravated later on if the requirements for surgical repair are not met. Necrosis can then occur, if too aggressive surgery directly or indirectly injures the microcirculatory system of the damaged skin. Omitted or undesirable acts are dangerous at the stage of trophic disorders and surgery may fail to reach its aim, which of course would be to definitively and quickly eliminate the varicose disease.

[The value of Adams and de Weese's technic of cava clipping]. / Der Stellenwert des Cava-Clippings nach Adams und de Weese.

Indications and methods of inferior vena cava interruption in the management of recurrent pulmonary embolism are discussed. The results of a collected series are analyzed with special regard to the partial interruption technique using the Adams and de Weese clip. Five of our own cases, followed up 1 year postoperatively, are presented.

[Choice of transplant in cranial defects. Analysis of 73 cases]. / Transplantatwahl bei Kalottendefekten. Analyse von 73 Fällen

In many of the increasing number of primary or secondary calotte defects resulting from traumatic cranial injuries, plastic reconstruction of the cranium is required. Between 1965 and 1975 in the Surgical Department of Lucerne's Canton Hospital 73 posttraumatic defects of the cranium were repaired. In 69 cases autoplastic transplants and in 4 cases alloplastic transplants were used. The calotte plate (Elliot and Scott), pieces of pelvic bone (Converse), rib (Longacre and De Stefano), as well as costal cartilage (Peer) provided autoplastic material. Alloplasty for the cranium was carried out only in selected cases where special indications were present. Our results in the selection of autologous transplants for the reconstruction of secondary cranial defects is discussed and the surgical procedure is presented.

[Ulcerating duplication of the ileum as rare cause of massive intestinal hemorrhage in the adult]. / Ulcerierende Ileum-Duplikatur als ungewöhnliche Ursache einer massiven Darmblutung beim Erwachsenen

In this paper is presented the case of a 27 year old woman in whom a congenital duplication of the distal ileum led to a massive hemorrhage. Heterotopic gastric mucosa was found in the ileal lesion and ulcer formation histologically proven. This case shows that congenital lesions of this sort may not come to the attention of the pediatrician or pediatric surgeon but become the concern of the surgeon in adult life.

[The risk of hemorrhaging in the prevention of thromboembolism in general surgery: comparison of low-dose heparin and heparin-dihydergot 2500]. / Das Blutungsrisiko der Thromboembolie-Prophylaxe in der Allgemeinchirurgie: Vergleich von low-dose-Heparin mit Heparin-Dihydergot 2500.

In a prospective randomized double-blind study, the risk of heparin-induced intra- or postoperative hemorrhage in prophylaxis of thromboembolism was studied. 500 general surgical patients were divided into 2 groups; group A receiving a reduced portion of heparin (2 X 2500 IU) in combination with 0.5 mg dihydroergotamine (DHE) was compared to group B with conventional low dose heparin regimen (2 X 5000 IU) with regard to postoperative wound hematomas and reoperation for hematoma. After prophylaxis with heparin dihydroergotamine 2500 wound hematoma and reoperation for hematoma are shown to be reduced in a significant way (p = 0.03).

[Late results of Childs-Phillips mesenteric plication for therapy and prevention of small intestine ileus]. / Spätresultate der Mesenterialplikatur nach Childs-Phillips zur Therapie und Prophylaxe des Dünndarmileus.

During the past 7 years 45 patients have been operated upon using the Childs-Phillips method. Of those, 37 were subsequently examined for the study--7 patients had died in the meantime. None of the deaths occurred as a direct result of transmesenteric small-bowel plication. An early recurrence of intestinal obstruction occurred in 4.4% and a laparotomy was repeated. During the most recent examinations 86.5% of those patients checked had (virtually) no complaints--91.9% based upon the Visick classification. A subtotal intestinal obstruction occurred during the period of the study in 8.1% of cases, but could be conservatively treated. Up until the most recent examination there were still no instances of a late recurrence. Most intestinal obstruction recurrences are due to errors specific to the technique and are early recurrences. On the basis of our results, we are of the opinion that plication in the presence of existing peritonitis, as well as partial plication, is acceptable.

[Infected vascular prostheses]. / Infizierte Gefässprothesen.

Szilagyi's statement: 'The management of cases with infected arterial implants proves to be a task of grave and sometimes insurmountable difficulty' has kept its validity until today. In spite of restrictive patient selection, perfect surgical skill and perioperative antibiotic prophylaxis, infection of vascular grafts still do occur. Diagnosis has to be established without delay, and treatment of such often fatal infections is an aggressive surgical one.

[Deep venous thrombosis of the lower limb: experiences of thrombectomy within and outside the iliacofemoral segment]. / Tiefe Venenthrombose der unteren Extremitäten: Erfahrungen mit der Thrombektomie inner- und ausserhalb des iliakofemoralen Bereichs.

A series of 23 venous thrombectomies of the lower limb is presented. In 19 instances indirect thrombectomy of the iliacofemoral segment was performed. 1 direct thrombectomy of the v. cava inferior led to full lumen restoration. Direct thrombectomy of the popliteal vein was attempted in 3 cases, resulting in phlebographic and clinical normalization in 2 instances. In no instance did pulmonary embolism occur during or after venous thrombectomy.

[Paraganglioma of the glomus caroticum]. / Paragangliom des Glomus caroticum.

Extra-adrenal paraganglioma (chemodectoma) is a rare tumor; the tumor of the carotid body is the most frequently observed chemodectoma. Histochemical analysis of the glomus cell shows catecholamine in all cases, but functional activity of those tumors is an exception. The diagnosis of carotid body tumor can be confirmed by carotid arteriography. Surgery is the treatment of choice. Malignant degeneration of chemodectoma has been observed in a few cases.

Congenital duodenal membrane as cause for hiatus hernia, stricture of the oesophagus, and stricture carcinoma in an adult with Down's syndrome.

The case of a 31 year old male mongoloid patient is reported, where a congenital duodenal membrane, asymptomatic in childhood, had led to hiatal hernia, stricture of the oesophagus, and finally to carcinoma of the stricture (Fig. 1). Observation time until death was 26 months. In a first operation, the membrane was resected (Fig. 2) and Nissen's fundoplication performed. 31/2 months after that stricture, carcinoma was diagnosed. In the second operation, carcinoma was resected and continuity reestablished by oesophagogastrostomy. The patient died 8 months after the second intervention.

[Vascular injuries. Diagnosis and technical procedure]. / Gefässverletzungen. Diagnostik und taktisches Vorgehen.

Fractures complicated by vascular trauma are rare but very complicated injuries. Clinical diagnosis is confirmed by Doppler sonography and/or arteriography. Time effectiveness in investigation and therapy is most important, cooperation between orthopedic and vascular surgeons is crucial. If indication is correct, arterial reconstruction has excellent results in these severe injuries.

Delayed arterial embolectomy: a plea for a more active surgical approach.

In a series of 18 patients delayed embolectomy of the limb was performed 8-63 days after embolism had occurred. Three patients died (2 of them after amputation), and 7 limbs were amputated after surgery. In 10 instances blood flow was fully restored by the operation. Analysis of the 18 cases leads to the conclusion that the success of delayed embolectomy where neuromuscular function is intact depends primarily on surgical technique. Direct embolectomy by local or regional exposure of the obstructed arterial level is shown to produce better results than conventional (distant) balloon catheter embolectomy by proximal incision. This is thought to be due to increased mural adherence of the embolus, with secondary thrombus formation after a delay of 8 days or more. A plea is therefore made for a more aggressive surgical attitude to delayed arterial embolization. Provided that preoperative arteriography has localized the obstructive level and that the patient's general condition allows major vascular surgery, direct removal of the embolus and secondary thrombi by open exposure of the obstructed artery is recommended.