[Preventive surgery: cost-efficiency relationship--an introduction]. / Präventive Chirurgie: Kosten-Nutzen-Relation. Eine Einführung.

The problems of financial costs in our health care system have led to preventive surgery being criticized as well, since valid data regarding the value for patients are often missing. The decrease in resources should induce the physician to check the efficacy of his therapy in comparative studies, especially when taking preventive measures. To reach an optimum for the benefit of the patient it is ethically justifiable to also mention economic aspects in these studies in order to gain financial resources further on.

[Urologic complications following vascular prosthetic interventions in the aortofemoral area]. / Urologische Komplikationen nach gefässprothetischen Eingriffen im aorto-femoralen Bereich.

After vascular graft surgery within the pelvic area, urological complications occur in about ten percent of the patients. Overlooking 310 cases, four patients suffered from ureteral lesions and 21 patients had ureteral obstructions. Possible causes for ureteral obstructions are positioning of the ureter between vessel and prosthesis, hematoma, lymphoma, anastomotic aneurysm, prosthesis infection, Morbus Ormond as well as trophical lesions of the ureter wall. Use of ureteral splint could prevent surgical intervention in many cases. Application of prophylactic pre-operative splinting is recommended in case of large aneurysm, previously injured kidney and single kidney.

[Experience with the surgical treatment of peripheral arterial occlusions]. / Erfahrungen mit der chirurgischen Behandlung akuter peripherer Arterienverschlüsse.

A total of 293 patients were treated 320 times for acute peripheral vascular occlusion. Arterial embolism was most frequent followed by arterial thrombosis and traumatic vascular occlusion. For differential diagnosis other causes had to be considered. The method of choice is extraction of the thrombus by Fogarty catheter or ringstripper. The results depend on the time between occurrence and operative treatment of the occlusion. Angiography is not necessary in a clear case of embolism, but essential when exact preoperative classification of the vascular occlusion is not possible.

[The so-called medical team system in surgery, an alternative to hierarchy?]. / Das sogenannte Teamarztsystem in der Chirurgie, eine Alternative zur Hierarchie?

Since some years representatives of the "Bundesärztekammer" (German Board of physicians)--induced too by the German parliament of physicians--demanded the establishment of "team-work-models" as a new form of administration of our clinical departments. There are many reasons argueing against a reformation of the present structures like economical considerations, a well-organized education and especially patient-care-management. Only scientifically-based evidence could justify a change of the well-approved head-physician-system in Germany.

[What treatment expectations does the elderly patient have from surgery and what can surgery achieve? From the viewpoint of vascular surgery]. / Welchen Behandlungswunsch hat der Patient in höherem Lebensalter an die Chirurgie und was kann die Chirurgie leisten? Aus der Sicht der Gefässchirurgie.

Vascular surgery represents 70% of surgery in over 60-year-old patients and 50% in over 70-year-old patients. For prophylactic reasons indications for operating should be made carefully in carotid and aneurysm surgery. In the case of chronic aorto iliacal obstructions extraanatomic procedures like femoro-femoral, ilio-femoral or axillo-femoral reconstruction should be preferred in high-risk patients. Combined intraoperative interventional procedures or percutaneous transluminal angioplasty including regional thrombolysis should be considered in the elderly.

[Managing position of the surgery executive]. / Die Managementposition des leitenden Chirurgen.

Recent legislation on health service has once again made the head of the department of surgery aware of his managing responsibilities. Cost saving will be possible in the areas of laboratory and high-tech diagnoses, surgery materials, storage of supplies, and administration of drugs. Since 70% of hospital costs are personnel costs, a substantial reduction in the hospital budget can only be obtained by reducing staff. In planning for the long term, we will be obliged to discuss "total quality management", which demands continuous improvement of the quality of our management and our patient treatment.

[Value of EEG monitoring in operations of the supra-aortic arteries]. / Wert des EEG-Monitoring bei Operationen an den supraaortalen Arterien.

Experiences with 207 patients operated under EEG monitoring have shown changes of EEG in 20% which made the application of an intraluminal shunt necessary. The majority of these patients had multimorbidity of supraaortic branches. Earliest changes could be seen after seven seconds of clamping time. In these cases an operation of the carotic artery should be avoided and an extra-intracranial bypass is recommended.

[Angiospasm and dihydroergotamine--dangers in thromboprevention]. / Der Angiospasmus und Dihydroergotamin--Gefahren der Thromboseprophylaxe.

The advantages of perioperative low dose heparinization as well known. Angiospastic reactions of Heparin-DHE have been described. In some cases additional factors such as interruption of blood flow and application of sympathicomimetics, are supposed to be decisive for the course. In cases where the application of sympathicomimetics might be necessary, perioperative treatment with DHE should therefore be avoided. Consequent observation of the peripheric blood flow is required in traumatized patients. In addition to other vasodilating agents the intraarterial application of Prostaglandin E1 is of advantage in case of angiospastic reactions.

[Transient reduced adrenal gland function following large vascular surgical interventions]. / Die passager reduzierte Nebennierenfunktion nach grossen gefässchirurgischen Eingriffen.

In 48 patients with aorto-femoral bypass-operations pre- and postoperative measurements of total serumcorticoids were performed. All serum levels were then compared to a control group undergoing large abdominal operations. In contrast to the control group twelve patients with aorto-femoral bypass-operations showed values that were for a time clearly below preoperative levels. In six patients with bypass-operations values could be found which were for a short time within the limits of relative adrenal insufficiency. ACTH-stimulation test performed in these patients showed significant lower values than those preoperatively measured. Due to systemic overdose heparinization we believe haemorrhage within the adrenal glands to be responsible for these changes.

[Replacement of the common bile duct by an autologous vein (author's transl)]. / Choledochusersatz durch ein autologes Venentransplantat.

3 cm of the common bile duct was removed in 19 dogs and the defect was bridged by an autologous vein. The interposition of a vein graft was performed with a double end-to-end anastomosis. In four cases a T-drain was additionally placed into the transplant. GOT, GPT, LDH, AP and bilirubin were tested in regular intervals. The patency of the transplant was proved by radiography with dogs which survived longer than 6 weeks. 5 dogs died within the first 4 weeks, 4 were killed after 2 months, because of incrustation of the T-drain for a regular percutaneous rinsing of the drainage was not possible. 10 dogs survived for 6 to 12 months. These animals showed increasing laboratory results up to two months, then the tests normalized. The function of the transplanted vein was without complication and the liver histology did not show any pathological alteration. After two months the transplanted vein was bridged by bile duct epithelium.

[Xeroradiographic studies of arteriovenous shunts in patients on hemodialysis (author's transl)]. / Xeroradiographische Darstellung von Hämodialyse-Shunts mit Metrizamid.

A simple procedure for visualization of iatrogenic av-shunts in the upper extremity of patients on hemodialysis is presented. During compression proximal to the fistula (applying pressure of more than the patient's systolic value) 45 ml Metrizamide (80 mg iodine/ml) are injected into the venous limb of the shunt. A single xeroradiogram obtained 5-7 seconds later shows the arterial and venous vessels simultaneously. The examination requires less than 15 minutes to perform and is far less discomforting to the patient than arteriography. 42 patients were examined by this method without complications. Pathological findings - including stenoses, pseudoaneurysms and venous thromboses - were confirmed surgically.

[Somatostatin in pancreas and small intestine fistulas]. / Somatostatin bei Pankreas- und Dünndarmfisteln.

Infusing 6 mg of somatostatin continuously for 24 hours will lead to a reduction of pancreatic secretion and perfusion of the splanchnic area. Due to this mechanism, secretion is significantly reduced in case of pancreatic or small intestine fistulae. Somatostatin was applied continuously in 39 patients for a period of 7 days. This led to a healing of pancreatic fistulae in 85.7% and small intestine fistulae in 63.6% of cases.

[Transplantable sebaceous adenoma of the mouse with virus particles studied by electron microscopy (author's transl)]. / Transplantables Talgdrüsenadenom der Maus mit elektronenmikroskopischem Virusnachweis

Histology and ultrastructure of a sebaceous adenoma of the mouse -- derived from i.p.-injection of 0.1 ml DNA, isolated from cells of a transplantable mouse-leukemia -- were studied. The original tumour and all transplanted tumours display the same tissular differentiation. In all tumours virus particles were found. Structure and behaviour of the intracytoplasmic A-particles resemble those of the mouse mammary tumour virus while the C-particles found extracellular were identical with the leukemia viruses of the mouse. It might be suspected that mammary tumour virus and leukemia viruses are either non specific or that a new virus is present in the sebaceous adenoma.

[Results of Implantation of Aorto-Femoral Bifurcation Prostheses (author's transl)]. / Ergebnisse der Implantation aorto-femoraler Bifurkationsprothesen.

From June 1974 to December 1975, 139 aorto-femoral Y-grafts were implanted at the surgical clinic of the University of Münster. The operation mortality was 4.3 percent. Among the postoperative complications were sexual disfunction and paraesthesia. For the ileo-femoral occlusions the postoperative success rate was 90 percent, combined ileo-femoro-crural changes showed good results in 60 percent of the cases. The results show that isolated reconstruction in the pelvic area is successful in most cases, even in combined ileo-femoro-crural obstruction. Only in exceptional cases a second operation (reconstruction of femoral artery) is necessary after a period of about one year.

[Restoration of work capacity after major vascular surgical interventions. Expectations and reality]. / Wiedererlangung der Arbeitsfähigkeit nach grossen gefässchirurgischen Eingriffen. Anspruch und Wirklichkeit.

130 patients who had been working pre-operatively were examined and interviewed at least one year after an aorto-femoral bypass operation; 40.8% had continued smoking. Although 83.8% of patients were satisfied with the result of the operation, 73.9% could not be fully rehabilitated despite a successful operation. The majority of patients in whom work capacity had not been restored was in the group which was economically best protected (civil servants and employees). Apparently it is not the operation but the standard of socio-economic protection which is decisive in restoring work capacity.

[Clinical experience with acute mesenteric vascular occlusion (author's transl)]. / Akuter Mesenterialgefässverschluss.

Between 1964 and 1978 twenty patients suffering from acute mesenteric vascular occlusion were treated in the surgical department (University of Münster). The average duration of the anamnesis until their hospitalization was 3.1 days and the actual operation was performed 11.35 hours later on the average. In only 15% of the cases had a correct preoperative diagnosis been given. As regards the frequency of causation, 60% of the mesenteric vascular occlusions were caused by a mesenteric arterioembolism, 20% by a mesenteric venous embolism, 10% by a mesenteric arterial thrombosis and 10% by a non-obstructive occlusion. In a post cardiac infarction condition was the predisposing factor in 50% of all cases, valvular defect in 33.5% and tachyarrhythmia in 16.6%. The causes found for the mesenteric venous tbrombosis were insufficiency of the right heart, absolute bradyarrhythmia, recurrent venous thrombosis of the leg, and myeloproliferative syndromes.

[Clinical symptoms and morphology of ischemic proctitis (author's transl)]. / Klinik und Morphologie der ischämischen Proktitis.

Obliterating arteriosclerotic lesions of pelvic vessels may induce inflammation and fibrosis of the rectum and subsequently ischemic proctitis. This may lead to damage of the sphincter muscle and to complete incontinence. Clinical symptoms are pain and bloody stools, as in ischemic colitis. The combination of periproctitis and perianal necrosis may be misinterpreted as anal fistulas. An anus praeter sigmoideus is to be recommended for palliation. A case report of this particular disease is given including clinical, angiographic and morphological data.

[Venous end-to-end anastomosis with non-absorbable and absorbable screw flange rings]. / Venöse End-zu-End Anastomosen mit nicht auflösbaren und auflösbaren Schraubflanschringen.

Forty veno-venous anastomoses performed on femoral blood vessels of dogs showed good results using a new flange ring system. In 15 cases Palacos rings were used for the anastomoses. Follow-up studies during a period of 8 days to 1 1/2 years showed only one occlusion. Twenty-five anastomoses were performed with absorbable rings of vicryl. Follow-up studies of these anastomoses during a period of 10 days to 26 weeks showed two stenoses and two occlusions. Dissolution of the Vicryl rings lasts up to 26 weeks.