[Long-term results of 370 profunda-plasties]. / Langzeitergebnisse von 370 Profundaplastiken.

Three hundred and seventy profundaplasties were performed from January 1977 to December 1987. This procedure was considered indicated in stage IIb in 41%, in stage III in 25.8%, in stage IV in 22.8% and in acute ischemia in 10.4%. The operative mortality was 3%, the five-year-survival rate 53%. Local complications were observed in 12.6%. After 8 years, 76% of the limbs had been saved, although 92 reoperations had been required. According to our experience we consider profundaplasty as an alternative to bypass procedures, especially in multi-level-disease.

[Hemostasis with a new infrared-sapphire-coagulator (ISC-81). First clinical studies]. / Blutstillung mit einem neuen Infrarot-Saphir-Coagulator (ISC-81) Erste klinische Erfahrungen.

A new infrared sapphire coagulator (ISC-81) has been developed for the hemostasis of parenchymatous hemorrhage. Upon absorption by the bleeding tissue, light is converted into thermal energy thus causing coagulation and hemostasis. The light is transmitted to the bleeding tissue via a sapphire crystal, which is nonadhesive and of high thermal resistance. For application on flat surfaces or in ruptured tissues, either a cylindrical or a wedge-shaped crystal can be used. Up to now the ISC-81 has been used successfully on 22 patients, most of whom had hemorrhages from ruptured spleens or livers.

[Treatment of the polytraumatized patient in a clinic]. / Die Behandlung des Polytraumatisierten in einem Klinikum.

433 patients (mean age 33.3 years) with multiple injuries were treated from 1978 to 8/1982. Classification of the injuries was done according the S(skeleton)A(abdomen)T(thorax)scheme. The overall mortality was 18%. The cause of death were CNS-injuries in 50% of the patients. Besides CNS-injuries single and multiple organ failure were limiting the prognosis. In all cases of organ failure the lung was affected. Two patterns of multiple organ failure were found. Significant factors were shock, massive blood transfusions and abdominal trauma--but as well as errors in the treatment. Still improvement of the survival rate of the polytraumatised patients must be achieved in the future. Besides aggressive shock therapy and prevention of posttraumatic pulmonary insufficiency through earliest respiratory support we emphasize a strict strategy of treatment priorities. Based upon an intensive training especially in trauma care the surgeon will be able to recognize complications earlier and thus increase the chance of survival of the polytraumatised patient.

[Critical stenosis of the internal carotid artery--which parameters determine prognosis?]. / Die kritische ACI-Stenose--Welche Parameter sind ausschlaggebend?

Neurologic symptoms in the region of an internal carotid artery stenosis are due to emboli or the reduction of perfusion pressure. Measurements of cerebral blood flow correlate with perfusion pressure but not with the degree of the stenosis. By transcranial ultrasound sonography the reactivity of the cerebral vascular system can be measured. Thus subgroups of patients may be found who may or may not benefit from the operation. By analysis of color coded duplex sonography, ulcerated stenoses can be detected with high accuracy.

[Determination of the size and concentration of microemboli in ACD-blood following varying storage periods of preserved blood]. / Die Bestimmung von Grösse und Konzentration von Mikroembolie in ACD-Blut nach unterschiedlicher Lagerungsdauer der Blutkonserve

A method for the determination of the frequency-distribution of emboli in banked blood has been described. A significant shift towards larger emboli in banked blood can only be demonstrated within the first 10 days of storage. The possibility of a disturbance of microcirculation of the lung may only be of a higher degree after massive blood transfusions as the concentration of emboli in banked blood is relatively low.

[Multiple organ failure--the most important complication in polytraumatized patients]. / Das Mehrfach-Organversagen--die wichtigste Komplikation beim polytraumatisierten Patienten.

In 4 1/2 years 78 out of 433 polytrauma-patients came to death in our hospital ( = 18%), half of them because of their brain-trauma. 15 fatalities occurred in connection with pulmonary failure only, 19 in multiple organ failure. Pulmonary failure is of central importance in MOF. Two types of MOF are described: the rapid pattern directly following severe shock with slightly better prognosis and a delayed pattern caused by concomitant sepsis. The hope of further improving these results is connected with five demands: 1. an elaborate scheme of treatment: taking the priorities into account; 2. sufficient treatment of shock; 3. controlled use of the respirator as early as possible and as long as necessary; 4. avoiding any sepsis; 5. close monitoring of system function.

Inhibition of platelet aggregation during hypovolemic hypotension by acetylsalicylic acid and artificial respiration.

In vivo measurement of platelet aggregation was performed by a previously described photoelectric method. It is shown that platelet aggregation induced by arterial hypotension can be inhibited by i.v. administration of ASA and by artificial respiration. The inhibition of platelet aggregation following artificial ventilation is significantly more pronounced than by ASA given 24 h prior to the beginning of the experiments. Different sources of platelet aggregation in venous and arterial blood are informative about the canine lung not only as a filter for aggregates but also as a source of aggregating substances.

[Inhibition of thrombocyte aggregation in hemorrhagic shock using acetylsalicylic acid and mechanical ventilation]. / Inhibition der Thrombocytenaggregation im hämorrhagischen Schock durch Acetylsalicylsäure und maschinelle Beatmung.

Platelet aggregation in flowing venous and arterial blood during hypovolemic hypotension is followed by a previously described photoelectric method. It is shown that platelet aggregation can be inhibited by acetylsalicyclic acid (ASA) and by artificial ventilation. The inhibition of platelet aggregation by artificial ventilation is significantly more pronounced than that by ASA. That different times are needed for platelet aggregation in venous and arterial blood in dogs treated with ASA and with artificial ventilation is informative about the canine lung not only as a filter for aggregates but also as a source of aggregating substances.

Haemostasis in injuries of parenchymatous organs by infrared contact coagulation.

A series of 11 children aged from 1 day to 12 years is reported in which infrared contact coagulation with a sapphire coagulator was used for haemostasis in liver and splenic injuries. Seven children were cured. The four deaths were not related to the injuries of parenchymatous organs. Infrared contact coagulation is a suitable and cheap method for organ preservation in injuries or other pathological conditions of parenchymatous organs in childhood.

Infrared-contact coagulation of parenchymatous organs - report of three cases.

Infrared-contact coagulation of the spleen with an infrared-sapphire-coagulator was applied in two children with subcapsular hematoma and splenic cyst, thereby achieving complete and partial organ preservation, respectively. This method was also used for haemostasis following the dissection of a common liver in Siamese twins. Infrared-contact coagulation is a proper method for organ preservation in injuries or other pathological conditions of parenchymatous organs.

A new operative technique for kinking stenoses of the internal carotid artery.

A method of carotid artery plication for kinking stenoses of the internal carotid artery is described. This method has been used in 13 symptomatic patients with type III kinking up to now. Satisfactory long-term results were obtained in 11 patients, one patient had to be reoperated for postoperative stenosis and one patient died after the operation from ischemic cerebral injury. It is concluded that the method is a suitable alternative to resection procedures, particularly in cases of kinking and arteriosclerotic stenosis.

[Thrombosis prophylaxis with low doses of dextran 60 (author's transl)]. / Thromboseprophylaxe mit niedrig dosiertem Dextran 60.

The antithrombotic effect of dextran 60 (Macrodex) was studied in a prospective, randomized trial on patients undergoing general surgery. 42 patients (group A) received 500 ml of dextran 60 intraoperatively, 49 patients (group B) received an additional dose of 100 ml dextran 60 on days 1 to 5 after operation. As tested by the 125-iodine-radiofibrinogen test 16 patients (38%) from group A, but only 2 patients (4%) from group B developed deep venous thrombosis. The difference between both groups is statistically highly significant (P less than 0,0005). The use of dextran for thromboprophylaxis was associated neither with hemorrhagic complications nor with anaphylactoid reactions. The fractionated application of a total of 1000 ml of dextran 60 resulted in a very efficient prophylaxis against deep venous thrombosis.

[Traumatic segment III aneurysm of the thoracic aorta: surgical risk, technique, early and late results]. / Traumatische Aneurysmen der thorakalen Aorta im Abschnitt III: Operationsrisiko, Technik, Früh- und Spätergebnisse.

Aneurysmectomy was performed in 37 patients with a traumatic aneurysm the aorta in segment III. 34 "cross-clamping" without bypass was used, 6 after preliminary transposition of the subclavian artery. 3 patients died after surgery, two of whom were more than 70 years old. 2 patients developed a paraparesis, which has in the meantime considerably improved. Hesitation to operate is justified only in older asymtomatic patients at high cardiac risk. Cross-clamping is preferable to more elaborate procedures. Preliminary transposition of the subclavian artery simplifies the proximal anastomosis and may contribute to spinal-cord protection.

Effect on myocardial metabolic pattern of local complete and incomplete ischemia.

After local complete ischemia at normothermia of 60, 100, 140, and 180 min duration the status of the adenylic acid-creatine phosphate system in the canine myocardium recovered to 98, 85, 74, and 30 percent of the control values, whereas glycogen was restored even more. In the infarcted myocardium the extent of alterations of the metabolic status was a function of the residual blood flow. Deviations from a regular metabolic status developed if the blood flow dropped below about 35 ml/min/100 gm. This critical flow rate is expected to vary with the energy requirement of the heart, but it is in keeping with results obtained by Rudolph and coworkers (personal communication) who found that patients with a myocardial blood flow below 30 ml/min/100 gm had a life expectancy of less than 1 month. In the nonaffected myocardium, both in experiments with local complete ischemia and in experiments with infarction, the metabolic status was always within normal ranges. This is in contrast to results published by Gudbjarnason (1971/1972) and Gudbjarnason, Puri, and Mathes (1971), who found that in noninfarcted myocardium tissue levels of ATP and creatine phosphate decreased to about 50 percent of the control values and that there was no restoration to normal values within 10 days after infarction.

Metabolic and structural recovery of left ventricular canine myocardium from regional complete ischemia.

The capacity for recovery of the normothermic left ventricular myocardium from a regional complete ischemia (RCI) was investigated using changes in the myocardial metabolic status (ATP, ADP, AMP, creatine phosphate (CrP), free creatine, glycogen, glucose, lactate) and alterations of the morphology as parameters. In dogs, an area of the anterior wall of the left ventricular myocardium was temporarily deprived completely of its blood supply by 5--7 overlapping ligatures extending into the heart cavity. The metabolites of the adenylic acid-CrP system returned to normal tissue levels after 30 and 60 min of RCI within 14 and 35 days of recovery, respectively; restoration averaged 82% after 100 min, 74% after 140 min, and 38% after 180 min of RCI after 5 weeks of recovery. At the same time glycogen amounted to 163% after 100 min, 114% min, and 65% after 180 min of RCI. The biochemical data correlated well with the structural changes in the affected myocardium, especially with the amount of de- and regenerating heart muscle cells. These obviously were functionally defect and were not comparable with normal structured and functioning heart muscle cells.