[Giant cell arteritis of the leg arteries: saving the extremity by crural reconstruction?]. / Riesenzellarteriitis der Beinarterien: Extremitätenerhalt durch krurale Rekonstruktion?

A 78-year-old female patient presented with pretibial necroses of the right leg, and a one year history of Polymyalgia rheumatica. Anamnestic, clinical, and radiological findings allowed the diagnosis of giant-cell leg arteritis. Limb salvage was achieved by femoro-crural bypass implantation.

[Peripheral venous hypocaloric nutrition following large abdominal interventions]. / Peripher-venöse hypokalorische Ernährung nach grossen Abdominaleingriffen.

In a pilot study with 10 patients after major abdominal operations like gastrectomy or esophagectomy a postoperative hypocaloric peripheral-venous nutrition was performed. Prerequisite was a good nutritional status established by anthropometric measurements and determinations of visceral proteins and an uneventful operation of less than 4 hours duration and max. up to 1000 cc blood loss. After 10 days of infusion only body weight and the skin falt thickness were reduced. During the peripheral nutrition insulin, glucose, free fatty acids and beta-hydroxybutyrate showed only minor movements. Only on the 4th postoperative day the urinary-N-excretion increased over 16 g/24 h. The study demonstrates that hypocaloric peripheral-venous nutrition under certain preconditions will be an alternative to standard nutrition.

Preserved human umbilical cord veins in reconstructive surgery of peripheral arteries. Clinical experience and preliminary results.

Preserved human umbilical cord veins were used in 66 patients during 67 reconstructive interventions for replacement of arteries with a small diameter, in various anatomic sites. This includes 28 reinterventions (41.8% of the cases) after previous vascular surgery. In our predominantly negative selection of patients, 24 grafts were occluded within 3 months postoperatively, but some of these could be reopened successfully. Twelve more grafts were occluded by thrombosis up to one year after surgery. Taking into account the successful revisions, 62.5% out of 50 femoro-popliteal reconstructions were functioning one year after surgery. We therefore conclude that when an autogenous vein is no longer available, the use of glutaraldehyde-preserved human umbilical vein may thus be indicated for reconstructions extending beyond a joint.

Stenosis of the supraaortic branches combined with coronary artery disease: one-stage surgical treatment.

Combined one-stage surgery of the supraaortic branches and the coronary arteries was performed on 17 consecutive patients, 13 men and 4 women, having a mean age of 56.7 +/- 8 years. Angina pectoris was the primary symptom in all patients. Signs of cerebro-vascular insufficiency were present in 4 cases, 2 with syncopies, one with amaurosis fugax, and one with drop-out symptoms. All patients were invasively examined. Coronary angiogram verified triple vessel disease in 13 cases, double vessel disease in 3 and single vessel disease in one. Angiography of the carotid artery proved unilateral disease in 11 patients, in 5 both sides were either stenosed or occluded. One patient had a left-sided proximal 80% lesion of the subclavian artery. In all cases, the supraaortic branches were done first, followed by revascularization of the coronary artery system. All patients survived the early postoperative course; one died suddenly 33 months after operation. After 16.8 +/- 14 months, 11 out of 15 patients felt much better. Signs of cerebro-vascular insufficiency were not present. Our conclusion: one-stage surgery of the supraaortic branches and the coronary arteries would seem justified. A list of indications is presented.