[Manifestation of pneumothorax 7 days after port implantation. Report of a single case]. / Manifestation eines Pneumothorax sieben Tage nach Port-Implantation. Eine Einzelfallbeschreibung.

The subcutaneous implanted venous port device offers a safe central venous access and allows for ambulatory treatment. This case report describes a late manifestation of a pneumothorax after venous port implantation which, in fact, is a rare but significant complications. The lack of a correlation of the signs and symptoms with the interventional procedure may lead to inadequate or delayed treatment. The immediate postprocedural X-ray can be false negative when air leaks into the pleural cavity very slowly. Therefore both patients and referring physicians should be informed about the possibility of the late manifestation of a pneumothorax.

[Central venous access devices in treatment of patients with malignant tumors: venous port, central venous catheter and Hickman catheter. Cost-benefit analysis based on a critical review of the literature, personal experiences with 135 port implantations and patient attitude]. / Zentralvenöse Zugangsysteme in der Behandlung von Malignompatienten: Venöser Port, ZVK und Hickman-Katheter. Kosten-Nutzen-Analyse anhand einer kritischen Literaturübersicht, eigener Erfahrungen aus 135 Port-Implantationen und aus Patientensicht.

There are certain demands on central venous access devices in the ambulatory or long-term parenteral treatment of end-stage cancer-patients. The devices should offer both save and easy access, low related morbidity and acceptance of the patients. Ambulatory implantable venous ports fulfill all the these demands as own experiences with 135 implantations in cancer patients show: an overall complication rate of 6% which is - compared to other systems - very low, good acceptance of the patients and low costs. The venous ports can reduce duration of in-house treatment, bears a low morbidity and is the patients first choice. The port device is competitive and cost efficient alternative to conventional central venous access devices.

[Perforation of gastroduodenal ulcer. Risk factors and choice of procedure]. / Perforation des gastroduodenalen Ulkus. Risikofaktoren und Verfahrenswahl.

The well known surgical risk factors, such as age, time of perforation as well as size and localisation of necrosis, were confirmed in retrospective and prospective analyses of perforation of gastroduodenal ulcers (n = 504). Incidence was unchanged in the two different time-related groups, with 3.2 or 3.7 cases in one month. There was a clear-cut need for excision of the ulcer or necrotic margin. Perforation was attributable to malignant tumours in 2.1 per cent of the cases. The authors have definitely adopted the concept of earlier primary surgery (23 per cent of all cases, as compared to 10.4 per cent before). The risk associated to it was found to be lower than linked to palliative operations. The lethality rate was as low as 7.6 per cent, once due consideration was given to the above risk factors for adequate choice of surgical methods. Particular attention was given to ulcer localisation and clinical course. Hence, lethality has clearly dropped below earlier data.

[Bauhin's valve syndrome]. / Das Syndrom der Valva Bauhin.

The syndrome of the ileocecal valve is a rare and rather unknown disease. Its clinical diagnosis is very difficult. The symptoms are those of the transient, periodic small bowel obstruction. Radiologic and endoscopic examination may be helpful, but a definitive diagnosis is obtained only by exploratory laparotomy. Surgical treatment of the ileocecal valve syndrome is the right hemicolectomy with subsequent terminoterminal ileo-colostomy.

[Barium meal after pancreatic surgery (author's transl)]. / Die Magendarmpassage nach Eingriffen am Pankreas.

After duodenopancreatectomy the roentgenpattern of the upper gastrointestinal tract resembles the pattern after Billroth I- or Billroth II- resection. A different aspect results after Y-Roux anastomosis. The follow-up of pseudocysts drained into the stomach poses no problems. The follow-up of pseudocysts drained into the small bowel demands a roentgenexamination with duodenal intubation. The use of hypotonia is advisable in the diagnosis of malignancy. Problems may arise in roentgendiagnostics after palliative operations.

[The significance of laboratory chemical parameters for the diagnosis of mesenteric infarction (author's transl)]. / Zur Bedeutung laborchemischer Parameter für die Diagnostik des Mesenterialinfarktes.

A laparotomy was performed on 23 dogs with and without ligation of the mesenteric artery. Twenty-eight laboratory parameters of blood samples taken immediately and then every two hours after the operations were checked for systematic trends. The analysis of variance showed some differences between both groups. It was impossible to use the individual results of this investigation for a general diagnostic approach. Difficult and long-lasting biochemical investigations are of dubious value since time loss is one of the most important problems in mesenteric occlusion. Indications for invasive diagnostic procedures and for laparotomy should not be postponed; they should depend on the different aspects of clinical symptoms, as it is practised now.

[Caffeine and bile secretion. Experimental studies in the unanaesthetized piglet (author's transl)]. / Zum Einfluss des Coffeins auf die Gallesekretion. Tierexperimentelle Untersuchungen am nichtnarkotisierten Schwein.

We investigated the distribution and excretion of 8-14C-caffeine as well as the effects of caffeine on bile secretion in the unanaesthetized piglet after intravenous and intraduodenal application. The findings confirm a) data known from other species concerning the intestinal absorption, distribution and excretion of 8-14C-caffeine, b) the delayed plasma disappearance of 8-14C-caffeine known in the pig following an initial rapid disappearance rate and c) a hydrocholeresis, so far only known from rats. However, the increase in bile flow accompanied by an increase of urine flow was noticed not before 3--4 h after caffeine application. Therefore the question arises whether this increase is caused by caffeine itself or by its metabolites. On the basis of our results and those of the literature it is attempted to answer this question.

[Comparative studies in blood, bile and urine to the biliary excretion and multicompartmental analysis of glycocholic acid in the unanaesthezized pig (author's transl)]. / Vergleichende Blut-, Galle- und Urinuntersuchungen zur Gallexkretion und Multicompartmentanalyse markierter Glycocholsäure beim wachen, nichtnarkotisierten Schwein

A new model for experimental research in pigs is reported. It allows comparative analyses in blood, bile and urine in the unanaesthetized pig. Preliminary results to the physiology of biliary excretion and multicompartmental analysis of conjugated bile acids emphasize the applicability of the experimental model. On the basis of these results it is pointed out, that it is possible to analize the distribution and excretion kinetics of conjugated bile acids, namely C14-glycocholic acid, by a 3-compartmental analysis.

[Urologic complications in rectal surgery (author's transl)]. / Urologische Komplikationen nach Rectumexstirpation

Urinary disorders after amputation or resection of the rectum are much more frequent than commonly supposed. Out of 239 patients they were noticed by 56.6%, undergoing amputation, and 36.6% after resection. Longterm disturbances were observed by 26.4% respect. 15.1%. The most important reason is injury of autonomic pelvic nerves and ganglia. Urinary bladder infection was verified in 22% respect. 8%. Furthermore urinary disorders may be caused by changing of bladder localization (bladder hernia), wound infection (especially of the sacral cavity), edema of the urethra, and exacerbation or manifestation of pre-existing urologic diseases. Compared to these, lesions of the urinary tract are of little importance. To prevent such complications, we postulate: 1. careful pre-operative urologic examination, 2. if possible mobilisation of the rectum along its borderlines (so-called Grenzlamellen of Pernkopf), 3. critical analysis of urologic disorders, removal of the urinary catheter as soon as possible, regular systemic prophylaxis of urinary infection, and therapy controlled by antibiogram, 4. adequate follow-up, and 5. urologic examination of all disturbances lasting longer than three months.