[Extra-anatomical bypass in aorto-iliac obstruction]. / Extraanatomische Umgehung beim aorto-iliacalen Verschluss.

Our report describes the results of 35 extra-anatomic bypass operations for the treatment of aortoiliac occlusion in high-risk patients. This operation is an alternative to amputation for the therapy of claudication intermittens or gangrene. Long-term results are difficult to obtain, as many patients in this group die early from other causes. The problem of iatrogenic steal phenomenon is discussed. We consider Doppler ultrasound assessment a very valuable method for excluding aortoiliac insufficiency of the donor limb, not detected by other means.

[The value of measuring intraoperative pressure in carotid endarterectomy (author's transl)]. / Die Bedeutung der intraoperativen Druckmessung in der Karotischirurgie.

During the last 4 years 92 operations at the carotid bifurcation were performed. In almost all cases carotid stump pressure was measured. If the stump pressure was below one third of the systemic pressure endarterectomy was done with intraluminal shunt. Under these conditions neurologic symptome deteriorated 3 times, but improved after a few days. There was no hospital mortality.

[Pressure-and flow measurements during carotid-subclavian-bypass operations (author's transl)]. / Intraoperative Fluss-und Druckmessungen beim Karotis-Subklavia-Bypass.

In 7 Carotid-Subclavian-Bypass operations pressure and blood-flow were studied. In 4 patients a reduced flow in the common carotid artery was noticed after opening the bypass. There were no neurological complications in the postoperative period in any patient. This decreased flow can be explained as a so-called "pseudosteal" due to changing in direction of flow in numerous and good functioning collaterals of this area.

[Carcinoma of the head of the pancreas--diagnosis, surgical indications and results (author's transl)]. / Das Pankreaskopfkarzinom. Diagnostik, chirurgische Indikation und Ergebnisse

UNLABELLED: 89 cases of pancreatic or periampullary carcinoma were analysed and the following problems discussed: 1. DIAGNOSIS: "early" diagnosis is at present impossible--not even with E.R.C.P. or angiography, although these provide valuable information for planning the operation. 2. Indication for operation: a curative resection was possible in only 20% of cases. The apparent advantages of total pancreatectomy as against the conventional Whipple operation (increased radicality and reduced post-op. complications) have not yet paid off in terms of improved long-term survival. 3. RESULTS: in 46 pancreato-duodenectomies (for carcinoma as well as complicated chronic pancreatitis) the operative and hospital mortality was 4.3%.

[Postoperative total parenteral feeding with a carbohydrate mixture (autor's transl)]. / Postoperative totale parenterale Ernährung unter Verwendung einer Kohlenhydratmischung

After gastric operations, patients were fed completely by the parenteral route. Aminoacids, caloric nutrients and electrolytes were infused simultaneously and continuously 24 hours daily until the fourth postoperative day. The daily supply of aminoacids amounted to 80 g. Glucose, fructose and xylite in equal proportions were used to supply calories. The total daily amount was 605 g. The important electrolytes were contained in the infusion solutions in amounts corresponding to basic requirement. The results of the investigation confirmed that patients can be successfully nourished parenterally after extensive operations with the combined daily additives we have selected.

[Postoperative treatment of patients after pancreatectomy. Closely meshed monitoring of blood sugar (author's transl)]. / Nachbehandlung und Uberwachung total pankreatektomierter Patienten. Erfassung eines engmaschigen Blutzuckerprofils unter Alltagsbedingungen

A report is presented on the postoperative treatment of 4 patients who had undergone duodeno-pancreatectomy because of chronic pancreatitis. When the patients co-operate well satisfactory metabolic compensation can be achieved with small doses of insulin. Replacement of the pancreatic enzymes with the appropriate preparations can be particularly well monitored by means of the fat content of the faeces. The substitution of vitamins A, D, K, and B12 parenterally at intervals of several weeks is also advisable as a safety measure. A method is described for the closely meshed monitoring of the blood sugar. This method is suitable in co-operative patients who are capable of collecting capillary blood for achieving a particularly good control of the metabolic state.

[The influence of different plasma substitutes on blood clotting in isovolaemic haemodilution (author's transl)]. / Gerinnungsveränderungen bei Anwendung verschiedener Dilutionslösungen bei präoperativer isovolämischer Hämodilution

In a clinical study, the influence of 6 per cent Dextran 60 and 6 per cent hydroxyethyl starch (HES) on blood clotting was measured in 2 comparable groups of surgical patients. Haematocrit, platelets, thromboplastin time according to Quick, partial thromboplastin time and fibrinogen level were determined before and after isovolaemic haemodilution, and subsequently during a period of 14 days. There was no significant difference between the diluents with regard to their effect on blood clotting. Changes within each group may be ascribed to the diluting effect of the plasma substitutes.

[Behavior of the metabolism in gastric patients during a 4-day-long postoperative complete parenteral feeding with amino acids and a glucose-levulose-xylitol combination solution]. / Stoffwechselverhalten bei Magenpatienten während viertägiger postoperative vollständiger parenteraler Ernhrung mit Aminosäuren und einer Glucose-Lävulose-Xylit-Kombinationslösung

In a clinical study we tested the following parameters: free fatty acids, beta-hydroxybutyrate, acid-base-balance, lactate, bilirubin, uric-acid, fructose, xylitole, glucose in blood and urine. The tests were executed in 9 patients who were undergoing stomac operations. The cardio pulmonary system of all patients was normal, and there was a homeostasis in water and electrolytes preoperatively. In combination with the amino-acids we received a ratio of 1:1:1 for glucose, levulose and xylitole. Totally, the patients received 0.36 g per kg body weight and per hour of carbohydrates. Beta-hydroxybutyrate, aceto-acetat, and free fatty acids show normal values under conditions of parenteral nutrition as well as lactate, uric acid, and acid-base-balance. The ratio of the different carbohydrates in serum and urine prove that the infusion time and volume were extremely favourable. The loss of carbohydrates in urine was very low.

[The effect of various electrolyte solutions on the water and electrolyte balance during the postoperative phase]. / Die Wirksamkeit verschiedener Elektrolytlösungen auf den Wasser- und Elektrolythaushalt in der postoperativen Phase

Investigations with 3 electrolyte solutions having different qualitative and quantitative compositions were carried out to see their effect on the physiological equilibrium in the pre, intra- and postoperative phases in patients who had to undergo moderately severe surgery. On the basis of electrolyte and osmolarity determinations in serum and 24-hour urine, blood gas analyses, determinations of hemoglobin and hematocrit, 24-hour volume and specific weight of the urine, it was possible to establish an electrolyte administration adapted to the pre-, intra- and postoperative condition of the patients. By the infusion of a solution with this electrolyte content it was possible to keep the measured parameters within the normal range throughout the entire period of measurement before, during and after the operation.

[Metabolic behavior in total parenteral nutrition during the postoperative phase]. / Stoffwechselverhalten bei totaler parenteraler Ernährung in der postoperativen Phase

In patients who had undergone gastric operation, total postoperative parenteral nutrition was effected using a combination of two infusion solutions having complementary constituents. 80 g L-amino acids and about 2,500 kcal in the form of a glucose-levulose-xylitol mixture together with electrolytes and trace elements were infused daily. Metabolic parameters, serum levels and the concentrations of the most important administered substances excreted in the urine were determined every day at the same time. The 1:1:1 glucose-levulose-xylitol ratio of the caloric carrier proved to be a favourable combination with respect to metabolic behaviour and the necessary daily supply of calories. The basic electrolyte requirement of the patients was to a large extent met by the quantities contained in the solutions.