[Conventional and cine-MRT in patients with aneurysms of the abdominal aorta]. / Konventionelle und Cine-MRT bei Patienten mit Aneurysmen der Aorta abdominalis.

We studied 40 patients with aneurysms of the abdominal aorta by MRI. These results were compared with those obtained by real-time sonography (n = 40), angiography (n = 32) and CT (n = 16). In 30 patients the imaging results were compared--as far as possible--with the operative findings. MRI proved more reliable, especially if compared with sonography, in evaluating renal or iliac artery involvement. Mural thrombi were detected more often (93%) by MRI than by CT (85%) or sonography (83%). Cine-MRI showed strong turbulences in 33%. Turbulences did not correlate with the size of the aneurysm.

Hemodialysis via the Scribner shunt in childhood: a surgical evaluation.

From 1973 to 1988, 105 children with renal failure (average age, 6.5 years; range, 5 days to 16.2 years) were treated with hemodialysis via surgically implanted Scribner shunts (n = 120). The average duration of dialysis was 16 days (range, 1 to 194 days). Twenty-three patients died during treatment or during the hospital stay because of the underlying disease; no patient died because of shunt complications. The treatment was initially successful for 82 children, but 14 of them died within several months of discharge. Among the initially surviving 82 patients, the shunt was the only means of access for dialysis in 52. In the other 30, the primary Scribner shunt was unsuccessful; it required replacement, or the type of dialysis had to be changed. The shunts were implanted in the forearm in 23%, the groin in 40%, and the ankle in 37%. Early complications were local bleeding (17%) after an average of 37.3 days, shunt occlusion (34%) after an average of 47.3 days, infections (9.3%) after an average of 43.9 days, and decreased blood flow (8.5%) after an average of 47.7 days. Vessels were reconstructed after discontinuation of dialysis in 28 cases, in which the Scribner shunt had been implanted in the groin. No patient experienced immediate ischemic problems. Long-term follow up results were obtained for 60% (n = 40) of the surviving 68 children after an average of 7 years (range, 2.1 to 15.2 years). We found no evidence of arterial or venous complications at the former shunt site.(ABSTRACT TRUNCATED AT 250 WORDS)

Validity of SEP monitoring in carotid surgery. Review and own results.

OBJECTIVE: The sensitivity of intraoperative monitoring by means of somatosensory evoked potentials (SEP) in carotid surgery is to be examined. EXPERIMENTAL DESIGN: Prospective clinical investigation. In addition, the influence of circulatory parameters on SEP curves will also be tested. SETTING: Department of Surgery of a university clinic. MATERIALS AND METHODS: A total of 200 patients underwent intraoperative monitoring by means of somatosensory evoked potentials (SEP) during carotid endarterectomy between March 1, 1991 and August 1, 1994. MEASURES: In order to exclude blood pressure variations as a cause for amplitude changes the blood pressure and pulse were documented during the entire phase of preparation and clamping. RESULTS: A significant correlation could not be established between parameters of circulation and amplitude changes (r = 0.0026; p = 0.62). In seven cases of intraoperative amplitude reduction of more than 50% a stroke has been avoided by inserting a shunt. Despite the lack of an amplitude reduction, a watershed stroke of A.cerebri media and A.cerebri posterior occurred in two instances. Taking this into consideration the sensitivity of monitoring is 99.0% at a specificity of 100%. CONCLUSIONS: SEP-monitoring in carotid endarterectomy is simple to execute and is superior in sensitivity to EEG analysis. To avoid artefaction by anesthesia, a standard injection anesthesia is recommended. Farfield potentials should also be derived to avoid watershed infarctions.

[The beginnings of reconstructive vascular surgery in Austria]. / Anfänge der rekonstruktiven Gefässchirurgie in Osterreich.

Hans von Haberer (1875-1958) gained wide experience in the reconstructive surgery of traumatic aneurysms during the 1st world war at the Surgical Department of the University of Innsbruck. In the period 1914-1918 he operated on altogether 201 vascular aneurysms, mainly using a direct circular vascular suture. In 1914 von Haberer described the first reconstruction of a carotid aneurysm. On the basis of the detailed case notes and operation reports written by Hans von Haberer between 1904 und 1949 on approximately 16000 cases and from the contemporary literature, we describe his experiences in vascular surgery at the Surgical Department of the University of Innsbruck between 1914 and 1918.

[Therapy of renovascular hypertension in neurofibromatosis: surgical revascularization versus percutaneous transluminal angioplasty]. / Therapie der renovaskulären Hypertonie bei Neurofibromatose: operative Revaskularisation versus perkutane transluminäre Angioplastie.

Vasculopathy is a rare and undervalued complication in neurofibromatosis. Histopathological changes of the vascular wall may lead to relevant renal artery stenosis. We report a case of a 17-year-old patient with neurofibromatosis and severe renovascular hypertension resulting from a proximal renal artery stenosis. Attempted percutaneous renal angioplasty was unsuccessful and the patient was referred for operative revascularization. After insertion of an aortorenal bypass with a reversed saphenous vein graft the patient became normotensive without medication. Based on our own experience and a review of the literature we recommend operative reconstruction of stenotic renal arteries in neurofibromatosis.

[Ergotism--a rare cause of acute ischemia of the extremities]. / Ergotismus-seltene Ursache der akuten Extremitätenischämie.

Clinical ergotism as seen today results almost exclusively from the excessive intake of ergotamine tartrate in the treatment of migraine headache. Vasospasm of peripheral arteries is the leading clinical picture. Beside formation of collaterals and secondary thrombosis, vasospasm is one of the specific findings in angiography. Early diagnosis and withdrawal of the medication makes complete restitution possible. In all other cases intraarterial or intravenous infusion of sodium nitroprusside or nitroglycerin has turned out to be the most effective therapy. Balloon dilatation or operative intervention are an alternative therapy in those cases, where amputation of the limb seems to be necessary.

[Metabolic changes after transperitoneal vascular interventions]. / Stoffwechselveränderungen nach transperitonealen Gefässeingriffen.

Thirty patients who had undergone transperitoneal vascular surgery were examined for hormonal disturbances and alterations of energy and protein metabolism. Of all hormonal alterations only the increased level of insulin activity in the early postoperative period is clinically important. The higher oxygen consumption and carbon dioxide production together with the increased protein turnover indicate an elevated energy expenditure. In order to prevent decompensation of the hypermetabolic metabolism, a reduced nutritional support after major vascular surgery is justified.

[Functional relevance of the type I arteria proatlantica in carotid disobliteration]. / Funktionelle Relevanz der Arteria proatlantica Typ I bei der Carotisdesobliteration.

Primitive embryonic anastomotic vessels between the carotid and vertebrobasilar arterial systems occasionally persist into adult live. Coincidence with cerebrovascular disease may be of functional relevance. We report a case of segmental internal carotid occlusion and aplasia of both vertebral arteries in combination with persistence of proatlantal artery type I. Recurrent cerebral ischemia required revascularization of the segmental occluded internal carotid artery. Disobliteration was successfully performed with an uneventful postoperative course. The patient recovered well from his neurological deficits. Clinically, the combination of persistent proatlantal artery with occlusive disease of the carotid arteries may lead to atypical neurological deficits. In cerebrovascular surgery, a persisting proatlantal artery, as a main supply vessel of the vertebrobasilar system, is of great importance if the carotid artery is clamped.

[Juvenile arteriosclerosis: rare cause of generalized dilatative and stenosing vascular disease]. / Die juvenile Arteriosklerose: seltene Ursache einer generalisierten, dilatativen und stenosierenden Gefässerkrankung.

In addition to generalized arteriosclerosis connective tissue disease, systemic vasculitis as well as genetic metabolic disease are described to be the cause of stenotic and aneurysmatic vessel wall alteration. Although these causes are rather unusual, they must be considered for the diagnosis of a generalized vascular disease with arterial occlusion as well as aneurysm formation to determine the appropriate procedure for the individual. Whereas operative treatment should be avoided as far as possible for patients with Behçet's disease or Marfan syndrome, it is rather indicated for any kind of juvenile arteriosclerosis with arterial stenosis as well as dilatation. In this way the patient described in the following could be treated successfully by operation even though the cause of the juvenile arteriosclerosis was inexplicable, and in addition to local complications also the threatening rupture of the aneurysm could be controlled.

[Traumatic pseudoaneurysm of the axillary artery after shoulder dislocation]. / Das traumatische Pseudoaneurysma der Arteria axillaris nach Schulterluxation.

By means of a case report the diagnostic and therapeutic procedures and prognosis of a pseudo-aneurysm of the axillary artery after shoulder dislocation are demonstrated. The diagnosis of aneurysms of the axillary artery is difficult in some cases. It is important to mention a possible vascular injury in case of close reduction of the shoulder. Therefore in all patients with a penetrating or blunt trauma of the shoulder or the upper arm a thorough neurovascular examination is required. In patients with neurologic deficits or alteration of the pulse a duplex ultrasound examination should be performed and in dubious cases an additional arteriography is indicated.

[Renal angiomyolipoma as a rare cause of retroperitoneal hemorrhage]. / Renale Angiomyolipome als seltene Ursache einer retroperitonealen Blutung.

Angiomyolipomas are hamartomas that may be found sporadically or associated with tuberous sclerosis (M. Bourneville-Pringle). Clinically, this long-term asymptomatic tumor becomes evident as an acute retroperitoneal hemorrhage or by symptoms of a flank mass. Due to the high percentage of fat components in this tumor type, computed tomography is far superior to other radiological procedures. In view of two of our own case reports, the therapeutic strategies are discussed, paying regard to the actual literature in this field.

[Hans von Haberer--the beginnings of reconstructive carotid surgery]. / Hans von Haberer--Anfänge der rekonstruktiven Carotischirurgie.

Hans von Haberer (1875-1958) gained wide experience in the reconstructive surgery of vascular aneurysms at the universities of Innsbruck, Graz, Düsseldorf and Cologne. In this period he operated on 421 vascular aneurysms--including 30 carotid aneurysms--mainly by means of direct circular vascular suture. In 1914 von Haberer described the first repair of a carotid aneurysm. Therefore he is the pioneer of reconstructive carotid surgery. Based on detailed clinical and operation reports on approximately 16,000 cases, written by Hans von Haberer between 1904 and 1949, and on the contemporary literature, we describe his experience in vascular surgery.

[Surgical aspects of the implantation of catheters for acute peritoneal dialysis in premature, newborn and young infants]. / Chirurgische Aspekte der Implantation von Kathetern zur Akut-Peritonealdialyse beim Früh- und Neugeborenen sowie beim jungen Säugling.

Ten years experience with acute peritoneal dialysis in 39 preterm-, newborn and small infants shows advantage and low risk of surgically implanted single dacron cuffed silicone catheters compared to trocar catheters.

[Venous thrombectomy]. / La thrombectomie veineuse.

The aim of surgical treatment of acute deep venous thrombosis is to prevent lethal pulmonary emboli, the venous desobstruction and the maintenance of the valvular mechanism. From 1972 to 1982, 161 patients have been operated at the surgical clinic of Cologne. In 41.4% of the cases the long term result was excellent. The clinical examination, the complaints of the patients, the phlebography were judgement criteria.

[Palliative surgical treatment of cancer of the esophagus]. / Die palliativ-chirurgische Behandlung des Karzinoms der Speiseröhre.

Palliative surgery, including cleaning resection, colon or stomach bypass, intubation or fistula is all one can offer to the majority of patients suffering from oesophageal carcinoma due to an usually advanced tumor stage at the time of diagnosis. The primary goal is to prevent or resolve dysphagia. A prolongation of survival time can - with the exception of cleaning resection - not be expected by these procedures. The average survival time was 9.4 months after cleaning resection and 4.7 months after other palliative procedures in our series. If a cleaning resection is not possible, the endoscopic implantation of an endotube is the treatment of choice because of its low mortality and morbidity.

[Place of surgical treatment of lung metastases]. / La place du traitement chirurgical des métastases pulmonaires.

From 1.1.1980 to 31.12.1992, ninety-four of our patients underwent surgical removal of pulmonary metastases. The classification of the primary tumours found cas as follows: sarcoma 24.5% (n = 23), renal carcinoma 22.3% (n = 21), malignant melanoma 19.1% (n = 19), colon carcinoma 15.9% (n = 15) and ovarian and testicular tumours with 10.6% (n = 10). Three cases presented metastases from a carcinoma of the floor of the outh. The remaining cases were secondaries from bronchial, oesophageal and larynx carcinoma and from a malignant thymoma. In 71 cases, the tumour was removed using an atypical resection technique, and in 22 cases by carrying out a lobectomy. In one case an "extended lobectomy" was performed. Hospital mortality was 1.1%. Survival rate was 60% at 1 year and 40% at 3 years. 38.3% of the patients lived for five years or more.

[Bovine heterologous graft in replacement of a small calibre artery]. / Greffe hétérogène bovine en remplacement d'une artère de petit calibre.

An experimental study of a new biologic vascular graft for reconstruction of small diameter arteries was carried out in 50 sheep. Results up to 2 years allow us to conclude that the new vascular prostheses may be "reutilized" by the host. Infections and aneurysmal degeneration were be observed. Early occlusion of the graft due to technical reasons occurred in only one case.

[Ergotism and ischemia of the limbs]. / Ergotisme et ischémie des membres.

Clinical ergotism as seen today results almost exclusively from the intake of ergotamine tartrate in the treatment of migraine headache. Vasospasm of peripheral arteries is the leading clinical picture. Besides the formation of collaterals and a secondary thrombosis, the vasospasm is one of the specific findings in arteriography. Early diagnosis and withdrawal of the medication makes complete restitution possible. In all other cases intraarterial or intravenous infusion of sodium nitroprusside has turned out to be the most effective therapy. Balloon dilatation or operative intervention are an alternative therapy in those cases, where amputation of the limbs seems to be necessary.

[Surgical treatment of lung cancer: therapy or palliative?]. / Khirurgicheskaia terapiia raka legkogo - lechenie ili palliativ.

In spite of the revolutionary innovations concerning diagnostic and intensive care techniques as well as better understanding of tumor biology during the last decade, rates of resection and long-term survival in bronchogenic carcinoma could not be improved. All efforts are to be done in investigation on practicable, suitable, and supportable screening programs for early recognition of tumors in the first stages.