[Drainage following sigmoido-rectal surgery]. / Drainagen nach sigmoido-rektalen Operationen.

There is a great diversity of opinion concerning the management of wounds in rectal surgery. In resection of the rectum we recommend to use the soft Penrose drain, we put in several drains, if the operative field isn't completely clean, we rinse more thoroughly the wound per- and postoperatively in cases of massive bacterial and fecal contamination. Irrigation combined with suction drainage is only installed in presence of general peritonitis. In amputation of the rectum we have abandonned primary closure combined with suction drainage of the perineal wound, a loose bundle drainage neither delaying wound healing nor prolonging hospital stay. In cases of hemorrhage we plug the wound by a Mikulic tampon. If the pelvic floor cannot be closed, we place a plastic sheet on the abdominal side of the Mikulic tampon, this sheet serving as complementary draining system. The disadvantages of every draining system are overruled by their life saving capacities.

[Therapy of breast cancer. Results and prognosis after treatment with different surgical methods]. / Zur Therapie des Mammakarzinoms. Behandlungsergebnisse und Prognose bei verschiedenen chirurgischen Behandlungsmethoden.

Breast carcinoma is the most frequent form of cancer in women. In Switzerland 1265 women died of it in 1975, the mortality rate is rising slowly, the cause of this being unclear. There is no uniformity about the best treatment of breast cancer. We analyzed 454 carcinomas, operated in the years 1961--1971 according to Halsted, Patey and McWhirter. We found similar 5- and 10-year survival rates with the Halsted and the Patey method of operation, however, decidedly worse results with the simple mastectomy. Today we recommend the modified radical excision of the breast after Patey at all stages; in addition we treat all patients with postoperative X-ray therapy or prescribe an adjuvant cytostatic therapy based on the experimental study of the SAKK (Swis Therapy Group for Clincal Cancer Research).

[Panniculitis mesenterialis, a rare disease]. / Panniculitis mesenterialis, eine seltene Erkrankung.

Panniculitis mesenterialis is an illness of the mesenterium of the small intestine and is not familiar to all clinical physicians. The rare reports in the literature mostly describe a good outcome with a few cases ending lethal. Pathologists paying attention to detect panniculitis during postmortem examination report about an incidence of about 1%. This discrepancy may be based on the fact that only extended changes of the mesenterial fat tissue cause symptoms. The pathological base consists in extensive necrosis of fat tissue with fibrosis of the mesenterium. Aetiology is unknown, diagnosis is usually made during laparotomy. There is no specific treatment, prognosis is generally good.

[Surgical therapy of severe chronic constipation]. / Die chirurgische Therapie der schweren chronischen Obstipation

Primary chronic constipation is an ailment of modern civilisation. Severe forms can seldom be treated satisfactorily by conservative methods, and in these cases surgical intervention must be considered. This consists of subtotal colectomy with ileosigmoidostomy. Partial resection and hemicolectomy do not afford the desired result. A report is presented on 28 patients who had subtotal colectomy for chronic constipation during the period 1959 to 1976. Immediate and long-term results have proved to be surprisingly good. Unsatisfactory conditions are to be expected in patients with strong complementary psychoneurotic symptoms. Preoperative investigations must be carried out with precision, morphological changes accurately identified and treated by differentiated surgical methods. The indication for colectomy in cases of chronic constipation must be strictly established, if possible in collaboration with a gastroenterologist.

[Prognosis with different therapeutic methods and therapeutic recommendations in operable breast cancers]. / Prognose bei verschiedenen Behandlungsmethoden und therapeutische Empfehlungen beim operablen Mammakarzinom.

Breast carcinoma is the most frequent form of cancer in women. In Switzerland 1265 women died of it in 1975, the mortality rate is rising slowly, the cause of this fact being unclear. There is no uniformity about the best treatment of breast cancer. We analyzed 454 carcinomas, operated in the years 1961--1971 after Halsted, Patey and McWhirter. We found similar 5- and 10-year survival rates with the Halsted and the Patey method of operation, however, decidedly worse results with the simple mastectomy. Nowadays we recommend the modified radical excision of the breast after Patey at all stages; in addition we treat all patients with postoperative X-ray therapy or prescribe an adjuvant cytostatic therapy based on the experimental study of the SAKK (Swiss Therapy Group for Clinical Cancer Research).

[Mammographic and thermographic diagnosis of breast cancer]. / Zur mammographischen und thermographischen Diagnostik des Mammakarzinoms.

2731 mammography and thermography results were analyzed. The radiological examination could be histologically verified 468 times. The diagnosis made by means of mammography was wrong in 42%, by thermography in 52%. In this group only 3 occult carcinomas were discovered mammographically. A wide range of indications of mammography applied hitherto therefore becomes doubtful. It is recommended to assign all palpable tumours of the female breast directly to the surgeon without mammography.

[Management of rectal prolapse by rectal mobilization and fixation with Ivalon sponge]. / Behandlung des Rektumprolapses durch Rektummobilisation und Fixation mit Ivalon-Sponge.

Follow-up is reported in 34 patients with rectal prolapse treated at the Department of Surgery, Aarau, in the period 1972-1980 by mobilization of the rectum and fixation with Ivalon Sponge. The follow-up showed that the method has a low complication rate and a low recurrence rate (2 minor recurrences). Noteworthy is the good restoration of continence. Prior to surgery, 60% of the patients were also incontinent for solid stool. In the follow-up, all the patients were continent for normal stool and half for liquid stool. Despite the advanced age of some of the patients, postoperative mortality was nil.

[Solid and cystic pancreatic tumor]. / Solider und zystischer Pankreastumor.

The solid and cystic tumor of the pancreas (also called pancreatic cystic tumor of the pancreas) is a very rare tumor of the pancreas, which we meet mainly in younger women. The tumor was described for the first time in 1981 and since that time there were published more than 150 cases. It is a matter of a potentially malign tumor with low malign characteristics. By radical exstirpation most of the patients can be healed definitely. Long-term controls are yet necessary although recidives are rare (4-7%), but are described up to 10 years after the first treatment. Also singular cases with synchronous metastasis of the liver are mentioned. Except of abdominal volume increase the tumor gives little trouble. The diagnosis is placed with ultrasonography resp. with a computer-tomogram and ensured by needle cytology. The therapy consists in the radical exstirpation with resection of the left pancreas in case of location on the left side, with Whipple operation in case of localisation in the head of the pancreas.

[Multiple retroperitoneal and mediastinal lymph cysts in primary ectatic lymph vessels]. / Multiple retroperitoneale und mediastinale Lymphzysten bei primär ektatischen Lymphgefässen.

A unique case of a large retroperitoneal and multiple mediastinal lymphcysts is presented. Cystic abdominal tumors of lymphatic origin are very rare. Usually single cases or small numbers have been reported in the international literature. The aetiology, clinical findings and therapy of these lesions are discussed.