[Status determination in discussion of benign stenosis of Vater's papilla]. / Eine Standortbestimmung in der Diskussion um die benigne Stenose der Vater-Papille.

Inflammatory and cicatrical alterations are the morphological basis of papillary stenosis in most cases due to canalicular or lymphatic spreading of bacterial infection in gallstone disease. The consequences of papillary stenosis are elevated pressure in the ducts and reduced bile flow. At surgery you find dilatation of the bile ducts, increase of residual pressure, decrease of outflow, and--in cicatrical stenosis--stop for the probe. Only the inflammatory stenosis is reversible, but permanent alteration is not to determine. Therefore therapy is necessary, at first instrumental dilation to 4-6 mm. Impossibility of dilatation indicates transduodenal sphincterotomy. Recurrencies are best treated by endoscopic sphincterotomy and exceptionally by choledochoduodenostomy.

[Is dilatation of the papilla a differential diagnostic or therapeutic intervention?]. / Ist die Papillendilatation ein differentialdiagnostischer oder therapeutischer Akt?

Calculations were made to establish the action of probes of different thickness on both cicatric tissue and unstriated muscles of the major duodenal papilla. The findings are graphically represented. These calculations were based on histopathological findings recorded from the major duodenal papilla, expandibility, of collagenic fibres and unstriated muscles, and morphometric measurements. The conclusion was drawn that passage of a probe of more than 3 mm in diameter through a cicatrically narrowed papilla constituted an act of therapy or at least had a therapeutic component in addition to probing. The therapeutic range of papillary dilatation is limited to something from three to six millimetres.

[Benign stenosis of Vater's papilla from the pathogenetic viewpoint]. / Die benigne Stenose der Vater-Papille unter pathogenetischen Aspekten.

Data and surgical findings recorded from 7,640 primary operations on bile ducts were analysed and were investigated for their relationship with benign stenosis of Vater's papilla. Positive diagnosis of the latter was made in 487 cases (6.3 per cent). Clearly discernible correlations were found to exist between papillary stenosis, on the one hand, and severe chronic inflammation of the gall-bladder and choledocholithiasis, on the other. A relationship between papillary stenosis and advanced age was to some extent suggested by increased occurrence of severe chronic inflammations and choledocholithiasis in higher age groups. Primary stenosis without causative inflammation in the vicinity of the papilla was not recordable from the above surgical cases. The view has been confirmed that benign stenosis is likely to develop as a secondary alteration due to inflammatory processes along with lithiasis.

[Validation of intraoperative diagnostic criteria in the differentiation of benign stenoses of Vater's papilla]. / Die Validierung intraoperativ diagnostischer Kriterien zur Abgrenzung der benignen Stenose der Vater-Papille.

The following criteria were recorded from complex intraoperative bile duct diagnosis and were recalculated for validation: residual pressure, flow per minute, choledochal width, and possible probing of the papilla. A comparison was made between 189 cases of papillary stenosis without accompanying choledocholithiasis, on the one hand, and cases with non-contributory choledochus, on the other, for the period from 1970 to 1984. Probabilities by which presence of papillary stenosis could be established were 83 per cent by debitomanometry or 91 per cent by enlargement of choledochus in conjunction with possible probing of the papilla. With all four criteria tested, the probability went up to 99.9 per cent. Diagnosis of papillary stenosis thus proved to be possible with high probability by combination of several examination methods.

[Assessing performance in new German states]. / Probleme der Leistungserfassung in den neuen Bundesländern.

With the disbandment of the G.D.R., the following also ended: a) the central registration of all inpatients, which allowed statements to be made about hospital morbidity; b) the central tumor documentation, in which all tumor patients were registered up to 5 years after first treatment. Data relating to the clinic are being set up. We present a proven program of operating statistics set up by the working group for quality assurance.

[Surgical quality assurance in the former Cottbus district]. / Chirurgische Qualitätssicherung im ehemaligen Bezirk Cottbus.

30 years ago we began with systematical recording of dates from the main operation groups as cholelithiasis, gastroduodenal ulcer, goitre and appendicitis. This was followed by a regularly internal proving of this dates. A voluntary comparative audit was done between the 14 departments in the district. Besides surgical aspects there were also respected organisation and efficiency.

[Hierarchy and authority]. / Hierarchie und Autorität.

Although the term hierarchy isn't in keeping with the times for secular spheres, the identical term ranking omnipresent and indispensable in a political way. Without ranking there ist no final but only a general responsibility. Ranking is based on authority--to be distinguished between professional competence an official authority. The latter one should be gained with inner agreement--by sanctions only when needed.

[Important epidemiologic aspects of appendicitis]. / Wichtige epidemiologische Aspekte der Appendizitis.

In the past 20 years the frequency of appendectomies has been halved. The reason of this lies in the strictly indication for operation. A perforation rate more than 10% and a sex relation 1:1 point at a balanced indication.

[Early operation in biliary surgery? (author's transl)]. / Wie weit sind wir der Frühoperation der Gallensteinkrankheit näher gekommen?

In the last 15 years from 1961 to 1975 the number of operations caused by cholelithiasis increased three- and fourfold. This phenomenon is more due to the increase of the morbidity than to the extending of indication for operation. Reduction of letality from 2,4% to 0,7% and limitation of the acute complications can be considered as important results during this time. The pathological findings reveal a small improvement only. A correlation between the duration of the disease and the increase of serious pathological findings at the time of operation could not be found. During this period neither a shortening of the history of illness nor a reduction of the patients age at operation could be observed.

[Iatrogenic pneumothorax and its forensic evaluation]. / Der iatrogene Pneumothorax und seine gutachterliche Beurteilung.

Forty-three cases of iatrogenic pneumothorax were kept under follow-up observation, against the background of subclavia puncture, infiltration of dorsal muscles, pleural puncture, stellatum blockage, and Menghini puncture. Complications were successfully eliminated by intercostal pleural drainage in the majority of the above cases. It might be recommendable for lesser complications to prefer puncture of the internal jugular vein to puncture of the subclavian vein. The pneumothorax complication following infiltration of the dorsal musculature was attributable to inadequate technique, which would justify a compensation claim against the hospital.

[Appendicitis from an epidemiological viewpoint]. / Die Appendizitis aus epidemiologischer Sicht.

A general CDR-wide account is given in this paper of hospitalised treatment, frequent of operations, and lethality of appendicitis. Hospitalised treatment declined from 97.208 to 52.814 cases, i.e. by 46 percent, between 1971 and 1988. In 1988, ratios were 30.7 top 10,000 males and 32.7 to 10,000 females. The ratio of surgery was 21 to 10,000, with declining trend. Hence, about one third of all hospitalised patients were cases for observation rather than treatment. The decline has been attributable to more stringent criteria for surgery. Decline in frequency of operations has been accompanied by reduction in lethality and mortality. Overall lethality of acute forms of appendicitis has been 0.4 percent in 1988, which was primarily attributable to improvement of therapeutic methods. The mortality rate to 10,000 inhabitants is 0.15.

[Analysis of the frequency of blood transfusion in surgery]. / Analyse zur Frequenz der Bluttransfusion in der Chirurgie.

For the period from 1985 to 1987 were analysed the blood transfusions, which were carried out in seven surgical wards, within the scope of a study for quality assurance. 7.6% of the patients, treated in surgical ward and 5.4% of the patients, treated in traumatological ward, were given blood transfusion. The average was 3.6 transfusional units per treated patient. The biggest differences were to be remarked at cases of breast cancer and at thyroid gland surgery. The average transfusion frequency at breast cancer was 16% with a difference between 5 and 63%. In thyroid gland surgery the average transfusion frequency was 11%, differing between 1 and 54%. At these operation groups the blood transfusion were usually given once. Transfusional reactions, costs and responsibility towards the donor demand a turning away from scientifically non-established transfusion habits. The components concept by Lundsgaard should serve as an orientation.

[Postoperative haemorrhage in gastric ulceration and gallstone surgery (author's transl)]. / Postoperative Blutungen in der Magenulkus- und Gallenchirurgie.

5463 operations for gallstone disease were followed eleven times (0,2%) by haemorrhage. 16 intragastric (1,2%) and 11 haemorrhages into the peritoneal cavity (0,8%) could be observed after a total of 1370 operations for gastric or duodenal ulcer. For the most part haemorrhage into the peritoneal cavity frequently occurred within the first 24 hours, whereas the intragastric bleeding appeared later. Both manifestations showed the signs of haemorrhagic shock. While haemorrhage into the peritoneal cavity had to be treated mostly by secondary laparotomy after adequate shock therapy, intragastric haemorrhage could be cured most without surgical treatment.

[Treatment results in surgery of gastroduodenal ulcers]. / Behandlungsergebnisse der Chirurgie des Gastroduodenalulkus.

From 1969 to 1980, 1316 patients underwent surgery for gastric and duodenal ulceration. In 302 cases (23%) the indication was a vital one (158 times [12%] perforation and 144 times [11%] heavy bleeding). 1014 operations (77%) were of selective character: 1159 times partial gastrectomy, 60 times vagotomy and 97 times nonresective emergency procedures. The rate of complications following perforation was 2 1/2 times and after bleeding 3 times higher than after selective operations. The mortality rate after perforation came up to 9.5%, after hemorrhage to 13.2%, but in selective cases only to 0.6%. The total mortality rate came up to 3.0%. Our results demonstrate the fact that surgery for gastric and duodenal ulcer is mainly burdened by mortality following perforation and haemorrhage.

[Experiences with AV shunts for long-term dialysis with special reference to elbow shunts]. / Erfahrungen mit AV-Fisteln zur Langzeitdialyse unter besonderer Berücksichtigung der Ellenbeugenfisteln.

From 1968 until 1977 in 148 patients 202 arterio-venous fistulas for chronic hemodialysis were performed 41 out of them in the angle of the elbow. By the fistula in the angle of the elbow the V. mediana basilica is sutured end to side of the A. brachialis. This fistula is recommended, when the performance of a fistula in the forearm is failed.