[Ischemic necroses of the colon and rectum following alloplastic vessel substitution of the abdominal aorta]. / Ischämische Nekrosen des Colon und Rectum nach alloplastischem Gefässersatz der Aorta abdominalis

Arterial insufficiency to the colon and rectum followed by ischemic necrosis of this bowel portion is considered to be a rare complication after resection of abdominal aortic aneurysms and alloplastic replacement of the abdominal aorta in arterial occlusive disease. The main symptom is diarrhea and mucus or blood in stool. Sigmoidoscopic examination is of diagnostic value; the treatment of choice has to be colostomy and resection. A causative factor for the development of large bowel necrosis is diminution of collateral blood supply, which is discussed in detail.

[Splenectomy in osteomyelofibrosis. Indications and outcome]. / Splenektomie bei Osteomyelofibrose. Indikationen und Ergebnisse.

Osteomyelofibrosis is a myeloproliferative disorder in which fibrosis and sclerosis finally lead to bone marrow obliteration. Liver and spleen compensate for bone marrow loss with extramedullary hematopoiesis. In some patients the resulting splenomegaly causes severe symptoms such as local compression, thrombocytopenia and hemolytic anemia. In such patients, splenectomy is the only promising treatment, although it represents a significant risk.

[Cremaster resection in Shouldice repair. A prospective controlled bicenter study]. / Cremasterresektion bei Shouldice-Reparation. Eine prospektiv kontrollierte Bicenter-Studie.

The aim of this prospective controlled trial was to determine the value of the resection of the cremaster muscle in Shouldice's hernia repair. 237 Shouldice operations with resection of the cremaster muscle of the Department of Surgery of the RWTH of Aachen were compared with 153 Shouldice repairs without resection of the cremaster muscle of the Department of Surgery of the Elisabeth Hospital in Essen. A comparable follow-up of 12 to 26 months in both groups revealed no significant differences in postoperative complications. In the group without resection of the cremaster muscle four indirect recurrent hernias were diagnosed. In the group with resection of the cremaster muscle no indirect recurrent hernia was detected, only one direct recurrent hernia was documented. The significantly elevated rate of recurrent hernias (p less than 0.05) and the occurrence of atypical indirect recurrent hernias in the group without resection of the cremaster muscle demonstrate the important influence on the technique of repair. Based on our results the resection of the cremaster muscle in an essential part of Shouldice's hernia repair.

Intraoperative electromyogram monitoring of the recurrent laryngeal nerve: experience with an intralaryngeal surface electrode. A method to reduce the risk of recurrent laryngeal nerve injury during thyroid surgery.

INTRODUCTION: A clinical method to localize the recurrent laryngeal nerve intraoperatively in order to minimize the risk of accidental injury is presented. METHODS AND RESULTS: By means of an electrode, the nerve was stimulated by a pulsed contact current. The resulting muscle potential was detected using an electrode placed in the larynx. We applied this technique during the time period between 1 January 1997 and 31 December 1998. In 96 cases of primary thyroid resection, the recurrent nerve was identified 167 times. The patients were operated on for nodular thyroid (n=85), Grave's disease (n=9) and malignant papillary goiter (n=2). Retrospectively, the rate of intraoperative nerve injury, equivalent to the rate of postoperative transient and permanent nerve palsy, was 1.04% in the 96 patients and 0.60% with respect to the 167 nerves at risk. The rate of failure of the method was 7.29%.

Indications for and results of splenectomy in different hematological disorders.

The objective of this retrospective study was to determine the indications for splenectomy in hematological disorders and to analyze the results depending on the indication leading to surgery. Fifty-six patients with various hematological disorders were splenectomized between 1990 and 1994. The main indication was noted. Operative success was defined as: return to normal platelet counts without further medication in thrombocytopenia, relief of pain and local compression syndrome in painful splenomegaly, hemoglobin levels > 10 g/dl without the need for further transfusions in hemolytic anemia, response to chemotherapy after splenectomy for prior resistance because of massive splenic infiltration, and relief of infection in splenic infection. Morbidity and mortality were noted. Five major indications for splenectomy were found: thrombocytopenia (n = 36, success 78%), painful splenomegaly (n = 8, success 100%), hemolytic anemia (n = 5, success 60%), resistance to chemotherapy because of massive splenic infiltration (n = 5, success 100%). One patient with thrombocytopenia died (mortality 2%). Seven patients had major complications (13%). In hematological diseases, thrombocytopenia, painful splenomegaly and splenic infection are likely to be improved by splenectomy. In hemolytic anemia it can be a helpful approach, while in resistance to chemotherapy because of massive splenic infiltration success is less likely.

[Controlled study of cremaster resection in Shouldice repair of primary inguinal hernia]. / Kontrollierte Studie zur Kremasterresektion bei Shouldice-Reparation primärer Leistenhernien.

237 Shouldice operations with resection of the cremaster muscle from the Department of Surgery of the RWT University of Aachen were compared with 153 Shouldice repairs without resection of the cremaster muscle from the Department of Surgery of the Elizabeth Hospital in Essen. The aim of this prospective controlled trial was to determine the value of the resection of the cremaster muscle in Shouldice's hernia repair. A comparable follow-up of 12 to 26 months in both groups revealed no significant differences in early-postoperative complications. In the group without resection of the cremaster muscle the incidence of chronic inguinal pain was reduced. However, avoidance of the cremaster resection is not advisable because it leads to atypical indirect recurrences and totally higher recurrence rate (2.6%), so four indirect recurrent hernias were diagnosed. In the group with resection of the cremaster muscle no indirect recurrent hernia was detected, only one direct recurrent hernia was documentated. The significantly elevated rate of recurrent hernias (p less than 0.05) and the occurrence of atypical indirect recurrent hernias in the group without resection of the cremaster muscle demonstrates the important influence on the technique of repair. Based on our results the resection of the cremaster muscle is an essential part of Shouldice's hernia repair.