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A rare case of dysphagia caused by leiomyomatosis of the esophagus is presented. Esophageal leiomyomatosis is triggered by diffuse proliferation of smooth muscle cells in the wall of the entire esophagus. Only 1.0% of all tumors of the esophagus are benign lesions; 0.4% of all esophageal neoplasms are leiomyomas. Only a few cases of leiomyomatosis-a special form of diffuse leiomyomas-have been described so far in the literature. Modern diagnostic imaging techniques such as CT and MR are described in esophageal leiomyomatosis.

Intra-abdominal abnormality of vessels may sometimes lead to complications. A case of the rare combination of an abdominal aortic aneurysm (AAA) at the origin of the inferior mesenteric a. with duplications of the inferior vena cava (IVC), the right renal a. (RRA) and the right renal v. (RRV) as well as absence of the left common iliac v. is reported.

Focal nodular hyperplasia was diagnosed angiographically in 14 patients and confirmed histologically. Differentiation of this benign lesion from other space-occupying diseases of the liver can be very difficult, since focal nodular hyperplasia produces a variable angiographic appearance. The typical angiogram showing radial vessels in the arterial phase and sharply demarcated foci in the parenchyma phase is found in only one third of patients. Angiographic differential diagnosis includes adenomas and carcinomas of the liver. Resection of the tumours in case of malignant tumours is not indicated. Foci at the margin of the liver, or if they are pedunculated, should be removed in case of spontaneous perforation. Tumours in the centre of the liver should be observed (computer tomography). Oral contraceptives stimulate the growth of these foci. They may diminish in size after stopping these drugs. 70% of cases of focal nodular hyperplasia remain clinically silent and were discovered accidentally or at autopsy.

A 59 year old female with multiple gastric surgical procedures (Billroth I and Billroth II) for recurring ulcer disease developed a gastric phytobezoar following an additional truncular vagotomy within 2 months. Already 1 month after complete endoscopic removal the phytobezoar recurred in spite of dietary restrictions. The phytobezoar was successfully dissolved by oral Cellulase-therapy. The truncular vagotomy and its influence on gastric motility has to be considered as the cause of the repeated bezoar formation.

Septic or toxic shock is a life threatening complication after abdominal operations. The etiologic analysis of our 102 patients showed the following conditions: 1. diseases, which have already preoperatively a high incidence of septic complications, 2. sepsis developing after primary aseptic diseases, 3. septis without any etiologic connection to the primary disease or operation. An initial standarised intensive therapy must start before any irreversible organ damage may occur. First aim of all surgical measures is the eradication of the source of infection. Early relaparotomy is the only possibility for correction of intraoperativ technical defects. Only by longstanding combination of intensive personal and technical support prognosis of septic shock after abdominal operations can be improved.

In a randomized trial the efficiency of synthetic secretin (0,25 clinical units/kg bw/h; 15 patients) was compared with that of synthetic somatostatin (250 micrograms/h, 15 patients) in treatment of severe acute non arterial bleeding from peptic ulcers or stress lesions in the upper digestive tract. In all patients the presence of hemorrhage at beginning of the therapy was established by endoscopic examination. Both test preparations were given as continuous infusions over 48 h and had identical effects on the hemorrhage: in 12 patients (80%) out of each group bleeding stopped during the infusion of secretin or somatostatin, 6 patients (20%) had to be operated on for persistant bleeding or severe recurrence.

Anal and perianal lesions in Crohn's disease such as fistulae, fissures, abscesses and proliferative ulcerous proctitis are often misinterpreted and consequently unsatisfactorily treated. They always indicate a florid intestinal attack or a relapse after previous intestinal resection. Out of 153 patients with Crohn's disease in the last 11 years we have had 59 cases (= 38.6%) with a history of anal changes or such changes were demonstrable on admission to hospital. Only after subtle diagnosis in which the nature and extent of these complications and the location of the intestinal disease focus are determined, the most promising therapy, after all possibilities of conservative treatment have been exhausted, is intestinal resection. Local surgical measures which would often endanger continence, are reserved for the individual case.

66 patients suffering from tumors of the small intestine were operated upon between 1963 and 1976 in the Surgical Department of the University of Mainz Medical School. In 16 cases benign tumors were found (6 neurinoma, 4 leiomyoma, 4 lipoma, 2 polyps), in 50 cases the tumors were malignant (24 carcinoma, 20 sarcoma, 2 malignant schwannoma, 4 carcinoids). Only in 12 patients surgery was radical and no metastases found. In more than one third of the patients surgery had to be done as an emergency operation because of life threatening complications. The correct diagnosis was established preoperatively only in 57.5% of all cases. Only 5 out of 15 patients still living have survived more than 5 years. Correct interpretation of early clinical symptoms, repeated X-ray studies and additional chemotherapy may improve the prognosis of malignant tumors of the small intestine.

A new technique for lumbar sympathectomy is described. It consists of CT-guided trans-abdominal fine needle puncture and injection of alcohol. The technique is simple and well tolerated by the patient, and it permits accurate application of the alcohol. Complications have so far not been observed.

The influence of cis-platinum on the wound healing of bowel anastomoses was studied in 104 male Sprague-Dawley rats. After a single preoperative doses of 5 mg/kg body weight, the wound-breaking strength (WBS) was tested with a material tester on the 4th, 7th, 14th and 28th day postoperatively. The WBS was significantly lower in treated animals as compared to the untreated controls. The reasons for this are discussed in comparison with other cytotoxic agents. Before cis-platinum can be used as adjuvant chemotherapy to cystectomy, which is frequently combined with an ileum or colon conduit procedure, further investigations on the operative side effects of cis-platinum on bowel anastomoses are necessary.

Valvuloplasties of which, for example, the Nissen fundoplication is perhaps the most effective operation, have been devised to correct gastroesophageal reflux. Fundopexia, a more anatomical antireflux procedure has been performed in 326 patients with 80% good (Visick I + II) clinical results. Postoperative complications and side effects are more frequent after fundoplication. In grade IV patients fundopexia is less successful. Since the introduction of H2-receptor antagonists the number of operations, especially fundopexia, has been considerably reduced.

Primary mesenteric venous thrombosis seldom occurs in young women. As a complication of oral contraceptives it is uncommon as well. Based on an own observation (39 year old female patient) pathogenesis and problems in diagnosis of this aspect of thrombosis are discussed. Involvement of the veins being segmentary and peripheral, small bowel resection is the effective treatment.

A microsurgical technique for mesenterico-caval shunting in the rat is described. The method results in a partial blood drainage from the upper abdominal content whereas the blood of the mesenteric vein is shunted to the inferior caval vein. Controls were undertaken after 1 and 3 weeks, either visually or radiologically. Twenty-two of 26 surviving animals showed patency of the shunt. All animals had undisturbed blood supply to the portal stump.

14 cases of carcinoid tumors over a period of 16 years are reported. There are 7 carcinoids of the vermiforme appendix, 3 of the small bowel, 1 of the rectum, and 2 carcinoids of the bronchus. No carcinoid syndrom was observed. Three patients with carcinoid tumors, localized in the small intestine died immediately post operationem. All others are still alife and followed up between 6 month and 13 years, are free of symptoms or rezidives. Poor prognosis of the carcinoids of the small intestine seems to depend on late diagnosis, complications already occured at the moment of operation, and advanced age of these patients. Different malignance is not considered to be an important factor of prognosis.

Atherosclerosis involving the terminal aorta usually is a diffuse process that commonly includes the iliac and femoral arteries. Less frequently, the lesions are limited to the infrarenal aortic segment with normal distal vessels. Patients with isolated occlusion or stenosis of the infrarenal aorta tend to be younger, more often female and have slower progression of atherosclerotic lesions. There is a causative relationship of this well-localized form of atherosclerosis to the use of oral contraceptives and heavy smoking. In 90% of the cases, surgery of these lesions is limited to endarterectomy. End results are satisfactory in a majority of the patients. Percutaneous transluminal angioplasty produces satisfactory early results for concentric stenosis, although long-term results have not yet been established.

The effectiveness of cimetidine or antacid in healing recurrent jejunal peptic ulcers after Billroth II gastric resection without vagotomy was tested in a randomized study of 18 in-patients. Mean stimulated acid secretion of the cimetidine group was 11.2 +/- 4.3 mmol/h, in the antacid group 12.6 +/- 5.6 mmol/h. Serum gastrin levels were within the normal range in all patients. Within four weeks the ulcers had healed completely in eight of the nine patients on cimetidine (1,000 mg/d), but in only three of the nine patients on antacids (magnesium-aluminiumhydroxide, neutralization capacity 564 mmol/d). The difference is statistically significant (P less than 0.025). All 11 patients with healed ulcers were given prophylactically either 800 mg cimetidine daily or magnesium-aluminiumhydroxide (neutralization capacity 564 mmol/d). During a follow-up period of one year recurrences occurred in two of the five patients on antacids, but in none of the six treated with cimetidine. The results indicate that cimetidine also accelerates the healing of recurrent jejunal peptic ulcers. But further studies are required to elucidate whether long-term treatment with histamine-H2-receptor antagonists is as good as surgery in the long-term prevention of ulcer recurrences.

Fifty-one patients, on whom a total of 64 carotid thromboendarterectomies had been performed, were followed up by duplex sonography. Five asymptomatic occlusions of the internal carotid artery (8%) and one occlusion of the common carotid artery were found. Two patients (3%) developed a restenosis of more than 50% and another two patients a restenosis of less than 50%. Changes in the vessel wall not producing significant luminal change were observed in another 18 cases (28%). Thirty-six of the operated vessels (56%) showed no change.

The postoperative blind-loop syndrome can occur after side-to-side, end-to side or by-pass anastomoses of the gut and presents clinically as malabsorption syndrome. Pathogenetically, stasis or slowing of the bowel movements will cause a rapid increase of pathogenic bacteria in the small intestine. Malabsorption is characterized by 3 symptoms: Loss of weight, anemia, steatorrhoea. The method of choice for therapy is to perform a new, end-to-end, anastomosis of the intestine in order to re-establish a physiological situation. During the last 6 years 14 patients with malabsorption syndromes of varying degrees were operated upon: 6 had pure small intestinal anastomoses, 7 anastomoses between the small and large intestine and 1 patient had a side-to-side sigmoidal anastomosis. In all patients the side-to-side or by-pass anastomoses could be reversed.

Upper gastro-intestinal bleeding or other complications after operations on this tract can lead to grave additional risk for the patient, especially in the early postoperative phase. Because of its high degree of diagnostic accuracy, emergency endoscopy is in most cases of decisive importance in planning the type (conservative or surgical) and timing of any necessary treatment. Special investigative techniques as well as the early use of endoscopy in 97 patients achieved a high rate of success at a low risk to the patients. Indications, results and risks of emergency endoscopy of the upper gastro-intestinal tract in the late postoperative phase are similar to those for the non-operated patient.

A case report is given of a 25 year old turkish patient, who had ascaridiasis and multiple stenoses of the small intestine. This syndrome was caused by extensive obliterating phlebitis of the small mesenterial veins and sclerosing lymphadenitis of the mesenterial lymph nodes. Granuloma containing epitheloid cells and giant cells could be found in the venous walls and in the lymph nodes, some of the granuloma being grouped around atrophic ascarides larvae; this demonstrates, that the intestinal stenoses represent an unusual complication of larvae migration in this worm disease. Perforation of the intestinal wall in one these stenotic areas possibly was caused by ascarides worms actively.

Seventy-three patients with vascular occlusions in the pelvis or lower limbs and three patients with upper limb lesions were treated by local low dose fibrinolysin, with strict control of any possible bleeding tendencies. Adequate recanalisation was obtained in 56 patients (73.6%). In ten patients, the occlusion recurred while the patient was still in hospital. After four to six months, 37 of the 56 (67%) of the vessels were still patent. In 18 patients, peripheral emboli resulted in some deterioration, but in 15 of these cases this could be treated successfully by operation. The methods and indications of local fibrinolysis therapy and the problems associated with it are discussed.

Fundophrenicopexy is an effective procedure for repairing important mechanical parts of the LES. Pre- and postoperative measurement of pressure in 52 patients demonstrated an increase from x = 20.1 mm Hg to x = 39.25 mm Hg. Fundophrenicopexy is the more simple surgical management compared with fundoplication and is followed less frequently by complications. If anatomical conditions allow, fundophrenicopexy is preferred in surgical treatment of reflux esophagitis.

The systemic availability of 3H-lorcainide in rats was investigated following oral doses of 1.5 to 100 mg/kg. Systemic availability increased from 14 to about 40% following the lowest and highest dose, respectively. Doses higher than 60 mg/kg produced a less marked increase of the systemic availability. In rats with portacaval shunt following an oral dose of 1.5 or 7.5 mg/kg lorcainide a systemic availability of 47% was found, indicating substantial prehepatic first-pass metabolism of lorcainide. Systemic availability of total radioactivity was 53% in control rats and 90% in rats with portacaval shunt. Since the maximal systemic availability obtained by increasing the dose was found to be identical with that obtained in rats with portacaval shunt, it is suggested that increasing doses will saturate the presystemic metabolism in the liver but will not affect the fraction of the dose which is metabolized in the gut.