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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.

A distinction is made between acute injury to the diaphragm (18 cases) and late sequels of such lesions (enterothorax, 9 cases). The acute trauma is often not felt as such and it is only after some time that its consequences manifest themselves. The effect of a trauma on the diaphragm depends on whether the former acts on the abdomen or thorax. Surgical repair of the damaged diaphragm is nearly always feasible regardless of whether the operation is performed at an early or late stage of the injury. In only two cases (since 1963) was it necessary to resort to heteroplastic material, viz.: lyophilized dura mater. The possibility that viscera displaced into the thorax are also injured must be taken into consideration. Rupture of the diaphragm involved the left side in 95% and the right half in 5% of the cases (protection provided by the liver).

The changes in the blood cell count and in the blood chemistry (fibrinogen in the plasma, Fe and Cu in the serum) that we have found, were only seen in a late tumor state. This is also valid for the serum aldolase activity, which is said to be a screening test for a recurrency of a tumor.

Diagnostic and therapeutic possibilities for esophageal varices hemorrhage in portal hypertension are indicated with reference to 149 patients. In the acute phase, operative measures are to be rejected because the lethality is too high. Conservative treatment with a Blakemore-Sengstaken probe should always be introduced at first. After confirmation of the conditions in the liver, a pressure-reducing anastomosis operation (delayed emergency shunt) must be performed. For this purpose we prefer the terminolateral splenorenal anastomosis.

Morphology, clinical signs and symptoms as well as surgical therapy of ulcerative colitis are discussed comparing own findings with results reported in the literature. Case reports are given of 48 patients with special emphasis on indications for surgical treatment, methods of surgery and complications. Timing of surgery and medical pretreatment do play a decisive role. The treatment of choice today is proctocolectomy with terminal ileostomy in one session; more serious complications as well as transition into a carcinoma can thus be avoided. In some acute cases a fistula-operation may be indicated for short-term relief.

In 12 anesthetized beagle dogs breathing spontaneously flow in the hepatic artery (168 ml/min + 10 SEM) and portal vein (576 ml/min +/- 20 SEM) was measured by means of angiodensitometry. Total hepatic blood flow (THBF) was 185 ml/100 g/min +/- 11 SEM. In our opinion this relatively high THBF depends upon the method used.

43 multiple carcinomas of the colon and rectum were studied. 20 of those tumours showed a simultaneous manifestation, and 23 of them a metachroneous one. The interval between primary and secondary manifestation varied from 1 to 17 years. This clearly demonstrates that even after a very long tumour-free interval a secondary manifestation of the carcinoma can still be possible. The high percentage of multiple carcinomas of the colon calls for a careful preoperative diagnosis and an extensive intraoperative exploration of the whole colon. After hospitalisation a repeated check-up (3 months) is needed in the outpatients department to detect any secondary or recurrent carcinoma at the very earliest stage. In this way we were able to find 23 metachroneous manifestations and 27 recurrent carcinomas which were still resectable. The treatment of choice for polyposis coli is total colectomy.

Familial polyposis of the colon and rectum does always present an absolute indication for immediate total colectomy because of the predictable malignant degeneration. The patient concerned as well as his family have to be examined and treated if necessary. 12 such cases have been operated upon in the surgical Department of the University of Mainz Medical School. In 4 cases proctocolectomy with terminal ileostomy were performed, in 7 cases ileorectostomies. The procedure of mucosectomy with subsequent pulling of the terminal ileum through the colon (Hochen-egg and Reifferscheid) has been tried by us so far only in animals. Since a terminal, life-long ileostoma does present a considerable disadvantage for the mostly younger patients we did perform in most cases an ileo-rectal end-to-end anastomosis. This procedure can be looked upon as adequate cancer prophylaxis if control rectoscopies are performed regularly in cooperative patients.