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The surgical procedure for recurrences at the saphenofemoral junction represents a great challenge for the surgeon due to the complex anatomic variability, the broad range of causes and the mostly extreme scar tissue. The incidences of postsurgical minor and major complications after recrossectomy in the groin area are determined and the clinical outcomes are analysed in this article. After specific and precise presurgical clinical and sonographical diagnoses having been undertaken a cutaneous incision is performed in the groin with the aid of tumescent local anaesthesia combined with total intravenous anaesthesia. From the proximal site any scar tissue exsisting is meticulously removed, the femoral vein is set free and the still remaining stump of the long saphenous vein or of the neovasculate as well as all left over varicose side branches of the saphenofemoral junction are removed. Within this special surgical procedure the stump of the long saphenous vein or the neovasculate are completely removed and, thereafter, a continuous longitudinal suture of the femoral vein is performed. Uncomplicated minor bleeding complications (haematoma in large extension or disseminated) appear quite frequently, lymphatic minor complications (conservatively treatable lymph oedema, lymphatic fistulae or lymphatic cysts) occur from time to time; major complications such as bleeding complications with the necessity of surgical reintervention occur only in sporadic cases and can be avoided by exact presurgical diagnosis, by meticulous special surgical technique matching the operation site as well as by regular and frequent postsurgical follow-ups. Absolute preconditions to achieve the very best results in the long run are the exact procedures of diagnosis and surgical technique. Performed by experienced phlebosurgeons or vascular surgeons, the recrossectomy of the saphenofemoral junction represents a low-risk surgery for the patient and is a singular and possibly time-consuming challenge for the surgeon., (© Georg Thieme Verlag KG Stuttgart ˙ New York.)

Soft tissue sarcomas are rare malignant neoplasms accounting for only 1% of malignant tumors in adults. Complete surgical resection of the tumor is key for therapeutic success. Comprehensive diagnostic imaging significantly contributes to adequate preoperative planning. With effective targeted molecular pharmacotherapies entering the clinical scenario, functional imaging strategies will have a significant effect on individual risk assessment and will contribute to optimized, noninvasive treatment response monitoring.

Spontaneous renal rupture is a rare but nevertheless life-threatening complication in cases of benign and malignant space-occupying lesions in the kidneys. A precise preoperative differentiation often turns out to be difficult because of the formation of a hematoma. We report on a 50-year-old female patient with a retroperitoneal hematoma due to a spontaneous renal rupture for which an angiomyolipoma could only by diagnosed after the nephrectomy with histological work-up. In search of the cause, sonography, abdominal computed tomography, and digital subtraction angiography were conducted, which could provide findings suggestive of a space-occupying lesion, but because of the distinct hemorrhagic infarction could not determine whether it was benign or malignant. As shown in this case, when the radiological result is ambiguous, renal exposure is indicated from both a diagnostic and therapeutic standpoint.

Hemangiopericytomas are rare perivascular tumors. The nasal cavity and paranasal sinuses are most often involved in the head and neck region. A case of hemangiopericytoma in a 63 year old patient is presented. The initial symptom was recurrent bleeding from the nose. The patient had a history of radiotherapy for a pituitary adenoma 30 years previously. Computed tomography and magnetic resonance imaging showed a polypoid opacification of the ethmoid, sphenoid and basal aspects of the frontal sinus on the right side. Histological diagnosis was obtained from nasal biopsy. Preoperatively, arteriography and tumor embolisation were performed. The tumor was completely excised using a combined endonasal and external approach as an osteoplastic revision of the frontal sinus via bicoronal incision. There was no recurrence at follow-up 1 year later.

Meningioangiomatosis is regarded as a rare, benign, hamartomatous malformation. Histopathologically, the lesion is characterized by circumscribed transcortical and leptomeningeal meningovascular proliferation with focal calcifications. It may be classified into cases with predominant cellular or vascular features and may occur in association with neurofibromatosis, mostly of type 2, but sporadic cases are more frequently reported. Sporadic cases often present initially with seizures and can be treated surgically. However, a certain percentage of patients will need ongoing anticonvulsive therapy. The lesions are seldom associated with an overlying meningioma. These are usually benign lesions that must be strictly separated from an invasive anaplastic meningioma, which would warrant an adjuvant therapy. We report on a 4-year-old girl who presented with spontaneous, predominantly cellular meningioangiomatosis with associated fibrous meningioma. Focal immunopositivity of the meningioangiomatosis for CD34 was helpful in ruling out an invasive meningioma.

A meticulous dissection of the sapheno-femoral junction (SFJ) at the time of primary surgery is regarded as best protection against the development of recurrences from this area. However, despite correct ligation of the junction recurrences may occur. In a prospective randomised trial, which has been started in 1998, we want to find out, whether this regrowth might be inhibited by the use of different ligation technics of the SFJ: Group 1: Ligation of the SFJ with resorbable Vicryl Group 2: Ligation with Vicryl and continuous non-resorbable stitching over (Prolene) the saphenous stump which precludes contact between free stump endothelium and the surrounding subcutaneous tissue Group 3: Non-resorbable ligation of the SFJ (Ethibond) Group 4: Ethibond ligation with Prolene stitching over the saphenous stump. The first follow-up examinations, which have been done by color-dupley-scan are presented. In each group about n = 100 groins could be examined. We found slight inguinal insufficiency due to a small branch of the femoral vein in group one: n = 10; group two: n = 6; group three: n = 3; group four: n = 1. Our hypothesis that the use of the suture material or the free lying stump endothelium might be influencing the development of the neovascularisation, seems to be supported by these results. We found the lowest rate of postoperative inguinal refluxes in the Ethibond-Prolene group, where the contact between free stump endothelium and the surrounding subcutaneous tissue is precluded. However, definite reliable data will be presented not before the third follow-up (24 months after the operation).

Background: There are conflicting reports on the value of cyclocryotherapy and it seems that the success rate is depending on glaucoma conditions, the period of follow-up and the technique. This retrospective study was carried out to assess the efficacy and complication rate of cyclocryosurgery for advanced glaucoma with and without neovascularization., Patients and Methods: We induced 76 eyes of 75 patients with inadequately controlled glaucoma, which underwent cyclocryotherapy during the period of 1993 and 1996 (treatment time 60 seconds with -80 degrees C, 6-12 applications (mean 9.8 +/- 2.3), 180-360 degree (median 270 degree), diameter of the probe tip 2.5 mm, 1-2 mm distance from the limbus). Depending on the etiology we distinguished between neovascular (NVG) and non-neovascular glaucoma (nNVG). Pre- and postoperative data from all patients were studied retrospectively, for follow-up after 12-36 months patients were examined., Results: Intraocular pressure (IOP) decreased in all patients from 44.7 +/- 12.6 mm Hg preoperatively to 15.6 +/- 6.5 mm Hg postoperatively after a follow-up of 12-36 months. In 88.2% IOP was lowered to < or = 25 mm Hg. NVG showed a mean IOP reduction from 49.1 +/- 12.5 mm Hg before cyclocryotherapy to 15.6 +/- 5.0 mm Hg at follow-up. In the nNVG group IOP was 40.5 +/- 11.3 mm Hg and 15.7 +/- 7.6 mm Hg after cyclocryotherapy. Pressure was controlled (< or = 25 mm Hg) for 83.8% of NVG and 92.3% of nNVG. A cyclocryotherapy-induced intense inflammation was seen more frequent in NVG (43.2%) than in nNVG (17.9%). 2 patients with NVG and 3 with nNVG developed phthisis postoperatively (total 6.7%)., Conclusions: Cyclocryosurgery is an effective method to reduce IOP in advanced, refractory glaucoma, when other methods have failed. The risk/success rate seems to be acceptable.

Unlabelled: The surgical removal of choroidal neovascularization (CNV) in age-related macular degeneration (AMD) causes a retinal pigment epithelial defect (RPED) corresponding to the area of diffuse RPE damage. We describe angiographic features of recurrent CNV in AMD after surgical membranectomy in order to elucidate the nature of persistence and recurrence., Methods: After digitalization of the pre- and postoperative fluorescein angiographic images of eight patients with recurrent CNV in AMD we determined the morphology (well or ill-defined) and the area of the CNV and of the subretinal hemorrhage preoperatively and of the recurrent CNV and of the RPE defect postoperatively., Results: The nature of recurrences showed differences between preoperatively well- and ill-defined CNV. Four preoperatively well-defined CNV with surrounding subretinal hemorrhage showed recurrences in the entire area of the preoperative CNV excluding the retinotomy 8-9 weeks postoperatively. Four preoperatively ill-defined CNV with subretinal hemorrhage developed marginal recurrences at the rim of the RPED. There was no background fluorescence in the area of the RPED., Conclusion: The nature of recurrences extending over the entire area of the preoperatively well-defined CNV without loss of background fluorescence only a few weeks after surgical removal of well-defined CNV suggests partial persistence. The removal of the subretinal well-defined CNV could leave sub-RPE parts in locations that preoperatively cannot be visualized angiographically. The marginal recurrence of preoperatively ill-defined CNV weeks to months postoperatively shows angiographic similarities to recurrent CNV after laser coagulation.

The pathologist's contribution to decision-making for or against breast conserving treatment is based on his examination of the specimen from primary tumour surgery. First-line criteria for the assessment of the specimen are completeness, contour and versus plurifocal/multicentric spread), intracanalicular tumour components, lymphangiosis and haemangiosis. Second-line criteria are the histological and cytological grade of malignancy, preconditions for breast conserving treatment are favorable in consolidated in situ carcinomas up to 25 mm in diameter and in unifocal invasive carcinomas up to stage pT2 with low grade malignancy and without additional intraductal spread or angiosis. Breast conserving treatment is not indicated for multifocal or pT4 carcinomas and for carcinomas with extensive intraductal components or angiosis. When considering an unselected group of breast cancer patients, the pathological anatomic preconditions for breast conserving treatment will be very favourable in one-quarter of the cases. This approach will be feasible with limitations only in another one-fourth of the cases, whereas in about 50% of the patients, breast conserving treatment is dubious or should be rejected.

The aim of the radical resection of lung tumors is curative treatment. However, in each lung tumor of more than 2 cm in diameter an angioinvasion of tumor cells could be proved by morphological means. Frequently, the existence of lymph nodes and especially hematogenic dissemination is underestimated at the time of resection. By pathological-anatomical means in 33% of T1/T2-N2 and 60% of T1/T2-N3 lung tumors, disseminated tumor cells or organoid metastasis in the bone marrow can be demonstrated. Therefore, the demand for radicalness of the surgeon does not agree with a curative tumor therapy in more advanced tumor stages. Actually, the course of the disease following a local radical resection is predominantly predetermined by the individual hematogenic metastatic spread.

Angiogenesis is an essential condition for tumor growth. Therefore, it seems to be of interest to prove if blood flow and vascularization of breast tumors give information concerning their dignity. Consequently, 205 patients with palpable and/or mammographically detected breast tumors were examined prior to surgery by doppler sonography for blood flow in the area of the tumor. In 174 patients of this group the corresponding area of the contralateral breast was also screened by doppler ultrasound. With third doppler generation angiodynography tumors can be visualized as B-images with simultaneous information on vascularization. An integrated doppler system shows the detected blood flow in form of a doppler curve, also allowing quantification according to doppler criteria (Resistance Index RI). Blood flow detection in the tumor itself was successful in 71% of all malignancies, whereas in only 6.6% of the 76 benign lesions (n = 5) blood flow was found in the central tumor area. In the area surrounding the tumor blood flow was detected in 83% of all carcinomas, but only in 29% of benign findings. Blood flow could be detected significantly higher in malignancies than in benign lesions (p = 0.003). Blood flow detection in the tumor itself was a highly specific (93%) method of discrimination between malignant and benign breast tumors. Further quantification by means of doppler parameters only increases insignificantly specificity, quantification of blood flow in the area surrounding the tumor using the RI and the comparison with the contralateral breast could improve the diagnostic value as our findings RI < 8 for benign vs. > or = 8 for malignant lesions demonstrated. Detection of malignant tumors showed a sensitivity of 80%, a specificity of 90%, and a positive predictive value of 93%. In patients with breast cancer (histologically confirmed) the detection rate of blood flow in tumors and surrounding areas was independent of tumor size or nodal status.

Background: In the literature laser treatment in ischemic central retinal vein occlusion (CRVO) is established to prevent iris neovascularization. We investigated the relationship of morphological and fluorescein angiographic findings with the results of laser treatment., Patients and Methods: In 70 (56%) of 125 examined patients with central retinal vein occlusion laser treatment was performed. Indications were either ischemic type of occlusion or macular edema with visual acuity < or = 0.5., Results: The results compare visual acuity before and after laser treatment (three months and 11.5 months on average) examined by Wilcoxon-test. There was no significant improvement in visual acuity (p = 0.62). After laser treatment 3 (9%) patients with ischemic CRVO developed iris neovascularization and 2 (6%) neovascular glaucoma. There was no correlation between visual outcome and ischemia type (non ischemic type p = 0.61, ischemic type p = 0.67), maculopathy (cystoid macula edema p = 0.87, ischemic maculopathy p = 0.5) and internal diseases (hypertension p = 0.43, diabetes mellitus p = 0.74)., Conclusions: The results of this study indicate that there is no significant visual improvement in patients with CRVO after laser treatment. There are no morphological and angiographic findings indicating a subgroup with good visual prognosis.

Nine eyes were treated by cryotherapy applied circularly over a large area: 4 rows in each quadrant, from 3 mm behind the limbus to the equator, with 4 burns in each row. Freezing time was 10 seconds. Clinical observations after an average of 19.4 months and histologic findings are communicated.

A retrospective study was conducted covering a total of 229 patients with choroidal neovascularizations in age-related maculopathy. Of these patients, 81 had been treated by photocoagulation and 148 had been followed up without treatment. After four years' follow-up of statistically comparable groups the photocoagulation group showed significantly better results than the control group with regard to both final visual acuity (p = 0.01) as well as changes between initial and final visual acuity (p = 0.03). This therapeutic effect of photocoagulation treatment in extrafoveolar choroidal neovascularization was only observed in patients followed up for a maximum of six years (p = 007), while in patients who had been followed up for longer periods of time similar visual results between the coagulation and control groups were found (p = 0.4).

Between 1982 and 1985, cataract extraction was performed on 144 eyes of 122 diabetics, and the early and late complications of the operation were recorded. There was seldom any intraoperative hemorrhaging or any postoperative anterior chamber hemorrhaging. On the first day after the operation, increased IOP was measured more frequently in diabetic patients than in those without diabetes. Diabetic retinopathy deteriorated in 12 eyes, while hemorrhaging glaucomas occurred in 5 eyes.

A large variety of diseases may cause a subretinal neovascularization originating from choroidal vessels. Four cases of parapillary choroidal neovascularisation are described, including neovascularization caused by senile and myopic degeneration, by drusen of the optic nerve head, and by angioid streaks. Obliteration of the neovascular membrane with confluent argon laser coagulation reduced metamorphopsia and prevented a progredient loss of visual acuity in all four patients.

Patients with neovascularization of the iris were treated with cryocoagulation of the peripheral retina alone (Group A, n = 29), or in combination with cryocoagulation of the ciliary body (Group B, n = 19). The basic disease was either diabetic retinopathy or occlusion of the central retinal vein. After a follow-up of at least six months, a marked reduction in neovascularization of the iris was seen in most eyes. Intraocular pressure was reduced from a mean of 35.4 to 13.4 mm Hg in Group A, and from 55,2 to 6 mm Hg in Group B. A phthisis bulbi developed in six of 30 eyes (20%) in Group A and in 11 of 20 eyes (55%) in Group B.

The size of macular scotomata is determined numerically by a series of parallel F2 programs of the Octopus Perimeter. As long as useful foveolar fixation is maintained, the results are reproducible within the limits due to fluctuation of the retinal sensitivity. The scotomata can be mapped on a fundus photograph either by direct calculation or after perimetric determination of a reference distance, e.g., foveola-disc or between angioscotomata. This method furnishes useful information which can facilitate evaluation of different types of lasers in macular photocoagulation.