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Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

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.

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.

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.

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.