Search

In a controlled randomized trial at four centers, using a common protocol, 57 patients with advanced chronic arterial occlusive disease (21 in stage III, 36 in stage IV) were treated with prostaglandin E1 (PGE1) or adenosine triphosphate (ATP) for three weeks. Both substances were administered intraarterially over 60 min. Daily dose of PGE1 was 20 micrograms, of ATP 30 mg. Both produced a significant reduction in resting pain at the end of the treatment phase, in stage III significantly better with PGE1. There was also a clear reduction in the use of analgesics, significantly more so with PGE1. Healing or improvement of ulcers was significantly better with PGE1, while there was no significant differences between the two drugs as regards stage improvement. Three amputations had to be performed in the PGE1 group, nine in the ATP group, a significant difference. Side effects in the form of reddening, pain and swellings occurred in 15 patients of the PGE1 group and six of the ATP group. Final verdict by the treating doctor about the success of treatment was significantly more favorable for PGE1.

Die native arteriovenose (AV-)Fistel ist als Goldstandard bei der Erstanlage eines Dialysezugangs anzusehen. Mit den Venen des Patienten sollte sparsam umgegangen werden. Primar sollte daher eine distale AV-Fistel angestrebt werden, um so eine lange Punktionsstrecke zu erzielen. Eine Ausnahme stellen Diabetiker dar, hier ist die Anlage einer primaren nativen Brachialisfistel indiziert. Die haufigste Komplikation der AV-Fistel ist eine Shuntthrombose. Bei der Shuntrevision sollte versucht werden, so viel Punktionsstrecke wie moglich zu erhalten, um eine Dialysetherapie unverzuglich fortzusetzen. Die Anlage eines zentralvenosen Katheters sollte vermieden werden, da eine erhohte Infektionsrate besteht. Eine Shuntinfektion tritt haufiger bei Kunststoffshunts als bei nativen AV-Fisteln auf und stellt eine lebensbedrohliche Erkrankung fur den Dialysepatienten dar.

Objective The present review gives an overview and evaluation of clinical studies proving the efficacy of EGb 761 in patients with PAOD. Methods Relevant original papers and reports on this topic were identified by means of a literature search. Only randomized, double-blind, placebo-controlled clinical trials in patients with the indication peripheral arterial occlusive disease in stage II according to Fontaine were included (only treatment with the oral form of EGb 761). For the selected studies the ratio theta of the walking distance between EGb 761 and placebo was calculated and a test for relevant superiority of EGb 761 was performed (according to the guidelines of the Deutsche Gesellschaft fur Angiologie (German Society of Angiology) [Heidrich et al. 1996]). Furthermore, a pooled estimation of the ratio was carried out. Results Nine studies complied with the criteria. The methodological quality and design of the trials were heterogeneous. In the majority of the studies, there was an advantage of EGb 761 in the increase of pain-free walking distance compared to placebo. For 7 studies, the advantage was found to be statistically significant. Testing the relevant superiority showed a significant result in 6 of the selected studies. The pooled estimator of the ratio amounts to theta = 1.23 (95% CI: 1.16, 1.31) and demonstrates the efficacy of EGb 761 over placebo as well. Conclusions This review confirms the efficacy of Ginkgo biloba special extract EGb 761. It demonstrates not only the statistical significance of the difference with respect to placebo but also the clinical relevance for the treatment of patients with PAOD.

BACKGROUND Aim of this study was to assess, by use of monitoring parameters and near infrared spectroscopy (NIRS), whether premature infants tolerate axillary temperature measurement better than rectal. METHODS Twenty-one infants were studied. Birth weight was 540-1680 g (median 840 g), weight at the time of investigation 470-1500 g (Median 920 g), gestational age 24-31 weeks (median 29 weeks), age at time of investigation 4-25 days (median 11 days). Four pairs of axillary/rectal temperatures were taken in every infant. Heart rate and oxygen saturation were monitored. Using NIRS cerebral oxygenated and deoxygenated hemoglobin were measured and total cerebral hemoglobin and the cerebral oxygenation index were calculated. RESULTS Mean heart rate increased slightly but significantly from baseline during axillary and rectal temperature measurement (axillary: +6/min (+/- 7); p < 0.0001; rectal: +4/min (+/- 6); p < 0.0001). Peak increase in heart rate was significantly higher during axillary than during rectal temperature measurement (axillary: +18/min (+/- 10); rectal: +14/min (+/- 8); axillary versus rectal: p = 0.02). There was no difference in the number of measurements during which oxygen saturation dropped intermittently below 88% (rectal: 21% of measurements; axillary: 20% of measurements). NIRS parameters were not significantly different between axillary and rectal measurements: cerebral oxygenated hemoglobin and the oxygenation index showed a decrease in cerebral oxygenation during both, axillary and rectal measurement. CONCLUSIONS Axillary temperature measurement is not better tolerated than rectal in premature infants.

Objective: For the assessment of the diagnostic value of real-time ultrasonography (US) in children with suspected acute appendicitis (a.A.) the results of graded compression US are compared with clinical and histological final diagnoses. Methods: In a prospective study over nearly 9 years we examined 1285 children aged 1–15 years (m=514, f=771). Using a 5-MHz curved array transducer the right lower quadrant was examined in a graded compression technique. Results: Prevalence of histologically proven a.A. was remarkably low (9%). In diagnosis of acute appendicitis in childhood US achieves a sensitivity of 92%, specificity of 98%, a positive predictive value of 90% and a negative predictive value of 98%. The overall accuracy was 98%. Mesenteric lymphadenitis was seen in 181 cases (prevalence 12%) and terminal ileitis occasionally accompanied by mesenteric lymphadenitis was seen in 116 cases (prevalence 9%). Conclusion: In children with suspected appendicitis US of the abdomen gives great diagnostical value for differential diagnosis of a.A. and other more frequent inflammatory diseases of the ileocoecal region. Thus US provides further reliable information to the referring physician. Consequently it is necessary to perform US in each child with acute abdominal pain, even if clinical diagnosis seems to be well established.

The appendectomy-rate in the Federal Republic of Germany is decreasing. German surgeons have begun to refuse appendectomy if there are no signs of acute inflammation. Preoperative assessment of patients with right lower quadrant pain has acquired new significance. The authors report on 2 years of experience with routine use of high-resolution ultrasonography in 669 cases of suspected acute appendicitis. Only 101 patients (= 15.1%) turned out to be suffering from acute appendicitis. Ultrasonography evaluation was found to have a sensitivity of 84.2%, a specificity of 96.8% and an overall accuracy of 94.9%. Ultrasonography was also useful in detecting mimicking diseases of acute appendicitis. Sonography should help to rule out severe disease in the frequent cases of functional abdominal pain.

This study was designed to control the results of conservative treatment using vacuum assisted wound closure (VAWC) applied exclusively to cases of deep groin infections with involvement of alloplastic graft material.During a 2 year period 10 patients with 11 deep inguinal infections involving alloplastic graft material were treated with supportive VAWC. Intraoperative management included extensive debridement, sartorius myoplastic and VAWC application. A retrospective case-note review was performed. Variables comorbidity, surgical management of the infection, microbiological results, complications and Doppler results were analysed.Six early graft infections (30 days after implantation) and 5 late infections were treated. In 3 cases (27.3%) the infected graft material was replaced by a silver-coated Dacron prosthesis. The mean duration of VAWC was 16+/-7.7 days; postoperative mean hospital stay was 25.3+/-8.5 days. Mean postoperative follow-up was 13.1 months with no procedure-related mortality.Even in the presence of synthetic vascular graft material, negative pressure therapy can greatly simplify challenging wound healing problems under maintenance of the alloplastic grafts. These preliminary results demonstrate the safety and effectiveness of VAWC for the treatment of deep alloplastic graft infections.

This study demonstrates the therapeutic value of the hybrid open and endovascular procedure in anatomically challenging thoracoabdominal aortic aneurysms (TAAAs) in high-risk patients.Between January 2000 and February 2006, 8 patients were treated with open visceral vessel revascularization and endovascular repair for TAAAs. Patient data were available from medical records. Pre- and postoperative physical examination, intra-arterial angiography, and spiral computed tomography scanning was performed in prearranged examinations.A total of 28 visceral bypasses were performed in the 8 patients: 6 patients with complete visceral vessel revascularization and 2 with an aorto-mesenteric-celiac bypass. Aneurysm exclusion was achieved through the deployment of in total 23 stent-grafts. Seven out of the 8 procedures were conducted electively and one under urgent conditions. The mean follow-up period was 21 months. We recorded one procedure-related death due to postoperative hemorrhage resulting from diffuse retroperitoneal bleeding with consecutive multiorgan failure. Moreover, one patient developed acute renal insufficiency, but returned to normal values after temporary hemodialysis. Major adverse events included 2 cases of pneumonia and one myocardial infarction. Two reoperations were performed due to one mesenteric bypass occlusion and one groin hematoma. No neurological complications were observed.The combined hybrid endovascular and open surgical approach in the treatment of complex TAAAs remains a feasible and effective operation technique. The less invasive character of the procedure and avoidance of aortic-cross clamping are clear advantages. Nevertheless, further study is mandatory to establish this alternative therapeutic option for complex TAAAs.

Native arteriovenous (AV) fistula are the first choice for primary hemodialysis access. It is essential to save as much vein as possible, and therefore distal AV shunts should be tried first. In patients with diabetes, primary brachiocephalic shunts are indicated and show better results than distal AV fistulae. The major complication of AV fistulae is shunt thrombosis. Immediate surgical repair is necessary, with the aim of preserving enough puncture sites to allow prompt continuation of the hemodialysis therapy. It is important to avoid central venous catheters, because these cause infectious complications more frequently. Shunt infections occur more often in polytetrafluoroethylene grafts than in native AV fistulae and represent a life-threatening situation for dialysis patients.

The symptomatic patient showing a string sign or ulcerative stenosis of the internal carotid artery (ICA) is subject to a high risk of arterial thrombosis or persisting intracranial embolization during the waiting period before operative revascularization.During one year 186 operative revascularization procedures of the ICA were performed on the symptomatic patient. 26 of them fulfilled the prophylactic urgency criteria: symptoms of the cerebrovascular insufficiency and a string sign or ulcerative stenosis of the ICA with ulceration greater than 2 mm in depth. These results were compared to the control group of the 157 procedures under elective circumstances.Mean clamping time of the urgency and the elective patients were 23.8 min vs. 24.5 min and operation time 50.1 min vs. 54.3 min. None of our urgency patients presented new neurological defects in the postoperative phase, while this occurred in 3.8% in the elective group. Mortality rate in the elective group was 2.7% and 0% in the urgency group. Furthermore, there were fewer local complications in the urgency group.The urgent indication for the desobliteration of the ICA showing a symptomatic string sign or ulcerative stenosis can be recommended. Early thrombosis or neurological defects during the waiting period may be prevented without increasing complication rates.

Aim of this study was to assess whether the decrease in heart rate and oxygen saturation occurring acutely after bolus administration of surfactant is different from the effect of endotracheal suctioning and whether there are effects on cerebral haemodynamics and oxygenation.Twelve premature infants, birth weight 720-1560 g (Median 935 g), gestational age 25-30 weeks (Median 28 weeks), were investigated during surfactant administration (Curosurf) as a single bolus and a preceding endotracheal suctioning procedure. Using near infrared spectroscopy changes in cerebral blood volume and cerebral oxygenation index were assessed. Heart rate, arterial oxygen saturation, PCO2, and arterial blood pressure were registered continuously. Data were compared at 30, 60 and 120 seconds after the beginning of suctioning and surfactant administration.Endotracheal suctioning and surfactant administration induced a similar decrease in heart rate (-29/min, SD 25, p0.01 and -30/min, SD 23, p0.001) during the first 30 seconds and in oxygen saturation at the 30 seconds datapoint (-3%, SD 2, p0.01 and -3%, SD 6, p0.05). The decrease in oxygen saturation persisted at 60 seconds after the start of suctioning (-4%, SD 5, p0.05). In contrast, oxygen saturation was no longer different from baseline levels 60 seconds after surfactant administration (+1%, SD 6, p = 0.5). After suctioning, cerebral oxygenation index had decreased significantly from baseline levels at 30, 60, and 120 seconds. In contrast, after surfactant administration, no significant difference from baseline was noted at 30 and 60 seconds and a significant increase occurred at 120 seconds. Mean arterial blood pressure, PCO2, and cerebral blood volume did not change significantly during endotracheal suctioning and during surfactant administration.Acute decreases in heart rate and oxygen saturation during bolus administration of surfactant are equal to effects occurring during endotracheal suctioning. However, the decrease in oxygen saturation is shorter and more importantly, no decrease in cerebral oxygenation occurs.

Ein definiertes Untersuchungsprogramm mit festgelegten Zielpunkten ist unerlasslich bei der Bestimmung des Langzeiterfolges nach der endovaskularen Therapie des Bauchaortenaneurysmas (BAA). Handelt es sich hierbei um den klinischen Behandlungserfolg, so sind klinikbezogene Kriterien aufzustellen, welche diesen Erfolg umschreiben. Im konkreten Fall lasst sich allerdings der Misserfolg der endovaskularen Behandlung leichter definieren. Die postoperativen Komplikationen der behandelten Patienten bilden als „Marker“ fur den Misserfolg die Basis fur die Bewertung des Therapieerfolges. Aus diesem Grund sind die Komplikationen und andere Faktoren zu besprechen, die im Zusammenhang mit dem Therapieversagen der endoluminalen BAA-Ausschaltung stehen. Das definierte Untersuchungsprogramm zielt auf die Feststellung und Bewertung der Komplikationen. Dieses umfasst neben der klinischen Untersuchung der Patienten eine Reihe von apparativen Diagnostikverfahren (Farbduplex, Nativrontgen, Computertomographie, Angiographie). Die Zielpunkte der postoperativen Kontrolle von endoluminal behandelten Patienten sind: Ruptur und Tod, Endoleaks, Grose des Aneurysmasackes (Diameter, Volumen), Stentdeformierung/-torsion und -migration, periphere Minderung der Durchblutung. Ein weiteres Kriterium fur die Definition des Erfolges ist die eventuelle Notwendigkeit von Reoperationen oder Reinterventionen.

Aim of this study was to assess, by use of monitoring parameters and near infrared spectroscopy (NIRS), whether premature infants tolerate axillary temperature measurement better than rectal.Twenty-one infants were studied. Birth weight was 540-1680 g (median 840 g), weight at the time of investigation 470-1500 g (Median 920 g), gestational age 24-31 weeks (median 29 weeks), age at time of investigation 4-25 days (median 11 days). Four pairs of axillary/rectal temperatures were taken in every infant. Heart rate and oxygen saturation were monitored. Using NIRS cerebral oxygenated and deoxygenated hemoglobin were measured and total cerebral hemoglobin and the cerebral oxygenation index were calculated.Mean heart rate increased slightly but significantly from baseline during axillary and rectal temperature measurement (axillary: +6/min (+/- 7); p0.0001; rectal: +4/min (+/- 6); p0.0001). Peak increase in heart rate was significantly higher during axillary than during rectal temperature measurement (axillary: +18/min (+/- 10); rectal: +14/min (+/- 8); axillary versus rectal: p = 0.02). There was no difference in the number of measurements during which oxygen saturation dropped intermittently below 88% (rectal: 21% of measurements; axillary: 20% of measurements). NIRS parameters were not significantly different between axillary and rectal measurements: cerebral oxygenated hemoglobin and the oxygenation index showed a decrease in cerebral oxygenation during both, axillary and rectal measurement.Axillary temperature measurement is not better tolerated than rectal in premature infants.

Arterielle Verschlusse im femoropoplitealen Bereich sind auf die untere Extremitat bezogen am haufigsten vetreten. Etwa ein Drittel der Patienten weist ein Mehretagen-Gefasverschlus auf. Hierbei wird die einzeitige Revaskularisation von Einstrom und Ausstrom in Form von kombinierter operativer und interventioneller Therapie befurwortet.

Intravenous iloprost, titrated from 0.5 up to 2.0 ng/kg/min has been shown in patients with PAOD III/IV to significantly improve healing of trophic lesions, relief of rest pain, and reduce the rate of major amputation or death at 6 months as compared to placebo. The effect is considered related to improvement of the microcirculation. The aim of the present trial was to identify an optimum dose regarding treatment response and tolerability, by studying 4 doses of 25, 50, 75 and 100 micrograms iloprost daily.302 patients with PAOD IV were randomised via a double-blind fashion to one of the 4 doses. The primary endpoint was the responder rate at end of treatment. Responders were defined as patients with very good or good global efficacy, as judged by lesion healing and pain relief. Side effects were documented and a pre-defined benefit/risk index was calculated.No dose-dependency of iloprost regarding primary or secondary endpoints was observed. The rate of responders ranged between 48.7-53.5%. Side effects, mainly related to vasodilation, increased dose-dependently (p0.001, chi 2-test), with a significant decrease of the benefit/risk index from 2.19 +/- 1.19 to 1.64 +/- 0.97 (p = 0.012, ANOVA). Responders had a better outcome at 6 months than non-responders (2.6 fold higher rate of major amputation or death; life table analysis).It is concluded that iloprost should be titrated to the optimum rather than maximum tolerated dose, since a higher incidence of side effects not associated with an increased treatment response was observed at higher doses.

In the time period January 1986 until April 1995 54 patients were sent to our hospital for further treatment after PTA procedure. 41 of these patients came from foreign hospitals and 13 patients had been treated with a PTA in our own radiological department. Of the mentioned 54 patients, 36 were women and 18 were men with an average age of 49 to 86 years. A high-risk group was not age linked, however, almost all patients had indulged in nicotin over years, suffered from hypercholesterolaemia or had noticed claudication over a number of years.

After a long period of up and downs, carotid surgery has become, not least due to the results of recent multicentre studies (1, 2), a worldwide established procedure in preventing cerebro-vascular accidents. The history of carotid surgery is accompanied by controversies about the indications and the operation technique and in most issues no definite answer is found.

Das retrorektale zystische Hamartom oder „Tailgut-Cyst“ findet seinen Ursprung in der Embryologie als Relikt aus dem letzten Teil des Darmrohres, distal der Kloakenmembran. In der Literatur wird uber diesen Tumor nur sehr selten berichtet. Der Fall einer 21jahrigen, Patientin dessen Klinik, radiologische Diagnostik, Operation, Histologie und Verlauf wir darstellen, unterstreicht die Bedeutung einer exakten praoperativen Diagnostik. Der Tumor ist ohne Zuwarten und in toto zu exstirpieren, um die durch seine Grose hervorgerufene Komplikationsrate minimieren und eine in 2% der Falle mogliche maligne Entartung verhindern zu konnen. Hierzu bieten sich der transanale, der transsakrale oder der abdominosakrale Zugang an.

The surgical treatment of high-grade extracranial stenosis of the carotid artery has been shown to reduce the incidence of cerebral vascular disease (4, 13). This elective and prophylactic surgical treatment must meet high quality standards with respect to preoperative diagnostics and operative management to be of benefit to the patient. Operations on arteries supplying the brain must be considered high-risk procedures and should therefore be performed with the highest possible level of security. Intraoperative monitoring of brain function is desirable since neurological complications cannot be detected intraopera-tively by clinical examination. These monitoring methods should be reasonably simple to perform, sensitive, reliable, and cost effective. The method of median-nerve evoked somatosensory evoked potentials (SEP) fulfills these requirements.

Since reports of the first successful carotid endarterectomy in the early 1950s (3), considerable controversy has evolved regarding the technique und technique of arteriotomy closure. Multiple authors have advocated the use of patch angioplasty in an attempt to decrease the reported high incidence of recurrent carotid artery stenosis after CEA (1, 5, 8). Equally controversial has been the selection of patch material, with supporters for both autogenous tissue and synthetic patches (7, 9,10).

Increasingly and justifiably, clinical studies are now being expected to investigate the influence of therapeutic measures also on the quality of life of the patient.Since no data on the variability of changes in the quality of life of the patient following PGE1 treatment are so far available, the initial investigation was designed as an uncontrolled pilot study. 104 patients (median age 64.5 years) with a maximum of walking distance on the treadmill (3 km/12%) of 50-250 m were included and given a daily intravenous infusion of 60 micrograms PGE1 (Prostavasin) over a period of 4 weeks excluding weekends. This was followed by a treatment-free follow-up period of 3 months. Changes in the quality of life were recorded with both the newly developed disease-specific questionnaire PAVK-86, and the generic questionnaire SF 36; in addition, the pain-free and maximum walking distances on the treadmill were also established prior to and immediately following treatment, as also at the end of the follow-up period.The quality of life was significantly improved in all dimensions (functional status, complaints, pain, mood, anxiety, social life, treatment expectations) in addition to a marked increase in the median pain-free walking distance from 77 to 108 m (p0.001) and the maximum walking distance from 118 to 171 m (p0.001). At the end of the 3-month observation period, the improvement was essentially still demonstrable.The study has shown for the first time that treatment with intravenous PGE1 brings about not only the already known increase in the walking distance, but also a clinically relevant and significant improvement in the patient's quality of life.

Additional therapy of symptomatic popliteal artery aneurysm includes intraoperative lysis for the treatment of the descending thrombosis and spinal cord stimulation for cases of chronic deterioration of the peripheral perfusion state. Between 1989 and 1996, we treated 50 patients with 55 symptomatic aneurysms using this concept, 18 of them as emergency cases. We reached a postoperative amputation rate of 12.7% and good long-term functional results in 34 of 37 patients.

Both transverse lie and preterm premature rupture of membranes (PPROM) are associated with neonatal morbidity and mortality. We present a neonate born at 29 weeks gestation with severe birth trauma after PPROM and transverse lie. The patient had extensive swelling and areas of desquamated and necrotic skin of the right lower limb. Neonatal compartment syndrome (NCS) was suspected. Perfusion of the limb improved after decompressing subcutaneous incisions. A fetus in transverse lie may be mechanically damaged in the case of PPROM, especially at an early gestational age. Early recognition is of great interest in the management and prognosis of NCS.

The tromboembolic and ischemic events during carotid endarterectomy can be avoided or detected with appropriate monitoring. Median nerve somatosensory evoked potentials recorded from the parietal cortex correlate with the blood flow in the middle cerebral artery. The good evoked responses after cross-clamping of the carotid artery indicate a sufficient collateral circulation, enabling a surgery without shunt, thus minimizing the risk of embolisation. Insufficient collateral circulation after cross-camping results in an amplitude reduction of the parietal N20-P25 complex of more than 50%. In this case an ischemic event can be prevented by shunting. As a total 83 carotid endarterectomies were done. In 65 cases (78.3%) the evoked potentials showed no significant alteration, and no postoperative neurological deficit occurred. Seven patients (8.45%) needed to be operated with a shunt, because of cross-clamping ischaemia. One of them presented a transient postoperative hemiparesis, which was predicted by the long-term loss of the SEP-s, and which resolved within 4 hours. Seven further patients (8.45%)--operated primarily with shunt, and 4 patients (4.8%)--monitored with transcranial Doppler sonography, showed no postoperative neurological deficit. We found that median nerve somatosensory evoked potential monitoring during carotid endarterectomy is a simple, sensitive and reliable method.

Berichtet wird uber 356 nachuntersuchte Operationen an der A. subclavia in den letzten 15 Jahren. 128 Patienten erhielten eine Subclavia-Carotis-Transposition, 228 Patienten wurden mit einem Bypass versorgt. An Operationsfolgen verstarb nur ein Patient der Bypass-Gruppe. Neurologische Komplikationen traten selten, aber ebenfalls nur in der Bypass-Gruppe auf. Dagegen werden technische Schwierigkeiten bei der Transposition der A. subclavia hervorgehoben. Bei der Transposition wird nur eine Anastomose erforderlich. Beim Vergleich der beiden Techniken uberwiegen die Vorteile fur die Transposition.

Spinal cord stimulation is a medically accepted therapeutic modality for the control of chronic pain (21, 25). For the past two decades, spinal cord stimulation has been advocated as a method of pain relief for therapeutic refractory ischemic pain (8). Strikingly, in vascular patients not only pain relief could be achieved but also healing of ischemic ulcers (2, 7, 10, 11, 12, 13, 24). This suggests that spinal cord stimulation improves the nutritional skin blood flow. This was confirmed in recent studies (15). However, there is a lack of prospective randomized studies, evaluating the effect of spinal cord stimulation on wound healing and limb salvage. Therefore we evaluated the efficacy of spinal cord stimulation on ulcer healing and limb salvage in a randomized-control study in patients with non-reconstructible PAOD undergoing 3 weeks i.v. PG E1. There is enough evidence that prostaglandins are valuable drugs for patients with rest pain and ischemic ulcers. There are no significant differences between the prostacyclin analogue iloprost and PGE1. In several studies it appeared that up to 60 % of patients given iloprost experienced significant pain relief and healing of ischemic ulcers and that during follow-up significantly more patients on iloprost than on placebo were alive without a major amputation (1, 3, 4, 5, 6, 9, 14, 23, 26).

Under study was the efficiency of epidural electrical stimulation of the spinal cord (ESSC) of 237 patients with obliterating diseases of the peripheral arteries. Reconstructive operations proved to be impossible in all the patients, and conservative treatment was not successful. The clinical status of 169 patients was determined as the 3rd stage, in 68 patients as the 4th stage after Fontain. The period of observation was 35.6 months at an average. High amputation was performed in 64 patients in spite of ESSC. In the other cases when the extremity could be kept safe, the intensity of pain was considerably relieved (more than 75%). We believe that ESSC can considerably relieve the intensity of the pain syndrome and improve the quality of life in patients with critical ischemia of the extremities when traditional methods of treatment are not possible.

Intraoperative autotransfusion is currently performed using two different systems, the relatively expensive cell-saving device washes and concentrates red cells and the more simple, economical total disposable device for whole blood collection and retransfusion. Some institutions prefer the cell-saving device because of previously documented side-effects of whole blood autotransfusion. As some investigators more recently reported the application of whole blood autotransfusion without clinical complications, the potential hazards of whole blood autotransfusion are now being controversially discussed.The potential side-effects using whole blood autotransfusion were studied in 100 patients prospectively undergoing venous thrombectomy. The effectiveness of homologous transfusion reduction was assessed in comparison with an historical patient group (n = 10, control group).In the study population a mean of 1064 ml shed blood (67% of total blood loss) was retransfused. A mean of 247 +/- 292 ml of homologous blood was transfused in the study group. In contrast, homologous blood requirement was significantly higher (1056 +/- 659 ml, p0.006) in the control group. No hematologic, hemeostatic, renal or pulmonary complications occurred after intraoperative whole blood autotransfusion.Whole blood autotransfusion is a safe, easy and economical procedure and highly effective in reducing homologous blood transfusions and costs.

Der Film zeigt die Kombination von intraoperativ durchgefuhrter Laser-angioplastischer Verbesserung der nachgeschalteten kruralen Strombahn mit einem in gleicher Sitzung angelegten supragenualen femoropoplitealen Bypass. Er prasentiert die statistische Auswertung von 16 gleichartigen Fallen im Krankenhaus Porz seit 1991 unter Berucksichtigung der Offenrate des Graftes (87%), des Primarerfolges der Laser-Angioplastie (71%) sowie deren Offenrate nach drei (66%) und sechs (58%) Monaten.

Kongenitale Gefasmisbildungen sind seltene Erkrankungen im Alltag eines Gefaschirurgen. Sie stellen eine inhomogene Gruppe von isolierten oder multiplen Malformationen dar, die mit komplexen Syndromen assoziiert sein konnen. Das Erkennen und die korrekte Klassifizierung dieser seltenen Misbildungen kann im Einzelfall schwierig sein. In der vorliegenden Literatur ist die Terminologie gefaschirurgisch relevanter Anomalien haufig ungenau und inkorrekt [14, 56]. So werden primare arterielle Aneurysmen haufig als kongenital bezeichnet, obwohl sie erst im Laufe von Jahren entstehen [14]. Arteriovenose Malformationen oder Hamangiome werden als kongenitale Gefasmisbildungen undifferenziert AV-Fisteln genannt, obwohl AV-Fisteln per definitionem erworben sind [8]. Das Paragangliom der Arteria carotis wird falschlicherweise „Karotistumor“ genannt [18].

High-resolution real-time ultrasound (US) with a 5 MHz transducer has proved to be an important method in the diagnosis of acute appendicitis. In a prospective study we examined 2074 unselected patients with suspected appendicitis to assess the diagnostic and epidemiological value of US. According to the clinical diagnosis females aged 10 to 30 represented the majority of suspected cases. Appendicitis was most often proved in male patients aged 15-30 years. The prevalence of acute appendicitis in childhood is lower (7%) than in elderly patients (33%). US enables the diagnosis of acute appendicitis with a sensitivity of 91%, a specificity of 98% and an overall accuracy of 97%. For differential diagnosis US demonstrates other diseases that mimic acute appendicitis. Thus it is possible to reduce the negative appendectomy rate particularly in children by revealing mesenteric lymphadenitis or terminal ileitis and in young women by directing attention to gynecological diseases.

The authors report a case of extracranial aneurysm of the internal carotid artery. This case of a 53-year-old man demonstrates how difficult an early and exact diagnosis can be, even in these days with their considerable variety of modern diagnostic techniques--depending on the order of their use. In comparable cases, we therefore postulate the early use of angiography, neuromonitoring during the operation and the ultrasound-examination of the complete arterial system in search for further aneurysms.

"Exulceratio simplex Dieulafoy" is a rare cause of massive upper gastrointestinal haemorrhage from a submucosal artery. Dieulafoy's disease is rarely recognized. We present 9 cases of Dieulafoy's lesion and have collected 176 cases described in the literature.

"Exulceratio simplex Dieulafoy" is a rare cause of massive upper gastrointestinal haemorrhage from a submucosal artery. Dieulafoy's disease is rarely recognized. We present 9 cases of Dieulafoy's lesion and have collected 176 cases described in the literature.

Der analgetische Effekt der epiduralen Ruckenmarksstimulation (RMS) ist bereits seit mehr als 20 Jahren bekannt. 1967 fuhrten Shealy und Mortimer (13) die RMS als Therapie zu resistenten chronischen Schmerzen verschiedener Genese ein. 1973 und 1976 beschrieben Cook und Oygar (3,4) den positiven Effekt der Hinterstrangstimulation bei peripheren Durchblutungsstorungen. Diese Beobachtungen boten neue Perspektiven in der Behandlung des konservativen oder chirurgisch austherapierten arteriellen Verschlusleidens.