Mesh contact with a nerve removed from its natural bed may cause chronic long-term pain. The combination of IIN neurolysis and the Lichtenstein repair should be avoided.

Diagnostic accuracy of acute appendicitis remains insufficient, with an unacceptable high rate of unnecessary operations. Only the promotion of routine ultrasonography might contribute to an improvement in the near future.

Based on data obtained in a prospective, multicenter trial investigating the surgical treatment of colorectal carcinomas, the aim of this study was to investigate the value and relevance of Hartmann's procedure compared with alternative surgical approaches in elective interventions and emergency situations in carcinoma of the rectum (n=10,355) and the left hemicolon (n=8,825). Only in 3.4% (n=353) of patients with rectal carcinoma was the Hartmann's procedure executed with curative intention, indicating that this approach is recommendable only in (1) rare emergency situations (1.66%, n=172), (2) selected cases with elective intervention such as high-risk patients or subjects with poor prognosis, and (3) individuals with rectal carcinoma of the lower third who require deep resection (2+3, 1.75%, n=181). However, Hartmann's procedure resulted in the lowest mortality (7.5%) of the various procedures aiming for radical resection in the case of luminal obstruction or perforation at the left hemicolon. With palliative intention, 4.3% of patients with rectal carcinoma (n=449) received primary colostomies. At the left hemicolon, palliative segmental colon resection with primary anastomosis maintaining intestinal passage showed the lowest mortality (6.1%) and perioperative morbidity (33.9%) under elective circumstances, whereas Hartmann's procedure was preferred in emergency situations.

Zusammenfassung. Von 1960Von -1980 wurden an der Chirurgischen Klinik der UniversitM Mfinchen 39 Patienten wegen maligner hormonaktiver Tumoren endokriner Organe operiert: 14 Patienten hatten ein medull/ires Schilddriisen-Carcinom, 5 ein Epithelk6rperchen-Carcinom, 7 ein malignes Insulinom, I ein malignes Gastrinom und 12 Patienten ein Nebennierencarcinom (Cushing-Syndrom n = 10, AGS n = 1, Ph/iochromocytom n = 1). Die Besonderheiten dieser malignen Tumoren liegen in der Tumoreigenschaft selbst, Hormonsekretion, chirurgischer und spezieller medikament6ser Therapie.Summary. Anastomosis of A. carotis and of N. ischiadicus of the rat were carried out by a microsurgical technique to compare the nonabsorbable suture material Ethilon and the absorbable Vicryl, both 0.2 metric. There were no suture insufficiencies with either sutured nerves or vessels. After 70-84 days the Vicryl sutures were completely absorbed. In nerve sutures Vicryl proved to be particularly superior to Ethilon, as the displacement of axons in the area of granuloma decreased with progressing absorption of the suture and thus also resulted in less renewed degeneration of the axons.

In a controlled study of patients with cholelithiasis and patients with cholelithiasis and duodenal diverticula a significantly higher rate of bacteriocholia and miscolonization of the duodenum with intestinal bacteria as well as a significantly higher rate of interdigestive disorder of motility with missing of a wandering activity front was found in the group of patients with diverticula in 11 out of 25 patients. If a cyclic sober motility is found in patients with diverticula, the duration of cycle, the maximum pressure of the interdigestive complexes and its wandering speed are not significantly different from those of the control group. The studies allow the interpretation that retention of food in the diverticula is not the reason for the bacterial miscolonization of the duodenum and the biliary tract, but in patients with diverticula a disturbed self-cleaning mechanism is present. The pathogenesis of duodenal diverticula is not clear.

Summary. Cardiac arrhythmias during hip-joint replacement are caused by monomers of methyl methacrylate from the bone cement. Both the amount of MMA monomer that is released into the bloodstream and the fall in blood pressure are dependent on the extracorporeal polymerization time (mixing time). Although prolongation of the mixing time reduces the frequency of intraoperative hypotension, it has no effect on intraoperative fat embolism. The temporal course and extent of effect of MMA monomer. In 3000 cases, implantation was effected with no monomer-induced lethal complications.

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The EGR is introduced into the abdominal cavity via a 10-mm port. Camera supervision is applied to select the exact position for any instrument. The tip of the EGR perforates the abdominal wall from inside, thus preventing any damage to blood vessels of viscera. A small skin incision is made over the tip once the skin bulges outward at the body surface. Once outside the abdomen the tip is removed, leaving a socket into which any instrument, e.g. a forceps, fits. The instrument is "guided" into the abdominal cavity by simply pushing it axially to the EGR. Inside the abdomen the EGR is disconnected from the instrument and withdrawn. The instrument is used without a port. There is no more loss of gas than when trocars are used. The EGR is especially useful for instruments that do not have to be changed during the operation and for the application of endoscopic drains. However, instruments can also be changed. The main advantage of the EGR is cost reduction, especially if disposable trocars have been used thus far. If reusable trocars have been applied so far there is a significant reduction in the maintenance effort (dismanting, cleaning, reassembly and resterilization of trocars). Moreover, endoscopic instruments can be positioned more safely and more precisely.