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.
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