The therapy concept of topical factor XIII application was developed on the basis of clinical and experimental investigations on improvement of wound healing, as well as on the morphological and pathophysiological topical site of venous ulcers. Topical treatment with factor XIII is special with regard to mode of application as well as efficacy, since a lot of other medications used for local wound treatment contain a fibrinolytic component. In the last 32 months, 23 inpatients (17 female, 6 male) averaging 62.9 +/- 14.1 years and suffering ulcerative leg disease were treated with topically applied factor XIII. The average period of distal venous ulcer in these patients was 3.3 +/- 2.04 years. The extent of the ulcer surface ranged between 2.5 x 3.0 cm (minimum) and 18.5 x 8.0 cm (maximum). All patients had been in medical consultation for several years. The venous ulcers were based upon a "postthrombotic syndrome" in 15 patients. Six patients were suffering from ulcerations due to arterial and venous mixed disease, and there were 2 patients with ulcerations of unknown etiology. In 5 patients, 2 with unknown etiology and 3 with arterial and venous mixed disease, local treatment with factor XIII was discontinued after 4 weeks because there was definitely no improvement in wound healing. Additionally, 3 patients with ulcerations due to arterial and venous mixed disease were treated for a maximum of 6 weeks with only moderate improvement in healing. Twelve of the 15 patients (79.3%) with extended, chronic ulceration on the basis of a postthrombotic syndrome showed such a distinct improvement of topical site after an average of only 3.15 +/- 1.14 weeks that they were released for further ambulatory treatment. Three patients had to be treated for a maximum period of 6 weeks, also with distinct improvement in wound healing. Apart from a wound surface reduction and a clinically documentable improvement of granulation tendency, there was a marked reduction of secretion and bleeding tendency within the ulcer area observed in all patients. None of the patients showed any systemic or local allergic reactions.

During gynaecological laparoscopy, in rare cases, life threatening injuries occur. The report describes three cases of vascular injuries performed due to vascular surgery. To avoid such vascular lesions serves near by to observe and take precautions in the hard altered topographic connexions between peritoneal cover and abdominal vessels during the typical gynaecological case. Every laparoscopist should know the symptoms of the complications beforehand, and he should be able also to perform the vascular sutures.

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The aim of these studies was to evaluate the light and electron microscopic changes of the gastric mucosa of restrained rats, and to determine if there were correlations between structural changes, histidine decarboxylase activity, histamine content, and gastric secretion.In areas with high-grade mucosal lesions, signs of functional hyperactivity of the oxyntic and chief cells and cytoplasmic degranulation of the enterochromaffin-like cells were observed. These changes were not influenced by vagotomy. The hyperactivity of the chief cells was related to a higher proteolytic activity of the gastric juice and to an increased excretion of uropepsinogen (p < 0.01). The hyperactivity of the oxyntic cells was not accompanied by an increase in total acidity, which could be explained by hydrogen ion back-diffusion through a damaged gastric mucosal barrier. The increase in histidine decarboxylase activity (p < 0.01) and the decrease of histamine content (p < 0.01) in the glandular mucosa of restrained rats, together with the microscopic and ultrastructural observations, suggest that the early microcirculatory changes are due to local alterations in the metabolism of vasoactive amines.Among the mechanisms involved in the pathogenesis of restraint ulcers, special significance has been attributed to acid hypersecretion, damage to the gastric mucosal barrier with H + back-diffusion, andPresented at the XXVIIth Congress of the Socidt6 Internationale de Chirugie, Kyoto, Japan, September 3-8, 1977.Reprint requests: Professor J.L. Balibrea, Department of Surgery, Autonomous University of Barcelona, Bellaterra (Barcelona), Spain. At present, special attention is directed toward the properties of the enterochromaffin cell system, described in the gastric mucosa of the rat by H~kan-son et al. [7], because of its high histidine and dopa decarboxylase activities. The existence of increased histidine decarboxylase activity in the mucosa of restrained rats [8] suggests a role for histamine in the genesis of restraint-induced ulcers, both through its influence on acid and peptic secretions and through microcirculatory effects that might disrupt the gastric mucosal barrier [9].The purpose of the experiments described in this report was to study the effects of restraint stress, in the absence of biliary reflux, on acid and mucus secretion and on proteolytic activity of gastric juice. Histidine decarboxylase and histamine content of the gastric mucosa and the effects of vagotomy on