A retrospective study of the possible value of standardized follow-up examinations was undertaken in a group of 251 patients (163 men, 88 women; mean age at diagnosis 58 [33-78] years) who had undergone putatively curative gastric resection for adenocarcinoma between 1.1. 1978 and 31. 12. 1987 and had survived at least 3 months after the operation. 113 patients (45%) regularly had follow-up examinations according to a standardized diagnostic protocol, 67 (27%) only irregularly, while 71 (28%) had none. Follow-up examination revealed tumour recurrence in 53 patients (30%), which in 18 (34%) was still asymptomatic. In one of these patients resection of the recurrence was again undertaken with curative intent, a palliative operation was performed in five, chemotherapy in seven, three received radiotherapy and 37 were treated purely symptomatically. The results do not indicate that the survival rate was improved by the standardized follow-up protocol and it is concluded that symptom-oriented and individualized follow-up examination without standardized protocol is sufficient in this type of case, except for scientific purposes.

Focal nodular hyperplasia of the liver was found in 3 women, and liver cell adenoma in a 4th woman. There is a possible association with the use of oral contraceptives. The indication for operation in these cases depends on the size of the tumour (danger of rupture of tumour and haemorrhage). It is also present when a malignant tumour cannot be excluded. Resection of the liver was performed predominantly with good results so far. Three of the patients described underwent the same surgical procedure. For the future one should aim at tumour enucleation alone.

Hans von Haberer (1875–1958) konnte als Ordinarius für Chirurgie an den Chirurgischen Universitätskliniken Innsbruck, Graz, Düsseldorf und Köln umfangreiche Erfahrungen in der rekonstruktiven Chirurgie der Gefäßaneurysmen gewinnen. So operierte er zwischen 1914 und 1948 insgesamt 421 Gefäßaneurysmen, wobei vorwiegend die direkte, zirkuläre Gefäßnaht zum Einsatz kam. Bereits 1914 berichtete von Haberer von der ersten Rekonstruktion eines Carotisaneurysmas. Insgesamt operierte er 30 Carotisaneurysmen und ist somit der Pionier der rekonstruktiven Carotischirurgie. Anhand der ausführlichen Operations- und Krankenakten, die Hans von Haberer von 1904 bis 1949 bei annähernd 16 000 Eingriffen geführt hat, sowie der zeitgenössischen Literatur, werden die gefäßchirurgischen Erfahrungen von Haberers dargestellt.

After carrying out the first free vein graft transplantation on an aneurysm of the axillary vein by Lexer in 1907, many attempts were made to reconstruct arterial injuries with direct vascular suture technique or vein graft transplants during the Balkan War (1912) and the First World War (1914-1918). Hans von Haberer gained wide experience in the reconstructive surgery of traumatic aneurysms al the Department of Surgery al the University of Innsbruck. During this period, he operated on a total of 201 vascular aneurysms, mainly using a direct circular vascular suture technique. In 1914, von Haberer described the first reconstruction of a carotid aneurysm. First experiences with vein bypasses were made, but not pursued in the following years.

Background: Palliative, minimal invasive treatment of rectal cancer is advocated in patients with advanced and incurable disease or poor clinical condition and in those who refuse radical surgery. Several methods have been used during recent years. We report our experience with palliative transanal endoscopic microsurgery. Materials: Between 1983 and 1995, 29 patients underwent transanal endoscopic microsurgery for palliation. Eleven patients had advanced malignant disease, nine were in poor clinical condition, and nine repeatetly refused radical surgery. Results: Intraoperatively one severe complication, an intra-abdominal perforation, occurred. The morbidity rate was 14%. Postoperatively, clinical signs were abolished or improved in all cases. Only three patients required further palliative resections after initial symptom relief. Conclusions: Transanal endoscopic microsurgery is a successful approach in the palliative treatment of rectal cancer. The technique enables complete resection of rectal tumors. Although anesthesia is needed, the morbidity is low, even in patients with poor clinical condition.

p = 0.32, NS). Arterial and mixed venous partial oxygen pressure and shunt also showed no significant differences 15 minutes before and after examination, nor did the blood pressure or pulse. The use of four of the bronchoscopes resulted in preinterventional contamination with Pseudomonas . Bronchoscopically controlled lavage shows no advantages over blind endotracheal lavage for diagnosing pneumonia. Blind suctioning with single-use sterile catheters can be done more quickly and inexpensively with fewer personnel and a lower complication rate.

Submucosal tissue oxygen tension (PtO2) was measured in 20 patients with cervical esophagogastrostomy after resection of esophageal carcinoma, using a Clark-type oxygen electrode. The mean gastric baseline PtO2 was 54.6 +/- 10.7 mm Hg. Following ligature of the vasa brevia and the left gastroepiploic artery PtO2 decreased to 45.8 +/- 9.9 mm Hg, ligature of the left gastric artery caused a decrease to 34.2 +/- 9.7 mm Hg and resection of the lesser curvature and pulling up of gastric tube led to 25.5 +/- 9.0 mm Hg. Clinical value and practicability of intraoperative PtO2 measurements could be proven.

The data from 1050 patients who had undergone colorectal carcinoma resection at the University of Cologne between 1976 and 1990 were studied. The aim of the study was to determine the concomitant effects on survival of several patient characteristics (sex, age, tumour localization, blood transfusion) and histopathological variables (Dukes' staging). We first calculated survival rates, both including and excluding post-operative mortality. We set up a hierarchical log-linear model for the detection of relationships between selected crossclassified categorial variables. We then used Cox's proportional hazard regression method to study the relationship between survival and different prognostic patterns. Dukes' staging was shown to be a highly discriminating factor in survival (P<0.001). Survival rates were better in women (P<0.001), and better for younger patients (<70 years; P<0.001). Tumour site (colon; P = 0.0362) and blood transfusion (P = 0.0857) also correlated with survival.

The influence of transhiatal blunt esophagectomy with dissection of all reachable lymph nodes (ESD) and en-bloc-esophagectomy (EB) on perioperative cardio-pulmonary stress and late results was analysed in a prospective randomized trial. Blunt dissection of the esophagus was performed without systematic lymph node dissection (SD) in patients with increased cardio-pulmonary dysfunctions. Until now 26 patients (ESD: 13, EB: 13) entered the study as well as 14 patients treated by blunt dissection. The number of dissected lymph nodes in each patient was 7.5 (SD), 19.9 (ESD) and 37.6 (EB). Ratio of invaded to removed lymph nodes was 0.26 (SD), 0.25 (ESD) and 0.1 (EB). The 30-day mortality rate was 8.0% in each group. Under the consideration of this mortality, one-year survival rate was 79% (SD), 70% (ESD) and 77% (EB). Patients with negative lymph node involvement showed a one-year survival of 85% and positive involvement lead to a survival rate of 70% after one year, independently of the surgical approach.

Quality of life (QL) after the "curative" resection of non-small cell bronchogenic carcinoma was assessed by patients using the EORTC QL questionnaire (QLQ) and by a psychologist using the Spitzer Index. Quality of life was assessed in 52 patients on one occasion 12 months postoperatively and in 20 patients regularly starting with a preoperative assessment. Self- and external evaluation showed a significant correlation (r = 0.41), but QL was assessed as being higher by the external observer. After surgery it was mainly affected by restrictions related to physical activities, job and household tasks, and disease symptoms, whereas limitations in emotional, social, and financial domains were found less frequently and less severely. Of the different medical (surgical procedures, tumor recurrence) and social factors (sex, marital and employment status), only tumor recurrence was determined to have a significant and negative influence on postoperative QL (P < 0.02). When compared to the preoperative assessment, QL had deteriorated on discharge from hospital but was restored within 3-6 months postoperatively in disease-free patients.

A retrospective study of the possible value of standardized follow-up examinations was undertaken in a group of 251 patients (163 men, 88 women; mean age at diagnosis 58 [33-78] years) who had undergone putatively curative gastric resection for adenocarcinoma between 1.1.1978 and 31.12.1987 and had survived at least 3 months after the operation. 113 patients (45%) regularly had follow-up examinations according to a standardized diagnostic protocol, 67 (27%) only irregularly, while 71 (28%) had none. Follow-up examination revealed tumour recurrence in 53 patients (30%), which in 18 (34%) was still asymptomatic. In one of these patients resection of the recurrence was again undertaken with curative intent, a palliative operation was performed in five, chemotherapy in seven, three received radiotherapy and 37 were treated purely symptomatically. The results do not indicate that the survival rate was improved by the standardized follow-up protocol and it is concluded that symptom-oriented and individualized follow-up examination without standardized protocol is sufficient in this type Of case, except for scientific purposes.

Die Insuffizienz und die späte Stenose der zervikalen Ösophago-Gastrostomie gehören zu den häufigsten Komplikationen nach Resektion eines Speiseröhrenkarzinoms und Ersatz der Speiseröhre durch den hochgezogenen Magen [1] und treten im Vergleich zu anderen intestinalen Anastomosen vermehrt auf. Trotz ungeklärter Ätiologie wird hierfür eine Hypoxie der Anastomosenregion und des Magenschlauches, der nur noch durch die Arteria gastroepiploica dextra versorgt wird, verantwortlich gemacht [2]. Um die Bedeutung der Oxygenierung des Magenschlauches an der ösophagogastralen Anastomose für die Entstehung einer Insuffizienz bzw. Stenose untersuchen zu können, wurde der submuköse Sauerstoffgewebedruck (PtO2) intra- und postoperativ gemessen.

Experimental studies were performed to investigate further the effects of immunotherapy with Propionibacterium avidum KP-40 on thymocyte proliferation, maturation and emigration in BALB/c-mice. Thymus weight and thymocyte counts, especially cells presenting the immature or cytotoxic/suppressor phenotype were significantly increased. Due to enhanced emigration, peripheral blood lymphocyte and monocyte counts as well as expression of activation markers were significantly upregulated. The antimetastatic effect of Propionibacterium avidum KP-40 was demonstrated in BALB/c-mice, where RAW 117-H10 lymphosarcoma liver colonization was significantly reduced after immunostimulation. Clinical investigations proved that surgical treatment of colorectal carcinoma induced an evident decrease of peripheral blood lymphocytes as compared with preoperative counts. However, single preoperative Propionibacterium avidum KP-40 administration induced a considerable increase of peripheral white blood cell counts, especially lymphocytes. Clinical effects of preoperative immunostimulation by Propionibacterium granulosum KP-45 were investigated in a prospective randomized trial in colorectal carcinoma patients. Positive effects on survival time, local tumor recurrence and distant metastasis could be demonstrated in stages I and II, whereas no advantage of immunotherapy was found in advanced stages III and IV. A recent prospective randomized clinical trial was initiated on the quality of life of colorectal carcinoma patients. Three months after surgical treatment negative effects could not be determined after immunotherapy. Quality of life even proved to be better in patients with abdominoperineal resection as compared to non Propionibacterium avidum KP-40 treated control patients.

Maligne Tumoren führen, wenn sie nicht adäquat therapiert werden, durch fortschreitendes Wachstum, Infiltration der Umgebung und Dissemination der Tumorzellen mit Bildung von Metastasen zum Tode. Trotz ständiger Verbesserungen der chirurgischen Behandlungsmethoden und Fortschritten in der Chemo-, Strahlen-, Hormon- bzw. Immuntherapie besteht weiterhin ein erheblicher Bedarf an wirkungsvollen Ergänzungen der etablierten Behandlungskonzepte.

The effects of pyloroplasty following subtotal oesophagectomy and gastric substitution with cervical oesophago-gastric anastomosis were studied in a prospective randomized trial. 52 patients received extramucosal pyloroplasty and were compared to a control group of 55 patients, in whom no drainage procedure was performed. 6 patients died postoperatively. One of these patients died following the insufficiency of pyloroplasty. The other causes of death were not related to the performance or non-performance of pyloroplasty. Regarding to patients subjective self-assessment of abdominal discomfort and radiologic emptying of the gastric tube no statistical significant differences between both groups were noted 2 weeks and 6 months postoperatively. Two patients with pyloroplasty, but no patient of the control group, suffered 12 months postoperatively from severe vomiting due to fibrotic stricture of the pylorus. The results of this study suggest, that usually no pyloroplasty should be performed following subtotal oesophagectomy and interposition of a gastric tube with oesophagogastric anastomosis in the neck.