Treatment Failures in Diabetic Foot Osteomyelitis Associated with Concomitant Charcot Arthropathy: The Role of Underlying Arteriopathy.

Objective: Therapy for diabetic foot osteomyelitis (DFO) with Charcot neuroosteoarthropathy is challenging. In patients with diabetic Charcot osteomyelitis (DCO), both the anatomic deformity and infection must be addressed. This study assessed the outcomes of DCO therapy and variables associated with treatment failure and compared them with outcomes of DFO cases.

Selective decrease of serum immunoglobulin G1 as marker for early stages of invasive breast cancer.

The diagnostic value of the decrease in percentage of immunoglobulin G1 (%lgG1) in breast cancer was analyzed with special emphasis on early tumor stages. IgG1 and total IgG were preoperatively measured in the sera of a total of 801 individuals using a modified quantitative affinity chromatography. Group A consisted of 174 healthy individuals of both sexes, group B of 324 female patients with benign breast disease, and group C of 303 patients with invasive and non-invasive breast cancer.

Immunological surrogate parameters in a prognostic model for multi-organ failure and death.

Objective: To assess the ability of clinical or biochemical parameters to predict outcome (survival or non-survival; severe or moderate/no complication) using multiple regression analyses.

Design: Prospective, descriptive cohort study with no interventions

Setting: 12 surgical intensive care units of university hospitals and large community hospitals; four medical school research laboratories in eight European countries

Patients: 128 surgical patients with major intra-abdominal surgery admitted for at least two days to an intensive care unit

Main Outcome Measures: Prediction of complications or survival based on analysis of clinical (Multiple Organ Dysfunction Score, Multi-Organ-Failure Score, Acute Physiology and Chronic Health Evaluation II scores) and immunological (plasma levels of endotoxin, endotoxin neutralizing capacity, IL-6, IL-8, cell associated IL-8, Fc-receptor polymorphism, soluble CD-14) parameters, with comparison of predicted and actual outcomes.

Results: APACHE II, MODS score, MOF score, platelets, IL-6, IL-8, ENC, cell ass.

Laparoscopic cholecystectomy using 2-mm instruments.

Today, laparoscopic cholecystectomy is the method of choice for treatment of symptomatic gallbladder disorders. It minimizes effects of the operation that are independent of the gallbladder, such as trauma to the abdominal wall and other soft tissue. The surgical wounds were even smaller when 2-mm trocars were used.

[Primary malignant non-Hodgkin's lymphoma of the breast: breast preserving therapy in 3 patients].

Primary malignant non-Hodgkin lymphoma is rare. The mammographic appearance is unspecific. The final diagnosis can usually be made after examination of paraffin-embedded tissue only.

Hemostatic methods for the management of spleen and liver injuries.

The spleen and liver are the most frequently injured organs during blunt and penetrating abdominal trauma. Emergency laparotomy is crucial for early control of bleeding and to prevent "secondary" injury as a result of physiologic splanchnic vasoconstriction and free oxygen radicals. Altogether 98 patients with spleen and liver injuries were treated over an 8-year period.

Laparoscopic partial splenic resection.

Twenty domestic pigs with an average weight of 30 kg were subjected to laparoscopic partial splenic resection with the aim of determining the feasibility, reliability, and safety of this procedure. Unlike the human spleen, the pig spleen is perpendicular to the body's long axis, and it is long and slender. The parenchyma was severed through the middle third, where the organ is thickest.

[Epithelioid leiomyosarcoma of the stomach. Clinical experiences with a rare stomach tumor].

Gastric epithelioid leiomyosarcoma (epLMS), which generally occurs in mid- or late adult life, is a rare smooth muscle tumor of the stomach. Out of 25 soft tissue tumors of the stomach operated at the Department of Surgery, University of Graz, two epLMS were diagnosed. This paper presents the case of a 67-year-old male with an epLMS in the corpus and of a 80-year-old female with an epLMS in the fundus of the stomach.

[A new concept in imaging pelvic recurrence of curatively operated rectal carcinoma--image fusion of nuclear magnetic resonance tomography and anti-CEA immunoscintigraphy (SPECT): technique and clinical example].

We present a new technique of image fusion (IF) of magnetic resonance imaging (MRT) and anti-CEA-immunoscintigraphy (Behring 431/26) and single photon emission computed tomography (SPECT). We performed SPECT and MRT within 8 hours on the same day. Glucagon intravenously was used to reduce artefacts due to intestinal motility.

[Percutaneous transhepatic cholangioscopy (PTCS)--evaluating the clinical status].

In 44 patients with biliary obstructions, percutaneous transhepatic cholangioscopy (PTCS) was performed during percutaneous transhepatic biliary drainage procedures (PTCD). In all patients the obstruction could be decompressed via the PTCD sufficiently. 30 of these cases who had PTCS showed suspect hepatic and pancreatic malignancies.

Partial splenic resection using the TA-stapler.

Since 1987, we have used the TA-stapler for 15 partial resections of the spleen. The cases included 5 second- to third-degree traumatic ruptures, 4 splenic cysts, 3 injuries resulting from accidents during upper-abdominal surgery, 2 diagnostic resections, and 1 intralienal pancreatic cyst. The TA-55 stapler was used 14 times and the TA-90 once.

The technique of the low anterior resection made by hand or with stapler.

After a short historical review of the surgical intervention for rectal cancer the precondition for the resection are presented. The technique of the resection is described in the following. We use routinely the double row suture for the anastomosis.

Is the low anterior resection justified in midrectal cancer?

The main reasons for using a resection in midrectal cancer are presented. The knowledge about the direction of the lymph-drainage and the cell infiltration in the rectal wall and the progress in the dissection technique of the ampulla now allow the preservation of the sphincterorgan without severe oncological doubts. The results are well comparable with those after the exstripation but the comfort of the patient is better.

TA-stapler resection of congenital splenic cyst. Case report.

Splenic cysts are uncommon. Primary (true, epithelial) and secondary (false, non-epithelial) forms may be distinguished, the latter being more usual. Organ-preserving resection of a primary mesothelial splenic cyst, using a TA-stapler, is described and alternative techniques of splenic preservation are discussed.

[Clinical use of new organ-saving technics in splenic surgery].

During a period of 19 months, 22 organ preserving splenic operations were performed. Eleven of these, were severe third degree traumatic bursting ruptures, which were treated using a resorbable compressive mesh. An intralienal pancreatic cyst, a case of splenomegaly suspicious for lymphoma, one traumatic and two accidental polar lesions were treated by partial splenic resection using stapler.

[Splenic cyst--a rare cause of epigastric expansion].

Cysts are rare lesions of the spleen, and may be divided into parasitic and non-parasitic types. After the parasitic cysts, the second most frequent group is the (secondary) posttraumatic form of non-parasitic cysts. The primary form (congenital and neoplastic) of the latter is the least frequent.

[New organ-preserving technics for third-grade splenic trauma. An experimental study].

We studied two new techniques for orthotopic preservation of the spleen in an animal model with respect to their technical feasibility and their hemostatic efficacy. This study was performed in two stages. In the first, the treatment of central bursting ruptures by splenorrhaphy using a resorbable compressive mesh was tested.

Spontaneous small bowel perforation. A rare cause of acute abdomen.

Spontaneous non traumatic small bowel perforation is a rare cause of an acute abdomen. Preoperative diagnosis is especially difficult, since the symptoms are extremely nonspecific. In most cases, the acute perforation is only diagnosed at exploratory laparotomy.

[Is the search for Meckel's diverticulum in appendectomy still a current problem in common surgical practice?].

During a ten year period from 1978 to 1988, 46 Meckel's diverticula (MD) were removed from patients with clinical symptoms of appendicitis. These were detected incidentally among 3230 appendectomies which were routinely followed by small bowel exploration. Only 45.

[Manual suture versus/or mechanical suture from the Austrian viewpoint].

A general inquiry was made at surgical units and university clinics in Austria about the anastomosis techniques used between 1980 to 1985. The result was that in 90.3% the suture was made by hand and in 9.

[Results of resection of gastroduodenal ulcers].

The principles of a standardized technique of partial gastrectomy are presented. Number and success of resections were reviewed between 1948 and 1981. Follow-up studies were performed twice (1969 and 1982) which showed a success in 93% according to Visick Grade I and II.

[Diagnosis and therapy of cancer of the large intestine (author's transl)].

A review is presented of the cases treated in this department between 1944 and 1979. Radical surgery was carried out in 388 patients out of 746, whereby the majority of patients were in the older age brackets. Paralytic ileus was present in about 25% of cases and three-stage procedure was, thus, required in the management of these patients.