Aggressive extracorporeal shock wave lithotripsy of gall bladder stones within wider treatment criteria: fragmentation rate and early results.

Two hundred and twenty patients with a total of 412 gall bladder stones of between 8 and 38 mm in size were treated with extracorporeal shock wave lithotripsy, using the overhead module Lithostrar Plus. Fifty six per cent of stones were solitary (mean (SD) diameter 23 (5) mm) and 9.5% of the patients had more than three stones.

[Prevention and treatment of postoperative fistulae--new indications for fibrin gluing].

The additional sealing of bronchial and gastrointestinal sutures and anastomoses, respectively, by means of fibrin sealant helped to significantly reduce the postoperative dehiscence rate; this rate amounted to 3.6% for additionally sealed bronchus stump occlusions and to 4.2% in gastrointestinal operations, whereby naturally in emergency abdominal operations the rate was higher (7.

[Reconstruction-plasty of iatrogenic choledochal stenoses using human pericardium. An experimental study in the domestic pig].

The effect of human pericardial patch plastic for reconstruction of iatrogenic common bile duct stenosis was investigated in experiments performed in pigs. All patches (n = 8) were overgrown with immature biliary epithelium detectable on light and electron microscopy within 6 weeks. No restenosis nor any fistula developed during this observation period.

[Extracorporeal shock wave treatment of calcium containing gallbladder calculi].

A total of 50 patients--37 female and 13 male--with an average age of 50 +/- 27 years (23-86 years), suffering from rim-calcified gallbladder stones, underwent extracorporeal shock-wave lithotripsy (ESWL), using an ultrasound-guided overhead module of Lithostar Plus (Siemens Company). The total number of stones was 87, with an average diameter of 16 +/- 7 (7-38) mm. 29 patients had a solitary stone, 13 had two and 8 patients three or more stones.

[A combined endoscopic surgical treatment concept in acute biliary pancreatitis].

This paper presents the results of a combined endoscopic-surgical approach with management of acute biliary pancreatitis in 91 patients. The diagnosis was always made by means of endoscopic-retrograde cholangiography. Papillary or bile duct stones, or unmistakable signs of previous stone passage, and in exceptional cases flow obstruction due to preiampullary diverticuli were considered criteria for a positive diagnosis.

[Technique of recurrent laryngeal nerve exposure within the scope of interventions of the thyroid gland].

In anatomical preparations performed during autopsy we developed a well-defined approach for the identification of the recurrent laryngeal nerve during surgery on the thyroid gland. The principle of this concept is to visualize the nerve near the branching of the inferior thyroid artery, where it shows a 30 degree angle to the trachea in a direction running from caudal lateral to cranial medial and lies in front of, behind, or between the branches of the artery. This preparation mode has been prospectively performed in 100 patients undergoing thyroid surgery.

[Intermittent incomplete ileus of the small intestine. Sonographic diagnosis and trends].

Intermittent incomplete intestinal obstruction was proven by sonography in 25 male and 48 female patients with an age range of 10 to 88 years. All of them suffered from intermittent colicky pain, nausea and meteorism followed by liquid stools. Only 52 patients had undergone a total of 69 abdominal operations.

Electromagnetic shock-wave lithotripsy of gallbladder calculi. Multicentered preliminary report on experience with 276 patients.

The Lithostar Working Group reports on the first 276 patients who underwent lithotripsy of biliary calculi by means of an electromagnetic Lithotriptor (Lithostar Plus from Siemens). Some 66% (183/276) and 27% (75/276) of the patients had solitary and two or three stones, respectively while 7% (18/276) had more than three gallbladder calculi. Calcified calculi were found in 11% of the patients.

[Biliary extracorporeal shockwave lithotripsy in the surgical treatment concept of cholelithiasis].

Extracorporeal shock-wave lithotripsy (BESWL) using the "Obertisch" module Lithostar Plus (Siemens AG) was carried out in 100 patients, comprising a total of 189 gallbladder stones with a size range from 8 to 35 mm. Chenodeoxycholic and ursodeoxycholic acid was given as adjuvant litholytic therapy, beginning 14 days before treatment. 53% of the patients suffered from radiolucent solitary stones with an average size of 21 +/- 6 mm.

[Ultrasonic diagnosis in appendiceal perforation].

In a prospective study comprising 154 patients, the efficacy of clinical, sonographic and combined assessment of appendiceal perforation was evaluated. 39 patients had appendiceal perforation, 44 no signs of inflammation and 71 chronic appendicitis as proven by histologic examination. Cases of 'simple' acute appendicitis were excluded.

[Non-occlusive disease--ultrasound diagnosis and trend analysis as a treatment guideline].

16 patients with angiographically proved NOD underwent immediate abdominal sonography (age: 76 +/- 24 years). All patients suffered from "low cardiac output syndrome". The sonographic criteria were as follows: bowel wall edema [16], hyper-peristalsis [16], free peritoneal fluid [14], and signs of incomplete ileus [14].

[Experimental ultrasound analysis of the appendix. Contribution to improving the diagnosis of acute inflammation in routine clinical practice].

Sonographic investigations of fresh operative specimens - 50 non-infected, 50 chronic and 50 acute inflammatory appendices - and also of 335 pertinent operated patients with "typical" appendiceal disorders were performed. All other entities, mimicking acute or perforated appendicitis were excluded from this study. Under experimental conditions, negative, chronic and acute or phlegmonous appendices appeared as "cockade" or "pseudokidney sign" with reflecting wall and echoless lumen.

[Acute cholecystitis in cholelithiasis: importance of early surgery (a comparative study)].

The results of early surgery (ES) for acute calculous cholecystitis obtained in 74 patients operated on between 3/78 and 12/87 were compared with relevant data obtained in 74 sex- and age-matched patients with a history of acute cholecystitis operated on for biliary colic or jaundice during the same period. Operative procedures, incidence of jaundice and common bile duct calculi, duration of operation, number of patients requiring blood transfusions, surgical and general complications and mortality showed no significant difference. Only operative blood loss was significantly higher in the ES group, but this was of no practical relevance.

Intermittent incomplete intestinal obstruction: a frequently mistaken entity. Ultrasonographic diagnosis and management.

Intermittent incomplete intestinal obstruction (IIIO) was diagnosed by sonography in 81 patients during the course of a study conducted from January 1984 to July 1988. The clinical presentation, history and characteristic sonographic findings are described. Successful conservative therapy was instituted in all patients based upon clinical and sonographic treatment response observations.

[Reactive acalculous cholecystitis: a bland and asymptomatic course--incidence of a classical stress disease].

A systematic search for reactive acalculous cholecystitis (RAC) performed from 11/85 until 11/87 rendered an incidence of 9 in 1272 patients recovering from surgery and 1 in 930 patients treated conservatively for various diseases. 8 patients presented with typical but discrete clinical symptoms whereas 2 remained asymptomatic. Abdominal sonography proved to be the most useful diagnostic procedure.

[Percutaneous layer differentiation of the colonic wall by ultrasound. Clinical case examples and experimental results].

Based on 3 case observations, the feasibility of the percutaneous sonographic objectivation of a five-layer image of the colon wall using a 5 Mhz linear transducer is reported for the first time. Sonographic stratification is promoted by means of "ultrasound windows" or contrasting borderlines. Employing stepwise dissection of autoptic specimens and ultrasonic comparison, it was possible to identify the hypodense zones 2 and 4 as mucous membrane and muscle layer, divided by the reflecting submucous layer (zone 3).

Ileus and intestinal obstruction--ultrasonographic findings as a guideline to therapy.

Between September 1, 1982 and January 31, 1986, a study was undertaken in a total of 111 patients to assess the efficacy of ultrasonography in diagnosing intestinal obstruction and ileus. In 109 cases (98%), ultrasonography provided the correct diagnosis. In one case, obstruction was correctly suspected.

[Ultrasound study of "acute appendicitis," an elective procedure or obligation in general surgery. A prospective study].

576 patients admitted for suspected acute appendicitis were prospectively assessed by sonography following physical examination. The collective comprised - as proven by operation - 156 patients with acute appendicitis, 178 patients with chronic appendicitis or mesenteric lymphadenitis, as proven by observation, 186 patients suffering from gastroenteritis. 56 patients suffered from other diseases and 21 of them required urgent surgery.

[Reconstruction of noncircumferential bile duct defects by omentumplasty and temporary stenting].

In a case of bile duct stricture associated with biliary peritonitis, longitudinal incision and duct repair using omental patch and T-tube stenting was performed. Functional and anatomic success was proven at 4-years follow-up. The simple procedure offers an option worthy of consideration even in adverse conditions.

[Sonographic diagnosis of complicated peptic ulcer].

The sensitivity of sonography was assessed in an unselected series of 56 patients suffering from complicated gastric (20) or duodenal (36) ulcers. Evidence of ingested material and/or free gas in the peritoneal cavity associated with a pathologic gastroduodenal cockade proves perforation. Ulcer penetration is visible as eccentric "tumour" extension into hepatoduodenal ligament, liver or pancreas, whereas callous ulcer is recognisable as pathologic noninfiltrating cockade, and duodenal obstruction from stomach distention in spite of fasting.

[Hematoma of the rectal sheath: clinical report of experiences with special reference to ultrasound diagnosis].

Rectus sheath hematomas are rare sequelae of direct or indirect trauma to the abdominal wall, with or without muscle rupture or laceration of epigastric vessels. "Spontaneous" hemorrhage may occur in patients receiving anticoagulant therapy. The diagnosis remains frequently unrecognized prior to ill advised laparotomies performed for suspected abdominal emergencies.

[Clinical relevance of sonography in acute diagnosis of perforated gastroduodenal ulcers].

In a prospective unselected series of 22 patients with perforated gastroduodenal ulcers the diagnostic efficacy of clinical and radiologic data was modest. In eight patients only (approximately 36%), clinical data yielded sufficient evidence; in 16 patients (approximately 73%), plain X-ray demonstrated subphrenic gas. Sonography was proven to be a major advance, especially rewarding in the diagnosis of perforations with negative plain X-ray.