[Metabolic changes and infusion therapy in ileus].

The aim of the investigation was to determine the changes in intermediary metabolism that occur in cases of ileus, and to develop a concept for parenteral perioperative nutrition on a pathophysiological basis. Seventeen metabolically healthy patients, suffering from mechanical ileus, have been evaluated. Besides the nonspecific metabolic changes characteristic of the postaggressive metabolism (abnormalities in peripheral glucose utilization, gluconeogenesis, lipolysis, proteolysis) we were able to demonstrate elevated serum levels of albumin, lactate and arachidonic acid preoperatively in these patients.

[Postaggression metabolism following laparotomy and thoracotomy].

The purpose of this investigation was to collect data concerning changes in carbohydrate and amino acid metabolism following different surgical operations (thoracotomies, laparotomies). Blood of 20 metabolically healthy adult surgical patients, who had to undergo elective surgery (lobectomies, pneumonectomies, colon resections) was examined preoperatively, immediately postoperatively and from 1.-4.

[Ultraradical surgery of the shoulder and thoracic wall--indications and prognosis].

Super-radical surgery upon shoulder-girdle and chest wall often means mutilation and is therefore a heavy burden for the patient. Nevertheless it can have very rewarding results, if the indications are correct. They include treatment of soft tissue tumours, under certain conditions of metastases within the thoracic wall and very rarely of trauma.

[Symptomless gallstone disease--when to treat surgically?].

The cholecystolithiasis is the symptom of a disease. Recent radiological procedures, above all sonography, can be helpful not only in more frequent detection of gallstones, but they can also provide information, even without clinical symptoms, on pathological changes to gallbladder and biliary tracts. However, early diagnosis of carcinoma of the gallbladder still is rare.

[Interwoven wire suture with fascia lata-plasty in the treatment of subcutaneous rupture of the Achilles tendon--an obsolete method?].

Lately there has been an increased incidence of rupture of the Achilles tendon following the general increase in mass sports. Surgery is the treatment of choice, and various methods are being described. We have been using the wire suture method with fascia lata plasty for more then twenty years.

[Rupture of the diaphragm--a frequently undetected injury].

Traumatic ruptures of the diaphragm are acquired separations of the diaphragm which are aetiologically divided into indirect and rare direct ruptures. The force required to produce indirect ruptures will usually lead to additional intraabdominal lesions of liver and spleen as well as to rib fractures and fractures at the lower extremity. Hence the sequels of these accompanying lesions are often prominent in the clinical pattern to such an extent that 50 to 70% of the diaphragmatic ruptures remain primarily unrecognised.

[Pohl's track screw for the surgical treatment of femoral neck fracture. Reliable surgical principle or obsolete method?].

Pohl's hip screw--the classic form of a dynamic osteosynthesis--is an approved method in the treatment of the fracture of the femoral neck (lateral and pertrochanteric fractures). Between 1963 and 1983 over 200 patients were treated with Pohl's hip screw. At an averaged stay of 29 days in hospital half of them were rehabilitated.

[The asymptomatic gallstone].

There are several sound arguments to operate on "silent" gallstones: The operative mortality following simple cholecystectomy in patients under 40 is zero. 50% of all patients with silent gallstones will be operated upon or develop symptoms within 10-20 years after the initial diagnosis. Carcinoma of the gallbladder is very rarely diagnosed in time and in most cases is incurable at the time of operation.

[Cancer surgery in advanced age].

The problems of surgical treatment of older carcinoma patients consist of the indication for operation, careful preparation and intensive after-care. With adherence to these conditions curative operations are possible even in patients over 70 years of age shown by the example of colo-rectal operations. The mortality rate is 9.

Screening for colorectal carcinoma.

Since the introduction in the Federal Republic of Germany of free routine screening for colorectal carcinoma (digital examination of the rectum in 1971; test for occult blood in the faeces in 1977), the number of Dukes' stage A cases diagnosed at one hospital has increased by 30%. The average interval between onset of symptoms and diagnosis has shortened from 5 to 3.8 months, and the proportion of inoperable carcinomas has decreased by 10%.

Pitfall in the CT diagnosis of pulmonary arteriovenous malformation.

A peripheral adenosquamous carcinoma of the right lung with atypical rich vascularization of the central scar was misinterpreted as an arteriovenous malformation based on a chest X-ray examination and a dynamic computed tomographic study.

[Significance of preventive examination for the prognosis of cancer of the large intestine].

Since screening for colorectal carcinoma was started in Germany (rectal digital palpation 1971, test for occult blood in stool 1977) the rate of early stage Dukes A in more than 3600 cases of colorectal carcinoma has increased significantly by 30%. The history of the disease has shortened and the number of inoperable patients has diminished by 10%.

[Recurrence of Crohn disease--a surgical and interdisciplinary problem].

Crohn's disease, an inflammatory illness of the large and the small intestine, has rising incidence in highly civilized populations. Its etiology is unknown; multifactorial causes are assumed. The outcome and the effect on the individual are cancer-like.

[Accidental finding: the small, differentiated thyroid carcinoma. Report of 46 thyroid carcinomas of up to 15 mm diameter].

Review of 190 cases of thyroid carcinoma between 1974 and 1981 showed an increasing rate of small papillary carcinoma. The study included 46 tumors which did not exceed 15 mm in diameter. Most of these lesions (3/4) were discovered incidentally at thyroid operations of various types.

[Significance of clinical symptoms in the early diagnosis of bronchial cancer].

The lack of symptoms in lung cancer is the main reason for its late diagnosis and therapy. In the surgical clinic of Northwest Hospital, Frankfurt/Main, only 32,5% of 1494 bronchogenic carcinomas (1970-1980) were operable. 40% of these lung cancers were detected by routine examination, 45,7% of the operable carcinomas and 25% of the inoperable carcinomas.