There are different opinions concerning the benefits of oblique anastomosis and stripping of the adventitia before microvascular anastomosis. For clarification of this question, microvascular anastomoses by different techniques were performed in the aortas and the femoral arteries of 80 female Wistar rats. The average diameter of the aortas in these rats was 1.4 mm, and the average diameter of the femoral arteries was 0.7 mm. The following procedures were carried out: transverse division of the vessel and end-to-end anastomosis; transverse division of the vessel with adventitial stripping of the ends before end-to-end anastomosis; oblique division of the vessel and end-to-end anastomosis; oblique division of the vessel with adventitial stripping before anastomosis. Forty of the animals were sacrificed after 5 hours, and the remaining 40 animals were sacrificed after 3 weeks, and histologic studies were performed. All anastomoses performed on the aorta were patent at the 5-hour follow-up. The 3-week follow-up showed no differences between the transverse anastomoses both with and without adventitial stripping, but there was an accumulation of false aneurysms in the groups with oblique anastomoses and adventitial stripping. In the animals that received femoral artery anastomoses, 80% of the transverse anastomoses without adventitial stripping were patent after 5 hours of 3 weeks. The animals that received oblique anastomoses without stripping had patent vessels after 3 weeks, but there was a significant accumulation of false aneurysms in the two groups that received adventitial stripping. As this study demonstrates, the patency rate of microvascular anastomoses in vessels less than 1 mm in diameter cannot be improved significantly by oblique division with or without adventitial stripping. In addition, adventitial stripping was followed by a high percentage of false aneurysms.

Aneurysm↗

PubMedDate not supplied

Adjuvant postoperative radiation therapy after curative resection of squamous cell carcinoma of the thoracic esophagus: a prospective randomized study.

Postoperative radiation therapy following curative resection of squamous cell carcinoma of the esophagus was investigated in a prospective randomized study. A group of 33 patients received postoperative radiation therapy and were compared to a control group of 35 patients treated by surgery alone. No statistically significant differences were noted between the two treatment groups concerning overall and disease-free survival rates. Postoperative irradiation significantly increased the incidence of fibrotic strictures of the esophagogastric or esophagocolonic anastomoses and caused a delayed recovery of patients quality of life. Based on these results, we believe that postoperative radiation therapy alone cannot be advocated as a adjuvant therapy following curative resection of squamous cell carcinoma of the esophagus.

Carcinoma, Squamous Cell↗

PubMedDate not supplied

[Carotid stenosis surgery: results after 10 years' experience].

From 1973 to July 1983 220 patients at the University clinic of Cologne, Germany, had carotid endarterectomies for carotid stenosis. A shunt has always been used. The procedure mortality and morbidity were 3,4% and 6,3% respectively. We do not see any indication to operate in acute stroke.

Arterial Occlusive Diseases↗

PubMedDate not supplied

[Venous thrombectomy].

The aim of surgical treatment of acute deep venous thrombosis is to prevent lethal pulmonary emboli, the venous desobstruction and the maintenance of the valvular mechanism. From 1972 to 1982, 161 patients have been operated at the surgical clinic of Cologne. In 41.4% of the cases the long term result was excellent. The clinical examination, the complaints of the patients, the phlebography were judgement criteria.

Catheterization↗

PubMedDate not supplied

[Ligation with elastic ligature: an alternative in the treatment of hemorrhoidal diseases].

Rubber band ligation, first described by Blaisdell, is an effective way of treating internal haemorrhoids. Treatment is ambulatory, thus saving time and costs. Experiences with 72 patients show this method to be superior to injection therapy and haemorrhoidectomy because of the simplicity of technique, the short period of treatment and the minimal discomfort for the patients. In our opinion rubber band ligation is the treatment of choice in managing internal haemorrhoids.

Hemorrhoids↗

PubMedDate not supplied

Preoperative immunostimulation by Propionibacterium granulosum KP-45 in colorectal cancer.

In order to improve the perioperative resistance to the spread of cancer during operation the effect of preoperative stimulation of the immunesystem by Propionibacterium granulosum KP-45 was investigated in patients with colorectal carcinoma. In a prospective randomized trial 101 patients were allocated to either treatment (n = 51) or control (n = 50). In the treatment 10 mg of Propioni bacteria were administered intravenously between the seventh and third day prior to surgical treatment. At the time of operation 21 tumours were classified as stage I (treatment n = 12, control n = 9), 22 as stage II (treatment n = 10, control n = 2). Postoperatively wound infections requiring treatment were more prevalent in the control group (n = 4) than in the treated group (n = 0). All patients were subsequently followed up for 76 months. For stage I carcinoma the survival rates, excluding perioperative deaths, were 91% in the treated and 63% in the control group respectively. One case of tumour metastasis was seen in the control group. For stage II carcinoma the survival rate was 90% for the treated group with distant spread in 1 case and 45% in the control group where the rate of recurrence was 55%. For stages III and IV there was no statistically significant difference in survival between the treated and the control groups.

Adjuvants, Immunologic↗

PubMedDate not supplied

The impact of patient's age on surgical therapy of colorectal liver metastases.

In a consecutive series of 90 hepatic resections for colorectal liver metastases which were performed during a 10-year period at one institution, the influence of patient's age on surgical strategies and postoperative results was investigated. The mean age of all patients was 61 +/- 11 years with a range from 27-78 years; 19 patients (21%) were younger than 50 years and 18 patients (20%) were older than 70 years. Thirty-six (40%) major and 54 (60%) minor hepatic resections were performed. The postoperative complication rate was 26% and resection mortality 3%. Estimated overall median survival time was 27 months, operative mortality included. 1-, 3-, and 5-year survival rates were 78%, 45%, and 32%, respectively. Although there is some suggestion that selection criteria are more aggressive in younger patients, neither surgical procedures nor postoperative results were found to be determined by the numeric age of the patient in a significant way.

Adenocarcinoma↗

PubMedDate not supplied

Immunostimulation by propionibacteria--effects on immune status and antineoplastic treatment.

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.

Adjuvants, Immunologic↗