Pelviscopic surgery in gynaecology (author's transl)

Surgery of the fallopian tubes has today developed into pelviscopic surgery. The development of suitable instruments such as the tube set, a new endocoagulation method were prerequisites for this development. Operative therapeutic pelviscopic surgery is a development past laparotomy. It is now possible to treat adhesions in the abdomen with this method, to coagulate and divide fallopian tubes for sterilization, to aspirate ovarian cysts and resect walls of ovarian cysts, to coagulate endometriosis and to perform salpingolysis and salpingostomy. In selected cases ovariectomy and myomectomy are possible through the pelviscope. Tables and statistics on 3300 pelviscopies are presented. The indications are discussed. The use of pelviscopy following previous laparotomy (1831 cases) is discussed. The complication rate was 1.10% without death, without injury to large vessels, without embolic phenomenon. The operative risk is therefore less than that of laparotomy. The operative therapeutic pelviscopy can replace the classical laparotomy in about 25% of the cases. For the operation of tubal infertility, a laparotomy is eliminated in about 80% of the cases.     

Gastrostomy in paediatric surgery (author's transl)

Gastrostomy has the same field of application as the feeding tube which is introduced either orally or nasally. With careful nursing and surgical technique, only few and slight disturbances are to be expected. This method, however, ist not suited for routine application by the premature baby because of its possible septic complications.     

A panel on vascular surgery (author's transl)

For this second panel by correspondence, we have asked 3 distinguished experts to answer 7 questions and to comment on 3 case histories concerning vascular surgery. Although a direct discussion between the participants was not possible an impressive degree of agreement is here being demonstrated.     

Angled micro-scissors for after-cataract surgery (author's transl)

A report is given on new micro-scissors for after-cataract operations. Its shape permits a perfect direction of incision in the pupillary region not only form a temporally placed corneal incision but also from all other meridians without its handling being impeded by the orbital border or th nose of the patient. Especially in certain injury sequels and other postoperative conditions the scissors extend the operative possibilities.     

The biomechanical pathogenesis and differentiated therapy of cervical headache (author's transl)

Dysfunction in the upper region of the cervical vertebral column is largely to be regarded as the primary disorder from which secondary anatomical substrates, especially degenerative manifestations, develop. We must shift our attention from pathomorphology to function. There are two main types of disordered vertebral function which may lead to headache in many cases: 1. hypomobility (blocking) 2. hypermobility. Suggestions are made for selective methods of examination which help the detection of disturbed function. Cinematography can be used for substantiation. Diagnostic differentiation indicates possibilities for special manipulative, physical, surgical and orthopedic treatment.     

Controlled EEG alpha feedback training in normals and headache patients (author's transl)

Headache patients and healthy controls underwent alpha-EEG feedback training in 12 sessions. The present study does not support the literature which reports alpha increase by feedback training. The study included a patient group receiving feedback, a patient control group receiving pseudofeedback, and a volunteer group receiving feedback. Increase of alpha EEG was observed under feedback and pseudofeedback. However, there was always more alpha during baseline times than during training times. Alpha increase over time is suggested to be a habituation effect. Headache pain decreased with training (within the boundaries of a placebo effect), and there was no difference in headache decrease between feedback and pseudofeedback patients.     

Possibilities and limits of outpatient surgery (author's transl)

The aims of modern outpatient surgery include: the comprehensive development of ambulatory therapy especially the repertoire of operations, preclinical standardized diagnostic procedures, postoperative outpatient care and rehabilitation. The main reasons for this development are analyzed. In order to make further progress in the direction indicated the number of surgeons working in outpatient departments will have to be increased. Own experiences in outpatient saphenectomy, excisions of Dupuytren's contracture, haemorrhoidectomy, mastectomy, herniorrhaphy, enucleation of cold nodes in the thyreoid gland (171 operations between 1972 and 1974) encourage further efforts in this direction.     

The facial nerve and the parotid gland (author's transl)

The modern histological classification of epithelial salivary gland tumours is described. An exact knowledge of the behaviour of each type of tumour permits correct surgical planning. Contrary to the teaching that the superficial parotidectomy is the minimal safe resection, the author feels that in many cases dependent on tumour site, size and histological type, a simple excision is sufficient. The application of microsurgical techniques permits careful and safe surgery.     

Controlled hypotension in difficult intraocular anterior segment surgery (author's transl)

During anaesthesia controlled hypotension -- induced by sodium nitroprusside -- was used in 60 patients undergoing intraocular anterior segment surgery. The advantages of this procedure are that the iris-lens diaphragma and the vitreous body have a lesser tendency to protrude than with other techniques despite even more superficial anaesthesia.     

Anaesthetic methods for surgery of cerebral aneurysms (author's transl)

The anaesthetist giving anaesthesia for the surgical removal of cerebral aneurysms faces a great variety of tasks. Experience gained in the course of 61 such operations has shown that a combination of controlled hypotension, careful monitoring of the function of the autonomic nervous system and a meticulous surgical technique with the aid of a microscope produces satisfactory results.     

Compression of the ulnar nerve at the wrist (author's transl)

Compressions of the ulnar nerve at the wrist in or beyond the canal de Guyon are comparative rare. Those originating from compression in the sulcus ulnaris at the elbow are much more common. The clinical symptoms are typical: Weakness of the small muscles of the hand, loss of sensibility and pain. The diagnosis can be made on the clinical picture. It has to be confirmed by electromyography. Surgery should be performed as early as possible to avoid permanent damage to the nerve. Any delay can cause irreversible loss of function of the ulnar nerve. As causes of the compression of the ulnar nerve tumours, inflammation of the sourrounding tissue or trauma have been described. In this paper we report about compression of the ulnar nerve in the canal de Guyon due to a thrombosed aneurysme of the ulnar artery. This condition is quite rare. It is characterized through sudden onset of pain in the hand. Immediate surgery with decompression of the nerve, as we did in our case, will result in complete recovery.     

Evaluation of laser surgery against brain tumor (author's transl)

A surgical carbon dioxide laser unit (Laser) has been used in 26 cases of various brain tumors, including 10 meningioma (4 sphenoid ridge, 3 parasagittal, 1 falx, 1 olfactory, 1 posterior fossa); 12 glioma (7 glioblastoma, 5 astrocytoma); two metastatic brain tumors; 1 hemangioblastoma, and 1 AVM. Criteria for Laser use based on evaluation and location of meningioma were: grade 1, convenient but adjuvant; grade 2, also necessary; grade 3, indispensable. Most meningioma in convexity and parasagittal were grade 1-2, with those in the sphenoid ridge grade 2-3. In the glioma group, hemorrhage in 3 cases of glioblastoma was easily Laser-controlled, and the tumors wasted away in a short time with vaporization. There was minimal mechanical effect on the adjacent tissue. Conclusion: In neurosurgery, Laser is obligatory in sphenoid ridge meningioma to dissect the internal carotid artery, middle cerebral artery, cavernous sinus, sphenoid ridge, etc. It is very useful in glioma, especially glioblastoma, considering shortened surgical duration, decreased blood loss and extended tumor resection. Laser surgery is proposed as most appropriate for brain tumors in elderly and poor risk cases mainly for its vaporizing function.     

Improvement of utero-placental perfusion by transcutaneous nerve stimulation (author's transl)

A report is given on 37 patients with a diminished utero-placental perfusion. 12 patients underwent only once, 25 patients daily over 2 to 3 weeks a transcutaneous lumbo-sacral electric nerve stimulation. Both, the 12 patients stimulated only once and the 25 patients with daily stimulation, showed a significant increase of utero-placental perfusion measured by the method of radioisotope placental perfusion. Transcutaneous nerve stimulation (TNS) therefore could be used for therapeutic purpose in cases of placental dysfunction.     

Dumping-prophylaxis (author's transl)

The dumping syndrome is due to a vigorous reflex distension of the jejunum, caused by the stomach violently evacuating its contents. The aim of treatment is to overcome the drastic evacuation by restoring the rhythmic peristalsis of the stomach (eukinetics). This can be achieved by a special diet. Every meal should begin with well chewed solids (pulp) and avoid all fluids. With a well organised medical staff a complete success can be achieved. Surgical measures in Dumping can be avoided.