Practice and theory of "delayed" embolectomy. A 22-year perspective

A study was made of delayed embolectomy in 45 patients (55 limbs). In 5 patients (11%) the cause of arterial embolization was rheumatic heart disease, and 40 patients (89%) suffered from atherosclerotic cardiovascular disease. The study was divided into 3 phases: I (1960-1964), II (1965-1974) and III (1975-1981). In phases II and III surgery was carried out using the Fogarty catheter technique. In 5 patients the embolus was located in the upper extremity. Seven patients died and 8 major amputations were performed within 30 days of surgery. Use of the Fogarty catheter technique and persistent anticoagulant therapy effected 71.8% limb salvage in phase II and 91.6% limb salvage in phase III. Successful revascularization was achieved in 70.9% of the limbs in which peripheral emboli had occurred on an average of 2.7 days prior to surgical intervention. A theoretical basis for the late development of the acute embolic onset is presented.     

Primary open therapy of acute necrotizing pancreatitis by the "open abdomen"]

There is no agreement about a conservative surgical strategy in the therapy of acute necrotizing pancreatitis yet. This report describes our experience with "open packing" laparostomy. This procedure is only performed when renal and pulmonary insufficiency is proceeding, despite optimal conservative treatment. Since 1986 15 patients were treated in this manner. Three compartments are established: an upper compartment (stomach, liver, spleen--covered by the omentum majus, which is dissected from the colon transversum); a lower compartment (small bowel--covered by the left colon) and the mid compartment that permanently opens the bursa omentalis and the left retrocolic space. Initially a careful necrosectomy is performed, followed by a tamponade. At the intensive care unit changing of the tamponade and lavage of the bursa omentalis was done every day. So far two patients have died pursuing this therapeutic regimen.     

Analysis of the collective term "periarthritis humeroscapularis"]

The functional and anatomical consideration of the shoulder joint in relation to the clinical aspects can differentiate the general term of "scapulohumeral periarthritis". The most frequently pathological findings are seen in the rotary cuff and the long head of the biceps muscle. Significant causes are further arthrosis of the acromioclavicular joint, the instability of the shoulder joint and the frozen shoulder. The exact diagnosis of the disease makes on operative therapy possible.