Die chirurgische Therapie des Ulcus cruris venosum durch Fasziektomie und Vakuumversiegelung

The venous crural ulcer is a persistent disease with a high recurrency rate; in Germany the number of patients with venous crural ulcers is estimated to be between 1 and 2 million. Based on our knowledge that chronic venous crural ulcers accompany sclerosis of the skin, subcutis and fascia and in most the cases chronic compartment syndrome in the affected lower leg, the following therapy regimen was created: (1) surgical therapy of underlying varicosis according to the clinical stage; (2) excision of the crural ulcer, including the underlying fascia; (3) vacuum sealing of the defect for rapid wound conditioning, (4) early meshgraft. Between February 1996 and May 1997, 26 patients with venous crural ulcers were treated according to this therapy regimen. There was complete healing of the crural ulcer in all cases. It took an average of 11.2 days from excision of the ulcer and fascia to the meshgraft; a mean of 2.1 vacuum sealings per patient was necessary; hospital admission time averaged 46.1 days. The above therapy regimen can be recommended as an effective and fast method of curing even long-lasting venous crural ulcers.     

An improved procedure for fixation and embedding of whole,intact lens tissue for light microscopy

Fixation and embedding of whole, intact lens tissue are often difficult. During studies of morphologic changes in various experimentally induced cataracts, an improved procedure was developed, utilizing isomolar fixative and water-soluble embedding medium (glycol methacrylate), while avoiding dehydration with organic solvents. Different rat and human cataractous lenses were processed in toto using this method, and the results were uniformly good upon light microscopic evaluation. The potential of this fixation-embedding procedure for lens research is discussed.In honor of Professor Otto Hockwin on the occasion of his 60th birthdayD.R.S. received support for this work from the Alexander von Humboldt-Stiftung     

A comparison of laparoscopic ultrasound with digital fluorocholangiography for detecting choledocholithiasis during laparoscopic cholecystectomy

Background: Laparoscopic ultrasound is an alternative to operative cholangiogram for evaluation of the common bile duct (CBD) during laparoscopic cholecystectomy. It is a safe, fast, and reliable method for detecting choledocholithiasis. Methods: We prospectively evaluated the sensitivity and specificity of laparoscopic ultrasound (LUS) and digital fluorocholangiogram (DFCG) in a three-phase study of 360 consecutive patients. Results: In phase I, 140 patients undergoing laparoscopic cholecystectomy had LUS performed first, followed by DFCG. Thirteen patients had CBD calculi identified on LUS. Four patients with confirmed (two cases) or presumed (two cases) CBD calculi on DFCG were not identified on LUS. Thus, the specificity of LUS was 100%, whereas the sensitivity was 76.5%. DFCG had four false positives, for a sensitivity of 100% with a specificity of 96.7%. LUS was performed, on average, in 6.6 min, whereas DFCG required 10.9 min to perform. In phase II, the infusion of saline through a cystic duct catheter was performed in instances where the distal CBD could not be well seen. This maneuver distended the intrapancreatic portion of the CBD, allowing better visualization. Nine stones were identified on LUS in 78 patients, increasing the sensitivity to 100%. One false positive DCFG was encountered, resulting in a sensitivity of 100% and a specificity of 98.6%. In phase III, we performed routine LUS and used DFCG only in select cases. The sensitivity and specificity for LUS were 95.7% and 100%, respectively, whereas DFCG had a sensitivity of 95.2% and a specificity of 100%. One patient in phase III has returned 11 months post-op with a CBD stone. This was initially missed on LUS, DFCG, and postoperative ERCP. The sensitivity and specificity in all 360 patients were 90% and 100% for LUS and 98.1% and 98.1% for DFCG, respectively. A total of five CBD stones were missed by LUS, four early in the study (phase I). One missed on LUS in phase III was also missed by DFCG and ERCP. Conclusions: LUS is a reliable alternative to DFCG during laparoscopic cholecystectomy (LC). With experience, it is as sensitive as DFCG and more specific. It is more rapidly performed than cholangiography.     

Ultraviolet-induced changes in corneal transmission properties and influence on Scheimpflug photography

The effects of ultraviolet B (UV-B) irradiation on transmission of the rat cornea were studied in combination with or without naphthalene feeding. UV irradiation as well as naphthalene feeding caused a decrease in transmission in the wavelength region from 315 to 450 nm, UV irradiation being thereby the more hazardous influence. The combination of both noxae did not lead to a pronounced decrease as compared with UV irradiation alone. Although the histological findings of the eye lens suggest a syncataractogenic action of UV-B and naphthalene feeding, a corresponding effect could not be found by means of Scheimpflug photography. This could be possibly due to the alteration in corneal transmission properties following UV-B irradiation.     

Videodensitometry in rats with pulmonary damage due to microembolism

Serial pulmonary angiography with videodensitometry was performed in 18 rats with pulmonary damage caused by administration of a fibrinolysis inhibitor, tranexamic acid (200 mg/kg body weight injected intraperitoneally) and bovine thrombin (500 NIH/kg body weight injected into the right femoral vein). The mean transit time (MTT) was calculated from videodensitometry, the observed area of interest consisting of approximately one-third of the right lung, including both central and peripheral parts. The impact of the pulmonary damage was analysed by morphologic methods and correlated to MTT. Although a pressure rise presumably occurred in the pulmonary circulation, no change in MTT was found after induction of pulmonary damage, indicating opening of actual and potential anastomoses between pulmonary arterioles and venules to serve as by-pass portions and as a safety-valve mechanism for the capillary bed and the right heart, respectively. Another explanation to unchanged MTT may be opening of resting capillary beds. Two rats with very severe pulmonary damage showed prolonged MTT. These rats may have suffered from cardiac failure.     

Osteogenic sarcoma with pulmonary metastasis visualized by bone imaging

Extraosseous soft tissue metastases from osteosarcoma occasionally accumulate Tc-99m MDP. The authors present a case of osteogenic sarcoma of the femur with a pulmonary metastasis detected by bone imaging with radiographic correlation including CT and magnetic resonance imaging. The implication of the detection of osseous and extraosseous metastasis in these patients by bone imaging is discussed. The changing role of bone imaging in the initial workup and follow-up of patients with osteogenic sarcoma is reviewed in light of the change in course and prognosis of the disease as a result of recent advances in adjuvant chemotherapy.     

Transplantation and preservation of tissue-typized skin in burns]

At the Department of Plastic Surgery and Burns, Berufsgenossenschaftliche Unfalklinik Ludwigshafen-Oggersheim, a skinbank with typed skin has been established. The storage system consists of deep-freezing at -196 degrees C in liquid nitrogen. The transplantation of HL-A typed skin was evaluated from the clinical and histological point of view. Due to the effort necessary for such an undertaking this method is critically reviewed.