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Very recent research results have demonstrated that the "Rostock Artificial Eye Collection" - assembled 150 years ago with 132 glass modelled exhibits of anterior segment pathologies - is mainly based on the figures of the Atlas of Ophthalmology published by Antoine Pierre Demours in 1818. This article focusses on the analyses of the imaging techniques of this atlas. Present knowledge implies that the author used different colour etching concepts which were partially re-coloured individually. In the opinion of contemporaries, the figures of Demours' atlas represent the climax of scientific imaging techniques. In the academic literature, it is still described as a "recent remarkable masterpiece", even 100 years later., Competing Interests: Die Autoren geben an, dass kein Interessenkonflikt besteht., (Thieme. All rights reserved.)

Complications following esophagectomy significantly affect the outcome, including perioperative mortality, costs and survival. Pulmonary complications and anastomotic leaks still remain the most serious complications and early recognition and appropriate initial treatment are essential. Mortality associated with esophageal leaks is decreasing due in part to the increased use of computed tomography (CT) scanning and endoscopy for diagnosis and subsequent appropriate multidisciplinary therapy. In this respect, it is critically important to differentiate between leaks and conduit necrosis, and endoscopic examination is the best method for making this assessment. Endoscopic and interventional radiology techniques are being applied increasingly for detection of intrathoracic leaks but appropriate patient selection is important. Adequate external drainage of the leak and prevention of further contamination are the primary therapeutic goals. The spectrum of therapeutic options ranges from simple conservative treatment for smaller, well drained leaks, interventional placement of drains, to endoscopic intervention with closure of the fistula or placement of stents and reoperation or discontinuity resection for conduit necrosis.

Background: Surgery, as well as conservative treatment, in patients with clinically apparent intrathoracic anastomotic leaks are often associated with poor results and carry a high morbidity and mortality. This report describes our results with the endoscopic treatment of intrathoracic anastomotic leakages., Patients: 27 consecutive patients presenting with clinically apparent intrathoracic anastomotic leak, caused by resection of an epiphrenic diverticulum (n=1), esophagectomy for esophageal cancer (n=19), limited resection for carcinoma of the gastroesophageal junction (n=1) or gastrectomy for gastric cancer (n=6) were endoscopically treated. The extent of the dehiscences ranged from about 10-70%. After endoscopic lavage and debridement of the leakage (mean duration: 16,8 days) the leaks were closed with fibrin clue (n=9) or endoclips (n=2) in cases of smaller leaks or by stent placement (n=11), stent placement after unsuccessful fibrin clue injections (n=3) or stent placement and endoclipping (n=1) in patients with a large leakage. Simultaneously the periesophageal mediastinum was drained by chest drains., Results: 25 of 27 patients were successfully treated endoscopically. Under endoscopic treatment one patient died due to septic multiorgan failure. Another patient developed a refractory, persistent leak. Procedure related complications (stent migration, anastomotic stenosis) were obtained in 6 patients., Conclusion: An endoscopic approach is successful and safe to treat symptomatic intrathoracic anastomotic leaks smaller than 70% of the circumference. An endoscopic lavage and debridement of the leak, prior to leak closure, seems to be helpful to reduce mediastinal and pleural inflammation. In patients with smaller leaks (<30%) fibrin clue injections and endoclipping is recommended. Patients with a dehiscence from 30-70% of the circumference profit from stent placement.

Background: Dysphagia may be due to oral, pharyngeal or esophageal dysfunction and poses a frequent problem for the otolaryngologist. Motor disturbances, structural disorders, functional problems, congenital lesions and malignancies have to be excluded in an interdisciplinary diagnostic approach. Currently, vascular diseases play a minor role in the diagnosis of dysphagia., Case Report: A 70-year-old female presented with constant dysphagia and a foreign body feeling in the throat of about 2 months duration. Palpation and ultrasound revealed a tumor situated in the right supraclavicular region. The lesion was identified as a true aneurysm of the subclavian artery by digital subtraction angiography. Successful resection and reconstruction was accomplished using a PTFE graft., Discussion: Aneurysms of the subclavian artery are rare and in most cases related to thoracic outlet syndrome (TOS) or arteriosclerosis. It can be assumed that an increasingly aged population will present with an increasing incidence of diseases related to atherosclerosis. Moreover, the increasing incidence of specific infections may contribute to this phenomenon. This neglected disease should be included in the differential diagnosis when dealing with supraclavicular lesions, foreign body feeling or dysphagia.

Introduction: With the increased use of endoscopic techniques, the rare, benign submucosal gastric tumors are being detected more frequently. We report our results with a combined laparoscopic-endoscopic approach for minimally invasive resection of these tumors., Method: The intraoperative endoscopy allows precise localization of the lesion by direct visualization and diaphanoscopy. Extragastral wedge resection of the stomach using the lifting method was carried out in patient with tumors of the anterior wall, lesser curvature and greater curvature. In tumors of the posterior wall, near the cardia or pylorus we performed an intragastric resection. One trocar with a balloon was inserted into the stomach. This trocar was used to introduce the endostapler into the stomach., Results: We performed this combined laparoscopic-endoscopic resection in 9 patients (5 extragastral; 4 intragastral). The tumor size of intragastral resection was 34 +/- 5 mm (range 28 to 41 mm) and 36 +/- 7 mm (range 26 to 47 mm) in intragastral resections. The histological examination revealed 7 gastric stromal tumors and 2 leiomyomas. There were no intra- or postoperative complications. The oral nutrition started on p.o. day 2. Hospital stay ranged from 4 to 8 days (6.4 days)., Conclusion: The minimally invasive combined laparoscopic-endoscopic resection of benign gastric wall tumors is a safe procedure with a low mortality and morbidity. The tumor localisation is the main criterion for decision on an extra- or intragastral approach.

Mediastinal anastomotic leaks are still catastrophic events following surgical procedures and are still a therapeutic challenge. A variety of conservative and surgical procedures have been proposed for the management of this conditions. An aggressive surgical approach is associated with considerable morbidity and lethality. A conservative approach is indicated only in a few selected patients with minimal anastomotic leaks. With advances in minimally invasive techniques, interventional endoscopic procedures have become an established therapeutic approach in the treatment of anastomotic insufficiencies. Our case report demonstrates that transesophageal placement of a selfexpandable metal stent in combination with interventional drainage of the paraesophageal space is a safe and effective procedure in the management of a mediastinal anastomotic leaks.

Methods: External perfusions of the pancreatic glands of Wistar-rats were done, using a modified Krebs-Ringer-Buffer (KRB). We looked for an elevation of amylase, lipase and lactate-dehydrogenase in the effusion fluid (portal outflow fluid). We investigated a normal perfusion (KRB, 60 minutes), a long term perfusion (KRB, 240 minutes) and a perfusion (60 minutes) including an additive of the detergents triton x-100 or the cholecystokinin analogue ceruletid (10(-8) M)., Results: An isolated external perfusion of a rat pancreas is possible without inducing any increase of parameters of damage such as amylase, lipase or lactate-dehydrogenase in the outflow medium. The perfusion time should be limited to 80 minutes including a 20 minutes equilibration period. A damage of pancreatic parenchyma is indicated by increased levels of pancreatic enzymes in the perfusion medium. Such damage can be induced by various noxious substances like detergents or cerulein, which has a significance in the pathophysiology of experimental acute pancreatitis. A significant increase (p < 0.01) of lactate-dehydrogenase, lipase and amylase was found 10, 20 and 30 minutes after an application of triton x-100. During a perfusion with the cholecystokinin analogue ceruletid (10(-8) M) we found an increase of lipase (p < 0.05) after 30 minutes and an increase of amylase (p < 0.05) after 50 minutes perfusion., Conclusions: The isolated perfused rat pancreas is a valuable experimental model to investigate the early phase of pathophysiology in acute pancreatitis.

Methods: The pancreas of 24 male Wistar rats was perfused extracoporally by modified Krebs-Ringer-buffer for 80 minutes (including a 20 minutes equilibration period). To verify any organ damage we measured the activity of pancreatic enzymes like amylase, lipase and lactatdehydrogenase in the portal effluent. Furthermore histological changes were analysed after perfusion. Organ damage was induced by adding cerulein in a physiological dose (10(-10) M, n = 6) and in a supramaximal dose (10(-8) M, n = 6) and by intraductal injection of taurocholate (3.5 %, n = 6)., Results: Already 10 minutes after stimulation with cerulein (10(-8) M) and after intraductal injection of taurocholate increased activities (p < 0.01) of amylase and lipase were measured in the portal effluent compared to the group without any treatment. Lactatdehydrogenase levels did not changed. Apart from marked oedema in both groups considerable zones of necrosis could be noticed especially in the taurocholate group., Conclusion: Our data suggest that the isolated perfused rat pancreas (IPRP) is a valuable experimental tool to verify pathophysiological changes in the early phase of acute pancreatitis (AP). Various established models of AP such as by cerulein hyperstimulation or intraductal injection of taurocholate, could be applied to the IPRP. We conclude that this method enlarges the spectrum of established experimental models of acute pancreatitis.

A method for classification of medical data using the Walsh transformation is demonstrated. The Walsh spectrum was obtained by the algorithm of Andrews-Kane-Pratt. The spectral points were used to declare the signals normal or abnormal. The example described in this paper shows that in the case of pulse wave the classification is successful in 93 percent.

The revalorization of the systolic time intervals in clincial and experimental cardiology is described on the basis of informations from literature and own experiences. Concerning the method of work the systolic time intervals have reached a limit which can be overcome only be automatized information processing. It is reported on principles and problems of the automatized information processing of systolic time intervals and an own development is described (HTME 101).

An evaluation of the HbF-content and the oxygen-half-saturation value took place in 15 newborn infants before, during and after an exchange transfusion. The initial HbF content decreased to 25% after the exchange transfusion with ACF-blood. The p50-value did not increase, as expected, but decreased dependent on the volume of the exchanged blood, caused by a quick loss of 2.3.-DPG in the ACD-blood within the first two days of storage. A normalization could be demonstrated 24 hours after the transfusion.