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Total ankle replacement has been introduced in the last 30 years. The TNK ankle is build from ceramics, and it was continuously improved. This prosthesis has the longest fellow-up times. Seventy ankle prostheses of the newest generation has been implanted between 1991 and 2001. Of these, 67 prostheses were assessed clinically and radiographically after 62 months (range, 24 to 132 months). Three ankles have been revised. The clinical score improved for the patients with primary or posttraumatic arthritis from 34 to 86, and for the patients with rheumatoid arthritis from 45 to 74. Loosening was found in 4 ankles with non-rheumatoid arthritis, and in 17 ankles with rheumatoid ankles. Total ankle replacement has emerged to a valuable alternative to ankle arthrodesis, and satisfactory results have been achieved with the current implants. The bone-implant interphase might play a most important factor for success. There is evidence that the biologic advantages of ceramics may help to improve long-lasting success in total ankle replacement.

In order to study the effect of postoperative irradiation on intestinal adhesions and fibrosis and also determine the effects of DM on these processes, experiments were carried out on 76 rabbits and the following results were obtained: 1. When irradiation alone was conducted without any operative procedure, neither thickening of the intestinal canal and serosa nor adhesions occurred immediately after irradiation. 2. One week after postoperative irradiation, no effect of irradiation was noted on the intestine or the surgically induced adhesion. Several months later, however, collagenization of the site of the adhesion was seen. At this time, inflammation still persisted, so that further intensification of the adhesions remains a possibility. 3. DM definitely prevented intestinal adhesions secondary to surgery due to operation. It is also evident that this substance inhibits intestinal adhesions and collagenization induced by combined surgery and irradiation.

At first an analysis is presented of 656 patients with early carcinoma of the stomach, which had been diagnosed during the last 10 years. Most frequently found were depressed or excavated lesions (type IIc, III). 53% of all lesions were located in the mucosa only, in 8.3% lymph nodes were infiltrated, - mostly in such cases, where the primary tumor was located in the antrum, where submucosal layers where involved, or where poor differentiated adenocarcinoma or signet-ring cell carcinoma were present. Diagnostic criteria of minute early gastric carcinoma are discussed. In a second part diagnostic importance of endoscopic sonography is described, especially its importance in regard to estimating depth of infiltration of the tumor. New possibilities of using laser to destroy very small tumors and to treat in a palliative manner malignant stenosis are discussed as well.

The pathologic and histologic features of 17 cases of pigmented villonodular synovitis and bursitis are described. Similar lesions were induced in rabbit knee joints by injection of hypercholesterolaemic serum. A therory is presented that the inflammatory reaction is induced by release of cholesterol esters and crystals from foam cells in a manner similar to crystal-induced synovitis. It is theorized that a disturbance of cholesterol metabolism is responsible for the development of foam cells.