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To address functional and smile dysfunction associated with post-facial paralysis synkinesis, the senior author (B.A.) has offered "modified selective neurectomy" of the lower division of the facial nerve as a long-term solution. This article examines technical considerations and outcomes of this procedure.A retrospective review was conducted of patients who underwent modified selective neurectomy of buccal and cervical branches of the facial nerve performed by a single surgeon over a 4½-year period. House-Brackmann facial grading scores, electronic clinician-graded facial function scale, and onabotulinumtoxinA (botulinum toxin type A) dosages were examined before and after the procedure.Sixty-three patients underwent modified selective neurectomy between June 20, 2013, and August 12, 2017. There were no serious complications. The revision rate was 17 percent. Temporary oral incompetence was reported in seven patients (11 percent) postoperatively. A statistically significant improvement was achieved in electronic clinician-graded facial function scale analysis of nasolabial fold depth at rest, oral commissure movement with smile, nasolabial fold orientation with smile, nasolabial depth with smile, depressor labii inferioris lower lip movement, midfacial synkinesis, mentalis synkinesis, platysmal synkinesis, static score, dynamic score, synkinesis score, periocular score, lower face and neck score, and midface and smile score. There was a significant decrease in botulinum toxin type A dosage and House-Brackmann score after surgery.Modified selective neurectomy of the buccal and cervical divisions of the facial nerve is an effective long-term treatment for smile dysfunction in patients with post-facial paralysis synkinesis.Therapeutic, IV.

In the years 1971-1976 five patients with Dieulafoy's ulcer were operated upon succfully in the Innsbruck University Surgical Clinic. A high consumption of alcohol and tobacco was an outstanding feature in the history of all these patients. Gastroscopy is the diagnostic procedure of choice in this disease; it should be done during the acute phase of hemorrhage since the rather minor morphological changes often cannot be detected when they are not bleeding. Occluding the bleeding vessel by stitches is the therapy of choice. Procedure including resections, especially a socalled "blind" resection, do not seem to be justified. If the bleeding vessel cannot be found during endoscopy a large gastrotomy ought to be done with careful inspection especially of the upper third of the stomach. Our patients were followed up to 64 months; they all are well and without complaints. Prognosis thus seems to be very good if a correct diagnosis is established quickly and if surgery is done adequately.

A case of “bowenoid” leukoplakia in the anal region of a 31-year-old woman is presented to our knowledge for the first time in the literature. Clinically the lesion appeared as a “simple” leukoplakia. Although excision of the lesion was performed as histologically shown in toto, three recurrences followed. Both retinoid therapy and local treatment with 5-fluorouracil were unsuccessful, whereas radiation therapy apparently cured the patient.

We report 3 patients with traumatic renal artery thrombosis treated successfully with revascularization. The diagnosis was made preoperatively in 2 cases and intraoperatively in 1. Treatment consisted of reanastomosis with a saphenous vein patch on the side of the arteriotomy in case 1, an aortorenal artery saphenous vein bypass in case 2 and a bypass graft from the aorta to the distal renal artery in case 3. Two patients had functioning kidneys and normal blood pressure, and 1 patient died 24 hours after reconstruction.

Etiology, pathophysiology, and clinical picture of local frost-injuries are described. By aid of literature, and by proper experiences in 49 patients, who had been treated at the University-Hospital of Innsbruck during the year of 1966 to 1973, therapy of local frost-injuries is discussed. Moreover the advantage of surgical therapy on the sympathicus over conservative treatment is pointed out.

Post-operative complications after colonic surgery because of malignant tumours were analysed in 412 patients from 1961 to 1974 at the Surgical-Clinic of Innsbruck University. 42% of the patients had postoperative complications. 60% of these complications were directly due to surgery, 40% indirectly. Attention should be paid to the fact that colonic surgery in particular has a high rate of complications, i.e. 76% of these cases seen in relation to 38% of routinely operated patients. With reference to all patients 18 different complications were observed. Causes of these complications and prophylactic treatment, likely to decrease the rate of lethality and complications are discussed.

Between 1961 and 1974 at the University Hospital Surgical Clinic at Innsbruck, 991 cases of malignant tumors of the colon have been treated. Statistically a significant increase is proved in the number of these patients above the age of fifty in the Tyrolean population during this period. On the other hand the percentage of colon-tumors is decreasing with the age in patients younger than fifty. 412 out of these 991 cases could be analysed very carefully. The malignant tumors have been studied, among other respects, in relation to the localisation in the particular part of the colon, the frequency in the different ages and sexes. Specially the symptoms due to the particular localisation of the tumor are stressed. It is also noticed that the long case history, mainly because of the patients' own negligence, plays a decisive part in the unsatisfactoring number of cured. Some measures are mentioned, which with the so far got knowledge and science can improve the final therapeutic results.

At the First University Clinic for Surgery Innsbruck a benign, scarred stenosis in the anal canal was found in 14 patients between 1975 and 1981. This stenosis turned out to be the cause of an anorectal incontinence. This stenosis results in a hampering of important organs in the anal canal that are conducive to continence. Therapy, therefore, aims at a restoration of continence. Within this therapy, removal of the stenosis is the first and most important step.

The operative results of 115 patients with pilonidal sinus are described. The patients were controlled in 1977, 2 to 11 years after surgery. Only small, non-infected pilonidal sinuses should be radically excised followed by primary suture and Redon-drainage. For extended sinuses and for recurrences the best results are obtained when the wound is left open or marsupialisation is applied. Pilonidal sinus-abscesses should be incised. This simple procedure resulted in primary healing in 23% of our patients.

Selective proximal vagotomy was performed on 165 patients at the I. Surgical Clinic of Innsbruck University, between 1970 and 1984. Results of 90 patients were retrospectively evaluated. Lethality was 0.6 per cent, while the rate of recurrence amounted to 14.4 per cent and average acid reduction to 50 per cent. 65 per cent of the above 90 patients were almost without any postoperative complaint, when rated by the I. and II. degree according to Visick. Results were particularly favourable in cases of perforated ulcer, combined ulcer (Type II according to Johnson), hyperacid gastroduodenitis, and in cases of duodenal ulcer of women.

An assay of lipolytic activity in human adipose tissue is described, in which native homogenates of the adipose tissue yield the enzyme, as well as the triglyceride substrate, and the emulsifying phospholipids. The lipolytic activity in the presence of serum is characterized mainly as lipoprotein lipase activity by a pH-optimum of 8.0, by the fact that serum is necessary for full activity, and that it is inhibited by 1 M NaCl and by protamine. At serum concentrations of higher than 50% a marked inhibition of the lipolysis is observed. Noradrenaline, insulin, and heparin have no effect on the serum-stimulated lipolytic activity.

By means of 20 liver abscesses in fourteen patients it is described how percutaneous drainage of abscesses can be applied. Method, technique, indications, contraindications as well as possible complications of this procedure are described and illustrated in four cases. In addition both principal differences and common features of percutaneous sonographic drainage and incision of the abscess are described. It is also stated which method is to be preferred in the individual case.

Problems of 39 patients with permanent colostomies/ileostomies are investigated one up to seven years after having got the anus praeternaturalis. The postoperative problems of everyday life are various and often serious, they are the more severe, the less patients had been informed preoperatively and the older the patients are. Younger and more intelligent patients integrate the colostomy easier and more quickly in their everyday life. Very useful for rehabilitation is the close contact between patient and the surgeon, respectively special colostomy-consulting hours.

A report concerning the follow-up examinations of the 14 patients with rectum cancer from the University Surgical Clinic in Innsbruck, Austria, who from 1961-1974 were operated on using Hochenegg's technique. Interestingly enough, it was noticed that when the height of the anastomosis was less than 5 cm from the anal ring, a partial incontinence appeared (in 3 of the 14 patients) and when it was more than 5 cm from the anal ring, a total continence was assured. A relapse was observed three times in the tumor cases type C2 and D (Duke). Post-operative complications occurred in 4 cases, none being life-threatening. The indications of this technique will be discussed.

Between 1969-1984 (16 years) 17 patients with "malignant haemangioendothelioma" of the thyroid were admitted to our services. This type of cancer is usually found in patients with a long history of goiter and is a very aggressive tumor. Infiltration of surrounding tissues is mostly responsible for death by asphyxia or uncontrollable bleeding. Some patients die also from metastases, which were seen frequently in the lungs. A precise preoperative diagnosis of the disease can be achieved rarely, histological classification has improved using immunohistochemical assays of Factor-VIII antigen in tumor tissue. No "prescription" for therapy can be given: results of surgery, radiotherapy and chemotherapy do not show significant differences (also in a variety of combinations). If the diagnosis is properly established, palliation will be the only therapeutic goal.