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Before introduction of endoscopic subfascial dissection, surgical treatment of the perforating veins was a neglected topic. High error rates in the preoperatively marked perforating veins, wound-healing problems due to the incision in trophically disturbed areas, and leg ulcers prevented correct surgical treatment. Endoscopic subfascial dissection allows the accurate elimination of all clinically relevant, insufficient perforating veins in the lower leg. Therefore, it has become an accepted, improved treatment concept in the surgical therapy of primary varicosis in all three stages of chronic venous insufficiency. This experience is demonstrated based on a prospective study of the patients treated in the year 2000.

Subfascial dividing of insufficient perforating veins is considered the most effective therapeutic principle in the treatment of primary varicosis and postthrombotic changes or varicosis-related trophic disturbances of the skin. A new endoscopic technique allows these veins to be sectioned under direct vision, with little trauma. Between November, 1986 and August 1991, 74 patients underwent endoscopic sectioning of perforating veins in a total of 106 legs. In 100 legs, the procedure was combined with a conventional stripping operation. The perforating veins divided most frequently involved the Cockett group (223), the 24 cm perforating vein (86) and the Boyd group (83). In three legs (2.8%) showing trophic skin changes in the lower leg area impaired wound healing was seen postoperatively. Follow-up examination carried out 27 months after the procedure revealed insufficient perforating veins in two of the legs treated. New varices were seen in nine legs. In terms of staging of chronic venous insufficiency, either a more favourable stage or complete healing can be achieved in 90 of the cases.

From January 1976 to December 1986 181 patients with chronic arterial occlusive disease were provided with an Y-prosthesis of the aorta. In a retrospective study we reviewed the history of these patients. From 130 (72%) patients we obtained information about the further course of the disease, 83 (46%) patients were reexamined. Depending on the preoperative stage (Fontaine-Ratschow classification) of the chronic arterial occlusive disease, patients in higher stages had a greater benefit from the implantation by shifting into a more satisfactory stage. The majority of patients without any postoperative complaints (48%) belonged to the group, preoperatively classified into stage II B. Depending on the type of occlusion the best results were obtained in unique occlusions of the aorto-iliac vascular segment. 50% of the reexamined patients had no complaints although in 61% of these cases the superficial femoral artery was occluded in the mean time. 47 patients deceased during the interval of observation. In most cases death was caused by other manifestations of the basic disease (e.g. cardiac infarction or cerebral apoplexy). The 10-year-survival rate was 59%. The majority of patients with chronic occlusive disease of the pelvic arteries profited from the implantation of an aortal Y-prosthesis. The long-term success of this operation with its low lethality depends on the preoperative stage and the extent of the occlusive process.

The subfascial discision of insufficient perforating veins is considered the most effective therapeutic principle for the treatment of postthrombotic disturbances of the skin as well as for trophic disturbances caused by varicose. A new endoscopic technique allows to be sectioned them under direct view control with little trauma. In the period from November 1986 to April 1990 61 patients underwent an endoscopic sectioning of perforating veins. Perforating veins have most frequently been separated in the area of the Cockett group (153), the 24 cm perforating vein (74) and in the area of the Boyd group (63). Two patients (3.3%) with trophic disturbances of the skin in the area of the shank showed disturbances of wound healing after the operation. First results of the follow-up examination 3-37 months postoperative have proved good (45%) to very good (40%) results. Criteria, which were observed, were pains in the leg, disturbances of sensibility, swellings and relapsed varices. Only two patients proved a bad result. Insufficient perforating veins in the area of the shank were not found by one of the 61 operated patients. Referring to a staging of chronic venous insufficiency it can be said that with the exception of the two patients above mentioned there is a ranging to a more favourable stage or to a complete treating.

Esophagus cancer is a heterogeneous disease with considerable differences in malignant behaviour. Some relevant factors for prognosis are known. In this study we analyzed DNA-ploidy as a potential prognostic parameter in esophagus carcinoma. Paraffin embedded histological material from 50 patients with an esophagus cancer, obtained by resection, were selected for analysis. Tumor areas within the paraffin material were identified by HE-stained reference sections. One 50 microns section was dewaxed, rehydrated and mechanically and enzymatically treated to a suspension of 10,000 cells/ml. 1 ml of the suspension, containing bare nuclei with small rests of cytoplasma was centrifuged on glass slides. The fixed nuclei were air-dried and stained by Feulgen-SITS technique, which allows quantitative measurement of DNA. The DNA analysis was carried out with a computer-controlled single cell cytophotometry (Leytas 2, Leitz, Wetzlar). In contrast to the flow cytometry with image cytometry only tumors cells were measured. Overlapping nuclei, dirt and other artefacts as well as inflammatory cells were efficiently eliminated. With the DNA image cytometry we could differentiate between diploid and hypotriploid, hypertriploid aneuploid tumors. Best prognosis had diploid and hypotriploid tumors, the worst hypertriploid carcinomas. In the multivariate analysis the DNA-content of the tumor cells in esophagus cancer was the only prognostic parameter. DNA-content of tumor cells may become considerably clinical relevant in esophagus cancer for the decision to perform a resection or palliative treatment. In patients with hypertriploid tumors an adjuvant oncological therapy may increase the prognosis.

A new 99mTc-labelled tracer (99mTc-Sestamibi) was used for the first time to demonstrate the perfusion of the skeletal muscle. In 16 patients with obstructive atherosclerosis of the lower limbs the change of perfusion of thigh and lower leg was studied with SPECT before and after vascular surgery (n = 11) or percutaneous transluminal angioplasty (n = 5). Comparative results of scintigraphic measurements and clinical observations (ankle-arm pressure, treadmill test) in 10 surgical patients (14 operated legs) showed correct positive or negative results in 86% (12/14).