Search

We reviewed 57 arthroscopic lateral release of the knee-joint during the period from January 1985 to December 1988. A high percentage of chondropathies affecting the patella and the patellofemoral joint was the mainly indication to this surgical operation. Included in the above mentioned cases were 8 traumatic patella luxations. Therefore, the necessity of strict indication and adequate postoperative therapy is emphasized.

Resection by pneumonectomy or lobectomy is the treatment of choice in lung cancer. At the Robert-Roessle-Clinic the 5-year survival rates have been improved by this method of treatment from 21% (120 of 570 cases) in the period 1949--1961 to 34% (163 of 498 cases) in the period 1962-1968. The increased survival is due, above all, to earlier detection by annual x-ray mass screening. The same conclusions could be drawn with regard to the results of a cooperative study of 17 chest clinics in the GDR reporting about more than, 11 000 operated cases. To guarantee and to improve this high level of detection and treatment of lung cancer the reorganization of the screening procedure with regard to high risk groups in man is necessary.

Correlations between obesity and prognosis of operated cancer of the breast have not been investigated until now. In 491 patients operated upon by radical mastectomy (1968 to 1972) it can be demonstrated that in patients in whom the weight of the resected breast is above 1100 g the survival rates are more unfavourable than in other cases. As to tumor size and invasion of lymphnodes the distribution in the group with "heavy breasts" is more unfavourable than in the other groups. The causes of the differences in survival may be attributed to worsened conditions for detection of cancer in cases with large breasts as well as to alterations of hormone production and metabolism in connection with nutritional factors.

Problems of vocational rehabilitation after radical operation of 307 patients with bronchial carcinoma, who are still living 3 years after the operation are analysed. Preoperative relation of professional groups: Employees 46%, industrial workers 28%, independent professions 15%, agricultural professions 11%. The success of rehabilitation is dependent on profession extent of resection, and other concomitant diseases.

This analysis of 1100 cases with cancer of the female breast treated by classical radical mastectomy demonstrates an improvement of the 5-year-survival-rate from 53,0% (1960-1964) to 61,2% (1968-1972). In this period we observed an increase of cases with cancernegative lymphnodes from 39,0% to 50,8%. This improvement is the result of earlier diagnosis because there has been no selection for surgical treatment during this period. Additional methods of treatment (irradiation, chemotherapy) are without convincing influence on survival rates. Therefore, earlier detection and radical surgical treatment will play the dominating role in the near future.

A randomized clinical trial on adjuvant treatment of operable breast cancer in female aged between 35 and 70 years was performed from 1962 to 1972. Criteria for admission into the trial were: unequivocal clinical evidence of breast cancer stage T1-3 NC-3; no general or technical contraindications against standard radical mastectomy type Rotter-Halsted; no contraindications against radiation or cytostatic treatment: 435 patients entered the trial and 372 patients were evaluable. Of these 126 were treated by surgery, 126 by surgery followed by cyclophosphamide (100 mg/kg BW in daily intravenous doses of 200 mg), and 120 by preoperative radiation therapy (about 5500 rad tumour dose by telecobalt) and surgery. The crude 5-year survival rate was 58.7 percent, 57.1 percent, and 57.5 percent respectively. The number of local recurrences and local node metastases was 29.4% after surgery, 23.0% after surgery combined with chemotherapy, and 12,5% after surgery combined with preoperative radiation therapy. This significant reduction in locoregional recurrences was most impressive in the supraclavicular node region. In the irradiated group, the mean diameter of tumours in the surgical specimen was obviously smaller and in 11 cases the tumour in the breast was completely destroyed.

The value of radical mastectomy in treating cancer of the breast has been questioned by some authors. With regard to the results published and on the basis of our own experiences limited operations without or with additional radiotherapy cannot be considered to be reliable procedures at present: it is only possible to approximately equal results by a strict case selection. With special cases such as in-situ carcinoma or small well defined cancers with beginning infiltration being expected there is no real basis for the indication to limited surgery in a single case. With the increase of small prognostically favourable cancers and border-line cases due to improvement of early detection more attention should be devoted to the problem of treating breast cancer by limited operations.

19 cases with carcinoma of the middle third of the oesophagus were treated by resection in one session by laparotomy and right thoracotomy: in two cases with instrumental perforation substitution of the oesophagus by stomach via the retrosternal route--in 15 cases resection and high intrathoracal oesophagogastrostomy--in 2 cases resection and colon interposition because of previous gastric resection. 2 patients died postoperatively. 2 patients survived more than 5 years. There is an indication for resection in all functionally and technically operable cases.

Further investigations of the study group for the early detection of lung cancer in the GDR have confirmed previous conclusions that annual x-ray screening of the chest significantly improves the results of surgical treatment of cancer of the lung. The study now covers 15,336 cases operated upon between 1949 and 1976. Two thirds of all cases treated surgically in the period from 1963 to 1972 were detected by roentgenologic screening. In the screening group the 5-year survival rates after resection were more favourable than in the clinical group: 36% in 1,915 screening cases and 29% in 785 clinical cases in the period from 1965 to 1968. The percentage of peripheral lesions which were treated by lobectomy was significantly higher in the screening group. Since the introduction of a biannual mode of screening, the overall results have worsened because the number of cases detected by x-ray screening has decreased.