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During the past 11 years (1985-1996), 324 patients with pilonidal sinus were treated. In 272 cases primary wound closure was performed, in contrast to 52 cases with secondary wound healing. One hundred and fourteen patients were additionally treated with an antibiotic carrier (group 1), 158 were not (group 2). In group 1 primary healing occurred in only 66% of cases vs 69% in group 2. We found wound complications with a lag time of 4 days in comparison with group 2. Serious wound secretion persisted longer in group 1, resulting in a longer hospital stay of 6.5 days on average. We conclude that the application of antibiotic carriers does not raise the rate of primary wound healing. Better results can be achieved by secondary wound healing appropriate treatment with hydrocolloidal moist wound dressings.

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In 40 wistar rats liver and spleen were traumatized under standardized conditions. The hemorrhage was stopped by four different methods: 1. traditional suture technique with 4 X 0 Catgut, 2. fibrin glue, 3. endocoagulation according to Semm and 4. infrared-coagulation according to Nath.--The results show that the infrared-coagulation was the best schedule for a quick and safe bloodclotting in order to stop the hemorrhage sufficiently Concerning the postoperative lesions the infrared-coagulation had the best results also. On the other hand it could be demonstrated that this method has disadvantages with regard to the histological findings of repair mechanisms. There were deep and large areas of necrosis after infrared--as well as thermo-coagulation. The histological findings of the fibrin gluing technique, however, showed that after a few days of operation a new soft tissue grew into the traumatic lesion. Necrosis could not be identified.--If there is only short time in order to stop the hemorrhage of a parenchymatous organ we emphasize the infrared-coagulation as a favorite method because of the advantages in handling, clotting time and postoperative lesions. If there is more time in order to stop the hemorrhage we favorite the fibrin glue.

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The cytogenetic relationship between cells of the hematopoetic system and prosthesis lining cells is still not known. The purpose of this experimental study was to determine to what degree blood monocytes may be transformed into those cells which line the inner surface of vascular grafts. Immunological identical rats (donors = 25) were pretreated with a total dose of 150 micrograms C 3H-thymidine. In 25 recipient rats of the same strain the infrarenal aorta had been replaced by a vascular graft of dacron (1.8 mm theta) by using microsurgical techniques. Arteriovenous cross-transfusion was installed in pairs of the donor and recipient animals allowing for mixing the total blood volumes of both many times. Following sacrifice of the recipients the grafts and the area of anastomosis were studied autoradiographically. In all animals labelled monocytes were found in the graft wall with a marking index (MI) running between 1.5% to 5.5%. The marking index of the prosthesis lining cells was 1.9% to 3.4%. In 6 animals the anastomotic area was labelled and the MI run from 1% to 7.5%. With this new experimental model we ascertained that blood monocytes have capability of transformation: our results would indicate the hematogenic origin of new endothelial cells on prosthetic vascular surface by transformation of blood monocytes. This appears to apply to the prosthetic wall as well as the inner surface lining cells and the neighbourhood of the anastomotic area.

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Pseudo-endothelial cell growth on Sparks' auto-alloplastic vascular prostheses which had been grafted in the arterial circulatory system are examined by light- and electron microscopy at different intervals after application. The obtained data clarify that in future we should speak of prosthetic endothelium or lining cells when referring to those cells which line the inner surface of prostheses; the present study reveals that these cells lack some important criteria, e.g. complete basement membrane and intercellular bridges, by which real endothelial cells are distinguished. The rapid and complete growth of lining cells, expected to accompany use of Sparks' prostheses, could not be confirmed by the present experiments. Using a new microsurgical experimental model in the rat, we were able to show that even in a small animal species prosthetic arterial replacement is possible. Hereby, an important contribution has been made to microsurgical work in the field of experimental vascular surgery with a technique hitherto unknown in the literature.

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The therapeutic effect of TGLVP a new hormonogen of vasopression in demonstrated in a pilot study: 9 patients suffering from bleeding oesophageal varices (in total 16) could be sufficiently treated by TGLVP, as well as 9 patients (in total 13) with abdominal haemorrhage of unknown aetiology and localization. Good results can be expected by TGLVP to bring gastrointestinal bleedings to a standstill.

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Experimental microsurgical techniques using a magnifying glass and surgical microscope enable nearly all abdominal operations and organ transplantations to be performed in rats. Vascular and prosthetic segment implantations, portocaval anastomoses, heterotopic heart-, kidney-, spleen-, pancreas-, and liver transplantations some with superselective organangiography, are excellently demonstrated. Continuing research in microsurgery has considerably expanded experimental surgery and given new impulse to clinical surgery.

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The interaction between the blood and the inner prosthetic wall after grafting with the autoalloplastic SPARKS prostheses was examined by light and electron microscopy as well as by autoradiography. The results indicate that intercellular bridges are missing, and therefore that those cells that line the inner surface of the prosthesis are no real endothelial cells, as observed with the electron microscope. The authoradiographic findings demonstrate that blood monocytes definitely contribute to the construction of the new inner surface. We showed that although there is a possibility of transformation, the results is not a real endothelial cell, as shown by electron microscope. Nevertheless this cell apparently can fulfil its function.

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From 1967 to 1976 49 reconstructions were undertaken in the area distal of the art. poplitea: 30 femoral-crural bypasses, 12 TEA und 7 orthogradic desobliterations. Complications until clinical demission were reviewed. There were in 8 cases postop. thrombosis which led to 4 amputations. 6 patients suffered from wound infection with one consecutive amputation. 4 hemmorages had to be stopped surgically. THE OVER ALL RATE OF COMPLICATIONS WAS 36,7% WITH A PRIMARY MORTALity of 4%.

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A new surgical repair of coarcation of the aorta is reported on 7 infants in the first year of life. Hereby the subclavian artery is used as a modified patch for the coarctation and utilised for re-establishing aortic continuity. The results and advantages are presented and discussed.

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Our investigations show that Sparks prostheses after subcutaneous implantation are suitable for vascular grafting. At the end of the organization period the connective tissue becomes strong, and after the third and fourth weeks collagenous and elastic fibers can be seen. Ten weeks after s.c. implantation, collagenous fibers predominate. After this the Sparks prostheses can be used as a vascular graft. Intraperitoneal implantation, however, shows a histologically different picture with characteristic findings: only fat cells can be observed, a strong granulation tissue with elastic and collagenous fibers is not present. After intraperitoneal implantation Sparks prostheses are therefore unsuitable for vascular grafts.

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547 operations performed for reconstruction of 637 chronically occluded arterial segments in the aorto-iliac and the femoro-popliteo-crural stages were analyzed for occurred complications. Lethal event as the gravest complication happened in 4.6 p.c. of the aorto-iliac and in 1,1 p.c. of the peripheral operations. Most frequently we saw a disturbed wound healing (9.8 p.c.), but only in 0.5 p.c. a deep, also the artery including infection. Early reocclusions, caused by technical imperfectness during the performance of the operation were registered in 2.5 p.c. of the cases. In addition further observed complications are discussed.

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602 patients had an operation on the cardia of stomach during 10-year period 1964-1973 in the Surgical Department of Kiel University. In total there were 395 operations without resection with a 9% postoperative complication rate opposite to 207 resections of the cardia with 38% complications. Here the primary lethality was 7% (14 patients). The complications of suture insufficiency and hemorrhage are demonstrated and their outcome checked up: 13 of 16 patients died of suture insufficiency (81%) and 8 of those 13 with hemorrhage (62%). Especially important for the successful treatment of suture insufficiency are early diagnosis, drainage of the area and closure of the leakage. A new technique of suture insufficiency treatment is reported: T-Drainage into the leakage. This has led to a lowering of the death rate.

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Sparks-prothesis of 3 mm diameter were implanted into inbred rats and withdrawn after one to ten weeks. They were then fixed in Formalin and embedded in Paraffin and Metachrylat. After cutting (2.5 mu), the histological and histochemical parameters were examined. Cellular infiltration was studied after a certain period of time. The basic results of the genesis of that infiltration are given as follows: during the first two weeks following the s.c. implantation, derivates of monocytes (cells which play an imminent and important role during arterial replacement) were found. After the third and fourth week collagenous and elastic fibers could be seen, the connective tissue became stronger. The most favorable time for grafting can be evaluated by these experiments.

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