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Between 1982 and 1997 inferior vena cava filters were implanted in 182 patients. Indications were recurrent pulmonary embolism, massive embolism and prophylactic use prior to planned high-risk-operations upon patients with thromboembolic complications in shorter history. Kimray-Greenfield, Cardial and Vascor-systems were implanted. Mortality was 0, neither relevant bleedings, nor infections occurred. Vena-cava-filters prevented from re-embolism in 98%. During hospitalisation 3 cases of re-embolism (1.6%) were noticed due to incorrect filter-placement. One patient died (< 1%). Follow-up-examinations were performed in 74 cases 6 to 24 months after implantation. We discovered 8 cases (11%) of filter-migration, 3 cases (4%) of filter-kinking, one case of filter-perforation and one case of filter-shrut-fracture. All these patients remained without clinical sequelae. Cava-thrombosis was found in 2 patients 6 to 24 months after filter-insertion (2.7%). There was no sign of re-embolism in our longterm follow-up. In our opinion the vena cava filter is an effective and safe method to prevent pulmonary re-embolism. Handling is quite easy and filter complications are low. In some elected cases prophylactic use of vena cava filters in high-risk-patients may be indicated.

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Since 1980, a total of 300 patients with colonic diverticulitis have undergone surgery. A vital indication forced us to do an emergency colostomy or Hartmann procedure in 22 cases. Except for 3 patients, the indication for resection was intentionally delayed by means of conservative treatment and a primary anastomosis was performed. Histological findings verified an inflammatory tumor, and abscess, a fistula or perforation in 50% and circumscript inflammation in 37%. The main complications were drainage problems (infection/retention of secretion, n = 18) and anastomosis insufficiency (n = 5), lethality was less than 2%. In general, we think that multistep surgery is not mandatory--even in advanced cases.

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In a controlled multicenter study 70 patients with chronic arterial occlusive disease stage IV according to Fontaine's classification were randomised to treatment with prostaglandin E1 (PGE1) or pentoxifylline (PX), administered over 4 weeks. Parameters of effectiveness were the reduction of analgesics, the relief of rest pain according to an analogue scale, the improvement of the ulceration according to an ulcer score and the healing of necrotic area. The results show that both forms of treatment produced a significant reduction in analgesic consumption and rest pain. Moreover in both groups a significant reduction of the ulcer score and healing of the necrotic area were observed. Side effects occurred in six patients of the PGE1-group and in ten patients of the PX-group, which required premature discontinuation of treatment in four patients of the PX-group. The study also demonstrated that PGE1 is more effective in the treatment of severe arterial occlusive disease than PX. With respect to the analgesic consumption, the reduction of ulcer score and the healing of necrotic area a significant difference was found in favour of PGE1. In accordance the six months follow-up examinations showed a marked deterioration in the PX-group opposed to the PGE1-group. The intravenous application of PGE1 over a period of 4 weeks in patients with severe arterial occlusive disease seems to be an effective therapeutical principle.

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An absorptive, hormonal, bacteriological and morphological study was performed in 9 proctocolectomized patients with continent ileal reservoirs established for 2-57 months. Vitamin B 12 malassimilation (as assessed by the Schilling test and serum vitamin B 12 concentration), bile salt deconjugation (modified 14C-glycocholate breath test), increased stool fat excretion and high intestinal sodium loss with secondary hyperreninism/hyperaldosteronism were encountered in a large percentage of patients; proximal small intestinal absorption (serum parameters, xylose test) appeared intact. In reservoir stool samples total and differential bacterial cell counts yielded values close to a normal rectum flora. Morphologically (endoscopy, quantitative histology) the reservoir mucosa showed moderate to severe inflammation; structural changes were essentially absent and inflammation in the adjoining ileum was minimal. These results indicate that reservoir bacteria frequently produce disturbances in small intestinal function and that these may be found without secondary structural transformation of the mucosa.

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On the basis of examinations made in 16 patients, morphological and clinical aspects as well as aetiology and therapy of desmoid tumours are discussed. For the first time human lymphocyte antigens (HLA) were determined, pointing to a genetic predisposition. Guide-lines for the surgical management are established. Hormonal, cytostatic and irradiation therapy are evaluated.

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1. An enhanced collagenolytic activity in the bowel tissue samples of M. Crohn and ulcerative colitis is demonstrated. 2. No inhibition of the collagenolytic activity was found when the specific collagenase inhibitor EDTA was applied. 2. In vitro, the application of EGLIN B resulted in a significant decrease of collagenolysis. EGLIN is a recently detected inhibitor of serine proteases such as Elastase.

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1. Fibrinolytic activity of colonic tissue samples rapidly decreased after wounding, independent of the plasminogen content of the plates. 2. Resorption of aprotinin into the colonic wall after IP application was found to be minimal. Bursting pressures and wall tensions were not altered by the drug.

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1. A kallikrein is isolated from the human colon. 2. A collagenolytic enzyme is detectable in this tissue. 3. On day 3 after surgery on the colon of the rat, an enhanced collagenolytic activity is demonstrated.

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A collagenolytic enzyme was extracted from the 6000 g sediment of homogenized postmortal human colon tissue. The enzyme digests native collagen at neutral pH. The enzyme has been concentrated by ammonium sulfate precipitation. The collagenolytic activity was measured using [1-14C]acetylated calf skin collagen, solubilized in 0.1 g/1 acetic acid. There was a significant inactivation of the enzyme solution after the addition of mumol EDTA to the test volume.

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Operations and follow-up examinations were conducted on 106 patient with ulcerative colitis, 33 with colitis Crohn, and 163 with diverticulitis, at the University Clinics of Cologne and Munich. Overall mortality rates were 24.5% (n=26), 6.1% (n=2) and 16% (n=26), respectively. In the surgical treatment of ulcerative colitis the possibility of malignant degeneration and, in the case of Crohn's disease, prevention of recurrences must be taken into consideration. Whether Crohn's disease is a precancerous condition remains to be clarified. Choosing the optimal time for operative intervention is as important in diverticulitis as in ulcerative colitis. Because of the possibility of complications and the high risk of operation, early intervention is recommended for diverticulitis.

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