American College of Surgeons Deutsche Gesellschaft fur Chirurgie Joint Meeting Munich 1968 Edited by H. Burkle de la Camp, F. Linder and M. Trede Assisted by G. Kolig and K. Junghanns Section on Gynecology edited by J. Zander Special Reprint of the Gynecological Section With 51 Figures Springer-Verlag Berlin Heidelberg GmbH 1969 Proceedings oft he Sectional Meeting oft he American College ofS urgeons z.n Cooperation with the Deutsche Gesellschafl fur Chirurgie june 26-29, 1968, in Munich These papers arc reprinted from the full report of the Joint Meeting of the American College of Surgeons and the Deutsche Gcscllschaft fur Chirurgie, Munich, June 26-29, 1968, and published by Springer-Verlag Berlin Heidelberg GmbH 1969 ISBN 978-3-662-23068-8 ISBN 978-3-662-25034-1 (eBook) DOI 10.1007/978-3-662-25034-1 The usc of general descriptive names, trade names, trade marks, etc. in this publication, even if the former arc not especially identified, is not to be taken as a sign that such names, as understood by the Trade Marks and Merchandise Marks Act, may accordingly be used freely by anyone All rights reserved. No part of this book may be translated or reproduced in any form without written per mission from Springer-Verlag Berlin Heidelberg GmbH. © by Springer-Verlag Berlin Heidelberg 1969. Ursprünglich erschienen bei Springer-Verlag 1969 Library of Congress Catalog Card Number 76-92154. Title No. 1616 Contents ZANDER, J.: Surgical Treatment of Defects of the Uterovaginal Tract . . . . 509 LEVENTHAL, M. L.: Polycystic Ovarian Disease . . . . . . . . . . . . . 516 MULLIGAN, W. J.: The Role of Fallopian Tubes in Physiology of Conception . 520 HuFFMAN, J. W.: Roentgenographic and Other Techniques in the Diagnosis of Uterotubal Factors in Sterility and Infertility . . . . . . . . . . . . 522 FIKENTSCHER, R.: Utero-tubal Insufflation and Perfusion . . . . . . . . . 530 PALMER, R.: Restorative Surgery of the Tubes (a study of 600 personal cases). 539 HAMPERL, H.: Histopathology and Biology of Carcinoma in Situ . . . . . . 548 KERN, G.: Early Detection and Cytology of Carcinoma in Situ 555 BEACHAM, W. D., and E. H. LAWSON JR.: Surgical Treatment of Carcinoma in Situ of the Cervix Uteri . . . . . . . . . . . . . . . . . . . . . . 560 OBER, K. G.: Tendencies of Growth and Spread of Squamous Cell Cancer of the Cervix ........................... . 574 GusBERG, S. B., and J. RuDOLPH: Individualization of Treatment for Cancer of the Cervix .................. . 585 PARSONS, L.: Abdominal Operations for Cervical Cancer . . . . . . . . . 592 NAVRATIL, E.: Vaginal Surgery of Cervical Carcinoma ......••.. 600 KXSER, 0., and A. CASTANO Y ALMENDRAL: Evaluation of Different Methods of Treatment of Cervical Carcinoma . . . . . . . . . . . 606 PRATT, J. H.: Diagnosis of Recurrent Carcinoma of the Cervix. 612 BRICKER, E. M.: Management of Recurrent Cervical Cancer . . 616 III Introduction, authors and titles of the other papers presented at this Meeting are listed below. Introduction This volume contains some hundred papers read before a Sectional Meeting of the American College of Surgeons held in conjunction with the German Surgical Society in Munich from 25th through 29th June 1968. The committee responsible for the scientific program, headed by WILLIAM P. LoNGMIRE (Los Angeles) and FRITZ LINDER (Heidelberg) was able to obtain the cooperation of American and European experts in providing a survey of topical problems concerning general and special operative medicine. Thus the subjects range from general surgery with all its specialities, to traumatology and orthopedics, urology as well as gynecology. The response from our colleagues was most gratifying: More than 1200 surgeons from 33 nations, two-thirds of them from the United States and Canada, participated in this international exchange of information, which was supplemented by a series of panel discussions. We wish to thank Springer-Verlag, Berlin-Heidelberg-New York for publishing these proceedings and thereby contributing to a world wide interest in the improvement of operative therapy. In addition our gratitude has to be expressed to many members of the Surgical Department of Heidelberg Uni versity who have given great support and enthusiasm to the preparation of this volume. The Editors. v Contents Opening Addresses BuRKLE DE LA CAMP, H. 1 VossscHULTE, K. 2 NESBIT, R. M ..... . 3 OcHSNER, A.: The Influence of German Surgery on American Surgery 4 LINDER, F.: American-German Relations in Surgery . . . . . . . . 10 Vascular Disease ScHETrLER, G.: Etiology of Arteriosclerosis. Relationships to Systemic Diseases 16 WENZ, W.: Radiographic Techniques in Diagnosis of Vascular Disease . . . . 22 VoLLMAR, J ., and K. LAUBACH: Management of Chronic Femoropopliteal Artery Obstruction . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31 RoB, C.: Indications for and Techniques of Surgical Treatment for Carotid Artery Ste- nosis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36 MoRRIS, G. C., ]R., E. S. CRAWFORD, and M. E. DE BAKEY: The Vertebral Artery in Cerebral Anoxia . . . . . . . . . . . . . . . . . . . . . . . 42 ZUIDEMA, G. D.: The Superior Mesenteric Artery Syndrome . . . . . . . . . . 49 WYLIE, E. J., W. K. EHRENFELD, and R. ]. STONEY: Renal Artery Stenosis . . . . . 53 HEBERER, G., and R. GIESSLER: The Treatment of Abdominal Aortic Aneurysms 61 AusTEN, W. G.: Management of Thoracic Aortic Aneurysms. . . . . . . . . . . 67 Cardiac Surgery Ross, D. N.: Plastic Homologous and Heterologous Valves 76 GERBODE, F., W. J. KERTH, P. A. SANCHEZ, and G. H. PuRYEAR: Reconstruction and Replacement of the Mitral Valve . . . . . . . . . . . . . 82 BIGELOW, J. C., and A. STARR: Multiple Valve Replacement . . . 91 MULLER, W. H., JR.: Assisted Circulation and the Artificial Heart 103 BoRST, H. G., and A. ScHAUDIG: Results of Intracardiac Pacing . 109 Shock and Trauma GoGLER, E.: Statistics of Civilian Trauma . . . . . . . . . . . . . . 113 SHIRES, G. T.: The Current Management of Hypovolemic Shock 123 FucHSIG, P., E. KuTSCHA-LISSBERG, and H. SPANGLER: Abdominal Injury 132 VosssCHULTE, K.: Chest Injury. . . . . . . . . . . 142 ALLGOWER, M.: Rigid Internal Fixation. . . . . . . . . . . . . . . 149 SPENCER, F. C.: Management of Acute Arterial Injuries . . . . . . . . 154 NAHUM, A.M.: Mechanism and Prevention of Design-Related Injuries in Automobile Collisions . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 160 VII Physiology and Surgery of Peptic Ulcer KAY, A. W. : The Physiology of Duodenal Ulcer with Special Emphasis on Gastric Acid Secretion . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168 GRIFFITH, C. A.: Selective Vagotomy. . . . . . . . . . . . . . . . . . . . . 172 ZuKSCHWERDT, L., and E. FARTHMANN: Treatment of Bleeding Gastric and Duodenal Ulcers . . . . . . . . . . . . . . . . . . . 181 WELCH, C. E., and J. F. BURKE: High Gastric Ulcers 186 The Pancreas GROZINGER, K. H.: Management of Acute Hemorrhagic Pancreatitis . . . . . . . 196 PRIESTLEY, J. T., and W. H. RE MINE: Surgical Treatment of Chronic Relapsing Pan- creatitis . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202 LoNGMIRE, W. P., JR., and W. L. BRUCKNER: Periampullary Carcinoma . . . . . . 210 ZENKER, R., H. HAMELMANN, A. GRABIGER, and R. BEDACHT: Diagnosis and Therapy of Islet-Cell-Tumors . . . . . . . . . . . . . . . . 216 ZoLLINGER, R. M.: Non-Insulin-Secreting Islet Cell Tumors 221 Portal Hypertension WARREN, W. D.: Hepatic Blood Flow and Portal Hypertension . . . . . . . . . 227 GtiTGEMANN, A.: Selection and Preparation of Patients for Porto-Caval Shunt Opera- tion. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238 EKMAN, C.-A.: Porto-Caval Shunt and Ascites . . . . . . . . . . . . . . . . . 244 VoORHEES, A. B., JR., J. B. PRICE JR., and R. C. BRITTON: The Late Results of Portacaval Shunts . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248 Surgery of Infants and Children GooDWIN, W. E.: Anomalies of the Genitourinary Tract . . 253 REHBEIN, F., and H. HALSBAND: Treatment of Megacolon . . . . . . . . . . . . 269 HENDREN, W. H., and J.D. CRAWFORD: Surgical Treatment of Endocrine Disorders in Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273 GROB, M.: Abdominal Tumours in Infants . . . . . . . . . . . . . . . . . . . 282 HALLER, J. A., JR., D. 0. MAZUR, and W. W. MoRGAN JR.: Diagnosis and Manage ment of Mediastinal Masses in Children . . . . . . . . . . . . . . . . . . 289 Plastic and Reconstructive Surgery LYNCH, J. B.: Reconstruction Following Facial and Thoracic Burns 298 SCHMID, E.: Surgery Following Facial and Thoracic Burns . . . 305 ScHUCHARDT, K.: Late Repair of Facial Injuries . . . . . . . . 310 DINGMAN, R. 0.: The Management of Acute Soft Tissue Injuries of the Face and Fractures of the Facial Bones . . . . . . . . . . . . 324 PEACOCK, E. E., JR.: Early Management of Injured Hands . . . . . 327 ScHINK, W.: Surgery Following Burns of the Hand . . . . . . . . 336 GEORG, H.: Delayed Primary Suture After Severe Injuries of the Hand 340 BoYES, J. H.: The Basic Principles of Tendon Transfers 347 - Dupuytren's Contracture. The Abductor Minimi Digiti Band . 349 BucK-GRAMCKO, D.: Dupuytren's Contracture . . . . . . . . 352 REIMERS, TH. C.: Plastic Surgery of the Hip Following Trauma 355 VIII GEORGIADE, N. G., and R. A. MLADICK: Traumatic Injuries of the Groin Including the Genitalia . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361 PICK.RELL, K., R. MLADICK, L. THOMPSON, and M. KASDAN: Reconstructive Surgery of the Legs Following Trauma . . . . . . . . . . . . . . . . . . . . . . 370 Operative Treatment of Fractures MAURER, G., and F. LECHNER: Indications for Conservative and Operative Treat- ment of Fractures . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377 ScuDERI, C. S.: Discussion . . . . . . . . . . . . . . . . . . . . . . . . 387 REHN, J.: Immediate Surgical Care of Fractures Involving the Socket of the Hip-joint 388 CAVE, E. F.: Discussion . . . . . . . . . . . . . . . . . . . . . . . . . 395 MERLE D'AuBIGNE, R.: Is Prosthesis Treatment of Fresh Femoral Neck Fractures Justified? . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396 HAMMOND, G.: Discussion . . . . . . . . . . . . . . . . . . . . . . . . 399 MAATZ, R.: Long Term Experience with Internal Nail Fixation of Fractures of the Fe- mur and Tibia . . . . . . . . . . . . . . . . . . . . . . . . . . 401 MooRE, M., )R.: Discussion . . . . . . . . . . . . . . . . . . . . 405 WILLENEGGER, H.: Prevention and Management of Infection in Osteosynthesis 406 MooRE, M., )R.: Discussion . . . . . . . . . . . . . . . . . . . . 414 WILSON, P. D., )R.: Surgery for Rheumatoid Arthritis of the Lower Extremities 415 HARRISON, E. G., )R., and M. B. CovENTRY: Synovial Tumors: Diagnosis, Treatment, and Prognosis . . . . . . . . . . . . . . . . . 420 WILSON, J. C., JR.: Injuries of Growth Cartilage . . . . . . . . . . . . 431 PoNSETI, I. V.: The Pathogenesis of Adolescent Scoliosis . . . . . . . . 439 MULLER, M. E.: Intertrochanteric Osteotomy in Arthrosis of the Hip-Joint 440 BAILEY, R. W.: Neurological Complications of Cervical Spine Injuries: Diagnosis and Treatment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 445 Urologic Injuries CocKETT, A. T. K., S. A. BROSMAN, and W. E. GooDWIN: Diagnosis of Injuries to the Kidney: a Review of 125 Cases . . . . . . . . . . . . . . . . . . . . . . 452 LUTZEYER, W.: Conservative Management oflnjuries to the Kidney . . . . . . . . 456 PETERS, P. C., M. 0. PERRY, and H. M. SPENCE: The Operative Management of Renal Injuries . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462 RoHL, L.: Results Following Conservative Surgery of Injuries to the Kidney 471 RoTH, R. B.: Surgical Injuries to the Ureter . . . . . . . . . . . . . . 474 Renal Stones BROSIG, W. J.: Etiology of Renal Calculi .... . 479 ScARDINO, P. L.: Diagnosis of Renal Calculus .. . 483 KLOSTERHALFEN, H.: Conservative Treatment of Urinary Stones 488 KERR, W. S., JR.: Surgical Management of Renal Stones . 496 ScHWAIGER, M.: Kidney Stones and Hyperparathyroidism 499 CoPE, 0.: Surgery of the Parathyroids . . . . . . 505 Gynecology ZANDER, J.: Surgical Treatment of Defects of the Uterovaginal Tract 509 LEVENTHAL, M. L.: Polycystic Ovarian Disease . . . . . . . . . 516 MuLLIGAN, W. J.: The Role of Fallopian Tubes in Physiology of Conception 520 IX HuFFMAN, J. W.: Roentgenographic and Other Techniques in the Diagnosis of Utero- tubal Factors in Sterility and Infertility . . . . . . • . . . . . . . 522 FIKENTSCHER, R. : Utero-tubal Insufflation and Perfusion . . . . . . . . 530 PALMER, R.: Restorative Surgery of the Tubes (a study of 600 personal cases) 539 HAMPERL, H. : Histopathology and Biology of Carcinoma in Situ . • . . . 548 KERN, G.: Early Detection and Cytology of Carcinoma in Situ • . . . . . 555 BEACHAM, W. D., and E. H. LAwsoN JR.: Surgical Treatment of Carcinoma in Situ of the Cervix Uteri . . . . . . . . . . . . . . . . . . . . . . . . . . . . 560 OBER, K. G.: Tendencies of Growth and Spread of Squamous Cell Cancer of the Cervix. . . • . . . • . . . . . . . . . . • . . . . . . . . . . . . . . 574 GusBERG, S. B., and J. RuDOLPH: Individualization of Treatment for Cancer of the Cervix . . . . . . . . . • . . . • . . . . . 585 PARSONS, L. : Abdominal Operations for Cervical Cancer . . . . . . . . . . . . . 592 NAVRATIL, E.: Vaginal Surgery of Cervical Carcinoma . . . . . . . . . . . . . 600 KXSER, 0., and A. CASTANO Y ALMENDRAL: Evaluation of Different Methods of Treatment of Cervical Carcinoma . . . . . . . . . . . 606 PRATT, J. H. : Diagnosis of Recurrent Carcinoma of the Cervix 612 BRICKER, E. M. : Management of Recurrent Cervical Cancer . 616 X List of Participants ALKEN, C. E., Professor Dr. med., Director of the Urological University Hospital and Medical School of the University at Homburg/Saar ALLGOWER, M., M. D., F. A. C. S., Professor and Chairman of the Department of Surgery, University of Basel, Switzerland AusTEN, W. G., M.D., F. A. C. S., Professor of Surgery, Harvard Medical School, Boston BAILEY, R. W., M.D., F. A. C. S., Professor of Surgery, Section of Orthopaedic Surgery, University of Michigan School of Medicine, Ann Arbor BAUER, K. H., Professor Emeritus of Surgery, Delegate of the Board of Trustees, German Cancer Research Institute, Heidelberg BEACHAM, W. D., M. D., F. A. C. S., Professor of Clinical Obstetrics and Gynecology, Tulane University School of Medicine, New Orleans BISCHOFF, P., Dr., Professor of Urology and Chief, Department of Urology, St. Elizabeth Hospital and Children's Hospital of Hochallee, Hamburg BLOCKER, T. G., JR., M.D., F. A. C. S., Professor of Surgery and Dean, University of Texas Medical Branch, Galveston BoRST, H.-G., M. D., Professor of Surgery and Director, Surgical University Hospital, Hannover BoYES, J. H., M. D., F. A. C. S., Clinical Professor of Surgery, University of Southern California School of Medicine, Los Angeles BRAMANN, C. voN, Dr. med., Specialist in Surgery, Berlin BREWER, J. I., M.D., F. A. C. S., Professor of Obstetrics and Gynecology, Northwestern University Medical School, Chicago BRICKER, E. M., M. D., F. A. C. S., Professor of Clinical Surgery, Washington University School of Medicine, St. Louis BROSIG, W. J., Dr., Professor of Urology and Director, Urological University Clinic, Free University School of Medicine, Berlin BucK-GRAMCKO, D., Dr. med., Chief, Department of Hand Surgery, Traumatology Hos pital, Hamburg-Betgedorf BuRKLE DE LA CAMP, H., Dr. med., Professor of Surgery and Secretary of the German Surgical Society, Dottingen CAVE, E. F., M.D., F. A. C. S., Consulting Visiting Orthopaedic Surgeon, Massachusetts General Hospital, Boston CocKETT, A. T. K., M. D., F. A. C. S., Associate Professor of Surgery/Urology, Harbor · General Hospital, Torrance, California CoPE, 0., M.D., F. A. C. S., Professor of Surgery, Harvard Medical School and Visiting Surgeon, Massachusetts General Hospital, Boston CuLP, D. A., M.D., F. A. C. S., Professor of Urology, State University of Iowa College of Medicine, Iowa City D'AUBIGNE, R. MERLE, Prof. M.D., F. A. C. S. (Hon.), Professor of Orthopaedic Surgery, University of Paris DETERLING, R. A., JR., M.D., F. A. C. S., Professor and Chairman, Department of Surgery, Tufts University School of Medicine, Boston DINGMAN, R. 0., M. D., F. A. C. S., Professor of Surgery and Head, Section of Plastic Surgery, University of Michigan School of Medicine, Ann Arbor XI