Search

Copyright of Der Unfallchirurg is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Copyright of Langenbecks Archiv fuer Chirurgie is the property of Springer Nature and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

We present the case of a 57-year old man who underwent total parathyroidectomy with autotransplantation into the brachioradial muscle (Wells' method) due to secondary hyperparathyroidism as a complication of chronic renal failure. Three years later the patient developed recurrent secondary hyperparathyroidism due to graft hyperplasia resulting in the removal of the graft. We point out various problems associated with Wells' method and discuss alternative surgical techniques.

The correction of complex long bone deformities with concurrent bending, twisting and shortening is primarily based on complex preoperative planning. Up to now, wedge-shaped cortico-spongiose osteotomy has usually been performed. The single cut osteotomy requires more complex mathematical calculations and was therefore less frequently undertaken. In this paper, we present a graphical approach to define the plane of the single-cut osteotomy without any calculations. The resulting osteotomy allows a simultaneous correction of a deformation in the coronal and sagittal planes, as well as a coexisting torsional error. The advantages of this graphical approach are evident. Preoperative planning is significantly simplified and abbreviated as mathematical calculations are no longer needed. Furthermore, the precision by which the osteotomy plane is defined is not decreased by application of this method. However, the osteotomy should be done preoperatively in a model.

Meckel's diverticulum is the most common anomaly of the gastrointestinal tract. Neoplasms are extremely rare. We report a case of carcinoid tumor of Meckel's diverticulum in a patient with acute abdominal pain. So far, 111 cases have been reported. Review of the literature reveals that carcinoids are the most common malignant tumors of Meckel's diverticulum. Two thirds of the patients remain asymptomatic. Metastases are seen in 25% at diagnosis. The probability of metastases depends on the size of the primary tumor. Because of the early metastases rate even in small tumors, aggressive surgical management is justified.

Between 1981 and 1993, 27 bronchial carcinoids were diagnosed in patients living in the Swiss Canton of Ticino, with a mean age of 55 (24-78) years. The incidence was 0.79/100,000 inhabitants. Main symptoms were cough (41%), hemoptysis (30%) and bronchial obstruction such as pneumonia or atelectasis (26%). There were no cases with carcinoid crisis. Preoperative evaluation included chest X-ray (100%), bronchoscopic biopsy (84%), computed tomography (44%) and mediastinoscopy (15%). Some 69% of the patients underwent lobectomy and 15% segmental resection. Pneumonectomy was required for curative surgery in 2 patients. One patient underwent bronchoscopic resection. Surgery is generally indicated. The 5-year survival rate for typical carcinoid was 94% and was significantly reduced to 42% in atypical carcinoid cases (p = 0.02). Prognosis after radical surgery is favorable and depends mainly on lymph node involvement and the histological type of carcinoid.

Ischemic preconditioning (IP) refers to a phenomenon whereby short periods of ischemia reduce tissue damage after a subsequent sustained ischemia. The effect of IP before tourniquet ischemia of the extremities has not yet been evaluated. We developed a rat model of skeletal muscle ischemia and measured the effect of IP on postischemic function and high-energy phosphate levels. IP consisted in three cycles of 10 min ischemia and 10 min reperfusion each. IP improved significantly skeletal muscle function after 3 hours of ischemia and 2 hours of reperfusion. High-energy phosphate levels, however, remained unchanged. This study is the first that shows a protective effect of IP in skeletal muscles. These results furthermore suggest that the protection of energy metabolism is not a mechanism of IP in this model. IP could be easily performed before surgery of the extremities under tourniquet ischemia. The protective effect on postischemic skeletal muscle has therefore to be further investigated.

During the last years the cases of severe group A streptococcus infection have increased. The clinical manifestation of this streptococcal toxic shock syndrome is similar to the better known toxic shock syndrome (TSS) provocated by staphylococcus. Shock, bacteremia and acute respiratory distress syndrome are common features, and death has been associated with this infection in 30% of patients. We present the case of a 46-year-old man who fell gravely ill with sepsis, diarrhoe, scarlatina rash, desquamation of hands and feet and acute abdomen caused by group A streptococcus infection. Finally we discussed the possible port of entry of this infection, the different clinical manifestation and the concepts of treatment.

The localized fibrous tumors of the pleura are rare neoplasms, also known as "benign pleural fibromas" or "localized mesotheliomas", but those names are inaccurate. The tumors are composed of undifferentiated mesenchymal cells, intermediate and differentiated fibroblasts and collagenous interstitial tissue. Their origin is normally the submesothelial layer of the visceral pleura. Mesothelial differentiation is not present. The grading of malignancy doesn't correlate with final outcome, adequacy of surgical excision being the most important factor. This neoplasm may recur but retain its basical histologic features. The positive results for vimentin and negative results for cytokeratin antibodies help to distinguish the localized fibrous tumors from the mesothelioma. We present too cases and their diagnostic possibilities.

We present the case of a sacral chordoma (S3-S5). Its diagnostic problems as well as its pathological properties and the epidemiologic situation are discussed. The therapy and the surgical procedure are outlined.

60 heads of surgical units of non-university hospitals in Switzerland were questioned about their opinion about their assistants. The questionnaire was divided into: general data about hospital size and number of assistants, employment criteria, further education, operative activities and working hours of assistants. The answers are representative for the situation in non-university hospitals in Switzerland.

533 patients with diagnosis of operable colorectal carcinoma were randomized to receive either a single course of portal infusion with Mitomycin-C (MMC) and 5-Fluorouracil (5-FU) starting immediately after operation, or no adjuvant treatment. Of these, 505 (94%) were evaluable. Over the median follow-up of 8 years, the adjuvant therapy reduced the risk of recurrence by 22% (Hazard ratio = 0.78%, 95% CI 0.61-0.99; P = 0.045). The relative reduction of relapse on death was similar in all subgroups (i.e. nodal status, localization). However, adjuvant portal chemotherapy proved to be most efficient in the subgroups of patients with tumor involvement of the regional lymph nodes (Dukes C) and of patients with colon cancer. Analysis of the pattern of relapse showed that most of the difference in overall and disease-free survival is to be attributed to a consistent reduction of all kinds of tumor recurrences (i.e. local relapses, liver metastases and/or other distant metastases) in the treated group, rather than to liver relapses alone. We conclude therefore, that part of significant benefit obtained for patients with operable colorectal carcinoma treated with a single course of adjuvant chemotherapy via the portal vein might be due to the additional systemic effects of the portal chemotherapy and further study of perioperative treatment with and without prolonged chemotherapy appears worthwhile.

The opinion about their residents of 60 heads of surgical departments of non-university hospitals in Switzerland is presented. Problems concerning employment criteria of residents, their professional education, operative activity and work hours are discussed.

The present retrospective study evaluates 197 mediastinoscopies, performed between 1981 and 1990. The aim of the study was an actual evaluation of mediastinoscopy as an investigation for diagnosis and staging of intrathoracic diseases. Although the introduction of CT-scanning has caused a considerable decrease in the number of performed mediastinoscopies per year, we find that mediastinoscopy because of its high sensitivity (75%) and specificity (100%) still has an important place in the evaluation of intrathoracic diseases. It represents no alternative to CT, but a complementary diagnostic tool. As a conclusion four indications for mediastinoscopy today are proposed.

Based on an epidemiological observation on traffic accidents in the Swiss canton of Ticino, 1985, the following statement is possible: In Switzerland, 900 people die every year as a result of traffic casualties. Many victims of these accidents will be disabled for life. Direct and indirect costs of traffic injuries reach 3 billion Swiss francs a year. Only a small amount (6%) is devoted to medical treatment. The biggest part is due as compensation for lost income, disability allocations and loss of productivity. Among the avoidable fatalities those caused by traffic accidents have a very undesirable effect, because they involve mainly the young. More efforts should be undertaken to lower the mortality on the road, because it changes the Swiss population pyramid in a significant manner.

Between 1981 and 1987, 533 patients from 9 institutions have been entered in a randomized trial to assess the value of adjuvant portal infusion (5-Fluorouracil, Mitomycin C) compared to radical surgery alone. Analysis of 469 evaluable patients at a median follow-up of 5.8 years revealed 110 recurrences in the control and 94 recurrences in the infusion group. Estimated 5-year disease-free survival was 52% and 61% respectively (hazard ratio 1:0.75; 95% confidence interval 0.57-0.99; p = 0.046). Overall survival was 59% in the control and 69 in the infusion group (p = 0.048). Adjuvant portal infusion did not influence the occurrence of liver metastases but reduced the overall recurrence rate.

We analysed the esophageal manometry of 36 patients before, and of 25 patients 1 to 14 years (5.8 years) after, fundoplication. The results were compared with the findings in 30 asymptomatic volunteers. Fundoplication raised the mean lower esophageal sphincter pressure from 6.2 mm Hg to 14.5 mm Hg, i.e. normal values (controls 20.2 mm Hg). The shortened lower esophageal sphincter length and its intraabdominal segment were overcorrected (increase from 3.2 to 5.2 cm [controls 4.1 cm] and 1.3 to 2.6 cm [controls 2.1 cm] respectively). The rate of non-specific motility disorders after fundoplication was reduced from 61% to 28% (controls 7%). A clear relationship between the success of fundoplication and either preoperative or postoperative manometric results could not be established.

The authors reviewed their experience with hanggliding injuries, and additional cases in the literature. As most accidents are due to how people fly (inexperience), and where people fly, the authors conclude that an adequate training is mandatory.

The report is based on a follow-up of over 54 osteosyntheses employing the Dynamic Hip Screw (DHS) of the AO on the proximal femur. The patients, of an average age of 72 years, exhibited the following lesions: fractures of 7 femoral necks, 43 fractures in the pertrochanteric region, 3 reverse fractures and 1 subtrochanteric metastasis. An unstable fracture was present on 26 occasions. The follow-up, carried out personally, was done from 3 to 26 months postoperatively on 38 out of 40 patients still alive. The average age was 68 years. In not a single case was an implant failure or a protrusion of the screw into the joint observed. Technical faults were present in 4 cases (7.4%) that led in 1 case to an infection (1.85%). 37 patients (97%), of which 23 were between 70 and 90 years of age, were able to walk during the follow-up. 34 (89%) of the patients showed symmetrical, or less than 20 degrees of limited hip movement while 12 (32%) sporadically complained of slight pain or weather dependency. 2 of the 7 patients with femoral neck fractures and 4 of the remaining 47 patients with trochanteric fractures (including 1 subtrochanteric metastasis) had to be reoperated. The DHS proved to be a simple and efficient fixation device for proximal femoral fractures in the hands of ten different surgeons. The telescopic sliding of the screw enables a compulsory sintering of the fracture, without leading to penetration of the femoral head or breakage of the implant.

The standard patient with colonic cancer is described. For the last 30 years surgery has been able to cure nearly 50% of colorectal cancers with 5% perioperative mortality. Technical novelties such as the stapler, antibiotics and colon wash have not improved this crude rate. Moderate improvement in cure rates can reasonably be expected from early detection methods. Surgery and endoscopic surgery are complementary and not competitive techniques.

Shaving the day before operation is safe only if it is combined by an adequate disinfection with Jodophoren and followed by sterile packing of the operation field.

15 patients with duodenal ulcer underwent clinical and manometric studies to assess distal esophageal function before and after proximal selective vagotomy. Position, pressure and function of distal esophageal high pressure zone were not altered by the operation. No rationale has been found for the trend to combine proximal selective vagtomy with antireflux procedures.

We report our experience with 11 patients treated with an external fixator that was dynamized at some stage of the treatment. In 7 patients bone union occurred without any other measures, 2 patients were protected in a cast after the external fixator removal, while 2 patients developed a non union that was plated and subsequently healed. According to these experiences, dynamization of an external fixator seems to be a reliable and elegant way to treat simple open shaft fractures, the method is however not advocated for more complex or comminuted fractures.

In the treatment of peptic gastroduodenal ulcers the modified vagomotor electrotest according to Burge has yielded remarkably good results as an intraoperative test for the completeness of proximal selective vagotomy (PSV). The test is as useful for the surgeon in training as for the expert in vagotomy. Moreover the clinical value of the test is demonstrated. If, according to this test, vagotomy is complete, an extreme reduction of gastric acid and a very low rate of relapsing ulcers are seen in our patients. We cannot recommend performing the PSV without this test.

More recently a number of retrospective analyses in rather ill defined patient populations demonstrated an association between perioperative blood transfusion and recurrence after curative resection of colorectal cancer. In the randomized trial (SAKK 40/81) (adjuvant cytotoxic intraportal infusion versus no further treatment) we evaluated the transfusion status in a well defined, prospectively documented and controlled patient population. Of 457 patients, 353 (77.2%) received either pre-, intra- or postoperatively blood transfusions. After a median follow-up of 4 years, the transfused patients developed significantly more recurrences (38.2%) than patients without blood transfusions (23.1%), the death-rate being 33.7% versus 23.0%, respectively. Patients without transfusion but treated with adjuvant intraportal chemotherapy are strikingly doing better (10.5% recurrences) than patients with perioperative blood transfusion not having an adjuvant treatment (44.5% recurrences).

In advanced cases of esophagitis with acquired short esophagus and stricture, operative treatment to eliminate gastroesophageal reflux may be difficult or impossible. 24 such patients were treated by transthoracic truncal vagotomy and pyloroplasty. In a long-term follow-up 9--11 years later 12 patients were examined by X-ray and esophagoscopy. In 9 patients symptoms due to reflux or obstruction had improved, 5 of them were symptom-free. At endoscopy and barium-swallow 2 patients showed back-formation of their stricture, the other patients had generally unchanged findings. Transthoracic truncal vagotomy with drainage seems to be able to prevent progression of severe esophagitis and to improve its symptoms.

In a recently concluded prospective multicenter trial, pyloric (PU) and prepyloric (PPU) ulcers showed a significantly higher recurrence rate after proximal gastric vagotomy (PGV) without drainage than duodenal (DU) or gastric ulcers (GU). The secretory pattern of the PU and PPU cannot explain the failure of PGV. However, PU and PPU (and some GU) exhibit a distinct and probably irreversible alteration of the muscular layer at the pylorus and distal antrum. This could be one factor which helps to explain the failure of vagotomy alone in these ulcer types. To deal with this antropyloric distrophy, addition of drainage or antrectomy to PGV must be considered. A refined concept for surgical treatment of peptic ulcer is proposed.

A 31-year-old female patient with "vesicule exclue" showed at laparotomy agenesia of gallbladder, annular pancreas and a probably congenital anomaly of portal and splenic vein. She had no clinical but angiographical signs of portal hypertension.