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Following endonasal sinus surgery, the operated area becomes a more or less extensive wound. Surgical trauma activates wound-healing mechanisms, the understanding of which is extremely important for the analysis of endonasal procedures. From this knowledge of physiology and pathophysiology of wound healing, the best and most effective course of follow-up treatment arises. We know that the postoperative treatment significantly influences operative results [27,38,118].

Die postoperative Uberwachung und konsequente Nachbehandlung ist fur das Ausheilungsergebnis nach Operation einer Dupuytrenschen Erkrankung unverzichtbar. Der fruhzeitigen Mobilisierung mit dem Ziel der aktiven Streckung insbesondere im Mittelgelenk kommt entscheidende Bedeutung zu. Bei ausgepragten Beugekontrakuren des Mittelgelenkes von mehr als 60° sollte grundsatzlich eine Schienenbehandlung mit statischer und dynamischer Anordnung fur die Streckung durchgefuhrt werden.

Wrongfully inpatient admission means unnecessary treatment of patients with the means of a hospital. In a study of the Medical Service (MDK) in the German state of Hessen 58% of 954 inpatients were considered wrongfully admitted. 199 patients were treated surgically, the wrongful admission rate of 63% is caused by an unnecessary duration of pre- and postoperative treatment time as well as by organizational deficits.

Between 1990 and 1994 94 patients over 65 years of age with subcapital humeral fractures were treated by plate osteosynthesis combined with a modified postoperative treatment including intensive physical exercise in the early postoperative period. Three months after surgery all osteosynthesis materials were removed using a differentiated treatment of the subacromial area. In the follow-up study 69 of the 94 patients were examined; 22 patients showed an excellent, 26 a good, 9 a satisfactory, and 12 an unsatisfactory result. Thus, we recommend plate osteosynthesis of subcapital humeral fractures in elderly people in combination with our standardized postoperative regimes.

In recent years there has been a growing appreciation of the menisci as an important component of the healthy knee joint. Whereas for decades meniscectomy was deemed the treatment of choice for all meniscal lesions, today there is a trend toward reconstructive knee surgery that seeks to preserve a maximum amount of meniscal tissue, despite initial skepticism regarding meniscus repair. The major impetus for meniscus salvage has been proof that the subtotal or total removal of a meniscus leads to the long-term sequelae of osteoarthritis and instability.

The ophthalmologic operations are based on a wide spectrum of indications. On one end we find emergency procedures which cannot be postponed. These comprise severe isolated ocular injuries, involvement of the eye in injuries of the face and ocular injuries in patients with widespread injuries. These patients should usually be operated on within seven hours after the injury, except when it may be assumed that diagnostic or other preparatory measures could improve the surgical results. On the other end of the spectrum we find operations which are performed because of aesthetic indications. There is no urgency to operate and the indications can be discussed between the physician and the patient without being pressed for time. Between the two extremes are the majority of operations which can be postponed by days or weeks, but should be scheduled within a reasonable period of time so that any disadvantages for the patient can be avoided. The urgency of an operation or the possibility to postpone it obviously influences obtaining the informed consent.

Electron therapy, as a postoperative medium for head and neck cancers, has been used for many years at the Gustave-Roussy Institute in Villejuif. This therapy became possible after an Almis-Chalmers betatron was installed in 1954 and was greatly improved when a Sagittaire linear accelerator was also installed 1972.

The question arising on whether to recommend fixation or early mobilisation in postoperative treatment of posterior cruciate ligament (PCL) injuries is a very interesting one. Some authors described the technique of temporary transpatellar fixation with a Steinmann’s nail to allow early mobilisation. Postoperative plaster fixation allowing movement of the knee from 0 1/2 to 90 1/2 transpatellar fixation using a Steinmann’s nail has been renounced by others. This technique does seem to be non-physiological, and therefore a study was conducted to investigate the influence of the nail fixation (Olekranisierung) on the tension of the cruciate ligaments.

Preoperative treatment for esophageal cancer is performed with the objective of improving the prognosis of esophageal cancer. Heretofore, there have been reports [1] indicating effectiveness in preoperative treatment results but a consensus of opinion has not been reached. However, it is possible to demonstrate the histological effects of preoperative treatment for esophageal cancer. The effects range from ineffective to disappearance of the cancer cells. In cases where preoperative treatment was markedly effective, satisfactory responses in postoperative treatment could be anticipated and, in accordance with treatment methods, improvement in prognosis can also be anticipated.

Digestive fistulas have furnished challenging problems for surgeons for many years. In 1971 Goligher wrote on this subject: “The crux of management of digestive fistulas is to decide when to abandon conservative treatment in favour of operation, whilst the latter has a reasonable chance of success, and there are few more difficult decisions in surgery.” Today, 15 years later, many things have changed in surgical technique and postoperative treatment: Dudrick et al. (1972) introduced total parenteral nutrition, and Levy (1974) devised the techniques of low-flow enteral nutrition. With these achievements the mortality of conservative treatment has been lowered (Thomas 1981) and, while the terms of the problem are always the same, surgical or nonsurgical treatment, most authors are in favor of a nonsurgical approach.

As a rule, a patient who is not free of symptoms or who even complains of an aggravation of his condition after he has been operated on for a prolapse in the lumbar region will seek neurosurgical advice at a relatively early date. What is the prognosis if it is decided to perform a re-operation?

Adjuvant therapy was given to patients with colorectal cancer stage Duke’s B2 and C. The 53 patients were randomized and stratified after surgery. One arm received radiotherapy and chemotherapy and the other radiotherapy, chemotherapy, and MER. The survival and disease-free interval up to 2 years were longer and better in the radiochemo-MER arm. It is too early to conclude whether this combination increases the cure rate or delays the appearance of metastases. The time interval between the cytotoxic therapy and the immunotherapy and the dose of the immunotherapeutic agent is very important for the success of the combination therapy. Further follow-up is necessary and more patients need to be entered into the trial.

Thymectomy in mayasthenia gravis patients is based on clinical experiences first published by Blalock in 1939 [2]. In early years thymectomy was the only manipulation to influence the defect of the immune system. A positive effect of thymectomy on myasthenic symptoms is reported by several authors since that time [1, 3, 8, 9, 14]. Thus, thymectomy became a standard method in myasthenia treatment next to symptomatic choline-esterase-inhibitor medication. The indication for early thymectomy was extended by Genkins et al. in 1975 to cases with isolated ocular myasthenic symptoms [4].

An arthroscopic meniscectomy is usually followed by quicker restitution of function in the injured joint than traditional open meniscectomy. In the recovery period, some patients are, however, troubled by persistent swelling, pain and inhibition of function [2-4]. We therefore thought it was of interest to Compare a group of patients who received postoperative treatment of antiphlogistics with a group who did not. The study was undertaken at Toronto Western Hospital, Toronto, Canada [6].

The Radiotherapy Center of the Cantonal Hospital in Geneva, which was inaugurated in January 1968, was originally equipped with a Siemens 18 MeV betatron in addition to a cobalt unit. In 1974 the betatron was replaced by a Varian 18 MeV linear accelerator because the output was too low for photon treatment. We had used the betatron exclusively for electron treatments. Our protocols for breast cancer treatments at the Cantonal Hospital in Geneva have been adapted from Fletcher’s techniques applied at the M.D. Anderson Hospital, Houston, Texas (Fletcher 1972). However, many of our patients did not have a Halstead mastectomy. They had either a Patey operation or a simple mastectomy, with or without axillary sampling. These differences in surgical procedures can be easily explained by the sources of patient referrals. Our patients came not only from University Clinics, where the treatments are standardized, but also from practicing physicians in the city who perform various surgical techniques.

Operations on the kidneys do not differ, in principle, from those on other organs insofar as the necessity of accurate preoperative diagnosis, well-founded indications, satisfactory operative technique, and rational pre- and postoperative treatment is concerned. Since, however, the kidneys are paired organs and have a vital function, specia1 demands are made on the preoperative examination and the choice of operation. It is accordingly essential, even in apparently unilateral involvement, to elucidate with the greatest possible care the morbid anatomy and the function of both kidneys. The surgeon must bear in mind at all times that an operation on one kidney where conservative surgery is envisaged may, of necessity, lead to nephrectomy or to such functional impairment that the outcome will be dependent on the integrity of the contralateral kidney.