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A quantitative analysis of the injury severity of 40 patients with open pelvic fractures was performed. Data were analyzed using the Statistical-Analysis-System (SAS Institute Inc., Cary, NC) with regard to patients' age, gender, trauma mechanism, classification and nature of the pelvic injury, associated lesions, and mortality. Trauma-scoring included the Hannover-Polytrauma-Score [11], the Pelvis-Fracture-Scale [2] and the Pelvis-Score [19]. Five patients died. The survivors had a mean Polytrauma-Score of 34.1, the nonsurvivors had a mean Polytrauma-Score of 44.6 (p = 0.7; Mann-Whitney-test). The nonsurvivors required highly significant more units of blood transfusions than the survivors (49.4 vs. 14.1; p = 0.003; Mann-Whitney-test). The loss of blood was related to the severity of the injury according to the Polytrauma-Score. There was no significant difference in the Pelvis-Fracture-Scale of survivors and nonsurvivors. Neither there was a significant correlation between the fracture type and the Polytrauma-Score nor between the fracture type and the mortality. The Pelvis-Score--with the variable "bleeding" defined as "major vessel lesion"--was significantly higher in the nonsurvivors than in the survivors (12.0 vs. 4.9; (p = 0.04; Mann-Whitney-test). In conclusion, in this retrospective study the Polytrauma-Score and the Pelvis-Score proved effective regarding some important aspects of the prognostic estimation of the general injury and the pelvic trauma, respectively. The Hannover-Pelvis-Fracture-Scale allows an exact documentation of the pelvic trauma as it pays proper attention not only to the fracture classification but especially to the soft tissue damage.

Patients and Methods: risk factors of recurrent laryngeal nerve (RLN) palsy after thyroid gland surgery were evaluated retrospectively in 1556 patients who were submitted to an operation because of a benign thyroid disease. Recurrences were also excluded., Results: RLN palsy occurred in 6.6%. In relation to the nerves at risk the incidence of primary postoperative nerve damages was 4.3%. After a long-term follow-up of in total 18 months the incidence of permanent nerve palsy was 1.6% (related to the nerves at risk: 1.1%) as 75.5% of the paralyses were transient in an average of 6.2 months. Substernal goitres especially when sternotomy became necessary, the ligature of the inferior laryngeal artery, serious perioperative complications and total lobectomy in comparison to subtotal resection were important risk factors for primary postoperative RLN palsy (p < 0.05 resp. p < 0.01). The ligature of the inferior laryngeal artery and the extension of resection were indeed significant risk factors also for permanent nerve damages, but the other factors had no influence on the risk of permanent RLN palsy. However, the non-exposure of RLN in subtotal lobectomy was significantly associated (p < 0.01) with permanent, but not with transient nerve palsy., Conclusion: The exposure of the RLN is one of the most important procedures during thyroid surgery and particular also during subtotal lobectomy to reduce the rate of permanent RLN damages.

Objective: Since minitracheotomy has been established in 1984 for prophylaxis and therapy of postoperative sputum retention, numerous publications represent technical descriptions, case reports or empirical results, but only few specific facts related to this method have been investigated. In this study we review the efficiency, complications and late follow-up results of minitracheotomy in a department of general surgery., Design: Between 1987 and 1991 we prospectively included 152 intensive-care patients who received minitracheotomy. The average follow-up was 24.2 +/- 6.1 (4-50) months., Results: Endotracheal secretion could be sucked off significantly more often after mini-tracheotomy. The rate of endotracheal suction increased from 5.9 +/- 4.5/d to 18.4 +/- 6.1/d (p < or = 0.01). The pulmonary gas exchange improved at the same time. PaO2 level of 78.9 +/- 9.9 mmHg that decreased to critical values of 60.7 +/- 8.9 mmHg, rose after minitracheotomy above the original levels. Although the PaCO2 level remained constant, a compensatory hyperventilation with a rate of 27.3 +/- 6.9/min was normalised by minitracheotomy. Furthermore, the various methods of minitracheotomy were opposed in this study. In the group of minitracheotomy by cricothyroideal stab incision (n = 55) we recorded 5.4% serious complications. In contrast minitracheotomy by the Seldinger technique (n = 87) could be accomplished without any disturbance., Conclusion: Minitracheotomy seems to be an effective and safe treatment for therapy and prophylaxis of postoperative complications due to tracheobronchial sputum retention in critically ill patients. Manipulation was simplified and rendered more safe by the technique of transcutaneous bouginage.

An ultrasound dissector especially developed for laparoscopic surgery was used during laparoscopic cholecystectomy on 34 patients. The ultrasound power, the volume of suction and irrigation could be determined individually at the generator and activated during the operation with a foot pedal. With the dissector it was possible to fragmentate, emulgate and aspirate simultaneously fat tissue as well as infected edematous structures. The cystic artery and cystic duct, small vessels, lymphatic and connective tissue were not damaged. Therefore this system seems to be excellent for the preparation of Calot's trigonum and blunt dissection of the gallbladder out of its bed, particularly in fatty, acute or chronic infected tissue. No complications were observed within the peri- and postoperative period.