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The dynamic pressure distribution around a cylinder tilted along and against the principal wave direction is measured. The cylinder was exposed to the action of random waves in the presence and absence of extreme waves. Six inclinations from the vertical plane, three along and three against the wave direction, were considered. The cylinder in upright position was also studied. The variation of dimensionless peak pressure (pressure maximum/average highest one-third wave height, H(1/3)) with the relative wave height (maximum wave height/H(1/3)) for locations facing the wave and at the rear of the cylinder for different angles of inclinations of the cylinder are reported for the two kinds of waves mentioned earlier. The statistical properties of the different asymmetries in the pressure traces are also discussed.The dynamic pressure distribution around a cylinder tilted along and against the principal wave direction is measured. The cylinder was exposed to the action of random waves in the presence and absence of extreme waves. Six inclinations from the vertical plane, three along and three against the wave direction, were considered. The cylinder in upright position was also studied. The variation of dimensionless peak pressure (pressure maximum/average highest one-third wave height, H1/3) with the relative wave height (maximum wave height/H1/3) for locations facing the wave and at the rear of the cylinder for different angles of inclinations of the cylinder are reported for the two kinds of waves mentioned earlier. The statistical properties of the different asymmetries in the pressure traces are also discussed.

Twenty patients who had suffered spinal trauma were examined by magnetic resonance tomography. Fifteen patients with first degree trauma in Erdmann's classification showed no abnormality. Magnetic resonance tomography of the cervical spine appears to be a suitable method for investigating patients with whiplash injuries. It is indicated following severe flexion injuries with subluxations and neurological symptoms, since it is the only method that can demonstrate the spinal cord directly and completely and show the extent of cord compression. For patients with thoracic trauma and rapidly developing neurological symptoms, magnetic resonance tomography is ideal for showing post-traumatic syringomyelia. Magnetic resonance tomography following whiplash injuries is recommended if plain films of the cervical spine show any abnormalities, as well as for the investigation of acute or sub-acute neurological abnormalities. The various findings are discussed.

In einer prospektiven offenen Studie wurden 43 Patienten (19 mannliche, 24 weibliche) uber funf bis 37 Tage\(\left( {\overline x = 9} \right)\) mit je 3×0,5 g Imipenem/Cilastatin als i. v. Kurzinfusion wegen schwerer bakterieller Infektionen wie Peritonitis (n=16), Weichteilinfektion (n=12), Pneumonie (n=7), Sepsis (n=6), Kathetersepsis (n=2), Cholangitis (n=4), Osteomyelitis (n=3), komplizierter Harnwegsinfektion (n=2) und Endokarditis (n=1) behandelt. Alle Patienten wurden durch die Behandlung mit Imipenem/Cilastatin allein oder in Kombination mit einer chirurgischen Intervention geheilt oder wesentlich gebessert. Am haufigsten wurdenEscherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus, Staphylococcus epidermidis undStreptococcus faecalis isoliert. 58 (83%) der 70 initial nachgewiesenen Erreger wurden eliminiert. Die 12 persistierenden Keime waren gramnegative aerobe Bakterien mit MHK-Werten von 0,32 bis 4 mg/l, die keinen Einflus auf die Infektion hatten. Die MHK-Werte von 60 Erregern war≤1 mg/l; die weiterer neun lagen zwischen 2 und 8 mg/l. Ein primar resistenterS. epidermidis (MHK 16 mg/l) wurde eliminiert. Die Vertraglichkeit war gut. Lediglich einmal wurde eine Phlebitis beobachtet. Aus unserer Erfahrung schliesen wir, das Imipenem/Cilastatin als Monotherapie zur Behandlung schwerer bakterieller Infektionen bei einer Dosierung von 3×0,5 g/Tag geeignet ist.

The authors report on the use of HFJV in operative laser fibre-optic bronchoscopy, especially in combination with the laser technique. The method and initial results are discussed. Also high-risk patients can be treated with this method without the need for general anaesthesia.

In a prospective study 43 patients (19 men, 24 women) suffering from severe bacterial infections such as peritonitis (n = 16), soft tissue infection (n = 12), pneumonia (n = 7), septicemia (n = 6), catheter sepsis (n = 2), cholangitis (n = 4), osteomyelitis (n = 3), complicated urinary tract infection (n = 2) or endocarditis (n = 1) were treated t. i. d. with short-time i. v. infusions of 0.5 g imipenem/cilastatin for five to 37 days (means = 9). All the patients were cured or significantly improved following therapy with imipenem/cilastatin alone or in combination with surgical intervention. The most frequent isolates were Escherichia coli, Pseudomonas aeruginosa, Proteus mirabilis, Staphylococcus aureus, Staphylococcus epidermidis and Streptococcus faecalis. 58 (83%) of the 70 pathogens isolated initially were eliminated. The 12 microorganisms (gram-negative aerobic bacteria) which persisted were non-contributory to the course of the infection and had MICs between 0.32 and 4 mg/l. The MICs for 60 isolates were less than or equal to 1 mg/l; the MICs for nine isolates were in the range of 2 to 8 mg/l. One S. epidermidis isolate presented primary resistance to imipenem (MIC 16 mg/l). The tolerability was good. Phlebitis was observed in one case only. Based on our experience we conclude that monotherapy with imipenem/cilastatin at a dosage of 0.5 g t. i. d. is appropriate for the treatment of severe bacterial infections.

Fiberoptic bronchoscopy is a valuable procedure in the diagnosis and treatment of pulmonary disorders and is usually performed under local anesthesia. The local application and ultrasonic nebulization of lidocaine is widely accepted for inducing topical anesthesia in the respiratory tract. We produced local anesthesia of the trachea and bronchial tree by nebulizing lidocaine via high-frequency jet ventilation (HFJV). At the same time, we measured serial plasma concentrations of lidocaine to determine the potential for toxicity due to systemic absorption from the tracheobronchial tree. METHOD. Twelve adult patients without known heart or liver disease were studied during diagnostic bronchoscopy. As premedication 0.5 mg atropine and diazepam (10 mg) or midazolam (5 mg) were given. After topical anesthesia of the oropharynx, all patients were intubated with a Hi-Lo jet endotracheal tube using a flexible bronchoscope. Spontaneous breathing was supported with a high-frequency jet ventilator (Acutronic MK 800). The humidification ventilator pump was used as a device for local anesthetic administration (lidocaine 0.5%). The following continuous application scheme was used: 0-5 min: 100 ml/h; 5-10 min: 50 ml/h; over 10 min: 5-25 ml/h. Plasma samples for lidocaine levels were taken intravenously 5 min after intubation and then at 5-min intervals. The last sample was taken 30 min after bronchoscopy. The plasma lidocaine concentration was determined by liquid chromatography. RESULTS. In general, this mode of lidocaine administration produced adequate anesthesia and was safe. None of the patients studied required additional lidocaine doses during bronchoscopy. Heart rates and blood pressures were stable.(ABSTRACT TRUNCATED AT 250 WORDS)

In the years between 1982 and 1984 44 patients (39 men and 5 women) were operated on Dupuytren's contracture. More than 61% of the patients were treated in the stage II and III according to the classification of Iselin and Dieckmann. In these stages the total fasciectomy is the operation of choice. As operative approach we prefer skin incisions in the linea vitalis and linea mensalis. The recovery of the full function of the hand (especially the working capacity) was seen in 62.5% of the cases. Real relapses appeared in 8 cases. As most frequent postoperative complications appeared perception disorder, wound-healing impairment and edema/respectively haematoma.

Detrimental effect of shock on gallbladder is a rare complication which may occur in the wake of trauma or surgery. Sex ratio, incidence, lethality, and possible pathophysiological processes are stated and discussed. The incidence of posttraumatic cholecystitis appeared to be higher among patients in the second to fourth decades of age, while postoperative cholecystitis was more often recorded from patients in the fifth to seventh decades of age. The aetiology is still unknown and may be of multifactorial nature. This cannot be conclusively elucidated from one individual case. Early detection of the complication and early operation may widely protect the patient from more severity.

A total of 93 patients with pulmonary diseases were examined by means of magnetic resonance tomography. Of these, 39 had a bronchial neoplasm of varying histological structure and varying hilar and mediastinal extension. Compared with other imaging methods, magnetic resonance tomography offers advantages in the imaging of a malignant process and accurate definition of its spatial extension. MR and CT seem to be essentially of equal value in respect of the diagnostic problem of deciding whether lymph node metastases are present in the mediastinum and in the hilus. On the other hand, CT is presently still superior to MR with regard to verifying small-scale processes which are in the process of undergoing endobronchial growth, since CT provides better spatial resolution. Hence, in our opinion the special value of magnetic resonance tomography is the exact definition of the extension of an already identified neoplastic process. This method can supply accurate pointers towards the operability of a bronchial neoplasm. In this regard it is an ideal complement to mediastinoscopy. However, MR will not be an important tool--even in the foreseeable future--for effecting early diagnosis of a neoplasm. The value of diagnostic information supplied by this method may improve by the future use of breath triggering, and additional diagnostic advantages are envisaged by the use of contrast media and the future possibility of producing thinner layers. That is why the catalogue of indications prepared at this time should be seen as a kind of momentary snapshot which may have to be supplemented or extended after the prevailing technical and equipment parameters have undergone further optimisation.

Follow-up checks were applied to 81 of 140 patients with 249 adenomas of the large intestine. The results obtained from that study are reported in this paper. The generally known dependence of adenoma carcinoma sequence on histology, size, and basis of adenomas was confirmed. Since patients with adenoma are exposed to higher risk of carcinoma, colonic polyps, basically, should be removed as a form of cancer prophylaxis, and patients concerned should be regularly monitored. A follow-up programme is proposed in this paper, with reference being made to the authors' own rates of recurrence and to those reported in the literature.

Twenty patients who had suffered spinal trauma were examined by magnetic resonance tomography. Fifteen patients with first degree trauma in Erdmann's classification showed no abnormality. Magnetic resonance tomography of the cervical spine appears to be a suitable method for investigating patients with whiplash injuries. It is indicated following severe flexion injuries with subluxations and neurological symptoms, since it is the only method that can demonstrate the spinal cord directly and completely and show the extent of cord compression. For patients with thoracic trauma and rapidly developing neurological symptoms, magnetic resonance tomography is ideal for showing post-traumatic syringomyelia. Magnetic resonance tomography following whiplash injuries is recommended if plain films of the cervical spine show any abnormalities, as well as for the investigation of acute or sub-acute neurological abnormalities. The various findings are discussed.

The surgical technique applied to 17 patients for acromioclavicular separation is described in this paper. Ligament repair and Balser's hookplate were used. Advantages over surgical joint fixation were recorded from twelve patients in clinical and radiological follow-up checks. No major complications were recordable from implants. Postoperative immobilisation of the patients was not necessary. Timing of plate removal is variable. In follow-up examinations, ten of the twelve patients were satisfied with the therapeutic result.