Insuffizienzen nach Anastomosen im Bereich des oberen Gastrointestinaltraktes

Anastomotic leaks are still among the most common severe postoperative complications and account for the majority of postoperative deaths after esophagectomy and gastrectomy. Every disturbance of the normal postoperative course should trigger surgeons to consider an underlying anastomotic leak and initiate a specific diagnostic workup. This includes direct endoscopic inspection of the anastomosis to evaluate the vitality of the anastomosed organs and the size of the leak. Adequate external drainage of the leak and prevention of further contamination are the primary therapeutic goals. Selection of therapy is guided by the available modalities for sufficiently draining the leak and avoiding sepsis. The spectrum of therapeutic options ranges from simple opening of the neck incision in cervical esophageal anastomoses, interventional placement of drains, to endoscopic intervention with closure of the fistula or placement of stents, and reoperation with exclusion, diversion, or discontinuity resection.     

Karotisdissektion mit Mediainfarkt nach Weichteiltrauma im Bereich des Pharynx

We report the case of an 8-year-old boy who suffered an internal carotid artery dissection as a result of an enoral soft tissue trauma. After an initial interval with minor symptoms he developed a cerebral infarction in the vascular region of the left middle cerebral artery. The patient was treated with decompression hemicraniectomy while therapy was monitored with intracranial pressure (ICP) measurements.     

Frakturen im Bereich des Ellenbogengelenkes im Kindes- und Jugendalter

73 cases of elbow joint fractures were treated in our Dep. of Paediatric surgery over a period of 10 years. Most of the fractures in the region of the distal humerus are localized at the ulnar epicondyle and the radial condyle. At the proximal forearm the radial head and the radial collum fractures are dominant in respect to olecranon fractures. Only two cases involved a comminuted fracture of the distal humerus. Due to the fact that only a small number of cases involving a fracture of the radial epicondyle after a luxation of the elbow were registered, it is possible that we paid no attention to this kind of fractures. An early functional therapy in the case of segmental fracture of the radial head must be emphasized among the 11 cases with a conservative treatment. Another 3 cases with a radial head fracture, type Judet III, should be mentioned, because they were treated without reposition but were spontaneously redressed. The operation procedure and the late results by 62 patients are discussed with the results of other examiners. As expected the comminuted fractures of the distal humerus and the radial head had a bad prognosis. Functional relevant dislocations were rare. Only in one case after a conservative treatment of a lateral condyle fracture a development of a valgus position with a pseudarthrosis after a secondary dislocation was observed. In more than 90% of our cases we could achieve a complete anatomical resposition with good to very good functional results.     

Plastisch-chirurgische Defektdeckung im Bereich des Beckens und des Rumpfes

Zusammenfassung. Komplexe Defekte im Bereich des Beckens und des Stamms sind im Rahmen der Allgemeinchirurgie insgesamt selten, meist aber Folge ernster Krankheitsbilder oder deren Behandlungsfolgen. Eine frühzeitige, stabile Defektdeckung nach suffizientem Débridement aller avitalen Strukturen kann für den Patienten von vitaler Bedeutung sein. Der Beitrag soll die M?glichkeiten der plastisch-chirurgischen Defektdeckung aufzeigen, die dem Allgemeinchirurgen gel?ufig sein sollten, um im Bedarfsfall interdisziplin?re Behandlungsoptionen in sein therapeutisches Konzept einbeziehen zu k?nnen.      

Die Arthrodese des oberen Sprunggelenkes nach Trauma

During a period of more than 20 years, 63 patients having undergone a trauma were submitted to arthrodesis of the upper ankle joint. 31 out of them could be followed up from autumn 1982 through spring 1983. The primary reasons and the individual courses making necessary the arthrodesis varied to such an extent that there were no identical anamneses in any of the patients. The destruction of the upper ankle joint by high kinetic energy was apparently an essential factor in the anamnesis of arthrodesis of the upper ankle joint. There is no correlation between the number of posttraumatic arthrodeses and the number of fractures of the ankle joint treated by surgery during the same period. A “good” or “satisfactory” result was achieved in nine out of ten cases submitted to arthrodesis, and it seemed to be unimportant which of the usual techniques was applied. The high complication rate reported in literature, too, has possibly to be considered as a consequence of the gravity of the disease. It seems to be independent of the previously existing risk factors. The follow-up period is very long.     

Die Bedeutung des Tubulusdurchmessers im Hodenbiopsiematerial bei Oligozoospermie

This publication deals with the question how the tubular diameter in testicular biopsy gives conclusion to spermatogenic activity in patients with oligozoospermia. Therefore a collective of 50 patients with oligozoospermia between 0.3-20.7 mill. spermatozoa/ml was examined. 30 patients with occlusion azoospermia were the normal control group. In all patients a rice grain-sized testicular biopsy were performed of both testes. One part of the tissue was prepared for paraffin sections, the other one for semithin sections. The mean tubular diameter measured in all patients (that means in oligozoospermia of different severity as well as in occlusion azoospermia) was about 160 micrometers in paraffin sections and about 200 micrometers in semithin sections. But the fixation must be taken into consideration: the diameter of tubules in paraffin sections is smaller (about 20%) than in semithin sections.     

Die Bedeutung des EEG-Befundes im Rahmen der Intensivbehandlung

Ohne Zusammenfassung (a. G.) Der ausführliche Tagungsbericht ist beim Springer-Verlag, Berlin, Heidelberg, New York, in der Schriftenreihe „Anaesthesiologie und Wiederbelebung” als Band XVII, 1966, erschienen.     

Die Diagnostik der Bandverletzungen im Bereich des oberen Sprunggelenkes

On the basis of history and clinical findings it is attempted to stage a trauma of the ankle joint according to the genetic classification of Lauge-Hansen. This procedure is understood as a prophylactic measure against overlooking combined ligamentous lesions. Tears of the lateral collateral ligaments of the ankle are proven by stress roentgenograms taken in varus tilt position; they are performed by a specially developed method. Additionally stress roentgenograms are taken, when the talus is moved forwards (“anterior drawer sign”). Lesions of the deltoid ligament are shown by talar tilt in valgus position. Isolated tears of the anterior tibiofibular ligament can be visualized only by arthrography. If stress roentgenograms cannot confirm the clinical diagnosis, an arthrography is necessary.     

111. Die Bestimmung des Lysozyms im Serum und Urin nach Nierentransplantation

Zusammenfassung Lysozym, ein Ferment, das vermehrt in den Lysosomen der Tubuluszellen der Niere lokalisiert ist, kann schon bei leichter Tubulusschädi-gung erhöht im Serum und Urin nachgewiesen werden. Die spektrophotometrische Bestimmung im klinischen Routinebetrieb ist einfach, schnell und zuverlässig. Nach 46 Nierentransplantationen beim Hund und 4 beim Menschen wurden die Lysozymwerte mit den Kreatinin- und Harnstoff-N-Werten verglichen. Aufgrund des Lysozymanstieges im Urin konnte durchschnittlich 2 Tage früher der Verdacht auf eine Abstoßungskrise geäußert werden als mit den bisherigen Methoden. Die Bestimmung des Urin- und Serumlysozyms darf als nierenspezifisch angesehen werden und kann als Routinemethode nach einer Nierentransplantation empfohlen werden.

---

Summary Lysozyme, an enzyme which is found extensively in the lysosomes of the renal tubular cells, can be shown to be increased in serum and urine even in only mild tubular damage. Spectrophotometric determination in everyday clinical routine is simple, rapid and reliable. After 46 kidney transplants in dogs and 4 in humans, the lysozyme-levels were compared with the urea-N-levels and the creatinine-levels. On the basis of the lysozyme increase in the urine, suspicion of a rejection-crisis could be asserted on average 2 days earlier than by previous methods. The determining of urine- and serum-lysozyme may be regarded as specific to the kidney and can be recommended as a routine test after a kidney transplant.

     

245. Die Bedeutung des Talo-Naviculargelenkes nach Arthrodese des oberen Sprunggelenkes

Zusammenfassung 75 Patienten wurden nach Arthrodese des oberen Sprunggelenkes im Mittel 11 Jahren nach Operation erfaßt. Funktionsaufnahmen des jeweilig betroffenen Fußes zeigten eine überwiegend im Talo-Naviculargelenk lokalisierte Kompensationsbeweglichkeit zwischen 7° und 34°. Entsprechend der veränderten Mechanik wurden im Talo-Kalkanear- und Talo-Naviculargelenk in ca. der Fälle röntgenologische Anschlußarthrosezeichen gefunden, die jedoch klinisch nicht immer in Erscheinung traten. Die routinemäßige Mitversteifung des Talo-Naviculargelenkes bei Arthrodesen des oberen Sprunggelenkes ist somit nicht zu empfehlen.     

Intestinale Anastomosen und Techniken im Bereich des unteren Gastrointestinaltraktes

Surgery of the lower gastrointestinal tract includes segmental resections for benign colorectal diseases and radical resections for treating colorectal cancer performed under elective and emergency conditions. The most important part of the surgical procedure is the reconstruction of the physiological intestinal continuity by anastomosis. At present laparoscopic surgery has widened the array of different suturing and stapling techniques. The effectiveness of manual and stapled anastomoses depends on the expertise of the surgeon. However, skilful preparation of the hand-sutured technique is essential.     

Die 180o-Propellerlappenplastik zur Defektdeckung im Bereich des distalen Unterschenkels

Objective

Operative technique of propeller flap reconstruction of soft tissue defects in the distal lower extremity. Soft tissue reconstruction of the distal third of the lower extremity with local, reliable perforator flaps avoiding free tissue transfer.

Indications

Complex wounds (maximum width of 6?cm) of the distal lower extremity with exposed bones, joints, tendons, and neurovascular structures.

Contraindications

Arterial vascular disease (stage III or IV), diabetes mellitus, postthrombotic syndrome, venous ulcers, chronic lymphedema, contusion of adjacent soft tissue, previous radiation, and lack of perforators

Surgical technique

The perforator represents the pivot point around which rotation of up to 180o of the subfascially harvested flap allows closure of the defect. The proximal donor site can be closed primarily up to a width of 6?cm.

Postoperative management

Strict elevation of the extremity for 5?days, then flap conditioning.

Results

This technique was used for soft tissue reconstruction in 17 patients. In one patient with diabetes, complete flap necrosis occurred, requiring amputation of the extremity. One case of epidermolysis healed without further surgery.     

Perspektiven nach Rückenmarkverletzung im thorakolumbalen Übergang

Spinal cord injuries at the thoracolumbar junction are characterised by recoveryof the ability to walk in almost all cases, strain on the injured region of the spine during walking and mobilisation in the wheelchair and various typical malfunctions of the bladder, bowel and sexual organs. The principles of comprehensive care devised by Guttmann are still applied even today in the treatment andrehabilitation of patients with spinal cord injuries. Modern techniques in emergency medicine and intensive care and spinal surgery and an effective rehabilitation system mean that it is now possible to achieve a quick physical stabilisation of these patients, prevent typical complications and, within the constraints of their personal and social circumstances, help them to achieve a satisfactory quality of life.     

115. Die Chirurgie des N. facialis im intratemporalen Bereich

Zusammenfassung Zur Diagnostik bei Facialisparesen gehören die mikroskopische Ohruntersuchung, Hörprüfungen, Röntgenaufnahmen des Felsenbeins einschließlich Tomographie und CT sowie Elektromyographie. Die Funktionsprüfung der einzelnen begleitenden Nervenäste (Topo diagnostik) erlaubt, die Schädigung zu lokalisieren. Idiopathische Bellsche Paresen werden kaum noch operiert. Die Indikation zur Operation bei Schädelbasisfrakturen, iatrogenen Schäden, Tumoren im Felsenbein, Mittelohrentzündungen und Tuberkulose werden im einzelnen besprochen. Bei erhaltener Kontinuität reicht die Dekompression aus, in anderen Fällen sind Rerouting, Nervennaht sowie Interposition freier Nerventransplantate notwendig.     

241. Die Veränderungen des spezifischen Immunsystems nach schwerem Trauma und ihre Interaktionen

Zusammenfassung Die posttraumatische Entwicklung eines Immundefekts trägt direkt zur Entstehung eines Multi-Organ-Versagens bei. In einer prospektiven Studie untersuchten wir an 13 polytraumatisierten Patienten (6 Überlebende, 7 Verstorbene) mit definiertem Verletzungsschweregrad sofort nach Aufnahme, am 4., B. und 12. Tag nach Trauma, verschiedene Parameter des spezifischen Immunsystems. Die initiale Antwort auf diverse Mitogene (PHA, ConA, Poke-weed) sowie die Lymphocytenzahl war meist vermindert und stieg nur bei den überlebenden bereits am B. Tag an. Dem Anstieg von TAC-positiven Zellen am 4. Tag, folgte eine Zunahme der Lymphoblasten sowie der SIg- und CIg-positiven Zellen am 8. Tag.