Freisetzung von LH und FSH nach Verabreichung eines LH-RH-Analogons bei Patienten mit adrenogenitalem Syndrom

D-Ser(TBU)6-EA10-LH-RH, an analogue of LH-RH with prolonged and increased effect upon the release of LH and FSH, induces in normal male subjects a secretory response of LH and FSH, which is qualitatively different from that seen in normal females. Female patients with increased plasma-concentration of testosterone due to congenital adrenal hyperplasia or adrenal neoplasm present upon the LH-RH-analogue with a secretory response of LH and FSH which is similar to that observed in normal female subjects. It is concluded that elevated plasma-adrogens fail to induce a masculine pattern of gonadotropin-secretion in patients with a genetically female determination of the hypothalamo-pituitary-gonadal system.     

Effekt eines sensomotorischen Trainingsprogramms bei Patienten mit subakromialem Schmerzsyndrom

The purpose of the present study was to evaluate the effectiveness of a special sensorimotor exercise rehabilitation program on shoulder function. In a prospective intervention study we evaluated 32 patients with subacromial pain syndrome, all of whom took part in a conservative rehabilitation program. No patient had surgery on the shoulder involved prior to the study. All patients performed a standardised sensorimotor training for the glenohumeral joint, which involved, in particular, the glenohumeral and scapulothoracal stabilisers. In this rehabilitation program special proprioceptive exercise tools (body-blade, BOING) were used as well as Tai Chi and aquatic gymnastics. The entire program lasted 4 weeks and was performed and supervised by the same physiotherapist. Prior to and after the program all patients underwent a standardised series of tests. These included the Constant- and the UCLA-Score tests and sensorimotor functions with an angle reproduction test, a threshold to motion test as well as isometric strength testing with a Cybex unit. Prior to the rehabilitation program all subjects showed decreased proprioceptive capabilities. This was particularly evident in the threshold to motion test. After 4 weeks of rehabilitation, significant increases in the Constant- and UCLA-Score tests were found. The sensorimotor test also showed an increased proprioceptive capability especially in the threshold to motion test. The angle reproduction test showed only moderate improvement, whereas the isokinetic strength test showed no improvement at all. The present study shows that patients with subacromial pathology suffer from a proprioceptive deficit which can be improved by a special rehabilitation program within only 4 weeks.     

Effekt eines sensomotorischen Trainingsprogramms bei Patienten mit subakromialem Schmerzsyndrom

Es ist bekannt, dass das klinische Bild des subakromialen Schmerzsyndroms mit propriozeptiven Defiziten einhergeht. Ziel der vorliegenden Untersuchung war die Abkl?rung der Frage, inwieweit mit einem speziell senomotorisch ausgerichteten Trainingsprogramm die propriozeptive F?higkeiten verbessert werden k?nnen.     

22. Die Aussagekraft präoperativer Risikofaktoren bei Patienten mit resezierbaren Oesophaguscarcinomen

Zusammenfassung Bei 245 Patienten mit Speiseröhrencarcinomen, die seit dem 1. l. 1964 in der Chirurgischen Universitätsklinik Köln operiert wurden, konnte eine signifikante Beziehung zwischen tumorspezifischen Risikofaktoren und der Frühprognose nicht festgestellt werden. Mit Hilfe mathematischer Modelle war es möglich, organspezifische Risikoindices zu entwickeln, die Patientengruppen mit signifikant erhöhtem Operationsrisiko erfassen konnten. Ihre Aussage für den einzelnen Patienten war jedoch zu ungenau, um aus ihnen eine Entscheidung für das operative Vorgehen ableiten zu können.     

Narkose bei einem Patienten mit Zustand nach endoskopischer Lungenvolumenreduktion

Chronic obstructive pulmonary disease (COPD) is a disease with a high incidence and extensive comorbidities that make COPD a key challenge for anesthesiologists. A new treatment strategy, such as endoscopic lung volume reduction (ELVR) with implantation of endobronchial valves is a rapidly developing area which is still unknown to many anesthesiologists. This article therefore describes first experiences in a patient with five endobronchial valves in the right upper lobe who needed urgent surgery due to lumbar disc herniation with neurological impairment. After preoperative evaluation of the patient’s condition, the use of bronchodilating volatile anesthetics and adjusting the ventilatory settings with long expiration times and low peak pressure in a pressure controlled mode seems favorable in these patients. Intraoperatively, the patient should be assessed with modern physiological monitoring tools to titrate the administration of anesthetic agents, opioids and myorelaxant drugs. In conclusion the care of patients with implanted endobronchial valves after ELVR does not differ from COPD patients without ELVR. A close cooperation between surgeons, anesthesiologists and internists is mandatory in the care of these patients.     

Endotracheale Intubation bei Patienten mit Pierre-Robin-Sequenz Erfolgreicher Einsatz eines Video-Intubationslaryngoskops

Patients with Pierre Robin sequence are a classic model for patients with a difficult airway. In these patients tracheal intubation may be facilitated using the lateral approach. In a 3-day-old newborn with Pierre Robin sequence, scheduled for anaesthesia to take a mould of the cleft palate, we used a video-intubation laryngoscope to give a video-display of the lateral approach intubation technique to the junior colleagues. The video-laryngoscopic view allowed detailed demonstration of the intubation procedure to all persons present. In addition, video-transmission of the laryngoscope picture enabled the attendant anaesthetist to quickly recognise the need for suctioning the hypopharynx and to coordinate the direction and extent of laryngeal pressure according the video-laryngoscopic findings. Of special value for the intuboscopist was the improved view of the cords provided by the video-display compared with direct laryngoscopy. This facilitated a non-traumatic insertion of the tube into the trachea and allowed reliable confirmation of the intubation depth by the tube marking between the vocal cords.     

Ein-Lungenventilation bei einem nasal intubierten Patienten mit Hilfe eines einlumigen Endobronchialtubus

We report the case of a 57-year-old patient who underwent a right-sided thoracotomy. The preoperative examination of the patient already revealed a clear diminution of the mouth opening (Mallampati class 4). Ventilation per mask following the induction of anaesthesia was unproblematic. As oral intubation with a double-lumen tube seemed to be impossible because of the difficult anatomic conditions, nasal intubation was carried out. For this we used a left-sided single-lumen endobronchial tube of Rüsch (size 8.0). The tube was inserted into the left mainstem bronchus using a fiberoptic bronchoscope. Intraoperatively we were able to ventilate exclusively the dependent left lung by inflating the bronchial cuff. The operation itself was performed on the collapsed right lung. At the end of the operation the right lung could be ventilated once again by deflating the bronchial cuff (tracheal cuff inflated). This example demonstrates that one-lung ventilation is possible even under difficult intubation conditions.     

224. Langzeitergebnisse nach portocavalen Anastomosen bei Patienten mit massiver Oesophagusvaricenblutung

Zusammenfassung Die Ergebnisse einer Nachuntersuchung an 90 von insgesamt 231 Patienten mit Anlage eines portosystemischen Shunts in den Jahren 1964–1977 (portocavale, splenorenale, mesentericovale Anastomosen) wegen massiver Oesophagusvaricenblutung bei Lebercirrhose zeigen, daß diese druckableiten den Maßnahmen das einzige auf längere Zeit erfolgreiche Behandlungsprinzip darstellen. Eine postoperative Encephalopathie war dabei nur in 4% der Fälle zu finden und sollte deshalb nur mit Vorbehalt gegen die AusfÜhrung einer portocavalen Anastomose verwendet werden.     

224. Langzeitergebnisse nach portocavalen Anastomosen bei Patienten mit massiver Oesophagusvaricenblutung

Zusammenfassung Vom 1.5.1977 bis 31.12.1978 wurden 21 Warren-Shunts angelegt. Unselektiertes Krankengut mit 4 Child A-, 14 Child B-, 3 Child C-Fällen. Postoperative Letalität 23,8%. (n = 5), jedoch nur ein technischer Fehler. Postoperative Komplikationen: Rezidivblutung in 19,04%; keine Pankreatitis. Kontrollangio (100%.) : nur bei 1 Patienten hepatofugale Strömung; Splenomegalieabnahme in 66,6%. Nur bei 1 Patienten klinische Zeichen einer Encephalopathie. 87,5%. postoperativ arbeitsfähig. Conclusio: keine negative Beeinflussung der Letalitätsrate durch diese Shunt-Variante. Portale Leberperfusion bleibt erhalten. Encephalopathierate nur 6,25 %. Spätthrombosen selten (6,25 %). Umwandlungsmöglichkeit in einen PC-Shunt bleibt erhalten.     

Korrektur eines Digitus valgus quintus bei Spaltfuß mit drei Metatarsalknochen (Oligodaktylie)

Ohne Zusammenfassung      

Operative Korrektur der Lid- und Augapfelstellung bei angeborenen und erworbenen Stellungsanomalien

Zusammenfassung Im vorstehenden augenärztlichen Beitrag werden zum Thema der plastischen und Wiederherstellungschirurgie die Ptosis, die Augenmuskellähmung sowie das Begleit- und Höhenschielen behandelt. Alle drei Gebiete betreffen motorische Ausfälle bzw. Fehlstellungen am Bewegungsapparat des Auges und der Lider Durch geeignetes operatives Vorgehen gelingt es in einem hohen Prozentsatz der Fälle, den motorischen Ausfall bzw. die Fehlstellung kosmetisch und — in Abhängigkeit von der Ausgangslage — auch funktionell zu korrigieren.Mit 8 AbbildungenHerrn Prof. Dr.A. Kettesy, Debrecen, zum 70. Geburtstag.     

Behandlungsmanagement eines polytraumatisierten Patienten mit HIV-Infektion

In orthopaedic surgery and emergency medicine, patients of the age groups with a HIV risk represent the largest part of the entire population. As necessary steps have to be taken immediately at the scene of an accident and in the emergency room, contact with HIV-positive blood is often unavoidable, so that there is an increased risk of transmission for doctors and personnel. Due to the immunological state, the HIV patient is exposed to considerable post-operative complications such as wound infection, pneumonia and even sepsis. With the case of a 35-year-old HIV-positive patient who was multiply injured in a traffic accident, we want to present an interesting example of the problems that occur in the treatment of this patient group.     

Achsenanalyse bei Patienten mit Patellaluxation

The authors investigated in 25 patients with luxations of the patella if an increased incidence of defective torsions of the leg skeleton could be demonstrated. The torsion conditions of the lower extremity can be easily shown by computed tomography. This was confirmed when 32 femur preparations and 95 sound extremities were examined. The comparison of measuring results does not show any difference between patients and control group regarding the torsion of tibia and femur and the position of the tuberosity of the tibia. Patients with luxations of the patella show an increased external rotation of the tibia with respect to the femur due to a lack of medial muscular and ligamentary guide.     

Vollorgantransplantation bei Patienten mit HIV-Infektion

BACKGROUND: Despite considerable advances following the introduction of highly active antiretroviral therapy, organ transplantation is usually denied categorically for human immunodeficiency virus (HIV) patients, and it is presented in German transplantation law as a contraindication. Today, this should be questioned critically. METHOD: A survey at all 87 German transplant centres was done concerning (1) how many HIV-positive patients were transplanted before and after February 2000, (2) willingness of the centres to transplant HIV-infected patients in the future, and (3) course of transplanted HIV patients so far. RESULTS: With a response rate of 78%, 39% of the questioned centres were accepting HIV patients in the future for transplantation, and 39% rejected this. Twenty percent voted for individual case decision. Three centres had practiced liver transplantation in 11 patients. CONCLUSION: The decision to transplant HIV-positive patients in Germany is mostly based on individual cases and not refused in general. However, prospective studies on this issue are justified and needed.     

Metallkonzentrationen bei Patienten mit Metall-Metall-Gleitpaarungs-Prothese

Increased wear leads to elevated systemic and local metal ion concentrations for patients treated with metal-on-metal bearings. The local metal ion content in the close environment of the joint replacement (e.g. joint aspirate or tissue) is several times higher compared to the systemic metal content (e.g. in blood or serum). As a result of increased metal ion levels, local and systemic effects, such as osteolysis, pseudotumors, sensitization or in rare cases toxicity may occur. Although the definition of a specific threshold to define clinical problems is difficult due to a lack of sensitivity, the systemic metal concentration is frequently measured clinically. Currently a threshold for cobalt and chromium between 4 µg/l and 7 µg/l is under debate. Very high levels (≥?20 µg/l) or a steady increase over time should be a warning sign; however, metal ion levels should not be interpreted as a single diagnostic tool but rather in the entire context of the clinical, radiological and cross-sectional imaging, metal artefact reduction sequence (MARS) magnetic resonance imaging (MRI), ultrasound and computed tomography (CT) findings.     

180. Korrektur eines großen Narbenbruches nach Omphalozelenoperation

Zusammenfassung Bei einem 3jährigen Mädchen bestand ein großer Narbenbruch nach Operation einer rupturierten Omphalocele. Darm und Leber waren nur von Bauchhaut bedeckt. Ein primärer Verschluß des Bruches war wegen der Größe nicht möglich. Deshalb wurde zwischen die Rectusränder ein Teflonnetz nach der Methode von Schuster implantiert. Dieses Netz wurde bei einer zweiten Operation in der Mitte gekürzt und in einer letzten dritten Sitzung ganz entfernt. Die Rectusmuskulatur konnte dann direkt vereinigt werden.

---

Repair of a large incisional Hernia after omphalocele

Summary A 3-year-old girl had a large incisional hernia after surgical treatment of a ruptured omphalocele. Intestine and liver were only covered by cutis plate. A primary repair was not possible because the hernial opening was too large. A teflon mesh was therefore implanted between the rectus muscles (after Schuster, 1967). In a second operation the teflon mesh was shortened in the midline.In a third operation the teflon mesh was removed and the rectus muscles approsximated in the midline.