Diagnostik und Therapie der Koalitionen und Synostosen bei Kindern und Jugendlichen

The majority of tarsal coalitions are located in the calcaneonavicular and talocalcaneal regions and other locations are rare. Complete early ossified synostoses are found not only in major limb deficiencies but also in otherwise normal feet. Magnetic resonance imaging (MRI) and computed tomography (CT) scans are the most important imaging techniques especially for preoperative planning. Early resection is advisable in calcaneonavicular coalitions as soon as it is detected in childhood and adolescence. Indications for or against resection or limited tarsal fusion are much more difficult in talocalcaneal coalition. The patient’s complaints, extension and location of the coalition, additional malalignment and especially patient age are some of the factors that should be considered carefully. Results of surgical resection are not always satisfactory with a long-lasting rehabilitation especially in older children or adolescents and the necessity for secondary procedures can never be ruled out. In cases of malalignment corrective tarsal osteotomy can be considered as a simultaneous or staged procedure. An overview with special emphasis on surgical options is presented with typical examples as well as rare conditions and a review of important literature from recent years is included.     

Neue und verbesserte Pendel- und Widerstandsapparate

Ohne Zusammenfassung Mit 18 Abbildungen im Text.     

Harnableitung und Harnumleitung Patientenselektion und -beratung

In the past 18 years, traditional methods of urinary drainage and diversion via conduits and ureterosigmoidostomy have been increasingly replaced by new techniques of orthotopic bladder substitution and continent urinary diversion. With growing knowledge of the physical and physiological relationships, the more than 40 techniques of continent urinary diversion using almost all segments of the gastrointestinal tract have ceased being spectacular and experimental. The various methods are well established, preparatory care and follow-up are standardized, and the technical and methodological aspects are sufficiently elucidated so that the underlying precept, i.e., improvement of these patients' quality of life, has priority.     

Verletzungen und Verletzungsrisiko beim Ski- und Snowboardsport

INTRODUCTION: An extensive gathering of data should contribute to evaluate the risk and to reduce prejudices. MATERIAL AND METHOD: Within 6 weeks 57 different criteria according to accident, person and circumstances from 3,512 skiers and snowboarders were gathered and collected in a database. For analysis additional data about frequency of transportation and weather and piste conditions were available. RESULTS: Injury risk for piste sports is 0.7%. The risk is especially influenced by bad weather conditions. Young people represent a risk group. The carving technique has led to a reduction of injury risk, but caused a shift of the injury pattern. Protectors reduce the risk up to 50%. DISCUSSION: Skiing and snowboarding are among the safest sports because of improved material and pistes. The new injury pattern with the carving technique is due to higher speeds in curves resulting in higher centrifugal forces; 18% of skiing accidents are collisions and 14% of all skiers do not know the FIS rules of conduct. CONCLUSION: There was no increase in injury risk at the pistes in recent years. The use of protectors has a positive effect and should be supported in the future too.     

Beckenring- und Apophysenverletzungen im Kindes- und Jugendalter

Background

Pediatric pelvic fractures are rare injuries. Typically they are associated with high-energy trauma, which often leads to life-threatening injuries of other organs. Anatomical differences (e.g., greater elasticity, different stages of maturation, remodeling) account for the different fracture mechanisms, fracture management, and outcome in children. The AO Classification (International Association for Osteosynthesis) is useful and can be used as a basis for the treatment algorithm in pediatric pelvic fractures.

Aim

This article provides a review on pediatric pelvic fractures and shows – based on the AO classification – principles of conservative und operative treatment.     

Diagnostik und Therapie von Schulter- und Ellengelenkempyemen

Diagnosis of acute joint infections is based primarily on clinical alterations, laboratory tests, sonography and examination of aspirated joint fluid. Conventional X-rays should also always be done, to exclude other diseases. We use three criteria for classification: previous treatment, extent of infection, and extent of joint destruction (4 grades). Treatment has to take account of all three criteria: if the joint alone is infected treatment is exclusively, or preferentially, arthroscopic in stages I–III; while in stage IV disease, two-stage open surgery predominates. Local antibiotic substances (fleece or chains) are often used; in cases of far advanced joint destruction joint resections cannot be avoided. Even in the case of combined joint and bone infections of the upper extremity we prefer to do resections preserving partial function. The results of treating 32 elbow infections and 26 shoulder joint infections are presented. Both these populations reflected negative patient population, but in spite of this the functional results were predominantly good to satisfactory. On the basis of these results, we conclude that even when the initial situation seems desolate, a comprehensive surgical therapy is the treatment of choice and that in the upper extremity greater importance should be attached to restoration of function than to stability, which means that arthrodeses are seldom necessary.     

Hirn- und Nervenverletzungen bei Kindern und Jugendlichen

Ohne Zusammenfassung Mit 6 Abbildungen in 10 Einzeldarstellungen Die Untersuchungen wurden unterstützt vom Bundesministerium für Arbeit und Sozialordnung und von der Europ?ischen Gesellschaft für Kohle und Stahl (Hohe Beh?rde). Vortragender:W. T?nnis-K?ln.     

Leber und Nieren vor und nach Operationen

Ohne Zusammenfassung Mit 11 Textabbildungen     

Zur Klinik und Therapie der Verletzungen und Erkrankungen des Mond- und Kahnbeines

Ohne Zusammenfassung     

Naevus und melanom bei Kindern und Jugendlichen

Ohne Zusammenfassung     

Baracke und Zelt in Krieg und Frieden

Ohne Zusammenfassung     

Blasenaugmentation und -ersatz bei Kindern und Jugendlichen

Background

In children and adolescents, the indication for continent urinary diversion or bladder augmentation is rare. Today, for most patients with a neurogenic bladder, conservative treatment (clean intermittent catheterization [CIC] and pharmacotherapy) is the method of choice, while for patients with bladder exstrophy-epispadias complex (BEEC), primary reconstruction is recommended. Only after failure of conservative treatment or primary reconstruction should bladder augmentation or urinary diversion be considered. Other rare indications include patients with malignant tumor involving the lower urinary tract (e.?g., rhabdomyosarcoma).

Discussion

In patients with a hyperreflexive, small capacity, and/or low compliance bladder with a normal upper urinary tract, bladder augmentation (bowel segments/ureter) is an option. For those unable to perform CIC via the urethra, a continent cutaneous stoma should be offered. In patients with irreparable sphincter defects and normal renal function, a continent cutaneous diversion is an option and in those with a competent anal sphincter the rectosigmoid pouch can be offered.

Conclusion

In this review, surgical options with their advantages and disadvantages are discussed.

     

Errichtung und Einrichtung transportabler Baracken und Barackenlazarethe

Ohne Zusammenfassung (Hierzu Tafel III–V.)     

Kathepsin und Pepsin nach Magenresektion und Gastrektomie

Ohne ZusammenfassungMit 9 Textabbildungen.     

Metallbeschaffenheit und Korrosionserscheinungen an Platten und Schrauben

Ohne ZusammenfassungMit 4 Abbildungen in 11 EinzeldarstellungenVortragender:F. Brussatis-Münster