Zur Mobilisierung beim Lippenverschluß der einseitigen Lippen- und Kieferspalte

Zusammenfassung Die verschiedenen Zugrichtungen, die beim Lippenverschlu? auftreten, werden beschrieben und die Technik einer gezielten 4f?ltigen Mobilisierung zur Erzielung einer spannungsfreien Naht der Lippe dargestellt. Zu der allgemein üblichen Methode der Unterminierung werden zus?tzliche Schnittführungen angegeben, mit denen es gelingt, auch bei ungünstigen F?llen die Lippe und den Naseneingang in ann?hernd anatomischer Position spannungsfrei zu schlie?en.

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Summary The various lines of tension occurring in plastic lip repair are described and the technique of a four-fold mobilization used in order to obtain a tension-free lip suture is presented. In addition to the gneerally applied method of undermining, further types of incisions are indicated; even in difficult cases the latter make it possible to obtain a tension-free repair of lip and nares in an approximately anatomical position.

     

Aneurysmen der Arteria pancreatico-duodenalis als gastrointestinale Blutungsursache

Zusammenfassung Bei 2 erfolgreich operierten F?llen mit Aneurysmen der pancreatico-duodenalis, kompliziert durch schwerste gastrointestinale Blutungen, zeigt sich, da? unklare Symptomatik und hypovol?mischer Schock die Diagnose erschweren. Die Drosselung der A. hepatica und die Belassung des Aneurysmengrundes erleichtern das operative Vorgehen. Als ?tiologischer Faktor wird die Pankreatitis angedeutet.

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Summary 2 cases of aneurysm of the pancreatico-duodenal artery were successfully treated by operation. Hypovolemic shock due to gastrointestinal bleeding and atypical symptoms caused diagnostic difficulties. Constriction of the hepatic artery and leaving behind the ground of the aneurysm facilitated the intervention. It is assumed that the lesions were caused by pancreatitis.

     

Die Morphologie und Behandlung des Deckbisses

Zusammenfassung An einer Gruppe von 50 mit festsitzenden Geräten behandelten Deckbißfällen wurden durch eine Longitudinalstudie die dabei auftretenden Veränderungen aufgezeigt und analysiert.

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Summary A group of 50 Class II Division 2 cases were analysed by a longitudinal study. The changes resulting from treatment are shown and analysed.

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Résumé Une étude longitudinale de 50 cas de Classe II division 2 traités par appareillages fixes a montré les changements obtenus par cette thérapeutique.

     

Experimentelle und klinische Erfahrungen mit bipolarer Mikrokoagulation

Zusammenfassung Die Einführung der bipolaren Koagulation in die Neurochirurgie erm?glichte eine Erweiterung der Indikationsstellung und eine wesentliche Verbesserung der Operationsergebnisse. Tierexperimente zeigten, da? selbst in unmittelbarer Nachbarschaft lebenswichtiger zentralnerv?ser Zentren eine exakte Blutstillung mit Hilfe der bipolaren Elektrokoagulation m?glich ist, ohne da? die lebensgef?hrdenden Auswirkungen der unipolaren Koagulation sich einstellten.

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Summary In a series of animal experiments, the grave effect of current loops resulting from electrical hemostasis in close proximity to vital areas (brain stem, spinal cord etc.) is demonstrated. A sudden rise in blood pressure and irregularities in respiration and cardiac rate, frequently resulting in cardiac arrest, were observed. The authors show, that a simple additional circuit now routinely used in their operating theatre, enables bipolar electrocoagulation and greatly reduces current spread permitting precision hemostasis even on the surface of the brain stem without side effects.

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Auszugsweise vorgetragen in der Sitzung der Gesellschaft der Chirurgen in Wien am 6. M?rz 1969.     

A huge low-grade fibromyxoid sarcoma of small bowel mesentery simulating hyper immune splenomegaly syndrome: a case report and review of literature

Introduction

Low-grade fibromyxoid sarcoma (LGFMS) is a rare non epithelial tumour. It usually arises from the smooth muscles of the extremities. It is, however, occasionally reported to arise from other regions of the body.

Case report

We report the case of a 32 year old man who complained of a progressive abdominal swelling of 4 months duration. There was associated abdominal discomfort and weight loss. Abdominal examination revealed a non-tender intra abdominal mass filling the abdomen completely. Abdominal ultrasound suggested a massive splenomegaly. Abdomina Computerized Tomography (CT) scan was not done due to financial constraints. At laparotomy, a large, pearl-coloured mass was found within the mesentery of the proximal jejunum, with dilated, tortuous vessels. It was resected along with the overlying 60cm of jejunum. It weighed 7.5kg. Histology and immunohistochemistry confirmed the diagnosis of lowgrade fibromyxoid sarcoma. Post-operative period was uneventful and there were no features of recurrent after 2 year of follow up.

Conclusion

LGFMS may cause a diagnostic dilemma, especially in a third world setting where preoperative diagnosis is hampered by lack of facilities and poverty. A high index of suspicion is needed for preoperative diagnosis, which is necessary for proper planning of the operation.     

Effect of wound infiltration with bupivacaine on pulmonary function after elective lower abdominal operations

Background

Subcutaneous or intrafascial wound infiltration of local anaesthetic with systemic opioids has been shown to enhance patient comfort with improved analgesia and reduced opioid requirements.

Objective

To demonstrate improved pulmonary function when postoperative analgesia was provided by combined bupivacaine wound infiltration and systemic opioid.

Methods

In a prospective, randomized, placebo-controlled study, 46 patients (23 per group) scheduled for elective gynaecological surgery under general anaesthesia had subcutaneous and intrafascial wound infiltration of 40 ml, 0.25% bupivacaine (study patients) or 40 ml 0.9% saline (control) just before the end of surgery. Forced vital capacity (FVC), forced expiratory volume in 1 second (FEV1) and peak expiratory flow rate (PEFR) were done before surgery and at 6, 12 and 24 hours postoperatively. Student''s T and chi-square tests were used for tests of significance set at P < 0.05.Postoperative analgesia was provided with intramuscular morphine 0.15mg/kg 4hourly and 10mg/kg of intravenous paracetamol as rescue analgesia.

Results

PEFR, FVC and FEV1 were reduced in both the control and study groups but the reduction was greater in the control group.

Conclusion

Bupivacaine wound infiltration produced statistically significant elevations in pulmonary function tests results at all assessment periods.