Indikation und Ergebnisse der Verkürzungsosteotomie der Ulna

A relatively or absolutely too long ulna leads always to pain in the wrist, so that a compensation in length of both forearmbones is achieved by shortening osteotomy. The gradual ulna shortening osteotomy, the stylectomy and the resection of the caput ulnae with or without radius transposition osteotomy are available as shortening operation. In 17 patients of the Gießener Unfallchirurgischen Klinik we performed in 14 cases a shortening osteotomy of the ulna and in 3 cases a resection of the caput ulnae. The shortening osteotomy lead in all cases to a reduction of complaints and to an improvement of the mobility of the wrist. Due to frequent arthropathy the resection of the caput ulnae should be taken more often into consideration in older people.     

Das Karzinom des Nierenparenchyms

Zusammenfassung Nach Aufgliederung der prim?ren epithelialen Nierenparenchymtumoren aus pathologisch-anatomischer Sicht in 1. hypernephroide Karzinome, 2. papill?re Adenokarzinome, 3. übergangsformen von 1 und 2, werden Nierenveneneinbruch und Einbruch in das Nierenholsystem im Hinblick auf überlebenszeit bzw. H?maturie untersucht. Altersverteilung, Inivialsymptome und Laboratoriumsbefunde werden in Tabellen aufgeführt. In der R?ntgendiagnostik wird die überragende Bedeutung der Aortographie hervorgehoben und ihre Grenzen besprochen. Schlie?lich erfolgt die Darstellung der überlebensrate nach verschiedenen Einteilungsprinzipien: Tumor auf die Niere beschr?nkt, perirenale Infiltration, Veneneinbruch, makroskopisch radikal operiert und die Ergebnisse aller operierten Patienten.

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Summary Classification of the primary epithelial tumors of the kidney parenchyma from a patho-anatomical standpoint in 1. hypernephroid carcinoma, 2. papillary adenocarcinoma, 3. transition of 1 to 2, invasion to renal vene and to calyx-pelvic system in relation to survival rate and haematuria is examinated. Age distribution, initial symptoms and laboratory findings are summarized in tables. The importance of aortography in the roentgenologic diagnostic of renal is emphasized. Discussion of survival rate according to: intraparenchymal tumor, perirenal and vene invasion, nephrectomy macroscopic radical and results of all operated patients.

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Mit Unterstützung aus dem Felix-Mandl-Fonds zur F?rderung wissenschaftlicher Arbeiten an den St?dtischen Krankenanstalten der Gemeinde Wien und aus der Ludwig-Boltzmann-Gesellschaft zur F?rderung der wissenschaftlichen Forschung in ?sterreich.     

Pankreas annulare

Zusammenfassung Mitteilung über 4 operierte F?lle von Pankreas annulare aus dem eigenen Krankengut. In 2 neonatalen F?llen mit dem Bild der Duodenalatresie konnte durch Duodenoduodenostomie eine Heilung erzielt werden. Auf die Wichtigkeit der rechtzeitigen Diagnosestellung wird hingewiesen. In 2 F?llen bei Erwachsenen waren Schmerzen, Erbrechen und Gewichtsverlust die wichtigsten Symptome. Die Diagnose wurde trotz mehrfacher vorangegangener Operationen und zahlreicher Voruntersuchungen erst nach Jahren gestellt. Zur Behandlung kam einmal die Duodenoduodenostomie, einmal die Duodenopankreatektomie erfolgreich zur Anwendung.

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Summary This is a report on 4 operated cases of annular pancreas. In 2 neonatal cases this condition presented symptoms of a complete duodenal obstruction. Duodenoduodenostomy and temporary gastric decompression by gastrostomy was performed in both cases and has proved to be satisfactory. The importance of an early diagnosis has been emphasized. In 2 adult cases the most pronounced symptoms were pain, vomiting and loss of weight. In spite of several previous operations of the abdomen and frequent examinations the correct diagnosis was not made for years. One case was treated successfully by duodenoduodenostomy, in the second case because of pancreatic fibrosis a duodenopancreatectomy was necessary.

     

Ein Catgutfaden als Ursache einer Gallensteinbildung nach transduodenaler Papillenspaltung

Zusammenfassung Es wird über einen Fall berichtet, bei dem es durch Inkrustation eines Catgutfadens zur Gallensteinbildung in den tiefen Gallenwegen gekommen war.

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Summary We report on a case in which incrustation of a plain catgut thread caused the formation of a gallstone in the common bile duct.

     

Endarterektomie mit Ultraschall

Zusammenfassung Die Wirksamkeit des Ultraschalles zur Endarterektomie wurde bei der offenen Aussch?lung von Leichenaorten überprüft. Ultraschall hat gegenüber konventionellen Aussch?lmethoden wesentliche Vorteile. Die Aussch?lwirkung des Ultraschalles beruht nicht auf einem Vibrationseffekt, sondern auf der Kavitation, die Ultraschall in der Aussch?lebene hervorruft.     

Die Bedeutung der Süchtigkeit für die Indikationsstellung zu schmerzchirurgischen Eingriffen

Zusammenfassung Die Medikamentensucht ist eine schwere Erkrankung, die sowohl den postoperativen Verlauf als auch das Ergebnis schmerzchirurgischer Eingriffe beeinflussen kann. Eine Nachuntersuchung von 136 Chordotomien, darunter waren auch 30 süchtige Patienten, ergab, da? beide Gruppen wohl die im wesentlichen gleiche Aussicht haben, durch den Eingriff schmerzfrei zu werden, jedoch ist die Zahl der Mi?erfolge in der Gruppe der süchtigen Patienten au?erordentlich hoch. Die Süchtigkeit ist unseres Erachtens keine absolute Kontraindikation zu einer Chordotomie, mu? jedoch als ein erh?htes Operationsrisiko berücksichtigt werden. Vor der beabsichtigten Operation sollte bekannt sein, da? der Patient süchtig ist und die „stabilisierende Dosis” des Suchtgiftes sollte ermittelt werden, die in der Lage ist, das Auftreten des Abstinenz-Syndroms zu verhindern. Vegetative St?rungen, Stoffwechselst?rungen, St?rungen im Flüssigkeitshaushalt sowie eine Unterern?hrung, die bei Suchtkranken, auftreten k?nnen, müssen pr?operativ entsprechend behandelt werden. Im Hinblick auf die Suchtgef?hrdung bei Patienten, die an starken chronischen Schmerzen leiden, sollte man sich frühzeitig zu einer Chordotomie entschlie?en.

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Summary Drug addiction is a grave disease which may influence the postoperative course as well as the result of cordotomies. An examination of 136 cordotomies, including 30 patients with drug addiction, showed that both groups had essentially the same chance to be relieved from their pains, that however, the number of failures was especially high in the group of drug addicts. The preexistence of drug addiction is not necessarily a contraindication for cordotomy, it should however be considered as a greater risk for an operation. Before a cordotomy it should be known that the patient is a drug addict, furthermore it is necessary to find out the „stabilizing dose” of the drug which may prevent an abstinence-syndrom. The manifold disturbances (vegetative, fluid-balance, malnourishment and metabolism) which may occur with drug addicts, have to be treated accordingly before the planned operation. In view of the fact that patients suffering from severe chronical pain, may likely become drug-addicted, one should decide to make a cordotomy at an early sage.

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Nach einem Vortrag am Neurochirurgischen Diskussionstag, 26. Oktober 1968, Salzburg.     

Serum analysis after transplant nephrectomy reveals restricted antibody specificity patterns against structurally defined HLA class I mismatches

This study deals with HLA-mismatched kidney transplants that have been removed following rejection. Sera from 27 patients were screened for HLA-specific antibodies by direct complement-dependent lymphocytotoxicity with HLA-typed cell panels. Circulating donor-specific antibodies were detected in 3 cases (11%) before and in 26 cases (97%) after allograft nephrectomy. These findings demonstrate the production of donor-specific antibodies in patients with rejected transplants, but in most cases, they were undetectable before nephrectomy, because the graft had adsorbed them. With an HLAMatchmaker-based serum analysis program, we observed restricted antibody specificity patterns against amino acid triplet-defined epitopes on donor HLA-A,B antigens. Many donor triplets were non-reactive while others were apparently recognized by antibodies. In some patients, the donor triplet specific antibodies persisted for a long time whereas in many other patients, they became undetectable after a few months. The characterization of the antibody specificity profiles of post-allograft nephrectomy sera is clinically useful in defining criteria of HLA mismatch acceptability for sensitized patients awaiting another transplant. It provides also opportunities for determining the relative immunogenicity of mismatched triplets.     

A comparison of the therapeutic efficacy and tolerability of etoricoxib and diclofenac in patients with osteoarthritis

OBJECTIVE: To evaluate and compare the efficacy and tolerability of etoricoxib and diclofenac in patients with osteoarthritis of the knee or hip. METHODS: In this 6-week double-blind, active comparator controlled, parallel-group study eligible osteoarthritis patients were randomised to receive either etoricoxib 60 mg once daily (n = 256) or diclofenac 50 mg three times daily (n = 260). The primary study endpoint was the Western Ontario McMaster osteoarthritis index (WOMAC) pain subscale. Other endpoints included were the WOMAC stiffness and physical function subscales, and the Patient's Global Assessment of Response to Therapy (PGART) questionnaire. Early efficacy was evaluated using WOMAC first question (pain walking on a flat surface) and PGART 4 h after the morning dose of each drug on days 1 and 2. Rescue medication (paracetamol) used was also recorded. The study was designed to show comparable efficacy between etoricoxib 60 mg once daily and diclofenac 50 mg three times daily with respect to the primary endpoint and was conducted outside the United States at 67 centres in 29 countries. RESULTS: Etoricoxib (60 mg once daily) was comparable in efficacy to diclofenac (150 mg daily) on all the above parameters. The one exception was in the assessment of early efficacy where etoricoxib demonstrated significantly greater benefit within 4 h of taking the first dose on the first day of therapy (p = 0.007) as evaluated by the percentage of patients with good or excellent (PGART) responses. The treatment effects of both drugs were similar by the time day 2 was reached and were sustained throughout the 6 weeks of therapy. Both treatments were generally well tolerated. CONCLUSIONS: Etoricoxib is clinically effective in the therapy of osteoarthritis providing a magnitude of effect comparable to that of the maximum recommended daily dose of diclofenac. The onset of clinical benefit with etoricoxib on day one is more rapid than that of diclofenac. Both drugs were generally well tolerated.