Erfahrungen mit der stabilen Osteosynthese bei Metacarpalebrüchen

Zusammenfassung Es wird über die Erfahrungen berichtet, die mit der stabilen Osteosynthese mittels Schrauben und Platten (Kleinfragmenten-Instrumentarium sind 60 Patienten mit 85 Mittelhandbrüchen operativ versorgt und nachkontrolliert worden. Bei drei Vierteln der Patienten gelang eine vollständige Wiederherstellung der Funktion, während 11 Fälle eine geringgradige Bewegungseinbuße der gebrochenen Finger aufweisen. Voraussetzung für den Erfolg der stabilen Osteosynthese sind eine strenge Indikationsstellung sowie die geübte Handhabung des vollständigen Instrumentariums.

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Open reduction and stable internal fixation of metacarpal fractures results and experiences

Summary Open reduction and stable internal fixation as postulated by the ASIF (Swiss Association for the Study of Internal Fixation) has found general acception in fracture treatment of large bones. It was therefore tempting to apply the same principles to the small bones of the hand, where a full restitution of function is of utmost importance.— In the present study the experiences in the treatment of fractures of the metacarpal bones by means of open reduction and stable internal fixation are being reported. A special set of so-called small fragment instruments and implants, as developed by the ASIF, was used for the purpose.Within 3 years, 60 patients with 85 fractures of the metacarpals were operated upon and reviewed thereafter. 75 % of the patients display full restitution of function, whereas in 11 cases the range of movement is slightly reduced.The necessity of carefull indication and good operative technique is emphasised.

Nach einem Vortrag gehalten am 14. 2. 1970 vor der Schweizerischen Arbeitsgemeinschaft für Handchirurgie.     

236. Problematik des Cava-Katheters

Zusammenfassung Zahlreiche der häufigen und der seltenen, aber schwerwiegenden Komplikationen beim Cava-Katheter lassen sich auf die Verwendung ungeeigneter Kathetermodelle (Material - Konstruktion) zurückführen. Unter Berücksichtigung dieser Tatsache haben wir gemeinsam mit Technikern und Kunststoffachleuten ein eigenes Modell geschaffen, das aufgrund seiner Beschaffen-heit und Konstruktion thrombotische und entzündliche Folgezustände reduzieren soll und gleichzeitig Gefäß- und Herzperforationen sowie Katheterembolien weitgehend verhindert.Das Material besteht aus weichen, silikonisierten Polyäthylen (keine Weichmacher), die Nadel ist nach der Punktion entfernbar und das Einlegen des Katheters unter sterilen Kautelen möglich.

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Problems with the caval catheter

Summary Numerous common complications as well as the rare but grave complications of caval catheterization can be traced to the use of unsuitable catheter models (material, construction). In view of this fact we have designed a model ourselves together with technicians and catheter specialists. This model is thought to reduce thrombotic and phlebitic complications because of its chemical and constructive design. At the same time, perforations of vessels and the heart and also catheter embolism should be almost completely avoided. The material is soft siliconized polyethylene. The needle can be removed after venal puncture. It is possible to insert the catheter under sterile conditions.

     

Chirurgische Behandlung infizierter Knochendefekte

Zusammenfassung Die unhappy triad der Knochenchirurgie, Infekt, Defekt und Instabilität stellt uns auch heute noch vor schwer zu lösende Probleme. Das Vorgehen der Wahl scheint uns die Stabilisierung der Fragmente mittels einer internen (Osteosynthese) oder externen (äußere Spanner) Fixation, die radikale Ausräumung des Herdes, die vorübergehende Spüldrainage nach Willenegger [26, 27, 28] und schließlich das Auffüllen des Defektes mit autologer Spongiosa zu sein. Bei allen unseren in dieser Studie erfaßten 25 Patienten kam es zum knöcherner Einbau des Transplantates und Abheilung des Haut- und Weichteildefektes, bei vier Patienten be schleunigte eine Spalthautverpflanzung die Heilung. 23 Fälle sind 1 bis 6 Jahre nach der Behandlung vom Infekt her rezidivfrei geblieben, bei sämtlichen Patienten konnte die Belastungsstabilität erreicht werden.Durch das beschriebene Vorgehen konnte in allen Fällen die Gelenkfunktion erhalten oder verbessert werden. Das aktive Eingreifen gestattet zudem Achsen- und Längenkorrekturen.Klinische, szintigraphische und histologische Untersuchungen zeigen, daß der Einbau des spongiösen Transplantates unmittelbar nach der Verpflanzung einsetzt und nach 3 Monaten soweit fortgeschritten ist, daß die Belastungsstabilität erreicht wird.

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Autogenous cancellous bone in osteomyelitis with defects of bone, soft tissue and skin

Summary Surgeons are still confronted with the grave problem of the unhappy triad of bone surgery, i.e. infection, osseous defect and instability. To us the stabilisation of fragments by means of internal or external fixation, the radical saucerization and packing of the cavity with autogenous cancellous bone with preceding irrigation drainage seems to be the procedure best suitable. 25 patients with infected defects of bone, soft tissue and skin were treated accordingly and followed up 1 to 6 years later: In all cases the graft had been integrated and the skin- and soft tissue defects had healed. In 23 cases osteomyelitis had not re-occured, weight bearing stability had been achieved in all 25 cases.The described procedure had either maintained or even improved articular function. Additionally the active intervention allowes correction of axis and length.It is demonstrated by radiological, scintigraphical and histological examinations, that the integration of the cancellous bone transplant begins immediately after transplantation and is advanced within three months to such a point that weight bearing becomes possible.

     

88. Komplikationen des Cava-Katheters

Zusammenfassung Anhand von Serienzusammenstellungen von Komplikationen aus Literatur und eigener Erfahrung wird die Punktion der Vena jugularis interna empfohlen, der Zugang über die Vena saphena ist beim Erwachsenen zu meiden. Zugangsunabhängige Komplikationen sind durch angewandtes Kathetermodell, mangelnde Einlegetechnik und Pflege verursacht. Ein eigenes Modell weist als Hauptmerkmale einen silikonisierten Polyäthylen-Schlauch und eine abnehmbare Punktionskanüle auf. Das Kathetermaterial erwies sich experimentell und klinisch als gewebefreundlich und vermochte gegenüber PVC die Thrombose- und Entzündungsrate signifikant zu senken.     

Oral valganciclovir in children: single dose pharmacokinetics in a six-year-old girl

We report a pharmacokinetic study in a 6-year-old girl with congenital human immunodeficiency virus type 1 and cytomegalovirus coinfection maintained on iv ganciclovir for 6 years. Increasing infection and thrombosis caused by her iv device necessitated alternative therapy. Single dose pharmacokinetics of ganciclovir 4.4 mg/kg iv and valganciclovir 13.2 and 26.3 mg/kg po were studied with high performance liquid chromatography/tandem mass spectrometry. The two oral dosages yielded areas under the concentration curve of 14.3 and 28.7 microg x h/ml, equivalent to 43% bioavailability of ganciclovir from valganciclovir, which exceeded the area under the concentration curve of 11.1 microg x h/ml yielded by ganciclovir 4.4 mg/kg iv. Oral valganciclovir achieved therapeutic and dosage-proportional plasma concentrations in the child we studied.     

Effects of neonatal high-dose short-term glucocorticoid treatment on the lung: a morphologic and morphometric study in the rat

Glucocorticoids are often applied in neonatology and perinatology to fight the problems of respiratory distress and chronic lung disease. There are, however, many controversies regarding the adverse side effects and long-term clinical benefits of this therapeutic approach. In rats, glucocorticoids are known to seriously impair the formation of alveoli when applied during the first two postnatal weeks even at very low dosage. The current study investigates short-term and long-term glucocorticoid effects on the rat lung by means of morphologic and morphometric observations at light and electron microscopic levels. Application of a high-dosage protocol for only few days resulted in a marked acceleration of lung development with a precocious microvascular maturation resulting in single capillary network septa in the first 4 postnatal days. By postnatal d 10, the lung morphologic phenotype showed a step back in the maturational state, with an increased number of septa with double capillary layer, followed by an exceptional second round of the alveolarization process. As a result of this process, there was an almost complete recovery in the parenchymal lung structure by postnatal d 36, and by d 60, there were virtually no qualitative or quantitative differences between experimental and control rats. These findings indicate that both dosage and duration of glucocorticoid therapy in the early postnatal period are very critical with respect to lung development and maturation and that a careful therapeutic strategy can minimize late sequelae of treatment.     

Efficacy and safety of intravenous amiodarone for incessant tachycardias in infants

Amiodarone is an effective anti-arrhythmic agent for the treatment of supraventricular and ventricular tachycardias. The safety and efficacy of intravenous amiodarone has been described in adults and children but only to a limited extent in infants. The purpose of this study was to evaluate the safety and efficacy of intravenous amiodarone in infants. Between February 1994 and June 2001, 23 infants with a median age of 8 days (range 1–300 days) with life-threatening incessant tachycardias (17 supraventricular, 6 ventricular) were treated with intravenous amiodarone as single anti-arrhythmic agent. At presentation, 22 infants were haemodynamically unstable. Amiodarone was given as an intravenous loading dose of 5 mg/kg over 1 h followed by an intravenous maintenance dose of 5 µg/kg per min with stepwise increase up to 25 µg/kg per min until arrhythmia control or side-effects occurred. Amiodarone was effective in 19 infants, partially effective in three and ineffective in one infant. The median time until arrhythmia control was 24 h (range 1–96 h) and the median maintenance dosage 15 µg/kg per min (range 5–26 µg/kg per min). Electrophysiological side-effects necessitating dose reduction comprised of sinus bradycardia in two patients. Hypotension in one patient resolved after dose diminution. Neurological side-effects consisted of choreatic movements in one infant, which resolved over time. Amiodarone administration was stopped in one patient with elevated liver enzymes. Conclusion:intravenous amiodarone is a safe and effective therapy for life-threatening incessant tachycardias in infants.