Pulmonary vein thrombosis after lower lobectomy of the left lung

Pulmonary vein thrombosis is a known complication after lung transplantation but has rarely been reported after lobectomy or bilobectomy. We report the case of a left upper pulmonary vein thrombosis following an uneventful left lower lobectomy for bronchial carcinoma. Postoperative arterial blood gas values and chest radiographs were normal. On postoperative day 5, the patient became progressively dyspneic, developed hemoptysis and showed total opacification of the left lung without mediastinal shift on chest radiography. The patient remained dyspneic despite intravenous antibiotic therapy for suspected pneumonia and absence of obstruction at bronchoscopy. Diagnosis of left upper pulmonary vein thrombosis was finally made by contrast-enhanced multislice computed tomography followed by pulmonary angiography. Further clinical deterioration under conservative treatment forced us to remove the remnant left upper lobe that already showed gangrenous alterations. Pulmonary vein thrombosis following lobectomy or bilobectomy is very rare. Only 7 cases have been reported in the literature so far. Conservative treatment with antibiotics and anticoagulants may be successful but in case of clinical deterioration the affected lobe has to be resected. The mechanism of thrombosis remains unclear although intraoperative torsion and injury of vessels seem to be most likely since pulmonary vein thrombosis occurred in the operated hemithorax only.     

Technik des alloplastischen Bandersatzes mit Kohlefasern

Chronic instabilities or remaining luxations of joints are not acceptable for an active human being. The desired result is often not achieved by surgical methods applying most different autologous and homologous materials. This is why our working group has been trying for several years to develop a more promising method using an alloplastic material in the form of carbon ligaments. Numerous mechanical, biological, biomechanical, and histological examinations showed that the implantation of woven carbon ligaments in man could be accepted. During the most recent years, we have effected 150 ligament grafts with this material and, in course of time, we have been able to modify and to ameliorate the operation techniques. Today we may state that the described operation methods using ligaments of carbon fibres in the sternoclavicular, acromioclavicular, knee and ankle joint can bring about favorable results with regard to their function and stability. Further improvements can probably be achieved by a careful examination of the results obtained hitherto which will possibly include another refinement of the operation technique. A definite evaluation of this method, however, will only be possible within several years, when clinical check-up examinations will be made.     

73. Ergebnisse der Behandlung bei Tumoren und Metastasen am Becken und proximalen Femur (Sammelstatistik der DAO,mit Unterstätzung der AO International)

Zusammenfassung Eine retrospektive Sammelstudie der deutschen AO mit 293 primären Tumoren und 244 Metastasen am Becken und proximalem Femur erbrachte folgende Erkenntnisse: Benigne Tumoren werden ausgeräumt. Semimaligne Formen müssen radikal operiert werden. Bei malignen Tumoren kann neben der Hemipelvektomie oder Exartikulation die totale innere Hemipelvektomie mit Erhaltung der Extremität angewendet werden. Metastasen werden mit erweitertem prothetischen Ersatz oder Verbundosteosynthese behandelt. Trotz z. T. ausgedehnter Eingriffe ist insgesamt die Frühletalität gering, die lokale Komplikationsrate vertretbar und die Mobilisation fast immer möglich.     

Carbon fiber ligament replacement in the treatment of chronic instability of the external ankle joint ligament

Ligament repair should be considered when a patient has disabling pain with giving way and chronic instability of the ankle from old ruptures of the lateral ligaments. Because of some incontestable disadvantages using Watson-Jones-or similar techniques we prefer the alloplastic with carbon fibres to reconstruct the anterior talofibular and calcaneofibular ligaments. Imitating the physiological course and insertions of the ligaments we managed to achieve a permanent lateral stability in 51 cases out of an operated group of 54 patients.     

Stability after obtaining cancellous bone from the greater trochanter]

To test the endangered stability after obtaining cancellous bone from the greater trochanter, the ultimate breaking force of 40 human femura was measured with a material testing machine (Instron 1115). 1. 10 Femura after removing bone from the greater trochanter as a routine clinical procedure showed a significantly reduced trochanteric stability (p less than 0.05), 4 subtrochanteric and 3 pertrochanteric fractures, compared to 10 intact opposite femura with vertical shear fractures of femural neck and head without damage to the trochanteric region. 2. The number of fractures crossing the window was reduced by half, p less than 0.05 when a round cortical window compared to when a square window of the same area was cut. As the reduced stability caused by the remove of cancellous bone can not be avoided, we can clearly reduce the danger of stress concentration in the notches by cutting a round corticalis window. Cancellous bone from the greater trochanter should only used, if it cannot be taken from the brim or posterior iliac spine of the pelvis.     

Effectiveness of a 10-day melarsoprol schedule for the treatment of late-stage human African trypanosomiasis: confirmation from a multinational study (IMPAMEL II)

BACKGROUND: Treatment of late-stage human African trypanosomiasis (HAT) with melarsoprol can be improved by shortening the regimen. A previous trial demonstrated the safety and efficacy of a 10-day treatment schedule. We demonstrate the effectiveness of this schedule in a noncontrolled, multinational drug-utilization study. METHODS: A total of 2020 patients with late-stage HAT were treated with the 10-day melarsoprol schedule in 16 centers in 7 African countries. We assessed outcome on the basis of major adverse events and the cure rate after treatment and during 2 years of follow-up. RESULTS: The cure rate 24 h after treatment was 93.9%; 2 years later, it was 86.2%. However, 49.3% of patients were lost to follow-up. The overall fatality rate was 5.9%. Of treated patients, 8.7% had an encephalopathic syndrome that was fatal 45.5% of the time. The rate of severe bullous and maculopapular eruptions was 0.8% and 6.8%, respectively. CONCLUSIONS: The 10-day treatment schedule was well implemented in the field and was effective. It reduces treatment duration, drug amount, and hospitalization costs per patient, and it increases treatment-center capacity. The shorter protocol has been recommended by the International Scientific Council for Trypanosomiasis Research and Control for the treatment of late-stage HAT caused by Trypanosoma brucei gambiense.