Interdisziplin?re Leitlinien zur Diagnostik und Therapie der extrazerebralen Amyloidosen

Ohne Zusammenfassung     

Functional reconstruction of Achilles tendon defects combined with overlaying skin defects using a free tensor fasciae latae flap.

We present our experience in functional reconstruction of the Achilles tendon with large tissue defects following after trauma and infection. To cover the skin defect and to reconstruct the Achilles tendon we used the free tensor fasciae latae (TFL) flap. From 1997 to 2003 six males, ranging from 22 to 71 (average 38.6) years, underwent this reconstructive procedure. All of them had sustained a trauma with following loss of the tendon and of the overlying tissue. After initial debridements the reconstruction with a tensor fascia latae free flap was performed. To achieve a strong distal fascia lata attachment to the calcaneal bone, we developed a special method of fixation. After vertical osteotomy in the calcaneus the distal part of the fascia flap was introduced between the bone segments, which were fixed together with a spongiosa screw. For functional outcome, it was important to fix the foot in a 90 degrees position with tension on the vascularised fascia lata. The range of motion of the ankle of the reconstructed foot showed 93.7% in comparison to the normal foot. No flap failure occurred in any of the six patients. Simultaneous soft-tissue and function restoration of the foot with TFL free flap is in our opinion an optimal one-stage reconstructive procedure.     

Postoperative evisceration

From 1930 to 1989 postoperative rupture of abdominal wound occurred in 0.42 per cent (n = 82) in the Department of Obstetrics and Gynaecology of the University of Rostock. 60 per cent of the patients were younger than 50 years. Patients of reduced general condition and anaemia were predisposed to this complication. We observed postoperative alterations of the respiratory tract in 13 per cent and alterations of the gastro-intestinal tract in 20 per cent which lead to increased intra-abdominal pressure. We observed postoperative wound rupture only in 8 cases after Pfannenstiel's incision, but all other times after median section, predominantly during the 7th and 12th postoperative day. All patients were treated by secondary suture, immediately. 8 patients came to death, three of them had no direct link to wound rupture. For prophylaxis the use of non-absorbable suture material, safety sutures, intraoperative blood and protein substitution and prevention of affections of the respiratory system and gastrointestinal tract are recommended.     

Urachal remnants in asymptomatic children: Sonographic morphology

The sonographic morphology of urachal remnants is not well known and findings tend to be misinterpreted. We present urachal remnants in 16 asymptomatic children (1 week-16 years). In the prevesical part two different types of urachal remnants were found: the tubular type with a small outer muscle wall and the fusiform type with a muscle wall thickness up to 12 mm. Further subvariants are presented. Differential diagnosis of the fusiform type includes urachal cyst and tumorous muscle thickening.     

Short-term lack of cerebral perfusion with good outcome. Advantages of early intracranial pressure monitoring

A 21-year-old man was injured by a tailboard of a truck. He suffered a severe head injury with bilateral depressed skull fractures necessitating surgical decompression. On admission to the hospital the patient showed bending to pain stimuli (Glasgow Coma Score 5). Anisocoria was noticed from the beginning. Initial intracranial pressure (ICP), measured 3 hours after injury, was 30 mm Hg, and the cerebral perfusion pressure (CPP) was 70 mm Hg. During surgical elevation of the skull fracture on the right side an unexplainable rise of ICP to values of 100 mm Hg occurred, which corresponded to the mean arterial blood pressure (MAP). At the same time both pupils were dilated and fixed indicating a lack of cerebral perfusion. Due to immediate trephination of the opposite side, the ICP was lowered to values below 20 mm Hg, and sufficient cerebral perfusion (above 50 mm Hg) was regained. The patient showed a good recovery and was transferred to a rehabilitation center 5 weeks after injury.This case report emphasizes the importance of early and continuous intracranial pressure monitoring for adequate therapy in neurosurgical emergencies.     

Cooling improves the writing performance of patients with writer's cramp.

Cooling of hand and forearm muscles by immersion in 15 degrees C cold water for 5 minutes improved the writing performance of patients with writer's cramp. Since abnormal processing of muscle spindle afferent discharges contributes to the pathology of writer's cramp, this effect might result from a reduction in muscle spindle activity by lowering muscle temperature. Cooling is a simple, cheap, and safe procedure, providing temporary relief for patients with writer's cramp.