Das Dilatationsverhalten von Polyesterprothesen

In a prospective, randomized multicenter trial, 175 patients with abdominal aortic aneurysms were treated by conventional operation. Two types of polyester prostheses (Gelsoft Plus, Vascute Terumo Corp., Hamburg, Germany or Microvel, Boston Scientific, Ratingen, Germany) were selected randomly for implantation. Diameters ranged from 14 to 20 mm. The diameters of the grafts were measured by ultrasound postoperatively, as well as 6, 12, and 24 months after operation. Local and systemic complications were recorded. Dilation of the main body of the “Gelsoft plus” prosthesis was 19% within the first 12 months and 30% for the Microvel prosthesis. Extreme dilation was not observed. Thus, vascular prostheses must be chosen small enough and the dilation of 20–30% should be considered. The most frequent complication was incisional hernia (32%).     

Treatment of post-traumatic limb shortening]

The physiological phenomenon of changes in callus formation during distraction was first described by Codivilla at the beginning of this century. Having investigated and proved the influence of tension stress on callus formation, Ilizarov used this as a method to treat limb shortening and deformities. Because of his remarkable results we introduced this method in our hospital in 1990, using the original Ilizarov ring fixator. From November 1990 to December 1991, we used this technique in 10 cases of combined post-traumatic bone shortening with deformity (the tibia was affected in six patients, the femur in three and the forearm in one). The mean shortening was 3.1 cm, the mean varus or valgus deformity 9.5 degrees, the mean anteflexion or recurvation 8.3 degrees, and the mean rotation deformity 8.5 degrees. Distraction/correction lasted between 8 and 55 days (mean: 37 days). Fixation was necessary for between 60 and 339 days. If corticotomy was performed in the diaphyseal bone, fixation lasted almost twice as long (11.33 days/mm lengthening) as in the metaphyseal area (6.55 days/mm lengthening). There were 14 complications, most of which were considered minor. The latter included pin infections (4), wire breaking (1) and restricted range of motion of the knee or ankle (5). Among the major complications were two nerve irritations, which recovered spontaneously, and two pin-induced local bone infections, which required surgical intervention. Achievement of the goals of treatment-complete correction of shortening and deformity-was not affected by these complications.     

Surgical closure of persistent ductus arteriosus in small premature infants in an incubator

In premature neonates a patent ductus arteriosus causes often other complications thus the immediate closure of the patent ductus arteriosus should be preferred or recommended. Performing the surgical closure of the ductus within the incubator can avoid complications during transportation from the premature neonates intensive care unit to the operating room. 25 very small premature neonates or those with another burden in addition were operated upon in the incubator on the premature infants intensive care unit of our hospital during the period from January 1987 to April 1989. No complications occurred during the operation, especially not caused by the strange circumstances for the operating team. Wound infections because of possible bacterial contamination of the incubator or the room were not observed during the postoperative period.     

Sekundärrekonstruktionen Achillessehne

Zusammenfassung Etwa 10% aller Achillessehnenrupturen werden verspätet erkannt. Während bei frischen Rupturen verschiedene direkte Nahttechniken angewendet werden, ist für die operative Behandlung veralteter Achillessehnenrisse meist eine plastische Sehnenrekonstruktion notwendig. Die Auswahl des geeigneten Operationsverfahrens ist von der Höhe der Ruptur und der Länge der Defektstrecke abhängig.     

Quadrizepssehnenruptur

Zusammenfassung Rupturen der Quadrizepssehne sind seltene Verletzungen des Kniegelenks und bewirken durch die Kontinuitätsunterbrechung im Streckapparat einen Funktionsausfall des Beins. Sie werden operativ behandelt. Bei frischen Rupturen wird die Sehne übungsstabil transossär am proximalen Patellapol refixiert. Veraltete Rupturen und Sehnendefekte werden meist mit lokalen gestielten autologen Sehnenplastiken rekonstruiert.     

Different kinetics of lung clearance of technetium-99m labelled diethylene triamine penta-acetic acid in patients with sarcoidosis and smokers

The rate of clearance from the lungs of inhaled technetium-99m labelled diethylene triamine penta-acetic acid (^99mTc-DTPA) is often increased in interstitial lung disease as well as in smoking. In smokers a bi-exponential clearance course of ⁹⁹mTc-DTPA when measured over 3 h has previously been shown. This study was performed to compare the kinetics of clearance of ^99mTc-DTPA, measured for 3 h, in sarcoid patients and healthy smokers. Forty-one never-smoking patients with sarcoidosis and radiological signs of intrathoracic disease were studied. The results were compared with those of 16 healthy current smokers and of 14 healthy never-smokers reported previously. A mono-exponential clearance equation described the clearance in 22 of the sarcoid patients and all normal never-smokers, but with a shorter average tracer half-life in the patients (P<0.05). In 19 patients and all smokers a bi-exponential equation gave a significantly better curve fit. The rate of clearance of the slow component was higher in patients with sarcoidosis than in smokers (P< 0.05). The fraction of the tracer cleared by the fast clearance component was smaller in patients with sarcoidosis than in smokers (P<0.01). Differences in kinetics of clearance of ^99mTc-DTPA in sarcoidosis and smoking could thus be demonstrated, suggesting that the abnormal clearance is caused by diverging pathophysiological mechanisms.     

Die Insuffizienz der intraabdominellen Infektabwehr bei der eitrigen Peritonitis — Folge einer gestörten Fremdkörperopsonierung

Summary Despite a high concentration of serum proteins and intact phagocytes peritonitis exudates contain a large number of viable, pathogenic bacteria. The reason for this biological paradox is unknown. Our investigations reveal a pronounced defect in humoral opsonization of foreign particles in peritonitis exudate. We evaluated a modified chemiluminescence system allowing the determination of opsonic activity in serum and exudate. In serum we found a close correlation between opsonic activity and immunologically measurable levels of C₃-complement and IgG. In purulent peritonitis exudates, however, the actual opsonizing activity was much less than expected according to the opsonin concentrations. We found a pronounced difference between immunologically determined opsonin levels and impaired opsonic function. Employing crossed immunoelectrophoresis massive C₃-splitting into smaller fragments could be demonstrated in peritonitis exudates. In these exudates we found very high concentrations of granulocyte proteolytic (elastase) and oxidative (myeloperoxidase) enzymes which may lead to a functional destruction of opsonins followed by impaired opsonization in peritonitis exudate. The great number of bacteria and foreign particles in addition can cause a pronounced physiological consumption of complement components. The almost complete breakdown of intact C₃-complement in intraabdominal exudate explains the deficient host defence in patients with severe peritonitis.

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Abkürzungsverzeichnis CL Chemilumineszenz - IgG Immunglobulin G - OK Opsonierungskapazität     

Abstention: arguments for stopping or withholding of life-sustaining treatment. Task Force Ethics, Philosophy and History of Medicine, Catholic University

A decision to withhold or withdraw life-sustaining treatment can only be justified if one (or more) of three arguments apply: (a) the patient refuses the treatment concerned, (b) the therapy cannot produce the intended medical effect, or (c) the therapy may be effective, but the effects are not meaningful. Assessment of effectiveness is a medical professional judgement. This assessment should take into account the proportionality of medical (technological) means and ends. Treatment is meaningful if (a) it serves a reasonable purpose for the patient, and (b) the benefits outweigh the burdens for the patient. The patient's own view determines the meaningfulness of treatment. Physicians should talk with patients about the meaningfulness of life-sustaining treatment while there is time, to avoid the situation that such questions come up just when a patient has lost his capacity to communicate. In case a patient is incompetent, physicians should try to infer from previous utterances of the patient what he or she would have wished in this situation. If it is impossible to reconstruct the patient's view, there is no basis for withdrawing or withholding medically effective life-sustaining treatment.     

Hirntumoren im Kindesalter

About 380 children younger than 16 years of age are diagnosed with a brain tumor in Germany every year. Compared to adults, different types of brain tumors are found in children. The diagnosis is often delayed in spite of presentation with characteristic symptoms. Unspecific persistent symptoms must be followed by further diagnostics. Since the 1980s, multimodal therapeutic regimens have been developed systematically by the Society for Pediatric Oncology and Hematology (GPOH) in the context of treatment optimalization trials. Neurosurgery, chemotherapy and irradiation are applied according to histology, stage of metastasis, and the age of the children. Currently, 80–90% of children diagnosed with a brain tumor in Germany are treated according to the respective trial in the context of the ‘treatment network HIT’. The principle aims are improved survival and quality of life, and the reduction of therapy-associated toxicity and late-effects. In this article, typical clinical symptoms, diagnostic recommendations and current treatment strategies are described.