Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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The aim of this prospective clinical study was to evaluate whether a combination of the endoscopic hemostasis together with fibrin sealing and consecutive conservative therapy could reduce the frequency of recurrent bleedings, thus the number of operations without adversely influencing the prognosis of the disease. 134 patients admitted to the surgical and medical hospital of the University of Ulm between 1/1990 and 1/1992 with bleeding gastroduodenal ulcers took part in this study. All patients were treated endoscopically by hypertonic saline solution plus epinephrine and fibrin sealant. If initial endoscopic hemostasis was not achieved patients were operated within 6 h after admission. ⋯ Half of these patients had an acute bleeding at the first gastroscopy (Forrest-Ia, Forrest-Ib bleeding). Recurrent bleeding became apparent between day 1 and 6 after admission to the hospital. Two patients refused surgical intervention, the other 14 were operated immediately.(ABSTRACT TRUNCATED AT 250 WORDS)
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Thoracoscopic identification of small and deep seated peripheral lung lesions may be difficult. To facilitate resection in such cases, a technique of CT-guided transthoracic hook wire localisation has been developed. ⋯ In all cases the hook wire was correctly placed within or just beside the nodule and subsequent thoracoscopic resection was fast and easily accomplished in all. The described localization technique has a low complication rate and can be recommended for patients with small peripheral lung nodules subjected to thoracoscopic surgery.
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The diagnosis of chylothorax following blunt chest trauma is rare, only few cases have been reported. We describe three patients with chylothorax following blunt chest trauma. ⋯ In case of persisting and/or increasing chylus production, thoracotomy and ligation of the thoracic duct may be required. In all of our patients thoracostomy was the definite therapeutic modality, no thoracotomy was necessary.
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Randomized Controlled Trial Comparative Study Clinical Trial
[Gamma nail osteosynthesis of per- and subtrochanteric femoral fractures. 4 years experiences and their consequences for further implant development].
The Gamma nail can be used in all types of per- and subtrochanteric fractures because of its biomechanical characteristics. In this prospective evaluation of our 330 patients treated between November 1989 and November 1993 the usefulness of the Gamma nail for the osteosynthesis of all types of fracture was evaluated. The rate of intraoperative and postoperative complications but also gait function, postoperative weight bearing, general complications, and survival were analysed. ⋯ The blade has a collar which makes it impossible to implant the blade to deep in the femoral neck. The larger nail profile at the femoral neck perforation reduces the risk of implant failure. The implant can be used as dynamic compression as well as static implant both in the direction of femoral neck and shaft.
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Eight patients with sacrum fractures combined with pelvic ring fractures type C were treated using a triangular osteosynthesis after reduction of the fracture. The additional vertical stabilization between the lumbar spine and the posterior iliac crest caused the stability, which is necessary for immediate mobilization of patients. ⋯ We observed no infections or redislocations. The described operative treatment is state of the art at our institution.