Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
-
Injuries of the joint surface interfere with joint mechanics. Avulsed fragments should be reattached to prevent development of arthrosis. ⋯ About half of the chondral lesions could be refixed successfully. If replantation is impossible, this cartilage defect has to be smoothed and, when indicated, connected to spongy bone by subchondral drilling.
-
Between October 1988 and July 1989 100 consecutive patients with suspected appendicitis were seen at the surgical clinic, University Hospital of Aachen. All patients underwent ultrasonographic examination corresponding to a prospective study protocol in order to determine the value of ultrasound for the diagnosis of acute appendicitis. The sonographic findings were correlated with the histologic diagnosis or the clinical course, respectively. ⋯ The predictive value of a positive test was 97% and the predictive value of a negative finding was 46%. The morphologic changes during the progress of inflammation of the appendix and their sonographic visualisation were discussed. A differentiated concept was developed to integrate the sonographic findings in the therapeutic decision.
-
Long-term respiratory therapy with high pressure levels in case of ARDS can lead to several symptoms requiring surgical treatment. Various forms of manifesting barotrauma predominate (bronchopleural fistula, pneumothorax, pneumatocele and soft tissue emphysema), while hematothorax, infected necrosis of parenchyma or esophagotracheal fistula are rare. Most of the operations became necessary because of bronchopleural fistula resp. pneumothorax, and with this indication the number of reoperations was especially high. Of 21 patients 13 (62%) survived.