Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
-
Review Case Reports
[Fixed rotatory subluxation of the atlanto-axial joint in polytrauma patients].
Traumatic atlanto-axial instabilities are rare entities in cervical spine injuries. There may be only subtle abnormal findings by plain radiographs, frequently resulting in a missed or delayed diagnosis. We report a polytraumatized patient with severe maxillofacial injuries, where preliminary radiological studies failed to verify rotatory instability of the atlanto-axial joint. A definite diagnosis was only established by further imaging studies, including CT scan reformations.
-
Review
[Therapy of phantom pain with salmon calcitonin and effect on postoperative patient satisfaction].
In this prospective clinical study we examined the intravenous application of salmon-calcitonin in eight patients with severe phantom limb pain (Visual Analogue Scale = 50-100). The patients presented at the Acute Pain Service (APS) section of the Second Department of Surgery, University of Cologne. Six of eight patients (75%) had no phantom limb pain after 10 days of intravenous treatment with salmon-calcitonin (maximum of five cycles of calcitonin infusion). ⋯ This study shows good or excellent results in patient satisfaction for six of eight patients (75%). A prospective randomized trial is required to verify the excellent results of intravenous salmon-calcitonin in a larger population. Alternative pharmacological and operative treatments of phantom limb pain are critically reviewed and assessed.
-
The management of 178 patients with liver trauma (132 male, 46 female; mean age 34 years (range 3-88) presenting from January 1979 to August 1996 is reviewed. There were 165 cases of blunt trauma and 13 cases of penetrating injury. 110 cases were classified as simple injuries (grade I or II) and 68 cases as complex injuries (grade III to V). The overall mortality was 32% (57 patients). ⋯ The majority of liver injuries can be managed by simple techniques, including electrocautery and application of hemostatic agents. In complex injuries hepatotomy, direct vessel ligation, and debridement of necrotic tissue is the method of choice (Pachter's procedure). In non-controlled bleeding, perihepatic picking is a standard method.
-
For patients with liver metastases, surgery currently represents the only possibility for cure, with a mean 5-year survival rate of 25-35%. Due to refinement in operative and anesthetic techniques and improved critical care with decreased morbidity (< 25%) and mortality (< 5%), hepatic resection is a safe and efficient procedure. Surgery has repeatedly achieved long-term disease-free survival in 20-25% of patients. ⋯ Only 20-35% of these recurrent metastases appear to be resectable, resulting in an overall 3-year survival rate of about 30%. The morbidity and mortality from repeat hepatectomy is similar to that of first hepatic resection. All results together demonstrate that resection and re-resection of liver metastases can provide long-term survival rates and can be beneficial in a carefully selected group of patients without extrahepatic disease.
-
Traumatic hemipelvectomy is a rare, but devastating pelvic injury with few survivors reported in the literature. We report on a 19-year-old motorcyclist with a near-total hemipelvectomy. ⋯ We review the experience of other authors and give details on the management of one of the most challenging injuries confronting surgeons. Successful treatment requires extraordinary efforts and multidisciplinary team cooperation.