Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
-
Case Reports
[Trans-scaphoid perilunar dislocation of the wrist (de Quervain) as a rare complication of electric injury].
We describe the case of a 67-year-old man with an electricity inflicted injury in the left hand and a transscaphoidal perilunear dislocation of the opposite right hand. On admission, the injury was missed on the standard ap-radiogram of the right hand, so the operative reconstruction was delayed. Later on, the lunate showed aseptic necrosis and wrist collapse as consequence.
-
[Does liberation of interleukin-12 correlate with the clinical course of polytraumatized patients?].
Interleukin-12-p70 (IL-12-p70) is a potent immunoregulatory cytokine composed of a heavy chain (p40) and a light chain (p35). Contradicting results have been reported with regard to leukocyte release and systemic concentration of IL-12 after polytrauma. ⋯ After major injuries there is no overall suppression of IL-12 formation. Patients with normal or elevated IL-12 levels belong mainly to the survivors, whereas patients with decreased IL-12 levels are at high risk of succumbing to multi-organ failure.
-
Penetrating neck injuries are potentially life-threatening injuries. Management is controversial despite decades of discussion in the literature. An algorithm for diagnosis and therapy is needed because of the potential risk of mortality. ⋯ Injuries were caused in seven cases by gunshots, in eight cases by broken glass, in one case by an iron rod, in one case by a spear, in one case by a branch and in 13 cases the penetrating injuries were stab wounds caused by knives. Complications like pseudoaneurysms and fistulas were not seen. No patient came to death.
-
Abdominal compartment syndrome is defined by increased intraabdominal pressure above 20 mmHg with increased pulmonary peak pressure and oliguria. In primary abdominal compartment syndrome the increased intraabdominal pressure is caused directly by peritonitis, ileus or abdominal and pelvic trauma. Secondary compartment syndrome is a result of forced closure of the abdominal wall after abdominal surgery. The effects are decreased cardiac output, pulmonary atelectasis, oliguria to anuria and hepatic as well as intestinal reduction of perfusion. Effective monitoring is done by standardised measuring of urinary bladder pressure. Normal values are between 0 and 7 cm H2O, after elective laparotomies 5-12 cm H(2)0. Above 25 cm H(2)0 they are definitely pathological. For the prevention and therapy of manifested abdominal compartment syndrome the application of a laparostomy using a resorbable mesh is recommended. Between 1988 and 1999 we applied a laparostomy to lower the intraabdominal pressure in 377 patients. In 16% of the cases it was indicated by primary abdominal compartment syndrome with a bladder pressure of 31 +/- 4 cm H(2)0 preoperatively, which could be lowered to 17 +/- 4 cm H(2)0 by laparostomy. An early reconstruction of the abdominal wall could be performed in 18% of the cases. ⋯ The abdominal compartment syndrome is an often underestimated problem in abdominal surgery involving multiple organ systems. The temporary laparostomy lowering intraabdominal pressure rather than a forced closure of the abdominal wall should be used in all circumstances.
-
Case Reports Comparative Study
[Streptococcal toxic shock-like syndrome with necrotizing myositis].
Streptococcal toxic shocklike syndrome is caused by group A streptococci and characterized by multiorgan failure and soft-tissue necrosis, often in young patients with a bland history and at most a minor trauma. Diagnosis is reached through the clinical presentation, imaging methods and positive bacterial verification. ⋯ Sometimes an unconfirmed diagnosis must be sufficient to operate. We report the case of a 29-year-old man without an exceptional history who was forced to undergo thigh amputation, multiple soft-tissue debridements, and after a total of 240 erythrocyte concentrates, finally hip joint enucleation.