Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1992
Review[Thoracic injuries--when is use of the heart-lung machine necessary?].
Most patients with severe blunt or penetrating thoracic injuries die early after the accident (approximately 50%). The majority of those who reach an emergency department (approximately 80-85%) can therefore be treated initially with intensive observation (following drainage and/or intubation). If clinical deterioration due to continuous bleeding or progressive hemodynamic and respiratory problems occurs, however, urgent surgical intervention is indicated. Transfer of those critical patients to specialized hospitals often becomes dangerous because of time loss, and it is unnecessary as major equipment (e.g., extracorporeal circulation) is demanded only in the minority of operations.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1992
Review[Surgical treatment of injuries of the upper cervical spine].
The surgical treatment of instabilities of the upper cervical spine requires the use of differentiated procedures if physiological anatomy is to be largely restored. Successful procedures are diagonal screw fixation of the axis from the anterolateral aspect in the case of odontoid fractures Anderson type II and III (high type), transpedicular screw osteosynthesis of C2 in hangman's fractures, and transarticular screw fixation of C1/2 with posterior fusion for atlantoaxial instabilities. In occipito-atlantal trauma occipitoatlantoaxial fusion is required.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1992
[Mesothelioma of the pleura--diagnosis with imaging procedures].
Typical radiological findings in patients with diffuse malignant pleural mesothelioma are nodular opacities of the pleura including the fissures, pleural effusion, shrinking of the ipsilateral hemithorax, and mediastinal shift. The radiological differentiation between pleural mesothelioma and benign pleural tumors is possible; however, a secondary metastatic pleural involvement imitates pleural mesothelioma. Magnetic resonance imaging is superior to computed tomography in the preoperative assessment of tumor extension, because it demonstrates exactly the tumor extension in the coronal or sagittal plane. The noninvasive ultrasound examination is helpful in the evaluation of the diaphragmatic pleura and the costodiaphragmatic spaces.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1992
Case Reports[Indications and technique of combined dorso-ventral stabilization of the spine].
In delayed treatment of fracture dislocations or luxation of the cervical spine, combined dorsoventral operative treatment is necessary. After anatomical reduction from dorsal, stabilization is performed from ventral using autologous bone grafting and a plate. ⋯ At the thoracolumbar spine this technique includes ventral bone grafting with a corticocancellous sandwich block and dorsal transpedicular fixation using an internal fixator system. This simplifies removal of the implant.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1992
[Complications in surgical management of spinal injuries].
Operative treatment of spinal injuries requires an accurate surgical technique and biochemical know-how to avoid complications due to mistakes in device handling, operative technique, and indication. Device failures are caused by loosening of locking clamps or fracture of Schanz screws, followed by loss of angle stability and early loss of reduction. Maldisplacement of pedicle screws may involve irritation of neurovascular structures or loss of correction as well as insufficient transpedicular bone reduction and bone grafting. In burst fractures with destruction of the vertebral body and loose canal fragments, the posterior approach is less efficient than a combined procedure.