Zentralblatt für Chirurgie
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From 1973 to 1991 a total of 422 patients underwent surgery because of an abdominal trauma. 12 patients had gunshot wounds and 46 patients stab wounds. In a retrospective study the diagnostic and therapeutic procedure and the indication for surgery are analysed. After gunshot wounds of the abdomen we always performed a laparotomy. ⋯ The indication for surgery then based on the development of clinical signs. The time between first examination and laparotomy was never more than 12 hours. 39 patients (84.7%) had injuries of intraabdominal organs. 5 patients (10.8%) had a negative laparotomy. The mortality rate was 3.4%, but there was no death as a result of the selective approach.
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Patients with an acute "brain damage" where an intracranial pressure rise can be suspected due to the pathophysiological context are an indication for intracranial pressure measurement. For registrating the reduction of the intracranial reserve space before the rise of the medium pressure, volume-loads from the side-ventricles were undertaken with 54 neurosurgical patients. A better bedside monitoring is possible though the mathematical registration of those factors which indicate the size of the functional intracranial reserve space. With the calculated parameters of the reserve space (pressure-volume-index) a theoretical pressure-volume-curve was demonstrated.
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A consecutive series of 119 type III B compound fractures in 103 patients was treated at the University of Louisville from May 1983 to May 1989. All patients had timely irrigation of their wounds, serial wound debridements, external skeletal stabilization and parenteral systemic antibiotics (penicillin, cefazolin, tobramycin). 96 open fractures were managed with the supplemental local use of tobramycin-PMMA-beads. ⋯ The amputation rate was overall 5%, 9.7% for the lower leg. Four patients died due to multiple trauma.
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Case Reports
[Post-traumatic hemobilia and successful direct treatment of the arteriobiliary fistula].
Traumatic hemobilia is a rare complication of deep and central liver injuries. Repeated and massive bleeding requires an active therapy. ⋯ Of surgical techniques, ligature of the art.hepatica comm. or propria and direct closure of the fistula in the liver parenchyma are recommended. The authors report on such a successful direct intervention in a 9-year-old girl.