Zentralblatt für Chirurgie
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We describe our method of transcranial Doppler (TCD) monitoring during carotid endarterectomy (CE) procedures. During a period of 35 months we performed 257 CE with TCD monitoring. ⋯ Further advantages of the TCD monitoring are: detection of microemboli, control of the potential collateralisation of the external carotid artery and the control of efficacy and accurate positioning of the intraluminal shunt. We comment our results of cerebral monitoring and consider it as a useful tool for optimizing the postoperative results of carotid surgery.
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Diagnosis of diaphragmatic rupture is often missed after blunt thoracic and abdominal injuries because diaphragmatic injury does not play an important role beside severe injuries of intrabdominal and/or thoracic organs. Between 1976 and 1993, 141 patients were treated for traumatic injury of the diaphragm. In 42 patients with penetrating injuries following stab or shot wounds diaphragmatic lesions were diagnosed by the emergent surgical therapy. 99 had diaphragmatic tears from blunt thoracic or abdominal trauma by accidents. 14 of 99 patients sustained isolated diaphragmatic rupture, in 85 the rupture was combined with other injuries, 24 had fractures of the pelvic ring. ⋯ Therapy of diaphragmatic injury was performed in 83 patients within 4 days, in 9 within 4 months and in 7 later than one year. For diaphragmatic repair 87 patients underwent laparotomy and 12 thoracotomy. Local complications were found in 13 patients (13.1%). 19 patients (19.2%) died postoperatively due to accompanying injuries.
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From the file online at the department of surgery of the Medical University Lübeck, 894 patients with soft tissue infections treated between 0.1 05. 90 and 31. 12. 94 were evaluated. 21 cases (10 men, 11 women) were classified as necrotizing fasciitis (i.e. 2.2%). The mean age was 59.7 years (range 17-84 years). Frequent predisposing diseases were diabetes mellitus (n = 12) and lower extremity ischemia (n = 8) and alcoholism (n = 4). ⋯ Meshgraft transplantation (n = 18) and secondary suture (n = 11) were done when wound conditions were suitable for it. 4 patients died (19%). An increased mortality was found in patients older than 65 years (36.4%) and if operative treatment was performed more than 5 days from the beginning of symptoms (33.3%). An early diagnosis and standardized treatment lead to better results in terms of mortality and preservation of the infected limb and its function.
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Biography Historical Article
[Ludwig Rehn (1849-1930) and his importance in the development of modern surgery].
The unusual course of Ludwig Rehn's professional development directed him from a general practitioner close to Frankfurt am Main to his convocation as first Professor in ordinary for surgery to the Frankfurt University, which was newly established in 1914. Among his numerous publications, especially the following contributed immensely to the development of modern surgery: in 1884, he already described the healing of patients with Graves' disease by subtotal resection of the goiter; in 1885 he first described the high prevalence of bladder tumors in workers of an aniline factory; in 1886, he managed the first successful heart-suture after a stab-incision of the right ventricle; in 1897, he already performed an operation at the thoracal oesophagus, with an access via the posterior mediastinum; in 1920, he established the operative treatment (pericardectomy) of patients with a calcified pericarditis (armour heart).
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Aim of the study was to evaluate the influence of early intubation at the scene on the outcome of polytraumatized patients with lung-contusion. ⋯ Early intubation at the scene can reduce the inhospital-time, the time at the ICU and the complications. In this way it becomes an important factor of cost-reduction. Therefore early intubation at the scene must become a standard for all patients with lung-contusion.