Zentralblatt für Chirurgie
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The spontaneous gastric rupture without a preexisting gastric ulcer is an extremely rare event. In the case presented we report the occurrence of a gastric rupture in context with a giant left scrotal hernia. ⋯ Other reasons of a spontaneous gastric rupture as well as the surgical therapy are discussed. Important are a fast diagnosis and surgical revision in order to prevent patients from a massive diffuse peritonitis.
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Treatment of Achilles tendon rupture is discussed controversially. Some trauma centers prefer a conservative therapy. Because of the tendency to a higher rate of reruptures and worse functional results following conservative treatment, operation is the standard therapy of fresh ruptures of the Achilles tendon in Germany. ⋯ The detected force- and motion-deficiencies were completely compensated. Therefore fibrin gluing of fresh ruptures of the Achilles tendon usually allows postoperatively the same leisure sports activity level as preoperatively. In competitive sporting athletes postoperative loss of performance must be expected.
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With 44.9 % trauma is the main cause of death in men under 40 years. From September 3(rd) 1997 to June 30(th) 1998 174 patients with severe injuries or polytrauma were treated in our hospital. The mean ISS was 29 (18-75). 15 (8.75 %) patients died within the first 24 hours. ⋯ The mean ISS of these patients was 48 (25-75). In a retrospective study we analyzed the pattern of injury as well as the preclinical and clinical management. The fact that orthopedic surgery still has got a poor position within the patient's satisfaction-scale and that 15 of 174 analyzed patients had to die within the first 24 hours points out the importance of internal and external quality improvement measurements.