Zentralblatt für Chirurgie
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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.
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Elective operation is an established therapy in the management of infrarenal aortic aneurysms. Surgery has an acceptable low risk in the presence of experienced surgeons and anaesthetists. Indication for surgery nevertheless remains a difficult problem, because diagnostic procedures and evaluation of different criteria do not exactly predict the likelihood of rupture. Indication for surgery is moreover dependent on operative mortality and late survival. This study analyses early and late results associated with the repair of abdominal aortic aneurysms in our institution in Hamburg and comments on indication for elective surgery. ⋯ In order to reduce the still high mortality associated with aneurysm rupture there is still a need for more prophylactic surgery.
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The bleeding complications of gastric- and duodenal ulcers have not declined in the past 20 years. This is the leading factor for the unchanged lethality of this disease. We present our results in 31 patients with gastroduodenal ulcer bleeding. ⋯ After control of bleeding by intra-and extraluminar ligature all patients underwent a primary resection (B I, B II or cardiofundectomy). The lethality was 12.9% (4/31), there was no re-bleeding. With the exception of one late duodenal insufficiency none patient had to be re-operated.