Zentralblatt für Chirurgie
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Historical Article
[Our surgical heritage. Thoracoplasty--discussion of a painting].
The author reports on a hitherto unknown painting of the South-German artist Hermann Otto Hoyer, representing 'Geheimrat' Ferdinand Sauerbruch surrounded by his coworkers Rudolf Nissen, Alfred Brunner, Emil-Karl Frey, Bernhard Jehn and Willi Felix in Munich 1922.
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The authors treated 115 fractures of the proximal part of the femur and its neck. Most of these fractures were treated surgically. Indications, surgical technique, complications and results are dealt with. Guidelines for adequate treatment of each fracture type are established.
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[Modern mechanical antibiotic preparation in colorectal operations. Results of a prospective study].
A prospective clinical study was made to compare the effectiveness of a short-term oral antibiotic prophylaxis (neomycin) and a longacting oral-parenteral aerobically and anaerobically effective combination (neomycin, metronidazol, chloramphenicol) on the incidence of wound infections. All patients had orthograde lavage as a mechanical bowel preparation. Preoperative administration of the antibiotic combination before lavage could not reduce the relative aerobic bacterial count of the faeces. ⋯ Lethal complications were significantly higher in the neomycin group (7/89 to 2/114), whereas nonlethal complications were not significantly higher in the combination group. These data suggest that long-term, oral-parenteral prophylaxis with an antibiotic combination was not superior to a short-term, sole neomycin prophylaxis applied after orthograde lavage. Cleansing the bowel as completely as possible is a fundamental prerequisite for an effective antibiotic prophylaxis.
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A group of 424 patients diversely injured with a lung contusion was examined on problems of diagnosis and therapy. Additional injuries and the modes of accident were helpful in deciding on early mechanical ventilation. Waiting for a deterioration of blood gas analysis or a positive x-ray proved to be too harmful. These rules together with exclusive application of PEEP-Ventilation correlates with a decrease in lethal outcome from 28.1% in 1974 with a mortality rate of 18.8% of pulmonary insufficiency to 8% in 1983 with a lethality of less than 2% of pulmonary insufficiency.
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After surgical procedures there are complex and typical changes of the homeostasis, which are summarized as postaggression syndrome. Energy demands in the immediate postoperative period are lower than presumed until recently. ⋯ Artificial nutrition is used in clinical practice to overcome this. Enteral and/or parenteral nutrition is necessary to meet the energy and nutritional demands in the postoperative period.