Langenbecks Archiv für Chirurgie
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Langenbecks Arch Chir · Jan 1990
[Treatment of unstable thoracic and lumbar spinal fractures with Cotrel-Dubousset instruments].
The present study is a retrospective analysis of first experiences of fracture treatment with the Cotrel-Dubousset instrumentation technique. Thirty-five unstable spine fractures were treated with the CD implant at the University of Louisville--Level I Trauma Center--between June, 1985 and August, 1987. There were 17 burst fractures, 12 compression fractures and 2 fracture dislocations, 2 flexion distraction fractures and 2 flexion rotation injuries. ⋯ The loss of correction in the sagittal plane varied between 0 and 20 degrees (mean 5.6) at final follow-up. Complications due to the implant have not been observed except an avulsion of an upper thoracic hook, which did not effect the clinical or radiographic result. The high stability of the implant provides a decreased risk of neurological deterioration, posttraumatic kyphosis as well as early rehabilitation.
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Langenbecks Arch Chir · Jan 1990
Case Reports[Complex trauma of the perineum, especially the anorectal continence organ. Experiences and results in 27 patients 1956-1988].
This report is based upon 27 patients with severe perineal injuries treated in a 30-year-period. Four groups of injuries could be identified. Severity of the trauma, correct diagnosis of concomitant injuries, right usage of antibiotics and protection of the perineal wound by a temporary colostomy represented key factors for a favorable outcome. ⋯ All these cases required a permanent colostomy. Concomitant tears of the membranous urethra frequently caused urethral stenoses and irreversible impotence. Mortality rates were low in patients with severe perineal injuries.
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Even though lungs can be injured solitarily, most of pulmonary lesions occur within the scope of multiple trauma. Because of various patho-physiological processes resulting from the multiple trauma, the valuation of extent, course and prognosis of pulmonary injuries is difficult. Depending on examined cases, mortality of thoracic injuries as stated in various references amounts to between 6 and 55%. ⋯ Because of described variety of injuries, it is necessary for better comparison of clinical investigations to specify the lesions in accordance with general and specific thoracic severity of injury--as described in the multiple trauma score of the Medical University of Hannover--. Especially pulmonary contusions with associated conspicuous injuries are often primarily underestimated concerning their dimensions and consequences. Therefore the importance of subtle inquiry of pulmonary findings must be strictly underlined.
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Langenbecks Arch Chir · Jan 1989
[Recommendation for primary resection with primary anastomosis in complicated sigmoid diverticulitis. Report of experiences of the Herford Surgical Clinic 1973 to 1986].
Of the 107 patients with complicated diverticulitis operated from 1973-1986 47 were females and 60 males. In 14 of the 107 patients a perforated diverticulitis with diffuse purulent/faecal peritonitis was found, a perforated diverticulitis with localized purulent peritonitis/paracolic abscess in 68 patients and an acute phlegmonous diverticulitis without perforation in 25 patients. Additional pathologic findings were internal fistulae (13 patients), necrotizing fasciitis (3 patients), obstruction (3 patients) and synchronous carcinoma (7 patients). ⋯ Three patients died after operation of the perforated diverticulitis with localized purulent peritonitis - 2 (6) after Hartmann procedure, 1 (5) after loop colostomy alone. In spite of forcing the primary resection with primary anastomosis in the years from 1980 - 1986 the mortality decreased for these operations from 35.7% in 1973 - 1979 to 0% in 1980 - 1986. The indication of primary resection with primary anastomosis is justified also for perforated diverticulitis with localized and diffuse peritonitis.
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Gastric surgery is still a major part of routine surgical practice. Diagnostic strategies should be oriented to the surgical consequences and their value for our understanding of pathophysiological connections. ⋯ Postoperative syndromes can be detected and classified by scintigraphic methods. The new procedure of endoscopic ultrasonography seems to offer special benefits for diagnostic problems such as gastric lymphoma and other intramural tumors.