Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera
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Although the medical advantages of autologous blood transfusion are undisputed today, it has been established only in a few hospitals. At our hospital we have employed infusion of previously stored autologous blood and normovolemic hemodilution routinely in all patients undergoing major orthopedic surgery since June 1, 1986. ⋯ The efficiency of autologous blood transfusions and hemodilution in reducing the need for homologous blood at our hospital, as previously described, could be increased by 22% using the solcotrans system. The advanced age of our patients (average 73 years) and the number of preexisting, in part considerable, medical problems permit the conclusion that these autotransfusion techniques are quite well tolerated. The contraindications could be reduced to a few exceptions. The logistics necessary to carry out these procedures are simple and can be achieved with a bit of will and effort in all hospitals including those of middle and small size.
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Comparative Study
[Thoracic sympathectomy in palmar hyperhidrosis: comparison of open with thorascopic procedure].
Between 1976 and 1994 we performed 26 thoracic sympathectomies for treatment of therapy-resistant palmar hyperhidrosis. Until the end of 1992 the operation was performed using an open transaxillary approach, since 1993 sympathectomy was done by video-assisted thoracoscopy. Both procedures consisted in excision of the thoracic ganglia T2 to T5. ⋯ We did not note further complications, e.g. no Horner's syndrome. All of our patients were satisfied with the result of the operation. Comparison of the two collectives shows significant advantages for video-assisted thoracoscopic surgery. the procedure is easier to perform, exposure is better, cosmetic results are favourable, operation-time and hospital stay are reduced.
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Fractures of the neck and the pertrochanteric region of the femur in elderly patients are often treated with dynamic hip screw or endoprothesis. In the aftercare, specially in fractures that have been stabilised with a DHS, partial weight-bearing is recommended. Some other authors describe immediate full weight-bearing after osteosynthesis with the same implant. ⋯ In patients who bear full weight on the operated limb immediately after operation, the rates of systemic complications are lower. The rates of local complications increased with the instability of the fracture. Both results are though not statistically significant.
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From August 91 to December 94, 20 external fixators were used for severely injured patients (avg. ISS 25.2). The fractures were essentially open book with or without lateral compression and vertical lesions. ⋯ One acetabulum fracture required surgery, two patients had internal fixation for loss of reduction and two others for late pubic and posterior pain. The clinical results are good; they are more related to the severity of the initial lesion than to the mode of fixation or the quality of the reduction. No superficial sepsis or osteitis was observed in relation to the pins.
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In type C pelvic ring fractures ORIF is the treatment of choice. Early definitive fixation often is not possible due to severe soft tissue injuries and hemorrhage. ⋯ Our first experience shows that a ventral stabilisation is necessary in combination with one dorsal screw. Both fixations are managed in the supine position of the patient during one anesthesia.