Helvetica chirurgica acta最新文献

Appendix carcinoid in children is a rare condition which is found by accident at the histological examination of the appendix. We report on a rare case in which a covered perforation of a diverticulum had occurred. First of all the patient was treated conservatively with antibiotics and 2 months later the appendectomy à froid was performed. The annual follow-up of these patients is certainly indicated.

The meniscusganglion of the knee is rare but it's an indication for the operation, because it is painful and in the most cases it is connected with an injury of the meniscus. Between 1987 and 1992, 23 patients with meniscusganglion were operated only with the method of the inner drainage. There was no recurrence. We have seen that the concept of the arthroscopy of the knee with the inner drainage of the meniscusganglion is an easy and effective treatment with all the advantages of the arthroscopy.

Rhabdomyosarcoma is the most common soft-tissue tumor in childhood. In infants it is frequently localized in the pelvis and in the prostata or bladder region. The aim of treatment should be to eradicate the tumor and yet maintain as normal function as possible. Effective preoperative chemotherapy has enabled one to frequently achieve this aim. We report on two patients both with a rhabdomyosarcoma of the bladder-prostata. One of them in 1983 was operated and treated with chemotherapy and cysto-prostatectomy and the other in 1991 with chemotherapy and eradication of the tumor without cystectomy. Both children are now tumor-free after 10 years/2 years resp. Both approaches are discussed.

We can report our experience of this operative method by internal rush pin fixation of shaft fractures in childhood. Our results are very convincing and we can say that this method is successful and a good alternative in future by the possibility of a functional treatment.

We report our experience in evaluating PSA-follow-up of patients treated with radical prostatectomy. Also PSA is the most sensitive available screening test for relapse after radical prostatectomy, it is not 100% specific for cancer relapse while this serum marker is not specific for prostate cancer. In our opinion, patients with biochemical relapse (PSA > 0.5 ng/l) should undergo an early restaging including biopsy of the anastomosis. In 57% of our patients with PSA > 1.0 ng/l two months after surgery we found clinical recurrence 27 months later on.

Adventitial cystic disease is a rare form of non-atherosclerotic stenosis of the popliteal artery. It is caused by synovial-like cysts in the subadventitial tissue layer of the arterial wall causing compression of the lumen. The cysts contain mucinous material similar to that found in joint-ganglia. Popliteal artery stenoses causing claudication in young patients is the leading symptom of this disease. The classical therapy is the surgical excision of the diseased artery and interposition grafting with saphenous vein. As an alternative method we present the technique of complete circumferential resection of the diseased adventitia to decompress the lumen of the artery by removing the cysts completely. This technique is called exarterectomy and has been applied in 2 patients. In both cases we could remove the cysts completely without opening the arterial lumen. Intraoperative arteriography documented complete decompression of the arterial lumen. Both patients presented with excellent results 6 months postoperatively without any symptoms or signs of recurrence. Late results of exarterectomy ar not yet available.

The case of a 35-year-old man is reported, who presented himself in the emergency room with anxiety and hallucinations. He then passed a small oval pack consisting of a dark paste wrapped in cellophane with his stool. This led to the suspicion of a "body packer syndrome" with cocaine intoxication. The plain abdominal X-ray revealed multiple oval structure scattered over the entire gastrointestinal tract. Cocaine metabolites in the urine confirmed the diagnosis. During the following whole-bowel irrigation the patient had a grand mal seizure. In order to accelerate the retrieval of this threatening load, surgical evacuation was immediately executed. 78 packs containing 650 grams cocaine were removed through a gastrotomy and a coecotomy, respectively. Two of these packs were leaking. Following an uneventful postoperative course the patient was discharged from the hospital 11 days later. According to the literature the recommended treatment for cocaine body packers is whole bowel irrigation. Operative treatment is mandatory in cases of small bowel obstruction or drug intoxication due to leaking packs.

Fractures with soft-tissue injury are urgent surgical emergencies. Fracture care in the first few hours after the injury crucially determines the course of healing. In open fractures aggressive debridement of all necrotic tissues is mandatory as well as stable external or internal fracture fixation. Secondary wound closure must be performed liberally and prophylactic antibiotics should be administered. Closely observing such a stringent regimen, the rate of posttraumatic osteitis in open fractures can be reduced significantly.

Experimental transplantation of vascularized canine knee joints has so far been associated with high complication rates in both auto- and allografts. We have now compared 4 autografts and 4 allografts that were successfully performed at our institution. This report details our surgical technique. Stable internal fixation enabling immediate postoperative weight bearing, microsurgical end-to-end anastomoses of popliteal artery and vein and postoperative control of immunosuppression in transplanted animals are crucial. Thus, an interdisciplinary approach of experts in microsurgery, orthopedic and trauma surgery and immunologists appears to be a prerequisite for successful joint transplantation.