Helvetica chirurgica acta最新文献

Fractures complicated by vascular trauma are rare but very complicated injuries. Clinical diagnosis is confirmed by Doppler sonography and/or arteriography. Time effectiveness in investigation and therapy is most important, cooperation between orthopedic and vascular surgeons is crucial. If indication is correct, arterial reconstruction has excellent results in these severe injuries.

In order to evaluate functional results and outcome of "limited surgery" in Crohn's disease we reviewed the data of 161 operations performed in 65 patients. In our series most of the patients had repeated operations. Nevertheless we saw no short bowel syndrome, no death occurred. Correlation was high between number of operations and length of resected bowel (r = 0.8) whereas no correlation was found between resected bowel and duration of disease nor between duration and number of operations. In conclusion strictly admitted principles of limited surgery seem to preserve good functional results. Risk of complications or short bowel syndrome seems not to be increased.

In a review of 328 cases the combination of laparoscopic cholecystectomy with specific use of endoscopic retrograde cholangiography (pre- and postoperatively) proved to be a riskless, secure and time-saving procedure. In our opinion this is a minimal invasive method of treatment for patients with cholecysto-/choledocholithiasis.

The treatment of displaced comminuted fractures of the radial head type III of the Mason classification is still controversial. The restoration of anatomy including additional lesions with a stable fixation is a prerequisite of early mobilisation. Removal of the radial head, in case of severe comminution, and complete separation of the fragments from the radial neck remain the exception. Insertion of a prosthesis as a spacer is only recommended if there is a remaining instability of the elbow after resection of the radial head. With this treatment modality we have 22/29 good to very good results evaluated by the Morrey score after a follow-up period of 8 years (4-11 years).

The complete acromioclavicular dislocation impairs the motility of the shoulder girdle. The surgical transfixation of the AC-joint with a screw, with K-wires or with special plates has a quite high complication rate and requires a second operation. We suggest the dynamic augmentation of the sutured ligaments with a coracoclavicular and an acromioclavicular PDS-cord cerclage. The paper presents the results of a follow-up examination of 10 patients.

60 heads of surgical units of non-university hospitals in Switzerland were questioned about their opinion about their assistants. The questionnaire was divided into: general data about hospital size and number of assistants, employment criteria, further education, operative activities and working hours of assistants. The answers are representative for the situation in non-university hospitals in Switzerland.

Between 1981 and 1990, 105 patients suffering from gunshot and stab wounds were admitted to the Department of Surgery of Zürich University Hospital. There were 17 female and 88 male patients aged 16-74 years (average 31 years) whose charts were studied retrospectively. 44 patients demonstrated gunshot injuries, while 60 suffered from stabwounds and 1 patient had both. The injuries were the result of a crime in 59, a suicide in 33 and an accident in 11 cases. In 2 patients the cause was not conclusive proven. Injuries to the lung (n = 54), the liver (n = 27) and to the stomach (n = 23) were seen most frequently. 45 patients underwent laparotomy, while 16 had a thoracotomy performed. Both thoracotomy and laparotomy were necessary in 10 cases. Complications were observed in 29.5% of the cases. They were significantly more frequent in patients with gunshot injuries (p < 0.0004). Overall mortality amounted to 14.3% (n = 15). Patients with gunshot wounds had a significantly higher mortality rate (p < 0.0005). Debridement and selective closure of the wounds (n = 25) did not result in a higher rate of abscess formation than open treatment (n = 17).

We present a standard protocol of postoperative controls designed for early recognition of possible stenosis or graft failures after peripheral bypass operations. This protocol includes: a) angiography during the first week after surgery, b) clinical and Doppler-pressure measurement 1, 3, 6 and 12 months after surgery. 53 patients with 62 peripheral bypasses were followed. The cumulative patency rate was 87.5% after 12 months.

In the controversy whether abdominoperineal resection of sphinctersaving resection is more radical for the treatment of lower rectal cancer, 77 consecutive patients with rectal cancer were retrospectively analysed. All resections were curative. 40 patients underwent a low resection and 37 patients an abdomino-perineal resection. Both groups were comparable with regard to age, sex and especially tumor-stage. The crude 5-year survival-rates were 52.5% in the resection group and 54.1% in the amputation group, respectively. The patients with a carcinoma located within 5-10 cm from the anal verge were of special interest. The crude 5-year survival-rates in these special subgroups were 61.9% for the sphinctersaving procedure and 61.5% for the amputation group, respectively. We conclude that the choice of surgical procedure does not influence the prognosis in rectal cancer, in particular, sphinctersaving resection does not worsen the prognosis. Therefore, whenever technically possible, the sphincter-saving resection should be chosen to cure rectal cancer.