Langenbecks Archiv fur Chirurgie. Supplement II, Verhandlungen der Deutschen Gesellschaft fur Chirurgie. Deutsche Gesellschaft fur Chirurgie. Kongress最新文献

A total of 56 patients underwent preoperative high-resolution sonography (4 MHz); 33 had additional computed tomography (4 mm slices, contrast material as drip infusion) to localize abnormal parathyroid tissue in primary hyperparathyroidism. The sensitivity of sonography was 48% compared to 38% for computed tomography. The efficiency of both techniques was mostly dependent on size and location of the parathyroid. Computed tomography was superior in detecting ectopic parathyroids. Because of its low sensitivity sonography is only of facultative importance as a localization procedure for primary hyperparathyroidism. Computed tomography is indicated only for localizing ectopic parathyroid tissue after initial operation has failed.

Postoperative volume therapy: 1. Replacement of fluid loss. 2. Therapy of intravasal hypovolaemia in case of permeability damage or intracellular fluid shift. Monitoring: 1. Circulation (HR, CVP, art. pressure). 2. Homeostasis (Na, K). 3. Metabolic changes (BE, pH). 4. Kidney function. In complications like sepsis or ARDS with pulmonary problems and increase of pulmonary vascular resistance the use of a pulmonary artery catheter is necessary. Differential treatment has to be based on additional measurement of cardiac output and pulmonary capillary pressure. Volume treatment in postoperative complications is essential because of intravasal hypovolaemia. Kidney and cardiac failure have to be ruled out.

Of the various types of hand fractures, metacarpal fractures occur quite frequently, predominantly in younger people. In order to maintaining hand function man's most important tool, the treatment of coice in recent years has shifted from predominantly conservative measures to more surgical procedures. From 1980 to 1988, 33 patients with metacarpal fractures were treated: 66% received surgical and 34% conservative treatment. We report on the results as regards hand function, the length of unemployment, the patient's subjective complaints and the peri- and postoperative complications.

In general the dislocation of the carpal bones with subsequent carpal instability is rare. The diagnosis depends on a correct interpretation of the X-ray. In a follow-up study 25 patients with closed carpal instabilities were examined. In 14 the carpal instability had been established in the primary diagnosis and treated adequately. The functional results were good. 11 patients, in whom the dislocation of the carpal bones had been overlooked, did not receive primary therapy and had unsatisfactory function of the hand.

Remnants after "classic" Subtotal Thyroidectomy are of constant size in constant position. "Selective" thyroidectomy intends to remove all nodules, but to save normal tissue--irrespective of their localization. From July 1985 to Dec. 1989 in 48.5% of 1124 thyroid lobes sel. surgery was performed, in 27.8% subtotal, in 23.8% total lobectomy. Primary postop. recurrent lar. palsy occurred in 1.3% after sel., 1.0% after subt. and 2.7% after total lobectomy. 90% of primary r.l.n.p.'s were transient--after sel. lobectomy only one persistend (0.2%). Hypocalcemia: 0.7% after sel., 1.4% after subt. thyroidectomy. Besides better quality and quantity of remnants selective thyroidectomy is supported by low rate of complications.

A total of 119 papillary and 67 follicular thyroid carcinomas were subdivided according to the WHO classification of 1988 in the morphological subtypes of occult, encapsulated and invasive carcinomas. The patients were monitored over a followup period of 16 years postoperatively. Initially 10.6% of all patients with early follicular carcinoma had distant metastases and 2 of 19 died of carcinoma. In cases of early papillary carcinoma there were no distant metastases and no deaths. Limited thyroid surgery is recommended as curative surgery only for such patients.

Unlabelled: Measurement of intraperitoneal fibrinolytic activity on 50 patients having undergone abdominal surgery (four of them controls). Instillation of streptokinase/streptodornase (Varidase) into the abdominal cavity. Determination of total protein, plasminogen, antiplasmin, alpha 2 Mx-plasmin-complex, spontaneous fibrinolysis and fibrinolysis + activator at different points in time p.op.

Results: Intraperitoneal fibrinolysis may be stimulated by local substitution of a plasminogen activator (Varidase). Systemic effects are confined to a high dose. No impaired wound healing nor increased propensity to hemorrhaging occurred.

The severity of a fracture of the distal radius is not only determined by the type of the fracture but also by concomitant ligamentous and carpal injuries, which are often underestimated and imply a higher degree of instability than the bony lesion alone. Therefore classifications are valuable, which combine fracture type and associated lesions, thus permitting conclusion about the therapeutic method of choice. The article discusses indication, operative technique and special features of radial fractures in combination with carpal injuries, of radial styloid fractures as well as Barton's and Reverse-Barton's fractures, of bilateral radial fractures and of radial fractures as part of a chain fracture. It is important to perform an early fasciotomy and carpal tunnel release in cases of severe soft tissue damage and threatening compartment syndrome.

1989 we reported on our first series of 277 laparoscopic appendectomies. This technique was introduced by Semm in 1982. We acquired this procedure in 1987 and modified this operation-technique for surgical routine. We could demonstrate that laparoscopic appendectomy can be performed in chronic, acute and even in peracute cases. We introduce the facts of 500 laparoscopic appendectomies.

In case of multi-locular supra-aortic lesions the correction of a hemodynamic carotid stenosis has priority over any reconstruction of another supra-aortic lesion. Thus carotid endarterectomy leads to an improvement of the global cerebral perfusion. Patients with a classical vertebro-basilar insufficiency profit most by these operations. A subclavian or vertebral reconstruction or PTA is indicated only if the patient is not symptom-free after the carotid endarterectomy.