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

Three approaches are considered: the left thoracoabdominal approach, the right-sided retro- or supracolic route and the transabdominal access. Aorto-common hepatic venous bypass grafting is the preferred procedure in singular occlusions of the celiac axis. Reimplantation and aorto-mesenteric venous bypass are the treatments of choice in singular occlusions of the mesenteric artery. Occlusions of both upper intestinal arteries can be treated with a venous bridge bypass graft or by transaortic end-arterectomy. Operative mortality is low (0.9%). Remaining occlusion and recurrent symptoms occurred in 12 of 92 patients.

The sequela of fractures of the distal radius show the same variety as the fracture models themselves, depending on conservative or operative repositioning. The most frequent disadvantages are deviation of the bone axis, depression of the basis of the radius, steps in the cartilage plain and rough deformity. Most important are the arthrotic changes in the joint, such as entrapment and compression neuropathies. The sequela of fractures in children, adults and the aged differ. The purpose of the expert appraisal is not only to assess the damages after fracture but also to give new proposals for further therapy.

Carpal bone fractures are rare, with an incidence of 13% compared to that of fractures and luxations of the hand bones. Generally they are intraarticular fractures. Fracture of the scaphoid bone occurs most frequently, with an incidence of 75%. The greater number of fractures is found in the middle-third of the wrist bordering on the os lunatum. They are usually treated conservatively by splinting with a cast. Surgery is indicated only when the fracture is open, instable, dislocated or combined with carpal instabilities.

Due to anatomical reasons the therapy of phalangeal fractures is a domain of conservative treatment in contrary to metacarpal fractures. Special attention must be focused on defective position in axis and rotation of the fractured phalanx. We use the Iselin splint. The indication for operation depends on the patients compliance, the type of fracture and its localisation. Indications for operation in our opinion are open fractures, dislocated, non reponible fractures, fractures involving the joint, condylar fractures. Conservative treatment gains the more importance the more the fracture is localized at the end of the phalanx.

The anatomical variant of the external branch of the superior laryngeal nerve is at risk during thyroid surgery. We recommend a careful dissection of the upper thyroid pole strictly avoiding even minor mass ligatures and all vascular structures have to be selectively identified. Of a consecutive series of 161 upper pole dissections the superior laryngeal nerve was found in 31% and no postoperative injury was detected by video stroboscopy.

Intensive care patients suffer according to literature in 20-60% from pneumonia with a mortality up to 80%. The patient, operation and postoperative therapy influence its pathogenesis. Mechanical ventilation is a special risk factor. However, in this regard origin and sequelae may not be changed by mistake. Specifity of clinical and plain X-ray diagnosis is only 30-50%. Selective gastrointestinal decontamination, exactly monitored fluid balance, and physio-, and paintherapy seem to be valuable preventive measures.

Surgical treatment of hepatic metastases is predominantly aimed at "curative" resection. This can be achieved in about 20% of colorectal secondaries, and is associated with a 30-40% 5-year survival. One to three metastases in the absence of extrahepatic disease are regarded a clear indication to resection. Among patients with non-colorectal malignancies, occasional long term survival was reported in leiomyosarcoma, breast cancer, and renal cancer metastases, respectively. Endocrine tumors such as carcinoid, gastrinoma, or pheochromocytoma, are different because of their remarkable symptoms along with a protracted natural history. Quality of life may be considerably improved here by even non-radical debulking. The vast majority of patients, however, ist not suitable to undergo hepatic resection. Palliative therapeutic options involve hepatic artery ligation or embolization, cryo-surgery and percutaneous laser coagulation, and various types of regional chemotherapy. These methods may enable a temporary relief of symptoms, but no significant impact on survival time, and no true long term benefit has been proven. Prospective randomized trials against combined treatment as well as untreated patients are required for a more meaningful judgement and improved effectiveness.

16 patients with angiographically proved NOD underwent immediate abdominal sonography (age: 76 +/- 24 years). All patients suffered from "low cardiac output syndrome". The sonographic criteria were as follows: bowel wall edema [16], hyper-peristalsis [16], free peritoneal fluid [14], and signs of incomplete ileus [14]. 11 patients were successfully treated with conservative therapy on the basis of followup ultrasound observation and analysis. 5 patients underwent operation because of worsening ultrasound findings. These patients died from the underlying cardiac illness.

Classification of renal trauma is given. Perforated trauma requires operation, blund trauma is treated conservatively, at least in stage I and II. Severe hemorrhage is reason for surgical exploration and nephrectomy in stage III and IV renal trauma. Renal trauma is best diagnosed by sonography and CT-scan. Bladder trauma is best diagnosed by cystogram and classified to intraperitoneal leasons which require immediate operation and to extraperitoneal leasons which are treated conservatively.

The form and severity of fracture of the distal radius as well as the concomitant injury of discoligamentary structures of the wrist depend on the position of the wrist at the moment of hitting the ground. The width of this angle influences the localization of the fracture. Pronation, supination and abduction determine the direction of force and the compression of the carpus and the different appearances of ligamentary injuries. The classifications of these fractures published by Frykman (1967) and M. E. Müller et al. (1989, AO-Group), incomplete, are useful for objective evaluation or documentation and may suggest indications for treatment when critically used.