[Treatment of femoral neck fractures with duo cup prosthesis]. / Die Versorgung von Schenkelhalsfrakturen mit der Duokopfprothese.

Between April 1992 and March 1994 Duo-cup endoprosthesis was inserted in 90 patients (mean age 80 years, 49-99 years) with fractures of the femoral neck, admitted to the Division of Trauma Surgery. University Hospital of Zürich, Switzerland. The purpose of this study was the clinical and radiological evaluation during a follow-up period of 3 to 24 months. The mechanism of trauma, pre-existing morbidity of the patients, operative stress and postoperative complications were analyzed retrospectively. The functional outcome of 75% of the patients was assessed according to a standardized protocol. In the follow-up, 85% of the patients showed good to excellent results. Radiolucent zones around the cement-bone interface were detected by x-ray scan in 7 patients without loosening of the prosthesis. In half of the patient group heterotopic ossifications appeared, but without clinical relevance. Complications appeared as followed: 3.3% superficial infections, 3.3% deep wound infections followed by replacement of the prostheses, 8.8% hematomas, 2.2% extraprothetic luxations. The perioperative lethality was 0%, whereas the lethality during hospitalisation was 2.2% and the average lethality of the first postoperative year 13%. Overall, 93% of the patients returned to their pre-existing housing environment. These results show that good to excellent clinical and functional results can be achieved in the treatment of femoral neck fractures with duo-cup prosthesis in elderly patients which enables the patients to return in their known social environment.

Arthroscopic partial meniscectomy: a 12-year follow-up and two-step evaluation of the long-term course.

The long-term results after arthroscopic partial meniscectomy of 119 patients with a mean follow-up of 12 years are presented in this study. The same series of patients had an earlier follow-up 4 years postoperatively. Thus, an evaluation of the actual long-term course and not only a single result after partial meniscectomy is presented. Arthroscopic partial meniscectomy is shown to be the definitive means of therapy for meniscal lesion of the knee joint; 91.7% of patients had an excellent or good result 4 years after surgery, and 78.1% rated excellent or good 12 years after surgery. Full recovery regarding ability to work and sports activity level was achieved in a very high percentage of patients. Early results were mostly representative and did not change significantly during the long-term course for the isolated meniscal lesion. The factor with the highest impact on long-term results was damage to the articular cartilage, which did not influence knee function for several years after surgery but became increasingly symptomatic over time after 5 years and more. Only 62% of patients with additional cartilage damage rated excellent and good 12 years after surgery, in contrast with 94.8% good and excellent results in patients with isolated meniscal tears. Similar observations were made for the untreated rupture of the anterior cruciate ligament.

[Cyst of the major omentum--laparoscopic diagnosis]. / Omentum-majus-Zyste--laparoskopisch diagnostiziert.

This report describes the case of a 22-year-old female patient with noncharacteristic complaints in the lower abdomen. Sonography revealed a large cyst close to the right adnexa, suggestive of adnexitis; however, laparoscopy, performed because of suspected adnexitis, revealed a cystic tumor connected to the omentum instead.

The number of circulating CD34+ blood cells predicts the colony-forming capacity of leukapheresis products in children.

In children, only a few guidelines are available for optimizing peripheral blood progenitor cell (PBPC) harvesting. We analyzed by means of flow cytometry and clonogenic assays 60 harvest products obtained from 20 children by standardized leukapheresis after treatment with chemotherapy and CSF. In addition, 27 fresh blood samples obtained prospectively during the mobilization phase were studied. CFU-GM/kg significantly correlated with MNC/kg, CD34+ cells/kg and CD34+33- cells/kg in apheresis products (P < 0.001). In fresh blood samples, CFU-GM/ml significantly correlated with MNC/ml, CD34+ cells/ml and CD34+33- cells/ml (P < 0.001). The numbers of CD34+ cells/ml, CD34+33- cells/ml and MNC/ml in 19 blood samples taken prior to leukapheresis were compared with CFU-GM/kg harvested and thawed after cryopreservation applying multiple regression analysis with stepwise variable selection. The number of circulating CD34+ cells/ml prior to leukapheresis highly correlated with and was predictive for the number of collected CFU-GM/kg (P < 0.001). In addition, a significant correlation (P < 0.05) between the number of progenitor cells/kg reinfused and the time to myeloid and platelet recovery was found in children undergoing high-dose therapy. Our data indicate that a single leukapheresis will be sufficient to obtain a minimum number of 5 x 10(4) CFU-GM/kg if the pre-harvest number of circulating CD34+ cells is > or = 10(5)/ml. Thus, our results will help to optimize PBPC transplantation in children.

[Combination of surgical therapy and interventional radiology in a recurrent myxoid liposarcoma with a 37-year history]. / Kombination von chirurgischer Therapie und interventioneller Radiologie bei einem seit 37 Jahren rezidivierenden myxoiden Liposarkom.

Extreme long-term survivals of low grade liposarcomas are rare. The authors present a case of a 75 year old man with a 37 year history of recurrent myxoid liposarcoma. The tumor dynamics are obviously related to the histology subtype. The clinical and radiological findings of the sixth tumor recurrence are discussed. The combination therapy of surgical tumor reduction and interventional radiology with implantation of endovascular prostheses for iliaco-femoral vein compression due to tumor recurrence is described.

[Arthroscopic intra-articular drainage as the therapy of choice in meniscus ganglia of the knee joint]. / Die arthroskopische intraartikuläre Drainage als Therapie der Wahl bei Meniskusganglien des Kniegelenks.

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.

[Graft patency and saving the extremity as a function of asymptomatic/symptomatic aneurysm of the popliteal artery and the graft material used]. / Graftdurchgängigkeit und Extremitätenerhaltung als Funktion des asymptomatischen/symptomatischen Aneurysma der A. poplitea bzw. des verwendeten Graftmaterials.

A 27-year experience with 252 popliteal artery aneurysms in 167 patients is reviewed. Long-term results with respect to graft patency and limb salvage rates are analyzed. The results emphasize the importance of early surgical intervention and demonstrate the superiority of autologous saphenous vein over other graft materials.

[Use of a semi-elastic synthetic cast in functional treatment of fresh injuries]. / Zum Einsatz halbelastischer Verbundkunststoffe in der funktionellen Behandlung frischer Verletzungen.

Functional treatment of injured joints is increasing since the introduction of semi-rigid plaster. Injuries to the ligaments of the ankle joint, ruptured Achilles tendon, but also other joints with injured ligaments are suitable for this therapy. We report about our experience of 120 treated ligamental injuries of the ankle joint, treated in a conservative way with semi-rigid plasters.

[Necrotizing soft-tissue infections of the extremities]. / Nekrotisierende Weichteilinfektionen an Extremitäten.

The term "Necrotizing soft tissue infections" describes a group of limb- and sometimes lifethreatening infections mostly of the limbs. The necrotizing soft tissue infections are classified, depending on the involved tissue level, microbiology and clinical course: 1. primarily located in the subcutaneous level and fascia: 1.1 hemolytic streptococcal gangrene, 1.2 necrotizing fasciitis, 1.3 gram-negative, synergistic, necrotizing cellulitis, 1.4 clostridial cellulitis, 1.5 anaerobic nonclostridial-cellulitis; 2. primary located in the muscle: 2.1 clostridial myonecrosis, 2.2 streptococcal myositis. Between 1989 and 1992 17 patients with necrotizing soft tissue infections were treated at the Department of Surgery, University Hospital of Zurich. Incipient necrotizing soft tissue infections are underestimated easily due to atypical or minor initial signs. The infections may be caused by a variety of bacteria, spread rapidly and can lead to a critical condition. The surgical treatment has to be aggressive with extensive debridement of the affected areas supported by intensive care. Delayed or even omitted surgical treatment, inappropriate therapeutic concepts and incomplete debridement with compromises may have fatal consequences. Repeated debridement as well as amputation of the affected limb is justified to guarantee the patient's survival.

[Necrotizing soft tissue infection of the extremities]. / Nekrotisierende Weichteilinfektion an Extremitäten.

The term "necrotizing soft tissue infections" describes a group of limb and life-threatening infections. Depending on the tissue level, microbiology and clinical course the necrotizing soft-tissue infections are classified in primary located infections to the subcutaneous level and fascia--like hemolytic streptococcus gangrene, necrotizing fasciitis, gram-negative synergistic necrotizing cellulitis, clostridium-cellulitis, anaerobic non-clostridium-cellulitis and in primary located infections to the muscle--like clostridium myonecrosis and streptococcal myositis. Between 1989 and 1992, 17 patients with necrotizing soft-tissue infections were treated at the Department of Surgery, University Hospital of Zurich. These infections originated from small traumatic injuries or operative wounds ("neglected wounds"). 11 patients suffered from debilitating diseases like diabetes mellitus, drug or alcohol abuse or were compromised by tumors. The average age was 42 years (21-84 years). Following bacteria were found: Staphylococcus aureus, hemolytic Streptococcus, Enterococcus, E. coli, Streptococcus milleri. 2 patients had a mixed infection with more than 3 different bacteria, 6 patients with 2, and 9 patients had a monoinfection. In 14 patients the infection was on the subcutaneous and fascia level, 3 patients showed a myositis or myonecrosis. No patient died, amputation of the limb was necessary in 4 cases. The average hospitalisation was 41 days (13-137 days) whereas 10 patients required between 4 and 53 days intensive care (average 18.3 days). Necrotizing soft-tissue infections are severe illnesses which are underestimated in the primary phase due to atypical or minor primary signs. The infections can be caused by a variety of bacteria and are spreading rapidly.(ABSTRACT TRUNCATED AT 250 WORDS)

[Blunt and penetrating diaphragmatic injuries]. / Stumpfe und penetrierende Zwerchfellverletzungen.

Between 1987 and 1992, 17 patients sustaining injury of the diaphragm were treated at our institution. All patients had associated injuries. Blunt diaphragmatic rupture (n = 13) was mostly diagnosed by chest X-ray, additional diagnostic procedures (contrast radiography, sonography) confirmed a suspected diaphragmatic rupture. In all 4 cases with penetrating injury the diagnosis was found by explorative laparotomy. In 2 patients sustaining blunt diaphragm rupture the diagnosis was delayed by 2 and 6 days. 3 patients (all sustaining blunt diaphragm rupture) died related to their associated injuries. All patients sustaining blunt or penetrating thoracoabdominal trauma, specially in high-velocity road accidents and injuries by shots or knives, are suspicious for diaphragmatic injury.

[Volvulus of the small intestine as a surgical rarity in acute abdomen. Analysis of 47 cases]. / Der Dünndarmvolvulus als chirurgische Rarität des akuten Abdomens. Eine Analyse von 47 Fällen.

In North America and Europe small bowel volvulus is a sporadic form of mechanical intestinal obstruction. Diagnostic problems may occur. The clinical presentation is that of an acute abdomen. The cause of symptoms may be due to narrowing of the bowel itself, or strangulation of the blood supply, or both. The types (primary and secondary) and incidence of small bowel volvulus are age-related and demonstrate astonishing geographical differences. Goals for treatment of small bowel volvulus should include physician awareness and accurate work-up of this uncommon diagnosis.

[Infection of the shoulder joint. Etiology, diagnosis and therapy]. / Der Schultergelenkinfekt. Atiologie, Diagnostik und Therapie.

Acute infections of the shoulder joint have to be considered as an emergency and must be treated immediately. The significance of an infected glenohumeral joint is demonstrated by the functional results, which are poorer than other in joint infections. Irreversible cartilage damage is already observable after one week, and impairment of motion resulting in invalidity may result. Early functional physiotherapy is necessary to avoid shoulder ankylosis. The etiology, characteristic clinical findings, radiologic examinations and different forms of therapy are summarized. By early diagnosis, with immediate and adequate therapy, it is possible to avoid devastating results.

[Functional therapy of Achilles tendon rupture]. / Zur funktionellen Therapie der Achillessehnenruptur.

We are going to present two cases with functional treatment of Achilles tendon ruptures. We define a treatment as functional if the involved limb is either not immobilized at all or whenever the immobilization is incomplete and for a limited time only and when no operation is necessary. The functional treatment is presented as an alternative, and we are going to present the advantage and disadvantage.

[Rupture of the patellar ligament of the tibial tuberosity as a complication after cruciate ligament-plasty]. / Ausriss des Ligamentum patellae an der Tuberositas tibiae als Komplikation nach Kreuzbandersatzplastik.

We report a complication of a rupture of the patellar ligament at the tibial tuberositas following autologous cruciate ligament reconstruction. To our knowledge, this complication has not yet been described.

[Arthroscopy of the shoulder joint. Technique, indications, surgery and complications]. / Arthroskopie des Schultergelenks. Technik, Indikationen, Operationen und Komplikationen.

Diagnostic and operative arthroscopy of the shoulder joint has gained considerable importance in traumatology and orthopedic surgery over the last years. Injuries of the limbus glenoidalis, in particular traumatic shoulder luxation, injuries of the rotator cuff, infection of the glenohumeral joint and unclear posttraumatic pain are indications for diagnostic and operative arthroscopy. Arthroscopy of the shoulder is a procedure, which offers exact diagnosis and the possibility of immediate surgery at the same time. The technique of the shoulder joint arthroscopy has to be carried out carefully and according to a standard protocol. The complication rate of around 5% of shoulder arthroscopy has not to be neglected.

Pharmacokinetics and therapeutic study with nimesulide suppositories in children with post-operative pain and inflammation.

The pharmacokinetic pattern of 100 mg nimesulide administered rectally at different times prior to undergoing minor surgery was studied in 45 children. Absorption of nimesulide was relatively fast, a peak plasma concentration of 75 mg/l being reached 3 h after administration, and the elimination half-life was 3.15 h. The efficacy and tolerability of the nimesulide suppositories were assessed in a randomized, double-blind, dipyrone-controlled study of 50 children suffering from moderate to severe post-operative pain, the drugs being administered one to three times daily as required; 26 patients received nimesulide and 24 dipyrone. A consistent reduction in pain was recorded during nimesulide therapy given for a mean period of 2.5 days, with a mean consumption of 3.5 suppositories. Similar results were obtained in dipyrone-treated patients. The efficacy of both drugs was judged by the physicians to be good or very good in 70% of cases and there were no statistically significant differences between the two treatment groups in the dosage required or the pain relief. Tolerability of both drugs was excellent, with only one patient in each treatment group complaining of nausea.