[Traumatic rupture of the cardiac auricle after forceful blunt abdominal trauma]. / Traumatische Ruptur des Herzohrs nach einem massiven stumpfen Abdominaltrauma.

Rupture of the heart after blunt trauma has been attributed to multiple mechanisms. We present a patient in whom massive abdominal blunt trauma leading to massive venous return resulted in rupture of the auricle without pericardial rupture.

[On the centennial of Ernst von Bergmann's death]. / Zum 100. Todestag Ernst von Bergmanns.

"dear aunt lina. i do not know any big letters yet, but i want to thank you in small letters for the beautiful pens. say hello to grandpa and to everybody. yours truly, ernst." These are the first surviving written words of Ernst von Bergmann. Between them and his last words about his suspected colon cancer on 25 March 1907 ("I diagnosed this 5 years ago, and now it has come to pass.") lie many years in a vigorous life characterised by untiring activity and creativity, self-discipline, and care for patients and his family. They were years of enormous success in surgery and private happiness but also of professional setbacks and tragic family loss. Ernst von Bergmann became a leading German surgeon not only because of his surgical and scientific achievements, particularly in the fields of asepsis and war surgery, but also due to his exemplary character, reliability, engaging personality, and commitment to medical training in various medical societies. Of these, the German Society of Surgery is most indebted to him. After assuming a chair in surgery in 1882, he continued to play a leading role in this society, not least as its five-time president from 1888 to 1890 and in 1896 and 1900. A worthy successor to Bernhard von Langenbeck, he was a full professor at the Berlin University Hospital for 25 years. He also taught at the Medical and Surgical Academy for the Military after being appointed there by Emperor Wilhelm I on 16 November 1882. This position was important to him and corresponded to his patriotic views.

[Hundred twentieth anniversary of the Berlin Surgical Society. Significance of military surgery]. / 120 Jahre Berliner Chirurgische Gesellschaft. Bedeutung der Militärchirurgie.

November 22, 2006 will mark the one hundred twentieth anniversary of the oldest regional surgical society in Germany, which was founded as the Free Association of Berlin Surgeons in 1886. For years, the chairmen were also chairmen of the German Surgical Society (established 1872). Thus they made important contributions to surgery in Germany as a whole. Professors such as Ernst von Bergmann, August Bier, and Ferdinand Sauerbruch furthered the reputation of the Berlin practitioners and German surgery throughout the world. In the states of Berlin and Brandenburg, development and promotion of surgery in the late eighteenth and nineteenth centuries owed much to the Prussian emperor Friedrich Wilhelm I and the necessities of Prussian battlefields (military surgical training). These battlefields also caused the sharp decline in worldwide importance of Berlin surgeons at the end of World War II. The special geopolitical situation of Berlin in post-war Germany constituted a negative turning point in this region, not only for surgery. As a result of the destruction of Berlin, most records and documents of the Berlin Surgical Society were lost. Research conducted in February 2006 revealed 20 membership lists from the founding years (1893-1914) which were presumed to be lost. These lists can now help us restore part of the Society's identity and roots. New insights have been made regarding the composition of the Society. For example, the large number of military surgeons in these lists reflects the spirit of the times around 1900 and emphasizes the importance of military medicine in imperial Germany.

[The value of thoracoscopy in thorax trauma]. / Hat die Thorakoskopie beim Thoraxtrauma einen Platz?

A hemodynamically stable patient presenting with persistent bleeding through his chest tube (ICD) is a classic indication for early thoracoscopic intervention in trauma. The source of bleeding and air leaks can be identified and often treated: bleeding and perforated pulmonary segments can be resected, and chest wall bleeding may be coagulated or sutured. Injuries to the diaphragm are difficult to diagnose, as they might not be seen in conventional trauma imaging without gross herniation of intra-abdominal contents into the thoracic cavity. Identifying the site of diaphragm perforation can give useful hints in thoracoabdominal trauma, identifying injured cavities and localizing the bullet or stab tract. Most often, diaphragmatic defects may be closed during diagnostic thoracoscopy as well. Non- or partially drainable hemothorax is another indication for thoracoscopy. Coagulated blood can be mechanically mobilised, and aspirated or primary bleeding may be stopped. Effective lavage and a high-performance suction device are required. Correct placement of the drainage is part of optimized therapy, along with inspection of all intrathoracic organs and surfaces. Furthermore, surgical and anaesthesiological teamwork and experience are prerequisites for the fast, professional application of a minimally invasive thoracoscopic approach in chest trauma patients. Diagnostically and theurapeutically, thoracoscopy plays an important role in the trauma setting--in the case of hemodynamically stable patients.

[Penetrating injuries to the pelvis]. / Penetrierende Beckenverletzung.

As criminality and weapon use increase, general and military surgeons are increasingly confronted with penetrating pelvic injuries both at home and on peacekeeping missions. Penetrating injuries to the iliac vascular axis are associated with considerable mortality, and thus the majority of these emergency patients arrive in a state of deep hypovolemic shock. Concomitant bowel injuries are present in one of five cases, resulting in contamination of the damaged area. Surgical options are simple lateral repair, ligation of the veins, temporary shunt insertion, and prosthetic graft interposition in the injured artery. In extremis ligation of the common or external iliac artery may be the only option to save the patient's life. Surgeons must be aware that damage control surgery and related methods may be needed early on to enable patient survival.

[What to do if incompressible bleeding from a stab wound occurs in EMS and ER? Temporary control with a Foley catheter]. / Was tun bei nicht komprimierbaren Stichkanalblutungen in Rettungsdienst und Notfallraum? Temporäre Versorgung mittels Blasenkatheter.

Exsanguination plays a key role in avoidable prehospital deaths. As some bleedings from deep stab wounds cannot be stopped with direct compression, the insertion of a Foley catheter can prevent ongoing bleedings. A case report of bleeding from a stab wound in the supraclavicular region is given. The simple measure of careful insertion and blocking of a Foley catheter proved to be a key resuscitative procedure which can be done under any suitable circumstances.

[Procedures of temporary wall closure in abdominal trauma and sepsis]. / Verfahren zum temporären Bauchdeckenverschluss bei Trauma und Sepsis.

Temporary abdominal closure methods differ mainly between vacuum-assisted and conventional approaches. Each method has its indications. Vacuum-assisted methods seem to be superior especially for trauma indications--in terms of lethality, the possibility of secondary closure during primary hospital stay, and frequency of enterocutaneous fistulas. Skin-only closure might be used as a short-term application (e.g. when damage control closure is needed), and the Bogota bag silo gives space to protruding bowels in pending or manifest abdominal compartment syndrome. Temporary fascial mesh closure enables repetitive laparotomies through the mesh, thus sparing the fascia. For that reason it is to be preferred, especially for its good practicability in clinical situations and on mission abroad.

[German education for treatment of penetrating gut traumata in army service]. / Penetrierendes Bauchtrauma aus der Sicht der Bundeswehr.

On military missions abroad, surgical care for penetrating abdominal injuries differentiates from that given at home. The different conditions in the field usually include a single general surgeon with no further specialists or hospitals to rely upon. Thus a mismatch between treatment capacity and needs can be experienced in mass casualty situations. Therefore the focus is on damage control surgery, getting patients fit for evacuation, and transport home under intensive care if needed. Knowledge of ballistics and explosive devices are adjunct fields of interest, as they improve the understanding and treatment of military injuries. Although these aspects add up to additional training requirements to be met by our surgeons, we are convinced that the new German education standards will allow successful training of future military surgeons.

[Prevention of infection in war wounds]. / Infektionsprophylaxe bei Kriegsverletzungen.

Medical treatment of injured patients by international missions of non-governmental organisations in crisis areas and out-of-area operations by troops, and also national disasters require special trauma management. Deviations from peacetime surgical guidelines are obligatory because of long-distance medical evacuation, the possibility of gaps in supply and the typical pattern of war injuries. Massive contamination combined with the high risk of infection is one typical attribute of wounds inflicted during a war or a disaster. In contrast to peacetime surgical guidelines, aggressive wound débridement is often needed. Timely and prophylactically prescription of a broad-spectrum antibiotic with a long half-life has great importance in the treatment of these wounds. Suitable antibiotics for these indications are: piperacillin/tazobactam and ceftriazon. Nevertheless the use of antimicrobial agents will only be effective with early surgical débridement.

[Surgical revision of the pilonidal sinus with single shot antibiosis]. / Die operative Sanierung des Sinus pilonidalis unter Single-shot-Antibiose.

For a therapy of the pilonidal sinus there are different surgical and non-surgical methods to be found in literature. In our surgical wing 140 male patients have been operated on this disease from September 1990 to July 1992. 16 cases out of these 140 were re-operations. Using a special surgical technique we applied the excision with a primary closure under single-shot antibiosis in 139 cases. By modifying this antibiosis prophylaxis we could reach a primary success healing rate of up to 96%. A retrospective study among our patients showed a recurrence rate of 5%.

["Inoperable" deep rectal cancer]. / Das "inoperable" tiefe Rectumcarcinom.

Rectal carcinoma usually requires surgery. In 1981-1988 43 (8.5%) of 504 patients were considered inoperable for medical, prognostic or technical reasons. Surgery should take the removal of urogenital organs, if necessary, into consideration. Electrosurgery, cryosurgery and laser surgery can be used to reestablish local passage. Twenty-one pelvic exenterations were performed during 52 operations for tumor recurrence. Adjuvant chemotherapy and radiotherapy were applied when needed. Each therapy must be individualized.

The pharmacokinetic properties of cefotetan and its relevance for prophylaxis in elective colorectal surgery.

In an open, prospective, non-randomised study involving 112 patients undergoing elective colorectal surgery, the effect of perioperative prophylaxis with cefotetan was investigated. Cefotetan (2g) was administered, pre- and intra-operatively only. Preoperative bowel preparation was done by the standardised "Würzburg Method" i.e. oral metronidazole pre and post orthograde lavage. Mucosal biopsies were obtained from the resected colon and simultaneously serum samples were taken to determine tissue and serum levels respectively. Antibiotic serum and gut mucosal levels were well in excess of the minimum inhibitory concentration (MIC90) levels of the isolated bacteria. Wound infections occurred in only 2 patients. Cefotetan was well tolerated and no adverse events were noted. In prolonged colorectal surgery, an antibiotic such as cefotetan with a long half-life is to be recommended.

Intraarterial prostaglandine E1 in arterial occlusive disease (AOD) stages III and IV.

Our physical, chemical and clinical findings - especially lactate, night pain and peripheral blood flow - have shown that in most cases of AOD stages III and IV, intraarterial infusions with prostaglandine E1 largely improved the peripheral situation. PGE1 seems to meliorate the blood flow - causing better oxygen supply - and to inhibit thrombocyte aggregation. An improvement of the clinical situation will be the result. In most cases a differentiation between responders and non-responders is possible but, on the other hand, it is not possible, however, to give a safe forecast of the success of this treatment in the individual patient.

The 111In-granulocyte scan in prosthetic vascular graft infections: imaging technique and results.

Fourteen patients were examined between 3 weeks and 11 years after implantation of an aortobifemoral vascular graft with 111In labelled leukocytes isolated with discontinuous gradient centrifugation. The camera acquisition was performed with a three phase technique (acquisitions at 30 min, 4 h and 24 h p.i.). The presence and extent of a graft or perigraft infection including complicating fistulas could be correctly diagnosed in six of eight patients with surgically proven infections. Leukocyte uptake index was calculated as 1.77 +/- 0.4 (30 min p.i.) and 2.4 +/- 0.7 (24 h p.i.). All infections could be diagnosed by 30 min p.i., fistulas only could be seen 24 h p.i. In two of eight patients, false positive results were observed. These patients suffered from suspected perigraft hematomas and noninfected aortic graft aneurysms. Both had a negative 30 min scan and a slight uptake in the late scans comparable to bone marrow activity. Six patients with fever of unknown origin showed true negative scans. There were no false negative scans. We conclude that only the leukocyte scan can diagnose the presence and the extent, including fistulas, of vascular graft infections. The three phase technique is recommended to localize the blood pool in the 30 min scan and to diagnose complications 24 h p.i. In cases of a negative 30 min scan and positive 4 h and 24 h scans, false positive results should be suspected. All infections have a leukocyte uptake index higher than 1.2.

[Femoropedal bypass: a step forward in peripheral bypass surgery?]. / Femoro-pedaler Bypass: Ein Schritt nach vorn in der peripheren Bypass-Chirurgie?

Femoropopliteal and femorocrural bypasses are standardized procedures. There is given a patency rate of 70-90% after a period of 5 years according to the progress of the disease and to the used graft material. Bypassing the lower limb in AOD (stage III and IV by Fontaine) it is possible to implant a femoropedal bypass. In our patients we had a patency rate of 81.3% during a follow-up time of 13 months. An av-shunt nearby the distal anastomosis seems to be important.

[Intragastric pH increase using antacids or secretin for stress ulcer prevention in surgical risk patients]. / Intragastrale pH-Anhebung mit Antacida oder Secretin als Stressulcus-Prophylaxe bei chirurgischen Risikopatienten.

The efficacy of an antacid or synthetic secretion on elevations in intragastral pH above 4 was tested in a controlled prospective study. 21 surgical high risk patients received an antacid, and 17 secretin. Antacid prophylaxis resulted in a significantly higher intragastral pH than with secretin. This was especially true in patients with several risk factors. The percentage of secretin patients with a pH reduction below 4 was higher. An increase in dosage was necessary in 4 of the 17 patients receiving secretin and in none of those receiving antacids. One stress ulcer hemorrhage occurred during secretin infusion.