[Comparison of laparoscopic splenectomy in supine position with hanging-spleen technique in idiopathic thrombocytopenic purpura]. / Vergleich der laparoskopischen Splenektomie in Steinschnittlage mit der Hanging-Spleen-Technik bei idiopathischer thrombozytopenischer Purpura.

BACKGROUND: Laparoscopic splenectomy has become the gold standard intervention for elective splenectomy. Several techniques have been described, which differ in trocar localisations and patient positions. The hanging-spleen technique was examined in comparison to the conventional laparoscopic splenectomy in the supine position among the patient population in our institution over a period of 8 years. PATIENTS AND METHODS: On the basis of a retrospective analysis, data were collected on all patients who underwent elective laparoscopic splenectomy for idiopathic thrombocytopenic purpura between May 1994 and April 2002 and were examined for operation time, blood loss and peri-operative complications. Two types of operation were compared, the conventional laparoscopic splenectomy in the supine position (group A) and the hanging-spleen technique (group B). Finally, the costs of materials of the two operation techniques were compared. RESULTS: For 51 patients (43.1 % men, 56.9 % women) (mean age: 45.5 ± 17.5 years) the mean operation times were 134.2 ± 47.3 min (group A) and 9.8 ± 39.9 min (group B). The mean blood losses were 691.3 ± 544.4 mL in group A and 638.3 ± 1050.6 mL in group B. The perioperative complications were 38.8 % in group A and 21.2 % in group B. There was no significant difference found for operation time, blood loss and perioperative complications in a multivariate analysis. The cost of materials was reduced in group B (use of Endo-GIA 42.4 % in group B, 100 % in group A). In group A 4 incisions, in group B 3 incisions were necessary. CONCLUSIONS: Regarding operation time, blood loss and perioperative complications the 2 laparoscopic techniques for splenectomy do not differ significantly. Merely reduced material costs and a reduction of incisions were found in patients -operated with the hanging-spleen technique. Whether the hanging-spleen technique is the method of choice will have to be shown by further prospective studies.

[Quality of a multidisciplinary orthopaedic-rheumatological consultation]. / Qualität einer interdisziplinären Sprechstunde in der Rheumaorthopädie.

AIM: An interdisciplinary approach plays an important role in orthopaedic rheumatology. The aim of this study was to test the quality of an interdisciplinary consultation, which analyzed a pool of orthopaedic patients in terms of rheumatological disease. METHOD: Orthopaedic patients (n=100) were transferred to a multidisciplinary team of experts in a two-stage selection process. Patient data were examined with regard to diagnosis and therapy. A patient interview analyzed the course of disease and effects of the consultation. Patients were questioned on the development of pain, diagnostics and therapy as well as their general satisfaction. RESULTS: Rheumatological disease was diagnosed in 42% of patients, while specific anti-rheumatic therapy was started in 41%. An improvement in symptoms as a result of treatment was seen in 63% of cases. Patient examinations revealed an above-average level of satisfaction in 63% of patients. CONCLUSION: Interdisciplinary consultation led to improved and faster diagnosis and therapy of rheumatological diseases, which was positively evaluated by the pool of patients treated.

[Closed reposition of an acute midfoot luxation fracture in Charcot arthropathy with the ring fixator]. / Geschlossene Reposition einer akuten Mittelfussluxationsfraktur im Rahmen einer Charcot-Arthropathie mit Hilfe des Ringfixateurs.

Diabetic neuropathic osteo-arthropathy (DNOAP; Charcot arthropathy) is a progressive disease characterized by joint luxation, fractures and excessive destruction of foot architecture. The operative therapy is indicated when conservative therapy fails, in progressive breakdown, in hindfoot Charcot and in spreading infections due to plantar ulcers. The complication rate of 10-20% in open surgery is high. We present a minimally invasive technique of closed reduction and application of a ring fixator for reconstruction of the foot architecture and arthrodesis of the involved joints.

[Principles of treatment for deep infections of the diabetic foot]. / Behandlungsprinzipien bei tiefen Infektionen beim diabetischen Fuss.

Infections are the typical complications of ulcers related to the neuropathic diabetic foot. The loss of the foot or sepsis is the consequence due to the progression of an untreated infection. Therefore, prophylaxis of ulcer formation is the key to lower the rate of amputation. If infection has occurred antibiotics and non-weight bearing are indicated. Abscesses and phlegmons can be localized by the clinical findings, ultrasound, x-rays, computer tomography and MRI and immediate surgical treatment is necessary to prevent further spreading. In the chronic phase dead tissue, necrotic tendons and bones need to be resected. Closure of the skin can be achieved by secondary healing or other methods of plastic surgery. Persistent bony prominences have to be removed and instabilities need fusion operations. In this way many amputations can be avoided or the extent of amputation can be noticeably reduced.

Ilizarov's method: a solution for infected bone loss.

We report the results of 22 infected nonunions treated by radical resection and bone transport technique according to Ilizarov with a minimal follow-up period of 2 years. This series involves four fractures of the femur diaphysis, ten at tibial level, four defects of the knee and four of the upper limb. The mean length of the bone defect was 7.7 cm. The mean time from the transport procedure to frame removal was 14.5 months. In 15 cases the docking site was reviewed to refresh the bone ends at the end of the transport procedure, of which eight had a bone graft performed. Five refractures were noticed at the docking site in the nonrevised group and one in the other group. Two of them were treated conservatively and four with a new external fixator. Consolidation was achieved in all but two nonunions at the knee level, which means a succesrate of 91%. The infection could be eradicated in all 22 patients. A revision of the docking site at the end of the bone transport procedure with or without bone grafting is recommended.