Comorbid conditions in old patients with femur fractures.

BACKGROUND AND METHODS: The incidence of preexisting medical diseases (comorbid conditions) and their influence on the high rate of falls, associated severe injuries, operative treatment, and outcome including mortality rate, duration of hospitalization, and rehabilitation success was retrospectively evaluated in a group of 102 patients (mean age, 81 years; 81% women) with femoral fractures. A comparison of polymorbidity rates in a control group of 102 patients (mean age, 79 years; 86% women) with proximal humeral fractures was added. RESULTS: The associated polymorbidity rate among patients with femoral fractures (FF) usually was statistically significantly higher than among patients with proximal humeral fractures (PHF) despite a comparable age and sex distribution: 80% of the patients with FF presented with cardiovascular (p < or = 0.001), 41% with pulmonary (p < 0.001), 67% with gastrointestinal (p < or = 0.001), 71% with neurologic (p < or = 0.001), 55% with urologic (p < or = 0.001), 75% with musculoskeletal (p < or = 0.1), and 61% with psychiatric (p < or = 0.001) disorders and complaints. Ninety percent of the patients used different medications (diuretics, cardiac agents, anticoagulants, antidiabetic agents, steroids, hypnotics, analgesics, psychotropic agents). The postoperative mortality rate was 11%, and the mean hospitalization period was 30 days. Forty-nine percent of the patients were discharged to their homes. Only 56% of the patients with PHF, however, presented with cardiovascular, 8% with pulmonary, 11% with gastrointestinal, 8% with neurologic, 9% with urologic, 64% with musculoskeletal, and 10% with psychiatric disorders. CONCLUSION: The polymorbidity in the old patient probably is a major intrinsic cause of the high incidence of falls and associated severe femoral fractures. It influences the perioperative and postoperative medical and anesthesiologic treatment, the postoperative mortality rate, and the duration and success of the postoperative rehabilitation phase.

[Intraperitoneal tumor seeding in colorectal carcinoma surgery--follow-up of a comparison of laparoscopic versus open procedure]. / Intraperitoneale Tumoraussaat bei kolorektaler Karzinomchirurgie--Follow up des Vergleiches laparoskopisches versus offenes Verfahren.

Follow-up 71 patients during 20 months (12-29) operated on for colorectal cancer by laparoscopic or open surgery demonstrated no correlation between port-side metastases (1/35) or tumor recurrences (5/71) and intraperitoneal tumor cells. All these patients were cytologic-negative; however, all were initial in an advanced tumor stage (pT3-4, N1-3). We conclude from these results that free tumor cells during operation do not seem to influence outcome or the development of port-side metastases.

Angioplasty balloon catheters used for distraction of the ankle joint.

Arthroscopy of the ankle joint is now routinely performed in diagnostic and therapeutic interventions but is still a demanding and difficult operative procedure in this very small and tight joint. Arthroscopy can be facilitated by a sufficient distraction that gives a better overview of the joint space. However, it is still a matter of debate how to obtain the adequate distraction. Distention by manual strength as well as by the help of a technical device have been proposed. We report our experience with distraction of the ankle joint by the help of one or two intraarticularily located and secondarily insufflated angioplasty balloon catheters that are routinely used in interventional radiology. These special catheters allow a careful and controlled distention of the joint with a fixed space of distraction and, according to our limited experience, without any morbidity.

[Tumor cells in peritoneal irrigation fluid in conventional and laparoscopic surgery for colorectal carcinoma]. / Tumorzellen in der peritonealen Spülflüssigkeit bei konventionellen und laparoskopischen Operationen wegen kolorektaler Karzinome.

BACKGROUND: In minimal invasive cancer surgery port-side metastases are observed. The most plausible theory of there development is by tumor cell contamination during the operation. This prospective controlled study was designed to evaluate the moment of liberation of cancer cells, frequency of implantation and follow up after laparoscopically assisted and open resections. METHODS AND PATIENTS: The peritoneal cavity is washed out 4 times with 200 mls of Ringer' solution (at the beginning of the operation, after central ligation of the vessels, after mobilisation of the cancer and at the end). The aspirate is centrifuged and stained by Papanicolaou. Follow up is by the protocol of the swiss cancer study group. Up to now 71 patients (35 laparoscopical, 4 conversions, 27 open, 5 peritoneal carcinomatosis) have entered the study. RESULTS: Positive cytology was found in 4/35 laparoscopic and 5/27 open resections. Excluding the first wash out 1/35 (3%) and 3/27 (11%) respectively were positive, however, none at the end of operation. Only in 4/5 peritoneal carcinomatosis tumor cells were present in the final wash out. Median follow up of patients with positive cytology was 9,5 months [6-15] for laparoscopy and 8 months [2-11] for open surgery. Three from each group were followed more than 7 months. No recurrence or port-side metastasis was observed. In patients with negative cytology two cancer progressions were detected. DISCUSSION: The significance of free tumor cells for the development of implantation metastases is unclear. In 8/13 patients cytology was positive at the beginning of the operation, and only patients with a peritoneal carcinomatosis demonstrated cancer cells in the final wash out. In laparoscopy no cells were found in the second and one in the third wash out, resulting in a 1/35 risk of cancer cell liberation. Whether this patient will develop a port-side metastasis is unknown. He is followed for 8 months without tumor progression. We believe that a positive cytology alone cannot be the reason for implantation metastases. CONCLUSION: Using the minimal invasive technique for colorectal carcinoma resection liberation of cancer cells tends to be less compared with open surgery. For further conclusions the time of follow up is not yet long enough.

Intestinal non-rotation and pseudoobstruction in myotonic dystrophy: case report and review of the literature.

Myotonic dystrophy is an autosomal dominant inherited disease of the skeletal and cardiac musculature that involves the pharyngeal and gastrointestinal smooth and striated muscles, resulting in velopharyngeal insufficiency, Swallowing difficulties, gastrointestinal motility disorders and anal incontinence. Gastrointestinal symptoms are found in a large proportion of patients suffering from this disease and may herald the onset of muscular disorders, in rare cases they are even the predominant feature of the disorder. We report on a 31-years-old patient with formerly undiagnosed myotonic dystrophy in combination with a non-rotation of the intestinal tract, an association of disorders that to our knowledge never has been reported before. Our patient was admitted as an emergency with signs of an acute abdomen with ileus, associated with acute aspiration pneumonia. Surgical intervention was avoided once the diagnosis of myotonic dystrophy had been confirmed and the patient was treated successfully by conservative therapy. A review of the literature indicates that conservative treatment of motility disorders of the bowel in patients with myotonic dystrophy is to be recommended.

[Anatomy and pathology of the parotid gland. COrrelation with magnetic resonance tomography]. / Anatomie und Pathologie der Glandula parotis. Korrelation mit der Magnetresonanztomographie (MRT).

Due to a very complex embryological development a variety of different tissues are mixed together within the parotid gland. Secondary degenerative metaplastic and regenerative alterations result in additional tissue variety. Epithelial cells of distinct differentiation, lymphatic tissue, partly within lymph nodes, partly in clusters, sebaceous tissue, fat and peripheral nervous tissue may be the origin of a pathological neoplastic or inflammatory intraparotid lesion. MRI is an optimal tool for the delineation of the anatomy of the parotid gland and of various intraparotid lesions and often permits differentiation among malignant and benign neoplastic and inflammatory lesions. The morphology of the different pathological lesions on MRI reflects the underlying histopathology. Due to great interindividual variations in the tissue characterization of a specific intraparotid lesion, great differences in MR morphology have to be expected.

[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.

[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.

[Lung abscess: evolution of a complication over 45 years]. / Der Lungenabszess: Evolution einer Komplikation über 45 Jahre.

143 patients with lung abscesses were hospitalised at the Department of Surgery at University Hospital Zurich from 1946 to 1990. Analysing our patients in a retrospective study we concluded as follows: 1. Lung abscesses have nearly disappeared in our patients. 2. Lung abscesses can be cured without lethality. 3. Cancers of the lung causing abscesses were not seen any more since 1960. 4. A compromised immunological system appeared as a new pathogenetical factor since the beginning of the 1980ies.