[Rush pin osteosynthesis of the clavicles as an alternative to conservative treatment]. / Die Rush-Pin-Osteosynthese der Klavikula als Alternative zur konservativen Behandlung.

Fractures of the clavicle in the middle third usually undergo closed treatment by external fixation, because they heal spontaneously in most cases. However, a correct reposition and fixation by external manner is sometimes impossible, and consolidation in malposition with functional and esthetic disturbance occurs. External fixation can be painful and inconvenient to the patient, and congestion and paresthesia of the upper limbs may occur. Therefore the indication for internal fixation has been extended on fractures in persisting severe malposition despite external fixation and painful congestion and paresthesia of the arms. A method of internal fixation by a Rush pin has been used. The fracture is exposed by a minimal incision, and both fragments are bored open axially and exactly reposed. The Rusph pin is inserted from the medial side through a second small incision. The corticalis layer on both sides of the bend of the clavicle is also to be penetrated by the pin. Postoperatively no external fixation is necessary, and the patient is told to move the shoulder as soon as possible. The pin is removed after three to six months on outpatient basis under local anesthesia. 43 cases of clavicle fractures and three cases of painful non-union after closed treatment, operated in this way, have been analyzed. In two cases of the fractures (4.6%) non-union occurred. Both healed after refixation by a plate. 34 of 41 fractures healed without radiologically visible callus. 64% of the registered patients have been handicapped in their daily activities only for two weeks or even less.(ABSTRACT TRUNCATED AT 250 WORDS)

[Diagnosis and therapy of stenosis or obstruction of the intrahepatic bile ducts]. / Diagnose und Therapie von Stenosen oder Verschlüssen der intrahepatischen Gallenwege.

15 patients are reviewed who had stenosis or obstruction at the hilus of the bile duct. Percutaneous transhepatic or endoscopic transduodenal cholangiography is indispensable for establishing the diagnosis before operation. Primary carcinomas involving the junction of the hepatic ducts may be regarded as resectable if proximal extension of the tumor is limited to below the second bifurcation of the intrahepatic bile ducts in both the right and left lobes and if the proper hepatic artery and portal vein are still free from tumor invasion. Our favourable operation procedures for resection or palliative decompression of the biliary tree are discussed.

[Lipomatosis of the ileocecal valve]. / Lipomatose der Ileozäkalklappe

Lipomatosis of the ileocecal valve is a diffuse infiltration of the submucous coat with fat cells. This syndrome is discussed on the basis of a personal observation and a review of the literature. The characteristic endoscopic picture is the overgrown, yellowish lips of Bauhin's valve prolapsing into the cecum, reminiscent of a uterine cervix. Coloscopy with biopsy is therefore the method of choice in assuring proper diagnosis. On the other hand, radiology cannot recognize the disease with certainty. Generally treatment of this benign syndrome is only necessary in the event of disturbances. As a surgical procedure ileocecal resection is suggested.