[Temporary articulating spacer with antibiotic-impregnated cement for an infected knee endoprosthesis]. / Die temporäre Antibiotikaspacerprothese bei der infizierten Knieendoprothese.

Two-stage reimplantation remains the gold standard in the treatment of late infected total knee arthroplasties. The reported disadvantages include difficult exposure at the time of reimplantation and less functional outcome by using static spacers. Patients who receive an articulating spacer retain a functional joint before second-stage reimplantation. This may reduce the disadvantages of static spacers (ligament contracture, extensor lag, arthrofibrosis). There is no difference in the success rates of eradicating infection (range: 90-96%). In a prospective study 24 consecutive patients were treated with an articulating spacer. The articulating spacer is made by cleaning and autoclaving the removed femoral component and the tibial polyethylene insert. These are reinserted during the same operation with antibiotic-loaded cement. The average time during which the spacer was in place was 16 weeks (range: 7-28 weeks). During an average follow-up period of 14.8 months (range: 5-33 months) one patient had a secondary reinfection. Use of an articulating spacer is economical and decreases the risk of complications in reimplantation with good functional outcome.

[Primary malignant tumors of the small intestine. A review with demonstration of a case]. / Die primären malignen Tumoren des Dünndarmes. Eine Ubersicht mit Demonstration eines Falles.

Malign tumours in the small bowel are rarely found. A survey is given on appearance, symptoms, diagnosis and therapy of these tumours (by exclusion of the tumours of the duodenum and the tumours derived from Meckel's diverticulum). By means of a case report and a number of observed patients it is demonstrated, how the non-characteristic symptoms cause a late diagnosis and therefore late therapy.

[Management of blunt chest trauma (author's transl)]. / Versorgung geschlossener Thoraxtraumen.

The diagnosis of life threatening situations due to blunt chest trauma, the priority of treatment, and therapeutical consequences are discussed. Rib fractures, pulmonary contusions could be treated conservatively. Tension pneumothorax and haemothorax need immediate decompression by intercostal tube drainage. The necessity for prompt exploratory surgery should always be considered in patients with massive haemothorax, tracheobronchial disruption and traumatic rupture of the diaphragm. Rupture or perforation of the oesophagus, traumatic aneurysms of the thoracic aorta, large diaphragmatic herniations, and penetrating thoraco-abdominal wounds demand an early thoracotomy. Indications for late thoracotomy are: clotted haemothorax and diaphragmatic herniations primarily not diagnosed.