[Acute abdomen in the elderly]. / L'abdomen aigu chez le vieillard.

From 1984 to 1992 we treated 4341 patients with acute abdominal disease in the elderly. We divided all patients in two groups. In the first group were all patients up to 60 years; in the second group all patients above 60 years. This last group was subdivided in patients between 60 and 65 years; IIIrd age between 65 and 75 years and IVth age between 75 years and plus. Total mortality affected in 48 (3.03%) patients.

[The status of plate osteosynthesis in the treatment of femur shaft fracture in polytrauma patients]. / Der Stellenwert der Plattenosteosynthese in der Behandlung der Femurschaftfraktur beim polytraumatisierten Patienten.

In the frame of multiple injuries we had 30% of the fractures of the femur. We treated 113 patients with polytraumas with fractures of the femur and with the plate. We had 25% AIS grade 1, 48% AIS grade 2, 21% AIS grade 3 and 6% AIS grade 4. Mortality was 4%. Indications for osteosynthesis with plate are: severe head injuries, fractures of the pelvis, open fractures, injuries of the nerves and blood vessels and severe trauma of the abdomen.

[Primary management and problems with osteosynthesis of subtrochanteric fractures of the femur]. / Die Primärversorgung und Probleme der Osteosynthesen von subtrochantären Frakturen des Oberschenkels.

From 1986 to 1991 we treated 63 patients with subtrochanteric fracture of the femur. The etiology in 53 patients with 40 fractures mostly pedestrians, hit by a car; or motor vehicle accidents, in other words high velocity injuries that resulted in a significant number of multiply injured patients of whom 38 were polytraumatized, by our definition a multiply injured person with a life threatening injury of at least one of the following body parts: head, neck, thorax, abdomen, spine, extremities with neurovascular compromise and pelvic girdle.

[Effect of chemotherapy on survival in advanced breast cancer]. / Wirkung der Chemotherapie auf die Uberlebenszeit bei fortgeschrittenem Mammakarzinom.

Survival time of 119 consecutive patients with metastasizing carcinoma of the breast who had been treated with various chemotherapeutic schedules after radical operation was determined retrospectively. 57 women received chemotherapy and hormones, as well as radiotherapy, while 62 had radiotherapy plus hormone treatment. The mean prolongation of life in the former group over that of the latter was 12 months (p less than 0.01). Although chemotherapy delayed death, the dynamics of cancer were not fundamentally affected. The chemotherapy-induced prolongation (2.5 months to five years) was independent of any risk, primary location of the metastases or age.

[Polytrauma with retroperitoneal injuries]. / Politraume sa povredama retroperitoneuma.

From 1971-1987, 598 polytraumatized patients had concomitant injuries of the retroperitoneal space. The mortality rate came up to 33.4%. Diagnostically abdominal lavage, laparoscopy, selective angiography and CT were carried out. Often life saving laparotomy had to be practised without further delay.

[Primary clinical experience with heterotopic autologous transplantation of the spleen]. / Nasa prva klinicka iskustva sa heterotopnom autolognom transplantacijom slezine.

On the basis of research and results obtained in recent years that the removing of the spleen increases an aptitude to the infection, the authors have carried out in 1981-1982 four autotransplantations of the spleen; they did it in polytraumatised patients with an extensive rupture of the spleen, where, because of the safe haemostasis, only a splenectomy should have to be performed. By a new technique, removed ruptured spleen is prepared with special procedure, and it is transplanted into the omentum majus of the same patient. There were no complications, although it is concerned of a few patients and a short postoperative follow-up. Three to four months after surgery, the Howwel-Jolly bodies became normal as well as vacuolated erythrocytes and immunophoresis, so that it corresponds to the normal, in-situ, spleen activity; it means that it is to expect a sufficient protection against an infection.

[Traumatic intestinal infarction]. / L'infarctus intestinal traumatique.

A study of 31 cases of traumatic intestinal infarction, often old cases, did not show any characteristic clinical picture or course but showed the following points: abdominal contusion, even mild, may induce intestinal infarction; the ileum and ascending colon are most commonly involved, and infarction usually follows a thrombosis of the mesenteric veins; the clinical course usually includes an interval between the trauma and the infarction.

[Superficial cancer of the stomach in our hospital]. / Le cancer superficiel de l'estomac chez nous.

Gastric cancer remains difficult to cure except in its superficial spreading stage, that is when it is mucosal or submucosal without any lymph node involvement. Its detection rate should reach 20% of all cancers. Three anatomical types are described: the malignant polyp, the muco-erosive cancer and the ulcero-cancer. The most efficient radiological procedure is fibroscopy rather than radiology: it permits biopsy and brush cytology, two procedures which yield 95% of positive diagnosis. The most frequent precancerous lesion seems to be chronic gastritis and especially gland dysplasia. Early detection may be made easier by defining a poor risk population: gastric ulcer, polyadenoma, partial gastrectomy going back to more than fifteen years, and dyspeptic patients in whom biopsy discovers atrophic gastritis. Such a population should be regularly followed up.

[Osteomyelitis after osteosynthesis]. / Osteomyelitis nach Osteosynthesen an unserem Krankengut.

In reparative surgery, and particularly reosteo-synthesis, latent or apathogenic germ invasion of "old" wounds must always be reckoned with. Antiinfectious measures, which must be pursued untiringly, are to be placed beside equivalent surgical measures which should go beyond mere operative care of traumatic tissue damage.

[Organization of surgical work in hospitals under special conditions]. / Organizacija hirurskog rada u bolnicama u vanrednim stanjima

A check-list consisting all the importants measures in hospital care for handling all sorts of disasters is described. In those situations the management of organization is primarily more important than medical attendance. The doctor educated in individual medicine overestimates the medical problems. In every hospital a disaster plan should be step up as a precuation. The importance of triage has been confirmed, and several aspects of its planning have been stressed. Excercise and test alarm are necessary to check the set upa organization.