Initial subcutaneous embedding of the peritoneal dialysis catheter--a critical appraisal of this new implantation technique.

BACKGROUND: The objectives of this open non-randomized study were to evaluate the impact of a new peritoneal catheter placement technique on catheter maintenance, and complications possibly related to the access, e.g. leakage, infectious complications, or drainage failure. METHOD: In a routine clinical setting, a two-cuff swan-neck catheter was implanted surgically, but its external segment was embedded in a subcutaneous pouch initially without exit site to enable uncontaminated wound healing and tight ingrowth of the cuffs. After 4 weeks at the earliest the distal catheter tip was set free by a small incision under local anaesthesia, and CAPD was started. RESULTS: Using this technique, 26 catheters were implanted in 17 males and nine females (mean age 52.3 +/- 17.4, range 19-83 years). The catheters were buried subcutaneously for a median of 79.5 (mean +/- SD 132.2 +/- 157.2, range 28-675) days, and were activated in 21 patients. No leaks were seen, and only one abdominal wall abscess secondary to a haematoma was found. Long-term follow up (mean duration of CAPD 467.0 +/- 338.1, range 32-1320 days) revealed a very low overall incidence of infectious complications, i.e. 0.80 per patient-year (1 episode per 14.9 patient-months), and the incidence of catheter-related peritonitis amounted to 0.036 per patient-year (1 episode per 27.2 patient-years), only. However, the postoperative course was complicated by seromas in two of 26, and subcutaneous haematomas in 12 of 26 patients, five of which were revised surgically. At catheter activation, fibrin thrombi were found in nine of 21 patients and two had to be operated. Omental catheter obstruction was diagnosed in four patients, and followed by omentectomy. No relationship was seen between thrombus formation and omental obstruction and duration of subcutaneous embedment (P = 0.27 and P = 0.5 respectively) or patient age (P = 0.06 and P = 0.13 respectively; Mann-Whitney-test). There was also no relationship with primary omentectomy or haematoma. CONCLUSION: We conclude that although the very low incidence of infectious episodes favours the new technique, further improvement is necessary to decrease the unacceptable rate of perioperative complications. Subcutaneous embedding of the catheter may then be considered in patients with expected problems of wound healing, and those who wish to be prepared for peritoneal dialysis in time.

[Intramedullary nailing of the tibia and compartment syndrome]. / Unterschenkelmarknagelung und Kompartmentsyndrom.

The subject of this paper is the question to what extent "closed" intramedullary nailing of the tibia is injurious to the soft tissues in the sense of producing compartment syndrome. The reports on 205 patients treated by closed intramedullary nailing were evaluated. For 197 of them X-ray investigation and clinical examination were possible 1-4 years after operation. Only in 5 patients did we find a temporary compartment syndrome, and none of them needed a decompression operation. Late consequences, such as atrophy or deformity of the foot or the toes, were not observed.

[The treatment of plastic deformities of the long tubular bones]. / Zur Behandlung der "plastischen Deformation" langer Röhrenknochen.

This paper presents a special reaction of long tubular bone to a singular compression or bending stress. The characteristics of this special type of reaction to injury are exposed on the basis of bibliographical data and experiences in 12 own patients. Traumatic bowing in the forearm and shank leads to loss of function respectively to delayed union. Up to the age for ten years spontaneous correction by further growth is possible. Beyond this age treatment consists in sensitive correction in general anesthesia and plaster fixation.

[Differentiated treatment of fractures of the distal radius]. / Differenzierte Behandlung von Frakturen am distalen Speichenende.

The question of our study was, if in the case of such a numerous fracture as the distal radius fracture, a different individual treatment would be possible and if the results could be thereby improved. Both can be replied by yes. Of the 200 fractures 157 cases in the plaster cast on the forearm or in the plaster cast on the upper arm in the restored position are healed in bone. Forty three times only the conservative routine treatment has not been enough, that means for about 2 patients a week. These ones need an individual adjusted treatment, care and control, a consumption which can absolutely be required. By distinctive operative treatment it was managed to reduce the number of the secondary deviations of the whole collective to 16%. That mainly was for the benefit of the age group 20-59 years, by the patients over 60 years an operation, indicated by the fracture, is not always possible regarding the above-mentioned reasons. In such a case it is useful to discuss with the patient the problems and the result which can be expected for preventing disappointments.

[Medical documentation on the accident unit at the Wels Hospital--13 years' experience]. / Medizinische Dokumentation an der Unfallabteilung des Krankenhauses Wels-Erfahrungen aus 13 Jahren.

Standardised documentation in accident surgery is to provide detailed information on surgical practice at the ward concerned, data for comparison with other hospitals, statistical documentation from which to find answers to topical questions, and material for counselling and assistance to partners. It is also intended to help in more effective economic planning. An account is given in this paper of the effectiveness of various therapeutic procedures, with reference being made to 13 years of data acquisition, using form sheet documentation of bone fractures. Reference is also made to postoperative infections, image documentation, and on some therapeutic techniques.

[Late results after primary surgical care of recent knee ligament injuries]. / Spätergebnisse nach operativer Primärversorgung frischer Kniebandläsionen.

This report presents late results of primary suture of fresh ruptures of knee ligaments. Considering the rapid development of knee surgery the control of a surgical procedure practically unchanged since 15 years seems necessary. On the basis of these late results immediate suture of ruptured knee ligaments is a useful surgical procedure.

[Plastic deformity of the long tubular bones]. / Zur plastischen Deformierung langer Röhrenknochen.

This paper presents a special reaction of long tubular bone to a singular compression or bending stress. The reaction is defined as "plastic deformation". The characteristics of this reaction are permanent bowing of a long tubular bone without fracture and the lack of periosteal reactions in follow-up roentgenograms. In the forearm the deformation leads to loss of function, in the tibia and femur a lasting deformation may lead to late arthrosis of the adjacent joints, therefore it should be corrected. Experiences in eight own patients and bibliographical data are discussed.

[Treatment of pertrochanteric femoral shaft fractures using the Küntscher trochanter nail]. / Die Behandlung der pertrochanteren Oberschenkelbrüche mit dem Trochanternagel nach Küntscher.

Pertrochanteric femur fractures may be problematic for patients in advanced age in whom a major surgical intervention or lasting bedrest may lead to dangerous complications or subsequent diseases. Immediate, tender osteosynthesis for good loadbearing stability is the answer to the problem. The author describes his own technique of trochanteric nailing according to Küntscher which has so far been applied with good success to 744 patients.