[Management of an explosion injury of the face]. / Versorgung einer Explosionsverletzung des Gesichtes.

A 19 year old soldier suffered an explosion injury of the face. He lost the left cerebral hemisphere, the left eye and ear and the majority of the facial musculature on the left side. Primary surgery with rotational flap and mesh graft. Further local flaps and revision of wound area followed. Inspite of nearly complete destruction of the left cerebral hemisphere the patient could walk with only slight hemiparesis. He learned to write with his left hand, he could read from the lips and stand. An understandable speech could not be obtained. Fitting of an epithesis.

[The effect of various steroid hormones on the course of pseudomonas infections in 3rd grade burns]. / Die Wirkung verschiedener Steroidhormone auf den Verlauf der Pseudomonasinfektion bei drittgradigen Verbrennungen.

The effect of hydrocortisone, aldosterone, and estrogen on the course of pseudomonas infection after third-degree burns was examined in animal experiments. The effect of the drugs is represented by different lethality rates. Hydrolytic hydrocortisone reduced the average survival time as well as aldosterone. Estrogen, however, had no statistically ascertained effect on lethality.

[Three different tumors in a case of synovial sarcoma of the hand]. / Dreifaches Tumor- geschehen bei einem Synovialsarkom der Hand.

Examining a 74 year old female patient with a nodular goiter, a tumor of the left thenar eminence with a concurrent radiolucent swelling in the adjoining second metacarpal was found. The diagnosis was a struma nodosa with regressive marginal changes, a hypervascularized monophasic synovial sarcoma of the wrist joint, and an enchondroma of the second metacarpal bone. Following the amputation of the forearm, no radiotherapy or cytotoxic therapy was performed. After a follow-up time of one year no metastases were detected.

[A new treatment method for hydrochloric acid burns of the hand]. / Eine neue Behandlungs-methode von Flusssäure-Verätzungen der hand.

The progression of hydrofluoric acid corrosion on the hands, which cannot be arrested by other means and leads to crippling or amputation, can be stopped by one single or several repeated intra-arterial perfusions of 10 ml 20% calcium-gluconate solution in 40 ml normal saline over 4 hours as close to the defect as possible via the brachial artery or one of the forearm arteries. In 4 patients, with corrosion of a severity judged to be between first and third degree, spontaneous healing resulted after this treatment. Based on our experience we advise the use of intra-arterial perfusion and show its advantages over subcutaneous injections or intravenous infusion of calcium.

[Studies on wound healing and secondary and tertiary wounds]. / Untersuchungen zur Wundheilung von Sekundär- und Tertiärwunden.

From animal experiments, the authors draw the following conclusions: 1. Compared with primary wounds, the tensile strength of secondary and tertiary wounds is significantly elevated. 2. Aside from a slight elevation on the third day, there is no difference of tensile strength between secondary and tertiary wounds. 3. Collagenous fibers are earlier formed in secondary and tertiary wounds because the initial phase of fibrillogenesis is shortened due to more developed granular tissue with increased vascularization as compared with primary wounds. Whether local factors influence the accelerated healing and the tensile strength of the wounds requires further investigation.

[Experimental studies on the effect of incisions with the electric knife on wound healing]. / Experimentelle Untersuchungen über die Wirkung von Inzisionen mit dem elektrischen Messer auf die Wundheilung.

In 114 albino rats the healing of incisions by scalpel and of several kinds of electrosurgically induced skin wounds was studied. The authors used the electrotome Martin 800 RFS. Incisions with the least coagulation which were the most blood-drenched healed best. These wounds were the tightest. Much coagulation distinctly worsened wound healing. That depends not only on the adjustment of the electrotome but also on the electrodes and the velocity of cutting. Proper cutting technique, adequate form of the electrode, and optimal amperage are required to combine the advantages of the less-bleeding non-pressing cut with satisfactory wound healing. The best results of the experiments are reported in detail.

[Animal studies on the modification of neuroma formation]. / Tierexperimentelle Untersuchungen über die Beeinflussung der Neurombildung.

In conclusion, the formation of the whole neuroma cannot be prevented completely by the local application of triamcinolon. The outgrowth of the neuronal fibres though, which seem to be responsible for the painful discomfort of the patients, can be suppressed or even prevented completely.

[A rare anatomical condition causing carpal tunnel syndrome]. / Anatomische Rarität als Ursache für das Karpaltunnelsyndrom

We present a case of carpal tunnel syndrome that was caused by longitudinal splitting of the median nerve by an additional M. flexor digitorum sublimis. This is an anatomical variant, that has in this form not yet been described as the cause of a carpal tunnel syndrome.

[Rupture of the distal biceps tendon and its treatment]. / Der distale Bizepssehnenabriss und seine behandlung.

Rupture of the distal tendon of the biceps muscle is an uncommon injury. It mostly happens to strong men whose biceps muscle are contracted and overstretched unexpectedly. Contrary to the good results after conservative treatment of the numerous ruptures of the proximal tendons the distal tendon must always be surgically reconstructed. Three cases of rupture of the distal biceps tendon are reported and their good results are shown following an modified operation originally described by PLATT.

The prognostic and therapeutic importance of changes in the CSF during the acute stage of brain injury.

This research deals with the gaseous and biochemical changes in the cerebrospinal fluid and their effects on the cerebral blood flow and metabolic rates in the acute stage of brain injury. The results have shown that the lactacidosis in the CSF is of importance for prognosis and therapy, because of its central position in the course of pathophysiological mechanisms after a traumatic brain injury. Thus the lactate concentration in the CSF does give early information about the further clinical course. CSF acidosis itself can be influenced in a favourable way by intrathecal therapy with sodium bicarbonate.

[Cerebrospinal fluid changes in severe craniocerebral injury and their therapy]. / Liquorveränderungen beim schweren Schädel-Hirn-Trauma und ihre therapeutische Beeinflussung

The sign of a traumatically caused alveolar hyperventilation in severe cranio-cerebral injury is a respiratory alcalosis as well as hypoxia and hypoxemia in the arterial as well in the cerebral veneous blood. The combination of decreased oxygen tension or saturation and hypocapnia can exist for several days and in a lethal course transform into a combined metabolic respiratory acidosis with increasing carbonic acid tension and so initiate the prefinal state. The extremely pathological blood gases are usually the first sign of shock-specific changes of the lung. The most impressing changes of the cerebrospinal fluid are the metabolic acidosis in combination with a diminished oxygen tension and tissue hypoxia of the brain. The acidosis of cerebrospinal fluid in severe brain injury is not only of prognostic but also of therapeutical importance. The treatment of the acidosis of cerebrospinal fluid by intrathecal administration of buffering substances in severe brain injuries and its sequelae can have a favourable influence on the cerebral circulation and brain metabolism.

[Conservative treatment of extensor tendon injuries]. / Konservative Behandlung von Strecksehnenabrissen

Report on 35 cases of mallet finger treated conservatively: a circular plaster cast was modeled in hyperextension of the distal interphalangeal joint. The immobilisation of the whole finger form the tip to the proximal phalanx was maintained for six weeks. The reported results were good or excellent with the exception of two cases.

[Gas levels and biochemical changes in cerebrospinal fluid after experimental brain injury: its effect on cerebral circulation and cerebral metabolism as well as its management]. / Gasanalytische und biochemische Liquorveränderungen nach experimenteller Hirnschädigung, ihre Wirkung auf die Hirndurchblutung und den zerebralen Stoffwechsel sowie ihre therapeutische Beeinflussung

1. After brain damage experimentally induced by balloon compression, liquor of the cistern shows a metabolic acidosis with significantly increased lactate level and L/P quotient, and statistically distinct decrease of pH, oxygen tension, and bicarbonate level. 2. There is a considerable disproportion between the changes of acid-base metabolism, gas tension, and metabolic products in cerebrospinal fluid compared with much less expressed disturbances in the blood. 3. The advanced edematous phase shows distinct accumulation of water in the tissue, considerable increase of intracranial pressure, resp. decrease of effective perfusing pressure, loss of autoregulation, and decreased regional and global cerebral circulation, while the pathologic alterations of cerebral fluid are intensified. 4. Treatment of lactate acidosis in the liquor by intrathecal application of sodium bicarbonate results in improved cerebral circulation and metabolism of the cerebral tissue, having thus a good influence on cerebral damage and its sequels.

[Verner-Morrison syndrome]. / Das Verner-Morrison-Syndrom

Based on one case the Verner-Morrison-syndrome is demonstrated and discussed in detail. Clinically profuse watery diarrhea and severe hypokalemia are predominant. The pathogenesis is not quite clear. Curative therapy consists in radical surgical removal of the endocrinologically active tumores or diffuse hyperplasia.