INTRODUCTION:In spite of new surgical techniques and recently developed antibiotics, there is no satisfactory solution for the treatment of chronic posttraumatic osteomyelitis. The introduction of local antibiotic treatment with gentamicin-PMMA beads according to Klemm has provided new stimuli for the treatment of chronic osteomyelitis. With the development of collagen as an absorbable carrier substance, the disadvantages of the rigid carrier system became evident. Due to the varying surgical techniques and different forms of adjuvant therapy, it is difficult to assess therapeutic methods and compare different studies. Therefore, it seemed appropriate to study the effect of local treatment with different antibiotic carriers in the setting of an animal study.MATERIALS AND METHODS:The proven rat model for Staphylococcus aureus-induced osteomyelitis was used to compare the results of monotherapy with cefazolin, gentamicin-PMMA beads, or gentamicin-containing collagen sponge with the combination of local and systemic antibiotic treatment.RESULTS:Single-agent therapy with parenterally administered cefazolin reduced the CFU from 3.7 x 10(6) to 2.9 x 10(4) g(-1) of tibial bone. The effect on osteomyelitis was more pronounced with the local application of antibiotics. The best results were achieved with the gentamicin-containing collagen sponge which reduced the bacterial colony count to 1.4 x 10(2) CFU/g compared with 9.8 x 10(2) CFU/g achieved with gentamicin-PMMA beads. The effect was most marked using a 4-week combination therapy with local application of the gentamicin-containing collagen sponge and systemic administration of cefazolin. In 9 of 11 animals, no bacteria could be detected in the bone.CONCLUSION:Each of the treatment modalities resulted in a significant therapeutic effect. Due to its ability to quickly release large amounts of gentamicin, the flexible gentamicin-containing collagen sponge proved to be superior to the rigid PMMA system. Although the gentamicin-containing collagen sponge provided high antibiotic concentration at the site of implantation, an additive effect was attained when combined with systemic antibiotic treatment.

Die dynamische Hüftschraube (DHS) der AO ist ein bewährtes Osteosynthesemittel bei stabilen Frakturen. Die Versorgung instabiler Frakturen bereitet hingegen Probleme, da es aufgrund des Schraubengleitprinzips zu einer erheblichen lateralen Dislokation der Fragmente kommen kann. Steht alternativ kein anderes Operationsverfahren zur Verfügung, kann die Belastungsstabilität der DHS durch eine lateral aufgesetzte T-Platte verbessert werden. In vier Fällen konnte primäre Belastungstabilität erreicht werden.

Die Versorgung der Koxarthrose mit einer zementierten Duokopfprothese stellt bei alten und multimorbiden Patienten eine sinnvolle Behandlungsalternative zur Totalendoprothese dar. Die Frühergebnisse zeichnen sich durch eine tolerable Rate von Komplikationen und eine rasche Mobilisierbarkeit der Patienten aus. Besonders die Mortalität scheint niedrig zu sein. Auch die Spätergebnisse sind gut. Die Rate von Protrusionen ist niedriger als bei einfachen Kopfprothesen. Paraartikuläre Verkalkungen finden sich oft. Schmerzen mit Projektion auf die operierte Hüfte sind häufig.

Inoperable tumor stenosis of anus and rectum may be treated surgically only by implantation of artificial anus. Cryosurgery proves to be a feasible alternative in order to maintain free passage of the gut. The cryoprobe is introduced through a rectoscopy under direct view. Visible tumor is touched with the tip of the cryoprobe and subsequently temperature is lowered to approximately -19 degrees C. Usually anesthesia is not required. From 1976 to 1989, 213 patients had been treated by cryosurgery in our department. In 23 cases the use of an artificial anus became inevitable afterwards.

Im Jahre 1906 gelang José Gayanes erstmals mit einem Vena-iliaca-Interponat eine Überbrüekung zwischen der Arteria iliaca und der Arteria femoralis. Die weitere Entwicklung der rekonstruktiven Gefäßchirurgie war von vielen Höhen und Tiefen geprägt. Entscheidende Weiterentwicklungen und Steigerungen der Offenheitsrate nach Gefäßrekonstruktionen erfolgten während der beiden Weltkriege und durch den Einsatz des Heparins.

Serumendotoxins were measured in 11 patients after gut surgery and compared with healthy people as a standard. In cases of uncomplicated course 3 to 4-fold raised serumendotoxin levels were observed in a typical two-peak pattern. It was not before the fifth day following operation that serum levels declined constantly. In contrast to these findings, patients suffering from septic complications showed a permanently raised endotoxin level, which correlated well with their clinical course. Therefore single peaks of serumendotoxin measured after operation should not be overvalued. Constantly raised levels following operation, however, may indicate some kind of septic complication.

Serumendotoxins were measured in 11 patients after gut surgery and compared with healthy people as a standard. In cases of uncomplicated course 3 to 4-fold raised serumendotoxin levels were observed in a typical two-peak pattern. It was not before the fifth day following operation that serum levels declined constantly. In contrast to these findings, patients suffering from septic complications showed a permanently raised endotoxin level, which correlated well with their clinical course. Therefore single peaks of serumendotoxin measured after operation should not be overvalued. Constantly raised levels following operation, however, may indicate some kind of septic complication.

The insulinoma is the most common pancreas tumour with endocrine activity, with more than 2,000 cases being described in the literature worldwide. The first successful extirpation was performed by Graham in 1928. Clinical appearance is characterized by severe paroxysmal hypoglycaemia together with inadequately increased serum insulin levels. Surgery is indicated in such situations because of limited effectiveness of medicamentous therapy. Surgical approach and long-time results are discussed in this paper, with reference being made to 13 cases of the authors.

The chances for conservative treatment of bleeding ulcers have been expanded by progress in endoscopic haemostasis. Surgery, nowadays, is in many cases applied only to patients with uncontrollable recurrent haemorrhage, after the internist's efforts have failed. This has increased lethality from 20 to 44 percent. To improve results, elective operation is recommended in the no-bleeding interval, following endoscopic haemostasis.

Our modified all-layer suture technique allows surgery of colon and rectum with a low rate of anastomotic leaks (2%). In experimental animal research on pigs we compared the modified all-layer suture with the Gambee and the stapling technique. The circulation was examined by radioactive marked microspheres, by microangiograms and by special injection preparations.

Auscultation of bowel sounds has a decisive position in management of intestinal paralysis, although personal bound interpretation and documentation may give rise to problems. Our computerized electronic analysis system of bowel sounds permits easy objectivation of auscultation findings. This noninvasive method is optional a repeatable. We investigated 15 patients suffering from intestinal paralysis using this method. Good correlations between clinical findings and the results of our analysis allow reliable estimations of therapeutic measurements. Dosage of drugs influencing peristalsis is facilitated.

Ultraschall erleichtert die zeitgerechte Zuordnung der vielfach infolge des Ersteingriffs maskierten postoperativen, konkrementfreien Streß-Cholezystitis bei Intensivpatienten. Histamin und der Faktor XII assoziierte Komplex gelten als prädominante Mediatoren. Bei vertretbarem Operationsrisiko und niedrigem HIS-Index (Hannover Intensive Score) erfolgt die Frühcholezystektomie. Besteht ein desolater Allgemeinzustand mit hohen Score-Werten, so favorisieren wir in Lokalanästhesie entweder die sonographisch geleitete, percutane oder die chirurgische, konventionelle Cholezystostomie. Dieses Vorgehen senkt die Kliniksletalität um etwa 10%.

A total of 57 consecutive cases of complete acromioclavicular dislocations are reported. They were treated by open reduction and Balser's hook plate fixation supplemented by ligament suture.

Intestinal noise analysis by means of a computerized analyser is a method by which various functional states of the gastro-intestinal tract can be diagnosed. Interference noise from respiration and cardiac action can be suppressed by filtering. Frequency patterns determined were in good correlation with the clinical picture and auscultation findings. It is, basically, possible to identify the original causative organ.