Zentralblatt für Chirurgie
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A consecutive series of 119 type III B compound fractures in 103 patients was treated at the University of Louisville from May 1983 to May 1989. All patients had timely irrigation of their wounds, serial wound debridements, external skeletal stabilization and parenteral systemic antibiotics (penicillin, cefazolin, tobramycin). 96 open fractures were managed with the supplemental local use of tobramycin-PMMA-beads. ⋯ The amputation rate was overall 5%, 9.7% for the lower leg. Four patients died due to multiple trauma.
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Patients with an acute "brain damage" where an intracranial pressure rise can be suspected due to the pathophysiological context are an indication for intracranial pressure measurement. For registrating the reduction of the intracranial reserve space before the rise of the medium pressure, volume-loads from the side-ventricles were undertaken with 54 neurosurgical patients. A better bedside monitoring is possible though the mathematical registration of those factors which indicate the size of the functional intracranial reserve space. With the calculated parameters of the reserve space (pressure-volume-index) a theoretical pressure-volume-curve was demonstrated.
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Case Reports
[Post-traumatic hemobilia and successful direct treatment of the arteriobiliary fistula].
Traumatic hemobilia is a rare complication of deep and central liver injuries. Repeated and massive bleeding requires an active therapy. ⋯ Of surgical techniques, ligature of the art.hepatica comm. or propria and direct closure of the fistula in the liver parenchyma are recommended. The authors report on such a successful direct intervention in a 9-year-old girl.
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One aim of the intracranial pressure measurement is observing constantly patients with intracranial space-occupying factors and therefore to act diagnosticly and therapeutically correct at the right time. Through the continual registration of the intracranial pressure amplitude in relation to the medium intracranial pressure it is earlier possible to forecast intracranial pressure rise and to deal with this than with just the simple measurements of medium intracranial pressure. With 40 neurosurgical patients such examinations were undertaken after implantation of a ventricle catheter. The value of this method was proven during the continual observation of the patient.