Zentralblatt für Chirurgie
-
Review
[Dislocation fractures in the area of the middle foot--injuries of the Chopart and Lisfranc joint].
Dislocation fractures of the Chopart and Lisfranc joint line result from rough force and lead to articular incongruities, complex derangement of the plantar arc geometry and shortening of the medial or lateral column of the foot. These injuries are often complicated by severe soft tissue damage causing a high incidence of compartment syndrome. Beside careful clinical examination radiographs in 3 standard projections are essential for the exact diagnosis, if necessary completed by conventional tomographies or CT. ⋯ Dislocation-fractures of the Lisfranc joint can be fixed by percutaneous K-wires if a closed reduction is possible. Open reduction and internal fixation are indicated in cases of instable and irresponsible fractures, and in open fractures as well as in lesions presenting with a compartment syndrome. A precise anatomic reduction of the tarsometatarsal joints is critical after this kind of injuries to avoid long-term disability.
-
Like other industrial countries Germany experiences a significant increase of cancer prevalence. Recent advances in the treatment of various types of cancer resulted in prolonged survivaltimes of patients. Cancer--especially in advanced incurable stages--often is accompanied by severe pain. ⋯ Most cancer-patients should experience sufficient pain-management if existing recommendations for the pharmacological treatment of cancer-pain (e.g. WHO-guidelines) are followed consequently. In case of intractable pain or ongoing disabling symptoms despite proper therapy consultation of an expert in palliative medicine should always be considered as well as the option to refer the patient to a specialized pain-management center.
-
To describe the idea of palliative medicine and its forms of organization in the inpatient and outpatient sectors, and in particular to describe the projects for palliative medicine at the University of Cologne, specifying costs and the 1996 statistics of the palliative care unit. ⋯ Palliative medicine is expensive; only a few patients have the benefit of this; relatives may suppose to be relieved of the burden of their responsibilities; however: the severely ill and dying patients of the hospital experience the best possible care at home or in a "family atmosphere"; gain in experience of palliative medicine and multiplier function, research; awaking our society to thoughts of their own hour of death and what comes after it.
-
We analyzed 276 patients operated on for acute appendicitis between January 1995 and June 1997. In 26 patients intraoperative assessment revealed a pathological finding other than appendicitis. ⋯ Negative histological findings were most common in younger females admitted on Mondays and Tuesdays. Clinical observation rather than immediate operation and laparoscopy rather than laparotomy appear appropriate for the latter group and may lower the rate of negative appendectomy.
-
Retrograde intramedullary fixation of proximal humerus fractures with flexible wires was evaluated in a prospectively documented study. Seventy-four fractures in 73 patients with unstable proximal humerus shaft or neck fractures were fixed with 3-11 flexible intramedullary wires. The age of the patients averaged 72 years (42 females, 31 males). ⋯ A minimum follow-up of 12 months (average 16.5 months) could be obtained in 61 patients (84%). According to the Neer- and Constant-scores 60% showed good or excellent results, 30% had a satisfactory and 10% had an unsatisfactory or poor result.--Retrograde intramedullary, flexible wire fixation can provide an overall satisfactory outcome in unstable proximal humerus fractures of the elderly. However, the high incidence of secondary wire dislocations especially in marked osteoporosis appears to be an unsolved problem of this treatment modality.