Zentralblatt für Chirurgie
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Osteotomy close to the knee is an established method to treat degenerative osteoarthritis of the knee with varus or valgus deformity. However, indications, surgical techniques and results are discussed controversially. ⋯ Supported by our results it is shown that osteotomy of the tibia for degenerative osteoarthritis together with operative arthroscopy in the same operative session gives better results compared to osteotomy alone. Despite the success of arthroplasty of the knee, osteotomy has it's place in the treatment of osteoarthritis.
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Aim of this study was to evaluate the importance of chest ultrasound and chest x-ray for the indication of thoracic drainage of pleural effusions in patients of an operative intensive care unit. Between December 1996 and June 1997 21 patients were included in a prospective trial in the operative intensive care unit. 26 thoracic drainages were used to drain pleural effusions. In all patients chest radiography in supine position and chest ultrasound were performed to assess the need of pleural drainage. ⋯ Considering both x-ray of the chest in supine position and chest ultrasound the correct indication to drain the pleural effusion was achieved in 25 cases (96%). In this prospective trial we compared chest ultrasound and chest radiography and demonstrated that ultrasound is more suitable to determine the amount of pleural effusions than radiography. In case of clinical and radiological suspicion on pleural effusion demanding for drainage a chest ultrasound should be performed to avoid underestimation of pleural fluid.
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Comparative Study
[Postoperative peripheral neuropathies in general surgery].
Postoperative nerve lesions beyond the operative area, the so called positioning traumas are considered uncommon in general surgery. But they can have serious consequences for the patient and the surgeon, including forensic sequelae. The objective of this work was to describe the incidence, pattern, risk factors and course of postoperative neuropathies in general surgery and to identify indicators to prevent these complications. ⋯ Nerve lesions caused by positioning can occur during any operation with any duration in general surgery. They should be avoided by thorough and careful positioning. Also the patient must be informed about the possibility of nerve lesions caused by the positioning.
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Comparative Study
[Early surgery after hip para-articular femoral fracture. Results of a prospective study of surgical timing in 161 elderly patients].
In a prospective analysis the question should be answered, wether the mortality rate of femur fractures close to the hip joint can be diminished by operating as early as possible. 161 patients elder than 65 years could be included in the study. 86% of the 161 patients were operated upon 24 hours after trauma. The infection rate amounted to 3.4% after endoprothesis and to 1.2% after osteosynthesis. The hospital mortality was 7.4%. ⋯ The hospital length of stay could not be diminished by this concept. By operating as early as possible the patients' request for mobility is fulfilled without running unjustifiable risks regarding mortality and postoperative complications. The mortality rate corresponds to the literature.
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Historical Article
[Contribution of Berlin clinics and especially the Charité to the development of modern anesthesia in Germany].
Soon after announcement of the first American ether anesthesias in 1846 one started to anesthetize with ether in Europe. The first ether anesthesia in Germany took place on January 24th, 1947, and was given by Johann Ferdinand Heyfelder in Erlangen. Two weeks later the first ether anesthesia in Berlin was given on February 6th, 1847, by the orthopaedic surgeon Heimann-Wolff Berend. ⋯ The nitrous oxide bottle was introduced into practice by the Barth company in cooperation with the dentist Carl Sauer and Kurt Schimmelbusch introduced his mask for ether anesthesia. Carl Ludwig Schleich reported at the German congress of surgery in 1894 about his first experience with infiltration anesthesia. Spinal anesthesia developed by August Bier in Kiel was improved during his time in Berlin.