[Pertrochanteric fractures in advanced age: optimal time of surgery (author's transl)].
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Biomedical subjects
Publications and source records attributed to L Schmid.
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The application of CT represents an important progress not only in diagnostic and therapeutic planning, but also in the evaluation of the effectiveness of follow-up procedures in gynecologic cancer therapy. The evaluation of the results of some follow-up procedures in a case of leiomyosarcoma uteri shows significance and importance of CT as a new radiologic method. Inspite of preliminary negative results of extensive radiologic, myelographic, laboratory investigations and of technetium- and gallium-scintigraphy, CT proved a solitary metastasis located at S-1 in the os sacrum. The diagnostic aspects of follow-up examinations in patients undergoing cytoreductive surgery or radiotherapy are discussed. CT should not be placed at first rank position, but be considered as an helpful additional means for special cases.
In a case of unilateral aplasia of one Arteria pulmonalis, i.e. proximal interruption, the diagnostic value of perfusion and ventilation scintigraphy is shown to be simple and non-invasive, exposing the patient to a lower radiation dose than other diagnostic screening methods. When an interruption of a main pulmonary artery is radiologically suspected the scintigraphic examination allows to distinguish between vascular and/or parenchymatous pulmonary diseases, thus clarifying the diagnosis of primary pulmonary malperfusion. The results of other examinations, the relevant literature, the pathogenesis and pathophysiology of unilateral pulmonary artery aplasia as well as therapeutical and prognostic aspects are reviewed.
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Radioimmuno-Assay (RIA) of Thyroid-Stimulating-Hormone (TSH) was performed before and after i.v.-injection of Thyrotropin-Releasing-Hormone (TRH) in 350 patients subsequent to previous resection of euthyroid goiter to find out the optimal treatment schedule for preventing recurrent goiter. In patients without recurrent goiter the dosis of thyroid hormone was considered to be sufficient, if the difference in TSH-levels before and after TRH (delta-TSH) was equivalent to or less than 10 microunits/ml. In patients with recurrent goiter the optimal suppressive dosis of thyroid hormone was accepted for a delta-TSH less than or equal to 2,5 microunits/ml. 126 out of 135 patients, who were set on an immediate and continuous postoperative treatment were free of goiter, 58 presented a delta-TSH less than or equal to 10 microunits/ml (average interval of treatment = 2,5 years), 68 patients had elevated delta-TSH (average interval of treatment 2,1 years) as a sign of insufficient treatment. In 9 patients recurrent goiter was detected in spite of "adequate" treatment. 41 out of 57 patients, set on delayed and partly continuous, partly discontinuous treatment had recurrent goiter (in average after 10 years). delta-TSH was not indicative. 158 patients without any treatment had borderline or slightly increased delta-TSH (in average after 10 years). 122 of these 158 patients had recurrent goiter, 36 were free of goiter. The results favor the necessity of treatment with thyroid hormones starting immediately after operation and with continuous treatment. The combined use of TSH-RIA and TRH-test reliably informs about the individual thyroid hormone dosis necessary for prevention or treatment of recurrent goiters.
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Two complications that occurred in connection with the use of CVP catheters in the SVC and IVC in one patient are described: 1. Extravascular injection in the superior mediastinum and in the extrapleural space. 2. Massive thrombosis of the IVC. The differential diagnosis of a wedening of superior mediastinum is discussed. Recommendations are made to prevent these complications.
Forty-one patients with fractures of the distal end of the femur are investigated and the importance of the angular plate designed by the AO group for stabilization of these fractures is discussed. For good results it is necessary to have the complete set of instruments and to consider biomechanical principles for stable osteosynthesis, so that early active exercises can be performed. The operation is not always simple but is indicated considering the poor functional and anatomical results after conservative treatment or inadequate fixation.
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In a 15 year old girl a combination of osteogenic sarcoma and non-ossifying fibroma in the distal shaft of femur is reported and discussed.
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Unilateral pulmonary edema due to chest drainage is reported in the present paper. Drainage was carried out, because of pneumothorax. The disorder could be treated successfully with differenciated mechanical respirator therapy and additionally with methylprednisolon, heparin, spirolactone and dopamin. Based upon clinical symptoms and on present literature we suggest to account this so called "pulmonary edema exvacuo" to the main complex of acute respiratory insufficiency (unilateral shock lung).
Several conditions must be accomplished for successful treatment of posttraumatic osteomyelitis, as there are stability in fracture region, surgical debridement, wound irrigation, cancellous bone transplantation and skin grafting. All this surgical methods involve possibilitis of complications. The most of them can be avoided observing certain rules of management.