Biomedical subjects
Publications and source records attributed to R Sailer.
Two cases in which the M. opponens pollicis was ruptured with a bony fragment are reported. In each case the injury, which occurred in young people (24-29 years of age), was the outcome of a fall during alpine skiing, whereby the hand hit the icy slope. Operative treatment was necessary due to the intense subjective pain which followed a significant thenar hematoma.
Malunion of distal radius fractures leads, especially in those patients who are manually employed, to functional disability of the hand. Painful impingement on the ulnar side of the wrist results in decreased range of motion in pronation/supination and loss of strength. By reconstructing as precisely as possible the axial and longitudinal relationship of the forearm bones, the desired congruence of the distal radioulnar joint can be achieved, this improving greatly the strength and function of the hand. Indications, point of time, as well as technique in operating will be presented in short form in 42 of our own cases: complications will also be discussed. The roentgenographic and functional results, as well as the subjective evaluation from 33 patients whose operations took place longer than a year ago, before and after the malunion correction, will be listed according to our postoperative examination protocol for radius fractures. In all three parameters positive results could be shown, especially in the patient's subjective analysis. Notice will be taken on the special difficulties in position corrections in cases in which the ulnar side fragment is dislocated.
Fractures at the distal end of the radius are the most frequent fractures. There are still many therapeutical problems. The success of conservative or operative treatment depends mainly on the different types of fractures. In order of compare end results and to recommend therapy, it is necessary to define different fracture types, based on practical classification. A classification of fractures at the distal end of the radius is presented, with localization and reference to the extent of injury with consideration of lesions of the radiocarpal joint and indirectly to the distal radio ulnar joint. In the period of growth five types of injuries are differentiated. In adults three main groups, depending on the involvement of the radio-carpal joint are described. These are subdivided according to dislocation. The fractures types were classified by using X-rays of cases over a period of several years. With this classification the pattern of injury of 593 fractures of the distal end to the radius, treated in 1980 in our clinic, was analysed.
In the Innsbruck University Clinic for Traumatology during the years 1978-1985, altogether 17,999 patients received initial treatment for injuries incurred through Alpine skiing. 3240, or 18% of these injuries were trauma to the hand. The most frequently injured area was the thumb, with 1995, or 61.6% of the cases. The most common hand injury in skiing is the socalled "ski thumb", the lesion of the ulnar ligament of the metacarpal-phalangeal joint. Finger injuries accounted for 262 cases, or 8%. The capsule-ligament lesions predominated, especially the palmar capsule lesion of the proximal interphalangeal joint. The most common ligament lesion was the rupture of the radial collateral ligament of the metacarpal-phalangeal joint of the small finger. The metacarpal region was involved in 192 (6%) of the patients. The 4th and 5th metacarpal fractures were often combined with volar dislocation of the caput; the 2nd and 3rd metacarpals showed more often torsion fractures. Luxated fractures were found in all carpal-metacarpal joints. Carpal injuries were the least common, with 2.2%; the bony and ligamentous injuries in this region were, however, more serious. 40 scaphoid fractures were found, along with fractures of the triquetrum, trapezium, hamatum, and pisiform, as well as luxations and luxated carpus fractures. The injuries of the wrist are worthy of more attention. They include lesions of the distal radial-ulnar joint and distal radius fractures, and made up 22.2% of all hand injuries. More emphasis should be placed on diagnostic, therapeutic, and prophylactic measures for these injuries.
Winter sport is of great importance in the Alpine countries. In 1980 3600 persons (10.24%) of all new admittances hospitalized in our hospital were injured when practicing winter sports. In 1983 they lessened to 2597 (7.73%) and in 1985 2999 (5.74%). Analysis of all injuries caused by winter sport activities shows that the number of injured persons is decreasing, severity of the injuries however, increasing. A comparison of the distal radius fractures in 1980, 1983 and 1985 indicates that extraarticular metaphyseal fracture types have decreased, intraarticular fracture with multiple fragments however, have increased. Mainly younger patient suffer from severe fractures. We regard the high pace-risk of the age group as the main course of this fact.
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Circulating levels of insulin, proinsulin-like component, glucagon, growth hormone, and pancreatic polypeptide were measured in 12 patients with functioning insulinomas, and the suppressibility of serum insulin by somatostatin and diazoxide was assessed before surgical removal of the tumors. The hormone content of the tumors was evaluated by radioimmunoassay and by immunofluorescence and the structure of the tumor cells by electron microscopy. Based on these findings, we propose a new classification of insulinomas in two groups: group A is characterized morphologically by abundant well-granulated typical B-cells, trabecular arrangement of tumor cells, and uniform insulin immunofluorescence; functionally, these tumors are associated with a moderate elevation of proinsulin-like component and with an almost complete suppressibility of serum insulin by somatostatin and diazoxide. In contrast, tumors of group B are characterized by scarce well-granulated typical B-cells, a medullary-type histologic structure, and irregular insulin immunofluorescence; functionally these tumors show elevated circulating levels of proinsulin-like component and a marked resistance of insulin secretion to somatostatin and diazoxide inhibition. This way of separating human insulinomas in groups A and B represents a simplification of existing classifications and emphasizes the quantitative ultrastructure in relationship to suppressibility of insulin secretion. The proposed classification of human insulinomas in groups A and B, however, does not allow the assessment of the clinical or histopathologic malignancy of the tumors.
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Stapled ileocolic and colocolic anastomoses can compete with those conventionally handmade. The advantages and disadvantages of the Russian and American EEA staplers are compared. An investigation in 44 German hospitals showed a breakdown of the anastomosis in anterior resection in 11.9%; half of these cases were symptomatic. Although we observed a narrowing of the anastomosis roentgenologically in 15%, it became only clinically relevant in a few cases. With the staplers the duration of the operation can be reduced. Although colostomy is not recommended because the anastomosis eventually shrinks, very deep colorectal anastomoses are now possible with these devices.
Till now etiology and pathogenesis of achalasia of the oesophagus are unknown. The disease is based on dysfunction of the lower oesophageal sphincter. Early and late results of dilatation and surgical procedures are compared. This review deals with 57 operated patients and 102 dilatated ones (Starck's Dilatator). Late results--25 operated and 22 dilatated patients were evaluated on an average at 9.5 or 8.3 years respectively. In the early stage of achalasia 2 to 3 dilatations are recommended. A cardio-myotomy combined witha fundoplication should be performed in high-graded stenoses and after unsuccessful dilatation.
The distribution of metastases in the skeleton corresponds to the presence of active hemato-poetic bone marrow. Osseous metastases distal to the elbow and knee joints are therefore rare. 67 patients with metastatic tumors of the hand were analyzed in a bibliographical review and two cases are added. A hypernephroid carcinoma and a bronchogenic carcinoma had both metastasized to the distal phalanx of the thumb and had simulated a whitlow in both cases. The distal phalanx is the most common site of metastases. The most frequent primary lesions are, in order, lung, kidney and breast. Not only clinically but also radiologically and peripheral bone metastasis can be taken for a whitlow. In most cases the X-ray shows a lytic lesion, often ruptured into the soft tissues. Benign and malignant neoplasms must be considered in the differential diagnosis of such lytic lesions, but mostly they are metastatis. X-ray and chemo therapy in this situation may at least reduce pain otherwise exstirpation of the appropriate fingers or part of the hand is indicated. As a rule survival is short.
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There were 68 thyroids with oncocytic cell changes among thyroid specimens from 2476 thyroid operations performed between 1969 and 1978. In 12 instances there were merely Hürthle cell nests, in 13 there was an oncocytic carcinoma and in 43 oncocytic adenoma. Thyroidectomy was the preferred treatment for Hürthle-cell carcinoma. Five patients were no longer suitable for radical operation, in one there was a recurrence. If there is a potentially malignant oncocytoma, hemithyroidectomy should be performed and careful follow-up is necessary. There was no recurrence maximally 82 months postoperatively.
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Endometriosis is a sufficiently common disease that should always be considered in the differential diagnosis of colon lesions in women of child bearing age. Six selected cases illustrate problems of diagnosis and management of endometriosis of the colon. Characteristics of colon endometriosis are typical large-bowel symptoms such as colicky pains and hemorrhage usually situated in the sigmoid and rectosigmoid region, extramucosal radiologic appearance of a marked smooth-walled stenosis, and the difficult endoscopic and histological preoperative diagnosis. Suspected malignancy and the presence of the symptoms of a colon lesion are indications for bowel resection, which is an effective form of therapy.