[Mechanical force exercised on the elbow joint in olecranon fractures (author's transl)]. / Mechanische Kraftwirkung auf das Ellenbogengelenk bei Olecranonfrakturen.

Opinion is fairly unanimous on the need for surgical treatment of disclocated olecranon fractures. However, opinions differ regarding the mechanical backgrounds and practical application of the presently widely used tension wiring. The article attempts to clarify the picture of the forces involved in the humero-ulnar joint. Basing on the points of attack of these forces and on the influence of the ligamentum collaterale ulnare, the fractures are subdivided into three groups with individual demands on the respective fixation method and the permissible post-operative exercise therapy. Post-operative plaster immobilisation is not indicated in these cases.

[Olecranon fractures. A retrospective examination of surgically treated fractures (author's transl)]. / Olecranon-Frakturen. Eine Retrospektivuntersuchung operativ behandelter Frakturen.

Retrospective examination of 27 patients with olecranon fractures who had undergone surgical treatment showed that--in agreement with theoretical considerations--osteosynthesis via tension wiring, although suitable for proximal fractures, is unsuitable for fractures of a more distal nature. A different method must be employed for distal fractures. Additional plaster immobilisation does not exercise any influence on consolidation, nor does it affect functional rehabilitation.

Halsted revisited: internal mammary sentinel lymph node biopsy in breast cancer.

OBJECTIVE: To investigate the feasibility of internal mammary sentinel lymph node biopsy as a method to refine and thereby improve nodal staging in breast cancer. SUMMARY BACKGROUND DATA: The internal mammary lymph node status is a major prognostic factor in breast cancer. If positive, prognosis is less favorable. However, staging this regional nodal basin is not performed routinely, thus discarding additional staging information. METHODS: In a consecutive series of 256 patients with primary breast cancer, sentinel node biopsy was performed based on lymphoscintigraphy, intraoperative gamma probe detection, and blue dye mapping using 10 mCi (370 MBq) (99m)Tc-nanocolloid injected peritumorally and 0.5 to 1.0 mL Patent Blue V injected intradermally. During surgery, whenever possible, both axillary and internal mammary sentinel nodes were sampled. RESULTS: Lymphoscintigraphy showed axillary sentinel nodes in 95% (243/256) and additional internal mammary sentinel nodes in 25.3% (65/256). The overall success rate of axillary sentinel node biopsy was 97% (249/256). Sampling the internal mammary basin, based on the results of lymphoscintigraphy, was successful in 63% (41/65). In three patients a small pleural lesion resulted from staging this basin. This technique revealed internal mammary metastases in 26.8% (11/41). In 7.3% (3/41), internal mammary nodes showed metastatic involvement without accompanying axillary metastases. CONCLUSIONS: Internal mammary sentinel node biopsy is feasible without serious additional complications. It improves nodal staging in breast cancer by identifying higher-risk subgroups with internal mammary nodal metastases, which might benefit from altered adjuvant treatment regimens.

No-touch isolation technique in colon cancer: a controlled prospective trial.

In order to assess the effect of the no-touch isolation technique, in the treatment of large bowel cancers, on the site of first recurrence and disease-free and overall survival, 236 patients were prospectively and randomly assigned to either the no-touch isolation technique (117 patients) or to a conventional resection technique (119 patients). No patient with distant metastases or unresectable disease entered the study. The two treatment groups were comparable with regard to patient characteristics. Pre- and postoperative complications (including mortality within 30 days) were similar in both groups. After a complete follow-up of 5 years, a tendency for reduction in the number of, and time to, occurrences of liver metastases was seen in the no-touch isolation group (P = 0.14). This effect was most obvious in the sigmoid colon with angio-invasive growth. Overall (P = 0.42) and corrected (P = 0.25) survival did not differ significantly among the treatment groups although in every analysis the survival data of the no-touch isolation group were superior. The data do suggest a limited benefit of the no-touch isolation technique. This observation is important since the morbidity and mortality of surgery were equal in both groups.