Minimally invasive bunionette correction.

OBJECTIVE: Bunionette or 'tailor's bunion' is a deformity of the fifth ray, which comes along with a metatarsus quintus valgus and a varus deformity of the fifth toe with subluxation of the metatarsophalangeal joint. A minimally invasive osteotomy of the fifth metatarsal without internal fixation using burrs is an increasingly used alternative for symptomatic tailor's bunion deformity. Similar to open surgery procedures the type of osteotomy complies with the underlying pathology. Minimally invasive surgical (MIS) procedures allow comprehensive treatment of various types of tailor's bunion deformities. INDICATIONS: Symptomatic tailor's bunion deformity, failed conservative treatment, a closed epiphyseal gap. CONTRAINDICATIONS: Osteoporotic bone, poor patient compliance. SURGICAL TECHNIQUE: The technique comprises percutaneous resection of the lateral exostosis of the fifth metatarsal head with a straight burr and an osteotomy of the fifth metatarsal, either distally, diaphyseal or proximally with a conical burr due to the shape of the deformity, usually without internal fixation. POSTOPERATIVE MANAGEMENT: Redressive wrapping, partial pain-adapted weight bearing. Non-steroidal anti-inflammatory drugs for 3-5 days, lymphatic drainage, intermittent cooling. Radiographic assessment on postoperative day 1; radiographic follow-up 6 weeks postoperatively. Thromboembolic prophylaxis. RESULTS: The clinical outcome is comparable to standard surgical procedures with the advantages of MIS. Based on our results and the current literature, the minimally invasive distal metatarsal osteotomy without fixation is becoming a reliable treatment for tailor's bunion.

["Routine" versus "on demand" ultrasonography in the surgical intensive care patient. A prospective randomized study]. / "Routine"-versus "On-demand"-Sonographie des chirurgischen Intensivpatienten. Eine prospektive randomisierte Untersuchung.

Between May 1988 und March 1989 all patients who underwent elective or emergency surgery followed by intensive care were randomly assigned to group A (n = 149): routine sonography at the postoperative day 1, 3, 7 and 9, group B (n = 151): sonography on demand. In these two groups, the following parameters were compared: number of relaparotomies, lethality of relaparotomies, total lethality, moment of relaparotomy, period of hospitalisation, time spent with sonography. In the analyzed parameters, our examination showed no difference between the two groups. For this we state that the routine sonographical control of the surgical patient with intensive care being opposed to the sonography on demand shows no significant advantage. The demand for a routine sonography as a postoperative control can not be generally supported.

The size of the aortic arch: a suitable criterion for differentiating between congenital heart diseases with left-to-right shunt?

A retrospective study was carried out to determine whether aortic arch size can be regarded as a reliable criterion for differentiating between congenital left-to-right shunt defects. The PA and AP plain chest films of children of all age groups with ductus arteriosus persistens (DAP) (n = 91), atrial septal defect (ASD) (n = 86), ventricular septal defect (VSD) (n = 87) and a normal control group (n = 387) were used to measure the size of the aortic arch, and an aortic index (AI) was calculated from aortic arch size and the height of the eighth thoracic vertebral body. Three age classes were defined from the AI values of the control group, and the diagnostic groups in each age class were compared with each other. Enlargement of the aortic arch, as reflected in an elevated AI value, was found most frequently in DAP cases. The size of the aortic arch is, however, of varying differential diagnostic value, depending on the age group. No correlation was found between aortic arch size and the size of the left-to-right shunt in cases of DAP.

[Disposable versus reusable instruments in laparoscopic surgery--a controlled study]. / Einmal-versus wiederverwendbare Instrumente in der laparoskopischen Chirurgie--eine kontrollierte Untersuchung.

The instruments for laparoscopic surgery are usually available in a disposable and in a reusable type. We performed a prospective, randomized study, based on the most frequent laparoscopic operation, the cholecystectomy, in order to directly quantify and compare the advantages and disadvantages of both types of instruments. 158 patients, who planned to undergo a cholecystectomy, were randomly distributed into two groups. 80 patients (group A) underwent surgery with reusable instruments and 78 patients (group B) with disposable instruments. We investigated the following parameters and compared them for both groups: length of operation, complications, conversion rate to open surgery, subjective postoperative pain, length of inability to work, technical problems during operation, postoperative hospitalization time, satisfaction of operating room personnel. The analysis of the results demonstrates no difference in the postoperative hospitalization time, in the postoperative complication rate, subjective pain sensation and postoperative inability to work. Differences in favour for the group of patients, operated with disposable instruments, were found in the conversion rate, in the length of operation and, statistically significant, in the amount of intraoperative problems, caused by instrument-technical reasons. Even if considering the greater expenses in time and personnel costs, operations with reusable instruments are in average 1015 DM cheaper.

[Long-term therapy following myocardial infarct with isosorbide dinitrate in a low and high dose]. / Langzeittherapie nach Herzinfarkt mit Isosorbiddinitrat in niedriger und hoher Dosis.

The favorable response to nitrates in the case of coronary heart diseases is based on both reduction in left ventricular pre- and afterload and improvement in coronary flow. These effects were studied in the setting of a long-term ISDN therapy with reference to the prognosis of patients after myocardial infarction. Following acute treatment in the respective hospitals, 608 patients with myocardial infarctions were allocated to two double-blind treatment groups with different ISDN dosage levels (group 1 = 5 x 2.5 mg i.d.; group 2 = 5 x 40 mg i.d.) and followed up over a period of 2 years. No differences were found with regard to the end points sudden cardiac death, reinfraction, and indication for revascularization. There was, however, a more frequent additional administration of calciumantagonists to patients of the low-dose group (p less than 0.05), a more frequent drop-out due to the lack of beneficial therapeutic results, and a more exceptional drop-out due to side effects in patients treated with low doses of ISDN (n.s.). The absence of any significant difference with regard to the end points might be attributed to; 1) a loss of potency of high-dose ISDN and simultaneous ineffectiveness of low-dose ISDN; 2) an efficacy of low doses; 3) an absence of actual influence on the target parameters, and 4) an inadequate follow-up time period.