[Traumatology in the elderly. Treatment concept in per- and subtrochanteric fractures in the elderly]. / Traumatologie beim alten Menschen. Behandlungskonzept bei per- und subtrochanteren Frakturen alter Menschen.

The aim of treatment of trochanteric fractures in the elderly patient is a prompt procedure, which allows early load bearing. Between 1986 and 1988 272 patients were treated with per- and subtrochanteric fractures: pertrochanteric fractures were stabilised by means of the dynamic hip screw (DHS), subtrochanteric fractures via the 95 degree condylar plate. With both methods an early mobilisation of the patients is possible. In 70 per cent of cases treated with DHS, early load bearing could be achieved within one week. 80 per cent of the patients were operated on within the first 24 hours after trauma. Complications of the methods (incorrect position of the lag screw, plate protrusion) were seen in one case in each group. The overall infection rate was 2.2 per cent. Hospital mortality was 10 per cent. On reviewing the results obtained, we approved of the concept of treatment.

Lung abscess (6 cm) of unexplained origin in a 36-year-old woman.

A 36-year-old woman developed a lung abscess following an episode of influenza. Repeated blood cultures were negative. In necrotic material obtained by bronchoscopy no pathogenic micro-organisms were found. Penicillin-clavulanate, cefodizim and metronidazole were without success. The combination therapy with imipenem-cilastatin together with clindamycin improved clinical symptoms, normalized pathological laboratory parameters and completely resolved the lung cavity.

[Drug induced esophageal ulcers]. / Das medikamentös bedingte Osophagusulkus.

Drug induced esophageal ulcers are more frequent than supposed. Four ulcerative lesions of the esophagus, two after ingestion of doxycycline-hydrochloride, one after metacycline-hydrochloride, and one after emeproniumbromide were detected at the department of Internal Medicine of a medium-sized standard-hospital during the last six years. Symptoms develop suddenly after taking the drug with minimum fluid, usually before going to bed. Retrosternal burning, odynophagia and dysphagia are pathognomonic features. The cause of ulceration is discussed to be a matter of the drug remaining in the esophagus and of its local cytolytic and corrosive effect. Cytomegalo and herpes-simplex-infections can be excluded as etiologic factor of such ulcers. The clinical diagnosis is verified by endoscopy only.

Thoracoscopic wedge resection of peripheral lung lesions.

The increasing experience with minimally invasive surgery and advances in endoscopic equipment have expanded the role of thoracoscopy to include thoracoscopic pulmonary resections. In 11 patients we have evaluated the technical feasibility of thoracoscopic wedge resection of single peripheral lung lesions. In 8 patients the lesion could be exactly identified by thoracoscopy and be effectively resected using an automatic endoscopic stapler. All lesions were located within the outer third of the lung parenchyma with a maximum distance of 1.4 cm between lesion and visceral pleura. Mean diameter of the nodules was 1.9 cm and ranged from 1.0 to 4.1 cm. Histological analysis revealed completely excised tuberculomas in 4, carcinomas in 2, hamartoma in 1, and localised fibrosis in one patient. In 3 patients the thoracoscopic approach was unsuccessful because of difficulty in identifying the lesion or impossibility of achieving a reliable assessment of the intraparenchymal extension of the tumor. In conclusion, thoracoscopic wedge resection is helpful for the diagnostic and therapeutic management of peripheral lung lesions in carefully selected patients. Continued experience is necessary to be able to establish reliable criteria to assess which types of lung lesion can be excised safely and effectively by videothoracoscopy.

Detection of Mycobacterium tuberculosis complex in clinical specimens by a commercial polymerase chain reaction kit.

A total of 722 respiratory and 86 nonrespiratory specimens obtained from 456 patients were tested for detection of Mycobacterium tuberculosis complex by a commercial polymerase chain reaction (PCR) kit (Amplicor, Roche Diagnostic Systems) and the results compared with those of microscopy and culture (solid and radiometric media). Respiratory and nonrespiratory specimens were analysed separately. Of the respiratory specimens, 54 were positive for Mycobacterium tuberculosis complex both in the PCR and in culture, five were positive in the PCR but negative in culture, and eight were positive in culture but negative in the PCR. Four cultures were positive for mycobacteria other than Mycobacterium tuberculosis; none of these gave a positive result in the commercial test. Resolution of discrepant results was performed by analysis of patients' clinical data. For respiratory specimens the sensitivity of the commercial test was 87.6%, the specificity 99.6%, the positive predictive value 96.6%, and the negative predictive value 98.7%. For nonrespiratory specimens the sensitivity was 60%, whereas the specificity ranged as high as 98.6%. For this group the positive predictive value was 85.7% and the negative predictive value 94.9%. When respiratory specimens are used, the commercial PCR test for detection of Mycobacterium tuberculosis complex, with its high sensitivity and specificity, is a good complementary diagnostic tool for rapid diagnosis of bronchopulmonary tuberculosis in a routine mycobacterial laboratory.