The nitric acid burn trauma of the skin.

Nitric acid burn traumata often occur in the chemical industry. A few publications addressing this topic can be found in the medical database, and there are no reports about these traumata in children. A total of 24 patients, average 16.6 years of age, suffering from nitric acid traumata were treated. Wound with I degrees burns received open therapy with panthenol-containing creams. Wound of II degrees and higher were initially treated by irrigation with sterile isotonic saline solution and then by covering with silver-sulphadiazine dressing. Treatment was changed on the second day to fluid-absorbent foam bandages for superficial wounds (up to IIa degrees depth) and occlusive, antiseptic moist bandages in combination with enzymatic substances for IIb degrees -III degrees burns. After the delayed demarcation, necrectomy and mesh-graft transplantation were performed. All wounds healed adequately. Chemical burn traumata with nitric acid lead to specific yellow- to brown-stained wounds with slower accumulation of eschar and slower demarcation compared with thermal burns. Remaining wound eschar induced no systemic inflammation reaction. After demarcation, skin transplantation can be performed on the wounds, as is commonly done. The distinguishing feature of nitric-acid-induced chemical burns is the difficulty in differentiation and classification of burn depth. An immediate lavage should be followed by silver sulphadiazine treatment. Thereafter, fluid-absorbent foam bandages or occlusive, antiseptic moist bandages should be used according to the burn depth. Slow demarcation caused a delay in performing surgical treatments.

[Delayed abscesses after unstable pelvic ring fractures of the lumbar spine. Case report from the viewpoint of the expert witness]. / Spätabszesse nach instabilem Beckenringbruch mit Frakturen der Lendenwirbelsäule. Kasuistik aus der Sicht des Gutachters.

As a result of medical certificates concerning traumatology and internal medicine the course of disease of a 51-year-old man after serious contusion with pelvic ring dislocation and lumbar vertebral fractures with extensive retroperitoneal abscesses is reported whereby the diagnosis and surgery of this complication has followed only five years after the accident. The significance of nosocomial infections by staphylococcus aureus in connection with closed injuries is pointed out; qualification and quality of the medical certificates are also referred to.

[Results of surgical treatment of colorectal cancers in patients over 70]. / Ergebnisse der chirurgischen Behandlung kolorektaler Karzinome bei über 70jährigen Patienten.

276 patients older than 70 years suffering from colorectal cancer underwent surgery during the past 12 years. Several of these patients had additional diseases and often advanced tumour stages. The overall postoperative mortality rate came up to 18%. The results of better preoperative preparation of the bowel by irrigation and antibiotics as well as advanced operative techniques (EEA-stapler) with regard to infection rate, postoperative course and time of hospitalisation are discussed. Extensive follow-up care of treated patient is necessary.