[The medial approach for total hip replacement]. / Der mediale Zugang am Hüftgelenk zur Implantation von Endoprothesen.

BACKGROUND: In an anatomical study we investigated the medial approach to the hip joint and developed the surgical technique for patients with hip joint replacement. MATERIAL AND METHODS: The temporary detachment of the adductor longus tendon allows a perfect exposure of the surgical site without risk of damaging important structures. RESULTS: The operation is possible with normal instruments. The blood loss is little. CONCLUSION: The abductor apparatus (gluteal muscles and fascia lata) and the superior gluteal nerve remain intact. Immediate lateral positioning is allowed after surgery. The scar is unremarkable.

[Standardized treatment of necrotizing fasciitis]. / Die standardisierte Behandlung der nekrotisierenden Fasziitis.

From the file online at the department of surgery of the Medical University Lübeck, 894 patients with soft tissue infections treated between 0.1 05. 90 and 31. 12. 94 were evaluated. 21 cases (10 men, 11 women) were classified as necrotizing fasciitis (i.e. 2.2%). The mean age was 59.7 years (range 17-84 years). Frequent predisposing diseases were diabetes mellitus (n = 12) and lower extremity ischemia (n = 8) and alcoholism (n = 4). The causing injuries were of minor nature (n = 11), crural ulcers (n = 4) and abscesses caused by intramuscular injection (n = 3). In 7 cases Streptococcus pyogenes group A was responsible for the infection. Different pathogen germs were found in 14 patients. The first essential steps to treat the patient are aggressive surgical debridement and programmed daily revisions. 76 debridements were performed (3.6 per patient). Amputations were necessary in 4 cases. Intensive care treatment and the administration of antibiotics support this surgical therapy. Meshgraft transplantation (n = 18) and secondary suture (n = 11) were done when wound conditions were suitable for it. 4 patients died (19%). An increased mortality was found in patients older than 65 years (36.4%) and if operative treatment was performed more than 5 days from the beginning of symptoms (33.3%). An early diagnosis and standardized treatment lead to better results in terms of mortality and preservation of the infected limb and its function.

[The importance of sonography before laparoscopic cholecystectomy]. / Die Bedeutung der Sonographie vor laparoskopischer Cholezystektomie.

The increasing use of minimally invasive techniques for the treatment of symptomatic cholecystitis requires exact preoperative diagnosis. The significant sonographic findings are stones in the biliary system or indirect evidence of stones, consisting in dilatation of the bile duct to more than 10 mm, as well as free mobility of the abdominal wall to exclude peri-umbilical adhesions. Amongst 100 patients who had laparoscopic cholecystectomies there were 7 with bile ducts wider than 10 mm. In two of these cases calculi could also be demonstrated. ERCP was performed on the remaining five and in 3 of these stones were seen. Peri-umbilical adhesions were seen in 6 Patients, resulting in alternative placing of the incision. The sonographic findings which are of relevance to the surgeon were analysed in these 100 cases. A standardised examination protocol is an important feature for proper patient selection.

[The value of pneumo-arthro-CT in diagnosis after traumatic shoulder dislocation]. / Die Wertigkeit der Pneumarthro-CT in der Diagnostik nach traumatischer Schulterluxation.

Traumatic subluxation of the shoulder in young patients may result in reluxation after further injury. 18 patients with traumatic subluxation and 22 patients with recurrent subluxation of the shoulder (after primary trauma) were examined by arthroscopy and pneumo-arthro-CT. This minimally invasive procedure showed high accuracy in the diagnosis of the typical glenoid margin and humoral head abnormalities. Nevertheless, arthroscopy cannot be abandoned for planning suitable operative treatment.

[Endoscopic pericardial fenestration. A minimally invasive method of diagnosis and therapy of pericardial effusion]. / Die endoskopische Perikardfensterung. Eine minimal-invasive Methode zur Diagnostik und Therapie des Perikardergusses.

Patients with effusive pericardial disease are often in poor general condition. In this case a well tolerated relatively safe therapy ist of mainly importance. We elaborate a technique of endoscopic pericardial window procedure. In this way it is possible to combine a minimally invasive proceeding with sufficient diagnosis and therapy.

[Laparoscopic laser cholecystectomy]. / Laparoskopische Lasercholezystektomie.

In an ex vivo- and an animal study a Holmium-YAG laser, a Nd:YAG laser and a CO2 laser were examined. For laparoscopic cholecystectomy the pulsed Holmium:YAG laser proved to be the best instrument. Dissecting and haemostatic effects were connected when working with a power of 4 watts. Dissected area per minute was 112 mm2, gallbladder dissection (15 cm2) can be performed in 13 min. In the animal study the cholecystectomy lasted 30 min on average when the Holmium:YAG laser was used. Bleeding was not observed, development of smoke was tolerable.

A ten-year hospital survey of eyelid cancer.

Two hundred and four cases of malignant eyelid tumours, managed at the Concord Hospital, were reviewed. These cases spanned a ten-year period between 1973 and 1982 and all were treated surgically. The nature of each tumour was confirmed by histopathological examination. Included in this review were the site of the tumour, the tumour pathology, the surgical management, the type of surgeon involved, the ocular complications, the management of recurrences and any mortality. The importance of preventing recurrences by adequate initial surgery with frozen section control is emphasized.