[Color-coded duplex ultrasound as a screening method in trauma surgery]. / Farbkodierte Duplexsonographie als Screening-Methode in der Unfallchirurgie.

Deep vein thrombosis with consecutive pulmonary embolism is one of the most important complications for trauma patients. At the University Hospital of Mainz, Department of Traumatology, colour duplex ultrasound is used as screening method in trauma patients. Fractures of thoracic and lumbal spinal bones, pelvis, hip and lower extremities, endoprosthesis of hip and knee joints and longer immobilisation are considered as special risk for the genesis of deep vein thrombosis. Out of 326 patients investigated with colour duplex ultrasound, 24 patients suffered from unknown deep vein thrombosis, 8 developing pulmonary embolism. We recommend colour duplex sonography on day 10, after the third week, and after longer immobilisation. Colour duplex sonography provides an easy performable and noninvasive method for screening evaluation of deep vein thrombosis in trauma patients.

[Clinical and neurologic results after surgical management of the cubital tunnel syndrome]. / Klinische und neurologische Ergebnisse nach operativer Versorgung des Ulnarisrinnensyndroms.

Fourty-two patients suffering from cubital tunnel syndrome were reexamined after anterior subcutaneous transposition of the ulnar nerve. In 25 patients, electrophysiological results could be compared pre- and postoperatively. Only few patients recovered completely, however, electrophysiological results showed an improvement in most of the patients. Sensory velocity proved to be more sensitive than motor velocity. We advice patients for early operation to avoid aggravation of symptoms, even if remission will be incomplete.

[Experimental determination of sliding friction during insertion of femoral intramedullary nails]. / Experimentelle Bestimmung der Gleitreibungskräfte beim Einschlagen von Oberschenkelmarknägeln.

No data have published concerning the procedure of driving in intramedullary nails. An extensive experimental device consisting of a contact-free distance measurement, a dynamograph connected to strain gages and an accelerometer now enabled this investigation. Among other things we determined the range of sliding friction for each stroke at different levels of nail-progression. Depending of the depth of nail-progression forces between 200 N und 400 N were measured. When the nail is stuck these values rise to over 1000 N. The sliding-process lasted between 10 ms and 20 ms. Knowledge of these data is of major importance for improvement of surgical technique and possible development of mechanical nail-insertion aids.

[Intramedullary bundle nailing for stabilization of pathologic humerus fractures in malignant tumors]. / Die Bündelnagelung zur Stabilisierung pathologischer Humerus-Frakturen bei malignen Tumoren.

Pathological fractures of the humerus are mostly due to skeletal metastases or to malignant bone tumours. In most of the cases fracture stabilization as a palliative measurement is the only possible therapy. Our own collective during 1980 through 1987 includes 77 pathological fractures of the long bones, 23 of them located in the humerus. In eight of 15 fractures of the humeral shaft intramedullary nailing was performed, in two cases bone cement was used in addition.

[Managing pathologic femoral fractures in malignant bone tumors and skeletal metastases]. / Versorgung pathologischer Femurfrakturen bei malignen Knochentumoren und Skeletmetastasen.

In adults pathological fractures of the femur are mostly caused by skeletal metastases. In our own collective of femoral fractures 58 were caused by skeletal metastases and five by multiple myeloma. Average age was 59.8 years, women prevailed. In most of the metastatic fractures breast cancer was found to be the primary tumour. In all cases fracture stabilization as a palliative measure was the only possible therapy. Two patients could not be operated on because of other vital problems. In femoral neck fractures resection and endoprosthesis was the operative measure of choice. The pertrochanteric and subtrochanteric fractures were mostly treated by composites of cement and the 95 degrees condylar-plate. Also in shaft fractures cement-implant composites were performed with straight plates. Rarely, intramedullary nailing was done. Exercising stability could always be achieved, weight-bearing stability in most of the cases. The mean survival time was 7.2 months regarding 43 patients with well documented course. Six patients are controlled regularly, the operative treatment was done on an average 16 months before.

[Diagnosis and therapy of traumatic patellar dislocation in the athlete]. / Diagnostik und Therapie der traumatischen Patellaluxation beim Sportler Diagnosis and Therapy of Traumatic Dislocation of the Patella in Sportsmen.

Traumatic dislocations of the patella usually occur in sport activities. The review of our in-patient collective between 1980 and 1985 showed twenty traumatic dislocations of the patella among 1106 sport injuries. Most patients were adolescents. Seventeen of these injuries resulted from a typical valgus-flexion-external rotation-mechanism. Only three cases followed direct trauma. The therapy of choice in fresh traumatic dislocations of the patella in sportsmen is a suture of the medial retinaculum and if necessary refixation of osteochondral fragments. We performed operative treatment in sixteen of our own patients.

[Apophyseal injuries of the pelvis and tibia in adolescent athletes]. / Apophysenverletzungen an Becken und Tibia beim jugendlichen Sportler.

Pelvic and tibial avulsion fractures of the apophysis are typical though rare injuries of adolescent sportsmen. In apophyseal lesions of the pelvis, problems may arise in therapy rather than in diagnostics because treatment is conservative in most of the cases. In contrast, avulsion fractures of the tibial tuberosity usually require a surgical procedure. Among our own in-patient groups between 1980 and 1985, five injuries of the anterior inferior iliacal spina, one lesion of the ischial tuberosity, and five avulsion fractures of the tibial tuberosity were noted in adolescent sportsmen.

[Carcinoma of the anus - clinical signs and symptoms, therapy and prognosis (author's transl)]. / Das Analkarzinom -- Klinik, Therapie und Prognose

Case reports are given of 37 patients treated between 1964 and 1976 because of carcinoma of the anus, and clinical signs and symptoms, therapy and prognosis are discussed. Most of the patients were 50-70 years old, women being more often afficted then men. Often the carcinoma was misdiagnosed as a benign disease. Hemorrhage and pain were the presenting symptoms in most of the case. Therapy depends upon the localization and the stage of the tumor. Carcinoma localizad distally of the linea dentata were excised locally; infiltrating carcinomas received radiotherapy postoperatively. Abdominal amputation of the rectum was performed if the linea dentata or regional lymph-nodes were involved. Bilateral dissection of inguinal lymph-nodes was performed only if inguinal metastases were suspected. No patients surviving 5 years were observed in the group with lymph-node metastases. On the contrary all patients survived, if carcinoma was localized distally to the linea dentata and had been excised locally. Recurrent malignancy was found only in 3 of these cases. On the basis of these findings it can be concluded that local excision is the therapy of choice in selected cases.

[Echinococcus alveolaris and cysticus of the liver]. / Echinococcus alveolaris und cysticus der Leber

From 1964-1976 34 patients were treated for Echinococcus of the liver at the Mainz University department of surgery. There were 25 cases of E. cysticus and 9 cases of E. alveolaris. Decisive for the diagnosis are Casoni's intracutaneous test, scout film of the abdomen, liver scan and arteriography. In all cases a surgical therapy is indicated. A central localization of the parasite cysts makes problems to the surgical management. In these cases we prefere the cystectomy. All other echinococcal cysts were removed totally, either by pericystectomy or hepatic lobectomy. Such a radicality is the exception in E. alveolaris. Twice we performed right hepatic lobectomy. In the other cases operative treatment was carried out to confirm diagnosis and ensure bile passage by a hepato-enterostomy. However, palliative bile draining procedures may prolong survival time to more than 10 years.