[Can preoperative lung function diagnosis detect risk of intraoperative pulmonary gas exchange insufficiency in artificial hip replacement with polymethylmethacrylate cement?]. / Lässt die präoperative Lungenfunktionsdiagnostik das Risiko intraoperativer pulmonaler Gasaustauschstörungen in der Hüftendoprothetik mit Polymethylmetacrylat-Zement erkennen?

In a study of 90 patients in whom a hipjoint had been replaced for the first time using polymethylmetacrylate cement, the extent of intraoperative pulmonary gas exchange disorders was established. The effect of a preexisting disorder of lung function was determined. We checked whether an appraisal of the risk patients who are operated on can be assisted by a preoperative analysis of lung function. After preoperative diagnosis of lung function, the arterial blood gases were analysed at defined times during the operation. An intraoperative fall in the partial pressure of oxygen and an increase in carbon dioxide partial pressure in the arterial blood were found in all patients. There were pronounced interindividual differences in the extent of the disorder of pulmonary gas exchange. The degree of severity of the respective acute disorder of lung function did not show any correlation with the pre-existing disorder of pulmonary ventilation. Major hemodynamic changes were not observed. According to the present findings, a definitive statement with regard to the degree of severity of intraoperatively occurring disorders of pulmonary function cannot be expected from a preoperative analysis of pulmonary function.

Intrathoracic dural ectasia mimicking neurofibroma and scoliosis. A case report.

Angular thoracic scoliosis combined with dural ectasia and foraminal enlargement is reported in a patient with neurofibromatosis. The dural cyst was resected through a high thoracic approach and the scoliosis dealt with by posterior spinal fixation with Modulock instrumentation. Follow up after 12 months showed no neurological deficit and no progress of the scoliosis.

[Cement-free cup and cemented shaft--concept of a hybrid solution and results of a 3-to-6-year clinical experience]. / Zementfreie Pfanne und zementierter Schaft--Konzept einer "Hybrid-Lösung" sowie Ergebnisse einer drei- bis sechsjährigen klinischen Erfahrung.

Report about the Marburg Hybrid THA using a cementless cup and a cemented stem. The acetabular component consists of an hemispheric inner polyethylene cup and an outer five-layer sintered titanium wire mesh fused together. The socket is primarily anchored by one peg as well as 2 self-stabilizing titanium nails. The forged titanium alloy stems are meeting all the requirements of the latest biomechanic research. A total of 292 Hybrid THA were implanted in 273 patients from 1. 8. 1986 to 1. 1. 1989. 6 patients (2.1%) had to undergo THA exchange surgery (1 early, 3 late infections, 1 acetabular fracture after fall, 1 loosened stem). The clinical data of 62 patients (21.2%) had to be disregarded for various reasons. Thus the data of 212 (72.6%) implanted THA in 194 patients were analyzed. 204 of the analyzed THA (96.2%) judged the result of the operation as good or very good. Radiolucency at the bone-titanium-interface of the cementless cups was present in 60 of 212 cases (28.3%), in revision operations twice as often as in primary implantations. There were no signs of progression. Radiolucency at the bone-cement-interface of the cemented stems was present in 27 of 212 cases (12.8%), with radiolucencies > 1 mm only occurring in area 7 of Gruen (1979). The overall results are thus very promising and support the concept of a hybrid solution for THA.

Role of oxygen radicals in experimental acute pancreatitis.

A growing body of evidence suggests that oxygen radicals are generated in all forms of experimental pancreatitis at an early stage of disease. Moreover, first indirect observations assume that also in human acute recurrent and chronic pancreatitis oxygen free radicals are generated and add to the damages seen. The source of the enhanced production of oxygen radicals remains still unclear. Experimentally, the efficiency of scavenger treatment varies between three different models, whereby these differences depend more on the design of the experimental models than on the form of pancreatitis which was induced. Antioxidant treatment with radical scavengers should therefore interrupt these deleterious pathomechanisms or at least mitigate the damages normally seen. Most studies, however, pretreated the experimental animals before inducing acute pancreatitis, which does not mirror the clinical reality. Patients, however, are admitted after onset of the disease. Therefore, well-defined, controlled clinical studies are needed to validate the involvement of oxygen radicals in acute and chronic pancreatitis and the effect of scavenger treatment in patients with pancreatitis.

[Severe cholestasis in congenital choledochus cyst]. / Schwere Cholestase bei kongenitaler Choledochuszyste.

A nineteen year old female was admitted to the hospital presenting with sudden onset of severe jaundice and the biochemical constellation of cholestasis. The sonographically and radiologically diagnosis of choledochal cyst was confirmed intraoperatively. The choledochal cyst of type IVa reached from the papilla until the hepatocholedochal junction. A lateroterminal choledochojejunostomy with a Y-Roux-anastomosis was constructed. The patient became symptom-free after the operation.