[Concepts of the German Society of Tropical Surgery]. / Konzepte der Deutschen Gesellschaft für Tropenchirurgie (DTC).

The DTC promotes access to surgical care facilities of acceptable medical quality for all people in third world countries. To achieve this goal following concepts and activities are persued: Establishment of a 2-year training programme district surgery Postgraduate surgical training in Germany Workshops and annual scientific meetings Development of adapted surgical technologies Cooperation with national and international organisations Promotion of north-south partnerships between colleagues and hospitals.

[Education of foreign physicians from developing countries]. / Ausbildung von Gastärzten aus Entwicklungsländern.

Qualification as specialized consultants in Germany is nearly impossible today for doctors from developing countries. Due to the dense medical job market, foreigners from overseas countries have no chance of being hired for a normal hospital job, which is necessary to get the specialist education. The author, therefore, emphasizes the necessity to create new possibilities of financing such colleagues. The reputation of German medicine might depend to an important extent on such a possibility. It is just this period of professional formation that gives the most important practical professional education for the future work of the candidates. The author asks the German Association of Surgeons for public support of this problem.

[Experiences as a surgeon in a mobile hospital of the German Red Cross--German Referral Hospital/Benaco (Tanzania)]. / Erfahrungen als Chirurg im Modulkrankenhaus des DRK--German Referral Hospital/Benaco (Tanzania).

The German Red Cross Society participated in the international aid activities for the refugees of Ruanda. Among other duties the German Red Cross became responsible for the medical care of the refugee camp population of Benaco, Tanzania. From 1994 until 1997 the German Red Cross used its so-called Module Hospital. This is a transportable hospital, which can be installed within a few days. The technical facilities of this hospital are well adapted to the conditions of medical work in developing countries. The authors, who are surgeons, report about their experiences in this sort of emergency surgery.

[The contribution of the general and trauma surgeon in neurotraumatology: experiences and results of 10 years]. / Die Stellung des Allgemein- und Unfallchirurgen in der Neurotraumatologie: Erfahrungen und Ergebnisse aus 10 Jahren.

In acute medical service, general and traumatic surgeons are faced with the problem of treating severe head and brain injuries. In the department of surgery of the University Hospital in Munich, we have been performing neurotraumatological treatment since 1982. Within 10 years we saw 138 patients with severe head and brain injury. We had 48 cases of epidural hematoma. 81 of acute subdural hematoma. 84 of intracerebral contusional bleeding, 5 of depression fractures and 3 of hygromas. All these patients underwent surgical treatment. Osteoplastic trepanation was performed in 49 patients and osteoclastic trepanation in 60. Further interventions were elevation of the 5 depression fractures and evacuation of the 3 hygromas. Comparison with other investigations in departments of neurological surgery in the United States suggest that our results reflect a similar outcome (according to Jennet and Bond's outcome scale: 1, cured; 2, slightly handicapped; 3 severely handicapped; 4, vegetative state; 5, expired). The Traumatic Coma Data Bank (1991) recorded outcome of severe head and brain injuries as follows: 1, 27%; 2, 16%; 3, 16%; 4, 5%; 5, 36%; and our own results were: 1, 24%; 2, 17%; 3, 15%; 4, 5%; 5, 39%. Organization procedures and treatment strategies are suggested.

[Treatment in septic and aseptic bone defects of the spine]. / Behandlung bei septischen und aseptischen Knochendefekten im Bereich der Wirbelsäule.

Today it is possible to cure septic or non-septic defects of the spine with the help of diverse, specially designed implants for spinal surgery. The replacement of bone defects is realized by autologous bone grafts from the iliac crest, ribs or fibula pieces. Tumorous defects are preferably filled with bone cement and plates. A prerequisite for such operations is exact knowledge and operative experience with suitable approaches to the different levels of the spine.

[Tuberculosis of bones and joints]. / Tuberkulose von Knochen und Gelenken.

In developing countries tuberculosis of the bones and joints is a disease with an endemic character. In industrialized nations it is also gaining importance again as a result of social problems and of cases of immune deficiency. After the bacteriologic/histologic diagnosis of tuberculosis of the bones and joints, the primary therapy is non-operative with immobilization and antituberculous chemotherapy. Nevertheless, there are indications when an abscess and arthrodesis or spondylodesis must be cleaned operatively. An absolute and urgent indication for operative cleansing and stabilization is acute progressive paraplegia.

[Operative injury in spinal surgery in the management of polytrauma patients]. / Operationstrauma Wirbelsäule in der Versorgung polytraumatisierter Patienten.

The release of indicators and mediators of the posttraumatic inflammatory response following spine surgery was measured in patients with multiple injuries. Eight of a group of 113 patients (mean injury severity score 36) who underwent delayed operative stabilization of vertebral fractures (> 24 h after trauma) were studied. The following significant postoperative changes of blood levels (median values, Wilcoxon signed-rank test) compared with the preoperative starting point were found: polymorphonuclear granulocyte elastase rose from 220 to 337 ng/ml, cathepsin B from 84.5 to 135.5 mU/l, C-reactive protein from 9.1 to 11.6 mg/dl, lactate from 9.6 to 15.2 mg/dl and neopterin from 6.9 to 15.2 nmol/l, while antithrombin III fell from 107.5% to 84%, platelet count from 102 to 88 x 10(9)/l and pO2/FiO2-ratio from 361 to 260. The alterations in the blood levels of these parameters following spine surgery showed a pattern similar, albeit of lesser magnitude, to that which can be observed after severe accidental trauma. We conclude that the additional activation of the inflammatory response following surgery for vertebral lesions should be taken into account when planning these operations in patients with multiple injuries.

[The value of extended resection in locally advanced bronchial carcinoma]. / Der Wert der erweiterten Resektion beim lokal fortgeschrittenen Bronchialcarcinom.

A retrospective study on 68 patients with non-small-cell lung cancer (NSCLC) treated by extended resections is presented. Compared to simple resections extended resections carried a higher risk for postoperative complications, whereas 30-days-mortality was not influenced by type of resection. Analysis of survival rates after extended resections revealed no influence by T- or N-stage, whereas a residual tumor lowered the survival rates significantly. Overall, a 2-year-survival rate of 35% was observed after extended resections. In conclusion, even in locally advanced cases of NSCLC a resection with curative intent seems to be warranted, provided that a R0-stage can be achieved by surgery.

[Spinal injuries in polytrauma patients]. / Wirbelsäulenverletzungen bei polytraumatisierten Patienten.

In about 30% of all multiple trauma patients, spinal injuries are found. The diagnostic and therapeutic procedure follows the five-step program for acute multiple trauma patients. Only in cases of open lesions or secondary deterioration of neurologic symptoms do we indicate an urgent operative treatment in step 3. All other patients should only be operated on after normalization of vital functions in step 5. The high risk for further complications is represented by the combination of thoracic spine lesions and lung contusion.

Two different types of potassium channels in human skeletal muscle activated by potassium channel openers.

The inside-out patch clamp technique was used to record the effects of K+ channel openers (EMD 52692, RP 49356 and Cromakalim) on single channel currents in membrane blebs of human skeletal muscle. Two types of K+ channels were activated by these drugs: an ATP-sensitive K+ channel which was inhibited by 3 mM ATP and 5 microM Glibenclamide and an ATP insensitive K+ channel. The open probability of both types was strongly increased by K+ channel openers. Glibenclamide antagonized the action of the K+ channel openers.

[Expanded trans-pedicular spongiosa grafting--dorsal approach to filling of the intervertebral spaces with cancellous bone]. / Erweiterte transpedikuläre Spongiosaplastik--Auffüllung des Zwischenwirbelraumes mit Spongiosa von dorsal.

Internal fixation of dorsolumbar spinal fractures can be accomplished by dorsal plating or internal fixator. So far, the technique of transpedicular grafting has been applied to fill the vertebral body with cancellous bone. In this paper, we present a new technique of extended transpedicular bone grafting to fill the intervertebral space also. By this means, the disadvantage of secondary loss of height after removal of the metal implants can be prevented.

[Long-term results following treatment of spondylitis]. / Langzeitergebnisse nach Spondylitisbehandlung.

The preliminary results of a follow-up examination of patients with spondylitis are presented. The 127 patients concerned comprised 94 specific and 33 nonspecific cases. With the combination of conservative treatment (immobilisation, chemotherapy) and surgery (excision of an abscess, chip spondylodesis), all but two of the infections (one progressive infection, one recurrence) proved manageable. At the time of the follow-up examination, bony reorganisation had occurred in all but 8 cases. But also the segments in which bony reorganisation had not yet taken place, were functionally stable. Despite the good physical results of treatment, the social impairment due to the disease remained considerable. The results obtained compare well with those reported in the literature (2).

Is ultrasound superior to carcinoembryonic antigen (CEA) measurement in recurrent tumor screening of patients with colorectal carcinoma?

Assuming that in the postoperative recurrent tumor screening CEA levels are as important as imaging techniques in elucidating the spread or the recurrence of a tumor, we examined 61 patients with colonic carcinoma. Those patients were operated curatively and were regularly controlled by clinical examination, laboratory, sonographic, endoscopic or radiological methods. In 3 patients there was a local recurrent, in 3 other patients there was a local recurrent and metastases. 8 patients showed sonographic livermetastases only, proved by computed tomography. In 6 patients CEA-levels rose. In 2 patients with sonographically confirmed metastases of the liver, there were neither clinical nor laboratory hints for metastases and the CEA-levels were normal. No one had elevated CEA-levels before detecting metastases. Our results indicate that ultrasound of the liver can detect metastases of colonic tumors earlier than clinical or laboratory sings do. Because of its greater diagnostic security, ultrasound is superior to CEA-measurement in recurrent tumor screening.

[Cervical transverse spinal cord injury caused by knife stab injury]. / Zervikaler Querschnitt durch Messerstichverletzung.

This clinical report refers to a case of quadriplegia caused by a knife stab wound in the cervical spine. Open removal of the knife made it possible to avoid such complications as bleeding and infection. Nevertheless, the tetraplegic signs and symptoms were the result of complete severance of the cervical spinal cord and therefore persisted.

[The "chapeau-claque" mechanism. Biomechanical aspects of roentgen diagnosis of vertebral fractures]. / Der "Chapeau-claque"-Mechanismus. Biomechanische Aspekte bei der Röntgendiagnostik von Wirbelfrakturen.

During follow-up examinations of patients with fractures of the spine at the Inner City Surgical Clinic in Munich, particular attention was paid to the problem of the diagnosis of fractures of the dorsal edges of vertebral bodies. Repeatedly we found a kind of a deformation resembling collapse or folding up of a "chapeau claque" top hat.

[Fractures of the spine]. / Frakturen der Wirbelsäule.

The standard treatment for stable fractures of the spine is functional. Owing to the improvement of surgical methods and special implants, the percentage of operatively treated spine fractures has increased from 10% to 20%. In contrast to the necessity for multisegmental fixation with the rod instruments used formerly, the recently developed implants (plates, fixators) allow stable, brief, and therefore functionally more favourable immobilization.

[The problem of load stability in pathological fractures. Considerations on its indications using typical cases as examples]. / Das Problem der Belastungsstabilität bei pathologischen Frakturen. Uberlegungen zur Indikation anhand von typischen Fallbeispielen.

Differentiated management of pathological fractures and multiple bone metastases is shown by means of 7 typical case examples. In the proximal femur, the total replacement of tumor-bearing bone areas by total hip prosthesis seems to provide the best stability. The femur shaft is stabilised without risk by intramedullary nailing, whereas metaphyseal stabilisation is best done by means of the interlocking nail. In the humerus, neutralisation plates are used, but they should be chosen long enough to anchor the implant in zones free fo tumour. The limitations of operability are demonstrated in one case. On the other hand, one case is shown where multiple metastases were treated palliatively by excochleation and filling the defect with bone cement, thus preserving the functional ability of the limb and the independence of the patient.