RESUMEN
The deepithelialized "turn-over-flap" is a reversed dermis flap. The pedicle of the flap remains intact. The mobile upper part of the flap is turned over the defect and the pedicle itself. A mesh graft covers both, the flap and the donor side. Two case reports will present the principles of the flap design and the clinical outcome of a patient with a defect over the lateral malleolar region and a patient with a defect over the Achilles tendon.
Asunto(s)
Tobillo/cirugía , Melanoma/cirugía , Papiloma/cirugía , Neoplasias Cutáneas/cirugía , Colgajos Quirúrgicos , Adulto , Anciano , Humanos , Masculino , Trasplante de Piel , Mallas QuirúrgicasRESUMEN
A skin closing system formed like a zipper (MEDIZIP) was tested in a total of 75 operated patients. The handling, wound healing, and scar formation at two and six to eight weeks postoperatively were evaluated. The time required for closing of the skin was on average 2.3 min. The ease of handling during operation and wound inspections was rated very good to good in 88% and 86%, respectively. Cosmetically and therapeutically, the results of scar formation are of high quality. The comfort of the skin closure was evaluated by the patients as pleasant, the assessment of the scars was positive.
Asunto(s)
Procedimientos Quirúrgicos Dermatologicos , Engrapadoras Quirúrgicas , Cicatrización de Heridas/fisiología , Adulto , Anciano , Anciano de 80 o más Años , Cicatriz/fisiopatología , Femenino , Hernia Inguinal/cirugía , Humanos , Masculino , Persona de Mediana Edad , Estudios ProspectivosRESUMEN
Thirty-seven patients with chronic sinus pilonidalis were treated after total excision by Dufourmentel flap. We saw seroma complications in three and wound infections in two cases. Patients stayed in hospital 6.3 days on an average and were able to work after 2.5 weeks. The method is easy to use. We have not seen a return to sinus problems in any of this cases.
Asunto(s)
Seno Pilonidal/cirugía , Colgajos Quirúrgicos , Absceso/cirugía , Enfermedad Crónica , Estudios de Seguimiento , Humanos , Tiempo de Internación , Técnicas de Sutura , Cicatrización de Heridas/fisiologíaRESUMEN
Between 1990 and 1994 we performed tumor resection on 21 patients with a cholangiocarcinoma of the porta hepatic. In 5 cases a segmental resection/ligature of the patent right hepatic artery was performed. The postoperative course of recovery in these 5 patients was compared to that of the other 16 patients. We found no significant differences in either the postoperative course of recovery or the laboratory parameters of the two groups. There was no clinical liver necrosis or bile duct necrosis (which would have manifested itself as a leak in the anastomosis) in either group. On the basis of our experience, segmental resection/ligature of the right hepatic artery as part of a radical cholangiocarcinoma resection is possible provided that the right portal vein is patent.
Asunto(s)
Neoplasias de los Conductos Biliares/cirugía , Conductos Biliares Intrahepáticos/cirugía , Colangiocarcinoma/cirugía , Arteria Hepática/cirugía , Hepatectomía , Humanos , Ligadura , Pruebas de Función Hepática , Complicaciones Posoperatorias/etiología , Estudios RetrospectivosRESUMEN
A 58-year-old woman presented with multiple gastroduodenal ulcera caused by a pancreatic polypeptidoma (PPoma) without hypergastrinemia or gastrin-producing tumor cells. After curative resection of the neoplasm, the clinical symptoms disappeared and the patient has now been disease-free for 6 years. We conclude that patients with non-gastrin-producing endocrine pancreatic tumors may demonstrate the clinical features of Zollinger-Ellison syndrome and should be included in the differential diagnosis of this syndrome.
Asunto(s)
Tumores Neuroendocrinos/cirugía , Neoplasias Pancreáticas/cirugía , Polipéptido Pancreático/metabolismo , Síndrome de Zollinger-Ellison/cirugía , Biomarcadores de Tumor/análisis , Diagnóstico Diferencial , Femenino , Humanos , Persona de Mediana Edad , Tumores Neuroendocrinos/diagnóstico , Tumores Neuroendocrinos/patología , Páncreas/patología , Neoplasias Pancreáticas/diagnóstico , Neoplasias Pancreáticas/patología , Somatostatina/análisis , Síndrome de Zollinger-Ellison/diagnóstico , Síndrome de Zollinger-Ellison/patologíaRESUMEN
Between 1978 and mid-1990, 135 patients suffering from dislocated, non-luxated fracture of the humerus at the anatomical neck (fractura colli anatomici) were treated by means of open or closed percutaneous drill wire osteosynthesis. Follow-up examination after an average of 9 months did not show any significant differences between the two surgical approaches in 117 patients, independent of the shape of the fracture. However, in about 30% of the cases it was impossible to employ the percutaneous approach due to the presence of an obstacle to reduction, so that open reduction and fixation was the only choice. A great majority of the functional results must be considered as good, fractures of the tubercles having the most unfavourable prognosis independent of the surgical technique. It is, therefore, recommended to first try closed reduction with percutaneous drill wire osteosynthesis. If there are any obstacles to reduction, open reduction should be restored to during the surgery session.
Asunto(s)
Hilos Ortopédicos , Fijación Interna de Fracturas/métodos , Fracturas del Hombro/cirugía , Adulto , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Complicaciones Posoperatorias/fisiopatología , Rango del Movimiento Articular/fisiología , Articulación del Hombro/fisiopatología , Cicatrización de Heridas/fisiologíaRESUMEN
Following curative operation for rectal cancer, 14-44% of the patients develop a local recurrence, in most instances situated in the operative bed. Differentiation of recurrent tumor, scar tissue and inflammation is not always possible by computerized tomography and magnetic resonance imaging. Recurrent tumor in these patients is diagnosed by percutaneous biopsy and histological analysis. In 24 patients in whom operation was impossible and a maximum irradiation dose was also applied, chemotherapy was administered in the form of regional perfusions. The internal iliac arteries were perfused with folinic acid and 5-fluorouracil in these patients. This procedure reduced the intensity of pain or achieved a pain-free interval of 9 days to 8 months.
Asunto(s)
Quimioembolización Terapéutica , Quimioterapia del Cáncer por Perfusión Regional , Recurrencia Local de Neoplasia/epidemiología , Neoplasias del Recto/cirugía , Femenino , Alemania Occidental/epidemiología , Humanos , Imagen por Resonancia Magnética , Masculino , Persona de Mediana Edad , Recurrencia Local de Neoplasia/patología , Recurrencia Local de Neoplasia/terapia , Neoplasias del Recto/epidemiología , Estudios Retrospectivos , Tomografía Computarizada por Rayos XRESUMEN
92% of all patients with a thorax-trauma suffer from a blunt chest trauma. In the early diagnosis by plane chest X-ray only a quarter of all pathological findings in comparison to the CT of the thorax are found. In addition to that the special deviations and imaging of the thoracic organs in the plane chest X-ray have to be noted. With the demonstration of same examples the special value of the thorax-CT in early diagnosis and patient control was demonstrated. Specially in showing the grade of lung contusion, the volume of bilaterally hemato-serothoraces, ventral pneumothoraces and additional injuries CT was more sensitive. The main disadvantage is the possibly long way of transportation and a contraindication is a severe trauma of the upper extremities and an instable fracture of the spine column.
Asunto(s)
Traumatismos Torácicos/diagnóstico por imagen , Tomografía Computarizada por Rayos X , Heridas no Penetrantes/diagnóstico por imagen , Contusiones/diagnóstico por imagen , Tórax Paradójico/diagnóstico por imagen , Humanos , Fracturas de las Costillas/diagnóstico por imagenRESUMEN
Gastric acid secretion was measured in six healthy volunteers following the intravenous administration (over 30 min.) of oxmetidine 200 mg, 400 mg and 800 mg in a randomized double blind trial for 12 hours. Gastric aspirates were fractionated into hourly aliquots and pH, volume, gastric acidity and gastric acid output were determined. Total gastric acid output over 12 hours was significantly reduced from 24.4 mmol/12 h (median) after placebo to 13.5 mmol/12 h, 11.8 mmol/12 h and 7.7 mmol/12 h after oxmetidine 200 mg, 400 mg and 800 mg respectively. An inhibition of at least 90% was achieved with all doses of oxmetidine and this lasted dose-dependently for 4 to 6 hours. A rise in pH to greater than 5 occurred during the 2nd or 3rd hour after dosing which lasted for 2-5 hours depending on the dose administered. Mean hourly pH was dose-dependently significantly higher for 4-6 hours following oxmetidine treatment than after placebo. A significant reduction in gastric acidity after oxmetidine infusion was also observed while the reduction in volume output calculated for 12 hours was not statistically significant. No significant rises in serum gastrin levels were observed with the oxmetidine doses used. Three out of the six subjects tested showed an increase in serum prolactin levels in response to the highest dose of oxmetidine but this was not statistically significant. The results of the present study have shown that the administration of 400 mg oxmetidine did not cause a longer pH elevation greater than 5 than 200 mg, while with 800 mg side effects were observed in one of the six subjects studied.(ABSTRACT TRUNCATED AT 250 WORDS)