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The postoperative course of 138 patients with a pertrochanteric fracture treated by nailing according to Ender is analysed with regard to the operative morbidity and lethality. As secondary factors associated with morbidity the specific and unspecific rate of complications, the lethality, the perioperative loss of blood and the duration of postoperative hospitalisation are evaluated. Specific complications occurred in 27%, unspecific complications in 50%, and the rate of hospital mortality was 15.2%, 60.9% of patients required a postoperative transfusion to compensate the perioperative blood loss. In contrast to other authors we cannot regard Ender nail osteosynthesis as a lowrisk procedure with a low operative morbidity. When choosing the treatment procedure alternative methods of stabilisation should be taken into account. An intensive postoperative care is of utmost importance in elderly patients.

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Between 1980 and 1989 in 195 elderly patients with fractures of the femoral neck a duo-cup endoprosthesis was inserted. The average age was 78 years, most of them were high risk patients with sometimes more than 2 preexisting diseases. The hospital mortality after hip replacement was 9.7%, specific complications like protrusio acetabuli and shaft fractures were not observed. In 2 cases immediate postoperative luxation required reintervention. The incidence of infection was significantly reduced to 2.4% after antibiotic therapy. When discharged from hospital, 86% had a good functional result. We regard hemiarthroplasty with duo-cup endoprosthesis as an acceptable alternative to total hip replacement in elderly patients with fractures of the femoral neck.

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In a retrospective study the clinical course of 393 patients treated for proximal femur fractures is evaluated. Intraoperative complications occurred in 2% whereas early complications related to the operative procedure were seen in 19.8% and unspecific complications in 36.8%. Factor analysis proved the following items to be associated with a high risk of complication: age (p less than 0.01), preexistent diseases, kind of operative procedure (p less than 0.05) and the lapse of time between trauma and operation. The extraordinary high incidence of unspecific complications is explained by the prevailing proportion of elderly patients with a corresponding multimorbidity. A decrease in complications and lethality can be achieved by early operative treatment. With regard to the necessity of early mobilization we prefer a hemiarthroplasty in fractures of the femoral neck for elderly patients. Stable pertrochanteric fractures are treated by a dynamic hip screw whereas instable pertrochanteric fractures are an indication for Ender nailing.

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Between January 1, 1970 and March 1, 1985 530 patients underwent graft replacement of the abdominal aorta for infrarenal aortic aneurysms. 28 (5.3%) patients had inflammatory aneurysmal disease, in 3 cases (10.7%) the aneurysm was ruptured. Operation mortality was 17.3%. Characteristic appearance was an unusually thick aortic wall with diffuse, shiny white fibrotic reaction in the retroperitoneum. In most cases the duodenum, inferior vena cava, left renal vein, transverse mesocolon or the ureter were involved into the inflammatory mass. Thoracic aortic involvement was not observed. Contrast CT showed enhancement of the periaortic tissue similar to the blood in the aortic lumen. Standard operation techniques had to be modified to avoid mobilisation of the adherent structures and organs to the aorta.

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This article describes a new flexible bipolar neuroelectrode which is inserted percutaneously into the epidural space for segmental spinal cord stimulation. This electrode was used in experiments with dogs and monkeys for recording cortical somatosensory evoked potentials in order to identify intraoperative spinal cord ischemia during periods of aortic occlusion.

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Benign epithelial tumours of the papilla of Vater seem to be very rare. Since 1910, 75 cases have been published. 3 own cases were added. Diagnostic and therapeutic problems were discussed. Benign epithelial neoplasms of the papilla of Vater are precanceromatous. Many cases of carcinoma of the papilla may grow from benign adenomas. The treatment of choice is the local exzision of the adenoma, occasionally necessitating the reimplantation of bile and pancreatic ducts. The main problem is the treatment of adenomas with severe epithelial dysplasia. Metastatic deposits are possible but duodenopancreatectomy seems to be too aggressive an operation in such cases. In cases of severe epithelial dysplasia and focal invasion of the stroma duodenopancreatectomy should be performed. In cases of familial adenomatosis coli adenomas of the papilla should be thought of. In cases of adenomas of the papilla of Vater the colon should be examined to exclude a familial polyposis coli.

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The importance and necessity of the trace element zinc for tissue restitution after injuries has been known for a long time. The influence of zinc on the healing of tibial fractures in rats is studied by daily administration of 0.6 mg zinc-dl-aspartate compared to a non-treated control group. There is a significant decrease of bone-zinc concentration after fracture. This decrease can be balanced out by zinc administration. There are no significant alterations in serum levels of zinc in both groups. Fracture healing is not affected. Zinc accumulates in bones.

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