Biomedical subjects
D Filler
Publications and source records attributed to D Filler.
[Surgical aspects of open and closed chest injuries (author's transl)].
263 persons with chest injuries were treated over a period of 16 years. 47 had performating chest injuries, in the remaining cases it was a blunt trauma. Prompt recognition of a life-endangering situation (cardiac tamponade, tension pneumothorax, mediastinal emphysema, massive haemothorax) is essential; radiological and laboratory diagnostic methods play a secondary role. The most effective emergency treatment is intercostal continuous suction; in many cases it is the only one needed. A haemothorax must be evacuated completely because of the risk of complications and fibrin formation. Thoracotomy is rarely, and surgical removal of lung tissue hardly ever, indicated. 30 persons needed emergency thoracotomy. Accompanying intraabdominal injuries, mostly rupture of the diaphragm and spleen, were observed in 45 patients. Late sequels were lung abscesses, posttraumatic cysts, pleural empyema and adhesions, atelectases. Decortication, if indicated, should be performed at an early stage.
[Tracheal and bronchial ruptures (author's transl)].
Rupture of the major airways is rare. Open injuries usually involve the trachea; injuries to the airways in closed chest trauma are in 80-90% of the cases located at the bifurcation or the main bronchus. Rupture of the bronchial system may cause an immediate threat to life, but may also produce few symptoms. The possibility of such an injury should always be taken into consideration, even if at first the clinical signs only point to damage of the lung parenchyma. Intubation and continuous suction drainage are life-saving emergency measures to be followed as soon as possible by bronchoscopy to establish the diagnosis. Treatment is by prompt suture or anastomosis. Failure to diagnose rupture of a bronchus results very soon in stenosis and, later on, in damage to the lungs and jeopardizes the success of subsequent reconstructive surgery. The repair of extended stenoses presents particularly difficult technical problems. Alloplastic grafts may be the answer. During 1961-1978 7 persons with injuries to the trachea and bronchi were treated at the Department of Surgery, Giessen. 3 persons were saved by immediately performing an anastomosis.
[Injury to the mediastinal organs in chest trauma (author's transl)].
10% of chest traumata are accompanied by injuries to the mediastinal organs. Since rupture of a bronchus may be masked by additional intrathoracic injuries any suspicion of such lesion must be verified by bronchoscopy. Symptoms of a shock condition after traumatization of the precordial region point to damage to the heart the extent of which may range from a slight disturbance of cardiac function (commotio cordis) to laceration of cardiac tissue and rupture of the myocardium. Enlargement of the mediastinum after a sufficiently forceful chest trauma should be examined by visualization of the aortic arch to elucidate its aetiology and exclude an aortic aneurysm. The mortality of chest trauma involving the mediastinal structures is 35%. This fairly high figure is partly attributable to severe accompanying injuries.
[Continence of anus praeter -- a problem solved? Erlangen magnetic stoma seal (author's transl)].
Primary or secondary implantation of the Erlangen magnetic stoma seal in case of colostomy or ileostomy is technically simple, although it requires a critical selection of patients and careful surgical technique. The best follow-up of the operated cases should be in the special protological clinics in the hands of stoma therapists. About 15% of the cases meet local complications and therefore the magnet-ring is explanted. An ideal continence is not always achieved. We hope that these patients can be better helped with magnetic stoma seal through further development.
[Problems of intraoperative diagnosis and operative strategy in malignant struma (author's transl)].
Explore the source record for details and available documents.
[Problems of the so-called spontaneous intestinal perforation].
Among 250 cases of perforation of the large and small bowel during the past 5 years there were 11 patients in whom the cause of the perforation was not clear at first and which were labeled spontaneous. After thorough investigation a satisfactory explanation for the perforation of the apparently normal bowel could be given for all patients. The most frequent causes were distention of the bowel wall, particularly of the cecum, and ischemic enterocolitis. We consider the incidence of really spontaneous bowel perforations very unlikely.
[Indication for surgery in colitis ulcerosa].
Explore the source record for details and available documents.
[Long-term prognosis in ulcerative colitis].
Explore the source record for details and available documents.
[Injuries to the rectum in diagnostic and therapeutic measures (author's transl)].
From 1955 to 1973, 28 anus praeter or rectal perforations were observed in the Chirurgische Universitätsklinik Erlangen. Ten of these patients died. The perforation of the intestine was already noted at the time of injury in 14, in 14 it deteriorated until a peritonitis at the end of three days on the average required laparotomy. The perforations arose mainly through rectoscopy or enemas. Such everday measures need care, in particular to stop the manipulation when the patient complains of pain. If there is the slightest suspicion, visualize the point of injury with a water soluble contrast medium.
[Continent colostomy through magnetic closure in animal experiments on dogs].
In dog experiments a continent colostomy be means of magnetic occlusion has been developed. Around a terminal anus praeter a silicon-coated ringmagnet was placed between muscular fascia and subcutaneous fascia. The colon was pulled through the lumen of the ring and sutured to the skin. There has been a primary wound healing. There was no leakage of gas and faeces beneath the magnetic cap, thus providing an excellent closure of the colostomy. After removal of the cap spontaneous defecation took place.
[The acute abdomen caused by trauma (author's transl)].
Explore the source record for details and available documents.