[Personal therapeutic attitude in pleural empyema].
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Biomedical subjects
Publications and source records attributed to F Meissner.
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On the basis of experience with 35 children suffering from short-gut-syndrome its pathogenesis and clinical symptoms were discussed. Not all of these cases can be treated surgically. This burdens the surgeon with high responsibility to calculate the extent of bowel resection. With a two stage operation--enterostomy followed by anastomosis the area of resorption and the ileocoecal valve can be preserved.
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Report of three cases of injury to the bile ducts, of which one was a haemobilia, and two were ruptures of the hepatic ducts with external bile fistulae. The latter could be removed using tissue adhesive (blue Histoacryl). After an observation period of 4 years, no symptoms are noted; there are no calcifications in the area of the erstwhile fistulae. The haemobilia was cured by ligature of the right hepatic artery.
The so-called "selection for surgery" of myelomeningoceles is compared with objective data, which are derived from experience in neonatal surgery, surgery of malformations and general surgery. In children who are not primarily operable the full range of therapeutical possibilities is used; they do no receive basis care only. This approach brings about better results than forced surgical closure of the cele.
Among 3 000 injuries of the hand in 65 children over 10 years, 95 injuries to tendons were found. About a quarter of these were to the extensor tendon. Results from the lengemann-suture are good. Tearing of the extensor-tendons in the end-phalanx remains a problem. They are inreasingly being treated conservatively. 20 sutured flexor tendons proximal to the wrist healed well. 32 injuries in "No Man's Land" were sutured primarily, 19 were treated by secondary tendon transplant. 2 primary sutures, 4 transplants were unsuccessful. The primary suture technique of Kleinert is preferred. The healing phase is suported by a hyaluronidase preparation.
The author in his present paper discusses traumatic cerebral pressure crises with particular reference to the aggregate of symptoms involved, the therapy to be employed, and the results of treatment obtained. So far as measurements of the pressure of liquor are concerned, single measurements were found to yield reliable values in rare cases only. On the other hand, the value of the pressure of liquor, when used in combination with the arterial systemic pressure, permits to roughly determine the cerebral perfusion pressure and build a suitable therapy thereon. Hyperventilation therapy, the use of which is strongly recommended here, has proved a very important addition to cerebral pressure treatment.
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Analysing 199 cases of funnel chest operations the following proposals are to be discussed: early operation of boys in a modified Ravitch-technique with transverse osteotomy of the anterior sternum-wall, resection of the xiphoid process and fastening of the perichondrium to the pectoral muscles. The cosmetic indication excludes a late operation. If any late operations are performed they should be considered only for girls. Stabilisers should be used only in case of later operations, recurrences and asymmetrical forms. No operation should be performed in case of genetic defects (malformationsyndrome, flat-chest and channel-chest). The therapeutic results should be made objective by means of the sagittal inner thorax-diameter after Stucki. The submammary incision should be omitted.
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