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[Anxiolysis vs. intravenous conscious sedation during maxillary fracture splinting in local anesthesia].

For the conservative treatment of mandibular fractures with arch bars under local anaesthesia we used two forms of premedication in 140 patients: 1. an analgetic sedation with pethidine 1 mg/kg body weight and promethazine 0.5 mg/kg body weight i.m. (n = 70 cases) 2. an anxiolytic sedation with midazolam 0.05-0.1 mg/kg body weight i.v. (n = 70 cases). The effect of the premedication was measured retrospectively by the mean amount of local anaesthetics used during splinting. It could be noted that the mean consumption of local anaesthetics was significantly lower in the midazolam-group than in the pethidine/promethazine-group. The postoperative subjective assessment of the operation by the patients is better under anxiolytic than under analgetic sedation, too.

Adolescent↗

[Intraosseous screw splinting of mandibular fragments].

Fractures in the frontal region of the mandible may be treated by intra-ossal splinting without the risk of injuring nerves or vessels. Function-stable fixation of the reposited fragments was achieved in 15 patients by means of a transfragmental screw with metric thread. The advantages of this procedure consist in the easy removability of the material and the superfluidity of new developments of material or instruments. As the possibility of early functional treatment prevents the late impairment of the articular function, this procedure is particularly indicated in case of concurrent paramedian and articular fractures.

Bone Screws↗

Results of postoperative treatment of ileus in infants and children by means of gastrocecal tube splinting of the intestine.

Since 1966, gastrocecal tube splinting of the small intestine has been used in 77 instances of postoperative ileus, the over-all mortality being 5.2 per cent. Six to seven patients in whom the operation had been performed at least one year ago, a mean value of 3.5 years, had follow-up examinations. One child had a recurrence of ileus, and in one patient, postoperative invagination was observed. Seventy per cent of the children having follow-up examinations were completely asymptomatic, 24 per cent had slight complaints and 6 per cent did not respond. The method described can, therefore, be recommended for the prevention and therapy of postoperative ileus, provided these contraindications are observed: severe disturbances of intestinal circulation; enterocolitis and ulcerations of intestinal mucosa; meconium ileus, in primary operations, and gastroschisis, in primary operations.

Child↗

[Iatrogenic secondary retroperitoneal fibrosis (secondary Ormond disease) caused by contrast medium enema, and the treatment of the resulting hydronephrosis with endourethral splinting ("endoprosthesis")].

A case of secondary retroperitoneal fibrosis with bilateral hydronephrosis, following a barium enema is presented. The mechanism of perforation and the ways of perforation are being discussed. The importance of early surgical intervention is stressed. For treatment of the hydronephrosis an endoureterine splinting was indicated.

Aged↗

[Intestinal stomas and internal splinting of the intestine in the combined treatment of peritonitis and ileus].

Personal experience with the operative management of 28 patients presenting acute purulent peritonitis with ensuing ileus using a complex approach, based on total "internal" splinting of the small intestine, is shared. The 4-channel sound, designed and constructed in the clinic for intubation and simultaneous lavage of the small intestine, promotes effective staged evacuation of the toxic content from the disconnected bowel segments. What is more, a possibility is created for the formation of controlled adhesions between the intestinal loops. The significant clinical effect of bowel intubation in conjunction with adequate peritoneal cavity lavage plus infusional therapy with antibiotics and antianaerobic agents contribute greatly to the prompt recovery of patients.

Acute Disease↗