Forty-one patients were analyzed after surgical treatment of Achilles tendon ruptures. The following parameters served as the outcome measure: (1) duration of wearing cast, (2) length of hospital stay, (3) outpatient treatment, (4) time of absence from work, (5) complications, (6) re-rupture rate, (7) subjective evaluation by patients, (8) scar condition, (9) ability to stand on tiptoes, (10) Thompson test, (11) movement of talocrural joint, (12) circumference data of lower extremity, (13) radiographs, (14) power measurement of the ankle (in kg), (15) ultrasound examination, (16) blood cholesterol levels, (17) scoring by Trillat's score. Surgical treatment achieved an excellent or good outcome in 91% of patients as evidenced by the Trillat score. Furthermore, cholesterol levels were found to be elevated in 83% of patients. Given the good results, surgical treatment of Achilles tendon ruptures is recommended, but patients of status post-Achilles tendon rupture should be checked for high cholesterol levels. In the future, controlled, prospective trials need to prove a correlation between Achilles tendon rupture and a pathological blood lipid status.
So far, psychiatric-psychoanalytic theories have been able to explain the phenomenon "self-injury" only unsatisfactorily. Moreover, the patients do not turn to a psychiatrist in the first place, but to surgeons, dermatologists, gynecologists or general practitioners. This is therefore an interdisciplinary problem. Since general medical knowledge is relatively unhelpful in diagnosing self-inflicted disease and its treatment, these patients often do not receive adequate psychiatric co-management or further care or indeed often get the chance to delegate the act of self-injury to the physician. In view of the sustained tendency for the disorder to chronify, this frequently results in severe, partly irreversible and sometimes iatrogenically co-induced physical impairments. In the final analysis, it also leads to enormous financial burdens for the agencies which bear the costs.
We have analysed the data of 136 patients with multiple injuries treated between 1983 and 1988 in order to assess the sensitivity, specificity, and accuracy of ultrasound, lavage and computed tomography (CT) for the preoperative diagnosis of blunt abdominal trauma. CT was carried out in doubtful cases (n = 29) if ultrasound and lavage had not provided sufficient information. Fifty-eight patients were primarily excluded from the study because neither clinical examination nor ultrasound gave any sign of an intra-abdominal lesion. In 25 cases, sonography could be compared with lavage, CT, and the intraoperative situs. Ultrasound showed reliable results in respect to accuracy (100%), sensitivity (84%), and specificity (98%). Computed tomography confirmed all sonographic diagnoses in 29 patients but did not provide further information. Peritoneal lavage gave correct information in all patients operated upon. Our 5-years' experience suggests that ultrasound is a reliable, quick, cheap, and repeatable technique of great value in patients with blunt abdominal traumata.
Between 1974 and 1989 39 patients with multi-fragmentary fractures of the head of the radius or radial neck fractures were treated by resection of the radial head at the Department of Trauma and Reconstructive Surgery (UKE-University Hospital Hamburg). Follow-up of 22 patients after 0.5 to 15 years (average 7.8 years) by means of patient documents, actual condition, functionally re-examination of the upper limb and evaluation of the roentgenological changes revealed 22.8% good, 63.6% acceptable and 13.6% poor results according to a modified scoring system. Characteristic complications after excision of the radial head are the increase of the carrying angle of the elbow, the proximal migration of the radius and the loss of grip strength. Due to a critical review of the international literature prosthetic replacement by now does not lead to convincing better results. Reoperations may be mandatory to remove the implant because of tissue reactions or failure of the implant.
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