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.
No abstract
Our experiments on transmitting high-power excimer laser pulses through optical fibers and our investigations on excimer laser ablation of hard tissue show the feasibility of using the excimer laser as an additional instrument in general and accident surgery involving minimal invasive surgery. By combining XeClexcimer lasers and tapered fused silica fibers we obtained output fluences up to 32 J/cm2 and ablation rates of 3 pdpulse of hard tissue. This enables us to cut bone and cartilage in a period of time which is suitable for clinical operations. Various experiments were carried out on cadavers in order to optimize the parameters of the excimer laser and fibers: e.g., wavelength, pulse duration, energy, repetition rate, fiber core diameter. The surfaces of the cut tissue are comparable to cuts with conventional instruments. No carbonisation was observed. The temperature increase is below 40°C in the tissue surrounding the laser spot. The healing rate of an excimer laser cut is not slower than mechanical treatments; the quality is comparable.
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.
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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