Acute interruption of the blood flow of the bowel is a very severe disease. The very high lethality mainly depends on the difficulties in diagnosis. Laboratory findings were not considered until now. Earlier investigations have demonstrated the bowel's high demand for blood and oxygen and a specific high vulnerability by ischemia. Therefore anaerobic metabolism of the bowel should cause a high lactacidemia, even before necrosis.
Goitre operations were done in 2114 patients; 1648 patients had a simple solitary nodule or multinodular goitre with regressive changes. Malignancies were found in 54 cases with a clear-cut predominance of papillary carcinomas. Nearly half of the goitres diagnosed as solitary nodules preoperatively were shown to be multinodular. This discrepancy was taken into account in the determination of the rate of malignancy. Malignomas were found in 4.6% of "true" solitary nodules and in 2.8% in multinodular goitres. These findings confirm our liberal indications for operation in multinodular goitres with regressive changes also in the area of endemic goitre. The high incidence of microcarcinomas in our patients can thus be explained.
15 rabbits underwent osteotomia of the left femur including lesion of the medullary vessels, 5 times in the proximal, 5 times in the middle, 5 times in the distal diaphysis. Changes in blood flow before and after osteotomia were measured by the "tracer microspheres" -method in the proximal, middle, and distal diaphysis of the femur and the tibia, in the marrow of femur and tibia, in the m. rectus femoris, and the m. tibialis anterior. After lesion of the femur diaphysis a significant reduction of blood flow was found in all tissues of the left leg which must have been caused by arterial spasm. In the diaphysis and marrow of femur, however, the reduction of blood flow was even greater and showed a characteristic pattern concerning the lesion of the medullary vessels. Osteotomia in the proximal diaphysis led to a greater reduction of blood flow in diaphysis and marrow than osteotomia in the middle and distal diaphysis did. The alteration of the diaphysis blood flow is different in the proximal, middle, and distal part in all cases of osteotomia. The characteristic pattern of diaphysis blood flow alteration by osteotomia can be explained by topography of the femur vessels. Their relations to clinical observations are discussed.
The CT appearances of healing fractures were studied following tibial osteotomy in a dog. Traditional radiological investigations and CT were carried out until healing was complete; CT showed callus on the ninth day, whereas radiographs only showed it after 19 days. After 32 days, callus filled nearly the entire medullary cavity. Similar observations were made in several human situations. CT demonstrates interposed material in the fracture very clearly, even if there is marked callus formation within the fracture.
Between 1976 and 1986 in our clinic 273 patients aged 3 to 93 years underwent operation of the femur shaft because of fracture. 79% had multiple injuries. 254 with 269 fractures survived. 52 out of them had open fractures. All operated fractures were analysed concerning fracture type, fracture localization and timing of operation. We saw 36 complications (13.4%), 13 bone infections (4.8) and 23 non-unions (8.6%). 40% of the patients were operated immediately, 23.4% within the first week. Early operation of closed fracture showed 11.5% complications, operation within the first week showed 14% complications, and delayed operation only 5.7% complications. We saw 7 infections (3.5%) and 20 non-unions (9.9%) after 202 fixations with AO-plates, and 2 infections (4.3%) and one non-union (2.2%) after 46 Küntscher-nailings. Multi-fragment fractures showed considerably more complications (15%) than other types. 23 fractures in the transition from the middle to the distal third had the highest complication rate (13% infections and 21% non-unions) followed by 115 fractures in middle part with 4.3% infections and 9.6% non-unions. Fixation of multiple-fragment fractures in the transition from the middle to the distal third with AO-plates had the worst rate of non-unions of all (4 out of 16). The reasons for the different complication rates are discussed. The striking increase of complications from proximal to distal shaft regions is explained by different blood flow alterations in femur diaphysis found in former experiments.
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