[Diagnosis, treatment and results of surgically treated fresh exterior ligament ruptures of the upper ankle joint]

Among 355 recent ruptures of the fibular ligaments which had been operated in seven years - by altogether 3413 traumas of supination and of distorsion - 271 patients have had a follow-up examination. A reduction of the mobility was found in 9% of the cases, a clinically demonstrable opening of the ankle was found in 11% of the cases. 11% of the cases specified complaint by burden. 95% of the operated patients attended sporting activities. The opening of the ankle was the same as against the other side in 79% of the cases - proved by radiological examination; there was a slight increased opening of the ankle compared with the non-operated ankle in 15% of the cases, an increased opening of the ankle was found in 6% of the cases. Subjective complaint and clinical and radiological findings were taken into consideration of the opinion of the results. We found good up to very good results in about 90% of the cases. The treatment of the recent rupture of the fibular ligaments only can consist in a combined suture including a following cast - in agreement with other authors; nevertheless an isolated rupture of the anterior fibulotalar ligament does not compel to operate all cases.

Transcutaneous PO2 monitoring during a Himalayan ascent

Transcutaneous PO2 (PtcO2) measurements were taken daily on seven subjects during two nine day ascents of the Himalayas to an altitude of 4,579 meters. Five of the subjects lived in areas under 450 meters (Group I), while two subjects lived at an altitude of 3,100 meters (Group II). The PtcO2 values decreased with increasing altitude. The Group II subjects had PtcO2 values greater than the Group I subjects and the difference became greater with increasing altitude. The linear regression lines of PtcO2/pbO2 to Group I during ascent and decent were lower than the regression line for Group II (PbO2 is the barometric oxygen partial pressure). The regression line for Group I data during the second half of the trek approached the data for Group II. We conclude that acclimatization to high altitude is possibly associated with increasing peripheral tissue oxygenation as assessed by PtcO2 values.

A human umbilical cord with four arteries

An unusual case of a newborn infant with four umbilical arteries is presented. Multiple catheterizations revealed that triplication of the right umbilical artery was responsible. There were no associated malformations, and follow-up at 9 months of age revealed age-appropriate growth and development. This case extends the spectrum of observable umbilical artery anomalies.

[Pancreatic pseudocysts. Treatment and results]

179 operations were performed for pseudocysts of the pancreas between 1960 and 1982. Basing on this experience the various methods of surgical treatment and the corresponding indications are discussed, and their advantage and disadvantage comparatively represented. In the treatment of very small cysts we suggest an expecting attitude, their statement must be controlled. In case of surgical treatment the enteroanastomosis in the form of a pancreatocystojejunostomy is supposed to be the best alternative.

Perinatal and neonatal aspects of maternal idiopathic thrombocytopenic purpura

The pregnant woman with idiopathic thrombocytopenic purpura (ITP) and her fetus-neonate present a number of challenging issues for both the perinatologist and neonatologist. A review of these issues within a single format is helpful because of the widely scattered nature of the pertinent information in the medical literature. Maternal ITP is described herein as chronic, idiopathic, immune thrombocytopenic purpura, and the multiple interactions between ITP and pregnancy are detailed. The chief effect of maternal ITP on the fetus-neonate is thrombocytopenia, which occurs in approximately 37% of infants born to mothers with ITP. Using available literature, the pathophysiology, natural course, and therapy for maternal ITP-induced neonatal thrombocytopenia are described. Because affected infants may be severely thrombocytopenic at birth and at risk for hemorrhagic symptoms secondary to the stress of vaginal delivery, cesarean section is advocated as the preferred route of delivery for mothers with ITP. This approach is controversial, however, principally because many cesarean sections are productive of unaffected or mildly affected neonates. The predelivery use of fetal blood sampling and the presence of maternal circulating (unbound) antiplatelet antibody in this setting may provide the perinatologist guidance as to the appropriate delivery route for the at-risk thrombocytopenic infant.

A technical aid in transoral wiring of mandibular fractures

A technique is discussed for drilling and securing the inferior border of mandible fractures by a complete transoral approach. It simplifies the passage of interosseous wires and provides a stable fixation.

[Feeding gastrostomy--last possibility for a palliative operation in malignant stenoses of the esophagus-cardia]

From 1960-1980 we operated 326 patients suffering from a malignant stenosis of the esophagus-cardia region. We had to establish a nutritional fistula as a palliative operation in 56 patients (17.2%). The operative tactics and the final results are described. The postoperative lethality with these dangerously ill patients is up to 23.9%.

Epidermal growth factor-urogastrone receptors in normal human liver and primary hepatoma

Epidermal growth factor-urogastrone (EGF-URO) receptors have been demonstrated in rodent liver and modulation of ligand binding during transformation has been shown in a variety of study systems. A patient presented with a resectable primary hepatoma arising in a histologically normal liver. We carried out ligand binding studies using 125I-EGF and homogenates or plasma membrane preparations of normal and hepatoma tissues. EGF-URO receptors were demonstrated in normal human liver; half-maximal binding occurred at 2.5 X 10(-9) M 125I-EGF. Binding decreased in association with hepatoma formation. These results provide initial evidence that EGF-URO receptors exist in human liver and that ligand binding changes accompany hepatoma formation in man.

[The endoesophageal intubation--a favourable palliative operation of malignant stenoses in the esophagus-cardia-region? (author's transl)]

131 patients with malignant stenoses in the esophagus-cardia-region were palliatively treated with an endoprosthesis. The procedure in these patients of an average age of 65.5 years is described. The average in patient time is 22 days. The postoperative mortality is 22.9%. The complications specific for the operation method are dislocation of the prosthesis, perforation of the esophagus, bleeding and occlusion. 74.4% of the patients subjectively considered the operation successful.

[Extra-uterine twin pregnancy. Observation of a case of bilateral tubal pregnancy and literature review]

Literature was reviewed for the rare case of extra-uterine twin pregnancy, with particular reference being made to a real case of bilateral tubal twin pregnancy. Topographic aspects and age of pregnancy should be taken into account for definition. Aetiological factors and clinical peculiarities are discussed. The author holds that so far less than 100 cases have been reported in which bilateral tubal twin pregnancy had been safely established.

An ultrastructural examination of early ventral root formation in amphibia

The morphology of early interactions between neural tube and myotome in the amphibian embryo and tail regenerate was examined using the electron microscope. Two types of contacts were observed. At the most primitive level where the myotome was yet unsegmented, multiple adhesive-type contacts linked neural tube and myotome. In newly segmented areas early ventral roots were recognizable as small bundles of one to five axons extending the short distance to the myotome. There was only one bundle per segment and in addition to axons, each bundle always contained one or more primitive glial cell processes which accompanied axons as they left the cord. At points of root exit primitive glial processes appeared to funnel axons into the root. The cytoarchitecture of the cord and the new roots suggested that the primitive glia may play a role in pathfinding for motor axons as they leave the cord and extend toward their targets.

Early heart failure as a cause of growth and tissue disorders in children with congenital heart disease

Height, weight, total body fat, lean body mass, size of fat cells and total number of lipid-containing fat cells were compared in two groups of children, ages 2-6 years, with congenital heart disease. Twelve children who developed heart failure in infancy made up one group and 14 asymptomatic patients made up the other. No patient was cyanotic or had undergone surgical repair. Patients with heart failure were shorter and lighter than asymptomatic patients. Whereas both fat and lean tissues were less in the heart failure group, reduction in body fat was more important in producing underweight. Although there was no difference in the size of fat cells, the number of lipid-laden fat cells was diminished in the children who had early heart failure. Thus hypocellularity of fat cells appeared to be the major determinant of diminished body fat with heart failure. Because shortness and decreased lean tissue were associated with these adipose tissue abnormalities, it is likely that widespread changes are caused by early heart failure. As previously reported with hypoxemia, the early development of heart failure seems to produce tissue changes that handicap growth.

[Experimental liver and kidney surgery with CO2, CO, holmium, and neodym lasers. Cutting effect, hemostasis, histopathology, and healing (author's transl)]

Various laser devices (CO2, CO, Nd: YAG, and holmium: YAG lasers) have been used on pig livers and on dog kidneys for comparison with conventional surgical instruments (electroscalpel, cryoscalpel, and scalpel). CO2 and CO lasers caused the least tissue damage, followed by the holmium laser; severe damage was caused by the Nd: YAG laser. The order was reverse for coagulative effect. The conventional reference instruments showed a weaker hemostatic effect. Surfaces cut by laser healed in four to eight weeks without complications. Remnants of charred tissue in various quantities could still be detected after eight weeks in all cases where CO2, CO, and Nd: YAG lasers had been used. This obviously did not affect scar formation.