[Fibrinolytic therapy of massive pulmonary embolism on the 1st postoperative day following cholecystectomy]

Two patients, aged 64 and 47 years, had a massive pulmonary embolism one day after cholecystectomy. Ultra-short fibrinolysis was undertaken with 1.5 million units of streptokinase. Both patients rapidly improved, with a fall in heart rate, pulmonary artery or central-venous pressure, and a rise in arterial pO2. There were no significant bleedings. Ultra-short fibrinolysis (maximally over one hour) can thus successfully lyse emboli--consisting of fresh plasminogen-rich coagulation thrombi in the early postoperative period--without re-opening wound- and capillary beds during this short period.

[Catheter brachial plexus anesthesia for intra- and postoperative pain control. Plasma concentrations and analgesia interval in the use of bupivacaine]

In 15 orthopedic patients, undergoing plastic surgery of the upper extremity (elbow, forearm, hand) we studied plasma levels and pain free intervals, when performing catheter axillary plexus block with 0.5% and 0.25% bupivacaine as postoperative analgetic agent respectively. 30 minutes after injection of 40 ml of 0.5% bupivacaine maximum plasma levels were reached (means = 1.46 micrograms/ml), followed by a constant but slow decrease to 1 microgram/ml approximately after 2 h. 11.5 h (mean) after brachial plexus block there was a need for reinjection of local anesthetic solution for postoperative pain control. The pain free interval after 30 ml of 0.25% bupivacaine lasted 10.5 hours on the average. The 'top-up-dose' of 75 mg approximately equal to 30 ml of 0.25% bupicavaine caused only a small rise in plasma levels up to 0.6 micrograms/ml. Catheter brachial plexus block with bupivacaine is an appropriate procedure for both intra- and postoperative pain relief, especially in re-implantation surgery of the upper limb.

[Plasma levels of bupivacaine following inadvertent intravascular injection via a peridural catheter]

We report on a 57 year old woman, who suffered from an inadvertent intravascular injection of bupivacaine via a perforating epidural catheter. At the end of the epidural injection she showed symptoms of toxicity caused by the local anaesthetic. Venous blood dripping out of the epidural catheter and central venous blood were sampled simultaneously and analysis of plasma levels of bupivacaine were performed.

[Rectosigmoidovesical fistula]

The symptomatology of vesico-colonic fistulae is presented and their differential diagnosis discussed. Management should be tailored to the individual case. Whenever possible, we perform a radical primary operation. An additional by-pass colostomy is indicated if it is felt that the integrity of the anastomosis is jeopardised.

[Treatment of unstable pelvic girdle fractures with Wagner external fixation]

Two cases of unstable pelvic ring fractures were stabilized by external fixation with a Wagner apparatus. This enabled a pain-free mobilization treatment to be started immediately afterwards, and, already 6 weeks later, a painless mobilization with a walking frame was achieved.

[Experiences with percutaneous K-wire osteosynthesis in distal radius fractures]

Follow-up controls were made on 300 patients whose fractures of the distal radius were treated by a primary operative fixation with percutaneous K-wire. This group showed significantly better results than a control group of 300 patients given conservative management. We recommend a primary percutaneous K-wire osteosynthesis as treatment of choice for the management of distal radius fractures.

[Perforation of the small intestine in systemic diseases]

Small intestine perforations caused by systemic disorders are, except with M. Crohn, extremely rare. Therefore we report two cases of "spontaneous" small intestine perforations: one with hypersensitivity angiitis and one with Moya-Moya-disease, the latter not yet described in the literature.