[The physician and accidents. Legal and medical problems].

German law requires that any physician at a place of accident is obliged to help according to his training and ability. As an emergency doctor on duty he works in a warrantee position. In cases with multiple accident victims triage may be necessary, corresponding to the priority of medical care.

Changes in the cellular immune response by a subfraction of burned murine skin.

Sepsis due to impaired host defence mechanisms is one of the most frequent causes of death in severely burned patients. However, it is not precisely known to what extent syntheses and release of suppressive mediators of the burned tissue affect the cellular and humoral immune responses. In this study a decreased production of plasminogen activator by macrophages is demonstrated after incubation with skin components, indicating a decreased macrophage helper function for T-B cell cooperation.

[When is a breast-preserving operation permitted?].

Breast preserving operations in cases of breast cancer are permitted only under following conditions: Tumor extension should not exceed stage pT1. Axillary lymph nodes have to be removed completely. Histological examination requires a competent pathologist.

[Early treatment of burn wounds].

Primary excision and immediate grafting are limited by blood loss and donor areas. This may never prevent primary excision of burnt hands and face. Excision should be limited to about 20% of the body surface.

[Secondary immunodeficiencies following severe skin burns].

Despite of modern fluid resuscitation, electrolyte management and respiratory care techniques 70% of severely burned patients often survive the early posttraumatic phase only to later succumb to septic complications. Acquired deficiencies in host defense mechanisms are largely held responsible for this increase in susceptibility to sepsis. The thermal insult affects the complex interactions of cells of the immune system by generation and release of suppressive mediators which, in turn, either cause defective cellular functions or overstimulation of regulatory pathways of host defense.

[Burns--introduction and organizational tasks].

A generally accepted treatment of severe burns has not yet been established. Important demands, such as early excision and avoidance of a granulating surface have not been asserted. Treatment frequently lasts too long, is too expensive, and results are disappointing.

Phagocytic activity of granulocytes and alveolar macrophages after burn injury measured by chemiluminescence.

Despite substantial progress in handling the acute phase, about 50 per cent of all severely burned patients are still subject to lethal infections during the later stages of the burn disease. Such patients frequently succumb to infections by opportunistic bacteria and viruses of normally low virulence indicating that the antiinfectious host defences are severely compromised. The present study was conducted in order to evaluate the effects of severe thermal injury on the two major categories of phagocytic cells, the circulating phagocytes of the blood and the alveolar macrophages as one population of the fixed phagocytes of the reticulo-endothelial system.

[New aspects of the treatment of larger bone defects].

A characterisation of mainly used implant materials into bone defects is performed. The materials are classified in two groups; their biological effects are described in detail. Using OCG as a typical osteoinductive implant histological and radiological findings are described which take place in animals after heterotopic and orthotopic implantation.

Osteoinduction. Part II: Purification of the osteoinductive activities of bone matrix.

Using a previously described experimental model for demonstration of osteoinduction biological activity of variably prepared fractions of demineralized bone matrix was studied. Sequential extraction of matrix using CaCl2, EDTA, LiCl and water results in an acceleration of the induction process and a reduction of immunological host reaction in the case of xenogenic implants. Application of chaotropic reagents such as guanidinium chloride and sodium thiocyanate has the consequency of lowering the inductive signal.

[Stomach replacement by iso-anisoperistaltic jejunum interposition (Tübinger replacement stomach)].

Since 1972 we have been using a new method of gastric replacement which was developed at our hospital. The reconstruction of passage is achieved by iso-anisoperistaltic interposition of two jejunal segments (30:10 cm). The reversed segment causes delayed and intermittent emptying of the above located isoperistaltic segment.

[Final procedure after colectomy with special consideration of ileorectal anastomosis (author's transl)].

The indication for ileorectal anastomosis after colectomy is most likely given - with all reservations - in cases of ulcerative colitis and polyposis coli, not so often in Crohn's disease. Our own studies of dwarf pigs have shown that no qualitative changes take place in the histochemical characteristics either of ileum mucosa or in that of the rectum, following ileorectostomy. Late results of shelling out the rectal mucosa, and the tendencies towards constructing a reservoir of terminal ileum in the pelvis, remain to be seen.

[Combined use of iso and aniso-peristaltic jejunal loops to reestablish continuity after total gastrectomy (author's transl)].

Following experiments in animals, a new procedure for gastric replacement after total gastrectomy has been employed since 1972. Digestive tract continuity is reestablished by interposing two jejunal segments, on iso- and the other aniso-peristaltic, between the esophagus and the duodenum. The proximal isoperistaltic segment should be between 30 and 40 cm in length, while the distal anisoperistaltic segment should measure 10 cm.