Primary reconstruction of open depressed skull fractures with titanium mesh

Open skull fractures have been traditionally managed in 2 stages: urgent craniotomy and elevation of the fracture with removal of contaminated bone, debridement, and delayed cranioplasty. Primary, single-stage repair of these injures has been said to entail risks such as infections. Recent experience, however, disproved these concerns.We used a primary single-stage reconstruction for patients presenting with open depressed skull fractures. All patients received antibiotic prophylaxis. The patients underwent elevation of the compound fracture and craniotomy if necessary. Debridement was performed, followed by skull reconstruction using a 0.6-mm titanium mesh.We present 5 consecutive male patients (age, 32.2 +/- 15.6 years) who underwent primary reconstruction of open depressed skull fractures. Clinical and radiologic follow-up was performed 2 months after surgery. The duration of the surgery was 2 +/- 1.6 hours. The size of the implanted mesh was 13 +/- 13.1 cm. No infection was detected in our series, with a follow-up period of 22 +/- 6.5 months (range, 16-29 months). The cosmetic result was defined in 4 patients as "excellent" and in 1 patient as "good."Primary reconstruction of open skull fractures with titanium mesh is feasible, safe, and cosmetically preferable than the conventional staged approach. The introduction into clinical practice can be warranted.

Complete arterial revascularization in multivessel coronary artery disease with 2 conduits (skeletonized grafts and T grafts)

BACKGROUND: Complete arterial CABG is a surgical option to improve long-term results in the treatment of coronary artery disease (CAD). Harvesting of multiple arterial grafts is commonly associated with prolonged operating times and increased trauma. By use of new operative techniques (skeletonized grafts and the T-graft approach), CABG in multivessel CAD is now possible with only 2 grafts. We present our experience in the use of these techniques on a routine basis. METHODS AND RESULTS: Between March 1996 and September 1999, 490 patients (aged 61+/-9 years, 20% female) underwent complete arterial CABG. Left ventricular ejection fraction ranged from 15% to 85% (mean 59+/-15%). Triple-vessel disease was present in 88% of the patients. The incidence of diabetes mellitus was 32% (14% insulin dependent). Either both internal thoracic arteries (ITAs) (23%) or the left ITA and radial artery (77%) were used as conduits. In 85% of the patients, a T graft was created. Mean operating time was 198+/-46 minutes; bypass time, 82+/-25 minutes; and ischemic time, 58+/-22 minutes. Two to 7 (mean 4.1+/-0.9) anastomoses were performed per patient. Perioperative intra-aortic balloon pump was necessary in 12 patients (2.4%). The rate of perioperative myocardial infarction was 1.2%. Sternal complications occurred in 1. 0%, and in-hospital mortality was 2.2%. Postoperative coronary angiography in 172 patients (35%) documented excellent patency rates (left ITA 98.3%, right ITA 96.5%, and radial artery 96.6%). CONCLUSIONS: Complete arterial revascularization in multivessel CAD is possible with the use of only 2 grafts with good perioperative results. This approach allows for complete arterial CABG on a routine basis.

„Neko bi pomislio da se barem delimično sačuva dogma o monarhiji”: Antilatinski traktati Varlaama Kalabrijskog u srpskoslovenskom prevodu 14. veka

Die antilateinischen Traktate von Gregorios Palamas und Barlaam von Kalabrien stellten für die serbischen Übersetzer des 14. Jahrhunderts eine grosse Herausforderung dar – nicht nur wegen ihres dogmatischen Inhalts, sondern auch wegen des ausgeprägt polemischen Charakters ihrer Argumentation. In diesem Aufsatz wird die argumentative Form der zwei Traktate („opuscula“ ) Barlaams von Kalabrien analysiert, die in cod. Dečani 88 enthalten sind (fol. 38r-81r). Der zweite von ihnen (fol. 69v-81r) richtet sich an ein griechisches (orthodoxes) Auditorium; die Anreden an die Lateiner, die sich darin finden, haben rein rhetorischen Charakter. Der erste Traktat (fol. 39r-69r), der während der Unionsverhandlungen des Jahres 1334/1335 entstand, hat jedoch eine für die byzantinische Unionspolemik eher ungewöhnliche Form: der Dialog mit der Gegenseite ist hier keine rhetorische Fiktion, sondern ein ernstes Anliegen des Autors. Dies hat bereits bei der Rezeption des Traktats im griechisch-athonitischen Milieu den Verdacht geweckt, Barlaam habe den Lateinern unzulässige Zugeständnisse gemacht. Barlaam hat versucht, diesen Verdacht durch metakommunikative Kommentare zu entkräften, die ausschliesslich in der serbisch-kirchenslavischen Übersetzung von Dečani 88 enthalten sind. Der Übersetzer der Traktate hat deren argumentative Form im wesentlichen nicht angetastet und nur gelegentlich versucht, die Zugehörigkeit der einzelnen Argumente dem Leser durch Marginalscholien deutlich zu machen.