M. Allgöwer – författare

International surgical meetings with thousands of participants speaking a dozen different languages tend to be frustrating for the individual who comes with the hope of learning about progress in his fields, but who additionally would like to be able to ex­ change ideas on controversial topics and to meet competent people with whom to discuss specific problems. In the "one-way" ses­ sions in which long papers are presented, details or specific points may be missed. Differing views often are not adequately discussed, because the meeting and its participants are pressed for time. The 44 breakfast and luncheon sessions, covering different topics of interest to the practicing surgeon, were mainly planned to overcome these classical "congress handicaps" and also to do away with the anonymous atmosphere of such a large congress. Slides and formal papers were banished from these sessions. The outcome of these very lively and pleasant discussions taking place around small well-dressed tables was unexpected by most participants. A chairman and several panel members shared their repast, caloric and intellectual, with some 10-30 congress par­ ticipants. The result was in each instance a lively, informative intimate discussion, very different from the anonymous atmo­ sphere of a large meeting. In the hope of preserving these ex­ changes, the chairmen were requested immediately the session finished to "distill the essence" of the 90-minute exchange into a summary captured on tape.

Seit der 1. Auflage gab es so wesentliche Neuerungen, vor allem in der Therapie, daß es notwendig war, das Werk fast völlig neu zu konzipieren und zu schreiben. Wie außerordentlich das Wissen in der Gastroenterologie in den letzten Jahren angewachsen ist, zeigt quantitativ der Umfang des Buches. Eigentlich gibt es jetzt keine 2. Auflage, sondern eine annähernd komplette Neukonzeption. Der Begriff "Chirurgische Gastroenterologie" beinhaltet sowohl die gastroenterologische Chirurgie als auch das notwendige Wissen, um eine adäquate Diagnostik und Entscheidungsfindung bei gastroenterologischen Erkrankungen herbeizuführen. Das Buch vermittelt nicht nur das moderne Wissen zur Pathophysiologie und Pathogenese gastroenterologischer Erkrankungen, sondern auch die zielstrebige Diagnostik und Indikationsstellung zur gastroenterologischen Chirurgie. Der interessierte Leser kann alle notwendigen Informationen finden, die zum Verständnis gastroenterologischer Erkrankungen und chirurgischer Entscheidungen notwendig sind - beschrieben von den jeweiligen Kapazitäten. Damit ist das Buch nicht nur für Chirurgen wertvoll, sondern auch für Gastroenterologen und Internisten, die sich über die chirurgischen Möglichkeiten bei Erkrankungen des Verdauungstrakts informieren möchten. Auch Vertreter anderer an der Behandlung gastroenterologischer Erkrankungen beteiligten Disziplinen wie Röntgenologie, Strahlentherapie, Nuklearmedizin, Onkologie etc. finden wesentliche Informationen.

More than a century ago, Cripps successfully employed the direct and complete division of the anal sphincters as a means of approaching the lower rectum and anal canal, and reported on a series of 36 patients who had been treated in that fashion. Cripps was pleasantly surprised to find good fecal continence in over two-thirds of the patients during later follow-ups, despite the fact that the divided sphincters had not been repaired. The transsphincteric procedure was largely forgotten in subsequent years, however, and only the parasacral proctotomy of Kraske, which spared the anal sphincters, can be said to have gained an established place in the" surgical armamentarium. " It remained for York Mason to redirect the attention of the surgical community to the great potential of the trans­ sphincteric approach and the excellent continence that can be achieved through adequate repair of the divided sphincters. Having recognized the outstanding practical value of this procedure, we felt it necessary to define more precisely the anatomical prerequisites that would ensure minimum operative bleeding, and to bring the procedure more in line with current knowledge of normal continence and defecation. Dr. A. Huber, in consultation with the director of the Institute for Clinical Anatomy of our surgical department, Prof. A. von Hochstetter, did many months of dissection work on fresh anatomic preparations in an effort to explore and refine the various aspects of the trans sphincteric ap­ proach.

The AOjASIF* dynamic hip screw (DRS) has been designed primarily to stabilize trochanteric fractures of the hip. Selected fractures of the femoral neck and some subtrochanteric fractures are further indications for the DRS [40, 46]. The dynam­ ic condylar screw (DCS) has been developed for fractures of the distal femur and is now being tested clinically. The DRS and DCS are carefully coordinated with the preexisting ASIF standard sets of equipment for internal fixation of fractures. The concept of a sliding screw for trochanteric fractures is not new. The first author describing such an implant was Schumpelick [44]; he gives credit to Pohl [22], who was primarily a manufacturer working for Gerhardt Kiinscher. Re described the possibility of impaction at the fracture site with a sliding device. In the United States Clawson [7, 8] introduced the hip screw and found it to be extremely beneficial in trochanteric fractures. At approximately the same time, Massie [31, 32] and Pugh [39] designed the sliding-type flange nails, which offer similar intramedullary splinting with the possibility of fracture impaction. The following chapters describe the concept and design features of the DRS, as well as the details of the surgical technique. The application of the DRS for different types of fractures is illustrated with clinical examples. The results of 268 cases of trochanteric fractures treated with the DRS are presented and compared with results using the angled blade plate and Ender's nails. Finally, some laboratory tests are described.

It is to the great and lasting credit of LORENZ BOHLER and his school that they have in the last decade developed and demonstrated so thoroughly the techniques for the conservative management of fractures. Nevertheless there have always been many, including some from BOHLER'S school, who have found considerable place for surgical management, and with the significant progress in general surgery seen in postwar years, a new stimulus has been given to this part of traumatic surgery, especially since bone injuries have become more complex and frequent. The concept of internal fixation is not new. The serious criticisms that have been levelled at it retain today their basic significance. Progress in the fields of asepsis, corrosion-free metal implants, operative experience and postoperative care has diminished the dangers but has not relieved the surgeon of responsibility. The Association for the Study of the Problems of Internal Fixation (AO) has devoted itself over a number of years to the basic principles and best methods of open treatment of fractures by means of extended clinical and scientific studies in order to determine in each individual case the most promising line of treatment. At the same time a well designed and tested instrument set has been developed with precise instructions for the appropriate techniques. As a result, the new observations about primary bone healing which have emerged from the practice of rigid internal fixation are as interesting as the uses to which they can be put in allowing early mobilization.