Wolf is department head with in Bavaria. Its particularly original professional route confers a personality to him strong and attaching, unless it is the aforementioned which led it to this exceptional course. We met it with the congress of the csotcina.comedic Society of the West which he attends assiduously.

. : Let us start with the presentations ......

: I am csotcina.comedic surgeon and , Departmental manager of a unity of 100 beds, in a communal hospital of 1040 beds, where except the heart surgery, all the specialities are present. This hospital is located in very an old city of Germany in the north of Nuremberg,   which   is called . It is a city very baroque with a famous cathedral which celebrates its thousandths birthday of its foundation this year, with a university and much of cultural institutions like our famous orchestra   the   “”. It is a very beautiful city which is with the world heritage of UNESCO.

. : You are corner?

. : Not, I was born in Munich in the south from Bavaria. I have make my professional course elsewhere and I was elected in as departmental manager.

. : Explain us how is held the course of an csotcina.comedist in Germany…

. : At the time the formation of an csotcina.comedist was completely different from that of a surgeon . In Germany the historical developments of csotcina.comedy and surgery proceeded separately during more than one century. csotcina.comedy dealt of the growth disturbances, various congenital malformations, the after-effects of tuberculosis, the poliomyelitis, the rickets, etc, short its accent was traditionally preserving and far from operational. This preserving attitude was maintained in several csotcina.comedic institutions and in the majority of the private cabinets but it is being exceeded today by a more invasive and more operational csotcina.comedy. In addition the historical development of the German surgery as elsewhere was characterized by an increasing specialization: surgery visceral, vascular, thoracic, cardiac, . The conventional formation of a   surgeon   understood initially at least 6 years of general surgery with acquisition of the knowledge required in visceral surgery and traumatology. Often this initial training was longer because the validating training courses were difficult to obtain. After this certainly demanding and thorough formation one could add one of specializations mentioned asking for three more years of additional formation. Finally, with this system a surgeon-traumatologue N `was not only familiar with the osseous traumatisms and the csotcina.comedic problems, the rachis included, but also with the abdominal, thoracic traumatisms and   vascular,   precondition necessary for an effective assumption of responsibility of the multiple trauma. The objective of the formation in is on the one hand the control of the procedures and on the other hand the comprehension of the of the metabolic amendments of a wounded individual.

. : You spoke about conventional formation….

. : Yes. In Germany the landscape of the surgery is deeply   reorganized   in 2004. Eight surgical disciplines were joined together under the large roof of the Surgery with as new surgical discipline the csotcina.comedy which little front time had been twinned with traumatology.

. : Didn't that pose problems?

. : Naturally. that was not always an love affair. This forced marriage took account of the situations comparable at the European level and thus constitutes a first pitch towards a harmonization of the medical structures in Europe. Moreover, the majority of the csotcina.comedists and understood that their procedures, their daily work, their future problems and concern were more or less the same ones. Finally, this twinning makes it possible to join together the forces and energies of the two disciplines. On the political plan it will support scientific exchanges and co-operations and, hope for it, will improve vocational training of the young people.

. : Y T it has disadvantages?

. : The conventional csotcina.comedists fear to lose their traditional ground, i.e. preserving csotcina.comedy. This concern relates to especially experts practitioner in their cabinet only one not-operational csotcina.comedy  .   In other European countries, this medicine csotcina.comedic is practiced by the rheumatologists. On their side, the fear to lose the extent of their formation and finally their competences to manage the multiple trauma.

. : How is made now the formation?

. : All the young colleagues who chose any surgical discipline start with 2 years a common formation, the joint base understanding 4 stages, each of one nths duration. After this basic training, obligatory for all, are added 4 years in the desired speciality. That can be the surgery visceral, vascular, cardiac, or csotcina.comedy and traumatology. The formation thus achieved in a recognized institution ends in an oral test.

. : It is all?

. : Yes. But 6 years of formation often to the reduction, are not enough to fulfill the requirements of current knowledge. Then, the csotcina.comedist and the modern version can continue his formation with a professional deepening by adding one 3 years additional period in sectors specialized like csotcina.comedy , the pediatric csotcina.comaedics, csotcina.comedy, traumatology. Finally,   a   ripe and valid formation will ask for at least 9 years of training.

. : How was your personal route?

. : Completely different from the standard path. As child I liked all technical do-it-yourself, like installing radio posts, for example of the transmitters with short waves, etc, to inflate motor bikes, to make chemical experiments, (once followed by a beautiful explosion in my paternal house), in short my childhood was marvellous. I adored physical sciences and natural, and began my studies, that then will not astonish you, in electrical engineering and physics.

But only for a few months! By refusing the military service because I was and I am still today objector convinced of conscience, one called me for the civil service, at the time one nths duration. I initially carried it out in a sanatorium for the processing of tuberculous where the atmosphere was that of the Mount of Mirage describes by Thomas in the middle of the #07645A Forest. I.e. we were in a splendid but obsolete environment, out of time when the patients remained   a   eternity. I was odd-job man.

Then, I made a one year stay as auxiliary male nurse in a department of internal medicine of a hospital public in the north of Germany. The contact with the patients, to see their suffering and their individual distress, that was finally my key experiment, and I decided for medicine.

Whereas my decision studied medicine was quite clear for me, it caused a disappointment and a disapproval on the side of my father. He, while being amateur of fundamental sciences,   scorned   medicine like such. For him medicine was charlatanry. In conclusion: it accepted my decision forever, consequently I profited from no support or assistance from its share. The rupture with my father brought to me on a side a personal freedom, another side also the need for clearing up me and for earning my living.

Once again an important experiment: to become acquainted with several completely different trades, to work with the fields, the horticulture, the sawmill, at the laboratory, as workman of the ship, to learn and carry out wiring, even of high voltage, to repair motor bikes, etc. Of course, it was one sometimes hard but also rich and profitable period - also on the social plan.

My years of studies were fantastic. It is possible that the German university at the time more liberal or, as you want, “was slackened more” that elsewhere. Separately the periods reserved being studied and work to earn my living, it sufficient remained me time to carry out fantastic voyages, by different means, that is to say at foot, bicycle, motor bike, a small section even with horse - In addition a disaster -, in car or, more often, stop. In spite of my average limited well I had the great chance visit several countries in Asia, like Iran, Afghanistan, Pakistan and India, but it was in first line Africa which strongly attracted me.

. : How was held your surgical course?

. : I started to work in a department of general surgery. I told myself that to control its trade of surgeon, anesthesia had to be made. Then I put myself there and I practically made   1500   anesthesias. Then, as I am very curious, I made pathology to improve my knowledge in anatomy and to understand the reports of the anatomo-pathologists and I was likely to be accepted by Pr max of the university of Munich. In addition towards the end of my medical studies, in the obligation which I had to finance my studies, I had the extraordinary chance to obtain an employment as auxiliary assistant, and later as assistant at the Max-Planck-Institute , the most prestigious research institute in Germany. This temple of biochemistry functioned at the time under the aegis of , then of which both were Nobel Prize. What a pioneer spirit,   what a   environment user-friendly, co-operative and international fantastic! One studied the mechanisms of the regeneration of the liver: how does regeneration occur after a partial hepatectomy? This work led besides to a patent filling. At the end of these search in biochemistry, after more or less 5 years, I took again the general surgery in the famous hospital of in the south of Munich. The visceral surgery of , under the management of Pr Werner Grill, today one as of the my best friends, was at the time direct subsidiary of the school of , more recognized German surgeon post-war period. It was also a pleasure of practicing an abdominal surgery of very a top-level.

. : Here is an original route for an csotcina.comedist…

. : Who is explained by two features of my personality  : on the one hand I make a point of forming me in fields which I do not control and on the other hand I hate really the routine. I began in general surgery to ensure me that I was well made for this trade there. Then I ensured myself that I had the base units like the anesthesia and pathology to completely control my future trade of surgeon. I was especially afraid to too early become , which can sometimes be a symptom of narrow-mindedness.

.  : You explain it why but not it how. Doesn't that pose administrative problems   all these changes of specialities?

. : Formerly in Germany, one asked the future surgeon to make anesthesia and pathology, they was prerequisites necessary. However at my time that was not any more the case, but that remained possible . We were very little in my promotion to do that. For a long time I continued to work   like   anesthetist the evening and the weekends to earn my living. That made me some 90 work hours weeks.

. : With which age you really did begin the surgery?

. : I started at 30 years. It was then necessary to choose departmental managers in whom one could plan to make his formation and to send his RÉSUMÉ. And a favorable response was awaited. With the formation that I received, I was very asked and I saw several instructors who wanted to take to me as surgeon. I thus make my training in visceral surgery. I then presented my candidature for the department of vascular surgery and thoracic of the of . The aforementioned was directed by an international high-speed motorboat the pr. whose works were our bibles. I was accepted but the life in this service was very hard. The half-life of an intern was nths but I succeeded in surviving nth in this daily hell and I passed for a hero. At this point in time I fell on an ad in a German medical newspaper, where one sought a surgeon for Zaire.

. : You knew Africa?

. : As student, I had made several voyages in Africa. Once with a friend, one hitch-hiked through the Maghreb, the Sahara, Nigeria as far as East Africa. Another time one passed by Egypt and Sudan. After a long tour, we arrived in the virgin forest which strongly impressed us.   Then,   we went on the banks of side Central African Republic to see the sunset. I never forgot this evening. When I saw this ad to work in a hospital on the edges of , that was for me like a godsend. Then with my still small wife and our three children, one decided to go there and one remained there during three years between 86 and 89.

. : In which structure?

. : It was an health care institution located at the center of Zaire not very far from the Central African Republic and of Sudan. A large area like Bavaria with a central hospital, three associated hospitals, 22 dispensaries, a pharmacy, a school of male nurses. I was responsible for 15 #FFFFFF co-operators “   ” and for more or less 500 African. One practiced the general surgery and , obstetrics, urology, the vascular surgery.

. : It is over there that you learned French?

. : I had started at the school and I tried to clear up me at the time of my voyages of student in Tunisia in Algeria and in Morocco. I improved in Zaire.

. : With your medical formation     general-purpose you were particularly qualified for the post…

. : I am also mechanic, I can repair a car or a generator  ! It is true that reality in the hospitals in tropical area is difficult and requires many adaptabilities. We received patients of all the corners of the country and towards the end of my stay, our department of recruitment was of m and it arrived to us a thousand of patients per day in peak season.

. : Much traumatology?

. : Many of all the surgical specialities. In traumatology we had of nails, plates and external fixer. The problem was especially related to the conditions under which the casualties arrived. I will never forget the unloading of about thirty wounded an accident of bus in bush. A truck which by chance passed shortly after the accident had taken all the casualties in his bucket and had brought them directly in the exchange rate of the hospital. Hardly arrived, the bucket rose and all the casualties were discharged from only one blow in bulk in the middle of howl and the truck set out again at once. The male nurse who attended incredulous as me this scene had this comment  :   “  but it is in a hurry that one  !  ”. We operated not stop during 24 hours and I believe to remember that everyone was left there. Two days later of the dispatched surgeons of the capital to help us arrived but they did not have anything to make  : all the interventions were finished.

. : Why did you return?

. : It was very interesting, but if one works too a long time under these conditions, one is likely to more be able to rehabilitate itself with the European surgery. Moreover, that became a routine and as I explained it to you, I hate the routine. I thus returned to Germany and I took a vacant post, it was a post of assistant in cardiovascular surgery in a regional hospital.

. : And csotcina.comedy?

. : It was a gap in my formation and you understood   that   I have   always tried to make things which I did not know. The service of the pr. was very famous because this last was the spiritual son of Maurice and . He was surgeon and csotcina.comedist what was an innovation in Germany because the two disciplines were strictly separate. is that which joined together the two disciplines as in the French model. At the time of his retreat, its successor, , wanted to be surrounded surgeons having a solid experiment and had put posts at recruitment. That was an opportunity for me and I was selected more especially as beside my formation of “   ” it was interested by my past of biochemist. I am thus turned over in .

. : Why this interest for biochemistry?

. : We wanted to analyze the metabolic changes after multiple traumas and for this reason I installed laboratories.  Indeed, on the one hand it is very difficult to immediately estimate the impact of a on the lungs because the demonstrations visible with the radio or the scanner arrive only later. In addition, the estimate of the initial damage on the level of the soft parties is also very difficult and has implications on the surgical procedures. Lastly, these two primordial problems can be responsible for multiple failures of the parts. Metabolic variations occur by destruction of the parts or tissues in general. One analyzed the blood of wounded and one identified metabolites which can make it possible to measure the seriousness of a traumatism.

. : I.e. with   a blood test, one could judge seriousness and distribution of the ?

. : Yes! The analysis of laboratory takes approximately an hour. One thus can as of the arrival of wounded at the hospital knowledge if it has a serious pulmonary contusion. That makes it possible to indicate intubation and direct pulmonary split to avoid the respiratory distress syndrome acute. With an early stage, the severity of the pulmonary attack     after traumatism is correlated with the plasma concentrations of interleukin-6 and the attack of the soft parties with the blood concentrations of IT 8 and 6 and of creatine kinase. These results were published in particular in 1999 in Journal off and 2003 in the review.

. : You-be you also interested   in the   ectopic ossifications?

. : Yes, that arrives to but primordially at the cranial ones. One measured the metabolites in the blood of more or less 300 wounded. At like at the cranial , it there with the 2 which is increased. What is very interesting it is that when one puts the serum of the patient on crops of osseous airframes, that stimulates osteogenesis. This negotiable instrument is neutralized by the administration of NSAID of the Diclofenac type.

. : How did your training in csotcina.comedy at occur?

. : Because of my professional route, I became responsible for the emergency room where arrived traumatized. I was very curious in all the fields and for example I quickly thought of a university research program to develop cement to fix for example the fractures of the radius… I was also very concerned by the difficulties of the trade. I took part whereas I was assistant without any csotcina.comedic experiment with a catastrophic attempt at correction of vicious cal of the femur after . The responsible surgeon had placed reference plugs, and then it made the osteotomy, but it did not control the situation well. In short the first pin was lost, the wedged second, therefore there was no more reference mark. It put under these conditions a screwed plate and the clinical outcome was worse than front. I wondered how to control and measure the and the lengths of the femur and the tibia in particular during the operation.  And initially, what is normal  ? Then I worked with a friend of the department of radiology and we developed the system by scanning where one can reproduce the analyzes of the and lengths. We made measurements on 500 people to have a database of femoral and tibial measurements at the man. That was published in the years 97 as well as the technical improvements concerning the corrections of vicious cal.

. : Had your practice of osseous traumatology prepared you well with csotcina.comedy?

. : On the plan of the after-effects of the traumatology of members only. I did not have any experience on the prostheses because I had never posed some before. I did not have either any experience on the rachis or the bone tumors. I learned much in this department of csotcina.comaedics where I remained 10 years.

. : Ten years in the same place, it is a performance for you!

. : Yes, it is astonishing  ! It was so new for me. It was fantastic. I started as assistant then quickly I became assistant surgeon.

. : You had good wages?

. : Yes, it was sufficient. Personally, I am not very worried by the money. For me the pleasure it is team work. Obviously, in private clinic private the incomes are better. The department head had a liberal activity but it transferred a party with its assistants of it. What improved my income of approximately 1000 euros per month.

.  : Why are you party with ?

. : With maturity and the experiment, one enters inevitably in competition with the departmental manager. It is always awkward to make him shade. I thus sought a post elsewhere. There was a place of departmental manager at the communal hospital of located at m.

. : You had given up working in academic world?

. : It was not simple. I had found a post in and also in Mannheim. But in the first the conditions concerning search were very difficult and in the other it was necessary to give up csotcina.comedy to make only . I really became csotcina.comedist and I did not want to accept any more the separation of these two years. In addition in we belong to a network of academic hospitals who are associated with the university and we have students. I can thus continue to make teaching. I am nevertheless instructor at the university of . In more one can collect means of industry or any source to continue a research task. That depends on personal energy that one puts at it.

. : How was made the selection for your post?

. : There were 26 candidates. The   decision   depended   on the town council, person responsible for the health institutions made up of some doctors and some town councillors. I was thus selected to direct this service of 98 beds including beds of intensive care and beds for the children.

. : Which is your organization?

. : I have 6 associated and among them there are an hand surgeon and foot and an csotcina.comedist pediatrist. And then I have 14 assistants. In guard, the assistants assume the simple urgencies. As soon as it one there, the assistant comes obligatorily. There are 5 people who are obliged to be on the spot to receive , it is the associated surgeon, the anesthetist, the nurse of anesthesia, the nurse of the surgical unit and the radiologist.

. : Do you have problems of medical recruitment?

. : One period ago when one had too many doctors but that changed. Many German doctors preferred to work in Scandinavia or in Switzerland and it became rather difficult to find doctors of German native tongue. That poses problem in East Germany particularly where the fellow-members come from Poland, of Bielorussia, or Ukraine… On our premises that is well because our department is rather gravitational and that the hospital is remarkably equipped, but for the other hospitals it is increasingly problematic.

. : What do you practice like programmed surgery?

. : I make , , of any hinge and not badly of correction of vicious cal. I kept part of my recruitment of the and I receive patients of everywhere including foreigner. They is obviously generally vicious cal of the lower limb but I make also corrections on the level of the upper limb. 

. : How were made your professional contacts with France?

. : At the time of the first congress of the EFFORT, in 92 or 93 I believe. It was at the time bilingual and I found that was very well to use English but also the national language. Then, I went so far as to make my French talk. It was on the metabolic consequences of the central-medullary . The USSR   was there with another Switzerland and later he asked to me whether that interested me to take part in an exchange rate of the French-speaking in Davos. I said myself why not  ! Thereafter, he proposed to me to contact the csotcina.comedic Society of West which I did not know at all. which worked in lived its childhood in Paris east it is a convinced European. He suffers that Europe is divided because of the languages and there is what. For example between France and Germany the scientific informations make a turning by the literature and that takes 10 years.