Levobupivacain in der Geburtshilfe

Levobupivacaine, the S-enantiomer of racemic bupivacaine, will be available in Germany in mid-2004. Pharmacological studies demonstrated that, compared to bupivacaine, levobupivacaine has equal local anaesthetic potency with reduced potential for cardiac and CNS toxicity. This review introduces the new long-acting amide local anaesthetic levobupivacaine to the reader and evaluates its place in obstetric analgesia and anaesthesia compared to bupivacaine and ropivacaine.     

Eigenblutspende in der Geburtshilfe

Objective. To demonstrate the safety of autologous blood donation in an obstetric practice. Methods. A total of 2350 pregnant patients were screened for an increased risk of peripartum bleeding. Excluding patients with contraindications, a total of 71 women participated in this autologous blood donation program. Blood was donated in the 35th and 37th weeks of pregnancy. Results. No problems occurred in the course of blood donation. All newborns were found to be healthy; 41 of the 71 patients received peripartum autologous blood transfusions. Homologous blood was not given to any of the patients. Conclusion. Our experience demonstrates that autologous blood donation is a safe practice in the setting of obstetrics, when the indications and contraindications are considered. Further studies in larger patient populations are necessary to expand or restrict the indications for autologous transfusion in obstetrics.     

Schwer verletzte Schwangere aus Sicht der Geburtshilfe

Die Unfallchirurgie - Die Behandlung der schwer verletzten Schwangeren stellt höchste Anforderungen an die interdisziplinäre Zusammenarbeit, um den maternalen und fetalen Ansprüchen...     

Patient Blood Management in der Geburtsvorbereitung,Geburtshilfe und postpartalen Phase

Die Anaesthesiologie - Die Implementierung eines Patient Blood Management (PBM) wird zunehmender Standard in der operativen Medizin. Seit einiger Zeit gilt das Interesse auch den vulnerablen...     

Analgesie und An?sthesie zur Geburtshilfe in der Schweiz 1999

Fragestellung. Ziel dieser Befragung war es, Informationen über die An?sthesie- und Analgesiemethoden in der Geburtshilfe an Schweizer Kliniken zu erhalten und einen m?glichen Einfluss der Interessengruppe für geburtshilfliche An?sthesie zu evaluieren.     

Durchführung von Analgesie- und Anästhesieverfahren in der Geburtshilfe

While guidelines represent systematically developed aids for decision-making on appropriate courses of action, recommendations should focus the attention of the medical profession on noteworthy circumstances which are in need of amendment. The new recommendations on the “Execution of analgesia and anesthesia procedures in obstetrics” of the German Society for Anesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI) and the Professional Association of German Anesthetists (Berufsverband Deutscher Anästhesisten, BDA) in cooperation with the German Society for Gynecology and Obstetrics (Deutsche Gesellschaft für Gynäkologie und Geburtshilfe, DGGG) comprehensively fulfill these requirements. The new recommendations include not only revisions in the form of updating but also supplementations in the form of the new chapters “Initial care of newborns”, “Postpartum hemorrhaging” and “Morbid obesity”. In the following article relevant alterations to newly formulated or completely amended sections with consequences for the clinical practice will be discussed.     

Die Epiduralanalgesie zur Geburtshilfe

Epidural analgesia is the most effective means of pain relief during labor and is considered to be the "gold standard". For sufficient epidural analgesia, a wide range of nerve-block has to cover the segments Th10 to S4. This article includes the pathophysiological background as well as aspects of risk information and informed consent. Practical issues such as the insertion of the epidural catheter, choice of medication and application modes are described. The influence of epidural analgesia on labor, instrumental delivery and rate of caesarean section is discussed.     

Stellung der Strahlentherapie in der Behandlung der Knochentumoren

Primary malignant bone neoplasms are relatively rare.The most common bone tumors are osteosarcoma,Ewing's sarcoma,chondrosarcoma, fibrosarcoma,malignant fibrous histiocytoma of bone, giant cell tumor, aneurysmal bone cyst and chordoma.These tumors are generally considered to be a radioresistant entities, but it has been suggested that radiotherapy may be effective in a palliative and in some curative situations, if a sufficient dose is given to an adequate volume. Only for the management of primary Ewing's sarcoma the radiation therapy is an essential part in the multimodal therapy concept.The most common bone neoplasms and the role of the radiotherapy are discussed in these chapter.     

Standards in der Diagnostik der Divertikulitis

The diagnostic procedure is determined by the severity of the diverticulitis. In complicated cases of diverticulitis, it is necessary to detect those patients with obstructive ileus, perforation, and peritonitis who require instant emergency surgery. In all other cases, diagnostic procedures serve as a tool to determine the best therapeutic options. The CT scan of the abdomen seems to have the highest reliability for determining therapy. Other investigations such as barium enema and coloscopy are not indicated in emergency cases or cannot exactly describe the stage of the diverticular disease. Many surgeons still prefer an enema with water-soluble contrast medium in emergency cases to visualize a perforation. CT scans have the same ability to answer this question, but they are more expensive and are not available everywhere at any given time.     

Verbesserung der Resultate in der Spaltenchirurgie

Ohne Zusammenfassung Mit 1 Textabbildung     

Erfahrungen mit der Spongiosaplastik in der Behandlung der chronischen Osteomyelitis

Ohne ZusammenfassungMit 5 Textabbildungen in 13 Einzeldarstellungen     

Die Bedeutung der Thorakoplastik in der operativen Behandlung der Lungentuberkulose

Ohne Zusammenfassung     

Stellenwert der Kirschner-Draht-Osteosynthese in der Behandlung der distalen Radiusfraktur

The age distribution of patients with distal radius fractures shows a clear predominance of patients over 60. In such patients fractures must be treated with due consideration for the general condition, accompanying illnesses, such as osteoporosis, and the often lesser ambitions concerning the function of the wrist joint. Three cases of patients over 70 years of age are presented: two of these patients were suffering from dementia and one, from multiple morbidities and poor general condition: In all three, severe osteitis of the distal radius developed after K-wire pinning to treat distal radius fractures. In two cases, the treatment culminated in radiocarpal arthrodesis, while in the third the definitive treatment was resection of the metaphysis of the distal radius. The presented cases indicate that in distal radius fracture patients who are affected by dementia or have a poor general condition K-wire pinning with protruding K-wires should not be regarded as the therapy of first choice.     

Stellenwert der Herz-CT in der Diagnostik der koronaren Herzerkrankung

The quantification of coronary calcifications using noncontrast-enhanced computed tomography (CT) as well as coronary CT angiography (cCTA) have rapidly evolved in the recent years. Nowadays, both techniques are increasingly clinically accepted regarding risk stratification and accurate exclusion of significant coronary artery disease (CAD). The higher acceptance of cCTA is mainly based on the higher robustness, lower radiation exposure through continuous technical innovations as well as by the growing scientific evidence. The poor predictive value of cCTA for predicting the hemodynamic significance of detected coronary artery stenosis may be improved by continuous technical developments in the area of functional imaging. The aim of this educational article is to summarize the current clinical status of calcium scoring and morphological cCTA and to provide an overview on novel functional CT techniques.     

Stellenwert der Strahlentherapie in der Urologie

Zusammenfassung Die Strahlentherapie von Patienten mit Prostatakarzinomen bietet eine gleichwertige Alternative zur radikalen Prostatektomie in frühen Stadien (T1–T2). Beim lokal fortgeschrittenen Prostatakarzinom ist eine hochdosierte oder kombinierte Strahlentherapie effektiver als eine Radikaloperation bei geringerer Morbidit?t und Mortalit?t. Durch die Entwicklung neuer Linearbeschleuniger und Fortschritte in der Bestrahlungsplanung mit besseren Bestrahlungstechniken ist es heute m?glich, h?here Bestrahlungsdosen zu applizieren und gleichzeitig das umgebende, gesunde Gewebe besser zu schonen. Somit ist es m?glich, da? die Rate von therapiebedingten Komplikationen konstant bleibt oder absinkt. Die Kombination von perkutaner Radiatio mit interstitieller Brachytherapie ebenso wie die Kombination von Hormontherapie mit perkutaner Radiatio sind m?glicherweise effektiver als die alleinige perkutane Radiatio. In ausgew?hlten F?llen mit niedrigem Risiko ist eine alleinige, interstitielle, permanente Brachytherapie angezeigt. Zukünftige Entwicklungen (IMRT, kombinierte Thermo-Radio-Therapie, Protonen- oder Neutronentherapien) k?nnen m?glicherweise die Rate kurativ behandelter Patienten weiter erh?hen.