157. Operative Behandlung der habituellen Schulterluxation nach Eden-Hybinette

Zusammenfassung Zur operativen Behandlung der habituellen Schulterluxation sind im Schrifttum zahlreiche Methoden angegeben worden. Diese Anzahl von Verfahren ist Beweis dafür, daß keine von diesen Methoden optimale Ergebnisse erbracht hat. Hier ist nicht allein die Methode als solche, sondern die Art der Durchführung der jeweiligen Operationsverfahren für Erfolg und Mißerfolg verantwortlich. In diesem Film wird die von uns seit Jahren mit Erfolg durchgeführte Operationsmethode nach Eden-Hybinette bei vorderem und hinterem Zugang während der Operation und auch als Trickzeichnung vorgeführt.     

Betrachtungen zur notwendigen Stabilität und zur Biomechanik der Frakturheilung bei Fixateur-externe-Osteosynthesen

In recent years, many investigators have concerned themselves with improving the construction of the external fixateur in order to achieve even greater stability. Clinical observations demonstrate a moderate callus formation and an often considerably delayed fracture healing resulting from such an extreme rigid mounting of the external fixateur. This report presents viomechanical considerations which indicate that extreme rigidity in the external fixateur is not only unnecessary, b ut may even interfere with fracture healing and the formation of functionally stable bone.     

Postoperative pulmonale Komplikationen

Postoperative pulmonary complications are a major problem after upper abdominal or thoracoabdominal surgery. They lead to a prolonged ICU stay as well as increased costs and are one of the main causes of early postoperative mortality. Even after uncomplicated operations, postoperative hypoxemia occurs in 30-50% of patients. Acute respiratory failure involves a disturbance in gas exchange. The mortality ranges from 10 to 60% according to the severity of respiratory failure. The most important complications are interstitial and alveolar pulmonary edema, atelectasis, postoperative pneumonia, hypoventilation, and aspiration. Preoperative optimization, postoperative prophylaxis according to a stepwise approach, and early mobilization decrease the rate of complications.     

Klinisch-neurologische Diagnostik des sepsisassoziierten Delirs

Sepsis is a frequent emergency and an acute disease which is still highly lethal. Due to an early involvement of the brain in terms of a sepsis-associated delirium the neurologist plays an important role in the early diagnosis of the interdisciplinary disease. The following review details the main diagnostic aspects of a sepsis-associated delirium.     

Impact of surgeon experience and buttress material on postoperative complications after laparoscopic sleeve gastrectomy

Background

Sleeve gastrectomy is gaining popularity whether as a primary, staged or revisional operation. The aim of this study is to evaluate the perioperative safety and the learning curve for laparoscopic sleeve gastrectomy (LSG).

Methods

We performed a retrospective review of the prospectively collected data for all patients who underwent LSG for the treatment of morbid obesity at our institution from January 2003 to December 2008.

Results

Data from 230 consecutive patients [male 47%, female 53%; mean age 44.0?±?10.0?years, mean preoperative body mass index (BMI) 56.7?±?11.5?kg/m²], who were operated upon by three surgeons with different degrees of bariatric experience, were analyzed. There was no 30-day mortality, but there were two cases of late mortality (0.87%). Early complications were noted in 23 cases (10.0%), including 10 cases of leak (4.3%) and 10 cases of hemorrhage (4.3%). In 17 cases (7.4%) reoperations were performed. The rates of overall and major complications did not differ among surgeons or between early and late period of experience for the three surgeons; this trend held true individually and in subgroups. Overall, over the course of the learning curve, a significant decrease in operative time was noted. The only factor that was independently associated with complications was use of buttress material; the likelihood of complications was found to be 72% lower in patients in whom buttress material was used.

Conclusions

LSG constitutes a potentially safe anti-obesity procedure with acceptable morbidity. Experience at the beginning can be discouraging, even for surgeons with advanced laparoscopic skills. LSG can be performed safely, with proper mentoring and in appropriate settings, even by less experienced bariatric surgeons. The use of staple-line reinforcement was associated with improved perioperative outcomes, and it should be considered in an attempt to decrease leaks.     

Repetitive mTBI is associated with age-related reductions in cerebral blood flow but not cortical thickness

Mild traumatic brain injury (mTBI) is a risk factor for Alzheimer’s disease (AD), and evidence suggests cerebrovascular dysregulation initiates deleterious neurodegenerative cascades. We examined whether mTBI history alters cerebral blood flow (CBF) and cortical thickness in regions vulnerable to early AD-related changes. Seventy-four young to middle-aged Veterans (mean age = 34, range = 23–48) underwent brain scans. Participants were divided into: (1) Veteran Controls (n = 27), (2) 1–2 mTBIs (n = 26), and (2) 3+ mTBIs (n = 21) groups. Resting CBF was measured using MP-PCASL. T1 structural scans were processed with FreeSurfer. CBF and cortical thickness estimates were extracted from nine AD-vulnerable regions. Regression analyses examined whether mTBI moderated the association between age, CBF, and cortical thickness. Regressions adjusting for sex and posttraumatic stress revealed mTBI moderated the association between age and CBF of the precuneus as well as superior and inferior parietal cortices (p’s < .05); increasing age was associated with lower CBF in the 3+ mTBIs group, but not in the VCs or 1–2 mTBIs groups. mTBI did not moderate associations between age and cortical thickness (p’s >.05). Repetitive mTBI is associated with cerebrovascular dysfunction in AD-vulnerable regions and may accelerate pathological aging trajectories.     

Sonographisch gef��hrte Gelenkpunktionen in der Rheumatologie

Joint and soft tissue injections are routinely performed in daily rheumatology practice to establish the diagnosis or as part of the treatment in patients suffering from rheumatic diseases. Consequently, joint injections have been included in the rheumatology further training curriculum. Despite numerous studies demonstrating a poor accuracy and outcome of joint injections guided only by clinical examination, most of the injection procedures are still performed in a "blind" fashion based on clinical judgment. Ultrasound has evolved as an established imaging method in rheumatology within the past decade and is considered the preferred imaging modality for joint interventions due to its availability and lack of radiation exposure. In this article the indications and important aspects of the practical management of ultrasound-guided injections performed in daily rheumatology practice are summarized.