Lungenverletzungen

Zusammenfassung Obwohl die Lungen auch isoliert verletzt werden können, entstehen die meisten Lungenverletzungen im Rahmen von Polytraumen. Aufgrund der hieraus resultierenden, vielfältigen pathophysiologischen Abläufe ist die Beurteilung von Ausmaß, Verlauf und Prognose der Lungen-verletzungen schwierig. Je nach untersuchtem Krankengut wird die Mortalität der Thoraxverletzungen in der Literatur zwischen 6 bis 55% angegeben [3, 5, 8, 9]. Bei den von uns untersuchten Thoraxverletzungen handelte es um selektionierte schwere Thoraxtraumen. Dies erklärt die von uns gefundene relativ hohe Thoracotomierate von 17% sowie die hohe Mortalität von 34%. Zur besseren Vergleichbarkeit klinischer Untersuchungen ist wegen der geschilderten Verletzungsvielfalt die Aufschlüsselung nach allgemeiner und speziell thorakaler Verletzungsschwere — wie etwa nach dem Polytraumaschlüssel der Medizinischen Hochschule Hannover — notwendig. Vor allem die Lungenkontusionen werden häufig bei auffälligen Begleitverletzungen in Ausmaß und Folgen primär unterschätzt. Daher kann die Bedeutung subtiler Lungenbefunderhebung sowie lungenbewußter Therapie nur unterstrichen werden.

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Pulmonary injuries

Summary Even though lungs can be injured solitarily, most of pulmonary lesions occur within the scope of multiple trauma. Because of various patho-physiological processes resulting from the multiple trauma, the valuation of extent, course and prognosis of pulmonary injuries is difficult. Depending on examined cases, mortality of thoracic injuries as stated in various references amounts to between 6 and 55% [3, 5, 8, 9]. Concerning thoracic injuries we dealt with severe traumas of the thorax. This explains the relatively high rate of thoracotomy of 17% as well as the high mortality of 34% we confirmed. Because of described variety of injuries, it is necessary for better comparison of clinical investigations to specify the lesions in accordance with general and specific thoracic severity of injury — as described in the multiple trauma score of the Medical University of Hannover —. Especially pulmonary contusions with associated conspicuous injuries are often primarily underestimated concerning their dimensions and consequences. Therefore the importance of subtle inquiry of pulmonary findings must be strictly underlined.

Herrn Professor Dr. Johannes Lang, Würzburg, zum 65. Geburtstag g ewidmet     

Commentary on "Issues in the Debriefing Debate for the Emergency Services: Moving Research Outcomes Forward"

Tuckey's (2007) article explores reasons why the debate on psychological debriefing has persisted for two decades without apparent resolve. One of its strengths lies in the focus on the methodology of the research literature (rather than findings), and problems are discussed without favor to either side. This disciplined approach has enabled delineation of flaws in the data as well as conclusions drawn on the basis of findings. The author uses her analysis of "what not to do" when you are conducting research in this area to develop research guidelines on what should be done. The present commentary begins with a historical précis of the debate on psychological debriefing and then explores some of the issues raised by Tuckey.     

Clinical impact of integrated PET/CT on the management of suspected cervical cancer recurrence

OBJECTIVES: To assess the value and clinical impact of integrated PET/CT using (18)F-FDG in the diagnosis and management of women with suspected cervical cancer recurrence. METHODS: Fifty-two patients with cervical cancer with suspected recurrence because of clinical, cytological, biochemical and radiological findings were retrospectively evaluated. A final diagnosis of recurrence was confirmed by histologic tissue biopsy or by further clinical or radiological evidence. The clinical impact of information provided by PET/CT on patient management was assessed on the basis of clinical follow-up data concerning further diagnostic or therapeutic approach. RESULTS: Twenty-eight of 32 positive PET/CT scans (87.5%) were proven to have recurrent disease. Seventeen of 20 negative PET/CT scans (85.0%) had no evidence of disease. The sensitivity, specificity, and accuracy of PET/CT for detecting recurrence were 90.3%, 81.0%, and 86.5% respectively. PET/CT changed the management of 12 patients (23.1%) by changing treatment plan (5 patients), by initiating unplanned treatment strategy (4 patients), or by obviating the need for planned diagnostic procedures (3 patients). Median duration after performing PET/CT and last follow-up was 12 (range: 6-27) months, and the 2-year disease-free survival rate of patients with negative PET/CT scan for recurrence was significantly better than that of patients with positive PET/CT (85.0% vs. 10.9%, P=0002). CONCLUSIONS: In patients with a suspected recurrence of cervical cancer, integrated PET/CT using (18)F-FDG provides good anatomic and functional localization of suspicious lesions, and the better diagnostic interpretation has an impact not only on clinical management and treatment planning of patients, but also on disease-free survival.     

医院感染流行病学监测分析

本文介绍了我院1990年5月～1991年4月30日,住院病人医院感染发病率的监测及控制医院感染措施。一年中感染率为2.5％,外科系统发病率高于内科系统。感染部位以下呼吸道、手术伤口、泌尿道为最多。侵袭性操作及易感因素在感染病例中分别是20.9％和54.9％。     

Low–Density Lipoprotein Removal Methods by Membranes and Future Perspectives

Abstract: Since the application by Thompson et al. in 1975 of plasma exchange for the treatment of 2 patients with familial hyperlipidemia, plasma purification techniques for selective low–density lipoprotein (LDL) removal (i.e., LDL apheresis) have been developed and adopted for the management of this disease. Thermofil–tration is one of the LDL apheresis systems that utilizes membrane techniques developed by Nose and Malchesky's group in 1985. This article reviews its rationale, in vitro studies, animal studies, and clinical investigation. Thermofiltration effectively and selectively removes LDL cholesterol while retaining in the plasma physiologically important macromolecules such as albumin and high–density lipoprotein (HDL) cholesterol. Based on the global view of the treatment of atherosclerosis by LDL apheresis, membrane techniques are as effective, safe, and simpler to apply than other methods. Additionally, these methods are effective for the removal of lipoprotein (a) and fibrinogen; thus, they can address the needs in these application areas.     

尘肺管理工作的回顾与控制策略的探讨

本文回顾了我国矽肺预防和控制的历史，重点阐述了有关矽肺预防的管理方法诸如１９４９年以来的有关法律和法规的建立方面。虽然几十年来取得了很大成绩，但矽肺仍是危害工人健康的最大威胁。主要问题是执法力度不够，各部门之间缺乏必要的协作，防治矽肺的策略有待改进。由此作者提出对矽肺的预防和控制应是②贯彻预防矽肺的综合措施，坚持“八字”方针；②向矽肺病人提供综合治疗，而不仅仅是特殊疗法；③加大执法力度；④把预防矽     

贯彻《医院感染管理规范》提高医院感染管理质量

阐述了卫生部1994年颁布的《医院感染管理规范(试行)》的现实意义,结合本院实际,对照《规范》,总结 工作,找出差距,然后提出了加强医院感染管理的具体措施。     

上海市心脑血管病防治点社区高血压分级管理现状分析

[目的 ]　了解上海市心脑血管病防治点社区高血压分级管理现状 ,探讨社区控制高血压的有效干预措施。　 [方法 ]　采用《上海市心脑血管病防治点工作手册》的方法及标准 ,对 2 0 0 2年上海市 3 4个心脑血管病防治点社区登记的“上海市社区高血压患者随访表”个案记录及社区 3 5岁以上高血压患者分级管理工作年报表进行统计分析。　 [结果 ]　 2 0 0 2年上海市 3 4个心脑血管病防治点社区高血压分级管理 ,共覆盖 10 65 90 5社区人口 ,登记管理 3 5岁以上高血压患者 415 88人 ,规范管理 3 7969人 ,管理率 91.3 0 %,控制率 88.0 8%。发现高血压新病例 2 62 1例 ,一级医疗机构 3 5岁以上首诊测量血压是发现高血压新病例的最主要途径 ,占 2 9.61%。　 [结论 ]　上海市心脑血管病防治点社区高血压分级管理的管理率和控制率已分别达到《上海市心脑血管病防治点工作手册》规定的标准 ,社区高血压分级管理是可行和有效的管理模式 ,值得推行