Die Bedeutung der Mediastinoskopie für die Beurteilung der Operabilität des Oesophaguscarcinoms

Ohne ZusammenfassungMit 2 AbbildungenVortragender:A. Akovbiantz-Zürich/Schweiz     

Die Mediastinoskopie zur sicheren differentialdiagnostischen Abklärung mediastinaler und hilusnaher Veränderungen im Kindesalter

Ohne Zusammenfassung     

Heutige Rolle der Mediastinoskopie und der Remediastinoskopie

For patients with lung cancer preoperative evaluation of the mediastinal lymph nodes is important to estimate local operability and/or to consider the necessity of neoadjuvant treatment. Cervical mediastinoscopy is generally accepted as a safe and highly accurate procedure in the staging of lung cancer. Nodes accessible to CM are the levels of the superior (level 2R and 2L) and inferior (level 4R and 4L) paratracheal and subcarinal (level 7) nodal stations. Additionally extended CM and left parasternal mediastinotomy allow the exploration of the aortopulmonary window (level 5) and anterior mediastinal nodes (level 6). In locally advanced lung cancer repeat mediastinoscopy was used after induction chemotherapy or chemoradiation to reexplore the upper mediastinum in order to select patients with a higher probability to undergo complete resection. Operative mortality of both investigations is less than 0.5%; the preoperative complication rate is very low (less than 4%). Because of the higher sensitivity, specificity, and accuracy, mediastinoscopy and repeat mediastinoscopy are superior to new methods like FDG-PET, FDG-PET/CT, EBUS-FNA, and EUS-FNA.     

20. Indikation zur Mediastinoskopie und Mediastinographie und deren Aussagewert

Zusammenfassung Zusammenfassend kann daher gesagt werden, daß in unserem Krankengut die Mediastinoskopie bei mediastinalen Prozessen eine Treffsicherheit von 86% hat und daß durch die routinemäßig präoperative Mediastinoskopie bei Bronehuscareinom mit positivem Ergebnis von 46% die Probethorakotomie von 25 auf 9% gesenkt werden konnte. Weiter kann festgestellt werden, daß bei ausgedehnten mediastinalen Prozessen durch die präoperative Mediastinographie ein genauer Operationsplan erstellt werden kann, wodurch auch fortgeschrittene Fälle mitunter noch zielführend operiert werden können. Auch für die Erkennung mediastinaler Rezidive nach vorangegangenen Resektionen ist die Mediastinographie eine nicht belastende und wertvolle Methode.

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Summary In our patient population mediastinoscopy had an accuracy of 86% in mediastinal disorders, and routine preoperative mediastinoscopy in carcinoma of the bronchus gave 46% positive results, so that it was possible to lower the incidence of trial thoracotomy from 25–9%. Preoperative mediastinoscopy made it possible to design an exact operation plan in the case of extensive mediastinal disorders, so that purposeful surgery might be undertaken even in advanced cases. Mediastinoscopy also proved to be a method free from stress and of value for the recognition of recurrences in the mediastinum following resections.

     

Die Olekranonosteotomie

In recent years the increase of interest for surgery of the elbow has fostered the development of new and modified triceps sparing approaches. Olecranon osteotomy is a widely accepted method especially for open reduction and internal fixation of displaced intra-articular fractures because it provides excellent exposure of the joint surfaces. Due to several reports describing numerous complications, the enthusiasm for this procedure is currently limited. Several intra-articular and extra-articular techniques for refixation of the olecranon have been developed to limit these complications and good results have been obtained. This paper describes various techniques, analyzes advantages and disadvantages and shows alternative ways and solutions for different indications.     

Die Sachse-Urethrotomie

The most commonly used treatment modality for urethral strictures is the direct visual internal urethrotomy (DVUI) method according to Sachse. It is an effective short-term treatment, but the long-term success rate is low. A number of factors influence the outcome of DVUI including stricture location, spongiofibrosis and previous endoscopic stricture treatment. Multiple urethrotomy has a negative impact on the success rate of subsequent urethroplasty. A thorough preoperative diagnostic work-up including combined retrograde urethrogram/voiding cystourethrogram (RUG/VCUG) and urethrocystoscopy is, therefore, mandatory to allow for patient counselling regarding the risk of stricture recurrence and other treatment options. After a failed primary DVUI, subsequent urethrotomy cannot be expected to be curative.     

Die Achillessehnenruptur

The rupture of the Achilles tendon is the most frequent tendon rupture in humans and it is associated with increasing incidence. The main risk factor is intrinsic degeneration of the tendon. During the rupture the person feels a whiplash or dagger thrust-like pain, followed by restricted walking ability and decreased plantar flexion of the ankle. The positive Simmond/Thompson test and a palpable dent above the tendon rupture are pathognomical. Diagnostically, ultrasound of the tendon and lateral x-ray of the calcaneus (bony pull-out of the tendon insertion) are necessary. Regarding correct indication and treatment modalities, most established conservative and surgical therapies realize optimal functional results. Surgical treatment promises better primary stability and slightly earlier better functional results, but there is the potential for surgical complications. Conservative therapy is associated with higher rates of re-rupture and healing of the tendon under elongation. Therefore, therapy planning in Achilles tendon rupture should be determined based on each patient. We recommend surgical treatment in patients with higher sporting demands and in younger patients (相似文献   

Die Lungenembolie

Ohne ZusammenfassungMit 2 Abbildungen     

Die Endo-Exo-Femurprothese

Because of insufficient soft-tissue conditions and variability in the size and mechanical friction of the stump treatment of upper leg amputees with an ordinary prosthesis might be difficult or even impossible. Alternatively, for such patients an endo-exo femoral prosthesis (EEFP) is sometimes the best treatment option. The use of EEFPs will be demonstrated as exemplified by the clinical course in a patient with a primary EEFP implantation including all relevant side-effects and associated problems.     

Die Meatusstenose

There is no common pathology in strictures of the external urinary meatus in men and women. These strictures have to be considered in their complexity and history with influential factors like additional diseases and previous surgical interventions. It is necessary to distinguish a simple situation from extensive findings. Successful therapy depends on the exact evaluation and classification of the stricture.     

Die Naviculare-Pseudarthrose

Ohne Zusammenfassung Mit 34 Textabbildungen.