Der Dauerpatient

A closer look at physiotherapy as an established treatment in statutory accident insurance clearly shows that the organization and the general contents of the procedure are basically regulated. Considering possible decision-making aids and case studies, it seems to be more advisable to integrate measures into the therapeutic procedure that optimize treatment planning and control and are based on current rehabilitation standards. The determination of individual context factors, patient counseling, the agreement of rehabilitation targets, the use of assessments, the specification of treatment focuses and the promotion of physician-therapist communication are considered to be significant entities for improving quality management and, consequently, finding the appropriate treatment dose. These should be taken into account in a forthcoming revision of the guidelines for the regulation of physiotherapy.     

Der Frozen-Elephant-Trunk

The frozen elephant trunk (FET) technique is a hybrid procedure combining conventional and endovascular aortic surgery to allow 1?stage treatment of the aortic arch and the proximal descending aorta. The indications for the FET operation include several aortic pathologies, such as aneurysms, acute and chronic dissections with involvement of the (distal) arch and the proximal descending aorta. The hybrid prosthesis consists of a vascular graft for transverse arch replacement with supra-aortic revascularization and a distally located stent for endovascular treatment of the descending aorta. After antegrade stent grafting of the distal aortic segment, partial or total aortic arch replacement is performed via the conventional open technique. The FET operation is nowdays routinely performed in specialized aortic centers worldwide. This article gives an overview with resoect to the clinical indications, technical aspects and postoperative results of the FET operation.     

Der Vaterschaftsnachweis

For centuries, difficulties have occurred in determining unresolved paternities. In addition to the modern standard methods, such as the examination of DNA or serological proof, expert opinion on fertility once played an important role. The andrological difference between incapability to fertilise and the inability to participate in sexual intercourse was also distinguished historically. Of special significance was the discovery of spermatozoa by the medical student Johan Ham in 1677 and their further investigation by Antoni van Leeuwenhoek.Recently, modern DNA methods have also been applied for historical investigations. Illustrious examples are the DNA analysis in the case of Kaspar Hauser of Ansbach and the dispute about Thomas Jefferson, President of the U.S., fathering a child by one of his slaves.In this discourse, a medicinal-forensic review of the development of expert opinion, illustrated with historical case studies, is given.     

Der Roboterfixateur

Trauma und Berufskrankheit - Mittels Verfahren der modernen Robotertechnik sind vielfältige Weiterentwicklungen des Fixateur externe möglich. Besonders vorteilhaft ist die Anwendung der...     

Der Taylor-spatial-frame-Fixateur

Despite adequate primary treatment many ankle fractures result in post-traumatic deformities and arthrosis. Revision mostly requires a multidirectional correction whereas internal fixation procedures are often not applicable due to soft tissue damage and the extent of deformity. The Taylor spatial frame enables simultaneous correction of multidirectional deformities through a virtual hinge using the same ideas of distraction osteogenesis as the Ilizarov fixator. The presented case demonstrates minimally invasive correction of a complex deformity of the ankle with the Taylor spatial frame fixator. Orthogonal alignment was achieved and a stabilizing tibiotalar arthrodesis was performed achieving a good functional and pain-free result.     

Der Hybridoperationssaal

A hybrid operating room must serve the medical needs of different highly specialized disciplines. It integrates interventional techniques for cardiovascular procedures and allows operations in the field of orthopaedic surgery, neurosurgery and maxillofacial surgery. The integration of all steps such as planning, documentation and the procedure itself saves time and precious resources. The best available imaging devices and user interfaces reduce the need for extensive personnel in the OR and facilitate new minimally invasive procedures. The immediate possibility of postoperative control images in CT-like quality enables the surgeon to react to problems during the same procedure without the need for later revision.     

Der Tibiasegmenttransport

Ohne Zusammenfassung     

Der Phantomschmerz

Ohne ZusammenfassungHerrn Prof. Dr.Pette zum 60. Geburtstage.     

Der Rezidivtumor

In Chap. 6 the German S3 guideline on prostate cancer addresses the issue of tumour recurrence following primary local treatment with curative intent, i.e. after radical prostatectomy or a form of radiotherapy. PSA recurrence after radical surgery is defined as a rising PSA of 0.2 ng/ml and after radiotherapy as an increase of at least 2 ng/ml above the individual nadir. Factors for the clinical judgement that a local recurrence is likely are empirical indicators from the primary tumour diagnosis and the PSA course after primary treatment. Salvage external beam radiotherapy after radical surgery does not require the histological proof of a local recurrence and should be initiated early (PSA < 0.5 ng/ml). Before salvage radical prostatectomy, which carries a higher complication rate, the presence of a local recurrence should be histologically verified.     

Der Larynxtubus

Airway management in emergency rescue can often be associated with great difficulties. The laryngeal tube is an alternative to laryngeal mask airway and Combitube for the management of the difficult airway. Although there is only very little data so far, the first results published give reason to consider the laryngeal tube as a promising, simple and fast adjunct to secure the airway in emergencies.     

Der Armplexusschaden

The treatment of traumatic brachial plexus lesions follows sequential steps. After acute therapy (phase I), neurological diagnostics (phase II), neurosurgery and postoperative treatment (phase III/IV), reconstructive operations (phase V) can be indicated and performed. In most cases an insufficient grade of muscle power remains. Within 6 months after injury, neurosurgery must be performed in patients with brachial plexus palsy. After malfunction of the muscles, taking into account the individual neuromuscular defects, passive joint function and bony deformities, different procedures such as muscle transposition, arthrodesis and corrective osteotomy can be performed to improve the function of the upper extremity. The treatment of patients suffering from brachial plexus lesion requires interdisciplinary teamwork.     

Der Lawinennotfall

In North America and Europe around 140 persons die every year due to avalanches, approximately 35 in North America, 100 in the European Alps, and 5 in other parts of Europe. Most of the victims are skiers and snowboarders. This article outlines the specific pathophysiology of avalanche burials, such as hypoxia, hypercapnia, and hypothermia and also other factors which influence survival. Strategies to minimize the mortality due to avalanches and the on-site treatment of buried persons are discussed. Finally, possibilities to reduce the number of avalanche deaths are pointed out.     

Der Zwerchfellbruch

Ohne ZusammenfassungMit 11 Textabbildungen.