Die Modularität von Schulterprothesen

Background

In a multicenter study, 441 anatomical shoulder prostheses were implanted. The goal of the study was to analyze the variability of these third generation implants and the specific adjustment parameters.

Material and methods

A total of 441 Aequalis^® shoulder prostheses were analyzed. There were 305 women and 136 men with an average age of 77 years. The mean follow-up was 2 years. All patients were documented prospectively using a standardized protocol. The main areas of interest were the types of implants used and their adjustment parameters.

Results

Shoulder function improved significantly in all patients. The Constant Murley score increased from 26 to 62 points. The inclination of 125° and 130° as well as a head index of 1 and 8 were the most commonly used prostheses adjustments. Furthermore, there was a significant clustering for the occurrence of these two parameters together.

Conclusions

Despite the variability of modern shoulder prostheses, only a specific combination of adjustments is adequate in most cases. In this study, an inclination of 125° and 130° as well as a head index of 1 and 8 were the ideal anatomical adjustments.     

Sekundäre Individualprävention von Rückenschmerzen bei Pflegepersonal

Background

To prevent occupational disability due to low back pain, nursing staff is offered a secondary prevention activity by the statutory accident insurance.

Objectives

The efficacy regarding the development of back pain was examined and risk factors for the development of adverse back pain were identified.

Materials and methods

In this retrospective cohort study, persons who participated in secondary prevention activities from 2009–2011 were interviewed in 2012.

Results

Of the 1282 participants (response rate: 80?%), pain scores were statistically reduced for both the overall group and for subgroups. For employees of nursing homes and persons who did not participate in the refresher course, increased odds ratios for adverse pain development were observed (OR?=?1.9, 1.4, respectively).

Conclusion

In the framework of the study design, the multimodal concept of the back school shows significant efficacy in the context of back pain reduction. For nursing home employees, the training seems to be less effective than for hospital nurses.     

Die Behandlung der Sekundärheilung bei der Küntscher-Nagelung

Ohne Zusammenfassung     

Die praktische Ausbildung von Notfallsanitätern

Die Anaesthesiologie - Das im Januar 2014 in Kraft getretene Notfallsanitätergesetz regelt die Ausbildung des Rettungsdienstpersonals grundlegend neu. In der nun dreijährigen Ausbildung...     

Sekundäre Kieferspaltosteoplastik

Secondary cleft osteoplasty as part of the treatment of patients with cleft lip, jaw and palate is performed between the ages of 6 and 12 years to reconstruct the bony defect in the alveolar ridge area. Graft material is usually obtained from the iliac crest, followed by reconstruction of the nasal floor, osseous augmentation, and wound closure. This procedure serves physiological eruption of cleft-adjacent teeth during orthodontic treatment and, amongst numerous others benefits stabilizes the upper jaw segments.     

Sekundärprophylaxe symptomatischer Karotisstenosen

The SPACE trial compared risk and effectiveness of stent-protected angioplasty (CAS) versus carotid endarterectomy (CEA) in patients with symptomatic stenoses. In the intention-to-treat analysis of the entire study population of 1,214 patients, primary endpoint events (ipsilateral stroke or death occurring between randomization and day 30) occurred in 6.92% of the CAS group and 6.45% of the CEA group. The 95% confidence interval (CI) of the absolute risk difference ranged from –1.94% to +2.87%; therefore, superiority could not be proven. The same was true for the per-protocol analysis. No significant differences between the two treatment groups were found either for the primary endpoint or for any of the secondary endpoints. There were also no differences found regarding short-term prevention. The endpoint of ipsilateral ischemic stroke up to 1 year plus any periprocedural stroke or death occurred in 8.7% of the CAS patients and 7.6% of the CEA patients [odds ratio (OR) 1.16; 95% CI 0.76–1.75]. Following the per-protocol analysis, this endpoint occurred in 8.7% of the CAS patients compared with 6.7% of the CEA patients (OR 1.32; 95% CI 0.85–2.05). Recurrent stenoses, defined as at least 70% following ultrasound criteria, were significantly more common in the CAS group (ITT data: 7.7% vs. 4.1%; OR 1.98; 95%CI 1.19–3.28). Surgery remains the gold standard for treating patients with symptomatic carotid artery stenosis. However, in the hands of an experienced practitioner with a proven low periprocedural complication rate, stenting is an alternative treatment option.     

Sekundäre posttraumatische Schulterendoprothetik

Indications

Displaced proximal humerus fractures after osteosynthesis are frequently associated with complications, such as loss of reduction, displaced fragments, non-union or avascular necrosis of the humeral head. In addition, after non-operative treatment with malunion of fractures of the humeral head or in chronic shoulder dislocations, a prosthetic replacement can be necessary in order to achieve a painless shoulder function.

Choice of therapy

In these cases the choice of implant depends on the posttraumatic glenohumeral bone situation on the one hand and on the quality of the rotator cuff on the other. Especially in cases of glenoid bone loss an implanted prosthesis can be difficult to anchor, which can involve augmentation of the glenoid defect using a bone graft.

Outcome

In particular, secondary or revision arthroplasty was found in the literature to be sometimes associated with high rates of complications.

     

Sekundäre Wiederherstellung von Nervenverletzungen und motorischer Ersatz an der oberen Extremität

Trauma und Berufskrankheit - Verletzungen von großen Nerven an der oberen Extremität können langfristige Einschränkungen für den Patienten bis hin zum Wechsel des Berufs...     

Die Versorgung von Wirbelsäulenverletzungen beim Polytrauma

Zusammenfassung Die Wirbelsäulenverletzung im Rahmen eines Polytraumas stellt eine besondere fachliche Herausforderung hinsichtlich der Diagnostik und der Einordnung sowohl ins therapeutische Gesamtkonzept als auch betreffend der Versorgungsschritte an der verletzten Wirbelsäule dar. Die 1. Phase der Diagnostik und Therapie folgt den Empfehlungen des ATLS^®-Protokolls unter Beachtung einer potentiell vorliegenden Wirbelsäulenverletzung. Für die Weiterbehandlung wurde das Konzept des damage control auf die verletzte Wirbelsäule im Rahmen des heute etablierten Algorithmus der Versorgung des polytraumatisierten Patienten in definierten Phasen angepasst. Diese etablierten Kriterien hinsichtlich des Zeitpunktes und der Art der operativen Versorgung von Wirbelsäulenverletzungen bei polytraumatisierten Patienten sollen nachfolgend vorgestellt und diskutiert werden.     

Die Bewertung von Skoliosen bei Wirbelsäulen-Verletzten

Ohne Zusammenfassung Mit 6 Abbildungen im Text.     

Sekundäre posttraumatische Schulterendoprothetik

Trauma und Berufskrankheit - Skapulafrakturen sind seltene Bruchverletzungen, welche sich prinzipiell in extra- und intraartikuläre Formen unterteilen lassen. Sie können selbst bei...     

Sekundäreingriffe nach Ellenbogengelenkverletzung

Elbow injuries can often lead, despite great caution in surgical care, to discomfort and impaired function, such as arthrofibrosis, joint surface incongruence, secondary arthrosis, heterotopic ossification, chronic luxation/subluxation (Monteggia injury), axial deviation or pseudoarthrosis, which prompt the desire for improvement by means of a secondary intervention. The present article discusses secondary therapy options while realistically assessing the likelihood of a successful outcome.     

Sekundärprävention nach urologischen Tumorerkrankungen

It is generally agreed upon that patients require a caring as well as careful medical follow-up after cancer treatment. The goal of secondary prevention is to recognize a recurrence at an early stage and to use the curative chance while the tumor mass is still small. There is evidence of a medically effective and successful follow-up for tumors of the testicle and the bladder. For quality reasons, these follow-up regimes should be adhered to for quality reasons. In other diseases, e.g., renal cell carcinoma, prospective randomized studies are missing which demonstrate the effectiveness of follow-ups. In these cases asymptomatic patients should be stratified to individualized follow-up care.     

Die interdisziplinäre Behandlung von Patienten mit Lippen-Kiefer-Gaumen-Spalten

Cleft lips and cleft palates (CLP) account for 11–15% of all malformations of the human body. In Germany about 1,200 children are born with a CLP every year. At present there is an understanding that clefts have a multifactorial genesis with a genetic component incorporating several genes. The only way to achieve a successful functional and aesthetic rehabilitation of this group of patients is a consistent interdisciplinary treatment scheme with the cooperation of oral and maxillofacial surgery, orthodontics, otorhinolaryngology (especially pedaudiology) and speech therapy. The surgeon has to utilize very subtle operation techniques particularly with respect to functional aspects, such as the reconstruction of anatomical muscle slings. In the vast majority of cases patients will be able to go to school at the regular time and be able to choose the professional field of their liking.     

Sekundärprävention nach urologischen Tumorerkrankungen

Secondary prevention and aftercare of urological cancers are an essential part of outpatient care provided by the urologist in private practice. More than one-half of the patients who are confronted with the diagnosis of cancer turn to so-called unconventional treatment procedures. The difficulties for those affected and caregivers lie in equal measure in distinguishing between sensible and less advisable or even counterproductive treatment options.Fixed plans of action for aftercare do not do justice to the exigencies of individualized care of cancer patients in private practice, especially with respect to longer survival. Early detection of local recurrence and metastases and the management of complications are determined by the individual disease course and have to be measured against the improvement in quality of life. Secondary preventive measures in the sense of complementary medicine can be helpful. Current evidence is quite promising only for prostate cancer and is of some importance in urological practice.     

Sekundäre Bandrekonstruktion am Ellenbogen

Chronic ligamentous elbow instabilities are posttraumatic in most cases, can lead to severe functional limitations, and are a risk factor for the development of an elbow joint arthrosis. Successful treatment requires an accurate knowledge of the pathogenesis, the necessary diagnostic options and the different reconstruction procedures. According to the direction of instability, chronic posterolateral rotatory instability, lateral, medial and combined multidirectional instabilities can be distinguished. Lateral and medial collateral ligament reconstruction using autologous or allogenic tendon grafts result mainly in good clinical outcomes. However, specific complications such as recurrent instability or ulnar neuropathy are not uncommon. In cases of bilateral ligamentous instability the box-loop technique allows to reconstruct both the lateral and medial collateral ligaments using a single tendon graft circumferentially looped through the humerus and ulna. If sufficient residual ligamentous tissue is still present, a direct augmented repair of the collateral ligaments may be performed even in chronic cases. Elbow joint arthrosis is the main limiting factor for good clinical results and therefore a relative contraindication for collateral ligament reconstruction in chronic cases.     

Sekundäre Hormonablation beim hormonunabhängigen Prostatakarzinom

After an average of 18–24 months under androgen suppression therapy, almost all patients with prostate cancer show a PSA progress. At this hormone-independent stage, a PSA regress can be achieved by secondary hormonal manipulation in approximately 50% of patients for 6–12 months before they become hormone-refractory. After progress under complete androgen ablation, in 40% of cases a temporary regress can be achieved by discontinuing of the anti-androgen. The administration of an alternative anti-androgen results in a PSA decrease in 80% of the patients responding to anti-androgen deprivation. Inhibition of the adrenal testosterone synthesis by oral administration of ketoconazol can further delay disease progression. Transdermal application of estrogens also allows temporary control of tumor activity by modulating the LHRH and testosterone release as well as directly effecting tumor cell apoptosis. Recent therapeutic modalities as for example somatostatin analogues influence the microenvironment of tumor cells and thereby intensify the effect of anti-tumor therapy.     

Die notfallmäßige endovaskuläre Therapie von Bauchaortenaneurysmen

ZusammenfassungEinleitung  Retrospektive Analyse des Krankenguts aus zwei gefäßchirurgischen Zentren, um den Stellenwert der endovaskulären Therapie bei rupturierten Bauchaortenaneurymen (AAA) zu ermitteln.Methode  Im Zeitraum von 1995 bis 2001 wurden aus einer Gesamtmenge von 154 notfallmäßig therapierten Patienten mit rupturierten AAA 32 Patienten (6 Frauen, 26 Männer) endovaskulär versorgt. Das Durchschnittsalter der Patienten lag bei 70 Jahren (Spannweite 26–92 Jahre). Das durchschnittliche Intervall vom Einsetzen der akuten Beschwerden bis zur Klinikaufnahme betrug 15 h. Von der Klinikaufnahme bis zum Beginn des Eingriffs dauerte es etwa 1,8 h. Ein suprarenaler Blockadeballon wurde nicht verwendet. In 20 Fällen wurde ein Y-Stentgraft, in 8 Fällen ein aortomonoiliakaler Stentgraft und in 4 Fällen ein Rohrstentgraft implantiert.Ergebnisse  In 31 Fällen (96,9%) war die Stentgraftplatzierung erfolgreich. In 2 Fällen erfolgte eine Konversion zur offenen Operation. Der Eingriff dauerte durchschnittlich 110 min. Die Klinikletalität lab bei 15,6% (n=5). Der Klinikaufenthalt dauerte im Durchschnitt 12 Tage. Die Endoleakrate (ausschließlich Typ-1-Endoleaks) erreichte 12,5% (n=4). Die 3-Jahres-Überlebensrate liegt bei 75%.Schlussfolgerung  Unsere Erfahrungen zeigen, dass die notfallmäßige endovaskuläre Therapie rupturierter Bauchaortenaneurysmen exzellente Ergebnisse aufweist. Die 30-Tage-Letalität liegt lediglich bei 21,8%. Prinzipiell sollten diese viel versprechenden Ergebnisse in einer breiter angelegten Studie überprüft werden.