Zur Frage der Entstehung der Spätchloroform-schäden

Ohne Zusammenfassung     

Interdisziplinäre Behandlung der Weichgewebesarkome der Extremitäten

Soft tissue sarcomas are a rare and heterogeneous group of tumors. Surgery clearly remains the standard therapy of non-metastatic soft tissue sarcoma. A pretreatment biopsy is necessary to determine the histology and grade of soft tissue sarcomas and to diagnose entities that can be treated by targeted therapies, such as dermatofibrosarcoma protuberans or alveolar soft tissue sarcoma once they are in a metastatic stage. Nevertheless, locally advanced disease requires multimodal treatment and interdisciplinary treatment decisions. Limb sarcoma of borderline resectability (encasement of vessels, invasion of joints or close proximity to motor nerves) may profit from isolated limb perfusion with recombinant tumor necrosis factor and melphalan. Preoperative chemotherapy may be applied in locally advanced high grade tumors when clear resection margins are difficult to achieve. Deep wave hyperthermia has proven to be a useful addition to systemic chemotherapy in such a neoadjuvant setting. Also preoperative radiation therapy has proven to be effective in controlling locally advanced sarcoma despite higher perioperative morbidity which pays off in the long run by better limb function. Postoperative adjuvant external beam irradiation therapy with the best available technique is recommended for any tumor larger than 5 cm with (FNLCC) grades 2 and 3 (American Joint Committee on Cancer stage IIb/III). Given all these therapeutic options, it is absolutely crucial that interdisciplinary decision-making starts early in the therapeutic process. Patients are often seen first by the surgeon. For an optimal treatment surgeons need to know the efficacy and toxicity of the multimodal treatment options described.     

Zur Begutachtung der Erkältung und der Erkältungskrankheiten

Ohne Zusammenfassung     

Zur Operation der Gynäkomastie und der Hängebrust

Ohne Zusammenfassung Mit 3 Abbildungen.     

Die Entwicklung der orthopädischen Versorgung der Kriegsbeschädigten

Ohne Zusammenfassung     

Pioniere der Extremitätenverlängerung

Successful lengthening of the extremities was first published at the beginning of the twentieth century. Those reports in which methods such as the distraction of fragments, callus or epiphysis were mentioned for the first time are reviewed. Lengthening of the extremities by epiphyseal distraction was first mentioned by Bernhard v. Langenbeck in 1869 in an animal experiment. The publications of Codivilla, who introduced lengthening by fragment distraction, Kirschner, Bier and others are cited and analyzed critically. Thus, the historical development of the lengthening of the extremities is reported from 1869 to the middle of the twentieth century.     

Zur Mechanik der Ringbrüche der Schädelbasis und der Verletzungen der oberen Halswirbelsäule

Zusammenfassung Bei Ringbrüchen der Schädelbasis kann es sich um Impressions- oder Traktionsfrakturen handeln. Impressionsfrakturen können beim Fall aus der Höhe und Aufschlag auf die Beine oder das Gesäß, Gewalteinwirkungen gegen die Scheitelgegend aber auch bei solchen gegen die Schädelbasis eintreten. Traktionsfrakturen sind die Folge einer Schleuderung des Kopfes nach hinten oben (Beugung und Zerrung) und können bei Gewalteinwirkungen gegen das Gesicht oder gegen den Rumpf, hier besonders gegen den Rücken, auftreten. Die Unterscheidung, ob eine Impressions- oder eine Traktionsfraktur vorliegt, wird nach dem Verhalten der Bruchkanten (Knochenquerschnitt) getroffen. Nach Gewalteinwirkungen gegen den Rücken, aber auch von der Seite gegen den Rumpf kann es zu einem Abriß des Bandapparates zwischen Hinterhaupt und den oberen Halswirbeln kommen, ohne daß Frakturen an der Insertionsstelle der Bänder aufzutreten brauchen. Abrisse des Dens epistrophei als indirekte Verletzungen treten vorzugsweise bei seitlich oder von hinten seitlich gegen den Körper ansetzenden Traumata auf. Rupturen der basalen Hirnarterien brauchen sich nicht in der Umgebung des Skeletschadens zu finden, sondern können durch Fortleitung der Zugwirkung auch an anderen Stellen hervorgerufen werden. Ein Locus minoris resistentiae gegenüber kräftigen Zerrungen ist der Übergang von der Pons zur Medulla oblongata.Mit 7 Textabbildungen (13 Einzelbilder)     

Experimentelle Beiträge zur Kenntnis der Wirkung der Nebennierenpräparate

Ohne Zusammenfassung (Mit 10 Kurven.)     

Zur Unterbindung der grossen Gefässstämme in der Continuität bei Erkrankungen und Verletzungen der unteren Extremitäten

Ohne Zusammenfassung Ein Erratum zu diesem Beitrag ist unter zu finden.     

Spätresultate der hochdiaphysären Osteotomie in der Behandlung der irreponiblen Luxatio coxae congenita

Ohne ZusammenfassungMit 6 Textabbildungen     

Regionalanästhesie in der Orthopädie

Regional anesthesia has its place in the perioperative pain management of orthopedic patients. A reduction in postoperative mortality and morbidity with regional anesthesia is acknowledged for subsets of patient populations. Single shot and continuous applications are techniques for providing regional analgesia. Continuous infusion of local anesthetics with catheter techniques provides for uninterrupted postoperative analgesia. The combination of regional and general anesthesia reduces the consumption of systemic anesthetics. The side effects of opioid therapy are thereby reduced. The inhibition of intraoperative stress reaction, especially with epidural anesthesia, helps to prevent or lower unwanted metabolic changes. Patient contentment with analgesic quality differs with the technique with which the regional anesthesia is applied (PDA, PCEA, IVRA, peripheral block, i.a. injection), and the medication (LA, opioid) used.     

Berufliche Belastungsschäden der Wirbelsäule

Ohne ZusammenfassungMit 7 TextabbildungenNach einem auf der Arbeitstagung über degenerative Wirbelsäulenerkrankungen in Leipzig (Juni 1955) gehaltenen Referat.     

Veränderungen der Muskarinrezeptoren der alternden Harnblase

The prevalence of the overactive bladder syndrome (OAB) increases with age. Unfortunately, treatment of the condition is still unsatisfactory. Since muscarinic receptor antagonists are the only effective drug treatment to date, it is logical to assume that muscarinic receptors play an important role in the pathogenesis of OAB. Muscarinic receptors are involved in both the normal and overactive detrusor contraction, and age-dependent changes in muscarinic receptor functions have been found in both animals and human detrusors. In animals as well as humans, two components of detrusor contraction have been demonstrated, the dominating one mediated by muscarinic receptors and the other by ATP (atropine-resistant component). The muscarinic receptor-mediated component decreases with age, and the ATP (purinergic) part increases. However, the clinical consequence of this is unclear, since no major age-dependent changes in the efficacy of antimuscarinic agents in the treatment of OAB have been demonstrated.     

Schäden in der Anästhesie

The Schlichtungsstelle in Hannover (expert panel for arbitration), northern Germany, was founded in 1976 to settle disputes between patients and doctors. Furthermore, publications regarding the decisions of the Schlichtungsstelle serve as an important medium to prevent malpractice by increasing doctors' awareness of critical processes in their field. Between 2001 and 2005 the Schlichtungsstelle decided on 435 malpractice claims in anaesthesia. An accumulation of injuries was observed in anaesthetic procedures with respect to the airways (23.9%), injuries related to regional anaesthesia (18.2%), vasopuncture (13.1%) and positioning of the patients (9.9%). In 21.8%, the Schlichtungsstelle advised to seek a resolution without going to court by paying financial compensation in favour of the patient. In these cases the Schlichtungsstelle's evaluation had come to the conclusion that malpractice was the cause of the patient's injury. We would like to mention that 21 cases of intraoperative awareness were included in the claims, of which 52.4% (average 21.8%) were evaluated to be the result of malpractice and thus financial compensation was advised. The appropriate care for the patient, required from every doctor, calls the anaesthesiologists to avoid all possible malpractices, thus reducing patients' injury due to such malpractices to a minimum. But even injuries not caused by malpractice need to be examined closely and improvement should be sought.     

Pathophysiologie der akuten Extremitätenischämie

Acute ischemia of an extremity constitutes an emergency. To initiate reasonable treatment steps knowledge of the underlying pathophysiology can help. During ischemia there is a drop in blood oxygen, which is required to allow the physiological energy generation. Inhibition of mitochondrial oxidative phosphorylation during ischemia leads to a rapid loss of cellular energy sources and thus affects the function of microsomal membrane pumps. This leads to altered intracellular electrolyte levels. The results are acidosis and cellular edema. By impairment of the endoplasmic reticulum, there is a persistent production of useless proteins, which interferes with the cell function sustainably. The fresh oxygen, rushing in during reperfusion, induces the formation of free radicals that additionally damage the tissue. In addition, leukocytes are submerged, promote an inflammatory response and provide further reactive oxygen species. Nitric oxide (NO) acts as a physiological radical scavenger and regulates the vascular tone. In the ischemic damaged vessels endothelium-mediated relaxation of NO does not work anymore. Furthermore, an increased filtration of fluid into the interstitial space and a rarefaction of the capillary vascular bed can be seen. Vasospasm and increased resistance further deteriorate blood flow. During reperfusion, it also comes to a distribution of metabolites and inflammatory cytokines in the whole organism, which can lead to inflammation in other organs like e.g. the lungs. Acute limb ischemia is a multifactorial process, which can lead to varying degrees of damage depending on the size of the affected area and the ischemic duration.     

Qualitätsmanagement aus der Sicht der Krankenhausleitung

Background

Within the framework of patient care quality assurance and therefore quality management are of decisive significance. In this context it is questionable whether quality management has the same importance for all players.

Quality management

In contrast to medical and nursing personnel who are more concerned with the perspective of the discipline with the aim of therapeutic validation with full responsibility for quality, the perspective of the hospital management is more comprehensive and includes the complete hospital, the system. The management perspective is therefore correspondingly different.

Problem

The different perspectives often lead to misunderstandings, for example between department heads and hospital management. The frequently observed lack of willingness to accept change also leads to tension between system (hospital management) and faculty management (medical and nursing personnel) and reduces performance, even for the quality management.

Conclusion

By the implementation of integratively effective multiprofessional hospital performance management (HPM) the quality management can be improved. Medical and nursing personnel should also be actively involved in the optimization as this problem can only be solved in an interdisciplinary and multiprofessional manner and also results in changes in internal behavior which in turn have an effect on the quality of results in hospitals.