Communicate? Transmission?

Through our own experience and that of others authors - surgeons, mathematicians, philosophers - we consider methods, reality ant future of communication and transmission in plastic and reconstructive surgery. Open to criticism, communication is always revocable; registered in the future, transmission is not so easy to challenge. Subjects and means of communication and transmission - language and pictures - are discussed, provided that to allow citicism and to be closed to self-love. A matter of course is that truth must rise above self-vanity. Communication is devoted to all those who take care of patients, but also to patients themselves and their relatives: the best wisdom must be used here and, too, with medias where in communication must follow the simplest morality: don't act for yourself but for others. We have to teach that we must be impassioned of strictness, and accept to waste needfull time for research as for practice. We communicate with all who wish for it, but we transmit only to those we guess able to follow right and prudent practice. Spirit of surgery must overcome technical tips.     

Pancreatic Biopsy: Why? When? How?

For final diagnosis of pancreatic cancer histologic or cytologic confirmation is needed. Tissue or cell material can be achieved by percutaneous puncture as part of the preoperative workup. During operation core-needle, incisional, and wedge biopsies or fine-needle aspiration cytology (FNAC) can be chosen. Sensitivity and diagnostic accuracy are high for both histologic and cytologic examinations, and false-positive results are exceptional, giving a specificity of 100% in most published series. The complication rate is low, also for knife biopsies in recent reports, provided biopsy of seemingly normal tissue is avoided. Percutaneous puncture is currently restricted to patients found to have advanced disease and who are not candidates for laparotomy. Microscopic confirmation is required in all patients in whom chemotherapy, radiotherapy, or both are planned. However, for attempted radical surgery per se, biopsy is not mandatory if the clinical suspicion of cancer is high and the surgical team has documented low postoperative mortality and morbidity rates.     

CT colonography: Why? When? How?

Although optical colonoscopy is still the gold standard for diseases of the colon, radiologic examination of the colon is now being performed by CT scan. Evaluation of the colon is enhanced by distension, which "de-folds" the intestinal wall, thus facilitating its examination for abnormalities of the mucosa, the wall as a whole, and the diameter of the bowel lumen. Water or gas (CO(2)) may be used for the distension, depending on the suspected lesions. The water enema method of colonography combines filling the bowel lumen with water and intravenous injection of a contrast medium. It is indicated when there is a clinical suspicion of colon cancer, or for initial discovery of liver metastases, and for staging of colon tumors. This technique, which requires little or no colon cleansing preparation, can be performed with no special equipment and has a short learning curve. The gas enema method of colonography, or virtual colonoscopy, is performed by distending the colon with CO(2), without any intravenous injection of contrast medium. Its purpose is to detect polyps as part of a screening for precancerous growths. This technique, which does require bowel cleansing preparation, uses a dedicated console for reading and requires specific training.     

K?rperliche Aktivit?t zur Prim?rpr?vention des Prostatakarzinoms

Background

An explanation of the possible connection between physical activity and prevention of prostate cancer was sought by reviewing the controversial data from prospective and case-control studies. Possible preventive mechanisms are to be described.

Method

Scientific publications mainly from the past 10 years were reviewed.

Results

Because of the postulated dependence of prostate carcinoma on testosterone, lowering the testosterone concentration by physical activity is of importance and seems to be a possible explanation. According to many studies there is a speculative connection between prostate carcinoma and calcium concentration in blood, parathormone and vitamin D₃, and the possibly preventive modulation by physical activity results in another beneficial mechanism. Less specific is the possible increase of the antioxidant capacity of the organism by physical activity. Strength training seems to have adverse effects on testosterone, while possibly yielding a beneficial effect on the immune system.

Conclusion

High intensive physical activity may contribute to the prevention of prostate carcinoma.     

原发性肝癌的治疗选择:切除?消融?介入?移植?

肝癌手术切除、局部消融、介入治疗和肝移植术是当前肝癌的主要治疗手段,但这四种方法的适应证有部分重叠,且综合应用时的实施次序有较大争议。如何确定最佳的个体化综合治疗方案,是普通外科医师面临的一个巨大挑战。     

Split liver transplantation: where? When? How?

Donor scarcity is among the greatest concerns in the transplantation community. Dividing a liver graft theoretically offers a double benefit for candidates on the waiting list. Split liver transplantation entails a higher logistic and technical complexity that is extensively compensated, not only with an increase in the accessibility for child and adult candidates on the liver transplant waiting list, but also acceptable survival results.     

Publizieren oder untergehen ? eine wissenschaftliche Einbahnstra?e?

Editorial

Publizieren oder untergehen ? eine wissenschaftliche Einbahnstra?e?     

Pr?vention von Verkehrsunf?llen ?u?erer Verkehrsteilnehmer (Fu?g?nger und Fahrradfahrer) in Deutschland

During a 1-day workshop organized by the German Society of Orthopaedics and Traumatology (DGOU) 15 German accident researchers used different approaches to improve the effectiveness of accident prevention for pedestrians and bicyclists on German roads. The main results of this analysis show: Fatal injuries of pedestrians have been significantly reduced by 82% between 1970 (n=6.056) and 2007 (n=695). Similarly, fatalities of bicyclists have been reduced during the same time period from 1,835 to 425 which amount to almost 80%. However, the total number of injured cyclists increased almost twice, i.e. from 40,531 (in 1979) to 78,579 (in 2007) a fact that needs to be analyzed in more detail. Although scientifically proven to provide protection against severe head injuries, helmets are worn less frequently by adolescents and women as compared to younger children and men. Fatalities of bicyclists might be reduced by using Dobli mirrors which allow the truck driver to see the bicyclist when turning right. Recently developed sensors are able to detect pedestrians walking closely (<2.5 m) and warn the truck driver acoustically. Bicycle lanes should be planned for one direction only, separated from the pedestrian way and large enough (2.0?m are safer than 1.6?m). Traffic education for school beginners and younger children should be repeated to be effective. Training for elderly bicyclists in cities with heavy traffic would also be reasonable. Active security systems in cars like ESP (electronic stability program), BAS (brake assist system), special light systems for curves, and night vision utilities are most effective to prevent collision with pedestrians and bicyclists. TV spots for bicyclists could help to point out dangerous situations and the proven benefits of wearing a helmet in the same way as previous campaigns, e.g."The 7th Sense" for car drivers.     

?Wirbelk?rperstabilit?t“ im spinalen Metastasenmanagement

BACKGROUND: Metastases are responsible for most tumor manifestations of the spine. About 25% are symptomatic; however, due to interdisciplinary management the tumor-associated mortality is regressing. Associated acute spinal cord injury (SCI) syndromes raise patient morbidity with a loss of independence and quality of life associated with a fair potential for recovery. Therefore, the management is focused on the avoidance of SCI. The assessment of mechanical stability of vertebral bodies is a central part of decision-making when considering operative therapy. This review gives an update on the current evidence-based data for metastasis management. DECISION MAKING: The NOMS concept is well established. Especially the parameters origin, neurologic symptoms, stability and vascularization are described and illustrated by clinical cases. OPERATIVE THERAPY CONCEPTS: Evidence-based operative therapy concepts are shown reflecting palliative and curative approaches. ASSESSMENT OF PARAMETERS FOR THERAPY ALGORITHM: Clinical and radiological parameters help to find the individual therapy. Generally a number of scores with significant time expenditure are needed. The spine instability neoplastic score (SINS) simplifies the management. Operative therapy shows the best results for the parameters pain and quality of life. However, potential perioperative and postoperative complications have to be estimated and should be avoided. Using these facts our therapy algorithm is helpful for therapy management. CONCLUSIONS: With rising life expectancy operative therapy is of increasing relevance. Decision-making uses information about tumor origin, neurologic symptoms, stability, prognostic factors and vascularisation to determine the individual therapy.     

Posttraumatische H?rst?rungen

The present paper is a retrospective chart analysis of 115 patients treated after occupational accidents. They all suffered from hearing disorders, either after blunt head trauma (40%), acute noise trauma or after whiplash injury. Treatment consisted of medical and surgical measures so that the majority of the hearing disorders, e.g. sensorineural hearing loss (SNHL), combined HL and peripheral tinnitus, could be either completely restored or improved. A poor prognosis was correlated with central auditory changes, e.g. central tinnitus or hyperacusis. Moreover, a time interval of several months between the injury and the onset of treatment also worsened the overall prognosis. In our series, this was a rare exception and best outcome can be expected after starting treatment within the first 20 days after the trauma.     

Pr?operative An?mie in der Orthop?die

In a national audit of elective orthopedic surgery conducted in the US, 30% of patients were found to have hemoglobin (Hgb) levels <?13?g/dl at preadmission testing. Preoperative anemia has been associated with increased mortality and morbidity after surgery, increased allogeneic blood transfusion therapy and increased rates of postoperative infection leading to a longer length of hospital stay. Because of the risks associated with allogeneic blood transfusions according to German law patients have to be offered the option of autologous transfusion if the risk associated with allogeneic blood transfusion is >?10%. However, one of these measures, the autologous blood donation, can exaggerate anemia and can increase the overall transfusion rates (allogeneic and autologous). As autologous procedures (autologous blood donation and cell salvage) are not always appropriate for anemic patients together with an expected shortage of blood and because preoperative anemia is associated with perioperative risks of blood transfusion, a standardized approach for the detection, evaluation and management of anemia in this setting was identified as an unmet medical need. A panel of multidisciplinary physicians was convened by the Society for Blood Management to develop a clinical care pathway for anemia management in elective surgery patients for whom blood transfusion is an option. In these guidelines elective surgery patients should have Hgb level determination at the latest 28?days before the scheduled surgical procedure. The patient target Hgb before elective surgery should be within the normal range (normal female ???120?g/l, normal male????130?g/l). Laboratory testing should take place to further determine nutritional deficiencies, chronic renal insufficiency and/or chronic inflammatory diseases. Nutritional deficiencies should be treated and erythropoiesis-stimulating agent (ESA) therapy should be used for anemic patients in whom nutritional deficiencies have been ruled out and/or corrected.