Die Bedeutung des Bindegewebes für die Wundheilung

Ohne ZusammenfassungMit 5 TextabbildungenAuszugsweise vorgetragen auf der Mittelrheinischen Chirurgentagung Wiesbaden vom 16. u. 17. 4. 48. — Durchgeführt mit Beihilfen derWilliam G. Kerckhoff-Stiftung Bad Nauheim.     

Die Bedeutung des Experiments für die praktische Ulcuschirurgie

Ohne ZusammenfassungMit 4 Abbildungen     

Die Bedeutung des Dickdarms für die plastische Urologie

Ohne ZusammenfassungMit 4 Textabbildungen     

Die Bedeutung des Diabetes mellitus für die Chirurgie

Ohne Zusammenfassung Mit 8 Textabbildungen     

Bedeutung der PET für die Chirurgie des Schilddrüsenkarzinomrezidivs

Background

The early detection of recurrent thyroid cancer and focussed surgery are essential for patients’ prognosis. Using I-131 whole body scintigraphy is often not sufficient to detect recurrent carcinoma making other imaging methods necessary to identify the tumor. Recent studies showed that positron emission tomography-computed tomography (PET/CT) is able to identify recurrent carcinoma and metastasis at an early stage.

Objective

The aim of this study was an evaluation of the impact of PET/CT on diagnostic and operation strategies in recurrent thyroid cancer.

Methods

A review of the literature was carried out combined with a case report from the daily practice. Furthermore, flow charts were created to clarify the aftercare procedure.

Results

In patients with recurrent thyroid cancer PET/CT significantly increased the identification of recurrent tumors and metastases. Depending on the subtype of cancer, different tracers are used. The use of a metabolically active tracer which shows the increase of tumor metabolism and the morphological correlation of the tumor using a CT scan enable preoperative planning for a focussed surgical approach.

Conclusions

The PET/CT procedure should be an integral part of the aftercare procedure in thyroid cancer for early identification of recurrent tumors and to enable focussed surgery.     

G-DRG-System für die Urologie

BACKGROUND: The German diagnosis-related group (G-DRG) system is based on the belief that there is only one specific coding for each case. The aim of this study was to compare coding results of identical cases coded by different coding specialists. MATERIAL AND METHODS: Charts of six anonymous cases -- except final letter and coding -- were sent to 20 German departments of urology. They were asked to let their coding specialists do a DRG coding of these cases. The response rate was 90%. RESULTS: Each case was coded in a different way by each coding specialist. The DRG refunding varied by 6-23%. The coding differences were caused by different interpretations of definitions in the DRG system and also by inaccurate chart analysis. CONCLUSION: The present DRG system allows a wide range of interpretation, leading to aggravation of the ongoing disputes between hospitals and insurance companies.     

Leben für die Medizin

Zeitschrift für Herz-,Thorax- und Gefäßchirurgie -     

Die Bedeutung des Torsionswinkels für die Behandlung der Oberarmfrakturen

Ohne Zusammenfassung Mit 2 Textabbildungen.     

Die Bewertung des Traumas für die Pathogenese des Torsionsgleitens bei Skolisoen

Ohne ZusammenfassungMit 3 Textabbildungen.     

Die Bedeutung des Antikörpermangelsyndroms für die Chirurgie

Zusammenfassung Bedeutung und Form des Antikörpermangelsyndroms (Synonyma in der Literatur: A- und Hypogammaglobulinämie, Immunkörperparese, Immunkörpermangel) werden beschrieben. Für die Diagnose und erforderliche Therapie sind die anamnestischen und klinischen Daten (Kette von Infektionen; schwerer Verlauf blander Infektionen; klinischer Verlauf durch Antibiotica allein unbeeinflußbar, durch Kombination mit -Globulinlösung gut beeinflußbar; Summation von Infekten mehrerer Organe in der postoperativen Phase) wichtiger als die Laboratoriumsdaten (A- und Hypogammaglobulinämie durch Papier- oder Immunoelektrophorese oder Fehlen des -Globulinanstieges im akuten Stadium der Infektion; Ausbleiben der Antikörperbildung nach Immunisierung).Für die Therapie akuter, insbesonder septischer Infektionen werden empfohlen:Alle 6 Std 0,2 g/kg Körpergewicht=10 ml der 16% igen -Globulinlösung intramuskulär oder 10 ml der 5% igen Lösung intravenös (max. 50–60 ml).Wenn aus anderen Gründen (Flüssigkeits- und Elektrolytersatz) eine Infusionstherapie angezeigt ist, kann man 20–40 ml der 5% igen -Globulinlösung der Infusionslösung zufügen.Als Erhaltungsdosis bei besonderer Infektionsgefährdung sind 0,2 g/kg Körpergewichtmonatlich ausreichend, d.h. pro Woche 10 ml der 16% igen Lösung intramuskulär.Fünf eigene Fälle mit AMS und die Erfahrungen mit der -Globulintherapie bei etwa 30 Patienten werden beschrieben.Mit 1 TextabbildungHerrn Professor Dr.A. Fromme zur Vollendung des 80. Lebensjahres.     

Bedeutung der PET für die Chirurgie des Ösophaguskarzinoms

Perioperative or preoperative radiochemotherapy (RCTx) is nowadays standard for locally advanced esophageal cancer in Europe, as randomized studies have shown a significant survival benefit for patients with multimodal treatment. As responders and nonresponders have a significantly different prognosis, a response-based tailored preoperative treatment would be of utmost interest. An established method is a metabolic response evaluation by 18F-fluorodeoxyglucose positron emission tomography (FDG-PET). The level of metabolic response is known to be dependent on the localization, tumor entity and type of preoperative treatment. Association of FDG-PET with later response and prognosis was shown for absolute standardized uptake values (SUV) or a decrease of SUV levels before and after therapy but there are also contradictory findings in the literature and no prospective validation. However, neither time points nor cut-off for metabolic response evaluation have been defined so far. The most interesting approach seems to be early response monitoring during preoperative chemotherapy, which has shown promising results in prospective single center trials (MUNICON I/II) during chemotherapy of adenocarcinoma of the esophagogastric junction (AEG), but needs to be validated in prospective multicenter trails.     

Bedeutung der PET für die Chirurgie des gastrointestinalen Stromatumors

Background

Gastrointestinal stromal tumor (GIST) is the most common mesenchymal neoplasm of the digestive tract. The GIST differ substantially from gastrointestinal carcinomas regarding tumor biology, treatment strategies and indications for surgery. Every surgeon involved in the treatment of GIST should be acquainted with these aspects.

Objectives

The aims of this article are to discuss the value of positron emission tomography (PET) in the surgical treatment of patients with GIST and to provide an outlook on the development of molecular tracers specifically tailored for GIST.

Results

PET is an invaluable decision aid in the multimodal therapy of GIST and particularly for deciding on surgical indications. Specific scenarios in which PET is used are primary staging monitoring during neoadjuvant therapy and staging and response assessment in the metastatic setting. The routinely used tracer is 18F-fluorodeoxyglucose (18F-FDG) and uptake reliably correlates with the metabolism of GIST lesions. Compared to computed tomography and magnetic resonance imaging (CT/MRI), 18F-FDG-PET often allows a more timely and accurate response assessment. GIST-specific molecular tracers, which could provide a direct prognosis regarding response and development of resistance to treatment, are currently in preclinical development. However, pharmacokinetic and immunological issues still need to be resolved. A distant aim is the development of “theranostics”, i.e. substances which serve both diagnostic and therapeutic purposes.

Discussion

PET has an established value in the multimodal treatment of GIST and is particularly useful for deciding on surgical indications.     

Abgrenzung der Verantwortung für die operative Lagerung des Patienten und Haftung für Lagerungsschäden

The cooperation of surgeon and anaesthetist in positioning of the patient is subject to the principles of horizontal division of labour recognized in the interdisciplinary agreement and confirmed by the legislature: anaesthetist and surgeon carry out their respective tasks independently of each other, each bearing full responsibility for their own work (principle of strict separation of functions), they tailor their procedures to fit in with each other (duty of coordination), and each is entitled to expect and rely on due care in the other (principle of trust). In the case of conflict--when the best position for the specific intervention leads to a higher anaesthesiological risk--the principle of predominance of the actual requirements applies. If no agreement is reached it is incumbent on the surgeon to make the decision; this means that the surgeon bears the medical and legal responsibility for appropriate deliberation. Faults in organization are regarded under the law as faulty treatment. Anaesthetist and surgeon are each responsible for their own errors. According to the interdisciplinary agreements, positioning and checks on position are the task of the surgeon, while the anaesthetist is responsible for the "infusion arm". This does not exclude the possibility that anaesthetist and surgeon may agree on a different division of labour in the operating room. The patient bears the burden of proof that errors were committed in a case for damages. The doctor does, however, have to prove that the patient was correctly positioned. The demands of jurisdiction in terms of documentation of the positioning and of presentation of evidence are practically oriented and can basically be met. The same is true of the information supplied to the patient on the risk that positioning can cause harm. The doctor is obliged to supply evidence of the patient's substantive consent and the provision of information that this implies.     

Abgrenzung der Verantwortung für die operative Lagerung des Patienten und Haftung für Lagerungsschäden

The cooperation of surgeon and anaesthetist in positioning of the patient is subject to the principles of horizontal division of labour recognized in the interdisciplinary agreement and confirmed by the legislature: anaesthetist and surgeon carry out their respective tasks independently of each other, each bearing full responsibility for their own work (principle of strict separation of functions), they tailor their procedures to fit in with each other (duty of coordination), and each is entitled to expect and rely on due care in the other (principle of trust). In the case of conflict--when the best position for the specific intervention leads to a higher anaesthesiological risk--the principle of predominance of the actual requirements applies. If no agreement is reached it is incumbent on the surgeon to make the decision; this means that the surgeon bears the medical and legal responsibility for appropriate deliberation. Faults in organization are regarded under the law as faulty treatment. Anaesthetist and surgeon are each responsible for their own errors. According to the interdisciplinary agreements, positioning and checks on position are the task of the surgeon, while the anaesthetist is responsible for the "infusion arm". This does not exclude the possibility that anaesthetist and surgeon may agree on a different division of labour in the operating room. The patient bears the burden of proof that errors were committed in a case for damages. The doctor does, however, have to prove that the patient was correctly positioned. The demands of jurisdiction in terms of documentation of the positioning and of presentation of evidence are practically oriented and can basically be met. The same is true of the information supplied to the patient on the risk that positioning can cause harm. The doctor is obliged to supply evidence of the patient's substantive consent and the provision of information that this implies.     

Die Bedeutung des dreidimensionalen Bewegungsablaufs des Femurotibialgelenks für die Ausrichtung von Knieführungsorthesen

Stimulated by investigations on the kinematics of the human knee joint conducted during the nineteenth and early twentieth centuries, we have determined the spatial motion of this articulation, describing it by means of the helical axis concept, as obtained with the assistance of modern tools. As expected, there are similarities with the results of other recent investigators. Some details of the photogrammetrical method employed are unique. We have now related our findings to unsolved problems in orthotics and prosthetics. The presentation also describes a technique to align the movement of a brace with that of the knee joint. This work serves as a basis on which criteria for the fitting of braces could be determined.     

Fit für die Rettung?

Aim

Prospective examination of cardiovascular (CV) risk factors and cardiorespiratory fitness in firefighters (FFs) in Germany and comparison with the international literature.

Methods

A total of 97 North Rhine–Westphalian FFs working in emergency service participated in the study (time period 1/2014–9/2014). Participation was voluntary and data were anonymized. Anthropometric parameters, CV risk factors and cardiorespiratory fitness were examined. In order to estimate the 10-year CV risk, the Framingham Risk Score was utilized. The metabolic syndrome was diagnosed using the definition of the International Diabetes Federation.

Results

The examined FFs demonstrated a significant tendency towards obesity which was shown by the BMI and by abdominal waist circumference. In 32?% of FFs, an increased abdominal waist circumference was measured. Systolic resting blood pressure was elevated in 17.5?% of FFs; diastolic resting blood pressure was increased in 40.2?%. The relative maximal oxygen uptake (rel. VO_2max; 37.3 ± 6.3 ml ? kg^?1min^?1) was comparable with the average citizen. In international comparison, the 10-year CV risk can be seen as equivalent or less (according to the Framingham Risk Score). In 14?% of the examined FFs, a metabolic syndrome was detected. When regarding the metabolic syndrome, the international comparison revealed that the prevalence of the German FFs was among the lowest.

Conclusion

The results showed frequent CV risks factors in the examined FFs. Especially in a job which requires physical fitness, the results lead to a need for action in order to minimize the CV risk factors and to improve their fitness. Due to the particular labor conditions FFs have to be educated (empowerment). The setting has to be changed (internal training programs and leisure time activities toward more physical fitness) to decrease CV risk factors and to improve cardiorespiratory fitness. Therefore, an implementation of health-promoting concepts should be taken into consideration.