Awake craniotomy in a super obese patient using high flow nasal cannula oxygen therapy (HFNC)

Die Anaesthesiologie - Super obesity with a body mass index (BMI) >50 kg/m2 presents a challenge for the neuroanesthesiologist during awake craniotomy procedures...     

Thoracoabdominal approach for traumatic diaphragmatic hernia in a hemodynamically unstable patient

European Surgery - Diaphragmatic hernias with strangulated contents are a surgical challenge. Thoracoabdominal incisions are commonly used for a variety of thoracic and vascular...     

Early detection of COVID-19 cholangiopathy using cholangioscopy—a case report of two critically ill patients

European Surgery - The coronavirus disease 2019 (COVID-19) crisis caused by the severe respiratory distress syndrome coronavirus 2 (SARS-CoV-2) rapidly led to a pandemic. While...     

Gerinnungsfaktor XIII

Die Anaesthesiologie - Faktor XIII (FXIII) spielt eine wichtige Rolle für den suffizienten Ablauf der Hämostase. In den vergangenen zehn Jahren ist den angeborenen...     

Dialogisches Rehabilitationsmanagement der VBG

Trauma und Berufskrankheit - In der Umsetzung des gesetzlichen Auftrags zur Heilverfahrensteuerung (§§26 Abs. 5, 34 Abs. 1 SGB VII)...     

Dokumentations- und Behandlungsqualität im Rettungsdienst: eine retrospektive Analyse von Einsatzprotokollen in der Stadt Aachen

Die Anaesthesiologie - Der deutsche Rettungsdienst wird jährlich zu ca. 7,3 Mio. Einsätzen alarmiert, welche zu einem Großteil (ca. 59 %) ohne Arzt...     

Towards a zero percent anastomotic leak rate using a defined risk reduction strategy

European Surgery - Anastomotic leak (AL) remains one of the most serious complications after colorectal surgery. This study reports prospective data on a defined risk reduction strategy...     

Correction to: Interleukin 6 is a better predictor of 5-year cardiovascular mortality than high-sensitivity C-reactive protein in hemodialysis patients using reused low-flux dialyzers

International Urology and Nephrology - The article “Interleukin 6 is a better predictor of 5-year cardiovascular mortality than high-sensitivity C-reactive...     

Transapical TAVI in chronic type A dissection

European Surgery - Transcatheter aortic valve implantation (TAVI) has been a routine procedure for quite some years. Advancements in technology and experience have enabled its use in even...     

Outcomes of arteriovenous fistula in elderly patients on maintenance haemodialysis

International Urology and Nephrology - The optimal vascular access strategy in elderly patients receiving haemodialysis (HD) remains controversial. We aim to report the...     

Organspende – Nicht nur eine intensivmedizinische Aufgabe

Die Anaesthesiologie - Im Jahr 2019 starben in Deutschland 756 Menschen, während sie auf der Warteliste für ein Spenderorgan standen. Sowohl im Eurotransplant-Verbund als auch...     

Programmed death ligand 2 expression plays a limited role in adenocarcinomas of the gastroesophageal junction after preoperative chemotherapy

European Surgery - The effects of cytotoxic chemotherapy on the expression of programmed death ligand 2 (PD-L2) are unknown and little is known about how the tumor microenvironment changes...     

Preoperative Type and Screen Before General Thoracic Surgery: A Nomogram to Reduce Unnecessary Tests

BackgroundA preoperative type and screen (T&S) is traditionally routinely obtained before noncardiac thoracic surgery; however an intraoperative blood transfusion is rare. This practice is overly cautious and expensive.MethodsWe included adult patients undergoing major thoracic surgery at the Mayo Clinic from 2007 to 2016. Patients receiving a T&S blood test ≤72 hours of surgery was the main exposure. We randomly split the cohort into derivation and validation datasets. We used multiple logistic regression to create a parsimonious nomogram predicting the need for a T&S in relation to the likelihood of intraoperative blood transfusion. We validated the nomogram in terms of discrimination, calibration, and negative predictive value.ResultsOf 6280 patients 46.1% had a preoperative T&S, but only 7.1% received intraoperative transfusions. The derivation dataset had 4196 patients. Patients who had a T&S were more likely to have baseline hemoglobin level <10 g/dL (7.9% vs 3.6%, P < .001) and less likely to have minimally invasive operations (36.1% vs 43.5%, P < .001) but were otherwise similar in baseline age and comorbidities. A transfusion threshold of 5% was selected a priori. The nomogram included age, planned operation, approach, body mass index, and preoperative hemoglobin. The nomogram was validated with a c-statistic of 86% and a negative predictive value of 97.9%. Patients who needed a blood transfusion but who did not have a preoperative T&S did not have a higher rate of mortality (P = .121).ConclusionsAn intraoperative blood transfusion during major thoracic surgery is a rare event. Patient who required transfusion but did not have a T&S did not have worse outcomes. A simple nomogram can aid in the selective use of T&S orders preoperatively.     

Mastopexie – Historie und aktuelle Techniken

Journal für Ästhetische Chirurgie - Die Entwicklung der Mammaplastik lässt sich medizinhistorisch über 100&nbsp;Jahre zurückverfolgen. Nach anfänglichen Techniken...     

Erratum zu: Infektionen durch multiresistente Erreger

Die Anaesthesiologie - Im ursprünglich veröffentlichten Beitrag wurden 3&nbsp;Antibiotikumdosierungen in Tab.&nbsp;1 falsch angegeben. Korrekt muss es in Tab.&nbsp;1...     

80 Jahre intramedulläre Marknagelung

Die Unfallchirurgie - Vor fast 80&nbsp;Jahren, im Herbst 1939, führte Gerhard Küntscher die erste Marknagelung am Menschen durch und verlieh damit der Osteosyntheseforschung neuen...     

Hypothetical intervention of targeted systolic blood pressure control of < 120 mmHg on renal prognosis for persons with stage 3–4 chronic kidney disease: an application of parametric g-formula using health checkup data in Japan

Clinical and Experimental Nephrology - The revised KDIGO guidelines recommend maintaining systolic blood pressure (sBP) &lt; 120&nbsp;mmHg in patients with chronic kidney...     

Management options for proximal humerus fractures – A systematic review & network meta-analysis of randomized control trials

AimsThe purpose of this study is to systematically review the randomized controlled trials on the various treatment options that can be utilized in the management of displaced proximal humerus fractures.Materials & MethodsBased on the PRISMA guidelines, three independent reviewers performed a systematic review of the literature. Randomized control trials (RCTs) focusing on the outcomes of the following interventions in the management of PHFs were considered for inclusion; (1) non-operative or conservative (NOC) management, (2) open reduction and internal fixation (ORIF), (3) intra-medullary nailing (IMN), (4) shoulder hemi-arthroplasty (HA), and (5) reverse shoulder arthroplasty (RSA). Network meta-analyses were performed using R and studies were ranked according to their P-score.ResultsOur study included 13 RCTs. RSA had improvements in abduction, constant score, flexion, as well as lowest rates of malunion and osteonecrosis when compared to other management modalities (P-Score = 0.9786, P-Score = 0.9998, P-Score = 0.9909, P-Score = 0.9590 and P-Score = 0.8042 respectively). HA was found to have improvements in health-related quality of life scores when compared to other management modalities (P-Score = 0.9672). ORIF had the highest improvement in quick disability of arm, shoulder and hand scores and visual analogue scale scores (P-Score = 0.8209 and P-Score = 0.7155 respectively). NOC was found to have the lowest rate of conversion to surgical intervention, with RSA having the lowest rate of surgical interventions (P-Score = 0.9186 and P-Score = 0.7497 respectively).Discussion & ConclusionRSA offers satisfactory improvements in clinical and functional outcomes when compared to other non-operative and operative treatment options in the management of carefully selected proximal humerus fractures, with a minimal revision rate when compared to other surgical management modalities.Level of EvidenceI - Systematic Review & Meta-Analysis of Randomized Control Trials     

Lebenslanges Lernen in der Notfallmedizin – „Continuous professional development“

Notfall + Rettungsmedizin - Dieser Beitrag stellt drei wesentliche Aspekte zum lebenslangen Lernen in der Medizin vor: (1)&nbsp;die Orientierung der Ausbildungsziele an beruflichen Kompetenzen...     

Abrechnung im niedergelassenen Bereich im Vergleich zur ambulanten Notfallbehandlung in der Notaufnahme unter besonderer Betrachtung von Laborleistungen

Notfall + Rettungsmedizin - Die Versorgung ambulanter Notfälle ist in Deutschland nach §&nbsp;75 Abs.&nbsp;1b SGB&nbsp;V durch die Kassenärztlichen Vereinigungen (KV) zu...