Das Mittellappen-Lingula-Syndrom (M-L-Syndrom)

Zusammenfassung Die anatomischen und pathologisch-anatomischen Eigenheiten des Mittellappens rechts und der Lingula links sind ähnlich. Auf Grund dessen halten wir es für gerechtfertigt, die Krankheitsprozesse in diesen beiden Lungenabschnitten unter der gemeinsamen Bezeichnung des Mittellappen-Lingula-Syndroms (M-L-Syndrom) zusammenzufassen. Es handelt sich um eine vorwiegend entzündliche Erkrankung, deren Entstehung durch die besonderen Bronchusverhältnisse begünstigt wird, so daß exogene Noxen leichter wirksam werden können. Daneben können Tumoren und traumatische Einwirkungen dasselbe Krankheitsbild entstehen lassen. Die Diagnostik ist schwierig, und in den meisten Fällen müssen dazu sämtliche diagnostische Methoden herangezogen werden. Die differentialdiagnostische Abgrenzung zwischen den bösartigen Tumoren und den übrigen Krankheitsprozessen ist im Hinblick auf Früherkennung und-behandlung des Carcinoms besonders wichtig, so daß bei Erkennung eines Malignoms die Diagnose nicht mehr M-L-Syndrom lauten darf. Die charakteristischen differentialdiagnostischen Merkmale werden dargelegt. Die Behandlung des M-L-Syndroms ist zunächst konservativ, später bei chronischer Entzündung chirurgisch. Die Therapie des Bronchialcarcinoms erfordert von vornherein eine radikale chirurgische Maßnahme. Die Gegenüberstellung der intern und chirurgisch behandelten Fälle zeigt, daß die operative Behandlung für das M-L-Carcinom aussichtsreich ist und auch bei den Folgezuständen von chronisch-entzündlichen Prozessen meist zu guten Ergebnissen führt.Mit 24 TextabbildungenHerrn Prof. Dr.A. Fromme zum 80. Geburtstag freundlichst gewidmet.     

Das Reamer-Irrigator-Aspirator (RIA)-System

Problem

Autologous bone transplantation is a treatment of choice in patients with large bone defects. However, the iliac crest bone graft harvest is associated with numerous limitations: low volume of graft, long operation times, acute and chronic pain.

Solution

The reamer-irrigator-aspirator (RIA) system is used to harvest large volumes of intramedullar bone graft for surgical procedures that require bone graft, including non-unions, delayed union, and bone loss.

Surgical technique

The RIA device should be assembled prior to the surgical procedure. The greater trochanter is used as entry point. Following the opening of the trochanteric region, a guide wire should be centrally positioned within the bone canal. Frequent fluoroscopic evaluation should be performed to assure the central position of the guide wire. Apply the advance/withdraw/pause/advance technique to maximize irrigation flow through the RIA. The guide wire could be placed in newly desired position within the condyle of the femur if more bone graft is required. While reaming, monitor the reaming head passage on both the anteroposterior and lateral planes to avoid bone perforation or excessive thinning. Remove the intramedullary bone graft from the graft filter.

Postoperative management

Cautious ambulation on the 2^nd postoperative day. In case of excessive bone thinning of the femur, partial weight bearing for 4?C6 weeks is recommended.

Results

The RIA system allows large amounts (25?C90?cm³) of high quality bone graft to be harvested. This alternative technique is associated with less donor site morbidity and lower rates of minor and major complications when compared with conventional harvest methods (iliac crest).     

Das transobturatorische Band (TOB)

The transobturator tape, a new technique for the treatment of female urinary stress incontinence, was evaluated with a 1 year follow-up.A total of 124 patients were treated with a low elasticity polypropylene tape according to the technique described by Delorme. The operative procedure is described step by step. All patients were followed-up after 3, 6 and 12 months.No intra-operative complications were observed. After 12 months 88.7% of the patients were cured and an additional 6.4% showed improvement.The transobturator technique (from exterior to interior) is, given proven indications and an exact consideration of the instructions, a simple, safe and efficient surgical procedure for the treatment of female urinary stress incontinence. The technique avoids complications such as bladder, intestinal and vascular lesions. It is suitable for genuine incontinence and patients with recurrent stress incontinence.     

Das Gasödem (G)

In spite of surgical, intensive, and hyperbaric oxygen therapy, the gas gangrene is still one of the most dangerous surgical infections. In recent literature, the average mortality is about50 %. The patients die with in a few days because of general intoxication. Areview of our own results achieved between 1971 and 1981 shows that 50 out of 73 patients with clostridium infection and all 77 patients in whom a gas gangrene was suspected have survived [2]. For the prognosis and therapy of the gas gangrene, the classification into stages I to IV according to the severity has proved to be useful. The prognosis depends on the incubation period (the shorter the incubation period the worse the prognosis), on the beginning of the treatment and on the site of a primary or secondary gas gangrene. The more distally the gas gangrene is situated in the extremities, the better is the prognosis with regard to mortality and invalidity. An early diagnosis of the gas gangrene is of primary importance. As early as a gas gangrene is suspected because of typical local findings and clinical symtoms, therapeutic measures are immediately necessary (surgery, intensive treatment and hyperbaric oxygen therapy). A transport of more than six hours with prolonged interruption of the treatment will decrease the chances of success even in a ?gas gangrene therapy centre”.     

Das Syndrom nach Rectumamputation (Postproktektomie-Syndrom)

Zusammenfassung Unter Postproktektomiesyndrom verstehen wir Beschwerden nach abdomino-perinealer Rektumamputation wegen eines Careinoms, die gewöhnlich 6 bis 10 Monate nach dem operativen Eingiff auftreten, zuerst. auf die Steiß-Kreuzbeinregion begrenzt sind, allmählich sich eranialwärts. zur Lendengegend ausbreiten und deren Art charakteristisch ist. Die Ursache liegt in einem metastatischen Befall der hypogastrischen, iliacalen und paraortalen Lymphknoten. Die Lymphographie sichert die Diagnose; die Thermographie hilft die Beschwerden zu klären.

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The syndrome following rectectomy (Postproctectomy-syndrome)

Summary Retroperitoneal metastases lead to an irritation of the sympathicus. Besides typical clinical findings, there are changes in the vascularity in the lower extremities. Thermography can detect disturbed heatpattern. There is a good correlation between pathological thermogramms of the lower extremity and pathological lymphogramms. Thus thermography seems to be a suitable pre-orientating examination for detection of retroperitoneal metastases.

     

Das komplexe regionale Schmerzsyndrom (CRPS)

Die Anaesthesiologie - In der Akutphase des komplexen regionalen Schmerzsyndroms (CRPS) dominiert pathophysiologisch eine Aktivierung des Immunsystems und der damit zusammenhängenden...     

Das (neue) Rehabilitationsmanagement der gesetzlichen Unfallversicherung

Since the fall of 2010, the German statutory accident insurance institutions have been conforming to a uniform guideline for rehabilitation management in the rehabilitation of serious accidents. By means of comprehensive planning and partner-like inclusion of all parties involved, insured persons are accompanied seamlessly through the various stages of rehabilitation to ensure prompt resumption of work or school. Early recognition of detrimental contextual factors and disruptive interfaces or points of conflict enables customized measures. Physician collaboration is now firmly established in the medical fee schedule at € 100.70.     

Das sogenannte Rankenangiom des Kopfes (Angioma racemosum Virchow)

Ohne ZusammenfassungMit 11 TextabbildungenHerrn Chefarzt Dr.F. Vollmar, Geislingen/Steige, zu seinem 72. Geburtstag am 27. 3. 64 gewidmet.     

Das bronehiolo-alveoläre Carcinom der Lunge (Alveolarzelleareinom)

Zusammenfassung Das bronchiolo-alveoläre Carcinom (Alveolarzellcarcinom) ist - verglichen mit der Häufigkeit der primären Lungencarcinome - selten. Im eigenen Obduktionsgut von 1956 bis 1969 fanden sich unter 576 Lungencarcinomen 12 bronchiolo-alveoläre Carcinome (2%).Alle Patienten wiesen Metastasen auf; 8mal wurden Tumorzellen im Sputum und in Pleuraergüssen gefunden. In 9 Fällen wurde das Carcinom dem nodulär-disseminierten und in 3 Fällen dem nodulär-pneumonischen Mischtyp zugeordnet. Das Durchschnittsalter der Patienten betrug 53 Jahre. Der mittlere Krankheitsverlauf erstreckte sich über 4,5 Monate. Eine Geschlechtsdisposition lag nicht vor.

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The bronchiolo-alveolar carcinoma of the lung (alveolar cell carcinoma)

Summary Bronchiolo-alveolar carcinoma occures rarely in comparison to primary carcinoma of the lung. In 576 cases of carcinoma of the lung, 12 cases of Bronchiolo-alveolar carcinoma were confirmed by autopsy (2%) in 1956 to 1969.All patients had metastases; in 8 cases tumor-cells were found in the sputum and pleura-effusions. The nodular-disseminated type had been confirmed in 9 patients, the nodular pneumonic mixed-type in 3 cases. The average age of the patients was 53 years. The average duration of clinical symptoms was 4,5 months. Sex dependence was not observed.

     

Das „Prostate Cancer Prevention Trial“ (PCPT)

The Prostate Cancer Prevention Trial (PCPT) has been the first interventional trial directly aimed at the prevention of prostate cancer. A total of 18,882 men over 55 years with a PSA serum level less than 3.0 ng/ml were randomized to receive either the 5-α-reductase inhibitor finasteride 5 mg/day or placebo for 7 years. Despite a 25% reduction of prostate cancers in the treatment arm the results were discussed controversially. This criticism was mainly due to the observation of significantly more high-grade cancers in the finasteride group. Meanwhile, results of extensive follow-up analyses have been published suggesting that this finding is most likely due to optimized tumor detection in smaller glands. Further work-up demonstrated that PSA diagnosis and the histopathological examination were not compromised by finasteride. Furthermore, in addition to a decrease of prostate cancer the amount of prostatic intraepithelial dysplasia (PIN) was also reduced under finasteride. Future research must now aim at defining high-risk groups specifically profiting from chemoprevention with a 5-α-reductase inhibitor.     

Das Sanitätskonzept beim World Economic Forum (WEF) in Davos

This year’s World Economic Forum (WEF) Annual Meeting 2008 will take place in Davos, Switzerland on 23–27 January. More than 2,000 participants from over 100 countries representing the realms of politics, economics, and science will meet to exchange views on political, social, and economic aspects of the development of the global community. The Annual Meeting of the WEF is one of the most important economic and sociopolitical events in the world. Experiences gathered in past years with the existing EMS concept adjusted to current conditions have shown that all situations encountered to date could be managed with the chosen approach. Problem areas concern the interface between the partners involved as is the case in all organizational structures. Close communication in joint sessions and daily rapport during the WEF are considered important elements. Consistent and good cooperation between all participating partners is crucial for implementing an EMS concept.     

Das Heidelberger Seminar „Invasive Notfalltechniken“ (INTECH) 2001–2004

Prehospital emergency medicine in Germany is based on a specially trained physician-staffed system, in order to realize a differentiate therapy at the scene. In the last years, the special education and the qualification were more and more discussed after the determination of deficits in the prehospital management of special emergency situations. In the presented paper we described the concept and organization of a practice-oriented training model of invasive emergency techniques, as like as the emergency cricothyrotomy, the thoracic tube and the intraosseous access. The relevance and the efficacy are discussed based on an evaluation of the participants. Practice-oriented training models seem to be adequate instruments in order to close the leak in educational programs and can help to improve the qualification of the physician-staffed system, generally.     

Das postoperative Monitoring von (frei) vaskularisierten Knochentransplantaten zur Rekonstruktion von Knochendefekten

Vascularized bone transplantation for reconstruction of bone defects remains a great challenge for experienced microsurgeons. The clinical evidence of a well-vascularized bone graft is key for the postoperative rehabilitation strategy. Especially the early postoperative period is decisive for the outcome of surgery. Continuous monitoring systems, e.g., the monitoring skin island, may be distinguished from noncontinuous monitoring systems, e.g., MRI. Techniques to monitor the free flap or graft depend on location and tissue composition. Several techniques have been described to monitor the postoperative viability of microsurgical free vascularized grafts, including surface or temporarily implanted Doppler, dynamic MRI, angiography or scinitgraphy, and many other techniques. The sensitivity and reliability of these techniques continue to be the subject of animal experiments and clinical trials. The optimal monitoring device should be objective, noninvasive, safe, reproducible, easily managed and interpretable for the nursing staff, and a clear indicator of changes in arterial and venous circulation. Presently, none of the techniques fulfill all of the criteria completely. The relative advantages and disadvantages of these various postoperative monitoring techniques are discussed.     

Das periostale Wachstum,Hauptmittel zur funktionellen Anpassung des Schenkelhals-Schaft-Winkels (CCD-Winkel)

Zusammenfassung Nach konsequenter Untersuchung vieler Coxa valga-Fälle gemäß physikalischen und biologischen Gesetzen sowie morphologischen Standpunkten muß man als Hauptgestalter des Schenkelhals-Schaft-Winkels das periostale Wachstum betrachten und nicht, wie bis jetzt angenommen, das epiphysäre Längenwachstum.

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The increase in thickness of the bone as a basic means of functional adaptation of the femoral neck

Summary Consistent investigation and analysis of cases of Coxa valga, as well as careful consideration of biological and physical laws should lead to the conclusion that the formation of the CCD-angle is mainly due to the growth of the bone along its width growth caused by the periosteum rather than its elongation.

     

Das Strengthening the Reporting of Observational Studies in Epidemiology (STROBE-) Statement

Much of biomedical research is observational. The reporting of such research is often inadequate, which hampers the assessment of its strengths and weaknesses and of a study’s generalizability. The Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) Initiative developed recommendations on what should be included in an accurate and complete report of an observational study. We defined the scope of the recommendations to cover three main study designs: cohort, case-control, and cross-sectional studies. We convened a 2-day workshop in September 2004, with methodologists, researchers, and journal editors to draft a checklist of items. This list was subsequently revised during several meetings of the coordinating group and in e-mail discussions with the larger group of STROBE contributors, taking into account empirical evidence and methodological considerations. The workshop and the subsequent iterative process of consultation and revision resulted in a checklist of 22 items (the STROBE Statement) that relate to the title, abstract, introduction, methods, results, and discussion sections of articles. Eighteen items are common to all three study designs and four are specific for cohort, case-control, or cross-sectional studies. A detailed “Explanation and Elaboration” document is published separately and is freely available on the web sites of PLoS Medicine, Annals of Internal Medicine, and Epidemiology. We hope that the STROBE Statement will contribute to improving the quality of reporting of observational studies.     

Das Lymphgefäßsystem (LGS I und II) aus chirurgischer Sicht

Sarcomatous malignancies only rarely develop regional lymph node metastases: about 2.7% of our evaluated cases. In this paper we provide evidence supporting a new hypothesis that two entirely separate lymph vascular systems exist in humans. One system (LGS I) exists in close proximity to the epithelium and drains into regional lymph nodes. Only sarcomas that originate in the epithelium or its immediate proximity are able to form regional lymph node metastases. The vast majority of sarcomatous malignancies (97.4% of cases) do not give rise to lymph node metastases, since they originate in proximity to a second, more deeply localized lymph node system (LGS II) in the mesenchymally derived tissues of the body. This second system has no connection to regional lymph nodes. Supporting evidence is provided by experience in the operative treatment of extremity lymphedema, PET-CT examinations, radionuclear lymphography, and scientific investigations using antibodies specifically directed at the elements of the lymph vascular system.