Akute hämorrhagische Pankreatitis durch Frühoperation geheilt

Ohne Zusammenfassung (Mit 2 Kurven.)     

Die Frühoperation der akuten Cholecystitis im höheren Lebensalter

Zusammenfassung. Innerhalb von 20 Jahren (1974– 1993) wurden 4230 Patienten an den Gallenwegen operiert. 869 Patienten (20,5 %) hatten eine akute Cholecystitis, davon wurden 621 Patienten im Sinne einer Frühoperation durch Laparotomie behandelt. Die retrospektive Auswertung hinsichtlich Alters- und Geschlechtsverteilung, Morbidit?t, Letalit?t und altersbezogene Letalit?t ergab, da? das h?here Lebensalter für die Akutoperation der akuten Cholecystitis im unkomplizierten Stadium kein bedeutsamer Risikofaktor ist und zu keiner h?heren Letalit?t als bei Elektiveingriffen führt. Ein durch Perforation, Peritonitis oder Steinbefall des Ductus choledochus kompliziertes Stadium der akuten Cholecystitis führt zu einem signifikanten Anstieg der Operationsletalit?t in h?herem Lebensalter.      

234. Die Frührelaparatomie

Zusammenfassung Der sogenannte paralytische Ileus bei Peritonitis istnicht durch eine Lähmung, sondern durch eine sympathicotone reflektorischeHemmung verursacht. Dementsprechend sollte der Ansatzpunkt der Therapie dieLyse — undnicht, wie noch allgemein üblich — die Stimulation sein. 35 Patienten mit schwerem, therapieresistentem funktionellem Ileus nach Operation wegen einer Peritonitis wurden nach Versagen der üblichen Maßnahmen erfolgreich sympathicolytisch behandelt. Verwendet wurden Chlorpromazin und Trifluperidol, wirksam als Alpha-Receptorenblocker am Plexus Auerbach.     

Akute Arterienverschlüsse

Ohne Zusammenfassung Mit 5 Textabbildungen     

Zur Früh-Relaparotomie

Ohne Zusammenfassung Mit 3 Abbildungen in 5 Einzeldastellungen     

95. Frühindikation der akuten Pankreatitis: Operativ

Zusammenfassung Das Versagen der konservativen Therapie bei den schweren Verlaufsformen der akuten Pankreatitis, denen eine hämorrhagisch-nekrotisie-rende Entzündung zugrundeliegt, ist einer der Gründe für ihre operative Behandlung mit dem Ziel, die Nekrosen zu entfernen. Bei den partiellen Nekrosen ging die Letalität unter operativer Therapie erheblich zurück, bei den subtotalen und totalen Nekrosen sind erst Einzelerfolge zu verzeichnen. Hier gilt die Forderung nach früherer Erkennung und orzeitiger Operation, d. h. vor Auftreten lebensbedrohlicher Komplikationen.     

Frühinfekt nach Osteosynthese

Efficient therapy of osteitis is only possible in suitably specialized centers. The treatment consists of an integral whole between infection cleansing, soft tissue covering and bony reconstruction. The indications for revision and resection should be liberally considered. Segment resection and callus distraction are at present the safest methods for cleansing of osteitis.     

Frühkomplikationen nach Magenresektion

Ohne Zusammenfassung a. G.     

Frührehabilitation nach Polytrauma

The survival chances of multiple trauma patients have risen continuously in recent decades. Therefore, not only the question of whether the patient survives a severe accident arises, but rather how the patient survives it. Knowing which parameters can influence outcome is essential for the planning, organization, and implementation of rehabilitation after a severe injury. The earlier the rehabilitation begins, the better the result. Early rehabilitation is part of acute medical treatment and requires close teamwork between rehabilitation medicine and trauma surgery. Standards for optimal rehabilitation place high demands on hospitals and rehabilitation teams, and can ultimately only be met in specialized facilities.     

Akute mesenteriale Isch?mie

Acute mesenteric ischemia (AMI) is a rare cause of acute abdomen. Coupled with a high patient age, non-specific clinical symptoms and a significant co-morbidity the disease is still associated with a significant mortality of 60?C85%. With a combination of preexisting cardiac arrhythmia and sudden abdominal pain AMI should always first be ruled out. Contrast-enhanced computed tomography (CT) scanning has replaced angiography as the first diagnostic step, largely because both intravascular and intra-abdominal pathologies can be diagnosed. In the case of an acute abdomen or lack of immediate access to diagnostic tools, rapid surgical exploration should be preferred. Surgical therapy includes embolectomy and resection of ischemic bowel segments. There should be a wide indication for second-look surgery. The most important prognostic factor and the only factor that can be influenced by the surgeon is the time interval between onset of symptoms and surgery. Therefore angiography or laparotomy should be performed as early as possible in cases of suspected AMI.     

Die Frühinstillation des Harnblasenkarzinoms

The high recurrence rate in superficial bladder cancer (>70%) is caused by the adhesion of free floating tumor cells during transurethral treatment, by incomplete resections, and by overlooked and new tumors. Frequent follow-ups and reoperations are necessary. A single immediate instillation after TUR shows positive effects in reducing recurrence rates and is therefore recommended in the European Guidelines from 2001. The amount, concentration, instillation time, and substances have not yet been standardized. By analyzing the literature we found many different techniques of early instillation therapy. Different substances, concentrations, varying instillation times, and application times make a comparison of these studies very difficult. Further studies are needed to standardize early postoperative instillation therapy.     

Zur Frühoperation bei Osteomyelitis

Ohne Zusammenfassung     

Die postoperative Krankheit. (Vorbeugung durch Bestrahlung und Frühaufstehen.)

Ohne Zusammenfassung Nach einem in Karlsbad gehaltenen Fortbildungsvortrag (Sept. 1937).     

Die geriatrische Frührehabilitation nach hüftgelenknahem Oberschenkelbruch

Background

Modern strategies for postoperative care of patients with hip fractures include early discharge from the acute care hospital to inpatient interdisciplinary rehabilitation facilities. Whether these programs are effective for the patients and improve their long-term outcomes or if they simply transfer costs, with a reduction of the inpatient days in the acute care hospital, is currently under discussion.

Patients and methods

This prospective study included 282 patients with hip fracture admitted to our trauma center were included into the prospective study. The mean patient age was 86±8 (65–110) years. All patients were treated operatively. After a mean of 12±9 days, the patients underwent inpatient interdisciplinary geriatric rehabilitation for a mean of 27±13 (4–103) days. The primary outcome measure was their activities of daily living (Barthel index) before, at the end of rehabilitation, and 1 year after trauma. In addition, patient-related variables were correlated with the Barthel index.

Results

With discharge from the acute care hospital, the Barthel index was 42±20 points and it increased during rehabilitation to 65±26 points. One year later the Barthel index was 67±28 points. Ninety percent of patients improved their Barthel index during rehabilitation. Within 1 year, 40% of patients deteriorated in their activities of daily living. Fifty one percent of patients were reintegrated back to their homes. Patients who lived at home before trauma and were reintegrated back to their homes had a significant higher Barthel index (75±24) 1 year after trauma than patients who were living in a nursing care facility before the trauma (Barthel index 52±27). The variables of age, level of cognition, and type of fracture had no influence on the long-term outcome. An extension of rehabilitation above the mean time period did not improve the sustainable clinical outcome.

Conclusion

Postoperative inpatient rehabilitation programs enhance short-term activities of daily living. In particular, patients who lived at home before the trauma and were reintegrated back home benefited in perpetuity from geriatric rehabilitation. A policy for early discharge to geriatric rehabilitation is associated with extension of overall hospital stay. This association along with the related increased health care costs should be weighed against the sociofunctional effectiveness of these programs.     

Frühlockerungen eines zementierten Hüftendoprothesenstiels aus Titan

Up to now there are no facts concerning the loosening rate of the cemented titanium stem (Trios). The central guiding canula and the longitudinal drilled stem shall ensure a symmetric cement mantle. In order to estimate the risk of aseptic loosening all Trios prostheses implanted in our clinic (n = 67; operations 1/95-11/96; max. follow-up: 3.1 years) were examined in a retrospective study and compared with a conventional femoral component (n = 141; Müller special; CoCr; operations 1977-1982). We used survivorship analysis to assess the results (Kaplan-Meier method; end point: revision). Compared to the conventional femoral stem the survival rate of the Trios prostheses was significantly worse (p = 0.0001). The probability of no revision after 3 years was 72% (conventional femoral component: 96%). Preoperative x-rays showed radiolucent lines surrounding the cement mantle. These findings as well as the loosening at the cement metal interface were confirmed intraoperatively. The explanted stems showed corresponding signs of abrasion on the surface. Our results prove that the application of cemented titanium stems might be problematic. With regard to the Trios prosthesis we recommend close routine check-ups to keep the chance of an early revision.     

Frühmobilisation auf der Intensivstation – Sind robotergestützte Systeme die Zukunft?

Die Anaesthesiologie - Bei etwa 43?% aller Überlebenden der Intensivmedizin wird ein erworbenes Syndrom an Muskelschwäche beobachtet, welches Überleben und Lebensqualität...