Rolle und Grenzen der Vertebro-/Kyphoplastie im Metastasenmanagement der Wirbels?ule

The spine is the most common site for skeletal metastases. Tumor-induced osteolysis may lead to pain, dysfunction and ultimately vertebral fracture. In some patients conventional surgery is not suitable because of the palliative therapy approach. Just for this patient population it was shown that cement augmentation of the vertebra is an effective therapy option and plays an important role. Nevertheless, cement augmentation of the vertebra has its limitations and should only be applied by appropriate indications.     

M?nnliche Sexualit?t im Alter

Male sexuality in the elderly is an important issue with a growing relevance. In contrast to the assumption of an asexual state when becoming older, recent representative surveys show that the majority of men maintain sexual desires and fantasies into old age. Sexual activity primarily depends on the availability of a partner and on maintaining intimacy and sexuality in the face of changes in the sexual response cycle and increasing comorbidity. This review aims to clarify the normal aging process, the sexual behavior of aging males and the prevalence of sexual dysfunction.     

Komorbidit?t im Patientenurteil – geht das?

To minimize the medical effort for the measurement of comorbidity, which is a relevant factor for various outcome measures, the Self-Administered Comorbidity Questionnaire (SCQ) for patient self-evaluation has been developed. After successfully testing the psychometric characteristics and content of the original English version a validation of the German translation (SCQ-D) has so far been lacking. A total of 218 patients with gonarthrosis and coxarthrosis (average age 71.5 years) were included in the survey. A questionnaire for doctors as well as patients was used to collect data at five different measurement times (postoperative, beginning and end of rehabilitation as well as 4 months and 1 year postoperatively). To evaluate the matching of comorbidities according to the SCQ-D and the Charlson Comorbidity Index (CCI), aggregate indices for "problems" and "treatment" as well as correlation and kappa coefficients were calculated. The assessment of predictive validity in terms of treatment outcome was operationalized using the WOMAC and the postoperative 1 year hospitalization by applying multilevel models. The patient self-assessment using the SCQ-D correlated well with the physician assessment using CCI in terms of aggregate indices of 13 given disease groups with r?=?0.49 (problems) and r?=?0.48 (treatment). However, the results showed significant differences for certain diseases in the conclusions. The comorbidity measured by the SCQ-D proved to be a valid predictor of the hospitalization and the treatment outcome. Concerning the need for resource efficient data collection especially in large sample studies, the SCQ-D is a useful patient self-administered instrument to assess the type and extent of comorbidities.     

Die Wirbelkörperbrüche im Kindes- und Jugendalter

Zusammenfassung An Hand von 21 eigenen Fällen werden die Besonderheiten der Wirbelbrüche beim Kind und Jugendlichen besprochen. Die Bruchform ist im Kindesalter durch ein Fehlen unstabiler Formen, der Kantenabbrüche und ausgeprägter Grundplatteneinbrüche charakterisiert. Die Nachuntersuchungen zeigten, daß subjektive Beschwerden — wenn auch geringgradiger Art — in hohem Prozentsatz vorkommen und sich auch eine traumatische Spondylose entwickeln kann. In Parallele zu bestimmten Bruchformen der langen Röhrenknochen ist ein Auswachsen des traumatischen Keilwirbels möglich. Andererseits kann aber auch eine Verschlechterung der Wirbelsäuleform auftreten, woraus sich die Notwendigkeit einer adäquaten Behandlung ergibt, die in Aufrichtung des Bruches, Ruhigstellung und nachfolgender, konsequenter Durchführung des Haltungsturnens besteht.Mit 13 Textabbildungen     

Qualit?t der R?ntgenbefundung im traumatologischen Bereitschaftsdienst

Background

The aim of the study was to ascertain the state of the art in x-ray assessment in an emergency surgical department.

Methods

From August 2008 to February 2009 a total of 1,588 plain x-rays of 658 patients from the emergency department were included in this study. The images were assessed by 3 experienced orthopedic surgeons and 1 experienced radiologist. The incidence of missed traumatic lesions and suspected lesions and the treatment of these patients were noted.

Results

A total of 136 pathological cases with 238 pathological x-ray findings were found. The mean rate of missed lesions was 13% of the assessed cases. Despite the fact that the rate of missed lesions varied from 9?C25% depending on the level of experience, all patients were treated adequately. The quality of x-ray assessment improved with the level of training of the individual doctors.

Conclusion

The present situation is in need of improvement but it is not critical. Junior medical staff should undergo a special training in x-ray assessment.     

Pathologische Wirbelk?rperfraktur nach kardiopulmonaler Reanimation

This article describes the case of a 78-year-old multimorbid female suffering from osteoporosis and severe dorsal kyphosis who sustained a fracture of the T10 vertebra during 6?min of cardiopulmonary resuscitation (CPR) without electrotherapy. This rare complication should be considered in elderly patients especially with concomitant osteoporosis. Current European Resuscitation Council (ERC) resuscitation guidelines recommend only a chest radiograph and do not reflect the need for further post-resuscitation diagnostics to recognize vertebral fractures as well as other severe, non-thoracic complications. Post-resuscitation abdominal ultrasound, echocardiography and thoracic spine radiography should be considered in such cases.     

Wie kontrolliert man die Kodierqualität im DRG-System?

The permanent adjustments ??since 2003 to the G-DRG system have made the system even less understandable, so that many users have the feeling of feeding data into a black box which gives them a result without them being able to actively use the system itself. While chief physicians, senior physicians, and nursing managers are responsible to management for the results of the billing, they are in most cases not involved in the steps of DRG coding and billing. From this situation, a common question arises: “How well does my department code?” This uncertainty is exploited by many commercial vendors, who offer a wide variety of approaches for DRG optimization. The goal of this work is to provide advice as to how coding quality can be determined.     

Radiologische Diagnostik entzündlicher Wirbelk?rpererkrankungen

Back pain is nonspecific and allows a broad range of differential diagnoses. In the early phase of infectious or neoplastic processes conventional diagnostic radiology rarely shows groundbreaking findings. Magnetic resonance imaging (MRI) is the method of choice to detect early changes in the vertebral bodies, intervertebral discs and surrounding tissues. Fluid-sensitive, fat-suppressed sequences (STIR) and contrast media are used to distinguish infections from other diseases. Due to the typical signal intensity in T1 and T2 sequences, infections of degenerative, rheumatic, and neoplastic processes can be defined and allow the initiation of appropriate therapy.     

Sexualität im Alter

The demographic development in the western industrial societies makes the quality of life of older people a very important issue. Leading a satisfying sexual life is part of this. The picture of older people as asexual humans can no longer be maintained.Recent studies show that the fundamental psychosociological need for acceptance, tenderness, warmness and security does not disappear with age. Sexual activity in the age primarily depends on the existence of a partnership. Sexual dysfunctions in aging result from physical, psychological, and partner-related changes, as well as lifestyles. This has to be considered in diagnosis and treatment. Principally, there is no difference between the treatment of older and younger sexual partners     

Kausalität im Sozialrecht

The term “causality” describes the philosophical construct that every change has a cause that generates an effect. However, an apparently simple causal chain that is assumed because of repetitive experiences concerning an alleged interrelationship can be liable to misperception, frequently combined with a neglect of judicial rules of evidence. Different legal norms can influence the assessment process to such an extent that the outcome of causality appraisal may differ depending on the legal field involved, e.g., private accident insurance or social law. As far as social law and, specifically, the German statutory accident insurance is concerned, differences also exist between the assessment processes concerning the causality of health disorders after work-related accidents on the one hand and after occupational exposures on the other hand. These differences are compared, and peculiarities that the medical expert must be aware of in order to avoid incorrect assessments are discussed.     

Radioaktivität im Rettungsdienst

Die Anaesthesiologie - Strahlenunfälle in kerntechnischen oder medizinischen/industriellen Anlagen sind aufgrund der gesetzlichen Vorschriften selten. Häufiger kommen Unfälle mit...     

Strukturqualität im Notarztdienst

BACKGROUND: A survey amongst emergency physician bases in the federal state of Baden-Wuerttemberg in 2001 concerning equipment available for airway management and the treatment of acute coronary syndromes showed striking differences with respect to implementation of European norms and international recommendations. The survey was repeated in 2005 to evaluate the development of the equipment in physician-staffed ambulance systems. METHODS: A questionnaire was sent to all emergency physician bases (ground ambulance and helicopter) registered with the Ministry of Health in Baden-Wuerttemberg. Questions encompassed availability of options to verify correct tracheal tube position (e.g. capnometry), supraglottic airway devices as alternatives to mask ventilation and tracheal intubation, 12-lead ECG and fibrinolytic agents. RESULTS: In 2001, 116 out of 127 bases (91.3%) participated and in 2005, 107 out of 120 bases (89.2%) returned the questionnaire. With availability in 97.2% of bases, prevalence of supraglottic airway devices is almost state-wide (2001: 54.3%, p<0.001, Fisher's exact test). The topics verification of tracheal tube position (2005: 73.8%, 2001: 26.7%, p<0.001), 12-lead ECG (2005: 89.7%, 2001: 52.6%, p<0.001) and fibrinolytic therapy (2005: 59.8%, 2001: 12.9%, p<0.001) showed noticeable increases in the corresponding availability, however, distinct regional structural deficits were still present in 2005. CONCLUSIONS: A favourable trend could be found concerning the equipment of physician-staffed ambulances state-wide. Further efforts must be undertaken to ensure the complete implementation of legal requirements and international recommendations concerning provision of medical equipment.     

Posttraumatische Schulterinstabilität im Wachstumsalter

BACKGROUND: Post-traumatic shoulder instability in adolescence represents a very rare condition. However, most of these patients develop recurrent shoulder dislocations over time. METHODS: We report about a retrospective study, which included 32 patients younger than 16 years of age. The mean follow-up was 5 years. Our evaluation focussed on patients' age at the time of first shoulder dislocation, type of injury, and the results after conservative and operative treatment. RESULTS: After the first dislocation, all shoulders were immobilized for 3 weeks and were treated with physiotherapy afterwards. Of these 32 patients, 30 (94%) developed recurrent shoulder dislocations. Eight patients remained in a conservative regimen (age <15 years) and 21 patients were operated for persistent shoulder instability (age >15 years). The recurrence rate was 8 of 21 patients (36.5%) in the operative group and 4 of 8 patients in the conservative group. At the time of follow-up, 4 of 8 conservatively treated patients had returned to their former sports activities and 15 of 21 (71%) in the operated group. CONCLUSIONS: Our results on post-traumatic shoulder instability in adolescence show high recurrence rates in both conservative and operative groups. After adolescence, including ossification of the glenoid, operative treatment is able to decrease the recurrence rate and to increase the sports ability of these young patients.     

Die Verität im Schultergelenk

Ohne Zusammenfassung (Mit 7 Abbildungen.)     

Wirbelkörperfrakturen und Osteopenie: Augmentieren oder langstreckig?

Trauma und Berufskrankheit - Frakturen im Bereich der Wirbelsäule zählen zu den häufigsten klinischen Manifestationen der Osteoporose. Beim Vorliegen instabiler oder sekundär...