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1.
Background
Surgical correction of severe and rigid cervical kyphosis with chin-on-chest deformity poses significant challenges to both the patient and surgeon once surgery is considered as the treatment of choice.Objectives
This article presents the current concepts of corrective surgery for patients with severe and rigid cervical kyphosis.Material and methods
Narrative review and report of clinical experience.Results
The treatment of severe cervical kyphosis indicates a dedicated deformity assessment, the analysis of regional and global imbalance, the identification of spinal sagittal plane compensation mechanisms, detailed radiographic and clinical planning of corrective surgery, and the meticulous performance of surgical correction. Most recent large-scale studies serve as evidence for the benefit of surgical correction and outline the complications that need to be targeted during and after surgery.Conclusion
Surgical correction of severe cervical kyphosis can be a pleasant and life-changing event for the disabled patient.2.
V. Beck M. Apfelbeck M. Chaloupka A. Kretschmer F. Strittmatter S. Tritschler 《Der Urologe. Ausg. A》2018,57(1):29-33
Background
The development of a stricture of the vesicourethral anastomosis is a serious complication after radical prostatectomy. Strictures occur in 5–8% of patients after radical prostatectomy.Symptoms
Usually the clinical symptoms include an irritative and obstructive component similar to benign prostatic hyperplasia. In rare cases, patients suffer from partial or complete stress incontinence as a result of the anastomotic stricture.Diagnostics
The diagnostic workup is similar to the procedure for urethral strictures. In addition to uroflowmetry, a cystourethrogram (CUG) or, if necessary, a micturating cystourethrogram (MCU) can be performed. A urethrocystoscopy can be performed to ensure the diagnosis.Therapy
In most cases, endoscopic procedures were performed for treatment. Beside a transurethral dilation of the stricture or the Sachse urethrotomy, the most common procedure is transurethral resection to treat the stricture. However, all procedures are associated with a high recurrence rate. In recurrent strictures, open surgical procedures, usually a perineal reanastomosis, should performed early.Conclusion
Endourological procedures like transurethral resection are a good treatment option, but due to the high recurrence rates, open surgical procedures should be discussed and if necessary should be performed early.3.
Background
Anterior cervical discectomy and fusion (ACDF) as well as posterior instrumentation of the cervical spine are frequently performed surgeries for cervical disc prolapse or spinal stenosis. Surgery itself harbors a very low risk of adverse events. Postoperative palsy of the C5 nerve root, however, is a severe complication and its origin is still not fully understood. The risk of such a C5 palsy is reported to be between 0 and 30%; 5% on average according to the literature.Objectives
To describe underlying pathomechanisms and to recommend strategies for risk reduction.Materials and methods
An extensive literature research via Medline was performed.Results
Potential risk factors are male gender, sagittal diameter below 5.6?mm, anterior approach, and higher age.Conclusions
Currently available data only originates from retrospective or anatomical studies. A prospective register study with the goal to put light on the pathogenesis is currently being performed.4.
Background
The tasks involved in reconstructing the urethra after failed hypospadias repair range from correction of a trivial meatal stenosis to reconstruction of the entire anterior urethra.Objectives
To describe pathological findings in the urethra after failed hypospadias repair and the respective surgical methods used for their correction.Materials and methods
The various pathological findings after unsuccessful hypospadias surgery are classified according to their location and complexity.Results
The general rules of reconstruction that should be applied in each particular situation are described.Conclusions
Successful reconstruction of the urethra in patients with failed hypospadias surgery requires experience and good knowledge of the anatomy of the normal and hypospadic urethra and penis. Mastery of plastic surgical techniques and profound knowledge of the various surgical methods of hypospadias surgery are essential.5.
Background
Spinal immobilization has been a standard procedure in out-of-hospital treatment of trauma patients for decades. There are increasing reports in the current literature about complications of spinal immobilization. Thus, the use of decision aids for the indication of spinal immobilization is recommended. The application of most existing immobilization protocols is limited to some extent. To our knowledge, an immobilization protocol, applicable for all adult trauma patients that permits variable decision-making depending on the current condition of the trauma patient and the pattern of injuries is currently not available.Objectives
The aim of the current study was to develop a protocol as a decision aid for preclinical spinal immobilization of adult trauma patients and to perform a preliminary test of applicability by German medical students via a questionnaire.Materials and methods
A structured literature search for publications concerning spinal immobilization was performed. Afterwards, the Emergency Medicine Spinal Immobilization Protocol (E.M.S. IMMO Protocol) for adult trauma patients, basing on the current literature and guidelines, was developed. A preliminary test of applicability was performed with 86 German medical students by means of a questionnaire.Results
A new protocol for preclinical spinal immobilization could be provided and visualized. Questions that analyze the correct application and understanding of the E.M.S. IMMO Protocol were predominantly answered correctly by German medical students. The main reasons for incorrect answers were evaluated in a direct feedback session and were not found to be directly related with the E.M.S. IMMO Protocol but with a lack of experience in emergency medicine.Conclusions
The E.M.S. IMMO Protocol provides a decision aid for the indication for out-of-hospital spinal immobilization in adult trauma patients that permits variable decision-making depending on the current condition of the trauma patient and the pattern of injuries for immobilization in general and for immobilization methods in particular.6.
Background
The pathogenesis of cervical spondylotic myelopathy (CSM) is often multifactorial. Hence, the treatment of this disease requires a differentiated surgical approach in order to adequately address the underlying pathology.Purpose
The aim of this review is to identify factors that influence the choice of treatment strategy and to summarize them in an algorithm that serves as a decision aid in choosing the optimal indication for surgical treatment. An attempt is made to define the threshold values for the indication of surgical treatment and to discuss the ideal timing for performing surgery.Materials and methods
On the basis of the published data, the influencing factors on the prognosis of CSM, as well as surgical approaches are discussed.Results
Circumferential spinal cord compression, a sharply defined myelopathy signal in the T2-weighted MRI sequence, and segmental instability at the level of the myelopathy signal mean an unfavorable prognosis for the worsening of CSM. The most important factors that influence the choice of the surgical access point are the sagittal profile of the cervical spine, the extent of myelopathy, the extent of stenosis, and the location of the myelopathy-inducing pathology. Previously existing neck pain and prior cervical surgery must also be considered.Discussion
On the basis of the research carried out, we developed an algorithm that could serve as an aid in choosing the right treatment in the setting of cervical spondylotic myelopathy.7.
Background
Pump thromboses are a frequent complication after implantation of a left ventricular assist device (LVAD) with an incidence of 10%.Objective
Evaluation of the risk factors and the necessary diagnostic tools, such as imaging investigations, determination of laboratory parameters and device settings. Recommendations for therapy and differentiation between pharmaceutical and surgical therapy.Material and methods
A literature search of PubMed and inclusion of own hospital recommendations for actions.Results
The diagnostics of a pump thrombosis are carried out by extraction of the data stored by the LVAD and are necessary to evaluate an increased pump performance. An increased lactate dehydrogenase 2.5 fold higher than normal values is highly suspicious of a pump thrombosis. For imaging investigations echocardiography provides indirect parameters, such as increased left ventricular end-diastolic diameter (LVEDD) and progressive mitral valve regurgitation, a frequent opening of the aortic valve and the flow velocity in the outflow cannula. A computed tomography (CT) scan can be used to detect a thrombus formation in the outflow cannula. Therapy can be carried out pharmaceutically using thrombolytic agents, such as recombinant tissue type plasminogen activator (rt-PA) or by a surgical replacement of the pump.Conclusion
The identification of a pump thrombosis is determined by the inclusion of various parameters. The therapy should be carried out individually and be device-specific.8.
Background
Mass casualties (MASCAL) are always a particular challenge for medical care and emergency services at the scene, as well as for the medical facilities, which care for the patients afterwards. Incidents due to a terrorist attack (TerrorMASCAL) are a particular challenge due to significant peculiarities and a very different situation.Objective
Within the scope of this work, the special aspects of a TerrorMASCAL are presented and explained with regard to the inner-clinic characteristics, in particular necessary surgical treatment.Material and methods
On the basis of the specifically acquired knowledge from the development of the Terror and Disaster Surgical Care® (TDSC®) course as well as a corresponding literature review, specific conceptual recommendations were developed and derived.Results
In the context of the in-hospital treatment of patients associated with a TerrorMASCAL scenario, numerous special features must be considered. This is related in particular to the number of patients and the influx of patients into the hospital, the special injury patterns, the infrastructural peculiarities and personnel resources. A very special focus also is on the applicable surgical care concepts with regard to the Early Total Care, Damage Control or Tactical Abbreviated Surgical Care.Discussion
TerrorMASCAL scenarios are different from the normal MASCAL situation in many ways and a variety of aspects need to be taken into consideration. In particular, an adapted preparation and training of the internal structures of the hospital is an essential component in the provision of public services.9.
Objective
Amputations and exarticulations of the toes may be necessary due to several reasons. The goal is to remove necrosis or infection prior to its spread to the midfoot region. From a functional or cosmetic point of view, amputation/exarticulation of a single toe plays no major role. However, this can be different with exarticulation of several toes.Indications
Necrosis, trauma, infection, tumor, deformity.Contraindications
Conditions where amputation/exarticulation of a toe is insufficient, e.?g., in progressing peripheral arterial disease.Surgical technique
The toe can either be amputated through the distal phalanx or exarticulated in the metatarsophalangeal joint.Postoperative management
Orthopedic shoes or orthotic devices are rarely necessary when a single toe is amputated/exarticulated. However, concomitant deformities of the foot have to be thoroughly addressed. If more than one toe is amputated, silicone spacers may be necessary to prevent the remaining toes from deviating.Results
Amputations and exarticulations of the toes are frequent and the procedure is technically simple. However, the complication rate is high due to typical indications making amputation necessary.10.
Katrin Müller 《Journal ?sthetische Chirurgie》2018,11(4):208-211
Background
New patients come more and more often over the internet; therefore internet marketing plays an increasingly important role.Question
How can physicians build an effective internet marketing strategy and avoid complications?Method
Selection and authorization of a reputable agency.Results
New customer acquisition through high visibility in the internet, at the same time increasing the image and awareness.Conclusions
In the overall “marketing mix” internet marketing has become indispensable to physicians who want to be successful. Those who are well positioned in Google are well known by their target audience and thus receive a higher response.11.
12.
Background
In order that the thumb as the most important part of a functioning hand can assume its functions, it must be stable, sufficiently long, sensitively innervated and sufficiently able to move.Objective
Alternatives to a thumb reconstruction, demonstration of a thumb lengthening procedure using a semi-circular distraction fixator and development of therapy recommendations are presented.Material and methods
A search of the current literature on the callus distractor was carried out. The prototype of a semicircular distraction fixator is presented.Results
An average extension of 3?cm can be realised using callus distraction. The advantages predominate, so that this method should be included in every individual treatment plan, especially when other possibilities are not considered acceptable options.Conclusion
The choice of the appropriate thumb reconstruction procedure after a traumatic amputation depends on the amputation level, age, occupation and the functional necessity of the patient. Callus distraction is a technically simpler procedure in comparison to microsurgical alternatives for reconstruction of an amputated thumb. The most significant drawbacks lie in the missing fingernail area, the interphalangeal joint and the long treatment period. The five essential goals of thumb reconstruction (length, stability, movement, painless function and sensitivity) can all be addressed with this procedure.13.
Background
Endoscopic vacuum therapy is a widespread method in the postoperative treatment of lower and upper gastrointestinal (GI) tract leakage.Objective
There is an absence of further technical development of the standardized material from 2007 for the lower GI tract.Material and methods
New strategies and new materials for endoscopic vacuum therapy are presented.Results
Alternative strategies in sponge placement, use of open-pore film drainage, use of a multiple sponge system, rinsing catheter, electronic pumps etc. enable the successful treatment of very complex pelvic defects.Conclusion
The wide variability of pelvic defects often necessitates a change in therapeutic strategies during the course of treatment for an optimized outcome.14.
Background
Benign, premalignant and malignant changes in the anogenital region, as in the oropharynx are often affected by a persistent HPV infection. Since a causal therapy isn’t possible, the focus is on early diagnosis of dysplasia. Better knowledge of the human papilloma virus led to the development of the HPV vaccine and now primary prevention of cancer is possible. These findings will also influence the German cervical cancer screening.Objectives
This article illustrates prevalence, significance, diagnostics, treatment and prevention of HPV infection and HPV-associated diseases in women.Material and methods
A literature research under pubmed.de has been carried out. In addition up-to-date guidelines and internet-based sources were considered.Results
Persistent infection can lead to dysplasia and carcinoma of the cervix, vagina and vulva, the anus and the oropharynx. In future an additional HPV testing is planned to be integrated in the German screening for cervical cancer for women above 35 years. Management of dysplasia is operative or topical. Accordingly, a primary prevention through vaccination is even more important. The German Standing Vaccination Committee recommends the vaccination for girls and boys between 9 to 14 years.Conclusion
HPV vaccination is a secure and efficient procedure to prevent cancer. In the following years it is of great importance to improve acceptance and vaccination rates.15.
Background
Despite the low incidence of individual heritable connective tissue disorders with vascular involvement, the prevalence of these diseases within the group of patients with aortic aneurysms is high. Current data suggest that at least 20?% of patients presenting with thoracic aortic disease have a genetic component. In patients under 40 years of age presenting with acute aortic dissection, the prevalence of Marfan syndrome is as high as 50?%. If there is a positive family history for thoracic aortic disease, roughly 75?% of patients carry a pathogenetic mutation.Objectives
How important are the preoperative diagnosis, operative strategy and experience of the attending physician in heritable connective tissue disorders with vascular involvement on the surgical long-term outcome?Materials and methods
The current guidelines and study results are summarized.Results
Vascular surgeons should be aware of these diseases and be familiar with the treatment strategies. Heritable connective tissue disorders with vascular involvement are a very heterogeneous group of diseases comprising those with a syndromic phenotype, such as Marfan, Loeys-Dietz and vascular Ehlers-Danlos syndromes as well as those with a relatively unspecific phenotype, such as ACTA2 mutations. The number of patients who cannot be assigned to any of the known defined syndromes is high and every year new mutations are identified. A precise preoperative diagnosis is important for the surgical long-term result as the operative strategy essentially depends on the underlying disease.Conclusions
In patients with connective tissue disorders, the progression of disease in the adjacent aortic segments has to be anticipated. From a technical point of view, the aim by replacement of individual segments is to leave as little residual aortic tissue as possible that can dilate over time; therefore, we recommend separate re-implantation of the aortic branches whenever possible and additional reinforcement of all anastomoses.16.
M. De Santis 《Der Urologe. Ausg. A》2018,57(11):1342-1345
Background
Prostate cancer (PCA) seems to be more of an immunologic desert than other tumor entities. It is striking that only rarely does prostate cancer show abundant immune cells and a proimmunogenic microenvironment.Objectives
Is immunotherapy in PCA effective and which patients can benefit.Materials and methods
A review of the literature and recent congress data are presented.Results
Preliminary results with sipuleucel-T for PCA cancer were very promising showing a significant overall survival benefit in randomised phase III studies and the US Federal Drug Administration (FDA) approval for this individualised vaccine. Contrary to other tumor entities this was not the immediate breakthrough to a new therapeutic era of immunotherapy but remained an isolated case and restricted to the USA. More recently, several trials evaluated immunotherapeutic agents but missed their preliminary endpoints. Interestingly, individual patients did benefit and showed long-term remission.Conclusions
Genome sequencing and new biomarkers are also paving a novel pathway towards individualised immunotherapy for PCA. On-going research and clinical trials are exploring the question of which patients will benefit.17.
C. Putz M. Alimusaj D. W. W. Heitzmann M. Götze S. I. Wolf J. Block 《Trauma und Berufskrankheit》2018,20(2):145-150
Background
The establishment of a database to document healthcare of lower limb amputees constitutes a medical necessity. Although various medical specialties perform amputations, the standardization of treatment strategies from amputation to fitting a prosthesis has to be optimized.Material and methods
From August 2013 to August 2017 clinical data of lower limb amputees were prospectively recorded in our database. A medical and prosthetic documentation and a patient-based questionnaire were used to evaluate data with respect to the amputation, stump conditions, range of motion and strength and the status of the prosthesis.Results
Analysis of 257 lower limb amputees showed that 232 (90%) patients had a major and 25 (10%) a minor amputation, mostly due to an accident, infection, sepsis and circulatory disorders. Overall 182 (71%) patients had a prosthesis, 42 (16%) had no prosthesis and in 33 (13%) patients no information was provided. Although 23% of the 182 patients had a prosthesis fitted, they were not able to use the prosthesis due to stump problems or inadequate fitting.Conclusion
The implementation of the amputation register and of a preoperative interdisciplinary board contribute to optimized treatment strategies and a faster reintegration into employment and normal activities of daily life. A multicentric distibution with interclinical possibilities of comparison can help to define interdisciplinary standards and quality characteristics.18.
Erol Oksuz Fatih Ersay Deniz Ozgur Gunal Ozgur Demir Sener Barut Fatma Markoc Unal Erkorkmaz 《European spine journal》2016,25(4):1006-1011
Background
Several methods have been used to reduce the infection rate in spinal surgeries with instrumentation.Purpose
Which method is the most effective for preventing postoperative infection?Study design
Basic science, animal model.Objective
In the present study, the efficiency of antibiotic prophylaxis, silver-plated screws, and local rifamycin application to the surgical site was investigated in an experimental animal model. Staphylococcus aureus was used as the pathogen.Methods
Fifty 6-month-old female Wistar albino rats were used. The animals were randomly numbered and divided into five groups of ten rats each (Group 1, control group; Group 2, titanium screw and S. aureus inoculation; Group 3, titanium screw, 0.1 ml rifamycin application to the surgical area, and bacterial inoculation; Group 4, titanium screw, single preoperative dose of IM cefazolin, and bacterial inoculation; Group 5, silver-plated screw and bacterial inoculation). Titanium micro-screws were placed into the pedicles. The control group received a sterile isotonic solution, and the other four groups received bacterial suspensions containing S. aureus. The animals were killed 15 days later.Results
Intensive S. aureus growth was observed in all tissue and screw samples from Group 2. The results for Group 3 were similar to those for Group 1, no growth was observed in the screw cultures. Intensive growth was observed in the five screw samples in Group 4 and in the eight samples in Group 5.Conclusion
Our study suggests that rifamycin application to the surgical area in spinal operations with instrumentation is an effective method to prevent S. aureus infections.19.
Background
Sudden cardiac death is frequent, and prognosis of survival—even with an optimal rescue chain—is poor. Implantation of a miniaturized heart–lung machine during cardiopulmonary resuscitation (CPR) is referred to as extracorporeal CPR (eCPR). The current 2015 Advanced Life Support (ALS) guidelines advocate consideration of eCPR in selected patients.Objectives
Discussion of eCPR basics and requirements for material, staff, and local structures.Materials and methods
Review of current guidelines and published data.Results
eCPR, which can be performed within a controlled environment after in-hospital and out-of-hospital cardiac arrest, is associated with high technical and personnel expenses. The implantation of a heart–lung machine during CPR takes about 30 min. A study with early eCPR after sudden cardiac death reported a 54?% patient survival. Studies with greater delay between collapse and eCPR show less favorable results.Conclusion
An improved survival in selected patients using eCPR seems plausible, however has not been scientifically proven. A benefit in survival might be only achievable with early eCPR.20.
C. K. Spies B. Hohendorff L. P. Müller W. F. Neiss P. Hahn F. Unglaub 《Operative Orthopadie und Traumatologie》2016,28(3):204-217