Einsatz eines modularen Knierevisionssystems MML im Rahmen des Knieprothesenwechsels und der Tumorendoprothetik

Increasing age and a higher level of mobility lead to an increasing incidence in revision arthroplasty after total knee replacement and tumor surgery. So far, the reconstruction of large defects in bony and soft tissue environments can be accomplished by the modern modular components of revision implants. The consecutive reconstruction of the extensor mechanism in extended revision has its own drawbacks and is often associated with significant functional limitations for the patient. Specially designed implants and methods are required to generate good functional results. The modular knee revision system MML provides specific modifications of the tibial component for reconstruction of the extensor mechanism. Combined with artificial strips, an excellent functional outcome could be achieved. In this study, 70 patients were operated with the MML endoprosthesis in knee revision or tumor surgery. An excellent functional outcome could be determined. At 7 years after surgery, an average of 32+/-13 points was achieved on the Oxford Knee Score. The outcome measurement using the functional scoring system of the American Knee Society (AKS score) showed similarly good results with 71+/-25 points out of 100. A minor deficit of only 2 degrees in active extension could be observed after reconstruction of the extensor mechanism. In conclusion, we have demonstrated that the MML modular revision system is appropriate for reconstruction of segmental bone defects.     

Beurteilung und Behandlung von Verletzungen des Brustkorbes und der Brustorgane im Rahmen der Mehrfachverletzungen

Summary A sixteen year-series of 395 patients with thoracic trauma admitted to the University-Hospitals of Marburg/Lahn (1951–1959), Cologne-Merheim (1959–1963), and Cologne-Lindenthal (1963–1967) have been critically evaluated. Particular attention is given to the treatment of non-penetrating chest injuries. The method of over-all evaluation and management of injuries to the thoracic musculo-skeletal system, respiratory organs, and of the mediastinal structures are pointed out and discussed placing particular emphasis on predominant symptoms and their indications.

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Unter Mitarbeit vonH. v. Brehm, K. Hoffmann undW. Vogel.     

Vorbereitende und Ersatzoperationen im Rahmen der chirurgischen Versorgung des peripheren Nervenschadens

Ohne Zusammenfassung     

Osteopathie im Rahmen der Unfall- und Wiederherstellungstherapie

A combination of osteopathic treatment and standard medical treatment leads to more effective rehabilitation. To scientifically and quantitatively assess the effectiveness of treatment, patients in two independent studies were divided into groups to receive either osteopathic or standard treatment or to receive a combination of both. Both studies demonstrated the significant efficacy of osteopathy within the scope of rehabilitation. The patients receiving osteopathic therapy experienced immediate improvement of their restrictions, and consequently of their pain. Treating the entire body as a coherent system, which osteopathy aims to do, appears to lead to the most successful healing. Osteopathy is a therapy that obtains extensive effects. An osteopath is capable of influencing the rehabilitation of both knee and neck injuries (whiplash) in a way that regular medical treatment cannot.     

Behandlungsfehler und Vertrauensgrundsatz im Rahmen der Arbeitsteilung

Treatment of the patient in preclinical emergency medicine is inconceivable without division of labor among several people. The resultant increase in risk for the patient must be counterbalanced by special measures. The various levels of horizontal and vertical division of labor are subject to different legal assessment. Particular sources for error encountered in the division of labor involve communication and coordination, mistakes in distribution of responsibilities, or conferment of a physician's duties. This gives rise to legal requirements for avoiding these errors. Finally, based on the principle of confidence, consideration should be given to assessing just how much each person can depend on the diligent cooperation of the others involved.     

Die Bedeutung des EEG-Befundes im Rahmen der Intensivbehandlung

Ohne Zusammenfassung (a. G.) Der ausführliche Tagungsbericht ist beim Springer-Verlag, Berlin, Heidelberg, New York, in der Schriftenreihe „Anaesthesiologie und Wiederbelebung” als Band XVII, 1966, erschienen.     

Perioperatives Management im Rahmen der CRS und HIPEC

Die Anaesthesiologie - Die zytoreduktive Chirurgie (CRS) und die hypertherme intraperitoneale Chemotherapie (HIPEC) sind Therapieverfahren zur Behandlung abdomineller Neoplasmen. Hierbei werden...     

17. Die Leber- und Pankreasruptur im Rahmen der Mehrfachverletzungen

Ohne Zusammenfassung     

Rekonstruktion und Stabilisierung im Gesichtsbereich

Traumatic injury of the facial skeleton incorportes defects of the facial soft tissue and of the osseous structures, in some cases extensive. The necessary reconstructive measures can prove complex and difficult. Modern methods of osteosynthesis in combination with microsurgical techniques are often the basis for successful and expedient rehabilitation of the trauma patients. Reconstruction of the dentoalveolar complex with precise adjustment of the occlusion is important for mastication and phonation. Vascular and avascular transplants are available for reconstruction when there are defects. Microvascular fibular, iliac crest or scapular flaps allow simultaneous reconstruction of soft and of osseous tissue. It will be increasingly possible to continue improving effective mastication later with the ongoing developments in the field of dental implantology.     

Biomechanischer Vergleich aktueller Refixationsarten im Rahmen der Rekonstruktion von Rotatorenmanschettenläsionen in einem in-vivo-Tiermodell

A significant controversy exists regarding the optimal fixation technique in rotator cuff surgery. The aim of this study was to compare the time-dependent bio-mechanical properties of the traditional open transosseous suture technique and modified Mason-Allen stitches (SMMA group) versus the double-loaded suture anchor technique and so-called arthroscopic Mason-Allen stitches (AAMA group) in rotator cuff repair. A total of 18 mature sheep were randomized to the two repair groups. After 6, 12, or 26 weeks, evaluation of the reinsertion site of the infraspinatus tendon was performed. In a biomechanical evaluation all specimens were loaded to failure at a constant displacement rate using a standard universal testing machine. The load-to-failure and stiffness of the healed bone-tendon interface were calculated. Magnetic resonance imaging analysis showed cuff integrity in all cases and no evidence of foreign body reaction to the anchors. Load-to-failure and stiffness data did not indicate any significant difference between the two treatment groups, neither at 6 weeks nor at 12 or 26 weeks. However, at time zero the AAMA group had a higher load-to-failure in comparison to the SMMA group (P<0.010), but there was no difference for the stiffness (P<0.121). This in vivo study showed that the AAMA technique provides superior stability and after healing would gain strength comparable to the SMMA technique.     

Herzdruckmassage im Rahmen der Laienreanimation

Background

The quality of chest compressions and early defibrillation are paramount in cardiopulmonary resuscitation (CPR). Whether real-time feedback devices may improve CPR efforts in lay person CPR is unclear.

Material and methods

Prospective randomized studies were carried out to test the influence of the electronic real-time feedback device PocketCPR? on the quality of chest compression by lay person CPR training in a mock-up cardiac arrest scenario. Altogether 42 inexperienced lay persons were randomized into 2 groups (groups A and B). The quality of chest compressions was analyzed with respect to depth and frequency in a cross-over design.

Results

PocketCPR? improved mean chest compression depth significantly (p=0.029) solely in one of both groups (44±7 versus 41±10 mm). However, both groups achieved recommended compression depths between 38–51 mm independent of device application. Also mean chest compression frequency was improved significantly (p=0.001) in one group only (100±21 versus 115±21 per min). There was no demonstrable significant potential learning effect through the application of the feedback device.

Conclusion

Real-time feedback devices do not ensure a consistent improvement of chest compression quality during mock-up lay person CPR training. Additional studies are needed to investigate potential effects for trained health care professionals.     

Komplikation im Rahmen der Kyphoplastie

A 59-year-old woman had a nontraumatic osteoporotic fracture of the seventh thoracic vertebral body. Despite correct operative technique, in the course of kyphoplasty cement was dislocated through the segment vein into the azygos vein and from there into the superior vena cava. The patient was free of cardiopulmonary symptoms throughout. Oral anticoagulation was administered for 3 months to prevent thromboembolism, and regular clinical and echocardiographic follow-up examinations were also performed during this period.     

Fistelbildungen im Rahmen der Alveolarechinokokkose

Zusammenfassung Bei 18 Patienten mit Echinococcus alveolaris fanden sich 2 spontane Fistelbildungen. Nach 21 Eingriffen im Bereich der Leber bei diesen Patienten traten 11 Fisteln, meist Gallefisteln, auf, die durchschnittlich 26 bis 27 Monate sezernierten. Beziehungen zu einem gleichzeitig bestehenden Verschlu?ikterus, m?gliche Prophylaxe und therapeutische Ma?nahmen werden diskutiert.      

Lymphadenektomie im Rahmen der radikalen Zystektomie

Pelvic lymph node dissection is an integral part of the radical cystectomy procedure for patients with muscle-invasive bladder cancer. The optimal extent of the lymphadenectomy (LND) and mainly the proximal template boundary remain controversial issues. In view of the existing mapping studies and retrospective analyses, extended LND up to the mid-upper third of the common iliac vessels appears to provide further prognostic and therapeutic benefit and therefore should be defined as standard LND. This applies for all procedures irrespective of the choice of surgical approach (open surgery, minimally invasive approach). In this context total lymph node count is not a quality criterion because nodal yield is overly influenced by the individual patient's anatomy, surgical technique, template applied and pathological work-up. Consecutively, considerable inter-institutional differences result, which render any comparison impossible. Lymph node density is thought to be a superior prognostic factor, but it is similarly influenced by the above-mentioned factors. Concerning molecular techniques to improve the sensitivity of postoperative nodal staging further research is necessary. The two ongoing prospective randomized trials will potentially help to further define the optimal LND template.     

Adrenalektomie im Rahmen der Tumornephrektomie?

Die Urologie - Das Nierenzellkarzinom ist das dritthäufigste Malignom auf urologischem Fachgebiet. Lokal begrenzte Tumoren ohne Metastasierung sind durch die radikale Tumornephrektomie meist...