The department system in surgery (author's transl)

The organisational model practised at the Department of Surgery at Hannover Medical School during the last 8 years has proven practicable, efficient and largely satisfactory to all of the staff. It is derived from Anglo-Saxon prototypes, differing from these, however, in a considerable participation of the residents in questions essential to their progress. The modalities of cooperation within the Department are presented in detail and ways and modalities for avoiding intra- and extradepartmental friction are discussed.     

Replantation surgery of the penis. A case report]

By the case of a subtotal traumatical amputation of the penis seen in our services, we discuss the advantages of a replantation by microsurgical technique. After presentation of the operational procedure and the management of the postoperative course the results of a thorough examination by questioning, physical examination, neurological examination including EMG testing of the bulbo-cavernous-reflex, Rigiscan NTM and angiography of the penal arteries are discussed. A review of the literature shows the advantages of the microsurgical technique but also the astonishing results by the former, conventional technique which still presents a possibility if microsurgery is not available.     

Intubating laryngeal mask airway (ILMA) in otorhinolaryngology surgery. A case of failure]

Intubating laryngeal mask airway (ILMA) is a very useful device for difficult airway management. The use of this device has not yet been studied in otorhinolaryngology surgery. The case of a 52-year-old man, weighing 104 kg, anesthetized for microlaryngoscopy due to aphonia occurred 6 months before, is reported. Traditional intubation was impossible. ILMA was easily positioned and the patient was ventilated. Intubation using ILMA was difficult and the operation postponed. Later, a bilateral false vocal chords hypertrophy was found. Impossible intubation using ILMA is a rare occurrence, less than 10% of cases. From previous evidence failed intubations are caused by anatomical anomalous formations, often predictables by clinical history. Blind intubation with ILMA is not, probably, the first alternative in these cases. Fiberoptic equipment intubation or use of ILMA with fiberoptic bronchoscope must be considered in these situations for possible better RESULTS. The use of ILMA in otorhinolarynogology surgery must be investigated with a specific study because there are only few experiences on this subject.     

Antibiotic prophylaxis in surgery. Results of a 4-year personal case series]

A prospective study of surgical infections in our Department of Surgery in the years 1986-1989 is reported. 2719 patients entered the study: they represent the total number of patients operated in the above said period (628 urgent and 2091 elective operations). As suggested in 1964 by Altmeier, surgical procedures were classified in four groups according to the potential risk of intraoperative contamination. For every septic complication observed pertinent cultures were performed and responsible pathogens identified. We present our protocol of antibacterial prophylaxis which distinguishes antibiotics given as "ultra short term", "short term", "antibiotic prophylaxis". The results obtained and particularly the total number of infections (3.9%), and the percentage of infections in group 3 (4.6%) and in group 4 (23.1%) procedures validate the usefulness of antibiotic prophylaxis in these patients. In group 1 and group 2 patients the usefulness of antibiotic prophylaxis seems very doubtful.     

普外科护理质量评价指标的研究

目的探讨普外科护理质量评价指标及各级指标的权重,为综合评价护理质量提供参考。方法以环节质量指标、终末质量指标、整体护理质量指标构成普外科护理质量评价指标,共3个一级指标、16个二级指标,运用Saaty's法确定各级指标的权重系数及最终指标权重。结果两轮专家咨询积极系数分别是91. 4%和100%,权威系数分别为0. 90和0. 89,变异系数0. 08～0. 26,协调系数为0. 34;普外科护理质量评价指标体系中,环节质量指标权重为0. 6878,终末质量指标权重为0. 2075,整体护理质量指标权重为0. 1047,权重分配结果可以接受。结论普外科护理质量评价指标为护理质量的评估提供了有效的工具,其中环节质量的权重较大,实际中应加强环节质量的护理工作。     

Remarks on the introduction of the German Diagnosis-Related Groups (DRGs) for the specialty of urology

In January 2003 a new system to charge inpatient treatment was established in Germany: the G-DRGs. This system is based on the thought that equal medical service causes equal costs all over Germany. Hospitals offering a broad spectrum of diagnostics and therapies and being unable to select their patients according to economical aspects are put at disadvantage: Despite a perfect documentation the G-DRGs reflect their medical service only in an insufficient way. Tools for an optimized coding must be a coding manual created for the specific needs of urologists and an infrastructure that allows a permanent quality control for all persons involved.     

Our experience of parenteral nutrition (PN) in general surgery]

The problems caused by malnutrition in postoperative complications are well know as is the importance of parenteral nutrition (NP). Thanks to the improvement in instruments and methods, NP can be used not only in intensive therapy departments, but also in less well equipped ones. The Authors report their experience of the use of NP in 77 patients from January 1978 to December 1989 treated in the Surgical Department of the Civil Hospital of Susa (TO), USSL 36, Regione Piemonte.     

Diagnosis and treatment of intestinal obstruction in children in the inter-district pediatric surgery department]

Within 25 years, 302 children with different forms of acquired ileus were treated at the inter-district surgical department. Intestinal invagination was revealed in 221 patient. In the complex of diagnostic and therapeutic measures, intravenous administration of "chromosmon", through insufflation of the intestine were employed. Intestinal intubation was performed by means of a magnet-dependent tube of original construction. Lethality was 0.3%.     

Telemedicine to follow patients in a general surgery department. A randomized controlled trial

BackgroundTelemedicine is becoming more popular in many medical specialties but few studies have been conducted in General Surgery. This study aims to evaluate the feasibility of its introduction in this specialty.MethodsA prospective randomized clinical trial (RCT) was conducted in 200 patients to compare conventional vs telemedicine follow-up in the outpatient clinics. The primary outcome was the feasibility of telemedicine follow-up and the secondary outcomes were its clinical impact and patient satisfaction.ResultsPatients were enrolled between March 2017 and April 2018 and there were no statistically significant differences between the groups’ characteristics. The primary outcome was achieved in 90% of the conventional follow-up group and in 74% of the telemedicine group (P = 0.003). No differences were found in clinical outcomes (P = 0.832) or patient satisfaction (P = 0.099).ConclusionTelemedicine is a good complementary service to facilitate follow-up management in selected patients from a General Surgery department.     

Intensification of surgical activities in the department of general surgery

The authors intensified and improved considerably the qualitative indices of surgical activity in a department of general surgery by means of simple and practicable organizational measures and by changing the tactics of surgical management of some diseases. This allowed the conclusion that the number of beds in the department must be reduced by 15 without reduction of the staff, which will not affect the activity of the department unfavourably. The organization of a resuscitation department without additional expenses is planned at the cost of the measures mentioned above.     

Pediatric surgery. A comparison of spinal anesthesia and general anesthesia]

Forty patients aged 2 to 5 years who were admitted for paediatric operations were randomly assigned to have either spinal or general anaesthesia. Spinal anaesthesia was achieved with isobaric bupivacaine 0.5% at a dose of 0.5 mg/kg. General anaesthesia was induced with thiopentone 2-5 mg/kg and continued with low-dose fentanyl (1-2 micrograms/kg, oxygen/nitrous oxide/isoflurane (30/70/0.1-0.5%), vecuronium normoventilating the patients. The time spent in the operation room was shorter in the spinal anaesthesia group because the children were awake and could immediately be transferred. The haemodynamic pattern and respiratory function were stable during spinal anaesthesia. After general anaesthesia, respiratory function deteriorated as indicated by arterial desaturation (< 90%), which was detected in 11 of the 20 patients after general anaesthesia. Vomiting (2), sore throat (4) and micturition difficulties (2) were the adverse events associated with general anaesthesia. Three patients were restless after spinal anaesthesia. It can be concluded that spinal anaesthesia is a suitable anaesthetic technique for paediatric surgery.     

A noncardiac pulmonary edema following aortocoronary bypass surgery. Diagnosis and therapy based on a case report]

Noncardiac pulmonary edema can occur not only after cardiac surgery with cardiopulmonary bypass but also after noncardiac operations. This so-called transfusion-related acute lung injury (TRALI) has been attributed to the transfusion of homologous blood and plasma. In the presence of normal left ventricular function an acute increase in pulmonary capillary permeability leads to massive protein-rich pulmonary edema, reduced pulmonary function, and intravascular hypovolemia. This may be caused by leukocyte antibodies. Signs and diagnostic and therapeutic procedures are discussed with reference to a case report.