Abbe-Plastik,Technik und Möglichkeiten

Ohne Zusammenfassung Mit 1 Textabbildung in 6 Einzeldarstellungen     

Möglichkeiten der Schlaganfallversorgungsforschung

Background

The implementation of thrombolysis to treat acute ischemic stroke patients in Baden-Württemberg was accompanied by a comprehensive stroke treatment concept with implementation of stroke units in every local district and a stroke registry has been running for many years. The possibilities for stroke healthcare service research using data from the registry are presented and exemplified with two typical analyses.

Method

This article presents a retrospective analysis of a consecutive register containing data from all stroke patients in the federal state of Baden-Württemberg admitted to hospital less than 7 days after stroke onset. Data from the time period 2008–2012 were analyzed.

Results

The exemplified analyses for the time-dependent effect of thrombolysis showed that early thrombolysis is also associated with a better outcome in the clinical routine. The analysis of thrombolysis rates showed substantial differences depending on the treatment level of the stroke unit, especially in patients over 80 years old and with preexisting disabilities.

Conclusion

The presented analyses show the possibilities for neurological health services research by analyzing routine quality assurance data. The stroke care concept of the federal state of Baden-Württemberg not only allows a good comprehensive patient care but due to the special features of regional responsibility, also offers outstanding possibilities for vascular health services research.

     

Chirurgische Möglichkeiten bei Hochdruckerkrankungen

Ohne ZusammenfassungMit 8 AbbildungenVortragender:G. Heberer-Köln.     

Klinische Möglichkeiten zur Steuerung der Körpertemperatur

The constancy of body temperature (CBT) is a cornerstone of homeostatic, homothermic organisms and is essential for a regulated course of biochemical and biophysical reactions. Severe deviations from normothermia (36.8+/-0.4 degrees C) are life threatening and even a moderate perioperative reduction of the CBT is coupled with an increased morbidity and mortality especially in high-risk patients. The relevant factors are coagulation disturbances, increased infection rate and increased cardiac risk. Normothermia should be achieved by the consistent use of warmth-conserving measures. On the other hand, a deliberate reduction in temperature or induced hypothermia is a neuroprotective procedure, which offers a therapeutic option to minimize neuronal secondary damage after primary hypoxic-ischemic events as well as extending the neuronal tolerance to ischemia. Management includes the practice of cooling down to a defined temperature, rewarming as well as a differentiated control of various parameters. Furthermore, side-effects which increase in severity with decreasing temperature must be taken into consideration.     

Mögliche Nervenverletzungen bei Sprunggelenkluxationsverletzungen

We present a patient with an exceptional fracture type--a Maisonneuve fracture associated with a lateral ankle fracture--and the therapy of this injury. The Maisonneuve fracture consists of a proximal fibular fracture which is associated with failure of the deltoid ligament or medial malleolus and diastasis of the distal tibiofibular syndesmosis. Diverse nerves of the lower leg can be affected by severe trauma as well as by fracture-associated complications or an operation. Fracture fragments, an excessive distension caused by the trauma, or a fracture-associated hematoma can cause injury to the deep peroneal nerve or the branches of the superficial peroneal nerve at the level of the ankle. We want to point out the possibility of nerve lesions of the lower leg associated with this complex fracture. Additionally the operative access to the ankle in this context is discussed.     

Anesthetic implications of Möbius syndrome

Möbius syndrome is a rare disorder characterized by unilateral or bilateral facial paralysis and defective extraocular eye movements secondary to congenital paresis of the facial (VII) and abducens (VI) cranial nerves. Associated dysfunction of other cranial nerves, orofacial abnormalities, and skeletal muscle hypotonia are common accompanying features. Given the multisystem involvement of Möbius syndrome, there are several potential perioperative concerns. Of primary importance to the anesthesia provider are the propensity for postoperative respiratory failure due to several pathological mechanisms, associated orofacial abnormalities that may make routine airway management difficult, the presence of gastroesophageal reflux and other factors that increase the risk of perioperative aspiration, and associated hypotonia of the skeletal musculature. The authors present a 10-month-old infant with Möbius syndrome who required anesthetic care during a Nissen fundoplication. The potential anesthetic implications of this syndrome are discussed.     

Grenzen und Möglichkeiten der Trachealplastik

Ohne ZusammenfassungMit 12 TextabbildungenMit freundlicher Unterstützung der Deutschen Forschungsgemeinschaft.     

Möglichkeiten der Weichteilrekonstruktion bei Pseudarthrosen

Die Unfallchirurgie - Pseudarthrosen können als Komplikation einer vorhergegangenen operativen oder konservativen Frakturbehandlung oder nach elektiven Knocheneingriffen entstehen. Ihre...     

Operative Möglichkeiten bei der generalisierten Epilepsie

Ohne Zusammenfassung Mit 3 Textabblidungen     

Möglichkeiten und Grenzen der modernen Polyethylene

Background

Polyethylene is still one of the most important materials in the field of hip and knee arthroplasty. The clinical results of the last decades have helped to further develop polyethylene into a high-tech material. Progress in the development of new materials must be compared with the tried and tested ones to provide optimal and most individual patient care.

Objectives

This article gives an overview of the history and current application profile of the material ultra-high molecular weight polyethylene (UHMWPE) in hip and knee arthroplasty.

Material and methods

With the aid of the current literature, new developments in the field of the material UHMWPE, also with respect to the biological activity of wear, the particular biomechanics of the knee joint as well as alternative hard-hard bearing surfaces in the hip, are represented in terms of implant safety.

Results

The problems concerning polyethylene are now well recognized. The disadvantages of the material UHMWPE could be consistently reduced based on material research so that modern polyethylenes have gradually been shown in clinical trials that they can be reliably used.

Conclusion

Despite this the potential for improvement has still not yet been fully exploited. Any further development must be extensively tested both biomechanically and biologically before the material can be used in vivo. Long-term results are still necessary before a material can be accepted as being clinically safe.     

Möglichkeiten der Strahlentherapie beim Sudeckschen Syndrom

Ohne Zusammenfassung     

Gentherapeutische Möglichkeiten in der plastischen Chirurgie

Advances in gene technologies have meanwhile reached plastic surgery. Important contributions in this field (which are not all included in the paper) come not only from plastic surgeons, but also from neighboring specialities like dermatology, trauma surgery, orthopedics and vascular surgery. The uniting principle for all this work is improving wound healing and reconstructing tissue defects taking into consideration functional and aesthetic aspects. Gene-therapy is gaining further importance in the clinical field of plastic surgery. In this regard, every clinician has to be aware of the fact that progress in experimental and experimental-clinical work will be achieved only with the help of basic science. On the other hand, basic science needs the clinical input to get relevant patient-oriented studies started. Further intensive cooperation between clinicians and basic scientists is therefore mandatory. In plastic surgery, 2 years ago we founded a forum called ECSAPS (European Conference of Scientists and Plastic Surgeons), which takes place in European city every year.     

Möglichkeiten,Vorzüge und Gefahren einer isolierten Nierenunterkühlung

Ohne Zusammenfassung Mit 5 Textabbildungen     

Wolff and Müller: fundamental eponyms of embryology,nephrology and urology

PURPOSE: Kaspar Friedrich Wolff and Johannes Petrus Müller, German physicians in the 18th and 19th centuries, respectively, contributed significantly to the study of the biological sciences, specifically embryology and the development of the genitourinary tract. Their eponyms are a part of daily conversation in medical education, practice and research. We reviewed their lives and works. MATERIALS AND METHODS: Commentaries on the works of these scientists as well as available English translations of their works were analyzed. RESULTS: Wolff and Müller were pioneers in their fields. Wolff gained renown for his Theoria Generatonis, a great embryological treatise, produced in 1759. Müller performed significant studies in the fields of anatomy, pathology, physiology and embryology. In 1834 he became editor of the physiology journal that later came to be known as Müller's Archiv. CONCLUSIONS: Studies of and inferences about the development of the urogenital system a century apart by these 2 men contributed greatly to the current understanding of embryology. Their names remain a part of everyday medical dialogue.     

Photodynamische Therapie im Gastrointestinaltrakt Möglichkeiten und Grenzen

Background. Photodynamic therapy (PDT) is characterized by the extensive selective accumulation of a photoactive agent, the photosensitizer, in malignant or precancerous tumour cells. The photoactive compound is activated by light beam of a specific wavelength and causes cell death. A significant proportion of patients with gastrointestinal malignancies cannot undergo curative treatment, as either the cancer is too advanced or the patient's general constitution is too poor to allow invasive strategies. In such cases, PDT has already proven to be a promising therapeutic modality for selected dysplasias and malignancies in the gastrointestinal tract. Material and methods. A retrospective review of the literature was performed in order to determine the experience gained with PDT and to assess its clinical value in the curative and palliative management of gastrointestinal neoplasms. Results. PDT seems to be an adequate treatment for selected forms of early cancer and small lesions of the GI tract or for small residual areas after the tumour has been debulked by other techniques (e. g. limited surgical resection, thermal ablation). Especially for patients who refuse or are ineligible for conventional surgery, PDT offers promising results compared to currently accepted clinical approaches. Conclusions. As a primary or adjuvant mode for either curative or palliative treatment of gastrointestinal neoplasms, PDT is a potentially effective, minimally invasive therapeutic modality. However, further clinical assessment by means of comparative, standardized studies is essential to the definition of its role in oncology.     

Möglichkeiten einer Prophylaxe der Serumhepatitis infolge Bluttransfusionen

Ohne Zusammenfassung a. G. Mit 1 Abbildung