Leberchirurgie im technischen und konzeptionellen Umbruch

Ohne Zusammenfassung     

Die Exartikulation im Sprunggelenk nach Syme im Kindesalter

Operationsprinzip James Syme beschrieb 1843 zum ersten Mal sein Verfahren zur Amputation im Sprunggelenk bei Erwachsenen [5]: Es umfa?t die Pr?paration eines vorderen und hinteren Weichteillappens, eine subperiostale Durchtrennung unter Erhalt des Fersenpolsters sowie eine Umformung von distaler Tibia und Fibula, um die Form des Amputationsstumpfes zu verbessern und die Anpassung einer Prothese zu erleichtern. Ein analoges Verfahren bei Kindern unterscheidet sich vom Vorgehen bei Erwachsenen dadurch, da? die Wachstumszonen erhalten bleiben. Sonst bestünde die Gefahr, da? der Stumpf überschie?end w?chst und der Knochen die Haut durchspie?en kann. Aufgrund des Anpassungs- und Wachstumspotentials kann bei Kindern eine echte Exartikulation des Sprunggelenks durchgeführt werden, ohne da? eine ausgedehnte operative Modellierung der Knochenenden notwendig ist. überarbeitete Fassung aus: Orthop. Traumatol. 1 (1992), 283–288 (englische Ausgabe).     

Der Forschungsaufenthalt im Ausland im Berufsweg des akademischen Chirurgen

Ziel der vorliegenden Studie war die kumulative Auswertung der Erfahrungen deutscher Chirurgen, die einen Forschungsaufenthalt im Ausland (FiA) im Laufe ihrer Karriere absolviert haben. Hierzu wurden chirurgische Auslandsforscher aus den Jahren 1986 bis 1995 u. a. zur Person, zum Forschungsprojekt, zum publikatorischen Output und zur klinischen und wissenschaftlichen Reintegration nach Rückkehr mittels eines Fragebogens schriftlich interviewt (n = 74 auswertbar). Der FiA führte bei den weitaus meisten Kollegen zur Habilitation, zu hoher publikatorischer Produktivit?t und zur Besch?ftigung im angestammten Forschungsgebiet mit im Ausland erlernten, neuen Methoden nach Rückkehr. Die Fortführung der Forschungsaktivit?ten war jedoch durch klinische Belastungen erheblich eingeschr?nkt und würde – laut vieler Einzelkommentare – von einer besseren Strukturierung der Forschung an unseren Kliniken mit l?ngerfristiger beruflicher Perspektive für Forschungsinteressierte profitieren.     

Weichteilschaden im Oberschenkelbereich

Anatomically, the thigh is well covered by soft tissue in the form of the muscles surrounding the shaft. In the assessment of the severity of an injury, not only the obvious skin wound but also the mechnism of the trauma has to be considered. The extent and severity of the soft tissue damage cannot usually be fully established until later in the course of treatment, when necrosis of the skin, the subcutaneous fat and the musculature and also compartment syndrome or a secondary disturbance of perfusion may become obvious. Therefore, when extensive soft tissue injuries are present, following the primary débridement, a repeat wound débridement after 24–48 hours is generally indicated. Only after consolidation of the wounds and the successful treatment of any infection is definitive soft tissue reconstruction performed. The main danger in the treatment of soft tissue injuries of the thigh is underestimation of their total extent.     

Analgetika im Notfall

Notfall + Rettungsmedizin -     

Zystektomie im Alter

Bladder cancer is a carcinoma of the elderly population. The highest incidence of bladder cancer is between the ages of 70 and 80 years old. Radical cystectomy remains the gold standard for muscle invasive bladder cancer treatment. In this article different aspects of radical cystectomy in elderly patients are reviewed. The Pubmed-MEDLINE database was searched using the following keywords: radical, cystectomy, elderly and age.     

Tumor-Stroma-Interaktionen im Harnblasenkarzinom

Die Urologie - Der histopathologische Aufbau maligner Tumoren schließt zwei Kompartimente ein – das Tumorparenchym mit den transformierten Zellen selbst und jene Strukturen, die deren...     

Urolithiasis im Kindesalter

Urinary stone disease is relatively rare in children with an overall incidence of 1-2 %; however, it is often associated with metabolic abnormalities that may lead to recurrent stone formation. Stone analysis and subsequent metabolic evaluation is therefore mandatory for this high-risk group after the first stone event. The objectives of stone management in children should be complete stone clearance, prevention of stone recurrence, preservation of renal function, control of urinary tract infections, correction of anatomical abnormalities and correction of the underlying metabolic disorders. The full range of minimally invasive procedures is available if active stone removal is necessary. The majority of stones in children can be managed either with extracorporeal shock wave lithotripsy which has a higher efficacy in children than in adults, percutaneous nephrolithotomy, ureterorenoscopy or a combination of these modalities while open or laparoscopic surgery is limited to well-selected cases with underlying anatomical abnormalities.     

Restdysplasie im Kleinkindesalter

Objective

Restoration of a congruent, stable, mobile hip joint with normal function.

Indications

Persistent acetabular dysplasia of congenital or neuromuscular origin in children with still open triradiate cartillage.

Contraindications

Age under 18 months, closed triradiate cartilage, femoral head deformity.

Surgical technique

Incomplete supraacetabular transiliac osteotomy, the correction is performed by reshaping the acetabulum taking advantage of the inherent flexibility of the triradiate cartilage and the periacetabular bone. A triangular bioresorbable xenograft is used to maintain the correction until bony healing.

Postoperative management

Cast immobilization is not necessary, non-weight bearing for 4 weeks after surgery, then full weight bearing.

Results

In all, 31 hips in 20 patients were surgically treated for persistent acetabular dysplasia with the Dega acetabuloplasty. The results were retrospectively studied. The mean age at surgery was 42 months (range 31–67 months). The mean follow-up was 31 months (range 12–60 months). The acetabular angle before surgery measured 31.5° (range 27–44°) and was corrected to 14° (range 8–20°) at last follow-up. All patients showed at last presentation normal hip range of motion and had no complaints. None of the patients had functional restrictions. Severe complications were not observed. Transitory inguinal swelling was observed in only 3 cases in the immediate postoperative period and resolved completely without sequelae.     

Psychopharmakotherapie im Notarztdienst

Part two of the CME article Psychotropic agents and psychopharmacotherapy in emergency medicine aims to give an understanding of the pharmacotherapy of psychiatric disorders in emergency medicine. In contrast to somatic emergencies, many emergency physicians are not familiar with the treatment of psychiatric emergencies, although there are guidelines and recommendations. In the following article, treatment recommendations for the 5 most common and relevant syndromes in emergency medicine (i.e., suicide, delirium, agitation, stupor, and syndromes due to psychopharmaceutical use) are described based on the German S2-Guideline Emergency Psychiatry that will be published soon.     

Osteomyelitis im Erwachsenenalter

Osteomyelitis in the adult is a rare disease. In this review we present the diagnostic and therapeutic principles for treatment of chronic osteomyelitis of long bones in adults. The most important step in treating osteomyelitis is the detection of the offending bacteria. The diagnostics should be performed with tissue and fluids from the depth of the wound. Superficial samples and swaps from fistulas should not be used to determine the offending bacteria. The defining criteria of chronic osteomyelitis are necrotic and non vascularized bony tissue. The appropriate therapy includes radical excision of the diseased bone and infected scar tissue, closure of the wound with well vascularized tissue including (muscle) flaps, stabilization of instable situations by external fixation and administration of adequate antibiotics. Remaining necrotic bone tissue is one of the most relevant sources for recurrent infection.     

Vergiftungen im Kindesalter

Child-resistant packaging and substituting dangerous and corrosive chemicals in household products have both contributed to a substantial decrease of life-threatening childhood poisonings. Despite all these therapeutic successes we have no scientific clinical evidence that any of the methods used in primary decontamination have in any way significantly contributed to a better patients outcome. Most of the evidence concerning childhood poisonings is derived from case series, small case-control-studies and studies in volunteers. Based on the best evidence available the EAPCCT and AACT in 1997 edited position statements on the role of primary decontamination in poisonings, such as the use of activated charcoal, the induction of emesis or gastric lavage. These consensus statements have hitherto been widely introduced in the daily work of all 10 German poison centers and their affiliated hospitals. The core of the new paradigm is focused on tailor-made decisions suiting the individual patient. No longer any method of primary decontamination in the acute treatment of poisoned children and adolescents is deemed routine measure.     

Operationen im Kindesalter

Ohne Zusammenfassung     

Chemotherapie im Alter

Zusammenfassung Die Inzidenz maligner Erkrankungen steigt mit dem Alter exponentiell an. Das Alter an sich stellt keine Kontraindikation für die Durchführung einer Chemotherapie dar. Allerdings sollte durch Erfassung von Komorbidität und funktionellem Status älterer Patienten eine an die eingeschränkte Organfunktion angepasste Dosisreduktion erfolgen. Unter dieser Voraussetzung ist auf dem Boden der bisher zur Verfügung stehenden Datenlage davon auszugehen, dass die Chemotherapie bei alten Menschen die gleiche Wirksamkeit und das gleiche Nebenwirkungsspektrum zeigt wie bei jüngeren Patienten. Klinische Studien zur Überprüfung der Wirksamkeit von Chemotherapie im Alter ist eine wichtige urologische Aufgabe und befindet sich bereits in Planung.