Therapiekosten bei erektiler Dysfunktion bei Beamten

Costs for treating erectile dysfunction after radical prostatectomy must be reimbursed. The application of the German state of North Rhine-Westphalia for revision of a judgment in this regard was dismissed by the Federal Administrative Court of Germany, so the decision is now legally binding.     

128. Erfahrungen bei 130 Operationen bei Carotiselongation

Zusammenfassung Berichtet wird über 130 Operationen bei Carotiselongationen. Die Indikation zur Rekonstruktion basiert auf der Angiographie, dem neurologischen Bild and neuerlich auf der Ultraschallsonographie. Die häufigste Methode bestand in Resektion, Neoimplantation and PatchPlastik. Die Operationsmortalität betrug 0 %, die Klinikletalität 2 %. In einem Beobachtungszeitraum von 6 Wochen bis zu 2 Jahren war bei 86 % eine deutliche Besserung, bei 14 % keine Veränderung des neurologischen Status eingetreten. Die guten neurologischen Ergebnisse sprechen für die operative Behandlung.     

STT-Arthrodese bei karpalen Instabilitäten und bei Mondbeinnekrose

Ohne Zusammenfassung      

Pneumokokkeninduzierte Septikämie bei normalen und bei splenektomierten Kaninchen

A new rabbit model to study the consequences of splenectomy in host resistance to induced pneumococcal septicaemia is presented. A simple, fast, of splenectomy in host resistance to induced pneumococcal septicaemia is presented. A simple, fast, non-invasive and complication-free technique of bacterial inoculation into the rabbit airways, using transcutaneous cannulation of the trachea, is also described. Sixteen normal and 24 splenectomised animals were used. The optimal dose of pneumonococcus (serotype B, type III) was found to be 1 × 10⁷ organisms. The above dose of bacteria given transtracheally failed to cause signs of pneumonia or death in any of the normal rabbits. However the same dose introduced using the same technique resulted reproducibly in the death of the low-resistance splenectomised animals.

---

Pneumokokkeninduzierte Septikämie bei normalen und bei splenektomierten Kaninchen

Zusammenfassung Hier wird ein neues experimentelles Modell zur Untersuchung der immunologischen Abwehr nach provozierter Infektion des respiratorischen Systems mit Typ-3-Pneumokokken bei normalen und bei splenektomierten Versuchstieren vorgestellt. Eine einfache, schnelle, nichtinvasive und komplikationsfreie Technik zur Bakterieninokkulation in das respiratorische System des Kaninchens durch transkutane Kanülierung der Trachea wird ebenfalls beschrieben. 16 normale und 24 splenektomierte Versuchstiere wurden benutzt. Die optimale Dosis von Pneumokokken (Typ 3, Serotyp B), welche eine Infektion im respiratorischen System verursacht, wurde bei 1 · 10⁷ Mikroben gefunden. Die oben genannte Dosis von transtracheal applizierten Bakterien führte weder zu den Symptomen einer Pneumonie noch zum Tode irgendeines der normalen Kaninchen Bei den resistenzgeschwächten splenektomierten Versuchstieren führten jedoch die in gleicher Technik und Dosis transtracheal applizierten Bakterien zum Tode der Kaninchen.

     

Endotrachealtuben bei Kindern

Background

Estimating the endotracheal tube size with the optimal internal diameter (ID) is of outstanding importance for airway management in pediatric patients. For many years different weight, height, and/or age-based formulas have been published. The aim of the present study was to identify and to compare published formulas to estimate optimal tube size in pediatric patients.

Materials and methods

A PubMed search was performed to identify published formulas for tube diameter in pediatric patients. The keywords ??pediatric?? or ??paediatric??, ??anesthesia?? or ??anaesthesia??, ??anaesthesiology?? or ??anesthesiology??, ??size??, ??formula??, ??diameter??, ??tube?? or ??endotracheal tube?? were used. Analysis was limited to articles published between 01.01.1951 and 30.06.2009. Additionally, similar publications retrieved from PubMed (related articles) and cited references were identified. Publications and formulas were assessed and classified by two independent colleagues.

Results

In the specified time-frame, 13 publications (11 original contributions and 2 letters to the editor) were identified with PubMed and 3 more formulas with the extended search. Altogether 22 formulas to estimate appropriate endotracheal tube size for pediatric patients (age 0?C18 years) were identified: 12 age-based formulas for tubes without a cuff, 4 height-based formulas for tubes without a cuff, 2 weight-based formulas for tubes without a cuff and one multivariate formula for tubes without a cuff as well as 3 age-based formulas for cuffed endotracheal tubes.

Conclusions

The identified formulas were comparatively simple to apply but were validated only for pediatric patients older than 1 year. Using tubes with a cuff can minimize the problem of optimal tube size. If a tube without a cuff is intended to be used other sizes should also be available.     

Harnableitung bei Kindern

For reconstruction of the urinary tract almost all bowel segments have been used. Today ileal and colonic segments are used for bladder augmentation, substitution, continent or incontinent urinary diversion. In patients with a competent anal sphincter and normal renal function, the rectosigmoid pouch is an option. Urinary diversion in the paediatric age group is mostly performed in patients with dilated upper urinary tracts. Consequently the complication rate is increased with reoperation rates of up to 42%.Incorporation of bowel segments into the urinary tract can have metabolic consequences. Each bowel segment has its own characteristic and specific complications. These relate to the acid-base balance, absorption of vitamins and reabsorption of bile acids (causing diarrhoea) from the small bowel. Due to the risk of secondary malignancies, lifelong surveillance of the patients is mandatory, especially in those with continent anal diversion and after bladder augmentation.     

Remodeling bei Vorhofflimmern

Atrial fibrillation is the most common arrhythmia in man and is characterized by not only a high tendency to become chronic but also has a high recurrence rate after conversion. Both are linked to a remodeling process induced by the atrial fibrillation itself, which at the cellular level includes changes in the density of various ion currents and on the tissue level changes in fibrosis and in intercellular communication. Intercellular communication is maintained by gap junction channels, which normally are found at the intercalated disks. In the atrium, these channels are made from the proteins connexin?43 (Cx43) and connexin?40 (Cx40). Atrial fibrillation leads to a change in these proteins, which are often expressed at a higher level and ?C most importantly ?C are less accentuated at the cell poles, but are incorporated more frequently at the lateral sides of the cells. The distribution change is functionally accompanied by an increase in the transverse conduction velocity, which together with inhomogeneities and fibrosis, stabilizes the multiple wavelets and contributes to the chronification of the arrhythmia. Metoprolol is the first drug to be shown that it affects this remodeling process and inhibits the changes regarding lateralization of Cx43, but not of Cx40, leading to a partial normalization of the transversal conduction velocity.     

Wach-ECMO-Therapie bei Atemwegsstenose

This article presents the case of a 62-year-old patient with cancer in the left upper pulmonary lobe who underwent lobe resection with postoperative respiratory insufficiency. The right upper lobe had already been resected 5 years earlier because of an adenocarcinoma. Prior to the present surgery a computed tomography scan detected a narrow stenosis at the former resection site; however, both pulmonary lobes beyond this stenosis appeared to be sufficiently ventilated. After resection of the left upper lobe attempted extubation was unsuccessful due to insufficient global gas exchange as the stenosis prevented ventilation of the right lung. Bronchoscopy provided evidence of a normal diameter of the bronchus behind the stenosis so both lobes were to be recruited after possible correction of this section. A veno-venous extracorporeal membrane oxygenation device (ECMO) was established as bridging therapy to attain normal gas exchange. As the patient showed no muscle weakness and was cooperative, extubation was performed and spontaneous breathing occurred without any support while still under ECMO treatment. The stenosis was reduced by bronchoscopic laser resection within seven consecutive sessions. Each of these surgeries was conducted with the patient under general anesthesia with oral intubation and jet ventilation in combination with the ECMO. The patient was extubated after each treatment session and weaned from ECMO after the final resection within 2 days. This case demonstrates the use of ECMO in combination with surgical procedures in a spontaneously breathing patient as a causal therapy and option for selected patients to prevent complications from long-term ventilation.     

Therapieoptionen bei Brachymetatarsie

Brachymetatarsia can be congenital, idiopathic or secondary and describes an abnormal shortening of a metatarsal bone. The indications for treatment are not only due to cosmesis. The shortening of a ray changes the biomechanics of the foot and can lead to metatarsalgia. A frequent clinical feature is dorsal dislocation of a toe causing painful shoe conflict and disturbed proprioception. There are three main options for operative correction: lengthening osteotomy, interposition of a tricortical bone and gradual lengthening by callus distraction. While one stage lengthening procedures such as osteotomy and interposition are more appropriate for correction of moderate length deficiencies, the callus distraction method is more suitable for larger elongation. Common to all procedures is a long-term treatment with a high risk of different complications whereby patient compliance can be problematical.     

Varikozele bei Jugendlichen

Testicular varicocele is present in 15 % of adolescent boys. The very impact of this pathology and who will be at risk of developing into infertility remains unclear. Research on the pathophysiology, results of surgical or radiological interventions and potential predictors for long-term impairment of spermatogenesis and thus fertility is still ongoing. Indications for treatment are mainly based on differences in testicular volumes as semen parameters are most often not available; however, whether testicular volume is a valuable prognostic parameter for later fertility remains questionable. Approximately 50 % of adolescent patients with varicocele experience spontaneous increase of testicular volume without any intervention.     

Biofeedback bei Analinkontinenz

Biofeedback training is a well established method for the treatment of faecal incontinence. Prior to any biofeedback training program, a definitive diagnostic study is essential. Idiopathic faecal incontinence is the main indication for biofeedback training. Additional indications are a menacing faecal incontinence after deep anterior rectal excision with restoration of the rectal reservoir by an ileoanal pouch, anal sphincter reconstruction, rectopexy and rectocele repair. Only four studies provide evidence-based medical criteria. These, as well as numerous uncontrolled studies, show the effectiveness of biofeedback training for the treatment of faecal incontinence. Electrical stimulation of the anal sphincter is only shown to be effective in one controlled study in which it was combined with biofeedback training.     

Kompressionsmarknagelung bei Pseudarthrosen

There are many reasons for delayed union or nonunion in fracture healing. Hypertrophic nonunion following conservative fracture treatment has become rare, while delayed union is quite frequently caused by extensive soft tissue injury, bone loss, deficient blood supply to bone fragments, and inadequate stability of the primary internal fixation. Reamed intramedullary nailing of nonunion is well established since Küntscher pointed out that reaming of the medullary canal caused formation of periostal new bone. The use of interlocking compression nails in the treatment of nonunions of the femur, the tibia and the humerus yields better stability at the fracture site than conventional interlocking nailing. The compression nail combines the advantages of the compression screws used in plating and the benefits of intramedullary reaming of the nonunion and allows immediate full weight bearing on the lower extremity. Interlocking compression nailing for nonunions of the humerus has been followed by a high incidence of failure. Operative treatment of nonunions requires an exact analysis of the causality.     

Weichteilbalanzierung bei Valgusgonarthrose

Implanting a condylar knee in patients with valgus deformity is challenging both for the surgeon and in terms of clinical instrumentation. Valgus deformity – defined as an anatomic angle >10° – consists of a bony and a soft tissue component. Frequently, the lateral femoral condyle is hypoplastic and can create a secondary osteochondral lesion on the tibial plateau. Concomitantly, there is a soft tissue contracture of the lateral side with an elongation of the medial collateral ligament. Correction of the deformity and restoration of anatomic alignment should be achieved to maximize the longevity of the replaced components. Soft tissue balancing is crucial for successful treatment. This is achieved if a symmetrical flexion and extension gap together with a centralized patella position is obtained. We describe our surgical approach to address valgus deformities in primary total knee arthroplasty with special emphasize on a stepwise release of tight lateral capsular and ligamentous structures controlled by a knee balancer.     

Chirurgie bei Hepatitis

Zusammenfassung. Virushepatitiden geh?ren weltweit zu den wichtigsten Infektionskrankheiten. Allein über 300 Millionen chronische HBsAg-Tr?ger und etwa die gleiche Anzahl chronischer Hepatitis-C-Virustr?ger werden gesch?tzt. Nach der Tuberkulose steht die Virushepatitis in der Statistik der infekti?s bedingten Berufskrankheiten an zweiter Stelle. Insbesondere Teile Asiens, Afrikas, Lateinamerikas sowie der Mittelmeerraum und der Nahe Osten werden zu den Hochendemiegebieten der Virushepatitis gez?hlt. Aufgrund der immunologischen und molekularen Differenzierung sind heute die Virushepatitiden von A bis E einschlie?lich G weitgehend charakterisiert. W?hrend die enteral übertragene Hepatitis A und E nur akute und in seltenen F?llen fulminante Verl?ufe induzieren, sind die Hepatitis B, ihre Koinfektion und Superinfektion mit Hepatitis Delta und die Hepatitis C insbesondere durch chronische Verl?ufe von gro?er medizinischer Bedeutung. Diese Erkrankungen k?nnen als Sp?tfolge in eine Lebercirrhose mit all ihren Komplikationen, einschlie?lich des prim?ren Leberzellcarcinoms übergehen. Die für die Chirurgie besonderen Aspekte der Virushepatitis sollen diskutiert werden.      

Kortisonsubstitution bei Sepsis

Die Anaesthesiologie -     

Callusdistraktion bei Unterschenkeldefektfrakturen

Zusammenfassung. Durch die Callusdistraktion nach Bier-Ilizarov k?nnen Unterschenkelfrakturen mit kn?chernem Defekt schonender und effektiver zur Ausheilung gebracht werden. Es handelt sich hier um ein wirklich biologisches Verfahren – im Gegensatz zu den oft zitierten. Denn die Knochenzellen werden gewisserma?en vor Ort gezüchtet und distrahiert. Besonders das vom Verfasser inaugurierte Verfahren der prim?ren Unterschenkelverkürzung bei freiliegendem Knochen zur Weichteildeckung mit nachfolgender kompensatorischer Verl?ngerung durch Callusdistraktion ist für die Praxis wertvoll und geeignet. Es ist nicht an Spezialkliniken gebunden. Die Verwendung der Callusdistraktion erfordert aber eine besonders enge Operateur-Patienten-Bindung, da der weit überwiegende Teil der Behandlung ambulant durchgeführt wird und w?hrend dieser Zeit besonders darauf geachtet werden mu?, da? kontinuierlich richtig verl?ngert, sich anbahnende Probleme frühzeitig erkannt und umgehend gehandelt wird. Behandlungszeit, kosmetische und funktionelle Ergebnisse sprechen für dieses, bei uns noch relativ neue Verfahren.