Prim?re und sekund?re Pr?vention der erektilen Dysfunktion

Erectile dysfunction has an incidence of up to 75% in men aged 80, thus making primary prevention really important. Aetiologically multiple reasons are responsible for erectile dysfunction; therefore, recommendations for primary prevention contain different parts. The first one is to maintain a healthy arterial system and prevent atherosclerosis. Besides that diabetes, neurogenic disturbances or mental distress should be avoided. Physical activity, balanced nutrition, nonsmoking, unsaturated fatty acids and moderate alcohol consumption are preventive. Regular erections cause oxygenation of the cavernous body and prevent fibrosis which could lead to an insufficient occlusion of the cavernous veins. If the patient already suffers from coronary heart disease or diabetes, blood pressure, pulse, blood lipids and blood sugar should be as normal as possible. Erectile dysfunction might be the primary symptom of coronary heart disease; therefore, consideration should be given to a cardiac examination in the diagnostic setting.     

Prim?re Endoprothetik

Treatment of complex proximal humeral fractures in elderly patients is the subject of controversial debate. Anatomical fracture prostheses should be deployed in non-reconstructable proximal humeral fractures in patients under 75 of age with an unimpaired rotator cuff. Indications for inverse fracture prostheses have recently become popular in patients older than 75 years due to mostly fair results after anatomical fracture hemiprosthesis. Modification of inverse prosthesis design is believed to solve current problems and complications such as scapular notching and limited external rotation. Longer follow-up periods must be awaited to clarify whether expectations will be fulfilled. Initial results are encouraging especially in cases of anatomical tuberosity healing. The final decision as to which type of prosthesis is best implanted is subject to individual patient-related factors under consideration of surgeon expertise.     

Prim?re und sekund?re freisetzung von interleukin 6 und 8 bei der gestuften polytraumaversorgung

Zusammenfassung Der polytraumatisierte Patient entwickelt wegen der unfallbedingten Kombination aus Schock, Weichteilschaden, Organverletzungen und Frakturen regelmäßig ein systemisches Entzündungssyndrom mit dem Risiko eines Multiorganversagens. Zur Minimierung der Belastung mit proinflammatorischen Mediatoren hat sich daher ein gestuftes Versorgungskonzept polytraumatisierter Patienten mit Primärstabilisierung aller relevanten Frakturen und Weichteilschäden und einer zeitlichen Aufschiebung sekundärer Rekonstruktionen oder Verfahrenswechsel durchgesetzt.Ziel dieser prospektiven klinischen Studie war die Evaluation der durch Sekundäreingriffe verursachten konsekutiven Entzündungsstimulation in Abhängigkeit vom Zeitpunkt ihrer Durchführung. Hierzu wurden die proinflammatorischen Zytokine Interleukin (IL) 8 und IL-6 am Tag vor und nach einem operativen Eingriff in der vulnerablen Phase bis Tag 5 und danach analysiert.Die Auswertung der Plasmaspiegel der Zytokine IL-8 und IL-6 zeigte, daß operative Eingriffe zwischen Tag 2 und 5 eine wesentlich ausgeprägtere proinflammatorische Antwort als Eingriffe ab dem sechsten Tag verursachen. Zwischen dem zweiten und fünften Tag boten postoperativ 14 von 26 Patienten erhöhte IL-8-Werte und neun von 27 erhöhte IL-6-Werte. Im Vergleich hierzu wurden nach dem sechsten Tag für IL-8 nur noch bei fünf von 28 Patienten (p = 0,017) und für IL-6 bei zehn von 30 Patienten erhöhte postoperative Werte festgestellt. Diejenigen Patienten, die außerhalb des gestuftes Versorgungskonzepts als Notfall großen Eingriffen zwischen Tag 2 und 5 unterzogen wurden mußten, hatten signifikant höhere Werte im Multiorganversagen-Score als Patienten mit geplanten kleineren Eingriffen im gleichen Zeitintervall (p = 0,001).Die beobachteten Veränderungen der proinflammatorischen Zytokine IL-8 und IL-6 bestätigen eindrücklich das Konzept der gestuftes Polytraumaversorgung.     

Primäre Refluxoesophagitis und ihre Folgen

Ohne Zusammenfassung Mit 5 Textabbildungen     

Primäre skeletogene Ectrodaktylie?

Ohne ZusammenfassungMit 3 Textabbildungen     

Primäre und sekundäre plastische Eingriffe an Gesicht und Schädel

Ohne Zusammenfassung Mit 4 Textabbildungen in 9 Einzeldarstellungen     

Primäre Knochenheilung

Ohne ZusammenfassungMit 3 Abbildungen     

Primäre Varikose

The classic varicose vein operation still represents the "gold standard" in the operative therapy of varicose veins. The results of this procedure in view of perioperative complications are very good, with the incidence of perioperative deep venous thrombosis varying between 0.05% and 0.1%. Recurrence rates between 6% and 60% are published. However, the true recurrence rate is unknown since an exact definition of recurrent varicosis is still lacking. In recurrent varices it is essential to distinguish between disease progression, including neorevascularisation, and technical errors. Endovascular procedures for elimination of the superficial venous system - radiofrequency obliteration and endovenous laser therapy - meanwhile have established themselves as alternative, minimally invasive procedures. The perioperative complication rate of endovenous procedures is very low and comparable to that of the classic operation. Good results, with occlusion rates of the treated vein around 87% to 93% up to 2 years postoperatively, have been published for both endovenous laser therapy and radiofrequency obliteration. For the latter, 5-year results were published, with occlusion of the treated vein in 87%. Results in the literature for radiofrequency are better documented than for endovenous laser treatment because there are now five prospective randomised trials for the former and most publications for endovenous laser treatment are single-center experiences. The advantage of endovenous procedures, especially radiofrequency obliteration, over the classic operation is the lower rate of perioperative pain and better quality of life. The spectrum of operative treatment methods of the superficial venous system has increased tremendously due to new technical developments. For the surgeon this implies the necessity of informing patients conscientiously about the pros and cons and available results of each procedure, and carefully weighing which methods are at the time best for the patient.     

Primäre Ellenbogengelenkendoprothetik

Primary joint replacement of the elbow is rare and as a rule even complex fractures of the distal humerus or proximal ulna can be stabilized with modern anatomical implants. In multifragmented articular AO (Working group for osteosynthesis questions) type C fractures and very far distal AO type A fractures (low flexion type), in osteoporosis of older patients and/or failure of internal fixation without a promising possibility of revision, semiconstrained joint replacement of the elbow can be a reliable form of treatment and frequently is the only viable option for difficult fracture situations especially in elderly patients. Between 2005 and 2010 a total of 14 patients with supracondylar humeral fractures were treated with primary total elbow arthroplasty and13 were followed up 1 year after surgery (range 11–14 months). Wound complications had not occurred in any case and all patients were satisfied with the functional result. Pain was present only in low grade and the mean arc of flexion-extension was 15–107°. The mean arc of pronation-supination was 84–70° and all elbows were stable. No patient needed a reoperation or an exchange replacement.     

Primäre angeborene Lipoidstoffwechselstörungen und Wirbelsäule

Ohne Zusammenfassung     

Primäre monosymptomatische Enuresis

Nocturnal enuresis is one of the most common problems in childhood. In this article a standardized terminology for basic diagnostics additionally to extended diagnostics will be presented. Depending on the findings a specialized therapy can be performed. Besides drug therapy with antidiuretic hormone (ADH) sleep arousal devices can be used and the combination of both approaches also shows excellent results. At the end of therapy a protracted withdrawal shows better results than abrupt cessation.     

Primäre posttraumatische Radiuskopfprothetik

Radial head fractures are common injuries in elbow trauma. Non-displaced fractures are best treated conservatively. Simple but displaced fractures require anatomic reduction and fixation, typically using screws. The treatment course for complex fractures with multiple fragments is still being debated, as results are less predictable. Radial head resection is not advised if concomitant injuries of the coronoid process or the collateral ligaments with instability are present. Favorable outcomes following open reduction and fixation using plates were reported recently. However, complication rates are very high. Radial head replacement is a valuable tool in treating complex fractures of the radial head with predominantly good and excellent results. Patients who suffer radial head fractures are typically of a younger age, resulting in high functional demands. Certainly, unspecific and specific complications related to radial head arthroplasty were reported in up to 40?% of cases in an acute fracture setting. This article highlights common complications in radial head arthroplasty and aims to present strategies to avoid them.     

144.Primäre und sekundäre Brustwandtumoren aus der Sicht des Pathologen

Zusammenfassung Bei den knöchernen Brustwandtumoren stehen die fibröse Dysplasie (20%) und Metastasen (16%) vor den Chondrosarkomen (11%) an erster Stelle. Abgesehen von Fettgewebstumoren sind auch thorakale Weichteiltumoren selten. Typische Ausnahmen bilden der Askin- und Abrikosoff-Tumor, das Elastofibroma dorsi sowie die aggressive Fibromatose. Für die histogenetische Klassifizierung von undifferentierten Sarkomen und Brustwandmetastasen, z. B. von Prostatacarcinomen und Mesotheliomen ist eine enge Kooperation von Klinikern und Pathologen ebenso unerlässliche Voraussetzung wie neuere immunhistochemische Untersuchungsverfahren.[/ p]

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Primary and secondary tumors of the chest wall in the view of pathology

Summary Fibrous dysplasia (20%), metastases (16%) and chondrosarcoma (11%) are the most common bone tumors of the chest wall. Except lipoma, primary lesions of the soft tissue of the chest occur rarely as well. The Askin- and Abrikosoff tumor, elastoBbroma dorsi and desmoid can be seen as typical exceptions. With respect to the histogenetic classification of undifferentiated sarcomas and thoracic metastases (f.e. prostatic carcinomas or mesotheliomas) an intimate cooperation of surgeons and pathologists as well as modern immunohistochecmical investigations are required.[/ p]

     

148. Primäre und sekundäre Thoraxwandtumoren —Diagnostik,Therapie, Ergebnisse

Zusammenfassung Von 1969–1986 führten wir bei 51 Patienten mit malignen Tumoren eine Thoraxwandresektion durch. Es waren 28 Männer und 23 Frauen zwischen 6 und 76 Jahren (Mittelwert 50 J.). Wir fanden 34 primäre Tumoren bzw. Tumorinfiltrationen von Nachbarorganen und 17 Metastasen. Die Lokalisation war 6mal das Sternum, ansonsten der Rippenbereich. Die Rekonstruktion erfolgte 16mal mit prothetischem Material und 10mal mit plastischen Massnahmen. Gute Heilungschancen bestehen bei den primären Tumoren. Nur dieser Patienten verstarb am Tumor. Patienten mit Mamma-Ca-Rezidiven oder Thoraxwandmetastasen wurden zwar selten tumorfrei, jedoch nach Beseitigung von Schmerzen und Hautulcera z. T. jahrelang symptomlos.     

Primäre Kniegelenkendoprothese nach Trauma

Intraarticular knee fractures and, in particular, complex fractures of the tibial head remain challenging for orthopaedic surgeons. Surgical reconstruction in elderly patients is limited due to several factors: osteoporosis, osteoarthritis, bone defects and limited coordination. Posttraumatic or secondary osteoarthritis with compromised soft tissue are predisposing factors for bad functional outcome. In such cases, primary total knee arthroplasty is a realistic treatment option. The few existing studies on this surgical approach reported on a reliable and safe procedure with moderate complication rates. Primary knee arthroplasty enables elderly patients to be mobilized while full weight bearing postoperatively and precludes complex revision arthroplasty. Although currently not an established procedure, primary arthroplasty could represent a viable option for the treatment of complex fractures. Further long-term studies are warranted to support these results.     

PrimÄre Knochenmarkseiterung der Kniescheibe

Zusammenfassung Es wird eine weitere Beobachtung einer der sehr seltenen prim?ren Knochenmarkseiterungen der Kniescheibe mitgeteilt. Die mit den bisherigen F?llen übereinstimmenden und von diesen abweichenden Besonderheiten derselben werden beschrieben.