Auswirkungen der endovaskul?ren Therapie von Nierenarterienstenosen auf Blutdruck und Nierenfunktion

Background

A retrospective analysis of the long-term success rates of endoluminal therapy of renal artery stenosis in a university hospital was carried out.

Material and methods

Preinterventional and postinterventional data contained in the clinical records of all 104 patients who underwent percutaneous transluminal angioplasty (PTA, 25 patients) or stent PTA (79 patients) from 01 January 1994 to 31 December 2007, were documented using an electronically structured questionnaire and a time period classification. Subgroup analyses and statistical calculations were done using t-tests for joint random samples.

Results

At day 1 postintervention all patients showed a statistically significant decrease in mean systolic blood pressure (all patients: p=0.002, stent PTA group: p=0.023, PTA group: p=0.022). The significant decrease in mean systolic blood pressure persisted in years 1 and 2 postintervention (all patients: p=0.009 and 0.007, stent PTA group: p=0.039 and 0.015, respectively). Mean blood pressure values remained constant during the other time periods analyzed. In patients with a stent PTA carried out between 2001 and 2007 there was no significant reduction of prescribed antihypertonic drugs (p=0.023 and p=0.046, respectively). Mean serum creatinine concentrations decreased during years 1 and 2 postintervention and increased starting in year 3. In patients with elevated serum creatinine levels prior to the intervention the increase in mean serum creatinine level started in year 5.

Conclusions

Endoluminal therapy of arteriosclerotic renal artery stenosis delays further deterioration of renal function and stabilizes blood pressure as well as the number of prescribed antihypertonic drugs. This can be considered a response to treatment in view of the mostly chronic progressive course of the disease.     

Auswirkung von Aprotinin und Tranexams?ure auf die Fibrinolyse und Thrombinbildung bei extrakorporaler Zirkulation

Fragestellung: Zur Reduktion des intra- und postoperativen Blutverlusts werden heute bei Eingriffen mit extrakorporaler Zirkulation (EKZ) in der Kardioan?sthesie h?ufig antifibrinolytisch wirksame Substanzen eingesetzt. Es bestehen jedoch gleichzeitig Bedenken hinsichtlich ihres Potentials als Ausl?ser thrombotischer Komplikationen. Vorliegend sollte daher die Wirksamkeit von Aprotinin und Tranexams?ure auf die Fibrinolyse und Thrombingeneration w?hrend Herzoperationen unter EKZ miteinander verglichen werden.     

Identifikation von Risikofaktoren anerkannter Vorw��rfe von ?rztlichen Behandlungsfehlern aus dem Fachgebiet Orthop?die und Unfallchirurgie

In Germany, orthopedic and trauma surgery rank first in the number of alleged malpractice claims amongst all medical disciplines. Thus, the German Association of Trauma and Orthopedic Surgery, together with the Bavarian Chamber of Physicians, set out to identify potential predictors of approved malpractice claims to improve process quality. In a case-control study, 164 cases of approved malpractice claims were matched according to age and gender to 336 controls of rejected claims, based on the 2004 to 2006 dataset of the Bavarian Chamber of Physicians. Potential predictors of acceptance of an alleged incident were modeled by uni- and multivariate logistic regression analysis. The final model explained 71% of the probability of acceptance of an asserted claim. It contained three medical consequences (i.e. delayed healing, reoperation, and loss of motion), one specific entity (i.e. fracture) and one socio-demographic variable (i.e. professional driver) as independent predictors of acceptance. Insufficient or lacking explanation of the planned procedure to patients or relatives and / or lacking informed consent (odds ratio [OR] 2.33, 95% confidence interval [CI]1.23-4.43), as well as inappropriate, low-quality, or erroneously interpreted imaging (OR 1.90, 95% CI 1.06-3.41) independently contributed to the likelihood of acceptance of a legal claim. Strict adherence to the principles of surgical quality assurance in terms of transparent patient information and joint informed consent procedures, as well as intransigent radiological imaging are mandatory to foster surgeon-patients-relationships and to avoid later legal claims.     

Einfluss von Kopfposition und Muskelrelaxierung auf die Effektivit?t der supraglottischen Atemwegssicherung

In the present study the laryngeal tube suction (LTS?) was compared with the ProSeal? laryngeal mask (PLMA) with respect to the influence of different head positions and neuromuscular block (NMB) on the clinical efficacy. In 54 patients seal pressures were observed according to a protocol for five pre-defined head positions before and after NMB. Regurgitation was observed using methylene blue as an indicator. Postoperatively a standardized interview was performed to rate subjective patient complaints. The LTS and PLMA provide a comparable seal and neuromuscular block did not impair the performance of both devices. With the PLMA the seal deteriorated with extension of the neck and with the LTS more airway manipulations were necessary to keep the airway patent. No signs of aspiration were observed in either group but of the patients in the LTS group four noticed hoarseness in the postoperative course. Altogether the subjective postoperative complaints were rated as mild to moderate in both groups.     

Sinn und Inhalt von Behandlungspfaden in der Orthopädie und Unfallchirurgie

The aim of the study was to find the best possible methodology to evaluate the perioperative processes in the main diagnosis-related groups in an orthopaedic and trauma centre. A model in five phases was followed to develop the care pathways. Optimization potentials were derived from estimated problems and their origin. Cases of missing objectives led to re-organization and the necessary quality in treatment could be prepared as a new work flow management. The cost-effectiveness of treatment procedures and the costs of processes conditionally led to a change in management. The advantages of the study were increased knowledge of the processes involved in diagnosis and therapy with regard to the evoked costs. So the limited budget became more calculable.     

Über Homöotransplantation von Kaninchenschilddrüse und einen Versuch,das Ergebnis zu verbessern

Ohne ZusammenfassungMit 9 Textabbildungen     

Anatomie und Verhalten von Sehnen und B?ndern

Sehnen und Bänder bestehen vorwiegend aus Kollagenfasern vom Typ I. Diese werden durch lockeres Bindegewebe zu Bündeln zusammengefasst. Sie zeigen ein komplexes mechanisches, viskös-elastisches Verhalten mit Kriechphänomenen und Stressrelaxation. Eine Sehne ist stets Teil einer komplexen Einheit mit der zugehörigen Muskulatur. Bei der Anpassung an mechanische Belastungen spielen neurosensible Rezeptoren, freigesetzte Wachstumsfaktoren und Zellkontakte zwischen den Tenozyten eine entscheidende Rolle. Diese beeinflussen den Metabolismus der Zellen und somit die Synthese der Extrazellulärmatrix. Bedingt durch die unterschiedlichen Anforderungen (direkte Zugsehnen bzw. Gleitsehnen mit Umlenkfunktion), das Ausmaß der Bewegungsfunktion und Besonderheiten in der Gefäßversorgung finden sich ausgeprägte Besonderheiten im Aufbau und Reaktionsverhalten von Sehnen und Bändern. Eine kurzzeitige Immobilisation kann die Belastbarkeit der Faserstrukturen deutlich vermindern. Darüber hinaus verändern Reifungs- und Alterungsprozesse die Morphologie und das Stoffwechselverhalten des Bindegewebes.     

Ueber die von mir angewandten Behandlungsmethoden von Fracturen der grossen Knochen der Extremitäten und Gelenkresectionen und die dabei erzielten Resultate

Ohne Zusammenfassung     

Interdisziplinäre Zusammenarbeit von Kieferorthopädie und Mund-Kiefer-Gesichtschirurgie

Background

Patients often have a very complex conception of requirements in the field of orthodontics, oral and maxillofacial surgery. They are often not only dissatisfied with the esthetics but also have extensive functional and muscular problems. Each individual discipline can, however, only operate within very limited boundaries.

Point in question

This article demonstrates how interdisciplinary cooperation and time schedules must be planned in order to achieve optimal results. The article is concerned with the middle and lower third of the face so that the position of teeth, maxilla and mandible, the nose and chin will be discussed.

Material and methods

Case planning and treatment techniques in orthodontics as well as the temporal succession of treatment stages of a combined treatment are presented and demonstrated by case examples.

Conclusion

A functioning interdisciplinary cooperation is decisive in order to realize a well-coordinated succession of treatment stages. The temporal management plays a particularly important role within the framework of combined treatment procedures.     

Diagnostik und Therapie von Wirbels?ulenmetastasen

Out of all skeletal metastases 30% are located in the spine as are 10% of primary bone tumors, whereby 52% of metastases occur in the lumbar region, 36% in the thoracic spine and 12% in the cervical spine. Patients suffer from local pain caused by irritation of the periosteum due to rapid growth of the tumor or subsequent pathologic fractures which may lead to compression and neurological impairment with paresthesia, paresis and paraplegia. If the diagnosis cannot be confirmed exactly by radiological imaging and laboratory tests, a biopsy should be performed. A precise diagnosis of the tumor entity as well as an estimation of the prognosis provides an important basis for further decision-making. The aim of therapy is pain relief and stabilization by operative and non-operative measures. Therapy is palliative with the aim of pain relief and preservation of mobility. In cases of solitary metastasis a curative operative treatment should be performed.     

Über die Kombination von Nabelfistel und Verdoppelung des Wurmfortsatzes

Zusammenfassung So k?nnen wir den beschriebenen Befund als eine Kombination von zwei Anomalien, einer Anomalie der Form—partielle Verdoppelung des Organes—und einer Anomalie der Lage—Nabelfistel des Organes—auffassen. Ob eine partielle oder nur angedeutete Verdoppelung des C?cums, ob andere Mi?-bzw. Spaltbildungen, wie z. B. Spaltbecken, bestanden, entzieht sich unserer Kenntnis. Wichtig war, darzutun, da? wir es in dem beschriebenen Falle mit einer, wie in allen ?hnlichen F?llen, aus unbekannter Ursache eingetretenen, in ihren Folgen diesmal harmlosen St?rung der Aufteilung der Kloake zu tun haben und da? sich an diese einmal eingetretene St?rung eine weitere anschlo?, soda? eine eigenartige, bis jetzt im Schrifttum noch nie erw?hnte, in ihrer wahren Form nur schwer erkennbare Mi?bildung des Organes entstand. 4 Abbildungen.     

Rechtfertigen die Ergebnisse der infragenualen und kruralen Bypasschirurgie die peri- und postoperativen Komplikationsraten?

Background

Infragenual bypass surgery has been proven to enhance the HR Life-Quality for at least 6-12 months. The infragenual vascular region and the morbidity profile of the affected patients are prone to complications.

Methods

Access database 01/06-03/07. N=156 patients. Perioperative 30 days and 1 year (N=70) postoperative 38 prospective observation units and 18 complication entities.

Results

Age 69 years, m:f ratio 2:1., 83% Fontaine III+IV (CLI). D.M. 48% (22 % NIDDM, 26% IDDM), 38% renal insufficiency (29% complications, 9% Pat. on dialysis). In 49 % arterial hypertension, HLP,D.M., consumption of nicotine was insufficiently ceased. In 24.8% additional intraoperative enhancement of inflow/outflow by means of multiple level reconstruction was necessary. Cardiac complications 9%, early graft occlusion 17%, secondary patency rate (30 days), compartment syndrome 7%. Minor and major amputations 25% and 12% respectively, wound infection (superficial + deep) including graft infection 8%, non-infectious liquid accumulation 23%. Mean ABI pre-op: 0,4, mean ABI post-op: 0,9, Alteration of pulse status in 47%. 1 y limb salvage for 70 patients 94%. 1 year mortality 17%.

Conclusion

After 25 days and 1 year, respectively, the infragenual/crural bypass surgery yields presentable results even with morbid patients. Our results advocate an offensive provision of indication even with these patients incl. long-term D.M. a./o. end stage renal disease.