Strategien zur Infektbehandlung am proximalen Femur

Revision surgery following failure of an endoprosthesis or of internal fixation of a hip owing to infection is a challenging task. The patient needs to be both highly motivated and totally compliant. As all procedures that might be used involve a high rate of failures and recurrences, a high frustration threshold is required in both patient and surgeon. In view of the necessity for intensive physiotherapy after surgery it is clear that such revision surgery should be performed in large regional centres.     

Hands-off-Zeiten durch AED-Sprachanweisungen

Background

Hands-off intervals during cardiopulmonary resuscitation (CPR) diminish the likelihood of success. The influence of voice prompts from an automated external defibrillator (AED) on the length of CPR interruption was investigated.

Material and methods

In a randomized, one-way blinded manikin CPR study we prospectively assessed intervals between the start of voice prompting and the start of execution by participants for a shockable and a non-shockable rhythm. Difficulties with executing AED voice prompts were assessed by a questionnaire. The influence on the length of CPR interruptions was evaluated in a post hoc analysis.

Results

Mean hands-off intervals measured in 57 voluntary participants accounted for 38.5?% of the total CPR time. Hands-off intervals between defibrillation and chest compressions were significantly shorter when CPR started with a non-shockable rhythm (6.5?±?3.5 s versus 9.0?±?5.5 s, p?<?0.043) and when participants rated the voice prompts as very good or good compared to middle or bad (7.1?±?4.5 s versus 11.3?±?4.7 s, p?<?0.020).

Conclusions

Confusing voice prompts that potentially delay CPR need to be identified and modified.     

Defibrillation durch Ersthelfer

Ohne Zusammenfassung     

Rippenfraktur durch Muskelzug

Ohne Zusammenfassung     

Fettembolie durch Humanolinjektion

Ohne Zusammenfassung     

Ileus durch Gallensteine

Ohne Zusammenfassung     

Thoraxwandstabilisierung durch Plattenosteosynthese

The improvement of mechanical respiration by surgical stabilization of the chest wall is an important measure to reduce disadvantages and complications of long time respiratory treatment. Indications are:

1. Chest wall instability with indication for emergency thoracotomy.
2. Respiratory insufficiency caused by chest wall instability, but without severe laceration of intrathoracical organs.
3. Respiratory insufficiency due to severe laceration of intrathoracical organs with additional chest wall instability as an obstacle for sufficient respirator treatment.

Prevailing injuries leading to chest wall instability are fractures of the sternum and serial or double fractures of the ventral ribs I–VII, which have their own sternal junctions. For restoration of mechanical respiration, stabilization of the sternum and ventral ribs III–VI is essential. Surgical technic and special advantage of rib plating using small ASIF-plates are described and demonstrated in clinical cases. Finally, the development of a new screwless elastic selfclasping rib plate is presented.     

Verletzungen durch Blitzschlag

Lightning injury is one of the most frequent injuries caused by a natural phenomenon, but the risk of being struck by lightning is low. The most vulnerable subjects for lightning injuries are individuals who work in open fields. Although lightning injuries may involve all organ systems, injuries to the cardiovascular system and central nervous system are the most frequent. Burns, tinnitus, blindness and secondary blunt trauma have also been reported. Even though immediate death through lightning-induced cardiac arrest is well documented, the majority of cases reported in the literature describe infrequent and enormously disparate sequelae.A 17-year-old man was admitted to our hospital approximately 3 h after a lightning strike. The Glasgow coma scale was recorded as 15/15 and partial thickness burns totaling of 11% were present on the chest, stomach and right and left lower leg. The entry point was approximately the right side of the neck and the current exited through the right foot. On arrival, the patient's vital signs were normal. Cardiac and pulmonary examinations were within normal limits. The patient suffered transient symptoms, including pain, loss of consciousness, tinnitus, iritis and paresthesia. The laboratory data obtained on admission were within normal limits except serum for WBC, CK, CK-MB, troponin and CRP. We postulate that the mechanism by which lightning caused injury to this patient was a flash discharge (side splash). During his stay in hospital, a debridement of the burn surface following graft coverage and Z-plasty to close the dehiscent wound on the right neck was performed. The patient was discharged from the hospital after 14 days.     

Oesophagusersatz durch Colon

Zusammenfassung Nach kurzer Erörterung der Literatur des mit Dickdarm durchgeführten Oesophagusersatzes, werden die anläßlich von 26 mit Colon-prothese verfertigten Oesophagusersatzoperationen gewonnenen Erfahrungen erläutert. Den Eingriff indizierten in zwölf Fällen narbige Stenose, in einem die Überbrückung einer carcinomatösen Obstruktion, in 13 die Rekonstruktion nach wegen Speiseröhrencarcinom durchgeführter Resektion. Zur Anwendung kam stets jener Colonabschnitt, dessen Blutversorgung am meisten gesichert zu sein schien. Infolge Blutversorgungs-störungen nekrotisierten drei Transplantate, der Defekt wurde in diesen Fällen mit einem Hautrohr ersetzt. Angesichts der drohenden Gefahr der intrathorakalen Komplikationen wird bei älteren Patienten, bei denen die Mesenterialgefäße sklerotisch sind, möglichst die antesternale Lösung angewandt. Bei jungen Patienten wird die Überbrückung narbiger Stenosen retrosternal in einer Sitzung durchgeführt. In Fällen, in denen die craniale Anastomose auf den Hypopharynx angelegt wurde, meldete sich vorübergehende Dysphagie. Um der infolge der Ausschaltung der Kardia auftretenden Regurgitation vorzubeugen, empfehlen Verfasser die cologastrische Anastomose mit Ventilbildung anzulegen; zu diesem Zweck werden zweierlei Methoden beschrieben. An Hand der gewonnenen Erfahrungen vertreten Verfasser die Ansicht, daß sich zur direkten Überbrückung von Oesophagusstenosen und-defekten das Colon am besten eignet.     

Darmzerreissung durch Hufschlag

Ohne Zusammenfassung (Nach einem in der medicinischen Section der Schlesischen Gesellschaft vaterl?ndische Cultur am 6. December 1901 gehaltenen Vortrage.)     

Halswirbelluxation durch Muskelzug

Ohne Zusammenfassung     

Ausschaltung der viscero-corticalen Reflexe durch die Lokalanaesthesie und durch die Intubationsnarkose

Ohne Zusammenfassung Mit 10 Textabbildungen     

Dystonie durch Metoclopramid

Normal doses of metoclopramide can cause intoxication with dramatic side effects. We describe the case of a young woman admitted to our outpatient department with a reflected/turned neck and fixed vision. This primarily, previously outward misdiagnosed dystonia caused by metoclopramide could be rapidly eliminated using biperiden (Akineton).     

Immunsuppression durch Bestrahlung

Zusammenfassung Es wird eine übersicht über die Methoden der Immunsuppression durch Bestrahlung für die Organtransplantation gegeben. Dabei werden vor allem die sublethale Ganzk?perbestrahlung, die Lokalbestrahlung des transplantierten Organs und die extrakorporelle Bestrahlung behandelt. Von allen Methoden hat zur Zeit lediglich die Lokalbestrahlung des transplantierten Organs allgemeine klinische Verwendung gefunden.

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Summary A review upon methods of immunsuppressiv by radiation technics (Total Body Radiation, Local Graft Radiation, Extracoporeal Irradiaton) is presented. At the present time only the local graft radiation can be considered as an easy practicable and universally used method in organtransplantation.

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a. E.     

Hautkrebs durch UV-Licht

The potentially harmful effects of the sun were recognized early on and we even know of a publication on sunlight-induced skin cancer dating back to the year 1875. In 1992, the International Agency for Research on Cancer classified sunlight as causal in malignant skin diseases. Until recently, the southern hemisphere in particular was burdened with a high incidence of skin diseases; however, cases are now rapidly increasing also in the northern hemisphere due to changes in the ozone layer. The increased occupation-specific risk for certain occupational groups (“outdoor workers”) was already taken into account in the expert recommendations on occupational skin diseases with the supplement of a Part 2,“Skin cancers”. However, due to the distanced attitude of some socio-political decision-makers, a reliable basis for claim for the insured, which goes beyond the approval of individual cases according to §9 para. 2 of the German Social Security Code (SGB) VII, is a long time in the coming. A new occupational disease,“UV light-induced skin cancer”, would not only give the insured and assessors more legal assurance, but would also have a significant impact on prevention.     

Kardiaresektion durch Laparo-Thorakotomie

Ohne ZusammenfassungManuskript nicht eingegangen.