The traumatic dural sinus injury — a clinical study

Summary In a period of 13 years 978 cases of severe head injuries were operated on in our clinic. An analysis of the medical reports includes injuries of the superficial dural sinus (39 cases=4%): among these injuries of the anterior and central part of the superior sagittal sinus (66 per cent), injuries of the transverse sinus (18 per cent), injuries of the posterior part of the superior sagittal sinus (8 per cent), and combined injuries of different dural sinuses (8 per cent).Clinical data, i.e. the causes of accident, radiological examination results, intracranial lesions, operation technqiues and outcome are analysed and discussed. The analysis of cases with dural sinus injuries shows a high mortality rate (total mortality rate: 16 patients=41%; intra-operative mortality rate: 8 patients=20%).     

Fingerfrakturen

Fractures of the phalanges and the metacarpus are among the most common injuries of the upper extremity, accounting for approximately 10% of all fractures. They are not uncommonly dismissed as trivial trauma, so that the primary treatment is often inadequate. One fourth of all stiff fingers are attributable to a fracture, and in 50% of the cases, the fractures are the result of work-related accidents. This article aims to give an overview of the different types of fracture and their current treatment options (nonsurgical/surgical); special attention is also given to the specific features of phalangeal fracture treatment.     

Aktuelles medizinrechtliches Schrifttum, Richtlinien und Empfehlungen

Ohne Zusammenfassung     

National survey on the management of primary hyperparathyroidism by Swiss endocrinologists

Background From the endocrine surgeon’s perspective, it is important to know how endocrinologists manage patients with primary hyperparathyroidism (pHPT). The aim of this survey was to evaluate the preoperative diagnostic workup and referral pattern for parathyroidectomy by Swiss endocrinologists. Materials and methods The survey was conducted by mailing a questionnaire to all members of the Swiss Society for Endocrinology and Diabetes in spring 2005. Results The questionnaire was sent back by 68 of 124 endocrinologists (55%). The median annual case volume of patients with pHPT was 6 (range 1–50). The mean fraction of these patients referred for surgery was 59 ± 24%. This fraction was significantly higher in the German-speaking part of Switzerland than in the French-speaking part (67 ± 21% vs 51 ± 27%). When considering surgery for asymptomatic pHPT, 62% of the endocrinologists rely routinely on the recommendations of the NIH consensus conference and 86% on the subsequent guidelines of the workshop in 2002. Sixty-seven percent of the endocrinologists routinely perform localization studies before possible referral for surgical exploration. Typically, they consisted of an ultrasonography of the neck (93%) and a ^99mTc-MIBI scintigraphy (80%). The impact of the availability of a minimally invasive surgical procedure on the number of patients referred for surgery seems to be considerable. Sixty-one percent of the participants would expand the indication for surgery if the operation could be done by a limited surgical approach. Conclusions In a relevant fraction of patients with pHPT, endocrinologists still do not regard curative therapy as mandatory. Surprisingly, there are significant cultural differences concerning referral patterns to surgery between the German-speaking and the French-speaking parts of Switzerland. Minimally invasive procedures seem to lower the threshold for referral for surgical therapy. This work was presented at the 2nd Biennial Congress of the ESES, May 2006, Krakow, Poland.     

Rechtsprechung aktuell

Ohne Zusammenfassung     

Aktuelles medizinrechtliches Schrifttum, Richtlinien und Empfehlungen

Ohne Zusammenfassung     

AC-Gelenk-Verletzungen

Injuries to the AC joint are influenced by the anatomical and biomechanical characteristics. The AC joint dislocation is classified by Rockwood into four types. Rockwood type III injuries should be further subdivided, since the therapy is controversial in type III injuries. In our opinion, grade I and II dislocations should be treated conservatively, as it should be in type III injuries with stable situation. Surgical treatment is indicated for types IV- VI, and in cases of type III injuries with instability. By adhering to these guidelines we achieve good results in our patients.     

Ernährungsrichtlinien zur Behandlung unfallchirurgischer Intensivpatienten

It is well accepted today that artificial nutrition support is relevant for improving clinical outcome for intensive care unit (ICU) patients. Severe trauma leads to a catabolic state with hypermetabolism, resulting in multiple complications. Artificial nutritional support can reduce complication and infection rates and significantly improve clinical outcome. National German and international organizations for nutrition have published clinical practice guidelines to provide assistance in nutritional support for ICU patients. The major methodological problem of these guidelines is the inconsistent definition of the ICU patients in the trials reviewed. We condensed current guidelines and publications to give a brief guiding principle of nutrition support, particularly for ICU trauma patients.