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Total-videoendoskopische Strumaresektion via“axillobilateral breast approach”

BACKGROUND: The axillobilateral breast approach (ABBA) is a procedure allowing thyroid resection without scarring at the neck. We operated on a series of 26 patients with this technique. METHOD: Via incisions at the edge of the mamilla and axilla, trocars are placed subcutaneously under the platyma. Dissection is performed bluntly and with an ultrasonographic scalpel under videoscopic control. The procedure itself corresponds to conventional surgery. The specimen is removed through the axillary trocar. RESULTS: Twenty-six female patients underwent thyroid resection using the ABBA technique. Subtotal resection was performed in 24. Mean operation times were 111 min (unilateral) and 187 min (bilateral). In none of these cases was conversion necessary. One transient recurrent laryngeal nerve palsy and one paresis of the arm plexus were found postoperatively. CONCLUSION: In selected patients the ABBA technique is feasible and safe with the mandatory radicalness. The primary aim of this method is the cosmetic result.     

Osteomyelitis

Osteomyelitis of the jaws differs significantly from osteomyelitis at other skeletal sites. These differences are due to a different group of pathogens, the presence of teeth, a different blood vessel density, an oral environment and a thin mucosa as opposed to skin. These differences are also related in the confusing array of terms used to describe the different forms of jaw osteomyelitis. Despite the availability of an antibiotic therapy and an improved dental and medical provision, the development of microorganisms resistant to commonly used antibiotics and the increased number of immunocompromised patients have led again to an increase of cases refractory to standard treatments. Especially older patients with risk factors such as vascular diseases, diabetes mellitus and poor oral hygiene can be affected.     

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Aktuelles medizinrechtliches Schrifttum, Richtlinien und Empfehlungen

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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.     

Tissue expansion and skin circulation. Simultaneous monitoring by laser Doppler flowmetry and transcutaneous oximetry

The skin circulation was examined in nine patients during filling of their breast expander prostheses. Despite the high expansion pressure, which was increased above the systolic blood pressure, the overlying skin showed good circulation both clinically and when measured with a laser Doppler flowmeter and a transcutaneous oximeter. We conclude that the expansion was therefore directed to the tissues between the expander and the skin--that is, the fibrous capsule surrounding the prosthesis. Nine subcutaneous tissue expanders located in different anatomical regions were overfilled to a pressure at which all skin circulation ceased. Sufficient saline was then removed to allow skin circulation to return. Oxygenation of the skin ceased at a relatively low pressure when measured by transcutaneous oximetry, whereas when the skin circulation was measured with a laser Doppler flowmeter it did not disappear until the expander pressure had been raised appreciably above that level.