Pseudomonas aeruginosa als Erreger opportunistischer Infektionen

Zusammenfassung Pseudomonas aeruginosa ist ein ubiquitär vorkommender Mikroorganismus, der aber als Bestandteil der endogenen mikrobiellen Flora gesunder Individuen nur selten isoliert wird. Die Hospitalisierung, die Krankenhausverweildauer erhöhen die Kolonisationsrate insbesondere bei immunsupprimierten Patienten signifikant. Eine Antibiotikatherapie oder -prophylaxe wie auch invasive diagnostische Maßnahmen begünstigen ebenfalls eine Besiedlung und Infektion der Patienten mitP. aeruginosa. Immundefekte der Patienten sowie eine negative Interaktion vonP. aeruginosa mit dem Immunsystem wirken infektbahnend. Somit begünstigen eine Vielzahl exogener wie endogener Faktoren und deren Wechselwirkungen das Auftreten vonP. aeruginosa-Infektionen.

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Opportunistic infections caused by pseudomonas aeruginosa

Summary Pseudomonas aeruginosa, in spite of being an ubiquitous microorganism, rarely colonizes healthy individuals. Hospitalization, as well as the length of time spent in hospital, significantly increase the rate of colonization, especially in immunocompromized patients. Antibacterial chemotherapy or prophylaxis together with invasive diagnostic procedures favour colonization and infection withP. aeruginosa. Immune deficiencies and adverse interactions ofP. aeruginosa with the immune system facilitate infection. Thus, a number of exogenous as well as endogenous factors and their interactions favour infection of patients withP. aeruginosa.

     

Zum 150. Geburtstag von César Roux (1857–1918)

César Roux was one of the few universal surgeons at the end of the 19th century who dominated all fields of surgery and influenced current surgery with his innovative spirit. Pioneering spirit and the story of the success of modern surgery are linked with his name. On the occasion of his 150th birthday, we recall the memory of this great surgeon. The personality and the history of Professor César Roux form a part of our medical and surgical heritage.     

Initially Accelerated Fractionation of the R1H Tumor of the Rat Increases Local Tumor Control and Might Reduce Impact of Overall Treatment Time

PURPOSE: To study the effect of treatment time prolongation following initial dose acceleration on the response of subcutaneously growing R1H tumor. MATERIAL AND METHODS: Continuous standard fractionation (30 fractions/40 days) was compared to initially accelerated treatment (30 fractions/21 days) followed by five to two fractions per week yielding total treatment times from 40 to 72 days. Local tumor control was assessed as endpoint. RESULTS: Radiation dose to control 50% of the tumors (TCD50%) decreased statistically significant from 83.5 Gy (95% confidence interval [CI]: 78.6 .. 88.4) for standard fractionation to 74.1 Gy (95% CI: 72.7 .. 75.5) determined for all accelerated treatment arms (p = 0.003). Prolongation of treatment time after initial acceleration from 40 to 72 days led to a small but statistically not significant increase in TCD50% from 72.0 Gy (95% CI: 71.0 .. 72.9) to 76.2 Gy (95% CI: 69.9 .. 82.4) corresponding to a repopulated dose of 0.9 Gy per week. This time factor is considerably smaller than for conventional radiation treatment as determined in previous experiments. CONCLUSION: The results indicate that initially accelerated irradiation not only improves local tumor control but also minimizes the negative effect of treatment time prolongation. This might be due to changes in tumor cell repopulation kinetics.     

Operative Versorgung von Achillessehnenverletzungen

Rupture of the Achilles tendon is typically associated with sportive activities with increasing tendency; it occurs most commonly in the third to fourth decade of life with a male-to-female ratio of 5–10:1. Ruptures are caused predominantly by a sudden, unexpected overextension of the tendon while direct trauma is less frequent. The recommended treatment of the injury remains controversial. In Germany, due to the good functional results, the open surgical repair represents the standard therapy since many years. The open suture technique offers the advantage of a lower re-rupture rate but is associated with the risk of wound-related complications including infection. By percutaneous suture techniques a significant decrease in the rate of infections and complications in wound healing could be achieved by minimal-access with reduced soft tissue trauma; on the other hand an increased rate of lesions of the sural nerve is reported. Dynamic imaging assessment of ultrasound or MRI allows a more accurate localisation of the ruptured ends of the tendons which is the prerequisite for the non-operative primary functional treatment of Achilles tendon ruptures. This conservative treatment regime is recommended when adaptation of the ends of the ruptured tendon is possible in 20° plantar flexion of the foot. Moreover, the desired level of daily activity and the patients’ degree of compliance has to be considered. Operative management should be avoided in the elderly patient or patients with risk factors like immunosuppressive therapy, diabetes mellitus, steroid use or failure to comply.     

Die Oberkieferosteotomie in der Le-Fort-I-Ebene — ein weites Indikations-spektrum zur Korrektur verschiedener skelettaler Dysgnathien

Zusammenfassung Die Osteotomie des Oberkiefers in der Le-Fort-I-Ebene, die heute routinemäßig in der Down-fracture-Technik durchgeführt wird, hat die chirurgische Behandlung skelettaler Dysgnathien grundlegend verändert. Sie ermöglicht eine dreidimensionale Korrektur des Oberkiefers und damit des gesamten Gesichtsschädels. Darüber hinaus kann der Oberkieferzahnbogen, zusätzlich zu einer Verlagerung des gesamten Oberkiefers, durch eine zusätzliche sagittale und transversale Osteotomie erweitert, verschmälert und verkürzt werden. Die Planung einer Oberkieferosteotomie erfolgt anhand des klinischen Bildes, der Kiefermodelle und des Fernröntgenbildes. Dabei muß der Unterkiefer frühzeitig mit in die Planung einbezogen werden, da er durch die Autorotation im Gelenk den Verlagerungen des Oberkiefers folgt. Erst durch eine gleichzeitige Osteotomie auch des Unterkiefers ergibt sich ein weites Indikationsspektrum für die Oberkieferosteotomie. Bei einer kombinierten Ober- und Unterkieferosteotomie ist praktisch jedes gewünschte Profil im unteren Gesichtsdrittel erzielbar.

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Summary The osteotomy of the maxilla using the Le Fort I technique, today routinely performed in the down-fracture-technique, has changed surgical corrections of dentofacial deformities fundamentally. It offers a three-dimensional correction of the maxilla and also of the whole facial skull. Furthermore the upper dental arch can be expanded, intruded and shortened using a sagittal or transversal osteotomy in addition to a complete transposition of the maxilla. Planning of a maxillary osteotomy is performed under consideration of the clinical situation, the casts and the lateral cephalogram. The mandible must be considered at an early state of the preoperative planning, since the mandible will follow all transpositions of the maxilla by rotating with the TMJ. Only by performing a simultaneous osteotomy of the mandible, a broad spectrum of indications for maxillary osteotomy will result and practically every desired profile of the lower third of the face can be achieved using combined maxillary and mandibular osteotomies.

     

Aesthetic aspects in reconstructive microsurgery

The reconstruction of a part of the body that has lost or inhibited function has been the most important aspect of reconstructive surgery in the past. Because of the existence of better techniques and the patient's wish for social reintegration, the plastic surgeon today is forced to consider the aesthetic results of his work more than in the past. Sometimes microsurgical procedures in reconstructive surgery are the only chance for the patient to be healed or palliated. Experience with more than 350 free tissue transfers gave us the opportunity to estimate the value of a donor flap with respect to the requirements of the receiving site. To satisfy the high aesthetic demands in these cases, it was necessary for the right place and shape the flap to fit as closely as possible, even if further corrections were necessary to achieve a satisfactory result. The transfer of latissimus dorsi and radial forearm flaps to the face and lower leg is discussed in cases of tumorus diseases and severe injuries of young and old patients.Presented to the IXth Congress of the International Society of Aesthetic Plastic Surgery, New York, October 13, 1987