210. Möglichkeiten der intertrochanteren Osteotomie bei hüftgelenknahen Fehlstellungen und Pseudarthrosen

Zusammenfassung Von 133 Pseudarthrosen am coxalen Femurende wurden 44 Schenkelhals- und 5 pertrochantäre Pseudarthrosen mittels intertrochanter valgisierender Osteotomie behandelt. Bei 31 subtrochantären Pseudarthrosen erfolgte 9mal eine valgisierende Osteotomie in der Pseudarthrose. Alle Pseudarthrosen heilten knöchern aus, eine bereits zum Osteotomiezeitpunkt vorhandene Hüftkofnekrose ließ sich in der Regel nicht beeinflussen.     

Extensive surgical excision of large hemispheric “malignant” astrocytoma in a 6-week-old infant

A massive hemispheric high-grade astrocytoma, diagnosed in a 6-week-old infant, was totally excised by means of two craniotomies. The child is still alive and well with minimal neurological dysfunction 1.5 years after operation. This case report illustrates the benefit of aggressive surgical excision (without radiation or chemotherapy) of massive malignant neonatal astrocytomas. While surgical deficits may be minimized by the plasticity of the developing nervous system, extensive excision may yield occasional long-term palliation.     

Acute rectus sheath hematoma (differential diagnosis of acute abdomen)

The rectus sheath hematoma is a generally rare disease, however the frequency of occurrence has increased with introduction of anticoagulant therapy. It almost always mimics the symptoms of acute abdomen. In 7 out of 14 cases, which we observed, an anticoagulant therapy was administered. During this therapy 5 rectus sheath hematomas occurred spontaneously. In the remaining 2 patients severe coughing attacks were reported additionally. The case histories of the other 7 patients included 3 patients with bronchitis, 2 patients with trauma and 2 patients without a relevant history ("spontaneous"). The correct diagnosis of rectus sheath hematoma could primarily be revealed by sonography in 8 of 14 patients, after which an appropriate therapy followed. In 6 patients a laparotomy was performed, because rectus sheath hematoma was not considered. The correct diagnosis was found intraoperatively as a surprising assessment. By inclusion of rectus sheath hematoma in the differential diagnosis of acute abdomen and the verification by sonography an emergency laparotomy because of a false diagnosis in the often severe ill patients can be avoided in favour of a minor and more appropriate procedure.     

Quantifying the Ripple Effects of Civil War: How Armed Conflict Is Associated with More Severe Violence in the Home

Both the fields of public health and that of human rights seek to improve human well-being, including through reducing and preventing all forms of violence, to help individuals attain the highest quality of life. In both fields, mathematical methods can help “visibilize” the hidden architecture of violence, bringing new methods to bear to understand the scope and nuance of how violence affects populations. An increasing number of studies have examined how residing in a conflict-affected place may impact one of the most pervasive forms of violence—intimate partner violence (IPV)—during and after conflict. This paper contributes to this effort by examining whether severe forms of IPV are associated with previous experience of political violence in one conflict-affected country: Liberia. Our findings indicate that living in a district with conflict fatalities increased the risk of IPV among women by roughly 60%. Additionally, living in a district with conflict fatalities increased the risk of a past-year injury from IPV by 50%. This analysis brings to light links between two of the most pervasive forms of violence—political violence and violence against women. The findings suggest that women residing in a district that is more highly affected by conflict, not only people experiencing direct trauma during conflict, may be at risk of increased violence long after peace is declared. These findings point to the need for targeted programs that address IPV postconflict.     

The hidden competencies of healthcare: why self-esteem, accountability, and professionalism may affect hospital customer satisfaction scores

Data from 103 for-profit, nonprofit, and government-owned hospitals, spread across about half of the United States clearly show that there are common elements and several core competencies in all hospitals, some probably driven by JCAHO accreditation standards, but others coming from universal experience stemming from the changes in healthcare. The common competencies that are not, in my opinion, driven directly by the JCAHO standards include professionalism, accountability, self-esteem, customer service/focus, communication, information management/using data in decision making, and teamwork. There are several possible connections among the core competencies that suggest that the effects of accountability and possibly self-esteem on such outcomes as patient satisfaction and quality of care should be the subject of more research in healthcare settings. There are, however, several possible interventions to increase the core competency base of any hospital, which can be applied without this research. Executives and managers who attempt to measure and change these common competencies through selection, assessment, organizational system change, or reward and compensation systems will change the competence base of their workforce in critical areas needed in the future healthcare economy. Using a competence model incorporating these competencies may change the culture of the organization toward that which will be needed for survival in the twenty-first century.     

Endoscopic vs conventional hernia repair from an immunologic point of view

Background: In this study we tried to estimate the local surgical trauma in patients undergoing endoscopic or conventional hernia repair via the changes in peripheral blood T cell subpopulations (i.e., T-helper 1 (TH1) and TH2 cells), recently shown to be recruited differentially to inflammatory sites. Methods: Cells were identified flow-cytometrically by intracellular cytokine staining on a single cell level in 30 patients undergoing conventional (Shouldice) or total extraperitoneal patch (TEPP) hernia repair. Results: The TH1 cells decreased postoperatively in Shouldice patients on an average of 20.8–31.4%, whereas in TEPP patients only a minor decline (mean, 7.8–9.2%) was observed. The TH2 cells did not change significantly in TEPP patients, and a small increase (mean, 7.7%) was detected in Shouldice patients. Conclusions: Our results suggest that the postoperative reduction in TH1 cells reflects local surgical trauma and can be helpful in evaluating different surgical procedures. When conventional and endoscopic hernia repair were compared, the latter proved less traumatizing. Received: 18 March 1998/Accepted: 24 July 1998     

Hydronephrosis after aorto bifemoral graft surgery: a marker for late graft complications

Ureteral obstructions are serious late complications after aortoiliac reconstructive vascular surgery, which lead to loss of kidney function if they remain untreated. One case report serves to describe the incidence, aetiology, clinical presentation and treatment options of an obstructive uropathy following graft surgery. Hydronephrosis due to a ureteral obstruction is considered as a "marker" of graft complication. Therefore, ultrasound examination and close follow-up beyond 1 year are recommended in all patients who undergo aortoiliac surgery.     

Incidence of pertussis infection in healthcare workers.

OBJECTIVE: To determine the incidence of pertussis infection in two groups of healthcare workers. DESIGN: Retrospective cohort study. SETTING: 660-bed, urban, tertiary-care university hospital. PARTICIPANTS: 106 resident physicians and 39 emergency department employees. INTERVENTIONS: Antibodies to pertussis toxin and filamentous hemagglutinin were determined in fresh serum specimens and in stored sera collected 1 to 3 years previously. A 50% rise in both the pertussis toxin and filamentous hemagglutinin from the initial to the follow-up specimen was considered diagnostic of a pertussis infection. RESULTS: Two of 106 residents had serological evidence of a pertussis infection during 151.3 subject-observation years, for an annual incidence rate of 1.3% (95% confidence interval [CI95], 0%-3.5%). Three of 39 emergency department employees had serological evidence of a pertussis infection during 81.2 subject-observation years, for an annual incidence of 3.6% (CI95, 0%-9.6%). Of these 5 subjects, 2 had symptomatic disease. CONCLUSION: We found both symptomatic and asymptomatic pertussis infections in two cohorts of healthcare workers. Although the incidence rates were somewhat lower than found in other studies, they nonetheless were higher than for almost all other diseases for which we vaccinate healthcare workers. Our results would support the use of acellular pertussis vaccine in healthcare workers.     

244. Spätergebnisse der operativen Therapie der Luxationsfrakturen des oberen Sprunggelenkes

Zusammenfassung Von 1972–1979 wurden im Bergmannsheil Bochum 728 Malleolarfrakturen operativ behandelt. Zum Zeitpunkt der Metallentfernung (im Durchschnitt 6,8 Monate post op.) zeigten von 684 nachuntersuchten Patienten 534 (= 78%) ein gutes, 103 (=15%) ein befriedigendes und 47 (= 7%) ein unbefriedigendes funktionelles Ergebnis. Die Nachuntersuchung von 306 Patienten 3–8 Jahre post op. ergab in 235 (=77%) ein gutes, in 52 (= 17%) ein befriedigendes und in 19 Fällen (= 6%) ein unbefriedigendes Spätresultat.