Tracheostomy: a Multiprofessional Handbook. C. Russell and B. Matta (editors). Published by Cambridge University Press, Cambridge. Pp. 391; indexed; illustrated. Price {pound}19.50. ISBN 1-841-10152-4

Throughout most medical careers the practical aspects of dealingwith tracheostomies are an ignored but simultaneously fearedaspect of patient care. They are generally regarded as someoneelse's business, right up to the point when a disaster occurs.Even when the patient is breathless and needing help many healthpractitioners of all types fear to step in and execute     

Kniearthrodesen

When arthrodesis of the knee is indicated, the operative procedure selected for fixation depends on the condition of the soft tissues, the bone stock, whether infection is present, and the age of the patient and his or her capacity for partial weight-bearing. In young patients with no infection or soft tissue problems, when adequate bone stock is present compression plating or the use of an intramedullary nail is possible and allows stable fixation. Soft tissue problems with defect(s) or infection are a good indication for the use of an external fixator. The most common indication for knee arthrodesis is a failed total knee prosthesis that has become infected. Deficient bone stock with osteopenic bone or a defect after failed total knee arthroplasty are problems that can be solved by the use of modular fusion nail systems, especially in older patients. These systems are more comfortable for the patient than external fixation devices and allow early full weight-bearing.     

Komplikationen bei Densfrakturen

A distinction is made between intra- and postoperative complications. Intraoperative complications embrace incorrect repositioning, a poor overall view and injuries to organs in the neck (the carotic artery or the oesophagus). These can be avoided by precise repositioning preoperatively and adjustment of the dens in both planes with the aid of two image converters, and preoperative marking of the orientation of the screws. Postoperative complications can take the form of pseudoarthrosis and/or progressive myelopathy. Pseudarthrosis is stabilised with the aid of transarticular screw fixation after Magerl in combination with fusion using the Gallie or the Brooks technique. Progressive myelopathy frequently has its roots in inadequate repositioning resulting in restriction of the diameter of the spinal cord.     

Group versus individual treatment in obsessions without compulsions

The principal goal of the current study was to compare the efficacy of two treatment formats, group and individual, of an empirically proven manualized cognitive–behavioural treatment (CBT) package, for obsessions without overt compulsions. It was hypothesized that individualized treatment would be more effective both in terms of post-treatment group mean improvement and end state functioning. A secondary goal was to assess the relationship between cognitive and behavioural change during treatment and link it to symptom change. Both group and individual CBT format produced a significant clinical change, but as expected individual treatment produced the greater change in symptoms and in obsessional belief. Also, the individual format showed a clear superiority over the group format in the reduction of anxiety and depression. Severity of OCD symptoms showed little relationship with strength of obsessional beliefs at the start of treatment, but change in beliefs was strongly correlated with behavioural improvement post-treatment. The results of the study suggest that the impact of a group format may lie in the value of shared social support and motivational effect of peer feedback, but at the expense of individualized targets. Copyright © 2005 John Wiley & Sons, Ltd.     

Factors causing interrupted delivery of enteral nutrition in trauma intensive care unit patients.

BACKGROUND: The intent of this study was to ascertain the adequacy of delivery of enteral nutrition (EN) to critically ill adult multiple trauma patients and to identify potential detrimental factors that affect EN delivery. METHODS: Retrospective observational study. Trauma intensive care unit (TICU) in a university-affiliated hospital. Adult patients (>/=18 years of age) admitted to the TICU who received enteral feeding. RESULTS: Fifty-six adult patients were enrolled for study. Patients received, on average, 67% +/- 19% of what was prescribed for 5.7 +/- 2.0 days. A total of 222 occurrences for temporary discontinuation of tube feeding were identified. Gastrointestinal intolerance, as defined by a gastric residual volume of >150 mL, abdominal pain, or >3 liquid stools per day, accounted for only 11% of the occurrences for discontinuation of feeding. Surgery (27%) and diagnostic procedures (15%) represented the majority of reasons for inadequate nutrient delivery. Minor factors for EN interruptions were mechanical feeding tube problems (8%), pharmacy delivery delay (4%), and miscellaneous factors (3%). Multiple and unknown reasons contributed to 14% and 18% of the occurrences, respectively. CONCLUSIONS: Surgery and diagnostic procedures accounted for the largest factor in enteral feeding discontinuations in our critically ill trauma patients. Gastrointestinal intolerance contributed a minor role in the temporary discontinuation of enteral feeding.