Einfach und praktisch: rechtliche Grundlagen und Verhalten an Einsatzorten mit Verstorbenen

Notfall + Rettungsmedizin -     

CT of hemangiomas of the upper airways in children

OBJECTIVE: Hemangiomas of the airways in infants are commonly diagnosed at bronchoscopy performed for the investigation of stridor or other respiratory symptoms. Occasionally on bronchoscopy the appearances are atypical or the entire extent of the suspected hemangioma cannot be appreciated. We report on the clinical usefulness of dynamic contrast-enhanced CT in the evaluation of suspected hemangiomas of the airways in infants. CT findings of 11 infants who underwent investigation for a suspected airway hemangioma were correlated with bronchoscopic findings. CONCLUSION: Dynamic contrast-enhanced CT is a valuable noninvasive method for the evaluation of airway hemangiomas. Although it can be used to confirm the diagnosis in patients with equivocal findings on bronchoscopy, we believe that CT findings are specific enough that CT can be recommended as the primary method of establishing the diagnosis. Multiplanar reconstructions illustrate the location, extent, and degree of luminal narrowing and any involvement of adjacent tissues.     

Chronisch fibrosierende (sklerosierende) Peritonitis als Ursache des „plötzlichen“ Todes

We report a case of a 43-year-old male who died suddenly of sclerosing encapsulating peritonitis (SEP) after a short interval of acute abdominal pain and vomiting. He was diagnosed HIV-positive 10 years prior to death. Only one case of HIV-associated SEP has been reported in the literature. The cause of death was unclear until autopsy where small bowel obstruction and mechanical ileus due to an adhesive process, encapsulating the jejunum and ileum was discovered. Histological examination led to the diagnosis of peritonitis chronica fibrosa incapsulata, or sclerosing encapsulating peritonitis. The etiology of this disease remains unknown but the occurrence is associated with abdominal operations, inflammatory processes of the peritoneum and several drugs. The causes of sclerosing mesenteritis as well as the treatment with mostly immunosuppressive drugs is discussed. Prognosis differs and in this case it is remarkable that SEP evolved despite immunological deficiency due to HIV and medical treatment. Under full retroviral therapy with a low virus count, the man died a few weeks after the first symptoms of ileus caused by sclerosing encapsulating peritonitis.     

Einfach und praktisch: Feststellung des Todes

Notfall + Rettungsmedizin -     

Einfach und praktisch: Durchführung der Leichenschau und Ausfüllen der Todesbescheinigung

Notfall + Rettungsmedizin -     

Invisible scar endoscopic thyroidectomy by the dorsal approach: experimental development of a new technique with human cadavers and preliminary clinical results

Background A unilateral gasless single-surgeon videoendoscopic thyroidectomy procedure using a dorsal cephalic approach from the scalp with the option for a bilateral approach was developed with human cadavers and a porcine model for access training. The final preclinical trials and the first three clinical cases are described in detail. Methods Preclinical evaluation and training for the procedure were conducted with fresh human cadavers. The procedure was defined precisely by a sequence of nodal points initiating surgical steps. A quality score was developed by issuing each important anatomic structure a specific organ value and a factor for positive identification, inability to identify a given anatomic structure, spare it (meaning omit causing a lesion) or injure the structure. The quality of each operation was expressed as a single number or quality score value, calculated by summing the points achieved for the individual anatomic structures. The results of the procedures were controlled by prospective video documentation and autopsy. After conclusion of the preclinical training, the operation was performed for patients. The reported patients are part of a feasibility study approved by the institutional review board of the University of Munich. Results Nodal points were helpful in preparation for the operation by mental training. During the procedure, they helped to guide the preparation in the neck, where the working space must first be created on the way to the target organ. The surgical quality score improved over the first three cases and reached the maximum score, which was reproducible every time after that. It showed that the dorsal approach from the scalp to the thyroid gland is easily achievable without complications. The technical challenge is exposure of the recurrent laryngeal nerve (RLN) and the parathyroid glands. There was no difference between the results achieved by the resident and the senior surgeon. Preclinical training was good preparation for hemithyroidectomy in patients. All cases could be managed without postoperative hemorrhage or impairment of the parathyroid or the RLN. Conclusions Videoendoscopic thyroidectomy by the dorsal approach is feasible in both human cadavers and patients. It leaves no visible scars. Nodal points are helpful for executing a new operation. The surgical quality score is a complex and objective measure of ability to deal with the procedure. Further clinical studies are required for evaluation of this new procedure.     

Das neue deutsche Gewebegesetz unter Berücksichtigung des TPG-Gewebeverordnungsentwurfs hinsichtlich praktischer Umsetzung der postmortalen Gewebespende

Background

In the course of the European guidelines (2004/23/EC, 2006/17/EC and 2006/86/EC) and necessary subsequent corrections, a new law on tissue donation and retrieval for the purpose of transplantation was implemented in the German legislation in May 2007. The law came into force on August 1st 2007. The law regulates safety and quality standards for the donation, retrieval, storing and distribution of human tissues and cells. In anticipation of this new tissue law, the Institute for Legal Medicine (I.f.R.) of the University Medical Center Hamburg-Eppendorf developed the model for a tissue retrieval unit in 2006 already.

Methods

The I.f.R. developed, in collaboration with the German Institute of Cell and Tissue Replacement (Deutsches Institut für Zell- und Gewebeersatz DIZG); a model allowing for identification of potential Post Mortem Tissue Donors (PMTD) among deceased applying defined criteria. The procedure is supplemented by the intended exclusion criteria of the tissue regulation draft (TPG GewV) in accordance with the European guideline (2006/17/EC).

Results

In 14% of deceased eligible for PMTD tissue donation was effectuated thanks to the application of the criteria. The retrieved tissue was then sent to the DIZG, a non-profit tissue bank with a licence for further processing. This final processing into transplantable tissue then resulted in the allocation to hospitals in Germany and other EU countries.

Discussion

Our results up to now show a relatively small number of PMTD in comparison to the big amount of deceased within the Hamburg area. The aim of the model developed by the I.f.R. is to increase the PMTD and to avoid any conflict of interest between organ donation and tissue donation.