Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Many patients undergoing thoracic surgery are treated with anticoagulants or platelet aggregation inhibitors because of different comorbidities. Additionally the risk of thromboembolic events is increased perioperatively; therefore, a perioperative thrombosis prophylaxis is necessary. On the other hand the risk of intraoperative or postoperative bleeding is increased because of the volume of the thoracic cavity and the partially negative intrathoracic pressure. ⋯ For the correct perioperative application of vitamin K antagonists, platelet aggregation inhibitors, new oral anticoagulants and drugs for thrombosis prophylaxis, it is of major importance to conceive an individual risk profile of thoracic surgery patients. However, there are not enough evidence-based data referring to the correct perioperative management for new oral anticoagulants.
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Habilitation defines the qualification to conduct self-contained university teaching and is the key for access to a professorship at German, Austrian and Swiss universities. Despite all changes implemented in the European higher education systems during the Bologna process, it is the highest qualification level issued through the process of an university examination and remains the core concept of scientific careers in these countries. In the field of medicine, this applies not only to scientific staff at the universities but also to those medical doctors aiming at a clinical career track. ⋯ Based on this data analysis, the authors discuss the related literature and describe five main distinguishing areas of habilitation guidelines in terms of the set of the formal and procedural framework as well as the prequalification and postqualification criteria imposed on habilitation candidates. There are therefore substantial differences in the organization of the habilitation for medicine.
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Review
[Intraoperative avoidance and recognition of recurrent laryngeal nerve palsy in thyroid surgery].
Recurrent laryngeal nerve palsy is an intrinsic complication of thyroid surgery. Prevention of nerve palsy is considered to be a feature of quality in this very frequently performed operation. ⋯ The use of intraoperative neuromonitoring allows preservation of the anatomical structure and functional integrity of the nerve and lesions which are not visible can be detected. Preconditions for correct interpretation are a standardized application and preoperative and postoperative laryngoscopy.
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Approximately 20 % of the population are affected by gastroesophageal reflux disease (GERD). The subjective clinical and objective pathological extent of the disease is highly variable and the underlying pathophysiological mechanisms extraordinarily diverse. ⋯ Currently, additional relevant pathophysiological cofactors are being detected with the continuous improvement in diagnostic methods and used for therapeutic decision-making. Despite standardization of the operative technique and increasing criticism on long-term proton pump inhibitor (PPI) therapy, antireflux surgery still requires a very critical assessment of indications based on a comprehensive diagnostic evaluation.
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The treatment of patients with aneurysms of the ascending aorta and aortic arch often represents a challenge due to their complexity. The clinical picture is characterized by further progression of the disease and severe complications, such as acute aortic dissection or even aortic rupture are not uncommon. ⋯ An aortic aneurysm of the ascending aorta is defined as a dilatation of all wall layers of the aorta of more than 50 % in comparison to the normal diameter. This is dependent on age, sex, body surface area and the underlying diseases. In most cases the cause is the presence of atherosclerosis. Connective tissue diseases, bicuspid or monocuspid aortic valves and aortitis represent additional risk factors. Surgical treatment of the ascending aorta, aortic root and aortic arch is carried out in patients without connective tissue diseases and a diameter of ≥ 55 mm and for patients with Marfan syndrome and bicuspid aortic valves with a diameter of ≥ 50 mm. Earlier indications for surgery are present with an aortic diameter of ≥ 45 mm in patients with the following risk factors: familial disposition for aortic dissection (often unrecognized as sudden cardiac death), annual growth rate of the aortic diameter of > 2 mm, comorbid severe aortic valve or mitral valve insufficiency and female patients with a desire to have children. The standard surgical procedures include aortic root replacement, aortic valve reconstruction with aortic root or ascending aorta replacement and partial or total aortic arch replacement depending on the extent of the aneurysm. The so-called hybrid procedures for aortic arch surgery include frozen elephant trunk (ET) techniques and debranching procedures. Good perioperative and postoperative results can be achieved by early diagnostics and an assessment of the indications depending on the individual etiology. Individual and valve-preserving treatment strategies have a favorable influence on the operative outcome.