Wiener medizinische Wochenschrift
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Wien Med Wochenschr · Nov 2020
Review[Modern thyroid surgery - the surgeon's endocrine-surgical understanding and his responsibility for the extent of surgery and complication rate].
High quality thyroid surgery implies a surgeon with an endocrine-surgical understanding aiming at best possible outcome. This includes an appropriate extent of the resection and a low rate of complications. It is important that the surgeon is involved at an early stage being part of the decision process for or against partial or total thyroidectomy. ⋯ Nowadays, permanent recurrent laryngeal nerve injury and postoperative hemorrhage rarely occur due to subtle surgical techniques. Extracervical surgical access to the thyroid is still a matter of clinical trials and should be restricted to centers. Radiofrequency ablation is an alternative method for benign lesions or hyperfunctioning nodules in patients with high surgical risk.
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Wien Med Wochenschr · May 2020
Review[Anesthesiological perspectives on perioperative management in continuous subcutaneous insulin infusion (CSII): stop or continue?]
Perioperative handling of insulin pumps (CSII) is inconsistent. The aims of this study were a literature search addressing this clinical question, analysis of data found and a proposal for perioperative management recommendations for clinical practice. ⋯ Growing evidence for improved patient outcome with perioperative CSII usage warrants interdisciplinary transfer of knowledge and experiences on intensified insulin therapy and patient empowerment.
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Although ketamine has been known and clinically applied for a long time, questions still arise around the many possible indications in which the anesthetic and analgesic substance could be used. In particular, these questions relate to new indications in which ketamine is used in low subanesthetic doses. ⋯ Possible applications include the prevention of chronic postoperative pain as well as the treatment of neuropathic pain. With the treatment of refractory depression completely new therapeutic areas for ketamine could be established.
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Wien Med Wochenschr · Mar 2019
Review[Reduction the risk in pediatric anesthesia-what should we know-what should we do].
Pediatric anesthesia has always been conjuncted with higher risk than anesthesia for adults (JP Morray; Pediatric Anesthesia 2011;21:722-9). Not only the imminent critical events, but also, caused by recently published data, the theoretical neurotoxicity of anesthetic agents and a potencial negative influence of anesthetics on braindevelopement, are in the spotlight. Concerns about the neurodevelopement and the general warnings from the U. ⋯ Food and Drug Administration (FDA) for anesthesia in young children led to a worldwide discussion about safety in pediatric anesthesia (FDA Safety Anouncement 2017). Beside these theoretical risks, which are based only on animal research, we have to pay much more attention to the widely spread out poor quality of anesthesia in children. The following article should summarize the state of science about the risks and the opportunities to minimize them.
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Changes in medical curricula have led to a shift of focus in medical education. The goal was to implement a more practical approach to teaching and thereby create better doctors. However, the question of what makes a good doctor is not easy to answer. ⋯ The different stakeholders showed different ideas of the concept of a good doctor. Interestingly, patients had a stronger focus on communication skills, whereas doctors put more emphasis on medical skills. Balancing this discrepancy will be a challenge for future medical education.