Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
-
Olecranon and prepatellar bursitis have a prevalence of 3 in 1000 patients; the predominant etiology is a traumatic lesion with or without inoculation of infectious material, mainly during professional or leisure activities. Separation into septic and non-septic bursitis is possible in most cases according to clinical parameters and characteristics of the contents of the affected bursa. The therapy of acute and chronic bursitis is guided mainly by the nature of the aspirate retrieved from the bursa: a serous content justifies conservative treatment with compression, immobilization, antiphlogistic medication, and (in selected cases) the instillation of corticosteroids; a purulent aspirate necessitates bursotomy with incision and drainage, or bursectomy. Only in selected cases is a conservative trial with antibiotics, immobilization, and antiphlogistic medications justified.
-
Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
Review[Evaluation and quality management in multiple trauma care].
In total quality management of polytraumatised patients, it is necessary to use analysis of structure, process and outcome quality to search for problem areas and improvement possibilities. The structure includes the attributes of material and human resources. ⋯ To prove the outcome quality, an internal and external judgement is possible. Our own results show that quality assessment, concerning the process as well as the internal and external quality outcome, brings a significant improvement to the care of polytrauma patients.
-
Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
Review[Treatment of increased intracranial pressure in craniocerebral trauma].
The management of trauma patients with increased intracranial pressure is based on maintaining a normal "milieu interne", i.e. avoiding posttraumatic hypoxia and hypotension and applying specific treatment modalities, if indicated. If there are clinical signs of increased intracranial pressure or signs of cerebral edema in the CT scan, monitoring of intracranial pressure is indicated. ICP above 20 mmHg should be treated and the cerebral perfusion pressure should be maintained between 60 and 70 mmHg. Accepted treatment modalities of increased ICP are: 1) analgosedation, 2) head elevation, 3) hyperventilation, 4) osmotherapy, 5) barbiturate therapy, and 6) THAM (tris puffer).
-
Langenbecks Arch Chir Suppl Kongressbd · Jan 1992
Review[Thoracic injuries--when is use of the heart-lung machine necessary?].
Most patients with severe blunt or penetrating thoracic injuries die early after the accident (approximately 50%). The majority of those who reach an emergency department (approximately 80-85%) can therefore be treated initially with intensive observation (following drainage and/or intubation). If clinical deterioration due to continuous bleeding or progressive hemodynamic and respiratory problems occurs, however, urgent surgical intervention is indicated. Transfer of those critical patients to specialized hospitals often becomes dangerous because of time loss, and it is unnecessary as major equipment (e.g., extracorporeal circulation) is demanded only in the minority of operations.
-
Langenbecks Arch Chir Suppl Kongressbd · Jan 1992
Review[Surgical treatment of injuries of the upper cervical spine].
The surgical treatment of instabilities of the upper cervical spine requires the use of differentiated procedures if physiological anatomy is to be largely restored. Successful procedures are diagonal screw fixation of the axis from the anterolateral aspect in the case of odontoid fractures Anderson type II and III (high type), transpedicular screw osteosynthesis of C2 in hangman's fractures, and transarticular screw fixation of C1/2 with posterior fusion for atlantoaxial instabilities. In occipito-atlantal trauma occipitoatlantoaxial fusion is required.