Zentralblatt für Chirurgie
-
The multiple organ dysfunction syndrome (MODS) with a mortality of 50% to 70% represents the number 1 cause of death in surgical intensive care units. It is divided in a primary and a secondary MODS based on time of manifestation and pathophysiological events which attribute to it. ⋯ The treatment of the secondary MODS remains supportive and its prevention is essential. Further studies have to be carried out to evaluate the clinical significance of new therapeutical agents such as monoclonal antibodies or cytokine receptor antagonists.
-
Though German hospitals are normally not built for day case surgery, this became a new challenge based on changed legal regulations. A stepwise adaptation of the present facilities to the altered necessities seems to be a relatively simple way to realise day case surgery also in hospitals. Preoperatively surgeons and anaesthetists offer office hours during the same time to avoid patients having to wait. ⋯ At a fixed time in the afternoon patients are visited by the surgeon and the anaesthetist to clear the conditions for dismission. While anaesthesia, surgery and recovery take the same time as for inpatients, the pre- and postoperative procedures are more time consuming. With a rising number of outpatients a separate department for outpatient surgery with its own administration, operating theaters and day case ward should be developed.
-
In the Department of Traumatology and Reconstructive Surgery of Steglitz Medical Center, Berlin, a total of 1,323 patients with proximal femoral fractures were treated between 1978 and 1992. 988 patients were female and 335 male, age range 18-99 years, mean age 74 years. 479 fractures were classified as medial femoral neck fractures and 205 as lateral femoral neck fractures, further 461 pertrochanteric and 178 subtrochanteric fractures were seen. Based upon computerized data--especially regarding lethality and complication rates--the evolution of fracture treatment is outlined. ⋯ In older patients with medial femoral neck fractures the therapeutic standard today is the bipolar prosthesis, in younger patients osteosynthesis. In lateral femoral neck fractures as well as pertrochanteric fractures the most suitable osteosynthesis is the DHS, in subtrochanteric fractures the condylar plate. Whenever possible osteosynthesis should be preferred to total hip arthroplasty if patient condition and hip joint integrity allow this treatment. The more stable and biological procedure of osteosynthesis should be preferred.
-
Cerebral lesions of variable severity lead to systemic and intracranial reactions. These create secondary brain damage due to hypoxia and ischemia. The causes as well as the sequelae of secondary brain damage necessitate long-term intensive care treatment with high technical and personal expenditure. ⋯ The decision to limit treatment should be based on the numerous national and international statistical models and discussed on an individual basis, excluding even a 5% chance of survival. Early information of the family on the probable prognosis is useful. Their participation in the process of decision can be assessed only on an individual basis.
-
In contrast to earlier classifications, Tile's classification of pelvic ring disruptions considers mechanism of injury, clinical and x-ray evaluations and is therefore almost universally accepted. We propose a more comprehensive classification which gives a guide for treatment of these complex injuries. Moreover it can be used to compare results from different authors. ⋯ The location of injury is indicated by adding numbers 1-9 (1: rupture of symphysis pubis; 2: transpubic fracture; 3: acetabular fracture; 4: iliac wing fracture; 5: sacroiliac fracture-dislocation; 6: sacroiliac disruption; 7: sacral wing fracture; 8: transforaminal sacral fracture; 9: central sacral fracture). These numbers are arranged in increasing order, one hemipelvis after the other. Thus, in case of a complex pelvic injury with rotational instability on one side and vertical instability on the other each hemipelvis may be classified separately.