Zentralblatt für Chirurgie
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The indication for operative or conservative treatment of the anterior cruciate ligament remains still difficult. Many years of intensive basic and clinical research and a better knowledge of biology, biomechanics and pathology have not been achieved standards of therapy. Therefore varying treatment options exist. ⋯ In all other types of ruptures only a reconstruction using autologous material (lig. patellae, semitendinosous tendon) is recommended. Rehabilitation after ACL ruptures depends on the method of treatment (conservative procedure, reconstruction material, fixation technique, associated lesions) and has to be adapted to the biological healing process. Normally an immobilisation (cast, orthesis) has no benefit for ligament healing.
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Biography Historical Article
[History of surgical instruments: 7. The first electrosurgical instruments: galvanic cauterization and electric cutting snare].
In 1854 the surgeon Albrecht Theodor Middeldorpf (1824-1868) published the first monography on the application of electrical current in surgical operations ("galvanocautery"). By galvanocautery Middeldorpf defined a procedure in which specially constructed parts of surgical instruments (usually thin platinum wires) were transformed into glowing heat by means of galvanic current from a zinc-platinum-battery. In this manner it was possible to perform dissection and destruction of tissue as well as coagulation of vessels for hemostasis. ⋯ The glowing platinum wire was later also applied as a light source of cystoscopes. Thus, galvanocautery enabled development of endoscopy. Modern diathermy with high-frequent alternating current was introduced in medicine by the Dermatologist Franz Nagelschmidt from Berlin.
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Randomized Controlled Trial
[Influence of laparoscopic or conventional colorectal resection on postoperative quality of life].
In a prospective randomised study the influence of the operative technique on postoperative quality of life was evaluated in 60 patients undergoing laparoscopic (n = 30) or conventional (n = 30) resection of colorectal tumors. Quality of life was assessed using the European Organisation for Research and Treatment of Cancer Quality of Life Core 30 Questionnaire (EORTC-QLQ-C30) before surgery as well as 1 week, 4 weeks and 3 months after surgery. Age, sex, sociological parameters, tumor characteristics and type of resection were comparable in both groups. ⋯ Pain, dyspnea and loss of appetite were more severe 1 week after conventional than laparoscopic surgery (each p < 0.05). There were no differences in quality of life in the further postoperative course. Laparoscopic resection of colorectal tumor is related with a better short-term quality of life than conventional resection, but a longer lasting effect of the laparoscopic technique on quality of life could not be detected with the EORTC-QLQ-C30.
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Review Case Reports
[Ethical challenges in preclinical emergency medicine].
Out-of-hospital emergency medicine, just like any other medical field, must be guided by general ethical principles of medical action. These include respecting the patient's autonomous decision, acting for his benefit, avoiding harm, and justice in distributing the available means. The confrontation with ethical conflicts in the routine of emergency medicine is illustrated by a case report. ⋯ Physiologically defined futility justifies the decision to withhold resuscitative efforts. In a particular case the refusal by the patient as well as an expected bad prognosis which is inconsistent with the patient's interest could support the emergency physician's decision not to initiate resuscitation. Such an individual decision should not only be guided by medical, but also by ethical considerations and be based on general ethical principles.
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We investigated the incidence of the recurrent laryngeal nerve (RLN) palsy after thyroid gland surgery in 725 cases. The incidence was correlated to the different diseases of the thyroid gland, to the operative procedure (subtotal resection, lobectomy, thyroidectomy), to the intraoperative exploration of the nerve and to the surgeons' state of training. RLN palsy was found in 7.6 per cent (4.8 per cent nerve at risk) five days after surgery. A permanent RLN damage was defined as a persisting paralysis of the vocal cord six months after surgery. Permanent nerve damage occurred in 2.1 per cent for euthyroid nodular goitre, for recurrent goitre in 11.7 per cent and for thyroid carcinoma in 10.1 per cent. There was a statistically significant difference between the number of RLN pareses occurring after nerve exposure with 4.2 per cent and that occurring after non-exposure with 1.1 per cent for subtotal lobectomy. 67.7 per cent of these pareses at day five were transient. The RLN palsy rate for Senior House Officers was 6.7 per cent but there where none for registrars and consultants. ⋯ The RLN damage five days after thyroid gland surgery is mainly caused by the great number of recurrent goitre and thyroid cancer (16.1 per cent), the rate of procedures performed by younger surgeons and the near total resection of euthyroid goitre. The exposure of RLN is important for the training to manage thyroid gland surgery.