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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Review
[Dislocation fractures in the area of the middle foot--injuries of the Chopart and Lisfranc joint].
Dislocation fractures of the Chopart and Lisfranc joint line result from rough force and lead to articular incongruities, complex derangement of the plantar arc geometry and shortening of the medial or lateral column of the foot. These injuries are often complicated by severe soft tissue damage causing a high incidence of compartment syndrome. Beside careful clinical examination radiographs in 3 standard projections are essential for the exact diagnosis, if necessary completed by conventional tomographies or CT. ⋯ Dislocation-fractures of the Lisfranc joint can be fixed by percutaneous K-wires if a closed reduction is possible. Open reduction and internal fixation are indicated in cases of instable and irresponsible fractures, and in open fractures as well as in lesions presenting with a compartment syndrome. A precise anatomic reduction of the tarsometatarsal joints is critical after this kind of injuries to avoid long-term disability.
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Like other industrial countries Germany experiences a significant increase of cancer prevalence. Recent advances in the treatment of various types of cancer resulted in prolonged survivaltimes of patients. Cancer--especially in advanced incurable stages--often is accompanied by severe pain. ⋯ Most cancer-patients should experience sufficient pain-management if existing recommendations for the pharmacological treatment of cancer-pain (e.g. WHO-guidelines) are followed consequently. In case of intractable pain or ongoing disabling symptoms despite proper therapy consultation of an expert in palliative medicine should always be considered as well as the option to refer the patient to a specialized pain-management center.
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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.