Zentralblatt für Chirurgie
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Four thesis related to economics of intensive care medicine are derived from an analysis of the intensive care unit of the university hospital of Basel, Switzerland, and the respective literature: (1) Intensive care medicine is costly but rationing can be avoided by rationalization. (2) Exemption or withdrawal of intensive care cannot be justified in the absence of accurate predictors of costs and outcomes of individual patients. (3) Intensive care physicians must not act as judges but on behalf of patients incapable of decision making. They must represent patients' interests vis-à-vis authorities and reimbursing institutions. (4) Analyses of cost-efficiency are instrumental for process improvement of intensive care, for negotiations on reimbursement and for the regulatory decisions of the authorities. Tools for economic analyses of intensive care medicine are therefore worthy of further development.
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Comparative Study
[Role of adenosine triphosphate (ATP) in trauma-induced and elective hypothermia].
In trauma patients hypothermia is a frequent event. According to the literature the majority of trauma patients are presenting a core temperature of less than 34 degrees C at admission. In contrast to the benefit of hypothermia in elective surgery, clinical experience with hypothermia in trauma patients has identified hypothermia to be one major cause of severe posttraumatic complications. It was hypothetized that this diverse effect of hypothermia is related to depletion of high energy phosphates like adenosine-tri-phosphate (ATP) in trauma patients. To verify this hypothesis the relation of ATP plasma levels and hypothermia was examined in a clinical study. ⋯ Hypothermia in elective surgery, established by active cooling, preserves the ATP storage and maintains an aerobic metabolism, which both contribute to the beneficial effect of hypothermia in ischemia/reperfusion in cardiovascular surgery. However, in trauma patients hypothermia is caused by insufficient heat production due to utilization of ATP under anaerobic metabolic conditions. Low ATP plasma levels combined with hypothermia seem to be a predisposition for posttraumatic complications like organ failure.
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Biography Historical Article
[Rahel Hirsch (1870-1953). The first Prussian woman medical professor].
Dr. Rahel Hirsch was only the second woman to attain a professional medical position at the Charité Hospital in Berlin. For more than 16 years, she worked in Clinic II Internal Medicine. ⋯ Not permitted to practice in London, she underwent a serious crisis. When she died, she was impoverished. More than a decade later, she was posthumously admitted into the "Galerie of famous Jewish scientists." Her discovery, which had been so greatly criticized, was named after her.
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The application of temporary vena cava filters for the treatment of deep venous thrombosis of the lower extremity has become increasingly important in recent years. The filters are supposed to guarantee temporary protection from more extensive pulmonary embolism. ⋯ Because of possible complications such as the above, the indication for insertion of temporary vena cava filters requires thorough consideration. Their duration of stay should be as short as possible and should be limited to the high risk phase, not exceeding ten days.
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Postgraduate training in general surgery in Germany is regulated by state law and administrated by the Arztekammer. The formal conditions for the performance of the postgraduate training are published in the postgraduate regulations of the Arztekammer. ⋯ The above mentioned regulations will be presented in this article as well as the procedure that is applied by the Arztekammer Nordrhein to evaluate the accreditation of those people and organisations who are eligible to administer the postgraduate training. Further perspectives on the professional future of surgeons in Germany are addressing the background of a growing number of doctors who are facing the changing conditions of the legal framework within which they will have to work.