Zentralblatt für Chirurgie
-
Case Reports Webcasts
[Surgery of high-grade asymptomatic stenosis of the internal carotid artery].
Surgery of carotid artery stenosis is an evidence-based procedure. In Germany approximately 25 percent of the strokes are caused by arteriosclerotic processes in the extracranial internal carotid artery and are consequently potentially avoidable by an appropriate treatment. The symptoms, the stenosis degree as well as the perioperative risk represent the basis for the indication. The perioperative complication rate should be under 3 percent for those cases with asymptomatic stenoses and under 6 percent for those with symptomatic stenoses. ⋯ In the hands of experienced vascular surgeons, the open carotid TEA including patch graft and the eversion endarterectomy under regional anaesthesia represent highly effective procedures for symptomatic/asymptomatic carotid stenosis. The S3-guidelines for the therapy of carotid artery stenosis will be published this year and should be consulted for the interdisciplinary therapy decision.
-
Medical devices must be safe and functioning states the law. Treatments with medical devices need not be efficacious to be allowed. We investigated special requirements and problems arising from the law. ⋯ Large, high quality clinical studies of the efficacy of medical devices for treating anal incontinence are urgently needed. Only such studies enable health technology assessment and comprehensible decisions on reimbursement by health insurance.
-
Providing surgical treatment for patients colonised or infected with multidrug resistant organisms (MDROs) is daily routine in German hospitals. However, there is uncertainty about the application of adequate infection control measures in the OR. One of the reasons is that specific guidelines are not available. ⋯ Guidelines addressing perioperative infection control measures for patients harbouring MDROs should be developed with a focus on practicability to reduce both transmission of MDROs and unreasonable measures. Implementation of existing SOPs can be a target for optimisation.