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  • 1
    Electronic Resource
    Electronic Resource
    Laparoscopic colectomy compares favorably with colectomy by laparotomy for reduction of postoperative ileus (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 61-65 
    Details
    ISSN: 1530-0358
    Keywords: Laparoscopic colectomy ; Laparotomy ; Postoperative ileus ; Complications ; Nasogastric tube ; Colectomy ; Colorectal surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to compare the length of postoperative ileus in patients undergoing colectomy by either laparotomy or laparoscopy. METHODS: A total of 166 patients were studied. These patients were divided into two groups: Group 1, in which colectomy was done laparoscopically, and Group 2, consisting of patients undergoing laparotomy. Both groups contained 83 patients who were matched for disease severity, indications for surgery, and procedure. Indications for surgery included sigmoid diverticulitis in 12 (14 percent) patients, polyps in 22 (27 percent), Crohn's disease in 21 (25 percent), colorectal cancer in 11 (13 percent), stoma reversal in 8 (10 percent), rectal prolapse in 3 (4 percent), and other indications in 6 (7 percent) in each group. Operations were colectomy with anastomosis (42 ileocolic, 26 colorectal, 6 colocolic, 4 ileorectal, and 2 ileal J pouch) or without anastomosis (3 abdominoperineal resections) performed by the same surgeons during the same time period (January 1993 to October 1996). The nasogastric tube was removed from all patients immediately after surgery in both groups. All patients received a clear liquid diet on the first postoperative day, followed by a regular diet as tolerated. The nasogastric tube was reinserted if two or more episodes of emesis of more than 200 ml occurred in the absence of bowel movement. Patients were discharged from the hospital when tolerating a regular diet without evidence of ileus. Statistical analysis was performed using unpairedt-test and Fisher's exact probability test. RESULTS: The male-to-female ratio was 38 to 45 in both groups. A total of 10 (12 percent) and 23 (28 percent) patients in Group 1 and Group 2 had emesis (P=0.02), and the rate of nasogastric tube reinsertion was 5 (6 percent) and 13 (16 percent), respectively (P〉0.05). There were significant differences between Groups 1 and 2 relative to the lengths of ileus (3.5±1.3vs. 5.4±1.7 days, respectively;P〈0.001), hospitalization (6.6±3.3vs. 8.1±2.5 days, respectively;P〈0.002), and operative time (170±60vs. 114±46 minutes, respectively;P〈0.001). The morbidity rate was 16 (19.2 percent) and 18 (21.6 percent) in the laparoscopy and laparotomy groups, respectively. CONCLUSIONS: Although early oral intake is safe and can be tolerated by 84 percent of patients after colectomy by laparotomy, laparoscopic colectomy reduced the lengths of both postoperative ileus and hospitalization.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237245
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  • 2
    Electronic Resource
    Electronic Resource
    Closedvs. open hemorrhoidectomy—Is there any difference? (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 31-34 
    Details
    ISSN: 1530-0358
    Keywords: Hemorrhoidectomy ; Postoperative pain ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to compare closed (Ferguson) hemorrhoidectomy to open (Milligan-Morgan) hemorrhoidectomy regarding postoperative conditions, complications, and long-term results. METHOD: This was a randomized study of 77 patients with second-degree or third-degree hemorrhoids suitable for hemorrhoidectomy. In 39 patients the Milligan-Morgan procedure was used, and in 38 patients the Ferguson procedure was used. Details of operations, postoperative complications, and length of postoperative stay were recorded. Pain was assessed from a visual analog scale and by registration of postoperative analgesic medication. Follow-up was done at three weeks, six weeks, and by visit or telephone interview after at least a year. RESULTS: No statistically significant differences were found between the two methods regarding complications, pain, or postoperative stay. There were four reoperations for bleeding, all after Milligan-Morgan operations. At follow-up after three weeks 86 percent of the Ferguson patients had completely healed wounds, and none had signs of infection. Of the Milligan-Morgan patients, only 18 percent had completely healed wounds, and symptoms of delayed wound healing were significantly more frequent. One patient had a superficial wound infection. After one year more than 10 percent in each group had recurrent hemorrhoids with symptoms. CONCLUSION: Both methods are fairly efficient treatment for hemorrhoids, without serious draw-backs. The closed method has no advantage in postoperative pain reduction, but wounds heal faster, and the risk of wound dehiscence seems exaggerated.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237240
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  • 3
    Electronic Resource
    Electronic Resource
    Audit of single-stage proctocolectomy for Crohn's disease (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 249-256 
    Details
    ISSN: 1530-0358
    Keywords: Single-stage proctocolectomy ; Crohn's disease ; Complications ; Delayed perineal wound healing ; Stomal complications ; Long-term results ; Recurrence ; Risk factor for recurrence
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study was undertaken to review our overall experience of single-stage proctocolectomy for Crohn's disease. METHODS: One hundred three patients who underwent single-stage proctocolectomy for Crohn's disease between 1958 and 1997 were reviewed. Factors affecting the incidence of recurrence were examined using a multivariate analysis. RESULTS: Principal indications for proctocolectomy were chronic colitis (49 percent), acute colitis (37 percent), and anorectal disease (14 percent). The commonest postoperative complication was delayed perineal wound healing (n=36; 35 percent), followed by intra-abdominal sepsis (17 percent) and stomal complications (15 percent). In 23 patients the perineal wound healed between three and six months after proctocolectomy, whereas in 13 patients the wound remained unhealed for more than six months. There were two hospital deaths (2 percent) caused by sepsis. The 5-year, 10-year, and 15-year cumulative reoperation rates for small-bowel recurrence were 13, 17, and 25 percent, respectively, after a median follow-up of 18.6 years. From a multivariate analysis, factors affecting reoperation rate for recurrence were gender (male; hazard ratio 2.4vs. female;P=0.03) and age at operation (≤30 years; hazard ratio 2.6vs. 〉30 years;P=0.04). The following factors did not affect the reoperation rate: duration of symptoms, smoking habits, associated perforating disease, coexisting small-bowel disease, postoperative complications, and medical treatment. CONCLUSIONS: Proctocolectomy for Crohn's disease is associated with a high incidence of complications, particularly delayed perineal wound healing. Proctocolectomy carries a low recurrence rate in the long term. However, young male patients are at high risk of recurrence.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236990
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  • 4
    Electronic Resource
    Electronic Resource
    Femoral neuropathy: An infrequently reported postoperative complication (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 419-422 
    Details
    ISSN: 1530-0358
    Keywords: Neuropathy ; Femoral nerve ; Colectomy ; Complications ; Retractors
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Postoperative femoral neuropathy is an uncommon complication of abdominal surgery. We present four cases occurring after colectomy at our institution and discuss the diagnosis and treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02258312
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  • 5
    Electronic Resource
    Electronic Resource
    Safety and efficacy of dynamic graciloplasty for fecal incontinence (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 743-751 
    Details
    ISSN: 1530-0358
    Keywords: Fecal incontinence ; Dynamic graciloplasty ; Neurostimulation ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Dynamic graciloplasty has been used for intractable fecal incontinence, and good results have been reported. The aim of this study was to assess prospectively the safety and efficacy of dynamic graciloplasty for intractable fecal incontinence in a prospective, multicenter trial. METHODS: A total of 123 adults were treated with dynamic graciloplasty at 20 institutions. Continence was assessed preoperatively and postoperatively by use of 14-day diaries. RESULTS: There was one treatment-related death. One hundred eighty-nine adverse events occurred in 91 patients (74 percent). Forty-nine patients (40 percent) required one or more operations to treat complications. One hundred seventy (90 percent) events were resolved. Sixty-three percent of patients without pre-existing stomas recorded a 50 percent or greater decrease in incontinent events 12 months after dynamic graciloplasty, and an additional 11 percent experienced lesser degrees of improvement. Twenty-six percent were not improved, worsened, or exited. In patients with pre-existing stomas, 33 percent achieved successful outcomes at 12 months. This number increased to 60 percent at 18 months. Seventy-eight percent of patients had increased enema retention time, and mean anal canal pressures improved significantly at 12 months. Significant changes in quality of life were also observed. CONCLUSIONS: Objective improvement can be demonstrated in the majority of patients with end-stage fecal incontinence treated with dynamic graciloplasty. Reduction in incontinence episodes can be correlated with improved quality of life. Adverse events are frequently encountered, but most resolve with treatment.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02238008
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  • 6
    Electronic Resource
    Electronic Resource
    A Prospective Analysis of the Cephalic Vein Cutdown Approach for Chronic Indwelling Central Venous Access in 100 Consecutive Cancer Patients (2000)
    Springer
    Annals of surgical oncology 7 (2000), S. 496-502 
    Details
    ISSN: 1534-4681
    Keywords: Cephalic vein ; Subclavian vein ; Central venous access ; Implanted port ; Tunneled catheter ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Chronic indwelling central venous access devices (CICVAD) generally are placed by the percutaneous subclavian vein approach. The cephalic vein cutdown approach is used only infrequently. Although the technique has been well described, few prospective data are available on the cephalic vein cutdown approach. Methods: From September 9, 1998, to July 20, 1999, the cephalic vein cutdown approach was attempted in 100 consecutive cancer patients taken to the operating room with the intention of placing CICVAD. Median patient age was 54.5 years (range 18–88), with 46 men and 54 women. Twenty-five patients had gastrointestinal malignancies, 17 had breast cancer, 15 had lymphoma, 13 had lung cancer, 12 had leukemia, 5 had multiple myeloma, and 13 had other malignancies. Patients were followed prospectively for immediate and long-term outcome. Results: CICVAD placement via the cephalic vein cutdown approach was successful in 82 patients; the remaining 18 patients required conversion to a percutaneous subclavian vein approach. The reasons for inability to place CICVAD via cephalic vein cutdown approach were a cephalic vein that was too small (10 patients), an absent cephalic vein (7 patients), and inability to traverse the angle of insertion of the cephalic vein into the subclavian vein (1 patient). There were 56 subcutaneous ports and 26 tunneled catheters. Median operating time was 44 minutes (range, 26–79 minutes). No postoperative pneumothorax occurred. Median catheter duration was 198 days (range, 0–513 days). Long-term complications included catheter-related bacteremia (6%), site infection (2%), deep venous thrombosis (5%), port pocket hematoma (1%), and superior vena cava stricture (1%). Thirty-seven percent of patients have died since CICVAD placement. Twenty-nine percent of the CICVADs have been removed. Conclusions: The cephalic vein cutdown approach was successful in 82% of patients. This approach is a safe and useful alternative to the percutaneous subclavian vein approach.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-000-0496-9
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  • 7
    Electronic Resource
    Electronic Resource
    Use of a gracilis muscle flap to facilitate delayed ileal pouch-anal anastomosis (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1628-1631 
    Details
    ISSN: 1530-0358
    Keywords: Gracilis muscle flap ; Ileal pouch-anal anastomosis ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Failure of an ileal pouch-anal anastomosis may result in unsuccessful completion of the anastomosis or removal of an ischemic pouch. We report a technique for preservation of the muscular wall of the rectum after mucosal dissection, which allowed a successful delayed pull-through.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236752
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  • 8
    Electronic Resource
    Electronic Resource
    Effect of previous surgery on abdominal opening time (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1749-1753 
    Details
    ISSN: 1530-0358
    Keywords: Adhesions ; Operative technique ; Complications ; Economics
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The purpose of this study was to document prospectively the time required to gain access to the abdomen to perform a planned procedure in patients with and without previous surgery. METHODS: Patients were obtained from the consecutive cases of 11 surgeons at three colorectal surgery centers. Opening time (skin incision to retractor placement) was measured and recorded in the operating room by the circulating nurse or by an independent researcher. Demographic data including the number and type of previous operations and the presence and severity of adhesions were recorded by the staff surgeon. A comparison of opening times between patients with and without previous abdominal operations was conducted. RESULTS: One hundred ninety-eight patients had abdominal operations. Fifty-five percent had previous abdominal procedures. Patients with prior surgery required a mean of 21 minutes to open their abdomens, whereas patients without prior surgery required a mean of 6 minutes (P〈0.01). The median times were 17 and 6 minutes, respectively. Eighty-three percent of patients with prior surgery had adhesions, whereas only 7 percent of patients had adhesions on their initial operation. Patients with prior surgery also had higher grade adhesions (P〈0.001). Irrespective of previous surgery, comparing patients with adhesions with those without, patients with adhesions required a mean of 22 minutes to open, whereas the lack of adhesions resulted in a mean opening time of 6 minutes. CONCLUSIONS: Previous surgery and the presence of adhesions add significant time to opening the abdomen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236862
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  • 9
    Electronic Resource
    Electronic Resource
    Lumbar osteomyelitis and epidural abscess complicating recurrent pilonidal cyst (2000)
    Springer
    Diseases of the colon & rectum 43 (2000), S. 1015-1017 
    Details
    ISSN: 1530-0358
    Keywords: Pilonidal cyst ; Lumbar osteomyelis ; Epidural abscess ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: This study was conducted to report the rare presentation of lumbar osteomyelitis and epidural abscess as a complication of a pilonidal cyst. METHODS: A case report is presented. RESULTS: We describe the rare case of a male patient with diabetes with a recurring pilonidal cyst who developed a lumbar osteomyelitis and epidural abscess three weeks after pilonidal cyst excision with epidural anesthesia, with a fatal outcome despite emergency treatment. CONCLUSIONS: Life-threatening complications should be kept in mind in high-risk patients with repetitive surgery and neurologic involvement.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237370
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  • 10
    Electronic Resource
    Electronic Resource
    Erfahrungen mit der Osteosynthese bei Fersenbeinfrakturen (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S442 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Intraartikuläre Fersenbeinfraktur ; Klassifikation ; Weichteilschaden ; Komplikationen ; Ergebnisse ; Keywords Intraarticular calcaneal fracture ; Classification ; Soft tissue lesions ; Complications ; Results
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Even now, the diagnosis of a dislocated intraarticular calcaneal fracture means a handicap for many patients. A bilateral fracture usually means the end of professional life – especially in the case of any job involving physical work. Because the functional outcome after an intraarticular calcaneal fracture is determined by the degree to which restoration of the different articular surfaces, and of the height, length and width of the affected calcaneus is achieved, operative treatment has become much more frequent in recent years. Discussion continues on the operative treatment of high comminuted fractures. The available studies are not comparable, differing as they do in the classification systems and criteria of outcome used and the postoperative check-up schedules followed. Despite some progress towards standardization of the operative procedure in the last 10 years, especially with respect to soft tissue treatment and the types of implants used, several questions remain to be answered. Our own experience is reported.
    Notes: Zusammenfassung Die Diagnose einer intraartikulären dislozierten Fersenbeinfraktur bedeutet auch heute noch für viele Patienten eine Einschränkung der künftigen Belastbarkeit, bei beidseitiger Betroffenheit in der Regel das Ausscheiden aus einem körperlich belasteten Beruf. Da sich das funktionelle Ergebnis der Fersenbeinfraktur im Wesentlichen durch die Wiederherstellung der Gelenkflächen, Höhe, Länge und Breite sowie Achsen des Fersenbeins beeinflussen lässt, hat die operative Rekonstruktion in den letzten Jahren deutlich zugenommen. Die Diskussion über die operative Versorgung von Fersenbeinfrakturen ist insbesondere bei Trümmerfrakturen noch nicht als abgeschlossen zu betrachten. Die vorliegende Fülle von Studien ist bezüglich der Klassifikation, der Nachuntersuchungskriterien und der Nachuntersuchungszeiträume nur schwer zu vergleichen. Trotz einer seit nun mehr als über einem Jahrzehnt perfektionierten und zunehmend standardisierten Operationstechnik bleiben noch viele Fragen zu beantworten. Über Schwierigkeiten bei der operativen Versorgung wird berichtet.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014967
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  • 11
    Electronic Resource
    Electronic Resource
    Aktuelle Behandlungsstrategien bei distalen Unterarmfrakturen (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S205 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Distale Unterarmfrakturen ; Konservative Therapie ; Operative Therapie ; Risiken ; Komplikationen ; Keywords Distal fractures of lower arm ; Conservative therapy ; Operative therapy ; Risks ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The treatment of distal fractures of the lower arm can be conservative or operative. The immediate aims of any treatment are anatomical realignment and the avoidance of trophic impairments, with the ultimate objective of unrestricted function of the hand and wrist. A graduated treatment scheme based on the ASIF classification is necessary to do justice to the different forms of fracture that can occur. The majority of injuries can still be successfully treated by conservative means; operative treatment becomes more important when there are signs of unusually high levels of instability or joint involvement. The authors’ own patient population is presented in this paper: in these patients fixation with Kirschner wires has proved to be the most successful of the operative procedures used, followed by palmar plate fixation with or without cancellous bone plasty, and for C-type fractures according to the ASIF classification or when there ¶is severe soft-tissue damage, application of ¶a fixateur externe spanning the joint has proved best. Treatment strategy, risks, complications and results are presented.
    Notes: Zusammenfassung Die Behandlung distaler Unterarmfrakturen kann konservativ oder operativ erfolgen. Ziel jeder Behandlung sind die anatomische Reposition und Retention sowie die Vermeidung trophischer Störungen mit dem Fernziel einer unbeeinträchtigten Funktion der Hand und des Handgelenks. In Anlehnung an die AO-Klassifikation ist ein stufenförmiges Behandlungsschema notwendig, um den verschiedenen Frakturformen gerecht zu werden. Ein Großteil der Verletzungen kann nach wie vor erfolgreich konservativ behandelt werden, bei Zeichen einer erhöhten Instabilität oder einer Gelenkbeteiligung rückt die operative Behandlung zunehmend in den Vordergrund. Im eigenen, dargestellten Krankengut hat sich bei den operativen Verfahren schwerpunktmäßig die Kirschner-Draht-Osteosynthese bewährt, nachfolgend die palmare Plattenosteosynthese mit oder ohne Spongiosaplastik und bei Frakturen der C-Typen nach AO und bei höhergradigem Weichteilschaden die gelenkübergreifende Fixateur-externe-Anordnung. Behandlungsstrategie, Risiken, Komplikationen und Ergebnisse werden dargestellt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014888
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  • 12
    Electronic Resource
    Electronic Resource
    Spezielle Probleme bei Wirbelfrakturen mit Querschnittlähmung (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S500 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Hoffnung ; Selbstständigkeit ; Komplikationen ; Gangschulung ; Keywords Hope ; Independence ; Complications ; Mobility training
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract In the treatment of paraplegic patients ¶there is a definite discrepancy between the ideas and wishes of the patients and the approaches and objectives of the physiotherapists. The greatest concern of the person affected is recovery of the ability to walk, while the main emphases of physiotherapy primarily involve avoiding complications of paralysis and achieving the highest possible degree of independence. One aid used in teaching partially paralysed patients to walk again is the walking belt, which complements the neurophysiological treatment methods very well. Mobility training with completely paralysed patients is obviously restricted owing to the lack of function. Sources of problems include relapsing shoulder pain and marked spasticity, which limit the results that can be achieved by way of rehabilitation medicine. With the support of an electronic measuring system the threat of pressure sores can be successfully combated.
    Notes: Zusammenfassung In der Behandlung Querschnittgelähmter besteht zwischen den Vorstellungen und Wünschen der Patienten und den Gesichtspunkten und Zielen der Physiotherapie eine deutliche Diskrepanz. Der Betroffene erhofft sich v. a. das Wiedererlangen seiner Gehfähigkeit, die Schwerpunkte der Physiotherapie liegen in erster Linie auf der Vermeidung lähmungsbedingter Komplikationen und dem Erreichen maximaler Selbstständigkeit. Gangschulung wird bei inkomplett Gelähmten u. a. mit Hilfe des Laufbands durchgeführt, das eine hervorragende Ergänzung der neurophysiologischen Behandlungstechniken darstellt. Das Gehtraining mit komplett Gelähmten reduziert sich naturgemäß aus Mangel an funktionellen Einsatzmöglichkeiten. Unter anderem können rezidivierende Schulterschmerzen und starke Spastik Probleme darstellen und sich limitierend auf das Rehabilitationsergebnis auswirken. Der Dekubitusgefahr wird, unterstützt durch ein elektronisches Messsystem, erfolgreich entgegengewirkt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014982
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  • 13
    Electronic Resource
    Electronic Resource
    Management intraoperativer Komplikationen bei der Applikation stentgestützter Aortenprothesen (2000)
    Springer
    Gefässchirurgie 5 (2000), S. 232-240 
    Details
    ISSN: 1434-3932
    Keywords: Schlüsselwörter Endovaskuläre Operationen ; Stents ; Aortenstentprothese ; Bauchaortenaneurysma ; Komplikationen ; Keywords Endovascular surgery ; Stents ; Aortic stent prostheses ; Aneurysm ; Abdominal aorta ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract  Intraoperative complications can be divided into three categories on the basis of the time of their occurrence: Group I – Problems associated with access; group II: introduction of the endovascular stent (a: release of the main segment, b: anchoring the second limb); and group III: incidence of primary endoleaks. The objective of the present study was to describe the management of these complications. In a group of 130 patients undergoing endovascular treatment of aneurysms of the abdominal aorta, a total of 31 complications occurred in 26 patients (20.0%). The most frequently encountered complication in each group and its respective management was as follows: Group I: Correction was performed using dilatation and retroperitoneal stretching as well as surgical shortening of the external iliac artery with interposition; group IIa: overstenting the renal arteries was corrected either by conversion or tugging at the endograft; group IIb: the guide wire or docking system could not be placed. Such cases were managed either through conversion or use of fresh systems; group III: such complications were treated with repeated stent placement, postoperative coil embolizations, or conversion. The endovascular therapy of aortic aneurysms is associated with intraoperative complications in 20% of cases. Adequate management helps to keep both morbidity and mortality rates low.
    Notes: Zusammenfassung  Intraoperative Komplikationen können je nach Zeitpunkt des Ereignisses in 3 Gruppen definiert werden: Gruppe I – Zugangsprobleme, Gruppe II – Einbringen des endovaskulären Stents (a: Absetzen des Hauptteils, b: Andocken des 2. Schenkels), Gruppe III – Inzidenz primärer Endoleaks. Zielsetzung dieser retrospektiven Studie war es, das Management zur Behebung dieser Komplikationen darzustellen. Von 130 Patienten mit endovaskulärer Ausschaltung eines Aortenaneurysmas traten bei 26 Patienten 31 intraoperative Komplikationen auf (20,0%). Die führenden Komplikationen in jeder Gruppe sowie das daraus resultierende Management waren: Gruppe I: Die Korrektur erfolgte durch Dilatation, retroperitoneale Streckung, Kürzungsoperation der A. iliaca externa und Interponat. Gruppe II a: Bei Überstentung der Nierenarterien erfolgte die Konversion oder Zug am Endograft. Gruppe II b: Führungsdraht oder Andocksystem können nicht platziert werden. Die Behebung erfolgte durch Konversion und Anwendung neuer Systeme. Gruppe III: Hier wurden erneute Stentplazierungen, postoperativer Coil-Embolisationen und Konversionen durchgeführt. Die endovaskuläre Therapie aortaler Aneurysmen birgt eine Rate intraoperativer Schwierigkeiten von 20%. In 3,8% der Fälle musste eine Konversion durchgeführt werden. Durch adäquates Management konnten die Letalität (1/26) und Morbidität jedoch gering gehalten werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00010600
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  • 14
    Electronic Resource
    Electronic Resource
    Risiken bei Sectio caesarea und vaginaler Geburt (2000)
    Springer
    Der Gynäkologe 33 (2000), S. 872-881 
    Details
    ISSN: 1433-0393
    Keywords: Schlüsselwörter Sectio caesarea ; Notsectio ; Geburt ; Schwangerschaft ; Müttersterblichkeit ; Letalität ; Morbidität ; Komplikationen ; Keywords Cesarean section ; Emergency cesarean ; Birth ; Pregnancy ; Maternal mortality ; Lethality ; Morbidity ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The rate of cesarean section now exceeds 20% and continues to increase. This effect is enhanced by the almost negligible surgery-dependent risks. Maternal mortality in Central Europe has evidenced a sharp decline to approximately 10–20 deaths per 100,000 live births. Cesarean mortality due solely to surgical and/or anesthesiological intervention has also decreased considerably in the past 20 years. Nevertheless, vaginal birth entails a lower risk per se for the mother. Thus, the letality rate for vaginal birth is lower by a factor of 5–10 excluding pregnancy-dependent risks. Primary cesarean section exhibits a 1.7-fold lower risk of letality in comparison to secondary cesarean section. The main causes of death continue to be hemorrhages and thromboembolism. The mortality rate due to cesarean section continues to remain higher than that for vaginal birth. The rate of severe blood loss is significantly higher. The risk of deep vein thrombosis is about ten times greater than for vaginal birth with concomitantly increased risk for a pulmonary embolism as well as post-thrombotic syndrome. Perioperative prophylactic treatment with antibiotics was able to reduce the morbidity rate due to infection by more than 50%, but endometritis and wound infection continues to occur 10–15 times more frequently than during vaginal birth. In summary, maternal risk during pregnancy and birth – be it vaginal or cesarean – has been further reduced considerably. Nevertheless, cesarean section constitutes a surgical intervention entailing significantly higher rates of morbidity and mortality in comparison to vaginal birth.
    Notes: Zusammenfassung Die Sectiorate hat die 20%-Grenze überschritten und steigt unvermindert an. Begünstigt wird dieser Effekt durch die schon fast vernachlässigbaren operationsbedingten Risiken; die maternale Mortalität verzeichnet in Mitteleuropa einen starken Rückgang auf ca. 10–20 Todesfälle bezogen auf 100.000 Lebendgeburten. Auch die reine operations- bzw. anästhesiebedingte Sectioletalität hat sich in den letzten 20 Jahren deutlich vermindert. Nichtsdestotrotz geht die vaginale Geburt mit einem für die Mutter per se niedrigeren Risiko einher. So liegt die Letalität bei vaginaler Geburt um den Faktor 5–10 niedriger bei Ausschluss gestationsbedingter Risiken. Die primäre Sectio weist gegenüber der sekundären Sectio ein 1,7fach vermindertes Letalitätsrisiko auf. Haupttodesursachen sind weiterhin die Hämorrhagie und Thrombembolien. Aber auch die sectiobedingte Morbidität liegt weiterhin über der einer vaginalen Geburt. Die Rate an stärkeren Blutverlusten ist signifikant höher. Das Risiko einer tiefen Venenthrombose liegt rund 10fach über dem einer vaginalen Geburt mit ebenfalls erhöhtem Risiko für eine Lungenembolie sowie einem postthrombotischen Syndrom. Zwar konnte durch die perioperative Antibiotikaprophylaxe die Infektmorbidität um mehr als 50% gesenkt werden, doch ist die Endometritis und die Wundinfektion nach Sectio noch rund 10- bis 15-mal häufiger als bei vaginaler Geburt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001290050656
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  • 15
    Electronic Resource
    Electronic Resource
    Doppelbilder durch Doppel-IOL (2000)
    Springer
    Der Ophthalmologe 97 (2000), S. 781-783 
    Details
    ISSN: 1433-0423
    Keywords: Schlüsselwörter Katarakt-Chirurgie ; Komplikationen ; IOL-Luxation ; Doppel IOL ; Doppelbilder ; Keywords Cataract surgery ; Complications ; Intraocular lens dislocation ; Double intraocular lens implant ; Double vision
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract An 80-year-old man had intraoperative loss of an intraocular lens (IOL) in the vitreous and simultaneous implantation of an anterior chamber lens. For the first 3 years his course was uncomplicated, but after this time he noted monocular double vision. The IOL in the vitreous had moved into the optic axis of the eye. The case presented here underlines the possibility of complications occurring even years after surgery due to an IOL left behind in the vitreous. The double IOL implant technique should be reserved for very few selected indications.
    Notes: Zusammenfassung Bei einem 80-jährigen Patienten war nach intraoperativer Luxation einer intraokularen Linse (IOL) in den Glaskörper (GK) eine zweite IOL in die Vorderkammer implantiert worden. Nach zunächst komplikationslosem Verlauf, bemerkte der Patient 3 Jahre später monokulare Doppelbilder, offensichtlich durch eine Mobilisierung der IOL im GK in die optische Achse. Der beschriebene Fall zeigt, dass Komplikationen einer in den GK luxierten IOL auch nach längerer Zeit noch auftreten können. Die Doppelimplantationstechnik sollte ganz wenigen Ausnahmefällen vorbehalten werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470070028
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  • 16
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    Electronic Resource
    Bilaterale simultane LASIK Pro und Kontra (2000)
    Springer
    Der Ophthalmologe 97 (2000), S. 881-884 
    Details
    ISSN: 1433-0423
    Keywords: Schlüsselwörter LASIK ; einzeitige und zweizeitige Operation ; Kostenaspekt ; Komplikationen ; Keywords LASIK ; Simultaneous and sequential operation ; Cost effectiveness ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Until recently simultaneous bilateral laser in situ keratomileusis (LASIK) was regarded as contraindicated in Germany. However, the procedure was sporadically performed, because it offers patient comfort and is more cost effective than sequential LASIK. Even though the complication rate is below the calculated rate of 0.01%, bilateral complications may have catastrophic effects on the patient. In addition, there is the theoretical disadvantage that the results from the first eye cannot be used for the second eye. However, this effect has yet to be clinically proven.
    Notes: Zusammenfassung Seit September 2000 wird in Deutschland die bilaterale simultane Laser-in-situ-Keratomileusis (LASIK) nicht mehr als ungerechtfertigt angesehen. Bereits zuvor wurde sie vereinzelt durchgeführt, da sie dem Patienten einen höheren Komfort bietet und kostengünstiger ist als ein zweizeitiges Vorgehen. Auch wenn die Komplikationsrate sehr gering ist und sicherlich unter der rechnerischen Komplikationsrate von 0,01% liegt, können beidseitige Komplikationen katastrophale Auswirkungen für den Patienten haben. Zudem besteht der theoretische Nachteil der schlechteren Vorhersagbarkeit für das zweitbehandelte Auge. Dieser Effekt konnte bisher klinisch nicht nachgewiesen werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470070014
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  • 17
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    Electronic Resource
    Operative Behandlung von Verletzungen des thorakolumbalen Übergangs Teil 2: Operation und röntgenologische Befunde (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 1032-1047 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Arbeitsgemeinschaft “Wirbelsäule” der DGU ; Prospektive multizentrische Studie ; Thorakolumbale Wirbelsäule ; Wirbelsäulenverletzung ; Operative Behandlung ; Operative Zugänge zur Wirbelsäule ; Dorsale Stabilisierung ; Kombinierte Stabilisierung ; Ventrale Stabilisierung ; Fusionsoperation ; Fixateur interne ; Spinalkanaldekompression ; Komplikationen ; Schraubenfehllagen ; Grund-Deckplatten-Winkel ; Segmentale Kyphose ; Körperwinkel ; Sagittaler Index ; CT der Wirbelsäule ; Keywords Working group “spine” of the German Trauma Society, prospective multicenter study ; Thoracolumbar spine ; Fractures and dislocations of the spine ; Injuries of the spine ; Operative treatment ; Posterior surgery ; Combined surgery ; Anterior surgery ; Spinal fusion ; Internal fixator ; Decompression of the spinal canal ; Complications ; Misplaced pedicle screws ; Segmental kyphosis angle ; Wedge angle ; Sagittal index ; Computertomography of the spine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary The authors report on a prospective multicenter study with regard to the operative treatment of acute fractures and dislocations of the thoracolumbar spine (T10–L2). The study should analyze the operative methods currently used and determine the results in a large representative collective. This investigation was realized by the working group “spine” of the German Trauma Society. Between September 1994 and December 1996, 682 patients treated in 18 different traumatology centers in Germany and Austria were included. Part 2 describes the details of the operative methods and measured data in standard radiographs and CT scans of the spine. Of the patients, 448 (65.7%) were treated with posterior, 197 (28.9%) with combined posterior-anterior, and 37 (5.4%) with anterior surgery alone. In 72% of the posterior operations, the instrumentation was combined with transpedicular bone grafting. The combined procedures were performed as one-stage operations in 38.1%. A significantly longer average operative time (4:14 h) was noted in combined cases compared to the posterior (P〈0.001) or anterior (P〈0.05) procedures. The average blood loss was comparable in both posterior and anterior groups. During combined surgery the blood loss was significantly higher (P〈0.001; P〈0.05). The longest intraoperative fluoroscopy time (average 4:08 min) was noticed in posterior surgery with a significant difference compared to the anterior group. In almost every case a “Fixateur interne” (eight different types of internal fixators) was used for posterior stabilization. For anterior instrumentation, fixed angle implants (plate or rod systems) were mainly preferred (n=22) compared to non-fixed angle plate systems (n=12). A decompression of the spinal canal (indirect by reduction or direct by surgical means) was performed in 70.8% of the neurologically intact patients (Frankel/ASIA E) and in 82.6% of those with neurologic deficit (Frankel/ASIA grade A–D). An intraoperative myelography was added in 22% of all patients. The authors found a significant correlation between the amount of canal compromise in preoperative CT scans and the neurologic deficit in Frankel/ASIA grades. The wedge angle and sagittal index measured on lateral radiographs improved from −17.0° and 0.63 (preoperative) to −6.3° and 0.86 (postoperative). A significantly (P〈0.01) stronger deformity was noted preoperatively in the combined group compared to the posterior one. The segmental kyphosis angle improved by 11.3° (8.8° with inclusion of the two adjacent intervertebral disc spaces). A significantly better operative correction of the kyphotic deformity was found in the combined group. In 101 (14.8%) patients, intra- or postoperative complications were noticed, 41 (6.0%) required reoperation. There was no significant difference between the three treatment groups. Of the 2264 pedicle screws, 139 (6.1%) were found to be misplaced. This number included all screws, which were judged to be not placed in an optimal direction or location. In seven (1.0%) patients the false placement of screws was judged as a complication, four (0.6%) of them required revision. The multicenter study determines the actual incidence of thoracolumbar fractures and dislocations with associated injuries and describes the current standard of operative treatment. The efforts and prospects of different surgical methods could be demonstrated considering certain related risks. The follow-up of the population is still in progress and the late results remain for future publication.
    Notes: Zusammenfassung Die Autoren berichten über eine prospektive multizentrische Studie zur operativen Behandlung frischer Verletzungen des thorakolumbalen Übergangs (Th10 bis L2). Die Studie soll die derzeitigen Behandlungsmethoden und ihre Ergebnisse an einem großen Kollektiv repräsentativ analysieren und wird von der Arbeitsgemeinschaft “Wirbelsäule” der Deutschen Gesellschaft für Unfallchirurgie (DGU) erarbeitet. An 18 unfallchirurgischen Kliniken in Deutschland und Österreich wurden von September 1994 bis Dezember 1996 insgesamt 682 Patienten prospektiv erfasst. Die Nachuntersuchung der Patienten ist z. Z. noch nicht abgeschlossen. Im Teil 1 (Epidemiologie) wurden Studiendesign und epidemiologische Daten des Kollektivs dargestellt. Der vorliegende Teil 2 schildert die Details der Operationen sowie Messdaten der konventionellen Röntgenuntersuchungen und Computertomographien (CT); 448 (65,7%) Patienten wurden von dorsal, 197 (28,9%) kombiniert dorsoventral und 37 (5,4%) isoliert von ventral operiert; 72% der 448 von dorsal stabilisierten Patienten erhielten eine transpedikuläre Spongiosaplastik. Die kombinierten dorsoventralen Eingriffe wurden bei 75 (38,1%) Verletzten einzeitig und bei 122 (61,9%) zweizeitig durchgeführt. Die durchschnittliche Operationszeit war bei kombiniertem Eingriff mit 4:14 h signifikant länger als bei dorsalem (p〈0,001) oder ventralem (p〈0,05). Der durchschnittliche Blutverlust war bei dorsalem und ventralen Vorgehen vergleichbar hoch und signifikant geringer als bei kombinierter Operation (p〈0,001 bzw 〈0,05). Die intraoperative Durchleuchtungszeit war mit 4:08 min bei dorsaler Behandlung am längsten und signifikant (p〈0,005) länger als bei ventraler. Als dorsales Implantat wurde fast ausnahmslos ein Fixateur interne verwendet (8 verschiedene Modelle). Bei den ventralen Eingriffen kamen überwiegend winkelstabile Platten- oder Stabsysteme (n=22) und seltener winkelinstabile Platten (n=12) zum Einsatz. Der Spinalkanal wurde bei 82,6% der Patienten mit neurologischem Defizit und bei 70,8% derjenigen ohne Ausfallserscheinungen direkt mit Eröffnung des Spinalkanals oder indirekt mit Hilfe des Instrumentariums dekomprimiert. Eine intraoperative Myelographie wurde bei 22% der Patienten für notwendig gehalten. Wir fanden eine statistisch signifikante Korrelation zwischen dem Ausmaß der neurologischen Beeinträchtigung und der Einengung des Spinalkanals im präoperativen CT. Der im seitlichen Röntgenbild ermittelte Körperwinkel des betroffenen Wirbels und der sagittale Index betrugen im Gesamtkollektiv präoperativ im Mittel −17,0° und 0,63; postoperativ lagen die Werte bei −6,3° und 0,86. Eine signifikant (p〈0,01) stärkere Verformung des Wirbelkörpers bestand präoperativ in der kombinierten gegenüber der dorsalen Gruppe. Der segmentale Kyphosewinkel GDW 1 wurde von prä- zu postoperativ durchschnittlich um 11,3° und der GDW 2 um 8,8° lordosiert. Die signifikant (p〈0,005) größte Korrektur wurde bei den kombiniert Behandelten erzielt. Bei insgesamt 101 (14,8%) Patienten wurden intra- oder postoperative Komplikationen beobachtet, davon 41 (6,0%) revisionspflichtige. Die 3 Behandlungsgruppen wiesen unterschiedliche Komplikationsraten auf, der Unterschied war jedoch nicht signifikant (χ2-Test). Die Rate von Fehllagen transpedikulärer Schrauben betrug 139 von 2264 (6,1%) Schrauben; jede nicht optimal plazierte Schraube wurde dabei als Fehllage dokumentiert. Bei 7 (1,0%) Patienten wurde eine Schraubenfehllage als Komplikation gewertet und 4 (0,6%) von diesen wurden deswegen revidiert. Die Sammelstudie ermöglicht eine aktuelle Standortbestimmung für Verletzungshäufigkeiten und -muster sowie die verschiedenen, heute angewendeten Operationsmethoden. Mit der multizentrischen Studie konnten erstmals der operative Aufwand sowie Möglichkeiten und Risiken der verschiedenen Behandlungsformen dargestellt werden. Weiterführende Ergebnisse sind von den noch andauernden klinischen und radiologischen Nachuntersuchungen zu erwarten.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050667
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  • 18
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    Electronic Resource
    Zur Implantatpositionierung bei der Epiphysiolysis capitis femoris Folgen des schlechten Verlaufs und Konsequenzen (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 820-825 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Implantatpositionierung ; Epiphysiolysis capitis femoris ; Komplikationen ; Behandlungskonsequenzen ; Keywords Implant position ; Slipped capital femoral epiphysis ; Complications ; Consequences of treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Which consequences can be ascribed to the intraarticular position of devices in the operative treatment of a slipped capital femoral epiphysis? Which steps are to define as a standard of a careful procedure? The clinical and radiological results of five cases of a pin or nail penetration after the operative treatment of a slipped capital femoral epiphysis are described, a possible connection of causalities is investigated. The intraarticular position of devices in most cases goes along with an unfortunate clinical outcome and leads to a higher risk of developing chondrolysis. Because of the radiologic overprojection with the femoral head it is possible to oversee the malposition of the pin. Any operative treatment of a slipped capital femoral epiphysis requires a careful intraoperative X-ray examination combined with documentation. With this procedure the bad results of an intraarticular implant position must be ascribed to the reminding risk of a fateful development.
    Notes: Zusammenfassung Welche Folgen bei der operativen Behandlung der Epiphysioslysis capitis femoris sind einer intraartikulären Implantatlage zuzurechnen, und welche Maßnahmen sind als Sorgfaltsmaßstab zu definieren? Anhand von 5 Fällen mit intraartikulärer Implantatlage nach der operativen Behandlung einer Epiphysiolysis capitis femoris werden die klinischen und radiologischen Folgen aufgezeigt und ein möglicher Kausalzusammenhang anhand der Literatur untersucht. Die intraartikuläre Implantatlage geht meistens mit einem ungünstigen klinischen Ergebnis einher und führt zu einer erheblichen Risikoerhöhung für das Auftreten einer Chondrolyse. Durch Überlagerung mit dem Femurkopf kann sich die Fehlposition des Implantates der radiologischen Diagnostik entziehen. Jede operative Behandlung der Epiphysiolysis capitis femoris erfordert eine sorgfältige intraoperative Durchleuchtungskontrolle, eine entsprechende Dokumentation ist zu empfehlen. Bei einem solchen Vorgehen sind die Folgen einer intraartikulären Position des Implantats als Restrisiko dem schicksalshaften Verlauf zuzurechnen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050627
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  • 19
    Electronic Resource
    Electronic Resource
    Behandlungsergebnisse nach primärer und sekundärer Radiusköpfchenresektion (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 437-443 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Radiusköpfchenfraktur ; Primäre Resektion ; Osteosynthese ; Sekundäre Resektion ; Komplikationen ; Keywords Radial head fracture ; Primary resection ; Osteosynthesis ; Secondary resection ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Apart from comminuted fractures of the radial head the indication for resection of the radial head is discussed controversially. To evaluate our own results, the hospital notes of 113 patients treated between 1.1.1984–31.12.1994 in our clinic by posttraumatic primary or secondary radial head resection were examined retrospectively. 79 patients were controlled by clinical and radiological examination with an average follow-up of 37,8 months. We examined at 46 patients the influence of additional lesions of the elbow joint on the functional outcome. In 33 patients follow up was done with special regard to the time of resection. Poor results due to the score from Radin and Riseborough especially followed secondary radial head resection (〉14 days after trauma) and in case of additional elbow lesions. We could not observe problems of the wrist joint after radial head resection as described by other authors. According to our own experience primary resection is recommended in case of doubtful reconstruction of the radial head. In these fracture types radial head resection should not be seen as an alternative treatment because of the worse results following secondary resection.
    Notes: Zusammenfassung Abgesehen von Trümmerfrakturen wird die Indikationsstellung zur Radiusköpfchenresektion kontrovers diskutiert. Zur Evaluation eigener Ergebnisse führten wir eine retrospektive Untersuchung der 113 Patienten durch, die von 1.1.1984–31.12.1994 mittels primärer oder sekundärer posttraumatischer Radiusköpfchenresektion behandelt wurden. Nach einem durchschnittlichen postoperativen Intervall von 37,8 Monaten konnten insgesamt 79 Patienten klinisch und radiologisch nachuntersucht werden. Bei 46 Patienten wurde die Auswirkung der Begleitverletzungen auf das Endergebnis untersucht. Bei 33 Patienten erfolgte die Nachuntersuchung unter besonderer Berücksichtigung des Resektionszeitpunktes. Schlechte Behandlungsergebnisse nach den Kriterien des Scores von Radin und Riseborough resultierten besonders häufig nach sekundärer Radiusköpfchenresektion (〉 14 Tage nach Trauma) und bei Begleitverletzungen des Ellenbogengelenks. Die Berichte anderer Autoren über negative Langzeitfolgen auf das Handgelenk können wir nicht bestätigen. Nach unseren Erfahrungen sollte daher bei zweifelhaften Rekonstruktionsversuchen die primäre Radiusköpfchenresektion bevorzugt werden, die aufgrund der eindeutig schlechteren Resultate nach sekundärer Resektion nicht als Option für mißlungene Erhaltungsversuche des Radiusköpfchens betrachtet werden darf.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050563
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  • 20
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    Electronic Resource
    Perforation eines mucocelenartig transformierten Hartmannstumpfs (2000)
    Springer
    Der Chirurg 71 (2000), S. 572-574 
    Details
    ISSN: 1433-0385
    Keywords: Keywords: Mucocele ; Ileostomy ; Complications ; Hartmann procedure. ; Schlüsselwörter: Mucocele ; Ileostoma ; Komplikationen ; Hartmannstumpf.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Wir berichten über eine 53 jährige Patientin, bei der 22 Jahre nach Anlage eines Ileostomas wegen eines Morbus Crohn eine Stenose im distalen Colonsegment (Hartmannstumpf) zu einer mucocelenartigen Transformation und nachfolgenden Ruptur geführt hat. Über die Ruptur eines stillgelegten Colonabschnitts nach Anlage eines Ileostomas wurde bisher offenbar noch nicht berichtet.
    Notes: Abstract. We report an unusual complication in a 53-year-old woman following ileostomy for Crohn's disease 22 years previously. A stenosis of the distal colonic segment was the reason for the formation and subsequent rupture of a huge colonic mucocele. To our knowledge, this is the first report of a ruptured mucocele of colonic origin after ileostomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050859
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  • 21
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    Electronic Resource
    Patient reports of complications of bone marrow transplantation (2000)
    Springer
    Supportive care in cancer 8 (2000), S. 33-39 
    Details
    ISSN: 1433-7339
    Keywords: Key words Marrow transplantation ; Complications ; Oral mucositis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  In recent years, significant improvements have been made in the management of neutropenia and thrombocytopenia and other potentially life-threatening complications of ablative chemotherapy. While these complications are of particular concern to physicians, patients receiving ablative therapy for bone marrow or blood stem cell transplants are often troubled by other side effects such as nausea, vomiting, diarrhea and mouth sores. The purpose of the study was to gain a better understanding of patients' experiences while undergoing a transplant. The same professional medical interviewer conducted in-depth interviews with 38 subjects (10 men, 28 women; mean age 46.9 years) who had received ablative therapy for bone marrow and/or peripheral blood stem cell transplants. Participants were consecutively identified through physician and patient referrals, cancer and BMT patient support groups, and newspaper advertisements. Twenty-eight patients (74%) received autologous stem cell transplants and 10 patients (26%) received allogeneic transplants. Participants reported mouth sores, nausea and vomiting, diarrhea, and fatigue as the most troubling side effects of their transplants. Mouth sores were selected as the single most debilitating side effect (42%), followed by nausea and vomiting (13%). Many patients mentioned that mouth sores made it difficult or impossible to eat (n=23), swallow (n=21), drink (n=17), and/or talk (n=8). Twenty patients reported pain in the mouth, throat, and/or esophagus. Two-thirds (66%) of patients reported receiving opioid analgesics, most frequently morphine, to relieve oral pain. For many, opioids caused incapacitating side effects, including hallucinations, a feeling of loss of control and a decrease in mental acuity. Patients receiving ablative chemotherapy identify oral mucositis as a significant cause of suffering and morbidity. Effective interventions to alleviate this complication are urgently needed.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005209900095
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  • 22
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    Electronic Resource
    Heilungsverlauf und Komplikationen nach Augenmuskeloperationen (2000)
    Springer
    Der Ophthalmologe 97 (2000), S. 22-26 
    Details
    ISSN: 1433-0423
    Keywords: Schlüsselwörter Augenmuskeloperation ; Komplikationen ; Heilungsverlauf ; Key words Eye muscle surgery ; Complications ; Healing process
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Background: Varying reports on the incidence of operative and postoperative complications following eye muscle surgery have been published. The purpose of this study was to quantify complications after various types of eye muscle surgery as well as minor pathological changes of the anterior and posterior segment. Patients and methods: This prospective study included all patients who underwent eye muscle surgery at the Department of Strabismology and Neuroophthalmology, Giessen, from January to May 1998. Five hundred eyes of 377 patients aged 2–82 years were included. The spectrum of procedures comprised: recessions, resections, tucks, R&R procedures, transpositions, bimedial retroequatorial myopexies, and revisions of rectus and oblique muscles. All patients were examined 1 day preoperatively and 1 day, 1 week, and 3 months postoperatively. Any complications and even minor pathological changes of the anterior and posterior segment were documented. Some changes were assessed by means of a score (0–3). Results: One day postoperatively, 30% of eyes had inflammatory pseudoptosis, most of them mild. Conjunctival swelling and injection were frequently mild and moderate, after 1 week mostly mild. Conjunctival irritation was more pronounced following resection than tucking. Punctate epithelial keratopathy was noted in 1.6% of cases (first postoperative day), dellen in 4.3% (first postoperative week). Three months postoperatively, 14.3% of eyes had biomicroscopically visible conjunctival folds and 91.3% had minimal conjunctival scars. None of the patients had a scleral perforation or other serious complication. Conclusions: Eye muscle surgery rarely entails complications. Revisions due to organic pathological changes are extremely rare. Possible development of dellen requires check-up 4–7 days postoperatively. Tucking of rectus muscles causes less conjunctival irritation than resection.
    Notes: Hintergrund: Zur Inzidenz operativer und postoperativer Komplikationen bei Augenmuskeloperationen liegen unterschiedliche Mitteilungen vor. Ziel der vorliegenden Studie war es, sowohl Komplikationen als auch geringfügige pathologische Veränderungen des vorderen und hinteren Augenabschnittes nach unterschiedlichen Augenmuskeloperationen zu quantifizieren. Patienten und Methode: Es wurden prospektiv alle Patienten erfaßt, bei denen im Zeitraum Januar bis Mai 1998 an der Augenklinik für Schielbehandlung und Neuroophthalmologie Gießen eine Augenmuskeloperation durchgeführt wurde. In die Studie konnten 500 Augen von 377 Patienten im Alter von 2 bis 82 Jahren einbezogen werden. Das Spektrum der durchgeführten Eingriffe umfaßte Rücklagerungen, Resektionen, Faltungen, kombinierte Operationen, Transpositionen, Fadenoperationen und Revisionsoperationen an allen geraden und schrägen Augenmuskeln. Die Patienten wurden am Tag vor der Operation und postoperativ am ersten Tag, nach einer Woche und nach drei Monaten untersucht. Alle Komplikationen des vorderen und hinteren Augenabschnittes wurden dokumentiert und quantitativ erfaßt, teilweise erfolgte eine Gradeinteilung (0–3). Ergebnisse: Am ersten postoperativen Tag war bei 30% der Augen eine zumeist diskrete Lidschwellung auffällig. Die Bindehautschwellung und -injektion waren meist gering bis mäßig, nach einer Woche häufig nur noch gering. Der Reizzustand der Bindehaut war geringer nach Faltung als nach Resektion eines horizontalen M. rectus. Bei den Hornhautveränderungen dominierte am ersten postoperativen Tag eine Epitheliopathie (1,6%), nach 1 Woche standen diskrete Fuchs'sche Dellen (4,3%) im Vordergrund, die unter lokaler Therapie abheilten. Mikroskopisch erkennbare Bindehautfalten wurden überwiegend zur 3-Monats-Kontrolle (14,3%) dokumentiert, ebenso Bindehautnarben (91,3%), die i.d.R. sehr gering waren. Perforationen oder schwerwiegende Komplikationen kamen nicht vor. Schlußfolgerungen: Eine Augenmuskeloperation ist ein komplikationsarmer Eingriff, der nur selten einen erneuten Eingriff wegen organischer pathologischer Veränderungen erfordert. Zur Erkennung von Fuchs'schen Dellen ist eine Kontrolluntersuchung 4–7 Tage postoperativ wichtig. Faltung eines horizontalen M. rectus führt zu weniger Bindehautreiz als Resektion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470050005
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  • 23
    Electronic Resource
    Electronic Resource
    Okuläres vernarbendes Pemphigoid Retrospektive Analyse von Risikofaktoren und Komplikationen (2000)
    Springer
    Der Ophthalmologe 97 (2000), S. 113-120 
    Details
    ISSN: 1433-0423
    Keywords: Schlüsselwörter Okuläres vernarbendes Pemphigoid ; Therapie ; Komplikationen ; Glaukom ; Key words Ocular cicatricial pemphigoid ; Therapy ; Complications ; Glaucoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Cicatricial pemphigoid (CP) is a rare autoimmune disease characterized by subepidermal blistering and progressive cicatrization affecting the skin and mucosa. Ocular involvement occurs in approximately 70% of the patients. Methods: The course of the disease, complications and putative risk factors in patients with ocular cicatricial pemphigoid (OCP) treated at the Departments of Ophthalmology and Dermatology were analyzed retrospectively from 1986 to 1998. Results: Eighteen of 28 patients (64%) with CP demonstrated ocular involvement. The mean age of patients with OCP was 73 years; 61% were female. At the time of referral to our hospital, all patients had reached advanced stage III (83%) or IV (17%) of OCP. In 38% of patients vision was already reduced to 〈20/200 at first presentation. Twenty-eight percent of patients additionally suffered from glaucoma. Two patients exhibited life-threatening extraocular manifestations of CP (larynx stricture, esophagus stricture). Conjunctival or mucosal biopsies were performed in 15 patients with OCP and showed typical immunodeposits at the basement membrane zone in 12/15 patients. Therapy with dapsone (12 patients), oral steroids (11 patients), azathioprine (5 patients), cyclophosphamide (4 patients), colchicine (2 patients) and methotrexate (1 patient) was used concomitantly or consecutively. Complications of OCP including entropion, recurrent epithelial erosions, corneal ulcers, keratitis, and corneal perforations required multiple surgical interventions such as entropion surgery (8 patients), tarsorrhaphy (3 patients), mucous membrane grafting (1 patient), amniotic membrane transplantation (1 patient), tectonic keratoplasty (1 patient), keratoprosthesis (1 patient) and enucleation (1 patient). Despite control of the inflammatory process, further visual loss occurred in 53% of eyes. Reading visual acuity could only be maintained in 35% of eyes. Discussion: Early diagnosis and therapy can prevent ocular complications of OCP. This study indicates that advanced stages of the disease often result in irreversible visual loss despite institution of immunosuppressive therapy. Whether or not the high association of OCP with glaucoma and/or anti-glaucomatous treatment in our patients represents part of the underlying disease process or plays a role in the pathogenesis of OCP must still be clarified.
    Notes: Zusammenfassung Das vernarbende Pemphigoid (cicatricial pemphigoid, CP) ist eine seltene, mit subepidermaler Blasenbildung und Vernarbung einhergehende Autoimmunerkrankung, die sich an Haut und Schleimhaut manifestiert. Eine Augenbeteiligung liegt bei etwa 70% der Patienten vor. Methode: Retrospektiv wurden Krankheitsverlauf, klinische Komplikationen und mögliche Risikofaktoren von Patienten der Augen- und Hautklinik mit vernarbendem Pemphigoid von 1986–1998 untersucht. Ergebnisse: 18/28 Patienten (64%) mit CP hatten eine okuläre Beteiligung. Das Durchschnittsalter der Patienten mit okulärem vernarbendem Pemphigoid betrug 73 Jahre, 61% der Patienten waren weiblich. Bereits bei Erstvorstellung in unserer Klinik bestand bei allen Patienten ein Krankheitsstadium III (83%) oder IV (17%), mit einem Visus 〈0.1 in 38% der Augen. Bei 28% der Patienten wurde zusätzlich ein Glaukom diagnostiziert. Zwei Patienten zeigten eine lebensgefährliche extraokuläre Schleimhautbeteiligung (Larynx- bzw. Ösophagusstriktur). Bei 15 Patienten mit okulärem vernarbendem Pemphigoid wurde eine Bindehaut- bzw. Schleimhautbiopsie aus dem Mund oder Nasen-Rachen-Raum durchgeführt, welche die Verdachtsdiagnose bei 12/15 Patienten immunhistologisch sicherte. Eine Therapie mit Dapson (12 Patienten), oraler Kortikosteroidgabe (11 Patienten), Azathioprin (5 Patienten), Cyclophosphamid (4 Patienten), Colchizin (2 Patienten) und Methotrexat (1 Patient) wurde in Folge oder Kombination eingesetzt. Komplikationen wie Lidfehlstellungen, rezidivierende Epitheldefekte, Hornhautulzera, Keratitiden und Hornhaut-Perforationen erforderten multiple operative Eingriffe wie Entropium-Operation (8 Patienten), Tarsorrhaphie (3 Patienten), Kryoepilation (2 Patienten), Mundschleimhaut-Transplantat (1 Patient), Amniontransplantat (1 Patient), tektonische Keratoplastik (1 Patient), Keratoprothese (1 Patient) und Enukleation (1 Patient). Trotz befriedigender Kontrolle des okulären vernarbenden Pemphigoids kam es bei 53% der Augen zum weiteren Visusabfall. Ein Lesevisus konnte nur in 35% der Augen erhalten werden. Schlußfolgerung: Wahrscheinlich kann die Früherkennung und rechtzeitige Behandlung des okulären vernarbenden Pemphigoids okuläre Komplikationen verhindern. Diese Studie zeigt, daß trotz immunsuppressiver Therapie in Spätstadien häufig ein irreversibler Visusverlust resultiert. Es bleibt zu untersuchen, ob die auffällig hohe Assoziation von okulärem vernarbendem Pemphigoid zu Glaukom bzw. antiglaukomatöser Therapie in unserem Patientenkollektiv als Folge der Grunderkrankung oder als pathogenetischer Faktor zu werten ist.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003470050021
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  • 24
    Electronic Resource
    Electronic Resource
    Qualitätssicherung in der gynäkologischen Endoskopie (2000)
    Springer
    Der Gynäkologe 33 (2000), S. 213-219 
    Details
    ISSN: 1433-0393
    Keywords: Schlüsselwörter Qualitätssicherung ; Endoskopie ; Komplikationen ; Key words Quality control ; Endoscopy ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Due to the expanding use of laparoscopic surgery in gynecology, the necessity for evaluation of results was raised. With the intention of quality control in gynecological endoscopy, the gynecological department of the Evangelisches Diakonie-Krankenhaus in Bremen has developed, in cooperation with the Institute for Artificial Intelligence at the University of Bremen and on behalf of the German Society for Gynecological Endoscopy, the quality control program “German Gynecological Endoscopy Complication Register”. In 1997, 20 German endoscopic centers took part in the prospective observational study. A total number of 17,745 cases were reported. Altogether 20,050 endoscopic procedures were performed, 8020 hysteroscopies and 12030 laparoscopies. The complication rate for hysteroscopies amounted to 7.0‰ and that of laparoscopies to 9.6‰. The quality control program of the German Society for Gynecological Endoscopy is a unique tool, comparable to the “German Perinatology Study”. It allows to compare individual hospital profiles, an option that is necessary to gain the best possible results in terms of quality in gynecological surgery in the long term.
    Notes: Zusammenfassung Mit dem Ziel der Qualitätsverbesserung in der gynäkologischen Endoskopie hat die Frauenklinik des Evangelischen Diakonie-Krankenhauses in Bremen im Auftrag der Arbeitsgemeinschaft der Gynäkologischen Endoskopie (AGE) zusammen mit dem KI-Labor der Universität Bremen das Qualitätssicherungs-Programm “Komplikationsregister gynäkologische Endoskopie” entwickelt. Es ermöglicht dem Anwender die differenzierte Betrachtung der durchgeführten Operationen von den Indikationsstellung bis zum Therapieerfolg. Im Jahre 1997 haben 20 endoskopisch tätige Institutionen an der prospektiven Dokumentation der gynäkologisch-endoskopischen Operationen teilgenommen. Bei insgesamt 17.745 Patientinnen wurden 20.050 Eingriffe erfasst, darunter 8020 Hysteroskopien und 12.030 Laparoskopien. Die Komplikationsrate der Hysteroskopien betrug 7,0‰, die der Laparoskopien 9,6‰. Mit dem Qualitätssicherungs-Programm der AGE steht heute ein Instrument zur Verfügung, das vergleichbar der Perinatologiestudie die Daten in Form von vergleichenden Klinikprofilen liefern kann, die notwendig sind, um im Zusammenhang mit endoskopischen Operationen langfristig die bestmögliche Ergebnisqualität zu erzielen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001290050537
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  • 25
    Electronic Resource
    Electronic Resource
    Neurologische Komplikationen nach Organtransplantation (2000)
    Springer
    Der Nervenarzt 71 (2000), S. 249-258 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Organtransplantation ; Immunsuppression ; Neurotoxizität ; ZNS-Infektionen ; Komplikationen ; Key words Organ transplantation ; Complications ; Immunosuppression ; Neurotoxicity ; CNS infection
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Following organ transplantation, 30–60% of patients develop neurologic complications which can be classified as pre-existing deficits due to the underlying disease, complications during surgery, metabolic encephalopathies, neurotoxicity of immunosuppressant agents, opportunistic CNS infections, and secondary malignomas as indirect side effects of immunosuppression. While encephalopathies, seizures, or CNS infection can occur in all types of transplantation, some specific neurological complications exist for different types of organ transplantation. In this review, the clinical symptoms and treatment of both the common neurological complications as well as the particular neurological syndromes after liver, heart, and bone marrow transplantation are discussed.
    Notes: Zusammenfassung Nach Organtransplantation entwicklen 30–60% der Patienten neurologische Komplikationen, die eingeteilt werden können in vorbestehende Störungen im Rahmen der Grunderkrankung, intraoperative Komplikationen, metabolische Enzephalopathien, neurotoxische Nebenwirkungen der verschiedenen Immunsuppressiva sowie opportunistische ZNS-Infektionen und sekundäre Malignome als indirekte Folge der Immunsuppression. Differentialdiagnostisch relevant ist, dass einerseits Enzephalopathien, Anfälle oder ZNS-Infektionen bei allen Transplantationen auftreten können, andererseits für einzelne Organtransplantationen bestimmte neurologische Komplikationen typisch sind. In dieser Übersicht werden die allgemeinen neurologischen Komplikationen mit klinischen Leitsymptomen und Therapie sowie die spezifischen neurologischen Krankheitsbilder nach Leber-, Herz- und Knochenmarktransplantation vorgestellt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050554
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  • 26
    Electronic Resource
    Electronic Resource
    Management von Komplikationen nach prothetischer Stimmrehabilitation (2000)
    Springer
    HNO 48 (2000), S. 508-516 
    Details
    ISSN: 1433-0458
    Keywords: Schlüsselwörter Stimmprothese ; Komplikationen ; Laryngektomie ; Tracheoösophageale Fistel ; Keywords Voice prosthesis ; Complications ; Total laryngectomy ; Tracheoesophageal fistula
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The growing popularity of prosthetic voice restoration after total laryngectomy confronts ENT specialists with an increasing number of prosthesis-related complications. The ENT specialist should be familiar with the management of these complications in order to maintain the patients speech and social rehabilitation. In a retrospective study on 108 consecutive patients, complications were encountered in 30%. The incidence was not related to the factors age or primary vs. secondary insertion of the prosthesis. Complications consisted of formation of granulation tissue (15,7%), shunt dilatation (5,5%), loss of prosthesis (3,7%), local cellulitis (2,8%), extrusion (1,9%), ingrowth of prosthesis (1,9%) and formation of excessive scar tissue with dislocation of prosthesis (0,9%). Permanent removal of the prosthesis due to complications was necessary in 3 cases (2,8%). Therapeutic measures for the management of complications are described and evaluated. The treatment of complications was well tolerated by all patients and led to satisfying results in most cases. Our observations show that prosthetic voice rehabilitation is associated with various difficulties and complications, but that these can be handled quite easily and successfully in the majority of cases.
    Notes: Zusammenfassung Die wachsende Beliebtheit der prothetischen Stimmrehabilitation nach Laryngektomie konfrontiert den HNO-Arzt immer häufiger mit stimmprothesenbedingten Komplikationen. Als solcher sollte man daher die Komplikationen der Stimmprothesenversorgung kennen und deren Management beherrschen, um die kommunikative und soziale Rehabilitation des Patienten nicht zu gefährden. Die retrospektive Untersuchung von 108 Stimmprothesenträgern erbrachte eine Komplikationshäufigkeit von 30%. Eine Abhängigkeit der Komplikationsinzidenz vom Alter des Patienten oder vom Faktor primäre / sekundäre Protheseneinlage gab es dabei nicht. Häufigste Komplikation war die Entwicklung von Granulationsgewebe (15.7%), gefolgt von Shunterweiterung (5,5%), Prothesenverlust (3,7%), lokalen Infektionen (2,8%), Abstoßung (1,9%), eingewachsener Prothese (1,9%), narbiger Shuntwandverdickung mit Prothesendislokation (0,9%). In nur 3 Fällen (2,8%) mußte die Stimmprothese aufgrund verschiedener Komplikationen wieder entfernt werden. Die erforderlichen therapeutischen Maßnahmen waren für die Patienten wenig belastend und führten in fast allen Fällen zu befriedigenden Ergebnissen. Diese Beobachtungen zeigen, daß die prothetische Stimmrehabilitation zwar nicht ohne Komplikationen und Schwierigkeiten ist, diese jedoch in weitaus der Mehrzahl der Fälle medizinisch leicht zu beherrschen und daher zumutbar sind.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001060050607
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  • 27
    Electronic Resource
    Electronic Resource
    Die stabile und instabile pertrochantäre Femurfraktur Differenzierte Indikationsstellung für die dynamische Hüftschraube (2000)
    Springer
    Der Unfallchirurg 103 (2000), S. 741-748 
    Details
    ISSN: 1433-044X
    Keywords: Schlüsselwörter Pertrochantäre Fraktur ; Dynamische Hüftschraube ; Instabile Frakturen ; Komplikationen ; Keywords Trochanteric fracture ; Dynamic hip screw (DHS) ; Instable fractures ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract The aim of all surgical procedures in the treatment of trochanteric fractures in elderly and even geriatric patients is achievement of initial stability. We examined in a clinical trial whether primary stability was achieved in all types of trochanteric fractures following osteosynthesis with the Dynamic Hip Scres (DHS). From 1994 to 1996, 122 patients with trochanteric fractures had osteosynthesis by dynamic hip screw. Patient records were evaluated and all data got registered with a standardized protocoll; clinical and radiological outcome was analysed after an average period of 1,9 years after injury according to the Traumatic Hip Rating Score. 22% of all patients died meantimes, 51,6% of the remaining 95 patients could get examined. The average age was 75,5 years, the patient population showed an increased preoperative morbidity (2,5 points) according to ASA-Score. 81% showed progressive osteoporosis. According to the AO-classification 47% stable fractures (type A-1) and 53% instable trochanteric fractures (type A-2 and A-3) occured. Surgery lasted 77 minutes average in osteosynthesis of stable fractures. The duration of 108 minutes in instable fractures was significantly higher, as well as the blood loss was 43% increased in these complex fractures. Complications closely associated to the osteosynthesis appeared only in instable fractures (7%). Also common complications (24,6%) predominated with 15,6% in tpy A-2 and A-3 fractures versus 9% in type A-1 fractures; mortality was also different with 5,7% versus 1,6%. Assesment of the functional outcome according to THRS showed a significant deterioration of 20 points in 71% of all patients compared with the preoperative score. The results show that dynamic hip screw osteosynthesis in instable trochanteric fractures is associated to a higher incidence of complications. While the dynamic hip screw still represents the standard implant in stable fractures of the trochanteric regio, beeing aware of improved intramedullary implants regarding biomechanical features and surgical technique, the results justify to critical consider the use of DHS for osteosynthesis in instable fractures of the trochanteric region.
    Notes: Zusammenfassung Bei der operativen Versorgung petrochantärer Femurfrakturen im geriatrischen Krankengut stellt eine sofort übungs- und belastungsstabile Osteosynthese das Therapieziel dar. In einer klinischen Studie wurde vergleichend untersucht, ob dieses Ziel mit der DHS (dynamische Hüftschraube) bei allen pertrochantären Frakturtypen erreicht werden kann. Von 1994–1996 wurden 122 pertrochantäre Frakturen mit der DHS behandelt. Neben der Auswertung durch standardisierte Datenerhebungsprotokolle wurden die Patienten durchschnittlich 1,9 Jahre nach Trauma radiologisch und klinisch nach dem “Traumatic hip rating score” nachuntersucht; 22% waren verstorben, von den verbliebenen 95 Patienten konnten 51,6% nachkontrolliert werden. Bei einem Altersdurchschnitt von 75,5 Jahren lag mit dem ASA-Score von durchschnittlich 2,5 Punkten eine hohe präoperative Morbidität vor; 81% der Fälle wiesen eine fortgeschrittene Osteoporose auf. Nach der AO-Klassifikation handelte es sich um 47% stabile (Typ A1) und 53% instabile (Typ A2 und A3) Frakturen. Die mittlere Operationszeit war bei den instabilen im Vergleich zu den stabilen pertrochantären Frakturen mit 108 gegenüber 77 min signifikant höher, der Blutverlust um 43% größer. Direkt mit der Osteosynthese assoziierte Komplikationen betrafen ausschließlich instabile Frakturen (7%). Allgemeine Komplikationen (24,6%) überwogen ebenfalls mit 15,6% in der Gruppe der Typ A2 und A3 gegenüber der Typ-A1-Frakturen, was sich auch in einer entsprechend höheren Klinikletalität mit 5,7% gegenüber 1,6% ausdrückt. Bei der Bewertung des funktionellen Nachuntersuchungsergebnisses mit dem THRS wiesen 71% der Patienten im Vergleich zum präoperativen Ausgangswert eine deutliche Verschlechterung um durchschnittlich 20 Punkte auf. Die Osteosynthese instabiler pertrochantärer Femurfrakturen durch die DHS ist mit einer höheren Komplikationsrate belastet. Während die DHS für die stabilen Frakturen das Standardverfahren darstellt muss die Osteosynthese instabiler Frakturen vor dem Hintergrund neuerer, operationstechnisch und biomechanisch verbesserter intramedullärer Implantate kritisch betrachtet werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001130050613
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  • 28
    Electronic Resource
    Electronic Resource
    Unaufgebohrter Humerusnagel (UHN) (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 277-283 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Humerusschaftfraktur ; Intramedulläre Marknagelosteosynthese ; UHN ; Komplikationen ; Behandlungsergebnisse ; Keywords ; Fracture of the humeral diaphysis ; Humerus nail ; UHN ; Complications ; Results
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: In a retrospective study, 115 fractures of the humeral diaphysis were evaluated, and 94 of the patients were treated by surgical operations. In 64 patients we used an unreamed humerus nail (UHN) to stabilize the fractures of the humerus diaphysis. All patients with an UHN were followed up. Having analysed the system-specific and general complications and the functional, subjective and radiological results we can recommend the UHN for the treatment of both fractures and pseudarthrosis of the humeral diaphysis.
    Notes: In einer retrospektiv durchgeführten Studie wurden 115 Humerusschaftfrakturen ausgewertet. Operativ wurden 94 Patienten, davon 64 mit einem unaufgebohrten Humerusnagel (UHN), versorgt. Die mit einem UHN behandelten Patienten wurden nachuntersucht. Nach Auswertung der systemspezifischen und allgemeinen Komplikationen sowie der funktionellen, subjektiven und radiologischen Ergebnisse kann der UHN sowohl zur Behandlung der frischen Humerusschaftfraktur als auch zur Versorgung von Humerusschaftpseudarthrosen empfohlen werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100390000318
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  • 29
    Electronic Resource
    Electronic Resource
    Wann ist die arthroskopische Diagnostik und Therapie am Ellbogengelenk beim Trauma angezeigt? (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. S81 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Arthroskopie ; Ellbogengelenk ; Trauma ; Minimalinvasive Osteosynthese ; KomplikationenArthroscopy ; Elbow joint ; Injury ; Osteosynthesis ; Complications ; Key words ; Arthroskopie ; Ellbogengelenk ; Trauma ; Minimalinvasive Osteosynthese ; KomplikationenArthroscopy ; Elbow joint ; Injury ; Osteosynthesis ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Elbow arthroscopy, unlike arthroscopy of the knee or shoulder, is technically a very demanding procedure that is associated with a high risk of complications owing to the surrouding neurovascular structures. In the case of trauma the arthroscopic approach is even more difficult because of the altered anatomy. In addition, the time available for the performance of any surgical procedures is very much limited by the immediate onset of periarticular swelling with fluid loss caused by the damage to the joint capsule that is present in most cases. Arthroscopy of the elbow should not therefore be considered to be indicated in acute trauma except in isolated cases and after very careful consideration of the risks and benefits for the patient. This procedure cannot be generally recommended as a standard method of examining or treating freshly sustained injuries.On the other hand, elbow arthroscopy can be very helpful in the case of posttraumatic functional deficiencies or such pathologic findings as loose bodies after osteochondral fractures, adhesions and intraarticular scars, while little or no improvement can be expected for vague joint symptoms or posttraumatic arthrosis. As there is a relatively high risk of neurological complications the patient needs to be given quite comprehensive information in an intensive preoperative session. Diagnostic arthroscopy is hardly ever indicated in a trauma case because of the excellent results yielded by modern noninvasive imaging methods, such as ultrasound, X-ray, computed tomography and MRI.
    Notes: Zusammenfassung Im Gegensatz zur Arthroskopie des Knie- oder Schultergelenks ist die Arthroskopie des Ellbogengelenks mit erheblichen technischen Schwierigkeiten und entsprechend hohen Komplikationsrisiken verbunden. Beim Trauma ist die Arthroskopie zudem aufgrund der veränderten anatomischen Verhältnisse noch weit komplizierter. Die Operationszeit ist wegen der rasch auftretenden periartikulären Schwellung infolge der meist bestehenden Gelenkkapselläsionen deutlich limitiert. Die Indikation zur Arthroskopie sollte daher nur im Einzelfall unter sorgfältiger Abwägung der Risiken und der zu erwartenden Vorteile gestellt werden. Eine generelle Empfehlung für dieses Verfahren bei frischen Verletzungen kann nicht ausgesprochen werden. Sinnvoll ist der Einsatz dagegen bei einigen posttraumatischen Veränderungen, z. B. freien Gelenkkörpern nach osteochondralen Frakturen oder Arthrolysen bei intraartikulären Vernarbungen, während bei „unklaren Gelenkbeschwerden“ oder posttraumatischer Arthrose kaum Verbesserungen zu erwarten sind. Wegen des relativ hohen Risikos neurologischer Komplikationen ist eine intensive präoperative Aufklärung der Patienten erforderlich. Eine diagnostische Arthroskopie beim Trauma ist bei der Aussagekraft der modernen nichtinvasiven Untersuchungsverfahren kaum noch angezeigt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00014932
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  • 30
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    Electronic Resource
    Indikationsstellung und Verfahrenswahl bei Beckenringverletzungen (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 39-45 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Beckenringfrakturen ; Klassifikation ; Behandlungsverfahren ; Komplikationen ; Ergebnisse ; Keywords ; Pelvic ring fractures ; Classification ; Treatment ; Complications ; Results
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Injuries of the pelvis are caused by high-energy trauma, and concomitant injuries are therefore often found. Many patients with such pelvic injuries have multiple injuries. Accurate diagnosis and classification are both fundamental to adequate therapy. Especially in the presence of complex pelvic trauma and in polytraumatised patients priority-oriented and fast procedures are essential. Type B and C instabilities require operative treatment. In emergency cases with unstable pelvic fractures external fixation has proved successful. For definitive treatment with internal stabilisation different internal fixation procedures with screws and plates selected with reference to the features of the injury are needed. The operative stabilisation of the pelvic ring demands particular care, because various main vessels and nerves are adjacent to the injury site. Ultimately, the results of treatment depend heavily on the quality of anatomical restoration of the pelvic ring.
    Notes: Beckenverletzungen entstehen aufgrund hoher lokaler Gewalteinwirkung und sind deswegen häufig mit Begleitverletzungen kombiniert. Bei vielen beckenverletzten Patienten liegt ein Polytrauma vor. Grundlage einer adäquaten Therapie von Verletzungen des Beckenrings sind eine exakte Diagnostik und Klassifikation. Vor allem beim komplexen Beckentrauma und beim Vorliegen eines Polytraumas ist ein rasches und an Prioritäten orientiertes Vorgehen entscheidend. Instabilitäten vom Typ B und C erfordern eine operative Stabilisierung. Dabei steht in der Notfallbehandlung des instabilen Beckenrings die externe Stabilisierung im Vordergrund. Beim Übergang auf interne Fixationsverfahren haben sich abhängig von der Verletzungsmorphologie verschiedene Schrauben- und Plattenmontagen bewährt. Die operative Stabilisierung des Beckenrings erfordert wegen der engen Nachbarschaft zu verschiedenen Gefäß- und Nervenbahnen besondere Sorgfalt. Das Endergebnis hängt dabei ganz wesentlich davon ab, wie gut die Wiederherstellung der anatomischen Form des Beckenrings gelungen ist.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100390050089
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    Electronic Resource
    Verletzungen des thorakolumbalen Übergangs (2000)
    Springer
    Trauma und Berufskrankheit 2 (2000), S. 162-166 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter ; Thorakolumbale Frakturen ; Transpedikuläre Spondylodese ; Spongiosaplastik ; Komplikationen ; Keywords ; Thoracolumbar fractures ; Transpedicular spondylodesis ; Bone grafting ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Spinal fractures are located predominantly at the thoracolumbar junction. After conservative treatment, for unstable fractures operative procedures were established during the last 20 years. Using implants with angular stability, dorsal transpedicular fixation yields good clinical results even compared with those of combined dorsoventral procedures. Transpedicular bone grafting is controversial as resorption frequently occurs; it has given disappointing results in fracture types in which definitive segmental fusion is unavoidable, so that combined dorso-ventral stabilization is necessary in such cases. The most frequent complications of dorsal instrumentation are the result of badly positioned transpedicular screws.
    Notes: Die Verletzungen des thorakolumbalen Übergangs stellen die Mehrzahl der Frakturen der Wirbelsäule dar. Nach der konservativen Therapie hat sich in den letzten beiden Jahrzehnten die operative Versorgung instabiler Frakturen etabliert. Die dorsale transpedikuläre Spondylodese unter Verwendung winkelstabiler Implantate stellt ein Verfahren dar, mit dem sich auch im Vergleich zu aufwändigen dorsoventralen Rekonstruktionen bei den meisten Frakturen gute klinische Resultate erzielen lassen. Der additionellen transpedikulären intrakorporalen Spongiosaplastik wird aufgrund der zu beobachtenden Resorption des Transplantats zunehmend geringere Bedeutung beigemessen. Auch bei Frakturtypen, bei denen eine definitive Fusion angestrebt werden sollte, hat die transpedikuläre interkorporale Knochentransplantation enttäuscht, sodass in derartigen Fällen nach primärer dorsaler Stabilisierung sekundär die Fusion von ventral erfolgen sollte. Die häufigsten Komplikationen bei der dorsalen transpedikulären Spondylodese sind auf Fehllagen der transpedikulären Schrauben zurückzuführen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00010931
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    Electronic Resource
    Electronic Resource
    Infantile acute pancreatitis after mumps vaccination simulating an acute abdomen (2000)
    Springer
    Pediatric surgery international 16 (2000), S. 488-489 
    Details
    ISSN: 1437-9813
    Keywords: Key words Pancreatitis ; Childhood ; Mumps vaccination ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  We describe an extremely rare case of acute pancreatitis presenting as an acute abdomen that appeared as a complication of mumps vaccination in a young child. A laparotomy performed because of suspected perforated appendicitis proved unnecessary in retrospect. No similar case in infancy and early childhood has been reported to date.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830000417
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  • 33
    Electronic Resource
    Electronic Resource
    Patient perception of magnetic resonance arthrography (2000)
    Springer
    Skeletal radiology 29 (2000), S. 265-269 
    Details
    ISSN: 1432-2161
    Keywords: Key words MR arthrography ; Joint injection ; Gadolinium (intra-articular) ; Pain-rating scores ; Arthrogram ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Objective. Magnetic resonance (MR) arthrography has been demonstrated to be more accurate than MR imaging alone in the identification of a variety of musculoskeletal pathology. While the complication rate of intra-articular gadolinium: saline injection has been shown to be relatively low, MR arthrography is more invasive, painful, and costly, and less convenient, than MR imaging alone. The purpose of this study was to evaluate patients’ perception of the fear and discomfort, and to assess their overall acceptance of the intra-articular gadolinium injection. Design and patients. Between October 1997 and January 1998, 113 outpatients who were referred to Yale-New Haven Hospital for MR arthrography of the ankle, elbow, hip, knee, shoulder, or wrist were asked to complete a questionnaire rating their fear of factors most commonly associated with the procedure including ”pain”, ”needles”, ”complications”, and ”discovery of results that would lead to surgery”. In addition, after having undergone the intra-articular gadolinium:saline injection, patients were asked to rate their perception of pain. Results. While many patients expressed fear of ”pain” and ”needles”, after having undergone the injection their overall pain rating score was low. Only 6% actually found gadolinium arthrography more painful than expected. Conclusion. Despite the fact that patients expressed apprehension about certain aspects of MR arthrography, subjects who underwent the intra-articular gadolinium injection considered the discomfort less than expected. Clinicians should not hesitate to order MR arthrography because the accuracy of the procedure is high enough that patients accept the discomfort.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050605
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    Electronic Resource
    Rapid chondrolysis after an intra-articular leak of bone cement in treatment of a benign acetabular subchondral cyst: an unusual complication of percutaneous injection of acrylic cement (2000)
    Springer
    Skeletal radiology 29 (2000), S. 275-278 
    Details
    ISSN: 1432-2161
    Keywords: Key words Bone subchondral cyst ; Acetabulum ; Interventional radiology ; Complications ; Methylmethacrylate ; Chondrolysis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Percutaneous injection of methylmethacrylate is now increasingly employed to treat bone lesions, both malignant and benign. However, the risks of this procedure are still to be fully established. In this report, we describe a case of rapid chondrolysis appearing after the intra-articular leakage of cement during injection of an acetabular subchondral cyst, resulting in hip replacement. Although the mechanism of such chondrolysis is unknown, this event suggests a chondrolytic effect of the acrylic cement. Thus, it is essential to systematically search for the presence of an intra-articular passage before injecting bone cement into a peri-articular cyst. This unusual complication highlights the need for rigorous evaluation of the benefits and risks of percutaneous injection of acrylic cement in the treatment of benign lesions, especially close to an articulation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002560050607
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    Electronic Resource
    D3 Lymph Node Dissection in Gastric Cancer: Evaluation of Postoperative Mortality and Complications (2000)
    Springer
    Surgery today 30 (2000), S. 700-705 
    Details
    ISSN: 1436-2813
    Keywords: Key words Gastric cancer ; Lymph node dissection ; Mortality ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Since November 1995 we have been performing a D3 lymph node dissection in patients undergoing an operation for gastric cancer with a curative intent. The aim of the present study was to evaluate whether this procedure results in an increased postoperative mortality or complication rate in a Western population. Between November 1995 and August 1997 the postoperative courses of 76 patients were retrospectively assessed (45.3 lymph nodes per patient, lymph node ratio: 0.16). The patient outcome was compared with data from a historic control group of patients (n = 383) in whom the newly established D2 dissection was studied in our department. Regarding the demographic, clinical, and tumor-pathologic data, and the choice of resection and reconstructive procedures, the two groups differed only slightly. The postoperative mortality of 1% was lower (vs 6.8%) while the overall complication rate of 34% (vs 32.1%) was identical. In particular, no anastomotic leakage (vs 9.4%) and fewer nonsurgical complications (17.1% vs 27.9%) occurred. The reoperation rate was 1% vs 9.7%. However, in 6% of the patients drainage tubes had to be inserted under computed tomographic guidance. The average hospital stay remained unchanged (21.9 vs 20.7 days). A D3 dissection was shown to be feasible while demonstrating no disadvantages in the patients when compared with the D2 procedure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005950070080
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    Electronic Resource
    Differentialindikation zentraler und peripherer Leitungsanästhesien (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 495-504 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Regionalanästhesie ; Spinalanästhesie ; Epiduralanästhesie ; periphere Nervenblockaden ; Komplikationen ; Keywords Regional anesthesia ; Spinal anesthesia ; Epidural anesthesia ; Nerve blocks ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Serious neurological complications caused by spinal hematoma or abscess following central neuraxial block have been reported more often during the last years. In contrast, severe complications are extremely rare associated with peripheral nerve blocks. Concerned about the safety of spinal and epidural anesthesia, we encourage the use of peripheral regional techniques for procedures on the lower extremity and especially for postoperative regional analgesia. Motor block due to lumbar epidural anesthesia using high concentrations of local anesthetic makes spinal hematoma or abscess difficult to recognize. Therefore, low concentrations of local anesthestic should be used for postoperative epidural analgesia. Any increase in motor block following neuraxial blockade should raise the suspicion of a spinal compression (e.g. hematoma or abscess). Other symptoms are back pain, radicular pain or paresthesia and incontinence. Disastrous neurological injuries can only be prevented by immediate diagnosis (MR, CT or myelography) and therapy (surgical decompression).
    Notes: Zusammenfassung In den letzten Jahren wird vermehrt über schwerwiegende neurologische Komplikationen durch spinale Hämatome und Abszesse nach rückenmarksnahen Regionalanästhesien berichtet. Vor diesen Hintergrund werden die verschiedenen Regionalanästhesietechniken für die untere Extremität und ihre Komplikationen gegenübergestellt, denn die komplikationsärmeren peripheren Leitungsanästhesien bieten sich im Bereich der unteren Extremität als Alternative zur Spinal- oder Epiduralanästhesie an. Es wird empfohlen, zur postoperativen Schmerztherapie lumbale Epiduralanalgesien soweit möglich durch periphere Leitungsblockaden zu ersetzen. Kontinuierliche Blockaden, z.B. im Bereich des N. femoralis eignen sich auch zur postoperativen Schmerztherapie. Bei der postoperativen lumbalen Katheter-Epiduralanalgesie erschweren hohe Lokalanästhetika-Konzentrationen mit ausgeprägter motorischer Blockade die Diagnose intraspinaler Raumforderungen. Zur postoperativen Epiduralanalgesie sind Lokalanästhetika daher nur in niedriger Konzentration einzusetzen. Bis zum Ausschluss des Gegenteils begründet nach rückenmarksnaher Regionalanästhesie jede Zunahme der motorischen Blockade den Verdacht auf eine spinale Raumforderung (z.B. Hämatom oder Abszess). Weitere Kardinalsymptome sind Rückenschmerzen, Wurzelkompressionsschmerzen und Inkontinenz. Nur die sofortige Diagnose (MR, CT oder Myelographie) und Therapie (ggf. operative Entlastung) kann katastrophale neurologische Schäden verhindern.
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    URL: http://dx.doi.org/10.1007/s001010070089
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    Electronic Resource
    Auswirkungen von Luftbläschen in der Infusionsspritze auf die Funktion von Spritzenpumpen (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 1018-1023 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Infusionssysteme ; Spritzenpumpen ; Luft ; Fehlerquellen ; Gefahren ; Keywords Syringe pumps ; Air ; Infusion line occlusion ; Drug delivery ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Application of highly concentrated short-acting vasoactive drugs in the critically ill patient requires precisely working syringe pump systems for continuous intravenous drug delivery. We performed a bench study to investigate the consequences of small amounts of air entrapped within a 50-ml infusion syringe. In particular we studied the effect of entrapped air on drug delivery after moderate vertical displacement of the pump by 50 cm (e. g. in preparation for transport) and the effect on the time required to trigger the pressure alarm after occlusion of the infusion line. At a flow rate of 1 ml/h, lowering the syringe pump prolonged the zero-drug delivery time from (mean±SD) 4.1±0.8 min (without air) to 6.2±0.9 (with 1 ml air) and to 13.1±0.9 min (with 2 ml of air, p〈0.001 for all comparisons). Entrapping of 2 ml of air within the syringe resulted in a 2.6-fold prolongation of the occlusion alarm time after accidental occlusion of the infusion line and a 3-fold increase of the resulting infusion bolus after occlusion. Enclosed air within infusion syringes considerably affects the syringe compliance. It increases the susceptibility of constant drug delivery to vertical displacement of syringe pumps and impairs the occlusion alarm function. Therefore, any air in syringe of infusion pump systems should be carefully removed. To avoid infusion boluses of short-acting vasoactive drugs after accidental occlusions, the occluded infusion line should be released to ambient pressure first.
    Notes: Zusammenfassung Werden hochdosierte kreislaufwirksame Pharmaka mit kurzer Halbwertszeit bei niedrigen Flussraten appliziert (z. B. bei Neugeborenen oder in der Kinder-Herzchirurgie), so ist eine konstante Zufuhr des Medikaments für die hämodynamische Stabilität eine unabdingbare Voraussetzung. Wir untersuchten in einem experimentellen Modell den Einfluss von geringen Luftmengen in 50-ml-Infusionsspritzen auf die Konstanz der Flussrate und die Alarmfunktion in 2 klinisch relevanten Situationen: relative Niveauänderungen zwischen Spritzenpumpe und Patient (etwa bei Transport oder Umlagern) und akzidentieller Verschluss (etwa Abknicken) einer Infusionsleitung. Nach Absenken der Spritzenpumpe um 50 cm gegenüber dem Ausgangsniveau verlängerte sich die Zeit unterbrochener Medikamentzufuhr (wegen hydrostatischer, retrograder Aspiration) von 4,1 min ohne Lufteinschluss auf 6,2 min bei 1 ml und auf 13,1 min bei 2 ml Lufteinschluss. Bei akzidentiellem Verschluss verlängerte sich die Zeit bis zum Okklusionsalarm bei 2 ml Lufteinschluss um das 2,6fache auf über 1 h, der resultierende Bolus nach Aufheben des Verschlusses verdreifachte sich. Daher sollten bei der Zufuhr hochkonzentrierter Vasoaktiva nicht nur relative Lageveränderungen zwischen System und Patient vermieden, sondern jegliche eingeschlossene Luft konsequent evakuiert werden. Dies gilt gleichermassen für alle über dasselbe Katheterlumen infundierenden Perfusoren. Bei Erkennen eines Verschlusses ist es sinnvoll, das okkludierte Infusionssystem vom Patienten zu trennen und den Druckentlastungsbolus zu verwerfen, bevor der Verschluss aufgehoben wird.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010070016
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    Electronic Resource
    Ciaglia Blue Rhino: Ein weiterentwickeltes Verfahren der perkutanen Dilatationstracheotomie (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 202-206 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Perkutane Dilatationstracheotomie ; Ciaglia Blue Rhino ; Komplikationen ; Key words Percutaneous dilatational tracheostomy ; Ciaglia Blue Rhino ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Objective: Elective tracheostomy has become an established treatment modality in modern intensive care medicine, and the number of percutaneously performed tracheostomies is steadily increasing. The Ciaglia Blue Rhino (CBR) represents another percutaneous technique in which the tracheostoma is formed by one-step dilation. Our study presents the technique itself and the early clinical experiences. Methods: In 20 adult patients on long-term ventilation, CBR was done. After puncture of the trachea in typical manner, dilation of the tracheostoma was achieved in one single step by means of a curved dilator with a special hydrophilic coating. Then, the tracheostomy tube was inserted over a curved loading dilator. Practicability and safety were determined as well as gas exchange during the procedure by means of arterial blood gas samples. Results: As a result of the dilator’s hydrophilic coating, dilation of the tracheostoma was rapidly achieved within 152±22 s, virtually free from resistance of the trachea or the cervical tissues. Complications such as bleeding, aspiration or postoperative infection of the stoma were not noted in any of our patients. Fractures of isolated tracheal cartilage rings were seen in 5 patients, however, no therapeutic intervention was necessary. In terms of perioperative gas exchange, pre- and postoperative levels of FiO2, PaO2, PaCO2 and the oxygenation index (PaO2/FiO2) did not change significantly. Conclusions: Based on our early clinical experience, Ciaglia Blue Rhino represents a new method that may combine the typical advantages of each of the other techniques for percutaneous tracheostomy (i.e. Ciaglia, Griggs, Fantoni) in one single technique. This method is distinguished by a high level of safety and practicability. However, further comparative trials need to be done before a definitive judgement can be made.
    Notes: Zusammenfassung Fragestellung: Die elektive Tracheotomie stellt in der modernen Intensivmedizin einen festen Bestandteil der Beatmungstherapie dar und wird zunehmend perkutan durchgeführt. Mit der Ciaglia Blue Rhino (CBR) steht nunmehr eine weitere perkutane Technik zur Verfügung, bei der zur Anlage des Tracheostomas nur noch ein einziger Dilatationsschritt erforderlich ist. Ziel der vorliegenden Untersuchung war es, die Technik der CBR und erste klinische Ergebnisse vorzustellen. Methodik: Bei 20 langzeitbeatmeten, erwachsenen Intensivpatienten wurde eine CBR durchgeführt. Nach Punktion der Trachea in typischer Weise erfolgt die Dilatation des Tracheostomas in einem Schritt mittels eines gebogenen Dilatators, der über eine spezielle hydrophile Beschichtung verfügt. Anschließend wird die Trachealkanüle über einen Führungsstab eingeführt. Neben Praktikabilität und Komplikationen der Technik wurde deren Einfluß auf den perioperativen Gasaustausch mittels Blutgasanalysen untersucht. Ergebnisse: Aufgrund der hydrophilen Beschichtung des Dilatators und der damit verbundenen nahezu widerstandslosen Bougierung gelang die Anlage des Tracheostomas im Mittel in 152±22 s. Akut interventionsbedürftige Komplikationen wie Blutungen, Aspiration oder eine postoperative Infektion des Tracheostomas wurden nicht beobachtet. Bei 5 Patienten kam es zu einer Fraktur einzelner Trachealspangen, die jedoch keine therapeutische Konsequenz hatte. Hinsichtlich des perioperativen Gasaustauschs ergaben sich keine Signifikanzen hinsichtlich der prä- und postoperativen Höhen von FiO2, paO2, paCO2 und des Oxygenierungsindex (paO2/FiO2). Schlussfolgerung: Die Ciaglia Blue Rhino-Technik könnte aufgrund dieser ersten klinischen Erfahrungen ein Verfahren darstellen, das die jeweiligen Vorteile der anderen perkutanen Tracheotomietechniken nach Ciaglia, Griggs und Fantoni in sich vereint. Diese weiterentwickelte Technik zeichnet sich durch hohe Praktikabilität und eine sehr rasche und sichere Durchführbarkeit aus. Zur endgültigen Bewertung dieses Verfahrens auch im Hinblick auf Spätkomplikationen müssen jedoch detaillierte Vergleichsstudien folgen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050815
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    Electronic Resource
    Die Larynxmaske bei Adenotonsillektomie bei Kindern Gefährliche Spielerei oder medizinischer Fortschritt? (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 706-712 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter AT ; TE ; Larynxmaske ; Technik ; Komplikationen ; Keywords Adenotomy ; Tonsillectomy ; Laryngeal mask ; Technique ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Anaesthesia both for adenotomy (AT) and for tonsillectomy (TE) frequently presents a challenge. On one hand, children scheduled for adenotomy often have upper airway infections and are thus at risk of laryngo- and bronchospasm; on the other hand the ENT surgeon and the anaesthetist have to share the “workspace” in the patient's mouth. Since the succinyl choline debate in the early 1990s, the question of the best muscle relaxant has gone hand in hand with that of the most appropriate means of securing the airway. The concept of the laryngeal mask as airway was initially greeted with scepticism. Following several years' use of the mask for this purpose in AT and TE in young children, we report our experience and summarise the literature on this topic. The laryngeal mask represents a safe alternative to intubation, provided there is close cooperation with the ENT surgeon.
    Notes: Zusammenfassung Die Narkosen zur Adenotomie, aber auch zur Tonsillektomie stellen für Anästhesisten immer wieder große Herausforderungen dar. Zum einen haben die Kinder, die zur Adenotomie anstehen, häufig Infekte der oberen Luftwege und sind damit laryngo- und bronchospasmusgefährdet, zum anderen müssen sich HNO-Arzt und Anästhesist den “Arbeitsraum” im Mund teilen. Seit der Succinylcholindebatte der frühen 90er-Jahre stellte sich mit der Frage nach dem geeigneten Muskelrelaxans die Frage nach der geeigneten Atemwegssicherung. Der Anwendung der Larynxmaske als Airway bei AT und TE wurde zunächst mit Skepsis begegnet. Nach langjähriger Anwendung der Larynxmaske zur Atemwegssicherung bei AT und TE im Kleinkindesalter wird hier nicht nur über Ergebnisse und langjährige Erfahrungen berichtet, sondern auch die Literatur zu diesem Thema zusammengefasst. Daraus ergibt sich, dass die Larynxmaske bei AT und TE eine sichere Alternative zur Intubation darstellt. Voraussetzung dazu ist jedoch eine gute Kooperation mit dem HNO-Arzt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010070064
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  • 40
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    Electronic Resource
    Pneumothorax bei der Vertikalen Infraklavikulären Blockade des Plexus brachialis Fallbericht einer seltenen Komplikation (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 901-904 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Vertikale Infraklavikuläre Blockade ; Pneumothorax ; Komplikation ; Plexus brachialis ; VIP ; Keywords Vertical infraclavicular blockade ; Pneumothorax ; Complications ; Brachial plexus ; VIP
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract A 50 year old female patient received anaesthesia of the arm by the vertical infraclavicular blockade of the plexus brachialis (VIP). Postoperatively an ipsilateral pneumothorax occured complicated by pleural effusion and a contralateral bronchopneumonia, which resolved completely after treatment. The blockade of the plexus was performed correctly, failures in determining the correct point of needle insertion could be excluded. Therefore a pneumothorax has to be regarded as a specific complication of the VIP, which might occur despite correct technique, and requires that the patient be informed of this eventuality. Nevertheless, the VIP is an important method due to its high success rate concerning blockade of the musculocutaneous nerve and tolerance of tourniquet. The risk of a pneumothorax is about 0.2 to 0.7%.
    Notes: Zusammenfassung Bei einer 50-jährigen Patientin wurde im Rahmen einer elektiven Operation an der Hand die Anästhesie durch die Vertikale Infraklavikuläre Plexus-brachialis Blockade (VIP) nach Kilka durchgeführt. Postoperativ kam es zum Auftreten eines ipsilateralen Pneumothorax, welcher durch einen Pleuraerguss und eine kontralaterale Bronchopneumonie kompliziert wurde. Unter invasiver Behandlung der Patientin kam es bezüglich aller Komplikationen zur restitutio ad integrum. Die Durchführung der Anästhesie war lege artis entsprechend der Erstbeschreibung, Fehler bei der Bestimmung der Punktionsstelle konnten mit größtmöglicher Wahrscheinlichkeit ausgeschlossen werden. Ein Pneumothorax bei der Vertikalen Infraklavikulären Plexus-brachialis Blockade stellt auch bei korrekter Durchführung unter Vermeidung von beschriebenen Kardinalfehlern ein methodenspezifisches und somit aufklärungspflichtiges Risiko dar. Der VIP ist dennoch eine wichtige Ergänzung der herkömmlichen Methoden zur Blockade des Plexus brachialis, da er sich durch eine hohe Erfolgsrate speziell im Bereich des N. musculocutaneus und in der Toleranz eines Tourniquets auszeichnet. Nach den bisherigen Erfahrungen ist von einem Pneumothoraxrisiko von 0,2–0,7% auszugehen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010070044
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  • 41
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    Electronic Resource
    Kombinierte Anästhesie mit Epiduralkatheter Eine retrospektive Analyse des perioperativen Verlaufs bei Patienten mit radikalen Prostatektomien (2000)
    Springer
    Der Anaesthesist 49 (2000), S. 949-959 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Kombinierte Anästhesie ; Thorakale Epiduralanästhesie ; Lumbale Epiduralanästhesie ; Prostatektomie ; Schmerztherapie ; Komplikationen ; Keywords Combined anaesthesia ; Thoracic epidural anaesthesia ; Lumbar epidural anaesthesia ; Prostatectomy ; Pain management ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Patients requiring radical prostatectomy (rPE), including retroperitoneal lymphadenectomy are often aged and have coexisting cardiopulmonary diseases, increasing the risk of perioperative complications. The aim of the present study was to evaluate our perioperative anaesthesiologic regimen over the last five years, in terms of safety and patients comfort. Records of 433 patients who underwent rPE between 1994 and 1999 in our hospital were retrospectively reviewed. Patients were divided in those who received: 1. general anaesthesia (GA) alone, 2. a combination of lumbar epidural anaesthesia (LEA)+GA or, 3. thoracic epidural anaesthesia (TEA)+GA. General anaesthesia was performed as balanced anaesthesia, and epidural administered local anaesthetics were bupivacaine 0.25% or ropivacaine 0.2%, 8–12 ml/h. In terms of intra- and postoperative numbers of tachycardic and hypertensive episodes, a reduced stress response was observed under epidural anaesthesia (EA). Moreover, the weaning duration was shorter under EA and onset of gastrointestinal motility was found earlier ([h] GA: 50.6±11.1/ LEA: 39.3±13.6/ TEA:33.8±13.0). Furthermore, a trend to rarer phases of postoperative vomiting and a significant decrease of in hospital stay of about one day ([d] GA: 12.4±5.8/ LEA: 11.1±3.1/ TEA: 11.5±3.8) was observed. The duration of personnel binding in the OR did not differ significantly between GA and TEA ([min] GA: 222.9±43.5/ LEA: 238.2±41.8/ TEA: 227.0±46.2), but ICU stay was shortened under TEA. Besides this, TEA reduced the number of pathologic postoperative thorax-x-rays. Senso-motor blockades, decreases of SaO2 and cardiac complications were experienced more frequent under LEA as compared with TEA. Combination of GA and EA, especially TEA, appears to improve perioperative care of patients undergoing rPE, in terms of patients safety and comfort.
    Notes: Zusamenfassung Patienten, die sich einer radikalen Prostatektomie (rPE) einschließlich retroperitonealer Lymphadenektomie (rLA) unterziehen, haben aufgrund ihres Alters und ihrer Begleiterkrankungen ein erhöhtes perioperativen Risiko. Ziel dieser Untersuchung war es, den intra- und postoperativen Verlauf der standardisierten Operation rPE+rLA unter verschiedenen Anästhesieregimen zu analysieren. Krankenakten von 433 Patienten, die sich zwischen 1994 und 1999 in unserer Einrichtung einer rPE+rLA unterzogen, wurden retrospektiv ausgewertet. Die Patienten wurden nach dem durchgeführten Anästhesieverfahren eingeteilt: 1. Allgemeinanästhesie (AA), 2. Kombination lumbale Epiduralanästhesie (LEA)+AA, 3. thorakale Epiduralanästhesie (TEA)+AA. Für die intra- und postoperative Katheteranalgesie wurden Bupivacain 0,25% oder Ropivacain 0,2%, 8–12 ml/h verwendet. Die Allgemeinanästhesie wurde als balancierte Anästhesie durchgeführt. Diese retrospektive Erhebung zeigt unter epiduraler Analgesie, gemessen an Tachykardien und hypertensiven Episoden, eine reduzierte intra- und postoperative Stressantwort, kürzere Extubationszeiten, früheres Wiedereinsetzen der gastrointestinalen Motilität ([h] AA: 50,6±11,1/ LEA: 39,3±13,6/ TEA:33,8±13,0), tendenziell selteneres Erbrechen und eine um einen Tag verkürzte Krankenhausverweildauer ([d] AA: 12,4±5,8/ LEA: 11,1±3,1/ TEA: 11,5±3,8). Dabei war unter TEA die Dauer der Anästhesiepräsenz im OP-Bereich vergleichbar mit AA ([min] AA: 222,9±43,5/ LEA: 238,2±41,8/ TEA: 227,0±46,2), und der Wachstationsaufenthalt verkürzt. Daneben war unter TEA die Anzahl der auffälligen postoperativen Thoraxröntgenbefunde reduziert. Zum Erreichen einer der TEA vergleichbaren Analgesie mussten unter LEA häufiger sensomotorische Blockaden, saO2-Abfälle und tendenziell eine höhere Anzahl kardialer Komplikationen in Kauf genommen werden. Gemessen an den von uns erhobenen Parametern stellt damit die Kombination einer Allgemeinanästhesie, insbesondere mit thorakaler Epiduralanalgesie ein sicheres und auch betriebswirtschaftlich effizientes anästhesiologisches Vorgehen bei radikalen Prostatektomien dar.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010070030
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  • 42
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    Electronic Resource
    Lasertherapie in der Dermatologie und Ästhetischen Medizin Nebenwirkungen, Komplikationen und Behandlungsfehler (2000)
    Springer
    Der Hautarzt 51 (2000), S. 463-473 
    Details
    ISSN: 1432-1173
    Keywords: Schlüsselwörter Laser ; Nebenwirkungen ; Komplikationen ; Behandlungsfehler ; Keywords Laser ; Side effects ; Complications ; Treatment faults
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Many different laser systems are used in dermatology. To wisely choose the correct laser for a given problem, one must be aware of both the spectrum of disorders for which each laser is suited and the potential side effects. We compare the side effect and complication profiles of the common laser systems pointing out their possibilities and limitations. Typical treatment errors will be pointed out. Dermatological training, extensive experience in laser therapy and compliance with quality guidelines are prerequisites for safe and successful treatment.
    Notes: Zusammenfassung In der Dermatologie werden unterschiedliche Lasersysteme eingesetzt. Für die Anwender ist nicht nur das jeweilige Behandlungsspektrum von Bedeutung, sondern auch welche unerwünschten Reaktionen im Rahmen einer Laserbehandlung auftreten können. Das Nebenwirkungs- und Komplikationsprofil der gängigen Geräte wird in der vorliegenden Arbeit vorgestellt und verglichen, und deren Möglichkeiten und Grenzen werden dargestellt. Typische Behandlungsfehler werden aufgezeigt. Eine dermatologische Facharztausbildung, umfangreiche lasertherapeutische Erfahrungen sowie die Einhaltung und Erfüllung von definierten Qualitätsrichtlinien sind Voraussetzungen für ein sicheres Behandlungsergebnis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001050051155
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  • 43
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    Electronic Resource
    Osteochondroma: MR imaging of tumor-related complications (2000)
    Springer
    European radiology 10 (2000), S. 832-840 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Osteochondroma ; Complications ; Chondrosarcoma ; Bone tumors ; MRI
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. Osteochondromas can be complicated by mechanical irritation, compression or injury of adjacent structures, fracture, malignant transformation, and postoperative recurrence. Magnetic resonance imaging represents the most valuable imaging modality in symptomatic cases, because it can demonstrate typical features of associated soft tissue pathology, which can be differentiated from malignant transformation. Reactive bursae formation presents as an overlying fluid collection with peripheral contrast enhancement. Dislocation, deformation, and signal alterations of adjacent soft tissue structures can be observed in different impingement syndromes caused by osteochondromas. Magnetic resonance imaging provides excellent demonstration of arterial and venous compromise and represents the method of choice in cases with compression of spinal cord, nerve roots, or peripheral nerves, depicting changes in size, position, and signal intensity of the affected neural structures. Malignant transformation as the most worrisome complication occurs in approximately 1 % of solitary and 5–25 % of multiple osteochondromas. Magnetic resonance imaging is the most accurate method in measuring cartilage cap thickness, which represents an important criterion for differentiation of osteochondromas and exostotic (low-grade) chondrosarcomas. Cartilage cap thickness exceeding 2 cm in adults and 3 cm in children should raise the suspicion for malignant transformation. Finally, MR imaging can detect postoperative recurrence by depiction of a recurrent mass presenting typical morphological features of a cartilage-forming lesion.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300051014
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  • 44
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    Electronic Resource
    Implanted central venous catheter-related acute superior vena cava syndrome: management by metallic stent and endovascular repositioning of the catheter tip (2000)
    Springer
    European radiology 10 (2000), S. 1329-1331 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Central venous catheters ; Venous obstruction ; Vena cava ; Interventional procedure ; Catheters and catheterization ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We describe a case of a 49-year-old woman with stage-IIIB lung adenocarcinoma who experienced an acute superior vena cava syndrome related to an implanted central venous catheter without associated venous thrombosis. The catheter was surgically implanted for chemotherapy. Superior vena cava syndrome appeared after the procedure and was due to insertion of the catheter through a subclinical stenosis of the superior vena cava. Complete resolution of the patient's symptoms was obtained using stent placement and endovascular repositioning of the catheter tip.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003300000361
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  • 45
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    Electronic Resource
    Risikofaktoren für das Auftreten von lokalen Komplikationen beim Erysipel (2000)
    Springer
    Der Hautarzt 51 (2000), S. 14-18 
    Details
    ISSN: 1432-1173
    Keywords: Schlüsselwörter ; Erysipel ; Komplikationen ; Diabetes mellitus ; Hepatopathien ; Nephropathien ; Key words ; Erysipelas ; Complications ; Diabetes mellitus ; Hepatopathy ; Nephropathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Background and objective: A complicated course of erysipelas is not uncommon. Bullous, haemorrhagic, necrotic and purulent lesions may be encountered. Today no reliable data exist as to which constitutional factors renders a patient at risk for developing complicated erysipelas though several risk factors, particularly diabetes mellitus, are often suggested. Based on the analysis of patients with erysipelas at the Department of Dermatology in Graz, factors determining the risk for complicated erysipelas should be identified. Patients/Methods: In a retrospective case-control study clinical data sheets of 766 in- patients treated at the department were evaluated with respect to the course of the erysipelas and with respect to potential risk factors. Results: General risk factors for local complications were location at the lower extremities, pre-existing hepatic or renal disease, hyperuricaemia, and diabetes mellitus. Hepatic and renal disease and – to a lesser extent – diabetes particularly predisposed for bullous and haemorrhagic lesions, while vascular occlusive disease enhanced the risk for ne- crotic lesions. Conclusions: Location and hepatic and renal disease are the most important risk factors, while diabetes is probably of less significance than previously suggested.
    Notes: Zusammenfassung Hintergrund und Fragestellung: Im Zuge eines Erysipels treten immer wieder Lokalkomplikationen (Blasen, Hämorrhagien, Nekrosen, Abszesse) auf. Derzeit gibt es keine verlässlichen Daten darüber, aufgrund welcher Merkmale ein Patient als komplikationsgefährdet einzustufen ist, wobei aber verschiedene Risikofaktoren, insbesondere Diabetes mellitus, vermutet werden. Anhand des Patientenguts der Grazer Hautklinik sollten klinische Risikofaktoren für einen komplizierten Erysipelverlauf erhoben werden. Patienten/Methodik: In einer retrospektiven Fall-Kontroll-Studie wurden von 766 Patienten, die in den Jahren 1986–1995 wegen eines Erysipels stationär behandelt worden waren, klinische Daten hinsichtlich Erysipelverlauf und möglicher Risikofaktoren erhoben und statistisch ausgewertet. Ergebnisse: Das Risiko eines komplizierten Erysipelverlaufs wird allgemein durch Lokalisation am Bein, durch Leber- und Nierenerkrankungen, Hyperurikämie und durch einen Diabetes mellitus erhöht. Lebererkrankungen und – in geringerem Maße Diabetes – disponieren speziell zu bullösen und hämorrhagischen Verläufen, eine periphere arterielle Verschlusskrankheit zu nekrotischen Läsionen. Schlussfolgerungen: Betroffene Körperregion sowie Leber- und Nierenerkrankungen scheinen die wichtigsten Risikofaktoren zu sein, während der Diabetes mellitus möglicherweise eine geringere Rolle spielt, als bisher angenommen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001050050004
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  • 46
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    Electronic Resource
    Sleep-related breathing disorders following discharge from intensive care (2000)
    Springer
    Intensive care medicine 26 (2000), S. 426-433 
    Details
    ISSN: 1432-1238
    Keywords: Key words Outcomes ; Hypoxaemia ; Sleep-related breathing disorders ; Obstructive sleep apnoea ; Central sleep apnoea ; Mechanical ventilation ; Complications ; Intensive care
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: To determine the incidence of sleep-related breathing disorders and nocturnal hypoxaemia in patients discharged from ICU following prolonged mechanical ventilation.¶Design: Prospective, consecutive patient observational study.¶Setting: The medical and surgical wards of a University Hospital.¶Patients and participants: Fifteen consecutive, adult patients discharged from the ICU who had received more than 48 h of mechanical ventilation were studied. Ten healthy volunteers acted as controls.¶Measurements and results: Overnight, multi-channel pneumographic studies were performed on all patients and controls. Chest and abdominal wall movement, air flow, oxygen saturation and snoring were continuously recorded. Data was analysed by both visual inspection of the traces and by computer-based algorithms. An apnoea/hypopnoea index was calculated for each patient and volunteer. Volunteers had an apnoea/hypopnoea index of less than 5 and had no episodes of nocturnal oxygen desaturation (SaO2 〈 90 %). Despite oxygen therapy 13/15 patients had episodes of desaturation and 9/15 spent more than 2 h with an SaO2 〈 90 %. Eleven patients had an abnormal apnoea/hypopnoea index (range 5–34 events/h). Four patients had predominantly obstructive events while 7 primarily had hypopnoeas.¶Conclusions: Significant overnight oxygen desaturation is common in patients discharged from ICU who have received prolonged mechanical ventilation. This group also has a significant incidence of sleep-related breathing disorders and this mechanism is likely to be important in the pathogenesis of the hypoxaemia.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051177
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  • 47
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    Electronic Resource
    Translaryngeal tracheostomy: two modified techniques versus the basic technique – early experience in 75 critically ill adults (2000)
    Springer
    Intensive care medicine 26 (2000), S. 457-461 
    Details
    ISSN: 1432-1238
    Keywords: Key words Tracheostomy: percutaneous, translaryngeal ; Complications ; Oxygenation ; Intensive care medicine
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objectives: Elective tracheostomy is an established procedure in the management of ICU patients on long-term ventilation. In addition, percutaneous tracheostomy techniques are increasingly being used. In 1997, Fantoni's translaryngeal technique (TLT), another minimally invasive procedure, was introduced. While clinical studies of TLT showed that the technique is safe and can be performed rapidly, technical difficulties which sometimes led to prolonged operating times were also noted. Our study compared the basic TLT technique to a modified TLT approach and to TLT performed with the manufacturer's new, improved “Straight Cannula” set. Twenty-five patients were enrolled in each group, and the advantages and disadvantages of the respective techniques were evaluated.¶Setting: Surgical ICU of a university hospital.¶Patients: Seventy-five adult, surgical intensive care patients.¶Measurements and results: Average operating times with the modified TLT techniques were significantly shorter, 4 and 5 min respectively, as compared to 11 min for the basic TLT technique. Initially, use of the new, improved TLT set resulted in a complete passage of the tracheal cannula in two patients; uneventful Griggs's tracheostomy was performed instead. Regardless of the technique used, no other perioperative complications were noted and the perioperative gas exchange remained unaffected by the tracheostomy procedure.¶Conclusions: The modified TLT procedures are safer and more readily performed than the basic technique. Difficulty in the retrograde passage of the guide wire was seen only occasionally with the modified techniques. Based on our data we conclude that the modified techniques are superior to the basic technique and represent significant progress in TLT.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051181
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  • 48
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    Electronic Resource
    Delay of extubation in neonates and children after cardiac surgery: impact of ventilator-associated pneumonia (2000)
    Springer
    Intensive care medicine 26 (2000), S. 942-949 
    Details
    ISSN: 1432-1238
    Keywords: Key words Ventilator-associated pneumonia ; Cardiac surgery ; Children ; Pediatric intensive care ; Complications ; Extubation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Objective: This study was undertaken to determine the delay of extubation attributable to ventilator-associated pneumonia (VAP) in comparison to other complications and complexity of surgery after repair of congenital heart lesions in neonates and children.¶Methods: Cohort study in a pediatric intensive care unit of a tertiary referral center. All patients who had cardiac operations during a 22-month period and who survived surgery were eligible (n = 272, median age 1.3 years). Primary outcome was time to successful extubation. Primary variable of interest was VAP. Surgical procedures were classified according to complexity. Cox proportional hazards models were calculated to adjust for confounding. Potential confounders comprised other known risk factors for delayed extubation.¶Results: Median time to extubation was 3 days. VAP occurred in 26 patients (9.6 %). The rate of VAP was not associated with complexity of surgery (P = 0.22), or cardiopulmonary bypass (P = 0.23). The adjusted analysis revealed as further factors associated with delayed extubation: other respiratory complications (n = 28, chylothorax, airway stenosis, diaphragm paresis), prolonged inotropic support (n = 48, 17.6 %), and the need for secondary surgery (n = 51, 18.8 %; e. g., re-operation, secondary closure of thorax). Older age promoted early extubation. The median delay of extubation attributable to VAP was 3.7 days (hazards ratio HR = 0.29, 95 % CI 0.18–0.49), exceeding the effect size of secondary surgery (HR = 0.48) and other respiratory complications (HR = 0.50).¶Conclusion: VAP accounts for a major delay of extubation in pediatric cardiac surgery.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001340051285
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  • 49
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    Electronic Resource
    Operative or endovascular treatment of ruptured intracranial vertebral artery aneurysms? (2000)
    Springer
    Neuroradiology 42 (2000), S. 685-691 
    Details
    ISSN: 1432-1920
    Keywords: Key words Aneurysm, vertebral artery ; Haemorrhage, subarachnoid ; Surgery ; Embolisation ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Our purpose was to evaluate the surgical and endovascular treatment outcomes of ruptured intracranial vertebral artery aneurysms (RIVAA). The outcomes of 44 patients with RIVAA treated between 1983 and 1998 surgically (26), endovascularly (20) or both (2) were evaluated. The aneurysms were clipped in 24 patients, and clipped and wrapped in two. We treated 20 by the endovascular approach, 12 with Guglielmi detachable coils (GDC), and eight by parent-vessel occlusion using detachable balloons. Three patients had endovascular treatment after a failed or inadequate surgical attempt. Post-treatment follow-up was 17–183 months (mean 101 months) for surgically treated patients. For the GDC-treated group angiographic follow-up was carried at 8–49 months (mean 19 months). The condition of seven (27 %) of the surgically treated patients worsened due to procedure-related complications, compared with 10 % in the endovascular treatment group. Of the patients initially presenting with Hunt and Hess grade IV or V, three of five (60 %) died who were treated surgically and two of eight (25 %) who were treated endovascularly. A good outcome was achieved in 17 surgically treated patients (85 % of the survivors) and in 16 of the endovascular group (89 % of the survivors). This present “same-site” report on treatment of a specific abnormality, RIVAA, treated surgically or by an endovascular approach indicates that especially in poorer Hunt and Hess grade patients, the latter may offer a clinical outcome as good as that of surgery, although long-term efficacy of GDC treatment is still to be determined.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002340000378
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  • 50
    Electronic Resource
    Electronic Resource
    Pediatric biopsy of a single native kidney (2000)
    Springer
    Pediatric nephrology 15 (2000), S. 66-69 
    Details
    ISSN: 1432-198X
    Keywords: Key words Biopsy ; Kidney ; Complications ; Percutaneous ; Internet ; e-mail
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Technological improvements have reduced the frequency of complications in children receiving a percutaneous renal biopsy. No study has systematically compared the safety of open and percutaneous kidney biopsy. Yet many nephrologists consider a single native kidney an absolute contraindication to percutaneous biopsy. We have established an international registry of single native kidney biopsies in children and we now report our early results. Eight biopsies are included. Seven patients had percutaneous biopsies and one an open biopsy. None of the patients had major complications, and adequate tissue was obtained from all. Our limited experience indicates that the presence of a single native kidney is not an absolute indication for an open approach. We encourage our colleagues to report to the international registry in order to further document the safety of percutaneous biopsy of the single native kidney in children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004670000417
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  • 51
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    Electronic Resource
    Duodenal duplication cyst identified with MRCP (2000)
    Springer
    European radiology 10 (2000), S. 1277-1279 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Duodenum ; Congenital anomalies ; Duodenal duplication ; Imaging ; Duodenal duplication ; Complications ; Treatment
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. We report a case of a stalked cystic duodenal duplication. The lesion, hyperintense on T2-weighted GRE images, maintained the signal intensity after oral administration of a negative contrast agent (Lumirem, Guerbet, Aulnay-Sous-Bois, France), confirming its independence from the duodenal lumen. To our knowledge, this is the first demonstration of duodenal duplication by means of MR cholangiopancreatography.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003309900286
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  • 52
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    Electronic Resource
    Late complication following percutaneous cholecystostomy: retained abdominal wall gallstone (2000)
    Springer
    European radiology 10 (2000), S. 1284-1286 
    Details
    ISSN: 1432-1084
    Keywords: Key words: Percutaneous cholecystostomy ; Complications ; Gallstone ; Abdominal wall imaging ; Ultrasonography
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract. A case of recurrent abdominal wall abscess following percutaneous cholecystostomy (PC) is presented. Transperitoneal PC was performed in an 82-year-old female with calculous cholecystitis. Symptoms resolved and the catheter was removed 29 days later. The patient came back 5 months later with a superficial abscess that was drained and 8 months post PC with a fistula discharging clear fluid. Ultrasonography revealed the tract adjacent to an area of inflammation containing a calculus, whereas CT failed to depict the stone. Subsequent surgery confirmed US findings. To our knowledge, this is the first report of a dislodged bile stone following percutaneous cholecystostomy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003309900309
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  • 53
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    Electronic Resource
    Complications following anterior approaches to the cervical spine (2000)
    Springer
    European journal of orthopaedic surgery & traumatology 10 (2000), S. 177-181 
    Details
    ISSN: 1432-1068
    Keywords: Cervical spine ; Anterior approach ; Complications ; Dysphagia ; hoarseness
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The authors present a retrospective study of 535 consecutive anterior approaches to the cervical spine back to 5 years. The data were analyzed for post-operative complications. This surgical procedure has been commonly used for more than 40 years, but the post-operative complications due to the anterior approach itself were presented with few accompanying statistics, with various and contradictory results. Injury to nearly all of the structures has been reported in the literature, the more frequent problems are hoarseness and dysphagia; other complications include perforation of the oesophagus, hematomas, vascular injury⋯ Analysis of this data allows to understand better the specific problems related to this surgical approach, and to suggest precautions at each stage of the course of exposure of cervical vertebrae.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01682311
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  • 54
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    Electronic Resource
    Perinatal indomethacin treatment and neonatal complications in preterm infants (2000)
    Springer
    European journal of pediatrics 159 (2000), S. 153-155 
    Details
    ISSN: 1432-1076
    Keywords: Key words Indomethacin ; Premature infants ; Antenatal ; Postnatal ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract To evaluate the incidence of neonatal complications among infants exposed to indomethacin antenatally, postnatally or both ante-and postnatally (combined), the records of 240 infants of gestational ages between 23 to 32 weeks were analysed retrospectively. Antenatal indomethacin treatment for longer than 2 days with a daily or cumulative dosage ≥150 mg correlated with a significantly higher incidence of grade I-II intraventricular haemorrhage. Combined exposure, cumulative antenatal exposure ≥150 mg and duration of antenatal exposure of more than 2 days was associated with necrotising enterocolitis and a cumulative exposure with sepsis. There was no independent association between indomethacin exposure and pneumothorax, bronchopulmonary dysplasia or respiratory distress syndrome. Conclusion Preterm infants with exposure to antenatal indomethacin might be at increased risk of grade I and II intraventricular haemorrhage and those with both ante- and postnatal exposure at an increased risk of necrotising enterocolitis and sepsis.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s004310050040
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  • 55
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    Electronic Resource
    The results of anterior fusion and Cotrel-Dubousset-Hopf instrumentation in idiopathic scoliosis (2000)
    Springer
    European spine journal 9 (2000), S. 505-515 
    Details
    ISSN: 1432-0932
    Keywords: Key words Idiopathic scoliosis ; Anterior instrumentation ; Surgical treatment ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Anterior instrumentation for the correction of scoliotic curves has recently been gaining in popularity. The problems of high mortality and morbidity that were associated with the employment of anterior instrumentation in the first years it was used have now been overcome. Efforts are now being concentrated on increasing the correction rates in the frontal plane and decreasing the kyphotic effect in the sagittal plane. The anterior Cotrel-Dubousset-Hopf (CDH) system is a recently developed instrumentation that has been claimed to decrease the kyphotic effect through the use of double rods. This study aimed to investigate the impact of the anterior CDH system on idiopathic scoliotic curves in frontal and sagittal planes. To this end, 26 idiopathic scoliosis patients treated with the CDH system were followed for a mean period of 32.8 ± 5.3 months. In the frontal plane, Cobb angles of major and secondary curves were measured, and postoperative and final correction rates determined. In the sagittal plane, sagittal contours of both the instrumented region and the thoracic and lumbar regions were measured, and their preoperative, postoperative and final control values were determined. In addition to clinical examination, lateral trunk shift (LT), shift of head (SH) and shift of stable vertebra (SS) were measured in vertebral units (VU), on the preoperative and postoperative radiographs in order to evaluate the effect of the system on trunk balance. It was established that in patients with single flexible thoracolumbar and lumbar curves and those with rigid thoracic curves, the correction rates obtained in the frontal plane were respectively 79.4 ± 14.8%, 68.0 ± 9.4% and 61.5 ± 8.0%, with statistical significance. Their final corrections at the last control were 76.3 ± 17.4%, 56.9 ± 9.1% and 52.3 ± 8.3%, respectively. Although the corrections in the lumbar rigid curves were relatively low, they were still statistically significant. Taking all the patients together, the mean preoperative Cobb angle of the major curves of 67.2°± 20.2° improved to a mean of 28.6°± 21.0°, which was a statistically significant difference (P 〈 0.05), giving a mean correction rate of 61.2 ± 20.3%. The mean correction loss of major curves in the frontal plane in all patients was 6.0°± 3.8° and the mean final correction rate was 52.6 ± 23.2%. In the sagittal plane, there was a favorable kyphotic effect on the thoracic region of patients with hypokyphosis and lordosis pattern, whilst in patients with kyphotic pattern, this effect was minimal. In patients with a single flexible lumbar curve, kyphotic effect was not observed except in two patients. In these two patients, it was thought that excessive compression force may have been used. As to the patients with a rigid lumbar curve, there was a slight decrease in lumbar lordosis. No postoperative complaints were made about imbalance, and the mean overall correction in LT values was 60.1 ± 21.7%. While preoperatively, the SH and SS values of all patients were over 0.5 VU, postoperatively, 12 patients (46.2%) were completely balanced (SH = 0 VU, SS = 0 VU) and 8 patients (30.8%) were balanced (0 VU 〈 SH and SS 〈 0.5 VU). The remaining six patients, whose balance values were corrected with statistical significance but were still over 0.5 VU, were found to be the ones with rigid lumbar curves. Implant failure and systemic complications were not noted in the follow-up period. In view of these findings, it was determined that CDH instrumentation achieves significant correction rates in the frontal and sagittal planes, particularly in single flexible lumbar, thoracolumbar and thoracic rigid curves. It was found that the kyphotic effect was minimized with a double rod system. Significant clinical and radiological corrections were achieved in balance values, without any imbalance and decompensation problems.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005860000176
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  • 56
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    Electronic Resource
    Increasing chronic subdural hematoma after endoscopic III ventriculostomy (2000)
    Springer
    Child's nervous system 16 (2000), S. 402-405 
    Details
    ISSN: 1433-0350
    Keywords: Keywords Endoscopic III ventriculostomy ; Overdrainage ; Chronic SDH ; Shunt ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Object: Endoscopic III ventriculostomy (ETV) is an effective and a rather safe treatment for noncommunicating hydrocephalus secondary to aqueductal stenosis and other obstructive pathologies. Though not devoid of risk, ETV is increasingly replacing shunt operations, and it prevents related complications, including overdrainage. Methods: We report a rare case of a large chronic subdural hematoma (ChSDH) after ETV in a patient with aqueductal stenosis. Three weeks after he was shunted elsewhere, he presented to us with clinical symptoms of intracranial hypotension and overdrainage. ETV was performed and the shunt removed uneventfully. On routine postoperative MRI a few weeks later, a large ChSDH was noted, the patient being totally asymptomatic. Since the ChSDH grew significantly, causing a mass effect on the follow-up MRI, it was finally drained. Large and increasing ChSDHs have previously been reported secondary to overdrainage after shunt placement, but not after ETV. Conclusions: We conclude that though rare, a ChSDH may evolve even after ETV, if there is a substantial decrease in previously elevated intracranial pressure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003810000298
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  • 57
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    Electronic Resource
    Evolution of living donor liver transplantation in adults: a single center experience (2000)
    Springer
    Transplant international 13 (2000), S. S134 
    Details
    ISSN: 1432-2277
    Keywords: Key words Liver transplantation ; Living donor ; Adult patient ; Right lobe graft ; Small-for-size graft ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050300
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  • 58
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    Incidence and clinical characteristics of posttransplant lymphoproliferative disorders: report from a single center (2000)
    Springer
    Transplant international 13 (2000), S. S382 
    Details
    ISSN: 1432-2277
    Keywords: Key words Transplantation ; Complications ; PTLD
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract In the period 1973–1998, among 2 139 allograft recipients treated with standard immunosuppression, posttransplant lymphoproliferative disorders (PTLD) developed in 19 patients (0.9 %): one plasmacytic hyperplasia, two polymorphic PTLD, one myeloma, and 15 lymphomas. PTLD developed 1 year after transplantation (tx) in 14 patients. Five patients were diagnosed at autopsy, 2 were lost to follow up, 3 died before therapy could be instituted, and 1 patient has just started chemotherapy. Of the 8 evaluable patients, 2 received acyclovir and are alive in complete remission (CR) and 6 received chemotherapy ± surgery. Of these 6, 4 died of lymphoma and/or infection, 1 died of unrelated causes in CR, and 1 is alive in CR. PTLD is a severe complication of tx, usually running an aggressive course which may preclude prompt diagnosis and treatment. Nevertheless, therapy is feasible and must be tailored on the histologic subtype. Seventy-four percent of patients were diagnosed with late-onset PTLD stressing the need for long-term follow up.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001470050367
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  • 59
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    Electronic Resource
    Prevention of permanent arthrofibrosis after anterior cruciate ligament reconstruction alone or combined with associated procedures: a prospective study in 443 knees (2000)
    Springer
    Knee surgery, sports traumatology, arthroscopy 8 (2000), S. 196-206 
    Details
    ISSN: 1433-7347
    Keywords: Keywords Anterior cruciate ; ligament ; Immediate motion ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Sports Science
    Notes: Abstract We prospectively determined the effectiveness of an immediate knee motion and early intervention program to prevent permanent motion limitations in a consecutive series of patients who had anterior cruciate ligament autogenous patellar tendon reconstruction for isolated rupture (219 knees) or combined with other procedures (224 knees). The subjects were placed into either a progressive or delayed rehabilitation program and were followed for at least 12 months postoperatively. At follow-up a normal range of motion (0° to at least 135°) was found in 436 knees (98%), and mild losses of extension (–5°) were found in 7 knees. Twenty-three knees (5%) required interventions; 9 had extension casts, 9 had gentle manipulations under anesthesia, 3 had arthroscopic débridements, and 2 had continuous epidural anesthetic and inpatient therapy. All of these 23 knees regained full motion. The 7 patients with mild losses of extension had refused treatment intervention. The 0% incidence rate of permanent arthrofibrosis, and 0.7% reoperation rate for knee motion limitations, demonstrated the effectiveness of our program.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001670000126
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  • 60
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    Electronic Resource
    Two Cases of Fulminant Mycoplasma pneumoniae Pneumonia within 4 Months (2000)
    Springer
    Infection 28 (2000), S. 180-183 
    Details
    ISSN: 1439-0973
    Keywords: Key WordsMycoplasma pneumoniae ; Pneumonia ; Complications ; Immunoblot
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We report the clinical course and diagnostic findings in two patients with life-threatening Mycoplasma pneumoniae (MP) pneumonia who were treated in the same hospital in the course of only 4 months. The patients were previously healthy adults, aged 31 and 37 years, respectively. In both of them severe complications occurred which coincided with the acute MP respiratory infection.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s150100050077
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  • 61
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    Electronic Resource
    Hospitalization for Primary Varicella-Zoster Virus Infection and Its Complications in Patients from Southern Israel (2000)
    Springer
    Infection 28 (2000), S. 200-204 
    Details
    ISSN: 1439-0973
    Keywords: Key Words Varicella ; Hospitalization ; Complications ; Bedouins ; Jews
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Background: We conducted this study to determine the impact of chickenpox on two different ethnic populations in southern Israel: Jews and Bedouins. Methods: Hospital records of 113 patients discharged from the Soroka Medical Center with the diagnosis of varicella during a 4.5-year period were reviewed. Results: Mean age was 9.2 years and the average hospital stay was 5.4 days. Bacterial skin or soft tissue infections were the most common complications (30%), followed by pneumonia (17%) and central nervous system complications (11.5%). There were no fatal cases throughout the study period. The calculated hospitalization rate for varicella was one in every 319 cases. Major differences between Jews and Bedouins included an older mean age of Bedouin patients (13.9 years versus 4.5 years); higher hospitalization rate (relative risk [R.R.]: 2.8, 95% confidence interval: 1.9–4.2), and higher risk for complicated varicella (R.R.: 2.1, 95% confidence interval: 1.3–3.4). Conclusion: Hospitalization of patients with varicella in southern Israel is common and varicella infection in Bedouins is associated with greater morbidity compared with that in Jews in southern Israel.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s150100070035
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  • 62
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    Electronic Resource
    Aktueller Einsatz und Stellenwert der intraaortalen Ballongegenpulsation in der kardiologischen Routine (2000)
    Springer
    Medizinische Klinik 95 (2000), S. 429-434 
    Details
    ISSN: 1615-6722
    Keywords: Schlüsselwörter Intraaortale Ballongegenpulsation ; Indikation ; Kardiogener Schock ; Akuter Myokardinfarkt ; Komplikationsrate ; Langzeitergebnisse ; Keywords Intraaortic balloon counterpulsation ; Indication ; Cardiogenic shock ; Acute myocardial infarction ; Complications ; Follow-up
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Background: Intraaortic balloon counterpulsation (IABC) is an established technique for temporary support of the left ventricular function. However, less is known about the current use and outcome of IABC in daily clinical practice. Patients and Method: From July 1995 to May 1999 all patients receiving an IABC in the Department of Cardiology of the Heart Center Ludwigshafen were included in a consecutive registry and follow-up data were obtained. Results: Sixty-six patients (mean age 65 years, 64% male) received an IABC during the registration period. In 95% of cases the indication for IABC was the presence of cardiogenic shock. The shock was due to an acute myocardial infarction in 83%, other reasons were less frequent (≤ 5%). Total inhospital mortality was 48%. Patients in shock due to myocardial infarction (53%) showed the highest mortality. During follow-up (median 20 months) another 21% died. Complications occurred in 20% of patients under IABC, including vascular complications in 12%, infections in 5% and major bleedings in 3%. There was no difference between mortality among patients with complications and total mortality. Conclusion: Main indication for IABC in daily practice is the presence of cardiogenic shock (95%), dominantly due to myocardial infarction (83%). Despite IABC therapy, half of these patients die during the hospital stay. High mortality of cardiogenic shock in myocardial infarction with pharmacological therapy justifies IABC treatment with regard to a rate of complications of 20%.
    Notes: Zusammenfassung Hintergrund: Die intraaortale Ballongegenpulsion (IABP) ist ein etabliertes Verfahren zur passageren Linksherzunterstützung. Es gibt jedoch kaum Daten über den Stellenwert in der klinischen Routine sowie Früh-/Langzeitergebnisse. Patienten und Methodik: Von Juli 1995 bis Mai 1999 wurden alle Patienten, die in der Kardiologie des Herzzentrums Ludwigshafen eine IABP erhielten, in einem konsekutiven Register erfasst und ein Follow-up durchgeführt. Ergebnisse: 66 Patienten (mittleres Alter 65 Jahre, 64% Männer) erhielten im Untersuchungszeitraum eine IABP. Indikation war in 95% der Fälle ein kardiogener Schock, davon in 83% nach akutem Myokardinfarkt. Andere Indikationen waren selten (≤ 5%). Die Intrahospitalmortalität lag insgesamt bei 48%. Am höchsten war sie bei Infarktpatienten mit Schock (53%). Im Follow-up von im Median 20 Monaten verstarben weitere 21%. Die Komplikationsrate der IABP lag bei 20%, davon Gefäßkomplikationen in 12%, Infektionen in 5% und schwere Blutungen in 3%. Die Moralität dieser Patienten entsprach der im Gesamtkollektiv. Schlußfolgerung: Die Indikation zur IABP wird auch an einem interventionellen Zentrum selten gestellt (66 Fälle in vier Jahren). Die Hauptindikation ist der kardiogene Schock (95%), in erster Linie bei Myokardinfarkt (83%). Trotz IABP verstirbt die Hälfte der Patienten in der Klinik. Aufgrund der hohen Mortalität von Infarktpatienten mit medikamentöser Therapie des kardiogenen Schocks scheint ein liberaler IABP-Einsatz trotz einer Komplikationsrate von 20% gerechtfertigt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s000630050002
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  • 63
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    Electronic Resource
    Therapie der hypertensiven Krise (2000)
    Springer
    Medizinische Klinik 95 (2000), S. 286-292 
    Details
    ISSN: 1615-6722
    Keywords: Schlüsselwörter: Hypertensive Krise ; Hypertensiver Notfall ; Hypertensive Dringlichkeit ; Komplikationen ; Therapie ; Ursachen ; Key Words: Hypertensive emergency and urgency ; Etiology ; Complications ; Therapy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Hypertensive crisis is defined as an extreme elevation of arterial blood pressure, with diastolic pressure 〉 120 mm Hg, and represents an imminent risk to the patient. In such cases, a rapid orientating diagnosis and adequate antihypertensive treatment to avoid sequelae are needed, sometimes even before diagnostic test are completed. Hypertensive emergencies and hypertensive urgencies can be distinguished. If the critical increase in blood pressure is associated with end-organ damage such as encephalopathy, acute left heart failure and pulmonary edema, angina pectoris, myocardial infarction or dissecting aortic aneurysm, a hypertensive emergency is presnet, that is an acute threat to the patient's life. A hypertensive emergency requires effective lowering of blood pressure within minutes, but not necessarily to normal range. The choice of suitable antihypertensive agents depends on clinical symptoms, contraindications, duration of pressure elevation and underlying conditions, prior cardiovascular, cerebrovascular and renal disorders. The risk of imminent end-organ damage must be weighed against the risk of rapid blood pressure lowering. In hypertensive urgencies without end-organ complications, blood pressure can be lowered more slowly over several hours, often with oral agents to avoid detrimental fall in blood pressure. The drugs of choice are mainly urapidil IV and nitroglycerine.
    Notes: Zusammenfassung Die hypertensive Krise stellt mit ihren kardialen, zerebralen und renalen Folgeerscheinungen eine potentiell lebensbedrohliche Komplikation der arteriellen Hypertonie dar. Bei einem hypertensiven Notfall (emergency), der den Patienten vital gefährdet, geht der kritische Blutdruckanstieg mit Organschä,den wie der Enzephalopathie, einer akuten Linksherzinsuffizienz, Angina pectoris, Herzinfarkt oder einem dissezierenden Aortenaneurysma einher. Der hypertensive Notfall erfordert eine umgehende effektive Blutdrucksenkung innerhalb von Minuten. Liegt eine Dringlichkeit (urgency) vor, bei der die oben genannten Folgeerscheinungen und Symptome bei stark erhöhten Blutdruckwerten fehlen, reicht eine langsame Absenkung des arteriellen Blutdrucks über mehrerer Stunden aus. Die Auswirkung der Hypertonie auf die Zielorganfunktion muß gegen das Risiko einer exzessiven Blutdrucksenkung abgewogen werden. Das Ausmaß der notwendigen Drucksenkung sowie die Wahl des geeigneten Antihypertensivums werden durch die klinische Symptomatik, Kontraindikationen, Dauer und Ausmaß der Blutdrucksteigerung und die zugrundeliegenden Vorerkrankungen des Patienten bestimmt. Eine zu langsame, aber auch eine zu rasche Blutdrucksenkung können zu schwerwiegenden Folgeschäden führen. Bei einer hypertensiven Dringlichkeit ohne Endorgankomplikationen ist meist eine allmähliche Blutdrucksenkung mir oral verabreichten Antihypertensiva ausreichend. Mittel der Wahl sind Urapidil intravenös und Nitroglycerin.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002123
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  • 64
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    Electronic Resource
    Behandlungsstrategien bei der akuten komplizierten Divertikulitis (2000)
    Springer
    Coloproctology 22 (2000), S. 205-210 
    Details
    ISSN: 1615-6730
    Keywords: Schlüsselwörter Akute Divertikulitis ; Komplikationen ; Chirurgische Behandlungsstrategien ; Key Words Acute diverticulitis ; Complications ; Surgical management
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract Interval single stage resection with primary anastomosis is the new strategy in management of acute complicated colonic diverticulitis. With increasing tendency localized complications are treated with minimally invasive techniques. Life threatening peritonitis with evidence of free perforation in old, multimorbid, bad conditioned patients should be further an indication for 2-stage resection. Laparoscopic assisted Hartmann reversal can be done with minimally invasive risk in experienced hands.
    Notes: Zusammenfassung Die möglichst einzeitige, elektive Resektion ist der Trend in der chirurgischen Behandlung der akuten komplizierten Divertikulitis. Lokalisierte Komplikationen werden nach Abklingen der akuten Entzündung zunehmend minimalinvasiv reseziert. Auch bei der vital bedrohlichen Perforationsperitonitis ist eine Tendenz zur primär einzeitigen Resektion erkennbar. Im Stadium der fortgeschrittenen Peritonitis hat bei multimorbiden Patienten in schlechtem Allgemeinzustand die Diskontinuitätsresektion weiterhin ihre Berechtigung. Die Hartmann-Wiederanschlussoperation kann heute risikoarm und zunehmend laparoskopisch assistiert durchgeführt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00001867
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  • 65
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    Electronic Resource
    Irreducible Displacement of Comminuted Metacarpal Head Fracture (2000)
    Springer
    European journal of trauma 26 (2000), S. 315-318 
    Details
    ISSN: 1615-3146
    Keywords: Key Words Metacarpal head fractures ; Irreducibility ; Complications ; Avascular necrosis
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The case of a comminuted metacarpal head fracture of the index with distinct displacement and 180° longitudinal malrotation as well as irreducibility of head fragments due to entrapment in volar soft tissues is presented. Our case might illustrate the complications possibly encountered in these severe fractures, such as neural compromise and postoperative adhesions. Although the final functional outcome was good and the patient felt minimal pain, radiographic signs of avascular necrosis developed 12 months after injury.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002458
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  • 66
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    Electronic Resource
    Complications amd Problems in Intramedullary Nailing of Children's Fractures (2000)
    Springer
    European journal of trauma 26 (2000), S. 287-293 
    Details
    ISSN: 1615-3146
    Keywords: Key Words Fracture ; Children ; Elastic stable intramedullary nailing (ESIN) ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Elastic stable intramedullary nailing (ESIN) is well established for stabilizing pediatric diaphyseal and special metaphyseal limb fractures. Expanding its application requires the evaluation of problems and complications to prevent uncritical use. Four pediatric surgical departments participated in a retrospective study. Between 1990 and 1998, 937 fractures were treated by ESIN. Major indications were forearm and femur fractures. Continuous documentation of treatment, postoperative course and follow-up formed the basis of evaluation. Analysis was subdivided into intraoperative problems, postoperative problems, and complications. Intraoperative problems (6.5%) were characterized by open reduction, cortical perforation by a nail tip with subsequent instability and by iatrogenic bursting of a third fragment. Postoperatively, 6.4% of patients showed soft tissue irritation due to nail ends or joint effusions. Complications (8.4%) included axial deviation 〉10° or instability of osteosynthesis in 5.3% and nerve injuries in 1.4%. Delayed healing, pseudarthrosis, osteomyelitis and synostosis were only observed in isolated cases, 5 children sustained a refracture. Severe complications are rare, problems arise from suboptimal technique and incorrect indication. Detailed knowledge of technical principles and procedural recommendations constitutes the mainstay in prevention.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002453
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  • 67
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    Electronic Resource
    Evaluation of the long-term outcome of wounds closed with ”Indermil” adhesive (2000)
    Springer
    European journal of plastic surgery 23 (2000), S. 330-332 
    Details
    ISSN: 1435-0130
    Keywords: Key words ”Indermil” adhesive ; Scar quality ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  ”Indermil” is a new formulation of n-Butyl-2- Cyanoacrylate used for securing skin grafts and surface wound closure. We report a prospective randomized trial, comparing the use of ”Indermil” adhesive with suture in wound closure. A total of 30 patients underwent 37 procedures for the removal of benign skin lesions under local anaesthesia. ”Indermil” was used in the skin closure in 18 procedures and sutures were used in 19 procedures. Scar quality, patient satisfaction and complications were recorded at a period between 8 and 18 months (median 12.2) following the procedure. The study showed no difference between the two groups in terms of scar quality and patient satisfaction. We conclude that long term outcome of wounds closed with ”Indermil” are no different from sutured wounds.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002380000175
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  • 68
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    Electronic Resource
    Serious Complications of Tuberculous Epididymitis (2000)
    Springer
    Infection 28 (2000), S. 193-195 
    Details
    ISSN: 1439-0973
    Keywords: Key Words Epididymitis ; Tuberculous ; Complications ; Psoas abscess ; Addison's disease
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary Tuberculous epididymitis is a rare entity associated with minor complications. We present two cases of tuberculous epididymitis associated with serious complications (bilateral psoas abscesses and Addison's disease with psoas abscess). A review of the literature disclosed six additional cases associated with serious complications (Addison's disease, inappropriate antidiuretic hormone secretion, central nervous system involvement) which are discussed and compared to these cases. We conclude that tuberculous epididymitis represents a grave sequela of genital tract involvement and may be associated with serious and even fatal complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s150100050080
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  • 69
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    Hospitalization and Complications in Children under 2 Years of Age with Bordetella pertussis Infection (2000)
    Springer
    Infection 28 (2000), S. 106-110 
    Details
    ISSN: 1439-0973
    Keywords: Key words Pertussis ; Bordetella pertussis ; Hospitalization ; Complications ; Vaccine ; Children
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary We prospectively followed 725 children under 2 years of age with laboratory-diagnosed Bordetella pertussis infection to investigate the hospitalization rate and complications. Diagnosis was made by culture and polymerase chain reaction (PCR) from nasopharyngeal swabs in 11,016 children who presented with ≥ 7 days of cough at 63 pediatric practices in Germany. Of these children, 33 (4.5%) were hospitalized at a mean age of 4.8 months (range, 17 days to 19.5 months). Complications occurred in 16 (48%) of the 33 patients. Pneumonia developed in two (6%) children and a convulsion was observed in one (3%). Intensive care monitoring was required for 23 (70%) children. Further complications were bradycardia (21%), apnea (12%), conjunctivitis (12%), loss of weight (12%), otitis media (6%), atelectasis (3%) and dehydration (3%). Children aged 6–24 months who had not received any dose of pertussis vaccine had a ten-fold increased risk of hospitalization compared to those who had been partially or fully immunized (p 〈 0.05). Pertussis immunization should be given at an early point in time and completely in order to prevent severe courses of pertussis and hospitalization in young children.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s150100050056
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  • 70
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    Electronic Resource
    Trapping of the double-J stent in the urinary tract eight years after extracorporeal shock wave lithotripsy (2000)
    Springer
    International urology and nephrology 32 (2000), S. 29-31 
    Details
    ISSN: 1573-2584
    Keywords: D-J stent ; Extracorporeal shock wave lithotripsy (ESWL) ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract We report a case of the `forgotten' DJ stent in the urinary tract for eight years. In spite of years DJ stent spent in the urinary tract, and the great burden of the new-formed stones, residual renal function still exist. One year after treatment patient is stone free, infection free, with the mild renal failure.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1023/A:1007109412707
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  • 71
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    Electronic Resource
    Lateral sinus thrombosis after untreated otitis media (2000)
    Springer
    European archives of oto-rhino-laryngology and head & neck 257 (2000), S. 1-5 
    Details
    ISSN: 1434-4726
    Keywords: Key words Otitis media ; Complications ; Sinus ¶thrombosis ; Antibiotics ; Anticoagulation therapy ; Ear surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Antimicrobial agents have greatly reduced the incidence of intracranial complications of infections of the middle ear and mastoid. Too many prescriptions and overconsumption of antibiotics when otitis media is suspected has caused resistance to many antibiotics, leading to a pronounced and justifiable desire to reduce the widespread excessive use of antibiotics. The possible untoward consequences of a too restricted antibiotic policy, however, is illustrated by the following case of a 14-year-old boy who, after non-treatment of an ear infection, fell ill with one-sided headache and vomiting caused by a lateral sinus thrombosis. After intravenous treatment with antibiotics, anticoagulants and ventilation of the middle ear, the infection was cured without complications. This case calls attention to the symptoms of otitic complications arising outside the temporal bone. The physician must always bear in mind the possibility of an unusual event. The general treatment of endocranial complications is outlined, giving details of the treatment given in this special case. We stress that one should not be too cautious in prescribing antibiotics in otitis media.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00007504
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  • 72
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    The use of gold weight in facial palsy lagophthalmos (2000)
    Springer
    European journal of plastic surgery 23 (2000), S. 72-77 
    Details
    ISSN: 1435-0130
    Keywords: Key words Facial paresis ; Lid loading ; Gold weight ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract  Peripheral facial paralysis is often accompanied by incomplete closure of the lid. In the past, tarsorrhaphy has been the primary method for achieving improved eyelid closure, but it has functional and cosmetic drawbacks.As an alternative, a gold weight implant has been used for closure of the upper lid by gravity and, ifnecessary, can be combined with further rehabilitative facial surgery. A total of 36 patients with peripheral facial paresis were treated with gold weight upper lid implants. Postoperative closure of the lids was sufficient in all cases. Complications were observed, such as pseudoptosis, deficiency of eyelid closure, a prominent bulge of the gold implant, in one case frank extrusion of the gold implant, and, surprisingly, in several cases the formation of a low grade corneal astigmatism. The satisfactory functional results show that the implant is both aesthetically and functionally superior to tarsorrhaphy.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s002380050018
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  • 73
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    Stoma complications (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 1575-1580 
    Details
    ISSN: 1530-0358
    Keywords: Enteric stomas ; Enterostoma ; Colostomy ; Ileostomy ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: A retrospective analysis of enteric stomas performed at Cook County Hospital was undertaken to evaluate stoma complications per stoma type and configuration and operating service. In addition, we attempted to identify factors predictive of increased enteric stoma complications. METHODS: From 1976 to 1995, data cards on 1,616 patients with stomas were compiled by Cook County Hospital enteric stomal therapists. Data card information included age, gender, weight, early and late stoma complications, emergency status, operating service, type and configuration of the stoma, and whether the patient was seen preoperatively by an enteric stomal therapist. Data were then analyzed using a logistic regression model to identify those variables that influenced the rate of complications. RESULTS: There were 553 (34 percent) patients with complications. Among the total complications, 448 (28 percent) occurred early (〈1 month postoperative), and 105 (6 percent) occurred late (〉1 month). The most common early complications were skin irritation (12 percent), pain associated with poor stoma location (7 percent), and partial necrosis (5 percent). The most common late complications were skin irritation (6 percent), prolapse (2 percent), and stenosis (2 percent). The enteric stoma with the most complications was the loop ileostomy (75 percent). The enteric stoma with the least complications was the end transverse colostomy (6 percent). The general surgery service had the most complications (47 percent), followed by gynecology (44 percent), surgical oncology (37 percent), colorectal (32 percent), pediatric surgery (29 percent), and trauma (25 percent). Age, operating service, enteric stoma type and configuration, and preoperative enteric stomal therapist marking were found to be variables that influenced stoma complications. CONCLUSIONS: Complications from enteric stoma construction are common. Preoperative enteric stoma site marking, especially in older patients, and avoiding the ileostomy, particularly in the loop configuration, can help minimize complications.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236210
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  • 74
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    Electronic Resource
    Seprafilm®-induced peritoneal inflammation: A previously unknown complication (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 1639-1642 
    Details
    ISSN: 1530-0358
    Keywords: Postoperative adhesions ; Prevention ; Bioresorbable membrane ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract INTRODUCTION: Various substances and agents have been evaluated to prevent postoperative adhesion formation. Recently a sodium hyaluronate-based bioresorbable membrane was introduced with promising clinical results. Its application was regarded as safe and efficient. METHODS: We present the first reported case of a severe inflammatory reaction to a bioresorbable membrane and give a review of the related literature. CONCLUSION: Bioresorbable membranes are increasingly used by general surgeons and gynecologists to reduce postoperative adhesion formation. Bioresorbable membranes may produce extensive inflammatory reactions.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236221
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  • 75
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    Incidence of small-bowel obstruction and adhesiolysis after open colorectal and general surgery (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 241-248 
    Details
    ISSN: 1530-0358
    Keywords: Adhesions ; Complications ; Small-bowel obstruction
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The study contained herein was undertaken to establish the incidence of small-bowel obstruction, adhesiolysis for obstruction, and additional abdominal surgery after open colorectal and general surgery. METHODS: A retrospective cohort study was performed using patient-specific Health Care Financing Administration data to evaluate a random 5 percent sample of all Medicare patients who underwent surgery in 1993. Of these, 18,912 patients had an index abdominal procedure. Two-year follow-up data documented outcomes of hospitalizations with obstruction, adhesiolysis for obstruction, and/or additional open colorectal or general surgery. RESULTS: Within two years of incision, excision, and anastomosis of intestine (International Classification of Diseases (ICD)-9 code 45), 14.3 percent of patients had obstructions, 2.6 percent required adhesiolysis for obstructions, and 12.9 percent underwent additional open colorectal or general surgery. After other operations of intestine (ICD code 46), 17 percent of patients had obstructions, 3.1 percent required adhesiolysis for obstructions, and 20.2 percent underwent additional open colorectal or general surgery. After operations of rectum, rectosigmoid, and perirectal tissue (ICD code 48), 15.3 percent of patients had obstructions, 5.1 percent required adhesiolysis for obstructions, and 16.4 percent underwent additional open colorectal or general surgery. After other operations on the abdominal region (ICD code 54), 12.4 percent of patients had obstructions, 2.3 percent required adhesiolysis for obstructions, and 8.8 percent underwent additional open colorectal or general surgery. CONCLUSIONS: In this retrospective study of Medicare patients, we learned that bowel obstruction, adhesiolysis for obstructions, and additional abdominal surgery occurred more often after abdominal surgery than was previously published.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02237135
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  • 76
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    Perforating ileocecal Crohn's disease does not carry a high risk of recurrence but usually re-presents as perforating disease (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 519-524 
    Details
    ISSN: 1530-0358
    Keywords: Crohn's disease ; Perforating disease ; Nonperforating disease ; Ileocecal resection ; Complications ; Recurrence rate
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to study the natural history of perforating and nonperforating ileocecal Crohn's disease. METHODS: One hundred sixty-five cases of primary ileocecal Crohn's disease operated on between 1975 and 1995 were reviewed. Perforating disease was defined as acute free perforation, subacute perforation with an abscess, or chronic perforation with an internal or external fistula. RESULTS: Perforating disease was identified in 72 patients (44 percent); 11 with acute free perforation, 18 with abscess formation, and 43 with fistulas. Postoperative complications occurred in 29 percent of perforating and in 23 percent of nonperforating disease (not a significant difference). There was no significant difference in the cumulative reoperation-free rate for recurrence at the ileocolonic anastomosis (perforating, 78 percentvs. nonperforating, 73 percent at 5 years and perforating, 61 percentvs. nonperforating, 55 percent at 10 years), or in the median time interval from the primary to the secondary operation (perforating, 49vs. nonperforating, 37 months). Seventy percent of perforating disease re-presented with perforating recurrence. Likewise, 83 percent of nonperforating disease re-presented with nonperforating (P〈0.0001) recurrence. Re-reoperation rate for re-recurrence at the ileocolonic anastomosis and median duration from the second operation to the third operation did not differ between perforating and nonperforating disease. Seventy-nine percent of perforating disease re-presented again with perforating disease, and 87 percent of nonperforating disease re-presented again with nonperforating disease as before (P=0.001). CONCLUSIONS: These data suggest that perforating ileocecal disease usually re-presents in the way it did originally but does not represent a high-risk group for recurrence.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02234180
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  • 77
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    An audit of strictureplasty for small-bowel crohn's disease (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 797-803 
    Details
    ISSN: 1530-0358
    Keywords: Small-bowel Crohn's disease ; Strictureplasty ; Complications ; Recurrence ; Short-bowel syndrome ; Small-bowel carcinoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to review the long-term outcome of strictureplasty for small-bowel Crohn's disease. METHODS: We reviewed 111 patients who underwent 285 primary strictureplasties (Heineke-Mikulicz, 236; Finney, 49) between 1980 and 1997. RESULTS: Eighty-seven patients (78 percent) had had previous bowel resections. Forty-six patients (41 percent) required synchronous resection for perforating disease (abscess or fistula) or long strictures (〉20 cm). The mean number of strictureplasties was three (range, 1–11). There were no operative deaths. Septic complications (fistula or intra-abdominal abscess) related to strictureplasty developed in eight patients (7 percent), of whom two required a proximal ileostomy. Abdominal symptoms were relieved in 95 percent of patients. The majority (95 percent) of patients with preoperative weight loss gained weight (median gain, +2 kg; range, −6 to +22.3 kg). After a median follow-up of 107 months, symptomatic recurrence occurred in 60 patients (54 percent). In 11 patients symptomatic recurrence was successfully managed by medical treatment. Forty-nine patients (44 percent) required reoperation for recurrence: strictureplasty alone in 22 patients, resection alone in 19 patients, strictureplasty and resection in 6 patients, and ileostomy alone in 2 patients. Eighteen patients (16 percent) required a third operation. One patient died from a small-bowel carcinoma which developed in the vicinity of a previous stricture-plasty. Two of 19 patients with diffuse jejunoileal disease developed short-bowel syndrome, and were receiving long-term parenteral nutrition. Two other patients were taking corticosteroids for recurrent symptoms. All other patients were asymptomatic, receiving neither medical treatment nor nutritional support. CONCLUSIONS: Strictureplasty is a safe and efficacious procedure for small-bowel Crohn's disease in the long-term.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236939
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  • 78
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    Early discharge after external anal sphincter repair (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 457-459 
    Details
    ISSN: 1530-0358
    Keywords: Sphincter repair ; Acceleratedstay program ; Hospitalization ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: The aim of this study was to describe an accelerated-stay program for repair of the external anal sphincter. METHODS: Twenty consecutive patients undergoing overlapping repair of the external anal sphincter were included in the study. Effect parameters were length of hospitalization and complications within 30 days after the operation. Surgery was performed during the period of March 1993 to May 1997. The accelerated-stay program included preoperative information, no premedication, a surgical procedure without colostomy, single-dose prophylactic antibiotics, paracetamol for analgesia, free oral fluid and food immediately after the operation supplemented by laxatives, and enforced mobilization. Follow-up by questionnaire was performed at a median of 14 (range, 4–52) months after the operation. RESULTS: Median hospital stay was one day. Fifteen patients were discharged the day after surgery and 5 patients stayed for 48 hours after the operation. There was no 30-day morbidity, and no patient received a colostomy in conjunction with the sphincter repair. Fourteen of 19 patients available for follow-up reported a significantly improved functional result compared with preoperative state. CONCLUSION: We have described a safe accelerated-stay program (24 to 48 hours) for overlapping repair of external anal sphincter.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02234166
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  • 79
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    Secondary coloperineal pull-through and double dynamic graciloplasty after miles resection—feasible, but with a high morbidity (1999)
    Springer
    Diseases of the colon & rectum 42 (1999), S. 776-780 
    Details
    ISSN: 1530-0358
    Keywords: Rectal cancer ; Colostomy ; Perineal colostomy ; Anorectal reconstruction ; Dynamic graciloplasty ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract PURPOSE: Until recently, patients who underwent abdominoperineal resections had to cope with a colostomy for the rest of their lives. For some of these patients this colostomy was a terrible burden, physically and mentally. Publications about abdominoperineal pull-through and double dynamic graciloplasty immediately after a Miles resection showed good results. The purpose of this study was to investigate the procedure as a secondary approach after abdominoperineal resections. METHODS: In this study seven patients were evaluated. All had had an abdominoperineal resection and proved to have unbearable problems with their stoma. All had a secondary pull-through and double dynamic graciloplasty, a mean of 8.5 (range, 1.1–34.8) years after the Miles resection. RESULTS: In five patients continence was regained; two were reversed to colostomy because of several complications. Patients who had a successful outcome also suffered from numerous complications, with a total mean hospital stay of 73.8 (range, 27–167) days, a mean of 3.1 (range, 1–6) additional operations, and 1.8 (range, 0–4) readmissions. CONCLUSION: Secondary anorectal reconstruction after abdominoperineal resection is a feasible option, but with a high morbidity. Because of this the procedure was stopped at the beginning of 1997.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF02236934
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  • 80
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    Electronic Resource
    Positive Iliac and Obturator Nodes in Melanoma: Survival and Prognostic Factors (1999)
    Springer
    Annals of surgical oncology 6 (1999), S. 255-262 
    Details
    ISSN: 1534-4681
    Keywords: Groin dissection ; Survival ; Complications ; Melanoma
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: The need for deep groin dissection when superficial nodes contain metastatic melanoma is controversial. Methods: A review of 362 therapeutic groin dissections performed at our tertiary referral center between 1961 and 1995 revealed 71 patients (20%) with positive iliac and/or obturator nodes. This group was analyzed for survival rates, prognostic factors for survival, regional tumor control, and morbidity. Results: Patients with involved deep nodes exhibited overall 5-year and 10-year survival rates of 24% (SE, 5%) and 20% (SE, 5%), respectively. Independent prognostic factors for survival were the number of positive iliac nodes (P = .0011), the Breslow thickness (P = .0069), and the site of the primary tumor (P = .0075). Patients with an unknown primary tumor seemed to have better prognoses. Seven patients (10%) experienced recurrence in the surgically treated groin. The shortand long-term morbidity rates (infection, 17%; skin flap necrosis, 15%; seroma, 17%; mild/ moderate lymphedema, 19%; severe lymphedema, 6%) compared well with those of other series studying inguinal as well as ilioinguinal dissections. Conclusions: From the present study it can be concluded that removal of deep lymph node metastases is worthwhile, because one of every five such patients survives for 10 years. Prognostic factors for survival are the number of involved iliac nodes, the Breslow thickness, and the site of the primary tumor. Long-term regional tumor control can be obtained for 90% of the patients. The morbidity of an additional deep lymph node dissection is acceptable.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s10434-999-0255-5
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  • 81
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    Bestehen begründetete Zweifel an der Methylprednisolontherapie bei Querschnittgelähmten? (1999)
    Springer
    Trauma und Berufskrankheit 1 (1999), S. 422-428 
    Details
    ISSN: 1436-6274
    Keywords: Schlüsselwörter Kortisontherapie ; Querschnittlähmung ; Komplikationen ; Key words Methylprednisolone ; Spinal paralysis ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: The clinical picture drawn from postoperative follow-up of patients with acute spinal cord injuries who received high-dose methylprednisolone therapy led us to question the validity of the results in the NASCIS II study. Therefore, we reviewed 40 patients with acute traumatic spinal cord injuries admitted to our hospital from 1994 to 1998. Thirty patients underwent high-dose methylprednisolone therapy within 8 hours according to the NASCIS II protocol. During the same period, ten patients received no methylprednisolone. Neurological deficits were recorded at time of admission and after discharge according to ASIA scoring. Complications during entire hospital stay were noted. Neurological and functional outcome of incomplete spinal cord syndrome improved in all cases (100%) treated without methylprednisolone, but only 61% of those who did receive methylprednisolone. Control patients with primary complete spinal cord syndromes showed functional improvement in 25% of cases, compared to 9% of those receiving methylprednisolone. The rate of postoperative infections also increased in patients receiving methylprednisolone therapy. In particular, 16.7% were diagnosed with pneumonia, compared to 10% in patients without methylprednisolone therapy. Our study demonstrated a higher complication rate and no benefits to neurological or functional outcome in patients treated according to the NASCIS II protocol. Therefore, we do not recommend high dosage administration of methylprednisolone in cases of acute spinal cord injury.
    Notes: Der klinische Eindruck von postoperativen Verläufen nach hochdosierter Methylprednisolontherapie der traumatischen Rückenmarkverletzung veranlaßte uns, die Ergebnisse der NASCIS-II-Studie auf ihre funktionelle und damit qualitative Relevanz zu überprüfen. Am Berufsgenossenschaftlichen Unfallkrankenhaus Hamburg wurden von 1994–1998 40 Patienten mit isolierter, akuter traumatischer Rückenmarkverletzung behandelt. 30 Patienten erhielten innerhalb von 8 h hochdosiert Methylprednisolon nach dem NASCIS-II-Schema. 10 Patienten wurden im gleichen Zeitraum ohne Kortikoide behandelt. Der Verlauf der neurologischen Ausfallsymptomatik wurde zum Zeitpunkt der Aufnahme und bei der Entlassung auf der Basis des ASIA-Scores erfaßt. Außerdem wurden über den gesamten stationären Aufenthalt die Komplikationen ermittelt. Es fand sich bei primär inkompletter Querschnittsymptomatik in 100% der Fälle eine Verbesserung der neurologischen Situation mit funktionellem Gewinn, wenn auf die Gabe von Methylprednisolon verzichtet wurde. Demgegenüber trat eine funktionell verwertbare Verbesserung in der Methylprednisolongruppe in nur 61% der Fälle ein. Bei primär kompletter Querschnittsymptomatik verbesserten sich in der Kontrollgruppe 25% mit funktionellem Benefit gegenüber 9%, die Methylprednisolon erhielten. Infektionen traten gehäuft unter Methylprednisolongabe auf. Insbesondere entwickelten die mit Methylprednisolon behandelten Patienten häufiger eine Pneumonie (16,7% vs. 10%). Aufgrund der erhöhten Komplikationsrate und der in unserem Patientengut nicht nachweisbaren qualitativen Verbesserung der neurologischen Situation können wir daher die Anwendung von hochdosiertem Methylprednisolon in der Akutbehandlung von Rückenmarkverletzten nicht empfehlen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100390050076
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  • 82
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    Fettembolie (1999)
    Springer
    Notfall + Rettungsmedizin 2 (1999), S. 134-140 
    Details
    ISSN: 1436-0578
    Keywords: Schlüsselwörter Reanimation ; Komplikationen ; Fettembolie ; Extrathorakale Kompression ; Key words Fat embolism ; Resuscitation ; Closed-chest cardiac massage ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Chest compressions are a simple and efficient measure during CPR and well established since many years. However, whether they lead to serious complications yet needs to be answered. Among them thoracic fractures and injuries of inner organs (cardiac, hepatic, splenic) are well known. Additionally fat embolism of the lungs as well as other organs have been described. Concerning the pathogenesis different theories are discussed in the literature. This article reviews the most relevant literature of the last decades. Studies focusing on fat embolism have especially been carried out in trauma surgery and pathology. The actual incidence of fat embolism during trauma, long bone surgery, shock and CPR seems to be rather high. However a clinical manifestation is rarely apparent. Especially after (unsuccessful) CPR pathological studies revealed the degree of fat embolism to be rather low. Because specific studies on the incidence of fat embolism during CPR lack completly, the significance for CPR is unknown and can only be speculated on.
    Notes: Zusammenfassung Die extrathorakale Kompression des Herzens im Rahmen der Reanimation ist eine einfache und suffiziente Methode, die seit Jahren etabliert ist. Immer wieder wurde aber die Frage nach möglichen Komplikationen dieser mit großer Kraft durchgeführten Maßnahme gestellt. Neben Frakturen im Bereich des Thorax, sowie Verletzungen innerer Organe, vorwiegend Herz, Leber und Milz, wird in diesem Zusammenhang häufig auch die Fettembolie, vor allem der Lungen aber auch anderer Organe, genannt. Zu deren Entstehung gibt es unterschiedliche Theorien. Diese Übersicht berücksichtigt die wesentlichen Veröffentlichungen der letzten Jahrzehnte zu diesem Thema. Die Fettembolie wurde vor allem in pathologischen und unfallchirurgischen Studien untersucht. Die tatsächliche Inzidenz der Fettembolie bei Traumen, der operativen Versorgung von langen Röhrenknochen, Schockzuständen allgemein und nach Reanimationen scheint hoch zu sein. Sie scheint allerdings klinisch selten manifest zu werden. In den meisten Fällen nach (erfolgloser) Reanimation ist die in der pathologischen Untersuchung gefundene Ausprägung der Fettembolie gering bis mittelgradig. Aufgrund des Fehlens entsprechender Studien sind Überlegungen über die Bedeutung von Fettembolien im artifiziellen Kreislauf während einer Reanimation spekulativ.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100490050114
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  • 83
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    No psychological emergence reactions in schizophrenic surgical patients immediately after propofol, fentanyl, and ketamine intravenous anesthesia (1999)
    Springer
    Journal of anesthesia 13 (1999), S. 17-22 
    Details
    ISSN: 1438-8359
    Keywords: Key words: Schizophrenia ; Intravenous anesthetic agents ; Ketamine ; Propofol ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Purpose. We attempted to determine the frequency of adverse psychological events after total intravenous anesthesia with propofol-fentanyl-ketamine (PFK) in surgical schizophrenic patients. Methods. PFK was used in 25 schizophrenic patients undergoing various surgical procedures from 1995 to 1997. Adverse events occurring during and after anesthesia were recorded. Psychiatric follow-up was also done during the first 3 postoperative weeks at least. Results. One patient died postoperatively of airway obstruction from concomitant severe malignant thyroid disease, but in the remaining patients neither respiratory nor cardiovascular states during or after anesthesia became unstable. None of the patients developed adverse psychological emergence reactions immediately after anesthesia. Two patients undergoing major surgical procedures exhibited delirium in the early postoperative days despite taking their routine antipsychotic drugs postoperatively. Conclusions. We suggest that PFK maintains stable respiratory and cardiovascular states, and causes no psychological emergence reactions in schizophrenic surgical patients. However, adverse psychological events may occur postoperatively, probably due to continued psychic stress. We therefore recommend appropriate perioperative management and further psychological studies for such patients.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005400050016
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  • 84
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    Accidental subdural catheterization suspected on administration of a test dose of lidocaine and successfully managed by a small dose of dibucaine (1999)
    Springer
    Journal of anesthesia 13 (1999), S. 236-239 
    Details
    ISSN: 1438-8359
    Keywords: Key words: Subdural catheterization ; Complications ; Epidural anesthesia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s005400050063
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  • 85
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    Orthopedic and neurosurgical treatment of severe kyphosis in myelomeningocele (1999)
    Springer
    Neurosurgical review 22 (1999), S. 45-49 
    Details
    ISSN: 1437-2320
    Keywords: Key words Myelomeningocele ; Kyphosis ; Spinal osteotomy ; Complications ; CSF circulation
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Kyphosis in myelomeningocele is characterized by a complex pattern of problems during development and therapy. On the one hand, decompensation of upright posture leads to loss of sitting ability and social integration; on the other hand, accompanying malformations and trophic alterations threaten the physical integrity and performance. Neurologic function, cerebrospinal fluid (CSF) circulation, skeletal deformity and the urinary transport system need to be kept in mind and need to be treated with cooperation between the different specialties. Especially during serious surgical interventions such as spinal surgery, neither the nervous system nor the kidneys must be ignored. Sixteen patients underwent kyphectomy in the Orthopedic Department of the University of Mainz between 1993 and 1997, all of them supervised by the Neurosurgical Department. In 13 cases, transversal myelotomy was performed. No insufficiency of CSF circulation was seen; neither were there any CSF fistulae. Particular problems arose from the skin and soft tissue above the gibbus, the lack of muscles and the regeneration deficiency caused by trophic disorders. Therefore, a significantly higher complication rate was found than with other correctional operations.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101430050008
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  • 86
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    Tödliche Blutung in die Beckenhöhle nach transrektaler Stanzbiopsie der Prostata (1999)
    Springer
    Rechtsmedizin 9 (1999), S. 145-147 
    Details
    ISSN: 1434-5196
    Keywords: Key words Prostate ; Transrectal biopsy ; Complications ; Fatal haemorrhage ; Pelvis ; Schlüsselwörter Prostata ; Transrektale Biopsie ; Komplikationen ; Tödliche Beckenblutung
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine , Law
    Description / Table of Contents: Zusammenfassung Bericht über einen 79jährigen Mann, der 2 Tage nach Durchführung einer ultraschallgesteuerten transrektalen Biopsie der Prostata an den Folgen einer massiven Blutung in das kleine Becken verstarb. Ursächlich war eine Perforation des linken Prostatalappens mit Verletzung periprostatischer Gefäße. Über eine derartige Komplikation wurde im wissenschaftlichen Schrifttum bisher nicht berichtet. Das Ermittlungsverfahren unter strafrechtlichen Gesichtspunkten wurde eingestellt.
    Notes: Abstract A 79-year-old man died of fatal haemorrhage into the soft tissue of the true pelvis 2 days after transrectal ultrasound-guided prostatic biopsy. Autopsy revealed a perforation of the left prostatic lobe with ruptures of the periprostatic vessels. A similar case of transrectal prostatic biopsy-associated complication has not been described previously. The judicial enquiries were discontinued.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001940050098
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  • 87
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    Electronic Resource
    Risiken des oralen Piercings (1999)
    Springer
    Mund-, Kiefer- und Gesichtschirurgie 3 (1999), S. 98-101 
    Details
    ISSN: 1434-3940
    Keywords: Schlüsselwörter Piercing ; Oral ; Komplikationen ; Lokal ; Systemisch ; Key words Piercing ; Oral ; Complications ; Local ; Systemic
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Oral and facial piercing with different kinds of body art are being observed more frequently in medical and dental practices. Principally, piercing is not a new form of body art and is traditional in different geographical areas. Various materials are used. Besides tongue and lip piercing, different locations of the face such as the eyebrows and the nose are anatomical areas of piercing. The aim of this article is to demonstrate different forms of oral piercing, illustrated by own observations. The piercing procedure is briefly described. Piercing is usually performed without local anaesthesia and stepwise. In a literature review, the possible risks and complications are summarised. Postprocedural complications are oedema, haemorrhage and infection. Other complications are foreign body granulomas or allergies, particularly against nickel. Dentists, and oral- and maxillofacial surgeons should be in a position to advise patients with oral or facial piercings or those who plan to have this type of body art performed.
    Notes: Orales und faziales Piercing mit unterschiedlichen Schmuckelementen wird in den letzten Jahren zunehmend häufiger in ärztlichen und zahnärztlichen Praxen beobachtet. Das Piercing ist prinzipiell keine neue Schmuckform und hat in verschiedenen geographischen Bereichen lange Tradition, wobei verschiedene Materialien zur Anwendung kommen. Neben dem Zungen- und Lippenpiercing werden unterschiedliche Gesichtsregionen, wie die Augenbrauen und Nasenflügel, als anatomische Orte des Piercings gewählt. Ziel dieses Beitrags ist die Darstellung verschiedener oraler Piercingformen anhand von eigenen Beobachtungen. Die eigentliche Piercingprozedur wird kurz beschrieben. Sie erfolgt ohne Lokalanästhesie und meist zweiseitig. In einer Literaturübersicht werden mögliche Risiken und Komplikationen zusammengestellt. Neben unmittelbar postprozeduralen Komplikationen, wie Ödem, Blutung oder Infektion, können Spätfolgen in Form von Fremdkörpergranulomen oder Allergien, v.a. gegen Nickel, auftreten. Zahnärzte, Oralchirurgen und Mund-, Kiefer- und Gesichtschirurgen sollten in der Lage sein, Patienten, die orofaziales Piercing tragen oder sich anfertigen lassen wollen, entsprechend zu beraten.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s100060050105
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  • 88
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    Electronic Resource
    Operative Therapie der Arthrofibrose (1999)
    Springer
    Arthroskopie 12 (1999), S. 252-259 
    Details
    ISSN: 1434-3924
    Keywords: Schlüsselwörter Arthrofibrose ; Arthrolyse ; Kniebandchirurgie ; Komplikationen ; Arthroskopische Arthrolyse ; Offene Arthrolyse ; Key words Arthrofibrosis ; Arthroscopic arthrolysis ; Open arthrolysis ; Knee ligament surgery ; Complications ; Loss of range-of-motion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Arthrofibrosis of the knee may be a localized or generalized condition. The localized forms are cylops tumors, hypertrophic cruciate grafts due to notch-impingement, and intra- or extraarticular adhaesions. These problems can usually be managed by limited, arthroscopic procedures. Generalized arthrofibrosis is caused by a diffuse inflammatory reaction of the knee with fibrosis of the anterior fat pad and the parapatellar retinaculae and contracture of the posterior capsule. Treatment should include open resection of the dense fibrotic tissue, replacing the fat pad and parts of the anterior retinaculae. In addition, open posterior capsulotomy allows for complete extension of the knee. A total of 115 cases have been treated by the authors, and the results of 53 are reported.
    Notes: Die Arthrofibrose des Kniegelenks sollte in eine lokalisierte und eine generalisierte Form differenziert werden. Lokalisierte Arthrofibrosen sind das Zyklopssyndrom, die Transplantathypertrophie bei Notch-Impingement und die intra- bzw. extraartikuläre Bridenbildung. Diese Pathologien können durch limitierte, meist arthroskopische Eingriffe therapiert werden. Die generalisierte Arthrofibrose ist eine entzündliche Reaktion des gesamten Gelenks unter besonderer Betonung des Hoffa-Fettkörpers und der Retinacula. Durch Sklerosierung des Hoffa-Fettkörpers und hintere Kapselschrumpfung entstehen hartnäckige Streckdefizite. Therapeutisch sollte in diesen Fällen ein limitiertes anteriores Débridement mit einer posterioren Kapsulotomie kombiniert werden. Insgesamt wurden 115 Fälle operativ behandelt, die Ergebnisse von 53 nachuntersuchten Patienten werden dargestellt.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001420050134
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  • 89
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    Electronic Resource
    Chronic pain and cutaneous sensory changes after inguinal hernia repair: comparison between open and laparoscopic techniques (1999)
    Springer
    Hernia 3 (1999), S. 75-80 
    Details
    ISSN: 1248-9204
    Keywords: Hernia repair ; Laparoscopy ; Complications ; Neuralgia
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Summary The aim of our retrospective study was to quantify the incidence of chronic pain and cutaneous sensory changes among various anterior and posterior hernia repairs and then to compare laparoscopic with open techniques. A detailed questionnaire was sent in January 1998 to patients operated on from 1992 to 1996. Patients had to record their current parietal status and assess the result from their personal point of view. The replies were recorded without any medical adjustment. Of 545 patients treated for 617 groin hernias, 490 were followed for 1 to 5 years (median 3 years, 2 months). One hundred and ten patients (23%) experienced symptoms persisting for more than one year, including 50 cases of cutaneous sensory changes and 71 cases of pain. Twenty-four patients (5%) assessed their discomfort as more troublesome than the hernia they had before, overriding the benefits of a solid repair. There was no statistical difference concerning the incidence of chronic pain between the nonprosthetic and prosthetic (“tension-free”) subgroups or between the open and laparoscopic subgroups. Forty-five of 50 cutaneous sensory changes occurred after the inguinal approach. The incidence of such changes was 10 times lower in the laparoscopic than in the open subgroup (p〈0.001). Our study confirms that pain and sensory changes are more frequent and persistent than generally estimated and that they can interfere with the patient's daily life. Posterior approaches, in particular laparoscopic, were associated with statistically fewer sensory changes than inguinal approaches. These results suggest using questionnaires about the quality of life when evaluating hernia repair.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/BF01194609
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  • 90
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    Electronic Resource
    Coloanal anastomosis: is a defunctioning stoma necessary? (1999)
    Springer
    Techniques in coloproctology 3 (1999), S. 79-82 
    Details
    ISSN: 1128-045X
    Keywords: Key words Coloanal anastomosis ; Defunctioning stoma ; Complications ; Disease-free survival
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract: The role of a temporary defunctioning stoma in patients undergoing coloanal anastomosis remains controversial. Previous experimental studies have shown that the defunctioned colon is more resistant to neoplasia. The aim of this study was to investigate whether a defunctioning stoma was able to decrease complication rates and, also, to evaluate whether it had any impact on recurrence and survival rates in patients who underwent coloanal anastomosis. The records of 173 patients, 54 with benign rectal disease and 119 patients with cancer, operated on between 1980 and 1996, were retrospectively reviewed. Eighty-nine patients had a defunctioning stoma, 34 in the benign rectal disease and 55 in the cancer group. Mean age was 57.2 years (range 17–88). There were 126 men and 47 women. Follow-up was 57.2 month (range 17–88). There were 126 men and 47 women. Follow-up was done by clinical examination, telephone or mailed questionnaire. Mean time of follow-up was 3.8 years (range 0–13 years). There was no operative mortality. Non-stoma patients tended to have more early complications (pelvic sepsis and obstruction) and more probability of having a permanent stoma than the stoma group, but no significant differences could be found between the two groups (P 〉 0.05). The probability of being free of stricture was greater in the non-stoma group (stoma 62.6%; non-stoma 78.5%; P 〈 0.05). Probability of disease-free survival, at 5 years, for rectal cancer patients, was 73.7% for the stoma group and 53.6% for non-stoma group (P = 0.02). After coloanal anastomosis, defunctioning stomas may decrease postoperative complications, increase the likelihood of anastomosis structure and allow a greater disease-free survival.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101510050020
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  • 91
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    Electronic Resource
    Pneumorachis (1999)
    Springer
    Emergency radiology 6 (1999), S. 146-148 
    Details
    ISSN: 1438-1435
    Keywords: Key words Intraspinal air ; traumatic ; Injuries ; spinal canal ; Radiography ; epidural space ; Radiography ; emphysema ; Radiography ; skull fractures ; Complications ; Wounds ; Nonpenetrating
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Traumatic pneumorachis is a rare but known complication of basilar skull fracture with air localized in the cervical subarachnoid space. Extradural, intraspinal and epidural air may also be associated with other traumatic etiologies. The incidental finding of intraspinal air in the trauma setting mandates a search for the etiology. We present a case of traumatic cervical pneumorachis and open skull fracture. Plain radiographs demonstrated subtle air lucency in the spinal canal.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s101400050041
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  • 92
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    Electronic Resource
    Behandlungsfehler bei Operationen der Schilddrüse (1999)
    Springer
    Der Chirurg 70 (1999), S. 1131-1138 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Thyroid ; Surgery ; Litigation ; Recurrent nerve palsy ; Complications ; Malpractice. ; Schlüsselwörter: Schilddrüse ; Chirurgie ; Haftung ; Komplikationen ; Recurrensparese ; Behandlungsfehler.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung: Trotz steigender Häufigkeit medikolegaler Probleme ist die Kenntnis über Art und Häufigkeit von Behandlungsfehlern nach Operationen der Schilddrüse gering. Die Analyse eines Kollektivs von 21.515 Beschwerdefällen aus der Zeit von 1975–1998 im Raum der Ärztekammern Nordrhein und Baden-Württemberg ergab 222 Beschwerden (1 %) nach Operation der Schilddrüse. Die Zahl der Beschwerden stieg im Beobachtungszeitraum exponentiell an. In 36 Fällen (16 %) stellten die Gutachterkommissionen Behandlungsfehler fest. Die Beschwerde betraf in 95 % den Chirurgen, in 2 % den Anaesthesisten, in 3 % beide Disziplinen und einmal einen HNO-Arzt. Von den Beschwerden bezogen sich 90 % auf Komplikationen nach Routine-Eingriffen an der Schilddrüse. Operationstypische Komplikationen wie Recurrensparesen (50 %), Hypoparathyreoidismus (14 %), Nachblutung (3 %) und Spätrezidiv (1 %) machten zusammen 63 % der Behandlungsfehlervorwürfe, aber nur 31 % der bestätigten Behandlungsfehler aus. Atypische Komplikationen wie neurologische Defizite (10 %), Infektionen (5 %), belassene Knoten (4 %), Narbenprobleme (5 %) machten 37 % der Vorwürfe, aber 70 % der Behandlungsfehler aus. Aufklärungsmängel lagen bei nur 11 % der festgestellten Behandlungsfehler vor. Die Feststellung eines Behandlungsfehlers war besonders häufig gegeben, wenn eine erneute Operation erforderlich wurde (p 〈 0.001), wenn das Operationsziel nicht erreicht wurde (p 〈 0.001) oder wenn einer Komplikation ein Fehler in der Nachbehandlung folgte (p 〈 0.001).
    Notes: Summary. The frequency of medico-legal issues after surgery is rising. Knowledge of the character and frequency of such problems following surgery of the thyroid gland is scant. Analysis of 21,515 cases of adverse effects after medical treatment from 1975 through 1998 identified 222 cases (1 %) of litigation following surgery for thyroid diseases. The frequency of litigation problems rose exponentially during this interval. Malpractice was confirmed in 36 cases (16 %). The litigation was directed against the surgeon in 95 % of cases, the anesthesiologist in 2 %, both of them in 3 % and the ear-nose-throat surgeon in one case. Eighty-nine percent of the 222 cases occurred after routine thyroid surgery. Typical complications such as recurrent nerve palsy (50 %), hypoparathyroidism (14 %), bleeding (3 %), and late goiter recurrence (1 %) accounted for 63 % of the presumed but for only 31 % of ascertained malpractice cases. Atypical complications such as other neurologic deficits (10 %), infections (5 %), residual nodules (4 %), scar problems (5 %) accounted for 37 % of the suspected but for 70 % of confirmed malpractice cases. Deficiencies in obtaining informed consent were present in only 11 %. Malpractice was more frequently judged to be present, if a second operation was necessary (P 〈 0.001), if the goal of the operation had been missed (P 〈 0.001), or if any kind of complication was followed by a fault in postoperative care (P 〈 0.001).
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050875
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  • 93
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    Electronic Resource
    Die kontinente Ileostomie Gegenwärtige Indikationen, Vorgehensweisen und Ergebnisse (1999)
    Springer
    Der Chirurg 70 (1999), S. 635-642 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Continent ileostomy ; Ileoanal pouch ; Conversion operation ; Complications ; Quality of life. ; Schlüsselwörter: Kontinente Ileostomie ; ileoanaler Pouch ; Konversionsoperation ; Komplikationen ; Lebensqualität.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. In 12 Jahren wurden 73 Patienten mit kontinenter Ileostomie operiert. Wegen Kontraindikationen gegen den ileoanalen Pouch erfolgten 19 Primäranlagen, wegen der psychologischen Ablehnung des inkontinenten Stomas wurden 30 Ileostomien und wegen Dysfunktionen 9 ileoanale Pouchanlagen konvertiert. 15 präexistente kontinente Ileostomien wurden wegen Ventilkomplikationen korrigiert. Perioperative Komplikationen (14/73) waren nur zu einem Drittel mit der Konstruktion der kontinenten Ileostomie assoziiert. Chirurgische Spätkomplikationen der Nippelfunktion sanken mit Änderungen der Operationstechnik von 41,1 % über 20,0 % auf 4,8 % und waren immer reparabel. Eine Pouchitis trat in 26,8 % bei Colitis ulcerosa (11/41) auf im Gegensatz zu umschriebenen Ileumrezidiven in 40,0 % bei Morbus Crohn (6/15). Die definitive Erfolgsrate über die Zeit betrug bei Colitis ulcerosa und familiärer adenomatöser Polyposis zusammen 98,1 % (53/54), ansonsten nur 63,2 % (12/19). Zuletzt war die kontinente Ileostomie zur universellen und sicheren Konversionsoperation nach anderen Voroperationen geworden.
    Notes: Summary. Over a period of 12 years, 73 patients received a continent ileostomy. 19 Kock pouches were primarily constructed due to contraindications against the ileoanal pouch, 30 ileostomies were converted due to psychological rejection of the incontinent stoma and 9 ileoanal pouches for dysfunction. 15 Kock pouches had to be corrected for nipple valve complications. Perioperative complications (14/73) were related to the Kock pouch in only one third of cases. Surgical late complications of the nipple valve function decreased with technical modifications from 41.1 % to 20.0 % and then to 4.8 %. They could always be dealt with surgically. Pouchitis was observed in 26.8 % of cases of ulcerative colitis (11/41), and in 6/15 patients with Crohn's disease (40.0 %) complicated ileal recurrences developed. The definitive rate of success over the time was 98.1 % in ulcerative colitis and familial adenomatous polyposis (53/54) and 63.2 % in other conditions (12/19). Continent ileostomy has become universal and safe method for conversion of any previous operation.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001040050699
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  • 94
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    Electronic Resource
    Spätmyelopathie nach Chemonukleolyse Fallbericht und Übersicht über die Literatur (1999)
    Springer
    Der Nervenarzt 70 (1999), S. 920-923 
    Details
    ISSN: 1433-0407
    Keywords: Schlüsselwörter Bandscheibenprolaps ; Chemonukleolyse ; Komplikationen ; Myelopathie ; Key words Disc prolapse ; Chemonucleolysis ; Complications ; Myelopathy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Summary Chemonucleolysis is a debated therapeutic method for herniated lumbar disc. We report a patient who suffered a sequence of characteristic sequels cumulating in late-onset myelopathy with persistent spastic paraplegia, sensory loss below T8 and bladder incontinence. Complications of chemonucleolysis are less frequent as compared to herniated disc surgery, but may cause severe impediment. Serious complications are anaphylactic shock, intracranial or spinal hemorrhage and transverse myelitis. This has to be taken into account for indication and patient information.
    Notes: Zusammenfassung Die Chemonukleolyse ist eine kontrovers beurteilte Behandlungsmethode des lumbalen Bandscheibenprolaps. Wir berichten über eine Patientin, die eine Reihe typischer Komplikationen erlitt, darunter eine subakute Spätmyelopathie. Statistisch treten nach Chemonukleolyse zwar seltener Komplikationen auf als bei operativen Therapieverfahren des lumbalen Bandscheibenprolaps, sie führen jedoch z.T. zu erheblichen Beeinträchtigungen. Zu den schwersten Komplikationen zählen allergische Reaktionen, zerebrale und spinale Blutungen und transverse Myelitiden. Dies muß bei Indikationsstellung der Chemonukleolyse und bei der Aufklärung der Patienten berücksichtigt werden.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001150050597
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  • 95
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    Electronic Resource
    Freier intraperitonealer Clip als Ursache eines mechanischen Dünndarmileus (1999)
    Springer
    Der Chirurg 70 (1999), S. 1492-1493 
    Details
    ISSN: 1433-0385
    Keywords: Key words: Small bowel obstruction ; Laparoscopy ; Complications ; Staples. ; Schlüsselwörter: Dünndarmileus ; Laparoskopie ; Komplikationen ; Clip.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Die Benutzung von mechanischen Klammergeräten hat in der endoskopischen Chirurgie weitverbreitete Anwendung und Akzeptanz erfahren. Auch eine der häufigsten durchgeführten chirurgischen Operationen, die Appendektomie, wird oft laparoskopisch durchgeführt. Dabei kommt es zu dem Gebrauch von endoskopischen Staplern, bei deren Einsatz es häufig zu einem Verlust einzelner abgefeuerter Clips in die freie Bauchhöhle kommt. Wir berichten über den Fall einer 23 jährigen Patientin, die sich 2 Wochen nach durchgeführter laparoskopischer Appendektomie mit den klinischen Zeichen eines Dünndarmileus in unserer Klinik vorstellte. Bei der daraufhin durchgeführten explorativen Laparotomie fand sich ein mechanischer Dünndarmileus, der durch eine von einem freien intraperitonealen Clip ausgehende Bride verursacht wurde. Die Klammer wurde entfernt und die Bride gelöst. Der Darm erholte sich vollständig, so daß eine Darmresektion nicht notwendig wurde. Der weitere postoperative Verlauf war komplikationslos. Wir sehen in dem intraperitoneal verlorengegangenen Clip die Ursache dieses mechanischen Dünndarmileus.
    Notes: Summary. In the last 10years the use of mechanical stapling devices in endoscopic surgery have found widespread application and acceptance. Even one of the most common surgical operations, the appendectomy, is done regularly laparoscopically. Therefore, utilization of endostaples is commonplace and often results in the spillage of fired staples beyond the margin tissue. We report the case of a 23-year-old patient who developed the clinical signs of bowel obstruction 2 weeks after laparoscopical appendectomy. An exploratory laparotomy was subsequently performed. At the time of exploration, a single band was identified that draped over the ilium central affixed to a staple. The staple was removed and the obstruction relieved without bowel resection. The patient had an uncomplicated recovery. We believe that the cause of this mechanical bowel obstruction was a loose staple.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00002583
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  • 96
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    Electronic Resource
    Arthroscopic ankle surgery. Indications, surgical technique, results, complications (1999)
    Springer
    Der Orthopäde 28 (1999), S. 538-549 
    Details
    ISSN: 1433-0431
    Keywords: Key words Ankle • Arthroscopy • Surgery • ; Complications ; Schlüsselwörter OSG • Arthroskopie • Operationen • ; Komplikationen
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung Anhand der eigenen Erfahrung sowie den Angaben in der Literatur werden Indikation, notwendige Ausrüstung, Lagerung, Operationstechnik, Ergebnisse und Komplikationen beschrieben. Als günstige Indikationen haben sich die Entfernung freier Gelenkkörper sowie Synovektomien bei Rheumapatienten oder im Falle eines akuten Gelenkinfekts erwiesen. Die arthroskopische Therapie der anterioren Pathologie des Sportlersprunggelenks erfordert eine sorgfältige präoperative Abklärung; die Ergebnisse sind nicht immer zufriedenstellend für das oft hohe Anspruchsdenken der Patienten. Knorpelchirurgische Maßnahmen sind technisch durchführbar, eine abschließende Bewertung hierzu ist jedoch nicht möglich, gleiches gilt für die Behandlung der Osteochondrosis dissecans. Bei klinisch manifesten arthrotischen Veränderungen ist durch ein arthrokopisches Débridement allenfalls eine temporäre Besserung zu erwarten. Die arthroskopisch assistierte Arthrodese (AAA) ist technisch anspruchsvoll, stellt bei entsprechender Indikation jedoch eine sehr gute Alternative zur konventionellen Technik dar. Die Komplikationsrate bei der Arthroskopie des Sprunggelenks ist höher als bei anderen Gelenken. Dieses betrifft vor allem neurologische Komplikationen; aber auch die Infektionsrate ist größer als bei anderen arthroskopischen Maßnahmen. Beides muß im Rahmen der präoperativen Aufklärung mit dem Patienten sorgfältig besprochen werden.
    Notes: Summary Based on the one experience and the information that is available in the literature indications for ankle arthroscopy are given, surgical equipment, patient placement and surgical technique of different procedures are described. Finally the results and possible complications are presented. Removal of loose bodies as well as synovectomies in case of an acute infection or rheumatoid arthritis are good indication. Arthroscopic treatment of anterior pathology in the athletic ankle need a thorough diagnostic work-up; the results of the treatment do not always meet the expectations of this especially demanding population. Cartilage treatment is technically possible, however, long term results are still missing. This is also true for the treatment on osteochondritis dissecans. In patients with degenerative joint disease arthroscopic debridement can only lead to a temporary benefit. Arthroscopic assisted arthrodeses (AAA) is technically demanding, but can serve as an excellent alternative to conventional open techniques. The complication rate in ankle arthroscopy is high compared to other joints, which is especially true for neurologic complications and postoperative infections. This should be addressed when performing the informed consent.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/PL00003639
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  • 97
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    Electronic Resource
    The vulnerable stomach in babies born with pure oesophageal atresia (1999)
    Springer
    Pediatric surgery international 15 (1999), S. 467-469 
    Details
    ISSN: 1437-9813
    Keywords: Key words Oesophageal atresia ; Gastrostomy ; Complications ; Gastric perforation ; Amniotic fluid
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Nine babies with pure oesophageal atresia were treated in our institution in the years 1979–1996. All received a feeding gastrostomy as their initial operation. After initiation of gastrostomy feeds seven (78%) developed gastric complications, including two posterior gastric perforations (one fatal). We propose that the high complication rate is due to a small, abnormal stomach that is vulnerable to damage by operative trauma and the effects of handling large volumes of feed. We hypothesise that the stomach is abnormal because it has not been exposed to the maturing effects of amniotic fluid in utero. Feeds should be introduced very cautiously to these babies and built up very slowly.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050640
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  • 98
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    Electronic Resource
    A method to overcome the inability to draw blood from central venous lines in children (1999)
    Springer
    Pediatric surgery international 15 (1999), S. 525-526 
    Details
    ISSN: 1437-9813
    Keywords: Key words Central venous catheters ; Children ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract The insertion of central venous catheters has become an established practice in the management of children with different types of malignancies for the administration of chemotherapeutic agents, antibiotics, blood and blood products, as well as drawing blood for various investigations. A commonly encountered problem is that despite the catheter being patent it may be impossible to draw blood from it. We believe this is related to the cut of the catheter tip. To overcome this problem, a technique for cutting the tip of the catheter is described.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s003830050659
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  • 99
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    Bewegungseinschränkung nach Trauma und Operationen am Kniegelenk (1999)
    Springer
    Arthroskopie 12 (1999), S. 222-232 
    Details
    ISSN: 1434-3924
    Keywords: Schlüsselwörter Arthrofibrose ; Arthroskopie ; Arthroly- ; se ; Bewegungseinschränkung ; Knie ; Komplikationen ; Key words Arthrofibrosis ; Arthroscopy ; Arthrolysis ; Complications ; Knee ; Loss of range of motion
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Arthrofibrosis is the term generally used to describe restricted range of motion of the knee after surgery and trauma. However, in many cases this does not reflect the clinical problem. The term arthrofibrosis should only be used for real, generalized fibrosis of the joint. Other localized forms of fibrotic reaction such as localized scar formation, hypertrophic grafts or tumor-like fibrotic tissue after anterior cruciate ligament reconstruction or other localized forms of restricted motion by impingement of ligament grafts in the fossa or osteophytes should not be included, since the therapeutic approach is different. In these cases arthroscopic removal of the mechanically disturbing factor is the treatment of choice; the results in gain of motion are good. Generalized arthrofibrosis is characterized by severe limitation of knee motion in extension and flexion. Infrapatellar constracture syndrome is a specific form of this condition and may be associated with patella infera. In permanent limitation of motion due to arthrofibrosis, only a surgical intervention can improve range of motion. We usually use the arthroscopic technique for intra-articular débridement and scar resection combined with additional arthrotomies in difficult intraarticular scar resection in the upper recessus and when resecting the fat pad or for posterior capsulotomy. In clinically significant patella infera, osteotomy of the tibial tubercle with shifting of the tubercle superiorly is used. Adequate aftercare is important. We performed 80 operations for arthrofibrosis; in 16 out of 21 cases of loss of extension without limitation of flexion, normal extension was achieved, and in 16 out of 19 patients with isolated loss of flexion a comparable flexion with less than 5 degrees of deficit was restored as compared with the other knee. Out of 40 cases with combined loss of flexion and extension, operative treatment restored normal extension in 21 and normal flexion in 17 patients. Extraarticular etiology of limited motion includes fibrosis of the thigh musculature and adhesions to the femur as well as heterotopic ossifications. In these cases, arthrofibrosis is not involved and the operative treatment consists of quadricepsplasty or resection of the heterotopic bone formation.
    Notes: Für Bewegungseinschränkungen nach Trauma und Operationen am Knie wird der Begriff Arthrofibrose verwendet, ein Sammeltopf, der der klinischen Problematik oft nicht gerecht wird. Die Analyse der zugrundeliegenden Ursache bestimmt die einzuschlagende Therapie. So ist es sinnvoller, lokale Störungen, die auch mit einer vermehrten, aber abgegrenzten Fibrosierung einhergehen können, von der eigentlichen generalisierten Arthrofibrose abzugrenzen. Diese schließen einzelne intraartikuläre Narbenbildungen, spezielle Probleme im Bereich der Fossa intercondylica nach vorderer Kreuzbandoperation und mechanisch störende Osteophyten ein. Ihre Behandlung ist arthroskopisch; das Ergebnis bezüglich der Wiederherstellung der Beweglichkeit gut. Die generalisierte Arthrofibrose ist durch einen monate- bis jahrelangen Verlauf mit massiven Streck- und Beugeausfällen gekennzeichnet. Eine spezielle Form stellt das „infrapatellar contracture syndrome” (IPCS) dar, in seiner fortgeschrittenen Form auch mit Patella baja. Die Therapie muss operativ sein, wobei wir prinzipiell eine arthroskopische Technik empfehlen, sofern notwendig unter Verwendung einer zusätzlichen Arthrotomie bei schwierigen intraartikulären Narbenresektionen im Bereich des Hoffa-Fettkörpers und im oberen Recessus und zur hinteren Kapsulotomie. Bei klinisch störendem Patellatiefstand wird die Tuberositas tibiae nach proximal verlagert. Eine adäquate Nachbehandlung ist entscheidend. Bei 80 Operationen wegen Arthrofibrose konnten bei alleiniger Extensionseinschränkung in 16 von 21 Fällen eine vollständige Streckung, bei alleiniger Flexionseinschränkung bei 16 von 19 Patienten eine Flexion mit 〈 5° Unterschied zur Gegenseite erreicht werden. In 40 Fällen mit kombinierter Flexions- und Extensionseinschränkung wurde bei 21 eine vollständige Extension erreicht, bei 17 Patienten eine volle Flexion. Extraartikuläre Ursachen der Bewegungseinschränkung am Knie wie Fibrosierung der Oberschenkelmuskulatur und Adhäsionen zum Femur oder heterotope Ossifikationen sind ebenfalls in Betracht zu ziehen und haben nichts mit Arthrofibrose zu tun; ihre operative Behandlung besteht in der Quadrizepsplastik bzw. in der vollständigen Resektion der heterotopen Verknöcherungen.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001420050130
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  • 100
    Electronic Resource
    Electronic Resource
    Ist die Spinalanästhesie bei Eingriffen in Bauchlage ein empfehlenswertes Verfahren? (1999)
    Springer
    Der Anaesthesist 48 (1999), S. 242-250 
    Details
    ISSN: 1432-055X
    Keywords: Schlüsselwörter Position: Bauchlage ; Klappmesserposition ; Spinalanästhesie: single-dose ; Kontinuierlich ; Lokalanästhetikum ; Barizität ; Komplikation: kardial ; pulmonal ; Key words Spinal anesthesia ; Single-dose ; Continuous ; Prone position ; Jackknife position ; Local anesthetic ; Baricity ; Complications
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Abstract There is still controversy on the usefulness of spinal anesthesia for operations performed in the prone or jackknife position. There is about the risk of inadvertent increase of the sensomotory blockade with the patient in the prone position and the difficulty of managing consecutive cardiorespiratory complications or inducing general anesthesia in case of failures. This article reviews the current literature in terms of safety and effectivness of spinal anesthesia for such operations. For lower-limb or perianal operations with limited extension and blood loss, performed in the prone position, spinal anesthesia seems to be a safe, effective and economic technique in patients without severe a cardiac history. Substantial knowledge about the onset time, fixation time, duration of sensomotory block and baricity of the applied local anesthetic is crucial in this setting. Obese patients are at risk for sudden extension of the block when turned into the prone position. Additional narcotics and sedatives should be avoided and continuous monitoring of hemodynamic and respiratory parameters, of the level of the blockade and vigilance of the patient is mandatory.
    Notes: Zusammenfassung Die Anwendung der Spinalanästhesie für die anästhesiologische Versorgung operativer Eingriffe in Bauchlage wird kontrovers diskutiert. Als nachteilig erscheint dabei eine denkbare Gefährdung des Patienten durch ein unerwünschtes Aufsteigen der sensomotorischen Blockade nach Umlagerung in Bauchlage mit daraus resultierenden kardiopulmonalen Komplikationen und die Schwierigkeit, bei unzureichender Wirkung der Blockade eine Allgemeinanästhesie einzuleiten. Es stellt sich daher die Frage, ob die Spinalanästhesie bei Eingriffen der unteren Körperhälfte mit vergleichbarer Sicherheit wie die Allgemeinanästhesie mit Intubation und Beatmung durchgeführt werden kann und ob sich darüber hinaus Vorteile der Spinalanästhesie gegenüber der Vollnarkose herausarbeiten lassen. Nach Analyse der internationalen Literatur scheint die Spinalanästhesie bei Patienten ohne gravierende kardiale Vorerkrankungen, die sich hinsichtlich Ausdehnung und Zeitdauer klar berechenbaren Eingriffen in Bauchhlage und ohne größeren Blutverlust unterziehen, eine sichere und insbesondere effektive und preisgünstige Alternative zur Intubationsnarkose zu sein. Eine umfassende Kenntnis über Anschlagzeit, Fixierungszeit, Wirkdauer und Barizität des verwendeten Lokalanästhetikums ist bei der Spinalanästhesie in Bauchlage essentiell. Vorsicht ist bei sehr adipösen Patienten hinsichtlich eines nach Umlagerung weiter ansteigenden Blockadeniveaus geboten. Auf zusätzliche (Analgo-)Sedierung sollte bei Spinalanästhesie in Bauchlage verzichtet werden. Eine engmaschige Überwachung von Hämodynamik, pulsoxymetrischer Sauerstoffsättigung, sensomotorischer Blockadehöhe und Vigilanz sowie die Möglichkeit einer frühzeitigen therapeutischen Intervention während der Operation bleiben unverzichtbar.
    Type of Medium: Electronic Resource
    URL: http://dx.doi.org/10.1007/s001010050697
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