Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Review Comparative Study
[Tracheostomy in intensive care long-term ventilation : indications, techniques and complications].
Percutaneous tracheostomy has become an established procedure in airway management of critically ill patients. It offers advantages over prolonged tracheal intubation and conventional tracheotomy. Nowadays six different techniques are available in Germany, all of which are based on Seldinger's technique. ⋯ It must be noted further that despite its minimally invasive nature percutaneous tracheostomy is still a surgical manipulation on the airway of a critically ill patient. Immediate recognition and adequate treatment of any complications are of primary importance. To reduce airway complications bronchoscopic surveillance is absolutely necessary.
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Tracheal injuries are altogether rare events and can be divided into three broad categories: tracheobronchial injuries caused by external violence, iatrogenic ruptures of the trachea and inhalation trauma. Successful management of tracheobronchial injuries requires a fast and straightforward diagnostic evaluation. In all severely injured patients with cervicothoracic involvement an injury of the tracheobronchial system should be actively excluded. Although it is commonly agreed that posttraumatic injuries require surgical intervention the management of iatrogenic injuries is presently shifting towards a more conservative treatment.
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Injuries of the midfoot comprise fractures, dislocations and/or fracture dislocations of the Chopart and Lisfranc joint lines. Fracture dislocations, in particular, represent prognostically severe lesions which may compromise foot function to a substantial degree. A number of injuries of the midfoot (up to one quarter) are still primarily overlooked. ⋯ Latent instability may be revealed by dynamic assessment employing stress fluoroscopy. Chronic instability may be detected by weight-bearing radiographs displaying manifest displacement and malalignment under load. The principal strategy of treatment includes anatomical reconstruction of the joint structures, the geometric proportions of the medial, central and lateral foot columns and the diagnostics and treatment of ligamentous instabilities.
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Nikolay Pirogoff (1810–1881), Russian scientist, physician, anatomist, military surgeon and teacher belongs to the most exceptional men of the 19th century. His actions have essentially contributed to recognition of the surgical field and its further development. Pirogoff is considered to be one of the pioneers of modern surgery and due to him surgery became a clinical discipline with a scientific basis.