Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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For 1 year now, German surgical multicentric randomised controlled trials (MRCT) in Germany may be included under the heading "Clinical Trials" in our monthly updated trial list. ⋯ The new regular heading gives important details about ongoing surgical trials in Germany. The steady growth of trials and recruited patients demonstrates the practicability of randomized controlled trials in surgery.
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Intraosseous (IO) infusion methods have been common for emergency treatment in infants and children for years. The role of IO access in adults is however much less clear, but its importance in this patient group is increasing, and different devices are available today. Each device has strengths and weaknesses, but all achieve rapid vascular access even in challenging situations. ⋯ Most drugs administered intravenously can be given intraosseously in equivalent dosages and with the same effects. Nevertheless the limitations and risks of IO access routes need to be considered for each application. Rapid IO access is now possible in all age groups, and the 2005 AHA Guidelines favor it over drug administration via the endotracheal tube.
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Nosocomial infections are still an important issue in surgical wards. About one patient in 15 is affected, most of them from surgical site or urinary tract infections, but pneumonia cases can also be observed frequently. ⋯ About one third of nosocomial infections can be regarded as avoidable. Routine surveillance of nosocomial infections and multiresistant pathogens, feedback of data to all personnel involved in patient care, and routine educational activities in this field are the crucial elements for achieving high compliance with the most important infection control measures.
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Review Comparative Study
[Endobronchial ultrasound for diagnosis of the mediastinum].
The development of endobronchial ultrasound (EBUS) is one of the most important advances in bronchoscopy in recent years. Two different techniques are available which improve sonographic diagnostics of the mediastinum and staging in patients with lung and non-lung cancer. ⋯ Endobronchial ultrasound as a diagnostic tool is expected to gain importance in the near future. Especially the method combining EBUS and TBNA may replace more invasive methods such as mediastinoscopy for evaluating patients with unknown mediastinal lesions or for staging patients with lung cancer.