Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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For pelvic fractures, pre- and postoperative imaging includes spiral computed tomography, providing high resolution and accuracy. In conventional pelvic operations, these image data cannot be used directly. Intraoperative imaging is limited with fluoroscopy and visualization by the approaches. ⋯ However, it helps to reduce complications caused by implant placement. With the introduction of new health care requirements in Germany, this may be an economic argument as well. Current developments focusing on accurate navigated reduction will provide new indications for CAS, further decrease complication rates, and help to reduce the invasiveness of pelvis operations.
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Intraoperative neuromonitoring (IONM) has yielded an increasing effect on thyroid surgery. During IONM, the recurrent laryngeal nerve is stimulated electrically and an acoustically transformed electromyographic signal is derived via either a needle electrode placed in the vocalis muscle or an electrode adjusted to the intubation tube. The IONM is used for identifying and predicting the function of the recurrent laryngeal nerve. ⋯ The reliability of the IONM signal (defined as the correlation between intraoperative signal interpretation and postoperative vocal cord function) is reflected by a specificity as high as 98.2%, as shown by German multicenter studies. Thus, normal vocal cord function could be demonstrated postoperatively in over 98.2% of patients with intraoperatively unchanged neuromonitoring signals. If the neuromonitoring signal changed during operation, 39% of the patients suffered from transient vocal cord immobility and 12% had permanent loss of vocal cord function.
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Since the phoniatrician H. Bauer described the first case of recurrent laryngeal nerve palsy most likely caused by intubation some 45 years ago, several case reports have been published. However, systematic analyses regarding the frequency of recurrent laryngeal nerve palsies due to intubation are scarce, and none of them has used the proper methods to demonstrate clearly that such a mechanism exists. ⋯ The differential diagnosis of postoperative recurrent laryngeal nerve palsy requires the use of specific tools which go beyond simple laryngoscopy and include stroboscopy as well as intra- and extralaryngeal electromyography. A partial palsy of recurrent laryngeal nerve due to intubation would be associated with severe dysphonia or aphonia, not with dyspnea because of the typical intermediate position of the paralyzed vocal folds with a normal electromyographic function of the cricothyroid muscle. The use of these methods to identify the nature of postoperative recurrent laryngeal nerve palsy is recommended in cases of regular intraoperative neuromonitoring but postoperatively impaired function of the vocal cords.
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A main target of surgical treatment is to minimize postoperative pain. The aim of this study was to evaluate the benefit of quality management on postoperative pain and to improve pain therapy. ⋯ A simple pain management system in a general surgical ward led to considerable improvement in postoperative pain scores as assessed by visual analogue scale.
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Carotid endarterectomy is a routine procedure in vascular surgery. Besides clinical symptoms and the degree of stenosis, indication for surgery is influenced by the perioperative complication rate. This depends on stroke and the mortality rate and should not exceed 6% in symptomatic, high-grade stenosis, according to the Stroke Council of the American Heart Association. ⋯ In the former, closure by direct suture or patch plasty are possible. Different methods for cerebral protection during the clamping time exist, of which shunt protection is the most common. The various operative techniques are described and critically discussed.