Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
-
Comparative Study
[Experimental fusion of the sheep cervical spine. Part I: Effect of cage design on interbody fusion].
There has been a rapid increase in the use of interbody fusion cages as an adjunct to spondylodesis, although experimental data are lacking. A sheep cervical spine interbody fusion model was used to determine the effect of different cage design parameters (endplate-implant contact area, maximum contiguous pore) on interbody fusion. ⋯ The parameter endplate-implant contact area was not able to determine subsidence of cages. In contrast, the maximum contiguous pore of a cage significantly correlates with interbody bone matrix formation inside the cage. Additionally, there was no correlation between in vitro and in vivo stiffness of interbody fusion cages. Therefore, biomechanical in vitro studies are not able to determine in vivo outcome of fusion cages. Animal experimental evaluations of interbody fusion cages are essential prior to clinical use.
-
Comparative Study
[Relaxation and the electromyographic identification of the recurrent laryngeal nerve].
Electromyography for the identification of the recurrent laryngeal nerve is gaining ever more acceptance in thyroid surgery. Relaxation of the patient, e.g., to improve intubation conditions for anesthesia, carries a potential risk for error. ⋯ The accuracy of electromyography of the recurrent laryngeal nerve can be substantially impaired by the administration of relaxants. If this medication cannot be dispensed with, the surgeon must be aware of the situation. In these cases, a peripheral relaxometer should also be employed to monitor relaxation as it subsides.
-
At times, making the diagnosis of acute appendicitis may pose a considerable problem. However, prompt and accurate diagnosis is essential to obtain minimal morbidity. ⋯ This review summarizes the diagnostic performance of these modalities and discusses their clinical impact. It is apparent that in everyday practice, none of the technical modalities can replace the skill and precision of surgical exploration.
-
Comparative Study
[Pain management in surgical wards. Quality and solutions for improvement in the early postoperative period].
Following guidelines pain levels should not exceed a score of 3 on the visual analog scale (VAS 1-10). We were interested in the actual surgical pain management of the postoperative period and the potential influences of a nurse-controlled intravenous morphine administration (NCA) on its quality. ⋯ This data revealed a relevant deficiency of surgical pain management. Already basic instructions on pain management can significantly improve this treatment. Assigning additional authority to the nursing staff, such as a nurse-based intravenous opioid administration, can significantly raise the motivation of the personnel as well as the satisfaction of the patients involved.