Der Anaesthesist
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The economic situation in German Hospitals is tense and needs the implementation of differentiated controlling instruments. Accordingly, parameters of revenue development of different organizational units within a hospital are needed. This is particularly necessary in the revenue and cost-intensive operating theater field. ⋯ Comparative analyses within different surgical fields on this data base should be avoided. The demonstrated method can be used as a guideline for other hospitals to calculate the DRG revenues within the OR. This enables pursuing cost-effectiveness analysis by comparing these revenues with cost data from the cost unit accounting at a DRG or case level.
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Raoultella ornithinolytica is a species of gram-negative encapsulated and aerobic bacteria belonging to the family Enterobacteriaceae and is mainly found in fish. The most distinctive feature of this bacterium is the ability to convert histidine to histamine; therefore, the consumption of decomposing fish infected by R. ornithinolytica causes rashes, diarrhea, flushing, sweating and vomiting. This food poisoning is also called histamine fish poisoning; however, human infections with R. ornithinolytica are extremely rare and have so far only affected patients with diseases suppressing the immune system. The current case report describes for the first time sepsis with evidence of bloodstream infection by R. ornithinolytica in an immunocompetent male patient and the successful antibiotic treatment.
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The demographic change is accompanied by an increasing number of elderly trauma patients. Geriatric patients with trauma often show several comorbidities and as a result have a high perioperative risk to develop postoperative morbidity and mortality. The 30-day mortality is high. ⋯ The level of evidence in the perioperative management of elderly trauma patients is poor; therefore, there is an urgent need for large prospective studies in order to define uniform standards and guidelines.
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Review Meta Analysis
[Estimation of the optimal tube length : Systematic review article on published formulae for infants and children].
The correct placement of an endotracheal tube in children is essential as incorrect placement following unilateral ventilation and tube displacement may lead to far-reaching consequences, such as volutrauma and hypoxia, respectively. Different formulae referring to the correct placement of nasotracheal and orotracheal tubes have been published with reference to body weight and age. ⋯ The published formulae were comparatively simply to apply but had notable limitations. Correlating the position of the endotracheal tubes with chest x-rays, the concordance analysis showed that for the age-based formulae using orotracheal as well as nasotracheal intubation and in both age groups, an accordance could only be achieved in a maximum of 81%. In the presence of a lack of alternative possibilities, only one formula based on the gestational age seemed to have an impact on estimation of correct endotracheal tube depth placement in newborns and infants. Therefore, a generally valid formula cannot be recommended without verification by auscultation or chest x-ray.
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Case Reports
Ultrasound-guided pulsed radiofrequency treatment of the pudendal nerve in chronic pelvic pain.
Chronic pelvic pain is a condition that can be caused by pudendal neuralgia, interstitial cystitis, piriformis syndrome and neuropathy of the ilioinguinal, iliohypogastric and genitofemoral nerves. Based on three case reports this article discusses the clinical effectiveness of pulsed high-frequency radiofrequency (PRF) treatment applied to the pudendal nerve under ultrasound guidance in medicinally treated patients with chronic pelvic pain.