Der Anaesthesist
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Toxic-shock-syndrome (TSS) is an acute febrile, exanthematous illness caused by toxins such as toxic-shock-syndrome-toxine-1 (TSST-1) and other endotoxines from staphylococcus aureus with an incidence of 0,5 per 100.000 inhabitants. Patients with menstrual toxic-shock-syndrome (menstrual-TSS) usually have TSS associated with menstruation and use of a vaginal device such as tampons. Other patients with non-menstrual toxic-shock-syndrome (non-menstrual-TSS) have a focus of staphylococcal infection such as a surgical wound infection or soft tissue abscess. ⋯ Possible complications including ARDS and myocardial failure require a thorough understanding of its underlying pathophysiology to ensure appropriate intensive-care treatment. Only if appropriate therapy is instituted as early as possible, most of patients will be able to survive their toxic-shock-syndrome. In other cases TSS can be a rapidly progressive and perhaps lethal ending disease because of possible multiple organe failure such as ARDS.
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An 31-year-old women with a long history of back pain without neurological symptoms underwent a caesarean section during the 36th week of pregnancy with combined spinal-epidural anaesthesia. Indication was the increasingly severe back pain. She delivered a normal healthy boy. ⋯ A few days later she underwent a laminectomy under general anaesthesia with resection of an intradural mass adherent to the cauda equina. Pathological review of the surgical specimen revealed a myxopapillary ependymoma WHO grade I. The postoperative course was uncomplicated with preservation of bladder dysfunction but after 4 weeks the bladder function was normalised.
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Nosocomial infections are a common problem in intensive care therapy and have relevant influence on morbidity, mortality and associated costs. The aim of this study was to assess data on the epidemiology of nosocomial infections and related risk factors in neurological intensive care patients and to use them for internal quality management. ⋯ The establishment of periodic surveillance proved to be a valuable tool for the promotion of quality management activities in both intensive care units.
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Epidural analgesia is the most effective means of pain relief during labor and is considered to be the "gold standard". For sufficient epidural analgesia, a wide range of nerve-block has to cover the segments Th10 to S4. ⋯ Practical issues such as the insertion of the epidural catheter, choice of medication and application modes are described. The influence of epidural analgesia on labor, instrumental delivery and rate of caesarean section is discussed.
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Against the background of an ever-increasing shortage of financial support, closure of smaller hospitals and shortage of personnel in the medical branch, the necessity of the Federal emergency system is being increasingly called into question. In reality the number of missions which are relatively indicated are clearly increasing nationwide: an emergency doctor is not absolutely necessary in many situations. ⋯ By the introduction of a ranked assistance system and the inclusion of "first responders", the time period before the arrival of the highly qualified emergency medical doctor can be bridged by qualified paramedics and general practitioners. The impulse of the legislators, assimilation of the rescue service acts, restructuring of rescue service catchment areas and the introduction of integrated demand-oriented control stations with a consequent quality management system as well as the implementation of a medical leader rescue system can reduce costs and further improve the quality of the emergency medical rescue system.