Zentralblatt für Chirurgie
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The modern hospice movement started in St. Christopher's Hospice, London. ⋯ Until 1990 there was not much of a hospice or palliative movement in Germany. In the early nineties an increasing interest could be recognized and since May 1997 there are 34 palliative care units in existence.
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The indication for operative or conservative treatment of the anterior cruciate ligament remains still difficult. Many years of intensive basic and clinical research and a better knowledge of biology, biomechanics and pathology have not been achieved standards of therapy. Therefore varying treatment options exist. ⋯ In all other types of ruptures only a reconstruction using autologous material (lig. patellae, semitendinosous tendon) is recommended. Rehabilitation after ACL ruptures depends on the method of treatment (conservative procedure, reconstruction material, fixation technique, associated lesions) and has to be adapted to the biological healing process. Normally an immobilisation (cast, orthesis) has no benefit for ligament healing.
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Review
[Dislocation fractures in the area of the middle foot--injuries of the Chopart and Lisfranc joint].
Dislocation fractures of the Chopart and Lisfranc joint line result from rough force and lead to articular incongruities, complex derangement of the plantar arc geometry and shortening of the medial or lateral column of the foot. These injuries are often complicated by severe soft tissue damage causing a high incidence of compartment syndrome. Beside careful clinical examination radiographs in 3 standard projections are essential for the exact diagnosis, if necessary completed by conventional tomographies or CT. ⋯ Dislocation-fractures of the Lisfranc joint can be fixed by percutaneous K-wires if a closed reduction is possible. Open reduction and internal fixation are indicated in cases of instable and irresponsible fractures, and in open fractures as well as in lesions presenting with a compartment syndrome. A precise anatomic reduction of the tarsometatarsal joints is critical after this kind of injuries to avoid long-term disability.
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Like other industrial countries Germany experiences a significant increase of cancer prevalence. Recent advances in the treatment of various types of cancer resulted in prolonged survivaltimes of patients. Cancer--especially in advanced incurable stages--often is accompanied by severe pain. ⋯ Most cancer-patients should experience sufficient pain-management if existing recommendations for the pharmacological treatment of cancer-pain (e.g. WHO-guidelines) are followed consequently. In case of intractable pain or ongoing disabling symptoms despite proper therapy consultation of an expert in palliative medicine should always be considered as well as the option to refer the patient to a specialized pain-management center.
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Posterior stabilization by internal fixator is used as a frequent procedure for the surgical treatment of thoracolumbar spine fractures. The technique of internal fixator stabilization and its results regarding the correction of spinal posture and spinal canal clearance are described. By transpedicular spongiosal filling of the reduced vertebral body, a complete consolidation can be achieved. ⋯ For spinal fractures with pronounced destruction of the anterior column and associated intervertebral disc ruptures, an interbody fusion by anterior approach should be performed. In case of additional posterior or transverse instability, a supplemental stabilization by internal fixator is necessary. For severe spinal canal encroachments at thoracic spine level with symptomatic or imminent spinal cord compression, the most efficient decompression by an anterior approach is preferred.