Zentralblatt für Chirurgie
-
Between 1982 and 1997 inferior vena cava filters were implanted in 182 patients. Indications were recurrent pulmonary embolism, massive embolism and prophylactic use prior to planned high-risk-operations upon patients with thromboembolic complications in shorter history. Kimray-Greenfield, Cardial and Vascor-systems were implanted. ⋯ In our opinion the vena cava filter is an effective and safe method to prevent pulmonary re-embolism. Handling is quite easy and filter complications are low. In some elected cases prophylactic use of vena cava filters in high-risk-patients may be indicated.
-
Laparoscopy is very useful in penetrating abdominal trauma, in particular to exclude intraabdominal lesions in stab wounds. In blunt abdominal trauma laparoscopy is not the first choice of diagnostic means though it warrants comparable good results to CTscan and ultrasound. ⋯ In the future it has to be thought about laparoscopy in local anesthesia and in bedside procedure e.g. on the intensive care unit. Laparoscopy should be regarded as an integral part of diagnostic spectrum in blunt abdominal trauma.
-
Comparative Study
[Role of adenosine triphosphate (ATP) in trauma-induced and elective hypothermia].
In trauma patients hypothermia is a frequent event. According to the literature the majority of trauma patients are presenting a core temperature of less than 34 degrees C at admission. In contrast to the benefit of hypothermia in elective surgery, clinical experience with hypothermia in trauma patients has identified hypothermia to be one major cause of severe posttraumatic complications. It was hypothetized that this diverse effect of hypothermia is related to depletion of high energy phosphates like adenosine-tri-phosphate (ATP) in trauma patients. To verify this hypothesis the relation of ATP plasma levels and hypothermia was examined in a clinical study. ⋯ Hypothermia in elective surgery, established by active cooling, preserves the ATP storage and maintains an aerobic metabolism, which both contribute to the beneficial effect of hypothermia in ischemia/reperfusion in cardiovascular surgery. However, in trauma patients hypothermia is caused by insufficient heat production due to utilization of ATP under anaerobic metabolic conditions. Low ATP plasma levels combined with hypothermia seem to be a predisposition for posttraumatic complications like organ failure.
-
While substantial and practical qualification for medical practice within the framework of emergency medical services have to be proven by an advanced training, there are no special training programs for in-hospital emergency situations. As in the emergency room a transparent in-hospital emergency management has to be established including definite competencies to avoid time delays and inadequate treatment due to disputes about competence. ⋯ Thus, the physician working in ICUs needs professional qualification and specialized knowledge as well as marked competence to co-operate. In any case the final clinical responsibility has to be taken over by physicians who not only have performed their internship on a ICU but are highly qualified in the whole range of intensive care medicine including all topics required in advanced intensive care medicine curricula.
-
Due to European law all examinations taken by officially recognized national boards have to be accepted in every member state. In 1958 the UEMS was founded on behalf of the European Council. Several Divisions in the "Section of Surgery" and the "European Board of Surgery" have to define the content and duration of their knowledge within the common trunk as well for the division's specialty itself. ⋯ East European countries start to harmonize their structure due to the demands of the UEMS. The charter on continuing Medical Education was established by the UEMS in 1998. This concept was also accepted by the national authorities in Germany and will be officially structured in our country very soon.