Zentralblatt für Chirurgie
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Due to the variety of differential diagnoses causing acute scrotum and their possible consequences, this finding is a challenge for diagnostic and therapeutic management in the daily clinical practice of paediatric medicine. ⋯ In approximately one fifth of registered patients, a testicular torsion is present causing the acute scrotum, and leading to an obligatory surgical intervention. Various causative differential diagnoses can be clarified by precise medical history and exact physical examination. Imaging procedures can be helpful in decision-finding. Finally, the clinical finding is crucial and decisive. If a testicular torsion cannot reliably be excluded by clinical investigation or imaging, an immediate surgical exploration of the testis has to be performed.
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Observational Study
[Teamwork in the operating theatre: the German Observational Teamwork Assessment for Surgery (OTAS-D) and its first application in Germany].
The quality of surgical teamwork contributes to performance of the operating theatre team, service quality and patient safety in surgery. Observational tools are a feasible and reliable way to capture and evaluate teamwork in the operating theatre (OT). We introduce the German version of the Observational Teamwork Assessment for Surgery (OTAS-D) and present the first observational results from German OTs. ⋯ The German version of OTAS-D is a psychometrically robust method to capture the quality of teamwork in operating theatres. It enables the analyses of teamwork between the surgical, nursing and anaesthesia professions in acute surgical care. Limitations of the first application results are considered. Finally, potential applications for surgical teaching, research and quality management are discussed.
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Splenic rupture is the most common injury in blunt abdominal trauma at any age. The grade of rupture, haemodynamic stability and, in the case of operative treatment, the experience of the surgeon all play an important role in preserving the spleen. Due to its important immunological function preservation of the spleen should be the goal. ⋯ The majority of primarily partially spleen-preserving operations result from OIS grade IV ruptures of the spleen. Use of a partially spleen-saving surgical approach was successful in ¾ of these patients. Low morbidity and documented perfusion of the remnant spleen at long-term follow-up indicate that a spleen-preserving technique is warranted if an operative approach is required.
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Gallbladder cancer is suspected preoperatively in only 30 % of all patients, while the other 70 % of cases are discovered incidentally by the pathologist (incidental or occult gallbladder cancer or IGBC). If gallbladder cancer is suspected preoperatively, an open cholecystectomy must be performed. The increasing rate of cholecystectomies via laparoscopy has lad to the detection of more gallbladder cancers in an early stage. Extended resection with regional lymph node dissection for T2 carcinomas and for more advanced cancer has been suggested. If IGBC is detected postoperatively by the pathologist after simple cholecystectomy, radical re-resection in cases of T2 tumours and more advanced stages is recommended. However, it has been argued that T1b cancers may have spread regionally or systemically at presentation and, thus, it remains debatable whether T1b cancers should be treated by simple cholecystectomy or by radical resection. PATIENTS / MATERIAL AND METHOD: This investigation was based on the German Registry of "Incidental Gallbladder Cancer" of the German Society of Surgery. In the present study, we evaluated whether T1 carcinoma patients do profit from a radical re-resection and if the different techniques of liver resection have comparable results in T1 carcinomas. ⋯ For T1a cancer a simple cholecystectomy is sufficient. An immediate re-resection is highly recommended for patients with IGBC in T1b stage. The wedge resection technique combined with a locoregional lymphadenectomy of the hepatoduodenal ligament seems to be the strategy of choice for T1b cancer. An extended re-resection is necessary to determine the nodal status exactly, and to determine an exact definite staging for patients with T1b cancer.