Zentralblatt für Chirurgie
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The authors have attempted to elucidate the differences between Chance, seat-belt, and flexion distraction fractures. Chance and seat-belt fractures have more common features, while flexion distraction fractures differ, in particular, due to the mechanism of injury. A difficult diagnosis is sometimes a common characteristic, while therapy is always the same. ⋯ The objective of this work is to illustrate the various types of spinal distraction injuries of a seat-belt character and Chance fracture, when the vertebral body is not compressed. X-rays and often also CT scans show a "benign" character. Interpretation of the findings is very important for the development of further chronic instability of the spine and all consequences. If the diagnosis of a distraction injury is made the operative stabilisation is essential. That is why all our patients were tretaed by operation.
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Comparative Study
[The thoracoscopic talc pleurodesis with intraoperative pleural biopsy - a retrospective analysis in patients with malignant pleural effusion].
The thoracoscopic pleurodesis with talc is an established therapy in case of malignant pleural effusion. With the instillation of talc a -localised inflammation is induced. However, some-times it turns into a severe systemic reaction. In this study of the postoperative course, the -question is examined whether a pleural biopsy is an additional risk factor for morbidity and mortality after talc pleurodesis. ⋯ There were no significant differences for the examined laboratory values or for the morbidity / mortality between the two groups. That is why a disadvantage for patients with an intraoperative pleural biopsy is not to be expected.
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Congenital diaphragmatic hernia (CDH) occurs sporadically with an incidence of 1:2,500 live births. Despite the progress in neonatal intensive care, CDH remains associated with a mortality of at least 30 % in isolated cases. The in essence surgically correctable defect of the diaphragm enables the prenatal herniation of abdominal organs into the thoracic cavity. ⋯ A trial in severely affected -fetuses with survival as main outcome is currently under review by ethics committee. A standardised neonatal management enables optimal treatment and multicentre compatibility. It remains to be proven if fetoscopic surgery can maintain a solid position in the prenatal treatment of CDH to improve both mortality and morbidity of the affected children.
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Fast-track surgery is a comprehensive perioperative treatment concept that has been successfully performed and widely accepted in adult surgery since the 1990s. The crucial aim is to speed up convalescence and to avoid perioperative complications as pneumonia and thrombosis. Compared to conventional treatment strategies, hospital stays are substantially reduced. ⋯ Shorter hospital stays lead to reduced expenses for the health insurances and parents. Fast-track concepts are not implemented in the German reimbursement system G-DRG. Thus, problems with intensified nursing and reimbursement remain to be solved.