Zentralblatt für Chirurgie
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Despite the decreasing frequency of gastric cancer in most Western countries prognosis could not be improved by surgery alone in the past. Advanced tumor stage due to late diagnosis is one of the reasons for this observation. Contrary to breast and colorectal cancer, postoperative chemotherapy failed to improve prognosis in gastric cancer. ⋯ Intraperitoneal, adjuvant chemotherapy showed a positive impact on survival in Asian studies only, but was also used successfully as a part of a multimodality approach in Western phase II trials. Since neoadjuvant therapy proved to create downstaging of tumor size in some patients with advanced gastric cancer some working groups tried to influence prognosis of potentially resectable tumors by preoperative chemotherapy, surgical resection and postoperative, adjuvant therapy in the recent past. However, the efficacy of this therapeutic approach has to be reconfirmed in a controlled, phase III fashion.
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The application of temporary vena cava filters for the treatment of deep venous thrombosis of the lower extremity has become increasingly important in recent years. The filters are supposed to guarantee temporary protection from more extensive pulmonary embolism. ⋯ Because of possible complications such as the above, the indication for insertion of temporary vena cava filters requires thorough consideration. Their duration of stay should be as short as possible and should be limited to the high risk phase, not exceeding ten days.
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Postgraduate training in general surgery in Germany is regulated by state law and administrated by the Arztekammer. The formal conditions for the performance of the postgraduate training are published in the postgraduate regulations of the Arztekammer. ⋯ The above mentioned regulations will be presented in this article as well as the procedure that is applied by the Arztekammer Nordrhein to evaluate the accreditation of those people and organisations who are eligible to administer the postgraduate training. Further perspectives on the professional future of surgeons in Germany are addressing the background of a growing number of doctors who are facing the changing conditions of the legal framework within which they will have to work.
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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.
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Hydroactive wound dressings retain exsudate in the wound region or incorporate wound exsudate by gel formation. They create the local environment for moist wound healing which is experimentally and clinically characterized by accelerated reepithelialization, inflammatory reaction and angiogenesis as well as reduced wound pain and wound infection rates. Clinically relevant product groups of hydroactive wound dressings (hydrocolloids and hydropolymers, semipermeable films, calcium alginates) are distinct as to chemical structure, physical properties and functional characteristics in local wound treatment. ⋯ Experimental and clinical results of moist wound treatment by hydroactive wound dressings such as hydrocolloids and hydropolymers, semipermeable films or calcium alginates reveal a wide range of local response on the different types of dressings. They offer the opportunity of therapeutic differentiation. To elucidate the differential indication for different product groups of hydroactive wound dressings in local treatment of chronic wounds, additional experimental and clinical research is required.