Zentralblatt für Chirurgie
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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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Objective of this study was to show the different causes and the importance of pulmonary complications after esophageal surgery and their management by general and intensive care measures. In the University Hospital for General and Abdominal Surgery of Mainz 222 patients were treated for esophageal cancer from 9/1985 to 5/1997. Data of 214 patients were available for this investigation. ⋯ Postoperative psychosyndrome, recurrent nerve palsy and ASA-risk stratification were accompanied by elevated rates of pneumonia. Careful selection of patients for esophageal resection, atraumatic surgical technique and reduction of general and surgical complications and intensive care measures can help to avoid postoperative pulmonary complications. Reduction of mediators activated by surgical trauma is not feasible so in the moment prevention of aspiration seems to be the most effective therapy in the postoperative course.
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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.
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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.
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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.