Deutsche medizinische Wochenschrift
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Dtsch. Med. Wochenschr. · May 2006
Case Reports Comparative Study[Wound botulism in heroin addicts in Germany].
5 heroin addicts (aged 31-44 years; 1 female, 4 men) presented with a history of blurred vision and diplopia followed by dysarthria. 3 of the patients also developed respiratory failure requiring long-term ventilatory support. Physical examination revealed cranial nerve deficits and abscesses at injection sites in 3 of them. ⋯ Progressive cranial nerve pareses in addicts who inject drugs intravenously or intramuscularly should raise the suspicion of wound botulism and require hospitalization. While indirect demonstration of toxin supports the diagnosis, false-negative results are common.
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Dtsch. Med. Wochenschr. · Apr 2006
[Clinical pathways -- first results of a systematic IT-supported application at a surgical department of a university hospital].
In analogy to industrial process management, clinical pathways have been introduced for operational process organisation in orthopedic and interventional procedures as well as for conservative treatments. Within this study, introduction and continuous, systematic application of clinical pathways at a surgical department of a university hospital was investigated. ⋯ Clinical pathways may not only be realised for operative procedures or conservative treatments, but represent a clinical and administrative management instrument at a surgical department of a university hospital for daily work routine. They are suitable as an instrument for clinical quality and risk management, as an economic control instrument in reorganisation phases as well as in the routine of surgical clinics.
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A 80 year-old woman contracted an abrasion of her right forearm while gardening. 5 days later, dysphagia, trismus and a cramp of the right hand developed. On admission (8 days after the injury) cramps of the platysma and pharyngeal muscles were observed. A tetanus vaccination had not been carried out for years. ⋯ Minor superficial injuries can lead to acute tetanus, if the level of anti-tetanus toxin-antibodies is non-protective and a disinfective wound cleaning and a postexpositional vaccination are not performed.