Deutsche medizinische Wochenschrift
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"Fast-track"-surgery -- also called "fast-track"-rehabilitation -- is an interdisciplinary, multimodal concept to accelerate postoperative reconvalescence and reduce general morbidity. "Fast-track"-rehabilitation focuses on preoperative patient education, atraumatic and minimal-invasive access to the operative field, optimized anesthesia under normovolemia and prevention of intraoperative hypoxia and hypothermia, effective analgetic therapy without high systemic doses of opioids, enforced postoperative patient mobilisation, early postoperative oral feeding, and avoidance of tubes and drains. "Fast-track"-rehabilitation plans have been published for numerous operative procedures in general-, visceral-, vascular- and thoracic surgery, as well for orthopaedic, urological and gynaecological operations. Until today, "fast-track"-rehabilitation was evaluated most thoroughly in elective colonic surgery. Here, the multimodal regime decreased general morbidity from 20 - 30 % to below 10 %, while postoperative hospital stay was reduced from 10 - 15 to 2 - 5 days. "Fast-track"-rehabilitation for major surgery should be evaluated in randomised, controlled trials.
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Haemoptysis and haemoptoe mainly differ in the amount of expectorated blood. Causes of haemoptysis are diverse and include bronchitis, bronchiectasis, carcinoma, tuberculosis and other infectious pulmonary disease. Haemoptysis almost exclusively involves bronchial arteries, rarely vessels of the pulmonary-artery circuit. ⋯ Chest X-ray is an integral part in each evaluation, as is bronchoscopy. Fiberoptic bronchoscopy is easily performed, although rigid bronchoscopy considerably extends the armamentarium of diagnostic and therapeutic measures. (Pulmangio-) chest CT scan as well as echocardiography and angiographic procedures provide extended diagnostic and therapeutic options. Surgery may be required in severe bleeding complications or during stable disease as a diagnostic approach.
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Dtsch. Med. Wochenschr. · Feb 2005
[Who contributes to research in intensive medicine in Germany? An update].
In today's times of financial short-cut, it is of highest interest to improve quality. Research in intensive care medicine is an important instrument to improve therapeutic strategies. The origin of papers published in the field of intensive care medicine by German universities were evaluated and compared to a previous analysis (1992 - 1997). ⋯ Scientific research in intensive care medicine is important to develop new strategies for treating the critically ill. Although the total number of publications has increased, it is astonishing that some intensive care units from German universities did almost not publish in the selected intensive care journals.
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Dtsch. Med. Wochenschr. · Jan 2005
[Expensive modern therapy options in intensive care medicine in Germany-- are they being used? Results of a questionnaire].
The use of new, high-priced therapies in intensive care medicine should be assessed by a questionnaire. ⋯ Modern, costly pharmaceutical approaches in intensive care medicine are widely not accepted in Germany. Especially a tight financial corset hinders most intensivists to use these strategies that may be life-saving in some patients. A solution to this problem is urgently required that can be reached only in intensive exchange with all who are responsible for this dilemma.