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Kongressband. Deutsche Gesellschaft fur Chirurgie. Kongress最新文献

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[Digital patient record in emergency care--organization, problems and futurology]. [急诊护理中的数字病历——组织、问题和未来]。
E Schöll, Stefan Eggli, H Zimmermann
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引用次数: 0
[Adenoma of Vater's ampulla: what is the value of endoscopic diagnosis and therapy?]. 壶腹腺瘤:内镜诊断和治疗的价值是什么?
D Hartmann, J F Riemann

The method of choice to detect tumors of the papilla of Vater is endoscopic diagnosis. However, no definite decision on the dignity can be made through the macroscopic appearance itself. Only the combination of various diagnostic methods (side view duodenoscopy with biopsy, endosonography, ERCP, IDUS) allows a reliable statement on the local growth of tumors and the dignity. If there are no signs for local infiltration, histological indications for a carcinoma or distant metastasis, the endoscopic resection in specialized centers is recommended.

诊断乳突肿瘤的首选方法是内镜诊断。然而,不能通过宏观的表象本身对尊严作出明确的决定。只有多种诊断方法(侧视十二指肠镜结合活检、内镜、ERCP、IDUS)才能对肿瘤的局部生长和尊严做出可靠的判断。如果没有局部浸润的迹象,组织学上没有癌或远处转移的迹象,建议在专门的中心进行内镜切除。
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引用次数: 0
[Prognostic risk factors in children and adolescents with craniocerebral injuries with multiple trauma]. [儿童和青少年颅脑损伤合并多发创伤的预后危险因素]。
H Rupprecht, A Mechlin, D Ditterich, R Carbon, K Bär

220 of 268 polytraumatized patients (82.1%) presented an additional head injury, which increased the mortality significantly. By the Hannover Polytrauma Score we could demonstrate that the severity of the polytrauma and the prognosis depended on the extent of the brain injury. Important risk factors were skull fractures and shock on arrival. 66.7% of the patients with a severe brain trauma and a skull fracture died; without this fracture, only 36.8% died. 76.1% of the children with a systolic blood pressure (SBP) > 80 mm Hg survived, but only 31.2% with a SBF < or = 80 mm Hg did not die. For all polytraumatized children we recommend a computer tomography of the head. In spite of a negative initial CT a follow up CCT should be performed.

268例多发创伤患者中有220例(82.1%)出现额外的头部损伤,显著增加了死亡率。通过汉诺威多发伤评分,我们可以证明多发伤的严重程度和预后取决于脑损伤的程度。重要的危险因素是颅骨骨折和到达时休克。重型颅脑外伤合并颅骨骨折患者死亡率为66.7%;没有这种骨折,只有36.8%的人死亡。收缩压(SBP) > 80 mm Hg的患儿有76.1%存活,而收缩压<或= 80 mm Hg的患儿只有31.2%没有死亡。对于所有多重创伤的儿童,我们建议进行头部计算机断层扫描。尽管初始CT阴性,仍应进行后续CT检查。
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引用次数: 0
[Joint infection caused by radiogenic defect: prevention and therapeutic options]. 放射源性缺陷所致关节感染:预防与治疗方案。
H H Homann, M Lehnhardt, S Langer, D Drücke, H U Steinau

Exposed irradiated joints are characterized by bone and cartilage necrosis with a chronically infected joint space. The indication for treatment results from possible infection spreading and more often because of severe pain. The usual concept of sequential debridement, joint replacement and regional flap coverage, is often impossible due to the radiodermitis and bone necrosis in the neighbourhood of the joint. Even free flaps are associated with a higher failure rate, because of the irradiation of the recipient vessels long vein grafts are often needed. If regional flap coverage is desired, distant flaps with long, not irradiated pedicles must be chosen. Prevention due to special considerations during the first surgery is essential.

暴露于辐照下的关节表现为骨和软骨坏死伴关节间隙慢性感染。治疗的适应症是由于可能的感染扩散,更常见的是由于剧烈的疼痛。通常的顺序清创、关节置换术和局部皮瓣覆盖的概念,由于关节附近的放射性皮炎和骨坏死,往往是不可能的。即使是自由皮瓣也有较高的失败率,因为受体血管的照射往往需要长静脉移植。如果局部皮瓣覆盖是理想的,远瓣长,不辐照蒂必须选择。在第一次手术中进行特殊的预防是至关重要的。
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引用次数: 0
[LISS versus condylar plate]. [LISS与髁钢板对比]。
U Hahn, A Prokop, A Jubel, J Isenberg, K E Rehm

Up to the seventies the surgical treatment of supra- and bicondylar femoral fractures was difficult and showed a lot of complications. In most studies a conservative treatment was recommended. In the least 30 years the clinical outcome after surgical treatment improved. This was a result of the development of new implants and improved surgical techniques. However, today the primary surgical treatment is the therapy of choice. We reviewed from 1986 to 2001 n = 121 distal femoral fractures which were in 32 cases treated with a Condylar Blade Plate and in 10 cases with a less invasive stabilisation system (LISS). The final results after condylar blade plating were rated using the system that was described by Neer. The averaged follow up time was 9 years. Low postoperative infection rates and in 75% excellent and satisfactory results combined with low cost are the reference for the evaluation of the LISS results. While in our owen series according to the literature there were no significant better functional results for the LISS group than for the Condylar Blade Plate group there were only few autologous bone grafts necessary. Due to the angle-stable self-drilling and self-cutting screws and the Internal-Fixater Principle the LISS has some mechanical and biological edge on the condylar blade plate.

一直到七十年代,股骨上髁和双髁骨折的手术治疗都很困难,并且出现了许多并发症。大多数研究推荐保守治疗。在至少30年的手术治疗后的临床结果有所改善。这是新植入物发展和手术技术改进的结果。然而,今天的主要手术治疗是首选的治疗方法。我们回顾了从1986年到2001年的121例股骨远端骨折,其中32例采用髁突钢板治疗,10例采用微创稳定系统(LISS)治疗。使用Neer描述的系统对髁刀片电镀后的最终结果进行评定。平均随访时间为9年。低的术后感染率和75%的优良率和满意的结果结合较低的成本是评价LISS效果的参考。而在我们的欧文系列中,根据文献,LISS组的功能结果没有明显优于髁突钢板组,只有很少的自体骨移植是必要的。由于角度稳定的自钻自切螺钉和内固定原理,LISS在髁钢板上具有一定的机械和生物边缘。
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引用次数: 0
[Locoregional recurrence]. (局部区域复发)。
Klaus-Jürgen Winzer
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引用次数: 0
[Laparoscopic therapy of sigmoid and colonic diverticulitis]. [腹腔镜治疗乙状结肠憩室炎]。
E Bärlehner, St Anders, B Heukrodt

The evidence of innovative surgical procedures is based on study results, general acceptance, and individual experiences. In Germany, 47% of all hospitals agreed to laparoscopic colonic surgery. In our own clientele, we noted a morbidity of 6.8% and a lethality of 0%. Up to now, studies of laparoscopic surgery for sigmoid diverticulitis showing a high level of evidence are still missing. Case-control studies and case studies describe some advantages of this procedure.

创新外科手术的证据是基于研究结果、普遍接受和个人经验。在德国,47%的医院同意进行腹腔镜结肠手术。在我们自己的客户中,我们注意到发病率为6.8%,死亡率为0%。到目前为止,腹腔镜手术治疗乙状结肠憩室炎的研究仍缺乏高水平的证据。病例对照研究和案例研究描述了该方法的一些优点。
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引用次数: 0
[Cystic pancreatic tumors--differential diagnosis, surgical therapy. Prognosis of cystic pancreatic tumors]. 胰腺囊性肿瘤——鉴别诊断,手术治疗。胰腺囊性肿瘤的预后[j]。
J Köhler

From 1986-2001 we treated 31 patients with cystic neoplasms of the pancreas. 13 patients showed a cystadenocarcinoma including one rare case of a serous cystadenocarcinoma. A curative resection (R0) was possible in 10 patients (resection rate: 76.9%). After median 61 months (range 29-144 months) 8 patients are alive without evidence of tumour. 2 patients died 2 months (pneumonia) and 36 months (local recurrence) respectively after operation. The latter case of tumour recurrence showed nodal involvement (pN1) in the Whipple specimen. One patient died 44 months after Whipple procedure with tumour-positive resection margin (R1 Situation) from local recurrence and hepatic spread. Our data reflect the good prognosis of cystic neoplasms of the pancreas reported in literature after curative resection--a result of the different biological behaviour compared with ductal adenocarcinome.

从1986年到2001年,我们治疗了31例胰腺囊性肿瘤。13例患者表现为囊腺癌,包括一例罕见的浆液性囊腺癌。10例患者可根治性切除(R0),切除率为76.9%。中位61个月(范围29-144个月)后,8例患者存活,无肿瘤证据。术后2个月(肺炎)和36个月(局部复发)死亡2例。后一例肿瘤复发在惠普尔标本中显示淋巴结累及(pN1)。1例患者在惠普尔手术后44个月因局部复发和肝脏扩散而死亡,切除边缘呈肿瘤阳性(R1情况)。我们的数据反映了文献报道的胰腺囊性肿瘤在根治性切除后的良好预后——这是与导管腺癌相比不同的生物学行为的结果。
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引用次数: 0
[Interferon-alpha in adjuvant treatment of colorectal carcinoma]. [干扰素在大肠癌辅助治疗中的应用]。
L Staib, K H Link, D Henne-Bruns

Unlabelled: Based on preclinical and clinical studies, in this German three-arm adjuvant multicenter trial the FOGT (Forschungsgruppe Onkologie Gastrointestinale Tumoren) studied whether one of the 5-FU modulations with either folinic acid(FA) or Interferon alpha-2a (IFNa) is superior to the recommended standard of adjuvant treatment in R0-resected colon cancer, 5-fluorouracil (5-FU) plus levamisole (LEV) for 12 months, in terms of overall survival rates.

Patients/methods: From 7/92 to 10/99 813 patients with resected colon cancer stage II (only T4N0M0, 63 pts.) and stage III (750 pts.) were randomized into three treatment groups and stratified according to N-stage and participating centers (64 hospitals). The patients received a postoperative loading course with 5-FU [450 mg/m2 d1-5 (arms A and C)] or 5-FU [450 mg/m2 plus folinic acid (Rescuvolin, medac, Hamburg, Germany), 200 mg/m2 d1-5 (arm B)]. After completion of the first chemotherapy cycle LEV was administered orally at 150 mg/d d1-3, every 2 weeks. After a 4-week chemotherapy-free interval the treatment was continued weekly for up to 52 weeks. The standard group, arm A (279 pts.) was treated with 5-FU i.v. (450 mg/m2 at d 1, q 1 w) plus LEV. 5-FU plus LEV was modulated in arm B (283 pts.) with FA (200 mg/m2 d1, q 1 w), and in arm C (251 pts.) with IFNa at 6 million units 3x/week, q 1 w. Chemotherapy doses were adjusted to toxicity if toxic events > WHO 2 occurred. The patients were followed-up to determine relapse rates and--patterns and survival. Survival rates were calculated according to Kaplan-Meier, and treatment costs and immune effects were analysed.

Results: Toxic event(s) > WHO2, mainly leukopenia, diarrhea and nausea, occurred in 113 pts. (14%), in arms A (8%), B (13%) and C (32%). Discontinuance rates were 28% (all), 29% (A), 21% (B), 34% (C), but 80% of patients received > or = 6 months treatment. Overall relapse rates were 27% (all), 30% (A), 24% (B) and 28% (C). Tumors relapsed either locally (2% each) or distant (A: 22%, B: 20%, C: 22%). 4-year overall survival rates in arms A, B and C were 66%, 77%, 66%, respectively. The 4-year survival rate in arm B was significantly superior to arms A and C (p < 0.02, log-rank). There were no signs of a superior immune function in either treatment arm (skin test, proliferation, cytotoxicity, flow cytometry). Treatment costs per patient were 2,500 [symbol: see text](arm A), 3,500 [symbol: see text](arm B) or 10,850 [symbol: see text](arm C), respectively.

Conclusion: Adjuvant therapy with 5-FU plus FA plus LEV for 12 months is superior to the recommended standard (5-FU + LEV, 12 m). IFNa-modulation of 5-FU (plus LEV) adds toxicity and high treatment costs without therapeutic benefit.

未标记:基于临床前和临床研究,FOGT (Forschungsgruppe Onkologie gastro胃肠道肿瘤)在这项德国三组辅助多中心试验中研究了叶酸(FA)或干扰素α -2a (IFNa)的5-FU调节是否优于r0切除结肠癌辅助治疗的推荐标准,即5-氟尿嘧啶(5-FU)加左咪唑(LEV)治疗12个月的总生存率。患者/方法:从7月92日至10月99日,813例切除的结肠癌II期(仅T4N0M0, 63例)和III期(750例)患者随机分为三个治疗组,并根据n期和参与中心(64家医院)进行分层。患者接受5-FU [450 mg/m2 d1-5 (a组和C组)]或5-FU [450 mg/m2 +亚叶酸(Rescuvolin, medac, Hamburg, Germany), 200 mg/m2 d1-5 (B组)]的术后负荷疗程。第一个化疗周期结束后,每2周口服150 mg/d d1-3给药LEV。在4周的无化疗间隔后,每周继续治疗至52周。标准组,A组(279名患者)给予5-FU静脉注射(450 mg/m2,第1天,第1周)加LEV。5-FU加LEV在B组(283例)用FA (200 mg/m2, d1, q 1 w)调节,在C组(251例)用IFNa(600万单位,3次/周,q 1 w)调节。如果毒性事件> WHO 2发生,化疗剂量调整为毒性。对患者进行随访,以确定复发率、模式和生存率。根据Kaplan-Meier法计算生存率,并分析治疗费用和免疫效果。结果:113例患者发生WHO2以上毒性事件,主要为白细胞减少、腹泻和恶心。(14%), A (8%), B(13%)和C(32%)。停药率分别为28%(全部)、29% (A)、21% (B)、34% (C),但80%的患者接受了>或= 6个月的治疗。总体复发率为27%(全部),30% (A), 24% (B)和28% (C)。肿瘤局部复发(各2%)或远处复发(A: 22%, B: 20%, C: 22%)。A、B、C组4年总生存率分别为66%、77%、66%。B组4年生存率显著优于A组和C组(p < 0.02, log-rank)。在两个治疗组(皮肤试验、增殖、细胞毒性、流式细胞术)均未发现免疫功能优越的迹象。每位患者的治疗费用分别为2,500[符号:见文](A组),3,500[符号:见文](B组)或10,850[符号:见文](C组)。结论:5-FU + FA + LEV辅助治疗12个月优于推荐标准(5-FU + LEV, 12 m), ifna调节5-FU (+ LEV)增加毒性,治疗费用高,无治疗效果。
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引用次数: 0
[Intramedullary fixation of pediatric bone shaft fractures]. [小儿骨干骨折的髓内固定]。
A Prokop, A Jubel, U Hahn, K E Rehm

Intramedullary stabilisation (Prévot-nailing) of shaft fractures in childhood allows full weight bearing without cast. Early fracture healing is seen by respecting soft tissue around fracture and by using distal or proximal approaches. Good indications of femoral shaft osteosynthesis are recommended in oblique- and transverse-fractures. Intramedullary stabilization seems to be a good alternative methode instead of casting calf-shaft-fractures. An instable fracture of forearm may be treated intramedullary to avoid often observed displacement ad axim and rotation. Humoral fractures primary have to be treated conservatively. Only in displaced fractures or in cases with additional injuries an intramedullary procedure with free range of motion is recommended.

儿童期椎体骨折髓内固定(pracimvo -钉钉)允许完全负重,无需石膏。早期骨折愈合应尊重骨折周围的软组织,并采用远端或近端入路。在斜骨折和横骨折中,推荐采用股骨干骨固定术。髓内固定似乎是一个很好的替代方法,而不是铸造小牛轴骨折。前臂不稳定骨折可以髓内治疗,以避免经常观察到的移位、轴向和旋转。原发性体液骨折必须保守治疗。只有在移位性骨折或有额外损伤的情况下,才推荐髓内手术,使其活动范围自由。
{"title":"[Intramedullary fixation of pediatric bone shaft fractures].","authors":"A Prokop,&nbsp;A Jubel,&nbsp;U Hahn,&nbsp;K E Rehm","doi":"","DOIUrl":"","url":null,"abstract":"<p><p>Intramedullary stabilisation (Prévot-nailing) of shaft fractures in childhood allows full weight bearing without cast. Early fracture healing is seen by respecting soft tissue around fracture and by using distal or proximal approaches. Good indications of femoral shaft osteosynthesis are recommended in oblique- and transverse-fractures. Intramedullary stabilization seems to be a good alternative methode instead of casting calf-shaft-fractures. An instable fracture of forearm may be treated intramedullary to avoid often observed displacement ad axim and rotation. Humoral fractures primary have to be treated conservatively. Only in displaced fractures or in cases with additional injuries an intramedullary procedure with free range of motion is recommended.</p>","PeriodicalId":81771,"journal":{"name":"Kongressband. Deutsche Gesellschaft fur Chirurgie. Kongress","volume":"119 ","pages":"526-31"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22349763","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
期刊
Kongressband. Deutsche Gesellschaft fur Chirurgie. Kongress
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