Kongressband. Deutsche Gesellschaft fur Chirurgie. Kongress最新文献

The head of the anaesthetic department in a teaching district general hospital affiliated to the University Heidelberg, gives an appraisal of her 20 year experience in dealing with organising part-time employment for doctors in her department. The project proved so successful that most doctors in the department changed from full-time to part-time employment. On average two thirds of the doctors choosing part-time employment are female, one third male. The advantages exceeded by far the disadvantages. The greater number of colleagues aids problem-solving. The disadvantages were overcome by organisational means and also by the active participation of the highly motivated colleagues. This project proved it is possible to make hospital work more attractive.

Polytrauma treatment (40-60,000,-[symbol: see text]) and trauma killed victims (750,000,-[symbol: see text]) are a severe economical problem. The data of the German Trauma Registry show a significant influence of arrival time of the emergency doctor and lethality. There is also a significant increase of the length of stay at the intensive unit in severe thoracic and abdominal trauma (AIS > 3). The analysis of the audit filter for quality management showed between 1999-2000 a decrease of the time till first CCT from 41 to 31 minutes and for the first thoracic X-ray from 20 to 16 minutes. The German Trauma Registry includes till now more than 10,000 polytraumatized patients. There is an increase of 110% between the years 1998 and 2000.

Considering the high incidence and mortality rate of colorectal cancer, great efforts are made for primary and secondary prevention. By doing so, primary prophylaxis includes the use of protective measures in order to prevent the development of adenomas and carcinomas. Epidemological studies have shown that nutrition or medication (e.g. NSAID) have an immediate influence on the pathogenesis of colorectal carcinomas. Secondary prevention includes early diagnosis and treatment of precursors of carcinomas. Considering this, colonoscopy is the cheapest and gentlest method and therefore the screening method of choice.

Laparoscopic fundoplication has become a popular procedure but several questions remain unresolved. Although randomised trials suggest that antireflux surgery is a good alternative to continuous medical therapy, the selection of patients for surgery remains crucial to achieve success. There is currently no proof that antireflux surgery will reduce the risk for developing esophageal adenocarcinoma. Complications, side effects and failures appear to be higher after a laparoscopic approach as compared to conventional open surgery, particularly in un-experienced hands. Partial fundoplications and tailored approaches have so far not shown convincingly better results than those that can be achieved by short and floppy 360 fundoplication.

The author has been operating on cases of lunatum necrose using all usual operating methods, excluding attached vessel pisiforme transfer, increasingly over the past 9 years without an overnight stay in hospital being necessary for patients. Depending on the quality of the structure, we have not experienced any disadvantages in comparison to hospitalised patients. Regarding funding: The costs of these operations are covered and are justifiable in combination with additional hand operations within the outpatients department.

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 method instead of casting calf-shaft fractures. An unstable 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.

Laparoscopic surgery showed a dramatic development in the last years of the 20th century. From the beginning laparoscopic cholecystectomy (LCCE) has been the pacemaker of this development. Today laparoscopic cholecystectomy is the first choice for treatment of cholecystolithiasis in nearly all surgical clinics. Therefore laparoscopic cholecystectomy is the most common part of minimal invasive technique. LCCE is the golden standard in therapy of gallstones, more than 90% of cholecystectomies in specialized clinics are done laparoscopically. It is an established, evidence based operation today. Open cholecystectomy is left for special indications only. A problem of LCCE is the occult carcinoma of the gallbladder. In histological proven carcinoma of the gallbladder LCCE is the adequate operation only for Tis and T1 carcinoma. In T2 and T3 carcinoma a radical oncologic resection with lymph node dissection should be performed. Due to the poor prognosis T4 tumors should be left with laparoscopic biopsy only.

Up to now many people demand treatment only with symptoms of a progressed cancer disease. As curative therapy is often not possible any more, endoscopy offers valuable palliative treatment options. Tumor destructive methods are mainly used for soft exophytic neoplastic tissue, whereas stent implantation is the therapy of choice in all other cases, especially if severe obstruction is present. The advantage of this method is the immediate and long lasting effect. Because of the different stent types and indications there is no optimal universal stent, so that we have to choose the individual best endoprosthesis.

From 1990 to 2000, 2268 (29.9%) of 9600 lung cancer patients underwent resection for stage I to IIIA non-small cell lung cancer. Reinterventions were done in one hundred (3.5%) patients, for locoregional recurrence in 27, metachronous cancer in 42, metastasis or a third tumor in 31. A third intervention was performed in 23 patients and a fourth in two. The in-hospital mortality rate was 9%. The overall survival was 31.9% at five and 17.9% at ten years. The 5-year survival after the first intervention (reintervention) was 26% (11%) for local recurrence, 80.3% (27%) for metachronous cancer, 7% (0%) for recurrence of synchronous cancers and 0% (0%) for lung metastasis after a solitary primary lung cancer.

Primary malignancy after solid organ transplantation has a more than three-fold incidence compared to the normal population. Causes are intensity and duration of immunosuppression, pre-operatively undetected, occult malignancy or pre-cancerous lesions in the recipient, direct or indirect tumor transmission via the transplant and environmental factors. Measures for prevention comprise antiviral treatment of individuals at risk for primary EBV-infection and prevention of sun exposure. Early detection follows general medical guidelines and, in addition, selective screening of certain risk groups of patients. Treatment of solid tumors follows established guidelines of professional working parties. Post-transplant lymphoproliferative disorders can often be treated with anti-CD antibody (rituximab). Antiproliferative immunosuppressants like rapamycin may seem promising with regard to a possibly reduced incidence of de-novo malignancy in the future.