Kongressband. Deutsche Gesellschaft fur Chirurgie. Kongress最新文献

Toxic colitis is still a major diagnostic and therapeutic challenge. Mortality rates depend on the severity of the disease and range from 2% to 30%. Interdisciplinary approaches are necessary and structured therapeutic steps from conservative to operative treatment seem to be most effective. The surgical option for toxic colitis usually is subtotal colectomy with closure of the rectal stump or mucus fistula and ileostomy. This procedure allows the reconstructive operation later on. In selected cases and suitable situations a primary colectomy with ilealpouch are also possible depending on local and general effects.

Fractures of the distal phalanx are common. Injuries often include the surrounding soft tissues especially the nail bed and nail plate. The therapy must be done under consideration of fracture type and soft tissues. The result depends on the type of the fracture and the surrounding structures. After operative and conservative therapy, radiologically unsatisfying results and longer rehabilitation times are common.

Vascular morphology and determination of plaque surface structure are getting more and more matter of interest before revascularisation procedures are performed. One reason may be the increase of interventional treatment (PTA). For that we investigated the value of ultrasound duplex scanning to predict preoperatively the vascular surface and plaque structure. 368 patients operated on obstructing stenosis of the carotid artery could be enrolled in this investigation. In all patients duplex ultrasound scanning was performed preoperatively. In 127 patient an analysis of TC-Doppler curve was possible. During some operations (eversion endarteriectomie) we performed experimental stent implantation. The evaluation was performed with statistical methods.

Surgical treatment of fractures of adolescents is often difficult as the epiphyses are still open or not yet completely closed. The osteosynthesis chosen has to consider the remaining prospective growth of the affected bone and biomechanical needs. Due to high physical maturity with small remaining growth capacity in adolescents, a number of different techniques known from osteosynthesis in adults with minor modifications can be used to treat these fractures.

Until December 2001 84 midclavicular fractures in 80 patients were treated with intramedullary nailing. Postoperatively there was a significant decrease of pain and a significant increase of mobility compared to the situation preoperatively. 6 months after hardware removal the mean Constant-Score was 97.4 points. There was one none union. In one patient there was a loss of reduction with shortening of 1.5 cm. In 5 patients a shortening of the proximal end of the nail had to be performed, due to painful skin irritation. Intramedullary nailing of midclavicular fractures is a safe and minimally invasive operation technique. It should be offered to the patient as an alternative to conservative treatment.

There are no prospective randomized studies available to decide which surgical approach should be superior to treat sigmoid diverticulosis. Analysis of clinical studies evaluating laparoscopic or conventional surgery are presenting results as follows: for elective surgery morbidity ranges between 12-20% and mortality rates between 0-2% indicating comparable complication rates. For emergency operations only data from open surgery are available, with morbidity of 33-57% and mortality rates of 7-16%. Advantages of conventional approach are availability, reliability of the surgical technique and there is no patient selection required. Laparoscopic access may offer superior patients comfort and reduce cost, length of hospital stay and resocialisation. It remains to be proven, which approach may be the option of choice in the future, while this surgical technique is still developing.

To improve patient's outcome of seriously injured occupants after vehicle accident rescue should be performed as soon as possible. While the rescue-time-period after EMS alarming is well-defined the rescue-time-period before EMS-alarm is very variable from minutes to several hours. To reduce the rescue-time-period between accident occurrence and EMS-alarm the Automatic Collision Notification (ACN) was developed. The ACN is a new invehicle-equipment which detects a severe vehicle crash and alarms via cellular phone the EMS automatically. Simultaneously the exact accident location is transmitted (GPS). Official data of the European Community predict a 15% reduction of road traffic fatalities with ACN. Thereby the economical benefit of about 561 million [symbol: see text] could be calculated for Germany 2000.

From 1995 to 2001, 243 patients with hepatocellular carcinoma were recorded at Jena University Hospital, 59 (24%) underwent curative hepatic resection or orthotopic liver transplantation. 28 tumors (12%) showed microvascular invasion, and 29 (12%) presented with gross vascular invasion. 32 patients (13%) had regional lymph node metastases. In one patient (0.4%) CT scan showed involvement of the extrahepatic bile duct. Curative removal of the tumor was possible in 61%, 21%, 3% and 0%, respectively. Vascular invasion did not influence survival statistically significant. 3 year survival rates in patients with and without regional lymph node involvement were 0% and 38% (p < 0.01).

The incidence of burns of the genitalia and peri-anal region which may cause a reconstructive intervention is very low. In the most cases the use of split thickness skin grafts yields a sufficient permanent wound closure. Upcoming problems such as painful scare formation require a reconstructive intervention (Z-plasty, full thickness skin grafting, pedicled flaps etc.). In case that the anal sphincter is involved with the consequence of incontinence or major damage of the genitalia occurred, sophisticated operative solutions are necessary.