Kongressband. Deutsche Gesellschaft fur Chirurgie. Kongress最新文献

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.

Reservoir function of a jejunum pouch is better than a simple Roux-en-Y limb. Postoperative processes of adaptation take at least 6 months. Pouch volume increases substantially after the operation and reaches about 200% of its initial volume. Morphological structure changes with muscular wall hypertrophy, plump deformation and widening of the villi, and a reduction of the mucosal surface. There is a change of motility pattern with a reduction of the propagation velocity. Randomized studies demonstrate a better reservoir function, less reflux, less heart burn, a slower passage time and fewer dumping symptoms after pouch reconstruction.

Liver failure following trauma or surgery is associated with a mortality of between 15-->50%, depending on the extent of the operation, pre-operative functional impairment of the liver as well as the occurrence of concomitant infectious disease. The liver can be the source as well as the target of posttraumatic liver failure (PLF). PLF can be caused by a reduction of liver perfusion due to hypotension, catecholamines or increased intraabdominal pressure. Further contributing factors include prolonged parenteral nutrition, endotoxemia, and potentially hepatotoxic drugs (sedatives, anticonvulsive drugs, antibiotics etc.). PLF is mostly associated with MOF. The Child classification and the APACHE score may predict prognosis before surgery and serum bilirubin levels thereafter. Prevention and therapy is based on treatment of shock and tissue hypoxia. It should be accompanied by appropriate diagnostic measures and followed by an aggressive medical and surgical approach.

Infection following arthroplasty is a rare but significant and threatening complication. The incidence is about 2%. Treatment of an infected joint replacement may be demanding, time consuming and expensive. For the treating institution there is a risk of substantial financial losses due to inadequate reimbursement. Calculated on the basis of approximately 150,000 implanted joint protheses/a, an infection rate of 2% and treatment costs of approximately 50,000 [symbol: see text]/infected case the economic burden is an estimated 150 million [symbol: see text]/a in Germany. This amount should justify a sound evaluation of costs related to infection in arthroplasty, which should be the effort of the health insurance organisations. Additionally specific research in the field of infection prevention must be sponsored. The system of reimbursement should be adequately adopted and corrected.

Three information systems are described, whose data are simultaneously used for quality management and others tasks. They show, that the completeness of documented diagnoses is dependent of their appraisal of the physicians. The support of coding by information technology brings an essential improvement. The compliance of physicians with rules has to be reviewed in regular intervals. Quality assurance of a process should be made in short intervals, to be able to intervene in time. Individual efficiency control stimulates each participant to improve his work. These examples show, that information systems can undertake quality management and other tasks besides. Such systems are important, when hospitals attend KTQ-certification.