Kongressband. Deutsche Gesellschaft fur Chirurgie. Kongress最新文献

Indications for surgery need individual risk-analysis. Operative strategy is more conservative with unilateral procedures, more radical with total lobectomy. The crucial risk is recurrent laryngeal nerve paralysis (r.l.n.p.). In 434 operations with 647 nerves at risk (1985-2001) we classified the anatomical situation of the nerve prospectively: X: not identified, A: not in scar and B: within scar (B1, B2 and B3 dorsally, laterally or ventrally). The risk of r.l.n.p. increased from types A to type B to X, and from B1 to B3. Up to now, intraoperative neuromonitoring did not reduce this risk, additionally.

The antibody SC-1 is a human IGM molecule, which binds to a tumor specific receptor. This SC-1 receptor is detectable on biopsies, it is present in about 50% of gastric cancers. After binding of the antibody to the receptor the tumor cells go into apoptosis. 50 patients expressing the SC-1 receptor on their tumors have been treated with SC-1 prior to gastrectomy. In 80% of cases apoptosis induction could be demonstrated in the tumors. The only side effect of the SC-1 therapy was a reversible episode of fever during antibody infusion in 8% of our patients.

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.