Kongressband. Deutsche Gesellschaft fur Chirurgie. Kongress最新文献

Injuries of the fingertips are often but not always of a simple, easily healing kind. If there are complications they are induced by the severity of the trauma itself or because the patient himself or the physician treating the injury is misjudging its severity. This leads to an inadequate therapy, which may very well be the cause of a dramatic development, ending in loss of function of the injured hand if it comes to the worst. By the means of some selected examples the pitfalls in the treatment of fingertip injuries shall be pointed out.

Patients after crural or pedal revascularization need a consequent surveillance to prevent graft failure. We compared the results of the clinical examination including duplexscanning with contrast-enhanced magnetic resonance angiography (MRA). 26 bypass grafts were evaluated for potential stenosis in five locations. Using both techniques, 93 of 109 locations were classified identically. 10 of 16 locations which were categorized differently were reviewed angiographically (DSA). In contrast to duplexscanning, MRA detected 3 high grade stenosis, which had to be dilatated percutaneously. MRA should be used regularly in surveillance programs of distal bypass grafting.

Nanotechnology in medicine is often associated with the vision of the so-called nano-robots, which may be able to do many different non-invasive interventions within the human body. Looked at more closely, it appears that the overall futuristic impression of nanotechnology in medicine is much more practical. E.g. superparamagnetic iron oxide nanoparticles are in use for a long time as contrast agents in magnetic resonance imaging. Nanoparticular pharmaceutics or medical products are used for new therapeutic approaches, which are able to enter specifically certain types of tumor tissues or tumor cells, so that the local effectiveness of former systemic therapies may be improved.

Severe sepsis and septic shock are still the leading causes of death in the surgical ICU. The only curative therapies of sepsis are still surgery as well as antibiotic therapy to cure the focus. In addition a supportive therapy (analgesia and sedation, mechanical ventilation, titrated volume substitution and positive inotropes/vasopressor support, parenteral and enteral neutron, renal replacement therapies) should be started as early as possible. A new promising approach in sepsis therapy is the application of rhAPC. The PROWESS study revealed a significantly lower 28 day mortality in patients with severe sepsis who received drotrecogin alfa (activated) compared to patients not treated with drotrecogin alfa (activated). Guidelines for the use in severe sepsis and septic shock in surgical patients (risk of bleeding, costs) are strongly recommended.

The technical success of endoluminal grafting in AAAs depends on the complete apposition of the fixation points of the stent graft with the proximal and distal aneurysm neck. Approximately 20% of patients presenting with AAAs have concomitant iliac artery aneurysms. To achieve a complete apposition at the distal landing zone without endoleak, intentional occlusion of the internal iliac artery is needed. To evaluate the inherent complications, our results of ELG were compared to those of the bibliography.

A strategy to protect the inferior laryngeal nerve (ILN, recurrent and non-recurrent) as well as the superior laryngeal nerve (SLN) includes the reason for and extend of the operation to avoid recurrent goiter, selection of an experienced institution and operating team, a cautious intubation, adequate and anatomical operating technique, recognition of risk factors and postoperative treatment with a sufficient dosage of hormone and/or iodine. The ILN should be dissected routinely in view of its anatomical variation. The "capsular dissection technique" should be applied. The "laterialisation technique" of the upper pole protects the SLN with regard to its anatomic variability. Neuromonitoring of both nerves can be helpful under difficult circumstances.