Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera最新文献

{"title":"Does Switzerland Train Tomorrow's Surgeons Today?","authors":"M. Schäfer, Y. Harder, M. Keel, C. Kulli, C. Müller, A. Perret, F. Saucy, C. Vallet","doi":"10.1024/1023-9332.8.3.103","DOIUrl":"https://doi.org/10.1024/1023-9332.8.3.103","url":null,"abstract":"Abstract Various factors are influencing the Swiss health care system, and therefore, surgeons' actual and future profession. Initiated by the current president of the Swiss Society of Surgery, a group of eight young Swiss surgeons constituted the ad hoc committee \"Chirurgie 2020\". The goal was to develop several scenarios of the surgeon's professional situation in 20 years. The future direction of surgery will be markedly influenced by medical innovation, political and economic relationships between Switzerland and Europe. However, the development of health care costs represents the most powerful factor predicting all further changes. The current situation of today's surgeons is best characterised as \"hamsters in the treadmill\" who try to fulfill a multitude of diverging tasks causing major demotivation. In order to retain a leading role in the health care system, surgeons must take part in social and political activities. To provide an excellent curriculum, university and county hospitals must join together to form clinical and educational networks. A clearly defined and structured curriculum must be introduced by the Swiss Society of Surgery. From our current point of view, only everyone's strong personal commitment will help to find solutions and to improve the current and future situation. In particular, today's surgical residents must actively take part in the development of tomorrow's surgery.","PeriodicalId":79425,"journal":{"name":"Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera","volume":"8 1","pages":"0103-0105"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57220373","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Das Schädel-Hirn-Trauma-neue pathophysiologische und therapeutische Gesichtspunkte. Teil 2: Die Behandlung in der Subakut- bis Spätphase","authors":"Bernhard Schaller","doi":"10.1024/1023-9332.8.3.123","DOIUrl":"https://doi.org/10.1024/1023-9332.8.3.123","url":null,"abstract":"Aim: As there is only few evidence-based knowledge in the treatment of head trauma, the aim of this work was to demonstrate the close relationship between pathophysiology and clinical treatment modalities during the primary phase of head trauma. Methods: Review article. Discussion: Cerebral hypoxia represents the main source of secondary brain injury. Depending on severity and duration, there results an irreversible brain damage. Under clinical conditions, the continuous monitoring of cerebral perfusion pressure (CPP) allows an estimation of the risk for cerebral hypoxia and the beginning of causal therapy. The priority of treatment lies in normalization of arterial 02 and increase in cerebral blood flow (CBF). In case of unchanged autoregulation of CBF, a decrease of CPP is followed by vasodilation with increase of cerebral blood volume (CBV) and a increase of CPP leads to a decrease of CBV by vasoconstriction. The usual shift of autoregulation on the right side after trauma requires CPP-values > 70 mmHg in the initial posttraumatic phase as there exists the most probable risk of hypoxia. The therapy of elevated ICP > 20 mmHg is oriented on CPP. A decrease in ICP under load of CPP has to be avoided. Beyond it, there is a need of origin of ICP-increase. Conclusions: The priority of initial treatment after head trauma lies in the individual optimization of CBF by maintenance of adequate CPP and cerebrovascular resistance. Afterwards, there will be performed a goal-directed treatment being based on the differentiation of the varying subgroups of head trauma and their related pathophysiology, what leads to the required treatment strategy. For this reason, it is necessary to put in the traditional treatment option by means of the multimodal monitoring as soon as possible.","PeriodicalId":79425,"journal":{"name":"Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera","volume":"8 1","pages":"123-137"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"57220445","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"The effect of virtual reality and training on liver operation planning.","authors":"C. Herfarth, W. Lamadé, L. Fischer, P. Chiu, C. Cardenas, M. Thorn, M. Vetter, L. Grenacher, H. Meinzer","doi":"10.1024/1023-9332.8.2.67","DOIUrl":"https://doi.org/10.1024/1023-9332.8.2.67","url":null,"abstract":"OBJECTIVE The three-dimensional relation of a liver tumour to the intrahepatic vascular trees is basis of operation planning in liver surgery. Yet it has not been proven whether 3D reconstruction and further computerised processing will enhance precision of operation planning in liver surgery which has been based on the liver segment classification of Couinaud up to now. DESIGN Our interdisciplinary group (department of Surgery, German Cancer Research Center and Department of Radiology) has developed a new interactive computer-based quantitative 3D operation planning system for liver surgery which is being introduced into the clinical routine. The system quantifies the organ structures semiautomatically, defines resection planes depending on safety margins and the vascular trees, and presents the data in digital movies as well as in quantitative reports. We conducted a clinical trial to evaluate whether 3D reconstruction will lead to an improved operation planning. Data of 7 virtual patients were presented to a total of 81 surgeons in different levels of training. The tumours had to be assigned to a liver segment and subsequently drawn together with the operation proposals into a liver model. The precision of both was measured quantitatively for each surgeon and stratified concerning 2D and different types of 3D presentations. RESULTS The 3D anatomy can be visualised in high quality which results in good perception of the third dimension (depth). Tumour assignment to liver segments was significantly correlated to the level of training (p < 0.05). There was a significant increase (p < 0.001) in the precision of tumour localisation by 51% and resection proposal from 2D through 3D reconstructions by 13%-21%. Quantitative differences of the simplified Couinaud's classification of the liver segments compared to the true vascular anatomy of up to 40% were found. CONCLUSION The impact of individual 3D-reconstruction on surgical planning has been proven to be significant and increases precision quantitatively. The merit of Couinaud's classification may be enhanced by individualisation of the segment borders in future.","PeriodicalId":79425,"journal":{"name":"Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera","volume":"29 1","pages":"67-73"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"77650196","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Craniocerebral trauma--new pathophysiological and therapeutic viewpoints].","authors":"B Schaller","doi":"10.1024/1023-9332.8.4.145","DOIUrl":"https://doi.org/10.1024/1023-9332.8.4.145","url":null,"abstract":"<p><strong>Aim: </strong>The prognosis has markedly improved during the last years after mild and moderate head injuries. After severe head trauma, this evolution could not be observed so far. This requires a better understanding of pathophysiological interaction, especially in the subacute and late phase of trauma.</p><p><strong>Methods: </strong>Review article.</p><p><strong>Discussion: </strong>Causes for the development of secondary brain damage are the intracranial space demand after traumatic injury and edema formation which max result in ischemia, as well as inflammatory processes. Both isolated severe head trauma and polytrauma with or without brain damage may result in a systemic inflammatory response syndrome due to the synthesis of cytokines and other inflammatory mediators which may cause a single or multiple organ failure. The hypermetabolism after severe head trauma is often regarded as an interaction between the central nervous system and the whole organism by the activation of the neuroendocrine axis. Moreover, coagulation, metabolism and fracture healing are influenced by the onset of SIRS as well.</p><p><strong>Conclusion: </strong>Our knowledge about the bidirectional inflammatory interaction between brain and whole organism is still limited. It is generally accepted that extracranial complications are highly influential in determining the outcome from severe head injury.</p>","PeriodicalId":79425,"journal":{"name":"Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera","volume":"8 4","pages":"145-58"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"21987160","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[(Impending) pathological fracture].","authors":"P. Sutter, P. Regazzoni","doi":"10.1024/1023-9332.8.2.81","DOIUrl":"https://doi.org/10.1024/1023-9332.8.2.81","url":null,"abstract":"Pathological fractures will be encountered in increasing frequency due to more patients with cancer, surviving a longer period. The skeleton is the third most frequent localization for metastases. Breast cancer is still the most common primary tumor, but bone metastases from lung cancer seem to be diagnosed more and more. Despite of finding metastases most often in the spinal column, fractures are seen mostly at the femoral site. A pathological fracture and, in almost all cases, an impending fracture are absolute indication for operation. An exact definition of an \"impending fracture\" is still lacking; it is widely accepted, that 50 per cent of bone mass must be destroyed before visualization in X-ray is possible, thus defining an impending fracture. The score system by Mirels estimates the fracture risk by means of four parameters (localization, per cent of destructed bone mass, type of metastasis, pain). Improving quality of life, relieving pain, preferably with a single operation and a short length of stay are the goals of (operative) treatment. For fractures of the proximal femur, prosthetic replacement, for fractures of the subtrochanteric region or the shaft, intramedullary nails are recommended. Postoperative radiation therapy possibly avoids tumor progression. In patient with a good long term prognosis, tumor should be removed locally aggressive.","PeriodicalId":79425,"journal":{"name":"Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera","volume":"208 1","pages":"81-7"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"76258594","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Medial meniscectomy in patients over the age of fifty: a six year follow-up study.","authors":"J. Menetrey, O. Siegrist, D. Fritschy","doi":"10.1024/1023-9332.8.3.113","DOIUrl":"https://doi.org/10.1024/1023-9332.8.3.113","url":null,"abstract":"PURPOSE Meniscectomy in the older patient remains a controversial topic. The aim of our study is to assess the mid-term outcome of arthroscopic partial medial meniscectomy in patients over fifty years of age and attempt to retrospectively identify symptoms and/or findings on examination which can differentiate between non-degenerative medial meniscal tears versus degenerative meniscal changes. MATERIALS AND METHODS Thirty-two patients over the age of fifty who had undergone arthroscopic medial partial meniscectomy, were reviewed. The average age was 60 (51-74 yrs) and the average follow-up was six years (3-7 yrs). Based upon the intra-operative findings, patients were divided into two groups: (1) non-degenerative meniscal tears (NDM; n = 12) and (2) degenerative meniscal changes (DM; n = 20). Our outcome measurements were with the HSS knee score, a satisfaction score, and weight-bearing X-rays. RESULTS In the NDM group, eleven patients were rated excellent or good, and one was rated poor. In the DM group, three patients were rated as excellent or good, eight as fair, and nine as poor. The HSS score was 97 +/- 4.6 for the NDM group and 85 +/- 9.5 for the DM group. The average satisfaction score was 9.2 +/- 0.7 (very satisfied) for the NDM group and 5.8 +/- 2.6 (fairly satisfied) for the DM group. There was no significant difference between the NDM and the DM groups with regards to pre-operative symptoms and signs, except for the McMurray sign, which was found to be positive in 83% of NDM cases versus 25% of DM cases (sensitivity = 83%). Using only these data, the McMurray sign was 67% specific for NDM. CONCLUSIONS Arthroscopic medial meniscectomy in older patients provides 90% good results six years after a non-degenerative meniscal tear, but only 20% of good results after a degenerative meniscal tear. However, based on this study, neither symptoms nor physical examination are able to differentiate between traumatic meniscal tears and degenerative meniscal changes in older patients. A positive McMurray's sign favors the diagnosis of a traumatic tear. However, a specificity of this test of only 67% as shown in our data questions its utility in clinical decision-making.","PeriodicalId":79425,"journal":{"name":"Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera","volume":"39 1","pages":"113-9"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84842195","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Laparoscopic and conventional cholecystectomy. Didactic concept for training and introduction of laparoscopic cholecystectomy and preventing complications].","authors":"P Vogelbach,&nbsp;B Bogdan,&nbsp;R Rosenthal,&nbsp;U Pfefferkorn,&nbsp;F Triponez","doi":"10.1024/1023-9332.8.6.250","DOIUrl":"https://doi.org/10.1024/1023-9332.8.6.250","url":null,"abstract":"<p><strong>Aim: </strong>This study has assessed the suitability of an educational concept for the introduction and training of laparoscopic cholecystectomy, a newly established operational procedure, within an university teaching hospital with a large number of surgeons.</p><p><strong>Patients and methodology: </strong>Since introduction of the first laparoscopic cholecystectomy all cholecystectomies were prospectively assessed over a period of two years (from May 1990 till May 1992). The educational concept applied was such that a given surgeon would first receive training from an instructor for 15 procedures and then assume responsibility for instruction of a subsequent trainee.</p><p><strong>Results: </strong>In two years 355 patients underwent cholecystectomy. 60% of the operations were performed laparoscopically and 40% of the operations performed openly. During the two year period 13 surgeons were trained in the new technique, with an average of 16 operations per surgeon. Throughout the introductory phase there were no serious complications, and in particular no damage to the bile duct.</p><p><strong>Discussion: </strong>The advantage of this introductory training phase has repeatedly been subject of discussion in the literature. In the meanwhile guidelines from specialist bodies and national institutions exist for regulating the education of new surgical techniques. In the past few years introduction to new techniques has gradually shifted toward training on the skill-stations and virtual reality trainers.</p><p><strong>Conclusion: </strong>The described educational concept for the introduction and training of laparoscopic cholecystectomy has been well approved and accepted since the early 90's.</p>","PeriodicalId":79425,"journal":{"name":"Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera","volume":"8 6","pages":"250-4"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22189496","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Brain concussion: risk factors].","authors":"U Baumgartner,&nbsp;P K Baier,&nbsp;D T Schmitz,&nbsp;E H Farthmann","doi":"10.1024/1023-9332.8.6.259","DOIUrl":"https://doi.org/10.1024/1023-9332.8.6.259","url":null,"abstract":"<p><strong>Aim: </strong>Identification of risk factors for intracranial bleeding after minor traumatic brain injury.</p><p><strong>Method: </strong>The charts of 464 patients treated between January 1976 and December 1997 with the initial diagnosis of minor traumatic brain injury were reviewed. They were analyzed for clinical and diagnostic signs putting the patients at risk for intracranial bleeding.</p><p><strong>Results: </strong>About two thirds of the patients (67.5%) were males, the average age being 36.1 years. Leading causes of accident were sudden falls (27.4%) and bike/autocycle crashes (24.8%). 30.4% of the patients were under the influence of alcohol. At the time of admission to the hospital 17.2% of the patients showed impaired consciousness and 12.5% presented neurologic signs. In ten patients an intracranial bleeding was found. All these bleedings were diagnosed at the primary investigation.</p><p><strong>Discussion/conclusions: </strong>Following groups of patients with traumatic brain injury have an increased risk for intracranial bleeding: Age > 60 and < 16 years, sudden falls, tachycardia, Glasgow-Coma-Scale < 15, impairment of consciousness, neurologic signs, fracture of the skull and patients suffering from coagulopathy. Drunk patients are difficult to judge; therefore, they should be handled as being at risk. Patients at increased risk should be observed on an intensive care unit whereas patients without those risk factors can be observed on a normal ward or, alternatively, discharged after reexamination and uneventful course after some hours.</p>","PeriodicalId":79425,"journal":{"name":"Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera","volume":"8 6","pages":"259-65"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22189498","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Vacuum sealing of problem wounds].","authors":"L Labler,&nbsp;K Oehy","doi":"10.1024/1023-9332.8.6.266","DOIUrl":"https://doi.org/10.1024/1023-9332.8.6.266","url":null,"abstract":"<p><p>Within the scope of a retrospective study, the efficiency of the vacuum sealing technique, a recent alternative to methods used in treatment of both chronic or acute infected wounds and acute traumatic soft tissue defects, was evaluated in 120 patients in the period between January 1995 and November 1997. The vacuum sealing technique offers an effective therapeutic option for the temporary closure of defect as well as of infected wounds, decreases the risk of wound infection and offers advantage regarding patient's comfort and hospital hygiene.</p>","PeriodicalId":79425,"journal":{"name":"Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera","volume":"8 6","pages":"266-72"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22189499","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"[Solitary duodenal diverticulum with enterolith as a rare cause of acute abdomen].","authors":"D Franzen,&nbsp;Th Gürtler,&nbsp;U Metzger","doi":"10.1024/1023-9332.8.6.277","DOIUrl":"https://doi.org/10.1024/1023-9332.8.6.277","url":null,"abstract":"<p><p>Diverticula of the duodenum are not rare and in the most cases without any symptoms. The incidence of duodenal diverticula in autopsies is known to be 20-22%. Only in a very small number of cases, they are complicated and therefore clinically presented by diverticulitis, perforation, hemorrhage, pancreatitis, or biliary obstruction. The most uncommon complication is the enterolith formed within the diverticulum. In all reported cases, the enterolith--formation was associated with small bowel obstruction or perforation. Complications of duodenal diverticula have a high mortality rate (33-48%) that could be due to difficulties in diagnostics and the adequate surgical procedure. In our case report, a patient presented at our institution with symptoms of an acute abdomen caused by an enterolith inside a solitary duodenal diverticulum \"ante perforationem\". The ultrasound and the CT scan of the abdomen showed free intraabdominal fluid beside the duodenum, the exact diagnosis however was not made. The indication for laparotomy was given by the clinical signs. The dicerticula was resected and ligated.</p>","PeriodicalId":79425,"journal":{"name":"Swiss surgery = Schweizer Chirurgie = Chirurgie suisse = Chirurgia svizzera","volume":"8 6","pages":"277-9"},"PeriodicalIF":0.0,"publicationDate":"2002-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"22190102","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}