RESUMEN
The surgeon is the key "prognosis factor" for colorectal cancer. For this reason quality criteria were recently established (including minimum numbers) in order to treat patients who are entitled to the best quality of care and to improve the prognosis. The aim of this study was to critically discuss the existing demands on the surgeon based on the current literature and our own results and to formulate evidence-based quality criteria for surgical clinics. After reviewing the current literature criteria were compiled, discussed and finally presented in a summarized form. These are based on current developments on the diagnostic and therapy of large intestine and colorectal carcinoma. New developments of the German Cancer Society for planning of organ centers are incorporated. The quintessence of our study is that the number of cases alone is not decisive for the success of therapy. Important are the application of the correct surgical-oncology operation procedure, adherence to standards and the training of surgeons. Following the S3 guidelines stage-oriented therapy should additionally be carried out in a structured sequence. This includes an interdisciplinary decision making on the diagnostic and therapy strategy (tumor board). The organization structure of the hospital (teams, tumor board, emergency care with intensive care unit, emergency diagnostic and options for interventional measures) can be more important than the hospital case numbers alone. These demands which have been evaluated from published data and own results are designed to raise the therapy of colorectal cancer to the best possible level of quality and to effect a further improvement in the prognosis.
Asunto(s)
Neoplasias Colorrectales/cirugía , Garantía de la Calidad de Atención de Salud/normas , Benchmarking/normas , Competencia Clínica/normas , Neoplasias Colorrectales/mortalidad , Neoplasias Colorrectales/patología , Vías Clínicas/normas , Medicina Basada en la Evidencia/normas , Alemania , Adhesión a Directriz/normas , Administración Hospitalaria/normas , Humanos , Estadificación de Neoplasias , Grupo de Atención al Paciente/organización & administración , Grupo de Atención al Paciente/normas , Pronóstico , Estándares de Referencia , Tasa de SupervivenciaAsunto(s)
Cirugía General/tendencias , Ciencia del Laboratorio Clínico/tendencias , Programas Nacionales de Salud/tendencias , Cambio Social , Sociedades Médicas/tendencias , Selección de Profesión , Curriculum/tendencias , Educación de Postgrado en Medicina/tendencias , Predicción , Cirugía General/educación , Alemania , Humanos , Satisfacción en el Trabajo , Pautas de la Práctica en Medicina/tendenciasAsunto(s)
Cirugía General , Asistentes Médicos , Sociedades Médicas , Cirugía General/tendencias , Alemania , HumanosAsunto(s)
Cirugía General/tendencias , Sociedades Médicas , Especialización/tendencias , Educación Médica Continua/tendencias , Educación de Postgrado en Medicina/tendencias , Predicción , Cirugía General/educación , Alemania , Necesidades y Demandas de Servicios de Salud/tendencias , Humanos , Pautas de la Práctica en Medicina/tendenciasRESUMEN
BACKGROUND: One of the reasons for young doctors to leave the clinical work to go abroad or into non-clinical fields is insufficient quality of training under bad circumstances. Aim of the study was to evaluate the surgical training in Germany from the viewpoint of the residents. METHODS: A questionnaire was prepared by residents and consultants and approved by the German surgical societies (Deutsche Gesellschaft fur Chirurgie und Berufsverband der Deutschen Chirurgen). It was sent to surgical residents between June 2003 and June 2004, published in "Der Chirurg BDC" and distributed among residents taking part in courses conducted by the BDC. It could be answered anonymously by email, mail or online. RESULTS: The questionnaire was sent back by 584 surgical residents (about 30 % of all). 58 % of the residents declared that they finished the training in the intended time (6 years). Rotation-systems as part of a structured residency program existed for 43 %. Standard surgical procedures were discussed or explained before the procedure in only 46 %. 61 % of the residents were not satisfied with the teaching assistance by their clinical teachers in the OR. Only 33 % had regular talks with the Chief about their progress in surgical training. 18 % of residents felt, that the hospital is interested in their progress in training. Indication-conferences took place in 52 % and mortality-conferences in only 20 % of programs. Regular seminars on recent issues took place in 62 %, and 61 % of residents did not get financial support to attend congresses. 36 % of residents had to use their holidays to attend congresses. CONCLUSIONS: Surgical training structures are not well established in about 50 % of the training hospitals from where we got answers to our survey. The training potential of daily surgical work is not used appropriately. It is therefore imperative to develop guidelines for surgical training, the use of log-books and rotation-programs.
Asunto(s)
Educación Médica Continua/normas , Cirugía General/educación , Hospitales de Enseñanza/normas , Internado y Residencia/normas , Congresos como Asunto/economía , Congresos como Asunto/estadística & datos numéricos , Educación Médica Continua/organización & administración , Alemania , Humanos , Internado y Residencia/organización & administración , Sociedades Médicas , Encuestas y CuestionariosRESUMEN
Focussing on possible mass casualty situations during events such as the soccer world championship in 2006, the Professional Board of Surgeons in Germany and the German Society for Surgery canvassed surgeons-in-chief in the last quarter of 2003 concerning disaster plans for hospitals. The rate of returned questionnaires amounted to 26% covering the following areas of interest: plans-ready to use, known by the employees as well as by the rescue coordination center, performance of exercises, and concepts on decontamination and detoxification. Based on past numbers of casualties during soccer disasters, an excursus into details also includes a description of an approach to reduce the danger of bottleneck effects at doors. A preliminary concept based on the upcoming system for funding hospitals in Germany and including new partnerships is outlined, succeeded by some hopefully helpful hints for a web-based hospital disaster plan.
Asunto(s)
Planificación en Desastres/métodos , Planificación en Desastres/estadística & datos numéricos , Medicina de Emergencia/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Trabajo de Rescate/estadística & datos numéricos , Fútbol/estadística & datos numéricos , Terrorismo , Desastres , Medicina de Emergencia/métodos , Alemania/epidemiología , Trabajo de Rescate/métodosRESUMEN
BACKGROUND: Myocardial oedema, non-surgical bleeding and the use of mechanical assist devices following major heart surgery sometimes prevent primary closure of the sternum. METHOD: We describe a reusable sterile device for temporarily stenting the open sternum for safety. RESULTS: The sternal stent was used in 32 patients for a mean time of 2 days. We observed no mediastinitis and no wound-healing disorders. A secondary closure of the sternum was performed in 28 patients. CONCLUSION: We present a device for sternal stenting that is reusable, easy to apply and allows a good handling of the critically ill patient due to its extreme stability.
Asunto(s)
Stents , Esternón/cirugía , Técnicas de Sutura , Humanos , Resultado del TratamientoRESUMEN
The epidemiology of salmonellosis has undergone a change during the last 2 years. An increase in the number of cases of enteritis and sepsis caused by Salmonella enteritidis has been observed. We report on the case of a 65-year-old woman with mitral valve endocarditis due to Salmonella enteritidis. The infective endocarditis occurred without prior episodes of gastroenteritis. After having undergone prosthetic valve replacement and antibiotic therapy with ciprofloxacin, the patient recovered completely.
Asunto(s)
Ecocardiografía , Endocarditis Bacteriana/diagnóstico por imagen , Insuficiencia de la Válvula Mitral/diagnóstico por imagen , Válvula Mitral , Infecciones por Salmonella/diagnóstico por imagen , Salmonella enteritidis , Anciano , Endocarditis Bacteriana/cirugía , Femenino , Prótesis Valvulares Cardíacas , Hemodinámica/fisiología , Humanos , Válvula Mitral/diagnóstico por imagen , Válvula Mitral/microbiología , Válvula Mitral/cirugía , Insuficiencia de la Válvula Mitral/cirugía , Infecciones por Salmonella/cirugía , Salmonella enteritidis/aislamiento & purificaciónRESUMEN
The sudden onset of tricuspid insufficiency following a blunt chest trauma is extremely rare. We operated on a young woman in a state of severe shock following a riding accident, in whom complete severing of the papillary muscle of the posterior tricuspid leaflet had occurred. The valvuloplasty operation itself and the postoperative course ran smoothly, apart from a late pericardial tamponade which required surgical revision. In accordance with other reported cases we believe that traumatic tricuspid insufficiency is still a very underestimated pathological occurrence. Echocardiographic examination should therefore be regarded as an essential standard procedure in all cases of blunt chest injury.
Asunto(s)
Traumatismos en Atletas/complicaciones , Lesiones Cardíacas/complicaciones , Músculos Papilares/lesiones , Insuficiencia de la Válvula Tricúspide/etiología , Heridas no Penetrantes/complicaciones , Enfermedad Aguda , Adulto , Ecocardiografía , Femenino , Humanos , Insuficiencia de la Válvula Tricúspide/diagnóstico por imagen , Insuficiencia de la Válvula Tricúspide/cirugíaRESUMEN
A superior mesenteric vein aneurysm was diagnosed by ultrasound, computed tomography, and angiography in a 55-year-old woman. It was successfully treated by partial resection and reconstruction of the confluent veins.
Asunto(s)
Aneurisma/patología , Venas Mesentéricas/patología , Angiografía , Femenino , Humanos , Persona de Mediana Edad , Tomografía Computarizada por Rayos X , UltrasonografíaRESUMEN
Tumor growth in a 72-year-old male patient with malignant haemangiopericytoma in the left hemithorax could be followed radiologically for 4 years before symptoms of recurrent hypoglycaemia appeared. The endogenous insulin level in serum was maximally and serum IGF-1 and IGF-2 markedly reduced. An intravenous arginine load test showed a normal stimulation capacity of the pancreatic glucagon secretion but not that of insulin. After resection of the tumor, blood sugar metabolism was completely normalised. The insulin level, IGF-1 and IGF-2 in serum returned to normal.