Zusammenfassung. Die Diagnostik und Therapie von Milzverletzungen nach stumpfen Abdominaltraumen hat sich in den letzten Jahren geändert. Das konservative Vorgehen hat für die Therapiestrategie beim Milztrauma zunehmend an Bedeutung gewonnen. Der Erfolg wird entscheidend vom Schweregrad der Milzläsion, von der Hämodynamik des Patienten und den Begleitverletzungen bestimmt. Die diagnostischen Möglichkeiten und Grenzen von Ultraschall, Computertomographie und Angiographie werden dargestellt. Anhand dieser Ergebnisse und des klinischen Zustandes des Patienten folgen stadienadaptierte Therapievorschläge, vom konservativen Vorgehen über milzerhaltendene zu resezierenden Operationsverfahren. Um unnötige abdominelle Explorationen oder die Inzidenz von zweizeitigen Milzrupturen zu minimieren, liegt der Schlüssel zum Erfolg in der frühzeitigen Identifikation von Risikopatienten. Die Indikation zum Abwarten ist beim kreislaufstabilen Patienten mit geringer intraabdomineller Flüssigkeit und ohne Verletzung des Milzhilus gegeben. Hohes Lebensalter und Grad-I ± III-Verletzungen stellen per se keine Operationsindikation dar.Schlüsselwörter: Milztrauma ± stumpfes Bauchtrauma ± Milzruptur Management of splenic trauma. Diagnosis and therapy of blunt spleen trauma have changed during the last years with a non-operative approach being most prominently employed. However, the therapeutic success strongly depends on the extend of splenic lesions, hemodynamics and also concomitant injuries. The significance of currently applied diagnostic tools, such as ultrasound, computer tomography and angiography are discussed in detail. With regard of this and the clinical status of single patients, therapeutic recommendations are given, ranging from the conservative approach to splenorrhaphy and partial spleen-resection. Identification of risk patients will clearly minimize unnecessary abdominal explorations and the incidence of secondary spleen ruptures. The best treatment for hemodynamic stable patients without hilus laceration is non-operative. Moreover, age and low-grade injuries (I ± III) do not automatically indicate a surgical intervention. EinleitungDas lebenslange Risiko, nach einer Splenektomie septische Komplikationen zu entwickeln, verlangt nach milzerhaltenden Verfahren im Management des Milztraumas [1 ± 6]. Die Inzidenz der foudroyant verlaufenden Sepsis (Overwhelming Postsplenektomy Infection-(OPSI-) Syndrom) liegt zwischen 0,5 ± 2,0 % [7]. Mit der Optimierung der Diagnostik konnte die therapeutische Sicherheit sowohl für das stumpfe als auch das penetrierende Milztrauma innerhalb der letzten 20 Jahre deutlich verbessert werden [6]. Die diagnostische Kombination aus Ultraschall (US) und Computertomographie (CT) gibt bereits in der Schockraumphase Aufschluss über den Ursprung und die Quantität der intraabdominellen Blutung. Das Spiral-CT bietet die derzeit beste Methode zur Einschätzung der Milzverletzungen [8]. Innerhalb der letzten Jahre konnte in Traumazentren die Rate des konservativen Milzerhaltes deutlich gesteigert werden. Na...
Regarding the Integration of OPD-CA Into Clinical PracticeThe axis structure of the Operationalized Psychodynamic Diagnostics in childhood and adolescence (OPD-CA) has proven to be a reliable and valid diagnostic tool under research conditions. However, corresponding data regarding the integration of OPD-CA axis structure into clinical practice is still lacking. Hence, this aspect was examined as part of a randomized controlled clinical trial realized at Asklepios Fachklinikum Tiefenbrunn. Here, the OPD-CA axis structure has been applied to assess the structural level of 42 adolescent patients (15-19 years). In contrast to previous studies, the assessment was not carried out by independent raters using a videotaped OPD-CA interview, but the rating was part of clinical routine procedures. Also under these conditions, inter-rater reliability was high, in particular regarding the four subscales of the OPD-CA axis structure. With respect to construct validity, the results of our study supported a two-factor solution, which is in accordance with the findings of two previous works. One factor corresponded to the dimension "self-regulation", while the other factor included both the dimension "self-perception and object perception" as well as the dimension "communication skills". Implications of the findings for research and practice are discussed.
Kryopreserved specimens of cystic ducts were used for displacement tests to investigate the security of different laparoscopic clips. The cystic duct was fixed, and the transverse placed clips were distracted in axial direction and the forces registered. The median values of the six investigated clips ranged between 4.1 N and 11.2 N with a highly significant difference (P < 0.001, Kruskal-Wallis ANOVA). In detail, both resorbable clips (polydioxanone, polyglyconate/polyglycol acetate) were superior to the four titanium clips (P < 0.005, Wilcoxon test). In addition to the advantage of complete biodegradibility, these data favour the use of absorbable clips because holding force is better than that of titanium clips.
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