[Primary adaptive vs. secondary wound closure in hand infections - differences and benefits]. / Primär adaptierende vs. sekundäre Wundverschlüsse bei Infektionen der Hand - Unterschiede und Vorteile.

BACKGROUND: Hand infections are common surgical emergencies. There are still controversial opinions regarding the ideal timing of wound closure after radical débridement of the infection. The aim of this retrospective study was to compare the outcome of primary adaptive and secondary wound closures after operative débridement in patients with hand infections. METHODS: We retrospectively analysed all infections of the hand treated operatively in our hospital in the years 2011 and 2012 with a follow-up of at least 6 months. We included 16 patients with primary adaptive wound closure (PWC) and 12 patients with secondary wound closure (SWC) in this study. The evaluated parameters were the need for re-operations, the length of hospital stay, the overall satisfaction with the treatment, the characteristics of the scar and the mobility of the hand. RESULTS: No patient had to be re-operated after PWC or SWC, respectively. Patients in the PWC group were kept significantly shorter as inpatients in comparison to patients in the SWC group (3.0 days vs. 5.1 days; p=0.048). Overall patient satisfaction with the treatment and the scar was comparable for both groups, as was the re-establishment of the mobility of the treated hand to preoperative levels. CONCLUSION: This study shows that wounds after radical débridement for infection of the hand can be closed primarily adaptive without disadvantages for the patient. The length of hospitalisation is significantly shorter if the wound is closed primarily adaptive, a fact that is important for patient comfort and the socio-economic system. Both, primary adaptive and secondary wound closures generally have good outcomes with possible advantages for primary adaptive wound closures concerning the characteristics of the scar.

[Operative standardization in randomized controlled surgical trials. Meeting of the INSECT trial]. / Operative Standardisierung bei randomisiert kontrollierten Studien in der Chirurgie. Studientreffen der INSECT-Studie.

BACKGROUND: INSECT is an internationally registered, three-armed, multicentre, intraoperatively randomised model trial of the Study Centre of the German Surgical Society. The interventions being compared are running suture technique with slowly absorbable monofilament suture material (PDS vs MonoPlus) and interrupted technique with a braided, rapidly absorbable suture material (Vicryl). The primary endpoint is the rate of incisional hernias 1 year postoperatively. MATERIAL AND METHODS: A total of 25 surgeons from 24 different institutions at all levels of care evaluated the theoretical and practical sessions of the surgical investigator meeting using 25 criteria, including course organisation, content, and speaker evaluation, and a categorical grading system from 1 (very good) to 6 (insufficient). RESULTS: Distribution of the 625 grades was: very good (1) n=367, good (2) n=207, satisfactory (3) n=39, adequate (4) n=2, and "No statement" n=10. The average score for the investigator meeting was 1.5. CONCLUSION: The participants felt they were successfully prepared theoretically and practically for trial interventions and conduct by attending the meeting. Clear explanation of the measures for treatment equivalence before and during trials is mandatory in randomised controlled surgical trials.

[Careers of women in academic surgery]. / Karriere im Gegenwind. Frauen in der universitären Chirurgie.

AIM: The aim of our national survey was to determine personal, working, and career conditions of women in academic surgery in Germany. METHODS: A questionnaire with 47 items was sent to 261 female surgeons working in 36 departments of general, abdominal, trauma, and vascular surgery. A total of 134 (51.3%) from all 36 surgical departments responded with completed surveys. RESULTS: The mean age of the women was 35.1 years (range 27 to 54). Seventy-eight percent of the surgeons worked in departments for general or abdominal surgery, 17% in trauma, and 5% in vascular surgery. 45% of the women had finished residency and 19% were in faculty positions. Eighty percent of those asked were mostly or always content with their working conditions. However, 79% perceived career obstacles in academic surgery. The most frequently addressed obstructions were: predominant male structures (80%), the absence of mentoring programs (70%), too few operative cases per month (67%), and no equality of career opportunities compared to male surgeons (60%). CONCLUSIONS: To reduce career obstructions, which were reported by 79% of the female surgeons, and to encourage those 33% who wanted to leave academic surgery, it seems necessary to improve cooperation between female surgeons, department chairs, and governmental institutions.

Differentiation of multiple sclerosis plaques, subacute cerebral ischaemic infarcts, focal vasogenic oedema and lesions of subcortical arteriosclerotic encephalopathy using magnetisation transfer measurements.

Although multiple sclerosis (MS) plaques, subacute cerebral ischaemic infarcts, focal vasogenic brain oedema, and subcortical arteriosclerotic encephalopathy (SAE) often have typical radiological patterns, they are sometimes difficult to distinguish from each other. Our aim was to determine whether they can be differentiated by magnetisation transfer (MT) measurements. We measured MT ratios (MTR) in ten patients with plaques of MS, 11 with subacute ischaemic infarcts, 12 with focal vasogenic oedema, and ten with lesions of SAE and compared the mean MTRs statistically. The MTR of normal white matter was 47.3%; the lowest MTR was found in plaques of MS (mean 26.4%). With the exception of vasogenic oedema and subacute cerebral ischaemic infarcts the mean MTRs were significantly different between all groups. MT measurements can provide additional information for the differentiation of these conditions, but we could not distinguish vasogenic oedema from subacute cerebral ischaemic infarcts.

Magnetisation transfer ratio is low in normal-appearing cerebral white matter in patients with normal pressure hydrocephalus.

We measured the magnetisation transfer ratios (MTR) of normal-appearing rostral (PR) and caudal (PC) periventricular white matter, the genu (CG) and the splenium (CS) of the corpus callosum and the thalamus (TH) in 12 patients with normal-pressure hydrocephalus (NPH) and compared them with 16 healthy control subjects. We found a significantly lower MTR in the NPH group than in the normal group for PR, PC, CG, and CS but not for TH. MT measurements give additional information which cannot be gained by conventional MRI, suggesting that NPH is associated with diffuse white matter damage, even in normal-appearing cerebral white matter.

Magnetization transfer measurements in normal-appearing cerebral white matter in patients with chronic obstructive hydrocephalus.

PURPOSE: The purpose of this work was to assess the presence of subtle changes in normal-appearing white matter on T2-weighted MR images in patients with chronic obstructive hydrocephalus using magnetization transfer (MT) measurements. METHOD: In 12 patients with chronic obstructive hydrocephalus, MT ratios (MTRs) of normal-appearing rostral (PR) and caudal (PC) periventricular white matter, of the genu (CG) and the splenium (CS) of the corpus callosum, and of the thalamus (TH) were measured and compared with those of 16 healthy control subjects. RESULTS: We found a significantly lower MTR in chronic obstructive hydrocephalus than in the normal group for PR, PC, CG, and CS but not for TH. CONCLUSION: Our study shows that MT measurements give additional information that cannot be gained by conventional SE MRI, suggesting that chronic obstructive hydrocephalus is associated with diffuse white matter damage that also affects normal-appearing cerebral white matter.