[Will carotid thromboendarterectomy remain competitive? Influence of intraoperative duplex ultrasound quality control]. / Wird die Karotischirurgie konkurrenzfähig bleiben? Einfluss intraoperativer duplexsonographischer Qualitätskontrolle.

BACKGROUND: Thromboendarterectomy (TEA) and stenting are in competition for treatment of carotid artery lesions. Both treatment modalities have to improve significantly. The goal of the study was to evaluate the influence of routine intraoperative duplex ultrasound examination. METHODS: In a continuous prospective study, 575 patients underwent 620 carotid operations. Intraoperative duplex ultrasound examination was performed prior to wound closure: 9.5% had significant contralateral ICA stenoses and 6.7% ICA occlusion; 8.5% presented special lesions. An eversion TEA was performed in 20.5% while 78.5% underwent conventional TEA with patch plasty and graft interposition in 1%. Intraoperative quality control revealed unexpected lesions in 10% requiring immediate repair. RESULTS: The combined morbidity/mortality rate (MMR) of the total series was 2.6%. Women had an elevated risk (4.2%) in comparison to men (1.9%). The risk of elder patients (>75 years, n=151) was remarkably low. The neurological complication rate of the total series was 1.6% and the incidence of major strokes 1.1%. CONCLUSIONS: Routine intraoperative duplex ultrasound examination of the carotid reconstruction allows early diagnosis and immediate correction of morphologic as well as hemodynamic lesions. Competing with stent placement a further reduction of complications of carotid TEA seems to be possible and necessary.

[The burned hand. A computer-assisted study of late function of 67 burned and operated hands]. / Die verbrannte Hand. Eine computergestützte Untersuchung der Spätfunktion von 67 thermisch verletzten und operierten Händen.

A good functional outcome of the hand is important in the rehabilitation of severely burned patients. The aim of the study was to evaluate the late functional outcome of deeply burned hands using a computer aided system and to correlate the function with the distribution of the hand burns. Over a 12-year-period 378 patients whose acutely burned hands had been operated on at the burn center of the university hospital Aachen were invited to a follow-up examination. 67 burned and operated hands were evaluated 57 (3-364) months after the burn by the computerized evaluation system EVAL. Active flexion and extension, grip strength, pinch (key, 3-tip and 2-tip), moving 2-point sensitivity and the pattern of skin grafts and scars were assessed. The use of the hand in daily activities was evaluated by a questionnaire. The hands were classified in 4 groups according to the burn pattern: I: patchy burns (total < 12 cm2), II: confluent dorsal burns, III: confluent palmar burns, IV: mutilating burns. Good results were found in group I (n = 25), comparable to normal hand function. In group II (n = 25) there was a significant loss of total active flexion with preserved strength. Increased extension lag and impaired grip strength characterized group III (n = 8). Late functional results in group IV (n = 9) depended on the reconstructive procedure. Between the 4 groups there were significant differences in function. The results were well correlated to the burn pattern and its extent according the classification.

[Multicenter study of obstetrico-perinatologic quality control in the Rostock district. II. Analysis of results with graphic aids]. / Multicenterstudie zur geburtshilflich-perinatologischen Qualitätskontrolle im Bezirk Rostock. II. Mitteilung: Resultatanalyse mit graphischen Hilfsmitteln.

Various graphic diagrams of obstetrical and perinatological quality assessment between 1984-1986 in the district of Rostock are demonstrated. The advantages of centralization of premature labors are visible. The prenatal diagnosis of intrauterine growth retardation is still insufficient. With an upper cesarean section rate of 10% good perinatological results are achieved. The cesarean section rate of obstetrical departments without high risk concentration is below 5%. There is a highly subjective influence in vaginal operative decision. A mean rate of prematurity may be combined with a high rate of perinatal mortality caused by an unproportional part of very low birth weight infants. The small number of data of the obstetrical basic-check-list allows different possibilities of comparing quality assessment. Different levels of the results and the reasons are better visible by means of graphs. The preliminary results of outcome control justify a general introduction. By means of further data processing we will get better mathematical and graphical interpretations.

[Multicenter study of obstetrico-perinatologic quality control in the Rostock district. I. Comparative medical statistics]. / Multicenterstudie zur geburtshilflich-perinatologischen Qualitätskontrolle im Bezirk Rostock. I. Mitteilung: Vergleichende Medizinalstatistik.

Report about outcome-quality assessment in obstetrics and perinatology using an uniform check list for data collection in the district of Rostock. Various possibilities of outprint of the results in 1985 are demonstrated. For daily data collection in obstetrics a special book has been developed. The investigation concerns a data pool of more than 55,000 deliveries. Considering a trend of the results the following optimal criteria in obstetrics and perinatology are postulated: (table; see text) The check list of the Society of Perinatal Medicine of the GDR for obstetrical and neonatal data collection should be generally used. The soft ware for the computed data analyses has been developed by the "Rechenzentrum der Ernst-Moritz-Arndt-Universität Greifswald". Analysis and output of obstetrical and perinatological datas by means of a personal computer are prepared.