Development of a risk index for the prediction of chronic post-surgical pain.

The incidence of chronic post-surgical pain (CPSP) after various common operations is 10% to 50%. Identification of patients at risk of developing chronic pain, and the management and prevention of CPSP remains inadequate. The aim of this study was to develop an easily applicable risk index for the detection of high-risk patients that takes into account the multifactorial aetiology of CPSP. A comprehensive item pool was derived from a systematic literature search. Items that turned out significant in bivariate analyses were then analysed multivariately, using logistic regression analyses. The items that yielded significant predictors in the multivariate analyses were compiled into an index. The cut-off score for a high risk of developing CPSP with an optimal trade-off between sensitivity and specificity was identified. The data of 150 patients who underwent different types of surgery were included in the analyses. Six months after surgery, 43.3% of the patients reported CPSP. Five predictors multivariately contributed to the prediction of CPSP: capacity overload, preoperative pain in the operating field, other chronic preoperative pain, post-surgical acute pain and co-morbid stress symptoms. These results suggest that several easily assessable preoperative and perioperative patient characteristics can predict a patient's risk of developing CPSP. The risk index may help caregivers to tailor individual pain management and to assist high-risk patients with pain coping.

Effect of low-dose subcutaneous heparin on postoperative wound hematomas: randomized clinical trial on hospitalized inguinal hernia patients in Germany.

A randomized prospective study of low-dose heparin was performed in 89 surgical patients during and after Bassini-Lotheissen repair. The patients were divided into two groups: (1) Low-dose heparin: 5000 units 2 hours before operation and 5000 units every 8 hours for 5 days after the operation. (2) Dextran 40 (Rheomacrodex); administered during the operation, with an additional infusion of dextran (500 ml/day) for the next 3 days. The frequency of wound complications in 45 the heparin-treated patients was 22.0% (comprising 10 hematomas), compared to only 4.5% in the dextran-treated patients (n = 44 patients). These findings are significant (p < 0.05). Low-dose heparin should therefore be administered routinely only to patients with increased risk of thromboembolism.

[Quality of life after prograde jejunum interposition with and without pouch. A prospective study of stomach cancer patients on the reservoir as a reconstruction principle after total gastrectomy]. / Lebensqualität nach prograder Jejunuminterposition mit und ohne Pouch. Eine prospektive Studie bei Magencarcinompatienten zur Frage des Reservoirs als Rekonstruktionsprinzip nach totaler Gastrektomie.

Out of 74 consecutive patients with gastric carcinoma only 39 patients fulfilled the inclusion criteria for this randomized study. These patients were divided into two groups intraoperatively, 21 were reconstructed with and 18 without performing a stapled interposed jejunal pouch. Quality of life was evaluated using Spitzer's QL index and Cuschieri's assessment for 6 months. Spitzer's QL index showed--as expected--no differences concerning the specific reconstruction in gastrointestinal complaints, whereas Cuschieri's assessment revealed an advantage in the pouch group. Cuschieri's assessment needs to be validated by larger comparable groups to prove its suitability for the determination of specific gastrointestinal complaints concerning the type of reconstruction in gastric cancer patients.

Orbita fractures in polytraumas and craniocerebral traumas.

The authors emphasize that the maxillo-facial surgeon or otorhinolaryngologist should: 1. take part in diagnosing and planning the therapy of poly-traumatic patients. 2. operate simultaneously when possible. 3. try to provide immediate maxillo-facial surgical and/or otorhinolaryngologic treatment because of the great importance of early treatment for longterm functional and aesthetic results.

Gyrification in the cerebral cortex of primates.

The degree of cortical folding in primates has been analyzed using a gyrification index (GI). Correlation analyses of the GI with body weight, brain weight and neopallial volume show that the human data fit the general trend of the nonhuman anthropoids. Bigger primate brains exhibit a higher degree of fissurization, but a taxonomic difference that is independent of brain weight between prosimians and anthropoids has also been observed. In these regressions, anthropoids differed from prosimians by having a larger increase in gyrification for every unit increase in body or brain weight or neopallial volume. A stepwise regression also shows a prosimian-anthropoid difference. The best predictor for convolutedness in anthropoids is neocortical volume, while in prosimians it is brain weight. The GI in catarrhines is correlated with total sulcal length but not number of sulci. This result suggests paleontological studies of total sulcal length can give direct information on the evolution of cortical folding in primates.

[Score systems, their importance for the intensive care patient]. / Score-Systeme, ihre Bedeutung für den Intensivpatienten.

Scoring systems are a technique for defining patients for scientific and management purposes. A hypothetical, severely ill patient with cirrhosis, peritonitis, renal insufficiency and coagulation problems can be precisely classified: Child C, Mannheim-Peritonitis-Index 34 and APACHE II score 27 which results in a mortality of at least 70% of patients. At our own hospital, the continuous APACHE score (CAPS) has been developed and tested. The CAPS performed better than daily APACHE scores and provided useful trend information for the individual patient.