Improving the detection of illicit substance use in preoperative anesthesiological assessment.

AIM: Illicit substance use (ISU) is a worldwide burden, and its prevalence in surgical patients has not been well investigated. Co-consumption of legal substances, such as alcohol and tobacco, complicates the perioperative management and is frequently underestimated during routine preoperative assessment. The aim of this study was to compare the anesthesiologists' detection rate of ISU during routine preoperative assessment with a computerized self-assessment questionnaire. METHODS: In total, 2,938 patients were included in this study. Prior to preoperative assessment, patients were asked to complete a computer-based questionnaire that addressed ISU, alcohol use disorder (AUDIT), nicotine use (Fagerström) and socio-economic variables (education, income, employment, partnership and size of household). Medical records were reviewed, and the anesthesiologists' detection of ISU was compared to the patients' self-reported ISU. RESULTS: Seven point five percent of patients reported ISU within the previous twelve months. ISU was highest in the age group between 18 and 30 years (26.4%; P<0.01). Patients reporting ISU were more often men than women (P<0.01), smokers (P<0.01) and tested positive for alcohol use disorder (P<0.01). Anesthesiologists detected ISU in one in 43 patients, whereas the computerized self-assessment reported it in one in 13 patients. The detection was best in the subgroup self-reporting frequent ISU (P<0.01). CONCLUSIONS: Anesthesiologists underestimate the prevalence of ISU. Computer-based self-assessment increases the detection of ISU in preoperative assessment and may decrease perioperative risk. More strategies to improve the detection of ISU as well as brief interventions for ISU are required in preoperative assessment clinics.

[Analysis and treatment of eye motility disorders following retinal detachment surgery]. / Analyse und Behandlung von Motilitätsstörungen nach Ablatio-Operationen.

Despite the most careful retinal detachment surgery saving the eye muscles and the fascial structures, an extraocular muscle imbalance may occur. This can be expected especially when for scleral buckling procedures large implants or exoplants were used, or had to be placed under a rectus muscle. In some cases, however, postoperative diplopia results from decompensation of preexisting heterophoria or congenital ocular motor imbalance. A clear-cut differential diagnosis to separate these entities is essential for therapeutic considerations.

[Epibulbar superficial spreading melanoma (author's transl)]. / Epibulbäres superfiziell spreitendes Melanom.

A report rarely a case of superficial spreading melanoma of the conjunctiva bulbi in a 40-year-old woman. As this kind of tumor is very found at this site, the unusual localisation rendered the differential diagnosis more difficult and delayed the radical operative therapy. After orbitectomy the patient has been free of local metastatic deposits for two years. She is fully rehabilitated by a good epithetis. The course of diagnosis in our case illustrates the necessity of uniform application of the nomenclature of cutaneous forms of melanomas and naevi in ophthalmology.

[The operative treatment of nystagmus-caused variable squint angles with Cüppers "Fadenoperation" (author's transl)]. / Die operative Behandlung nystagmusbeidingter schwankender Schielwinkel mit der Fadenoperation nach Cüppers

THE "Fadenoperation" developed by Cüppers is described. With this, the arc of contact is changed with retension of the anatomical insertion. It is indicated when an innervational factor is to be influenced, especially by the treatment of an instable squint angle caused by nystagmus. A differentiation between a static and dynamic angle must be made. Only the static angle can be corrected by common recession and resection. The dynamic angle can be corrected by the "Fadenoperation" described by Cüppers. The difficulty in recognizing the nystagmus and determining the width of the static and dynamic angle is described in detail. Satisfying results were attained, following these criteria, shown by 19 (76%) of the operated convergent squinters with an instable angle.