[Comparing Onset Times and Vascular Punctures in axillary Blocks with Nerve Stimulation or Ultrasound: Randomised Trial].

The use of ultrasound (US) guidance in regional anaesthesia has evolved in the last then years and has even been considered the fatest and safest way to identify peripheral nerves and vascular structures thus eliminating the risk of injuring them. Prior to US guidance, peripheral nerve stimulation (PNS) was the gold standard procedure of the last twenty years, still being used in the present alone or alongside US guidance. However, sometimes -especially in vessel rich areas such as the axillary plexus- it is hard to avoid injuring vascular structures with blind techniques such as PNS. The study's hypothesis was that out-of-plane US guided peri-neural axillary plexus block has a better success rate, faster onset and less intravascular punctures than the PNS method.

[Urgent surgery in colon carcinoma]. / Der Notfalleingriff beim Kolonkarzinom.

INTRODUCTION: About 10% of all operations in colon carcinoma are performed in emergency situations because of severe preoperative complications. PATIENTS AND METHOD: The prospectively collected data of 1496 patients with colon carcinoma treated from 1987 to 2002 at the Department of Surgery of the University of Erlangen were analysed with special interest on postoperative morbidity and long-term prognosis after elective and urgent surgery. RESULTS: The rate of urgent surgery was 11%. The most frequent complication was bowel obstruction (73%) followed by perforation (20%). Emergency patients were significantly older (p<0.001) and in worse general condition (p<0.001). The rates of surgical and nonsurgical postoperative complications were higher in urgent surgery than in elective surgery (28.8% vs. 19.8%, p=0.015) and also postoperative mortality was significantly higher (10.1% vs. 4.0%, p<0.001). The rates of locoregioanal recurrences and distant metastases were significantly higher. Urgent surgery was found to be an independent prognostic factor for distant metastasis (relative risk 1.8) and cancer-related survival (relative risk 1.6). DISCUSSION: Urgent surgery in colon carcinoma is usually performed in advanced tumours of elderly patients. This operation can be a challenge for the treating surgeon. Adequate medical emergency supply needs to provide an experienced surgeon for those interventions.