[New pediatric drug dosage aids. Improving patient safety]. / Neue Hilfsmittel zur Dosierung von Medikamenten im Kindesalter. Verbesserung der Patientensicherheit.

Dosing errors when administering medicine to children occur often and are due, e.g., to the commonly required dilution of the drugs, misjudgment of the patient's weight, confusion between drugs with similar names, and inadequate communication. Various aids (e.g., measuring tapes and dilution tables) have been designed to avoid mistakes to the greatest extent possible. In daily clinical practice, books and pocket cards are still used for rapid orientation. Use of smartphone-based apps continues to increase, whereby the user is ultimately responsible for their validity. In clinical practice, the simplest possible strategies should be used. A culture that encourages disclosure of errors is useful in order to optimize processes and avoid future errors.

Mesophilic and thermophilic BTEX substrate interactions for a toluene-acclimatized biofilter.

Benzene, toluene, ethylbenzene and xylene (BTEX) substrate interactions for a mesophilic (25 degrees C) and thermophilic (50 degrees C) toluene-acclimatized composted pine bark biofilter were investigated. Toluene, benzene, ethylbenzene, o-xylene, m-xylene and p-xylene removal efficiencies, both individually and in paired mixtures with toluene (1:1 ratio), were determined at a total loading rate of 18.1 g m(-3) h(-1) and retention time ranges of 0.5-3.0 min and 0.6-3.8 min for mesophilic and thermophilic biofilters, respectively. Overall, toluene degradation rates under mesophilic conditions were superior to degradation rates of individual BEX compounds. With the exception of p-xylene, higher removal efficiencies were achieved for individual BEX compounds compared to toluene under thermophilic conditions. Overall BEX compound degradation under mesophilic conditions was ranked as ethylbenzene >benzene > o-xylene > m-xylene > p-xylene. Under thermophilic conditions overall BEX compound degradation was ranked as benzene > o-xylene >ethylbenzene > m-xylene > p-xylene. With the exception of o-xylene, the presence of toluene in paired mixtures with BEX compounds resulted in enhanced removal efficiencies of BEX compounds, under both mesophilic and thermophilic conditions. A substrate interaction index was calculated to compare removal efficiencies at a retention time of 0.8 min (50 s). A reduction in toluene removal efficiencies (negative interaction) in the presence of individual BEX compounds was observed under mesophilic conditions, while enhanced toluene removal efficiency was achieved in the presence of other BEX compounds, with the exception of p-xylene under thermophilic conditions.

[Total intravenous anesthesia. On the way to standard practice in pediatrics]. / Total intravenöse Anästhesie. Auf dem Weg zum Standardverfahren bei Kindern.

Since venous cannulation in children has become easier and extensive experience has been gained with total intravenous anaesthesia (TIVA) in adults, the interest in TIVA for children has recently increased. An intensified sensitivity of the operating room atmosphere to contamination with volatile anaesthetic agents is another important reason to choose intravenous techniques for paediatric anaesthesia. One of the most interesting agents for TIVA in paediatric anaesthesia is propofol. The pharmacokinetic and pharmacodynamic data for modern intravenous drugs is poor. Because the interpatient variability is relatively large, pharmacokinetic data can only provide guidelines for the dosage of propofol. Propofol has a rapid and smooth onset of action and is as easy to titrate in children as in adults. Propofol can be excellently controlled. Severe haemodynamic side-effects are missing in healthy children and plasma is cleared rapidly of propofol by redistribution and metabolism. There is no evidence of significant accumulation, not even after prolonged infusion times. Because propofol has no analgetic properties it must be combined with analgetics or a regional block for all painful procedures. The combination with the ultra-short acting remifentanil is a major advantage, but requires effective analgetic concepts for painful procedures. In comparison the combination of propofol with long acting opioids abolishes some of the favourable properties of propofol. Further studies of the kinetics and dynamics of propofol and other intravenous agents are needed in paediatrics which should focus on age, maturity and severity of illness. The whole importance of the propofol-infusion syndrome has to be cleared up urgently. TIVA has an important significance in paediatric anaesthesia for diagnostic and therapeutic procedures, especially where these have to be repeated. In day-case anaesthesia TIVA has advantages for all short procedures and for ENT and ophthalmic surgery: even after prolonged infusion children have an short recovery time. There is no evidence of agitation or other behavioural disorders after TIVA with propofol in paediatric anaesthesia. Propofol has anti-emetic properties. TIVA with propofol can be combined with regional anaesthesia advantageously to provide long-lasting analgesia after surgery. TIVA with propofol has been used successfully for sedation of spontaneously breathing children for MRI and CT and other procedures with open airways like bronchoscopy or endoscopy. Propofol facilitates endotracheal intubation without the use of muscle relaxants. Of course, in malignant hyperthermia TIVA will continue to be the technique of choice. Nothing is known about awareness under TIVA in paediatric patients. TIVA must be considered by comparison with the volatile agents. The use of ultra-short acting agents may cause problems such as awareness, vagal response, involuntary movements and in some cases slow recovery after prolonged infusion of propofol. But it is not known exactly how often this happens during paediatric anaesthesia. With TIVA an effective postoperative analgesia must be provided. Newer administration techniques such as the target-controlled infusions or closed-loop control systems are under development and will help to minimise the potential risk of overdosage with TIVA in paediatrics. At the present TIVA is an interesting and practicable alternative to volatile anaesthesia for pre-school and school children. TIVA with propofol in infants younger than 1 year old requires extensive experience with TIVA in older children and with the handling of this special age group and should be undertaken with maximum precautionary measures.

[Endoprosthetic surface replacement of the head of the humerus]. / Der endoprothetische Oberflächenersatz am Humeruskopf.

The concept of an endoprosthetic surface replacement of the humeral head differs from that of stemmed endoprostheses. It is the replacement of the destroyed joint surface with reconstruction of the normal anatomy and minimal bone resection. The aim of this prospective study was to evaluate the short-term results of a newly developed cup arthroplasty (Durom-Cup) for the humeral head. In a prospective study, 39 patients with 46 Durom-Cups were evaluated preoperatively and every 3 months postoperatively. The average follow-up was 15 +/- 9 months. The group included 28 shoulders with rheumatoid arthritis, 15 joints with osteoarthritis, and 3 humeral head necroses. The Constant-score and SAS-function score were used. The Constant-score increased from 20.25 +/- 9.06 points preoperatively to 46.62 +/- 14.05 at 3 months, to 48.11 +/- 14.49 at 6 months, and to 55.25 +/- 11.6 at 9 months postoperatively. The Constant-score stayed at this level during further follow-up and was 55.81 +/- 16.31 at 12 months postoperatively. The best results were seen in the group of humeral head necroses with a Constant-score of 71.0 +/- 12.2 compared to 54.66 +/- 13.89 in the group of osteoarthritis and 56.78 +/- 13.33 in patients with rheumatoid arthritis at 12 months postoperatively. The results with the Durom-Cup are encouraging so that cup arthroplasty seems to be a good alternative to stemmed prostheses. The main advantages of the humeral head resurfacing are the bone-preserving fixation and the relatively simple surgical technique.

BTEX catabolism interactions in a toluene-acclimatized biofilter.

BTEX substrate interactions for a toluene-acclimatized biofilter consortium were investigated. Benzene, ethylbenzene, o-xylene, m-xylene and p-xylene removal efficiencies were determined at a loading rate of 18.07 g m(-3) h(-1) and retention times of 0.5-3.0 min. This was also repeated for toluene in a 1:1 (m/m) ratio mixture (toluene: benzene, ethylbenzene, or xylene ) with each of the other compounds individually to obtain a final total loading of 18.07 g m(-3) h(-1). The results obtained were modelled using Michaelis-Menten kinetics and an explicit finite difference scheme to generate vmax and Km parameters. The Vmax/Km ratio (a measure of the catalytic efficiency, or biodegradation capacity, of the reactor) was used to quantify substrate interactions occurring within the biofilter reactor without the need for free-cell suspended and monoculture experimentation. Toluene was found to enhance the catalytic efficiency of the reactor for p-xylene, while catabolism of all the other compounds was inhibited competitively by the presence of toluene. The toluene-acclimatized biofilter was also able to degrade all of the other BTEX compounds, even in the absence of toluene. The catalytic efficiency of the reactor for compounds other than toluene was in the order: ethylbenzene > benzene > o-xylene > m-xylene>p-xylene. The catalytic efficiency for toluene was reduced by the presence of all other tested BTEX compounds, with the greatest inhibitory effect being caused by the presence of benzene, while o-xylene and p-xylene caused the least inhibitory effect. This work illustrated that substrate interactions can be determined directly from biofilter reactor results without the need for free-cell and monoculture experimentation.

[Intraoperative changes in arterial end tidal CO2 partial pressure difference in interventions with constant ventilation-perfusion ratio]. / Intraoperative Veränderungen der arterio-endtidalen CO2-Partialdruckdifferenz bei Eingriffen mit konstanten Ventilations-Perfusions-Verhältnissen.

During general anaesthesia, the endtidal CO2 pressure serves as an estimate of the arterial CO2 pressure to regulate the ventilator setting. Important arterial to end-tidal carbon dioxide tension differences (P(a-et)CO2) have been observed among patients undergoing procedures which have substantial impact on the ventilation-perfusion ratio (V/Q). Data on the P(a-et)CO2 for procedures in which the V/Q-ratio remains constant are lacking. Repeated measurements of P(a-et)CO2 in twelve patients with chronic obstructive lung disease (COLD) and nine pulmonary healthy patients undergoing jaw surgery were performed. The P(a-et)CO2 in the pulmonary healthy subjects (5.96 +/- 1.68 mmHg) was lower than in the COLD patients (9.05 +/- 3.49 mmHg) (p < 0.01). A clinically significant P(a-et)CO2 > or = 8 mmHg was observed in 52% of the measurements in patients with COLD compared with 11% in the pulmonary healthy subjects (p < 0.01). Both patient groups showed only minimal intraoperative changes of P(a-et)CO2. The deviation of all subsequent P(a-et)CO2 values from the initial P(a-et)CO2 was 2.17 +/- 1.52 mmHg in the pulmonary healthy patients and 2.02 +/- 1.49 mmHg in the patients with COLD (p = 0.76). Intraoperative changes of the P(a-et)CO2 are small during procedures with no major alterations of the V/Q ratio. For these procedures an initial measurement of the P(a-et)CO2 in patients with lung disease should be sufficient. In pulmonary healthy subjects the P(a-et)CO2 seems to be negligible.

Arthroscopic treatment of calcific tendinitis of the shoulder.

We evaluated 48 patients arthroscopically treated for calcific tendinitis. All patients' were treated by removal of the calcific deposit whenever possible and resection of the coracoacromial ligament. Those cases showing evidence of subacromial stenosis by x-ray evaluation or intraoperative findings were treated with an arthroscopic arcromioplasty during the same procedure. For postoperative functional assessment we used the Constant score. After surgery the Constant score significantly improved. All patients who were treated by acromioplasty showed significant flattening of the bony configuration of the acromion. The x-ray review showed that none of the blurred calcific deposits regained sharper borders after operation and also that no transparent deposit was converted into a denser appearance after the procedure. Those patients with postoperative elimination or reduction of the calcific deposits had significantly better outcomes than those who had no radiographic change. Acromioplasty did not improve the results. The aim of arthroscopic treatment in calcific tendinitis is to remove the calcific deposit.

[How relevant are calculations of mean intracompartmental pressure in functional compartment syndrome?]. / Wie relevant sind Mittelwertbestimmungen des intrakompartmentellen Druckes beim funktionellen Kompartment-Syndrom?

The intracompartmental pressure in the anterior tibial compartment was documented under standardized conditions in 29 patients walking at a speed of 4.5 km/h, as well as heel-and-toe running at a speed of 8 km/h. All pressure curves were integrated and the resulting mean pressure was compared with the arithmetic mean pressure indicated in the literature. During walking, the difference between calculated and integrated pressures was between 80 and 140%. In the case of heel-and-toe running, the difference was between 80 and 165%. On the basis of these results, the calculation of the mean intracompartmental pressure recommended in the literature does not appear to be of any clinical relevance.

Comparison of surgical procedures for degenerative lumbar spinal stenosis: a meta-analysis of the literature from 1975 to 1995.

Therapy for spinal stenosis remains difficult. The possibilities for conservative management are limited and not satisfactory in the more severe cases. Various surgical procedures are possible, such as decompression, decompression and fusion without instrumentation and decompression and fusion with instrumentation. The aim of our meta-analysis was to compare the postoperative results of these three surgical techniques in the literature and, thus, to establish a treatment of choice for degenerative lumbar spinal stenosis. Via Medline, 30 articles met the inclusion criteria for our study, leading to a total number of 1668 cases being included in the meta-analysis. The evaluation was made according to our own definition of outcomes, based on criteria most commonly used in the studies reviewed. We found that in patients suffering degenerative spinal stenosis for up to 8 years, decompression without fusion showed the best results. For a duration of symptoms of 15 years or more, decompression with instrumented fusion had the best results. Analysing all postoperative outcomes, decompression is the surgical procedure with the highest rate of success and the fewest complications, followed by decompression with instrumented fusion. In surgery for degenerative lumbar spinal stenosis, decompression and fusion without instrumentation was the least successful procedure. As patients suffering from a degenerative spinal stenosis often are elderly, operations are risky and place a strain on them. This review of the literature shows that the least invasive surgical procedure can obtain the best results if the correct diagnosis is made and if the operation is carried out within the first years of the disease.

[Arthroscopic therapy of tendinitis calcarea--acromioplasty or removal of calcium?]. / Arthroskopische Therapie der Tendinitis calcarea--Akromioplastik oder Kalkentfernung?

In a retrospective analysis we evaluated 48 patients who had been arthroscopically treated for tendinitis calcarea. The calcific deposit was removed whenever possible and all patients were treated by arthroscopic subacromial decompression. In subjects who showed subacromial stenosis by X-ray or by intraoperative findings, an arthroscopic acromioplasty was performed. At follow-up all patients were evaluated according to the Constant score. Additionally all pre- and postoperative X-rays were reviewed. After surgery the Constant score significantly improved. In all cases where acromioplasty was performed, a flattening of the bony configuration was achieved. The X-ray analysis showed that no calcific deposit with blurred borders converted to sharp borders. There was also no deposit that converted from a transparent appearance to a dense structure. Patients with disappearance of the calcific deposit post-operatively had significantly better outcome than patients with no change in the X-ray. An additional acromioplasty did not improve the results. The aim of arthroscopic treatment of calcific tendinitis has to be the removal of the calcific deposit. Acromioplasty does not lead to further improvement to the result.

[Degradation of halothane, enflurane, and isoflurane by dry soda lime to give carbon monoxide]. / Zersetzung von Halothan, Enfluran und Isofluran an trockenem Atemkalk zu Kohlenmonoxid.

In the presence of completely dry soda lime volatile anaesthetics will decompose to carbon monoxide (CO). In an in vitro study, the absorbent (soda lime, ICI) was dried with a constant gas flow of 11/min oxygen for 120 h. The weight loss during the drying was 17.1%. Two vol% of halothane, enflurane or isoflurane in oxygen was administered with a constant flow of 0.51/min oxygen through the completely dry absorbent. Concentrations of gases were measured before and after the absorbent using mass spectrometry (MGA 1100, Perkin-Elmer) and an electrochemical NO monitor (Mini PAC CO, Dräger). The temperature inside the soda lime was monitored continuously. Shortly after adding the anaesthetic to the oxygen passing through the absorbent, carbon monoxide appeared in the outlet of the soda lime container. The measured peak concentrations varied around 450 ppm (halothane), 3500 ppm (enflurane) and 3800 ppm (isoflurane). The temperature inside the absorbent rose from the ambient temperature (19.8 degrees C) to a maximum of 52.1 degrees C during CO production and decreased when the CO production lowered after approximately 1 h (all anaesthetics). During CO production no measurable concentration of halothane left the absorber. After passing through the absorbent the concentrations of isoflurane and enflurane were slightly lower than the corresponding concentrations in the fresh gas measured before absorption.

[Critical assessment of indications for arthroscopic lateral release and medial tightening of the knee joint]. / Kritische Wertung der Indikationen zum arthroskopischen lateralen Release und medialer Raffung am Kniegelenk.

UNLABELLED: Based on the results of a retrospective study of 50 patients with mild lateral tracking and lateral compression of the patella (32 patients) and recurrent patellofemoral dislocation (18 patients), we present the technique, the results, the complications and the indications for the endoscopic lateral retinacular release and medial drawing tight of the capsule. The average age of the patients was 28.8 years (range: 10-53). At time of follow-up (m = 51 months) the patients were examined clinically as well as radiologically. The results were scored according to a score by Crosby and Insall. 73% of the patients with mild lateral tracking and lateral compression (lateral release) were satisfied with the operative results (visual analogue scale), as well as 66.6% of the patients with recurrent patellofemoral dislocation (lateral release and medial drawing tight of the capsule). Only 40% of the patients with patellofemoral arthritis (lateral release) reported about an improvement of this procedure. The score showed significantly good results but didn't raise the differences in between the groups of different indications. 28% of the patients showed an abnormal lateral tracking of the patella in active motion, the passive patella-glide-test (Hughston) raised a patella-hypermobility to the lateral side in 36% of the cases and to the medial side in 76%. X-rays of both knees showed an increased lateral patellofemoral angle of 10.8 degrees and an increased sulcus angle of 144 degrees. There was no progression in osteoarthritis in the operated side of the patellofemoral joint found. Complications revealed in a high number of hemarthrosis right after the operation, in 2 cases an open revision was necessary. CLINICAL RELEVANCE: According to our results patients with patella compression syndrome without patellofemoral arthritis and patients with recurrent luxation or subluxation of the patella are good candidates for endoscopic lateral release and eventually medial drawing tight of the capsule. In a young population the endoscopic lateral release is a relatively simple surgical procedure making an open technique in failed cases possible.

Evaluation of two electrochemical monitors for measurement of inhaled nitric oxide.

Inhaled in low concentrations, nitric oxide (NO) acts as a potent pulmonary vasodilator, but when inhaled in high concentrations NO and its metabolite NO2 are potentially toxic molecules. Thus, an accurate and reproducible measurement of both NO and NO2 is necessary, and changes in NO concentration need to be detected instantly to avoid lung damage (high concentrations) or failure of NO therapy (low concentrations; unnoticed interruption of NO supply). We investigated two electrochemical NO monitors (Sensor Stik 4586 and Dräger PAC II) for accuracy and time constants. Both provided accurate and reproducible results at different NO concentrations. Known NO concentrations (standards: 10, 50, 75 ppm) were detected within a 3% tolerance, and acceptable time constants were seen when NO concentration was abruptly increased from zero to 50 ppm. The display read the final value within 60 s with the Sensor Stik and 11 s with the Dräger PAC II. Significant differences were seen when the NO concentration was rapidly reduced from 50 ppm to zero. The Sensor Stik took more than 2 h to reach zero, whereas the PAC II took 60 s.

Osteoneogenesis and its influencing factors during treatment with the Ilizarov method.

The radiographs of 57 patients who had undergone 58 callus distractions and 13 epiphyseal distractions were evaluated. During the course of treatment, the density of the distraction areas on radiographs was measured in total and along the medial, lateral, ventral, and dorsal margins using a digital radiograph processing system. The densities of the whole distraction length were correlated to the following parameters: age of patient, start of distraction after corticotomy, mean distraction speed, mean amount of weight load during the period of distraction and consolidation, location of corticotomy (distal femoral metaphysis versus the proximal tibial one), and diclofenac medication. Except for the location of corticotomy and the diclofenac medication, the density was influenced by all these parameters. Age of the patient and weight load were the most important parameters. Patients with leg shortening caused by poliomyelitis and a patient with a shortened leg after amniotic strangulation showed a slower rise of the density trend curve on radiographs than the other patients. When comparing the different regional density curves, a significant gradual density decrease could be observed from the medial to the lateral side in the femur, from lateral to medial in the tibia, and from the dorsal to the ventral side in both bones. The respective differences between lateral and medial density, and between dorsal and ventral density, were significantly higher in cases of callus distraction than in cases in which epiphyseal distraction had been used. The amount of bone regeneration varied regionally primarily because of the inhomogeneous soft tissue covering of the bone and the impairment of its local blood supply by the surgical exposure for the corticotomy. The clinical relevancy of the various parameters for osteoneogenesis is discussed in this article.

[Patient-controlled analgesia with clonidine and piritramide]. / Patienten-kontrollierte Analgesie mit Clonidin und Piritramid.

UNLABELLED: Following parenteral administration, clonidine has analgesic effects at both cerebral and spinal levels. Patient-controlled analgesia (PCA) makes it possible to determine equipotent dosages of analgesics by relating analgesic consumption per time to the levels of analgesia obtained in comparable patient populations. Therefore, we studied the equipotency ratios of clonidine and piritramide and the incidence of undesired side effects in the treatment of postoperative pain in patients undergoing maxillo-facial surgery. METHODS: After approval of the local ethics committee and informed consent 40 patients (age > 18 year, ASA I-III) were studied. Following randomization, the patients each received a PCA device containing either clonidine (bolus 30 micrograms), or piritramide (bolus 1.5 mg) for treatment of postoperative pain (lockout interval 5 min in both groups). During the postoperative period, pain was determined using a visual analogue scale, while analgesic consumption, sedation, haemodynamic parameters, respiration rate, and the occurrence of undesired side effects were documented additionally. RESULTS: The groups had comparable distributions of biometric data, duration of anaesthesia, and ASA classification. Pain level decreased significantly (P < 0.0001) in both groups during the first 2 h of PCA. Mean arterial pressure and heart rate were lower (P < 0.05) in the clonidine group 4 and 6 h after PCA onset, while the degree of sedation after 2 (P < 0.01) and 6 (P < 0.05) h was higher than in the piritramide group. Nausea and vomiting were more frequent (P < 0.05) in the piritramide group. Both groups showed a wide interpatient variation in analgesic requirement. The equipotency ratio clonidine/piritramid was 1:63.7. CONCLUSION: Intravenous clonidine is a potent analgesic and is suitable or the treatment of postoperative pain following maxillo-facial surgery. The analgesic potency of 150 micrograms clonidine i.v. was equivalent to that of 9.56 mg piritramide i.v. Nausea and vomiting occurred more rarely in the clonidine group, while deeper sedation was observed more frequently than in the piritramide group. Owing to the wide interindividual variation of analgesic consumption, clonidine dosages have to be adjusted to the actual requirements.

[Osteoneogenesis in callus and epiphyseal distraction]. / Die Knochenneubildung bei der Kallus- und der Epiphysendistraktion.

X-rays were reviewed after callus distractions (50 cases) and distraction epiphysiolysis (10 cases) in 45 patients. With the aid of a computerized digitization system for analogue films, the relative x-ray density of the distraction area was determined in the medial, lateral, ventral and dorsal surface areas, and in the median line of the callus tissue. Bone formation became evident within 21.7 +/- 3.7 days post-distraction in the thigh and 25.4 +/- 4.9 days in the shank. The lowest density values were found at the end of the distraction phase followed by a continual increase in x-ray density in the fixation phase. There was a significant decrease in callus x-ray density in the shank from lateral to medial and from dorsal to ventral, and in the thigh from medial to lateral and from dorsal to ventral. When the corticotomized callus distraction is compared to the distraction epiphysiolysis without corticotomy it becomes apparent that the differences between lateral-medial x-ray densities and dorsal-ventral x-ray densities were significantly greater in the group with callus distraction. The deminished bone formation in the ventromedial area of the shank and the ventrolateral area of the thigh seems to be due to soft tissue damage and disturbances in local bone blood supply after the operative approach for corticotomy.

[Intraoperative thrombosis of the inferior vena cava]. / Intraoperative Thrombose der V. cava inferior.

A pre-term infant weighing 900 g, gestational age 25 weeks, developed an acute abdomen. Intravenous lines had been inserted previously in the left (silastic catheter) and right (24 G cannula) saphenous veins in the neonatal intensive care unit. During surgical exploration, a perforation of the terminal ileum was found. The operation consisted in partial resection of the perforated ileum with an end-to-end anastomosis and a double-lumen colostomy. Major blood loss during the procedure caused serious haemodynamic problems. Despite transfusion of erythrocyte (100 ml), thrombocytes (75 ml), and albumin (50 ml), the patient developed bradycardia and hypotension. Administration of atropine, adrenaline, and calcium i.v. had no effect. The operation could be finished only with extrathoracic resuscitation. When the drapes were removed, livid, swollen lower limbs raised the suspicion of an acute thrombosis of the inferior vena cava. After insertion of a 24 G i.v. cannula into a vein of the right upper arm, the circulation stabilised after rapid transfusion of 40 ml blood and 25 ml thrombocytes and resuscitation was successful. Paediatricians and anaesthesiologists must consider the risk of thrombosis of the vena cava. If venous lines in the lower limbs are not visible to the anaesthesiologist during the operation, venipuncture of veins of an upper limb is recommended before starting the surgical procedure. Due to the high incidence of vena cava thrombosis caused by central venous lines and the difficulty of peripheral venipuncture in pre-termintanty, a safe venous line should be inserted if necessary by pre-operative venesection.

[Arthroscopic resection of the shoulder joint (Mumford operation)]. / Arthroskopische Resektion des Schultergelenkes (Mumford-Operation).

Based on results of anatomical studies, we established an arthroscopic procedure to resect all degenerative changes within the joint without endangering the stabilizing structures. Since November 1989 we operated on 26 patients with this technique. There were no major complications. The mean score significantly increased from 64.9 (+/- 12.8) to 86.8 (+/- 11.5). Analysis of postoperative x rays revealed an average length of resection of 21.3 mm at the inferior border of the clavicle, of 15.4 mm in the middle, and of 10.2 mm at the superior border of the clavicle. 21 out of 26 patients were completely satisfied and would undergo the same procedure again. In two of the five unsatisfied patients the resected length of the clavicle was insufficient and these patients required open surgery for resection of the remaining bone. Our first experiences are encouraging. The surgical technique is standardized and reproducible. The short time results score not worse compared to the open conventional technique. With the 2 to 4 year long term follow up we have to prove, whether maintaining the passive stabilizers of the joint improves the long term results better than the open technique.