Christoph Czermak

Rapidly fatal necrotizing fasciitis after aesthetic liposuction.

Abstract. Necrotizing fasciitis (NF) is a rapidly progressive soft tissue infection involving primarily the superficial fascia and subcutaneous tissue. The disease is caused by Streptococcus pyogenes or synergistic infection of anaerobic and facultative anaerobic bacteria. Further characteristics are severe, intolerable pain and a mortality rate of 30 to 50%. The NF can be initiated after surgical procedures, minor trauma, trivial scratches, in the setting of a chronic wound, or even in apparently intact skin. The age of the patient is not relevant for the prognosis of NF. As it is shown in this reported case, a young and previously healthy patient died after aesthetic liposuction in the course of a NF. Necrotizing fasciitis is a rare disease, therefore, it is important to review its diagnostic and clinical features, because only early diagnosis and prompt, radical surgery improves the survival rate.

Transcardiopulmonary thermal dye versus single thermodilution methods for assessment of intrathoracic blood volume and extravascular lung water in major burn resuscitation

The purpose of this study was to compare the approximated values for intrathoracic blood volume (ITBV) and extravascular lung water (EVLW) obtained from a single indicator dilution to the exact data measured by double-indicator dilution. Eighteen patients with an average TBSA of 46.3% (range, 26 to 67%) and an average abbreviated burn severity index of 8.7 (range, 7 to 11) were included into a intraindividual comparative prospective study over a 20-month period. The COLD Z-021 system (Pulsion Medical Systems, Munich, Germany) was used to obtain both the exact measurements, as well as the estimated values for ITBV and EVLW. Two hundred ninety intraindividually comparative measurements were performed during the first 4 days after the burn injury. A good correlation between both techniques was shown for ITBVI (0.77; P <.01) for the overall measurements. However, the overall bias demonstrated a standard deviation higher than the mean value (-87.4 +/- 136 ml/m2), and precision for the estimated values for ITBVI was poor (-491 to 783 ml/m2). Additional analyses demonstrated a poor but significant correlation for low states of ITBV (r =.37; P <.01), but no significant correlations were found between the techniques for normal and high ITBV states. Thus, the approximated ITBV obtained from single thermodilution should not be used to guide volume therapy in major burn resuscitation. Furthermore, the EVLW is neither suitable for diagnostic use nor for therapeutic decisions because it is calculated on the basis of the poorly estimated values for ITBV in single thermodilution. Transcardiopulmonary single thermodilution is not suitable to assess intrathoracic blood volume and extravascular lung water in burn shock. However, the method is suitable to assess cardiac output and its derived parameters in burn resuscitation as shown in previous studies. It still must be proven whether the exactly measured ITBV obtained from transcardiopulmonary double-indicator dilution is superior to the commonly used parameters to guide major burn resuscitation.

Surgical correction of pterygium colli

BACKGROUND/PURPOSE Webbing of the neck is a deformity seen in various syndromes, including Turners, Klippel-Feil, or Escobar-Syndrome. There is little information in literature to provide the surgeon with treatment options for these children. We reviewed our experience with the surgical correction of pterygium colli deformity in eleven patients. METHODS A retrospective review was conducted on all patients that underwent surgical correction of pterygium colli deformity within the last 8 years. Data recorded included patient demographics, diagnostic evaluation, surgical treatment, complications, and outcome. RESULTS Eleven patients underwent an operation to correct pterygium colli deformity. Six patients had z-plasties, and three patients underwent bilateral excision of an ellipsoid portion of skin and closure via unilateral advancement flaps. We later modified our technique to combine the unilateral advancement flap with Z-Plasties. The mean age at operation was 10.7 years (range 2-23 years). No postoperative wound infections occurred. Mild recurrence of webbing was found in one case. In four patients we found mild to moderate hypertrophic scarring. Average overall content was 7.8 (scale of 0-10, 10 being total content), and all patients, respectively their parents, would undergo the surgery again. Mean length of follow-up was 28.3 months. CONCLUSION Our study shows that overall patient satisfaction is very high, but an accurate preoperative planning with the patient and parents and an honest discussion of all questions and concerns raised by the parents are essential.

Handchirurgische Verletzungen@@@Injuries to the hand: Elektronische Dokumentation durch semantische Netze@@@Electronic documentation with semantic networks

ZusammenfassungEine effiziente medizinische Dokumentation ist für eine traumatologisch ausgerichtete Klinik unter DRG-Bedingungen obligat. Insbesondere in der Handchirurgie besteht aufgrund der Vielzahl von Klassifikationen im Bereich Diagnostik und Therapie ein hoher Differenzierungsbedarf für die klinische Dokumentation. Die Entwicklung eines Werkzeugs, welches im klinischen Prozess die Definition von medizinischen Geschäftsvorgängen vornimmt und gleichzeitig daraus klinische und administrative Informationen erzeugt, war Gegenstand des vorgestellten Entwicklungsprojekts. Durch die Nutzung einer Standardterminologie, innovativer semantischer Netze und einer völlig neuartigen grafischen Dokumentationsoberfläche konnte erfolgreich ein auf die Handchirurgie abgestimmtes Werkzeug entwickelt werden, welches es einer Klinik erlaubt, mit einer einmaligen Datenerfassung in der nötigen wissenschaftlichen Differenziertheit zu dokumentieren und gleichzeitig die DRG-, QS- und BG-erlösrelevanten Merkmale zu erzeugen. Damit steht ein Werkzeug zur Verfügung, das sowohl für den administrativen Bereich eine einfache Datenerfassung ermöglichen kann als auch zukünftig die Plattform für vielfältige Zwecke der klinischen Abbildung und BG-Dokumentation bietet.AbstractEfficient medical documentation is mandatory for any trauma-oriented department in the DRG environment. Especially in hand surgery, a sophisticated and thoroughgoing system of clinical documentation is essential in view of the wide variety of classification systems used in diagnosis and therapy. The development of a software tool that defines administrative/business processes and simultaneously generates clinical and administrative information from them was the goal of this project. The application of standard medical terminology, an innovative semantic network, and a completely new graphic user interface made it possible to develop and introduce a software program specifically tailored to hand surgery. With this program it is possible for the first time to acquire clinically relevant scientific data and simultaneously to generate from it information relating to DRG, quality assurance and administration insofar as it is relevant to the hospital’s revenues. This provides us with an instrument that can not only allow simple data acquisition for the administrative sector, but also, in the future, provide the platform for multiple uses of clinical data and for insurance companies’ documentation.