RESUMO
The medical councils (Ärztekammern) develop the contents of the further training regulations with the support of the specialist society. The hospitals with the training supervisors have to implement these contents for the trainees in continuing education and confirm the acquisition of competence for the individual tasks. Surveys of young surgeons in recent years have shown that many participants do not receive structured continuing education, so that there is general dissatisfaction. Therefore, the German Society for General and Visceral Surgery (DGAV) is required to provide assistance to its members to improve continuing education in the departments. For example, the DGAV organizes more than 100 surgical courses annually on all topics of visceral surgery, anatomy, skills courses and revision courses with the Further Education and Advanced Training Quality Center (WeiFoQ). This year a continuing education curriculum was developed over the 6year continuing education period, so that a structured continuing education is achievable. The contents of the continuing education regulations are included in this continuing education curriculum with explanations, video clips, and graphics, thus providing quick information on each individual surgical clinical picture. A digital surgical catalog provides a quick overview of the status of personal continuing education. It is planned to set up an interface to the eLogbook of the medical councils.
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Cirurgiões , Humanos , Currículo , Sociedades , Educação Continuada , Educação Médica ContinuadaRESUMO
BACKGROUND: During the coronavirus disease 2019 (COVID-19) pandemic the standard inpatient care of patients was restricted to increase overall and intensive care capacity reserves for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infected persons. OBJECTIVE: This article presents the impact of the COVID-19 pandemic on the surgical and postoperative care of bariatric patients in Germany. MATERIAL AND METHODS: A statistical analysis of the national StuDoQ/MBE register data for the period from 1 May 2018 until 31 May 2022 was performed. RESULTS: Throughout the entire study period there was a continuous increase in documented operations, which continued even during the COVID-19 pandemic. A significant intermittent decline in surgery performed was observed only during the imposition of first lockdown in the months of March to May 2020, with a minimum number of 194 cases performed monthly in April 2020. The pandemic had no measurable effect on the surgically treated patient population, the type of surgical procedure, the perioperative and postoperative outcomes and follow-up care. CONCLUSION: Based on the results of the StuDoQ data and the current literature, it can be deduced that bariatric surgery can be carried out with no increased risk during the COVID-19 pandemic and the quality of postoperative care is not impaired.
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Cirurgia Bariátrica , COVID-19 , Humanos , COVID-19/epidemiologia , COVID-19/etiologia , Pandemias , SARS-CoV-2 , Controle de Doenças Transmissíveis , Alemanha/epidemiologiaRESUMO
OBJECTIVES: Hepatocellular carcinoma (HCC) can be diagnosed non-invasively with contrast-enhanced ultrasound (CEUS) in cirrhosis if the characteristic pattern of arterial phase hyperenhancement followed by hypoenhancement is present. Recent studies suggest that diagnosis based on this "hyper-hypo" pattern needs further refinement. This study compares the diagnostic accuracies of standardized CEUS for HCC according to the current guideline definition and following the newly developed CEUS algorithms (CEUS LI-RADS®, ESCULAP) in a prospective multicenter real-life setting. METHODS: Cirrhotic patients with liver lesions on B-mode ultrasound were recruited prospectively from 04/2018 to 04/2019, and clinical and imaging data were collected. The CEUS standard included an additional examination point after 4-6 min in case of no washout after 3 min. The diagnostic accuracies of CEUS following the guidelines ("hyper-hypo" pattern), based on the examiner's subjective interpretation ("CEUS subjective"), and based on the CEUS algorithms ESCULAP and CEUS LI-RADS® were compared. RESULTS: In total, 470 cirrhotic patients were recruited in 43 centers. The final diagnosis was HCC in 378 cases (80.4%) according to the reference standard (histology 77.4%, MRI 16.4%, CT 6.2%). The "hyper-hypo" pattern yielded 74.3% sensitivity and 63% specificity. "CEUS subjective" showed a higher diagnostic accuracy (sensitivity, 91.5%; specificity, 67.4%; positive predictive value, 92%; negative predictive value, 66%). Sensitivity was higher for ESCULAP (95%) and "CEUS subjective" (91.5%) versus CEUS LI-RADS® (65.2%; p < 0.001). Specificity was highest for CEUS LI-RADS® (78.6%; p < 0.001). CONCLUSIONS: CEUS has an excellent diagnostic accuracy for the non-invasive diagnosis of HCC in cirrhosis. CEUS algorithms may be a helpful refinement of the "hyper-hypo" pattern defined by current HCC guidelines. KEY POINTS: ⢠Contrast-enhanced ultrasound (CEUS) has a high diagnostic accuracy for the non-invasive diagnosis of hepatocellular carcinoma (HCC) in cirrhosis. ⢠The CEUS algorithm ESCULAP (Erlanger Synopsis for Contrast-enhanced Ultrasound for Liver lesion Assessment in Patients at risk) showed the highest sensitivity, whereas the CEUS LI-RADS® (Contrast-Enhanced UltraSound Liver Imaging Reporting and Data System) algorithm yielded the highest specificity. ⢠A standardized CEUS examination procedure with an additional examination point in the late phase, after 4-6 min in lesions with no washout after 3 min, is vital.
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Carcinoma Hepatocelular , Neoplasias Hepáticas , Algoritmos , Carcinoma Hepatocelular/complicações , Carcinoma Hepatocelular/diagnóstico por imagem , Meios de Contraste , Humanos , Cirrose Hepática/complicações , Cirrose Hepática/diagnóstico por imagem , Neoplasias Hepáticas/complicações , Neoplasias Hepáticas/diagnóstico por imagem , Imageamento por Ressonância Magnética , Estudos Prospectivos , Estudos Retrospectivos , UltrassonografiaRESUMO
INTRODUCTION: Due to technological changes, working time restrictions and the creation of specialized centers, surgical training has changed. A competence-based learning technique of surgical skills is the sub-step practice approach, which has been proven important in nationwide opinion surveys. The aim of this prospective multi-center trial was to determine the status quo of the sub-step concept in Germany. METHODS: Over 6 months, the voluntarily participating centers evaluated the following index procedures: laparoscopic cholecystectomy (LCHE), laparoscopic and open sigmoid resection, minimally invasive inguinal hernia repair, thyroid resection and pylorus-preserving pancreaticoduodenectomy (PPPD). Patients with private insurance were excluded. The detailed sub-steps were documented as well as the reason why these were not performed. In addition, an online survey regarding the sub-step concept was performed before and after the study. RESULTS: In total, 21 centers included 2969 surgical procedures in 2018 for final analyses. While 24.4% of the procedures were performed by residents, sub-steps were performed in 22.2%. LCHE was most often performed completely by residents (43.3%), and PPPD revealed the highest rate of performed sub-steps (43.3%). Reasons for not assisting sub-steps to residents were often organizational and other reasons. After an initial increase, the number of performed sub-steps decreased significantly during the second half of the survey. The opinion survey revealed a high importance of the sub-step concept. The number of resident procedures was overestimated, and the number of performed sub-steps was underestimated. After the study, these estimations were more realistic. CONCLUSION: Even though the sub-step practice concept is considered highly important for surgical education, it needs to be put into practice more consequently. The current data suggest a low participation of surgical residents in the operating room, although the participating hospitals are most likely highly interested in surgical education, hence their voluntary participation. Conceptual changes and a control of surgical education are needed.
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Educação de Pós-Graduação em Medicina/métodos , Hérnia Inguinal/cirurgia , Internato e Residência , Adulto , Colecistectomia Laparoscópica/educação , Competência Clínica , Currículo , Feminino , Alemanha , Humanos , Laparoscopia/educação , Masculino , Salas Cirúrgicas , Estudos ProspectivosRESUMO
Algorithms are increasingly being developed on the basis of large data sets, also in the field of health, whether for predicting treatment outcomes or life-expectancy. In surgery it is also becoming increasingly more important to analyze complications at an early stage and to subsequently reduce them. The aim is to improve the quality of treatment and quality of life and thus to improve patient well-being. The German Society for General and Visceral Surgery (DGAV) has developed 12 StuDoQ registers in which pseudonymized data from a total of 150,000 patients are recorded. Risk models were developed and validated at the Institute for Medical Information Processing, Biometry and Epidemiology (IBE) of the Ludwig Maximilian University in Munich using the collected data from the StuDoQ|colon cancer and StuDoQ|rectal cancer registers. Based on the collected patient data, the risk calculator determines the statistical probability of the individual complication profile of the patient who is to undergo surgery. The aim is to support surgeons and patients in the decision making process for the individual procedure. The surgeon with his individual experience ultimately remains responsible for the patient.
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Algoritmos , Neoplasias Colorretais , Neoplasias Colorretais/cirurgia , Humanos , Participação do Paciente , Qualidade de Vida , Medição de RiscoRESUMO
PURPOSE: MTL is a composite outcome measure based on routine administrative data defined as (a) postoperative mortality and/or (b) postoperative transfer to another hospital and/or (c) length of hospital stay ≥ the prespecified time period. Aim of the present study was to investigate MTL for profiling hospitals on surgical performance in colorectal cancer surgery, using data from the national registers of the German Society of General and Visceral Surgery (DGAV) and to determine the time interval for length of stay with the highest accuracy regarding major complications (Clavien-Dindo grade ≥ 3). METHODS: All patients undergoing colorectal cancer resection between January 2010 and February 2017 were included. MTL rates were calculated and compared to well-established single outcome measures using multivariate regression analysis. For each outcome measure, postoperative complications were tested regarding their predictability. RESULTS: Data from 14,978 patients were analyzed. Length of stay was significantly prolonged if postoperative complications occurred (p < 0.0001). Thirty-day mortality and the indication for a transfer to another hospital mainly resulted from cardiopulmonary complications. MTL occurs significantly more often than any of the single-outcome parameters. The time interval of 22 days demonstrated the highest accuracy regarding severe complications (Clavien-Dindo grade ≥ 3). CONCLUSIONS: MTL reflects the complete spectrum of postoperative complications. Compared to individual surgical outcome parameters, MTL may have a better discriminatory power and is therefore suitable to mirror surgical quality. Because of its high accuracy regarding surgical major morbidity, 22 days is the best cut-off for length of stay within the German healthcare system.
Assuntos
Neoplasias Colorretais/cirurgia , Cirurgia Colorretal , Hospitais , Avaliação de Resultados em Cuidados de Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Tempo de Internação , Masculino , Pessoa de Meia-Idade , Morbidade , Complicações Pós-Operatórias/etiologia , Análise de Regressão , Adulto JovemRESUMO
An elimination diet (ED) followed by re-challenge has been the reference standard to diagnose adverse food reactions (AFR) in dogs, but can be challenging to conduct. This study investigated the accuracy of a saliva-based test for food-specific IgA and IgM and an ELISA serum test for food-specific IgE. Three groups of dogs were tested. Group 1 (n=11) included dogs with previously diagnosed and controlled AFR; group 2 (n=15) comprised dogs with allergic dermatitis at the beginning of their ED; and group 3 (n=16) was composed of clinically healthy research dogs. Saliva samples were collected from all groups and blood samples from group 1 and group 3. The results of clinical re-challenges with individual food components were compared with the test results. Specificity, sensitivity, positive and negative predictive values and likelihood ratios were determined. Forty-one dogs completed the study; one dog was lost to follow up. There was a total of 163 re-challenges. Sensitivity, positive predictive value and likelihood ratio, specificity, negative predictive value and likelihood ratios were unsatisfactory for both tests in most instances, except for IgM testing in group 2, which had moderate specificity. There was no clear difference in the number of positive reactions between the allergic dogs and healthy dogs from a research population. Based on these results, the saliva test for food specific IgA and IgM and the ELISA serum test for food specific IgE were not reliable to diagnose adverse food reactions in dogs. Until more data are available, elimination diets remain the reference standard in the diagnosis of this disease.
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Anticorpos/análise , Dieta/veterinária , Doenças do Cão/imunologia , Hipersensibilidade Alimentar/veterinária , Saliva/imunologia , Alérgenos , Animais , Dieta/efeitos adversos , Cães/imunologia , Hipersensibilidade Alimentar/imunologia , Imunoglobulina A/análise , Imunoglobulina E/sangue , Imunoglobulina M/análise , Sensibilidade e EspecificidadeRESUMO
A 46-year-old woman presented with acute abdominal pain in the right upper quadrant. Esophagogastroduodenoscopy revealed a duodenal stenosis within the horizontal part of the duodenum. Based on the findings of abdominal computed tomography (CT), endosonography, Doppler duplex sonography and angiography, the diagnosis of an aneurysm of a branch of the inferior pancreaticoduodenal artery was established. This arterial branch was part of a collateral circulation between the superior mesenteric artery and the proper hepatic artery caused by obturation of the celiac artery. The symptomatic duodenal stenosis was the result of a local hematoma due to prior rupture of an aneurysm. After successful coiling of the afferent vessels to the aneurysm follow-up examinations showed progredient resorption of the hematoma and the patient was free of complaints.
Assuntos
Dor Abdominal/etiologia , Dor Aguda/etiologia , Aneurisma Roto/complicações , Obstrução Duodenal/complicações , Duodeno/irrigação sanguínea , Pâncreas/irrigação sanguínea , Dor Abdominal/diagnóstico , Dor Abdominal/terapia , Aneurisma Roto/diagnóstico , Aneurisma Roto/terapia , Obstrução Duodenal/diagnóstico , Embolização Terapêutica , Feminino , Hematoma/complicações , Hematoma/diagnóstico , Hematoma/terapia , Humanos , Pessoa de Meia-IdadeRESUMO
An expert committee was appointed by the German Society for General and Visceral Surgery to develop a panel of appropriate quality indicators to collate the quality of results, indications and structure in metabolic and bariatric surgery. This entailed assimilating the available evidence (systematic literature search), results from the national registry of the society (StuDoQ|MBE) and specific socioeconomic aspects (e. g. severely limited access to metabolic and bariatric surgery in Germany). These quality parameters were to be incorporated into the national guidelines and the rules of procedure for certification in the future. The committee concluded that mortality, MTL30 and severe complications needing intervention (Clavien-Dindo ≥ 3b) are suitable indicators to measure surgical outcome quality due to their relevance, scientific soundness and practicability. As a systematic follow-up is mandatory after bariatric surgery, a minimum follow-up quota is now required using reported quality of life data as an indicator of process quality. As intestinal bypass procedures have been shown to be superior in the treatment of type 2 diabetes, these procedures should be offered to eligible patients and also be performed. The proposed threshold values based on the results of the available literature and StuDoQ registry are to be considered as preliminary and need to be validated and adjusted if necessary in the future. The StuDoQ|MBE is considered a valuable tool to gather this information and also represents the appropriate infrastructure for the collation of relevant risk adjustors.
Assuntos
Cirurgia Bariátrica , Diabetes Mellitus Tipo 2 , Indicadores de Qualidade em Assistência à Saúde , Cirurgia Bariátrica/normas , Confiabilidade dos Dados , Alemanha , Humanos , Qualidade de VidaRESUMO
The definition of valid quality indicators is an essential task of medical self-administration and quality assurance. Based on the literature and the results of the Study, Documentation, and Quality Center (StuDoQ) Rectal Cancer Registry, we suggest the following QIs: rate of circumferential resection margin (CRM) positive resected material, rate of anastomotic leak in patients with anastomoses, rate of abdominal wound healing disorders and rate of patients with newly established permanent urinary diversion. Additionally, a new marker, the MTL30, which subsumes patient death within 30 days after the index operation, patient transfer to another acute hospital within 30 days after the index operation or a length of inpatient hospital stay of more than 30 days.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório , Indicadores de Qualidade em Assistência à Saúde , Sistema de Registros , Fístula Anastomótica , Procedimentos Cirúrgicos do Sistema Digestório/normas , Medicina Baseada em Evidências , Humanos , Tempo de Internação , Reto , Resultado do TratamentoRESUMO
BACKGROUND: Quality assessment in surgery is gaining in importance. Although sporadic recommendations for quality indicators (QI) in oncological colon surgery can be found in the literature, these are usually not systematically derived from a solid evidence base. Moreover, reference ranges for QI are unknown. OBJECTIVE: The aim of this initiative was the development of evidence-based QI for oncological colon resections by an expert panel invited by the German Society of General and Visceral Surgery (DGAV). Reference ranges from the literature and reference values from the Study, Documentation, and Quality Center (StuDoQ)|Colon Cancer Register were compared in order to deduce recommendations which are tailored to the German healthcare system. RESULTS: Based on the most recent scientific evidence and agreed by expert consensus, five QI for oncological colon surgery were defined and evaluated according to the QUALIFY tool. Mortality, MTL30 (mortality, transfer to another acute care hospital, or length of stay ≥30 days), anastomotic leakage requiring reintervention, surgical site infections necessitating reopening of the wound and ≥12 lymph nodes in the specimen qualified as QI owing to their relevance, scientific nature, and practicability. Based on the results of the systematic literature search and the statistical analysis of the StuDoQ|Colon Cancer Register, preliminary reference values are proposed for each QI. CONCLUSION: The presented set of QI seems appropriate for quality assessment of oncological colon surgery in the context of the German healthcare system. The validity of the QI and the reference values must be reviewed within the framework of their implementation. The StuDoQ|Colon Cancer Register provides a suitable infrastructure for collecting clinical data for quality assessment and risk adjustment.
Assuntos
Neoplasias do Colo , Procedimentos Cirúrgicos do Sistema Digestório , Indicadores de Qualidade em Assistência à Saúde , Neoplasias do Colo/cirurgia , Confiabilidade dos Dados , Atenção à Saúde , Procedimentos Cirúrgicos do Sistema Digestório/normas , Medicina Baseada em Evidências , HumanosRESUMO
Pregnancy-associated malaria (PAM) poses a threat to both the mother and fetus, increasing the risk of severe maternal anemia, fetal growth restriction and low birth weight infants. Two vaccines are currently in development to protect women from Plasmodium falciparum in pregnancy. Both vaccine constructs target the ID1-DBL2X domain of VAR2CSA, a protein expressed on the surface of infected erythrocytes (IEs) that mediates parasite sequestration in the placenta. Although development of an effective vaccine may be hampered by ID1-DBL2X polymorphisms expressed by field isolates, a recent study showed that genetic variation of this domain in South American parasite populations is much lower than in other geographical locations. This suggests that a recombinant vaccine designed to be efficacious in Africa and Asia is likely to be efficacious in South America. However, these studies did not include Colombian parasite populations in their analyses, which are known to be genetically distinct from other South American parasite populations due to their independent introduction from Africa. Therefore, we sought to determine the genetic variation of the ID1-DBL2X domain in Colombian parasites to assess the potential efficacy of the vaccine against PAM in this region. Through sequence analysis and population genetics, we show that there is a low degree of genetic variation amongst Colombian parasite populations and that a vaccine containing conserved antigen variants for worldwide populations is likely to be protective against PAM in Colombia. Our analysis also points towards an African origin for Colombian parasite populations, and suggests that their introduction into Colombia was a recurrent process encompassing multiple introduction events.
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Variação Genética , Vacinas Antimaláricas/imunologia , Malária Falciparum/imunologia , Malária Falciparum/parasitologia , Plasmodium falciparum/genética , Plasmodium falciparum/imunologia , Adolescente , Adulto , Anticorpos Antiprotozoários/imunologia , Criança , Colômbia , Feminino , Genética Populacional , Genótipo , Humanos , Malária Falciparum/prevenção & controle , Pessoa de Meia-Idade , Testes de Neutralização , Filogenia , Plasmodium falciparum/classificação , Gravidez , Complicações Parasitárias na Gravidez/imunologia , Complicações Parasitárias na Gravidez/parasitologia , Complicações Parasitárias na Gravidez/prevenção & controle , Proteínas de Protozoários/imunologia , Adulto JovemRESUMO
From a sociopolitical aspect there is increasing interest in the quality of healthcare. In this context valid, reproducible, comparable and risk-adjustable markers that are easily identified have become crucial for consistent documentation of quality. We recommend MTL30 (mortality, transfer, length of stay) as one of these markers to consistently measure the quality of large visceral surgical interventions. The MTL30 subsumes a number of known markers that may help to predict postoperative complications. The MTL30 is considered to be fulfilled when a patient on the 30th day following surgery, a) has died b) is still in the hospital or c) has been transferred to another acute care hospital. The evaluation of the StuDoQ register of the German Society for General and Visceral Surgery (DGAV) shows that MTL30 occurs significantly more often than any of the individual parameters. The correlation between MTL30 and other patient-specific risk factors, e.g. American Society of Anesthesiologists classification (ASA), age, etc. enables a risk adjustment.
Assuntos
Biomarcadores , Cirurgia Geral/normas , Garantia da Qualidade dos Cuidados de Saúde/normas , Sistema de Registros , Sociedades Médicas , Procedimentos Cirúrgicos Operatórios/normas , Vísceras/cirurgia , Alemanha , Mortalidade Hospitalar , Humanos , Tempo de Internação/estatística & dados numéricos , Transferência de Pacientes/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/mortalidadeRESUMO
Cytosine-phosphate-guanine oligodeoxynucleotides (CpG ODN) are a promising new immunotherapeutic treatment option for canine atopic dermatitis (AD). The aim of this uncontrolled pilot study was to evaluate clinical and immunological effects of gelatine nanoparticle (GNP)-bound CpG ODN (CpG GNP) on atopic dogs. Eighteen dogs with AD were treated for 8 weeks (group 1, n=8) or 18â weeks (group 2, n=10). Before inclusion and after 2 weeks, 4 weeks, 6 weeks (group 1+2), 8 weeks, 12 weeks and 16â weeks (group 2) 75â µg CpG ODN/dog (bound to 1.5â mg GNP) were injected subcutaneously. Pruritus was evaluated daily by the owner. Lesions were evaluated and serum concentrations and mRNA expressions of interferon-γ, tumour necrosis factor-α, transforming growth factor-ß, interleukin (IL) 10 and IL-4 (only mRNA expression) were determined at inclusion and after 8 weeks (group 1+2) and 18â weeks (group 2). Lesions and pruritus improved significantly from baseline to week 8. Mean improvements from baseline to week 18 were 23 per cent and 44 per cent for lesions and pruritus, respectively, an improvement of ≥50 per cent was seen in six out of nine and three out of six dogs, respectively. IL-4 mRNA expression decreased significantly. The results of this study show a clinical improvement of canine AD with CpG GNP comparable to allergen immunotherapy. Controlled studies are needed to confirm these findings.
Assuntos
Dermatite Atópica/veterinária , Doenças do Cão/terapia , Gelatina/química , Imunoterapia/veterinária , Nanopartículas , Oligodesoxirribonucleotídeos/uso terapêutico , Animais , Dermatite Atópica/terapia , Cães , Feminino , Imunoterapia/métodos , Masculino , Projetos Piloto , Prurido/prevenção & controle , Prurido/veterinária , Resultado do TratamentoRESUMO
We report the case of a 76-year old female patient with a hepatic mass after staying in eastern Turkey. There were no indices for malignancy or an infection with Echinococcus or Entamoeba histolytica. Finally we diagnosed a Fascioliasis (liver fluke) and cured the patient successfully.
Assuntos
Fasciola hepatica , Fasciolíase/diagnóstico , Febre/parasitologia , Viagem , Idoso , Animais , Entamoeba histolytica , Feminino , Humanos , TurquiaRESUMO
AIMS: We aimed to quantify the relative contributions of the medial femoral circumflex artery (MFCA) and lateral femoral circumflex artery (LFCA) to the arterial supply of the head and neck of the femur. MATERIALS AND METHODS: We acquired ten cadaveric pelvises. In each of these, one hip was randomly assigned as experimental and the other as a matched control. The MFCA and LFCA were cannulated bilaterally. The hips were designated LFCA-experimental or MFCA-experimental and underwent quantitative MRI using a 2 mm slice thickness before and after injection of MRI-contrast diluted 3:1 with saline (15 ml Gd-DTPA) into either the LFCA or MFCA. The contralateral control hips had 15 ml of contrast solution injected into the root of each artery. Next, the MFCA and LFCA were injected with a mixture of polyurethane and barium sulfate (33%) and their extra-and intra-arterial course identified by CT imaging and dissection. RESULTS: The MFCA made a greater contribution than the LFCA to the vascularity of the femoral head (MFCA 82%, LFCA 18%) and neck (MFCA 67%, LFCA 33%). However, the LFCA supplied 48% of the anteroinferior femoral neck overall. CONCLUSION: This study clearly shows that the MFCA is the major arterial supply to the femoral head and neck. Despite this, the LFCA supplies almost half the anteroinferior aspect of the femoral neck. Cite this article: Bone Joint J 2016;98-B:1582-8.
Assuntos
Artéria Femoral/anatomia & histologia , Cabeça do Fêmur/irrigação sanguínea , Colo do Fêmur/irrigação sanguínea , Adulto , Idoso , Cadáver , Meios de Contraste , Dissecação/métodos , Feminino , Artéria Femoral/diagnóstico por imagem , Cabeça do Fêmur/diagnóstico por imagem , Colo do Fêmur/diagnóstico por imagem , Gadolínio DTPA , Humanos , Imageamento por Ressonância Magnética/métodos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Tomografia Computadorizada por Raios X/métodosRESUMO
BACKGROUND: The purpose of surgical literature is to publish the latest study results and to provide continuing medical education to readers. For optimal allocation of resources, institutional subscribers, professional societies and scientific publishers require structured data on reading and subscription preferences of potential readers of surgical literature. OBJECTIVES: To obtain representative data on the preferences of German general and visceral surgeons regarding reading of and subscription to scientific journals. MATERIAL AND METHODS: All members of the German Society for General and Visceral Surgery (DGAV) were invited to participate in a web-based survey. Questions were asked on the affiliation and position of the member, individual journal subscriptions, institutional access to scientific journals, preferences regarding electronic or print articles and special subscriptions for society members. Answers were descriptively analyzed. RESULTS: A total of 630 out of 4091 (15 %) members participated in the survey and 73 % of the respondents had at least 1 individual subscription to a scientific journal. The most frequently subscribed journal was Der Chirurg (47 % of respondents). The institutional access to journals was deemed insufficient by 48 % of respondents, predominantly in primary care hospitals and outpatient clinics. Almost half of the respondents gave sufficient importance to reading printed versions of articles for which they would pay extra fees. A group subscription for society members was perceived as advantageous as long as no relevant extra costs were incurred. CONCLUSION: This structured survey among members of the DGAV provides data on preferences regarding reading of and subscription to scientific journals. Individual subscriptions to journals are still common, possibly due to suboptimal institutional access particularly at smaller non-academic institutions. In an age of online publications it seems surprising that many respondents place a high value on printed versions. The results are relevant for potential institutional subscribers, professional societies and scientific publishers.
Assuntos
Procedimentos Cirúrgicos do Sistema Digestório/educação , Educação Médica Continuada/estatística & dados numéricos , Cirurgia Geral/educação , Publicações Periódicas como Assunto/provisão & distribuição , Publicações Periódicas como Assunto/estatística & dados numéricos , Leitura , Sociedades Médicas , Vísceras/cirurgia , Alemanha , Humanos , Internet , Sociedades Médicas/estatística & dados numéricos , Inquéritos e QuestionáriosRESUMO
This study investigates and defines the topographic anatomy of the medial femoral circumflex artery (MFCA) terminal branches supplying the femoral head (FH). Gross dissection of 14 fresh-frozen cadaveric hips was undertaken to determine the extra and intracapsular course of the MFCA's terminal branches. A constant branch arising from the transverse MFCA (inferior retinacular artery; IRA) penetrates the capsule at the level of the anteroinferior neck, then courses obliquely within the fibrous prolongation of the capsule wall (inferior retinacula of Weitbrecht), elevated from the neck, to the posteroinferior femoral head-neck junction. This vessel has a mean of five (three to nine) terminal branches, of which the majority penetrate posteriorly. Branches from the ascending MFCA entered the femoral capsular attachment posteriorly, running deep to the synovium, through the neck, and terminating in two branches. The deep MFCA penetrates the posterosuperior femoral capsular. Once intracapsular, it divides into a mean of six (four to nine) terminal branches running deep to the synovium, within the superior retinacula of Weitbrecht of which 80% are posterior. Our study defines the exact anatomical location of the vessels, arising from the MFCA and supplying the FH. The IRA is in an elevated position from the femoral neck and may be protected from injury during fracture of the femoral neck. We present vascular 'danger zones' that may help avoid iatrogenic vascular injury during surgical interventions about the hip.