[The "value" of the medical documentation assistant in trauma surgery]. / "Wert" des medizinischen Dokumentationsassistenten in der Unfallchirurgie.

BACKGROUND: Five years after implementation of a medical documentation assistant (MDA) as a pilot project in our trauma department, this paper examines the results. METHODS: We evaluate practice and integration in our daily ward/department work. The measurable parameter or "value" of the MDA is the settlement reserve demonstrated as the cost weight (CW) for better demonstration of performance. RESULTS: The MDA is now an essential part of the daily routine in our department. In addition to the advisory function in codifying medical services, relevant secondary diagnoses are documented and clinical progress is checked to identify additional profitable services. We thus achieve an average additional monthly CW benefit of 11.4046. We have not yet assessed the improved documentation of medical records, which is especially important when checked by the medical service of the health fund. Furthermore, half of the hours of one doctor can thus be saved and therefore used for proper medical activities every day.

[A new possibility for determining the size and position of the tricortical bone graft in ventral spine stabilisation]. / Eine neue Möglichkeit der Grössen- und Lagebestimmung trikortikaler Späne bei der ventralen Wirbelsäulenfrakturversorgung.

AIM: Ventral stabilisation of thoracolumbar fractures is often done with autogenous iliac crest grafts as an alternative to other filling and stabilisation systems. Today the golden standard for this kind of reconstruction is the minimally invasive thoracoscopic stabilization. Often there was a problem with the determination of the size and the position of the graft, especially on video-assisted minimally invasive stabilisation. The aim of this study was now to develop a new instrument that would be able to minimise this kind of intraoperative problems. METHOD: For measuring and for checking the exact position of the bone graft the vertebrometer as a new measuring apparatus was developed. With the simple and good handling of the vertebrometer, there is an easy possibility of determine the size and the position of the graft. As this tool is made of metal, it is possible to localise and to check the positioning and the right size of the necessary bone graft during the intraoperative radiological control. DISCUSSION: This tool may help to improve the prognosis of osseous integration of the implanted material and lower the rate of pseudarthrosis. Furthermore, the handling of the thoracoscopic ventral stabilisation may be somewhat easier and, even for the inexperienced surgeon, there is now an instrument available to fit in the graft with a satisfactory result.

[An X-ray appliance for postoperative control of osteosynthesis with locking plate in patients with distal fracture of the radius]. / Anwendung einer Röntgenvorrichtung zur postoperativen Kontrolle der distalen Radiusfraktur nach winkelstabiler Plattenosteosynthese.

PURPOSE: A possible complication in regard to osteosynthetic treatment of a lower radius fracture with a locking plate is perforation of the articular surface by screws or a malpositioned ulnar fragment. In order to create good conditions for a homogeneous, reproducible X-ray picture for post-operative imaging control, an appliance for the production of standardised X-ray views has been devised. MATERIALS AND METHODS: The X-ray device was constructed at an angle of 20 degrees to the camera. The arm was positioned on the appliance in the side beam path, in shoulder adduction as well as in the dp-beam in 90 degrees abduction of the shoulder. RESULTS: Through standardisation of the X-ray technique the appliance it is able to supply comparable and reproducible X-ray images. In practice, the representation of both the joint gap and the bolt in the resulting image could be improved. CONCLUSIONS: Better and comparable picture series can be created by standardisation of the imaging technique using this X-ray device.

[Idiopathic dilatation of the large intestine (Ogilvie syndrome--acute pseudo-obstruction)]. / Idiopathische Dickdarmdilatation ("Ogilvie-Syndrom"--"Akute Pseudoobstruktion").

Acute colonic pseudo-obstruction (Ogilvie's syndrome) is characterized by abdominal distention and massive colonic dilatation without any mechanical cause of obstruction. We have reviewed the records of 57 patients, 36 men and 21 women (median age 65.4 y), from 1/1992 to 12/1996, with a colonic pseudo-obstruction, defined as dilatation of at least 10 cm on plain abdominal x-ray. 38 cases (66.5%) followed surgery or trauma and 19 (33.5%) developed symptoms during severe medical illness. 36 cases (63.2%) got i.v. narcotics prior to development of Ogilvie's syndrome. 4 patients underwent conservative treatment alone, 53 patients (93%) had endoscopic decompression with a decompression tube placed in 49 (86%). Due to 2 failures and 2 complications of endoscopic treatment (one ischemic lesion, one perforation; complication rate 3.8%) 4/53 patients had to be operated (7.5%). Clinical success of endoscopic treatment was 88.6% at first attempt and 92.5% at second attempt. General complications tended to be severe, according to the concomitant diseases (morbidity 35%); overall hospital mortality was 21% (12/57). In conclusion, we believe that endoscopic decompression and tube placement is effective and safe for acute colonic pseudo-obstruction not responding to 24 hour conservative treatment.