Sedierungsverfahren: State of the Art

The tendency towards outpatient performance of even complex, long-lasting surgical and implantation interventions and also the wishes of patients for alternatives to local anesthesia have contributed to an increasing importance of sedation procedures as a supplement to local anesthesia in operative oral and maxillofacial medicine. European and international guidelines and curricula on the administration of sedative measures by non-anesthetists define criteria by which operator sedation procedures must be carried out. These include prerequisites for the necessary apparatus and technical equipment, treatment protocols as well as selection and exclusion criteria for safely carrying out parenteral sedation. In this article the current treatment standards are described taking the most recent publications into consideration.     

Intravesical Gemcitabine: State of the Art

Intravesical gemcitabine has been tested in several phase 1 studies. The 2000-mg dose of gemcitabine in 50 or 100 ml normal saline when administered intravesically for up to 2 h once a week for 6 wk has unremarkable systemic and local side effects; therefore, this schedule should be considered the most convenient.Phase 2 studies have assessed the activity of intravesical gemcitabine on a marker lesion in intermediate-risk superficial bladder cancers (SBCs), showing complete responses in up to 60% of cases. Few attempts have been made to test the activity of intravesical gemcitabine in high-risk SBC, achieving unexpected complete responses in carcinoma in situ refractory to Bacillus Calmette-Guérin. Initial trials have also documented “clinically relevant” responses in prophylaxis.The current level of evidence indicates that gemcitabine possesses clinical activity, but further confirmation is awaited from additional exploratory phase 2 and, preferably, phase 3 trials.     

Robotic Endocrine Surgery: State of the Art

Over the last decade, developments in technology have led a rapid progress in robotic endocrine surgery applications. Robotics is attractive to the surgeon because of the three-dimensional image quality, articulating instruments, and stable surgical platform. Safety and effectiveness of robotic adrenalectomy and thyroidectomy have been shown in many studies. While these robotic procedures offer better ergonomics for the surgeon, they provide similar outcomes compared to the laparoscopic approach for adrenalectomy and better cosmetic results versus the conventional option for thyroidectomy. Recently, while the robotic approach for adrenalectomy has been popularized, enthusiasm for robotic thyroidectomy has decreased. In the present review we aim to describe emerging robotic procedures and review the literature regarding outcomes.     

Surgery for Pancreatic Carcinoma: State of the Art

Carcinoma of the pancreas remains a malignancy with a generally dismal outcome owing to the delayed presentation of the disease. To date, surgery affords the best outcomes when a complete resection can be achieved. Improvements in imaging, surgical techniques and adjuvant therapies are perceived advancements in the management of this cancer. This article reviews the latest evidence in terms of the diagnosis and management of pancreatic cancer.     

Anterior Cruciate Ligament Reconstruction: State of the Art

Abstract The rupture of the Anterior cruciate ligament (ACL) belongs to the most common ligament injuries of the human knee joint. ACL rupture results in an increased anterior translation and internal rotation of the tibia. Untreated knee instability causes a disintegration of the roll and sliding movement and a high incidence of secondary meniscus and chondral damages with consecutive or advanced arthritic changes. For deciding on a conservative or operative therapy, it is necessary to develop a high-risk profile. Elderly, inactive patients without instability symptoms can be treated conservatively; younger, active people and complex ligament injuries should receive an ACL replacement. The goal is to eliminate instability by maintaining the physiological kinematics of the knee. Anterior cruciate ligament may be reconstructed arthroscopically assisted by autologous tendons. Predominantly, hamstring- and bone-patellar-tendon grafts are used. No significant differences in knee laxity, clinically and functionally, were observed between both grafts. Various reconstruction techniques, single- or double-bundle techniques, were described. Successful replacement depends on a correct tunnel placement and reconstruction of the physiological band tension, a sufficient mechanical stability of fixation, an impingement-free range of motion and an adequate rehabilitation. A high degree of patient satisfaction in clinical and functional outcome could be evaluated.     

Deep Vein Thrombosis Prophylaxis: State of the Art

The selection of a prophylaxis regimen to prevent symptomatic pulmonary embolism and deep vein thrombosis is a balance between efficacy and safety. The latest American Academy of Orthopaedic Surgeons guideline recommended that either chemoprophylaxis or mechanical prophylaxis be used after total joint arthroplasty but did not recommend specific agents. However, the latest evidence-based American College of Chest Physicians guideline recommended a variety of chemoprophylaxis and mechanical agents for a minimum of 10 to 14 days after total joint arthroplasty. Risk stratification is the key to the selection of the appropriate prophylaxis regimen for the individual patient, but the optimal risk stratification protocol still needs to be developed.     

Colorectal Liver Metastases: State of the Art Imaging

Colorectal cancer is a leading cause of death with mortality determined predominately by metastatic involvement of the liver. Treatment of liver metastases continues to evolve and imaging plays an essential role in initial staging, preoperative planning, and treatment monitoring. This review article discusses the current role of imaging in the management of patients with colorectal liver metastases. Particular challenges such as hepatic steatosis, disappearing metastases, and following treated lesions are addressed.     

胰腺移植和胰岛移植的现状

糖尿病是临床常见病 ,据推测至 2 0 10年全球糖尿病患者预计将超过 3 .5亿 ,其中 5 %～ 10 %的患者将因糖尿病晚期出现的糖尿病肾病、视网膜病变、微血管病变和神经末梢病变等并发症而直接影响生命 ,因此糖尿病及其并发症作为一项重要而艰巨的课题仍然困扰着广大医务工作者。胰腺移植和胰岛移植能增加患者胰岛素分泌细胞 ,从而有效地控制血糖 ,防止和改善糖尿病的并发症 ,提高生活质量 ,是治疗胰岛素依赖性糖尿病 (IDDM )的有效手段[1,2 ] 。现就胰腺移植和胰岛移植的现状综述如下。1　胰腺移植的现状自 1966年 12月Kelly等[3 ] 实施了首…