Biomedical subjects
Publications and source records attributed to J Horntrich.
30 years ago we began with systematical recording of dates from the main operation groups as cholelithiasis, gastroduodenal ulcer, goitre and appendicitis. This was followed by a regularly internal proving of this dates. A voluntary comparative audit was done between the 14 departments in the district. Besides surgical aspects there were also respected organisation and efficiency.
Although the term hierarchy isn't in keeping with the times for secular spheres, the identical term ranking omnipresent and indispensable in a political way. Without ranking there ist no final but only a general responsibility. Ranking is based on authority--to be distinguished between professional competence an official authority. The latter one should be gained with inner agreement--by sanctions only when needed.
Between January 1st, 1979 and December 31st 1993, 2501 operations for benign diseases of the thyroid gland were performed. The documentation was done prospectively. The operation technique remained the same during these years. The recurrent laryngeal nerve wasn't routinely identified. All together we saw 0.6% permanent vocal cord palsies. The incidence of nerve paralysis was correlated to the size (weight), to the expansion of the goiter, to the performed operative procedure and to patients' age and gender.
In the past 20 years the frequency of appendectomies has been halved. The reason of this lies in the strictly indication for operation. A perforation rate more than 10% and a sex relation 1:1 point at a balanced indication.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
With the disbandment of the G.D.R., the following also ended: a) the central registration of all inpatients, which allowed statements to be made about hospital morbidity; b) the central tumor documentation, in which all tumor patients were registered up to 5 years after first treatment. Data relating to the clinic are being set up. We present a proven program of operating statistics set up by the working group for quality assurance.
For the period from 1985 to 1987 were analysed the blood transfusions, which were carried out in seven surgical wards, within the scope of a study for quality assurance. 7.6% of the patients, treated in surgical ward and 5.4% of the patients, treated in traumatological ward, were given blood transfusion. The average was 3.6 transfusional units per treated patient. The biggest differences were to be remarked at cases of breast cancer and at thyroid gland surgery. The average transfusion frequency at breast cancer was 16% with a difference between 5 and 63%. In thyroid gland surgery the average transfusion frequency was 11%, differing between 1 and 54%. At these operation groups the blood transfusion were usually given once. Transfusional reactions, costs and responsibility towards the donor demand a turning away from scientifically non-established transfusion habits. The components concept by Lundsgaard should serve as an orientation.
When evaluating 4232 appendectomies between 1977-1986 there were 12.5% perforations and in 19.3% the diagnosis was not justified. In 5.1% surgical intervention was done without acute appendicitis. The overall lethality was 0.5%, the cases of perforation 2.3%. The diagnosis of lethality was cardiopulmonary disease. In this follow up study we discuss possibilities of giving a secure diagnosis.
Inflammatory and cicatrical alterations are the morphological basis of papillary stenosis in most cases due to canalicular or lymphatic spreading of bacterial infection in gallstone disease. The consequences of papillary stenosis are elevated pressure in the ducts and reduced bile flow. At surgery you find dilatation of the bile ducts, increase of residual pressure, decrease of outflow, and--in cicatrical stenosis--stop for the probe. Only the inflammatory stenosis is reversible, but permanent alteration is not to determine. Therefore therapy is necessary, at first instrumental dilation to 4-6 mm. Impossibility of dilatation indicates transduodenal sphincterotomy. Recurrencies are best treated by endoscopic sphincterotomy and exceptionally by choledochoduodenostomy.
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A general CDR-wide account is given in this paper of hospitalised treatment, frequent of operations, and lethality of appendicitis. Hospitalised treatment declined from 97.208 to 52.814 cases, i.e. by 46 percent, between 1971 and 1988. In 1988, ratios were 30.7 top 10,000 males and 32.7 to 10,000 females. The ratio of surgery was 21 to 10,000, with declining trend. Hence, about one third of all hospitalised patients were cases for observation rather than treatment. The decline has been attributable to more stringent criteria for surgery. Decline in frequency of operations has been accompanied by reduction in lethality and mortality. Overall lethality of acute forms of appendicitis has been 0.4 percent in 1988, which was primarily attributable to improvement of therapeutic methods. The mortality rate to 10,000 inhabitants is 0.15.
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Data and surgical findings recorded from 7,640 primary operations on bile ducts were analysed and were investigated for their relationship with benign stenosis of Vater's papilla. Positive diagnosis of the latter was made in 487 cases (6.3 per cent). Clearly discernible correlations were found to exist between papillary stenosis, on the one hand, and severe chronic inflammation of the gall-bladder and choledocholithiasis, on the other. A relationship between papillary stenosis and advanced age was to some extent suggested by increased occurrence of severe chronic inflammations and choledocholithiasis in higher age groups. Primary stenosis without causative inflammation in the vicinity of the papilla was not recordable from the above surgical cases. The view has been confirmed that benign stenosis is likely to develop as a secondary alteration due to inflammatory processes along with lithiasis.