Wladimir Putin - Führer, Diktator, Kriegsherr

Das "System Putin" hat sich zu einer Führerdiktatur entwickelt. Unter dieser politischen Herrschaft wirkt das Führerprinzip für den Präsidenten und gibt ihm oberste Befehlsgewalt auf allen politischen, rechtlichen und militärischen Gebieten ohne Kontrollinstanzen. In vielen ihrer Attribute scheinen die Führersysteme des zwanzigsten Jahrhunderts, die Diktaturen Hitlers, Francos, Mussolinis und Stalins, wieder auf. Wladimir Putin hat als Besonderheit seines Regimes die neu inszenierte "Symphonie" zwischen seinem Staat und der Russisch-Orthodoxen Kirche mit ihrer "imperialen Theologie" als politische Ressource vereinnahmt. Putins Führerdiktatur nähert sich mit umfassend werdender terroristischer Repression zunehmend einer totalitären Herrschaft an, deren Machtwahn ihr selbst zum Verhängnis werden kann

The concept of negative pressure wound therapy (NPWT) after poststernotomy mediastinitis – a single center experience with 54 patients

Deep sternal infections, also known as poststernotomy mediastinitis, are a rare but often fatal complication in cardiac surgery. They are a cause of increased morbidity and mortality and have a significant socioeconomic aspect concerning the health system. Negative pressure wound therapy (NPWT) followed by muscular pectoralis plasty is a quite new technique for the treatment of mediastinitis after sternotomy. Although it could be demonstrated that this technique is at least as safe and reliable as other techniques for the therapy of deep sternal infections, complications are not absent. We report about our experiences and complications using this therapy in a set of 54 patients out of 3668 patients undergoing cardiac surgery in our institution between January 2005 and April 2007

Short term outcomes of total arterial coronary revascularization in patients above 65 years: a propensity score analysis

<p>Abstract</p> <p>Background</p> <p>Despite the advantages of bilateral mammary coronary revascularization, many surgeons are still restricting this technique to the young patients. The objective of this study is to demonstrate the safety and potential advantages of bilateral mammary coronary revascularization in patients older than 65 years.</p> <p>Methods</p> <p>Group I included 415 patients older than 65 years with exclusively bilateral mammary revascularization. Using a propensity score we selected 389 patients (group II) in whom coronary bypass operations were performed using the left internal mammary artery and the great saphenous vein.</p> <p>Results</p> <p>The incidence of postoperative stroke was higher in group II (1.5% vs. 0%, P = 0.0111). The amount of postoperative blood loss was higher in group I (908 ± 757 ml vs. 800 ± 713 ml, P = 0.0405). There were no other postoperative differences between both groups.</p> <p>Conclusion</p> <p>Bilateral internal mammary artery revascularization can be safely performed in patients older than 65 years. T-graft configuration without aortic anastomosis is particularly beneficial in this age group since it avoids aortic manipulation, which is an important risk factor for postoperative stroke.</p

A rigid barrier between the heart and sternum protects the heart and lungs against rupture during negative pressure wound therapy

<p>Abstract</p> <p>Objectives</p> <p>Right ventricular heart rupture is a devastating complication associated with negative pressure wound therapy (NPWT) in cardiac surgery. The use of a rigid barrier has been suggested to offer protection against this lethal complication, by preventing the heart from being drawn up and damaged by the sharp edges of the sternum. The aim of the present study was to investigate whether a rigid barrier protects the heart and lungs against injury during NPWT.</p> <p>Methods</p> <p>Sixteen pigs underwent median sternotomy followed by NPWT at -120 mmHg for 24 hours, in the absence (eight pigs) or presence (eight pigs) of a rigid plastic disc between the heart and the sternal edges. The macroscopic appearance of the heart and lungs was inspected after 12 and 24 hours of NPWT.</p> <p>Results</p> <p>After 24 hours of NPWT at -120 mmHg the area of epicardial petechial bleeding was 11.90 ± 1.10 cm²when no protective disc was used, and 1.15 ± 0.19 cm²when using the disc (p < 0.001). Heart rupture was observed in three of the eight animals treated with NPWT without the disc. Lung rupture was observed in two of the animals, and lung contusion and emphysema were seen in all animals treated with NPWT without the rigid disc. No injury to the heart or lungs was observed in the group of animals treated with NPWT using the rigid disc.</p> <p>Conclusion</p> <p>Inserting a rigid barrier between the heart and the sternum edges offers protection against heart rupture and lung injury during NPWT.</p

Major bleeding during negative pressure wound/V.A.C.® - therapy for postsurgical deep sternal wound infection - a critical appraisal

Negative-pressure wound therapy, commercially known as vacuum-assisted closure (V.A.C.®) therapy, has become one of the most popular (and efficacious) interim (prior to flap reconstruction) or definite methods of managing deep sternal wound infection. Complications such as profuse bleeding, which may occur during negative-pressure therapy but not necessarily due to it, are often attributed to a single factor and reported as such. However, despite the wealth of clinical experience internationally available, information regarding certain simple considerations is still lacking. Garnering information on all the factors that could possibly influence the outcome has become more difficult due to a (fortunate) decrease in the incidence of deep sternal wound infection. If more insight is to be gained from fewer clinical cases, then various potentially confounding factors should be fully disclosed before complications can be attributed to the technique itself or improvements to negative-pressure wound therapy for deep sternal wound infection can be accepted as evidence-based and the guidelines for its use adapted. The authors propose the adoption of a simple checklist in such cases

Coronary artery bypass surgery in a patient with Kartagener syndrome: a case report and literature review

Kartagener syndrome consists of congenital bronchiectasis, sinusitis, and total situs inversus in half of the patients. A patient diagnosed with Kartagener syndrome was reffered to our department due to 3-vessel coronary disease. An off-pump coronary artery bypass operation was performed using both internal thoracic arteries and a saphenous vein graft. We performed a literature review for cases with Kartagener syndrome, coronary surgery and dextrocardia. Although a few cases of dextrocardia were found in the literature, no case of Kartagener syndrome was mentioned

Is age an independent determinant of mortality in cardiac surgery as suggested by the EuroSCORE?

BACKGROUND: The proportion of older patients in cardiac surgery is continuously increasing. 37% of patients undergoing heart surgery in Germany in the year 2000 were 70 years of age and older. We have studied the role of age as a determinant of mortality in cardiac surgery in our institutional patient population. METHODS: We have calculated the EuroSCORE and the corresponding age-adjusted EuroSCORE in 8769 patients who underwent heart surgery between January 1996 and January 2002 and collected the information on the occurrence of postoperative complications and 30-days mortality. RESULTS: The multimorbidity increased with ascending age. Both the EuroSCORE and the age-adjusted EuroSCORE values increased significantly with age in the whole group of patients as well as in the group of patients who were alive 30 days after heart surgery. The incidence of postoperative complications and 30-days mortality increased significantly with age. In patients who died within 30 days after surgery, the EuroSCORE increased significantly with age, whereas the age-adjusted EuroSCORE did not. The occurrence of diabetes mellitus, arterial hypertension and atrial fibrillation, i.e., the risk factors not considered by the EuroSCORE, exhibited a significant age dependence in our patients. The univariate analysis identified the significant dependence of 30-days mortality on diabetes and atrial fibrillation. The stepwise logistic regression analysis showed the dependence of mortality on diabetes. CONCLUSIONS: On the background of the well-known age-dependent structural and functional changes of different body organs, our data show that age is a significant risk indicator in cardiac surgery, strongly correlating with morbidity and mortality. Consequently, special preventive and therapeutic measures are required in clinical environment in the case of elderly patients undergoing cardiac surgery

Komplikationen nach Sternotomie – eine interdisziplinäre Herausforderung

A mediastinitis is a rare complication (incidence 1–4%) following cardiac surgery with a mortality of up to 50%. Treatment is somewhat difficult since no standardized treatment options are established. Thus, every German clinic proceeds differently. It is thus the paper’s intention to describe an optimal treatment plan that guarantees higher patient safety, as well as determining whether the occurrence of postoperative infections can be diminished by raising awareness of involved risk factors.Backed up by first-hand experiences in the treatment of mediastinitis patients a therapy algorithm correlating to the amount of infection was developed. The treatment consists of radical surgical debridement, sternal restabilization (depending on the elapsed time between procedure and cardiac operation) and vacuum therapy (as short as possible). Plastic reconstruction (usually via M. pectoralis plasty) may be performed as soon as supporting condition is attained. If treatment fails, the reconstruction of defects of the anterior chest wall is achievable by different muscle flaps. Based on the results of early interdisciplinary cooperation, a therapy concept was developed, which is adaptable to the patient’s individual condition in order to ensure the best possible treatment concept concerning the patient’s recovery and safety