Search

Conventional paradigms for the management of elevated intracranial pressure (ICP) are in many ways imperfect. Clinicians respond to increases in ICP, or to worsening of the clinical neurological examination, after critical thresholds of brain ischemia have been crossed, at a point when irreversible injury may have already occurred and the window of opportunity for therapeutic intervention has closed. Even with the benefit of direct ICP monitoring, the true biochemical environment of the brain is unknown, so that measurable changes in blood pressure, cerebral perfusion pressure (CPP), circulating blood volume and rheology, blood oxygen and glucose levels, and other clinical parameters result in uncertain global or regional effects in areas of the brain at risk. The goal of multimodality monitoring is to titrate clinical therapy at the bedside to foster a biochemical environment that favors preservation of function and healing within the brain — a proactive, in place of a reactive, approach. This chapter suggests different ways in which ICP, brain tissue and jugular bulb oxygen content, microdialysis, continuous electroencephalography (EEG), and transcranial Doppler ultrasound data can be integrated into a practical management algorithm for patients with elevated ICP.

Die Begriffe Arthrolyse (Wolff 1895) und Arthroplastik (Gluck 1902) wurden 1946 von Hackenbroch sen. inhaltlich dahingehend getrennt, das mit der Arthroplastik eine Gelenkflachenresektion verbunden ist, wahrend die Arthrolyse eine Gelenkentsperrung unter Erhaltung der Gelenkflachen bedeutet.

Arthrolyse und Arthroplastik haben nach wie vor ihren Stellenwert in der Behandlung der Gelenksteifen des Ellbogens. Wenn wegen der Destruktion der Gelenkflachen die Arthrolyse nicht ausreichend ist, wird die Operation um die Gelenkflachenresektion und fakultative Interposition zur Arthroplastik erweitert.

The question of whether to treat knee instabilities post operatively by immobilization or early functional mobilization was solved at our hospital in favour of immediate mobilization.