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H Püschmann

Publications and source records attributed to H Püschmann.

16 recordsLinked to original sources

[Evaluation of 157 arbitration procedures against maxillofacial surgeons handled by the arbitration office of the North German Medical Associations from 2000 to 2005].

Medical work is, just like any other profession, not always without error and even when no mistake has been made the patient may suffer health damages, because such are the unavoidable risks. Arbitration procedures of medical liability disputes can in particular cases resolve the individual conflict between physician and patient. The results of these arbitration procedures can point towards the main focus of diagnosis, patient accusations (patient dissatisfaction) and treatment errors. In the space of 6 years from 2000 until 2005 the North-German arbitration office handled 157 arbitration procedures against Maxillofacial surgeons. The decisions were statistically and casuistically analysed with regard to patient accusations, type of treatment error, frequency of treatment error, health damages that were caused and not caused by errors. Liability claims against a physician result only from those errors that have caused health damages to a patient. Not all errors cause damage automatically. Patient claims were found to be justified in 28% of all procedures and a recommendation for regulation was made to the physician's insurance. Maxillofacial surgery, with reference to the 20.4% of cases analysed, clearly represents less than the total average. The main focus of accusations raised by patients and also the main focus of the observed treatment errors are operative errors as a cause of sensitivity defects of the lower lip and the tongue, also of tongue damages and their associated taste defects. Parallel to the 20.4% of cases, which showed iatrogenic health damages caused by errors, 60.9% of cases showed patients had also suffered iatrogenic damages even though no medical errors had caused them.

Cross-Sectional Studies↗

[Restorative surgery on the lower leg using muscular shifting grafts -- anatomical and clinical aspects (author's transl)].

The long clinical course and the great number of complications after open fracture of the lower leg are due to the thin soft-tissue layer coating the tibia. Large defects may occur here and expose the tibial periosteum. In post-mortem studies, various methods to repair pretibial defects by means of muscular shifting grafts were investigated. It is possible to cover almost the entire tibia with the aid of pedunculated muscular flaps (M. gastrocnemius, M. soleus, M. abductor hallucis). The muscles can be grafted primarily with split skin. By this, stable wound conditions are created, allowing the fracture to heal after osteosynthesis without the risk of a secondary infection. One case of repair, using the M. gastrocnemius, is demonstrated.

Aged↗

[The lower-limb amputation in geriatrics suffering from occlusive artery disease (author's transl)].

Owing to the biology of arteriosclerosis elderly previously affected patients have, as a rule, to undergo lower limb amputation for occlusive artery disease. This creates particular problems which must be taken into account when choosing the surgical technique and providing the prosthesis. The article surveys the common methods and describes, in particular, the knee disarticulation including the early prosthetic fitting carried out at the author's hospital, which in their experience can decisively improve the patient's rehabilitation.

Aged↗

[Misdiagnosis: Raynaud's disease].

Within a few hours a patient developed necrosis of two finger tips. A provisional diagnosis of Raynaud's disease was made and an arteriogram was performed. This showed considerable hypervascularisation of the affected fingers. After 48 hours, the typical clinical picture of an acute infection became evident. The differential diagnosis and pathogenesis are discussed.

Angiography↗

[Scanning and transmission electron microscopic studies of the development of the joint surfaces (author's transl)].

The late embryonic and post partum development of the rat knee-joint has been studied by the transmission and scanning electron microscope. Undergoing a transformation in the sense of functional adaption to extrauterine life there is a final breakdown of the mesenchym cell layer (interzone) which separates in the embryo the anlagen of the bones. Its is followed by an accelerated growth of the collagen-containing intercellular substance which finally forms the surface.

Adaptation, Physiological↗

[Nerve injuries after computer-assisted hip replacement: case series with 29 patients].

AIM: In Germany computer-assisted hip replacement (CAHR), e. g., ROBODOC, has been carried out in several thousand cases. After a period of enthusiasm, the technique now faces growing resistance from both patients and physicians. After CAHR many patients complain about persistent pain and problems with walking. Due to these problems, patients very often ask whether they have a nerve injury. In general, it is important to know whether or not there is a specific risk of nerve injuries with CAHR. At present neurological data are inconsistent, and neurophysiological studies have not yet been reported. METHODS: We have analysed a case series of 29 patients after CAHR with ROBODOC in 30 operated joints. All patients underwent a systematic neurological and neurophysiological examination. RESULTS: In 3 out of 30 operated sites functionally relevant nerve injuries were found, which led to disability in the first year after surgery. Permanent disability due to nerve injury was not found. CONCLUSION: There is no evidence of a specific risk of nerve injury after CAHR. The incidence of partial and transient nerve damage in the first year after operation might be higher than in classical hip replacement (3.1 %).

Adult↗