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Published incidence of delirium in orthopaedic patients ranges from 5.1% to 61%. Delirium may present before or after the patient undergoes the surgical procedure and has demonstrated increased risk, including mortality. Yet, delirium goes unrecognized by both physicians and nurses. This article focuses on the literature on delirium in the orthopaedic patient, including incidence, how to identify those patients at risk, patient outcomes, nonpharmacological and pharmacological interventions, and provides an example of how one tertiary care hospital implemented a prevention and management program of delirium in orthopaedic patients.

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Summary. In 37 patients suffering from disseminated liver metastases from colorectal primaries, who had undergone a local radical operation and had no other distant metastases, intra-arterial chemotherapy was performed ambulatory during a 30-min block via special catheters. During an average treatment time of 10 months until thrombosis with 5-FU (average of 1000 mg/week), the median survival of all stages (Lausanne) was 14 months, the 1-year survival rate 76 + 16~ (act. surv.). Dosage was regulated according to the patients individual tolerance and showed minimal toxicity by careful dose escalation. This kind of treatment provides safe, effective local palliation with increased quality of life.Key words: Disseminated liver metastases -Intra-arterial chemotherapy -Transient intraluminary hypoxia. Znsammenfasseng. Bei 37 Patienten mit disseminierten Lebermetastasen lokal radikal operierter colorectalerCarcinome ohne sonstige Fernmetastasen wurden eine intraarterielle Chemotherapie w~ihrend eines dreil3ig-miniitigen Blocks mitteis eines speziellen Katheters durchgefiihrt. Bei einer Behandlungszeit yon im Mittel 10 Monaten bis zur Thrombosierung mit w6cbentlich im Mitte11000 mg 5-FU betriigt die mediane 12berlebens-zeit aller Stadien (Lausanne) 14 Monate, die 1-Jahresiiberlebensrate 76 + 16 ~ (act. surv.). Die Dosierung nach der individueUen Toleranz bei vorsichtiger Dosiseskalation ergab eine minimale Toxizidit, erh6hte die Lebensqualidit bei sicherer und schonender Palliation.Schliisselwiirter: Disseminierte Lebermetastasen -Intraarterielle Chemotherapie -Intermittierende, intralumin~ire Hypoxie. Indikation und Ergebnisse der Resektion von Indications and Results of Hepatic Resection of Metastatic Abdominal TumorsSummary. In a series of 368 malignant abdominal tumors in 81 patients (= 22 ~) liver metastases were found during the primary operation. In 15 patients a simultaneous hepatic resection was performed; in 3 hepatic resections were done after discovery of metastases by CT or sonography during a follow-up study. No patient died because of the hepatic resection. Of 11 patients with colorectal tumors, 6 are still alive after 9-72 months. Two of four patients who underwent a gastrectomy and simultaneous hepatic resection are alive after 9 and 17 months, respectively. The results are better with the lobectomy than with simple excision or segmentectomy.