Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Visceral outpatient operations are well established in Dresden. Since 1978, 13,948 cases have been operated on in general surgery. Most patients (57.8%) had local anesthesia; only 9.2% needed general anesthesia. ⋯ With careful selection of patients and the right indication, complications are rare in outpatient surgery. In only 0.7% of all cases did wound infections occur postoperatively. None of the patients died.
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The culture and transplantation of keratinocytes are considered an important progress in the treatment of severe burns. The keratinocyte grafts take best (50 to 90%) on remaining dermal structures after deep dermal (II b) burns. ⋯ As vital wound cover they allow for a rapid and near scarless reepithelialization. For deep (III) burns we use composite grafts of cultured auto-keratinocytes on allo-dermis with increasing success (up to 75% take rate) without rejection.
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Establishing day care and short stay surgery in trauma departments requires a careful estimation of the perioperative risks. Having the therapy be successful for each patient admitted to day care surgery should have precedence over any economic limitations. In day care surgery a trauma surgeon has to make sure that appropriate postoperative supervision is available for each patient discharged from the hospital. The surgeon is responsible for qualified care on an outpatient basis.
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The aim of this prospective clinical study was to evaluate whether a combination of the endoscopic hemostasis together with fibrin sealing and consecutive conservative therapy could reduce the frequency of recurrent bleedings, thus the number of operations without adversely influencing the prognosis of the disease. 134 patients admitted to the surgical and medical hospital of the University of Ulm between 1/1990 and 1/1992 with bleeding gastroduodenal ulcers took part in this study. All patients were treated endoscopically by hypertonic saline solution plus epinephrine and fibrin sealant. If initial endoscopic hemostasis was not achieved patients were operated within 6 h after admission. ⋯ Half of these patients had an acute bleeding at the first gastroscopy (Forrest-Ia, Forrest-Ib bleeding). Recurrent bleeding became apparent between day 1 and 6 after admission to the hospital. Two patients refused surgical intervention, the other 14 were operated immediately.(ABSTRACT TRUNCATED AT 250 WORDS)