Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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For patients with liver metastases, surgery currently represents the only possibility for cure, with a mean 5-year survival rate of 25-35%. Due to refinement in operative and anesthetic techniques and improved critical care with decreased morbidity (< 25%) and mortality (< 5%), hepatic resection is a safe and efficient procedure. Surgery has repeatedly achieved long-term disease-free survival in 20-25% of patients. ⋯ Only 20-35% of these recurrent metastases appear to be resectable, resulting in an overall 3-year survival rate of about 30%. The morbidity and mortality from repeat hepatectomy is similar to that of first hepatic resection. All results together demonstrate that resection and re-resection of liver metastases can provide long-term survival rates and can be beneficial in a carefully selected group of patients without extrahepatic disease.
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In a porcine model, ten animals with a mean body weight of 18.9 (15-24) kg were exposed either to intravenous boli of 10, 20, and 30 ml argon (n = 5) or CO2 gas (n = 5). Gas embolism with argon led to increased pulmonary artery pressure (P > 0.001) and induced a decrease in end tidal CO2 (P < 0.001) and reduced cardiac output (P < 0.001) with a consecutive decrease in mean arterial pressure (P < 0.05). One animal died in cardiac shock after a 20 ml argon gas embolism and another after a 30 ml argon bolus. ⋯ Animals in the CO2 group receiving 10, 20, or 30 ml bolus neither required resuscitation nor died. Hemodynamic parameters were not affected by a 10 to 30 ml bolus of CO2 gas. Thus, gases with a low solubility in blood like argon should not be used during procedures with an increased risk of gas embolism.