Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Review Comparative Study
[Ex situ resection and resection of the in situ perfused liver: are there still indications?].
Most liver tumors can be removed with conventional resection techniques employing partial or total vascular occlusion when needed. Duration of tolerable warm ischemia has not yet been defined, but it seems to be well tolerated up to 60 min. In a few cases with extended vascular resection and reconstruction liver protection by hypothermic perfusion is advantageous. ⋯ Major reconstruction of hepatic vessels with good technical access should be performed under in situ hypothermic protection using veno-venous bypass. Tumors involving the hepatic venous confluence and/or retrohepatic vena cava should be approached by either the in situ, or preferentially, the ante situm resection technique. The indication for an ex situ liver resection resulting in autotransplantation of the remnant liver exists only in rare cases for oncological reasons.
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Hypothermia following pre-hospital treatment of burn patients is a common risk with increasing lethality. Soon after admission to our burn unit, the body temperature of 212 adult patients with more than 5% total body surface area burned was documented. We found no influence of the time of pre-hospital care and cold-water treatment alone on the body temperature. ⋯ Only the anesthetized and artificial ventilated patients were hypothermic. We conclude that hypothermia is not a problem of the non-anesthetized and cold-water-treated patient. However, all anesthetized patients must be carefully treated to avoid hypothermia as an important complication in the pre-hospital management.