Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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For critically ill medical patients until the year 2000, increases in patient age and severity of disease but also acute prognosis have been described. Since then, further improvement appears possible. Several controlled studies have recently demonstrated that acute mortality may be further lowered by new adjuvant therapies such as aggressive glycemic control. However, it is still unknown whether demographic changes and progress in intensive care can be reproduced in surgical critically ill patients outside of a controlled trial setting. ⋯ General demographic trends and progress in intensive care can be demonstrated also in unselected surgical cohorts. Furthermore, the results here confirm the efficacy of new therapeutic modifications in routine therapy.
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Isolated injuries to the gallbladder are extremely rare in blunt abdominal trauma, with a reported incidence of less than 2%. We report a case with partial avulsion of the gallbladder and subsequent hemorrhagic shock in a patient with liver cirrhosis. ⋯ We estimate that the gallbladder avulsion occurred due to compressional waves of the ascites (during blunt abdominal injury) which may have sheared off the gallbladder from the cirrhotic liver. The patient received cholecystectomy, which is recommended as standard in case of gallbladder injury.
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Severe injuries in patients of all ages and injuries in elderly multi-morbid subjects are a relevant medical and economic challenge. Optimal care of the polytraumatized patient can be best delivered by physicians specializing both in causal treatment of the injury or underlying disease and in intensive care. For care of critically ill injured patients, trauma surgeons with a certified specialty in intensive care medicine appear best suited. ⋯ Organ dysfunctions have to be modulated as they develop. Surgeons and trauma surgeons lead worldwide in this field of research. Obviously, competent research in polytrauma care requires competence in polytrauma intensive care.