Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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From 1. 11. 93 to 30. 3. 97, 1149 patients were prospectively studied during their ICU stay. Of them, 114 met the criteria of septic shock, with lethality of 47.3%. A neural network was trained with datasets from 91 of these 114 patients. Testing the trained neural network with the remaining 23 patients, the following result was obtained: all 10 patients dying from septic shock were correctly predicted; of 13 surviving patients, 12 were correctly identified (sensitivity 100%; specificity 92.3%).
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Direct puncture of the vertebral artery for angiography has been abandoned since the introduction of angiography catheters. Nowadays puncture of jugular veins for intravenous nutrition or monitoring is the predominant cause of accidental arteriovenous vertebral artery fistulas. We describe the history of four patients with such fistulas and the long-term results after surgical repair.
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Thirty-eight patients with 40 fractures of the thoracic spine and the thoracolumbar junction were treated by a minimally invasive procedure, which includes partial corporectomy, the interposition of a tricortical bone graft and anterior stabilization by plate spondylodesis under thoracoscopic control. For 36 patients the operation was successfully performed in a complete thoracoscopic way; in 2 patients conversion to an open technique was necessary. ⋯ Our experience with this minimally invasive stabilizing procedure for injuries of the thoracic spine and the thoracolumbar junction demonstrated the feasibility of the method. Compared to the open method the benefit of minimally invasive surgery included postoperative pain reduction, shorter hospitalization, early recovery of function and reduced morbidity of the operative approach.
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Case Reports
[Widening mediastinum after blunt thoracic trauma: an unexpected differential diagnosis].
We report our experience concerning a young, white, healthy woman who had a typical blunt chest injury caused by a severe car accident. We had to evaluate and differentiate the initial roentgenographic post-traumatic mediastinal enlargement in order definitely to exclude a suspected covered rupture of the thoracic aorta or the heart caused by this high-velocity deceleration trauma. ⋯ The diagnostic algorithm in blunt chest injury is also discussed. The controversy about the classification and management options of primary thymic tumors is also presented.
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Randomized Controlled Trial Clinical Trial
[Postoperative analgesia after endoscopic abdominal operations. A randomized double-blind study of perioperative effectiveness of metamizole].
In comparison to conventional operating technique endoscopic surgery reveals numerous advantages, particular rapid mobilisation and earlier discharge from observation. For a effective utilization of these advantages, it is desirable to have a efficient postoperative analgesic scheme, which can be continued into the period after discharge from hospital. In a randomised, prospective double-blind study we investigated the analgesic efficacy of dipyrone in 40 patients, scheduled for endoscopic abdominal surgery (mainly endoscopic cholecystectomy). ⋯ After surgery all patients were allowed to self-administer buprenorphine intravenously from a PCA-pump (Bolus 30 micrograms, lockout 5 min in the recovery room, 30 min on the ward). Every hour for the first 6 h and after 24 h, cumulated doses of buprenorphine, pain scores (0-10), pulse, blood pressure and side effects were recorded. Dipyrone-treated patients had significantly less pain immediately after surgery and used a significantly lower cumulated dose of buprenorphine (-67%; 90 micrograms vs. 270 micrograms buprenorphine) in the first 24 h after surgery.