Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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We present a case of acute occlusion of the right branchial artery in a 56-year-old male caused by bronchogenic tumor embolus as the first manifestation of malignancy. The primary tumor was shown to be inoperable and rapidly formed metastases in skin and liver. The case presented demonstrates, that embolic events originating from malignant tumor cells are characteristic for organ-exceeding tumor growth. Thus the prognosis is generally poor.
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Parathyroid carcinoma occurs in 0.1 to 5% as the cause of primary hyperparathyroidism (HPT). It is difficult to determine the true incidence, because parathyroid carcinoma is diagnosed too often due to unreliable histologic criteria. It is only justified to make the diagnosis, when a local recurrence or metastases with the clinical picture of a recurrent or persistent HPT occurred. ⋯ The clinical courses of 3 patients with metastasizing parathyroid carcinoma are presented and discussed. In these patients 3 to 11 surgical interventions were performed in combination with an intermittent medical treatment. By this regimen we achieved long-term palliations up to 13 years.
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The value of ASA classification in assessment of perioperative risk, i.e. especially postoperative morbidity, was analyzed prospectively using the data of 2937 patients. The analysis took into account the criteria validity, reliability, and sensitivity. The incidence of post-operative morbidity after elective surgery rose from 3.9% in ASA class I to 36% in ASA class IV. ⋯ Morbidity, mortality respectively, after emergency surgery was 10.2% in ASA class II compared to 69% in class IV, mortality 1.4% compared to 21.5%. Differences between the ASA classes were confirmed (p-value < 0.05) considering separate kinds of complications and different periods. Furthermore, ASA classification was a valuable reference to length of stay and severity of necessary therapy at the ICU.