Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Review Comparative Study
[Transesophageal ultrasonography for mediastinum diagnostics].
Along with endosonographic fine needle aspiration, transoesophageal ultrasonography is now well established for staging gastrointestinal tumors. It is especially well suited to assessing mediastinal structures due to its transoesophageal approach and its high local definition. The mediastinum can be viewed all the way from the tracheal bifurcation to the diaphragm. This technique is already in regular use for pulmonary problems and especially for staging pulmonary carcinomas.
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The acute and early phase of polytrauma management is decisive for determining and implementing priority-based operative strategy. The patient's general condition and pattern of injury have to be considered. ⋯ Conceptual damage control surgery is distinguished from early total care. Damage control surgery should be performed only in patients meeting certain instability and risk criteria to avoid additionally burdening their condition.
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The success of modern burn therapy is based mainly on special burn intensive care, topical treatment, early eschar excision, and wound closure by immediate skin grafting or skin substitutes. This paper describes the current state of wound care and skin substitutes in burn therapy.
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Review Comparative Study
[The use of antithrombotic drugs during various surgical procedures].
Neuraxial blockade has been shown to provide essential benefits in terms of reduced perioperative morbidity and mortality. Case series from recent years indicate that spinal epidural hematoma is more common than previously estimated, with incidences of 1:200,000 in obstetric patients and as high as 1:3,600 in female orthopedic patients. ⋯ In such patients an alternative plan for postoperative pain management such as patient-controlled intravenous analgesia or peripheral nerve blocks should be established. In patients on continued acetylsalicylic acid therapy, neuraxial blockade may be performed if thromboembolism prophylaxis is not administered concurrently.
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Surgery inevitably leads to bleeding, and hemostasis aims at reducing the amount of blood loss and the need for transfusion as well as preventing rebleeding, hematoma formation, and the need for repeat surgery. Various locally applicable agents are in use including bone wax, gelatin, collagen, oxidized regenerated cellulose, fibrin sealant glues, and synthetic glues. ⋯ There is much albeit sometimes conflicting evidence from RCT regarding the use of these substances in surgery. The role of recombinant activated factor VII in achieving systemic hemostasis is being investigated.