Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Axillary dissection aims at local tumor control and staging. Among breast cancer, malignant melanoma and other solid malignancies, the nodal status is still the most important predictive and prognostic factor. Today, because of its morbidity, axillary lymphadenectomy is indicated only when the sentinel lymph node is involved by metastasis after histopathologic investigation. The surgical technique of axillary dissection is presented, complications and oncologic outcomes are summarised after dissection for breast carcinoma and malignant melanoma, respectively.
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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.
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The improvement of surgical and nonsurgical approaches to control bleeding offers new strategies for overcoming coagulopathy. Massive hemorrhage is usually caused by a combination of surgical and coagulopathic bleeding. ⋯ However, the transfusion of red blood cells has been shown to be associated with post-injury infection and multiple organ failure. Therefore it is crucial to develop a clear strategy for correcting coagulopathy, preventing exsanguination, and minimizing the need for blood transfusion.
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Retention of surgical sponges is rare. They cause either an aseptic reaction without significant symptoms or an exudative reaction which results in early but non-specific symptoms. ⋯ However, apart from radio-paque markers there are no specific signs for the existence of surgical sponges in CT. Therefore, an experienced radiologist is needed to differentiate foreign bodies from morphologically quite similar differential diagnoses such as abscess and haematoma.