Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Hemostasis management plays an important role in surgery. Anti-platelet drugs and oral anticoagulants are taken by an increasing number of patients. ⋯ For the diagnosis of acquired coagulopathy secondary to massive bleeding, point of care tests have been introduced that should help focus substitution therapy in emergency situations. However, physicians should be aware of the limitations of these methods, and a full diagnostic workup should be done in order to uncover hemorrhagic diatheses not detected by point of care testing.
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Case Reports
[Chronic mesenteric ischemia with consecutive ischemic colitis. Suggestions for diagnosis and therapy].
The incidence of acute mesenteric ischaemia has decreased over the last few years. However, cases of chronic mesenteric ischaemia have grown in number, as this disease is the most frequent disorder of the large intestine in the elderly. The typical clinical presentation of ischaemic colitis develops gradually and only becomes recognisable in the late stage of the disease. ⋯ However, no carcinoma was found in histological examination. In fact, the individual multidisciplinary considerations play an important role in determining the best treatment strategy, if intervention is warranted. Based on our experience, sequential intervention with a common clinical pathway is the safest and most suitable and economic procedure for curing complex pathologies.
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A hemodynamically stable patient presenting with persistent bleeding through his chest tube (ICD) is a classic indication for early thoracoscopic intervention in trauma. The source of bleeding and air leaks can be identified and often treated: bleeding and perforated pulmonary segments can be resected, and chest wall bleeding may be coagulated or sutured. Injuries to the diaphragm are difficult to diagnose, as they might not be seen in conventional trauma imaging without gross herniation of intra-abdominal contents into the thoracic cavity. ⋯ Correct placement of the drainage is part of optimized therapy, along with inspection of all intrathoracic organs and surfaces. Furthermore, surgical and anaesthesiological teamwork and experience are prerequisites for the fast, professional application of a minimally invasive thoracoscopic approach in chest trauma patients. Diagnostically and theurapeutically, thoracoscopy plays an important role in the trauma setting--in the case of hemodynamically stable patients.
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With increasing experience in minimally invasive surgery, laparoscopy's role in abdominal trauma can be defined exactly. Main exclusion criteria are hemodynamic instability and increased intracranial pressure. A literature review of 1996 to 2006 reveals perforating injury mainly of the left thoracoadominal area as the most important indication for laparoscopy. ⋯ In this, sensitivity is only 25%. In case of proven lesions of the gastrointestinal tract, conversion to laparotomy is to be considered. Despite the reports on laparoscopic treatment, open repair of hollow organ injuries is still to be recommended.
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The improvement of surgical skills of trainees in Germany often occurs solely in the operating room. In recent years, several countries have established surgical skills labs as an essential part of surgical education, with the goal of improving and refining surgical skills before clinical application. Several years ago, training units were established by the industry wherein the curricula focused on products of the respective company. ⋯ A surgical skills lab with a comprehensive curriculum of training courses was introduced at the University Hospital of Marburg in 2005. The present article describes the development and introduction of such facilities. The authors are convinced that surgical skills labs will become increasingly important in German surgical education for improving patient safety in the operating room.