Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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The need for general or regional anesthesia due to nonobstetric surgery occurs in up to 2% of all pregnancies. Safe perioperative care is a challenge to anesthetists. ⋯ Although data from randomized controlled trials is missing, safe anesthesia during pregnancy is well documented for nearly every operative procedure. Interdisciplinary cooperation between surgeon, obstetrician, neonatologist, and anesthetist is the key to optimal patient care.
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Obesity, defined as a body mass index of > or =30 kg/m(2), is a modern epidemic and is increasing worldwide. Depending on genetic make-up, lifestyle factors such as nutrition, physical activity, and psychosocial conditions are the main determinants of its manifestation and severity. ⋯ For this reason, there is a need for evidence-based treatment considering the individual risk. For patients with extreme obesity exceeding a BMI of 40 kg/m(2), surgical intervention is the most effective treatment, not only to improve most somatic and psychological comorbidities significantly but also to prolong life.
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Drug treatment of colorectal cancer has made impressive progress during the past 10 years. In addition to the traditional 5-fluorouracil, newer anticancer drugs are available including irinotecan and oxaliplatin. Monoclonal antibodies like bevacizumab and cetuximab have been integrated into modern treatment regimens. Based on randomized clinical trials we can formulate rational treatment strategies as outlined in this article.
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Comparative Study
[Abdomino-right-thoracic esophagectomy with intrathoracic anastomosis in Barrett's cancer].
The modified technique of abdomino-right-thoracic esophagectomy (the Lewis-Tanner approach) is increasingly being favoured as the surgical procedure of choice in patients with resectable adenocarcinoma of the distal esophagus, so-called Barrett's cancer. The technical details of this procedure and the reconstruction of gastrointestinal continuity using a gastric tube with high intrathoracic anastomosis are illustrated, as they have proved useful in our own practice during recent years.
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Tracheostomy has become the method of choice in managing patients requiring long-term mechanical ventilation. At present, there are several alternatives to conventional surgical tracheostomy such as percutaneous dilatational techniques according to Ciaglia, Frova, and Fantoni. The basic principle of these new techniques is percutaneous puncture of the trachea and subsequent dilatation of the puncture channel until the tracheal cannula can be inserted. ⋯ Some significant complications and contraindications have been recognized recently. This should be taken into account when planning tracheostomy in long-term ventilated patients. Compared to conventional surgical tracheostomy, this new procedure retains its value and benefit only if these contraindications are carefully observed.