Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Review Comparative Study
[Ex situ resection and resection of the in situ perfused liver: are there still indications?].
Most liver tumors can be removed with conventional resection techniques employing partial or total vascular occlusion when needed. Duration of tolerable warm ischemia has not yet been defined, but it seems to be well tolerated up to 60 min. In a few cases with extended vascular resection and reconstruction liver protection by hypothermic perfusion is advantageous. ⋯ Major reconstruction of hepatic vessels with good technical access should be performed under in situ hypothermic protection using veno-venous bypass. Tumors involving the hepatic venous confluence and/or retrohepatic vena cava should be approached by either the in situ, or preferentially, the ante situm resection technique. The indication for an ex situ liver resection resulting in autotransplantation of the remnant liver exists only in rare cases for oncological reasons.
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Hypothermia following pre-hospital treatment of burn patients is a common risk with increasing lethality. Soon after admission to our burn unit, the body temperature of 212 adult patients with more than 5% total body surface area burned was documented. We found no influence of the time of pre-hospital care and cold-water treatment alone on the body temperature. ⋯ Only the anesthetized and artificial ventilated patients were hypothermic. We conclude that hypothermia is not a problem of the non-anesthetized and cold-water-treated patient. However, all anesthetized patients must be carefully treated to avoid hypothermia as an important complication in the pre-hospital management.
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Randomized Controlled Trial Clinical Trial
[Effect of recombinant growth hormone on wound healing in severely burned adults. A placebo controlled, randomized double-blind phase II study].
Recombinant growth hormone (rGH) has been used successfully in burned children with a shortened donor-site healing time and length of hospital stay as well as a protein-sparing effect. In adult burn patients, no comparable study exists to date. ⋯ In severely burned adult patients rGH has no positive effect on burn wound or donor-site healing.
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We report the case of a 46-year-old man who was admitted to the medical department of the hospital Reichenbach with a 2-day history of central and upper abdominal pain. The pain was displaced in the right lower abdominal quadrant, which is why the patient was transferred to our department. At laparoscopy a toothpick was found perforating the cecum. ⋯ The patient does not recall having ingested a toothpick. The laparoscopic treatment of perforation of the cecum by a toothpick might be among the rarest operations ever conducted. In the literature no such publication could be found up to now.