Langenbeck's archives of surgery
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Langenbecks Arch Surg · Apr 2011
ReviewNeurosurgical intensive care unit--essential for good outcomes in neurosurgery?
Neurosurgical intensive care units were increasingly agglomerated in large centralized interdisciplinary intensive care units in the last two decades. In the majority, these centralized interdisciplinary intensive care units were directed and managed by intensivists coming from anaesthesiology. We sought to review the evidence supporting neurosurgical intensive care as a highly specialized discipline resulting in benefits for the treated patients. ⋯ In general, neurosurgical and neurocritical intensive care has been associated with improved outcomes and reduced mortality rates, reduced length of intensive care stay, improved resource utilisation, decreased in-hospital mortality, and fiscal benefits.
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Langenbecks Arch Surg · Mar 2011
A modified fast-track program for pancreatic surgery: a prospective single-center experience.
The objective of this study is to evaluate the impact of a fast-track protocol in a high-volume center for patients with pancreatic disorders. ⋯ Fast-track programs are feasible, easy, and also applicable for patients undergoing a major surgery such as pancreatic resection.
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Langenbecks Arch Surg · Mar 2011
The need for extended intensive care after pancreaticoduodenectomy for pancreatic ductal adenocarcinoma.
Pancreaticoduodenectomy (PD) is standard for patients with resectable pancreatic ductal adenocarcinoma (PDAC) in the pancreatic head, neck, and uncinate process, but it is associated with a relatively high morbidity. This study aimed to identify risk factors for extended postoperative intensive care unit (ICU) admission and assess the impact of ICU treatment on patient survival. ⋯ The need for extended ICU admission is associated with higher in-hospital mortality and reduced long-term outcome. The highest mortality was observed after delayed ICU admission. Preoperative diabetes, heart failure and long operations, and intraoperative blood transfusions substantially increased the risk for ICU requirement.
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Langenbecks Arch Surg · Feb 2011
Angioembolization and laparotomy for patients with concomitant pelvic arterial hemorrhage and blunt abdominal trauma.
Treatment of patients with concomitant pelvic arterial hemorrhage and blunt abdominal trauma (BAT) is challenging. Controversies remain over the diagnostic approach and the priority of available treatment resources. ⋯ The revised clinical algorithm served well for guiding the treatment pathway. Priority of laparotomy or angiography should be individualized and customized according to the clinical evaluation and CT findings. Angiography can be both diagnostic and therapeutic and simultaneously treat multiple bleeders; thus, it has a higher priority than laparotomy. The primary benefits of our later clinical pathway were in reducing nontherapeutic laparotomy and repeat angioembolization rates.
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Langenbecks Arch Surg · Feb 2011
Is the function of alveolar macrophages altered following blunt chest trauma?
The purpose of this study was to characterize the local pulmonary inflammatory environment and to elucidate alterations of alveolar macrophage (AMØ) functions after blunt chest trauma. ⋯ Already very early after chest trauma, inflammatory mediators are present in the intraalveolar compartment. Additionally, AMØ are primed to release cytokines and chemokines. Blunt chest trauma also changes the phagocytic and chemotactic activity of AMØ. These functional changes of AMØ might enable them to better ward off potential pathogens in the course after trauma.