Langenbeck's archives of surgery
-
Langenbecks Arch Surg · Mar 2009
MFH revisited: outcome after surgical treatment of undifferentiated pleomorphic or not otherwise specified (NOS) sarcomas of the extremities -- an analysis of 140 patients.
Undifferentiated pleomorphic sarcoma/NOS (not otherwise specified; former pleomorphic and storiform MFH) of the extremities is a common malignant soft tissue tumor in adults. The objective of this study is to determine prognostic factors for the outcome after surgical treatment with respect to the recent developments in classification. ⋯ In terms of OS and ILR, primary or recurrence, negative surgical margins, size and grading had a highly significant influence, whereas the site of surgery and adjuvant chemotherapy, adjuvant radiation and tumor depth did not. Prognosis for patients with undifferentiated pleomorphic sarcoma of the extremities depends predominantly on adequate wide resection of the primary tumor.
-
Langenbecks Arch Surg · Mar 2009
Age, microbiology and prognostic scores help to differentiate between secondary and tertiary peritonitis.
Tertiary peritonitis is a severe persisting intra-abdominal infection and associated with high mortality. The aim was to find significant risk factors for mortality and tertiary peritonitis including the Mannheim Peritonitis Index (MPI), the Acute Physiology and Chronic Health Evaluation (APACHE) II score, and a sumscore of both. ⋯ Prognostic scores besides age and fungal infections are risk factors for mortality and help to differentiate between secondary and tertiary peritonitis. The combination of prognostic scores is comparable to the APACHE II and superior compared to the MPI in regard to detection of tertiary peritonitis.
-
Langenbecks Arch Surg · Jan 2009
Prognostic factors affecting oncologic outcomes in patients with locally recurrent rectal cancer: impact of patterns of pelvic recurrence on curative resection.
The purpose of this study is to investigate prognostic factors affecting oncologic outcomes in patients with locally recurrent rectal cancer and determine whether recurrence patterns influence curative resection of recurrent tumor. ⋯ Patients with central recurrences have a high probability of curative resection. Disease-free survival less than 1 year and curative resection of local recurrence were independent prognostic factors affecting oncologic outcomes in patients with locally recurrent rectal cancer.
-
Langenbecks Arch Surg · Nov 2008
ReviewCurrent insights in intra-abdominal hypertension and abdominal compartment syndrome: open the abdomen and keep it open!
The abdominal compartment syndrome (ACS) is associated with organ dysfunction and mortality in critically ill patients. Furthermore, the deleterious effects of increased IAP have been shown to occur at levels of intra-abdominal pressure (IAP) previously deemed to be safe. The aim of this article is to provide an overview of all aspects of this underrecognized pathological syndrome for surgeons. ⋯ The ACS was first described in surgical patients with abdominal trauma, bleeding, or infection, but in recent years ACS has also been described in patients with other pathologies such as burn injury and sepsis. Some of these so-called nonsurgical patients will require surgery to treat their ACS. This review article is intended to provide surgeons with a clear insight into the current state of knowledge regarding IAH, ACS, and the impact of IAP on the critically ill patient.
-
Langenbecks Arch Surg · Nov 2008
ReviewClinical sepsis and septic shock--definition, diagnosis and management principles.
Sepsis remains a common problem in critically ill patients. ⋯ Considerable advances have been made in our understanding of the pathophysiology of sepsis and recent years have seen a surge of potential new therapeutic agents for sepsis. Definitions have been rethought and strategies proposed to better characterise patients with sepsis as the importance of individually targeted treatment packages has been realised. Current management aims to control infection, to achieve haemodynamic stabilisation, to modulate the immune response and to provide metabolic and organ support. As new therapies are introduced, treatment recommendations will need to be adapted accordingly.