Langenbeck's archives of surgery
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Langenbecks Arch Surg · Mar 2001
Comparative StudyDiagnosis of occult scaphoid fractures and other wrist injuries. Are repeated clinical examinations and plain radiographs still state of the art?
To examine the efficacy of repeated clinical examinations and follow-up radiographs, 121 patients were prospectively and consecutively randomised and clinically followed until a final diagnosis was achieved. All of these patients additionally underwent magnetic resonance imaging (MRI) scans within an average of 3 days after trauma to control the results of this study. MRI detected 112 injuries in 82 patients (67%). ⋯ Only 30% of all scaphoid fractures detected were really occult and all of these were diagnosed correctly. This prospective study demonstrates that clinical and radiological standard procedures are reliable in the diagnosis of occult fractures of the carpus and wrist when performed by experienced observers. MRI scans are indicated for early diagnosis of occult fractures and soft tissue injuries about the wrist.
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Enterogenic endotoxinemia was induced in 28 Wistar rats by means of intraperitoneal injection of 80 mg/kg carrageenan and intraduodenal administration of 5 x 10(10)/kg Escherichia coli bacteria and 10 mg/kg nebacetin. The control group A received 600 mg/kg albumin in addition via the duodenal probe, and the groups B, C and D received 20, 40 and 80 mg/kg lactoferrin, respectively. The therapeutic effect was investigated by determining the endotoxin activity in the plasma every hour. ⋯ The period of observation was 5 h. There was a dose-dependent improvement of the endotoxin activity in plasma and the bacterial contamination of the peritoneum cavity and mesenteric lymph nodes after lactoferrin administration. The maximum plasma endotoxin activity could be reduced by 89% with 80 mg/kg lactoferrin.
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Langenbecks Arch Surg · Mar 2001
Multicenter Study Comparative StudyAlternative shift models and the quality of patient care. An empirical study in surgical intensive care units.
On 1 January 1996, the German Arbeitszeitgesetz (working-time regulation) came into effect for hospital physicians. It states that working hours must not exceed 8 h per day, even for physician in hospitals. As a consequence, the prevalent two-shift model is legally inadmissible. The intention of this law is to protect the physician and to create better conditions for the patients. However, a systematic evaluation of the postulated benefits is still lacking. ⋯ Three hundred and forty seven patients (103 2-SM, 244 3-SM) were included. The epidemiological and the health status on admission to the ICU were comparable. Patients in the 3-SM stayed 1.6 days longer on ICU and 2.3 days longer in the hospital than the 2-SM patients. The frequency of complications, reinterventions, and readmissions to ICU was higher in the 3-SM. The median of the APACHE-II score decreased more for 2-SM than for 3-SM patients. This means a significantly quicker recovery of the patients in 2-SM (P < 0.05). The multivariate analysis with individual outcome measures as dependent variables revealed a significant positive effect of the 2-SM on the physicians' assessment of postoperative course, on the relative frequency of therapeutic procedures, and to a lesser extent on the duration of stay in the ICU.
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Langenbecks Arch Surg · Feb 2001
ReviewIntra-abdominal hypertension and abdominal compartment syndrome.
The effects of increased intra-abdominal pressure in various organ systems have been noted over the past century. The concept of abdominal compartment syndrome has gained more attention in both trauma and general surgery in the last decade. This article reviews the current understanding and management of intra-abdominal hypertension and abdominal compartment syndrome. ⋯ Akin to compartment syndrome in extremities, the pathophysiological effects of increased intra-abdominal pressure developed well before any clinical evidence of compartment syndrome. These effects include cardiovascular, pulmonary, renal and intracranial derangement, reduction of intestinal and hepatic blood flow, and reduction of abdominal wall compliance. Although abdominal compartment syndrome is more commonly noted in patients with abdominal trauma, it is now evident that non-trauma surgical patients could also develop the condition. Early initiation of treatment for intra-abdominal hypertension is currently advocated in view of the possibility of subclinical progress to the full-blown abdominal compartment syndrome.
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Langenbecks Arch Surg · Dec 2000
Postischemic cardiac function recovery in the isolated rat heart: effects of adenosine deaminase and nucleoside transport inhibition.
This study assessed the cardioprotective effects of inhibitors of adenosine metabolism in an isolated perfused rat heart model. Specifically, we studied the adenosine deaminase inhibitor erythro-9-(2-hydroxy-3-nonyl)-adenine and the selective nucleoside transport inhibitor S-(p-nitrobenzyl)-6-thioinosine, in terms of their potential to enhance protection when added to Bretschneider's cardioplegic solution. ⋯ A combination of both substances may be tested further for cardiac preservation, as it might improve the recovery from ischemia at moderate temperatures.