Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
[Ambulatory co-disciplinary risk-adjusted preoperative care].
Routine preoperative studies in asymptomatic patients are not helpful for perioperative risk evaluation, and the cost is considerable. The decision regarding the status of a patient for elective surgery can be accurately predicted in 95% of cases on the basis of a complete history and physical examination alone; selective testing should be preferred. Interdisciplinary outpatient premedication is suitable for an individual risk evaluation, and a significant reduction in cost and inpatient treatment.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
[Graduate education for specialist in surgery in the USA--aspects for the young German and American physician].
Due to high standards in clinical practice and outstanding research opportunities in the USA, German residents wish to do a part of their surgical education in an American teaching hospital. Currently, German applicants must have an unrestricted license and a valid Standard ECFMG Certificate. For this certificate they must have passed Step I and II of the United States Medical Licensing Examination, which also includes an English test. ⋯ In Germany, American residents have the opportunity to apply for a supervised training year without passing the German medical exams. At present, there are no clinical exchange programs in surgery between Germany and the USA. Therefore, the German and American College of Surgeons should develop an exchange program for residents in surgery.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
Randomized Controlled Trial Clinical Trial[Cause-oriented prevention of nosocomial pneumonia: the HI-LO EVAC tube].
Surgical high-risk patients were studied in a prospective randomized trial regarding nosocomial pneumonia (NP) using a subglottic lavage (SL). A total of 100 patients were investigated, in whom the primary infection was localized in the oropharynx. Independent of the kind of stress ulcer prophylaxis, intermittent subglottic lavage reduces the incidence of NP drastically to 3%, which is however, without statistical significance.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Plasma separation combined with CVVHF in septic and SIRS patients].
In a prospective non-randomized trial, 59 patients with sepsis (n = 43) and SIRS (n = 16) were treated on a surgical intensive care unit. In 22 patients plasmapheresis in combination with continuous venovenous hemofiltration (CVVHF) was administered. Lethality was 56% in the sepsis group; in the therapy group lethality was significantly lower in patients with plasmapheresis, even though in this population the organic failure rate was higher. ⋯ Lethality at 22% in the plasmapheresis group with double organ failure was significantly lower (P > 0.01) than in controls. Reduction of lethality seemed to be as high as 18% in patients with sepsis, while patients with SIRS did not profit from the additional therapy. A prospective randomized trial in sepsis and double organic failure should be projected.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
Multicenter Study[The diagnostic value of rectal examination of patients with acute appendicitis].
The results of rectal digital examinations performed on 477 patients upon admission with histopathologically proven acute appendicitis from a total of 2280 patients with acute abdominal pain were analyzed. Although 13.7% of the patients experienced pain on the right side and 7.4% pain in the pouch of Douglas during rectal examination, none of the rectal examination parameters was statistically significant for the diagnosis of acute appendicitis. There are well established and statistically significant clinical indications, such as guarding, rigidity, rebound tenderness or abdominal distention that actually make the unpleasant rectal-digital examination superfluous for patients with suspected appendicitis.