Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
Comparative Study[Stragegies for evaluation of non-randomized therapeutic comparisons exemplified by prehospital volume therapy after trauma].
Non-randomized comparisons of therapeutic approaches require extensive description of the patients. Classical subgroup analysis suffers from small sample sizes. Estimation of outcome based on known prognostic factors (e.g. scores) allow for an indirect comparison of treatment effects. ⋯ The propensity score approach classifies all patients according to their chance of receiving a certain therapy or not, thus giving comparable situations for stratified analysis. The preclinical fluid resuscitation for trauma patients can hardly be assessed by randomized trials. Application of the above mentioned methods shows no overall effect but polytraumatized patients seem to have a worse outcome with high volume resuscitation.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
[Video-assisted thoracoscopy for effective palliation of malignant pleural effusion. Pleurodesis--pleuroperitoneal shunt].
Dyspnea and reduced physical capability mean a significant reduction in quality of life of patients with advanced tumor disease. Video-assisted thoracoscopic talc poudrage or alternatively placement of pleuroperitoneal shunts were retrospectively evaluated as procedures for definitive palliation.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
[Intensive care medicine from the viewpoint of patients, their family and nursing personnel].
We wanted to know how our intensive care unit would be graded by the patients, their family members and the staff, as well as the impression that intensive care medicine made on them. A total of 82% of the patients and 90% of the family members were of the opinion that they owed their lives to intensive care medicine, and 100% of the patients and 96% of family members deemed intensive care medicine significant. ⋯ The nursing staff held a contrary opinion and were more critical. Competent explanation and transmission of information represented the most important factor in forming a positive opinion of intensive care medicine.
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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
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.