Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
[Surgery in patients over 80 years of age--a retrospective analysis of 642 general surgery patients].
We evaluated the data on 642 patients over 80 years of age who underwent general surgery within the preceding 10 years. Lethality in elective surgery was higher compared to younger patients and showed a threefold increase in emergency procedures. Preexisting co-diseases strongly determined survival, which emphasises the fact that a thorough preoperative risk-assessment is essential for elective surgery. Age itself is not a contraindication for elective surgery.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
[Treatment of postoperative lung failure with prone positioning].
Of forty-three consecutive patients with severe adult respiratory distress syndrome (ARDS) treated in the prone position pulmonary function improved significantly in 39 patients during the first 12 h in prone position. Changes were most pronounced in patients with high QS/QT, as well as in patients in the early stages of ARDS. Twenty-eight patients could be weaned from the ventilator, and 22 patients were able to leave the hospital. These results suggest that prone position has an important role in the overall therapeutic approach to ARDS and should be used as early as possible.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
[Extent of radical surgery in cardia carcinoma--esophagectomy or gastrectomy?].
In patients with cardia cancer, showing a tumor center between 1 cm above to 2 cm below the anatomical cardia, the results of transhiatal esophagectomy with proximal gastrectomy versus total extended gastrectomy with distal esophageal resection were compared. For gastrectomy, postoperative mortality was significantly lower (2% vs. 8.6%), whereas the rates of R0 resection (81% vs. 68%) and 5-year survival rate (48 vs. 25%) were significantly higher than after esophagectomy. If in cardia cancer, according to the mentioned definition, R0 resection can be achieved by extended total gastrectomy and distal esophageal resection, this represents the procedure of choice for this strictly defined type of carcinoma of the cardia.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
[Abdominal surgery in the elderly--a retrospective analysis over 11 years].
Particular problems of abdominal surgery in geriatric patients were analyzed in a retrospective study of 1569 surgical procedures of the abdomen carried out in 1420 patients aged 70 years or more. Emergency procedures were necessary in 357 (22.8%) cases with a lethality of 25.5% compared to 8.8% in the elective group. Morbidity was also visibly different in both groups (59.3% vs. 40.2%). While the average time of hospitalisation was 22.4 days, almost 80% of our patients could be released and 12.6% died in hospital.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
[Changes in the spectrum of the health provision contract and their effects on education, graduate education, research, quality of treatment and continuing development of surgery].
The legal "contract for patient care" issued by the Federal Government for all hospitals interferes with graduate medical education (approbation order), postgraduate surgical training, the KMK paper for new structures and financing of university medicine, health politics of the Physicians Parliament and the Legal Health System, guidelines for surgical practice, internal and external quality measurement, and, last but not least, with clinical research in surgery. The different effects are outlined in detail.