Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
Review[Evaluation and quality management in multiple trauma care].
In total quality management of polytraumatised patients, it is necessary to use analysis of structure, process and outcome quality to search for problem areas and improvement possibilities. The structure includes the attributes of material and human resources. ⋯ To prove the outcome quality, an internal and external judgement is possible. Our own results show that quality assessment, concerning the process as well as the internal and external quality outcome, brings a significant improvement to the care of polytrauma patients.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
[Measuring epidural intracranial pressure in patients with severe craniocerebral trauma].
In 30 patients with severe head injury (SHI), intracranial pressure (ICP) was monitored using epidural transducers. In 22 patients, the measurements were reliable, with average values of 19.4 mmHg in the survivors and 64.6 mmHg in those who died. It is concluded that epidural measurement of ICP provides a helpful method for the management of SHI and to control the indication for CT scans.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
[Oncologic risk in pylorus preservation in resection of ductal pancreas carcinoma].
We detected peripyloric lymph node metastasis in 2 of 24 patients with ductal adenocarcinoma of the pancreas who underwent Kausch-Whipple's procedure. The resection would have been palliative if these patients were treated by pylorus-preserving pancreatoduodenectomy.
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Olecranon and prepatellar bursitis have a prevalence of 3 in 1000 patients; the predominant etiology is a traumatic lesion with or without inoculation of infectious material, mainly during professional or leisure activities. Separation into septic and non-septic bursitis is possible in most cases according to clinical parameters and characteristics of the contents of the affected bursa. The therapy of acute and chronic bursitis is guided mainly by the nature of the aspirate retrieved from the bursa: a serous content justifies conservative treatment with compression, immobilization, antiphlogistic medication, and (in selected cases) the instillation of corticosteroids; a purulent aspirate necessitates bursotomy with incision and drainage, or bursectomy. Only in selected cases is a conservative trial with antibiotics, immobilization, and antiphlogistic medications justified.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
Review[Treatment of increased intracranial pressure in craniocerebral trauma].
The management of trauma patients with increased intracranial pressure is based on maintaining a normal "milieu interne", i.e. avoiding posttraumatic hypoxia and hypotension and applying specific treatment modalities, if indicated. If there are clinical signs of increased intracranial pressure or signs of cerebral edema in the CT scan, monitoring of intracranial pressure is indicated. ICP above 20 mmHg should be treated and the cerebral perfusion pressure should be maintained between 60 and 70 mmHg. Accepted treatment modalities of increased ICP are: 1) analgosedation, 2) head elevation, 3) hyperventilation, 4) osmotherapy, 5) barbiturate therapy, and 6) THAM (tris puffer).