Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1996
Comparative Study[Monitoring critically ill intensive care patients by semi-invasive COLD (Cardiac-Output-Liver-Diseases) monitoring instead of pulmonary artery catheterization].
The routine application of an arterial thermal-dye-dilution technique (so called COLD-Monitoring) offers new perspectives in the hemodynamic management of critically ill patients using a small invasive technique. COLD-Monitoring employs a computerized analysis of a double-indicator (temperature and dye) dilution technique which requires only a central venous catheter and a special fibre optic catheter with a temperature probe applied to the femoral artery. Especially in critically ill patients with septic course or multiple organ failure (MOF) COLD-monitoring serves to exactly measure volume and therefore distribution, to objectify capillary leakage by extravascular lung water index, to check the excretoric liver-function by plasma-deviation-rate of ICG and to perform a well controlled epinephrine therapy by measuring cardiac function index and systemic vascular resistance index.
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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.