Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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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.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
Multicenter Study Clinical Trial[Procalcitonin as marker of systemic inflammatory reaction after isolated extremity perfusion].
The systemic side effects of isolated limb perfusion (ILP) with rhTNF alpha and melphalan are characterised by the induction of a systemic inflammatory response syndrome (SIRS). Procalcitonin (PCT), a serum marker of bacterial sepsis, was investigated with respect to its role in SIRS after TNF-ILP. Serum-PCT was analysed in 24 patients (12 male, 12 female), who treated by ILP for regionally metastasized melanoma (n = 8) or locally advanced soft tissue sarcoma (n = 16). ⋯ Serum procalcitonin is induced as part of the specific SIRS after ILP with rhTNF alpha and melphalan. It may be induced directly by rhTNF alpha or by different cytokines, as serum peaks of IL-6 and IL-8 are reached well before the peak of PCT. Determination of PCT prior to and after ILP with TNF might be useful to assess patients at risk of developing hyperdynamic shock.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
Multicenter Study[Clinical value of diagnostic score for appendicitis: results of a prospective intervention study].
The clinical benefit of a diagnostic score for acute appendicitis was tested in a prospective interventional multicenter study on patients with abdominal pain. The study was performed in two consecutive phases: standard diagnostic work-up with no additional diagnostic support (870 patients) and additional diagnostic support with a score (614 patients). ⋯ There were no differences in the perforated appendix, negative appendectomy and complication rate, however, the delayed appendectomy rate (2% versus 8%) and the delayed discharge rate (11% versus 22%) were significantly lower with diagnostic support by the score. In summary, the score cannot be recommended as a standard diagnostic tool for diagnostic decision making in acute appendicitis.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
[Information exchange via internet--possibilities, limits, future].
Today, the exchange of information in the Internet is dominated by the WWW and e-mail. Discussion groups like mailing lists and newsgroups also permit communication in groups. Information retrieval becomes a crucial challenge in using the Internet. ⋯ Future developments will not only improve the existing services, but also lead to fundamental changes in the transfer technologies: Safer data transfer is to be ensured by new encrypting software together with the planned transfer protocol IPv6. Introducing the new transfer mode ATM will lead to better and resource saving transmission. Computer, telephone and TV networks will grow together, resulting in convergence of media.