Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
Comparative Study[Effect of pneumoperitoneum with carbon dioxide and helium on hemodynamic parameters after compensated acute hemorrhage].
If animals have been properly resuscitated after moderate bleeding and hypovolemia has been corrected with colloidal solution, pneumoperitoneum with 12 mmHg does not appear to be harmful in a porcine model. Helium showed no clear advantage as insufflating gas over carbon dioxide.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
[Tumor necrosis factor-alpha (TNF-alpha) gene polymorphism in surgical intensive care patients with SIRS].
Biallelic polymorphism in the promotor region of the TNF-alpha gene have been associated with variation in TNF-alpha production. We determined the TNFA polymorphism (position--308) and related these data to plasma cytokine levels of TNF alpha, IL6, IL6R and IL8 in patients with SIRS and sepsis. Although there seems to be a different cytokine secretion pattern for both allelic groups (TNFA1 and TNFA2), a clear risk group could not be determined. It still remains unclear whether there is a genetic factor that influences the development of sepsis and multi organ failure.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
Case Reports[Medical principles of thromboembolism prevention].
Since thromboembolic complications have been described to be one of the most frequent complications following surgery, a correct indication for prophylaxis is of great clinical importance. This requires comprehensive knowledge about the general thrombosis risk of various patient populations, experience in the assessment of the individual thrombosis risk, understanding of the mode of action of various prophylaxis modalities, and critical benefit/risk assessment when pharmacological agents are used. Patients with a moderate or high risk require medical prophylaxis with either unfractionated heparin, low molecular weight heparins, or oral anticoagulants unless there is too high a risk of bleeding. Mechanical methods such as physical exercise and early mobilisation of the patient remain the basic measurements which can be supplemented by graduated pressure stockings.
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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
Comparative Study[Minimal invasive, percutaneous ventriculostomy in therapy of severe craniocerebral trauma].
From May 1996 until April 1997 percutaneous CT-controlled ventriculostomy (PCV) was performed in 19 patients with severe traumatic brain injury and no indication for decompressive craniotomy. There was a significant reduction in the duration of the procedure compared to burr-hole ventriculostomy with no complications. Because of further advantage of PCV CT-controlling is the possibility of puncturing even very narrow ventricles.