Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
-
Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
[Ambulatory co-disciplinary risk-adjusted preoperative care].
Routine preoperative studies in asymptomatic patients are not helpful for perioperative risk evaluation, and the cost is considerable. The decision regarding the status of a patient for elective surgery can be accurately predicted in 95% of cases on the basis of a complete history and physical examination alone; selective testing should be preferred. Interdisciplinary outpatient premedication is suitable for an individual risk evaluation, and a significant reduction in cost and inpatient treatment.
-
Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
[Video-assisted thoracoscopy for effective palliation of malignant pleural effusion. Pleurodesis--pleuroperitoneal shunt].
Dyspnea and reduced physical capability mean a significant reduction in quality of life of patients with advanced tumor disease. Video-assisted thoracoscopic talc poudrage or alternatively placement of pleuroperitoneal shunts were retrospectively evaluated as procedures for definitive palliation.
-
Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
[Recommendations and guidelines for perioperative pain therapy in Germany].
The management of perioperative and post-traumatic pain in clinical practice is still significantly deficient in Germany as shown in a recently published representative and anonymous survey of 1,000 surgical clinics. Several steps were undertaken to improve the situation: in 1992, an agreement on responsibilities and organization was achieved between the "Berufsverbände" of German Surgeons and of Anaesthesiologists. In 1997, recommendations on the treatment of perioperative and post-traumatic pain were published by the two "Berufsverbände" together with the Scientific Societies of Surgeons and Anaesthesiologists. In 1998, national guidelines based on consensus methods in collaboration with the Association of the Scientific Medical Societies in Germany (AWMF) will be published at the Internet address http://www.uni-duesseldorf.de/WWW/AWMF/.
-
Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
[Thoracoscopic management of fractures of the thoracic and lumbar spine].
In 90 patients, stabilization of injuries of the thoracic spine and the thoracolumbar junction was performed using minimally invasive thoracoscopy. The method includes partial corporectomy with spinal decompression, interposition of a tricortical bone graft, and anterior spondylodesis by planting. Complications were rare and not severe, with only two conversions to open technique. Compared to the open, standard method benefits included reduced postoperative pain, shorter hospital stay and reduced morbidity.
-
Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
[Systemic effect of extremity-ischemia reperfusion surgical trauma. Assessment of tourniquet ischemia induced activation of poplymorphonuclear neutrophic granulocytes].
Ischemia-reperfusion-injury represents a fundamental common pathway of tissue damage in a wide variety of disease processes, i.e. myocardial infarction, septic or hemorrhagic shock, multiple organ failure, trauma and organ transplantation. Ischemia-reperfusion-injury is said to be initiated by leukocyte accumulation and adhesion to vascular endothelium as well as oxygen free radicals playing a pivotal role in the pathogenesis of ischemia-reperfusion-injury. However, only few data exist for measuring influence of tourniquet-ischemia on the activation of granulocytes in humans. ⋯ The tourniquet-ischemia of the upper limb without any operation (n = 10) induced an increase of the CD 11b-expression too (systemic, 149 +/- 76% and local 131 +/- 90%, both: p < 0.05 vs. bl). Furthermore there was a spontaneous release of free radical oxygen to 129.2 +/- 26.2% (systemic) und 154.8 +/- 35.9% (local: p < 0.01 vs. bl:) After stimulation by Phorbol-Myristat-Acetat (PMA) we demonstrated a decrease to 67.6 +/- 23.2% (systemic, p < 0.01 vs. bl) and to 68.3 +/- 15.6% (local, p < 0.01 vs. bl). These results indicate that ischemia-reperfusion-injury in humans induces a early measurable local and systemic activation of circulating PMN-granulocytes.