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 on hemodynamics and intestinal integrity in endotoxinemia: CO2 versus helium].
In a study in pigs pathophysiological effects of a pneumoperitoneum (PP) established during endotoxemia (2 micrograms/kg b.w./hr) were investigated. In this situation a PP with carbon dioxide (CO2) or helium induces a deterioration of systemic hemodynamics or acid-base-stability. ⋯ A CO2-PP adversely affects the intestinal energy metabolism and leads to significantly increased endotoxin levels in contrast to helium after desufflation of the abdominal cavity. Data of this study at least demand for a careful monitoring, if laparoscopy is performed in septic and critically ill patients.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
[Graduate education for specialist in surgery in the USA--aspects for the young German and American physician].
Due to high standards in clinical practice and outstanding research opportunities in the USA, German residents wish to do a part of their surgical education in an American teaching hospital. Currently, German applicants must have an unrestricted license and a valid Standard ECFMG Certificate. For this certificate they must have passed Step I and II of the United States Medical Licensing Examination, which also includes an English test. ⋯ In Germany, American residents have the opportunity to apply for a supervised training year without passing the German medical exams. At present, there are no clinical exchange programs in surgery between Germany and the USA. Therefore, the German and American College of Surgeons should develop an exchange program for residents in surgery.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
[Detection of disseminated carcinoma cells in bone marrow and peripheral blood in primary breast cancer with RT/PCR of parathyroid hormone-related protein (PTHrP)].
The analysis of tissue specific gene expression by reverse transcription based RT/PCR methods is currently evaluated as a method for the detection of tumor cell dissemination in patients with cancer. Breast cancer tissues express PTHrP and the level of PTHrP expression in the primary tumor correlates with the incidence of metastases in the bone. We applied a RT/PCR assay of PTHrP to detect tumor cells in the mononuclear cell fraction of peripheral blood (pb) and bone marrow (bm) of patients with newly diagnosed breast cancer. ⋯ During the period of observation there was no local and metastatic relapse detectable in the group of patients with primary lymph node negative breast cancer. In summary the increased risk for local or systemic relapse would have been predictable by RT/PCR of PTHrP alone in pb in 4 of the 9 local and in 2 of the 7 early metastatic relapses. Further follow-up of the patient cohort analysed is needed to assess the value of the RT/PCR of PTHrP as a prognostic and predictive marker in patients with breast cancer.
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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.