Helvetica chirurgica acta
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Helvetica chirurgica acta · Sep 1991
Randomized Controlled Trial Comparative Study Clinical Trial[Reduction of postoperative blood loss and donor blood use in heart surgery with aprotinin: experience with various dosages].
The effect of high dose aprotinin was evaluated in a prospective study on 100 patients undergoing cardiopulmonary bypass. Special attention was made on postoperative blood loss and transfusions of bank blood postoperatively. In the first part of the study, after induction of anesthesia, a loading dose of 2,000,000 kallikrein-inhibiting-unit (KIU) = 280 mg aprotinin was given intravenously over a 30-min period. ⋯ It appears possible that aprotinin reduces the activation of the coagulation during cardiopulmonary bypass and preserves platelet function without affecting platelet consumption during the extracorporeal circulation. The results of our study demonstrate that high dose aprotinin markedly reduces blood loss as well as homologous blood requirement in the early postoperative course of cardiosurgical patients. Similar effects due to reduced aprotinin dose have been observed in patients receiving aprotinin in the extracorporeal circulation only.
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Helvetica chirurgica acta · Jul 1991
[Helicopter and emergency physician at the accident site. Medical comparison between altitude and flat land emergency care].
In-field intensive care reduces lethality and morbidity in severe trauma. We analyze and compare 400 medical helicopter rescue flights in the region of Basel and 325 medical air-rescues in the mountains of Interlaken. The presence of a physician in the helicopter is based on an interventional concept, with clinical diagnosis, monitoring and early intensive in-field care. ⋯ In spite of high rates of severe conditions in both regions (57% in Basel, 17% in the mountains), the low mortality prior to and during air transport (2.5% in the Basel and 2.7% in the Interlaken region) confirms the necessity of the concept of early in-field intensive therapy. This concept allows good analgesia, is save and comfortable for the patients. The presence of a physician in the air rescue team has to be recommended not only for rescues in the plain, but also in the mountains.
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In the treatment of severe chest injuries with flail chest either positive-pressure mechanical ventilation (and tracheostomy) is necessary or the surgical stabilisation of the chest wall by osteosyntheses of the broken ribs. Fourteen patients (age 27-73) with severe chest injuries and paradoxical respiration were operated and the rib fractures stabilized by means of small reconstruction plates and cerclage wires. ⋯ The results are reported. In severe chest injuries surgical treatment seems to be justified; it reduces the need of artificial respiration and can be recommended.
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Helvetica chirurgica acta · Jul 1991
[Surgical indications, choice of procedure and results in upper gastrointestinal hemorrhage].
Even today acute upper gastrointestinal bleeding carries a high mortality rate. To improve results it is important to define and operate on those patients in whom recurrent bleeding is expected. ⋯ To improve long-term results we propose definitive ulcer surgery even in patients presenting as emergencies. Implementation of this policy does not increase operative mortality.
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In a retrospect study we evaluated the clinical impact of traumatic rib fractures. Our series included 96 patients treated between 1986 and 1988. ⋯ There was a highly significant association (p less than 0.001) between the number of fractured ribs and polytrauma. The leading cause of injuries was a traffic accident.