Zentralblatt für Chirurgie
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In the following paper a review is given on the development of scoring-systems of severe intraabdominal infections till now. After a critical reflection on various systems a heuristic assessment is shown in the summing-up about their possible utility in the future. At present the APACHE II index, the sepsis score by Elebute and Stoner and the Mannheim peritonitis index meet practically requirements for good scores by different revising questions.
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The change of target variables in palliative cancer treatment led to a new evaluation of quality of life. Its use as a target variable to discriminate different therapies is problematic. Investigations with a patient-questionnaire assessing quality of life showed that the validity of this term is difficult to judge. At present it should be used in clinical research as an accompanying variable only.
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Comparative Study
[Learning from mistakes. Thoughts on preclinical care of accident victims based on 10-year experience in a large city of West Germany].
On the occasion of the 25th anniversary of preclinical emergency medicine a review of the last decade of preclinical treatment of polytraumatized patients was performed. Initially preclinical emergency medical services were established for the immediate care of victims in road accidents. Therefore these services were first usually stationed in Centers for Surgery or Traumatology. ⋯ Only physicians of Search and Rescue helicopter teams and residents of surgical and trauma departments made significantly few mistakes in the early treatment of polytraumatized patients. Typical mistakes of less experienced physicians could be sorted into 5 groups: --volume treatment: incorrect estimation of the severity of polytrauma/incorrect estimation of the amount of blood loss/insufficient substitution of volume/logistical mistakes. --O2 treatment: incorrect estimation of the degree of blunt thoracic trauma/hesitant indication for early artificial respiration/hesitant indication for thoracic drainage. --local treatment: incorrect estimation of the severity of soft tissue trauma/incorrect treatment of amputated limbs. --logistics and transport: additional iatrogenic laceration of soft tissues due to insufficient reposition and retention/logistical mistakes in choosing in the best means of transport and the best suited hospital for the patient. --special types of trauma: incorrect estimation of the severity of burn trauma/lack of experience in triage in cases of major accidents. To get better results in the early treatment of polytraumatized patients, the installation of a specialized emergency medical service for trauma patients in the main trauma centers of major cities combined with the function of the surgeon in charge for major accidents and catastrophies is to be discussed.
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The problem of hand injuries from bullets and explosives is covered in this paper by the example of three cases. The recommendation is made to remove only easily accessible projectiles. ⋯ Essential measures should include immediate wound toilet with removal of devitalised tissue, primary osteosynthesis, preferentially with minifixateur externe, coverage of exposed tendons, nerves, bones, and joints, splitting of the ligamentum carpi volare, perioperative administration of antibiotics, and secondary skin suture. Definite treatment should be left to a centre of hand surgery.