Zentralblatt für Chirurgie
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The indication of vena cava filter implantation is controversially discussed. A pure prophylactic indication is increasingly favoured, especially for temporary filter systems without any anamnestic pulmonary embolisms. On the basis of the available literature and our own results a critical analysis of this issue is given. ⋯ Local infections of the catheter and introducer sets were observed in two patients. Moreover, in one case the strut of a temporary filter broke and subsequently dislocated 17 days after insertion. We conclude on the basis of these complication rates that until the results of randomised studies are available the usage of all filter systems should be limited to highly selected cases.
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Biography Historical Article
[Rahel Hirsch (1870-1953). The first Prussian woman medical professor].
Dr. Rahel Hirsch was only the second woman to attain a professional medical position at the Charité Hospital in Berlin. For more than 16 years, she worked in Clinic II Internal Medicine. ⋯ Not permitted to practice in London, she underwent a serious crisis. When she died, she was impoverished. More than a decade later, she was posthumously admitted into the "Galerie of famous Jewish scientists." Her discovery, which had been so greatly criticized, was named after her.
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Historical Article
[Surgery school. Tradition-transition-change in paradigm?].
First Schools in Surgery already at the antiquity. During the medieval some slow developments in this regard throughout Europe, especially in France and Italy. ⋯ Tremendous changes in our time with a break of the generations, new structures at the universities, far reaching separation into subdisciplines of surgery and explosive technical developments question the meaning of surgical schools in the old sense. But there will apparently be a continuation, even in a changed matter and this on the background of a shift of the paradigm.
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Hydroactive wound dressings retain exsudate in the wound region or incorporate wound exsudate by gel formation. They create the local environment for moist wound healing which is experimentally and clinically characterized by accelerated reepithelialization, inflammatory reaction and angiogenesis as well as reduced wound pain and wound infection rates. Clinically relevant product groups of hydroactive wound dressings (hydrocolloids and hydropolymers, semipermeable films, calcium alginates) are distinct as to chemical structure, physical properties and functional characteristics in local wound treatment. ⋯ Experimental and clinical results of moist wound treatment by hydroactive wound dressings such as hydrocolloids and hydropolymers, semipermeable films or calcium alginates reveal a wide range of local response on the different types of dressings. They offer the opportunity of therapeutic differentiation. To elucidate the differential indication for different product groups of hydroactive wound dressings in local treatment of chronic wounds, additional experimental and clinical research is required.
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The intraabdominal sepsis is one of the major surgical problems today. The Systemic Inflammatory Response Syndrome in peritonitis often leads to multiple organ failure. The surgical eradication of the infectious focus is the most important prerequisite for a successful treatment. ⋯ Using surgical and physiological as well as organ failure scores like the Mannheimer-Peritonitis-Index (MPI), the APACHE-II and the Septic-Severity-Score (SSS), the prognosis can be objectively assessed and different clinical studies can be compared. However, in 88 own patients suffering from diffuse purulent peritonitis with sepsis (May 1990 to December 1996), all the above mentioned scores significantly allowed to discriminate surviving (mean MPI: 25, APACHE-II day 1: 19, SSS day 1: 28) from non surviving patients (mean MPI: 31, APACHE-II day 1: 26, SSS day 1: 45). Furthermore, mortality increased significantly with increasing score ranges (< 20, 20 to 30, and > 30 points) for MPI from 0% to 28% to 81%, for APACHE-II day 1 from 20% to 46% to 100%, and for SSS day 1 from 10% to 37% to 71%.