Zentralblatt für Chirurgie
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Comparative Study
[Role of adenosine triphosphate (ATP) in trauma-induced and elective hypothermia].
In trauma patients hypothermia is a frequent event. According to the literature the majority of trauma patients are presenting a core temperature of less than 34 degrees C at admission. In contrast to the benefit of hypothermia in elective surgery, clinical experience with hypothermia in trauma patients has identified hypothermia to be one major cause of severe posttraumatic complications. It was hypothetized that this diverse effect of hypothermia is related to depletion of high energy phosphates like adenosine-tri-phosphate (ATP) in trauma patients. To verify this hypothesis the relation of ATP plasma levels and hypothermia was examined in a clinical study. ⋯ Hypothermia in elective surgery, established by active cooling, preserves the ATP storage and maintains an aerobic metabolism, which both contribute to the beneficial effect of hypothermia in ischemia/reperfusion in cardiovascular surgery. However, in trauma patients hypothermia is caused by insufficient heat production due to utilization of ATP under anaerobic metabolic conditions. Low ATP plasma levels combined with hypothermia seem to be a predisposition for posttraumatic complications like organ failure.
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Despite the knowledge about sepsis for many years, the definition of sepsis is contested more than ever since the early 90th. Therefore, the comparability of many clinical investigations and scientific work in the past is still impaired. To define the entrance criteria for further clinical studies, in 1991 a consensus conference was held in the USA, but its recommendations have not found unequivocal acceptance. Therefore, these recommendations are presented and their meaning will be discussed.
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Review Case Reports
[Primary hypertrophic pyloric stenosis. A are form and stomach outlet stenosis in the adult].
A 38-year-old white female with primary hypertrophic pyloric stenosis is presented. The patient was admitted to our service with a history of upper digestive tract pain and postprandial vomiting since her 17th year of life. ⋯ Primary hypertrophic pyloric stenosis in adults is a rare condition of unknown etiology. Only about 200 cases of primary hypertrophic pyloric stenosis in adults have been reported in the literature.
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Despite the decreasing frequency of gastric cancer in most Western countries prognosis could not be improved by surgery alone in the past. Advanced tumor stage due to late diagnosis is one of the reasons for this observation. Contrary to breast and colorectal cancer, postoperative chemotherapy failed to improve prognosis in gastric cancer. ⋯ Intraperitoneal, adjuvant chemotherapy showed a positive impact on survival in Asian studies only, but was also used successfully as a part of a multimodality approach in Western phase II trials. Since neoadjuvant therapy proved to create downstaging of tumor size in some patients with advanced gastric cancer some working groups tried to influence prognosis of potentially resectable tumors by preoperative chemotherapy, surgical resection and postoperative, adjuvant therapy in the recent past. However, the efficacy of this therapeutic approach has to be reconfirmed in a controlled, phase III fashion.
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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.