Zentralblatt für Chirurgie
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Observational Study
[An algorithm for postoperative pain management in visceral and thoracic surgery: an observational study].
We report the results of an observational study of pain intensity before and after implementation of an algorithm for postoperative pain management. The algorithm included multiple factors for treatment. ⋯ Implementing an algorithm for postoperative pain management resulted in a clinically relevant reduction of postoperative pain. Our findings reflect the result of a complex change in pain management, and therefore cannot be attributed to any single factors involved.
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In selected patients laparoscopic distal pancreatectomy with splenectomy has increasingly gained in importance as an alternative to the open approach. Modern imaging procedures detect more frequently neuroendocrine pancreatic tumours. A typical feature of the neuroendocrine pancreatic tumour is that this kind of tumour is mostly small with a size of 1 to 2 cm. Due to their mostly small size they are suited to a laparoscopic approach. We report here the feasibility and surgical technique of a laparoscopic distal pancreatectomy with splenectomy and partial gastric resection due to a neuroendocrine pancreatic tumour. ⋯ Laparoscopic distal pancreatectomy with or without splenectomy is feasible with a low morbidity rate by experienced laparoscopic surgeons. The advantages of laparoscopic compared to open approach are well known, but the laparoscopic approach in pancreatic surgery should be used in selected patients. Due to their mostly small size, especially neuroendocrine tumours in the tail of the pancreas are suited to a laparoscopic approach.
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The implantation of endoprostheses is an established procedure in orthopaedic and trauma surgery. However, the techniques are often associated with a high risk of post-interventional infections and wound healing disorders that can result in loss of the prosthesis or the limb--most likely based on an insufficient debridement and poor soft-tissue coverage. The purpose of this study was to evaluate the efficacy of the coverage methods in our patient population. ⋯ A radical debridement and an early appropriate defect coverage of the exposed prosthesis is crucial in the reconstruction process. Through a close interdisciplinary collaboration a stable soft-tissue covering can be achieved. Consequently it is possible to avoid a loss of the endoprosthesis, marked functional deficits or even amputations.
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Lung cancer is one of the leading causes of death in Europe and the USA. A relatively good prognosis is limited to those patients in whom the tumor is detected at an early stage. As clinical symptoms of lung cancer are a late finding in the natural course of the disease, most of the patients are diagnosed at an advanced tumor stage when palliative care remains the only therapeutic option. ⋯ First of all, the population that might benefit from CT lung cancer screening has to be defined precisely. Furthermore, guidelines have to be established about how to manage screening participants with detected lung nodules, as the vast majority of these pulmonary nodules will prove to be benign. This review article summarizes the results of the NLST and the initial data from the European screening trials, and will discuss some of the major open questions in lung cancer screening with CT.
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Patients with pleural thymoma spread (Masaoka stage IV a) should be treated within a multimodal treatment regime. However, the extent of local surgical resection to achieve optimal tumour control remains controversial. ⋯ Masaoka stage IV a thymoma could be safely treated with lung-sparing radical P/D and HITHOC with cisplatin in a multimodality treatment regime. Early results with respect to recurrence and survival are encouraging, but further studies are warranted and we have to await long-term results.