Zentralblatt für Chirurgie
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Increasing life expectancy, medication and disease burden, along with decreased functional status and organ reserve, place the elderly surgical patient at high risk for delirium in the peri-operative state. Alcohol abuse and an increased incidence of dementia may confound the picture. This overview describes definition, epidemiology, etiology, diagnosis, and therapy of delirium and explores the confounding effects of dementia.
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Advances in early diagnosis of abdominal aortic abnormalities, enhanced pre-and post-surgical care and improved pharmacological treatment, as well as new interventional strategies and surgical techniques have led to a considerable increase of those patients, who undergo surgical therapy, either using classical trans-abdominal open or endovascular techniques. These patients, as a result of their often underlying multi-morbidity, are prone to secondary complications that often require individual solutions. We present and discuss two cases of post-surgical complications that required individual strategies for risk reduction. The first case demonstrates the endovascular approach to a complication following open aortic surgery, the second describes a surgical intervention to solve a problem following endovascular therapy.
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Appendicitis is diagnosed by synoptic evaluation of typical symptoms, laboratory tests and sonography. The only therapy is a prompt operation. The main reason for appendicitis mortality is the condition not detected or not detected in time. ⋯ Only if appendicitis can be reliably ruled out an operation is not indicated. The not performed surgical intervention is often interpreted as a treatment error by the courts. In doubt, an operation should therefore be performed.
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The aim of this study was to evaluate the long-term outcome of multiple injured patients with foot injuries. While severity and frequency of multiple injuries could be decreased in the last years, it was not possible to decrease the severity of injuries of the foot and ankle region. These injuries are often not detected and their severity is underestimated in primarily diagnostics what might lead to complaints in the longterm course. ⋯ In our study period an increasing number and severity of injuries of foot or ankle can be shown. Furthermore multiple injured patients with concomitant injuries of foot or ankle show a lower ISS what suggests that these patients might have a higher survival rate and consecutively enter rehabilitation process.