Zentralblatt für Chirurgie
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Comparative Study
[First line application of a modified dilatational tracheostomy in the intensive care].
Despite the growing clinical use of the percutaneous dilatational tracheostomy data concerning their first line application are still lacking. ⋯ The first line application of the dilatational tracheostomy has a low morbidity.
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Comparative Study
[Establishing "fast-track"-colonic surgery in the clinical routine].
A multimodal perioperative concept ("fast-track"-surgery) may decrease the incidence of general complications following elective colonic resections, accelerate rehabilitation and shorten postoperative hospital stay. During the introduction of this new "clinical pathway" several obstacles have to be overcome. This manuscript describes a practical way to establish "fast-track"-colonic surgery in the clinical routine. ⋯ Establishing "fast-track"-colonic surgery requires close cooperation between surgery, anestehsiology and nursing personal. Most important is a surgeon prepared to overcome traditional concepts of perioperative care.
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Comparative Study
[Preoperative chemoradiation in esophageal cancer: experience of a single center in 102 patients].
The (dis-)advantages of preoperative chemoradiation in patients with esophageal cancer (EC) are still controversial as data are lacking showing a clear cut benefit. Therefore, data of neoadjuvant therapy of our hospital have been analyzed. Since 1994 102 patients with an EC (33 % adenocarcinoma, 67 % squamous cell cancer, scc) were operated after receiving preoperative chemoradiation (36 Gy radiation, 1.8 Gy/day for 4 weeks, 500 mg/m (2) 5-FU for 4 weeks and 20 mg/m (2) Cisplatin, day 1-5, week 1 and 4). ⋯ These results underline the benefit of neoadjuvant therapy in patients with a CR. Further on, a pN0 stage is an important prognostic indicator. However, it remains open, whether neoadjuvant therapy leads to a downstaging of lymph node involvement, as histological confirmation in clinically positive lymph node is seldom performed prospectively.
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Comparative Study
[Laparoscopic splenectomy: first experiences with a 3-trocar-technique and the 'hanging-spleen-maneuver'].
Laparoscopic splenectomy has been established as standard procedure for elective splenectomy and is performed for a variety of haematological diseases. However, different techniques have been used and a four- to five trocar technique is applied in most instances. We report our experience with a three-trocar technique using the triangular liver retractor and the so-called "hanging spleen" maneuver. ⋯ Laparoscopic splenectomy can be performed safely in the vast majority of patients. The described technique using three trocars with the so-called "hanging spleen" maneuver can be used in about 90 % of cases.
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It was the objective of this investigation to describe the results after stabilisation of pelvic fractures with the pelvic clamp in polytraumatized patients with unstable pelvic ring fractures. ⋯ Even if the number of patients who were treated is small, the study shows a positive trend in terms of stabilisation of the vital parameters after stabilisation of the pelvic fracture with the pelvic clamp.