Zentralblatt für Chirurgie
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Early diagnosis of the different severities of septic inflammation is important for early implementation of specific therapies. Sepsis and severe sepsis are accompanied by clinical and laboratory signs of systemic inflammation. ⋯ It is therefore important to identify markers, which, by enabling an early diagnosis of sepsis and organ dysfunction, would allow early specific therapeutic interventions. Wheras C-reactive Protein is a more sensitive parameter for the diagnosis of non-systemic infections, Procalcitonin seems to be a useful parameter to improve the diagnosis and monitoring of therapy in patients with severe sepsis and septic shock.
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The treatment of sepsis consists of focus control as well as supportive and adjuvant therapy. Especially the last option has been investigated during the last years. Different approaches showed promising results in animal experiments and phase-I trials but did not prove to be successful in large multicenter studies. ⋯ However, a recent large study with a monoclonal antibody against TNFalpha demonstrated a significant survival benefit. The recently published PROWESS study is the first investigation demonstrating the decrease of mortality in patients with sepsis after administration of protein C. Additionally, current data support the low-dose hydrocortisone therapy in patients with vasopressor dependent septic shock.
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Comparative Study
[Does hospital structure influence the outcome of operative treatment of femoral neck fractures?].
Data on 32 007 patients suffering from a medial fracture of the femoral neck have been collected between 1993 and 1999 in a database for external quality assurance organized by the chamber of physicians in Westfalia-Lippe. A statistical analysis (ANOVA, chi-square-test) has been performed to find out whether factors like specialization, annual volume or level of the hospital (primary, secondary or tertiary hospital) influence the outcome. ⋯ There are distinct differences regarding the way of treatment and procedural quality, but not concerning the short-term outcome between hospitals of different levels.
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In the era of cost containment in our health care system the demand is made of increasing outpatient surgery e. g. for carpal tunnel syndrome. To show the possibilities of carpal tunnel release performed under outpatient conditions we analysed 925 consecutive cases during 1. 1. 1981 to 30. 4. 2001. A tourniquet was used in all cases. ⋯ Numbness and paresthesias were relieved in 98 %, pain was relieved in 90 %, motoric weakness was relieved in 95 % of the hands. The overall satisfaction rate was 94 %. Carpal tunnel release can be performed safely and unexpensively under outpatient conditions.
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Comparative Study
[MR-angiography and duplex-ultrasonography: predictive reliability for angiographically determined internal carotid artery stenosis >/= 70-99%].
A prospective study was undertaken to evaluate whether digital subtraction angiography (DSA) which is still associated with a substantial morbidity can be replaced by less invasive diagnostic modalities such as duplex scanning (DS) and magnetic resonance angiography (MR-A) for the detection of angiographically defined internal carotid artery (ICA) stenosis >/= 70 %. ⋯ In our series, both duplex-derived PSV as well as MR-A provided high sensitivity to detect surgically relevant ICA stenosis. However, to select patients for surgery inclusion of EDV proved to be important due to a high PPV and may spare conventional angiography half of patients with stenosis exceeding 70 %.