Zentralblatt für Chirurgie
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Comparative Study
[Pathophysiology and clinical significance of the abdominal compartment syndrome].
Different causes, for example posttraumatic and postoperative complications, can lead to an elevated intra-abdominal pressure. Increased intraabdominal pressure effects cardiovascular, pulmonary and renal systems. The abdominal compartment syndrome can be defined as organ failure caused by an increased intra-abdominal pressure. ⋯ Early decompression by simple laparotomy and delayed closure is the treatment of choice. If untreated the abdominal compartment syndrome is lethal. Even treated it has a high morbidity and mortality as shown in our series where 2 out of 7 patients with this syndrome died despite surgical decompression.
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The fibrolamellar karzinoma of the liver (FLC) as an uncommon variant of the hepatocellular karzinoma (HCC) is an indolent growing tumor. In its prior manifestation the FLC occurs at the adolescence and young adult stage. Early stage diagnosis and aggressive surgical treatment achieve better long-term results than usual resection of the HCC. ⋯ Furthermore hyperthermic intraperitoneal chemotherapy was carried out the next day. The patient's postoperative course remained uncomplicated with fast recovery. Presently, 6 months after surgery, the patient has no evidence of recurrence.
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Review Comparative Study
[Efficacy of oncologic surgery. Does anesthesia influence the postoperative outcome?].
Major surgical interventions in tumour surgery are still associated with perioperative cardiopulmonary, infectious, thromboembolic, cerebral, and gastrointestinal complications. There are different prophylactic and therapeutic possibilities to anticipate or counteract these perioperative complications. The most important, including beta blockers and alpha-2-agonists for patients at coronary risk, preoperative optimisation of oxygen transport in high risk surgical patients and the concept of multimodal perioperative therapy (analgesia, early mobilisation, early enteral nutrition, and others) combined with high perioperative inspiratory oxygen concentration and maintenance of normothermia to reduce wound infection and cardiac complications are described in this paper.
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Septic complications are an important factor for the morbidity and mortality of acute pancreatitis. The gut has been identified as a source of infection early in the course of the disease allowing intestinal bacteria to translocate into pancreatic necrosis and other organs. Bacterial translocation is promoted by an impaired intestinal mucosal barrier which can be attributed to the reduced oxygen and substrate supply of the intestine during the early systemic response to the pancreatic injury. ⋯ Experimental data are presented to underline the significance of these nutritive factors and subsequent randomized multicenter trials performed to verify the positive experimental results are introduced. The effect of other nutritive factors (e.g. omega-3-fatty acids) has not yet been systemically investigated. Thus, experimental and clinical studies need to be performed for evaluating their effect on bacterial translocation and the disease course in acute pancreatitis.