Zentralblatt für Chirurgie
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Hydroactive wound dressings retain exsudate in the wound region or incorporate wound exsudate by gel formation. They create the local environment for moist wound healing which is experimentally and clinically characterized by accelerated reepithelialization, inflammatory reaction and angiogenesis as well as reduced wound pain and wound infection rates. Clinically relevant product groups of hydroactive wound dressings (hydrocolloids and hydropolymers, semipermeable films, calcium alginates) are distinct as to chemical structure, physical properties and functional characteristics in local wound treatment. ⋯ Experimental and clinical results of moist wound treatment by hydroactive wound dressings such as hydrocolloids and hydropolymers, semipermeable films or calcium alginates reveal a wide range of local response on the different types of dressings. They offer the opportunity of therapeutic differentiation. To elucidate the differential indication for different product groups of hydroactive wound dressings in local treatment of chronic wounds, additional experimental and clinical research is required.
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The intraabdominal sepsis is one of the major surgical problems today. The Systemic Inflammatory Response Syndrome in peritonitis often leads to multiple organ failure. The surgical eradication of the infectious focus is the most important prerequisite for a successful treatment. ⋯ Using surgical and physiological as well as organ failure scores like the Mannheimer-Peritonitis-Index (MPI), the APACHE-II and the Septic-Severity-Score (SSS), the prognosis can be objectively assessed and different clinical studies can be compared. However, in 88 own patients suffering from diffuse purulent peritonitis with sepsis (May 1990 to December 1996), all the above mentioned scores significantly allowed to discriminate surviving (mean MPI: 25, APACHE-II day 1: 19, SSS day 1: 28) from non surviving patients (mean MPI: 31, APACHE-II day 1: 26, SSS day 1: 45). Furthermore, mortality increased significantly with increasing score ranges (< 20, 20 to 30, and > 30 points) for MPI from 0% to 28% to 81%, for APACHE-II day 1 from 20% to 46% to 100%, and for SSS day 1 from 10% to 37% to 71%.
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Despite the knowledge about sepsis for many years, the definition of sepsis is contested more than ever since the early 90th. Therefore, the comparability of many clinical investigations and scientific work in the past is still impaired. To define the entrance criteria for further clinical studies, in 1991 a consensus conference was held in the USA, but its recommendations have not found unequivocal acceptance. Therefore, these recommendations are presented and their meaning will be discussed.
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Review Case Reports
[Primary hypertrophic pyloric stenosis. A are form and stomach outlet stenosis in the adult].
A 38-year-old white female with primary hypertrophic pyloric stenosis is presented. The patient was admitted to our service with a history of upper digestive tract pain and postprandial vomiting since her 17th year of life. ⋯ Primary hypertrophic pyloric stenosis in adults is a rare condition of unknown etiology. Only about 200 cases of primary hypertrophic pyloric stenosis in adults have been reported in the literature.
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Four thesis related to economics of intensive care medicine are derived from an analysis of the intensive care unit of the university hospital of Basel, Switzerland, and the respective literature: (1) Intensive care medicine is costly but rationing can be avoided by rationalization. (2) Exemption or withdrawal of intensive care cannot be justified in the absence of accurate predictors of costs and outcomes of individual patients. (3) Intensive care physicians must not act as judges but on behalf of patients incapable of decision making. They must represent patients' interests vis-à-vis authorities and reimbursing institutions. (4) Analyses of cost-efficiency are instrumental for process improvement of intensive care, for negotiations on reimbursement and for the regulatory decisions of the authorities. Tools for economic analyses of intensive care medicine are therefore worthy of further development.