Zentralblatt für Chirurgie
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Pheochromocytomas are active, catecholamine-producing tumours derived from chromaffine tissue, causing arterial hypertension. The therapeutical aim is the surgical removal of the tumour. Blockade of the alpha-adrenergic receptors during the preoperative phase is necessary to prevent cardiovascular complications. ⋯ With an adequate preoperative management, mortality of patients with pheochromocytomas has been reduced to less than 1 percent. Postoperatively, most patients become normotensive and other symptoms of excessive catecholamine-production disappear. In cases of long persisting and fixed hypertension paroxysmal crises of high blood pressure can be avoided.
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Comparative Study
Treatment of refractory intracranial hypertension in severe traumatic brain injury with repetitive hypertonic/hyperoncotic infusions.
Rapid resuscitation of clinical and experimental traumatic brain injury (TBI) with hypertonic saline (HS) has been shown to improve neurological function and decrease intracranial pressure (ICP). The purpose of the present study was to test the efficacy of administration of HS (7.5%) combined with 6% hydroxyethyl starch (molecular weight 200,000/0.60-0.66; HHES) for the treatment of intracranial hypertension refractory to standard therapy in patients with severe TBI. With approval of the Institutional Ethics Committee six consecutive patients with severe TBI (GCS < 8) between 22 and 47 years of age (mean 32) who met the inclusion criteria (therapy resistant ICP > 25 mmHg, cerebral perfusion pressure (CPP) < 60 mmHg, plasma-Na+ < 150 mOsm and > 4 hours since the last HS/HHES treatment) were prospectively enrolled in the study. ⋯ Plasma sodium normalized within 30 min. HS/HES might become an interesting addition to conventional treatment maneuvers currently used for ICP therapy. It reduces otherwise therapy-resistant intracranial hypertension without negatively affecting blood pressure, blood gases and cerebral perfusion.
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Comparative Study
[Management of large abdominal wall hernias with foreign implant materials (Gore-Tex patch)].
Incisional hernia repair with conventional techniques (simple closure, Mayo) is associated with high recurrence rates in the range of 30-50%. Surgical repair using different prosthetic biomaterials gains more and more acceptance. Therefore we wanted to evaluate our own results of hernia repair and analyze the results of a mesh hernioplasty using an expanded polytetrafluoroethylene patch (ePTFE). ⋯ The use of prosthetic mesh should be considered for repair of large or recurrent incisional hernias, especially in high risk patients (obesity, obstructive lung disease). Beside the most often used polypropylene mesh, the ePTFE patch (Gore-tex-Soft-Tissue-Patch) represents a valuable alternative in selected cases with direct contact of the prosthesis to abdominal viscera. Any previous septic wound complication or a contaminated operating field (e.g. colostomy) seems to be a contraindication for its use.
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Since 1990, we have been conducting ambulatory pediatric surgery in an unit established solely for this purpose, supported by a team of kindergarten teachers, pediatric nurses, anesthesiologists and pediatric surgeons. This prospective investigation includes all ambulatory pediatric operations performed in our department from 1990 to 1995. In this time 3665 infants and children between the ages of 6 weeks and 18 years underwent an ambulatory operation. ⋯ Further improvement is necessary in quality management. In the last 20 years only a few data have been published about recurrence rates after pediatric ambulatory operations for inguinal hernias and inguinal testes. Therefore we started a prospective long- term study.
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Acute mesenteric ischemia is a life-threatening vascular emergency. A retrospective analysis of our patients was performed to describe the development of the various procedures of diagnostic assessment and treatment between 1970 and 1996, to show the influence on survival and to define recent standards. ⋯ Early diagnostic assessment and treatment are decisive for survival. Abdominal-CT, angiography and serum-lactate constitute quick and reliable means to provide diagnosis and to judge the stage of AMI in addition to meticulous examination of patients' history, symptoms and physical conditions.