Zentralblatt für Chirurgie
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Conservative treatment of breast cancer is now an accepted oncological procedure. It further allows a good functional and cosmetic result. ⋯ As more than 1100 patients have been treated since 1977 in our area at a single radiooncological center by a breast conserving procedure. We have confirmed or defined criteria which lead to a good local tumor control as well as to good functional and cosmetic results.
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Diagnostic and therapeutic measures after severe head-injury in the intensive care unit are discussed. The main goal of all efforts consists in minimizing secondary brain damage. Adequate shock therapy in the initial phase proves crucial for the later outcome. ⋯ Surgical and conservative modalities of therapy are further examined. Controversial methods (barbiturates, steroids, some osmotic active agents) as well as new concepts of therapy are also included. The clinician is provided with a critical discussion of the value of the different methods from our point of experience.
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Patient-controlled analgesia (PCA) is a newer technique for pain management. Patients are allowed to self-administer small analgesic bolus doses, which have been preprogrammed by the physician, into a running intravenous infusion, intramuscularly, subcutaneously or even into the epidural space. Patients' demands are mostly controlled by computer-driven infusion pumps, but can also be delivered by simple disposable devices. ⋯ It is suggested that PCA results should be used for the improvement of conventional techniques. PCA has also been found valuable for scientific pain studies, e.g. to determine predictors of postoperative pain, drug interactions and pharmacokinetic experiments. This review concentrates on intravenous PCA during the early postoperative period.
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Open pelvic fractures are rare fractures usually resulting from a severe trauma. Only 4 of 121 patients treated operatively in 1994 for a pelvic trauma showed an open injury. ⋯ The presented concept comprises in the end the hemipelvectomy and an intensive care management for prophylaxis of septic complications. So the lethality was diminished.