Zentralblatt für Chirurgie
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Any patient admitted to an intensive care unit requires individual analgetic and sedative treatment, depending on type and severity of the disease with its associated physical and psychic problems. There is a wide range of possible medicaments and combinations of these from among which the authors investigated combinations of the short-action opiates fentanyl and alfentanyl and midazolam, a benzodiazepine, short-action as well. ⋯ Both analgosedation schemes yielded best results, when compared to other combinations also continuously administered through perfusion. Individually adapted synchronisation of the patients to respirator and therapeutic concept proved to be practicable at any time, in spite of that fixed combination of analgetic with sedative.
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An account is given by the authors of their own guidelines for surgical treatment of deformities of the anterior abdominal wall. The procedures described are based on experience obtained from 866 surgical interventions at the first author's clinic, between 1959 and 1987. Indications, techniques, and complications are discussed in some detail.
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Indication for thoracotomy is undisputed in cases of gaping wounds with massive haemorrhage. However, discrete stab and gunshot wounds may quite often conceal imminent pericardial tamponade. Three quarters of all penetrating thorax injuries are located in or close to the cardiac silhouette. ⋯ Hence, early thoracotomy is generally indicated and should be generously decided to handle penetrating wounds of the chest. Superiority of early thoracotomy in handling penetrating thorax injuries is demonstrated in this paper by six of the authors' own patients. While relief of cardiac tamponade is possible by pericardiocentesis, immediate and safe restoration of blood volume through a central vein or the right atrium, control of haemorrhage, and definite repair of the cardiac defect can be achieved only by thoracotomy.
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Quality control in surgery is undertaken to check on effects of preoperative risk, choice of surgical technique, use of surgical technique, and peri-operative therapy on the results of an operation. Attention is given, in this context, not only to complications but also to postoperative quality of life and prognosis, with efforts being made to quantify these latter aspects. Useful information can be obtained only by neutral data collection undertaken independent of the surgeons involved.
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A brief account is given of the aetiology and pathophysiology of the compartmental syndrome. Without decompression, acute compartmental syndrome causes irreversible muscle necrosis after six hours. ⋯ Compartmental syndrome of the anterior tibial zone, when misinterpreted and taken for a muscular hernia, may lead to the development of acute compartmental syndrome with all its complications, once the fascia has been closed. Surgical opinion is discussed on the basis of the above case history.