Langenbecks Archiv für Chirurgie
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Langenbecks Arch Chir · Jan 1992
Review[Acute pain in surgery: the significance of a neglected problem].
Acute pain represents a significant problem in surgical patients. However, the management of acute pain in Germany is unsatisfactory, mostly because surgeons are not interested in the pain of their patients, and anesthesiologists do not give pain treatment on surgical wards. The aim of this article is therefore to point out the significance of the problem of "acute pain" for surgeons. ⋯ It is not sufficient to know the methods and advantages of appropriate management of acute pain; one must also understand the dangers. Problems caused by the treatment of pain should be recognized from a clinical point of view. Surgeons must take a greater interest in the problem of "pain", which should lead to the establishment of new concepts in the management of acute pain in surgical patients.
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Langenbecks Arch Chir · Jan 1992
Case Reports[Subcapsular hematoma of the liver in HELLP syndrome. An interdisciplinary emergency].
The HELLP-syndrome (Hemolysis, Elevated Liver enzymes, Low Platelets), known as a complication during pregnancy, is associated with preeclampsia and may cause subcapsular liver hematomas. In case of hepatic rupture the lives of mother and unborn are threatened. ⋯ The diagnosis of subcapsular liver hematoma must lead to urgent delivery through Cesarean section. Thereafter, the surgeon may decide between observation on an intensive care unit and urgent operation in case of hepatic rupture, without endangering the unborn.
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Langenbecks Arch Chir · Jan 1992
[Doppler ultrasound measurements of blood circulation of the lower extremity in man. II. Hemodynamics after trauma and operation].
A duplex ultrasound system was used to examine the blood flow of the common femoral artery in ten young patients with fractures of the lower extremities. Two patients had fractures of both legs. In eight patients the blood flow in the injured leg was comparable with that in the not injured leg. ⋯ The hemodynamics of an injured extremity are compared with those reported elsewhere in the literature. The increased demand for oxygen or energy can explain the changes only in part. Another function of the reflective increase in blood flow could be the temperature increase in the extremity.
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Langenbecks Arch Chir · Jan 1992
[How much experience is required for ultrasound diagnosis of blunt abdominal trauma?].
Between July, 1st 1989 and June, 30th 1991, 312 patients were entered into a prospective study concerning the reliability of sonographic evidence in blunt abdominal trauma. There were 231 male and 81 female patients aged between 15 and 88 years (mean: 39.9 years). The sonographic team consisted of one experienced sonographer/surgeon (greater than 4000 examinations) and 3 sonographic beginners (less than 200 examinations at the start of the study). ⋯ Sensitivity and specificity for the sonographic finding of intraabdominal liquid were 100% each for the experienced sonographer and 96% and 100%, respectively for the beginners. Organ lesions were demonstrated with a sensitivity and specificity of 45% and 99% by the experienced and 36% and 100% by the beginners. The experienced sonographer misdiagnosed one case of free intraabdominal gas, which could not be corroborated both by clinical and radiological evidence.(ABSTRACT TRUNCATED AT 250 WORDS)