Langenbecks Archiv für Chirurgie
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Although several new imaging modalities have been developed, plain chest-film examination remains the diagnostic procedure of choice for diagnosis and followup of spontaneous pneumothorax. Perfect chest radiographs and additional conventional tomography or fluoroscopy show complicating tension signs and in several cases can clarify the etiology. Other imaging modalities, such as digital radiography, CT, and MR modalities, are of limited value, but may be helpful to stage complicated findings. Radionuclide studies and Ultrasound may be helpful in special cases.
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1) Traumatic rupture of the thoracic aorta is most frequently caused by a traffic accident with deceleration. Approximately 80% of these patients die immediately. In 29 patients (1973-1986) reaching surgical treatment, all aortic lesions were located at the aortic isthmus (28 covered and 1 free rupture). 25 (86%) of them had serious associated injuries of the head, other thoracic or intraabdominal organs and/or the extremities. ⋯ None of these patients with a delay up to 17 days for vascular repair developed a secondary free aortic rupture. Up to recently this risk has been obviously overestimated on the basis of earlier studies in the sixties. 3) The immediate repair of the aortic rupture with its high operative mortality and high rate of ischemic paraplegia can be restricted to a few exceptional cases with a secondary free rupture in the hospital. The transvenous DSA is the best approach for an early diagnosis and for the surgical decision to perform vascular repair immediately or with delay.
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Langenbecks Arch Chir · Jan 1987
[Risk of ulcer following conversion operations of Billroth I stomachs in restorative reflux-preventing procedures--an animal experiment].
In an experimental study on 74 rats the ulcer risk was analyzed after Billroth-I-resection changed into secondary Roux-Y-gastro-jejunostomy resp. jejunal interposition. The following results were obtained: 1) 10 months postoperatively stomal ulcers were found in up to 75%. 2) The gastric pH was comparable with the control and significantly lower than after Billroth-I-resection. 3) An additional vagotomy caused a reduction but not an elimination of the ulcer risk. We conclude from our results that there is a protective role of the postresectional intestino-gastric reflux on the gastrojejunal anastomosis. A reflux-preventive procedure is therefore heavily ulcer-prone.
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Artificial ventilation plays an important role in prophylaxis and therapy of failure or malfunction of organ systems. Augmented techniques today are used as first choice methods, rather than controlled modes. ⋯ Constituent part of these strategies is an integrated monitoring which also reflects the invasiveness of the ventilator setting. Such a parameter can be derived by calculating PEEP times I/E-Ratio times FiO2 and is useful for further therapeutic decisions.
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Langenbecks Arch Chir · Jan 1987
[Endobronchial administration of adrenaline in cardiopulmonary resuscitation: pharmacokinetic and dynamic studies in the dog].
The present animal study was designed to investigate the pharmacokinetic behavior of epinephrine after endobronchial (e.b.) and intravenous (i.v.) administration and its correlation to pharmacodynamic measurements. We found the effectiveness of e.b.-epinephrine (100 micrograms/kg BW) to be in the same magnitude as i.v.-epinephrine (100 micrograms/kg BW) with only a slight delay in the pharmacodynamic onset of a few seconds. ⋯ The therapeutic effect of e.b.-epinephrine (100 micrograms/kg BW) lasted much longer (30 min) when compared to i.v.-epinephrine (10 micrograms/kg BW) where the pharmacodynamic effect was terminated after 3 to 5 min. For the clinical situation of cardiopulmonary resuscitation a dose of 2-3 mg epinephrine in 5-10 ml of physiological saline instilled deeply into the bronchial system should be considered as alternative administration technique with fast onset and good effectiveness.