Der Chirurg; Zeitschrift für alle Gebiete der operativen Medizen
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Abdominal sepsis remains a major cause of perioperative morbidity and mortality in surgical intensive care units. It must be considered a life-threatening condition and requires multidisciplinary coordination of intensive care. Apart from the local abdominal infection (peritonitis), abdominal sepsis is defined by extraperitoneal systemic reactions potentially leading to septic shock and death in the further course. Early and radical focus sanitation as well as aggressive systemic antimicrobial therapy remain the causal therapy strategies of abdominal sepsis.
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In Germany, the mortality from sepsis remains high, and up to 60,000 patients die from it each year. Thus, sepsis is the third most common cause of death. More deaths occur only from coronary heart disease and acute myocardial infarction. ⋯ Based on these achievements, there is hope of reducing sepsis mortality by 25% in the next few years. Implementing new medical evidence in this context into daily clinical intensive care remains a major hurdle. The early diagnosis of sepsis prior to the onset of clinical deterioration is of particular interest, because this would increase the possibility of early and specified treatment, which is in turn the major determining factor of mortality in septic patients.
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Sepsis is still a major cause of postoperative morbidity and mortality. Numerous biochemical indicators have been evaluated regarding their potential in predicting prognosis in sepsis. Generally, one must differentiate between indicators: those for preoperative detection of patients at risk for lethal sepsis and those for early prediction of lethal outcome of septic complications. ⋯ Cytokine-associated gene polymorphisms such as the loss of monocyte HLA-DR expression and homozygotism for the tumor necrosis factor B2 allele have a place in preoperative risk evaluation, as they were associated with worse prognosis in sepsis. Among the most important biochemical indicators for early prediction of lethal outcome in sepsis are decreased L-selectin and elevated IL-18, IL-6, and PCT plasma concentrations. Increased nuclear factor kappaB activity in mononuclear phagocytes and elevated calcitonin gene-related protein plasma concentrations were associated with unfavourable prognosis.
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Obesity, defined as a body mass index of > or =30 kg/m(2), is a modern epidemic and is increasing worldwide. Depending on genetic make-up, lifestyle factors such as nutrition, physical activity, and psychosocial conditions are the main determinants of its manifestation and severity. ⋯ For this reason, there is a need for evidence-based treatment considering the individual risk. For patients with extreme obesity exceeding a BMI of 40 kg/m(2), surgical intervention is the most effective treatment, not only to improve most somatic and psychological comorbidities significantly but also to prolong life.
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Due to demographic changes in average life expectancy, the age of patients undergoing cardiac surgery is increasing. We have reviewed the literature to analyse whether and how far octogenarians benefit from cardiac surgical procedures. ⋯ The perioperative mortality and other postoperative complications are strongly dependent on comorbidities rather than on patients' age. Elderly patients benefit from improved functional status and quality of life.