Langenbeck's archives of surgery
-
Langenbecks Arch Surg · Mar 2009
Randomized Controlled Trial Comparative StudyProcalcitonin (PCT)-guided algorithm reduces length of antibiotic treatment in surgical intensive care patients with severe sepsis: results of a prospective randomized study.
Adequate indication and duration of administration are central issues of modern antibiotic treatment in intensive care medicine. The biochemical variable procalcitonin (PCT) is known to indicate systemically relevant bacterial infections with high accuracy. In the present study, we aimed to investigate the clinical usefulness of PCT for guiding antibiotic treatment in surgical intensive care patients with severe sepsis. ⋯ Monitoring of PCT is a helpful tool for guiding antibiotic treatment in surgical intensive care patients with severe sepsis. This may contribute to an optimized antibiotic regimen with beneficial effects on microbial resistances and costs in intensive care medicine.
-
Langenbecks Arch Surg · Mar 2009
Multicenter StudyAdult living donor liver transplantation: body mass index and MELD score of recipients are independent risk factors for hospital mortality.
Adult living donor liver transplantation (LDLT) has been established as elective procedure or urgent procedure to save the life of patients with terminal liver diseases. The outcome of LDLT varies between transplant centers. Here, we aim to evaluate the outcome of LDLT in our center and to identify the risk factors that are associated with hospital mortality of recipients. ⋯ Adult living donor liver transplantation should be reserved to less "sick" patients in the era of organ allocation based on MELD score.
-
Langenbecks Arch Surg · Mar 2009
Multicenter StudyDirect hemoperfusion with polymyxin-B-immobilized fiber columns improves septic hypotension and reduces inflammatory mediators in septic patients with colorectal perforation.
Although some studies have reported favorable effects of direct hemoperfusion with polymyxin-B-immobilized fiber columns (PMX) for the treatment of septic shock, few studies have demonstrated the efficacy of PMX in studies with a uniform case definition and without any other blood purification techniques. ⋯ Our findings suggested that PMX treatment appears to adsorb endotoxin and also modulates circulating cytokine during a 2-h interval of direct hemoperfusion in septic patients with such condition.
-
Prehospital triage is aimed at getting the right patient to the right hospital. Evaluations on the performance of prehospital triage tools are scarce. This study examines the ability of the American College of Surgeons' Committee on Trauma (ACSCOT) triage guidelines to identify major trauma patients in a European trauma system. Furthermore, this study evaluates the predictive power of other prehospital measurements. ⋯ The new triage model outperforms the ACSCOT triage guidelines in identifying major trauma patients in the prehospital setting. The new triage guidelines may improve patient outcomes but needs to be validated in a prospective study.
-
Langenbecks Arch Surg · Mar 2009
Laparoscopic liver resections for hepatocellular carcinoma. Is it a feasible option for patients with liver cirrhosis?
Laparoscopic surgery has gained growing acceptance, but this does not hold for laparoscopic surgery of the liver, above all for patients with hepatocellular carcinoma (HCC) and cirrhosis. This approach mainly includes diagnostic procedures and interstitial therapies. However, we believe there is room for laparoscopic liver resections in well-selected cases. The aim of this study is to assess: (a) the risk of intraoperative bleeding and postoperative complications, (b) the safety and the respect of oncological criteria, and (c) the potential benefit of laparoscopic ultrasound in guiding liver resection. ⋯ Laparoscopic treatment should be considered in selected patients with HCC and liver cirrhosis in the left lobe or segments 5 and 6 of the liver. It is clear that certain types of laparoscopic resection are feasible and safe when carried out by adequately skilled surgeons with appropriate instruments.