Langenbeck's archives of surgery
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Sepsis is an unsolved problem worldwide, with a 30-50 % mortality rate. The recent failures of anti-TLR4, recombinant activated protein C, and anti-TNF in clinical trials indicate a need to rethink our current understanding of sepsis’s pathophysiology. While the initial immune response is crucial for effective clearance of invading pathogens, an overly exuberant host response to infection can cause septic shock, tissue damage, and death. Profuse inflammation in sepsis is frequently followed by global immunosuppression that increases susceptibility to viral and bacterial infections. Despite the dangers of immune over-response, the immune system’s anti-inflammatory activities are likely necessary to reduce the initial over-activation of the immune system. ⋯ Future treatment strategies for sepsis should focus on maintaining balance between pro- and anti-inflammatory immune actions in a timely manner.
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Langenbecks Arch Surg · Oct 2013
ReviewPerioperative management of delirium and dementia in the geriatric surgical patient.
Older adults undergo operations as our population ages. Increasing life expectancy and disease burden, along with decreased functional status and organ reserve, place the elderly surgical patient at higher general risk in the perioperative state. In particular, these patients have more diseases including dementia and medications that put them specifically at higher risk of delirium. ⋯ Today, surgeons must be equipped to attend the geriatric patient's needs. Early recognition of comorbidities such as dementia and delirium as well as speedy and competent therapeutic treatment can limit consequences and impact.
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Acute pancreatitis remains an unpredictable, potentially lethal disease with significant morbidity and mortality rates. New insights in the pathophysiology of acute pancreatitis have changed management concepts. In the first phase, characterized by a systemic inflammatory response syndrome, organ failure, not related to infection but rather to severe inflammation, dominates the focus of treatment. In the second phase, secondary infectious complications largely determine the clinical outcome. As infection is associated with increased mortality in acute pancreatitis, numerous prophylactic strategies have been explored in the past two decades. ⋯ All attempts to develop treatment strategies to lower the infection rate in acute pancreatitis have failed. Accumulating evidence is emerging to show that the combination of centralization, the use of catheter drainage as the first step of invasive treatment, and the development of minimally invasive techniques, improve the outlook for patients with infected necrosis. It is uncertain at this point in time as to which of the three effects is dominant in the improvement of prognosis.
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Langenbecks Arch Surg · Aug 2013
Review Meta AnalysisEarly enteral nutrition after pancreatoduodenectomy: a meta-analysis of randomized controlled trials.
The aim of our study was to evaluate the safety and effectiveness of early enteral nutrition (EN) for patients after pancreatoduodenectomy (PD). ⋯ Current RCTs suggests that early EN appears safe and tolerated for patients after PD, but does not show advantages in infection and postoperative hospital stay.
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Langenbecks Arch Surg · Jun 2013
ReviewAcute complications after laparoscopic bariatric procedures: update for the general surgeon.
Development and widespread use of laparoscopic bariatric surgery exposes emergency room physicians and general surgeons to face acute or chronic surgical complications of bariatric surgery. ⋯ The general surgeon should be informed about modern bariatric procedures, their potential acute complications, and emergency management.