Langenbeck's archives of surgery
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Langenbecks Arch Surg · Nov 2010
Multicenter Study Comparative StudyNeoadjuvant chemoradiotherapy for rectal carcinoma: effects on anastomotic leak rate and postoperative bladder dysfunction after non-emergency sphincter-preserving anterior rectal resection. Results of the Quality Assurance in Rectal Cancer Surgery multicenter observational trial.
Randomized trials have demonstrated a reduction in local recurrence rate in rectal cancer patients treated with preoperative chemoradiotherapy and total mesorectal excision (TME) compared to patients undergoing TME alone. Accordingly, preoperative chemoradiotherapy in all UICC stages II and III rectal cancers has been recommended in the German treatment guidelines as of 2004. However, this policy has been questioned in recent years, partly due to concern regarding an increase in postoperative complications through preoperative therapy. Studies on this issue are sparse; most have been conducted in specialized centers, included relatively few patients, and yielded partly contradicting results. It was the aim of our analysis to investigate the influence of preoperative chemoradiotherapy on anastomotic leak rate and postoperative bladder dysfunction in rectal cancer patients using a representative data set from the Quality Assurance in Rectal Cancer Surgery multicenter observational trial. ⋯ Neoadjuvant chemoradiotherapy for rectal carcinoma does not increase the risk for anastomotic leakage or postoperative bladder dysfunction after curatively intended sphincter-preserving rectal resection.
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Langenbecks Arch Surg · Jun 2010
Multicenter StudyRisk of death after emergency repair of abdominal wall hernias. Still waiting for improvement.
The precise importance of factors affecting morbidity and mortality in patients with complicated abdominal wall hernias undergoing emergency surgical repair has been not completely elucidated. ⋯ Using multivariate logistic regression analysis, probabilities of death after complicated abdominal wall hernia surgery are increased in patients with: age over 70 years, high ASA class, and associated intestinal resection. Guidelines should be developed to improve prognosis in these patients.
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Langenbecks Arch Surg · Jan 2010
Multicenter Study Comparative StudyGeneral and visceral surgery practice in German hospitals: a real-time work analysis on surgeons' work flow.
Surgeons have criticized the working conditions at German hospitals. They complain in particular about long working hours, an inadequate salary for their work, insufficient training/supervision, and an increasing amount of time spent on administration duties. Since these critics are only subjective perceptions, they should be compared to data that can be quantified more objectively and accurately. In this study, we sought to report precise data on surgeons' workflow in several German hospitals. ⋯ For the first time, surgeons' workflow in German hospitals was studied in real time. The study results substantiate physicians' statements about their own working conditions, especially with concerns to large amount of time spent on administration tasks. The findings of this study form a basis upon which further analysis can be built and recommendations for improvements in physicians' workflows at German hospitals can be made.
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Langenbecks Arch Surg · Sep 2009
Multicenter StudyImpact of modern techniques on short-term outcome after surgery for primary hyperparathyroidism: a multicenter study comprising 2,708 patients.
Preoperative localization procedures and the use of intraoperative parathyroidism (iOPTH) have led to a shift of paradigm from bilateral neck exploration to focused parathyroidectomy in primary hyperparathyroidism (pHPT). However, only a small number of randomized trials from specialized centers have been published. The main purpose of the study was to analyze the impact of localization procedures and iOPTH on short-term outcome after pHPT surgery in a multi-institutional setting. ⋯ Localization procedures and iOPTH decreased the risk for hypocalcemia after pHPT surgery. Additionally, iOPTH influenced short-term cure rate favorably.
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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.