Rozhledy v chirurgii : měsíčník Československé chirurgické společnosti
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Surgery on the pancreas is a major abdominal procedure leading to a number of pathophysiological alterations during the early post-operative period. Novel approaches to perioperative care including shortened pre-operative starving periods, pre-operative glucose load, sophisticated pain management and early enteral feeding have resulted in major improvements of surgical results after major colorectal surgery. These alterations of perioperative care have been introduced to visceral surgery as so-called fast track surgery or multimodal rehabilitation (multimodal rehabilitation, ERAS = enhanced recovery after surgery). So far it is not known whether or not these approaches can also be applied in pancreatic cancer surgery. ⋯ While routine laboratory parameters showed similar changes during the postoperative course after pancreatic surgery, the clinical outcome parameters clearly indicated that the concept of fast track rehabilitation can be even beneficially applied to these high-risk patients undergoing elective surgery for pancreatic cancer.
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Mesenteric artery embolisation is serious complication of heart diseases. Its mortality is almost 95%. ⋯ This sign can be very helpful in diagnostics and consequently in treatment of this disease. Late diagnostics and treatment of vascular ileus has fatal prognosis.
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Case Reports
[A postoperative bronchopleural fistule--a success of the conservative treatment (a case review)].
Disintegration of the bronchial stub following the lung resection procedures together with development of the bronchopleural fistule and the postoperative empyema of the thorax, remain a feared complication following all lung resections, but especially pneumonectomies. In this case review, the authors report on a successful conservative management case, which followed an unsuccessful surgical revision and an attempt for the endobronchial stent introduction. 20 months following the closure of the fistule, the patient shows no signs of a relapse of the disorder.
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Perioperative optimalization of haemodynamics is associated with improved post-operative development, as presented in most published studies. This study has confirmed that intra-operative correction of cardiac output back to it's physiological level is associated with improved post-operative course in the group of patients undergoing major elective intraabdominal surgery. Statistically significant decreasing of post-operative complications (4.7% vs 17.7%), decreased length of stay (LOS) in the ICU by 33% and decreased LOS in the hospital by 24% was recorded. Interpretation of the study could be limited by using non-indexed cardiac output values and higher female presentation in the group of patients (although statistically not significant).