Läkartidningen
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The most important risk factor for the development of wound dehiscence and incisional hernia is the suture technique that is totally in the hands of the surgeon. A continuous suture line in one layer with a monofilament material should close midline incisions. Self-locking knots should be used for the anchor knots. ⋯ The only way to ascertain a suture length to wound length ratio of at least four is to measure and document the ratio at every laparotomy. An adequate ratio should be achieved by placing many stitches into the aponeurosis. High tension on the suture should be avoided.
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Transcranial Doppler (TCD) sonography, a noninvasive method to record cerebral blood flow velocity, is increasingly being used to predict the development of a delayed ischemic deficit after subarachnoid hemorrhage. Advantages and limitations of the TCD technique in neurosurgical practice are discussed.
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Antithrombin has been used for over two decades as adjuvant therapy in severe sepsis, especially when associated with coagulopathy. A positive effect has been demonstrated in several experimental sepsis models and a number of small clinical trials have suggested a beneficial effect. ⋯ Among various secondary effect and subgroup analyses, it is noteworthy that no trend indicating a beneficial effect of antithrombin substitution was found even in the subgroup of patients with plasma levels of antithrombin < 60% on randomization (n = 1,117). In summary, there is presently no support for the general use of antithrombin as adjuvant therapy in severe sepsis/septic shock.
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Prognostic factors for ICU-patients during and after ICU-discharge are reviewed as well as predisposing factors for readmissions. The overall mortality for ICU-patients are in most studies in the range of 12-32%, with a mortality rate after ICU discharge of 15-35%. ⋯ Readmissions to ICU are not uncommon and usually (45-65%) related to the underlying illness. The use of High Dependency Units or a sufficient ICU capacity might reduce the mortality rate as well as the rate of readmissions.