Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
Review[Treatment of increased intracranial pressure in craniocerebral trauma].
The management of trauma patients with increased intracranial pressure is based on maintaining a normal "milieu interne", i.e. avoiding posttraumatic hypoxia and hypotension and applying specific treatment modalities, if indicated. If there are clinical signs of increased intracranial pressure or signs of cerebral edema in the CT scan, monitoring of intracranial pressure is indicated. ICP above 20 mmHg should be treated and the cerebral perfusion pressure should be maintained between 60 and 70 mmHg. Accepted treatment modalities of increased ICP are: 1) analgosedation, 2) head elevation, 3) hyperventilation, 4) osmotherapy, 5) barbiturate therapy, and 6) THAM (tris puffer).
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
[Distal tibial fracture--an indication for osteosynthesis with the unreamed intramedullary nail?].
In a prospective study, 50 fractures of the distal fifth of the tibia with additional involvement of the ankle joint in 18 patients were stabilized by unreamed nailing. In all, 90% of all fractures healed uneventfully without further surgical intervention after unreamed nailing, the highest ratio of complications (22%) being seen in all patients with distal fractures of the fibula without additional plating (of the fibula). Tibial fractures close to the ankle joint can be managed by unreamed nailing; distal fractures of the fibula should be additionally stabilized by fibular plating.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
Comparative Study[Surgical research and publications in Germany--an analysis of 1984-1994].
The present study analyses a selection of German and American surgical and cancer research journals from the years 1984 and 1994. The aim of the study was to evaluate the amount of publications by German surgeons in these journals. ⋯ In parallel, German surgeons are still the major contributors to German language journals, but increasingly publish in the American ones as well. The impact factor is one of the major selection criteria on to which journal a paper shall be submitted.
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Ever-increasing knowledge of the pathomechanisms and the phasic pathogenesis of ARDS has increased the demand for adequate monitoring and has modified therapeutic strategies. The influence of monitoring by double indicator dilution technique (COLD system) with the close measurement of extravascular lung water on the diagnosis and therapy of ARDS is presented. Pressure-controlled ventilation (< 35 cm H2O) in combination with moderate PEEP, kinetic therapy (prone position) and elective CVVH already in the early stages of ARDS can be regarded as the standard therapy. The effectiveness of NO inhalation, prostaglandins and radical scavengers still has to be improved in controlled clinical trials.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1997
[Evaluation models for therapy planning/standardization exemplified by infection].
Models of evaluation in therapeutic management pathways (practice guidelines, clinical algorithms) are demanded today, both by public health research and health policy. However, practical achievements are lacking. ⋯ It was shown that there was no agreement between the providers and the daily users. However, every surgeon has a firm, personal view about sepsis.