Langenbecks Archiv für Chirurgie. Supplement. Kongressband. Deutsche Gesellschaft für Chirurgie. Kongress
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
Randomized Controlled Trial Comparative Study Clinical Trial[Plasma separation combined with CVVHF in septic and SIRS patients].
In a prospective non-randomized trial, 59 patients with sepsis (n = 43) and SIRS (n = 16) were treated on a surgical intensive care unit. In 22 patients plasmapheresis in combination with continuous venovenous hemofiltration (CVVHF) was administered. Lethality was 56% in the sepsis group; in the therapy group lethality was significantly lower in patients with plasmapheresis, even though in this population the organic failure rate was higher. ⋯ Lethality at 22% in the plasmapheresis group with double organ failure was significantly lower (P > 0.01) than in controls. Reduction of lethality seemed to be as high as 18% in patients with sepsis, while patients with SIRS did not profit from the additional therapy. A prospective randomized trial in sepsis and double organic failure should be projected.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
Multicenter Study[The diagnostic value of rectal examination of patients with acute appendicitis].
The results of rectal digital examinations performed on 477 patients upon admission with histopathologically proven acute appendicitis from a total of 2280 patients with acute abdominal pain were analyzed. Although 13.7% of the patients experienced pain on the right side and 7.4% pain in the pouch of Douglas during rectal examination, none of the rectal examination parameters was statistically significant for the diagnosis of acute appendicitis. There are well established and statistically significant clinical indications, such as guarding, rigidity, rebound tenderness or abdominal distention that actually make the unpleasant rectal-digital examination superfluous for patients with suspected appendicitis.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
Case Reports[Medical principles of thromboembolism prevention].
Since thromboembolic complications have been described to be one of the most frequent complications following surgery, a correct indication for prophylaxis is of great clinical importance. This requires comprehensive knowledge about the general thrombosis risk of various patient populations, experience in the assessment of the individual thrombosis risk, understanding of the mode of action of various prophylaxis modalities, and critical benefit/risk assessment when pharmacological agents are used. Patients with a moderate or high risk require medical prophylaxis with either unfractionated heparin, low molecular weight heparins, or oral anticoagulants unless there is too high a risk of bleeding. Mechanical methods such as physical exercise and early mobilisation of the patient remain the basic measurements which can be supplemented by graduated pressure stockings.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
[Intensive care medicine from the viewpoint of patients, their family and nursing personnel].
We wanted to know how our intensive care unit would be graded by the patients, their family members and the staff, as well as the impression that intensive care medicine made on them. A total of 82% of the patients and 90% of the family members were of the opinion that they owed their lives to intensive care medicine, and 100% of the patients and 96% of family members deemed intensive care medicine significant. ⋯ The nursing staff held a contrary opinion and were more critical. Competent explanation and transmission of information represented the most important factor in forming a positive opinion of intensive care medicine.
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Langenbecks Arch Chir Suppl Kongressbd · Jan 1998
Multicenter Study[Clinical value of diagnostic score for appendicitis: results of a prospective intervention study].
The clinical benefit of a diagnostic score for acute appendicitis was tested in a prospective interventional multicenter study on patients with abdominal pain. The study was performed in two consecutive phases: standard diagnostic work-up with no additional diagnostic support (870 patients) and additional diagnostic support with a score (614 patients). ⋯ There were no differences in the perforated appendix, negative appendectomy and complication rate, however, the delayed appendectomy rate (2% versus 8%) and the delayed discharge rate (11% versus 22%) were significantly lower with diagnostic support by the score. In summary, the score cannot be recommended as a standard diagnostic tool for diagnostic decision making in acute appendicitis.