Zentralblatt für Chirurgie
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During a period of 11 years operative placement of a Greenfield vena caval filter was planned in 132 patients. The clinical records of these patients were reviewed retrospectively. Main indications for filter placement were pulmonary embolism in patients with deep venous thrombosis in spite of anticoagulation therapy (45%) and patients with contraindications for anticoagulation (40%). ⋯ CT scans of the abdomen or venacavography studies were obtained in 60 patients. Major complications as recurrent pulmonary embolism (8%), caval thrombosis (13%), penetrations of struts through the caval wall (33%), tilting of filters (25%), migration (5%) and filter fracture (two cases) were observed. In conclusion, indication should be restricted to certain cases with failure of surgical intervention or drug therapy (thrombectomy, lysis, anticoagulation).
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Causes of septic multiple organ failure are endotoxin induced mechanisms, exotoxin induced mechanisms and sepsis associated immunosuppression. Pharmacological intervention is limited. ⋯ The prevention of systemic infections is mandatory. Approaches to new therapeutical concepts are outlined.
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Polytraumatized patients develop complex changes in blood coagulation and fibrinolysis even before their arrival at the emergency room (ER). Hemostaseological parameters (i.e. antithrombine 3, alpha-2-antiplasmine, D-dimers) obtained upon admission however, permit advance differentiation of later mortality vs. survival and of possible future secondary organ failure with varying specification. ⋯ In our study patients with multiple injuries displaying a systolic blood pressure of less than 100 mmHg either at the scene of the accident or upon arrival in the ER showed coagulation values which by other investigators were regarded as a sign of potential secondary organ failure or death.
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Though German hospitals are normally not built for day case surgery, this became a new challenge based on changed legal regulations. A stepwise adaptation of the present facilities to the altered necessities seems to be a relatively simple way to realise day case surgery also in hospitals. Preoperatively surgeons and anaesthetists offer office hours during the same time to avoid patients having to wait. ⋯ At a fixed time in the afternoon patients are visited by the surgeon and the anaesthetist to clear the conditions for dismission. While anaesthesia, surgery and recovery take the same time as for inpatients, the pre- and postoperative procedures are more time consuming. With a rising number of outpatients a separate department for outpatient surgery with its own administration, operating theaters and day case ward should be developed.
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In the Department of Traumatology and Reconstructive Surgery of Steglitz Medical Center, Berlin, a total of 1,323 patients with proximal femoral fractures were treated between 1978 and 1992. 988 patients were female and 335 male, age range 18-99 years, mean age 74 years. 479 fractures were classified as medial femoral neck fractures and 205 as lateral femoral neck fractures, further 461 pertrochanteric and 178 subtrochanteric fractures were seen. Based upon computerized data--especially regarding lethality and complication rates--the evolution of fracture treatment is outlined. ⋯ In older patients with medial femoral neck fractures the therapeutic standard today is the bipolar prosthesis, in younger patients osteosynthesis. In lateral femoral neck fractures as well as pertrochanteric fractures the most suitable osteosynthesis is the DHS, in subtrochanteric fractures the condylar plate. Whenever possible osteosynthesis should be preferred to total hip arthroplasty if patient condition and hip joint integrity allow this treatment. The more stable and biological procedure of osteosynthesis should be preferred.