Zentralblatt für Chirurgie
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The percentage of elderly people among surgical patients has been continuously rising. The purpose of this study was to show the course of operation and hospitalization of seniors in a department for general surgery. 191 patients aged 75 or older underwent surgery during the six months of observation. Information about preoperative social and environmental conditions, operative and postoperative treatments, complications, secondary symptoms and rehabilitation and homecare after discharge was retrospectively compiled. ⋯ Discharge into the accustomed environment was possible for 74.7% (118) of the successful cases. Old patients show a good physical and psychological acceptance of surgery and hospitalization, if they are well prepared and secondary symptoms are appropriately therapied. The decision for routine operation in sufficient time can help avoid an emergency operation with poor prognosis.
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The emergency room functions as a junction between preclinical and early clinical treatment of patients with multiple trauma and should have defined technical and room possibilities. The personal staff should continue resuscitation measures and perform clinical and technical diagnostic procedures according to trained algorithms. The recognition of life-threatening injuries, the set up of correct priorities and application of respective surgical procedures characterize a good emergency room management.
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Aim of the study was to evaluate the influence of early intubation at the scene on the outcome of polytraumatized patients with lung-contusion. ⋯ Early intubation at the scene can reduce the inhospital-time, the time at the ICU and the complications. In this way it becomes an important factor of cost-reduction. Therefore early intubation at the scene must become a standard for all patients with lung-contusion.
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Sequential organ failure after multiple trauma emerges from a whole-body inflammatory process which develops as a complex host defense response to hypovolemic shock/resuscitation and traumatic tissue injury. Successful prevention and treatment involves exact assessment of inflicted damage and profound knowledge of the different stages of posttraumatic immune alterations. Local release of potent inflammatory mediators (cytokines, complement, arachidonic acid derivatives, reactive oxygen metabolites) primarily induces a repair process. ⋯ Diffuse capillary leakage and microcirculatory disorder prepare cellular dysfunction. Secondary severe immune defects support septic complications which maintain an autodestructive process. Therapeutical advances depend on the analysis of local and time-dependent expression of relevant inflammatory mediators and cellular signalling systems.
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Over the last 30 years intensive care medicine has undergone drastic changes not only because of changes in patient population but also because of the progress in medical technology. Given that resources are finite and limited medical and socio-ethical principles should be applied for the distribution and withdrawal of these resources. ⋯ Whilst in intensive care patients should be scored every day to identify as early as possible those patients who are going to die and those who are going to survive in order to use intensive care resources efficiently. After discharge from intensive care quality of life should be an important factor to assess intensive care performance.