Zentralblatt für Chirurgie
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Operative procedures in multiple injured patients consist in the first stage in life-saving operations such as control of bleeding and cerebral decompression. Operative measures during the urgent second operative phase have to be undertaken under consideration of the development of a multiple organ failure syndrome. ⋯ Delayed operative procedures should only be performed after stabilization of the overall patient situation to prevent enhancement of the systemic inflammatory response. The required operative procedures of the multiple injuries have to be attributed to the respective operative phases.
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Talc pleurodesis was performed in a prospective trial in 38 patients with recurrent malignant pleural effusion. After insertion of a chest tube a slurry containing 8g of iodined talcum, 0.5 ml of 1% xylocain/kg/body weight, and 80 ml of 0.9% NaCl was administered and suction drainage was performed. ⋯ A successful therapy could be achieved in 33/38 patients (86.8%). 2 patients (5.3%) suffered from recurrent pleural effusion which only in 1 case had to be drained. 3 patients died within the first month after talc pleurodesis due to an advanced cancer stage. Complications did not come to evidence in any case.
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The patient-controlled analgesia (PCA) or "ondemand analgesia" is a pain-relieving therapy, which is regulated and monitored by the patient himself. Postoperative pain therapy is the main approach for PCA, which facilitates a long-term, individually controlled pain relief. ⋯ This kind of therapy needs the acceptance and understanding of the patient as a main condition for the success. Beside an increase of patients' comfort and patients' independence of analgetic demand from the medical staff a reduction in postoperative complications can be expected, the time of hospitalisation might be decreased.
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A prospective documentation of patients data on an internal and a surgical intensive care unit (ICU) has been transacted. The physician and nursing staff used an online electronic documentation program, which has been developed in Frankfurt. Main emphasis has been placed on the epidemiological data, clinical diagnoses as well as diagnostically and therapy costs. ⋯ Patients underwent 2.2 +/- 0.12 chest x-rays and 1.4 +/- 0.1 ultrasound investigations. The study shows that an online data processing is practicable and can be integrated in the daily work flow. Furthermore, it can be seen that the collected data play an important role to secure the increasing administrative requisition to the modern medicine in view of costs and quality management.
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We describe our method of transcranial Doppler (TCD) monitoring during carotid endarterectomy (CE) procedures. During a period of 35 months we performed 257 CE with TCD monitoring. ⋯ Further advantages of the TCD monitoring are: detection of microemboli, control of the potential collateralisation of the external carotid artery and the control of efficacy and accurate positioning of the intraluminal shunt. We comment our results of cerebral monitoring and consider it as a useful tool for optimizing the postoperative results of carotid surgery.