Zentralblatt für Chirurgie
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Observational Study
[An algorithm for postoperative pain management in visceral and thoracic surgery: an observational study].
We report the results of an observational study of pain intensity before and after implementation of an algorithm for postoperative pain management. The algorithm included multiple factors for treatment. ⋯ Implementing an algorithm for postoperative pain management resulted in a clinically relevant reduction of postoperative pain. Our findings reflect the result of a complex change in pain management, and therefore cannot be attributed to any single factors involved.
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The implantation of endoprostheses is an established procedure in orthopaedic and trauma surgery. However, the techniques are often associated with a high risk of post-interventional infections and wound healing disorders that can result in loss of the prosthesis or the limb--most likely based on an insufficient debridement and poor soft-tissue coverage. The purpose of this study was to evaluate the efficacy of the coverage methods in our patient population. ⋯ A radical debridement and an early appropriate defect coverage of the exposed prosthesis is crucial in the reconstruction process. Through a close interdisciplinary collaboration a stable soft-tissue covering can be achieved. Consequently it is possible to avoid a loss of the endoprosthesis, marked functional deficits or even amputations.
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In selected patients laparoscopic distal pancreatectomy with splenectomy has increasingly gained in importance as an alternative to the open approach. Modern imaging procedures detect more frequently neuroendocrine pancreatic tumours. A typical feature of the neuroendocrine pancreatic tumour is that this kind of tumour is mostly small with a size of 1 to 2 cm. Due to their mostly small size they are suited to a laparoscopic approach. We report here the feasibility and surgical technique of a laparoscopic distal pancreatectomy with splenectomy and partial gastric resection due to a neuroendocrine pancreatic tumour. ⋯ Laparoscopic distal pancreatectomy with or without splenectomy is feasible with a low morbidity rate by experienced laparoscopic surgeons. The advantages of laparoscopic compared to open approach are well known, but the laparoscopic approach in pancreatic surgery should be used in selected patients. Due to their mostly small size, especially neuroendocrine tumours in the tail of the pancreas are suited to a laparoscopic approach.
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Patients with pleural thymoma spread (Masaoka stage IV a) should be treated within a multimodal treatment regime. However, the extent of local surgical resection to achieve optimal tumour control remains controversial. ⋯ Masaoka stage IV a thymoma could be safely treated with lung-sparing radical P/D and HITHOC with cisplatin in a multimodality treatment regime. Early results with respect to recurrence and survival are encouraging, but further studies are warranted and we have to await long-term results.
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Comparative Study
[VATS lobectomy--a standard procedure in the therapy for stage I non-small cell lung cancer?].
Even though VATS lobectomy has been practised since 1991 in stage I of non-small cell lung cancer (NSCLC), it was not being considered equivalent to conventional lobectomy due to considerable doubts in terms of safety and oncological permissibility. This study describes our experience and an evaluation of the systematic establishment of lobectomy by means of video-assisted thoracic surgery (VATS) as standard treatment of NSCLC in stage I, which serves as an alternative to conventional surgery. For this purpose, 42 NSCLC patients in stage I, undergoing a conventional lobectomy in 2010 (group I), were retrospectively compared to 30 patients in the same tumour stage (group II) who were treated in 2011 using VATS lobectomy. ⋯ Therefore, VATS lobectomy constitutes an essential extension for the operative management in a lung cancer centre. Our results show that this new method is not only of equal, but of superior value compared to conventional lobectomy. Our experience and recent data in the literature illustrate that VATS lobectomy will play a decisive role in therapy for NSCLC in stage I, potentially even in stages II and IIIA.