Zentralblatt für Chirurgie
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We present the case of an overweight male patient with a lung hernia caused by a single massive coughing attack. The diagnosis could only be verified by CT-scans. Following a conservative therapeutic approach, surgical intervention was necessary. ⋯ Standard X-ray examinations where a subcutaneous air mass can be seen have become, since the inauguration of computed tomography, second line tests. Large traumatic lung hernias should be treated surgically. Spontaneous and especially cervical hernias should be handled conservatively and only must be surgically treated when complications or a progression in size should be observed.
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For the hemodynamically unstable patient with pelvic fracture a target focussed and rapid diagnostic and therapy is mandatory. After hemorrhage control at crash site the direct transport in a trauma center follows. Primary therapy in the emergency room sometimes includes stabilization by a pelvic clamp or an external fixator. ⋯ After that simple internal osteosynthesis is allowed. The presented article shows the possible options of the therapy. The main message is: hemorrhage control is not possible without stabilization of the pelvic ring.
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CRPS I represents a frequent complication following distal radial fractures. Early diagnosis may prevent chronification of the disease. However posttraumatic pain, swelling and motor disturbances render the differentiation from normal fracture patients more difficult. The incidence of CRPS I in patients at risk and the diagnostic value of clinical evaluation, radiography and thermography in the early posttraumatic phase are analysed. ⋯ The results of the study support the importance of clinical evaluation in the early diagnosis of CRPS I. Plain radiographs facilitate the diagnosis as soon as bony changes develop.
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Hospital-acquired infections affect 7% to 10% of hospitalized patients and account for approximately 80,000 deaths per year in the United States. Of all infections acquired in the hospital, more than 20% occur in intensive care unit patients. ⋯ The focus of this paper is to review the epidemiology of hospital-acquired infections that occur in the surgical ICU, particularly ventilator associated pneumonia, catheter-associated urinary tract infection, and catheter-related bloodstream infection, and to discuss ICU-related prevention strategies. By implementing effective preventative measures and maintaining strict surveillance of ICU infections, we hope to affect the associated morbidity, mortality, and cost that our patients and society bare.