Traumatic Rupture of the Aortic Isthmus: Program of Selective Management RID="" ID="" This International Association for the Surgery of Trauma and Surgical Intensive Care (IATSIC) article was presented at the 37th World Congress of Surgery International Surgical Week (ISW97), Acapulco, Mexico, August 24–30, 1997.

RID=" ID=" <E5>Correspondence to:</E5> J.W. Pate, M.D.     

Anterior Transhepatic Approach for Isolated Resection of the Caudate Lobe of the Liver

RID=" ID=" <E5>Correspondence to:</E5> J. Yamamoto, M.D.     

Microsomal Cytochrome P-450 Monooxygenase System and Its Drug-metabolizing Activity after Partial Portal Vein Ligation in the Rat

RID=" ID=" <E5>Correspondence to:</E5> K. Izuishi, M.D.     

Evaluation of Retinoblastoma and Ki-67 Immunostaining as Diagnostic Markers of Benign and Malignant Parathyroid Disease

RID=" ID=" <E5>Correspondence to:</E5> F. Farnebo, M.D., Ph.D.     

Physiologic Monitoring of Circulatory Dysfunction in Patients with Severe Head Injuries

RID=" ID=" <E5>Correspondence to:</E5> G.C. Velmahos, M.D., Ph.D.     

Long-term Survival after Resection of Proximal Bile Duct Carcinoma (Klatskin Tumors)

RID=" ID=" <E5>Correspondence to:</E5> T.M. van Gulik, M.D.     

Leitsymptom: Akute Dyspnoe

(as) In der pr?klinischen Notfallmedizin stellt Dyspnoe, das Symptom der subjektiv empfundenen Atemnot, neben dem Brustschmerz das am h?ufigsten zu behandelnde Symptom dar. Die Behandlung des Leitsymptoms Atemnot umfa?t dabei in der Differentialdiagnostik eine Vielzahl von Krankheitbildern, die unterschiedliche Behandlungsstrategien erfordern. RID="ID=" <E6>Quelle: </E6>Welte T (1998) <E6>Akute Luftnot. </E6>Der Internist 39: 152-160     

Kardiopulmonale Reanimation

(as) Die Standardtechnik der kardiopulmonalen Reanimation (CPR) hat sich seit der Einführung der externen Herzdruckmassage in den 60er Jahren nicht wesentlich ver?ndert. In den vergangenen Jahren sind einige Neuerungen im Ablauf der mechanischen Reanimation (intermittierende abdominale Kompression) sowie verschiedene technische Hilfsmittel zur Verbesserung der Reanimationstechnik (Westen-CPR, Cardiopump?, Lifestick?) entwickelt worden. Die bisher vorliegenden Studienergebnisse reichen jedoch noch nicht aus, um die etablierte Standard-Reanimationstechnik ersetzen zu k?nnen. RID="ID=" <E6>Quelle: </E6>Lindner KH, Wenzel V (1997) <E6>Neue mechanische Methoden der kardiopulmonalen Reanimation</E6> <E6>(CPR). Literaturstudie und Analyse der Effektivit&auml;t. </E6>Anaesthesist 46: 220&ndash;230     

Anaphylaktischer Schock und Allergie

(as) Der anaphylaktische Schock ist die Maximalvariante der allergischen Sofortreaktion. Ein akutes Larynx?dem stellt zusammen mit einer durch massive Vasodilatation ausgel?sten Schocksymptomatik die h?ufigste Todesursache dar. Bei Patienten mit anaphylaktischen Reaktionen hat daher die Sicherung der Atemwege und eine Verhin- derung bzw. Behandlung eines drohenden Kreislaufschocks oberste Priorit?t. RID="ID=" <E6>Quelle:</E6> M&uuml;ller-Werdan U, Werdan K (1997) <E6>Der anaphylaktische Schock. </E6>Der Anaesthesist 46: 549-563&para; Laubenthal H, H&uuml;gler P (1998) <E6>&Uuml;berempfindlichkeitsreaktionen. </E6>Der Internist 39: 171&ndash;178     

Polytrauma

(as) Das Polytrauma ist als Mehrfachverletzung verschiedener K?rperregionen oder Organe definiert, von denen mindestens eine Verletzung oder die Kombination der Verletzungen als vital bedrohlich einzustufen ist. In Deutschland stellen Verkehrsunf?lle oder Stürze aus gro?er H?he die Hauptursache für Polytraumen dar. Die Prognose polytraumatisierter Patienten kann durch eine ad?quate und effektive pr?klinische Versorgung entscheidend beeinflu?t werden. RID="ID=" <E6>Quellen: </E6>Maghsudi M, Nerlich M (1998) <E6>Polytrauma</E6> Internist 39: 188&ndash;194&para; Ziegenfu&szlig; T (1998) <E6>Polytrauma </E6>An&auml;sthesist 47: 415&ndash;431     

Recognizing, Scoring, and Predicting Blast Injuries RID="" ID="" This International Association for the Surgery of Trauma and Surgical Intensive Care (IATSIC) article was presented at the 37th World Congress of Surgery International Surgical Week (ISW97), Acapulco, Mexico, August 24–30, 1997.

n = 665, 51%) had an ISS ranging from 0 to 34 (mean 13) had wounds ranging from G1ST (soft tissue wounds caused by low energy transfer) to G3VF (massive wounds with fractures and injury of vital structures) according to the RCWC, with PSS/IS scores from 2 to 105 (mean 60). Statistically significant correlation was found between ISS and PSS/IS as well as RCWC and PSS/IS. Cytokines (IL-1, TNF _alpha ) and amino acids responded to a blast injury in similar manner as to gunshot wounds with a greater ISS or more severe RCWC injury type. The subjective sensations in blasted patients (deafness, thoracic pain, vertigo) and mediators, confirmed in previous experimental investigations as important factors in the pathogenesis of blast injuries (TxA ₂ , sulfidopeptide leukotrienes) were relationed only to the PSS/IS.RID=" ID=" <E5>Correspondence to:</E5> I. Cernak, M.D., Ph.D.     

Akutmanagement des Schlaganfalls

(as) In Deutschland mu? mit einer Inzidenz von ca. 150 000 Schlaganfallpatienten pro Jahr gerechnet werden. Bei ca. 30% der Patienten sind ein ungünstiges neurologisches Outcome und bleibende schwerwiegende Behinderungen zu erwarten. Durch die Einrichtung von sogenannten stroke units k?nnen die Ergebnisse hinsichtlich der Langzeitergebnisse verbessert werden. Da nur beschr?nkte Ma?nahmen zur pr?klinischen Behandlung des isch?mischen Hirninfarktes zur Verfügung stehen, mu? sich die Akutversorgung des Schlaganfallpatienten vor allem auf einen raschen Transport in eine entsprechend ausgestattete Klinik konzentrieren. RID="ID=" <E6>Quelle: </E6>Schellinger PD, Steiner T (1998)<E6> Notfall- und Intensivbehandlung nach Schlaganfall.</E6> Nervenarzt 69: 530&ndash;539&para; Berlit P, Popescu O, Kl&ouml;tzsch C, Diehl RR, Berg-Dammer E (1997)<E6> Behandlung des akuten Schlaganfalls auf der Stroke Unit. </E6>Nervenarzt 68: 122&ndash;128     

Wirkprofil von S-(+)-Ketamin

(as) Das bisher in der An?sthesie und Notfallmedizin verwendete Ketamin stellt eine Mischung (Razemat) aus dem links- und dem rechtsdrehenden Enantiomer (R)–Ketamin bzw. (S)–Ketamin dar. Mittlerweile wurde auch (S)–Ketamin für den klinischen Einsatz erprobt und befindet sich seit Oktober 1997 im Handel (Ketanest?S). Im Vergleich zum bisher verwendeten Mischpr?parat scheint (S)–Ketamin verschiedene Vorteile zu bieten. RID="ID=" <E6>Quelle:</E6> Hempelmann G, Kuhn DFM (1997) <E6>Klinischer Stellenwert von S-(+)-Ketamin. </E6>Anaesthesist [Suppl 1] 46:S3&ndash;S7&para; Kress HG (1997) <E6>Wirkmechanismen von Ketamin. </E6>Anaesthesist [Suppl 1] 46:S8&ndash;S19     

Akzidentelle Stechapfelintoxikation

(as) Ein 12j?hriger Junge mit den akut aufgetretenen Symptomen Verwirrtheit, Mydriasis und Mundtrockenheit wurde in der Kinderklinik vorgestellt. Trotz fehlender anamnestischer Hinweise zog man eine Vergiftung mit einer atropin?hnlichen Substanz in Erw?gung. Die toxikologische Untersuchung von Blut und Urin ergab Nachweise auf die Tropanalkaloide Skopolamin und Hyoszyamin ( l–Atropin). Nachdem sich der Junge unter Sedierung innerhalb der n?chsten 12 Stunden wieder erholt hatte, konnte er mitteilen, da? er eine „exotische Frucht” verzehrt habe, die im Nachhinein als Stechapfel identifiziert werden konnte. RID="ID=" <E6>Quelle: </E6>Claa&szlig; A, Rochholz G, Sch&uuml;tz H.W. (1997) <E6>Akzidentelle Stechapfelintoxikation. </E6>Monatsschr Kinderheilkd 145: 593-596     

Einsatzmöglichkeiten der präklinischen Blutgasanalyse

(as) Seit einigen Jahren sind tragbare Blutgasanalyseger?te im Handel erh?ltlich. Aufgrund ihrer einfachen Bedienbarkeit k?nnen die Ger?te auch im Rettungsdienst eingesetzt werden. Mit den transportablen Ger?ten kann, wie in der Klinik, eine komplette Blutgasanalyse („Astrup”) mit Bestimmung von pH–Wert, pO ₂ , pCO ₂ und Baseexcess durchgeführt werden. Ziel einer Studie von Prause et al. war eine Beurteilung des m?glichen Stellenwertes einer pr?klinischen Blutgasanalyse bei Patienten mit kardiopulmonaler Reanimation.RID="ID=" <E6>Quelle: </E6>Prause G, Hetz H, Doppler R (1998) <E6>Die pr&auml;klinische Blutgasanalyse. Teil 1. </E6>Anaesthesist 47: 400-405&para; Prause G, Kaltenb&ouml;ck F, Doppler R (1998) <E6>Die pr&auml;klinische Blutgasanalyse. Teil 2. </E6>Anaesthesist 47: 490-495     

Surgical Repair of Postinfarction Ventricular Septal Defect: 10-Year Experience

n = 10). Eight patients were supported perioperatively by intraaortic balloon counterpulsation (IABP). In all cases the surgical technique included infarctectomy and ventricular septum reconstruction with synthetic patches. Coronary artery bypass grafting was synchronously performed in four patients. Seven patients died perioperatively (mortality rate 50%) due to heart failure and to multiple organ failure. The most frequent complications were low cardiac output syndrome, hemorrhage, and respiratory and renal insufficiency. The PIVSD needs urgent surgical intervention with the patient hemodynamically stable after cardiac catheterization. Long-term results are favorable for survivors.RID=" ID=" <E5>Correspondence to:</E5> K. Athanassiadi, M.D., Ph.D., 34A Konstantinoupoleos Str., 15562 Holargos, Athens, Greece     

Changes in Erythrocyte Deformability after Liver Resection for Hepatocellular Carcinoma Associated with Chronic Liver Disease

p < 0.05). The incidence of postoperative complications was higher ( p = 0.001) in the patients (group A) with ETT increased during the first 3 postoperative days by ≥1 SD of the mean of the preoperative value than in patients (group B) with less change. Of the 12 patients whose ICGR ₁₅ value was ≥20%, all 9 patients in group A had postoperative complications. The increase in ETT (decrease in erythrocyte deformability) is associated with the development of postoperative complications. The measurement of erythrocyte deformability gives information useful for postoperative management, and special monitoring for postoperative complications is necessary in patients with the increase soon after liver resection.RID=" ID=" <E5>Correspondence to:</E5> K. Horii, M.D.     

Systematic Review of Combination Drug Therapy for Non-neurogenic Male Lower Urinary Tract Symptoms

Background

Several drugs are approved for the treatment of lower urinary tract symptoms (LUTS) in men, but these are mostly used by clinicians as monotherapies. The combination of different compounds, each of which targets a different aspect of LUTS, seems appealing. However, only few clinical trials have evaluated the effects of combination therapies.

Objective

This systematic review analyzes the efficacy and adverse events of combination therapies for male LUTS.

Evidence acquisition

PubMed and Cochrane databases were used to identify clinical trials and meta-analyses on male LUTS combination therapy. The search was restricted to studies of level of evidence ≥1b. A total of 49 papers published between January 1988 and March 2012 were identified.

Evidence synthesis

The α₁-adrenoceptor antagonist (α₁-blocker)/5α-reductase inhibitor (5-ARI) combination provides the most data. This combination seems to be more efficacious in terms of several outcome variables in patients whose prostate volume is between 30 ml and 40 ml when treatment is maintained for >1 yr; when given for <1 yr, α₁-blockers alone are just as effective. The combination of α₁-blocker/5-ARI shows a slightly increased rate of adverse events. It remains unknown whether its safety and superiority over either drug as monotherapy are sustained after >6 yr. The α₁-blocker/muscarinic receptor antagonist (antimuscarinic) combination was most frequently assessed as an add-on therapy to already existing α₁-blocker therapy. Inconsistent data derive from heterogeneous study populations and different study designs. Currently, the α₁-blocker/antimuscarinic combination appears to be a second-line add-on for patients with insufficient symptom relief after monotherapy. The combination seems to be safe in men with postvoid residual <200 ml. However, there are no trials >4 mo concerning safety and efficacy of this combination. The α₁-blocker/phosphodiesterase type 5 inhibitor combination is a new treatment option with only preliminary reports. More studies are needed before definitive conclusions can be drawn.

Conclusions

An α₁-blocker/5-ARI combination is beneficial for patients whose prostate volume is between 30 ml and 40 ml when medical treatment is intended for >1 yr. Based on short-term follow-up studies, add-on of antimuscarinics to α₁-blockers is an option when postvoid residual is <200 ml.     

Second-look Surgery after Cytoreduction and Intraperitoneal Chemotherapy for Peritoneal Carcinomatosis from Colorectal Cancer: Analysis of Prognostic Features

p = 0.04) and the completeness of resection at the time of the second look ( p = 0.066). In addition, a limited extent of peritoneal carcinomatosis distribution found at the time of the second look predicted a favorable result. A new objective assessment of peritoneal carcinomatosis, the peritoneal cancer index, was found to be of help during patient selection ( p = 0.066). We concluded that second-look surgery with potential curative intent should be considered in patients who had a complete initial cytoreduction and those in whom total removal of the recurrence is judged possible at the time of the second look. At the time of abdominal exploration, a limited distribution and volume of peritoneal carcinomatosis as defined by the peritoneal cancer index should be considered. Palliative debulking procedures should be used to alleviate symptoms in other patients.RID=" ID=" <E5>Correspondence to:</E5> P.H. Sugarbaker, M.D.     

Prognostic Significance of Gleason Score Discrepancies between Needle Biopsy and Radical Prostatectomy

Objectives

Discordance between the Gleason score (GS) on needle biopsy (NB) and the GS of the radical prostatectomy (RP) specimen is a common finding. The objective of this study was to evaluate the prognostic significance of these discrepancies with respect to outcomes following RP.

Methods

In the study, 6625 men treated by RP were categorized as having NB=RP (68.8%), NB<RP (25.0%) or NB>RP (6.2%) GS, and stratified for analyses into RP GS groups. The Kaplan-Meier method was used to analyze differences in biochemical recurrence–free survival (BRFS), and multivariate Cox analyses were performed to estimate the independent relative risk of progression associated with GS discrepancies.

Results

Across multiple RP GS strata (3+4, 7, 8, 8–10), patients with a lower NB GS experienced significantly better BRFS than patients with equal NB and RP GS (all p < 0.05). NB<RP GS was independently associated with better (pooled HR, 0.76, p = 0.001) BRFS, within and across RP GS strata. Similarly, patients with NB>RP GS had poorer BRFS than patients with NB=RP GS across multiple RP GS strata (≤3+3, 3+4, 7; all p < 0.05). NB>RP GS was independently associated with worse (pooled HR, 1.91, p < 0.001) BRFS probabilities, within and across RP GS strata.

Conclusions

Our data suggest that the GS of the NB adds additional prognostic value to the RP GS in a consistent manner that may be applicable to strategies of risk stratification and patient counseling after surgery.