Amebic Liver Abscess: Changing Trends over 20 Years RID="" ID="" This study was presented to the Turkish Surgical Congress in Izmir, Turkey.

RID=" ID=" <E5>Correspondence to:</E5> Y. Akgun, M.D.     

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.     

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

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

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     

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.     

Outcome Quality Standards in Pancreatic Oncologic Surgery

Purpose

To identify quality indicators and establish acceptable quality limits (AQLs) in pancreatic oncologic surgery using a formal statistical methodology.

Methods

Indicators have been identified through systematic literature reviews and guidelines for pancreatic surgery. AQLs were determined for each indicator with confidence intervals of 99.8 and 95 % above and below the weighted average by sample size from the different series examined.

Results

Several indicators have been identified with the following results as AQLs: resectability rate >59 %; morbidity, mortality, and pancreatic fistula rate in pancreaticoduodenectomy <55, <5, and <16 %, respectively; morbidity, mortality, and fistula rate in distal pancreatectomy <53, <4, and <31 %, respectively; number of lymph nodes retrieved >15; R1 resection <46 %; survival at 1, 3, and 5 years >54, >19, and >8 %, respectively.

Conclusions

A series of different indicators for quality surgical care outcome in pancreatic cancer, as well as their limits, have been determined according to a standard methodology.     

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.     

Bariatric Surgery in the Elderly Is Associated with Similar Surgical Risks and Significant Long-Term Health Benefits

Purpose

Older age (>?60) has been considered a relative contraindication for bariatric surgery due to increased complication risk. This study examined the risks and benefits of bariatric surgery for patients older than 60 years in Canadian population.

Methods

This was a retrospective cohort study of the Ontario Bariatric Registry: a database recording peri-operative and post-operative outcomes of publicly funded bariatric surgeries across the province. Patients who completed 1 year follow-up, who underwent laparoscopic gastric bypass (LRYGB) or laparoscopic sleeve gastrectomy (LSG) between January 2010 and May 2013, were divided into older (>?60) and younger (>?60) cohorts, and outcomes were compared.

Results

Between January 2010 and May 2013, 3166 registry patients underwent LRYGB or LSG and completed 1-year follow-up. Of these, 204 (6.5%) were older than 60 years, with 175 (85.8%) undergoing LRYGB and 29 (14.2%) LSG. Demographics were similar, except for a higher number of males in the older group (59 (28.9%) versus 452 (15.3%) (p?<?0.001)). No significant difference in complication rate was noted (15% for younger cohort versus 13.8% (p?=?0.889)). The average percentage of excess weight loss was significantly higher in the younger population (60.72% versus 56.25% (p?<?0.05)) overall, however not significantly in the LSG group. Reduction in medication use post-surgery for management of co-morbidities was significantly higher in the older patients (??0.91 versus ??2.03 (p?<?0.001)).

Conclusion

The older cohort who underwent LRYGB or LSG was at no greater risk for intra-operative and post-operative complications and showed greater reduction in medication use post-surgery when compared to the younger cohort.

     

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     

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     

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     

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     

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     

Criteria for failure and worsening after surgery for lumbar disc herniation: a multicenter observational study based on data from the Norwegian Registry for Spine Surgery

Purpose

In clinical decision-making, it is crucial to discuss the probability of adverse outcomes with the patient. A large proportion of the outcomes are difficult to classify as either failure or success. Consequently, cutoff values in patient-reported outcome measures (PROMs) for “failure” and “worsening” are likely to be different from those of “non-success”. The aim of this study was to identify dichotomous cutoffs for failure and worsening, 12 months after surgical treatment for lumbar disc herniation, in a large registry cohort.

Methods

A total of 6840 patients with lumbar disc herniation were operated and followed for 12 months, according to the standard protocol of the Norwegian Registry for Spine Surgery (NORspine). Patients reporting to be unchanged or worse on the Global Perceived Effectiveness (GPE) scale at 12-month follow-up were classified as “failure”, and those considering themselves “worse” or “worse than ever” after surgery were classified as “worsening”. These two dichotomous outcomes were used as anchors in analyses of receiver operating characteristics (ROC) to define cutoffs for failure and worsening on commonly used PROMs, namely, the Oswestry Disability Index (ODI), the EuroQuol 5D (EQ-5D), and Numerical Rating Scales (NRS) for back pain and leg pain.

Results

“Failure” after 12 months for each PROM, as an insufficient improvement from baseline, was (sensitivity and specificity): ODI change <13 (0.82, 0.82), ODI% change <33% (0.86, 0.86), ODI final raw score >25 (0.89, 0.81), NRS back-pain change <1.5 (0.74, 0.86), NRS back-pain % change <24 (0.85, 0.81), NRS back-pain final raw score >5.5 (0.81, 0.87), NRS leg-pain change <1.5 (0.81, 0.76), NRS leg-pain % change <39 (0.86, 0.81), NRS leg-pain final raw score >4.5 (0.91, 0.85), EQ-5D change <0.10 (0.76, 0.83), and EQ-5D final raw score >0.63 (0.81, 0.85). Both a final raw score >48 for the ODI and an NRS >7.5 were indicators for “worsening” after 12 months, with acceptable accuracy.

Conclusion

The criteria with the highest accuracy for defining failure and worsening after surgery for lumbar disc herniation were an ODI percentage change score <33% for failure and a 12-month ODI raw score >48. These cutoffs can facilitate shared decision-making among doctors and patients, and improve quality assessment and comparison of clinical outcomes across surgical units. In addition to clinically relevant improvements, we propose that rates of failure and worsening should be included in reporting from clinical trials.

     

Impact of Atrial Fibrillation on Postoperative Adverse Outcomes of Surgical Patients With Knee Endoprosthetic Surgery

Background

Atrial fibrillation/flutter (AF) is associated with increased mortality, thromboembolism, heart failure, and adverse perioperative outcomes. We aimed to investigate the impact of AF on adverse in-hospital outcomes of hospitalized patients who underwent knee endoprosthetic surgery (KES).

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