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  • 1
    Electronic Resource
    Electronic Resource
    Springer
    Der Chirurg 70 (1999), S. 253-258 
    ISSN: 1433-0385
    Keywords: Key words: Liver trauma ; Surgical therapy ; Results. ; Schlüsselwörter: Lebertrauma ; chirurgische Therapie ; Ergebnisse.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Von Januar 1979 bis August 1996 wurden an der Chirurgischen Universitätsklinik Ulm 178 Patienten aufgrund eines Lebertraumas chirurgisch versorgt. Es handelte sich dabei zu 91,6 % um stumpfe und nur zu 8,4 % um penetrierende Traumen. Bei 110 Fällen (62 %) handelte es sich um leichte Verletzungen der Schweregrade I und II, während sich bei 68 Patienten (38 %) schwere Traumen der Grade III, IV und V fanden. Die Letalitätsrate wird vom Schweregrad der Leberruptur und der Begleitverletzung bestimmt. Die Gesamtletalität lag bei 32 % (57 Patienten). Davon sind 28 Patienten an den Folgen der Leberverletzung verstorben. Dies bedeutet, die reine Sterblichkeit aufgrund der Leber betrug 15,7 %. Keiner der Patienten mit einer penetrierenden Verletzung ist verstorben. Die Komplikationsrate lag bei 55 %, wobei die Hämatombildung die am häufigsten beobachtete Komplikation darstellte (12,9 %), an zweiter Stelle folgte die Nachblutung mit 9,6 %. Die Absceßrate lag bei 2,8 %. Bei einem kreislaufstabilen Patienten sollte grundsätzlich die konservative Therapie angestrebt werden, sofern er die gegebenen Voraussetzungen erfüllt. Bei kreislaufinstabilen Patienten ist ein operatives Vorgehen unumgänglich. Das chirurgische Vorgehen hängt vom Schweregrad der Leberverletzung ab. Bei leichter Blutung steht die „einfache“ Versorgung durch Coagulation oder Naht im Vordergrund. Liegt eine schwere Blutung vor, so empfiehlt sich die Hepatotomie, die gezielte Blutstillung und Débridement (Pachters Vorgehen). Ist die Blutung nicht unter Kontrolle zu bringen, ist die perihepatische Bauchtuchtamponade das Mittel der Wahl.
    Notes: Summary. The management of 178 patients with liver trauma (132 male, 46 female; mean age 34 years (range 3–88) presenting from January 1979 to August 1996 is reviewed. There were 165 cases of blunt trauma and 13 cases of penetrating injury. 110 cases were classified as simple injuries (grade I or II) and 68 cases as complex injuries (grade III to V). The overall mortality was 32 % (57 patients). The mortality for true hepatic injury was 15.7 %. None of the patients with penetrating injuries died. Mortality was inflenced by the type of liver injury and the number of associated injuries. The postoperative complication rate was 55 %. The most-frequent postoperative complications related to the hepatic injury were intrahepatic or subcapsular hematoma (12.9 %) and postoperative bleeding (9.6 %). Intraabdominal abscess formation was seen in 2.8 %. Operative therapy for liver injuries depends on the grade of the injury. The majority of liver injuries can be managed by simple techniques, including electrocautery and application of hemostatic agents. In complex injuries hepatotomy, direct vessel ligation, and debridement of necrotic tissue is the method of choice (Pachter's procedure). In non-controlled bleeding, perihepatic picking is a standard method.
    Type of Medium: Electronic Resource
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  • 2
    Electronic Resource
    Electronic Resource
    Springer
    Langenbeck's archives of surgery 383 (1998), S. 300-305 
    ISSN: 1435-2451
    Keywords: Key words Basic clinical research in surgery ; Full time research ; Evidence-based surgery
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Background: Surgeons must be prepared to be questioned about their understanding, activities, and achievements in basic and clinical research in terms of structural, organizational, and financial support of surgical research. Results: Clinical research today comprises basic research related to accumulation of knowledge about biological systems, disease-related research including experimental research with animals, and in vitro research with biological material and clinical studies with the strongest empirical basis in data derived from controlled clinical trials. Most clinical methods related to diagnosis and treatment have been introduced into the practice of everyday medicine even in university hospitals without passing a prospective evaluation protocol. To test the efficacy of a new drug or a newly developed surgical technique, the controlled prospective clinical trial is the best method; however, fewer than 50% of clinical questions can be answered by controlled clinical studies. In Germany the frequency of controlled clinical trials for answering clinical questions is presently low; this is particularly true for surgery, in comparison with other countries. The concept of evidence-based medicine is based on the principles of data generation from controlled trials and meta-analyses of those studies. Best-evidence synthesis means a reasonable synthesis of evident knowledge, experience and intuition. The challenge of professionalization of clinical research in surgery is linked to the establishment of full time positions for basic scientists and clinical researchers and the establishment of clinical research teams and of research professorships including basic scientists in surgical departments. Conclusion: Clinical research can be effective only if there is good cooperation between clinicians and basic scientists, if high grade scientific methods are established in clinical research institutions, if there is sufficient financial and personal supply, and if there are enough laboratories and animal operating facilities. There is an urgent need for structures integrating basic scientists in clinical research groups, for more interdisciplinary research projects and more multidisciplinary research, independent of clinical care in terms of manpower.
    Type of Medium: Electronic Resource
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