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  • 1
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  128. Kongress der Deutschen Gesellschaft für Chirurgie; 20110503-20110506; München; DOC11dgch033 /20110520/
    Publication Date: 2011-05-20
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 2
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  128. Kongress der Deutschen Gesellschaft für Chirurgie; 20110503-20110506; München; DOC11dgch163 /20110520/
    Publication Date: 2011-05-20
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 3
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  132. Kongress der Deutschen Gesellschaft für Chirurgie; 20150428-20150501; München; DOC15dgch271 /20150424/
    Publication Date: 2015-04-25
    Keywords: ddc: 610
    Language: German
    Type: conferenceObject
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  • 4
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  132. Kongress der Deutschen Gesellschaft für Chirurgie; 20150428-20150501; München; DOC15dgch044 /20150424/
    Publication Date: 2015-04-25
    Keywords: ddc: 610
    Language: German
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  • 5
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    German Medical Science GMS Publishing House; Düsseldorf
    In:  GMS Krankenhaushygiene Interdisziplinär; VOL: 4; DOC03 /20091216/
    Publication Date: 2010-02-03
    Description: Background: Procedures for prevention of surgical site infections are clearly regulated in evidence-based guidelines. However, realisation of guidelines is still crucial. Several tools for implementation are available. Studies about compliance in terms of implementation of guidelines and recommendations confirm the necessity to realize consequently evid〈TextGroup〉 enc 〈/TextGroup〉e-based measures. Material and method: To support the implementation of the guideline "prevention of surgical site infections" of the commission for hospital hygiene and infection prevention at the Robert Koch Institute in Berlin an educational film was produced. Results: The film represents also the start of a practice-oriented training concept. The in-hospital stay of an exemplary surgical patient shows the prevention measures starting with information about prevention during the patient's interview followed by pre-, intra- and post-operative prevention measures.Conclusion: With the film a contribution is made to converse the World Alliance for Patient Safety of 2004. The involved societies and associations will promote the spreading of the film by adjust free of charge on their web sites.
    Description: Hintergrund: Das Vorgehen zur Prävention postoperativer Wundinfektionen ist in evidenzbasierten Richtlinien klar geregelt. Entscheidend ist die Umsetzung derartiger Empfehlungen, wofür unterschiedliche methodische Möglichkeiten zur Verfügung stehen. Studien zur Compliance der Umsetzung von Richtlinien und Empfehlungen bestätigen die Notwendigkeit, evidenzbasierte Maßnahmen konsequent umzusetzen. Material und Methode: Zur Unterstützung der Umsetzung der Richtlinie "Prävention postoperativer Infektionen im Wundgebiet" der Kommission für Krankenhaushygiene und Infektionsprävention beim Robert Koch-Institut wurde ein Lehrfilm zur Prävention postoperativer Wundinfektionen hergestellt, der zugleich der Auftakt für ein praxisorientiertes Fortbildungskonzepts ist. Ergebnis: Dargestellt ist der Operationsablauf für einen Patienten, beginnend mit der Aufklärung im Arzt-Patient-Gespräch, fortgesetzt über die präoperative Vorbereitung sowie intra- und postoperative Präventionsmaßnahmen.Schlussfolgerungen: Mit dem Lehrfilm wird ein Beitrag zur Umsetzung der World Alliance for Patient Safety von 2004 geleistet. Die beteiligten Fachgesellschaften und Verbände werden den Lehrfilm auf ihren Web-Seiten zur freien Nutzung einstellen und so zur Verbreitung beitragen.
    Keywords: educational film ; prevention of SSI ; compliance ; Lehrfilm ; Prävention postoperativer Wundinfektionen ; Compliance ; ddc: 610
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  • 6
    ISSN: 1432-1076
    Keywords: Key words Kidney transplantation ; Graft survival ; Infant ; Children preschool
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Between 1975 and 1994, 46 children under 6 years of age received a total of 52 renal transplants. Obstructive uropathy and dysplasia accounted for most causes of terminal renal failure (17 and 12 cases respectively). Four patients required a second, 1 patient a third transplantation. Cadaveric organs were used on 33 occasions; 19 patients received a living-related donor kidney. Immunosuppression was performed with azathioprine in 5, with cyclosporine A in 21 and combined azathioprine/cyclosporine therapy in 20 cases. After 1 year, graft survival was 81%, and after 5 years 78%. Creatinine clearance declined slightly between 1 and 5 years from 69 to 56 ml/min per 1.73 m2. Main causes of graft failure were thrombotic complications in 6 cases and death with functioning graft in 5 cases. Graft thrombosis occurred only in grafts from young donors under the age of 7 years and after vascular anastomosis to the iliac vessels. Only two transplants were lost in rejection episodes. Patient survival was 94% after 1 and 90% after 5 years. Two patients died due to septiacemia, 1 died of a ruptured aortic aneurysm, 1 of cerebral ischaemia and 1 suddenly of unknown cause. Patient and graft survival was not different compared with 204 patients aged 6–16 years who received a renal transplantation during the same time period at our institution. After transplantation the patients receiving cyclosporine A showed a marked catch-up growth in the 1st year. The median standard deviation score (SDS) of body length improved from −2.63 to −1.39 standard deviations. Conclusion Renal transplantation is the treatment of choice in end-stage renal failure in children under 6 years.
    Type of Medium: Electronic Resource
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  • 7
    ISSN: 1433-0385
    Keywords: Key words: Mushroom poisoning ; Liver transplantation ; Fulminant hepatic failure.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Der Verlauf von 12 Patienten mit Knollenblätterpilzvergiftung wurde retrospektiv analysiert, um prognostische Kriterien für die Indikationsstellung zur Lebertransplantation herauszuarbeiten. Acht Patienten erholten sich unter konservativer Therapie, bei 3 Patienten war eine Lebertransplantation erforderlich; ein Patient starb bei Vorliegen schwerer Begleiterkrankungen unter konservativer Therapie. Die transplantierten Patienten wiesen initial einen Quick- und Faktor-V-Wert unter 10 % auf. Die Höhe der Transaminasen, des Serumbilirubins, des Serumkreatinins, eine Verlängerung der PTT sowie eine Azotämie hatten keinen sicheren prognostischen Wert. Für die Indikationsstellung zur Transplantation war der initiale Quick- und Faktor-V-Wert und deren inadäquater Anstieg unter Substitution entscheidend. Die Ausbildung einer Encephalopathie sowie ein progredientes Nierenversagen stellen zusätzliche prognostisch schlechte Parameter dar.
    Abstract: Schlüsselwörter: Knollenblätterpilzvergiftung – Lebertransplantation – fulminantes Leberversagen.
    Notes: Summary. The clinical course of 12 patients with mushroom poisoning was evaluated in order to define the parameters considered to be relevant to the indication for liver transplantation. Eight patients recovered under conservative therapy; one patient died due to pre-existing, concomitant cardiopulmonary disease. In three patients transplantations had to be performed because of severe liver failure. On admission, the transplanted patients had a decreased Quick's test score and factor V value (〈 10 %). The peak of liver enzymes, serum bilirubin, serum creatinine, partial thromboplastin time and azotemia were not of any prognostic value. Main indications for liver transplantation were a very low initial Quick's test score and factor V value (both 〈 10 %) and their inadequate response under substitution therapy. The development of encephalopathy and renal failure were further parameters indicating poor prognosis.
    Type of Medium: Electronic Resource
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  • 8
    ISSN: 1433-0385
    Keywords: Key words: Liver tumor ; Liver resection ; Computed tomography ; Three-dimensional visualization ; Preoperative planning. ; Schlüsselwörter: Lebertumoren ; Leberresektionen ; Computertomographie ; dreidimensionale Visualisierung ; präoperative Planung.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Bei Patienten mit Lebertumoren stellen Sonographie, Computertomographie (CT) und in einigen Fällen die Magnetresonanztomographie (MRT) die Grundlage für die präoperative Planung von Leberresektionen dar. Auf der Basis von CT-Untersuchungen wurde ein dreidimensionales (3-D) Visualisierungsprogramm entwickelt. In dieser Studie wurde das 3-D-Visualisierungsprogramm bei 6 Patienten mit problematischer Lokalisation von Lebertumoren zur Planung des operativen Vorgehens angewendet. Bei 5 von 6 Patienten konnte die Leberresektion – wie präoperativ am Computermodell geplant – durchgeführt werden. Die intraoperativen Befunde entsprachen den 3-D-Visualisierungen. Die 3-D-Visualisierung der Leber erlaubte eine anschauliche und interaktive Planung von Leberresektionen am Computermodell und stellte somit eine verbesserte Vorbereitung für die komplexen Leberresektionen dar.
    Notes: Summary. Preoperative planning of liver resections in patients with liver tumors is based on sonography, computed tomography and magnetic resonance imaging. A new three-dimensional (3D) visualization program was developed based on CT data. This visualization program was used for preoperative planning in 6 patients with liver tumors in problematic intrahepatic localizations. In 5 out of 6 patients the liver resection could be performed as preoperatively planned. The intraoperative findings agreed with the 3D visualization in all these patients. 3D Visualization of the liver allowed clear and interactive planning of liver resections and improved the preparation of complex liver resections.
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  • 9
    ISSN: 1433-0385
    Keywords: Keywords: Liver resection ; Circulatory arrest ; Hepatoblastoma. ; Schlüsselwörter: Leberresektion ; Kreislaufstillstand ; Hepatoblastom.
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Description / Table of Contents: Zusammenfassung. Für die Resektion von großen kindlichen Lebertumoren in kritischer Lokalisation wurde die Resektion im Kreislaufstillstand und tiefer Hypothermie an der Herz-Lungen-Maschine eingeführt. Wir berichten über unsere Erfahrungen mit Leberresektionen an der Herz-Lungen-Maschine bei 3 Kindern mit Hepatoblastomen. Beim ersten Kind wurde die Resektion im kompletten Kreislaufstillstand durchgeführt, bei den beiden anderen unter Low-flow-Kreislaufbedingungen. Die Phasen an der Herz-Lungen-Maschine wurden von den kleinen Patienten gut vertragen. Es wurden erweiterte rechtsseitige Resektionen mit Gefäßrekonstruktionen vorgenommen. Die postoperativen Leberenzymanstiege waren überraschend niedrig. So lagen die maximalen Werte für die GOT zwischen 100 und 200 U/l. Durch die Resektion konnte in Kombination mit der Chemotherapie ein befriedigendes Langzeitüberleben trotz des ausgedehnten Tumorwachstums erreicht werden. Ein Kind lebt 8 Jahre, ein weiteres 10 Monate ohne Tumorrezidiv. Das 3. Kind verstarb an einer Sepsis während der adjuvanten Chemotherapie, nachdem es sich von der Leberresektion gut erholt hatte.
    Notes: Abstract. In order to perform resections of tumors at critical sites in the liver in young children, liver resections in cardiac arrest and deep hypothermia under cardiopulmonary bypass have been developed. We report our experience with liver resection under cardiopulmonary bypass in three children with hepatoblastoma. In the first child the operation was performed under cardiac arrest and, the other two children were operated on under „low flow“ conditions. The periods under cardiopulmonary bypass circulation were well tolerated. Extended right liver resections with vascular reconstructions were performed. The postoperative increase of liver enzymes was moderate. The increase in GOT was between 100 and 200 U/l. In spite of the extended tumor growth, reasonable long-term results were achieved by resection in combination with chemotherapy. One child has been living 8 years and another 10 months without tumor recurrence. The third child died due to sepsis during adjuvant chemotherapy, after she had recovered well from liver resection.
    Type of Medium: Electronic Resource
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  • 10
    ISSN: 1432-2277
    Keywords: Key words Kidney transplantation ; Ureteral complications ; Pyeloureterostomy
    Source: Springer Online Journal Archives 1860-2000
    Topics: Medicine
    Notes: Abstract Necrosis and stenosis of the ureter are severe complications after kidney transplantation and occur with mean incidence of 2,9–13,4 %. Several surgical techniques like simple nephrostomy or complex urinary tract reconstruction have been applied for repair. In this study, our experience with native pyeloureterostomy (NPUS) using the native ureter is presented. Between March 1978 and June 1996, 2592 kidney transplantations were performed in our institution. In 48 patients (1,9 %), secondary urinary tract reconstruction by NPUS was necessary. These patients were evaluated retrospectively by review of the case notes. At the time of operation the mean age was 45 ± 14 years. Indications for NPUS were distal ureteral stenosis (n = 29), necrosis (n = 17), bleeding (n = 1) or iatrogenic lesion of the ureter (n = 1). The mean time period between transplantation and urinary tract reconstruction was 20 ± 23 days (range: 1–90 days) for necrosis and 404 ± 637 days (range: 14–2385 days) for stenosis. A pyeloureterostomy was technically feasible in all patients using the recipient's ipsilateral ureter. In 40 out of 48 patients the graft developed a normal function postoperatively (follow up: 39 ± 48 months). A graft nephrectomy was necessary only in one patient, because of complete pyelonnecrosis 6 days after NPUS. Two grafts were lost due to acute rejection. Data of five patients were not available 〉 15 years after successful reconstruction. We can conclude that NPUS is a safe and simple rescue technique for the treatment of distal ureteral complications after kidney transplantation. Therefore, this technique should be the therapy of choice when secondary reconstruction by re-ureteroneocystostomy is not possible.
    Type of Medium: Electronic Resource
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