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The Glycocalyx Shedding Influences Hemodynamic and Metabolic Response to Fluid Load in Septic Shock. 糖萼脱落影响脓毒性休克患者对液体负荷的血流动力学和代谢反应
IF 0.6 4区 医学
Chirurg Pub Date : 2022-04-01 DOI: 10.5152/TJAR.2021.21224
Yana Ilyina, Eugenia Fot, Vsevolod Kuzkov, Mikhail Kirov
{"title":"The Glycocalyx Shedding Influences Hemodynamic and Metabolic Response to Fluid Load in Septic Shock.","authors":"Yana Ilyina, Eugenia Fot, Vsevolod Kuzkov, Mikhail Kirov","doi":"10.5152/TJAR.2021.21224","DOIUrl":"10.5152/TJAR.2021.21224","url":null,"abstract":"<p><strong>Objective: </strong>Sepsis-associated endothelial dysfunction and degradation result in release of inflammatory mediators, compromise endothelial permeability, and impair alveolar fluid clearance leading to pulmonary edema. Excessive fluid therapy in septic shock damage the endothelial glycocalyx which will increase capillary leakage. The aim of our study was to assess the relationship of endothelial glycocalyx shedding with hemodynamic and metabolic response to fluid load in patients with septic shock.</p><p><strong>Methods: </strong>Eighteen adult patients were included in prospective observational study. To predict the response to infusion, we performed fluid load test by using crystalloids 7 mL kg-1 for 10 minutes. The plasma concentrations of endothelial glycocalyx components including heparan sulfate proteoglycan and syndecan 1 were measured at baseline, 2, 24 hours after fluid load test.</p><p><strong>Results: </strong>We observed associations of syndecan 1 with extravascular lung water index (rho = 0.48, P =.04) at baseline and of heparan sulfate proteoglycan with extravascular lung water index (rho= -0.56, P = .03) and pulse pressure variation (rho = 0.53, P = .04) at 24 hours after fluid load test. The plasma concentration of syndecan 1 correlated with lactate at baseline (rho = 0.51, P = .02) and at 24 hours after fluid load test (rho = 0.76, P = .009). At 2 hours after fluid load test, the concentration of syndecan 1 correlated with global end-diastolic volume index (rho= 0.93, P = .001) in normovolemic patients.</p><p><strong>Conclusions: </strong>The shedding of endothelial glycocalyx after fluid load test in septic shock is associated with hemodynamic and metabolic responses and related with the severity of pulmonary edema.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"88 1","pages":"94-100"},"PeriodicalIF":0.6,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC9361336/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"73432001","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Digital documentation of complications in visceral surgery: possibilities and evaluation of an instrument for quality management]. [内脏手术并发症的数字记录:质量管理仪器的可能性和评价]。
4区 医学
Chirurg Pub Date : 2022-04-01 Epub Date: 2021-08-18 DOI: 10.1007/s00104-021-01482-x
A Winter, M M Maurer, M Schmelzle, T Malinka, M Biebl, P Fikatas, D Kröll, I M Sauer, M Hippler-Benscheidt, J Pratschke, S Chopra
{"title":"[Digital documentation of complications in visceral surgery: possibilities and evaluation of an instrument for quality management].","authors":"A Winter,&nbsp;M M Maurer,&nbsp;M Schmelzle,&nbsp;T Malinka,&nbsp;M Biebl,&nbsp;P Fikatas,&nbsp;D Kröll,&nbsp;I M Sauer,&nbsp;M Hippler-Benscheidt,&nbsp;J Pratschke,&nbsp;S Chopra","doi":"10.1007/s00104-021-01482-x","DOIUrl":"https://doi.org/10.1007/s00104-021-01482-x","url":null,"abstract":"<p><p>Against the background of the growing economization of clinical medicine, in the last decades the topics of risk and complication management have also become more important in surgical disciplines. The standardization and reproducible documentation of outcome and complication data play a key role for valid quality control. In this article a digital system implemented at the surgical clinic of the Charité University Medicine in Berlin is analyzed with respect to its practicability for perioperative and postoperative monitoring of complications within the framework of quality assurance.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 4","pages":"381-387"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1007/s00104-021-01482-x","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39321905","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
[Minimum case volume regulations in surgery from the perspective of the specialist society (DGCH) : Balancing act between science, politics, treatment reality and a range of other aspects]. [从专家协会(DGCH)的角度看外科最小病例量规定:科学、政治、治疗现实和一系列其他方面之间的平衡行为]。
4区 医学
Chirurg Pub Date : 2022-04-01 Epub Date: 2022-02-23 DOI: 10.1007/s00104-022-01596-w
Hauke Lang, Peter Philipp Grimminger, Hans-Joachim Meyer
{"title":"[Minimum case volume regulations in surgery from the perspective of the specialist society (DGCH) : Balancing act between science, politics, treatment reality and a range of other aspects].","authors":"Hauke Lang,&nbsp;Peter Philipp Grimminger,&nbsp;Hans-Joachim Meyer","doi":"10.1007/s00104-022-01596-w","DOIUrl":"https://doi.org/10.1007/s00104-022-01596-w","url":null,"abstract":"<p><p>The scientifically founded surgical specialist discussion regarding the legal requirements for minimum volume numbers for diverse organ systems and selected surgical procedures as the basis of quality assurance and optimization of treatment is not new. Comprehensive and also reliable data from national and international studies are available for colorectal surgery, pancreatic surgery, esophageal surgery, liver surgery and gastric surgery. Recently, the raising of the minimum volume for complex esophageal interventions by the Federal Joint Committee (G-BA) in Germany from 10 up to 26 procedures per hospital and year, reignited the debate on this topic as well as the debate on centralization in the healthcare system in general. This decision seems to be scientifically well-justified from the perspective of political bodies and realizable in the practical implementation; however, from the perspective of physicians routinely involved in the corresponding highly complex procedures, there is a very much broader basis for discussion, which is only partially covered by a report of the Institute for Quality and Efficiency in the Healthcare System (IQWiG) as the foundation of the decision of the G‑BA. For the scientifically oriented surgical specialist society, in the first instance priority is given to the scientific evidence as the guiding principle. Nevertheless, aspects of the treatment reality cannot and should not be ignored. Therefore, the recommendations of the specialist society must be oriented not only to the quality of results but also to the realistic options for successful implementation in practice. Furthermore, questions of further education, the right of the patient to freedom of choice of the physician and preservation of the attractiveness of the occupational profile of surgeons are immanent topics for the surgical specialist society.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 4","pages":"342-348"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8864976/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39808450","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 2
[Minimum case volume regulations of the Federal Joint Committee : Mode of function and application in practice]. [联邦联合委员会最低案件量规定:功能模式和实践中的应用]。
4区 医学
Chirurg Pub Date : 2022-04-01 Epub Date: 2022-03-22 DOI: 10.1007/s00104-022-01587-x
Horst Schuster, Peter Follert
{"title":"[Minimum case volume regulations of the Federal Joint Committee : Mode of function and application in practice].","authors":"Horst Schuster,&nbsp;Peter Follert","doi":"10.1007/s00104-022-01587-x","DOIUrl":"https://doi.org/10.1007/s00104-022-01587-x","url":null,"abstract":"<p><p>The minimum case volume regulations of the Federal Joint Committee determine the size of the respective annual minimum number for each site of a hospital, for selected scheduled inpatient services where the quality of the treatment results is dependent on the number of services carried out. In addition, further details on the elucidation of the prognosis are determined in the regulations. Due to the legally defined prognostic procedure as a prerequisite for a prospective justification for service provision, new or altered minimum case volumes come into effect even before the end of the validity period established on the justification for provision of services. The Federal Joint Committee established this basic principle also for the introduction procedure in a resolution from 16 December 2021. This article explains the background and should support the implementation.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":" ","pages":"325-334"},"PeriodicalIF":0.0,"publicationDate":"2022-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"40313958","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Multizentrische, randomisiert-kontrollierte Studien der ACO/AIO/ARO ACO/AIO/ARO的多中心随机对照试验
4区 医学
Chirurg Pub Date : 2022-03-28 DOI: 10.1007/s00104-022-01633-8
J. Betzler, P. Piso, R. Hofheinz, C. Reissfelder
{"title":"Multizentrische, randomisiert-kontrollierte Studien der ACO/AIO/ARO","authors":"J. Betzler, P. Piso, R. Hofheinz, C. Reissfelder","doi":"10.1007/s00104-022-01633-8","DOIUrl":"https://doi.org/10.1007/s00104-022-01633-8","url":null,"abstract":"","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"409-412"},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43764871","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
Webinar zur S3-Leitlinie „Diagnostik, Therapie und Nachsorge von Analkanal- und Analrandkarzinomen“ "肛门肿瘤诊断、治疗和后续诊断"
4区 医学
Chirurg Pub Date : 2022-03-28 DOI: 10.1007/s00104-022-01599-7
R. Siegel, F. Aigner
{"title":"Webinar zur S3-Leitlinie „Diagnostik, Therapie und Nachsorge von Analkanal- und Analrandkarzinomen“","authors":"R. Siegel, F. Aigner","doi":"10.1007/s00104-022-01599-7","DOIUrl":"https://doi.org/10.1007/s00104-022-01599-7","url":null,"abstract":"","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 1","pages":"413-414"},"PeriodicalIF":0.0,"publicationDate":"2022-03-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"42657236","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Targeted intraoperative molecular imaging for localization of nonpalpable tumors and quantification of resection margin distances]. [术中靶向分子成像对不可触及肿瘤的定位及切除边缘距离的量化]。
4区 医学
Chirurg Pub Date : 2022-03-01 Epub Date: 2022-02-22 DOI: 10.1007/s00104-022-01610-1
R Keiner, M Ardelt, U Settmacher
{"title":"[Targeted intraoperative molecular imaging for localization of nonpalpable tumors and quantification of resection margin distances].","authors":"R Keiner,&nbsp;M Ardelt,&nbsp;U Settmacher","doi":"10.1007/s00104-022-01610-1","DOIUrl":"https://doi.org/10.1007/s00104-022-01610-1","url":null,"abstract":"","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 3","pages":"307-308"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39943205","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[The surgeon's balancing act-Teaching in the clinical routine]. [外科医生的平衡术--临床常规教学]。
4区 医学
Chirurg Pub Date : 2022-03-01 Epub Date: 2021-07-23 DOI: 10.1007/s00104-021-01470-1
J Sterz, V Britz, P Carstensen, T Kollewe, S H Voß, M C Stefanescu, T Schreckenbach, R D Verboket, Miriam Rüsseler
{"title":"[The surgeon's balancing act-Teaching in the clinical routine].","authors":"J Sterz, V Britz, P Carstensen, T Kollewe, S H Voß, M C Stefanescu, T Schreckenbach, R D Verboket, Miriam Rüsseler","doi":"10.1007/s00104-021-01470-1","DOIUrl":"10.1007/s00104-021-01470-1","url":null,"abstract":"<p><strong>Background: </strong>Thus medical students must be inspired to undertake this specialty. Students complain that the teaching is subordinate to patient care and limited by a lack of time and medical personnel. Although there are many studies assessing student perceptions, few exist that focus on the issues that teachers face.</p><p><strong>Objective: </strong>To analyse student teaching in the daily routine and its potential' problems from the surgeon's perspectives.</p><p><strong>Material and methods: </strong>In this prospective study guidelines for semistructured interviews with formulated, open questions were created, which were specified with further questions. All interviews were conducted using these guidelines and recorded. The number of interviews were a function of the concept of content saturation.</p><p><strong>Results: </strong>All 22 participants perceived that the teaching in clinical practice is of paramount importance. Nevertheless, respondents described that learning goals in the clinical routine are not always achieved. The main reason is a lack of time; however, as clinical experience increases other factors will similarly become more important: Consultants and heads of departments complain about deficiencies in students' previous knowledge, including insufficient motivation. Most respondents described that they do not feel appreciated for teaching. Overall, student teaching was perceived as an additional burden but all respondents found the task to be extremely worthwhile.</p><p><strong>Conclusion: </strong>In addition to the lack of personnel, a lack of appreciation is the most significant obstacle towards effective teaching. It is therefore important to increase the value of teaching by rewarding good achievements and the creation of effective transparency.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 3","pages":"286-291"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894151/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39212337","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[ASCO guideline for the management of stage III NSCLC Part 2: Indications for surgery]. [ASCO III期NSCLC治疗指南第2部分:手术指征]。
4区 医学
Chirurg Pub Date : 2022-03-01 Epub Date: 2022-01-27 DOI: 10.1007/s00104-022-01593-z
Khosro Hekmat, Christiane J Bruns
{"title":"[ASCO guideline for the management of stage III NSCLC Part 2: Indications for surgery].","authors":"Khosro Hekmat,&nbsp;Christiane J Bruns","doi":"10.1007/s00104-022-01593-z","DOIUrl":"https://doi.org/10.1007/s00104-022-01593-z","url":null,"abstract":"","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 3","pages":"309"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39964413","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 0
[Intraoperative fascial traction (IFT) for treatment of large ventral hernias : A retrospective analysis of 50 cases]. 术中筋膜牵引(IFT)治疗大腹疝:50例回顾性分析。
4区 医学
Chirurg Pub Date : 2022-03-01 Epub Date: 2021-12-14 DOI: 10.1007/s00104-021-01552-0
Henning Niebuhr, Zaid Omar Malaibari, Ferdinand Köckerling, Wolfgang Reinpold, Halil Dag, Dietmar Eucker, Thomas Aufenberg, Panagiotis Fikatas, René H Fortelny, Jan Kukleta, Hansjörg Meier, Christian Flamm, Guido Baschleben, Marius Helmedag
{"title":"[Intraoperative fascial traction (IFT) for treatment of large ventral hernias : A retrospective analysis of 50 cases].","authors":"Henning Niebuhr,&nbsp;Zaid Omar Malaibari,&nbsp;Ferdinand Köckerling,&nbsp;Wolfgang Reinpold,&nbsp;Halil Dag,&nbsp;Dietmar Eucker,&nbsp;Thomas Aufenberg,&nbsp;Panagiotis Fikatas,&nbsp;René H Fortelny,&nbsp;Jan Kukleta,&nbsp;Hansjörg Meier,&nbsp;Christian Flamm,&nbsp;Guido Baschleben,&nbsp;Marius Helmedag","doi":"10.1007/s00104-021-01552-0","DOIUrl":"https://doi.org/10.1007/s00104-021-01552-0","url":null,"abstract":"<p><strong>Objective: </strong>The aim was to evaluate the effectiveness, clinical practicability, and complication rate of the intraoperative fascial traction (IFT) procedure for the treatment of large ventral hernias.</p><p><strong>Method: </strong>This study evaluated 50 patients from 11 specialized centers with an intraoperatively measured fascial distance of more than 8 cm, who were treated by IFT (traction time 30-35 min) using the fasciotens® hernia traction procedure.</p><p><strong>Results: </strong>Fascial gaps measured preoperatively ranged from 8 cm to 44 cm, with most patients (94%) having a fascial gap above 10 cm (W3 according to the European Hernia Society classification). The mean fascial distance was reduced from 16.1 ± 0.8 cm to 5.8 ± 0.7 cm (stretch gain 10.2 ± 0.7 cm, p < 0.0001, Wilcoxon matched-pairs signed-ranks test). A reduction in fascial distance of at least 50% was achieved in three quarters of the patients and in half of the treated patients the reduction in fascial distance amounted to even more than 70%. The closure rate achieved by IFT after a mean surgical duration of 207.3 ± 11.0 min was 90% (45/50). Hernia closure was performed in all cases with a mesh augmentation in a sublay position. Postoperative complications occurred in 6 patients (12%). A reoperation was required in 3 patients (6%).</p><p><strong>Conclusion: </strong>The described IFT method is a new procedure for abdominal wall closure in large ventral hernias. The presented results demonstrate a high effectiveness, a good clinical practicability and a low complication rate of IFT.</p>","PeriodicalId":50700,"journal":{"name":"Chirurg","volume":"93 3","pages":"292-298"},"PeriodicalIF":0.0,"publicationDate":"2022-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8894171/pdf/","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"39838035","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"OA","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
引用次数: 1
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