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Summary During a period of 18 months, 1640 patients were treated at the neurosurgical intensive care unit, University Hospital Essen. Of these, 85 patients died. Determination of brain death was performed in 37 cases. An agreement with family members for organ explantation was achieved in 10 cases. The most frequent diseases leading to dissociated brain death were aneurysmatic subarachnoid hemorrhage (38%) and traumatic brain injury (27%).¶ Using selected case reports, we show that even in extreme devastating cases, a specific therapy (e.g., operation) was performed as long as a minimal chance of restitution existed. Unfortunately sometimes a change for fatal outcome appeared early after onset of symptoms or after many days of treatment so that survival with acceptable life-quality was not possible and progradient cerebral herniation occurred. Recognizing of this fatal change and further management will be demonstrated. Zusammenfassung Über einen Zeitraum von 18 Monaten wurden auf der Neurochirurgischen Intensivstation des Universitätsklinikums Essen 1640 Patienten behandelt. Davon verstarben 85 Patienten. Eine Hirntodfeststellung ergab sich bei 37 Betroffenen. In 10 Fällen erfolgte durch die Angehörigen eine Zustimmung zur Organentnahme (27% Zustimmungsrate). Die häufigsten zum dissoziierten Hirntod führenden Erkrankungen waren die aneurysmatische Subarachnoidalblutung (38%) und das Schädel-Hirn-Trauma (27%).¶ Es wird anhand ausgesuchter Fallbeispiele demonstriert, dass selbst bei extrem schlechter Prognose, solange noch eine minimale Chance auf Heilung besteht, eine spezifische Therapie (z.B. Operation) durchgeführt wird. Leider ergibt sich insbesondere bei den o.g. Krankheitsbildern manchmal zu sehr frühem Zeitpunkt oder nach vielen Tagen ein Wendepunkt, der anzeigt, dass ein sinnvolles Überleben nicht mehr möglich ist und es zur progredienten zerebralen Einklemmung kommt. Das Erkennen dieses Wendepunkts im Krankheitsverlauf und das weitere Management werden aufgezeigt. 相似文献
54.
Erfan?Amini Tracy?Campanelli?Palmer Jie?Cai Gary?Lieskovsky Siamak?Daneshmand Hooman?DjaladatEmail authorView authors OrcID profile 《World journal of urology》2018,36(8):1233-1239
Purpose
Few studies have evaluated prostate cancer oncologic outcomes in different ethnic groups following radical prostatectomy for clinically organ-confined disease. Existing studies lack long-term outcome data. We conducted this study to assess the impact of racial differences on risk profile and oncologic outcomes in a large cohort of patients with prostate cancer who underwent radical prostatectomy.Methods
Using our institutional review board-approved prostate cancer database, we retrospectively reviewed the records of 3437 patients who underwent radical prostatectomy with curative intent in our institution between 1987 and 2009. Based on ethnicity, patients were divided into Asian Americans (n?=?133), African Americans (n?=?155) and Caucasians (n?=?3149). Baseline characteristics and oncologic outcomes including biochemical recurrence free, clinical recurrence free and overall survival were compared between the study groups.Results
A total of 3437 patients with a mean age of 63?±?9.8 years and median follow-up period of 8.7 (range 0.1–24.1) years were included in the analysis. Pathologic stage and the frequency of poorly differentiated cancer were higher in Asian Americans; however, margin status did not differ significantly. Moreover, oncologic outcomes were comparable between different ethnic groups. In multivariate analysis, both pathologic stage and grade were independent predictors of oncologic outcomes, but race was not.Conclusions
In this large, ethnically diverse long-term follow-up study, we noted that Asian Americans compared to African Americans and Caucasians are more likely to have high risk prostate cancer; however, race was not an independent predictor of oncologic outcome following radical prostatectomy with curative intent.55.
Pelin Tufekci Aramesh Tavakoli Constantin Dlaska Mirjam Neumann Mihir Shanker Siamak Saifzadeh Roland Steck Michael Schuetz Devakar Epari 《Journal of orthopaedic research》2018,36(6):1790-1796
56.
Purpose of Review
Endoscopy coupled with targeted resections represents a cornerstone in the diagnosis, staging, and treatment of patients with bladder cancer. Direct visualization can be challenging and imprecise due to patient-, tumor-, and surgeon-specific factors. We will review contemporary endoscopic technologies and techniques used to improve our ability to safely identify and resect malignant lesions in patients with bladder cancer.Recent Findings
Enhanced endoscopic imaging technology may improve detection rates for bladder cancer throughout the upper and lower urinary tract, which may lead to improvements in recurrence and progression rates for non-muscle invasive bladder cancer (NMIBC). New techniques including narrow-band imaging (NBI), photodynamic diagnosis (PDD), Storz Professional Image Enhancement System (SPIES), optical coherence tomography (OCT), and others have shown benefit and may further improve our ability to detect and stage bladder tumors.Summary
Enhanced endoscopy technologies have already demonstrated value in improving the sensitivity of bladder cancer detection and early results suggest they may improve short- and long-term oncologic outcomes.57.
58.
Siamak Daneshmand Sanjay Patel Yair Lotan Kamal Pohar Edouard Trabulsi Michael Woods Tracy Downs William Huang Jeffrey Jones Michael O’Donnell Trinity Bivalacqua Joel DeCastro Gary Steinberg Ashish Kamat Matthew Resnick Badrinath Konety Mark Schoenberg J. Stephen Jones 《The Journal of urology》2018,199(5):1158-1165
59.
Mohammad Abufaraj Guido Dalbagni Siamak Daneshmand Simon Horenblas Ashish M. Kamat Ryu Kanzaki Alexandre R. Zlotta Shahrokh F. Shariat 《European urology》2018,73(4):543-557
Context
The role of surgery in metastatic bladder cancer (BCa) is unclear.Objective
In this collaborative review article, we reviewed the contemporary literature on the surgical management of metastatic BCa and factors associated with outcomes to support the development of clinical guidelines as well as informed clinical decision-making.Evidence acquisition
A systematic search of English language literature using PubMed-Medline and Scopus from 1999 to 2016 was performed.Evidence synthesis
The beneficial role of consolidation surgery in metastatic BCa is still unproven. In patients with clinically evident lymph node metastasis, data suggest a survival advantage for patients undergoing postchemotherapy radical cystectomy with lymphadenectomy, especially in those with measurable response to chemotherapy (CHT). Intraoperatively identified enlarged pelvic lymph nodes should be removed. Anecdotal reports of resection of pulmonary metastasis as part of multimodal approach suggest possible improved survival in well-selected patients. Cytoreductive radical cystectomy as local treatment has also been explored in patients with metastatic disease, although its benefits remain to be assessed.Conclusions
Consolidative extirpative surgery may be considered in patients with clinically evident pelvic or retroperitoneal lymph nodal metastases but only if they have had a response to CHT. Surgery for limited pulmonary metastases may also be considered in very selected cases. Best candidates are those with resectable disease who demonstrate measurable response to CHT with good performance status. In the absence of data from prospective randomized studies, each patient should be evaluated on an individual basis and decisions made together with the patient and multidisciplinary teams.Patient summary
Surgical resection of metastases is technically feasible and can be safely performed. It may help improve cancer control and eventually survival in very selected patients with limited metastatic burden. In a patient who is motivated to receive chemotherapy and to undergo extirpative surgical intervention, surgery should be discussed with the patient among other consolidation therapies in the setting of multidisciplinary teams. 相似文献60.