Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Klimawandel und Gesundheit Neues aus dem Markt COVID-19 Praxis und Beruf Seltene Erkrankungen GOÄ & EBM Panorama
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende
Erweiterte Suche
Anmelden
nach oben
Critical Care
Erschienen in: Critical Care 4/2002

01.08.2002 | Review

Clinical review: Immunodepression in the surgical patient and increased susceptibility to infection

verfasst von: Martin K Angele, Eugen Faist

Erschienen in: Critical Care | Ausgabe 4/2002

Einloggen, um Zugang zu erhalten

Abstract

Several studies indicate that organ failure is the leading cause of death in surgical patients. An excessive inflammatory response followed by a dramatic paralysis of cell-mediated immunity following major surgery appears to be responsible for the increased susceptibility to subsequent sepsis. In view of this, most of the scientific and medical research has been directed towards measuring the progression and inter-relationship of mediators following major surgery. Furthermore, the effect of those mediators on cell-mediated immune responses has been studied. This article will focus on the effect of blood loss and surgical injury on cell-mediated immune responses in experimental studies utilizing models of trauma and hemorrhagic shock, which have defined effects on the immunoinflammatory response. Subsequently these findings will be correlated with data generated from surgical patients. The results of these studies may generate new approaches for the treatment of immunodepression following major surgery, thus reducing the susceptibility to infection and increasing the survival rate of the critical ill surgical patient.
Literatur
1.
Carrico CJ, Meakins JL, Marshall JC: Multiple organ failure syndrome. Arch Surg 1986, 121: 196-208.CrossRefPubMed
2.
Stahl GL, Bitterman H, Terashita Z, Lefer AM: Salutary consequences of blockade of platelet activating factor in hemorrhagic shock. Eur J Pharmacol 1988, 149: 233-240. 10.1016/0014-2999(88)90653-XCrossRefPubMed
3.
Chaudry IH, Ayala A: Immunological Aspects of Hemorrhage. Austin: Medical Intelligence Unit, RG Landes Company; 1992.
4.
Stephan RN, Ayala A, Chaudry IH: Monocyte and lymphocyte responses following trauma. In Pathophysiology of Shock, Sepsis and Organ Failure. (Edited by: Schlag G, Redl H). Berlin: Springer-Verlag 1993, 131-144.CrossRef
5.
Roumen RM, Hendriks T, van der Ven-Jongekrijg J, Nieuwenhuijzen GAP, Sauerwein RW, van der Meer JW, Goris RJA: Cytokine patterns in patients after major surgery, hemorrhagic shock, and severe blunt trauma. Ann Surg 1993, 6: 769-776.CrossRef
6.
Faist E, Baue AE, Dittmer H: Multiple organ failure in poly-trauma patients. J Trauma 1983, 23: 775-787.CrossRefPubMed
7.
Haupt W, Riese J, Mehler C, Weber K, Zowe M, Hohenberger W: Monocyte function before and after surgical trauma. Dig Surg 1998, 15: 102-104. 10.1159/000018601CrossRefPubMed
8.
Faist E, Storck M, Hultner L, Redl H, Ertel W, Walz A, Schildberg FW: Functional analysis of monocytes activity through synthesis patterns of proinflammatory cytokines and neopterin in patients in surgical intensive care. Surgery 1992, 112: 562-572.PubMed
9.
Hensler T, Ecker H, Eeg K, Eidecke CD, Artels H, Arthlen W, Agner H, Iewert JR, Olzmann B: Distinct mechanisms of immunosuppression as a consequence of major surgery. Infect Immun 1997, 65: 2283-2291.PubMedCentralPubMed
10.
Fingerle-Rowson G, Auers J, Kreuzer E, Fraunberger P, Blumenstein M, Ziegler-Heitbrock LH: Expansion of CD14+CD16+ monocytes in critically ill cardiac surgery patients. Inflammation 1998, 22: 367-379. 10.1023/A:1022316815196CrossRefPubMed
11.
Ayala A, Ertel W, Chaudry IH: Trauma-induced suppression of antigen presentation and expression of major histocompati-bility class II antigen complex in leukocytes. Shock 1996, 5: 79-90.CrossRefPubMed
12.
Schinkel C, Sendtner R, Zimmer S, Faist E: Functional analysis of monocyte subsets in surgical sepsis. J Trauma 1998, 44: 743-748.CrossRefPubMed
13.
Wakefield CH, Carey PD, Foulds S, Monson JR, Guillou PJ: Changes in major histocompatibility complex class II expression in monocytes and T cells of patients developing infection after surgery. Br J Surg 1993, 80: 205-209.CrossRefPubMed
14.
15.
Christou NV, Tellado JM: The impact of preexisting disease conditions for host defense integrity in traumatized and critically ill patients. In Host Defense Dysfunction in Trauma, Shock and Sepsis. (Edited by: Faist E, Meakins J, Schildberg FW). Berlin-Heidelberg: Springer-Verlag 1993, 73-82.CrossRef
16.
Levy EM, Alharbi SA, Grindlinger G, Black PH: Changes in mitogen responsiveness lymphocyte subsets after traumatic injury: relation to development of sepsis. Clin Immunol Immunopathol 1984, 32: 224-233.CrossRefPubMed
17.
Keane RM, Birmingham W, Shatney CM, Winchurch RA, Munster AM: Prediction of sepsis in the multitraumatic patient by assays of lymphocyte responsiveness. Surg Gynecol Obstet 1983, 156: 163-167.PubMed
18.
Ayala A, Lehman DL, Herdon CD, Chaudry IH: Mechanism of enhanced susceptibility to sepsis following hemorrhage: interleukin (IL)-10 suppression of T-cell response is mediated by eicosanoid induced IL-4 release. Arch Surg 1994, 129: 1172-1178.CrossRefPubMed
19.
Stephan RN, Kupper TS, Geha AS, Baue AE, Chaudry IH: Hemorrhage without tissue trauma produces immunosuppression and enhances susceptibility to sepsis. Arch Surg 1987, 122: 62-68.CrossRefPubMed
20.
Riddle PR, Berenbaum MC: Postoperative depression of the lymphocyte response to phytohaemagglutinin. Lancet 1967, i: 746-748.CrossRef
21.
O'Mahony JB, Palder SB, Wood JJ, McIrvine A, Rodrick ML, Demling RH, Mannick JA: Depression of cellular immunity after multiple trauma in the absence of sepsis. J Trauma 1984, 24: 869-875.CrossRefPubMed
22.
Daniels JC, Sakai H, Cobb EK, Lewis SR, Larson DL, Ritzmann SE: Evaluation of lymphocyte reactivity studies in patients with thermal burns. J Trauma 1971, 11: 595-607.CrossRefPubMed
23.
Sakai H, Daniels JC, Lewis SR, Lynch JB, Watson DL, Ritzmann SE: Reversible alterations of nucleic acid synthesis in lymphocytes after thermal burns. J Reticuloendothelial Soc 1972, 11: 19-28.
24.
Abraham E, Chang YH: The effects of hemorrhage on mitogen-induced lymphocyte proliferation. Circ Shock 1985, 15: 141-149.PubMed
25.
Angele MK, Ayala A, Cioffi WG, Bland KI, Chaudry IH: Testosterone: the culprit for producing splenocyte depression following trauma-hemorrhage. Am J Physiol 1998, 274: C1530-C1536.PubMed
26.
Zellweger R, Ayala A, DeMaso CM, Chaudry IH: Trauma-hemorrhage causes prolonged depression in cellular immunity. Shock 1995, 4: 149-153.CrossRefPubMed
27.
Lyons A, Goebel A, Mannick JA, Lederer JA: Protective effects of early interleukin 10 antagonism on injury-induced immune dysfunction. Arch Surg 1999, 134: 1317-1323. 10.1001/archsurg.134.12.1317CrossRefPubMed
28.
van der Poll T, Marchant A, Buurman WA, Berman L, Keogh CV, Lazarus DD, Nguyen L, Goldman M, Moldawer LL, Lowry SF: Endogenous IL-10 protects mice from death during septic peritonitis. J Immunol 1995, 155: 5397-5401.PubMed
29.
Feeney C, Bryzman S, Kong L, Brazil H, Deutsch R, Fritz LC: T-lymphocyte subsets in acute illness. Crit Care Med 1995, 23: 1680-1685. 10.1097/00003246-199510000-00012CrossRefPubMed
30.
O'Mahony JB, Wood JJ, Rodrick ML, Mannick JA: Changes in T lymphocyte subsets following injury. Assessment by flow cytometry and relationship to sepsis. Ann Surg 1985, 202: 580-586.PubMedCentralCrossRefPubMed
31.
Abraham E, Freitas AA: Hemorrhage in mice induces alterations in immunoglobulin-secreting B-cells. Crit Care Med 1989, 17: 1015-1019.CrossRefPubMed
32.
Abraham E, Freitas AA: Hemorrhage produces abnormalities in lymphocyte function and lymphokine generation. J Immunol 1989, 142: 899-906.PubMed
33.
Fuchs D, Gruber A, Wachter H, Faist E: Activated cell-mediated immunity and immunodeficiency in trauma and sepsis. In The Immune Consequences of Trauma, Shock and Sepsis. Mechanisms and Therapeutic Approaches. (Edited by: Faist E, Baue AE, Schildberg FW). Lengerich: Pabst Science Publishers 1996, 235-239.
34.
Fuchs D, Malkovsky M, Reibnegger G, Werner ER, Forni G, Wachter H: Endogenous release of interferon-gamma and diminished response of peripheral blood mononuclear cells to antigenic stimulation. Immunol Lett 1989, December 23: 103-108. 10.1016/0165-2478(89)90120-XCrossRef
35.
Ayala A, Perrin MM, Meldrum DR, Ertel W, Chaudry IH: Hemorrhage induces an increase in serum TNF which is not associated with elevated levels of endotoxin. Cytokine 1990, 2: 170-174.CrossRefPubMed
36.
Ayala A, Wang P, Ba ZF, Perrin MM, Ertel W, Chaudry IH: Differential alterations in plasma IL-6 and TNF levels following trauma and hemorrhage. Am J Physiol 1991, 260: R167-R171.PubMed
37.
Damas P, Reuter A, Gysen P, Demonty J, Lamy M, Franchimont P: Tumor necrosis factor and interleukin-1 serum levels during severe sepsis in humans. Crit Care Med 1989, 17: 975-978.CrossRefPubMed
38.
Damas P, Ledoux D, Nys M, Vrindts Y, De Groote D, Franchimont P, Lamy M: Cytokine serum level during severe sepsis in human IL-6 as a marker of severity. Ann Surg 1992, 215: 356-362.PubMedCentralCrossRefPubMed
39.
Romagnani S: Th1 and Th2 in human diseases. Clin Immunol Immunopathol 1996, 80: 225-235. 10.1006/clin.1996.0118CrossRefPubMed
40.
Martin C, Boisson C, Haccoun M, Thomachot L, Mege JL: Patterns of cytokine evolution (tumor necrosis factor-α and interleukin-6) after septic shock, hemorrhagic shock, and severe trauma. Crit Care Med 1997, 25: 1813-1819. 10.1097/00003246-199711000-00018CrossRefPubMed
41.
Ertel W, Morrison MH, Ayala A, Perrin MM, Chaudry IH: Anti-TNF monoclonal antibodies prevent haemorrhage-induced suppression of Kupffer cell antigen presentation and MHC class II antigen expression. Immunology 1991, 74: 290-297.PubMedCentralPubMed
42.
Porteu F, Nathan C: Shedding of tumor necrosis factor receptors by activated human neutrophils. J Exp Med 1990, 172: 599-607.CrossRefPubMed
43.
Ertel W, Morrison MH, Ayala A, Chaudry IH: Chloroquine attenuates hemorrhagic shock induced suppression of Kupffer cell antigen presentation and MHC class II antigen expression through blockade of tumor necrosis factor and prostaglandin release. Blood 1991, 78: 1781-1788.PubMed
44.
Wong GC, Clark SC: Multiple actions of interleukin 6 within a cytokine network. Immunol Today 1988, 9: 137-139. 10.1016/0167-5699(88)91200-5CrossRefPubMed
45.
Okusawa S, Gelfand JA, Ikejima T, Connolly RJ, Dinarello CA: Interleukin-1 induces a shock like state in rabbits. Synergism with tumor necrosis factor and the effects of cyclooxygenase inhibition. J Clin Invest 1988, 81: 1162-1172.PubMedCentralCrossRefPubMed
46.
Tracey KJ, Lowry SF, Fahey TJI, Albert JD, Fong Y, Hesse D, Beutler B, Manogue KR, Calvano S, Wei H, Cerami A, Shires GT: Cachectin/tumor necrosis factor induces lethal shock and stress hormone responses in the dog. Surg Gynecol Obstet 1987, 164: 415-422.PubMed
47.
Lejeune P, Lagadec P, Onier N, Pinnard D, Ohshima H, Jeannin JF: Nitric oxide involvement in tumor-induced immunosuppression. J Immunol 1994, 152: 5077-5083.PubMed
48.
O'Neill PJ, Ayala A, Wang P, Ba ZF, Morrison MH, Schultze AE, Reich SS, Chaudry IH: Role of Kupffer cells in interleukin-6 release following trauma-hemorrhage and resuscitation. Shock 1988, 1: 43-47.CrossRef
49.
Ayala A, Meldrum DR, Perrin MM, Chaudry IH: The release of transforming growth factor-β following hemorrhage: its role as a mediator of host immunosuppression [abstract]. FASEB J 1992, 6: A1604.
50.
Miller-Graziano CL, Szabo G, Griffey K, Metha B, Kodys K, Catalano D: Role of elevated monocyte transforming growth factor beta (TGF-beta) production in posttrauma immunosuppression. J Clin Immunol 1991, 11: 95-102.CrossRefPubMed
51.
Waal Malefyt R, Abrams J, Bennett B, Figdor CG, Vries JE: Interleukin 10 (IL-10) inhibits cytokine synthesis by human monocytes: an autoregulatory role of IL-10 produced by monocytes. J Exp Med 1991, 174: 1209-1220.CrossRefPubMed
52.
Faist E, Mewes A, Baker CC, Strasser T, Alkan SS, Rieber P, Heberer G: Prostaglandin E 2 dependent suppression of interleukin-2 production in patients with major trauma. J Trauma 1987, 27: 837-848.CrossRefPubMed
53.
Knapp W, Baumgartner G: Monocyte-mediated suppression of human B lymphocyte differentiation in vitro. J Immunol 1978, 121: 1177-1183.PubMed
54.
Johnston PA, Selkurt EE: Effect of hemorrhagic shock on renal release of prostaglandin E. Am J Physiol 1976, 230: 831-838.PubMed
55.
Bonta IL, Parnham MJ: Immunomodulatory-antiinflammatory functions of E-type prostaglandins. Minireview with emphasis on macrophage mediated effects. Int J Immunopharmacol 1982, 4: 103-109. 10.1016/0192-0561(82)90057-1CrossRefPubMed
56.
Plaut M: The role of cyclic AMP in modulating cytotoxic T lymphocytes. I. In vivo-generated cytotoxic lymphocytes, but not in vitro-generated cytotoxic lymphocytes, are inhibited by cyclic AMP-active agents. J Immunol 1979, 123: 692-701.PubMed
57.
Chaudry IH, Ayala A: Immune consequences of hypovolemic shock and resuscitation. Curr Opin Anaesthesiology 1993, 6: 385-392.CrossRef
58.
Ayala A, Chaudry IH: Dietary n-3 polyunsaturated fatty acid modulation of immune cell function pre- or post-trauma. Nutrition 1995, 11: 1-11.PubMed
59.
Beutler B: Tumor necrosis factor and other cytokines in septic syndrome. In Sepsis. (Edited by: Vincent JL). Berlin: Springer-Verlag 1994, 107-121.CrossRef
60.
Shirakawa T, Tokunaga A, Onda M: Release of immunosuppressive substances after gastric resection is more prolonged than after mastectomy in humans. Int Surg 1998, 83: 210-214.PubMed
61.
Feldbush TL, Hobbs MV, Severson CD, Ballas ZF, Weiler JM: Role of complement in the immune response. Fed Proc 1984, 43: 2548-2552.PubMed
62.
Marks JD, Marks CB, Luce JM, Montgomery B, Turner J, Metz CA, Murray JF: Plasma tumor necrosis factor in patients with septic shock. Am Rev Respir Dis 1990, 141: 94-97.CrossRefPubMed
63.
Marano MA, Fong Y, Moldawer LL, Wei H, Calvano SE, Tracey KJ, Barie PS, Manogue K, Cerami A, Shires GT, Lowry SF: Serum cachectin/tumor necrosis factor in critically ill patients with burns correlates with infection and mortality. Surg Gynecol Obstet 1990, 170: 32-38.PubMed
64.
Waage A, Halstensen A, Espevik T: Association between tumor necrosis factor in serum and fatal outcome in patients with meningococcal disease. Lancet 1987, i: 355-357. 10.1016/S0140-6736(87)91728-4CrossRef
65.
Waage A, Brandtzaeg P, Halstensen A, Kierulf P, Espevik T: The complex pattern of cytokines in serum from patients with meningococcal septic shock. Association between interleukin 6, interleukin 1, and fatal outcome. J Exp Med 1989, 169: 333-338.CrossRefPubMed
66.
Molloy RG, Mannick JA, Rodrick ML: Cytokines, sepsis and immunomodulation. Br J Surg 1993, 80: 289-297.CrossRefPubMed
67.
Angele MK, Wichmann MW, Ayala A, Cioffi WG, Chaudry IH: Testosterone receptor blockade after hemorrhage in males: restoration of the depressed immune functions and improved survival following subsequent sepsis. Arch Surg 1997, 132: 1207-1214.CrossRefPubMed
68.
Zapata-Sirvent RL, Hansbrough JF, Cox MC, Carter WH: Immunologic alterations in a murine model of hemorrhagic shock. Crit Care Med 1992, 20: 508-517.CrossRefPubMed
69.
Simons RK, Hoyt DB, Winchell RJ, Rose RM, Holbrook T: Elevated selectin levels after severe trauma: a marker for sepsis and organ failure and a potential target for immounomodula-tory therapy. J Trauma 1996, 41: 653-662.CrossRefPubMed
70.
Bone RC: Toward an epidemiology and natural history of SIRS (systemic inflammatory response syndrome). JAMA 1992, 268: 3452-3455. 10.1001/jama.268.24.3452CrossRefPubMed
71.
Center for Disease Control: Mortality Patterns – United States, 1989. MMWR 1992, 41: 121-125.
72.
McGowan JE, Barnes MW, Finland N: Bacteremia at Boston City Hospital: occurrence and mortality during 12 selected years (1935–1972) with special reference to hospital-acquired cases. J Infect Dis 1975, 132: 316-335.CrossRefPubMed
73.
Schroder J, Kahlke V, Staubach KH, Zabel P, Stuber F: Gender differences in human sepsis. Arch Surg 1998, 133: 1200-1205. 10.1001/archsurg.133.11.1200CrossRefPubMed
74.
Zellweger R, Ayala A, Stein S, DeMaso CM, Chaudry IH: Females in proestrus state tolerate sepsis better than males. Crit Care Med 1997, 25: 106-110. 10.1097/00003246-199701000-00021CrossRefPubMed
75.
Wichmann MW, Zellweger R, DeMaso CM, Ayala A, Chaudry IH: Enhanced immune responses in females as opposed to decreased responses in males following hemorrhagic shock. Cytokine 1996, 8: 853-863. 10.1006/cyto.1996.0114CrossRefPubMed
76.
Angele MK, Knoferl MW, Ayala A, Cioffi WG, Bland K, Chaudry IH: Male and female sex steroids: do they produce deleterious or beneficial effects on immune responses following trauma-hemorrhage? Surg Forum 1998, 49: 43-45.
77.
Knoferl MW, Diodato MD, Angele MK, Ayala A, Cioffi WG, Bland KI, Chaudry IH: Do female sex steroids adversely or beneficially affect the depressed immune responses in males after trauma-hemorrhage? Arch Surg 2000, 135: 425-433. 10.1001/archsurg.135.4.425CrossRefPubMed
78.
Mannucci PM: Venous thromboembolism and hormone replacement therapy. Eur J Intern Med 2001, 12: 478-483. 10.1016/S0953-6205(01)00169-8CrossRefPubMed
79.
Catania RA, Angele MK, Ayala A, Cioffi WG, Bland K, Chaudry IH: Dehydroepiandrosterone (DHEA) restores immune function following trauma-hemorrhage by a direct effect on T-lymphocytes. Cytokine 1998, 11: 443-450. 10.1006/cyto.1998.0458CrossRef
80.
Angele MK, Catania RA, Ayala A, Cioffi WG, Bland K, Chaudry IH: Dehydroepiandrosterone (DHEA): an inexpensive steroid hormone which decreases the mortality from sepsis. Arch Surg 1998, 133: 1281-1288. 10.1001/archsurg.133.12.1281CrossRefPubMed
81.
Wichmann MW, Ayala A, Chaudry I: Male sex steroids are responsible for depressing macrophage immune function after trauma-hemorrhage. Am J Physiol 1997, 273: C1335-C1340.PubMed
82.
Angele MK, Ayala A, Monfils BA, Cioffi WG, Bland KI, Chaudry IH: Testosterone and/or low estradiol: normally required but harmful immunologically for males after trauma-hemorrhage. J Trauma 1998, 44: 78-85.CrossRefPubMed
83.
Angele MK, Xu YX, Ayala A, Catania RA, Cioffi WG, Bland KI, Chaudry IH: Gender differences in immune responses: increased thymocyte apoptosis occurs only in males but not in females after trauma-hemorrhage. Surg Forum 1997, 48: 95-97.
84.
Gannon CJ, Napolitano LM, Pasquale M, Tracy K, McCarter RJ: Male gender increases risk of postinjury pneumonia. Surg Forum 2001, 52: 468-469.
85.
Offner PJ, Moore EE, Biffl WL: Male gender is a risk factor for post-injury major infections [abstract]. In Proceedings of the 19th Meeting of the Surgical Infection Society 1999, 20.
86.
Oberholzer A, Keel M, Trentz O, Ertel W: Die inzidenz von septischen komplikationen nach polytrauma ist geschlechts-spezifisch [abstract]. Hefte zu Der Unfallchirurg 63. Jahrestagung der Deutschen Gesellschaft fuer Unfallchirurgie: 1999, 231-232.
Metadaten
Titel
Clinical review: Immunodepression in the surgical patient and increased susceptibility to infection
verfasst von
Martin K Angele
Eugen Faist
Publikationsdatum
01.08.2002
Verlag
BioMed Central
Erschienen in
Critical Care / Ausgabe 4/2002
Elektronische ISSN: 1364-8535
DOI
https://doi.org/10.1186/cc1514

Weitere Artikel der Ausgabe 4/2002

Critical Care 4/2002 Zur Ausgabe

Review

Bench-to-bedside review: Lactate and the lung

Commentary

Endotoxemia in critically ill patients: why a reliable test could be beneficial

Research

The effects of IgM-enriched immunoglobulin preparations in patients with severe sepsis [ISRCTN28863830]

Book report

Pharmacology of the critically ill

Research

Quality of life effects of antithrombin III in sepsis survivors: results from the KyberSept trial [ISRCTN22931023]

Commentary

Lactate: A key metabolite in the intercellular metabolic interplay

Neu im Fachgebiet AINS

Bei schweren Reaktionen auf Insektenstiche empfiehlt sich eine spezifische Immuntherapie

25.04.2024 Allergien und Intoleranzreaktionen Nachrichten

Insektenstiche sind bei Erwachsenen die häufigsten Auslöser einer Anaphylaxie. Einen wirksamen Schutz vor schweren anaphylaktischen Reaktionen bietet die allergenspezifische Immuntherapie. Jedoch kommt sie noch viel zu selten zum Einsatz.

Hinter dieser Appendizitis steckte ein Erreger

23.04.2024 Appendizitis Nachrichten

Schmerzen im Unterbauch, aber sonst nicht viel, was auf eine Appendizitis hindeutete: Ein junger Mann hatte Glück, dass trotzdem eine Laparoskopie mit Appendektomie durchgeführt und der Wurmfortsatz histologisch untersucht wurde.

Ärztliche Empathie hilft gegen Rückenschmerzen

23.04.2024 Leitsymptom Rückenschmerzen Nachrichten

Personen mit chronischen Rückenschmerzen, die von einfühlsamen Ärzten und Ärztinnen betreut werden, berichten über weniger Beschwerden und eine bessere Lebensqualität.

Mehr Schaden als Nutzen durch präoperatives Aussetzen von GLP-1-Agonisten?

23.04.2024 Operationsvorbereitung Nachrichten

Derzeit wird empfohlen, eine Therapie mit GLP-1-Rezeptoragonisten präoperativ zu unterbrechen. Eine neue Studie nährt jedoch Zweifel an der Notwendigkeit der Maßnahme.

Update AINS

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

hier abonnieren
Bildnachweise