Background and aims Since the introduction of endovascular aortic aneurysm repair (EVAR) for aortic aneurysms, the number of juxtarenal aortic
aneurysms (JRA) has been growing steadily due to selection bias (neck morphology for EVAR). This case-match study compares
the perioperative outcome and midterm results of suprarenally clamped JRA with infrarenal aortic aneurysms (AAA).
Methods From 1997 to 2004, patients who received open surgery with suprarenal clamping for JRA were included in the study and compared
to matched patients with infrarenal clamping (AAA). Measurements analyzed were the in-hospital mortality and morbidity. Midterm
results were obtained through clinical investigation and magnetic resonance angiography imaging.
Results Thirty-five patients (mean age, 68.4 years; 30 male and 5 female) received suprarenal cross-clamping for JRA. The overall
in-hospital mortality for JRA and for the controls (AAA) with elective aortic repair was 4.5% (6.1% JRA; 3% AAA, p = 0.058). The morbidity of JRA was elevated according to the rate of pulmonary complications (p = 0.021) and the need for re-operation (p = 0.019). The mean follow-up time was 2.3 years (range, 8–96 months). At follow-up, 28 patients (80%) from the JRA group
and 29 patients from the AAA group (82.9%) were alive.
Conclusion Open aortic surgery for JRA with the need for suprarenal cross-clamping shows a slightly elevated in-hospital mortality rate
without statistical significance and equal midterm mortality results in comparison with infrarenally clamped aortic aneurysms. 相似文献
Background To our best knowledge, Panton–Valentine leucocidin (PVL)-positive methicillin-sensitive Staphylococcus aureus (MSSA) has not been described yet as cause for severe pyomyositis.
Case report We present a 23-year-old apparently healthy male patient without any typical predisposing findings who developed severe pyomyositis
secondary to an operated pilonidal cyst. In the follow-up, the patient showed signs of immunocompromisation. The causative
agent for purulent infection of multiple muscles was a MSSA strain harbouring PVL toxin.
Results In the reported case, aggressive antibiotic and surgical treatment with additional application of immunoglobulins has lead
to recovery from the disease without relapse.
Conclusions PVL-positive S. aureus are associated with skin diseases, multiple abscesses and often complicated by severe sepsis and necrotising pneumonia. Under
such circumstances, the mortality rate can reach up to 75%. In addition, the PVL toxin can cause immunocompromisation and
might be therefore involved in the aetiology of pyomyositis. Aggressive antibiotic and surgical treatment with additional
application of immunoglobulins is recommended for treatment. 相似文献
Skeletal ratios and bone lengths are widely used in anthropology and forensic pathology and hip axis length is a useful predictor
of fracture. The aim of this study was to show that skeletal ratios, such as length of femur to height, could be accurately
measured from a DXA (dual energy X-ray absorptiometry) image. 相似文献
Liver transplantation in presence of diffuse portal vein thrombosis is possible by using caval blood as portal inflow, through
cavo-portal transposition. However, clinical results are heterogeneous and experimental studies are needed, but similar hemodynamic
conditions are difficult to obtain, especially in small animals. Herein we describe a new simple model of cavo-portal transposition
in rat. 相似文献
Background: Anesthesia is associated with complications, and some of them may be fatal. The authors investigated the circumstances under which deaths were associated with anesthesia. In Denmark, the specialty anesthesiology encompasses emergency medicine, chronic and acute pain medicine, anesthetic procedures, perioperative care medicine, and intensive care medicine.
Methods: The authors retrospectively investigated anesthesia related deaths registered by the Danish Patient Insurance Association.
Results: From 1996 to 2004, 27,971 claims were made by the Danish Patient Insurance Association covering all medical specialties, of which 1,256 files (4.5%) were related to anesthesia. In 24 cases, the patient's death was considered to result from the anesthetic procedure: 4 deaths were related to airway management, 2 to ventilation management, 4 to central venous catheter placement, 4 as a result of medication errors, 4 from infusion pump problems, and 4 after complications from regional blockades. Severe hemorrhage caused 1 death, and in 1 case the cause was uncertain. 相似文献
Health service policy in the United Kingdom emphasises the importance of self-care by patients with chronic conditions. Written
information for patients about their condition is seen as an important aid to help patients look after themselves. From a
discourse analysis perspective written texts such as patient information leaflets do not simply describe the reality of a
medical condition and its management but by drawing on some sorts of knowledge and evidence rather than others help construct
the reality of that condition. This study explored patient information leaflets on osteoarthritis (OA) to see how OA was constructed
and to consider the implications for self-care. 相似文献
This article presents a review on the efficacy of surgical ventricular restoration and direct surgery for ventricular tachycardia
in patients with left ventricular aneurysm or dilated ischemic cardiomyopathy. The procedure includes a non-electrophysiologically
guided subtotal endocardiectomy and cryoablation in addition to endoventricular patch plasty of the left ventricle. Coronary
artery bypass surgery and mitral valve repair are performed concomitantly as needed. In our experience, this procedure yielded
a 90% success rate in terms of freedom from spontaneous ventricular tachycardia, with an early mortality rate of 3.8%. A practical
guide to the pre- and postoperative management of these patients is provided.
Electronic supplementary material The online version of this article (doi: ) contains supplementary material, which is available to authorized users. 相似文献
Small bowel transplantation (SBT) is associated with poorly understood enteric dysfunction. The study of SBT in mice is hindered
by the technical difficulty of orthotopic SBT in the mouse. Our aim was to develop an easy preparation of extrinsic denervation
of the entire jejunoileum in mice as a model of orthotopic SBT. All neurolymphatic tissues accompanying the superior mesenteric
artery (SMA) and vein (SMV) were ligated just distal to the middle colic vessels. The SMA and SMV were then stripped of investing
adventitia, and the mesentery to jejunum and colon were transected radially. Jejunum and colon were not transected and reanastomosed.
To confirm extrinsic denervation 1, 3, and 6 months later, segments of small bowel were stained for protein gene product 9.5
(PGP9.5) and tyrosine hydroxylase (TH). Tyrosine hydroxylase immunoreactive intensity was then quantified using a semiquantitative
analysis. Immunohistochemical fluorescence showed persistence of PGP9.5 immunoreactivity confirming enteric nerves in jejunoileum;
however, there was no TH immunoreactivity in jejunoileum in denervated mice despite the expected preservation of TH immunoreactivity
in the still-innervated duodenum at 1 month. At 3 months, sparse immunoreactivity for TH was present, and by 6 months, reinnervation
of TH-containing nerves appeared similar to controls. Quantification of intensity at each time-point further confirmed this
trend. This technique in the mouse accomplishes a complete extrinsic denervation of jejunoileum early postoperatively (1 and
3 months); reinnervation occurs by 6 months. This is an easily learned murine model of orthotopic SBT.
Presented at the American Gastroenterological Association during Digestive Disease Week in Los Angeles, CA, as a poster presentation
on May 23 2006. Abstract published in GastroenterologyE 2006; 130:A604. 相似文献
Few studies have examined outcomes of laparoscopic and open sigmoid colectomy performed at US academic centers. Using ICD-9
diagnosis and procedural codes, data was obtained from the University HealthSystem Consortium (UHC) Clinical Database of 10,603
patients who underwent laparoscopic or open sigmoid colectomy for benign and malignant disease between 2003–2006. A total
of 1,092 patients (10.3%) underwent laparoscopic sigmoid colectomy. Laparoscopic sigmoid colectomy was associated with a significantly
shorter length of stay (5.4 vs 7.4 days), lower overall complication rate (19.7 vs 26.0%), lower 30-day readmission rate (3.4
vs 4.6), and a lower hospital cost ($13,814 vs $15,626). When a subset analysis of malignant and benign groups was performed,
a significantly shorter length of stay in both the malignant laparoscopic group (6.4 ± 6.4 vs 7.8 ± 6.6 days) and in the benign
laparoscopic groups (5.1 ± 3.5 vs 7.2 ± 7.6) exists. A lower wound complication rate (2.1 vs 5.5%, malignant and 4.0 vs 6.1,
benign) is also evident. Laparoscopic sigmoid colectomy was associated with a shorter length of stay, less complications,
and a lower 30-day readmission rate. The shorter length of stay and wound infection rate maintain significance when comparing
laparoscopic vs open sigmoid resections for malignant and benign disease.
Presented at the 48th annual meeting of the Society for Surgery of the Alimentary Tract at Digestive Disease Weak, Washington,
DC, May 21st 2007.
The information contained in this article was based on the Clinical Data Base provided by the University HealthSystem Consortium. 相似文献