Recurrent Left Cervical Swelling and Chylothorax due to Lymphatic Thrombosis

CardioVascular and Interventional Radiology -     

Indocyanine Green Tissue Angiography Can Reduce Extended Bowel Resections in Acute Mesenteric Ischemia

Purpose

Surgical exploration and bowel resection are frequently required for treating non-occlusive mesenteric ischemia. Intraoperative evaluation of intestinal perfusion is subjective and challenging. In this feasibility study, ICG fluorescence angiography was performed in order to evaluate intestinal perfusion in patients with acute mesenteric ischemia.

Methods

This is a retrospective analysis of 52 patients who were operated for acute mesenteric ischemia using ICG fluorescence angiography. Patients with occlusive disease requiring recanalization were excluded. The SPY and PinPoint imaging systems were used for open and laparoscopic surgery, respectively. Intraoperative macroscopic assessment of perfusion was compared with the ICG angiography results.

Results

Surgical exploration was performed for ischemia of the colon (n?=?12), the small bowel (n?=?23), or both (n?=?16). One patient had ischemia of the esophagus and stomach. All patients had a preoperative CT angiography to rule out stenosis or occlusion of the mesenteric vessels. In 18 cases (34.6%), ICG fluorescence angiography provided information that was supplemental to macroscopic evaluation, but most patients did not survive the postoperative course. However, in six of those cases (11.5%), ICG angiography led to a major change in operative strategy resulting in a significant clinical benefit for those patients. For two cases, ICG fluorescence produced false negative results.

Discussion

ICG tissue angiography is feasible and technically reliable for evaluating intestinal perfusion in acute mesenteric ischemia and led to a significant clinical benefit in 11% of our patients. A relevant discrepancy between surgical visual assessment and fluorescence angiography was found in 35% of the cases, which may help to define resection margins more accurately and thus support surgical decision-making.

     

In Search of Benchmarking for Mortality Following Multiple Trauma: A Swiss Trauma Center Experience

Background  

The manifestations associated with non-survival after multiple trauma may vary importantly between countries and institutions. The aim of the present study was to assess the quality of performance by comparing actual mortality rates to the literature.     

甲氰咪胍对恶性梗阻性黄疸病人术后细胞免疫功能的影响

目的: 观察甲氰咪胍对恶性梗阻性黄疸病人术后细胞免疫功能的影响,探讨其临床应用价值。方法: 将44例病人随机分为甲氰咪胍治疗组和对照组,观察两组间术后感染发生情况;用间接免疫荧光法检测T淋巴细胞亚群变化。结果: 治疗组术后感染发生率明显低于对照组（9% 对36%,P<0.05）;治疗组术后周围血CD4+细胞计数、CD4+/CD8+比值明显高于对照组(P<0.05）。结论: 围手术期应用甲氰咪胍可以改善恶性梗阻性黄疸病人的细胞免疫功能,预防术后感染的发生,具有临床应用价值。     

鲁甸地震极危重伤员治疗模式的探讨

目的 探讨适合于地震中极危重伤员的治疗模式.方法 鲁甸地震中将对极危重伤员的诊疗模式,由平时的“诊断—治疗”改为“抢救—诊断—治疗”模式.对治疗效果进行分析.结果 20例极危重伤员中4例直接收入中心ICU,16例经多学科会诊后由专科重症监护室转入中心ICU治疗.给予合理评估、集中救治全面生命支持,多学科专家小组一对一管理,强化护理质量及医院感染管理.死亡3例（15.00％）,好转转出中性ICU12例（60.00％）,病情平稳仍住中心ICU治疗5例（25.00％）.结论 对极危重地震伤员集中救治试行“抢救—诊断—治疗”模式效果良好.     

Thoracic and abdominal MRA with gadofosveset: Influence of injection rate on vessel signal and image quality

The purpose of this study was to investigate the influence of different injection rates on the maximum signal intensity and the arterio-venous transit time of dynamic gadofosveset-enhanced first pass MR angiography (MRA). Twenty-one healthy male volunteers were examined with a time-resolved echo-shared MRA at 1.5 T. The volunteers were assigned into three groups using injection rates of either 1, 2 or 4 ml/s. The maximal signal enhancement and peak signal-to-noise ratio in the pulmonary trunk, the aortic arch, the abdominal aorta as well as both kidneys and lung parenchyma were analyzed. The arterio-venous transit time was determined. The time between maximal enhancement of the pulmonary trunk and the aortic arch was higher with the slow injection rate of 1 ml/s, while there were no differences in the time between maximal enhancement of the aortic arch and the abdominal aorta above or below the origin of the renal veins with all three injection rates. With the slow injection protocol of 1 ml/s a longer purely arterial phase of 10.5 s was achieved compared to 7.7 s with higher injection rates (p = 0.045). The time between maximal aortic signal intensity and maximal renal enhancement was equal for all injection protocols. Johanna C. Nissen and Ulrike I. Attenberger contributed equally.     

A prospective study of multiple needle biopsies versus a single open biopsy for testicular sperm extraction in men with non-obstructive azoospermia

Little is known about the efficacy and the factors affecting the outcome of fine needle aspiration biopsy of the testis for sperm retrieval in azoospermic men with defective spermatogenesis. A prospective study was designed to compare the efficacy of needle and open (window) testicular biopsies for testicular epididymal sperm extraction (TESE) in 35 consecutive men with azoospermia due to defective spermatogenesis undergoing testicular biopsy for intracytoplasmic injection of oocytes. Each of the consecutive 35 patients underwent TESE using a 19 gauge butterfly needle followed by a window (1-1.5 cm-sized incision) testicular biopsy in the same procedure. The extraction of spermatozoa into culture medium was compared with the assessment of testicular biopsies by histology, the mode of biopsy (needle or open biopsy) and the amount of tissue retrieved by either method. Testicular spermatozoa were retrieved in 22 (63%) who had an open testicular biopsy compared with five (14%) patients who had multiple needle biopsies, respectively; the difference was statistically significant. Open testicular biopsy retrieves more testicular tissue than needle biopsy. Needle testicular biopsy retrieved testicular spermatozoa in 50% of those with hypospermatogenesis, 10% with focal spermatogenesis and in no patients with maturation arrest or Sertoli cell-only pattern. In contrast, sperm retrieval was successful in 100%, 90% and 66% of those with respective histologies using open testicular biopsy. Other than bruising, for which they required no analgesia, none of the patients suffered any obvious complications associated with traditional testicular biopsy. We conclude that open testicular biopsy is more effective than needle biopsy for the retrieval of testicular spermatozoa in azoospermic men with defective spermatogenesis. The difference observed may be related to the amount of testicular tissue retrieved and to the influence of testicular histology.