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1.
Background
Deferoxamine mesylate is known to ameliorate tissue ischemia-reperfusion injury. This study was designed to explore the impact of deferoxamine mesylate preconditioning (DMP) on pancreatic tissue and its possible effects during orthotopic liver autotransplantation.Methods
A modified orthotopic liver autotransplantation model was used to simulate pancreatic ischemia-reperfusion injury. Sprague-Dawley rats (0.25-0.30 kg) were randomly divided into normal control, autotransplantation (AT), systemic deferoxamine mesylate preconditioning (SDMP), and partial deferoxamine mesylate conditioning (PDMC) groups. The SDMP group was injected with deferoxamine mesylate (75-90 mg; 300 mg/kg), via the celiac artery at 24 and 48 hours before surgery. During surgery, the PDMC group underwent liver perfusion by means of deferoxamine mesylate solution (20 ml; 0.6 mmol/L) rather than Ringer's lactate solution, with no prior preconditioning. At 6, 24, and 48 hours after surgery, the rats were sacrificed to sample their pancreatic tissues for the expression of hypoxia-inducible factor-1α (HIF-1α) and malondialdehyde (MDA) content. The samples were subjected to blood chemistry analyses, light and transmission electron microscopic morphological studies, and quantitative measurement of HIF-1α expression.Results
The serum levels of amylase, lipase, and MDA in SDMP and PDMC groups were significantly lower than those in the AT group at 6, 24, and 48 hours after orthotopic liver autotransplantation (P < .05). Light and electron microscopic analyses showed much more severe pancreatic injury in the autotransplantation than in the SDMP and PDMC groups. The HIF-1α expression was increased in the SDMP and PDMC groups more than in the autotransplantation group (P < .05).Conclusions
Deferoxamine mesylate preconditioning protected pancreatic tissue in orthotopic liver autotransplantation in rats. Inhibition of oxidative toxic reactions and up-regulated expression of HIF-1α protein are possible mechanisms. 相似文献2.
Pawanindra Lal M.S. D.N.B. F.R.C.S. Ed. F.R.C.S. Glasg. Anubhav Vindal M.S. D.N.B. M.R.C.S. Ed. N.S. Hadke M.S. 《American journal of surgery》2009,198(3):319-323
Background
Giant duodenal ulcer (GDU) perforation remains an extremely uncommon but a rather challenging condition to manage wherein routine surgical procedures are fraught with an extremely high incidence of failure and mortality. It therefore follows that this condition must be identified and managed differently at laparotomy than are most duodenal perforations. We describe a method by which to deal with this condition using triple-tube-ostomy.Methods
In a prospective setting, 20 patients underwent surgery using the technique described in the article. During the same period, 20 patients with GDU perforation, who were managed in the conventional manner, were evaluated. The outcomes of the 2 groups were compared.Results
The success rate was 100% in the study group compared with 30% in the control patients.Conclusions
Based on the ease of the technique and the high success of the procedure in our experience in this select group, we recommend this procedure for the management of GDU perforation as a safe, reliable, and easy technique to learn. 相似文献3.
Aim
To compare systemic fat extravasation in unreamed and experimentally reamed nailing.Methods
An osteotomy was created in the proximal third of the femoral shaft in 16 sheep, and intramedullary pressure increase and fat extravasation were monitored for the two nailing techniques.Results
The highest intramedullary pressures, median 2700 mmHg, and highest percentages of fat extravasation, peaking at almost 90% of fat, were found for the unreamed nailing technique. The values for the reamed group were significantly lower.Conclusions
The extravasation of intramedullary fat can be attributed to the great increase in intramedullary pressure that occurs during unreamed nailing. Correctly performed intramedullary reaming with the new reaming system produces lower pressures and much less systemic fat extravasation, reducing the risk for fat embolism. 相似文献4.
Chen C Friedman S Butler S Jeruss S Terrin N Tighiouart H Ware J Wilson JM Parsons SK 《Journal of pediatric surgery》2007,42(6):1052-1056
Background
Infants with congenital diaphragmatic hernia require complex surgical care and may have neurodevelopmental morbidity. We examined the performance of reports of motor functioning in 25 congenital diaphragmatic hernia survivors using the parent-completed Developmental Profile-II and a clinical evaluation by a neurodevelopmental pediatrician (MD) measured against the Bayley motor scale.Methods
Bayley motor scores were dichotomized as normal or abnormal. Sensitivity and specificity were calculated for each test.Results
The median age at assessment was 25 months. Bayley motor scores were abnormal in 77% of infants tested (10/13). The MD examinations detected motor problems in 92% (12/13). Sensitivity and specificity of the MD examination were 1.0 and 0.33, respectively. Developmental Profile-II physical scores were abnormal in 15% (2/13); sensitivity and specificity were 0.2 and 1.0, respectively.Conclusions
The high rate of abnormal motor findings in this study supports the need for ongoing screening and evaluation. The sensitivity of MD examinations was excellent, but hypotonia findings were not universally corroborated by the Bayley. Although specificity of parent-reported motor findings was high, parents underreported abnormal motor findings. Parental reports of neurodevelopmental problems should be heeded, and physicians should perform screening motor examinations. Bayley assessments may be warranted to determine the functional implications of observed abnormalities. 相似文献5.
Woo Seok Kang Jeong Hyun Lee Ha Na Lee Kwang-Sun Lee 《Otolaryngology--head and neck surgery》2010,143(1):101-108
Objective
To investigate postoperative outcomes after cochlear implantation in young children with cochlear nerve deficiency and compare the results with those of cochlear implantation in patients with normal cochlear nerve.Study Design
Historical cohort study.Setting
Tertiary referral center.Subjects and Methods
Six children under the age of 36 months with cochlear nerve deficiency, as determined by magnetic resonance imaging (MRI), received cochlear implantation between July 2006 and March 2008. Fifteen children under the age of 36 months with normal cochlear nerve in the implanted ear underwent cochlear implantation during the same period and were selected as the control group. Medical records, imaging studies, and speech evaluations were reviewed.Results
Our study group scored lower in the Infant-Toddler Meaningful Auditory Integration Scale compared to the control group. Our study group produced categories of auditory performance scores not less than 4 except for one patient. Speech intelligibility rating scores in the control group gradually increased after cochlear implantation, but for the study group, the score remained zero 12 months after the implantation. In open-set one-syllable tests, five patients with cochlear nerve deficiency showed no response at the latest follow-up, whereas patient 6 began to show delayed improvement after 18 months. The results of the open-set two-syllable test were similar to those of the open-set one-syllable test.Conclusion
Young children with nonvisualized cochlear nerve on MRI showed worse outcomes compared to the children with normal cochlear nerve. Cochlear nerve deficiency on MRI is a marker of very poor outcome with cochlear implantations. 相似文献6.
Yazbeck-Karam VG Siddik-Sayyid SM Abi Nader EL Barakat DE Karam HS Cherfane GM Hussein JN Aouad MT 《Journal of clinical anesthesia》2011,23(5):393-397
Study Objective
To evaluate the effect of clonidine when added to local anesthetics on duration of postoperative analgesia during retrobulbar block.Design
Prospective, randomized controlled trial.Setting
Operating room and Postanesthesia Care Unit of a university-affiliated hospital.Subjects
80 ASA physical status 1, 2, and 3 patients undergoing vitreoretinal surgery with or without scleral buckling.Interventions
Patients in the control group (n = 40) received a retrobulbar block with 4.5 mL of lidocaine-bupivacaine and 0.5 mL of saline. Clonidine group patients (n = 40) received 4.5 mL of lidocaine-bupivacaine and 0.5 μg/kg of clonidine in a 0.5 mL volume.Measurements
The time to first analgesic request, frequency of postoperative pain, and number of postoperative analgesic requests per patient were assessed.Main Results
37 patients in the control group (92.5%) versus 24 patients (60%) in the clonidine group reported pain postoperatively (P = 0.001), with a shorter time to first analgesic request noted in the control group (4.9 ± 3 vs 11.9 ± 5.3 hrs; P < 0.001). The median number of postoperative analgesic requests per patient during the first 24 hours was higher in the control group than the clonidine group [2 (0-3) vs. 1 (0-3); P < 0.001].Conclusions
The addition of clonidine 0.5 μg/kg to the local anesthetics of a retrobulbar block for vitreoretinal surgery decreases the frequency of postoperative pain and prolongs the time of analgesia. 相似文献7.
Luo JM Chou NK Chen YS Huang SC Chi NH Yu HY Ko WJ Wang SS 《Transplantation proceedings》2012,44(4):913-914
Purpose
Heart transplantation is indicated for children with end-stage heart failure or complex inoperable congenital defects. When the transplanted heart fails, retransplantation is suggested and herein we have presented the prognosis of these pediatric cases.Materials and methods
From March 1987 to March 2011, we performed 404 heart transplantations including 45 pediatric patients, 6 (13.3%) of whom experienced graft failure requiring retransplantation. Only four of the six patients (66.7%) had a chance for retransplantation.Results
Six of 45 pediatric heart transplant patients (13.3%) experienced graft failure requiring retransplantation. Four of them (66.7%) underwent retransplantation. Only one of the four died due to severe postoperative sepsis with acute respiratory distress. The other three patients recovered well and remain alive with no neurological sequelae; all are in New York Heart Association functional classification I at present.Conclusion
Pediatric post-heart graft failure require expectations retransplantation, which shows a good prognosis. 相似文献8.
Background
Unadjusted abuse-related mortality has been demonstrated to be nearly 4-fold higher for African American (AA) children. Little is known about the etiology of this disparity. This study examines the importance of injury severity and initial presentation in explaining the observed disparity.Method
Our trauma database was reviewed to identify all abused patients admitted over a 10-year period. Outcomes among white and AA children were compared with specific attention to injury severity scores and initial presentation. Logistic regression and Cox proportional hazard analyses were performed to evaluate the impact of race on outcome.Results
There were 443 abused children identified. Thirty-eight percent of the group was AA. The overall mortality was 7.7%; however, the AA mortality was significantly higher than white children (14.8% vs 3.3%; P < .05). After controlling for injury severity and physiology at presentation, the odds ratio of mortality for an AA child was 9.14 (95% confidence interval, 1.97-42.43). Survival analysis confirmed the disparity after revealing a hazard ratio of dying for AA children of 6.51 (95% confidence interval, 2.74-15.47) compared with white children.Conclusion
Despite attempts to control for the clinical presentation and injury severity of abused children, significant differences in mortality persist between AA and white children. 相似文献9.
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11.
A.L. Tenório 《Transplantation proceedings》2010,42(2):407-411
Background
Since July 2006, the Model for End-stage Liver Disease (MELD) score has served as the national basis for allocation of donor livers for transplantation in Brazil. Patients with higher MELD scores receive greater priority for allocation regardless of the time on the waiting list.Purpose
To investigate the impact of MELD score implementation on the survival of waiting list patients.Methods
A retrospective study of patients registered at the national Organ Procurement Organization (OPO) for the liver transplantation waiting list between January 2004 and June 2006 (pre-MELD) and between July 2006 and December 2008 (post-MELD).Results
We included listed patients awaiting liver transplantation in the pre-MELD era (n = 250, 48.4%) and in the post-MELD era (n = 266, 51.6%). The times awaiting transplant prior to and after the MELD system were 487.2 ± 384.8 days and 183.9 ± 157.2 days, respectively. Prior to the MELD score, waiting list survivals were greater when compared to rates in the current system. Early posttransplant patient survival rates were significantly reduced in the post-MELD era (83.4%) compared to the period before MELD implementation (93.2%).Conclusions
MELD score provides a transparent, objective system to drive allocation policy; however, it presents several important limitations. Constant need of changes and reevaluation are needed as an evolutionary process. Future changes in the present system may be addressed by adjusting the MELD system. 相似文献12.
Schaarschmidt K Lempe M Kolberg-Schwerdt A Schlesinger F Hayek I Jaeschke U 《Journal of pediatric surgery》2005,40(3):575-577
Background
Wandering spleen is an uncommon diagnosis, difficult to prove by standard investigations. The authors report a new method for laparoscopic splenopexy in children using a balloon-dilated retroperitoneal pouch.Methods
From 3 accesses, the spleen is mobilized and displaced into a retroperitoneal pouch dilated to the double splenic volume. The pouch is dilated by a self-made balloon via a further intercostal access and narrowed by sutures incorporating the cranial and caudal edge of the gastrosplenic ligament.Results
The peritoneal pouch contracts around the retroperitoneal spleen resulting in a firm fixation of the organ. This technique was successful in a 9-year-old girl with a 5-year history of severe recurrent abdominal pain.Conclusions
Laparoscopic retroperitoneal pouch splenopexy is a safe and effective procedure for symptomatic wandering spleen precluding the use of foreign materials in this age group. 相似文献13.
Lee KD Yamataka A Kato Y Kobayashi H Lane GJ Maeda K Kojima Y Sueyoshi N Miyano T 《Journal of pediatric surgery》2005,40(12):1881-1886
Purpose
The aim of this study was to assess whether adult small bowel grafts (ASBGs) can survive transplantation without vascular reconstruction if graft serosectomy (SS) is performed.Methods
Syngeneic ASBG transplants were performed in 85 Lewis rats. The entire serosa was removed just before transplantation in the SS group (n = 50) and left intact in the nonserosectomy group (n = 35). Transplanted ASBG was harvested 1, 3, 5, 7, 14, 21, or 28 days after transplantation and studied using staining with hematoxylin-eosin, immunohistochemistry for protein gene product 9.5, S-100, CD34 and vascular endothelial growth factor (VEGF), and quantification of VEGF messenger RNA (mRNA). Adult small bowel graft viability was assessed blindly using a mucosal surface expansion score (0, no mucosa; 1, mucosa on one fourth of graft; 2, mucosa on one half of graft; 3, mucosa on three fourths of graft; and 4, circumferential mucosa on graft).Results
No rejection was identified in any ASBG. Average mucosal surface expansion score and VEGF mRNA expression were significantly higher in the SS group (both P < .01). Vascular endothelial growth factor protein was detected in enterocytes from day 3 posttransplant in the SS group. Distribution of protein gene product 9.5 and S-100 was normal in SS-group ASBG.Conclusions
Our results suggest that SS allows VEGF mRNA and, subsequently, VEGF protein in ASBG to be induced very soon after transplantation, which may contribute to the survival of ASBG transplanted without vascular reconstruction. 相似文献14.
Background
Turkey is one of the worst countries in the European region for the number of deceased organ donors (3.6) per million people. The aim of this study was to evaluate the location of nurses who have been attached to the National Coordination System as coordinators to increase this number.Methods
We chose 4 regional coordination centers in which the most brain death cases were reported: Istanbul, Izmir, Antalya, and Ankara. Coordinators were classified according to their occupations. We evaluated the numbers of brain deaths and of donors from 2006 to 2009 in hospitals that have coordinators.Results
The centers that have only nurse organ transplantation coordinators reported 60.3 (total n = 138) of the brain deaths in 2007, 54.8% (n = 97) in 2008, and 47.5% (n = 152) in 2009 in the Istanbul region; 8.4% (n = 131) in 2007, 25% (n = 164) in 2008, and 20% (n = 169) in 2009 in the Izmir region; 42.6% (n = 61) in 2007, 42.6% (n = 56) in 2008, and 32.4% (n = 111) in 2009 in the Antalya region; and 54% (n = 120) in 2007, 45.2% (n = 104) in 2008, and 41.8% (n = 122) in 2009 in the Ankara region.Conclusion
Brain death numbers have increased in all regions after the nurses started to work as coordinators. Still many potential donor center have no transplantation coordinator. 相似文献15.
Objective
This study aimed to compare the perspectives of leading ethical issues related to organ transplantation as perceived by health professionals (HP), legal professionals (LP), and religious experts (RE) from Taiwan (TW) and Mainland China (MC).Materials and Methods
A purposive sample including TW's organ transplant health professionals (OTHP), LP, and RE and MC's HP was obtained in this qualitative research. Data were analyzed by content analysis.Results
A total of 127 subjects participated in this project (n = 119 in TW, 8 in MC). They were HP (n = 92), RE (n = 25 TW), and LP (n = 10 TW). Seven ethical dilemmas were reported: (1) difficulties in touching the hearts of the public (HP 100%, LP 100%, RE 100%); (2) challenges in helping donors and their families (HP 96%, RE 80%, LP 50%); (3) competence and availability of HP (HP 93%, RE 72%, LP 50%); (4) questionable social farewell (HP 92%, RE 20%, LP 100%); (5) questionable legitimacy of prisoners' motivations (LP 90%, RE 64%, HP 60%); (6) worry about public discrimination (LP 90%, HP 50%, RE 20%); and (7) challenges to families in taking care of the recipients (HP 87%, LP 70%, RE 52%).Conclusions
To provide holistic care, HP need to invite RE to provide spiritual support for the donors of cadaveric organs, recipients, and their families. Reliable LP can help them to complete the sophisticated legal procedures. With help from this triangulated collaborative team, the value of organ transplantation will be appreciated by the public. 相似文献16.
Edward I. Lee Chuma J. Chike-Obi Patricio Gonzalez Ramon Garza Mimi Leong Anuradha Subramanian Jamal Bullocks Samir S. Awad 《American journal of surgery》2009,198(5):650-657
Background
The role of acellular dermal matrix (ADM) in abdominal wall reconstruction (AWR) is unclear. The aim of this study was to review the management, complications, and long-term outcomes of AWR using ADM in a large surgical cohort.Methods
Retrospective chart review of patients undergoing AWR using ADM from 2004 to 2007 was performed. Demographic data, comorbidities, complications, and long-term outcomes were collected.Results
There were 77 cases in 68 patients with mean age of 61.1 ± 1.4 years. The most common indication was infected fascia (n = 19 [25%]). Wound closure was achieved in 75% of the cases via primary (n = 26 [45%]), secondary intention (n = 17 [29%]), or skin graft (n = 15 [26%]). Nonprimary closure was achieved in 5.7 ± .7 months. There were 32 perioperative (39%) and 33 long-term (43%) complications. Over a mean follow-up period of 13.2 ± 1.5 months, the hernia recurrence rate was 27% (n = 21).Conclusion
Although ADM is a viable option in AWR, the high hernia recurrence rate warrants a continued search for alternative biologic materials to improve outcomes. 相似文献17.
Alachkar N Ugarte R Huang E Womer KL Montgomery R Kraus E Rabb H 《Transplantation proceedings》2010,42(9):3399-3405
Introduction
Delayed graft function (DGF) and slow graft function (SGF) due to ischemic and reperfusion injury (IRI) are common complications of deceased donor kidney transplantation. We tested whether a panel of serum and urine cytokines represent early biomarkers for DGF and SGF.Methods
We collected serum and urine samples from 61 patients 48 hours posttransplantation and used a multiplex enzyme-linked immunosorbent assay (ELISA) technique to measure levels of 23 cytokines. Fourteen patients developed poor graft function (PGF), with 6 having DGF and 8 with SGF.Results
Area under receiver operation characteristics curve (AUC) demonstrated the following: serum levels of SCF (0.88) and interleukin (IL) 16 (0.74).Conclusions
This study showed that a select panel of cytokines measured early post kidney transplantation may predict poor graft function. 相似文献18.
Hans F. Schoellhammer Armen C. Gregorian Grant G. Sarkisyan Beverley A. Petrie 《American journal of surgery》2008,196(6):904-908
Background
Colonoscopic localization of rectal and rectosigmoid tumors may be inaccurate. Rigid proctosigmoidoscopy has been suggested as an adjunctive technique to accurately localize rectal tumors as it may alter treatment options.Methods
A retrospective review was performed of patients with rectal and rectosigmoid cancer from 2001 to 2006. Patients were stratified into 1 of 4 anatomic regions based on colonoscopic localization of the tumor. The distances of the tumor from the anal verge by colonoscopy were compared with distances obtained via rigid proctosigmoidoscopy.Results
Rigid proctosigmoidoscopy localization likely changed the treatment options in 21% of lower rectal tumors, 14% of middle rectal tumors, 38% of upper rectal tumors, and 29% of rectosigmoid tumors. Overall, this modality impacted 25% of patients.Conclusions
Rigid proctosigmoidoscopy localization of rectal tumors can significantly change treatment options and should be performed on all patients with colonoscopic localization of a cancer thought to be in the rectosigmoid or rectum. 相似文献19.
Objective
To investigate the role of peritubular capillary damage and vascular endothelial growth factor (VEGF) in chronic allograft injury and to evaluate their correlation with clinical factors.Patients and Methods
The study included 56 patients who underwent transplantation between 1987 and 2004 and experienced chronic graft dysfunction. CD34 (peritubular capillaries) and VEGF were evaluated at histologic analysis. Patients were classified into 3 groups: 47 with chronic allograft injury, 9 with pure cyclosporine toxicity, and 26 who served as the control group (time 0 biopsy).Results
Compared with the control group, CD34 total expression in chronic nephropathy was indirectly proportional to Banff stage (P < .05), and VEGF was increased in chronic allograft injury grade I or II or nephrotoxicity (P < .05). CD34 expression was correlated with age (P < .007) and number of acute rejection episodes (P = .005). A negative correlation was observed between expression of CD34 and of VEGF (P < .001). Low expression of CD34 was associated with risk of graft loss of 1.45 (95% confidence interval, 1.15-7.24; P = .04).Conclusion
Peritubular capillaries decreased progressively with development of chronic allograft injury. The VEGF demonstrated a bimodal behavior, increasing at the onset of nephropathy and decreasing in the final stages. Loss of peritubular capillaries was associated with worse graft survival and overexpression of VEGF. 相似文献20.
Yung-An Tsou Meng-Hung Lin Chun-Hung Hua Hsien-Chang Tseng Da-Tian Bau Ming-Hsui Tsai 《Otolaryngology--head and neck surgery》2010,143(4):538-543