腹主动脉瘤腔内修复术后髂支闭塞的危险因素分析

目的探讨腹主动脉瘤腔内修复手术(endovascular repair,EVAR)后髂支闭塞的危险因素。方法对2008年1月至2018年3月在新疆维吾尔自治区人民医院诊治的146例腹主动脉瘤EVAR病人的临床资料进行回顾性分析,按髂支闭塞情况分为闭塞组和非闭塞组,在单因素分析后,行多因素Logistic回归分析。结果146例病人术后髂支闭塞17例(11.6%),两组间差异有检验效应(P<0.05)的因素为:合并高脂血症、慢性支气管炎,中性粒细胞百分比,活化部分凝血活酶时间,凝血酶比率,手术入路为切开显露,手术时间(min),右髂总动脉直径分层(≤12 mm、12~16 mm、≥16 mm),髂动脉狭窄或钙化≥50%,髂动脉扭曲成角≥60°,术后髂动脉流出道狭窄,髂内动脉流出道闭塞,支架远端延伸到髂外动脉。行多因素Logistic回归分析,EVAR术后髂支闭塞危险因素(OR>1)为:髂动脉狭窄或钙化≥50%[OR=7.727,95%CI(1.045,57.149),P=0.045];髂动脉扭曲成角≥60°[OR=5.258,95%CI(1.055,26.198),P=0.043];术后髂动脉流出道狭窄[OR=10.099,95%CI(1.156,88.257),P=0.037];手术入路为切开显露[OR=15.121,95%CI(1.841,124.197),P=0.011]。结论髂动脉狭窄或钙化≥50%、髂动脉扭曲成角≥60°、术后髂动脉流出道狭窄是肾下型腹主动脉瘤病人EVAR术后髂支闭塞独立危险因素。     

腹主动脉瘤腔内修复术后髂支闭塞的原因及治疗策略

目的:探讨腹主动脉瘤(AAA)腔内修复术(EVAR)后髂支闭塞的原因及治疗策略。方法:回顾性收集2016年1月—2018年7月中南大学湘雅医院血管外科收治130例行EVAR的AAA患者临床资料,对其中并发髂支闭塞患者的临床资料进行分析。结果:130例成功接受EVAR的AAA患者中,6例(4.61%)发生术后髂支闭塞,均为单侧闭塞,发生闭塞的平均时间为(55±87)d。临床表现主要为间歇性跛行和静息痛。治疗方式包括:股动脉切开取栓+股-股动脉转流术2例,髂动脉支架植入术1例,股动脉切开取栓+髂动脉支架植入术3例。术后患肢缺血症状均消失。术后随访时间12个月,所有患者均未再次出现下肢缺血症状。结论:髂支闭塞是EVAR术后较为常见的并发症之一,其原因包括瘤颈条件差、髂动脉入路扭曲、髂支远端锚定区解剖异常等;股动脉切开取栓和(或)髂动脉支架植入是行之有效的治疗方法。     

腹主动脉覆膜支架腔内修复术后并发症相关的术中危险因素与预警模型研究

目的 探讨腹主动脉覆膜支架腔内修复术（EVAR）后并发症相关的术中危险因素与预警模型。方法 收集2020年1月至2022年12月于首都医科大学附属北京友谊医院进行覆膜支架EVAR治疗的90例腹主动脉瘤患者的临床资料,将30例发生术后并发症的患者作为并发症组,根据并发症组患者的年龄、性别按1:2的比例采用倾向性评分匹配法将60例未发生术后并发症的患者作为无并发症组。采用多因素Logistic回归模型分析腹主动脉覆膜支架EVAR术后并发症相关的术中危险因素,明确危险因素与腹主动脉瘤覆膜支架EVAR术后发生并发症的关系并建立预警模型,根据预警模型制定术中预防措施。结果 单因素分析结果显示,并发症组患者术中栓塞双侧髂内动脉的比例、术中最低体温、术中平均动脉压（MAP）最大差均高于无并发症组患者,差异均有统计学意义（P﹤0.05）。多因素分析结果显示,术中最低体温较高为腹主动脉覆膜支架EVAR术后发生并发症的保护因素（P﹤0.05）,术中MAP最大差较大、术中栓塞双侧髂内动脉均为腹主动脉覆膜支架EVAR术后发生并发症的危险因素（P﹤0.05）。根据危险因素建立腹主动脉覆膜支架EVAR术后发生并发...     

腹主动脉瘤腔内修复术后髂支闭塞的治疗

目的 总结腹主动脉瘤腔内修复术(abdominal aortic aneurysm endovascular repair,EVAR)后髂支闭塞患者的病因、治疗选择,并评价治疗结果.方法 回顾性分析2008年1月至2012年12月收治的305例患者的临床资料,所有患者使用分叉支架型血管,术后6例男性患者的髂支(1.97％)在EVAR术后0～36个月发生闭塞.其中4例患者出现髂支移植物扭曲,出现扭曲的3个分支中全部发生血栓形成.临床表现为1例患者出现静息痛；4例患者出现跛行；另1例患者无症状.治疗:1例患者采用取栓+股-股旁路；1例采用髂支封堵+股-股旁路；4例患者采用取栓+支架植入.结果 6例患者手术均成功,静息痛和跛行症状消失.6例患者随访时间为6 ～18个月,平均(10±8)个月.5例患者无下肢缺血症状发生,1例患者术后半年跛行症状再次加重,行下肢动脉球囊扩张+支架植入术治疗后症状消失.结论 髂动脉扭曲可能是EVAR术后髂支闭塞的重要因素.外科旁路手术和血管腔内治疗是治疗EVAR术后发生的髂支闭塞有效和安全的方法.     

腔内治疗腹主动脉瘤合并双髂总动脉瘤的疗效分析

目的总结腹主动脉瘤合并双髂总动脉瘤的腔内治疗经验。方法总结2016年4月至2018年11月新疆维吾尔自治区人民医院18例接受腹主动脉腔内修复术(EVAR)的腹主动脉瘤合并双髂总动脉瘤患者。其中6例双侧髂总动脉直径18～25 mm,选择合适口径的髂动脉分支支架完成传统EVAR;9例双侧髂总动脉直径≥25 mm,选择双侧髂外动脉作为锚定区完成EVAR,并行髂总动脉直径较大侧或合并髂内动脉瘤样变侧进行髂内动脉弹簧圈栓塞术;3例双侧髂总动脉直径≥25 mm,选择双侧髂外动脉作为锚定区完成EVAR,并行三明治技术单侧髂内动重建。结果腔内手术均获得成功,手术时间(120±35)min,出血量(100±40)ml。术中无即刻Ⅰ型内漏出现。1例双侧髂外动脉作为锚定区治疗患者术后发生臀肌缺血症状;3例三明治技术单侧髂内动重建患者中,1例髂内动脉Ⅱ型内漏发生,1例髂内动脉闭塞。术后随访3～32个月,平均10.3个月,无动脉瘤破裂,髂动脉直径无明显扩张。结论腹主动脉瘤合并双髂总动脉瘤患者根据髂总动脉直径选择合适的腔内治疗方法可达到理想的治疗效果,重建髂内动脉与否术后生活质量无明显差异。     

复杂解剖结构腹主动脉瘤腔内修复术后主要并发症的影响因素分析

目的 探讨复杂解剖结构的腹主动脉瘤（AAA）腔内修复术（EVAR）后发生并发症的影响因素。方法 收集2007年8月至2022年6月于内蒙古医科大学附属医院行EVAR治疗的162例AAA患者的临床资料,根据EVAR术后是否发生并发症将其分为并发症组（n=42）和无并发症组（n=120）。记录患者的一般情况、实验室检查指标、腹主动脉瘤解剖形态信息、术中指标,统计术后1个月病死率及并发症发生情况,分析EVAR术后发生并发症的影响因素。结果 两组患者血清白蛋白水平、老年营养风险指数（GNRI）、髂动脉狭窄/闭塞、短瘤颈、大成角、瘤颈血栓比较,差异均有统计学意义（P﹤0.05）。多因素分析结果显示,GNRI﹤82、瘤颈血栓、髂动脉狭窄/闭塞均是复杂解剖结构AAA患者EVAR术后发生并发症的独立危险因素（P﹤0.05）。结论 GNRI﹤82、髂动脉狭窄/闭塞及瘤颈血栓可提示行EVAR的复杂解剖结构的AAA患者术后并发症发生风险增高。     

血清纤维蛋白原、D-二聚体水平对腹主动脉瘤患者腔内修复术后发生髂支闭塞的预测价值

目的 探讨血清纤维蛋白原（FIB）、D-二聚体（D-D）水平在腹主动脉瘤（AAA）患者腔内修复术（EVAR）术后发生髂支闭塞中的预测价值。方法 收集2020年1月至2021年12月于潍坊医学院附属医院行EVAR治疗的130例AAA患者的临床资料,根据术后是否发生髂支闭塞将其分为发生组（n=60）和未发生组（n=70）,使用倾向性评分匹配法得到组间协变量均衡的样本,最终每组50例。统计患者术前血清FIB、D-D、甘油三酯（TG）等实验室指标,采用受试者工作特征（ROC）曲线下面积（AUC）、决策曲线分析血清FIB、D-D预测AAA患者EVAR术后发生髂支闭塞的价值。结果 发生组患者的TG、FIB、D-D水平均高于未发生组患者,差异均有统计学意义（P﹤0.05）。Logistic回归模型分析结果显示,TG、FIB、D-D水平升高均是AAA患者EVAR术后发生髂支闭塞的危险因素（P﹤0.05）。术前血清FIB、D-D水平联合预测AAA患者EVAR术后发生髂支闭塞的AUC最大,预测价值最高。决策曲线分析结果显示,当高风险阈值为0.18～0.41、0.51～0.72、0.89～0.99时,血清F...     

主动脉瘤腔内治疗术后全身炎症反应综合征的风险因素研究

目的 探讨腹主动脉瘤患者行腔内修复术(endovascular aortic repair,EVAR)后围手术期全身炎症反应综合征(systemic inflammatory response syndrome,SIRS)的发生情况和相关风险因素.方法 回顾性分析2010年9月至2012年3月因腹主动脉瘤行EVAR治疗的93例患者临床资料,分析术后7d内SIRS发生率,并根据SIRS发生情况对患者进行分组统计,使用Logistic多因素回归模型进行危险因素分析.结果 本组腹主动脉瘤患者EVAR后SIRS发生率为58.1％,瘤体大小、附壁血栓、髂动脉病变、支架数量、手术时间、对比剂用量、出血量和住院时长等因素在SIRS组和非SIRS组间均差异有统计学意义(P＜0.05).Logistic多因素回归分析提示肾病、既往手术史、瘤体大小、瘤体破裂、支架数量均是EVAR后SIRS发生的独立危险因素.结论 EVAR后SIRS发生率较高,针对其疾病特征和风险因素优化治疗策略可以降低风险.     

腹主动脉瘤腔内修复术中髂内动脉的疏与堵

腹主动脉瘤腔内修复术(EVAR)中髂内动脉的疏与堵的问题,是长期伴随EVAR发展过程的焦点问题。笔者复习了数十篇国外文献,总结和分析了从百年前至今对髂内动脉的系统的解剖学研究、非血管外科手术过程中髂内动脉结扎或栓塞、腹主动脉与髂动脉开放手术中对髂内动脉实施结扎或栓塞、EVAR术中各种栓塞髂内动脉方式的临床后果、导致盆腔缺血各种并发症的危险因素,最终认为,EVAR术中,维持髂内动脉通畅是必要的,并对没有维持通畅的条件而必须栓塞髂内动脉,操作时如何防止或减少盆腔脏器缺血、具体实施技巧、术中术后注意事项等进行了归纳。     

腹主动脉瘤腔内修复术后髂支闭塞的腔内处理

目的 探讨腹主动脉瘤腔内修复(endovascular aneurysm repair, EVAR)术后髂支闭塞的腔内再手术效果。方法 回顾性分析2018年3月～2023年3月6例EVAR术后髂支闭塞的资料。均行同侧股动脉切开Fogaty取栓、髂支球囊扩张,其中3例联合支架植入,1例联合Rotarex腘动脉取栓。结果 6例髂支闭塞再通率100%(6/6)。术后中位随访时间24个月(6～48个月)。5例术后下肢缺血症状消失(Rutherford 0级),1例膝下缺血、干性坏疽(RutherfordⅢ级)。结论对于EVAR术后髂支闭塞,需仔细分析原因,选择个体化腔内治疗方案。     

维生素D受体在糖尿病肾病足细胞损伤及蛋白尿缓解中的作用

目的探讨维生素D受体(VDR)在糖尿病肾病(DKD)足细胞中的表达水平及在足细胞损伤及蛋白尿缓解中的作用。方法(1)本研究纳入了65例诊断患有2型糖尿病(伴或不伴蛋白尿)的患者,并纳入了25例年龄和性别相匹配的健康体检者为对照组。根据白蛋白/肌酐(ACR)的尿排泄比例对2型糖尿病患者进行分组,分别为无蛋白尿(ACR<30 mg/g,n=24)、微量白蛋白尿(ACR 30~300 mg/g,n=18)和临床蛋白尿(ACR>300 mg/g,n=23)。另选择25例经肾活检确诊的DKD患者作为DKD组。正常肾脏组织标本均取自泌尿外科同一时期肾脏肿瘤切除患者10例。将各组检测指标进行对比,同时采用实时定量PCR、ELISA法和免疫组化法检测VDR在各组患者的血液、尿液样本和肾脏组织中的表达情况,以及使用Pearson相关分析分析VDR与尿蛋白的相关性。(2)在2型糖尿病肾病小鼠模型中对上述结果进行验证,将遗传背景均为C57BLKs/J的雄性db/db小鼠及同窝出生的db/m小鼠,随机分为正常对照组(A组)、DKD对照组(B组)、DKD二甲基亚砜处理组(C组)、DKD帕立骨化醇(VDR激动剂)处理组(D组),C、D组连续腹腔注射处理8周,对照组不做任何处理。小鼠10周龄时开始连续干预8周,在小鼠22周龄(开始干预后12周)检测各组小鼠体重、血、尿生化指标对比;Western印迹法检测β⁃catenin、VDR的变化;免疫荧光观察足细胞标志蛋白podocin及足细胞损伤蛋白α⁃SMA的表达变化。结果(1)与正常健康对照组相比,无蛋白尿组、微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿组的糖尿病患者相比,微量白蛋白尿组和临床蛋白尿组的糖尿病患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05)。(2)与正常健康对照组相比,无蛋白尿糖尿病组和DKD组患者血浆中VDR的mRNA和蛋白水平均较低(均P<0.05);与无蛋白尿糖尿病组患者相比,DKD组患者血浆中VDR的mRNA和蛋白水平亦较低(均P<0.05)。(3)免疫组化结果显示,DKD组肾组织中VDR的表达明显少于正常对照组。(4)DKD患者血浆中VDR mRNA相对水平与ACR呈负相关(r=-0.342,P<0.05)。(5)各组尿液上清液中VDR的水平与血浆中的水平呈相反趋势。(6)Western印迹结果显示,B组、C组肾小球足细胞β⁃catenin蛋白表达高于D组(均P<0.05),VDR蛋白的表达低于D组(均P<0.05);免疫荧光结果显示,B组、C组肾小球足细胞podocin的表达低于D组(均P<0.05),α⁃SMA的表达高于D组(均P<0.05)。结论VDR高表达缓解DKD足细胞损伤及蛋白尿。     

Comparison of University of Wisconsin and University of Pittsburgh solutions for heart transplantation

The effectiveness of University of Wisconsin (UW) and University of Pittsburgh (UP) solutions for the preservation of rat hearts was compared. Lewis rat hearts were preserved with UW (group A, n=45) or UP (group B, n=45) solution for 0 or 24 h and then transplanted heterotopically into the recipients' abdomen. Ten recipients in each group were observed to obtain 1-week graft survival rates. Tissue water content and tissue content of adenine nucleotides were measured 2 h after transplantation in six grafts from each group. Six hearts preserved for 0 h and seven hearts preserved for 24 h were taken from each group 24 h after grafting for histopathology. The 1-week graft survival rates of groups A24 and B24 were 60% and 10%, respectively. In the 24-h preserved grafts, adenosine triphosphate (ATP) and energy charge [(ATP+adenosine diphosphate/2)/(ATP+adenosine diphosphate+adenosine monophosphate)] of groups A and B were 0.972±0.165 and 0.200±0.123 mg/g wet tissue (P<0.05) and 74.4% and 61.1% (P<0.05), respectively. The tissue water content of group A24 was 71.7%, whereas that of group B24 was 74.1% (P<0.05). Histopathology revealed more severe muscle edema and necrosis and infiltration of polymorphonuclear cells in group B24 than in group A24. We conclude that UW solution is more appropriate for rat heart preservation than UP solution.     

Role of Conventional and Diffusion-Weighted Magnetic Resonance Imaging of Spinal Treatment Protocol for Hydatid Disease

Objective:

To demonstrate the role of magnetic resonance imaging (MRI) in determining the treatment protocol for hydatid disease of the spine.

Design:

Case report; literature review.

Findings:

Diffusion-weighted MRI can help differentiate complicated infected hydatidosis from abscesses, epidermoid cysts from arachnoid cysts, and benign from malignant vertebral compression fractures. It is also helpful in differentiating between abscesses and necrotic tumors.

Conclusion:

Diffusion-weighted MRI can help differentiate between infections requiring immediate surgery and those that can be treated medically with antihelmintic treatment.     

罗伊适应模式对腹股沟疝无张力疝修补术后恢复情况的影响

目的探讨罗伊适应模式对患者腹股沟疝无张力疝修补术后恢复情况的影响。 方法将2016年1月至2019年5月在秦皇岛市第二医院择期进行无张力修补术治疗的120例腹股沟疝患者，按照随机数字法分为对照组和观察组，每组各60例。对照组采用常规护理治疗，观察组在对照组的基础上采用罗伊适应模式。比较2组患者的术后临床指标、心理状态、围手术期并发症发生情况及满意度。 结果术后观察组患者的首次排气时间、恢复正常饮食时间、离床活动时间和术后住院时间均低于对照组（P<0.05）；术后观察组患者的抑郁自评量表（SDS）和焦虑自评量表（SAS）评分显著低于对照组（P<0.05）；术后2组患者均无切口感染发生，2组患者尿潴留、急性疼痛、认知功能障碍、发热、血肿等发生率相比无统计学差异（P>0.05）；术后观察组患者护理满意度为96.67%，显著高于对照组的83.33%（P<0.05）。 结论在常规护理的基础上，罗伊适应模式用于患者腹股沟疝无张力修补围手术期，能有效改善术后患者的焦虑/抑郁情绪，不增加围手术期并发症，促进术后患者的恢复及提高治疗满意度。     

Long-term follow-up of callotasis lengthening of the capitate after resection of the lunate for the treatment of stage III lunate necrosis

The callotasis lengthening technique was used to gradually lengthen the capitate after resection of the lunate in stage IIIa necrosis in 23 patients. Results of ten patients with a follow-up of at least 5 years showed rapid and sufficient callus formation in every patient regardless of age. The callotasis lengthening modification of the Graner II operation provides all advantages and avoids the major inconvenience of the traditional Graner II operation. There was no increased rate of disturbed fracture healing. Results of the DTPA-gadolinium MRI study did not show any significant impairment of vascularization within the region of the capitate bone. With the “intrinsic bone formation,” contrary to every other intercarpal arthrodesis at the wrist, there is no need for an additional bone graft.     

不同尿钙水平的Gitelman综合征患者临床特点比较

目的观察不同尿钙水平Gitelman综合征(GS)患者的临床特点,探讨尿钙在GS疾病临床分型中的价值。方法收集2016—2018年来自中国国家罕见病注册系统(NRSC)、在北京协和医院行SLC12A3基因检测诊断为GS患者的临床资料,分析其尿钙特点,比较不同尿钙水平患者的临床和实验室检查指标。氢氯噻嗪试验按照标准操作流程进行,测定患者基线和用药后3 h内氯离子排泄分数改变量的最大值(ΔFECl)。结果共有83例GS患者被纳入研究,其中低尿钙患者53例(63.86%)。低尿钙组尿钙/肌酐比明显低于非低尿钙组[(0.085±0.058)mmol/mmol比(0.471±0.284)mmol/mmol,t=7.349,P<0.001]。两组患者在年龄、性别、估算肾小球滤过率、血压、血尿电解质水平、代谢性碱中毒方面差异均无统计学意义。低尿钙组患者乏力(χ2=4.595,P=0.032)及多尿(χ2=5.778,P=0.016)发生比例低于非低尿钙组,两组患者在其他临床症状方面差异无统计学意义。低尿钙和非低尿钙组各有16例患者行氢氯噻嗪试验,中位ΔFECl结果分别为0.539%(0.430%,1.283%)和0.829%(0.119%,1.298%),均提示对氢氯噻嗪无反应,组间差异无统计学意义(U=130.000,P=0.956)。结论GS患者中低尿钙比例为63.86%,尿钙水平与疾病临床表型、NCC功能损伤严重程度之间均无明确相关性。     

Safety and tolerability of single intravenous doses of sugammadex administered simultaneously with rocuronium or vecuronium in healthy volunteers

BACKGROUND: Sugammadex rapidly reverses rocuronium- and vecuronium-induced neuromuscular block. To investigate the effect of combination of sugammadex and rocuronium or vecuronium on QT interval, it would be preferable to avoid the interference of anaesthesia. Therefore, this pilot study was performed to investigate the safety, tolerability, and plasma pharmacokinetics of single i.v. doses of sugammadex administered simultaneously with rocuronium or vecuronium to anaesthetized and non-anaesthetized healthy volunteers. METHODS: In this phase I study, 12 subjects were anaesthetized with propofol/remifentanil and received sugammadex 16, 20, or 32 mg kg(-1) combined with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1); four subjects were not anaesthetized and received sugammadex 32 mg kg(-1) with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) (n=2 per treatment). Neuromuscular function was assessed by TOF-Watch SX monitoring in anaesthetized subjects and by clinical tests in non-anaesthetized volunteers. Sugammadex, rocuronium, and vecuronium plasma concentrations were measured at several time points. RESULTS: No serious adverse events (AEs) were reported. Fourteen subjects reported 23 AEs after study drug administration. Episodes of mild headache, tiredness, cold feeling (application site), dry mouth, oral discomfort, nausea, increased aspartate aminotransferase and gamma-glutamyltransferase levels, and moderate injection site irritation were considered as possibly related to the study drug. The ECG and vital signs showed no clinically relevant changes. Rocuronium/vecuronium plasma concentrations declined faster than those of sugammadex. CONCLUSIONS: Single-dose administration of sugammadex 16, 20, or 32 mg kg(-1) in combination with rocuronium 1.2 mg kg(-1) or vecuronium 0.1 mg kg(-1) was well tolerated with no clinical evidence of residual neuromuscular block, confirming that these combinations can safely be administered simultaneously to non-anaesthetized subjects. Rocuronium and vecuronium plasma concentrations decreased faster than those of sugammadex, reducing the theoretical risk of neuromuscular block developing over time.     

Magnetic resonance imaging for the evaluation of rejection of a kindney allograft in the rat

Orthotopic DA (RT1^a) into Lewis (RT1¹) rat kidney allografts and control Lewis-into-Lewis grafts were assessed by magnetic resonance imaging (MRI) and perfusion measurement after intravenous injection of a superparamagnetic contrast agent. MRI anatomical scores (range 1–6) and perfusion rates were compared with graft histology (rank of rejection score 1–6). Not only acute rejection, but also chronic events were monitored after acute rejection was prevented by daily cyclosporine (Sandimmune) treatment during the first 2 weeks after transplantation. In acute allograft rejection (n=11), MRI scores reached the maximum value of 6 and perfusion rates were severely reduced within 5 days after transplantation; histology showed severe acute rejection (histologic score 5–6). In the chronic phase (100–130 days after transplantation), allografts (n=5) manifested rejection (in histology cellular rejection and vessel changes), accompanied by MRI scores of around 2–3 and reduced perfusion rates. Both in the acute and chronic phases, the MRI anatomical score correlated significantly with the histological score (Spearman rank correlation coefficient r _s 0.89, n=30, P<0.01), and perfusion rates correlated significantly with the MRI score or histological score (r _s values between-0.60 and -0.87, n=23, P<0.01). It is concluded that MRI represents an interesting tool for assessing the anatomical and hemodynamical status of a kidney allograft in the acute and chronic phases after transplantation.     

Fibrinogen-thrombin collagen patch reinforcement of highrisk colonic anastomoses in rats

AIM To evaluate the effectiveness of human fibrinogenthrombin collagen patch(TachoSil~?) in the reinforcement of high-risk colon anastomoses.METHODS A quasi-experimental study was conducted in Wistar rats(n = 56) that all underwent high-risk anastomoses(anastomosis with only two sutures) after colectomies. The rats were divided into two randomized groups: Control group(24 rats) and treatment group(24 rats). In the treatment group, high-risk anastomosis was reinforced with TachoSil~? (a piece of Tacho Sil? was applied over this high-risk anastomosis, covering the gap). Leak incidence, overall survival, intra-abdominal adhesions, and histologic healing of anastomoses were analyzed. Survivors were divided into two subgroups and euthanized at 15 and 30 d after intervention in order to analyze the adhesions and histologic changes. RESULTS Overall survival was 71.4% and 57.14% in the TachoSil~? group and control group, respectively(P = 0.29); four rats died from other causes and six rats in the treatment group and 10 in the control group experienced colonic leakage(P 0.05). The intra-abdominal adhesion score was similar in both groups, with no differences between subgroups. We found non-significant differences in the healing process according to the histologic score used in both groups(P = 0.066).CONCLUSION In our study, the use of TachoSil~? was associated with a non-statistically significant reduction in the rate of leakage in high-risk anastomoses. TachoSil~? has been shown to be a safe product because it does not affect the histologic healing process or increase intra-abdominal adhesions.     

Cost-effectiveness of three combinations of antiemetics in the prevention of postoperative nausea and vomiting

Background. This study compares the cost-effectiveness of threecombinations of antiemetics in the prevention of postoperativenausea and vomiting (PONV). Methods. We conducted a prospective, double-blind study. NinetyASA I–II females, 18–65 yr, undergoing general anaesthesiafor major gynaecological surgery, with standardized postoperativeanalgesia (intrathecal 0.2 mg plus i.v. PCA morphine), wererandomly assigned to receive: ondansetron 4 mg plus droperidol1.25 mg after induction and droperidol 1.25 mg 12 h later (Group1); dexamethasone 8 mg plus droperidol 1.25 mg after inductionand droperidol 1.25 mg 12 h later (Group 2); ondansetron 4 mgplus dexamethasone 8 mg after induction and placebo 12 h later(Group 3). A decision analysis tree was used to divide eachgroup into nine mutually exclusive subgroups, depending on theincidence of PONV, need for rescue therapy, side effects andtheir treatment. Direct cost and probabilities were calculatedfor each subgroup, then a cost-effectiveness analysis was conductedfrom the hospital point of view. Results. Groups 1 and 3 were more effective (80 and 70%) thanGroup 2 (40%, P=0.004) in preventing PONV but also more expensive.Compared with Group 2, the incremental cost per extra patientwithout PONV was €6.99 (95% CI, –1.26 to 36.57) forGroup 1 and €13.55 (95% CI, 0.89–132.90) for Group3. Conclusion. Ondansetron+droperidol is cheaper and at least aseffective as ondansetron+ dexamethasone, and it is more effectivethan dexamethasone+droperidol with a reasonable extra cost. Br J Anaesth 2003; 91: 589–92