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21.
Roger S Chan Michael H Duong Aaron V Kaplan 《Catheterization and cardiovascular interventions》2007,70(3):374-378
Percutaneous intervention in saphenous vein grafts (SVG) carries a higher risk of distal embolization than intervention in a native vessel, and use of a distal protection device has been shown to improve the outcomes in SVG interventions. We describe an intervention done in an unexpected 'Y' SVG which required dual distal protection with Filterwires placed in both limbs of the diseased graft and which was performed via a 6 Fr guide catheter. 相似文献
22.
23.
Teruyuki Usuba Yutaka Suzuki Akira Kuramochi Hisao Tajiri Katsuhiko Yanaga 《Digestive endoscopy》2007,19(1):18-21
Background: Buried bumper syndrome (BBS) is a rare complication of percutaneous endoscopic gastrostomy (PEG). Along with the widespread use of the button‐type kit, BBS is encountered frequently. Methods: In the present study, we examined causes and treatments for BBS among 1400 patients who had undergone PEG. Results: The causes of BBS after PEG were classified into two categories: early causes consisted of wound infection, inappropriate size of kit and severe lordosis, while late causes were inappropriate exchange of kit, rough management or weight gain. The treatments for BBS could be determined by the degree of wound infection, fistula and burial of the bumper. Conclusion: We prepared a flowchart for replacement, by which BBS can be managed safely and quickly without surgical or endoscopic intervention. 相似文献
24.
Pratipal Singh Vivek Vijjan Manu Gupta Deepak Dubey Aneesh Srivastava 《International journal of urology》2007,14(6):558-560
Congenital thoracic ectopic kidney is a very rare developmental anomaly and the rarest form of all ectopic kidneys. It is usually asymptomatic and discovered incidentally on routine chest radiography. Herein we reported the first case of staghorn stone in a thoracic kidney managed successfully by percutaneous nephrolithotomy. 相似文献
25.
Bertalanffy H. Kretzschmar H. Gilsbach J. M. Ott D. Mohadjer M. 《Acta neurochirurgica》1990,104(3-4):151-155
Summary This case report describes a patient presenting with symptoms of increased intracranial pressure, whose computerized tomographic (CT) scan was highly suggestive of a large low-grade glioma invading the basal ganglia. Magnetic resonance imaging (MRI) revealed a well-demarcated space-occupying mass of increased intensity in the left lateral ventricle and adjacent white matter. Following stereotactic biopsy, which yielded a homogeneous jelly-like material, the mass was removed microsurgically and was found to be most like a colloid cyst on histological examination. Discussion focusses on the clinical and differential diagnostic implications of this very unusual combination of findings. 相似文献
26.
腹腔镜卵巢穿刺内凝治疗多囊卵巢不孕症的临床研究 总被引:2,自引:0,他引:2
目的探讨腹腔镜卵巢穿刺内凝对多囊卵巢不孕症的治疗价值。方法151例腹腔镜卵巢穿刺内凝术(实验组)和151例开腹卵巢楔切术(对照组)治疗多囊卵巢不孕症配对对比研究。结果实验组的手术时间33.1±7.2min,术中失血15.6±4.7ml,总排卵率92.05%,总妊娠率49.67%,均优于对照组(P<0.01);术后雄激素、LH/FSH下降幅度小于对照组(P<0.01)。随时间推移,两组术后排卵巢、妊娠率均有下降倾向,而术后雄激素、LH/FSH则有逐渐回升的倾向。结论腹腔镜卵巢穿刺内凝术对多囊卵巢不孕症有较好的治疗效果 相似文献
27.
T. Scholz Ø. Mathisen A. Bergan S. Osnes R. Innes T. Pedersen A. O. Aasen O. Søreide 《Transplant international》1997,10(3):180-184
We have introduced and evaluated several modifications of the conventional venovenous bypass (VVBP) in 29 adult patients
undergoing liver transplantation (OLT). A percutaneous technique for insertion of a jugular venous return cannula and a femoral
vein cannula was applied. The inferior mesenteric vein (IMV) was used for splanchnic decompression, which facilitated dissection
of the recipient liver and allowed portal anastomosis to be performed without disconnecting the portal bypass. A heat exchanger
was introduced into the bypass circuit to prevent heat loss. The percutaneous technique prevented complications related to
dissection in the axilla and groin. Hemodynamic characteristics corresponded to those found using the traditional technique.
Complications related to the VVBP were seen in only one patient in whom the femoral catheter was accidentally introduced into
the femoral artery. We conclude that percutaneous cannulas, use of the IMV for splanchnic decompression and the introduction
of a heat exchanger offer significant benefits and that they are safe and reliable.
Received: 23 August 1996 Received after revision: 14 January 1997 Accepted: 27 January 1997 相似文献
28.
Incidence of post-lumbar puncture syndrome reduced by reinserting the stylet: a randomized prospective study of 600 patients 总被引:1,自引:0,他引:1
The post-lumbar puncture syndrome (PLPS) can best be explained by prolonged spinal fluid leakage owing to delayed closure
of a dural defect. Its incidence after spinal anaesthesia is much lower than after diagnostic lumbar puncture (LP). This difference
could be caused by a strand of arachnoid, which might enter the needle with the outflowing cerebrospinal fluid (CSF) during
diagnostic LP and upon removal of the needle be threaded back through the dura to produce prolonged CSF leakage. To find a
technique that further reduces the incidence of PLPS, this hypothesis was tested by evaluating the effect that reinserting
the stylet before removing the needle had on the incidence of PLPS. By reinserting the stylet to the tip of the needle, the
hypothesized strand would be pushed out, thereby reducing the frequency of PLPS. Sprotte’s “atraumatic needle” (21 gauge)
was used for LP. A total of 600 patients participated in the prospective study. They were randomized into two groups and questioned
about their complaints every day for up to 7 days after the LP. All LPs were performed by two experienced neurologists (T.B.,
M.S.). In 300 patients, the stylet was reinserted to the tip of the needle; in the other 300 it was not reinserted. Whereas
49 of the 300 patients without reinsertion developed PLPS, only 15 of the 300 patients with reinsertion did. This significant
difference (16.3 vs 5.0%, P < 0.005, chi square test) supports our hypothesis. On the basis of our results, we recommend reinserting the stylet before
removing the needle in order to reduce the incidence of PLPS.
Received: 30 September 1997 Received in revised form: 9 March 1998 Accepted: 20 March 1998 相似文献
29.
Sixteen patients receiving percutaneous endoscopic gastrostomy (PEG) feeding following a period of nasogastric (NG) feeding were investigated to assess acceptance and identify problems by means of a questionnaire. PEG was considered to be superior to NG feeding in terms of tolerance and cosmetic acceptance by 81% and 88% of participants respectively ( P < 0.001). Pain was an infrequent problem. Interruptions to feeding were consideed to be more common with NG feeding by 50% of participants; 38% considered interruptions equally common with both PEG and NG, and 12% considered interruptions more common with PEG feeding ( P = NS). The time for care was equivalent for both methods. Seventy-five percent considered PEG to have made a valuable contribution to enteral feeding. Leakage was however considered to be more frequent in PEG feeding by 81% of participants (compared to 12% who considered leakage to be more common with NG feeding; P < 0.001) and leakage was more frequent at die junctions in the catheter rather than from the stoma. Thirty-one percent of patients with PEG had needed systemic antibiotics for stomal infections. All patients with both PEG and NG feeding needed professional help. Sixty-two percent needed professional help more frequently with PEG than with NG feeding (compared to 19% who considered that the NG tube needed professional help more frequently; P <0.05). We conclude that leakage and infections are major problems in PEG enteral feeding. 相似文献
30.
Amir Kimia MD John S. Brownstein PhD Karen L. Olson PhD Victor Zak PhD Florence T. Bourgeois MD MPH Kenneth D. Mandl MD MPH 《Academic emergency medicine》2006,13(7):767-773
Background: The Centers for Disease Control and Prevention is incorporating laboratory data into real-time surveillance systems. When normal patterns of laboratory test orders and results are modeled, aberrations can be detected. Because many test orders are available electronically well before results, atypical patterns of test ordering may signal outbreaks.
Objectives: The authors sought to characterize baseline patterns in the ordering and early results of lumbar punctures, motivated by the possibility of using these data for real-time surveillance for early detection of meningitis or encephalitis outbreaks.
Methods: Retrospective cohorts of pediatric emergency department patients at a single hospital (1993–2003) and from the National Hospital and Ambulatory Medical Care Survey (1992–2000) were used for analysis.
Results: Test ordering exhibits seasonal patterns, with monthly peaks in January and August (p < 0.0001). For the hospital cohort, the rate of cerebrospinal fluid pleocytosis exhibits seasonal patterns (p < 0.0001), with a peak from August to October. This is strongly associated with the rate and pattern of clinical neurologic disease (p < 0.0001). A long-term secular decline in daily test ordering is evident, dropping from 5.3 to 2.9 in the hospital sample, and from 371.8 to 185.3 in the national sample (p < 0.001). The long-term rate of pleocytosis has declined (p < 0.0001), though the yield of testing for pleocytosis has improved (p = 0.0104).
Conclusions: Laboratory test patterns correspond with those of clinical disease and are a promising source of surveillance data. Using such data for real-time monitoring requires specific adjustments for patient age, periodicities, and secular trends. 相似文献
Objectives: The authors sought to characterize baseline patterns in the ordering and early results of lumbar punctures, motivated by the possibility of using these data for real-time surveillance for early detection of meningitis or encephalitis outbreaks.
Methods: Retrospective cohorts of pediatric emergency department patients at a single hospital (1993–2003) and from the National Hospital and Ambulatory Medical Care Survey (1992–2000) were used for analysis.
Results: Test ordering exhibits seasonal patterns, with monthly peaks in January and August (p < 0.0001). For the hospital cohort, the rate of cerebrospinal fluid pleocytosis exhibits seasonal patterns (p < 0.0001), with a peak from August to October. This is strongly associated with the rate and pattern of clinical neurologic disease (p < 0.0001). A long-term secular decline in daily test ordering is evident, dropping from 5.3 to 2.9 in the hospital sample, and from 371.8 to 185.3 in the national sample (p < 0.001). The long-term rate of pleocytosis has declined (p < 0.0001), though the yield of testing for pleocytosis has improved (p = 0.0104).
Conclusions: Laboratory test patterns correspond with those of clinical disease and are a promising source of surveillance data. Using such data for real-time monitoring requires specific adjustments for patient age, periodicities, and secular trends. 相似文献