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61.
《Expert review of cardiovascular therapy》2013,11(5):871-880
Obstructive lesions in the aortic arch are comprised of discrete coarctation, tubular hypoplasia and interruption. This review discusses the anatomy of the lesions relevant to interventional treatment. Catheter intervention, using not only balloon angioplasty but also stent implantation for coarctation, has been developed over the past couple of decades as an alternative treatment to surgery. Several studies have reported long-term outcome and the benefits of surgery and catheter intervention for treating obstructive lesions in the aortic arch but more studies are needed for comparable evaluations. The development of imaging and further improvement of surgical and catheter intervention, such as hybrid intervention or new devices, will help in removing the obstruction safely. 相似文献
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IntroductionKyphoscoliosis, which is a deformity of the spine caused by aging and osteoporosis, results in various surgical difficulties for laparoscopic cholecystectomy (LC) due to low-lying costal arches, such as a small abdominal working space, disturbance of the surgical view and decreased controllability of the surgical instrument.Presentation of caseWe herein report the case of a 92-year old woman with severe kyphoscoliosis who was diagnosed with Grade II acute cholecystitis. Taking her general status into consideration, emergency percutaneous transhepatic gallbladder drainage (PTGBD) was initially performed. After PTGBD, the patient’s physical status and systemic inflammation markedly improved. She then underwent interval LC. The surgical view of the upper abdomen including the gallbladder was entirely interrupted by bilateral low-lying costal arches with adhesion to the greater omentum. To access the gallbladder without interruption by the low-lying costal arch, the first umbilical port was changed to a multi-port with surgical glove and an additional port was added in the left abdomen. Consequently, LC was safely accomplished with the creation of the critical view.DiscussionA low-lying costal arch due to kyphoscoliosis can prevent surgeons from accessing the gallbladder. LC with the standard 4-port method could not be accomplished because of insufficient lifting of the low-lying costal arch. Devised placement of the ports is needed to access the gallbladder between bilateral low-lying costal arches.ConclusionA transumbilical multi-port and left abdominal port may be effective for successful LC of acute cholecystitis with kyphoscoliosis. 相似文献
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目的 探讨白介素-2应用于主动脉夹层全弓置换术后多乳糜引流量患者的安全性及有效性.方法 将41例主动脉夹层全弓置换术后的多乳糜引流量患者随机分为实验组(20例)和对照组(21例).并于术后5、7、9d上午10:00左右,在试验组纵隔引流管内注入白介素-2注射液400万U(加生理盐水20 mL),对照组注入等量的生理盐水.术后记录患者24 h引流量(5、7、9、11、15 d)、带引流管时间、住ICU时间和住院时间,并观察并发症发生情况.结果 术后两组引流量均逐渐减少,试验组各时间点引流量均少于对照组,两者相比,在术后7、9、11、15d差异有统计学意义(P<0.05).试验组带引流管时间明显少于对照组(P<0.05).两组术后发热、肺部感染及住ICU时间相比,差异无统计学意义(P>0.05).试验组营养不良发生率及术后住院时间明显低于对照组(P<0.05).结论 经纵隔引流管注入白介素-2能明显降低主动脉夹层全弓置换术后引流量,缩短住院时间,且不增加感染、营养不良等发生率. 相似文献
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目的:探讨可摘义齿修复对于天然牙短牙弓患者口腔健康相关生活质量的影响。方法该院口腔科自2010年1月—2013年12月共收治160例天然牙短牙弓患者,所有160例天然牙短牙弓患者均给予可摘义齿修复,在义齿修复前和修复后3个月发放口腔健康影响程度量表,比较修复前后患者口腔健康相关生活质量评分。结果患者行义齿修复前口腔健康相关生活质量评分10(6,14)分,义齿修复3个月后得分5(3,8)分,显著低于义齿修复前得分(P <0.05);生理疼痛、生理障碍、残障得分修复后得分显著低于修复前(P <0.05),功能限制修复后得分显著高于修复前(P <0.05)。结论可摘义齿修复虽然增加功能限制,但能够在生理疼痛、生理障碍、残障方面提高患者口腔相关生活质量,从而总体上能够提高患者生活质量。 相似文献
68.
正主动脉弓离断(interruption of aortic arch,IAA)是主动脉弓的两个节段之间或主动脉弓与降主动脉之间的管腔完全失去解剖上的连续性,或仅由闭锁的纤维束条相连,而无直接的血液相通。因血流动力学影响严重、预后差,未及时治疗,75%多于出生后1个月死亡,90%在1年内死亡~([1]),因此早期诊断及手术非常 相似文献
69.
The aortic arches of 34 specimens with hypoplastic left heart syndrome were studied in order to establish the frequency, the nature and the clinical implications of aortic arch anomalies. A localized aortic coarctation was present in 23 specimens. The coarcation was located preductally in 2 and paraductally in 21 cases. The degree of obstruction caused by the coarctation varied considerably. In only 6 cases (1 preductal and 5 paraductal) was the obstruction judged to be severe. One of these cases had an additional aneurysm of the aortic wall proximal to the coarctation. An aberrant relation of the ductus arteriosus and the aortic arch was found in 2 specimens without localized coarctation. In the remaining 9 specimens the aortic arch appeared normal. The aortic arch anomalies were mostly present in specimens with a severely hypoplastic ascending aorta. Clinicians, when preparing infants with hypoplastic left heart syndrome for surgical palliation, should always suspect associated aortic arch anomalies, especially when there is severe hypoplasia of the ascending aorta. Coarctation of the aorta will require additional surgical treatment. 相似文献
70.
Summary A case of relapsing polychondritis with aortic arch aneurysm and aortic arch syndrome is described. The pattern of vascular involvement supports the inclusion of relapsing polychondritis within the spectrum of systemic vasculitides. 相似文献