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Background
The significance of a positive culture at reimplantation remains an important topic of consideration given the lack of clear metrics for when reimplantation can be performed. The purpose of this study is thus to investigate the (1) association between a positive culture during reimplantation and failure following 2-stage exchange arthroplasty and the (2) influence of prolonged antibiotics on these patients.Methods
We retrospectively reviewed 117 patients undergoing 2-stage exchange hip arthroplasty from 2012 to 2016. Of them, 23 had positive culture during reimplantation and were treated with 2 weeks of intravenous and 4 weeks of oral antibiotics following reimplantation. All patients had a minimum follow-up of 1 year. Logistic regression models were performed to identify association between positive culture and subsequent treatment failure. A meta-analysis was also performed to validate findings. A subgroup analysis was performed to explore whether 6-week antibiotics (oral, intravenous, or both) after reimplantation improved outcomes.Results
A total of 11 studies, which included 141 cases with a positive culture at reimplantation and 784 with negative cultures, were included in the meta-analysis. The pooled data showed a higher risk of failure in patients with a positive culture than those with a negative culture (41.1% vs 14.8%, odds ratio 4.58). The subgroup analysis revealed that 6 weeks of antibiotic administration following reimplantation decreased the odds of reinfection from 9.35 to 3.12. The findings in the retrospective cohort were consistent with those of the meta-analysis; the failure rate was significantly higher in patients with a positive culture than those with negative cultures (26.1% vs 6.4%, P < .001).Conclusion
Six weeks of antibiotics appear to decrease the odds of reinfection after reimplantation. However, despite patients receiving 6 weeks of antibiotics after reimplantation, the risk of reinfection in patients with a positive culture at reimplantation is still more than 3 times higher than those with negative cultures. Further studies are needed to investigate optimal management for such patients. 相似文献63.
《Journal of vascular and interventional radiology : JVIR》2019,30(8):1265-1272
PurposeTo evaluate the safety and efficacy of balloon pulmonary angioplasty (BPA) for nonoperable chronic thromboembolic pulmonary hypertension (CTEPH) patients during the initial experience of a single center.MethodsA total of 18 CTEPH patients (5 with residual pulmonary hypertension after pulmonary endarterectomy) were treated with BPA during the period 2014–2018 and were retrospectively reviewed. Mean age was 61 ± 19 years; 55% were female; mean pulmonary artery pressure was 44 ± 12 mmHg; cardiac output was 4.3 ± 1.0 l/min; and pulmonary vascular resistance was 8.4 ± 3.6 WU. Patients were evaluated by New York Heart Association functional class, 6-minute walk distance, N-terminal pro b-type natriuretic peptide, echocardiography, right heart catheterization, and before and after completions of BPA.ResultsA total of 91 procedures were performed, with a median number of 4 BPA sessions per patient (range, 2–8). There were no deaths or major complications requiring extracorporeal support or (non)invasive ventilation. The most common complication was self-limiting hemoptysis (3%). According to Society of Interventional Radiology classification, 4 mild, 4 moderate, and 1 severe adverse events were noted. Invasive hemodynamics significantly improved, with a cardiac index increase of 15% (P = .0333), decrease of mean pulmonary artery pressure of 30% (P = .0013), and decrease of pulmonary vascular resistance of 45% (P = .0048). Stroke volume index (P = .0171) and pulmonary arterial compliance (P = .0004) were also significantly enhanced.ConclusionsBPA significantly improves cardiopulmonary hemodynamics with an acceptable safety profile. Further studies assessing the long-term efficacy of BPA are required. 相似文献
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Ashok Garg Deepak Agrawal Deepika Mishra Gyarsi Lal Sharma 《Echocardiography (Mount Kisco, N.Y.)》2019,36(7):1421-1422
Raghib syndrome is a rare developmental complex consisting of termination of the left superior vena cava in the left atrium, absence of the coronary sinus, and an atrial septal defect commonly located at the posterior‐inferior angle of the atrial septum. This complex was considered unique to Raghib syndrome; however, cases with a normal atrial septum have been reported where the orifice of the unroofed coronary sinus functions as the inter‐atrial communication. Our patient demonstrated an isolated persistent left superior vena cava draining into the left atrium through unroofed coronary sinus and presence of ostium primum atrial septal defect. 相似文献
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Ranjit Philip Jeffrey A. Towbin Shyam Sathanandam Jason Goldberg Thomas Yohannan Nithya Swaminathan Jason Nathaniel Johnson 《Congenital heart disease》2019,14(1):33-36
There continues to be controversy on the long‐term effects of a patent ductus arteriosus (PDA) and its management. However, the hemodynamic effects of a large PDA in a preterm infant are well known. This article aims to provide insight into the adaptive changes and remodeling effects of a PDA on the myocardium in preterm infants. 相似文献
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