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1.
Managing traumatic liver injury (TLI) is always challenging and demands precise clinical judgment. Currently, treatment of TLI in most circumstances is non-operative; however, surgical therapy might be required for severe TLI, particularly those that result in extensive blood loss. In the current institutional study carried out from June 1995 to April 2017, we describe our experience with 5 patients who received an orthotopic liver transplant for severe TLI. One patient passed away postoperatively from cerebral edema; 1 patient died of renal failure 4 years after the liver transplantation, and 3 patients are still alive. Based on our experience, we conclude that in patients with TLI, especially those with uncontrollable bleeding or those who develop liver failure, liver transplantation should be taken into consideration. 相似文献
2.
Sabin J. Bozso Jeevan Nagendran Roderick G.G. MacArthur Michael W.A. Chu Bob Kiaii Ismail El-Hamamsy Raymond Cartier Ali Shahriari Michael C. Moon 《The Journal of thoracic and cardiovascular surgery》2019,157(5):1763-1771
Objectives
We describe the Canadian results of the Ascyrus Medical Dissection Stent (AMDS), a novel partially uncovered aortic arch hybrid graft implanted antegrade during hypothermic circulatory arrest to promote true lumen expansion and enhance aortic remodeling.Methods
From March 2017 to February 2018, 16 consecutive patients (66 ± 12 years; 38% female) presented with acute type A aortic dissections and underwent emergent surgical aortic repair with AMDS implantation. All patients presented with DeBakey I aortic dissection, with evidence of malperfusion in 50% (n = 8) of patients. All cases were performed under hypothermic circulatory arrest with an additional average duration for AMDS implantation time of 2.1 minutes.Results
All 16 device implantations were successful. Overall 30-day mortality was 6.3% (n = 1) and stroke occurred in 6.3% (n = 1) of cases. There was no incidence of device-related aortic injury or aortic arch branch vessel occlusion. During the follow-up period, 12 patients had completed at least 1 postoperative computed tomography scan. At initial follow-up computed tomography scan, complete or partial thrombosis, and remodeling of the aortic arch occurred in 91.7% of cases (n = 11/12) and in the proximal descending thoracic aorta, complete or partial thrombosis, and remodeling occurred in 91.7% (n = 11/12).Conclusions
Preliminary results suggest that the AMDS is a safe, feasible and reproducible adjunct to current surgical approaches for acute DeBakey I aortic dissection repair. Further, the AMDS manages malperfusion and promotes early positive remodeling in the aortic arch and distal dissected segments, with favorable FL closure rates at follow-up. Ongoing follow-up will provide additional insight into the long-term effects of the AMDS. 相似文献3.
《Clinical colorectal cancer》2022,21(2):80-88
Lateral lymph nodes in low, locally advanced, rectal cancer have proven implications for local recurrence rates, which increase drastically in the presence of persistently enlarged lateral lymph nodes. These clinical implications warrant a thorough understanding of lateral nodal disease with awareness and knowledge from all three specialties involved – radiology, radiation oncology, and surgery – to ensure proper treatment. Relevant literature for each specialty, including all current guidelines and perspectives, were examined. Variations in definitions and treatment paradigms were evaluated. There is still no consensus for the standardized treatment of lateral nodal disease. Each discipline works according to their own available evidence, but relevant data are scarce. Current international guidelines and standard recommendations for the diagnostics and treatment of lateral lymph nodes are lacking. This results in differing perspectives and interpretations between the disciplines which can lead to challenging communication in an area where multidisciplinary collaboration is essential. This review addresses this by presenting the current evidence, perspectives and practices of each specialty and makes suggestions for each phase of the diagnostic and treatment process for patients with lateral nodal disease. By doing this, steps are taken toward achieving international consensus, and multidisciplinary collaboration. 相似文献
4.
目的探讨前列地尔联合长春西汀治疗急性脑梗死的疗效。方法选取2015年3-12月在我科接受治疗的90例急性脑梗死患者,随机分为治疗组(45例)和对照组(45例)。两组患者均给予抗血小板、降血脂等常规对症治疗,11 d为1个疗程。对照组给予长春西汀静脉输液治疗,治疗组在对照组基础上加以前列地尔治疗。比较两组临床治疗效果,治疗前后神经功能恢复情况、日常生活能力恢复情况、并发症发生率及安全性。结果治疗组总有效率为93.3%,对照组为71.1%,治疗组明显高于对照组,差异有统计学意义(P<0.05)。两组患者用药11 d后,神经功能缺损评分均高于治疗前,且治疗组明显高于对照组,差异均有统计学意义(P<0.05)。治疗组患者用药11d及90 d后日常生活能力恢复情况优于对照组,差异有统计学意义(P<0.05)。两组均无严重药物不良反应。结论前列地尔联合长春西汀治疗急性脑梗死疗效显著,值得临床推广应用。 相似文献
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【摘要】 目的 探讨富血小板血浆(PRP)、前列地尔注射液及其联合应用对兔缺血皮瓣的影响。 方法 选择 40 只健康新西兰兔随机分为20组,每组2 只,每只兔背部设计两块以中线对称的 10cm×2.5cm 大小超长宽比例任意皮瓣,形成每组 4 个兔背缺血皮瓣模型。每组随机分为对照瓣及实验瓣1、试验瓣2、试验瓣3。对照瓣:采用局部及静脉均注射生理盐水;实验瓣1:局部注射 PRP,静脉注射生理盐水;试验瓣2:局部注射生理盐水,静脉注射前列地尔注射液(0.8mL/kg);试验瓣3:局部注射 PRP,静脉注射前列地尔注射液。术后 7d 在统一标准下拍照并取材。测量各瓣存活面积,计算皮瓣存活率;HE 染色后镜下观察各瓣组织结构层次、炎性细胞浸润情况及微血管口径变化;免疫组化检测 CD34 表达、测量微血管密度;酶联免疫吸附法(ELISA)检测血管内皮生长因子(VEGF)含量。结果 术后 7d,各瓣远端均发生不同程度坏死,经测量计算后得出:各瓣平均存活面积、存活率、微血管密度、VEGF 含量由大到小依次为:实验瓣3>实验瓣1>实验瓣2>对照瓣,组间比较差异有统计学意义(均P<0.05)。HE 染色后镜下观察可见:所有实验瓣较对照瓣组织水肿轻,新生毛细血管增多;实验瓣3较对照瓣及实验瓣1、实验瓣2结构、层次更清晰分明,新生毛细血管最多,大部分管腔扩大,炎性细胞浸润较少,组织水肿轻;实验瓣1较实验瓣2组织结构分明,新生毛细血管较多,炎性细胞浸润较少,但实验瓣2血管管腔直径更大。结论 富血小板血浆、前列地尔注射液单独应用时均能不同程度改善兔缺血皮瓣缺血坏死,提高皮瓣存活率,并且二者联合应用效果优于单独使用。 相似文献
9.
Xiaoying Liang Dandan Zheng Maria Mamalui-Hunter Stella Flampouri Bradford S. Hoppe Nancy Mendenhall Zuofeng Li 《Practical radiation oncology》2019,9(1):38-48
Purpose
Using planning target volume (PTV) to account for setup uncertainties in stereotactic body radiation therapy (SBRT) of lung cancer has been questioned because a significant portion of the PTV contains low-density lung tissue. The purpose of this study is to (1) investigate the feasibility of using robust optimization to account for setup uncertainties in volumetric modulated arc therapy plan for lung SBRT and (2) evaluate the potential normal tissue–sparing benefit of a robust optimized plan compared with a conventional PTV-based optimized plan.Methods and materials
The study was conducted with both phantom and patient cases. For each patient or phantom, 2 SBRT lung volumetric modulated arc therapy plans were generated, including an optimized plan based on the PTV (PTV-based plan) with a 5-mm internal target volume (ITV)-to-PTV margin and a second plan based on robust optimization of ITV (ITV-based plan) with ±5-mm setup uncertainties. The target coverage was evaluated on ITV D99 in 15 scenarios that simulated a 5-mm setup error. Dose-volume information on normal lung tissue, intermediate-to-high dose spillage, and integral dose was evaluated.Results
Compared with PTV-based plans, ITV-based robust optimized plans resulted in lower normal lung tissue dose, lower intermediate-to-high dose spillage to the body, and lower integral dose, while preserving the dose coverage under setup error scenarios for both phantom and patient cases.Conclusions
Using ITV-based robust optimization, we have shown that accounting for setup uncertainty in SBRT planning is feasible. Further clinical studies are warranted to confirm the clinical effectiveness of this novel approach. 相似文献10.