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1.
Anand Dayama Nikolaos Tsilimparis Stephen Kolakowski Nathaniel M. Matolo Misty D. Humphries 《Journal of vascular surgery》2019,69(1):156-163.e1
Background
Chronic limb-threatening ischemia (CLTI), defined as ischemic rest pain or tissue loss secondary to arterial insufficiency, is caused by multilevel arterial disease with frequent, severe infrageniculate disease. The rise in CLTI is in part the result of increasing worldwide prevalence of diabetes, renal insufficiency, and advanced aging of the population. The aim of this study was to compare a bypass-first with an endovascular-first revascularization strategy in patients with CLTI due to infrageniculate arterial disease.Methods
We reviewed the American College of Surgeons National Surgical Quality Improvement Program targeted lower extremity revascularization database from 2012 to 2015 to identify patients with CLTI and isolated infrageniculate arterial disease who underwent primary infrageniculate bypass or endovascular intervention. We excluded patients with a history of ipsilateral revascularization and proximal interventions. The end points were major adverse limb event (MALE), major adverse cardiovascular event (MACE), amputation at 30 days, reintervention, patency, and mortality. Multivariable logistic regression was used to determine the association of a bypass-first or an endovascular-first intervention with outcomes.Results
There were 1355 CLTI patients undergoing first-time revascularization to the infrageniculate arteries (821 endovascular-first revascularizations and 534 bypass-first revascularizations) identified. There was no significant difference in adjusted rate of 30-day MALE in the bypass-first vs endovascular-first revascularization cohort (9% vs 11.2%; odds ratio [OR], 0.73; 95% confidence interval [CI], 0.50-1.08). However, the incidence of transtibial or proximal amputation was lower in the bypass-first cohort (4.3% vs 7.4%; OR, 0.60; CI, 0.36-0.98). Patients with bypass-first revascularization had higher wound complication rates (9.7% vs 3.7%; OR, 2.75; CI, 1.71-4.42) compared with patients in the endovascular-first cohort. Compared with the endovascular-first cohort, the incidence of 30-day MACE was significantly higher in bypass-first patients (6.9% vs 2.6%; adjusted OR, 3.88; CI, 2.18-6.88), and 30-day mortality rates were 3.23% vs 1.8% (adjusted OR, 2.77; CI, 1.26-6.11). There was no difference in 30-day untreated loss of patency, reintervention of treated arterial segment, readmissions, and reoperations between the two cohorts. In subgroup analysis after exclusion of dialysis patients, there was also no significant difference in MALE or amputation between the bypass-first and endovascular-first cohorts.Conclusions
CLTI patients with isolated infrageniculate arterial disease treated by a bypass-first approach have a significantly lower 30-day amputation. However, this benefit was not observed when dialysis patients were excluded. The bypass-first cohort had a higher incidence of MACE compared with an endovascular-first strategy. These results reaffirm the need for randomized controlled trials, such as the Bypass versus Angioplasty in Severe Ischaemia of the Leg (BASIL-2) trial and Best Endovascular vs Best Surgical Therapy in Patients with Critical Limb Ischemia (BEST-CLI), to provide level 1 evidence for the role of endovascular-first vs bypass-first revascularization strategies in the treatment of this population of challenging patients. 相似文献2.
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4.
Tarek A. Amer Tarek F. Elwakil Mahmoud S. Elbasiouny 《European journal of plastic surgery》2007,30(2):67-73
Haemangiomas are the most common tumours of infancy. They typically proliferate then involute with considerable variation
as regards to their rates of proliferation and involution. Haemangioma of the nasal tip is a lesion of special characteristics.
During proliferation, it expands, contracts and deviates the nasal cartilages. Particularly, it regresses slowly and frequently
involutes incompletely. That is why excision of the lesion is frequently suggested. The present study was conducted to evaluate
open rhinoplasty after initial non-excision treatment modalities namely, intra-lesional corticosteroid injections and laser
treatment, as a protocol of treatment for nasal tip haemangiomas. Twelve patients with nasal tip haemangiomas were included
in the present study. Patients of both sexes, of different ages, with deep and mixed haemangiomas were studied. Disfigurement
was the constant presenting symptom. Initial non-excision treatment reported different responses as denoted by the regression
of the lesions’ size. Haemangiomas constantly extended between the medial crura of the alar cartilages as noted by the constant
widening of the columella pre-operatively and the obvious separation of the nasal cartilages intra-operatively. This separation
was constantly found to require approximation by sutures. The results of the present study concluded that whenever an early
presentation with nasal tip haemangioma could be established, initial non-excision treatment followed by open rhinoplasty
could be a useful protocol of treatment. Within the limitations of the present study, this protocol could achieve an early,
safe and effective treatment for nasal tip haemangiomas with provisionally acceptable cosmetic outcomes so far. 相似文献
5.
腹腔镜手术与开放手术治疗精索静脉曲张的对比性研究(附273例分析) 总被引:5,自引:0,他引:5
目的:对比研究腹腔镜和开放手术精索静脉高位结扎术治疗精索静脉曲张的疗效。方法:回顾分析121例腹腔镜和152例开放手术精索静脉高位结扎术的临床资料,比较两种方法在手术时间、术后住院天数及综合治疗费用及术后止痛药应用等的差异。结果:两组在手术时间、术后住院天数及止痛药应用等方面差异均有高度显著性(P<0.01),腹腔镜组均优于开放手术组;综合治疗费用两组差异无显著性(P>0.05)。结论:腹腔镜治疗精索静脉曲张较开放手术具有创伤小、康复快,术后住院时间短及美容效果好等优点。 相似文献
6.
目的 评价开放复位可塑形钛板内固定治疗跟骨骨折的疗效。方法 对33例(37足)以后关节突移位为主的跟骨骨折,行跟骨外侧入路、开放性复位可塑形钛板螺钉内固定,必要时行植骨术(18例)。结果 平均随访11.5个月,参照Mary—land food score评分,对患足是否疼痛、步态、距下关节及踝关节活动度、是否支架辅助、术后X线摄片等加以评估,19足疗效为优,17足为良,1足可。其中钛板断裂1例,手术切口皮缘坏死1例,换药后自愈。结论 跟骨外侧入路开放复位可塑形钛板螺钉内固定,必要时植骨术是治疗跟骨骨折的有效方法。 相似文献
7.
21例心内直视术后急性心包填塞的临床分析 总被引:1,自引:1,他引:0
目的:分析21例心内直视术后急性心包填塞的临床特点,探讨其发生原因、预防、救治及其二次开胸的早期指征。方法:对1991年1月-2005年12月心内直视术(共1096例)后21例急性心包填塞二次开胸(发生率1.92%)病例进行总结分析。结果:急性心包填塞患者经二次剖胸解除心包填塞后17例痊愈出院,4例死亡,二次剖胸手术死亡率为19.05%。二次剖胸手术者所患疾病包括先天性心脏病6例,瓣膜病13例,大血管手术1例,心脏移植1例。结论:减少心内直视术后出血、渗血是避免术后发生急性心包填塞的关键,早期诊断并尽早行二次剖胸手术可明显降低围手术期死亡率。 相似文献
8.
C. Faldini M. Manca S. Pagkrati D. Leonetti M. Nanni G. Grandi M. Romagnoli M. Himmelmann 《Journal of orthopaedics and traumatology》2005,6(4):188-193
Abstract Complex tibial plateau fractures are a challenge in trauma surgery. In these fractures it is necessary to anatomically reduce
the articular part of the fracture and to obtain stable fixation. The aim of this study is to review the results of a surgical
technique consisting of fluoroscopic closed reduction and combined percutaneous internal and external fixation. Thirty-two
complex tibial plateau fractures in 32 patients were included. Twenty-one fractures were closed, 4 were open Gustilo grade
I, 3 were Gustilo grade II and 4 were Gustilo grade III. The mean age was 37.8 years (range 21–64 years). Surgery was performed
with patients in transcalcaneal traction and the knee flexed at 30° was used. Through a 1-cm incision centred over the tibial
metaphysis of the tibia, a 3.2-mm hole was drilled in the antero-medial tibial aspect. The tibial plateau fracture fragments
were elevated using either 1 or 2 curved Kirschner wires under fluoroscopy to control the reduction. Then the fragments were
fixed with 2 cannulated AO screws inserted through small incisions into the medial aspect of the tibial plateau. Knee rehabilitation
started postoperatively. Weight bearing started after 8–12 weeks depending upon the radiographic appearance. All external
fixators were removed in outpatient facilities. All patients were clinically and radiographically evaluated at a mean follow-up
of 48 months (range 38–57 months). Clinical results were evaluated according to the Knee Society clinical score. Average healing
time was 24 weeks (range 18–29 weeks). In 1 patient a non-union occurred. This patient was treated with open reduction and
plate fixation. In 2 patients a varus knee deformity occurred and a surgical correction was performed. There were no surgical
complications. Mean knee range of motion was 105° (range 75–125°) and mean Knee Society clinical score was 89. Twenty-five
results were scored as excellent, 4 good, 2 fair and 1 poor. Using this technique there is limited soft tissue damage and
virtually no periosteum damage to the fracture fragments. However anatomical reconstruction of the joint can be obtained.
Furthermore knee rehabilitation can be started immediately after surgery. We think that these factors were responsible for
the optimal clinical long-term results. 相似文献
9.
Koji Tomobe Hajime Fujii Buxiang Sun Hiroshi Nishioka Okezie I Aruoma 《Biomedicine & Pharmacotherapy》2007,61(7):427-434
Oligonol is produced from the oligomerization of polyphenols (typically proanthocyanidin from a variety of fruits such as lychees, grapes, apples, persimmons, etc.) and contains catechin-type monomers and oligomers of proanthocyanidins. The ability of Oligonol to affect infection-dependent eye inflammation, locomotion and longevity in senescence-accelerated prone mice (SAMP8) (a model of senescence acceleration and geriatric disorders with increased oxidative stress and neuronal deficit) was investigated. Oligonol (60mg/kg) significantly modulated the extent of inflammation scores in the eye of SAMP8 mice. Examination of the mice indicated infection with mouse hepatitis virus and pinworm (Syphacia obvelata) in both males and females and with the intestinal protozoa (trichomonad) in males. A comparison of the two groups (using log-rank test) and the difference in the mean life span between groups (using Student's t-test) indicated significant differences in survival (p=0.043) and the mean life span (p=0.033) in male SAMP8 mice. Oligonol increased the mean life span and this was statistically significant. In the open-field locomotive test, the 7-week-old SAMP8 mice crossed more than 40 partitioned lines in 1min. At 48-week-old control untreated male SAMP8 crossed 2 lines. The Oligonol-treated 48-week-old male SAMP8 mice crossed 17 lines however. The improved locomotive activity was statistically significant even after 36weeks in the Oligonol-treated male SAMP8 but this was not the case throughout the time course of the study in the Oligonol-treated female SAMP8. Thus Oligonol treatment to SAMP8 mice modulated the severity of infection-dependent inflammation, prolonged life-span and significantly improved locomotive activity indicating potential benefit to aging-associated diseases such as Alzheimer's or Parkinson's diseases. This presents potential for further research to define infection-dependent inflammation associated with degenerative conditions and the molecular mechanism of dietary antioxidant protection. 相似文献
10.
Laparoscopic flip-flap technique versus conventional inguinal hernia repair in children. 总被引:1,自引:0,他引:1
Mohamed E Hassan A R Mustafawi 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2007,11(1):90-93
BACKGROUND AND OBJECTIVES: Inguinal hernia repair is one of the most frequently performed pediatric surgical operations. Several pediatric laparoscopic inguinal hernia repair techniques have been introduced. But debate is unresolved regarding the feasibility of laparoscopy for treating pediatric inguinal hernias. METHODS: A retrospective cohort study enrolled 33 patients who underwent congenital inguinal hernia repair by either the new laparoscopic flip-flap technique or conventional open repair. Patients were divided into 2 groups according to the type of surgery: Group A included those who underwent the new laparoscopic technique, and Group B included those who underwent conventional open repair. RESULTS: Group A comprised 15 patients (mean age, 39 months), and group B comprised 18 (mean age, 44 months). Mean operative time was 47.5 minutes for Group A versus 27.5 minutes for Group B. Intraoperative complications for Group A included 1 case (7%) of vas deferens injury, and 3 cases (20%) in which the flaps were torn during suturing. In Group B, no intraoperative complications were encountered. In both groups, the mean postoperative hospital stay was 5.5 hours. Postoperative follow-up of 3 months revealed recurrence in 4 patients in Group A (27%), while there were no recurrences in Group B. CONCLUSION: Our preliminary experience shows unsatisfactory outcomes with laparoscopic flip-flap hernia repair in children. In spite of advancement in the application of laparoscopy in pediatric surgery, conventional open hernia repair is still the gold standard for children, in our experience. Future studies with more numbers and longterm follow-up should be conducted. 相似文献