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Increased arterial stiffness in young normotensive patients with Turner syndrome: associations with vascular biomarkers 下载免费PDF全文
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Gastroesophageal reflux is the most common benign disorder of the esophagus and laparoscopic Nissen fundoplication has become the standard surgical treatment for its treatment. In our area, where the use of bougie calibration is debatable, postoperative dysphagia is encountered often after this surgery although it is usually not permanent. The aim of this study was to investigate the effect of using a soft silicone tube 39 F in diameter for esophageal calibration during laparoscopic Nissen fundoplication on the incidence of postoperative dysphagia. We divided cases scheduled to undergo laparoscopic Nissen fundoplication between January 2009 and November 2010 into two groups, each consisting 25 patients. Esophageal calibration with a 39 F silicone orogastric tube was used for the first group while there was no operative calibration in the second group. The surgical duration was recorded; the presence and severity of the postoperative dysphagia was calculated by using a dysphagia severity scoring system during the 1-year postoperative follow-up. The dysphagia severity scores were significantly lower in group 1 than group 2 on the postoperative second day and at the end of the first week and first month. We did not find a significant difference at the end of the 6-month and first year. There was also no significant difference regarding surgery duration. The use of a soft orogastric tube 39 F in diameter for esophagus calibration during laparoscopic Nissen fundoplication has significantly decreased the incidence of postoperative transient dysphagia without affecting the duration of surgery. Although dysphagia gradually resolves in the majority of patients, a safe and easy calibration method for its prevention is worth developing, and we believe that the use of our method in larger series could be beneficial. 相似文献
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BackgroundChildren with adrenal suppression (AS), a potential side effect of glucocorticoids (GCs) may be asymptomatic, present with nonspecific signs and symptoms or with adrenal crisis. Asymptomatic AS (AAS) can only be diagnosed through screening. Identifying and treating asymptomatic patients before symptoms develop may reduce morbidity. Screening guidelines for AS are lacking. Consequently, screening practices are highly variable.ObjectiveTo assess (1) the screening practices for and recognition of paediatric AAS among clinicians in Canada and (2) the educational impact of a 2-year surveillance program of symptomatic AS cases.MethodsBefore and after a 2-year Canadian Paediatric Surveillance Program (CPSP) study of symptomatic AS, participants were surveyed through the CPSP. The prestudy survey was sent to 2,548 participants in March 2010 and the poststudy survey was sent to 2,465 participants in April 2013.ResultsResponse rates were 32% for the prestudy survey and 21% for the poststudy survey. Between the pre- and poststudy surveys, the percentage of physicians who reported routinely screening patients on GCs for AS increased from 10% to 21% and the percentage who reported having a screening policy in their office/centre increased from 6% to 11%. There was no significant change in the percentage of physicians who had diagnosed a child/youth with AAS in the preceding year.ConclusionFrequency of screening for AAS increased following the 2-year study but remains low. Development of a clinical practice guideline should increase both awareness of asymptomatic AS among Canadian paediatricians and the identification of AAS, before symptoms develop. 相似文献
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Hidir Esme MD Huseyin Fidan MD Ahmet Cekirdekci MD 《Indian Journal of Thoracic and Cardiovascular Surgery》2006,22(2):137-140
Background Hydatid disease is the most severe helminthic zoonosis, with an important public health problem especially in rural areas
in Turkey. The aim of this study was to review the problems and advantages encountered in surgical treatment of 43 patients
who were ventilated with one-lung ventilation during last four years.
Methods Patients, operated with one-lung ventilation, constitute the study group. Data related to symptoms, radiographic findings,
performed surgical procedures, perioperative and postoperative morbidity, hospitalization time, and cyst recurrence were collected
from each individual's records.
Results Cystotomy and capitonnage were performed in all cases. Perioperative complications were seen in 5 patients. Four of these
5 patients had double-lumen endotracheal tube malpositioning. In one patient hypoxemia developed. The most common postoperative
complication was atelectasis. One patient had recurrent cysts. There was no perioperative or postoperative death.
Conclusions We prefer cystotomy and capitonnage because it is a fast and effective technique with limited postoperative complications.
One-lung ventilation prevents the exposure of lower lung areas from massive aspiration, which may cause acute obstruction
of airways, and contamination by cyst contents from the operative part of the lung that causes recurrent disease. One-lung
ventilation in pulmonary hydatid cyst surgery may be preferred owing to lower mortality and morbidity rates. 相似文献
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Nurzat Elmali Nevzat Elmali Irfan Esenkaya Ahmet Harma 《European Journal of Trauma》2005,31(6):586-589
Abstract Traumatic knee dislocations are relatively rare and almost always respond to closed reduction; however, a small percentage
of knee dislocations are irreducible and in these cases open reduction is frequently required. A 65-year-old man with an unreduced
posterolateral knee dislocation with laterally dislocated patella was seen 3 weeks after a motor vehicle accident. Medial
femoral condyle was found buttonholed through the medial capsule together with the medial collateral ligament and lying in
the medial joint space that allowed posterior rotary dislocation of the joint. Both cruciate ligaments and medial meniscus
were torn. There was no evidence of any vascular or nerve injury. Reduction was accomplished by removal of the capsuloligamentous
structures which were incarcerated in the trochlea and intercondylar notch and by excision of meniscal tear. Following posterior
cruciate ligament reconstruction with patellar tendon autograft, lateral patellar release, vastus medialis advancement, and
gracilis transfer were done. 相似文献
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Predictive Factors for Conversion of Laparoscopic Cholecystectomy 总被引:10,自引:0,他引:10
Ahmet Alponat Cheng K. Kum Bee C. Koh Andrea Rajnakova Peter M.Y. Goh 《World journal of surgery》1997,21(6):629-633
Reliable predictive factors for conversion of laparoscopic cholecystectomy (LC) would be extremely useful in the preparation and planning of admission for patients with symptomatic cholelithiasis. Data from 783 patients in whom LC was attempted in a university clinic from June 1990 to December 1995 were retrospectively analyzed. The aim of this study was to determine preoperative indicators that can be useful for predicting conversion to open cholecystectomy (OC). Conversion was required in 58 (7.4%) patients, of which 48 (83%) were elective and 10 (17%) emergency. Factors evaluated were age, sex, obesity, duration of gallstone disease, co-morbid factors, indication for surgery, previous abdominal surgery, fever, physical examination findings, white blood cell (WBC) count, liver function tests, ultrasound findings, and the experience of the surgeon. Acute cholecystitis, rigidity in the right upper abdomen, fever, thickened gallbladder wall on ultrasonography, elevated alkaline phosphatase (ALP), liver transaminases and the WBC count were significant predictors of conversion in the univariate analysis. Multivariate logistic regression analysis on these significant predictors showed that acute cholecystitis [odds ratio (OR) = 3.12], thickened gallbladder wall on ultrasonography (OR = 3.75), elevated ALP (OR = 2.23), and WBC count (OR = 3.69) were jointly significant. 相似文献