共查询到20条相似文献，搜索用时 15 毫秒
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Hans-Eric Rosberg Derya Burcu Hazer Rosberg Illugi Birkisson Lars B. Dahlin 《Journal of orthopaedic science》2017,22(5):915-918
Background
Digital nerve injuries in children are not common, but they are considered to have an excellent prognosis, compared to adults, after nerve injury and repair. In studies including both children and adults age have been found to have an effect on outcome after nerve repair.Methods
We investigated in a retrospective follow up study the long-time result after digital nerve injury and repair in children, 1–16 years of age (n = 38), and evaluate if age influences outcome. A group with young children, 1–10 years of age (n = 18), was compared with a group with older children, 11–16 years of age (n = 20). A clinical evaluation to evaluate sensation and grip strength was performed and questionnaires were used [Disability of the Arm, Shoulder and Hand (DASH), Cold Sensitivity Severity Scale (CISS), VAS-function and VAS-cosmetic] in median 40 months (range 12–131 months) after the injury and repair.Results
All patient regained normal sensation. No correlations between age and monofilaments were found. Twenty children (52%) reported some problems with cold intolerance (i.e. CISS), but no other abnormal disability was found (i.e. DASH, VAS); again with no differences between the two groups.Conclusions
Children have an excellent long-term recovery after a digital nerve repair and without any influence of age. 相似文献3.
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Jonathan C. DeLong Erin P. Ward Thinzar M. Lwin Kevin T. Brumund Kaitlyn J. Kelly Santiago Horgan Michael Bouvet 《Surgery》2018,163(2):388-392
Background
Our aim was to evaluate the ease and utility of using indocyanine green fluorescence angiography for intraoperative localization of the parathyroid glands.Methods
Indocyanine green fluorescence angiography was performed during 60 parathyroidectomies for primary hyperparathyroidism during a 22-month period. Indocyanine green was administered intravenously to guide operative navigation using a commercially available fluorescence imaging system. Video files were graded by 3 independent surgeons for strength of enhancement using an adapted numeric scoring system.Results
There were 46 (77%) female patients and 14 (23%) male patients whose ages ranged from 17 to 87 (average 60) years old. Of the 60 patients, 43 (71.6%) showed strong enhancement, 13 (21.7%) demonstrated mild to moderate vascular enhancement, and 4 (6.7%) exhibited little or no vascular enhancement. Of the 54 patients who had a preoperative sestamibi scan, a parathyroid adenoma was identified in 36, while 18 failed to localize. Of the 18 patients who failed to localize, all 18 patients (100%) had an adenoma that fluoresced on indocyanine green imaging. The operations were performed safely with minimal blood loss and short operative times.Conclusion
Indocyanine green angiography has the potential to assist surgeons in identifying parathyroid glands rapidly with minimal risk. 相似文献7.
Bipin Sunkara Mark S. Cohen Barbra S. Miller Paul G. Gauger David T. Hughes 《Surgery》2018,163(1):42-47
Background
The influence of chronic kidney disease on intraoperative parathyroid hormone monitoring during parathyroidectomy for primary hyperparathyroidism has not been well-established. We hypothesize that chronic kidney disease influences intraoperative parathyroid hormone degradation kinetics during parathyroidectomy.Methods
This is a single institution retrospective cohort study of consecutive patients with primary hyperparathyroidism underdoing parathyroidectomy. Patients were stratified according to normal kidney function (glomerular filtration rates ≥60?mL/min/1.73?m2 or presence of chronic kidney disease (glomerular filtration rates 15???60?mL/min/1.73?m2). Demographics, laboratory data, operative findings, and intraoperative parathyroid hormone data were compared between groups.Results
Of the 964 study patients, 235 had chronic kidney disease (24.4%), while 729 (75.6%) had normal kidney function. The chronic kidney disease population had a greater median preoperative serum parathyroid hormone (PTH) (125 vs 114?pg/mL; P?<?.001), but similar median intraoperative parathyroid hormone levels (chronic kidney disease versus normal): baseline (190 vs 189; P?=?.232), 5 minutes (51 vs 47; P?=?.667), 10 minutes (37 vs 35; P?=?.626), and at 15 minutes postexcision (28 vs 27; P?=?.539). There was no significant difference in the kinetics of the intraoperative parathyroid hormone degradation slope from the baseline to the 15-minute postexcision levels comparing chronic kidney disease with normal kidney function (?21.02 vs ?20.83; P?=?.957). Patients with chronic kidney disease had 15-minute postexcision intraoperative parathyroid hormone levels within the normal range (12???65?pg/mL) as frequently as patients with normal kidney function (81% vs 82%; P?=?.906) and had similar rates of persistent disease (3.4% vs 3.4%; P?=?.985).Conclusion
Patients with chronic kidney disease undergoing parathyroidectomy for primary hyperparathyroidism have similar intraoperative parathyroid hormone degradation kinetics, and the intraoperative parathyroid hormone criteria used to predict cure should be similar to those with normal kidney function. 相似文献8.
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In 34 post-mortem examinations of car occupants wearing seat belts and killed in straight or oblique head-on collisions, a thorough investigation of the spine was performed. The autopsy results were correlated with the findings in the cars in order to reconstruct the events when the occupant's body struck the interior of the car. In 2 cases the victims had worn lap belts, in 15 cases shoulder belts and in 17 cases combined shoulder-lap belts (three-point belts). In victims involved in head-on collisions while wearing lap belts, fractures of the neural arch of the axis were found which were probably due to flexion of the neck pivoting round the lower part of the impacting face and simultaneous stretching of the neck. Severe injuries to the cervical spine in those victims wearing shoulder belts were mainly due to the occupant sliding under the belt which then caught the neck and mandible. Such injuries were also caused by the impact of the head against forward parts of the car. In those wearing shoulder-lap belts injuries to the upper part of the cervical spine resulted from the impact of the head against internal parts of the car. When a slight impact of the head occurred minor injuries to the lower cervical spine were seen. Injuries to the thoracolumbar spine in the cases examined were the consequence of a violent extension between the upper part of the trunk held back by the shoulder belt and the pelvis restrained by the lap belt or by the knees striking the fascia panel. In front seat occupants this extension can be increased if either rear seat occupants without belts or heavy objects on the rear seat are projected forwards against their backs. 相似文献
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Andrea R. Marcadis Richard Teo Wenqi Ouyang Josefina C. Farrá John I. Lew 《Surgery》2018,163(3):633-637
Background
The effect of altered parathyroid hormone metabolism in renal insufficiency on intraoperative parathyroid hormone monitoring during parathyroidectomy is not well known. This study evaluates operative outcomes in patients undergoing parathyroidectomy guided by intraoperative parathyroid hormone monitoring for primary hyperparathyroidism with mild and moderate renal insufficiency.Methods
A retrospective review of prospectively collected data in 604 patients with sporadic primary hyperparathyroidism undergoing parathyroidectomy guided by intraoperative parathyroid hormone monitoring was performed. Patients were stratified by stage of chronic kidney disease (CKD); those with overt secondary hyperparathyroidism (CKD stages IV and V) were excluded. Rates of bilateral neck exploration, multiglandular disease, and long-term operative outcomes, including success, failure, and recurrence were compared.Results
Of the 604 patients, 38% (230/604) had normal renal function or stage I CKD, 44% (268/604) had stage II CKD, and 18% (106/604) had stage III CKD. Overall, there were no differences in the rates of bilateral neck exploration or multiglandular disease or in rates of operative success, failure, or recurrence in patients with normal renal function and stages I to III CKD.Conclusion
Parathyroidectomy guided by intraoperative parathyroid hormone monitoring is performed with high operative success uniformly in primary hyperparathyroidism patients with mild and moderate renal insufficiency with outcomes similar to those with normal renal function. 相似文献11.
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Sven-Erik Persson Kurt Boman Anders Wanhainen Bo Carlberg Conny Arnerlöv 《Journal of vascular surgery》2017,65(3):651-658
Objective
A significant reduction in the incidence of cardiovascular disease, including abdominal aortic aneurysm (AAA), has been observed in the past decades. In this study, a small but geographically well defined and carefully characterized population, previously screened for AAA and risk factors, was re-examined 11 years later. The aim was to study the reduction of AAA prevalence and associated factors.Methods
All men and women aged 65 to 75 years living in the Norsjö municipality in northern Sweden in January 2010 were invited to an ultrasound examination of the abdominal aorta, registration of body parameters and cardiovascular risk factors, and blood sampling. An AAA was defined as an infrarenal aortic diameter ≥30 mm. Results were compared with a corresponding investigation conducted in 1999 in the same region.Results
A total of 602 subjects were invited, of whom 540 (90%) accepted. In 2010, the AAA prevalence was 5.7% (95% confidence interval [CI], 2.8%-8.5%) among men compared with 16.9% (95% CI, 12.3%-21.6%) in 1999 (P < .001). The corresponding figure for women was 1.1% (95% CI, 0.0%-2.4%) vs 3.5% (95% CI, 1.2%-5.8%; P = .080). A low prevalence of smoking was observed in 2010 as well as in 1999, with only 13% and 10% current smokers, respectively (P = .16). Treatment for hypertension was significantly more common in 2010 (58% vs 44%; P < .001). Statins increased in the population (34% in 2010 vs 3% in 1999; P < .001), and the lipid profile in women had improved significantly between 1999 and 2010.Conclusions
A highly significant reduction in AAA prevalence was observed during 11 years in Norsjö. Treatment for hypertension and with statins was more frequent, whereas smoking habits remained low. This indicates that smoking is not the only driver behind AAA occurrence and that lifestyle changes and treatment of cardiovascular risk factors may play an equally important role in the observed recent decline in AAA prevalence. 相似文献13.
Georg Jancke Firas Aljabery Sigurdur Gudjonsson Anne Sörenby Fredrik Liedberg 《European urology》2019,75(2):e32-e33
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A patient is reported who had persistent hypercalcemia for thirty-two months after renal transplantation. The incidence of tertiary hyperparathyroidism after transplantation for chronic renal disease appears to be between 1 and 7 per cent. The etiology, management, and complications of parathyroid hyperplasia are reviewed. It is suggested that this complication is not reversible in some instances and that an arbitrary period of nine months to one year of medical management be allowed prior to surgical intervention by subtotal parathyroidectomy. 相似文献
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Roxana de Fátima Camelo Albuquerque Cinthia Esbrile Moraes Carbonara Rita de Cássia T. Martin Luciene Machado dos Reis Climério Pereira do Nascimento Sérgio Samir Arap Rosa M.A. Moysés Vanda Jorgetti Fábio L.M. Montenegro Rodrigo Bueno de Oliveira 《Surgery》2018,163(2):381-387
Background
Parathyroidectomy (PTx) decreases the mortality rate of refractory secondary hyperparathyroidism (rSHP) due to chronic kidney disease. A consensus regarding which techniques of PTx are associated with better outcomes is not available. The aims of this study are to evaluate the clinical and laboratory evolution of 49 hemodialysis patients with rSHP who underwent PTx using different techniques.Methods
Patients underwent subtotal PTx (sub-PTx) or total PTx with autotransplantation (AT) of 45 (PTx-AT45) or 90 parathyroid fragments (PTx-AT90) and were followed for 12 months. We analyzed the expression of proliferating cell nuclear antigen (PCNA), calcium-sensing receptor (CasR), vitamin D receptor (VDR), fibroblast growth factor receptor-1 (FGFR1), sodium-dependent phosphate cotransporter-1 (PIT1), and Klotho in parathyroid glands.Results
Baseline median serum intact parathyroid hormone (iPTH) levels were 1,466 (1,087–2,125) pg/mL; vascular calcification scores correlated with serum iPTH (r?=?0.529; P?=?.002) and serum phosphate levels (r?=?0.389; P?=?.028); and Klotho expression was negatively correlated with serum phosphate levels (r?=??0.4; P?=?.01). After 12 months, serum iPTH and alkaline phosphatase levels were significantly controlled in all groups, as was bone pain. The proportions of patients with serum iPTH levels within the ranges recommended by Kidney Disease: Improving Global Outcomes were similar among the treatment groups. During the hungry bone disease (HBS), patients received 3,786?g (1,412–7,580) of elemental calcium, and a trend toward a positive correlation between the cumulative calcium load at the end of follow up and VC score post-PTx was noted (r?=?0.390; P?=?.06). Two cases evolved to clinically uncontrolled hyperparathyroidism in the sub-PTx group. The expression patterns of PCNA, VDR, CasR, PIT1, FGFR1, and Klotho in parathyroid glands did not correlate with serum systemic iPTH levels or the duration of HBS.Conclusions
All 3 operative techniques were effective at controlling rSHP, both in clinical and laboratory terms. Neither the quantity nor quality of parathyroid fragments influenced serum systemic iPTH and AT-iPTH levels. The cumulative calcium load appeared to correlate with the VC score and may have affected its progression. The effects of phosphate restriction on Klotho expression in human parathyroid glands and the subsequent decrease in FGF23 resistance must be addressed in further studies. 相似文献16.
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Per-Ola Granberg Gunnar Johansson Nils Lindvall Ulf Öhman Alexander Wajngot Sigbritt Werner Jan-Silvester Willems 《American journal of surgery》1982,143(3):296-300
The reasons for failure of the initial exploration and the results of reoperation were analyzed in 53 patients with a diagnosis of primary hyperparathyroidism, 29 of whom were referred after initial operations elsewhere. Seventy-nine reoperations were performed. Sternotomy was used in 15 patients, and in retrospect was necessary in only 5. There was no operative mortality. The reasons for initial failure were incorrect diagnosis in 6 patients, true recurrence in 4 and persistent disease in 43. Persistence was caused by surgical failure in two thirds and pathology failure in one third. Of 47 patients reoperated on for hyperparathyroidism, 39 (83 percent) were cured, a rate warranting this type of surgery. Analysis of a long-term series of initial operations demonstrates a persistence rate of 5 percent (24 of 461) and a recurrence rate of 1 percent (4 of 461) in this disease. The need for reoperation was less than 1 percent over the recent 5 year period. 相似文献
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The effect of legislation for the compulsory wearing of seat belts by car drivers and front seat passengers was prospectively analysed in the county of Skaraborg, Sweden. After legislation fewer vehicle occupants were admitted to the hospitals, despite a 40 per cent increase in crashes reported to insurance companies in the country. The frequency of seat belt wearing among injured victims was considerably lower than that recorded in regular traffic surveys. Significantly fewer head and neck injuries were suffered by restrained drivers than by unrestrained. Restrained front seat passengers had more thoracic injuries than unrestrained, but the degree of severity was less. The frequency of seat belt wearing by rear seat passengers was low, but they were injured as severely as front seat occupants. It seems important to insist on an increase in seat belt wearing for this category. 相似文献
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To achieve a safe application of the aortic clamp, even under difficult anatomic conditions, a new instrument with detachable shanks was constructed. This aortic clamp minimizes the risk for damage to the caval vein and the renal vessels, especially in emergency situations. 相似文献