肢体缺血/再灌注致急性肺损伤的研究现状

肢体缺血,再灌注是临床常见的一种病理生理过程,再灌注损伤不仅存在于局部缺血组织,尚可进一步引发远隔器官肺的损伤,现就肢体缺血/再灌注(limb ischemin-reperfusion,LIR)致急性肺损伤(acute lung injury,ALI)的病理生理机制和防治措施作一综述.     

肢体缺血/再灌注致急性肺损伤的研究现状

肢体缺血,再灌注是临床常见的一种病理生理过程,再灌注损伤不仅存在于局部缺血组织,尚可进一步引发远隔器官肺的损伤,现就肢体缺血/再灌注(limb ischemin-reperfusion,LIR)致急性肺损伤(acute lung injury,ALI)的病理生理机制和防治措施作一综述.     

肢体缺血/再灌注致急性肺损伤的研究现状

肢体缺血,再灌注是临床常见的一种病理生理过程,再灌注损伤不仅存在于局部缺血组织,尚可进一步引发远隔器官肺的损伤,现就肢体缺血/再灌注(limb ischemin-reperfusion,LIR)致急性肺损伤(acute lung injury,ALI)的病理生理机制和防治措施作一综述.     

肢体缺血/再灌注致急性肺损伤的研究现状

肢体缺血,再灌注是临床常见的一种病理生理过程,再灌注损伤不仅存在于局部缺血组织,尚可进一步引发远隔器官肺的损伤,现就肢体缺血/再灌注(limb ischemin-reperfusion,LIR)致急性肺损伤(acute lung injury,ALI)的病理生理机制和防治措施作一综述.     

肢体缺血/再灌注致急性肺损伤的研究现状

肢体缺血,再灌注是临床常见的一种病理生理过程,再灌注损伤不仅存在于局部缺血组织,尚可进一步引发远隔器官肺的损伤,现就肢体缺血/再灌注(limb ischemin-reperfusion,LIR)致急性肺损伤(acute lung injury,ALI)的病理生理机制和防治措施作一综述.     

肢体缺血/再灌注致急性肺损伤的研究现状

肢体缺血,再灌注是临床常见的一种病理生理过程,再灌注损伤不仅存在于局部缺血组织,尚可进一步引发远隔器官肺的损伤,现就肢体缺血/再灌注(limb ischemin-reperfusion,LIR)致急性肺损伤(acute lung injury,ALI)的病理生理机制和防治措施作一综述.     

肢体缺血/再灌注致急性肺损伤的研究现状

肢体缺血,再灌注是临床常见的一种病理生理过程,再灌注损伤不仅存在于局部缺血组织,尚可进一步引发远隔器官肺的损伤,现就肢体缺血/再灌注(limb ischemin-reperfusion,LIR)致急性肺损伤(acute lung injury,ALI)的病理生理机制和防治措施作一综述.     

肢体缺血/再灌注致急性肺损伤的研究现状

肢体缺血,再灌注是临床常见的一种病理生理过程,再灌注损伤不仅存在于局部缺血组织,尚可进一步引发远隔器官肺的损伤,现就肢体缺血/再灌注(limb ischemin-reperfusion,LIR)致急性肺损伤(acute lung injury,ALI)的病理生理机制和防治措施作一综述.     

肢体缺血/再灌注致急性肺损伤的研究现状

肢体缺血,再灌注是临床常见的一种病理生理过程,再灌注损伤不仅存在于局部缺血组织,尚可进一步引发远隔器官肺的损伤,现就肢体缺血/再灌注(limb ischemin-reperfusion,LIR)致急性肺损伤(acute lung injury,ALI)的病理生理机制和防治措施作一综述.     

兔后肢缺血再灌注后足背肌腱表面微循环变化

应用活体显微镜技术,观察了兔后肢常温止血带缺血2h(n=8)及5h(n=8)再灌注后最初1h 期间足背肌腱表面微循环动态变化,尤其是白细胞内皮粘附及微血管灌注状况的变化,旨在探讨缺血再灌注损伤的发生机制,从而指导临床治疗。结果表明:①肢体缺血再灌注后缺血组织微静脉内皮上粘附的白细胞数显著增加,而且缺血时间越长,增加越显著。②肢体缺血5h 再灌注后,缺血组织的微循环并不能均匀恢复,部分区域发生“无复流现象”,包括原发性无复流和继发性毛细血管灌注衰竭两种形式。提示:①白细胞内皮粘附参与了缺血再灌注损伤的病理生理过程。②肢体缺血5h 再灌注后发生的局部组织损伤并非皆属缺血再灌注损伤,部分区域可能系单纯缺血性损伤,部分区域则可能属缺血再灌注—继发性缺血损伤。     

Annual report of perioperative mortality and morbidity for the year 1999 with a special reference to anesthetic methods at Certificated Training Hospitals of Japanese Society of Anesthesiologists

The Committee on Operating Room Safety of Japanese Society of Anesthesiologists (JSA) sends annually confidential questionnaires of perioperative mortality and morbidity to Certificated Training Hospitals of JSA. This report is on perioperative mortality and morbidity in 1999 with a special reference to anesthetic methods. Four hundred and sixty-seven hospitals reported the number of cases referred to anesthetic methods and total numbers of cases were 727,723. The incidences of cardiac arrest per 10,000 cases due to all etiology are estimated to be 6.77 cases in average, 5.33 cases in inhalation anesthesia, 34.26 cases in total intravenous anesthesia (TIVA), 5.26 cases in inhalation anesthesia plus epidural or spinal or conduction block, 5.29 cases in TIVA plus epidural or spinal or conduction block, 0.73 cases in spinal with continuous epidural block (CSEA), 2.85 cases in epidural anesthesia, 1.63 cases in spinal anesthesia, 2.53 cases in conduction block and 46.51 cases in other methods. However, the incidences of cardiac arrest per 10,000 cases totally attributable to anesthesia are estimated to be 0.78 case in average, 0.51 case in inhalation anesthesia, 1.35 cases in TIVA, 0.97 case in inhalation anesthesia plus epidural or spinal or conduction block, 1.51 cases in TIVA plus epidural or spinal or conduction block, 0.73 case in CSEA, 1.71 cases in epidural anesthesia, 0.54 case in spinal anesthesia, 2.52 cases in conduction block and 1.08 cases in other methods. The incidences of severe hypotension per 10,000 cases due to all etiology are estimated to be 16.64 cases in average, 13.61 cases in inhalation anesthesia, 100.36 cases in TIVA, 13.32 cases in inhalation anesthesia plus epidural or spinal or conduction block, 9.07 cases in TIVA plus epidural or spinal or conduction block, 3.65 cases in CSEA, 6.26 cases in epidural anesthesia, 7.31 cases in spinal anesthesia, 2.52 cases in conduction block and 28.12 cases in other methods. On the other hand, the incidences of cardiac arrest per 10,000 cases totally attributable to anesthesia are estimated to be 2.40 cases in average, 1.65 cases in inhalation anesthesia, 0.81 cases in TIVA, 3.92 cases in inhalation anesthesia plus epidural or spinal or conduction block, 2.77 cases in TIVA plus epidural or spinal or conduction block, 2.56 cases in CSEA, 3.42 cases in epidural anesthesia, 2.71 cases in spinal anesthesia, zero case in conduction block and zero case in other methods. The incidences of severe hypoxia per 10,000 cases due to all etiology are estimated to be 5.32 cases in average, 6.7 cases in inhalation anesthesia, 9.17 cases in TIVA, 5.16 cases in inhalation anesthesia plus epidural or spinal or conduction block, 4.53 cases in TIVA plus epidural or spinal or conduction block, 2.56 cases in CSEA, zero case in epidural anesthesia, 1.08 cases in spinal anesthesia, zero case in conduction block and 1.08 cases in other methods. On the other hand, the incidences of severe hypoxia per 10,000 cases totally attributable to anesthesia are estimated to be 2.39 cases in average, 3.22 cases in inhalation anesthesia, 2.43 cases in TIVA, 2.26 cases in inhalation anesthesia plus epidural or spinal or conduction block, 2.77 cases in TIVA plus epidural or spinal or conduction block, zero case in CSEA, zero case in epidural anesthesia, 0.54 cases in spinal anesthesia, zero case in conduction block and 1.08 cases in other methods. The mortality rates of cardiac arrest per 10,000 cases due to all etiology are estimated to be 3.56 cases in average, 2.82 cases in inhalation anesthesia, 24.55 cases in TIVA, 1.4 cases in inhalation anesthesia plus epidural or spinal or conduction block, 1.51 cases in TIVA plus epidural or spinal or conduction block, zero cases in CSEA, 0.57 cases in epidural anesthesia, 0.27 cases in spinal anesthesia, zero case in conduction block and 42.18 cases in other methods. On the other hand, the mortality rates of cardiac arrest per 10,000 cases totally attributable to anesthesia are estimated to be 0.08 case in average, 0.09 case in inhalation anesthesia, 0.27 case in TIVA, 0.05 case in inhalation anesthesia plus epidural or spinal or conduction block, zero case in TIVA plus epidural or spinal or conduction block, zero case in CSEA, 0.57 case in epidural anesthesia, zero case in spinal anesthesia, conduction block and other methods. The outcomes of cardiac arrest totally attributable to anesthesia are 70.2% of full recovery without any sequelae, 10.5% of death within 7 days, 1.8% of vegetative state and 17.5% of unknown results while the outcome of critical events including severe hypotension and severe hypoxia totally attributable to anesthesia is 94.9% of full recovery without any sequelae, 0.4% of death within 7 days, 0.2% of vegetative state and 4.5% of unknown results. These results indicate that there are no differences in mortality and morbidity totally attributable to anesthesia among anesthetic methods in 1999 at Certificated Training Hospitals of Japan Society of Anesthesiologists.     

Postoperative intussusception: experience with 36 cases in children

Intestinal obstruction is a common postoperative complication and is usually related to peritoneal adhesion formation. A less well-recognized cause is postoperative intussusception (POI). Thirty-six instances of POI in children (aged 1 month to 18 years) were treated between 1970 and 1987. POI followed Nissen fundoplication in 9 patients, neuroblastoma resection in 5, small-bowel procedures in 4, inguinal herniorrhaphy in 3, pull-through procedures in 3, ureterostomy in 2, thoracic procedures in 2, ventral hernia in 1, nephrectomy in 1, hepatic resection in 1, Heller myotomy in 1, ventriculo-atrial shunt in 1, and gastrocystoplasty in 1. Initial symptoms included bilious vomiting or increased nasogastric drainage (after initial return of gut function) in 26 patients, abdominal distension in 24, irritability in 10, intermittent pain in 7, palpable abdominal mass in 2, rectal bleeding in 2, and lethargy in 1. The symptoms occurred 1 to 24 days (mean, 8 days) after the initial surgery. Plain abdominal radiographs revealed multiple air-fluid levels in 31 and an "adynamic ileus" in five patients. Barium contrast techniques could successfully reduce two ileocolic and one distal ileo-ileal lesions. The remainder necessitated operative management. Manual reduction was possible in 29 cases, and four children with diagnostic delay required bowel resection and an anastomosis for intestinal necrosis. The site of intussusception was ileo-ileal in 23 patients, jejunojejunal in 6, ileocolic in 5, and jejuno-ileal in 2. The diagnosis of POI should be considered in children with signs of bowel dysfunction in the early postoperative period. Contrast studies are of limited value, since most cases are confined to the small bowel. A high index of suspicion and prompt laparotomy will usually allow manual reduction of the lesion. Diagnostic delay may result in bowel necrosis.     

Long-term results after the total cavopulmonary connection

Between July, 1988 and November, 2002, 108 patients underwent total cavopulmonary connection (TCPC) at Kobe Children's Hospital. The primary malformation was univentricular heart in 40 tricuspid atresia in 21, mitral atresia in 16, and other complex cardiac defects in the remaining 31. Fenestrated TCPC, staged TCPC, and off-pump TCPC were performed in 39, 26, and 15 high risk patients, respectively. Nitric oxide inhalation was administered in 46 patients. The mean follow-up period was 4.3 years (range, 1 month to 14 years). There were 10 early deaths due to low cardiac output syndrome in 4, thrombosis in 3, tracheal bleeding in 2, and disseminated intravascular coagulation in 1. There were 5 late deaths due to congestive heart failure in 2 patients, arrhythmia in 1, cerebral infarction in 1, and subarachnoid hemorrhage in 1. Late complications included arrhythmia in 17 patients, systemic desaturation caused by abnormal systemic venous channels in 10, pleural or pericardial effusion in 3, chylothorax in 1, and aortic valve incompetence in 1.     

Evaluation of cases of off-pump CABG with mid-sternotomy

Off-pump CABG was utilized on patients who had multivessel coronary artery disease and other organ diseases. A total of 79 patients who underwent off-pump CABG were evaluated. Of these, 66 suffered from OMI and AP, 4 form AP, 6 from u-AP, and 3 from AMI. LITA was used in 75 cases, RA in 48, GEA in 45, RITA in 13, IEA in 3, and SVG in 38. Revascularization was performed at # 2 in 3 cases, # 3 in 11, 4 PD in 37, 4 PL in # 7 or # 8 in 79, # 9 in 27, # 12 in 51, and # 14 in 17. A time of 10.3 min was spent on LAD revascularization, 9.8 min on D 1, 10.2 min on Cx, anf 11.5 on RCA. Seven patients were transferred to on-pump beating CABG because of hemodynamic instability. One patients suffered postoperative CVA, and 2 had wound infection. Complete revasculization was accomplished in 78 patients, and hospital death was not reported.     

Spinal deformities in patients with muscular dystrophy other than Duchenne. A review of 11 patients having surgical treatment

Eleven patients diagnosed as having muscular dystrophy and who underwent posterior spinal fusion were reviewed: Becker dystrophy in one, limb girdle in two, facioscapulohumeral in one, myopathia unspecified in one, myotonia dystrophica in two, myotonia congenita in one, and hypotonia congenita in three. There were eight females and three males. The curve pattern was thoracic in four, thoracolumbar in three, double thoracic and thoracolumbar in three, and thoracolumbar lordosis in one. Scoliosis was associated with kyphosis in two, with lumbar lordosis in one, and thoracic lordosis in four patients associated with poor vital capacity and shortness of breath. Seven patients had nonoperative treatment, five showing increase of the curve, and two having control of the curve. All patients had posterior spinal fusion with instrumentation with a follow-up of 9-89 months (average, 41 months). Postoperative support was used in all but one. Major complications occurred in four patients: a symptom of vascular obstruction of the duodenum in two, extubation delayed until the 7th day postoperatively in one and pseudarthrosis in one resulting in an increasing curve and refusion. One patient (limb girdle), 6 years after surgery at 21 years died from cardiomyopathy. The second (limb girdle) lost ambulation at age 22 years, 6.6 years after spinal surgery. In conclusion, patients with muscular dystrophies other than Duchenne generally have slowly evolving curves, and the use of an orthosis in the juvenile years controlled the curve until the pubertal growth spurt, when progression occurred. Surgical treatment was successful in stabilizing the deformities.     

Percutaneous nephrostomy as management technique of obstructive uropathy: review of 105 cases

105 percutaneous nephrostomies in 73 patients. Indication for nephrostomy was obstruction in the drainage system in all cases. Nephrostomy was bilateral in 24 cases. Reasons for nephrostomy were: lithiasis in 35 cases, carcinoma of the bladder in 17, post-surgical iatrogenic stenosis in 13, prostate carcinoma in 9, cancer of the rectum in 9, infection in 5, neoplasia of the upper urinary tract in 5, retroperitoneal fibrosis in 3, glandular cystitis cystica in 3, ovarian cancer in 3, congenital in 2, lymphoma in 1. Six case were single-kidney patients. Renal puncture through the lower calyceal group was the preferred approach. Purulent urine was extracted in 10 cases. Complications of nephrostomy included haematuria in 34 cases, contrast extravasation in 8, fever in 6, 1 case of death due to septic shock, 2 perirenal haematoma (nephrectomy was required in 1 case), and catheter detachment in 5 cases. All patients showed improvement of both clinical signs and symptoms, and lab results.     

儿童陈旧性孟氏骨折的手术治疗

目的:通过研究火器伤所致骨折患者的治疗及预后情况,探讨如何选择合理方法对其进行及时有效的治疗。方法:对25例火器伤所致骨折患者的治疗及预后情况进行回顾性总结分析,其中男18例,女7例;平均年龄36.2岁。骨折的部位为股骨骨折9例,胫骨骨折7例,肱骨骨折2例,骨盆骨折2例,锁骨骨折1例,椎体骨折1例,尺、桡骨骨折1例,髋关节骨折1例与膝关节损伤1例。骨折类型为未移位1例,移位2例,粉碎性10例,粉碎且移位6例,骨缺损6例。19例接受了骨科手术治疗,其他6例接受了清创治疗。10例采用外固定架固定,7例行内固定,4例行管形石膏固定,2例骨盆与髋臼骨折采用牵引治疗,2例锁骨骨折应用锁骨带治疗。结果:25例患者获得了平均4.2年的随访,18例骨折Ⅰ期愈合,6例需后期手术促进骨折愈合,1例截肢。有5例需要后期手术覆盖创面。大的并发症包括2例骨不连,4例延迟愈合,3例周围神经功能受损。结论:骨折固定方法的选择与骨移植是治疗火器伤所致的骨折与骨缺损的一项很有效的方法。     

Clinical studies of chemonucleolysis patients with ten- to twenty-year follow-up evaluation

A follow-up evaluation of 357 patients injected with chymopapain ten to 20 years earlier included 97 females of mean age 42.2 years and 260 males of mean age 41.6 years. Pain distribution and physical findings were positive for discogenic involvement of long duration prior to chemonucleolysis. Eighteen patients were treated under worker's compensation. Postoperation, significant back pain persisted less than 24 hours in seven patients, less than six days in 133, less than 21 days in 178, from one to three months in nine, and between three and six months in two patients. Leg pain remained less than 24 hours in 32 patients, between one and five days in 212, between six and 21 days in 96, between one and three months in seven, and between six and 12 months in three patients. Similar improvement in extensor hallucis longus weakness and straight leg raising was also noted. Pain relief in the long term showed none persisting in the 158 patients or 44%, mild remaining pain in 107 or 30%, moderate pain in 71 or 20% and some pain in 21 or 6%. Thus the result was graded satisfactory in 74%. Complications included thrombophlebitis in two, pulmonary emboli in two, severe abdominal stress two days postoperation in one, severe anaphylatic reaction in one, and transient chest pain of undetermined etiology in one patient. All made good recovery from these complications.     

Barrett's esophagus and associated adenocarcinoma in a mouse surgical model

BACKGROUND: The development of Barrett's esophagus (BE) and Barrett's associated adenocarcinoma (BAA) in the rat after experimental inducement of esophageal reflux of gastric, bile, and pancreatic juice has been reported by others. The purpose of this study was to determine whether similar results could be demonstrated in the mouse model. MATERIALS AND METHODS: One hundred eight Swiss-Webster mice were used in this study and were divided into three groups: Group I, 37 mice with esophagojejunostomy; Group II, 39 mice with esophagojejunostomy and the carcinogen N-methyl-N-benzylnitrosamine (MBN); and Group III, 32 mice with MBN alone. The animals were sacrificed after 19 weeks. Macroscopic and histopathologic examinations were performed. RESULTS: One hundred mice survived and were available for pathologic study. Macroscopic evidence suggested esophagitis in 60.6% of mice in Group I, 62.8% of mice in Group II, and 9% of mice in Group III and suggested tumor in 3% of mice in Group I, 51.4% of mice in Group II, and 53.1% of mice in Group III. Histopathologic analysis disclosed BE in 42.4% of mice in Group I, 20% of mice in Group II, and 12.5% of mice in Group III. Cancer was present in 12.2% of mice in Group I, 54.3% of mice in Group II, and 46.9% of mice in Group III. Adenocarcinoma with or without squamous cell carcinoma was present in 6.1% of mice in Group I, 37.1% of mice in Group II, and 12.5% of mice in Group III. CONCLUSIONS: Esophagojejunostomy plus MBN in the mouse results in BE, BAA, or both in 57.1% of animals, consistent with findings in the rat model after similar interventions.     

Minimally invasive craniotomy using the Steiner-Lindquist stereotaxic guide.

Thirty-three obscure intracranial lesions were located using the Steiner-Lindquist microsurgical stereotaxic guide and then surgically resected. Seventeen of the lesions were located in the parietal region, six in the frontal region, three in the parietooccipital region, three in the temporoparietal region, one in the thalamic region, one in the centrum semiovale, one in the brainstem, and one in the third ventricle. Twenty-three lesions were in subcortical or cortical locations. In 28 cases, the lesion was totally removed, while in 5 the lesion was subtotally resected. Pathological examinations confirmed glial tumor in eight patients, metastasis in seven, meningioma in two, cavernous angioma in eight, arteriovenous malformation (AVM) in four, hematoma in two, dysembryoblastic neuroepithelial tumor in one, and septum pellucidum cyst in one. Two patients developed transient complications postsurgery. Mean lesion size was 23 +/- 0.97 mm. The hospitalization period ranged from 1 to 6 days (mean 3.4 +/- 1.3 days). Surgeries were performed under general anesthesia, or under local anesthesia with the patient awake. The Steiner-Lindquist microsurgical stereotaxic guide is useful for pinpointing small lesions, especially those in the subcortical and deep areas. Knowing the precise location of the lesion facilitates removal through a small craniotomy incision. This minimally invasive procedure reduces the number of postoperative neurological complications, and also cuts costs by shortening the hospital stay.