股动脉注射毒品致假性动脉瘤破裂诊治体会

目的探讨股动脉反复注射毒品后引起股动脉假性动脉瘤破裂出血的手术治疗经验.方法对我科在1998年6月至2005年12月收治16例因经股动脉反复制注射毒品后致股动脉假性动脉瘤破裂出血行手术治疗病人的临床资料回顾性分析.结果16例均行病灶切除清创手术.其中3例行血管重建术,术后半年到一年均发生人工血管感染需手术切除人工血管.13例行股动脉结扎术,1例术后股动脉出血死亡,所有病例无一例术后发生下肢坏疽.结论应用股动脉结扎瘤体切除清创术治疗反复注射毒品引起股动脉假性动脉瘤破裂出血似乎是一种简单和安全的方法,似应作为首选的治疗措施.如术后发生肢端严重缺血时,可再考虑紧急行髂-股动脉解剖外径人工血管旁路术.     

Mycotic pseudoaneurysms in a CAPD patient.

Sir, We report a case of a 49-year-old male with prior history ofmembranous glomerulonephritis, who had been on haemodialysissince 1991. He had received two kidney transplants (1992 and1994), losing both due to relapse of the underlying disease.In 1994 he was placed on a     

Mycotic aneurysms in parenteral drug abusers: An Indian experience

Four femoral and one brachial mycotic aneurysms were identified in five mainliners who took various narcotic injections for personal gratification. All presented with contained rupture of a pseudoaneurysm with bleed into surrounding tissues; inflammation and celluitis with loss of distal pulses; and varying degrees of ischaemia. All patients underwent emergency surgery consisting of excision of the aneurysm and debridement of the wound which was left open to granulate. Two patients had revascularisation in the same setting by an extra-anatomic bypass using a prosthetic graft. In the other three patients only ligation was performed. The state of the local tissues, degree of ischaemia and general condition of the patient governed the decision in favour of vascular reconstruction versus simple ligation. The organism most commonly identified from the arterial wall and clot culture was Staphylococcus aureus. No fungi were isolated. All patients survived without serious ischaemic complications. None needed amputation. Appreciation of this increasingly important cause of mycotic aneurysm prompts judicious decision making and surgery towards saving limb and life.     

腹腔镜脾切除术十年经验总结

目的 总结10年来行腹腔镜脾切除术(LS)的临床经验,探讨LS的安全性和有效性.方法 从1996年4月至2006年3月连续进行了135例LS,119例为原发性和继发性脾功能亢进,16例为其他脾疾病,其中48例为巨脾.结果 135例LS中因出血转行开腹脾切除术3例(2.2%),1例术后5 h需作小切口开腹止血,3例术后8～18 h需再次腹腔镜探查和清除脾窝积血.平均手术时间2.3 h,平均失血160 ml,平均术后住院6.5 d.结论 LS安全、有效、切实可行,适用于有脾切除指征的原发性和继发性脾功能亢进或其他脾疾病.     

Extracorporeal membrane oxygenation: a ten-year experience

BACKGROUND: Extracorporeal membrane oxygenation (ECMO) is a supportive therapy used for severe acute respiratory distress syndrome (ARDS). We present outcome, clinical parameters, and complications in a cohort of 245 ARDS patients of whom 62 were treated with ECMO. METHODS: Data of all ARDS patients were prospectively collected between 1991 and 1999. Outcome and clinical parameters of patients treated with and without ECMO were evaluated. RESULTS: One hundred thirty-eight patients were referred from other hospitals, 107 were primarily located in our hospital. About one fourth of these patients were treated with ECMO. The survival rate was 55% in ECMO patients and 61% in non-ECMO patients. CONCLUSIONS: ECMO is a therapeutic option for patients with severe ARDS, likely to increase survival. However, a randomized controlled study proving its benefit is still awaited. Until the development of a causal or otherwise superior therapy ECMO should be used in selected patients.     

Cardiac injuries: a ten-year experience.

OBJECTIVE: To present our experience of cardiac injuries treated at one Swedish emergency department in the 10 years 1988-97. DESIGN: Retrospective study. SETTING: Teaching hospital. SUBJECTS: 11 patients (9 men and 2 women, mean age 33 years, range 19-54); in 7 they were penetrating injuries and in 4 blunt. MAIN OUTCOME MEASURES: Morbidity and mortality. RESULTS: The mechanisms of injury were stab wound (n = 7), and car crash, fall, boat crash, and abuse (n = 1 each); drug or alcohol misuse played a part in all those with penetrating injuries. The penetrating wounds involved the left ventricle (n = 3), the right ventricle (n = 2), and the pericardium (n = 2). All 5 patients with ventricular wounds presented with cardiac tamponade, in 1 of whom it was fatal (he bled to death during emergency thoracotomy). The main complications were anoxic brain damage and postpericardiotomy syndrome (1 each). There was no case of myocardial concussion. CONCLUSION: Our data reflect the Swedish experience of heart trauma: there are few cases, alcohol and drug misuse is the principal risk factor, and there were no gunshot wounds.     

毒品注射致股动脉假性动脉瘤破裂出血的诊治

目的探讨注射毒品引起股动脉假性动脉瘤形成并破裂出血的诊断与治疗方法。方法回顾性分析2003年3月—2009年12月收治的22例因反复注射毒品致股动脉假性动脉瘤形成并破裂出血患者的临床资料。结果 22例患者均接受手术治疗,术中行瘤体切除、清创后,8例行股动脉破口修补术;4例行破口两侧股动脉结扎术;10例行髂外动脉-股动脉人工血管移植术。22例均手术成功,手术后早期出现人工血管与股动脉吻合口破裂出血1例,急诊手术重新吻合,随后出现切口感染,经换药后切口愈合。术后患侧下肢功能均好。随访6个月至7年,平均3年。1例患者术后2年出现人工血管感染,1例出院后14d发生吻合口出血,均经再次血管吻合治愈;2例股动脉结扎患者遗留轻间歇性跛行。结论治疗股动脉假性动脉瘤形成并破裂出血的手术方式,以股动脉假性动脉瘤切除+清创+股动脉修补术最为简单、安全有效;人工血管移植术疗效确定,能最大限度保证患肢血供;股动脉修补或结扎术在选择病例中也是有效的治疗方法。     

Sarcoma of the uterus: a ten-year experience

Nine cases of sarcoma of the uterus treated during the last ten years are reported. Histology showed three of these to be mixed Müllerian sarcomas, five leiomyosarcomas and one rhabdomyosarcoma. Difficulties in preoperative diagnosis and modes of therapy are discussed. The findings are correlated with those of other authors and ways to improve survival are stressed.     

Ipsilateral femoral vein compression: a contraindication to thrombin injection of femoral pseudoaneurysms

Development of a femoral artery pseudoaneurysm occurs in 0.6% to 3.2% of interventional procedures. Nonsurgical treatment has consisted of ultrasound scan-directed compression and, more recently, direct thrombin injection into the pseudoaneurysm cavity to achieve thrombosis. Reported complications after thrombin injection are rare. We report two cases of femoral venous compression associated with pseudoaneurysm injection and review the literature. A 76-year-old man and an 86-year-old man both underwent thrombin injection of pseudoaneurysms compressing the ipsilateral common femoral vein. Both patients were diagnosed with deep venous thrombosis and subsequently needed surgical exploration for repair of the pseudoaneurysm and release of the venous compression. At exploration, both were found to have significant inflammation surrounding the femoral vessels, which made vessel exposure challenging. Because of the venous outflow obstruction involved in femoral pseudoaneurysms with secondary venous compression and the surgical difficulty caused by surrounding inflammation, avoidance of thrombin injection in favor of early surgical intervention is suggested.     

External carotid revascularization: review of a ten-year experience

In the presence of ipsilateral internal carotid artery (ICA) occlusion, external carotid artery (ECA) revascularization can improve cerebral perfusion or eliminate an embolic source. From 1974 through 1984, 37 patients at The Cleveland Clinic underwent 42 ECA reconstructions; autologous patch angioplasty and intraluminal shunting were used when feasible. Thirty procedures were limited to primary ECA revascularization, whereas 12 extended procedures were performed as reoperations after previous ECA endarterectomy or required complementary subclavian or intracranial bypass. There were no early postoperative deaths nor neurologic morbidity in the limited group, but one death, four ipsilateral hemispheric strokes, and one retinal embolism occurred in the extended group. Ten patients have died during a follow-up interval of 1 to 72 months (mean 27 months). Five late deaths were caused by myocardial infarction, only one of which was complicated by a contralateral stroke. Two additional strokes have occurred; one involved the ipsilateral and one the contralateral cerebral hemisphere. Five other patients experienced recurrent cerebral or ocular ischemic symptoms. In conclusion, extended ECA reconstruction is associated with a higher operative risk than limited revascularization. Late follow-up is necessary to detect those patients who may eventually require additional management of recurrent cerebrovascular symptoms or incidental coronary artery disease.     

Femorofemoral bypass grafts: ten-year experience

From August 1972 to September 1982, one of us (F.R.P.) performed 119 femorofemoral bypass grafts on 78 men and 35 women with an average age of 62 years. Axillofemorofemoral grafts were excluded. The 30-day operative mortality rate was 1.7% (2 of 119). The cumulative patency rates determined by the life-table method were 97.4% at 30 days, 95.1% at 1 year, 83.3% at 3 years, 72.2% at 5 years, and 55% from 6 through 10 years. There were no graft failures in the 21 patients followed up for more than 6 years. There were 21 grafts at risk at 7 years, 15 at 8 years, 10 at 9 years, and four at 10 years. Donor iliac arteries were judged to be acceptable by a combination of simple analyses including physical examination, noninvasive laboratory testing, angiography, and intraoperative direct blood pressure measurements. There was no evidence of a vascular steal in any of the postoperative patients. One patient required an inflow procedure 2 years following femorofemoral grafting. Two patients required resection of an abdominal aortic aneurysm 2 and 3 years, respectively, following femorofemoral grafting. There was one early graft failure secondary to infection, and five grafts became infected at 20,29,33,46, and 62 months, respectively, following femorofemoral grafting. False aneurysm formation, diabetes, and trauma were significant factors in these infections. Initially only high-risk patients were selected as candidates for femorofemoral grafting. Because we were encouraged by the early success rate and the apparent durability of the method, the indications were broadened to include good-risk patients who met rigid criteria for femorofemoral grafting.     

Post-traumatic peripheral arterial pseudoaneurysms: Our experience

Background Pseudoaneurysms are usually post-traumatic, iatrogenic, in intravenous drug abusers or due to anastomotic disruption. Pseudoaneurysms continue to be a clinical challenge in recent time. Patients and Methods In this retrospective study of 10 years, consisting of 60 cases, we aim to document and evaluate the causes, presentation and treatment modalities. Results All patients underwent surgical intervention. There was no mortality and minimal morbidity. Conclusions The repair by Saphenous venous interpositional graft is the key to successful management of post-traumatic peripheral arterial pseudoaneurysm.     

Laparoscopic adrenal surgery: ten-year experience in a single institution

Background

Minimal invasive adrenalectomy has become the procedure of choice to treat adrenal tumors with a benign appearance, ≤ 6 cm in diameter and weighing < 100 g. Authors evaluated medium- and long-term outcomes of laparoscopic adrenalectomy (LA), performed for ten years in a single endocrine surgery unit.

Methods

We retrospectively reviewed 88 consecutive patients undergone LA for lesions of adrenal glands from 2003 to 2013. The first 30 operations were considered part of the learning curve. Doxazosin was preoperatively administered in case of pheochromocytoma (PCC), while spironolactone and potassium were employed to treat Conn's disease. Perioperative cardiovascular status modifications and surgical and medium- and long-term results were analyzed.

Results

Forty nine (55.68%) functioning tumors, and one (1.13%) bilateral adrenal disease were identified. In 2 patients (2.27%) a supposed adrenal metastasis was postoperatively confirmed, while in no patients a diagnosis of incidental primitive malignancy was performed. There was no mortality or major post operative complication. The mean operative time was higher during the learning curve. Conversion and morbidity rates were respectively 1.13% and 5.7%. Intraoperative hypertensive crises (≥180/90 mmHg) were observed in 23.5% (4/17) of PCC patients and were treated pharmacologically with no aftermath. There was no influence of age, size and operative time on the occurrence of PCC intraoperative hypertensive episodes. Surgery determined a normalization of the endocrine profile. One single PCC persistence was observed, while in a Conn's patient, just undergone right LA, a left sparing adrenalectomy was performed for a contralateral metachronous aldosteronoma.

Conclusions

LA, a safe, effective and well tolerated procedure for the treatment of adrenal neoplasms ≤ 6 cm, is feasible for larger lesions, with a similar low morbidity rate. Operative time has improved along with the increase of the experience and of the technological development. Preoperative adrenergic blockade did not prevent PCC intraoperative hypertensive crises, but facilitated the control of the hemodynamic stability.

     

Ultrasound-guided thrombin injection of iatrogenic femoral pseudoaneurysms: a prospective analysis

An adverse consequence of the use of the femoral artery for the endovascular evaluation and treatment of arterial disease is the increased incidence of iatrogenic femoral pseudoaneurysms. Although surgical repair has traditionally been used to treat such aneurysms, less invasive modalities have emerged. The purpose of this study is to prospectively evaluate ultrasound-guided thrombin injection (UGTI) for the treatment of iatrogenic femoral pseudoaneurysms. A treatment protocol was approved and 30 stable patients (21 female; age range 43-85 years; mean 67 years) were prospectively enrolled from December 1997 through June 1999 to undergo UGTI on 30 iatrogenic femoral pseudoaneurysms. Pseudoaneurysms occurred after cardiac intervention (n = 22, 73%), peripheral intervention (n = 7, 23%), and after a femoral line placement (n = 1, 3%). They ranged in size from one to 5 cm with a time interval from intervention until UGTI of one to 132 days (median 3 days). Eleven patients (37%) were systematically anticoagulated at the time of UGTI. All pseudoaneurysms were treated using sterile technique and local anesthesia with ultrasound-guided injection via a 20-gauge spinal needle of 0.1 to 2 cm3 (median 0.6 cm3) of 1000 units/cm3 topical thrombin solution administered by one of six physicians. A period of bedrest for 4 to 6 hours after injection was followed by repeat groin duplex scan at 24 hours and a clinical follow-up at 30 days. There were no procedural deaths or nonvascular complications. Twenty-seven (90%) UGTIs resulted in successful pseudoaneurysm ablation with no recurrences at 24 hours or 30 days. Two (7%) UGTIs failed and one (3%) femoral artery embolic complication occurred; all were successfully treated with surgery. Success appeared to be independent of anticoagulation status, pseudoaneurysm age, size, or operator experience. We conclude that UGTI is a safe, easy, well-tolerated and effective noninvasive method for treatment of iatrogenic femoral pseudoaneurysms and should be considered in all stable patients before operative repair.     

Management of femoral artery pseudoaneurysm due to addictive drug injection

Objective: To study surgical management for patients with femoral pseudoaneurysm resulting from addictive drug injection. Methods： Clinical data of 34 patients with femoral pseudoaneurysm resulting from addictive drug injection were retrospectively reviewed. Results: Thirteen patients underwent bypass graft ( end to side) of external iliac artery and superficial femoral artery using expanded polytetrafluoroethylene (ePTFE). Three patients who had an autogenous saphenous vein graftin situs, one of whom was then performed an ePTFE graft when rupture and bleeding occurred at the anastomotic site. Color Doppler image showed patent grafted blood vessels in all the patients after operation. Eighteen patients had their femoral arteries ligated. Limbs of all the 34 patients were saved. Conclusions： Ligating femoral artery is an effective way to treat femoral artery pseudoaneurysm if autogenous saphenous vein graft or artificial vessel graft is not applicable.     

Wilson bunionectomy with internal fixation: a ten-year experience.

One hundred fifteen feet that underwent a Wilson (lateral, transpositional, shortening) osteotomy for the correction of hallux valgus between 1979 and 1989 were retrospectively reviewed. All osteotomies were stabilized either with a single cortical or cancellous screw, or with crossed Kirschner wires. The Wilson procedure is not technically difficult and can allow for tri-plane correction. Of the 115 feet on which this surgical procedure was performed, 92 (80%) were graded in long-term postoperative recovery as excellent or good. Only one complication of hallux varus occurred, which required additional surgery. Survey of the results of the 10-year experience in utilization of this operative procedure has shown a high patient satisfaction with minimum of postoperative complications and a low failure rate.