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1.
Kassira N Pedroso FE Cheung MC Koniaris LG Sola JE 《Journal of pediatric surgery》2011,46(10):1956-1964
Objective
The objective of this study is to determine outcomes of pediatric patients with primary gastrointestinal tract lymphoma (PGTL) and the impact of surgery or radiation on survival.Methods
The Surveillance, Epidemiology, and End Result database was queried from 1973 to 2006 for patients younger than 20 years with PGTL.Results
265 patients with PGTL were identified. Overall 5- and 10-year survivals were 84% and 83%, respectively. Tumors of the stomach (9%) and rectum/anus (2%) had the worst and best 10-year survivals, respectively (59% vs 100%, P = .023). There was no significant difference in 10-year survival for patients younger than 10 years of age who had surgical extirpation (83% vs 85% no surgery, P = .958) or radiotherapy (76% vs 85% no radiotherapy, P = .532). However, there was a significantly decreased 10-year survival in patients 10 years or older who had surgical extirpation (79% vs 100% no surgery, P = .013) or radiotherapy (49% vs 87% no radiotherapy, P = .001). Under multivariate analysis, tumor location was an independent predictor of improved survival (small bowel, HR 0.21, P = .002; large bowel, HR 0.23, P = .004).Conclusion
We found no significant survival advantage for surgical extirpation or radiotherapy in patients younger than 10 years with PGTL, whereas either treatment modality was associated with lower survival in patients 10 years or older. 相似文献2.
Cortes RA Keller RL Townsend T Harrison MR Farmer DL Lee H Piecuch RE Leonard CH Hetherton M Bisgaard R Nobuhara KK 《Journal of pediatric surgery》2005,40(1):36-46
Background/Purpose
Fetal tracheal occlusion (TO) was developed in an attempt to enhance prenatal lung growth and improve survival in fetuses with severe congenital diaphragmatic hernia (CDH). We conducted a randomized, controlled clinical trial in 24 fetuses with severe left CDH (liver herniated into the thorax and low lung-to-head ratio) to compare survival after endoscopic fetal TO vs standard perinatal care (control) and prospectively followed up the 16 survivors (9 control, 7 TO) to compare neurodevelopmental, respiratory, surgical, growth, and nutritional outcomes.Methods
At 1 and 2 years old, subjects underwent evaluation consisting of medical and neurological history and physical, developmental testing, nutritional assessment, oxygen saturation and pulmonary function testing, chest radiograph, and echocardiogram. Growth and developmental measures were corrected for prematurity. Data were analyzed by Mann-Whitney rank sum test, Fisher's Exact test, and logistic and linear regression.Results
Infants with TO were significantly more premature at birth (control vs TO, 37.4 ± 1.0 vs 31.1 ± 1.7 weeks; P < .01). Growth failure (z score for weight <2 SDs below mean) was severe in both groups at 1 year of age (control vs TO, 56% vs 86%; P = .31). There was considerable catch-up growth by age 2 years (growth failure: control vs TO, 22% vs 33%; P = .19). There were no differences in other growth parameters. There were also no differences in neurodevelopmental outcome at 1 and 2 years. Supplemental oxygen at hospital discharge was a significant predictor of worse neurodevelopmental outcome at 1 and 2 years old (P = .05 and P = .02, respectively). Hearing loss requiring amplification has been diagnosed in 44% of the group (control vs TO, 44% vs 43%; P = 1.0).Conclusions
In this group of infants with severe CDH, there were no differences in outcome at 2 years old despite significant prematurity in the TO group. Oxygen supplementation at hospital discharge identified the most vulnerable group with respect to neurodevelopmental outcome, but all infants had significant growth failure, and hearing impairment is a substantial problem in this population. Severe CDH carries significant risk of chronic morbidity. 相似文献3.
Lemoine C Paris C Morris M Vali K Beaunoyer M Aspirot A 《Journal of pediatric surgery》2011,46(5):870-873
Background
Open transumbilical pyloromyotomy (UMBP) and laparoscopic pyloromyotomy (LAP) have been compared on different outcomes, but postoperative pain as a primary end point had never been assessed. The aim of this study was to compare the use of analgesia in UMBP and LAP patients.Methods
Infants with hypertrophic pyloric stenosis treated by UMBP in 2008-2009 were matched with LAP-treated infants. Demographics, type and use of analgesia, and length of stay were recorded. Statistical analysis was performed using the Fisher exact test.Results
Each group contained 19 patients (N = 38) with comparable demographics and no comorbid condition. Bupivacaine was injected intraoperatively in all UMBP and 89% of LAP infants. There was a trend toward increased acetaminophen use in LAP infants (79% vs 58%, P = .61) in the recovery room. There was no difference in opiates use (3 UMBP vs 1 LAP, P = .60). In the ward, more UMBP patients received acetaminophen (78% vs 53%, P = .03). This difference was significant. Mean postoperative length of stay was similar in both groups.Conclusion
Our study suggests that UMBP infants might experience more postoperative pain in the ward, without any impact on various outcomes. A prospective study with a larger sample size should be undertaken to verify these findings. 相似文献4.
Valerie EP Durrant AC Forte V Wales P Chait P Kim PC 《Journal of pediatric surgery》2005,40(6):904-907
Background
We compared the efficacy and clinical outcomes of aortopexy versus tracheal stents in the management of tracheomalacia.Methods
A retrospective analysis of 25 consecutive patients undergoing aortopexy (n = 11; 8 boys, 3 girls) or tracheal stents (n = 14; 9 boys, 5 girls) between 1993 and 2003 was performed.Results
Both treatment groups, aortopexy versus stents, were comparable in their mean age of diagnosis, timing of intervention, surgical indications (“dying spell” or failed extubation), and previous underlying conditions. The operative time (190 vs 72 minutes) and blood loss (26 vs 0 mL) were significantly greater in aortopexy group (P < .01). There were no perioperative deaths in either group. Interestingly, 4 of 11 patients in the aortopexy group developed pericardial effusion (P < .01). With stents in place for a mean of 15 (range 2-41) months, 3 of 8 patients with stent removal had significant granulation tissue requiring further dilatation. No death was observed in aortopexy group, whereas 1 stent-related death and 1 cardiac arrest requiring median sternotomy occurred during stent removal in 44 and 32 months' follow-up, respectively.Conclusion
Both aortopexy and tracheal stents are effective treatment modalities in the management of tracheomalacia. However, although aortopexy is associated with early perioperative complications, tracheal stents are associated with higher failure rate and more severe stent-related morbidity and mortality. 相似文献5.
Gelfand HJ Ouanes JP Lesley MR Ko PS Murphy JD Sumida SM Isaac GR Kumar K Wu CL 《Journal of clinical anesthesia》2011,23(2):90-96
Study Objective
To determine if the use of ultrasound guidance (vs non-ultrasound techniques) improves the success rate of nerve blocks.Design
Meta-analysis of randomized controlled trials (RCTs) in the published literature.Setting
University medical center.Measurements
16 RCTs of patients undergoing elective surgical procedures were studied. Patients underwent ultrasound-guided or non-ultrasound techniques (nerve stimulation, surface landmark) for peripheral nerve blocks. Success rates were measured.Main Results
Ultrasound guidance (vs all non-ultrasound techniques) was associated with a significant increase in the success rate of nerve blocks [relative risk (RR) = 1.11 (95% confidence interval [CI]: 1.06 to 1.17, P < 0.0001]). When compared with nerve stimulator techniques only, ultrasound guidance was still associated with an increase in the success rate (RR = 1.11 [95% CI: 1.05 to 1.17, P = 0.0001]). For specific blocks, ultrasound guidance (vs all non-ultrasound) was associated with a significant increase in successful brachial plexus (all) nerve blocks (RR = 1.11 [95% CI: 1.05 to 1.20, P = 0.0001]), sciatic popliteal nerve block (RR = 1.22 [95% CI: 1.08 to 1.39, P = 0.002]) and brachial plexus axillary nerve block (RR = 1.13 [95% CI: 1.00 to 1.26, P = 0.05]) but not brachial plexus infraclavicular nerve block (RR = 1.25 [95% CI: 0.88 to 1.76, P = 0.22]).Conclusions
Ultrasound-guided peripheral nerve block is associated with an increased overall success rate when compared with nerve stimulation or other methods. Ultrasound-guided techniques also increase the success rate of some specific blocks. 相似文献6.
Raval MV Sturgeon C Bentrem DJ Elaraj DM Stewart AK Winchester DJ Ko CY Reynolds M 《Journal of pediatric surgery》2010,45(10):1947-1954
Purpose
Lymph node metastases (LNM) from medullary thyroid cancer (MTC) are common in adults and are a poor prognostic factor. Less is known about LNM in children, who often have hereditary forms of MTC. Guidelines recommend prophylactic thyroidectomy in early childhood, but randomized prospective trials are not feasible. We hypothesized that LNM is associated with poor prognosis in children.Methods
Patients with MTC 21 years or younger from the National Cancer Data Base from 1985 to 2007 were studied. Multivariable logistic regression was used to identify factors associated with lymph node evaluation. Survival was estimated using the Kaplan-Meier method.Results
Of 430 patients, 276 (64.2%) had nodal evaluation with LNM present in 121 (28.1%). Older patients, those with tumors larger than 2 cm, and those with involved margins were more likely to have LNM (all P < .05). Patients undergoing total thyroidectomy, those with involved margins, and older patients were more likely to undergo lymph node evaluation after controlling for patient, tumor, and hospital factors (all P < .05). Over time an increasing number of patients with MTC have undergone total thyroidectomy. Patients 16 to 21 years of age had lower 10-year overall survival compared to patients 0 to 15 years old (88.7% vs 98.1%, P = .005). Lymph node metastases were also associated with decreased 10-year overall survival (84.4% vs 100%, P < .001).Conclusions
In pediatric MTC, LNM predict poorer overall survival. Adequate lymph node assessment can provide valuable prognostic information for the pediatric MTC patient. Lymph node assessment should be considered for older pediatric patients undergoing surgery for hereditary MTC or biopsy confirmed MTC. 相似文献7.
Cabello M Cobelo C Gonzalez-Molina M Leon G Garcia I Gutierrez E Sola E Lopez V Gutierrez C Burgos D Hernandez D 《Transplantation proceedings》2010,42(8):2845-2847
Background
In Spain, the number of ideal kidney transplant donors has fallen, with at the same time an increase in the number of older recipients on the waiting list.Aim
To analyze the results of expanded criteria cadaveric donor kidney transplants into older recipients using grafts selected by kidney biopsy.Patients and methods
We studied 360 kidney transplant recipients who had been followed to December 2009: 180 in the study group and 180 in a control group composed of younger patients who received grafts from non-expanded criteria donors between 1999 and 2006. A paraffin-embedded kidney biopsy was evaluated by the percentages of sclerosed glomeruli, arteriolar hyalinosis, intimal wall thickening, interstitial fibrosis, and tubular atrophy.Results
Significant differences were observed in donor age (63.50 ± 5.46 vs 31.90 ± 13.29 years; P < .001) and recipient age (58.40 ± 8.80 vs 40.71 ± 13.23 years; P < .001). Donor renal function was significantly worse among the expanded criteria group (90.80 vs 108.11 mL/min/1.73 m2; P = .006), remaining so over time in the recipient (at 1 year: 42.08 vs 63.71 [P < .001]; at 3 years: 41.25 vs 62.31 [P < .001], and at 7 years: 38.17 vs 64.18 [P < .001]). Censored 7-year graft survivals were 73% versus 87% (P < .001) with similar patient survivals (90.5% vs 95%; P = .39).Conclusions
Selection of expanded criteria donors by kidney biopsy resulted in good renal function as well as graft and patient survivals at 7 years in older recipients. 相似文献8.
Bhavin C. Shah 《American journal of surgery》2009,198(6):759-764
Background
Theoretically, a lighter and softer mesh may decrease nerve entrapment and chronic pain by creating less fibrosis and mesh contracture in laparoscopic inguinal hernia repair.Methods
We performed a telephone survey of patients who underwent laparoscopic inguinal hernia surgery between 2001 and 2007. We recorded patient responses for chronic pain, foreign body sensation, recurrence, satisfaction, and return to work, and then studied the effect of type of mesh (polypropylene vs polyester) on these factors.Results
Of 109 consecutive patients surveyed (mean age, 54.5 y), 67 eligible patients underwent 84 transabdominal extraperitoneal procedures and 2 transabdominal preperitoneal procedures. Patients with polypropylene mesh had a 3 times higher rate of chronic pain (P = .05), feeling of lump (P = .02), and foreign body perception (P = .05) than the polyester mesh group. Our overall 1-year recurrence rate was 5.9%. The recurrence rate was 9.3% for the polypropylene group and 2.9% for the polyester group (P = .26).Conclusions
A lightweight polyester mesh has better long-term outcomes for chronic pain and foreign body sensation compared with a heavy polypropylene mesh in laparoscopic inguinal hernia repair. We also saw a trend toward higher recurrence in the polypropylene group. 相似文献9.
Background/Purpose
We questioned whether primary surgical correction of neonatally diagnosed Hirschsprung's Disease (HD) incurs higher costs or increased incidence of adverse events (AE) when compared with staged repair.Methods
We reviewed the medical records of all neonates diagnosed with HD at our institution between 1997 and 2007. Sixty subjects fulfilled criteria for inclusion. Twenty-seven neonates had primary repair, and 33 had staged repair. We measured inflation-adjusted total costs, direct costs, and total charges and 6 AE between the 2 groups. A generalized linear model was used to examine differences between group variables.Results
We found no statistically significant difference in costs or AE between primary and staged repair. Inflation-adjusted median financial data for primary or staged repair were, respectively, as follows: total costs, $35,670 vs $38,538 (P = .617); direct costs, $18,453 vs $23,937 (P = .128); total charges, $107,315 vs $102,492 (P = .690). Adverse events occurred in 48% of primary repair subjects and 36% of staged repair subjects (P = .434); no single AE differed significantly between the two groups.Conclusions
We found no statistical evidence that primary neonatal correction of HD adds cost or risk of AE when compared with a traditional staged approach in neonates who met inclusion criteria. 相似文献10.
Faggian G Forni A Milano AD Chiominto B Walpoth BH Scarabelli T Mazzucco A 《Transplantation proceedings》2010,42(9):3679-119
Background
In cardiac transplantation, high-dose antithymocyte globulin (ATG) induction therapy as short-term rejection prophylaxis has not been used.Objective
To evaluate the efficacy and safety of intraoperative use of single high-dose ATG induction therapy after heart transplantation.Patients and Methods
Fourteen patients received single high-dose ATG therapy plus shortened standard therapy (group1), and 16 patients received ATG standard therapy (group2).Results
No perioperative deaths were reported. During follow-up, 3 deaths were recorded. Five- year patient survival was 92.8% in groupl vs 85.7% in group2 (P = .34). The mean (SD) number of acute rejection episodes per patient was 2.5 (2.2) in the high-dose ATG group vs 2.7 (2.5) in the standard therapy group (P = .83), with 5-year freedom from acute rejection of 45.5% in group 1 vs 35.6% in group 2 (P = .85). Infections were observed in 6 patients in group1 and in 8 patients in group2 (P = .69). Malignant disease was diagnosed in 1 patient in the high-dose group and 3 patients in the standard therapy group (P = .35). Chronic allograft vasculopathy was recognized in 4 patients (28%) in group1 and 8 (50%) in group2 (P = .05). Five-year actuarial freedom from allograft vasculopathy was 69.2% in the high-dose ATG group vs 50.0%% in the standard therapy group (P = .35).Conclusions
High-dose ATG for prevention of rejection episodes is safe and efficacious, with a lower rate of early and late complications, in particular, graft vasculopathy. 相似文献11.
Aimee C. Pastor Margaret A. Marcon Sharifa Himidan 《Journal of pediatric surgery》2009,44(7):1349-1354
Purpose
Treatment modalities for achalasia are evolving and remain controversial. Herein, we report the relative efficacy and outcomes after dilatation or myotomy in children with achalasia.Methods
A retrospective analysis of all children treated for achalasia at a tertiary center from 1981 to 2007 was performed (n = 40). Demographics, presenting symptoms, perioperative parameters, and outcomes were analyzed using t tests and χ2 statistics.Results
Thirty patients were initially treated by esophageal dilatation (ED), whereas 10 were treated by laparoscopic or open Heller myotomy (HM). Both groups were similar with respect to age (10.6 vs 12.4 years; P = .19). There were 18 males and 12 females in the ED group, compared to 5 males and 5 females in the HM group (P = .72). Mean duration of symptoms before diagnosis, including dysphagia, vomiting, food sticking, chest pain, and weight loss, was 15.9 months for ED and 10.7 months for HM (P = .41). Mean time from diagnosis to initial intervention was 76 days in ED vs 86 days in HM (P = .78). Subsequent interventions by myotomy or both dilatation and myotomy were required in 9 (30%) of 30 patients in the ED group and 2 (20%) of 10 patients in the HM group (P = .70). A clear transition from open to laparoscopic approach occurred between 1995 and 2001. Mean operating times were comparable (186.3 vs 156.0 minutes; P = .48). Of 14 laparoscopic myotomies, 11 (79%) had fundoplication, and 2 (18%) of the 11 were converted to open procedure. Intraoperative mucosal perforation rates were similar between open and laparoscopic groups (17% vs 18%). At follow-up, 32% of ED patients vs 43% HM had complete symptom relief (mean follow-up duration, 75.2 months; SD, 196.5).Conclusion
Both dilatation and myotomy are effective immediate treatment of achalasia. A clear transition to and preference for laparoscopic approach has occurred in the treatment of achalasia in children. 相似文献12.
Chitra N. Sambasivan Karen E. Deveney Katherine T. Morris 《American journal of surgery》2010,199(5):599-603
Background
This study examined outcomes of laparoscopic and open rectal cancer surgery in a community hospital setting.Methods
A community health care system cancer registry was reviewed retrospectively (2004-2007) for rectal cancer patients undergoing surgical treatment. Primary end points were rates of recurrence and survival.Results
Both open and laparoscopic resection groups had similar demographic, treatment, and tumor characteristics. Most patients in the open resection and laparoscopic resection populations experienced no recurrence (79% vs 83%, respectively; P = .5). Overall, the groups had similar mean (88% vs 96%, respectively; P = .4) and disease-free (21 and 23 months, respectively; P = .5) survival.Conclusions
In a community hospital setting, laparoscopic resection of rectal cancer was found to be as safe and effective as open resection in selected patients. 相似文献13.
Darcy A. Reed M.D. M.P.H. Thomas J. Beckman M.D. Scott M. Wright M.D. 《American journal of surgery》2009,198(3):442-444
Background
This study examined the methodologic quality of medical education research published in The American Journal of Surgery (AJS) relative to other journals and in AJS itself over time.Methods
Medical Education Research Study Quality Instrument (MERSQI) scores were determined for 198 education studies published in 2003 in 13 peer-reviewed journals including AJS and all 38 AJS education studies published in 2007.Results
In 2003, the mean (standard deviation) MERSQI scores of AJS studies were 11.03 (2.12) compared with 9.83 (2.37) for studies published in the other 12 journals (P = .03). AJS studies received higher scores for response rate (P < .001) and content validity (P = .03) than other journals. The mean MERSQI scores among AJS studies remained constant between 2003 and 2007 (12.03 [2.35] vs 11.03 [2.12], P = .13).Conclusions
Education studies published in AJS compared favorably with those published in other journals, and this quality was maintained over time. Nonetheless, there is room for improvement with respect to study designs and outcome assessment. 相似文献14.
Clinical, histopathologic, and radiographic indicators of malignancy in head and neck paragangliomas
D. Brandon Chapman Dylan Lippert Carol P. Geer Henry D. Edwards Gregory B. Russell Catherine J. Rees J. Dale Browne 《Otolaryngology--head and neck surgery》2010,143(4):531-537
Objective
The goal of this study is to review our series of head and neck paragangliomas to identify factors that may help in predicting malignancy.Study Design
Case series with chart review.Setting
Academic medical center.Subjects and Methods
Subjects with head and neck paragangliomas at our institution from 1976 to current were reviewed. In addition to statistical comparisons of epidemiologic factors, pathologic and radiographic characteristics were reviewed.Results
Of the 84 subjects, there were seven malignant paragangliomas (8%). Age was found to be significantly different between the benign and malignant subgroups, with an average age of 54 ± 16 and 40 ± 12 years, respectively (P = 0.02). Pain was a presenting complaint in five patients with benign disease (6%), and five of the seven malignant patients (71%) presented with pain, showing a significant association between pain and disease type (P < 0.0001). The odds ratio for a patient with pain having a malignant tumor was 36 (95% CI: 5.5-234). Enlarging neck mass was noted in all cases of malignant disease, but only in 31 percent of cases of benign disease (P < 0.0001). In a secondary analysis of carotid body tumors alone, enlarging neck mass was not found to be significant between benign and malignant disease (P = 0.14). However, pain continued to be significantly different, with 67 percent of malignant lesions demonstrating pain, compared with only 11 percent of benign lesions (P = 0.01).Conclusion
This study suggests that pain, a rapidly enlarging neck mass, and younger age are predictive factors of underlying malignancy, which should prompt one to consider an aggressive diagnostic and management approach. 相似文献15.
Nanmoku K Matsuda Y Yamamoto T Tsujita M Hiramitsu T Goto N Katayama A Watarai Y Kobayashi T Uchida K 《Transplantation proceedings》2012,44(1):281-283
Background
Elderly renal transplant candidates constitute one the fastest-growing populations among end-stage renal disease patients. Since the impacts of advanced recipient age have not yet been fully defined, we evaluated the clinical characteristics and outcomes of elderly renal transplant recipients.Methods
Among 564 adult renal transplant recipients, at our center between 2000 and 2009, 64 were at least 60 years of age (Elderly group), and 500 were younger than 60 years (Young group) at the time of the procedure. We compared their clinical features and surgical management.Results
There were significant differences in mean donor age (55.6 years vs. 53.2 years, P = .030) and gender mismatch (77.0% vs. 63.4%, P = .035). However, there were no significant differences between the two groups in patient and graft survivals (P = .177 and P = .365, respectively). Malignancy after transplantation was a significant risk factor upon univariate evaluation but only ABO incompatibility upon multivariate analysis of patient and graft survival. The main cause of graft loss among the Elderly group was death with a functioning graft due to heart failure.Conclusions
Renal transplantation is a feasible, safe option for the elderly and should be actively implemented. However, screening for cancer and heart disease should be mandatory to improve outcomes. 相似文献16.
Yiping Gong Juan Xu Jun Shao Hongtao Cheng Xinhong Wu Demian Zhao Bin Xiong 《American journal of surgery》2010,200(3):352-356
Introduction
We aimed to reduce the incidence of seroma formation by altering surgical technique.Methods
Two hundred one breast cancer patients were randomly divided into 2 arms: arm 1 was operated on using an altered surgical technique, which is to ligate all of the tissue connecting axillary vein bundles to the specimen, to suture the anterior edge of the latissimus dorsi to the chest wall, and to fix the skin flap to the underlying muscle by subcutaneous sutures; arm 2 was operated on using the conventional technique.Results
The drainage volume, in the initial 3 days, for patients in arm 1 was significantly less than that for patients in arm 2 (P < .01). The duration of drainage in arm 1 was shorter than that in arm 2 (P < .01). The incidence of seroma formation in arm 1 (2%) was significantly less than that in arm 2 (14%) (P < .01).Conclusion
The modified operating technique is an effective approach to reducing the incidence of seroma formation after mastectomy and axillary dissection. 相似文献17.
Sandrine Kamoun M.D. Arnaud Alves M.D. Ph.D. Frdric Bretagnol M.D. Jeremy H. Lefevre M.D. Patrice Valleur M.D. Yves Panis M.D. Ph.D. 《American journal of surgery》2009,198(3):450-455
Background
Because it has been suggested that obese patients may be at higher risk of morbidity and mortality after surgery, we conducted a prospective case-matched study to compare outcomes of elective laparoscopic colorectal surgery in obese and nonobese patients.Methods
Sixty-two consecutive nonselected obese patients (body mass index ≥30 kg/m2) were matched with 118 nonobese patients. Postsurgical mortality and morbidity were defined as in-hospital death and complications.Results
Cardiopulmonary comorbidities were significantly more frequent in obese compared with nonobese patients (44% vs 24%, P < .01). Obesity was significantly associated with increased mean operating time (268 ± 74 min vs 232 ± 59 min, P < .001), and conversion rate (32% vs 14%, P < .01). The mortality rate was nil. The overall postsurgical morbidity rate (31% vs 19%, P = not significant) and mean hospital stay (11 ± 10 days vs 9 ± 8 days, P = not significant) were similar in obese and nonobese patients.Conclusions
The results of this large case-matched study suggest that laparoscopic approach for colorectal surgery is feasible and safe in obese patients. 相似文献18.
K Morita T Seki D Iwami H Sasaki N Fukuzawa K Nonomura 《Transplantation proceedings》2012,44(6):1795-1799
Background
Spontaneous rupture risk of a renal artery aneurysm (RAA) is extremely low. Indications for surgical repair of RAA remain uncertain.Objective
Long-term outcomes of conservative therapy and surgical repair were evaluated.Patients
The study included 58 patients (17 males, 41 females) who were diagnosed with RAA during the last 21 years. Median age at the time of diagnosis was 62 (19-85) years, and the median follow-up 69 months (range 3-216).Methods
The patients were divided into two groups, conservative group (n = 30) who had been followed with blood pressure control, and treatment group (n = 29), who underwent an intervention.Results
Multiple efferent aneurysmal branches were observed in seven conservative and 16 treatment cases (P = .002). The median maximum diameter of the aneurysm was lower in the conservative than the treatment group (15 versus 25 mm, P = .005). Two conservative group cases showed increases in aneurysm size during follow-up. The hypertensive state showed essentially no change in either group during the follow-up. Renal function decreased with age similarly both in conservative and treatment groups.Conclusions
Our conservative management criteria for RAA are justifiable and even too strict. 相似文献19.
de Buys Roessingh AS Herzog G Cherpillod J Trichet-Zbinden C Hohlfeld J 《Journal of pediatric surgery》2008,43(4):668-674
Background
The aim of this retrospective study was to evaluate speech outcome and need of a pharyngeal flap in children born with nonsyndromic Pierre Robin Sequence (nsPRS) vs syndromic Pierre Robin Sequence (sPRS).Methods
Pierre Robin Sequence was diagnosed when the triad microretrognathia, glossoptosis, and cleft palate were present. Children were classified at birth in 3 categories depending on respiratory and feeding problems. The Borel-Maisonny classification was used to score the velopharyngeal insufficiency.Results
The study was based on 38 children followed from 1985 to 2006. For the 25 nsPRS, 9 (36%) pharyngeal flaps were performed with improvements of the phonatory score in the 3 categories. For the 13 sPRS, 3 (23%) pharyngeal flaps were performed with an improvement of the phonatory scores in the 3 children. There was no statistical difference between the nsPRS and sPRS groups (P = .3) even if we compared the children in the 3 categories (P = .2).Conclusions
Children born with nsPRS did not have a better prognosis of speech outcome than children born with sPRS. Respiratory and feeding problems at birth did not seem to be correlated with speech outcome. This is important when informing parents on the prognosis of long-term therapy. 相似文献20.
Ladd AP Nemeth SA Kirincich AN Scherer LR Engum SA Rescorla FJ West KW Rouse TM Billmire DF Grosfeld JL 《Journal of pediatric surgery》2005,40(6):974-977