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1.
Satoshi Masutani Clara Kurishima Akiko Yana Seiko Kuwata Yoichi Iwamoto Hirofumi Saiki Hirotaka Ishido Hideaki Senzaki 《The Journal of thoracic and cardiovascular surgery》2017,153(4):912-920
Objective
Elevated central venous pressure is a major cause of morbidity and mortality after the Fontan operation. The difference between mean circulatory filling pressure and central venous pressure, a driving force of venous return, is important in determining dynamic changes in central venous pressure in response to changes in ventricular properties or loading conditions. Thus, noninvasive central venous pressure and mean circulatory filling pressure estimation may contribute to optimal management in patients undergoing the Fontan operation. We tested the hypothesis that central venous pressure and mean circulatory filling pressure in those undergoing the Fontan operation can be simply estimated using peripheral venous pressure and arm equilibrium pressure, respectively.Methods
This study included 30 patients after the Fontan operation who underwent cardiac catheterization (median 8.6, 3.4-42 years). Peripheral venous pressure was measured at the peripheral vein in the upper extremities. Mean circulatory filling pressure was calculated by the changes of arterial pressure and central venous pressure during the Valsalva maneuver. Arm equilibrium pressure was measured as equilibrated venous pressure by rapidly inflating a blood pressure cuff to 200 mm Hg.Results
Central venous pressure and peripheral venous pressure were highly correlated (central venous pressure = 1.6 + 0.68 × peripheral venous pressure, R = 0.86, P < .0001). Stepwise multivariable regression analysis showed that only peripheral venous pressure was a significant determinant of central venous pressure. Central venous pressure was accurately estimated using regression after volume loading by contrast injection (R = 0.82, P < .0001). In addition, arm equilibrium pressure measurements were highly reproducible and robustly reflected invasively measured mean circulatory filling pressure (mean circulatory filling pressure = 9.1 + 0.63 × arm equilibrium pressure, R = 0.88, P < .0001).Conclusions
Central venous pressure and mean circulatory filling pressure can be noninvasively estimated by peripheral venous pressure and arm equilibrium pressure, respectively. This should help clarify unidentified Fontan pathophysiology and the mechanisms of Fontan failure progression, thereby helping construct effective tailor-made approaches to prevent Fontan failure. 相似文献2.
K. Lakhal S. Ehrmann D. Benzekri-Lefèvre I. Runge A. Legras P.-F. Dequin E. Mercier M. Wolff B. Régnier T. Boulain 《Annales fran?aises d'anesthèsie et de rèanimation》2012
Objective
The passive leg raising maneuver (PLR) for fluid responsiveness testing relies on cardiac output (CO) measurements or invasive measurements of arterial pressure (AP) whereas the initial hemodynamic management during shock is often based solely on brachial cuff measurements. We assessed PLR-induced changes in noninvasive oscillometric readings to predict fluid responsiveness.Study design
Multicentre interventional study.Patients and methods
In ICU sedated patients with circulatory failure, AP (invasive and noninvasive readings) and CO measurements were performed before, during PLR (trunk supine, not modified) and after 500-mL volume expansion. Areas under the ROC curves (AUC) were determined for fluid responsiveness (> 10% volume expansion-induced increase in CO) prediction.Results
In 112 patients (19% with arrhythmia), changes in noninvasive systolic AP during PLR (noninvasiveΔPLRSAP) only predicted fluid responsiveness (cutoff 17%, n = 21, positive likelihood ratio [LR] of 26 [18–38]), not unresponsiveness. If PLR-induced change in central venous pressure (CVP) was at least of 2 mmHg (n = 60), suggesting that PLR succeeded in altering cardiac preload, noninvasiveΔPLRSAP performance was good: AUC of 0.94 [0.85–0.98], positive and negative LRs of 5.7 [4.6–6.8] and 0.07 [0.009–0.5], respectively, for a cutoff of 9%. Of note, invasive AP-derived indices did not outperform noninvasiveΔPLRSAP.Conclusion
Regardless of CVP (i.e., during “blind PLR”), noninvasiveΔPLRSAP more than 17% reliably identified fluid responders. During “CVP-guided PLR”, in case of sufficient change in CVP, noninvasiveΔPLRSAP performed better (cutoff of 9%). These findings, in sedated patients who had already undergone volume expansion and/or catecholamines, have to be verified during the early phase of circulatory failure (before an arterial line and/or a CO measuring device is placed). 相似文献3.
Andrea Stroud Jill Zalieckas Corinne Tan Sarah Tracy David Zurakowski David P. Mooney 《Journal of pediatric surgery》2014
Background/Purpose
Optimal central venous catheter (CVC) tip location is necessary to decrease the incidence of complications related to their use. We sought to create a practical method to reliably predict the length of catheter to insert into the subclavian vein during CVC placement in children.Methods
We performed a retrospective review of 727 chest radiographs of children who underwent either left or right subclavian CVC placement. We measured the distance from the subclavian entry site to the to the right atrium/superior vena cava (RA/SVC) junction, following the catheter's course. We analyzed the relationship between that length and patient characteristics, including: age, gender, height, weight and body surface area (BSA).Results
Two derived formulas using the BSA best correlated with the optimal subclavian CVC length. For the left subclavian vein approach, the optimal catheter length was 6.5*BSA + 7 cm, and for the right subclavian vein approach it was 5*BSA + 6. The use of these formulas correlated in CVC tip placement in a clinically proper location in 92.9% of smaller children and in 95.7% of larger children.Conclusion
The optimal length of central venous catheter to insert into the subclavian vein may be determined through the use of a simple formula using the BSA. 相似文献4.
S. -E. RICKSTEN A. MEDEGÅRD I. CURELARU B. GUSTAVSSON L. E. LINDER 《Acta anaesthesiologica Scandinavica》1986,30(1):13-17
The pressure in the proximal axillary vein (AVP) was compared with central venous pressure (CVP) in eight patients during and after elective abdominal surgery. Both pressures were recorded from soft, elastic, polyurethane catheters inserted in the basilic or cephalic veins ("half-way" catheters), punctured at the fossa cubiti (AVP), and via the right jugular vein (CVP). The AVP and CVP were recorded simultaneously using hydrostatic, conventional disposable venous pressure measurement sets. The measurements were performed during intermittent positive pressure ventilation with positive end-expiratory pressure from 0 to 7.5 cmH2O (0-0.74 kPa), as well as during spontaneous breathing. During both controlled and spontaneous respiration, small mean differences (0.2-1.0 cmH2O) (0.02-0.1 kPa), and a highly significant (P less than 0.001) positive correlation between CVP- and AVP-values were found. An increase of 1 cmH2O (0.10 kPa) in the CVP was associated with an increment of practically identical order (0.99-1.04 cmH2O) (0.10-0.11 kPa) in the AVP. The results suggest that monitoring of the AVP by a basilic "half-way" catheter produces diagnostic information similar to that from the measurement of the CVP from subclavian, external or internal jugular, as well as "long-way" brachial catheter, with no risk of the major mechanical complications which accompany the use of the latter catheters. 相似文献
5.
Background
The purpose of this study was to determine if laterality of internal jugular vein (IJV) sampling affects the accuracy of intraoperative parathyroid hormone (PTH) monitoring during parathyroidectomy for primary hyperparathyroidism.Methods
In this study, 109 patients underwent parathyroidectomy (82 with unilateral disease, 27 with multigland disease). PTH samples were taken from both the left and the right IJV at these time points: preincision (baseline) and then at 5, 10, and, in selected patients, 20 minutes after excision. The Miami criterion was used to determine operative success.Results
In all 109 patients combined, the mean decreases in intraoperative PTH levels were 73.8 ± 22.2% for the left IJV and 71.9 ± 23.0% for the right IJV (P = .22). The Miami criterion was met in 105 patients: in 100 (95%) left IJV samples and 99 (94%) right IJV samples (P = 1.00).Conclusions
No difference was found in the accuracy of intraoperative PTH monitoring between patients' left and right IJV samples. Central venous laterality did not affect fulfillment of the Miami criterion. 相似文献6.
Purpose
The purpose of this study was to determine, in a pediatric population less than 5 years of age, which size catheter is ideal for central venous access via the subclavian and internal jugular vein based on the children’s age, weight, and height.Methods
This was a retrospective chart review of children less than 5 years of age at The Children’s Hospital in Denver, Colorado who underwent subclavian or internal jugular central venous catheter placement from January 1, 1998 through December 31, 2001. Age, height, weight, primary disease, access site, type of central venous catheter, size of central venous catheter, and complications were recorded. Age, weight, and height were stratified and compared with catheter size to determine any correlation between age, weight, height, and complications.Results
There were 430 central venous catheters placed via the subclavian or internal jugular vein in 331 patients less than 5 years old. One hundred ninety-five catheters (45.4%) were less than 6F in size, and 235 (54.6%) catheters were ≥6F in size. Children, who were between 0.5 and 0.99 years old, 5 to 7.49 kg in weight, 7.5 to 9.99 kg in weight, and 60 to 74.9 cm in height had higher complication rates (P < .05) when catheters ≥6F were inserted. Children who were greater than 1 year of age, greater than 10 kg in weight, and longer than 75 cm in height did not experience a significant difference (P > .05) in complications versus catheter size.Conclusions
The choice of central venous catheter size should be predicated, not only on the primary disease, but also on the child’s age, weight, and height. Insertion of central venous catheters larger than 6F in children less than 1 year of age, less than 10 kg in weight, or less than 75 cm in height, was associated with higher complications compared with other settings. 相似文献7.
Megan E. BowenMary C. Mone R.N. B.S.E. Edward W. NelsonCourtney L. Scaife M.D. 《American journal of surgery》2014,208(6):937-941
Background
The goals of this study were to evaluate the complication rate for intraoperative placement of a long-term central venous catheter (CVC) using intraoperative ultrasound (US) and fluoroscopy and to examine the feasibility for eliminating routine postprocedure chest X-ray.Methods
Retrospective data pertaining to operative insertion of long-term CVC were collected and the rate of procedural complications was determined.Results
From January 2008 to August 2013, 351 CVCs were placed via the internal jugular vein using US. Of these, 93% had a single, successful internal jugular vein insertion. The complications included 4 arterial sticks (1.14%). Starting in October 2012, postprocedure chest radiography (CXR) was eliminated in 170 cases, with no complications. A total of $29,750 in charges were deferred by CXR elimination.Conclusions
This review supports the use of US for CVC placement with fluoroscopy in reducing the rate of procedural complications. Additionally, with fluoroscopic imaging, postprocedural CXR can be eliminated with associated healthcare savings. 相似文献8.
Madhukar S. Patel M.D. M.B.A. Sc.M. Tyler Ewing David NguyenCristobal Barrios M.D. Marianne Cinat Matthew Dolich Michael Lekawa Darren Malinoski 《American journal of surgery》2013
Background
We sought to identify independent predictors of venous thromboembolism in critically ill general surgery patients who cannot receive chemical prophylaxis in order to identify those who may benefit from aggressive screening and/or prophylactic inferior vena cava filter placement.Methods
Nontrauma patients in the surgical intensive care unit were prospectively followed for 2 years. Patients who had contraindications to prophylactic anticoagulation and received routine screening duplex examinations were included. Data regarding lower-extremity deep venous thrombosis or pulmonary embolism (PE) rates, past medical history (PMH), surgeries, and transfusions were collected. Logistic regression was used to identify independent predictors of lower-extremity deep venous thrombosis or PE (venous thromboembolism) with a P < .05.Results
Data were complete for 204 patients. Twenty (9.8%) patients developed venous thromboembolism. Independent predictors of venous thromboembolism included postoperative blood product requirements (odds ratio = 1.04 per unit), a PMH of PE (OR = 10.1), and a PMH of renal insufficiency (odds ratio = 5.1).Conclusions
Aggressive screening and/or prophylactic inferior vena cava filter may be considered when prophylactic anticoagulation is prohibited in patients with increased postoperative transfusion requirements or a PMH of either PE or renal insufficiency. 相似文献9.
Background
Simulation-based learning is a common educational tool in health care training and frequently involves instructional designs based on Experiential Learning Theory (ELT). However, little research explores the effectiveness and efficiency of different instructional design methodologies appropriate for simulations. The aim of this study was to compare 2 instructional design models, ELT and Guided Experiential Learning (GEL), to determine which is more effective for training the central venous catheterization procedure.Methods
Using a quasi-experimental randomized block design, nurse anesthetists completed training under 1 of the 2 instructional design models. Performance was assessed using a checklist of central venous catheterization performance, pass rates, and critical action errors.Results
Participants in the GEL condition performed significantly better than those in the ELT condition on the overall checklist score after controlling for individual practice time (F[1, 29] = 4.021, P = .027, Cohen's d = .71), had higher pass rates (P = .006, Cohen's d = 1.15), and had lower rates of failure due to critical action errors (P = .038, Cohen's d = .81).Conclusions
The GEL model of instructional design is significantly more effective than ELT for simulation-based learning of the central venous catheterization procedure, yielding large differences in effect size. 相似文献10.
Validation of the Pliance X System in measuring interface pressure generated by pressure garment 总被引:1,自引:0,他引:1
Candy H.Y. Lai Cecilia W.P. Li-Tsang 《Burns : journal of the International Society for Burn Injuries》2009,35(6):845-851
Introduction
Pressure monitoring is crucial for effective pressure therapy. Precise and reliable interface pressure measurement system, however, remains unavailable in current practice.Methodology
This is a validation study on the application of a recently developed device, the Pliance X System, for static interface pressure measurement. Sensor properties were evaluated through series of laboratory tests in the first phase of the study. Phase II was a clinical study using the Pliance X system to differentiate the loading generated on the patients’ scars through additional inserts and pressure garment.Results
Results showed high test–retest and inter-rater reliability (ICC ≥ 0.995) with good linearity (adjusted R-square = 0.997) by measuring standard weights. The maximum deviation between the measurement generated by the sensor and the sphygmomanometer cuff was ±1.451 mmHg. Results in the clinical trial revealed its discriminant ability in distinguishing different levels of pressure loading on patients with scars (p < 0.01).Conclusion
The commercially available pressure measurement system was found to be a reliable tool for measurement of low interface pressure under static condition. 相似文献11.
Brian W. MacLaughlinDavid S. Plurad M.D. William SheppardScott Bricker M.D. Fred BongardAngela Neville M.D. Jennifer A. SmithBrant Putnam M.D. Dennis Y. Kim 《American journal of surgery》2015,210(6):1082-1087
Background
The effect of intracranial pressure (ICP) monitoring on mortality after severe traumatic brain injury (sTBI) remains unclear. We hypothesized that ICP monitoring would not be associated with improved survival in patients with sTBI.Methods
A retrospective analysis was performed on sTBI patients, defined as admission Glasgow Coma Scale score of 8 or less with intracranial hemorrhage. Patients who underwent ICP monitoring were compared with patients who did not. The primary outcome measure was inhospital mortality.Results
Of 123 sTBI patients meeting inclusion criteria, 40 (32.5%) underwent ICP monitoring. On bivariate and multivariate regression analyses, ICP monitoring was associated with decreased mortality (odds ratio = .32, 95% confidence interval = .10 to .99, P = .049). This finding persisted on propensity-adjusted analysis.Conclusions
ICP monitoring is associated with improved survival in adult patients with sTBI. In addition, significant variability exists in the use of ICP monitoring among patients with sTBI. 相似文献12.
Pedro-Jose Lopez Bernardita Troncoso Jean Grandy Francisco Reed Alejandra Ovalle Soledad Celis Danielle Reyes Nelly Letelier Ricardo Zubieta 《Journal of pediatric surgery》2014
Purpose
Central venous catheters (CVC) are frequently used for haemodialysis (HD) in children. However, there is paucity of information on the outcomes of CVCs when used for HD in very young patients. Our objective is to report the success, safety and complication rates of CVCs used for HD in children weighing less than 15 kg.Materials and methods
This is a single-center retrospective study of all patients with end-stage renal disease (ESRD) weighing < 15kg, who underwent a tunneled CVC placement for HD, between July 2006 and June 2012 at our institution. Analysed data included clinical background, age and weight at initiation of HD, outcome of HD, CVC vein insertion site, reason for removal, and catheter survival (in days).Results
Thirty-one CVC were placed in 11 patients weighing < 15 kg, 8 males and 3 females. The main causes of ESRD were renal dysplasia and congenital nephrotic syndrome. At the beginning of HD, mean age was 27.5 (range 5–60) months and mean weight was 10.4 kg (4.5–13 kg). The preferred insertion site was the right internal jugular vein (90%). Mean duration of HD was 312 days. Mechanical factors were the main reason for catheter removal (39%). Mean catheter survival was 110 days/catheter.Conclusions
We believe our study provides relevant information and encouraging data to support the use of CVC for HD in this cohort of infants; however, further improvement in prevention of catheter thrombosis and management of infections needs to be achieved. 相似文献13.
Bacchi G Buscaroli A Fusari M Neri L Cappuccilli ML Carretta E Stefoni S 《Transplantation proceedings》2010,42(9):3387-4748
Introduction
Delayed graft function (DGF) is a common complication in kidney transplantation. We sought to evaluate possible correlates for DGF including intraoperative parameters, focusing on fluid replacement and central venous pressure (CVP) values among patients undergoing kidney transplantation at our center.Methods
One hundred fifty-five cadaveric donor transplantations performed at our center between 2001 and 2005 were selected for the study. We compared intraoperative parameters together with 15 other clinical and socio-demographic recipient and donor variables among patients experiencing DGF (n = 58) versus those with immediate graft function (IGF; n = 97). All significant variables at P < .05 upon univariate analysis were entered into a multivariate logistic regression model to identify risk factors for DGF.Results
CVP at awakening of ≤8 mm Hg (odds ratio [OR] = 3.53; 95% confidence interval [CI], 1.63-7.63), fluid input during surgery ≤2.250 mL (OR = 2.12; 95% CI, 1.00-4.51), and recipient age ≥50 years (OR = 2.72; 95% CI, 1.11-6.68) were the strongest correlates of DGF.Conclusions
Our data suggested that reduced intraoperative perfusion as measured using CVP monitoring might increase DGF risk. This study provides the rationale to further investigate the optimal CVP target during this surgery. 相似文献14.
Hao Tang Dong Liu Hai-Feng Qi Ze-Ping Liang Xiu-Zhu Zhang Dong-Po Jiang Lian-Yang Zhang 《中华创伤杂志(英文版)》2018,21(1):20-26
Purpose: To evaluate the effect of retention sutures on abdominal pressure and postoperative prognosis in abdominal surgery patients.
Methods: This prospective cohort study included patients who were admitted to Daping Hospital from May 15, 2014 to October 11, 2014. A total of 57 patients were enrolled, including 18 patients in the “U” type retention suture group, 17 patients in the intermittent retention suture group, and 22 patients in non-retention suture group. The demographic data, clinical data and risk factors for abdominal wound dehiscence were recorded. The bladder pressure (IVP) was monitored preoperatively, intraoperatively,
and four days postoperatively. Additionally, the incidence of abdominal wound dehiscence and infection 14 days after the operation was recorded.
Results: During the operation, the IVP decreased and then increased; it was at its lowest 1 h after the start of the operation (5.3 mmHg ± 3.2 mmHg) and peaked after tension-reducing (8.8 mmHg ± 4.0 mmHg). The IVP values in the “U” type retention suture group and intermittent retention suture group were higher than in the non-retention suture group 4 days after operation (p < 0.005). The Visual Analogue Scale (VAS) pain scores were 3.9 ± 2.2, 3.8 ± 2.0, and 3.0 ± 1.0 in the retention suture group, intermittent retention suture group and non-retention suture group, respectively. The VAS pain scores in the “U” type tension-reducing group and intermittent tension-reducing group were higher than in the non-tension-reducing group (p < 0.005).
Conclusion: Although retention sutures may reduce the incidence of postoperative wound dehiscence in abdominal surgery patients, they can increase the IVP and postoperative pain. 相似文献
15.
Arianna Bertocchini Pierluigi Falappa Chiara Grimaldi Giuseppe Bolla Lidia Monti Jean de Ville de Goyet 《Journal of pediatric surgery》2014
Background
Children with extrahepatic portal hypertension typically present with cavernomatous transformation of the portal vein and a poorly defined intrahepatic portal vein system on conventional imaging. With the Meso-Rex Bypass becoming the gold-standard intervention for a cure, a precise assessment of the intrahepatic portal vein system provides helpful data for deciding whether a Meso-Rex Bypass is feasible or not.Methods
All children with extrahepatic portal hypertension were prospectively assessed by wedged hepatic venous portography. Venous anatomy was categorized into five subtypes (A to E), depending on the presence of thrombosis in the Rex recessus, or not, and its extension within the intrahepatic portal venous system.Results
Eighty-nine children entered the study. Previous umbilical vein catheterization is usually associated with Rex thrombosis, while the Rex recessus and the intrahepatic portal venous system are patent in idiopathic cases, thus allowing for the performance of a Meso-Rex Bypass with a good outcome.Conclusions
Wedged hepatic venous portography is a very effective tool for detailed preoperative assessment and identification of children being considered for Meso-Rex Bypass surgery. An anatomic–radiological classification is useful in selecting patients for Meso-Rex Bypass with anticipation of a high rate of success. 相似文献16.
Xiaobao ZhangHengfei Luan MD Pin ZhuJiying Feng MD Jizheng CuiZhibin Zhao MD 《The Journal of surgical research》2014
Background
Ultrasonography has been suggested as a useful noninvasive tool for the detection of hypovolemia in critically ill patients. Hypovolemia after preoperative fasting and bowel preparation may compromise hemodynamic function during gastrointestinal surgery. However, there are few data comparing ultrasonographic examination of the inferior vena cava (IVC) diameter with central venous pressure (CVP) measurement in patients undergoing gastrointestinal surgery in the assessment of intravascular volume status.Materials and methods
Forty American Society of Anesthesiologists I–II patients who underwent elective gastrointestinal surgery and 32 healthy volunteers were enrolled in the study. The IVC diameters, both during expiration (IVCe) and inspiration (IVCi), and right ventricle (RV) were measured with ultrasonography in patients both before and after fluid resuscitation. Volunteers were also measured during the time they participated in the study.Results
Forty patients (mean age 51 y; 45% female) and 32 volunteers (mean age 46 y; 44% female) underwent IVC and RV sonographic measurements. The diameters of the IVCe, IVCi, and RV in patients (1.83, 1.34, and 3.23 cm) were significantly lower compared with those of healthy volunteers (1.18, 0.62, and 2.71 cm). After fluid resuscitation, IVCe, IVCi, and RV in hypovolemic patients (1.75, 1.25, and 3.27 cm) significantly increased. The pre-IVCe and the post-IVCe were closely correlated to the CVP (r = 0.585 and r = 0.609, respectively). Similarly, the pre-RV and the post-RV were correlated to the CVP (r = 0.347 and r = 0.439, respectively).Conclusions
Our data demonstrate that the IVC and RV diameters are consistently low in patients undergoing gastrointestinal surgery when compared with healthy subjects. Ultrasonographic measurements of the IVC and RV diameters are useful supplement of CVP for the evaluation of preoperative patients with hypovolemia. 相似文献17.
Efstathios Karamanos Pedro G. TeixeiraEmre Sivrikoz M.D. Stephen VargaKonstantinos Chouliaras M.D. Obi OkoyePeter Hammer M.D. FACS 《American journal of surgery》2014
Background
Intracranial pressure (ICP) monitoring is a standard of care in severe traumatic brain injury when clinical features are unreliable. It remains unclear, however, whether elevated ICP or decreased cerebral perfusion pressure (CPP) predicts outcome.Methods
This is a prospective observational study of patients sustaining severe blunt head injury, admitted to the surgical intensive care unit at the Los Angeles County and University of Southern California Medical Center between January 2010 and December 2011. The study population was stratified according to the findings of ICP and CPP. Primary outcomes were overall in-hospital mortality and mortality because of cerebral herniation. Secondary outcomes were development of complications during the hospitalization.Results
A total of 216 patients met Brain Trauma Foundation guidelines for ICP monitoring. Of those, 46.8% (n = 101) were subjected to the intervention. Sustained elevated ICP significantly increased all in-hospital mortality (adjusted odds ratio [95% confidence interval]: 3.15 [1.11, 8.91], P = .031) and death because of cerebral herniation (adjusted odds ratio [95% confidence interval]: 9.25 [1.19, 10.48], P = .035). Decreased CPP had no impact on mortality.Conclusions
A single episode of sustained increased ICP is an accurate predictor of poor outcomes. Decreased CPP did not affect survival. 相似文献18.
Background
This study of patients who received either aggressive or less-aggressive treatment for superficial venous disease was undertaken to determine its effects on deep venous insufficiency (DVI).Methods
From 1998 to 2004, we treated 1,500 consecutive patients with superficial venous disease at our outpatient care center. A total of 100 patients were available for the study; the remaining patients were not available for the complete follow-up duplex scans 6 months after therapy, irrespective of the therapeutic results. Sixty-four patients underwent aggressive therapy, which included high ligation with partial selective perforation-invagination (PIN) axial stripping of the greater saphenous vein, ambulatory stab phlebectomy of the varicose veins, and transdermal treatment of the spider veins. Thirty-six patients underwent less-aggressive treatment, which included high ligation with selective partial PIN axial stripping of the greater saphenous vein and ambulatory phlebectomy of varicose vein clusters but no spider vein treatment.Results
Follow-up duplex scanning after aggressive treatment of superficial venous disease showed improvement or complete reversal of DVI in the majority of patients. This improvement was defined as a marked decrease in the size of the deep veins in 80% of patients and a decrease of the reflux closure time of the deep venous valves in 83% of patients. Only 28% of patients receiving less-aggressive treatment without transdermal laser therapy of the spider veins showed improvement in their reflux valve closure time; the remaining 72% were unchanged or deteriorated.Conclusions
Aggressive treatment of superficial venous disease can prevent or even eliminate deep vein insufficiency (DVI). 相似文献19.
Background
Selective non-operative management (SNOM) of penetrating abdominal wounds has become increasingly common in the past two or three decades and is now accepted as routine management for stab wounds. Gunshot wounds are more frequently managed with mandatory laparotomy but recently SNOM has been successfully applied. This review systematically appraises the evidence behind SNOM for civilian abdominal gunshot wounds.Methods
A Medline search from 1990 to present identified civilian studies examining success rates for SNOM of abdominal gunshot wounds. Case reports, editorials and abstracts were excluded. All other studies meeting the inclusion criteria of reporting the success rate of non-operative management of abdominal gunshot wounds were analysed.Results
Sixteen prospective and six retrospective studies met the inclusion criteria, including 18,602 patients with abdominal gunshot wounds. 32.2% (n = 6072) of patients were initially managed non-operatively and 15.5% (n = 943) required a delayed laparotomy. The presence of haemodynamic instability, peritonitis, GI bleeding or any co-existing pathology that prevented frequent serial examination of the abdomen from being performed were indications for immediate laparotomy in all studies. Delayed laparotomy results in similar outcomes to those in patients subjected to immediate laparotomy. Implementation of SNOM reduces the rates of negative and non-therapeutic laparotomies and reduces overall length of stay.Conclusions
SNOM can be safely applied to some civilian patients with abdominal gunshot wounds and reduces the rates of negative or non-therapeutic laparotomy. Patients who require delayed laparotomy have similar rates of morbidity and mortality and similar length of stay to those patients who undergo immediate laparotomy. 相似文献20.