The electrocardiographic reperfusion peak in patients with ST-elevation myocardial infarction

OBJECTIVES: To analyse the incidence and the prognostic value of the reperfusion peak in a population of patients with AMI treated with thrombolysis. DESIGN: Two hundred and sixty-nine patients with ST-elevation myocardial infarction treated with thrombolysis were monitored with continuous on-line vectorcardiography. RESULTS: A reperfusion peak defined as a transiently increased ST-VM of >50 microV followed by an immediate decrease to a level lower than the starting point was seen in 112 of all 269 (42%) patients and in 111 of 149 (75%) of the patients with successful ST-resolution. A reperfusion peak was an independent predictor of better prognosis both in the short- and the long term but had no implications on the prognosis in the subgroup with successful ST-resolution. CONCLUSION: A reperfusion peak was equally common in patients treated with thrombolysis having a successful ST-resolution as observed in studies of patients with successful primary coronary angioplasty. The reperfusion peak was associated with better prognosis and should be recognised as a possible marker of successful reperfusion but can mimic aggravated ischemia.     

Management of infected total knee arthroplasty

A retrospective study of the Mayo Clinic experience with the management of 61 infected total knee arthroplasties treated between 1970 and 1980 revealed rheumatoid arthritis as an underlying diagnosis in 47%. Previous operations had been performed in 58%. Arthrodesis was the most frequently utilized salvage technique and was successful in 83%. Reimplantation of a new prosthesis was successful in 63%. Debridement alone was successful in six knees when performed early for acute infections.     

Reversed dynamic slings. A new concept in the treatment of post-traumatic elbow flexion contractures.

Following the successful treatment of knee-flexion contractures in haemophiliacs using an external corrective system with reversed dynamic slings, these have been adapted to treat post-traumatic elbow contractures. A case is described in which 90 degrees of fixed flexion was corrected in 1 week without discomfort. Clearly there is no need to resort to an internally applied hinge-distractor apparatus or capsulectomy if a simple external sling system is successful without complications.     

Medial thighplasty,prevention of scar migration,and labial flattening

As more people seek body contour surgery spurred on by the media's great interest in suction lipectomy and the seemingly increasing numbers of satisfied patients, we should re-examine an area where results of body contour surgery have been less satisfying, the inner thigh. In those patients whose problem remains skin flabbiness rather than excessive fat, either alone or after successful or partially successful suction lipectomy, an inner-thigh procedure is indicated.     

Increased delivery of haemodialysis assists successful pregnancy outcome in end-stage renal failure

Pregnancy in patients on maintenance dialysis is rare, with few cases of successful live births reported in Australian women on dialysis at the time of conception. Increasing dialysis delivery may improve outcomes for both mother and foetus in this high-risk situation. We report a case of successful pregnancy outcome with the application of an intensive dialysis regimen.     

A comprehensive treatment approach is necessary for the closure of open window thoracostomy: an institutional review of 35 cases

Purpose

Although life-threatening situations can be avoided using an open window thoracostomy (OWT), the closure is often difficult. We investigated the predictors of a successful closure of an OWT at the time of OWT creation.

Methods

Thirty-five consecutive patients who underwent an OWT at our institute between January 1991 and December 2010 were reviewed. We directly compared the patients with and without a successful OWT closure. A logistic regression analysis was employed to determine the predictive factors of a successful closure.

Results

OWT closure was only achieved in 12 patients. The closure of the OWT and absence of diabetes mellitus significantly influenced the survival of the OWT patients. The OWT in patients with preceding lung resection was difficult to close, especially if the underlying disease was lung cancer. The existence of a bronchopleural fistula (BPF) was not related to successful closure. Among the post-lung resection patients, the nutritional status tended to affect the success of the closure.

Conclusion

Successful closure is difficult to predict at the time of the creation of an OWT. A comprehensive approach, including nutritional support and the precise timing of intervention is critical to promote a successful closure.     

A 1-year follow-up quality of life study after hemodynamically successful or unsuccessful surgical revascularization of lower limb ischemia

PURPOSE: The impact of hemodynamically successful or unsuccessful bypass grafting or angioplasty on patients' quality of life was assessed throughout the first year postsurgery. METHODS: A total of 146 patients, 97 patients who underwent successful revascularization and 49 patients who underwent unsuccessful revascularization, were assessed for quality of life with the Nottingham Health Profile. RESULTS: Hemodynamically successful revascularization resulted in an immediate and lasting impact on the patients' quality of life. Despite hemodynamic failure, patients had improvements in pain, emotional reactions, sleep, and family relationships at the 1-year follow-up assessment. A successful revascularization in patients with claudication demonstrated the most marked quality of life benefits, including all health dimensions that were not normal at baseline. Patients with critical ischemia had improved quality of life for pain, sleep, and physical mobility. High ankle pressure, in the claudicant group, and a high sense of coherence were significantly associated with high quality of life. CONCLUSION: The treatment of lower limb ischemia resulted in an immediate and relatively lasting improvement in patients' quality of life. Patients who underwent hemodynamically successful bypass grafting procedures or angioplasty demonstrated higher quality of life benefits than patients who underwent a failed bypass grafting procedure. Quality of life was further determined by means of the patients' sense of coherence.     

联合主动免疫治疗原因不明习惯性流产疗效分析

目的探讨淋巴细胞主动免疫联合人绒毛膜促性腺激素(hCG)/黄体酮治疗原因不明习惯性流产(UHA)的疗效。方法50例UHA患者采用淋巴细胞行主动免疫治疗,妊娠后分别采用hCG或黄体酮保胎治疗。结果经治疗后50例患者中29例妊娠,其中分娩21例,中晚期妊娠各2例,流产4例,妊娠成功率86%(25/29);主动免疫联合hCG妊娠成功率88%(14/16),联合黄体酮成功率85%(11/13),两者疗效相似;主动免疫治疗后封闭抗体转为阳性3例,其中2例成功妊娠,封闭抗体仍为阴性26例中,成功妊娠23例,二者比较无统计学差异。结论对于UHA患者,淋巴细胞主动免疫联合hCG/黄体酮是一种简单有效的治疗方法,两种联合主动免疫疗法的疗效无显著差异,主动免疫治疗后封闭抗体转阳与否与妊娠结局无相关性。     

Management of erectile impotence. Use of implantable inflatable prosthesis

A completely implantable erectile prosthesis for the treatment of erectile organic impotence has been developed in conjunction with an artificial prosthetic urinary sphincter' Five patients have undergone successful surgical implantation of this device, two of these patients have had sufficient postoperative follow-up to achieve successful vaginal penetration for sexual intercourse.     

Thomas Annandale and the first report of successful orchiopexy

PURPOSE: We investigate the surgeon and factors behind the first report of successful orchiopexy. MATERIALS AND METHODS: We reviewed the first reports of orchiopexy, and the work and writings concerning Thomas Annandale and the time in which he practiced. RESULTS: Annandale was a surgeon in Edinburgh, Scotland, in the late 19th century. In 1877 he successfully brought down an ectopic testicle in a 3-year-old boy. This first reported successful orchiopexy was due in large part to Lister's antiseptic technique. CONCLUSIONS: Annandale performed the first successful orchiopexy by integrating the surgical and antiseptic ideas of his predecessors and contemporaries.     

The failed bladder closure in cloacal exstrophy: Management and outcomes

PurposeCloacal exstrophy (CE) is the most severe presentation of the Exstrophy-Epispadias Complex (EEC) and is associated with an omphalocele, making the bladder and abdominal wall closure difficult. If the bladder closure fails, a secondary closure is necessary. The objective of this study is to identify patient or surgical factors associated with a successful secondary closure.MethodsThe institution's EEC database was reviewed for CE patients between 1975 and 2015. Inclusion criteria included a failed primary bladder closure with a secondary closure. Patient demographics, surgical factors and outcomes of the secondary bladder closure were reviewed.ResultsTwenty-four patients met inclusion criteria. 8/8 patients had a successful two-staged closure at the author's institution (100%); 2/16 patients had a successful closure at an outside institution (12.5%). Older median age at secondary closure was associated with outcome, p = 0.045. Pelvic osteotomy was associated with successful secondary closure, p = 0.013. Using Buck's immobilization with external fixation was associated with a higher proportion of successful secondary closures compared to Spica cast, p = 0.012.ConclusionSuccessful reclosure in CE patients is associated with the use of osteotomy as well as Buck's immobilization with external fixation. While successful reclosure can be achieved, it is often at the cost of multiple procedures and, therefore, all efforts should be expended to achieve a successful primary closure.Type of Study: Prognostic.Level of Evidence: III.     

Response of Recurrent Binge Eating and Weight Gain to Topiramate in Patients with Binge Eating Disorder after Bariatric Surgery

Background: The effectiveness of topiramate was evaluated in the treatment of recurrent binge eating and weight gain in patients with binge eating disorder (BED) and obesity who had undergone initially successful bariatric surgery. Methods: The records of 3 consecutive patients with BED and obesity who presented to our clinic with recurrent binge eating and weight gain after undergoing initially successful bariatric surgery were reviewed. They were treated with topiramate for an average of 10 months. Results: All three patients reported complete amelioration of their binge eating symptoms and displayed weight loss (31.7 kg in 17 months, 14.5 kg in 9 months, 2 kg in 4 months, respectively) in response to topiramate (mean dose 541 mg). Conclusion: Although anecdotal, these observations suggest that topiramate may be an effective treatment for patients with BED and obesity who experience recurrent binge eating and weight gain after initially successful bariatric surgery.     

Successful replantation of both legs in a child--5-year followup: case report

Replantation of lower extremities is an infrequent procedure, and is rarely indicated, due to the usual severity of the primary injury plus the possibility of good prosthetic substitution. We report a case of successful replantation of both legs in an 8-year-old boy (despite Aspergillus flavus septicemia) with followup of 5 years. This case suggests that leg replantation should be considered in young patients. This appears to be the second reported case of successful replantation of both legs.     

Severe wrist contracture in a child with linear scleroderma

Linear scleroderma is an unusual disorder characterized by linear streaks of fibrotic skin involvement, which can lead to severe limb deformities and contractures. The authors present a case of severe wrist contracture in a child with linear scleroderma treated by release of the contracture with coverage of the exposed carpus with an abductor digiti minimi flap and skin graft. Reports of successful treatment of extremity deformities are rare. At 1 year this correction appears to have been successful.     

Successful colonoscopic decompression of colon after development of an early postoperative obstruction at the stapled anastomosis after an anterior colectomy and early chemotherapy: a case report

A case report describing the successful colonoscopic decompression and catheter drainage of an early postoperative large bowel obstruction caused by swelling at the stapled anastomosis after the initiation of chemotherapy. Our case illustrates that colonoscopy can be successful in managing early postoperative bowel obstruction secondary to swelling at the stapled colonic anastomosis.     

Successful digital replantation after 42 hours of warm ischemia.

Previously, 6 to 10 hr were believed to be an acceptable limit of warm ischemia for successful digital replantation. The longest warm ischemia time ever reported was 33 hr. This report presents successful replantations of two fingers after 42 hr of warm ischemia.     

Groin pain after replacement of the hip: aetiology, evaluation and treatment

Persistent groin pain after seemingly successful total hip replacement (THR) appears to have become more common. Recent studies have indicated a high incidence after metal-on-polyethylene and metal-on-metal conventional THR and it has been documented in up to 18% of patients after metal-on-metal resurfacing. There are many causes, including acetabular loosening, stress fracture, and iliopsoas tendonitis and impingement. The evaluation of this problem requires a careful history and examination, plain radiographs and an algorithmic approach to special diagnostic imaging and tests. Non-operative treatment is not usually successful. Specific operative treatment depending on the cause of the pain usually involves revision of the acetabular component, iliopsoas tenotomy or other procedures, and is usually successful. Here, an appropriate algorithm is described.     

Epidural analgesia for labour in a patient with Ebstein’s anomaly

Ebstein’s anomaly is an uncommon congenital cardiac defect which is associated with cyanosis and arrhythmias. There have been very few previous reported cases of successful outcome in pregnancy in women with this disorder. We describe the successful analgesic management of an obstetric patient who had been known to have Ebstein’s anomaly since childhood. Her first pregnancy was uneventful and analgesia during labour was provided by an epidural. During her second pregnancy she presented to our hospital as her condition had deteriorated. Symptomatic control was achieved with digoxin. Despite this, several episodes of hospitalization were needed pre-partum for rest and oxygen therapy. After the onset of spontaneous labour, analgesia was managed by an epidural using bupivacaine. Invasive monitoring was not deemed appropriate due to increased risk and questionable usefulness. Vaginal delivery was managed with elective lift-out forceps to minimize the stress of pushing. When reviewed two months post-partum she still required digoxin although her symptoms had improved considerably. The successful management of Ebstein’s anomaly in pregnancy should include team management from early in pregnancy.     

Microsurgical procedures for management of giant middle cerebral aneurysm causing increased intracranial pressure

There have not been many cases reported of giant aneurysms of the middle cerebral artery with a remarkable mass and causing increased intracranial pressure, and the successful operation for resecting an aneurysm is still low. Considering it essential that the mass of an aneurysm should be reduced and the blood flow of parent and distal arteries should be preserved, we are reporting two successful results.     

Successful replantation following an accidental forearm amputation. Case report and review of the literature

We report a patient who suffered an accidental complete amputation of the right forearm followed by a successful replantation and comment on the indications and management of macro-replantations of the upper limbs. This is the first time that a successful surgical procedure of this nature has been performed in Bolivia, with no post-operative complications and excellent long-term functional recovery.