Cardiac Surgery in Patients With Liver Cirrhosis (CASTER) Study: Early and Long-Term Outcomes

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游离血管化髂骨瓣：26例回顾分析

该文对应用游离髂骨瓣修复颌骨缺损的病例进行回顾研究，并分析手术并发症。作者共用26块髂骨肌瓣、1块髂骨肌皮瓣修复18例下颌骨和8例上颌骨缺损。1例因微血管再灌注问题而导致手术失败：3例术后行组织瓣抢救，其中2例吻合口血栓形成，重新吻合血管后抢救成功；10例术后出现股外侧皮神经支配区皮肤麻木，3例并发切口疝，1例供区创口裂开，2例并发口鼻瘘，1例颈部创口感染，     

Histologic and histomorphometric evaluation of alveolar ridge augmentation using bone grafts and titanium micromesh in humans

BACKGROUND: Recently, the use of titanium micromesh for alveolar bone augmentation has drawn interest; however, only limited histologic data are available on the quality of the bone regenerated. Therefore, this study compared the use of 100% intraoral autogenous bone to a combination of intraoral autogenous bone (70%) and bovine porous bone mineral (BPBM) (30%) for alveolar ridge augmentation with titanium micromesh histologically and histomorphometrically. METHODS: Twelve partially edentulous patients required alveolar bone augmentation before implant insertion because of ridge resorption. The defect sites, six in the maxilla and six in the mandible, were reconstructed with particulate autologous bone (control group, N = 6) or a mixture of autologous bone and BPBM (test group, N = 6) in combination with titanium micromesh. Core biopsies were taken from the defect sites 8 to 9 months after grafting at the time of implant insertion. RESULTS: Newly formed compact bone with a well-organized lamellar pattern was identified in all specimens. In the samples taken from the test group, the BPBM particles were surrounded completely by newly formed bone with no signs of resorption. The mean total bone volume was 62.38% +/- 13.02% in the control group and 52.88% +/- 11.47% in the test group. The soft tissue volume was 37.61% +/- 13.02% and 29.96% +/- 12.58%, respectively, and the residual BPBM volume was 17.15% +/- 2.72% in the test group. No statistical difference was observed in the histologic parameters evaluated, irrespective of graft type and site (P >0.05). CONCLUSION: Within the limits of this study, BPBM (30%) in combination with autogenous bone (70%) did not yield a lower percentage of new bone formed compared to autogenous bone alone in ridge augmentation with titanium micromesh.     

Fracture stiffness measurement in tibial shaft fractures: a non-invasive method

This paper presents a non-invasive method of assessing healing by measurement of fracture stiffness. The method works on the principle that if the load (F) applied at a certain known distance (Y) from the fracture is measured, then the moment (M = FY) at the fracture site can be calculated. By measuring the angle/deflection (θ) occurring at the fracture site using a suitable instrument (electrogoniometer), the necessary data to calculate fracture stiffness (FY/θ) would be available. The method was employed to assess the stiffness in a series of tibial shaft fractures treated conservatively, all of which healed uneventfully. This paper concentrates on a group of tibial shaft fractures in which the radiological criteria for fracture union were not satisfied even after a mean duration of 20 weeks treatment. The non-invasive method of measuring fracture stiffness supported the clinical impression of union in most cases at the first test, but was repeated on two more occasions to confirm the trend of progressive healing. The objective evaluation of fracture healing led to avoidance of surgical intervention in these patients, who went on to sound union.     

The J-wave: A new electrocardiographic sign of an occult cardiac injury

Background

The aim of this study was to determine the sensitivity and specificity of a J wave on the electrocardiogram (ECG) to detect an occult cardiac injury in patients following penetrating chest trauma.

Method

A prospective study conducted on patients admitted to the Groote Schuur Hospital Trauma Centre following penetrating chest trauma during the period of 1st October 2001 and 28th February 2009, who did not have an indication for emergency surgery and that underwent an ECG and later a subxiphoid pericardial window (SPW) for a potential cardiac injury. All the patients were easily resuscitatable with less than 2 l of crystalloid. A standard 12-lead ECG was performed shortly after admission. A J wave was defined as the small positive reflection on the R-ST junction.

Results

There were 174 patients where an ECG was performed and the patient underwent SPW for a possible cardiac injury. The mean age of the patients was 28 years (range 11–65). The mechanism of injury was stab wounds in 167 patients and 7 low velocity gunshot wounds. A J-wave was present on the ECG in 65 (37%) of the 174 patients with a possible cardiac injury. The sensitivity of a J wave to detect a hemopericardium was 44%, specificity was 85%, and positive predictive value of 91% (p < 0.001).

Conclusion

The presence of a ‘J’ wave on ECG signifies a significant risk of an occult cardiac injury after penetrating thoracic trauma.