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991.
Shuman WP Leipsic JA Busey JM Green DE Pipavath SN Hague CJ Koprowicz KM 《European journal of radiology》2012,81(9):2444-2449
Objective
To compare prospectively ECG gated CT pulmonary angiography (CTPA) with routine helical ungated CTPA for cardiac related motion artifacts and patient radiation dose.Subjects and methods
Twenty patients with signs and symptoms suspicious for pulmonary embolism and who had a heart rate below 85 were scanned with prospectively ECG gated CTPA. These gated exams were matched for several clinical parameters to exams from twenty similar clinical patients scanned with routine ungated helical CTPA. Three blinded independent reviewers subjectively evaluated all exams for overall pulmonary artery enhancement and for several cardiac motion related artifacts, including vessel blurring, intravascular shading, and double line. Reviewers also measured pulmonary artery intravascular density and image noise. Patient radiation dose for each technique was compared. Fourteen clinical prospectively ECG gated CTPA exams from a second institution were evaluated for the same parameters.Results
Prospectively ECG gated CTPA resulted in significantly decreased motion-related image artifact scores in lung segments adjacent to the heart compared to ungated CTPA. Measured image noise was not significantly different between the two types of CTPA exams. Effective dose was 28% less for prospectively ECG gated CTPA (4.9 mSv versus 6.8 mSv, p = 0.02). Similar results were found in the prospectively ECG gated exams from the second institution.Conclusion
Compared to routine helical ungated CTPA, prospectively ECG gated CTPA may result in less cardiac related motion artifact in lung segments adjacent to the heart and significantly less patient radiation dose. 相似文献992.
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995.
Daniel K.‐I. Bring MD PhD Kent Paulson Per Renstrom MD PhD Paul Salo MD PhD David A. Hart PhD Paul W. Ackermann MD PhD 《Wound repair and regeneration》2012,20(1):50-60
The aim of the study was to assess healing after capsaicin‐induced substance P (SP) depletion during rat Achilles tendon repair by biomechanical testing. Capsaicin treatment reduced the concentrations of SP by ~60% and calcitonin gene‐related peptide by ~40% as compared with the control group, as assessed by radioimmunoassay in the dorsal root ganglia, at 1 and 4 weeks post‐tendon rupture. Also, the peripheral neuronal presence of SP and calcitonin gene‐related peptide, as assessed by immunohistochemistry, was lower at both weeks 1 and 4. The decreased peripheral neuronal presence of SP at week 1 correlated with the corresponding levels in the dorsal root ganglia (r = 0.54, p = 0.018). The reduced presence of SP/calcitonin gene‐related peptide after capsaicin treatment was verified by a decreased sensitivity to painful mechanical and thermal stimuli (p < 0.05). Correlation analyses between individual residual SP levels and biomechanical tissue properties were performed because of differences in failure mode between the groups and high individual variations in the SP levels after capsaicin treatment. Thus, the residual SP levels in the dorsal root ganglia correlated with transverse area, ultimate tensile strength, and stress at failure (r = 0.39, p = 0.036; r = 0.53, p = 0.005; and r = 0.43, p = 0.023, respectively). Furthermore, individual pain sensitivity at week 2 correlated with peripheral occurrence of SP and was correlated with tensile strength and stress at failure (r = 0.89, p = 0.006 and r = 0.78, p = 0.015) at week 4. In conclusion, rats with higher residual SP levels after capsaicin‐induced neuropathy develop improved tensile strength and stress at failure in the healing of Achilles tendon. 相似文献
996.
Kent C. Sasse Dionne C. L. Lim Jared Brandt 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2012,16(3):380-386
Background:
Repair of ventral hernias, including primary ventral hernias and incisional ventral hernias, is performed in the United States 90,000 times per year. Open or traditional ventral hernia repairs involve the significant morbidity and expense of a laparotomy and a significant risk of recurrent herniation. Laparoscopic ventral hernia repair (LVHR) may offer a less-invasive alternative with shorter length of hospital stay, fewer cardiopulmonary complications, and low recurrence rates.Methods:
225 patients underwent laparoscopic ventral hernia repairs in which carboxymethylcellulose-sodium hyaluronate coating (Sepramesh, Davol, Providence, RI) was used primarily. All cases were included prospectively from the study period of 2002 through 2009. Patient characteristics were recorded, and follow-up analysis was performed over a period of 42 mo following surgery. Recurrence, reoperations, and all complications were recorded. Mesh awareness and mesh-related pain were assessed using the hernia-specific Carolinas Comfort Scale (CCS) instrument, completed by 72 patients.Results:
Over 42 mo of follow-up, 2 ventral hernias have recurred, and no long-term bowel erosion or fistulization has occurred. Little or no mesh-related symptoms were reported, and mean scores for mesh awareness and mesh pain were 3.6 and 3.2, respectively, on a scale from 0–40 (lower scores signify less pain or awareness). Two serious early complications occurred related to intestinal ileus and metal tacks producing intestinal perforation, and this led to a change in the tacking devices used.Conclusions:
LVHR with carboxymethylcellulose-sodium hyaluronate coating (Sepramesh) is safe and effective. Complications are rare, the repair is durable, and long-term results are good with rare recurrences, low awareness of mesh, and little pain. Technical lessons include use of at least one transfascial suture and the avoidance of metal tacks for fixation. 相似文献997.
JG Crompton TA Oyetunji KM Pollack K Stevens EE Cornwell DT Efron ER Haut AH Haider 《Archives of surgery (Chicago, Ill. : 1960)》2012,147(7):674-676
Motorcycle collisions are increasing at a precipitous rate, and reliable and valid data regarding all aspects of helmet safety are needed to better inform ongoing debates on mandatory helmet laws. The objective of this study was to determine the effect of motorcycle helmets on the likelihood of a facial injury after motorcycle collisions, using data from the National Trauma Data Bank, version 7.0, on 46 362 patients from January 1, 2002, through December 31, 2006. Multiple logistic regression was used to analyze the independent association between helmets and facial injury with adjustment for potential confounders. Helmeted motorcyclists were less likely to suffer facial injuries after a motorcycle collision, with a lower adjusted odds ratio of facial injury (0.40; 95% CI, 0.37-0.43) and a lower prevalence of specific types of facial injury compared with their nonhelmeted counterparts. 相似文献
998.
Bittner N Merrick GS Galbreath RW Butler WM Lief JH Allen ZA Wallner KE 《BJU international》2012,109(2):220-225
Study Type – Prognosis (individual cohort) Level of Evidence 2b What’s known on the subject? and What does the study add? Cardiovascular disease is a leading cause of death in prostate cancer patients. Pretreatment ED is a surrogate for vascular pathology. Aggressive treatment of medical co‐morbidity in prostate cancer patients may positively impact overall survival.
OBJECTIVE
- ? To evaluate the relationship between pre‐treatment erectile function and all‐cause mortality in patients with prostate cancer treated with brachytherapy.
PATIENTS AND METHODS
- ? In all, 1279 consecutive patients with clinically localized prostate cancer and pre‐implant erectile function assessed by the International Index of Erectile Function‐6 (IIEF‐6) underwent brachytherapy.
- ? Potency was defined as an IIEF‐6 score of ≥13 without pharmacological or mechanical support.
- ? Patients were stratified into IIEF‐6‐score cohorts (≤12, 13–23 and 24–30).
- ? The median follow‐up was 5.0 years.
RESULTS
- ? The 8‐year overall survival (OS) of the study population was 85.1%.
- ? The 8‐year OS for IIEF‐6scores ≤12, 13–23 and 24–30 were 78.0%, 92.8% and 91.4%, respectively (P < 0.001).
- ? Cardiovascular events accounted for a significant portion of deaths in each IIEF‐6 group.
- ? When combined with other risk factors for cardiovascular disease, an IIEF‐6 score of ≤12 had an additive effect on all‐cause mortality (IIEF‐6 score of ≤12 and less than two comorbidities vs two or more comorbidities were 18.2% and 32.1%).
CONCLUSIONS
- ? A pre‐implant IIEF‐6score of ≤12 was associated with a higher incidence of all‐cause mortality.
- ? Pre‐treatment erectile dysfunction is a surrogate for underlying vascular pathology, probably explaining the lower OS in this subset of patients.
- ? Aggressive treatment of medical co‐morbidity is warranted to impactOS.
999.
K Wallner 《BJU international》2012,110(6):834-838
Study Type – Therapy (case series) Level of Evidence 4 What's known on the subject? and What does the study add? Little has been published related to transponders per se, but a number of studies relating to prostate biopsy‐related infections and the increased incidence of quinolone‐resistant Escherichia coli have been published. The study alerts the practising urologist to the risk of quinolone‐resistant E. coli in the setting of transrectally placed transponders. Furthermore, it proposes an antibiotic regimen that should reduce this risk.
OBJECTIVE
- ? To report our series of early infectious complications after placement of Calypso® transponders (Calypso Medical, Seattle, WA, USA) into the prostate.
PATIENTS AND METHODS
- ? Between February 2008 and October 2010, 50 consecutive patients underwent placement of Calypso® transponders into the prostate.
- ? Patients were administered ciprofloxacin 500 mg every 12 h, starting the night before the procedure and for 2 days after the procedure.
- ? Data were collected via chart review, and complications were classified according to the Clavien classification system.
RESULTS
- ? Of the 50 patients undergoing the procedure, five (10%) developed infectious complications, and three (6%) developed a grade II complication with a UTI requiring antibiotic therapy. One patient (2%) developed a grade IIIb complication with an epidural abscess and osteomyelitis of the lumbar vertebrae requiring open debridement and a lumbar fusion. One patient (2%) developed a prostatic abscess with methicillin‐resistant Staphylococcus aureus and subsequently died of an unrelated lower GI bleed.
- ? In 4/50 patients (8%), a culture confirmed the responsible bacteria, of which three cases were quinolone‐resistant Escherichia coli.
CONCLUSION
- ? As with prostate biopsy, the emergence of quinolone‐resistant E. coli remains a challenging infectious complication with transrectal prostate procedures. We propose an alternative strategy of double antibiotic coverage with one dose of oral ciprofloxacin 500 mg and gentamicin 80 mg i.m. before this procedure.
1000.
Amanda Brown Raphael Hirsch Tal Laor Michael J. Hannon Marc C. Levesque Terence Starz Kimberly Francis C. Kent Kwoh 《Arthritis care & research》2012,64(12):1846-1854