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951.
Klaus Distelmaier Dominik Wiedemann Christina Binder Thomas Haberl Daniel Zimpfer Gottfried Heinz Herbert Koinig Alessia Felli Barbara Steinlechner Alexander Niessner Günther Laufer Irene M. Lang Georg Goliasch 《The Journal of thoracic and cardiovascular surgery》2018,155(6):2471-2476
Objective
The overall therapeutic goal of venoarterial extracorporeal membrane oxygenation (ECMO) in patients with postcardiotomy shock is bridging to myocardial recovery. However, in patients with irreversible myocardial damage prolonged ECMO treatment would cause a delay or even withholding of further permanent potentially life-saving therapeutic options. We therefore assessed the prognostic effect of duration of ECMO support on survival in adult patients after cardiovascular surgery.Methods
We enrolled into our single-center registry a total of 354 patients who underwent venoarterial ECMO support after cardiovascular surgery at a university-affiliated tertiary care center.Results
Through a median follow-up period of 45 months (interquartile range, 20-81 months), 245 patients (69%) died. We observed an increase in mortality with increasing duration of ECMO support. The association between increased duration of ECMO support and mortality persisted in patients who survived ECMO support with a crude hazard ratio of 1.96 (95% confidence interval, 1.40-2.74; P < .001) for 2-year mortality compared with the third tertile and the second tertile of ECMO duration. This effect was even more pronounced after multivariate adjustment using a bootstrap-selected confounder model with an adjusted hazard ratio of 2.30 (95% confidence interval, 1.52-3.48; P < .001) for 2-year long-term mortality.Conclusions
Prolonged venoarterial ECMO support is associated with poor outcome in adult patients after cardiovascular surgery. Our data suggest reevaluation of therapeutic strategies after 7 days of ECMO support because mortality disproportionally increases afterward. 相似文献952.
Pedro Palazón Laura Saura Irene de Haro Oriol Martín-Solé Asteria Albert Xavier Tarrado Victoria Julià 《Journal of pediatric surgery》2018,53(10):1945-1950
Purpose
Hirschsprung's disease (HD) is uncommon in females. There are very few reports on the patients' obstetric and gynecological outcome. Hydrosalpinx causes pain and infertility. It is rare in nonsexually active teenagers. It may be because of an intrinsic disease of the fallopian tubes or secondary to surgery. Aim: to describe the relationship between hydrosalpinx and HD or its surgical approach; to report the impact of bilateral hydrosalpinx on fertility in HD.Methods
The records of all females with HD since 1980 were reviewed. Only patients who reached menarche were included. Prevalence of hydrosalpinx and hydrosalpinx-free survival were compared after abdominoperineal (A) or transanal (T) surgery. Treatment for hydrosalpinx was reviewed.Results
Seventeen out of 27 patients had reached menarche (Group A: 13 patients; Group T: 4 patients). Five patients in group A and none in group T presented bilateral hydrosalpinx (p = 0.261). There were no statistical differences in hydrosalpinx-free survival between groups (p = 0.344). Hydrosalpinx treatment: two bilateral and one unilateral salpingectomy, one pyosalpinx evacuation and one untreated. Three patients had conception desire: one has children; two are on IVF program.Conclusion
An association between hydrosalpinx and HD was observed. The development of hydrosalpinx was not associated with surgical approach in our study. Females with HD should have a gynecological follow-up for the development of hydrosalpinx, which can impair fertility.Level of evidence
Level III, retrospective comparative study. 相似文献953.
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955.
Anna M. Blokhuis Max Koppers Ewout J. N. Groen Dianne M. A. van den Heuvel Stefano Dini Modigliani Jasper J. Anink Katsumi Fumoto Femke van Diggelen Anne Snelting Peter Sodaar Bert M. Verheijen Jeroen A. A. Demmers Jan H. Veldink Eleonora Aronica Irene Bozzoni Jeroen den Hertog Leonard H. van den Berg R. Jeroen Pasterkamp 《Acta neuropathologica》2016,132(2):175-196
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Irene Lecker PhD Dian‐Shi Wang PhD MD Paul D. Whissell PhD Sinziana Avramescu PhD MD C. David Mazer MD Beverley A. Orser PhD MD 《Annals of neurology》2016,79(1):18-26
Antifibrinolytic drugs are routinely used worldwide to reduce the bleeding that results from a wide range of hemorrhagic conditions. The most commonly used antifibrinolytic drug, tranexamic acid, is associated with an increased incidence of postoperative seizures. The reported increase in the frequency of seizures is alarming, as these events are associated with adverse neurological outcomes, longer hospital stays, and increased in‐hospital mortality. However, many clinicians are unaware that tranexamic acid causes seizures. The goal of this review is to summarize the incidence, risk factors, and clinical features of these seizures. This review also highlights several clinical and preclinical studies that offer mechanistic insights into the potential causes of and treatments for tranexamic acid–associated seizures. This review will aid the medical community by increasing awareness about tranexamic acid–associated seizures and by translating scientific findings into therapeutic interventions for patients. ANN NEUROL 2016;79:18–26 相似文献