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1.
A new prototype of the laryngeal mask airway (LMA), the intubating
laryngeal mask airway (ILMA), was used to facilitate tracheal intubation in
100 fasted patients presenting for elective surgery. Alignment of the ILMA
with the larynx was assessed fibreoptically before intubation without the
investigator performing the intubation being aware of the view score. Ease
of intubation correlated with the view obtained and with the degree of
manipulation of the ILMA needed to achieve tracheal intubation. Intubation
was successful in 93 patients. Of the seven intubation failures, five
occurred in the first 20 patients. Conventional connection to the breathing
system and ventilation of the lungs of the patients were possible
throughout the intubation procedure.
相似文献
2.
JC Bos R Stoeckart AIJ Klooswijk B van Linge R Bahadoer 《Surgical and radiologic anatomy : SRA》1994,16(3):253-258
Summary In view of the increasing popularity of the direct lateral approach to the hip joint for hemi- or total hip arthroplasty, the location of the superior gluteal nerve (SGN) was studied. This nerve is in danger when using a transgluteal incision. In 20 embalmed specimens the relation of the SGN to the tip of the greater trochanter (TT) was studied as well as the relation to the iliac crest. For this purpose macroscopy, microscopy and CT were used. In 13 hips a so-called most inferior branch was found at an average of 1 cm distal to the inferior branch, the main trunk of the nerve. There was substantial variation in the course of both the inferior and the most inferior branch of the SGN. In order to prevent nerve damage, proximal extension of the transgluteal incision should be limited to 3 cm cranial to TT. Furthermore the incision has to be confined to the distal one third of the distance TT-iliac crest. In tall people extra care should be taken.
Anatomie chirurgicale du nerf glutéal supérieur et bases anatomo-radiologiques de l'abord latéral direct de la hanche
Résumé Les recours de plus en plus fréquent à la voie latérale directe de la hanche pour les prothèses totales ou cervico céphaliques nous a conduit à étudier la localisation du nerf glutéal supérieur (SGN) qui est exposé lors de l'incision transglutéale. Les rapports du SGN avec le sommet du grand trochanter (TT) et avec la crête iliaque ont été étudiés sur 20 cadavres embaumés. Nous avons eu recours à l'étude macroscopique, microscopique ainsi qu'au scanner. Dans 13 cas nous avons mis en évidence une branche très inférieure, donc plus distale, située 1 cm en moyenne en dessous de la branche inférieure habituelle de bifurcation du tronc principal. Il existait des variations importantes dans les trajets de ces deux branches inférieures. Afin de prévenir une lésion chirurgicale du nerf, l'incision transglutéale ne doit pas aller au delà de 3 cm du sommet du grand trochanter, de plus l'incision doit être confinée en dessous du tiers distal de la ligne joignant le grand trochanter à la crête iliaque.相似文献
3.
A. Z. Ginai B. C. Halfhide J. Dees P. E. Zondervan A. I. J. Klooswijk P. P. M. Knegt 《European radiology》1998,8(2):264-269
Giant pedunculated esophageal polyps are very rare. They may stay asymptomatic for a long time, and first come to the attention
of the patient and the clinician after regurgitation into the mouth. Regurgitation, however, can be dangerous and has been
known to lead to asphyxia and death due to closure of the larynx by the polyp mass. For this reason resection of the giant
polyp is essential when it is discovered. We have seen four cases of giant esophageal polyps (GEP) at our institution. All
four patients have undergone removal of the giant polyps. The histological diagnoses were fibrovascular polyp, liposarcoma,
hamartoma and multiple lipomas. The mode of clinical presentation, radiological appearances, variable histological diagnoses,
and therapy options in these four patients are presented along with a review of the literature.
Received 4 March 1997; Revision received 13 June 1997; Accepted 15 July 1997 相似文献
4.
H van Overhagen J S Laméris M Y Berger R van Pel H W Tilanus A I Klooswijk H E Schütte 《Gastrointestinal radiology》1992,17(4):305-310
The use of ultrasound (US)-guided fine-needle aspiration biopsy (FNAB) for the assessment of distant metastases was prospectively studied in 135 consecutive patients with carcinoma of the esophagus and gastroesophageal junction. Patients with accessible lesions on US and computed tomographic (CT) studies of the supraclavicular regions and the abdomen underwent US-guided FNAB. In patients with multiple lesions biopsies were preferentially performed on enlarged supraclavicular nodes. Forty-nine patients underwent US-guided FNABs of 53 lesions. A cytologic diagnosis was established in 46 of 53 (87%) biopsies. Seven of 53 (13%) biopsies were nondiagnostic. Distant metastases were diagnosed by means of cytologic study in 33 of 135 (24%) patients. Supraclavicular metastases were diagnosed in 22 patients and abdominal metastases were diagnosed in 12 patients, including one patient who also had supraclavicular metastases. US-guided FNAB can improve the selection of patients for surgical and nonsurgical treatment by diagnosing distant metastases in an important number of patients. 相似文献
5.
The intubating laryngeal mask. I: development of a new device for intubation of the trachea 总被引:10,自引:1,他引:9
The standard laryngeal mask airway (LMA) functions both as a ventilatory
device and as an aid to blind/fibrescopic-guided tracheal intubation. We
describe the radiological and laboratory work used to bioengineer a new
laryngeal mask prototype, the intubating laryngeal mask airway (ILMA). The
aim was to create a new airway system with better intubation
characteristics than the LMA. Other design goals were to eliminate the need
for head-neck manipulation and insertion of fingers in the mouth during
placement. Development was aided by analysis of magnetic resonance images
of the human pharynx and laboratory testing with a variety of tracheal
tubes. The principal features of this new system are an anatomically
curved, rigid airway tube with an integral guiding handle, an epiglottic
elevating bar replacing the mask bars, a guiding ramp built into the floor
of the mask aperture and a modified silicone tracheal tube developed for
use with the device.
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6.
H van Overhagen J S Laméris M Y Berger F van der Voorde H W Tilanus A I Klooswijk H M Zonderland R van Pel 《Radiology》1991,179(1):155-158
The preoperative assessment of supraclavicular lymph node metastases was prospectively studied in 100 patients with carcinoma of the esophagus and gastroesophageal junction. Findings at computed tomography (CT), ultrasound (US), and palpation were compared, and US-guided fine-needle aspiration biopsy of nodes with a small axis of 5 mm or greater was performed. Supraclavicular metastases were detected on CT scans in 11 of 13 patients (85%) and on US scans in 14 of 16 patients (88%) but were palpable in only three of the 16 patients (19%). The predictive value of a supraclavicular node indicating metastases was .74 at US and .85 at CT. Metastases were diagnosed in 10 of 46 patients with squamous cell carcinoma (22%) and five of 50 patients (10%) with adenocarcinoma. Nodes with metastases had a round configuration, with a statistically significant greater short-axis to long-axis ratio than that of benign nodes (0.89 vs 0.54; P = .05). In four of 16 patients (25%) with supraclavicular metastases proved with cytologic examination, neither CT nor US of the mediastinum and abdomen showed enlarged nodes. 相似文献
7.
S W Lamberts H W Tilanus A I Klooswijk H A Bruining A J van der Lely F H de Jong 《The Journal of clinical endocrinology and metabolism》1988,67(5):1080-1083
Signs and symptoms of Cushing's syndrome developed rapidly after total gastrectomy in a 37-yr-old man with a metastatic gastrin-secreting islet cell carcinoma. Argyrophilic tumor cells in a lymph node removed during operation immunostained for gastrin and ACTH. Treatment for more than 6 months with the somatostatin analog SMS 201-995 (300 micrograms/day) greatly reduced serum gastrin levels and normalized plasma ACTH and cortisol levels and urinary cortisol excretion, and the signs and symptoms of Cushing's syndrome disappeared. The size of the primary tumor in the head of the pancreas, which had grown rapidly before SMS 201-995 therapy, stabilized after 6 months of treatment with the analog. We conclude that SMS 201-995 can reduce ACTH as well as gastrin secretion from islet cell carcinomas as well as control tumor growth. 相似文献
8.
J. Van Loosen A.I.J. Klooswijk D. van Velzen C.D.A. Verwoerd 《European journal of radiology》1990,10(3):211-214
The ossification of the anterior skull base, especially the lamina cribrosa, has been studied by computed tomography and histopathology. Sixteen human fetuses, (referred to our laboratory for pathological examination after spontaneous abortion between 18 and 32 weeks of gestation) and three infants, (1, 2 and 6 years of age, respectively) were examined. The cartilaginous preformation of the anterior skull base creates a ‘pseudo-defect’ on CT in the coronal plane, even with ultra thin sections and high resolution CT. By the age of 6 years of life this ‘artefact’ is no longer, as the present ossification of the lamina cribrosa is, by that time, complete. 相似文献
9.
We have assessed a prototype laryngeal mask airway (pLMA) in 50
anaesthetized children for ease of insertion, oropharyngeal leak pressures,
gastric insufflation and fibreoptic position. The pLMA has a second smaller
mask, which rests against the upper oesophageal sphincter, and a second
cuff to increase the seal pressure of the glottic mask. All insertions were
graded as easy and an effective airway was achieved in all patients.
Oropharyngeal leak pressure was > 40 cm H2O in 49 of 50 patients.
Gastric insufflation was not detected by epigastric auscultation. In 46 of
50 patients, the vocal cords were seen via a fibreoptic laryngoscope. One
patient regurgitated clear fluid, but aspiration did not occur. On removal,
blood staining was detected in three of 50 children. We conclude that the
pLMA was easy to insert, facilitated high airway pressure ventilation and
may provide some protection against gastric insufflation.
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10.
Diffusely enlarged nonhydronephrotic kidneys on ultrasound and computer-tomographic examination in a case of progressive preterminal renal insufficiency were very suggestive of extensive lymphomatous infiltration. Diffuse infiltration of the kidney by centrocytic/centroblastic non-Hodgkin lymphoma was confirmed upon renal biopsy. No other localizations of lymphoma could be found. After four courses of CHOP chemotherapy there was a complete remission of this primary renal non-Hodgkin lymphoma, with complete recovery of renal function. 相似文献