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91.
Angel C Yngve D Murillo C Hendrick E Adegboyega P Swischuk L 《Pediatric surgery international》2002,18(2-3):213-217
The treatment of vascular malformations (VM) of the extremities is controversial. Six patients with large, localized, symptomatic
VMs of the extremities underwent surgical excision. In five cases abnormal vessels were apparent under the skin; in two of
these there was also red discoloration of the skin secondary to skin involvement. Magnetic resonance imaging was the most
helpful imaging modality in evaluating these patients. Subfascial resection was performed in five cases. Muscle was involved
in four patients and was removed in all four cases. At follow-up, there was improvement in symptoms and function with no clinically
apparent recurrence an average of 30 months following the operation. There was improvement in pain intensity from an average
of 4.3 on a scale of 1 to 10 before surgery to 1.3 after surgery. Surgical excision of localized VMs that are extensive and
include fascia and muscle, as appropriate, can successfully improve pain and function without evidence of recurrence at 1
to 5 years of follow-up.
Accepted: 18 January 2001 相似文献
92.
Pulmonary hypertension is one of the major causes of morbidity and mortality of patients with sickle cell hemoglobinopathy (SCH). Although a clinically recognized complication of sickle cell disease (SCD), there are few published pathologic studies of pulmonary findings in these patients. The aim of this study was to define the pulmonary pathologic changes and to investigate correlation between the pathologic changes, the antemortem diagnosis of pulmonary hypertension, and the severity of SCH. Cases of SCH were identified from the autopsy database using Snomed codes. Clinical and echocardiograph data were collected for correlation with the pathologic data. A total of 20 adult patients (12 males and 8 females) were identified. Hemoglobin electrophoresis results were available for 16 patients, with hemoglobin S fraction percentages ranging from 23% to 97.8%. Eleven patients had SCD, 5 patients had sickle cell trait (SCT), and the remaining 4 patients without hemoglobin electrophoresis were included in the SCT group. The mean age of the SCT group was higher than that of the SCD group (P = 0.03). Histologically, all 20 patients demonstrated changes in pulmonary vasculature considered diagnostic of pulmonary hypertension grade I to grade IV, associated with plexiform lesions in 60% of patients. Medial hypertrophy and intimal hyperplasia/fibrosis, considered potentially reversible lesions, were seen in all patients. A weak association was found between SCD and plexiform lesions. Fibroelastic degeneration of small arteries, arterioles, and venules was identified in almost all (95%) cases. Clinically, tricuspid regurgitation was detected by echocardiogram in 10 of 20 (50%) patients; 6 of these 10 had significant regurgitation to allow estimation of systolic pressure. Sudden death occurred in 8 patients, with males having a significantly higher incidence. Cardiomegaly was present in 95% of patients, however, autosplenectomy and hepatic cirrhosis/hemochromatosis were observed almost exclusively in patients with SCD. Cirrhosis was found to have a strong positive association with SCD. This study demonstrates pulmonary hypertensive changes in all 20 autopsied patients who had SCH but died from various causes. We conclude that a high prevalence of pulmonary hypertension is associated with SCH with consequent high mortality. Therefore, patients with SCH would benefit from a regular periodic assessment for pulmonary hypertension regardless of age, sex, and severity of hemoglobinopathy. 相似文献
93.
Revision of Failed Gastric Bypass to Distal Roux-en-Y Gastric Bypass: A Review of 65 Cases 总被引:1,自引:1,他引:0
Fobi MA Lee H Igwe D Felahy B James E Stanczyk M Tambi J Eyong P 《Obesity surgery》2001,11(2):190-195
Background: No bariatric operation has been documented to effect adequate weight loss in all patients. Patients with inadequate
weight loss or significant weight regain with an anatomically intact short-limb gastric bypass, of which the Fobi pouch operation
(FPO) for obesity is a modification, are usually revised to a distal Roux-en-Y gastric bypass (DRYGBP) to enhance weight loss.
Method: A retrospective review of the charts of all patients who had a revision to a DRYGBP at our Center during an 8-year
period was carried out and the findings analyzed. Results: 65 patients who had the FPO had a revision to the DRYGBP.Most were
super obese patients who, even though they had lost significant weight, were still morbidly obese. Some were patients who
had not lost adequate weight or <40% excess weight, and a small number were patients who requested more weight loss even though
they had a BMI of < 35. 15 patients developed protein malnutrition requiring supplemental feeding. 6 required rerevision to
short-limb gastric bypass. Conclusion: Revision of short-limb gastric bypass to DRYGBP usually enhances weight loss but at
a cost of an increased incidence of protein malnutrition. 相似文献
94.
�������������Ũ�������ھ���Ӫ�����������������̽�� 总被引:2,自引:1,他引:2
目的探讨瘦素质量浓度与早期静脉营养及生长发育的关系。方法新疆医科大学第一附属医院新生儿科于2005-01—2006-02,将收治的86例早产适于胎龄儿用随机数字表法分为观察组(早期微量喂养同时辅助胃肠外营养组)45例和对照组(单纯早期微量喂养组)47例,分别测定脐血及第7天血清瘦素质量浓度,同时监测营养状况和生长发育指标,并作对比分析。结果(1)观察组与对照组脐血瘦素质量浓度分别为(4.6±3.7)ng/mL、(4.8±2.2)ng/mL,生后第7天两组瘦素质量浓度分别为(4.3±2.2)ng/mL、(3.1±1.7)ng/mL。对照组第7天血清瘦素质量浓度明显低于脐血(P<0.05),而观察组其差异无统计学意义(P>0.05)。(2)脐血瘦素质量浓度与出生体重、胎龄成正相关(r=0.56、r=0.67)。(3)观察组第7天热卡及蛋白质摄入量、血清瘦素质量浓度、皮褶厚度变化值与对照组相比,差异有统计学意义(P<0.05)。结论对早产儿应尽早喂养,同时需要胃肠外营养作为肠内营养的补充。瘦素可作为新生儿营养效果判定的实验室指标之一。 相似文献
95.
The clinicopathological associations of 33 singleton infants who died with intraventricular haemorrhage (IVH) without hyaline membrane disease (HMD) ('IVH only') were compared with those of 39 infants who died with IVH+HMD over the same gestation range in order to determine what factors other than those related to HMD may contribute to the pathogenesis of IVH. The incidence of 'IVH only' was inversely related to gestational age in the Hammersmith birth population, whereas the incidence of IVH+HMD rose to a peak at 28-29 weeks' gestation. Infants with 'IVH only' lived longer on average than those with IVH+HMD despite a lower birthweight and shorter gestation. Infants who died in the first 12 hours from 'IVH only' had suffered severe birth asphyxia but in those who died later the main symptom was recurrent apnoea. Fewer infants with asphyxia but in those who died later the main symptom was.recurrent apnoea. Fewer infants with 'IVH only' were given alkali therapy or were connected to the ventilator as compared to those with IVH+HMD, but there were no differences in alkali therapy in those who lived for 12 hours or more. In the 'IVH only' group there was a high incidence of haemorrhage from other sites and of bacterial infections. It is suggested that, in the absence of HMD, extreme immaturity is the main factor determining the occurrence of IVH. Birth asphyxia, apnoeic attacks, haemorrhage, and infections may play subsidiary roles, possibly through development of metabolic acidosis. 相似文献
96.
A group of girls is described with recurrent urinary tract infections characterized by predominantly lower tract symptoms. Clinical, laboratory, and radiography findings during the period of follow-up are presented. Infection persisted in most patients over several years. Response to medical and surgical treatment was unsatisfactory. The mean interval between the initial and most recent radiological study was 6 1/2 years. No case of renal parenchymal scarring was seen. 相似文献
97.
98.
R Skelton P Holland M Darowski PA Chetcuti LW Morgan JL Harwood 《Acta paediatrica (Oslo, Norway : 1992)》1999,88(9):942-946
A prospective study of infants under 1 y of age, ventilated for severe viral bronchiolitis, was carried out in four paediatric intensive care units in order to study surfactant activity and composition in this condition. Lung lavage fluid from 24 infants with bronchiolitis, 19 with bronchiolitis and sepsis or cardiac failure and 12 controls were analysed by the “click test” for surfactant activity and for phospholipids. Surfactant activity was present in all controls, but in only 2 of the 24 infants with bronchiolitis alone. The presence of phosphatidylglycerol correlated perfectly with the click test, suggesting that reduced activity is due to changes in surfactant lipid composition. In those with bronchiolitis plus coexisting disease, surfactant activity and phosphatidylglycerol were absent in only half. Surfactant activity and phosphatidylglycerol re-appeared by extubation. Severe viral bronchiolitis is associated with an absence of surfactant activity and PG, which resolves by clinical recovery. Infants with coexisting conditions are not always surfactant deficient. Surfactant administration is likely to be beneficial, but requires a selective approach. 相似文献
99.
Jennifer G. Goldman MD Christopher G. Goetz MD Melanie Brandabur MD Michelle Sanfilippo MPAS PA‐C Glenn T. Stebbins PhD 《Movement disorders》2008,23(15):2248-2250
Dopaminergic treatment in dementia with Lewy bodies (DLB) requires balancing risk of worsened psychosis and potential motor benefit. We assessed the effects of increased dopaminergic medication on psychosis and motor function in DLB. We studied 19 subjects fulfilling probable DLB Consensus criteria before and after increased dopaminergic medications. Standard clinical measures included: Thought Disorder score from the Unified Parkinson's disease Rating Scale (UPDRS) Part I, total motor score (UPDRS Part III), and Hoehn–Yahr (H&Y) stage. Motor benefit defined as >10% improvement over baseline UPDRS Part III score, occurred in only one‐third of subjects. In this group, worsened hallucinations or psychosis developed in one‐third. Considering motor benefit without exacerbation of psychosis as our aim, only 4 DLB subjects (22%) achieved this goal. Our results suggest that dopaminergic medications have limited benefit in DLB because of the low likelihood of motor improvement and the risk of psychosis exacerbation. © 2008 Movement Disorder Society 相似文献
100.
Nicholas C Stefanis Thomas A Trikalinos Dimitrios Avramopoulos Nikos Smyrnis Ioannis Evdokimidis Evangelia E Ntzani Alex Hatzimanolis John PA Ioannidis Costas N Stefanis 《Behavioral and brain functions : BBF》2008,4(1):46