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71.
Combined orthopedic and vascular injury in the lower extremities: indications for amputation 总被引:2,自引:0,他引:2
M D Odland V L Gisbert R B Gustilo A L Ney D P Blake M P Bubrick 《Surgery》1990,108(4):660-4; discussion 664-6
A retrospective review was undertaken to determine risk factors associated with amputation after open fractures of the lower extremity that were complicated by vascular injury. During an 11-year period ending in December 1987, we observed open fractures in 31 patients and injuries to the popliteal artery in 16 patients, to the tibial arteries in eight patients, to the femoral artery in five patients, and to the dorsal artery of the foot in two patients. Vascular repair was accomplished in 25 patients; 12 patients had primary end-to-end anastomosis, 12 patients had reverse saphenous vein grafts, and one patient had a bovine graft. Of these 25 patients, five patients required amputation because of infection and three patients required amputation because of continued ischemia. Three patients with irreparable damage had immediate amputation, and three patients without distal ischemia had vessel ligation only. The risk factors associated with amputation were shock on admission (10 of 19 patients [p less than 0.02]) and a crushed extremity (10 of 18 patients [p less than 0.01]). The overall amputation rate, which included three immediate amputations and eight late amputations, was 35.2%. The data suggest that limb salvage is possible in two thirds of patients with combined orthopedic and vascular injuries of the lower extremity, but a history of shock or crush injury with vascular compromise is an unfavorable prognostic sign. 相似文献
72.
Krishna Prasad Gourav MD DM Subhrashis Guha Niyogi MD Vikram Halder MS Sunder Negi MD DM Avneet Singh MD 《Echocardiography (Mount Kisco, N.Y.)》2020,37(7):1114-1115
Patients with large sub-pulmonic ventricular septal defect (VSD) present early as a results of their complications. Some present late, due to the restriction of VSD by the right coronary cusp (RCC) due to its prolapse. In this report, we present a rare case of sub-pulmonic VSD in a 33-year-old man who developed a sub-pulmonic stenosis due to the prolapse of the RCC into the right ventricular outflow tract. 相似文献
73.
Oleksandr Danylenko MD PhD Elena Surkova MD PhD Roxy Senior MD DM Wei Li MD PhD 《Echocardiography (Mount Kisco, N.Y.)》2020,37(8):1315-1317
Accurate assessment of etiology of mitral regurgitation (MR) is one of the key steps in the decision-making process and further clinical management of patients with severe MR. Our clinical case illustrates the added value of three-dimensional echocardiography (3DE) in assessment of mitral valve morphology and identification of an unexpected mechanism of MR which was not previously diagnosed using conventional echocardiography. 3DE helped to choose appropriate management strategy in this patient. 相似文献
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76.
Epstein-Barr virus lymphoproliferation after bone marrow transplantation 总被引:16,自引:7,他引:16
We review 15 cases of secondary B-cell lymphoproliferative disorders that occurred among 2,475 patients who received allogeneic bone marrow transplants (BMTs) at the Fred Hutchinson Cancer Research Center (Seattle) between 1969 and 1987. The histopathologic findings in 14 of the 15 patients spanned a wide spectrum of lymphoproliferative lesions. One patient had features characteristic of angioimmunoblastic lymphadenopathy. Epstein-Barr virus (EBV) genomic sequences were identified by Southern blot analysis in each of the 13 patients evaluated. Ten of the 12 lesions evaluated originated in donor cells. In two patients, who had mixed chimerism after transplantation, the lesions originated in host cells. The combined evidence from immunoglobulin light chain staining and the analysis of immunoglobulin heavy chain gene rearrangement indicated that the lesions in most patients represented polyclonal proliferations that gave rise to clonal subpopulations. The results indicate an overall actuarial incidence of 0.6% for this complication in BMT recipients. Anti-CD3 monoclonal antibody (MoAb) treatment of acute graft-v-host disease (GVHD) and T cell depletion of the donor marrow were statistically significant risk factors, and GVHD appeared to play a contributing role, particularly in the setting of human leukocyte antigen (HLA) disparity. Two patients had no identifiable risk factors. Prophylaxis or treatment with acyclovir had no detectable effect in the patients; all but two died with uncontrolled lymphoproliferation. 相似文献
77.
Failed Attempt With Paired Associative Stimulation to Separate Functional and Organic Dystonia 下载免费PDF全文
78.
Trajectories of impairment in amyotrophic lateral sclerosis: Insights from the Pooled Resource Open‐Access ALS Clinical Trials cohort 下载免费PDF全文
Nimish J. Thakore MD DM Brittany R. Lapin PhD MPH Erik P. Pioro MD PhD Pooled Resource Open‐Access ALS Clinical Trials Consortium 《Muscle & nerve》2018,57(6):937-945
Introduction: Rate of decline of the Amyotrophic Lateral Sclerosis Functional Rating Scale‐Revised (ALSFRS‐R) score is a common outcome measure and a powerful predictor of mortality in ALS. Methods: Observed rate of decline (postslope) of ALSFRS‐R, its linearity, and its relationship to decline at first visit (preslope) were examined in the Pooled Resource Open‐Access ALS Clinical Trials cohort by using longitudinal mixed effects models. Results: Mean ALSFRS‐R postslope in 3,367 patients was ?0.99 points/month. Preslope and postslope were correlated and had powerful effects on survival. ALSFRS‐R trajectories were slightly accelerated overall, but slope and direction/degree of curvature varied. Subscore decline was sequential by site of onset. Respiratory subscore decline was the least steep. Discussion: Variable curvilinearity of ALSFRS‐R trajectories confounds interpretation in clinical studies that assume linear decline. Subscore trajectories recapitulate phenotypic diversity and topographical progression of ALS. ALSFRS‐R is better used as a multidimensional measure. Muscle Nerve 57 : 937–945, 2018 相似文献
79.
Sarah Finlayson MBChB DPhil Jasper M. Morrow FRACP Pedro M. Rodriguez Cruz MD MSc Christopher D.J. Sinclair PhD Arne Fischmann PD DrMed John S. Thornton PhD Steve Knight BSc Ray Norbury PhD Mel White BSc Michal Al‐hajjar MD Nicola Carboni MD PhD Sandeep Jayawant MD FRCPCh Stephanie A. Robb MD Tarek A. Yousry DrMed Habil FRCR David Beeson PhD Jacqueline Palace DM 《Muscle & nerve》2016,54(2):211-219
80.
2016 Dietary Salt Fact Sheet and Call to Action: The World Hypertension League,International Society of Hypertension,and the International Council of Cardiovascular Prevention and Rehabilitation 下载免费PDF全文
Norm R. C. Campbell MD FRCPC Daniel T. Lackland DrPH Mark L. Niebylski PhD MBA MS Marcelo Orias MD Kimbree A. Redburn MA Peter M. Nilsson MD PhD Xin‐Hua Zhang MD PhD Louise Burrell MD MBChB MRCP FRACP Masatsugu Horiuchi MD PhD FAHA Neil R. Poulter MBBS MSc FRCP FMed Sci Dorairaj Prabhakaran MD DM MSc FRCP FNASc Agustin J. Ramirez MD PhD Alta E. Schutte PhD MSc Rhian M. Touyz MBBCh PhD FRCP FRSE Ji‐Guang Wang MD PhD Michael A. Weber MD 《Journal of clinical hypertension (Greenwich, Conn.)》2016,18(11):1082-1085