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61.
Immediate tracheal extubation of pediatric liver transplant recipients in the operating room 总被引:2,自引:0,他引:2
Keeping patients on mechanical ventilation after orthotopic liver transplantation (OLT) has been a standard anesthetic approach since the first utilization of liver transplantation. Advances in anesthetic management, surgical techniques and patient preparation, in addition to improved postoperative care and the reported advantages of early postoperative tracheal extubation of liver recipients. encouraged us to extubate most recipients at the end of the operation. The aim of the present study is to evaluate the pediatric liver recipients who were extubated immediately at the end of transplantation, in terms of respiratory complications and allograft function during their stay in the ICU. We retrospectively reviewed the records of 40 pediatric recipients who had undergone OLT at the Ege University Organ Transplantation Center between December 1997 and July 2002. Twelve out of 40 patients who had consecutively undergone OLT were extubated immediately at the end of the operation and were included this study. Mean Child Pugh scores of the patients were 9 +/- 2.3 (range 6-12) and the mean PELD score was 23.1 +/- 12.3 (range 7-41). The mean age of the patients was 8.4 +/- 5.2 (range 0.8-16.8 yr). Five of the 12 extubated patients received a cadaveric and seven a living donor liver graft. The mean ICU stay of the patients was 49.1 +/- 24.2 h (6-120 h). No patients required reintubation or mechanical ventilation in the ICU. Respiratory complications diagnosed in the 12 extubated patients were hypercapnia without hypoxemia in three, atelectasis in one and pleural effusion in two. No primary non-function or delayed graft function was detected. The aspartate transaminase (AST), alanine transaminase (ALT) and protrombin time (PT) were normalized within a week. We believe that immediate tracheal extubation in the operating room is a safe procedure for selected cadaveric and living-related liver transplant recipients and will facilitate the patients' recovery and mobilization leading to reduction in complications and a reduced ICU stay. 相似文献
62.
63.
Angiographic assessment of sequential and individual coronary artery bypass grafting 总被引:1,自引:0,他引:1
Farsak B Tokmakoglu H Kandemir O Günaydin S Aydin H Yorgancioglu C Süzer K Zorlutuna Y 《Journal of cardiac surgery》2003,18(6):524-529
OBJECTIVE: In trying to answer the question about the controversial use of sequential grafts, we determined the mid-term angiographic outcome of patients in whom coronary artery bypass was performed with different types of vein grafts. METHODS: A total of 1034 coronary anastomoses on 724 saphenous vein grafts (SVGs) (apart from 497 left internal mammarian artery (LIMA) anastomoses) were assessed in 509 patients in an average of 55.4 +/- 17.6 months after coronary artery bypass grafting. RESULTS: The patency rates of sequential conduits were markedly higher than those of individual ones (86.6% vs 69.6%, p = 0.0001). Also, the anastomoses on the sequential conduits had better patency rates (80.6% vs 69.6%, p = 0.0001). This difference was even more pronounced in coronary arteries of poor quality/small (< 1.5 mm) diameter (68.9% vs 51.6%) for the sequential and individual grafts, respectively (p = 0.03). Also, the patency of the entire sequential conduit was lower when most distally located anastomosis was of poor runoff (45.2%). CONCLUSIONS: The patency of a sequential vein conduit is generally superior than that of an individual one, especially for poor runoff coronary vessels, provided that the most distally located anastomosis is performed on a good coronary artery in terms of quality and diameter. Using a minimal length of SVG is another advantage. However, failure of a single sequential conduit jeopardizes all of the anastomoses along that graft segment. Besides, being technically more demanding, technical expertise in performing a sequential anastomosis is probably among the important predictors of patency. 相似文献
64.
Esophageal perforation is a serious life threatening injury that may occur during inadvertent esophageal intubation. We report two cases of iatrogenic esophageal perforation after attempted endotracheal intubation. Our experience confirms that early diagnosis (as in the first case) is associated with a more favorable outcome. Therefore, a high index of suspicion is required for early diagnosis of this complication because the symptoms are often nonspecific and may be delayed. 相似文献
65.
Planinsic RM Nicolau-Raducu R Caldwell JC Aggarwal S Hilmi I 《Anesthesia and analgesia》2003,97(3):648-649
Venovenous bypass has improved patient survival and decreased morbidity and mortality in the field of orthotopic liver transplantation. The standard at many transplant centers is the use of the internal jugular percutaneous venovenous bypass cannulae (PVVBC) for venous return to the patient. Placement of these large (18F) PVVBC may lead to several complications and requires confirmation before use. Use of transesophageal echocardiography, an effective and rapid method to guide placement of the PVVBC and minimize potential complications associated with insertion of the device, is described. 相似文献
66.
Paranasal sinus osteoma is a slow-growing, benign, encapsulated bony tumour that may be commonly asymptomatic, being detected incidentally in 1% of plain sinus radiographs or in 3% sinus computerized tomographic scans. In a patient presenting with epiphora and nasal obstruction, computed tomography disclosed a giant osteoma of the ethmoid. In this article, one patient having giant ethmoidal osteoma with orbital extension is described, and epidemiology, diagnosis, treatment, and pathological findings in paranasal sinus osteoma are reviewed. 相似文献
67.
Çağdaş Elsürer Hilmi Alper Şenkal Ehab Zayyan Taner Yılmaz Sefa Kaya 《European archives of oto-rhino-laryngology》2007,264(8):941-945
Squamous cell carcinoma (SCC) of the external auditory canal (EAC) is an extremely rare malignant tumor with a prevalance
between 1 and 6 cases per 1 million population. The incidence is higher in patients presenting with otological diseases (1
in 5,000 to 15,000). Certain associating factors have been described in the literature. This malignancy frequently presents
with symptoms similar to a case of otitis externa or a chronic suppurative otitis media. In this paper, we present a patient
who had bilateral SCC of EAC caused by radiotherapy for nasopharyngeal carcinoma. To our knowledge, our case is the fifth
bilateral SCC of the EAC and the first bilateral radiotherapy related SCC of the EAC reported in the literature so far. 相似文献
68.
Hasan Hilmi Muratli Halil Yalçın Yüksel Ertuğrul Akşahin Onur Hapa Tuğrul Günal Levent Çelebi 《Archives of orthopaedic and trauma surgery》2009,129(12):1607-1611
Introduction
To treat neglected developmental dysplasia of the hip (DDH), we performed Salter innominate osteotomy with a modification of transiliac lengthening. We asked whether this modified technique caused posterior coverage problems and triradiate cartilage injury. 相似文献69.
Aksoy Suleyman Hilmi Uygun Ozlem Yurdaisik Isil Ates Lora Aydin Selami 《Clinical and experimental medicine》2022,22(4):661-666
Clinical and Experimental Medicine - The TIRADS is a scoring system used for the selection of nodules for FNA and classification of the risk of malignancy based on ultrasound characteristics. The... 相似文献
70.