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101.
Mikko Jormalainen Risto Kesvuori Peter Raivio Antti Vento Caius Mustonen Hannu-Pekka Honkanen Stefano Rosato Jarmo Simpanen Kari Teittinen Fausto Biancari Tatu Juvonen 《Interactive Cardiovascular and Thoracic Surgery》2022,34(3):453
Open in a separate windowOBJECTIVESWe investigated whether the selective use of supracoronary ascending aorta replacement achieves late outcomes comparable to those of aortic root replacement for acute Stanford type A aortic dissection (TAAD).METHODSPatients who underwent surgery for acute type A aortic dissection from 2005 to 2018 at the Helsinki University Hospital, Finland, were included in this analysis. Late mortality was evaluated with the Kaplan–Meier method and proximal aortic reoperation, i.e. operation on the aortic root or aortic valve, with the competing risk method.RESULTSOut of 309 patients, 216 underwent supracoronary ascending aortic replacement and 93 had aortic root replacement. At 10 years, mortality was 33.8% after aortic root replacement and 35.2% after ascending aortic replacement (P = 0.806, adjusted hazard ratio 1.25, 95% confidence interval, 0.77–2.02), and the cumulative incidence of proximal aortic reoperation was 6.0% in the aortic root replacement group and 6.2% in the ascending aortic replacement group (P = 0.65; adjusted subdistributional hazard ratio 0.53, 95% confidence interval 0.15–1.89). Among 71 propensity score matched pairs, 10-year survival was 34.4% after aortic root replacement and 36.2% after ascending aortic replacement surgery (P = 0.70). Cumulative incidence of proximal aortic reoperation was 7.0% after aortic root replacement and 13.0% after ascending aortic replacement surgery (P = 0.22). Among 102 patients with complete imaging data [mean follow-up, 4.7 (3.2) years], the estimated growth rate of the aortic root diameter was 0.22 mm/year, that of its area 7.19 mm2/year and that of its perimeter 0.43 mm/year.CONCLUSIONSWhen stringent selection criteria were used to determine the extent of proximal aortic reconstruction, aortic root replacement and ascending aortic replacement for type A aortic dissection achieved comparable clinical outcomes. 相似文献
102.
Ester Orlandi MD Stefano Cavalieri MD Roberta Granata MD Piero Nicolai MD Paolo Castelnuovo MD Cesare Piazza MD Alberto Schreiber MD Mario Turri-Zanoni MD Pasquale Quattrone MD Rosalba Miceli MD Gabriele Infante PhD Fausto Sessa MD Carla Facco MD Giuseppina Calareso MD Nicola Alessandro Iacovelli MD Davide Mattavelli MD Alberto Paderno MD Carlo Resteghini MD Laura Deborah Locati MD Lisa Licitra MD Paolo Bossi MD 《The Laryngoscope》2020,130(4):857-865
103.
Vegezzi Elisa Berzero Giulia Barbetta Desiree Colombo Anna Amelia Borsani Oscar Bernasconi Paolo Compagno Francesca Zecca Marco Campanini Giulia Simoncelli Anna Paoletti Matteo Pichiecchio Anna Baldanti Fausto Brunetti Enrico Marchioni Enrico 《Journal of neurovirology》2020,26(2):257-263
Journal of NeuroVirology - The aim of this study was to review the quality of the diagnostic work-up for acute encephalitis carried out at our center in a cohort of patients with hematological... 相似文献
104.
105.
Francesco Vasques Antti Rainio Jouni Heikkinen Reija Mikkola Jarmo Lahtinen Ulla Kettunen Tatu Juvonen Fausto Biancari 《Heart and vessels》2013,28(1):46-56
Patients aged ≥80 years are at high risk of adverse events after coronary artery bypass grafting. This study was performed to evaluate whether off-pump coronary artery bypass surgery (OPCAB) is superior to conventional surgery (CCAB) in these high-risk patients. The outcome of 185 patients aged ≥80 years who underwent OPCAB or CCAB at our institution was reviewed and a meta-analysis on this issue was performed. Similar immediate postoperative results were observed after OPCAB and CCAB at our institution, despite significantly different operative risk (mean logistic EuroSCORE, OPCAB 20.3% vs CCAB 13.4%, P = 0.003). Among 56 propensity score matched pairs a trend toward lower postoperative stroke (0%, 95% CI 0–0 vs 3.6%, 95% CI 0–10.0, P = 0.50) was observed after OPCAB. No significant differences were observed in the other outcome end points. Five-year survival was 81.0% after OPCAB and 78.1% after CCAB (P = 0.239). Pooled analysis of eight studies including 3416 patients showed a significantly higher risk of postoperative stroke after CCAB (pooled rates: 4.2%, 95% confidence interval (95% CI) 2.4–7.1 vs 1.5%, 95% CI 0.9–2.5, risk ratio (RR) 2.15, 95% CI 1.17–3.96, P = 0.01). A trend toward higher immediate postoperative mortality was observed after CCAB (15 studies including 4409 patients, pooled rates: 6.5%, 95% CI 5.2–8.0 vs 5.6%, 95% CI 4.2–7.4, RR 1.29, 95% CI 0.86–1.93, P = 0.21). Generic inverse variance analysis showed similar intermediate survival after CCAB and OPCAB (RR 1.31, 95% CI 0.85–2.01, P = 0.22). At 2 years, survival was 82.8% (95% CI 76.4–89.2) after CCAB and 88.3% (95% CI 82.9–93.7) after OPCAB. Current results indicate that OPCAB compared with CCAB in patients aged ≥80 years is associated with significantly lower postoperative stroke and with a trend toward better early survival. However, suboptimal quality of the available studies, particularly the lack of comparability of the study groups, prevents conclusive results on this controversial issue. 相似文献
106.
Guido Tavazzi Carlo Pellegrini Marco Maurelli Mirko Belliato Fabio Sciutti Andrea Bottazzi Paola Alessandra Sepe Tullia Resasco Rita Camporotondo Raffaele Bruno Fausto Baldanti Stefania Paolucci Stefano Pelenghi Giorgio Antonio Iotti Francesco Mojoli Eloisa Arbustini 《European journal of heart failure》2020,22(5):911-915
We describe the first case of acute cardiac injury directly linked to myocardial localization of severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) in a 69‐year‐old patient with flu‐like symptoms rapidly degenerating into respiratory distress, hypotension, and cardiogenic shock. The patient was successfully treated with venous‐arterial extracorporeal membrane oxygenation (ECMO) and mechanical ventilation. Cardiac function fully recovered in 5 days and ECMO was removed. Endomyocardial biopsy demonstrated low‐grade myocardial inflammation and viral particles in the myocardium suggesting either a viraemic phase or, alternatively, infected macrophage migration from the lung. 相似文献
107.
Luca Aldrighetti Carlo Pulitanò Marco Catena Marcella Arru Eleonora Guzzetti Massimiliano Casati Laura Comotti Gianfranco Ferla 《Journal of gastrointestinal surgery》2008,12(3):457-462
Background Left lateral sectionectomy is one of the most commonly performed laparoscopic liver resections, but limited clinical data
are actually available to support the advantage of laparoscopic versus open-liver surgery. The present study compared the
short-term outcomes of laparoscopic versus open surgery in a case-matched analysis.
Materials and Methods Surgical outcome of 20 patients who underwent left lateral sectionectomy by laparoscopic approach (LHR group) from September
2005 to January 2007 were compared in a case-control analysis with those of 20 patients who underwent open left lateral sectionectomy
(OHR group). Both groups were similar for: tumor size, preoperative laboratory data, presence of cirrhosis, and histology
of the lesion. Surgical procedures were performed in both groups combining the ultrasonic dissector and the ultrasonic coagulating
cutter without portal clamping.
Results Compared with OHR, the LHR group had a decreased blood loss (165 mL versus 214 mL, P = 0.001), and earlier postoperative recovery (4.5 versus 5.8 days, P = 0.003). There were no significant differences in terms of surgical margin and operative time. Morbidity was comparable
between the two groups, but two cases of postoperative ascites were recorded in two cirrhotic patients in the OHR. Major complications
were not observed in either groups.
Conclusions Laparoscopic resection results in reduced operative blood loss and earlier recovery with oncologic clearance and operative
time comparable with open surgery. Laparoscopic liver surgery may be considered the approach of choice for tumors located
in the left hepatic lobe. 相似文献
108.
Pancreatoduodenectomy for Tumors of Vater’s Ampulla: Report on 94 Consecutive Patients 总被引:5,自引:0,他引:5
Di Giorgio A Alfieri S Rotondi F Prete F Di Miceli D Ridolfini MP Rosa F Covino M Doglietto GB 《World journal of surgery》2005,29(4):513-518
Evaluation of prognostic factors of adenocarcinoma of Vater’s ampulla is still a matter of debate. The aim of this study was to evaluate retrospectively factors that influence early and long-term outcomes in a 20-year single-institution experience on ampullary carcinoma. A total of 94 consecutive patients with ampullary carcinoma or adenoma with severe dysplasia were managed from 1981 to 2002. Among them, 64 underwent pancreatoduodenectomy, and the remaining 30 submitted to surgical (n = 5) or endoscopic (n = 25) palliative treatment. Demographic, clinical, and pathologic data were collected, and a comparison was made between patients who did or did not undergo resection. Standard statistical analyses were carried out in an attempt to establish a correlation between clinical variables, intraoperative and pathologic factors, and survival in patients with resection. A total of 85 (90.4%) patients had potentially resectable lesions due to the extent of the tumor, but only 64 (68%) underwent curative resection. The surgical morbidity rate was 34.3%. Postoperative mortality was 9.3%, with no deaths among the 38 more recently treated patients. Median survivals were 9 and 54 months for nonresected and resected patients, respectively. The overall 5-year survival was 64.4% for patients undergoing pancreatoduodenectomy. Survival was found to be significantly affected by resection, tumor size, tumor grade, and tumor infiltration. Patients with negative lymph nodes show a trend toward longer survival. In a multivariate analysis, only the depth of tumor infiltration influenced patient survival.Pancreatoduodenectomy is the treatment of choice for ampullary carcinoma and adenomas with high-grade dysplasia, with a good chance of long-term survival. Surgical resection remains the most important factor influencing outcome. 相似文献
109.
Luca Aldrighetti MD Carlo Pulitanò MD Marco Catena MD Marcella Arru MD Eleonora Guzzetti MD Jane Halliday MD Gianfranco Ferla MD 《Annals of surgical oncology》2009,16(5):1254-1254
Introduction Hepatocellular carcinoma (HCC) tends to invade the intrahepatic vasculature, especially the portal vein.1 The presence of portal vein tumor thrombus (PVTT) in patients with HCC is one of the most significant factors for a poor
prognosis.2
–
5 The presence of macroscopic PVTT in patients with HCC is also a significant factor for poor prognosis, with a median survival
of <3 months without treatment.1 In surgically resected series, in patients with gross PVTT (PVTT in the portal trunk, its first-order branch, or its second-order
branch), the 3-year and 5-year survival rates are reportedly 15% to 28% and 0% to 17%, respectively.2
–
5
Methods The patient was a 77-year-old woman with well-compensated hepatitis C virus–related cirrhosis (stage A6 according to Child-Pugh
classification) who sought care at our department for vague abdominal discomfort. Triphasic spiral computed tomographic scan
confirmed HCC 6 cm in diameter in the left lobe of the liver. In addition, portal vein tumor thrombosis of the left branch
that extended to the right portal vein was present.
Results The procedure included left hepatectomy and en-bloc portal vein thrombectomy with clamping of both the common portal vein
trunk and the right portal vein. The portal vein was incised at the bifurcation of the right and left portal veins, and the
thrombus was extracted from the incision in the portal vein. With this procedure, we were able to examine under direct vision
the exact extent of the portal vein thrombus, and we identified whether the tumor thrombus was adherent to the venous wall
or was freely floating in the venous lumen.
Portal clamping and length of operation were 16 and 330 minutes, respectively. Intraoperative blood loss was 550 mL. The
patient was discharged on postoperative day 6, and she was free of disease at 15 months after surgery.
Discussion Liver resection should be considered a valid therapeutic option for HCC with PVTT.
Electronic supplementary material The online version of this article (doi:) contains supplementary video material, which is available to authorized users.
Presented to Annual Meeting of the American Hepato-Pancreato-Biliary Association (AHPBA), Miami, Florida, USA, March 9-12,
2006. 相似文献
110.
Pacelli F Rosa F Papa V Tortorelli AP Sanchez AM Covino M Sofo L Doglietto GB 《Chirurgia italiana》2007,59(6):771-779
Gastrointestinal stromal tumours, though rare, are the most common mesenchymal neoplasms affecting the gastrointestinal tract. The most frequent sites of origin are the stomach and the small bowel, but they can occur anywhere in the gastrointestinal tract. Mesenteric and retroperitoneal forms have been described. The Authors present their personal experience with the treatment of gastrointestinal stromal tumours, with particular reference to the broad spectrum of clinical presentations and to the consequent therapeutic implications. We report on a retrospective analysis of the clinical presentations and courses, surgical management and pathological features of 27 patients with such tumours treated in our institution from 1993 to 2005. The variables analysed were the morphological and clinical characteristics of the tumours, demographic data, type of surgical treatment and postoperative course. Long-term survival was evaluated on the basis of clinical and/or telephonic follow-up in all patients. One tumour was located in the oesophagus, 14 in the gastric area, 7 in the small bowel, 2 in the colon-rectum, and 3 in the peritoneum. All patients studied received radical surgical treatment. In 7 patients surgical resection was extended to other organs. No postoperative mortality or major postoperative complications were observed. Twenty-two patients are still alive at follow-up. Three patients died as a result of neoplastic relapse and 2 of other causes. The median survival was 36 months. The actuarial 3- and 5-year survival rates were 89.7% and 67.8%, respectively. Our experience indicates that the site of origin of gastrointestinal stromal tumours with their broad spectrum of clinical presentations may influence both the therapeutic choice (neoadjuvant utilisation of imatinib mesylate) and the surgical treatment (wedge resection vs enlarged operations). 相似文献