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121.
Dittmar Böckler Hardy Schumacher Klaus Klemm Marcel Riemensperger Philipp Geisbüsch Drosos Kotelis Harry Rotert Jens-Rainer Allenberg 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(6):715-723
OBJECTIVES: to report our experience with hybrid vascular procedures in patients with pararenal and thoracoabdominal aortic pathologies. METHODS: 68 patients were treated for thoracoabdominal aortic pathologies between October 1999 and February 2004; 19 patients (16 men; mean age 68, range 40-79) with high risk for open thoracoabdominal repair were considered to be candidates for combined endovascular and open repair. Aortic pathologies included five thoracoabdominal Crawford I aneurysms, one postdissection expanding aneurysm, three symptomatic plaque ruptures (Crawford IV), five combined thoracic descending and infrarenal aneurysms with a healthy visceral segment, three juxtarenal or para-anastomotic aneurysms, and two patients with simultaneous open aortic arch replacement and a rendezvous maneuver for thoracic endografting. Commercially available endografts were implanted with standardized endovascular techniques after revascularization of visceral and renal arteries. RESULTS: Technical success was 95%. One patient developed a proximal type I endoleak after chronic expanding type B dissection and currently is waiting conversion. Nine patients underwent elective, five emergency and five urgent (within 24 h) repair. 17 operations were performed simultaneously, and 2 as a staged procedure. Postoperative complications include two retroperitoneal hemorrhages, and one patient required long-term ventilation with preexisting subglottic tracheal stenosis. Thirty-day mortality was 17% (one multiple organ failure, one secondary rupture after open aortic arch repair, one myocardial infarction). Paraplegia or acute renal failure were not observed. Total survival rate was to 83% with a mean follow-up of 30 months. CONCLUSIONS: Midterm results of combined endovascular and open procedures in the thoracoabdominal aorta are encouraging in selected high risk patients. Staged interventions may reduce morbidity. 相似文献
122.
Background
Hip dislocation in children with cerebral palsy (CP) is a common and severe problem. The dislocation can be avoided, by screening and preventive treatment of children with hips at risk. The aim of this study was to analyse the characteristics of children with CP who develop hip displacement, in order to optimise a hip surveillance programme. 相似文献123.
Steven Z George John D Childs Deydre S Teyhen Samuel S Wu Alison C Wright Jessica L Dugan Michael E Robinson 《BMC musculoskeletal disorders》2007,8(1):92
Background
There are few effective strategies reported for the primary prevention of low back pain (LBP). Core stabilization exercises targeting the deep abdominal and trunk musculature and psychosocial education programs addressing patient beliefs and coping styles represent the current best evidence for secondary prevention of low back pain. However, these programs have not been widely tested to determine if they are effective at preventing the primary onset and/or severity of LBP. The purpose of this cluster randomized clinical trial is to determine if a combined core stabilization exercise and education program is effective in preventing the onset and/or severity of LBP. The effect of the combined program will be compared to three other standard programs. 相似文献124.
Philippe Béchard Pierre Dolbec Julie Germain Gino Perron 《Journal canadien d'anesthésie》2004,51(4):398-399
125.
126.
127.
Ung-il Chung Hiroshi Kawaguchi Tsuyoshi Takato Kozo Nakamura 《Journal of orthopaedic science》2004,9(4):410-414
Mammalian bones have three distinct origins (paraxial mesoderm, lateral plate mesoderm, and neural crest) and undergo two different modes of formation (intra-membranous and endochondral). Bones derived from the paraxial mesoderm and lateral plate mesoderm mainly form through the endochondral process. During this process, hypertrophic chondrocytes play a vital role in inducing both osteogenesis and angiogenesis. One of the essential osteogenic factors secreted from hypertrophic chondrocytes is Indian hedgehog (Ihh). In contrast, bones derived from the neural crest mainly form through the intramembranous pro-cess and do not require Ihh. Thus, depending on their origin, bones have distinct signaling properties, which need to be considered in the research and application of bone biology.Presented at the 18th Annual Research Meeting of the Japanese Orthopaedic Association, Kitakyushu, Japan, October 17, 2003 相似文献
128.
129.
Fady K. Balaa T. Clark Gamblin Allan Tsung J. Wallis Marsh David A. Geller 《Journal of gastrointestinal surgery》2008,12(2):338-343
Background Application of linear stapling devices for extrahepatic vascular control in liver surgery has been well-established. However,
the technique for use of stapling devices in hepatic parenchymal transection is not well defined.
Purpose To describe the safety and efficacy of our technique for use of vascular stapling devices in hepatic parenchymal transection
during open right hepatic lobectomy is the purpose of this study.
Methodology We reviewed our experience with 101 consecutive open right hepatic lobectomies performed by a single surgeon between January
2003 and July 2006, in which vascular staplers were utilized for the parenchymal transection phase.
Results Of the 101 patients who underwent resection, 53 (52%) were female. The mean age was 58 years. Malignant disease was the indication
for resection in the majority of patients (88%). Of those with cancer, 78% (69 of 89) had metastatic colorectal cancer, 6%
(5 of 89) had metastatic neuroendocrine tumor, 4% (4 of 89) had hepatocellular carcinoma, 4% (4 of 89) had cholangiocarcinoma,
and the remaining 8% were other metastatic cancers. Twelve patients (12%) underwent resection for hepatic adenoma or symptomatic
benign disease (FNH or hemangioma). Forty-eight patients (48%) underwent a major ancillary procedure at the time of hepatic
resection. Thirty-nine patients (39%) had a nonanatomic wedge resection of a left lobe lesion, 27 patients (27%) had one or
more lesions treated with radiofrequency ablation (RFA), and 6 patients (6%) were treated with a synchronous bowel resection.
The median total operative time was 336 min (range 155–620 min). A Pringle maneuver for temporary vascular inflow occlusion
was utilized in all cases, with a median time of 9 min (range 4–17 min). Ten patients (10%) required blood transfusion during
surgery or in the postoperative period. The maximum transfusion was 2 U of packed red blood cells (PRBC) in seven patients
and 1 U of PRBC in three patients. The mean nadir postoperative hematocrit was 28.2. All patients with malignant disease had
tumor-free margins at the completion of the procedure. The average hospital length of stay was 6.0 days. One patient (1%)
developed a clinically significant bile leak requiring a postoperative endoscopic retrograde cholangiography (ERCP). No patient
required reoperation. The 30 and 60-day postoperative survival was 100%.
Conclusion These findings indicate that application of vascular stapling devices for parenchymal transection in major hepatic resection
is a safe technique, with low transfusion requirements and minimal postoperative bile leak. The technique allows for rapid
transection of the entire right hepatic lobe in under 10 min. Short video clips of the technique will be demonstrated.
Presented at the 2007 American Hepato–Pancreato–Biliary Association, Las Vegas, Nevada, April 19–22, 2007 (oral presentation/video
presentation). 相似文献
130.
Kyu-Won Shim Tae-Gon Kim Chang-Ok Suh Jae-Ho Cho Chul-Joo Yoo Joong-Uhn Choi Jung-Hee Kim Dong-Seok Kim 《Child's nervous system》2007,23(10):1155-1161
Object A radiation dose of 40–50 Gy is able to produce a cure rate of more than 90% in intracranial pure germinoma. However, many
attempts have been made to reduce the dose and volume of radiation without compromising the disease control rate because of
the toxicity of irradiation. This retrospective study is intended to provide the physician with an appropriate therapeutic
strategy.
Materials and methods We reviewed a series of 10 recurrent germinomas among 117 germinomas diagnosed histologically or clinically between 1979 and
2002. These patients involved underwent three different treatment modalities; radiation alone (N = 71), chemotherapy alone (N = 9), and combined therapy (N = 37). The 10-year overall and relapse-free survival rates were 97 and 93% in the radiation alone group, 89 and 67% in the
chemotherapy alone group, and 92 and 92% in the combined therapy group, respectively. As expected, both radiation therapy
and combined therapy were effective in controlling the disease. Tumor recurrence was closely related to the volume of radiation
but not to the dose of radiation. If the tumor bed and craniospinal axis were fully covered, the radiation dose might be reduced.
Chemotherapy alone showed earlier recurrence and a higher tumor recurrence rate. In the case of combined therapy, chemotherapy
was useful in reducing the radiation dose but revealed some toxicity (death of two patients).
Conclusions The investigation of a possible further dose reduction seems worthwhile. Radiation therapy alone with a dose of less than
40 Gy should be compared with ongoing chemotherapeutic protocols combined with low-dose irradiation. 相似文献