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61.
Eric W. Dickson MD Gary V. Doern PhD Leo Trevino PhD Michelle Mazzoni PhD Stephen O. Heard MD 《Academic emergency medicine》2003,10(10):1019-1023
OBJECTIVES: Patients undergoing emergent endotracheal intubation are at increased risk for developing pneumonia. Although numerous strategies have been investigated to reduce ventilator-associated pneumonia (VAP), the incidence of VAP and its associated mortality remains high. This investigation tested the hypothesis that LiquiVent (Alliance Pharmaceutical, San Diego, CA-LV) delivered antibiotics (via spray-dried microspheres-SDM) would improve survival in a rat model of descending gram-negative pneumonia. METHODS: Wistar rats (n = 49) were randomized to receive prophylaxis with 1). nothing (controls); 2). intramuscular (IM) tobramycin, 3). intratracheal LV plus SDM shells (vehicle), 4). intratracheal LV plus SDM shells plus IM tobramycin, or 5). intratracheal LV plus SDM containing 1 mg/kg of tobramycin. All interventions were given 24 hours before a bacterial challenge with 10(8) colony-forming units of intratracheal Klebsiella pneumoniae. Mortality at ten days was the sole outcome measure. Survival in individual groups was compared with controls by Fisher's exact test with Bonferroni correction for multiple comparisons. RESULTS: All animals in the control group died of pneumonia within ten days of bacterial inoculation (0% survival). Prophylaxis with either IM tobramycin or SDM vehicle plus IM tobramycin provided no protection (0% survival). This is in sharp contrast to the cohort receiving pretreatment with tobramycin-containing SDM delivered via LV, in which 60% of the animals survived to study completion (p < 0.05). CONCLUSIONS: Prophylaxis with SDM containing antibiotics delivered in low-dose LV provided significant protection in a rat model of descending gram-negative pneumonia. These data support the hypothesis that perfluorocarbon-delivered intratracheal antimicrobials may be useful in the prevention of VAP. 相似文献
62.
Mamoru Uemura MD Masahiko Higashiyama MD Jiro Okami MD Kazuyuki Oda MD Koji Takami MD Ken Kodama MD 《General thoracic and cardiovascular surgery》2006,54(2):289-292
We present a case of intrapulmonary metastasis developing 18 years after complete resection of thymoma. An 8 mm nodule in the lower lobe of the left lung was noted on chest X-ray in a 76-year-old woman who had undergone complete resection of Masaoka’s stage II thymoma 18 years earlier. Since the nodule grew to 17 mm during a 2-year follow-up, wedge resection was performed. The lesion was histologically diagnosed as an intrapulmonary metastasis from thymoma. Extremely late recurrence after complete resection of thymoma is discussed. 相似文献
63.
Robert J. Baumann MD 《Pediatric neurology》2006,35(6):448-449
64.
Ibrahim Ercan MD Burak
mür akr MD Ibrahim Sayn MD Muzaffer Baak MD Suat Turgut MD 《Otolaryngology--head and neck surgery》2006,134(6):1010-1014
OBJECTIVE: The uncinate process (UP) is an important anatomic landmark in frontal recess surgery. Its superior attachment shows great anatomic variability. The agger nasi (AN) cell is another important structure that affects frontal recess anatomy and there is a close neighborhood between them. The aim of this study was to investigate the relationship between superior attachment type of UP and the presence of AN cell. STUDY DESIGN: A retrospective anatomical study. METHOD: Computed tomography scans were evaluated of 486 sides of 243 patients who had had paranasal sinus. In 125 (26%) sides, the superior attachment of the UP could not be identified. In the remaining 361 (74%) sides, the prevalence of superior attachment of UP types and the presence of AN cell in each side were recorded. The results were evaluated with chi2 test. RESULTS: The AN cell was found in 290 (80.3%) of 361 sides. The prevalence of AN cell according to superior attachment of UP types were 79.6% for type 1/2, 90.1% for type 3, 71.4% for type 4, 86.5% for type 5, and 83.3% for type 6. The presence of AN cell according to superior attachment types of UP was not statistically significant (chi2= 3.54, P = 0.315). CONCLUSIONS: The AN cell was found to be present in 80.3% of the cases. However, the relationship between the presence of the AN cell and the superior attachment types of UP was not statistically significant. 相似文献
65.
Hiroto Egawa Koichi Tanaka Mureo Kasahara Yasutsugu Takada Fumitaka Oike Kohei Ogawa Seisuke Sakamoto Koichi Kozaki Kaoru Taira Takashi Ito 《Liver transplantation》2006,12(10):1512-1518
Living donor liver transplantation (LDLT) for patients with portal vein thrombosis (PVT) involves technical difficulty. The aim of this research was to analyze their preoperative diagnosis of PVT, operative procedures, and postoperative courses of patients with preoperative PVT. Thirty-nine patients of 404 adult patients (9.7%) undergoing LDLT in our hospital from 1996 June to 2004 December had PVT at their transplantation. Twenty-nine patients had intractable ascites, 21 had gastrointestinal bleeding, and 18 had encephalopathy. The thrombus was located in the portal trunk in 23, in the portal trunk and superior mesenteric vein (SMV) in 7, and developed into the SMV and the splenic vein in 8. The occlusive grade was partial in 29, and complete in 10 patients. The thrombus was removed by a simple technique, and eversion and/or incision technique, or total removal of the portal vein (PV). The PV was reconstructed with the thrombectomized native PV, with an interposed vein graft, or porto-caval hemitransposition. Advanced PVT had a significant impact on blood loss and hospital mortality. Three out of 10 patients with residual PVT required radiological and/or surgical intervention after transplantation. In conclusion, thorough planning is essential for a successful LDLT outcome for patients with preexisting PVT. 相似文献
66.
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69.
Gregory Guldner MD MS Jason Schultz BS Perry Sexton MD Corwyn Fortner BS Mark Richmond MD 《Academic emergency medicine》2003,10(2):134-139
OBJECTIVES: Physicians commonly use etomidate for adult rapid-sequence intubation (RSI), but the manufacturer does not recommend its use for children under 10 years of age due to a lack of data. The authors present their experience with etomidate for pediatric RSI in order to further develop its risk-benefit profile in this age group. METHODS: Trained abstractors reviewed the medical records for all children under 10 years old who received etomidate for RSI between July 1996 and April 2001. RESULTS: 105 children, with an average age of 3 (+/-2.9) years, received a median dose of 0.32 (+/-0.12) mg/kg of etomidate. The systolic blood pressure increased an average of 4 mm Hg (95% CI = -3.3 to 9.2); the diastolic blood pressure increased 7 mm Hg (95% CI = -3.1 to 11) within 10 minutes of receiving etomidate. The heart rate increased an average of 10 beats/min (95% CI = 4.0 to 17.4). Complications included three patients who vomited within 10 minutes of etomidate administration. There were no cases of documented myoclonus, status epilepticus, or new-onset seizures. Thirty-eight patients received corticosteroids during the hospital course, none for suspected adrenal insufficiency. Three patients died, all from severe brain injury. CONCLUSIONS: In children less than 10 years old, etomidate seems to produce minimal hemodynamic changes, and appears to have a low risk of clinically important adrenal insufficiency, myoclonus, and status epilepticus. The association between etomidate and emesis (observed in less than 3% of enrolled patients) remains unclear. For clinical situations in which minimal blood pressure changes during RSI are critical, etomidate appears to have a favorable risk-benefit profile for children under 10 years old. 相似文献
70.
Dr. Arni Raghavendrarao Raghuram M.Ch. Subbiah Kumar MD Kathamuthu Balamurugan DA Arulmurugan DA Ramiah Krishnan M.Ch. Perichiappan Sivakami BS Eluvathingal Varghese John M.Ch. 《Indian Journal of Thoracic and Cardiovascular Surgery》2006,22(3):178-181
Background Beating heart surgery has now become the commonest technique of doing Coronary Artery Bypass Graft Surgery (CABG) in our country.
It is being used even in such high risk situations like diffuse coronary disease and Critical Left Main stem Stenosis (LMCS)
with good results. The aim of this study is to retrospectively review our results in Off-Pump Coronary Artery Bypass Surgery
(OPCAB) in patients with critical left main stem stenosis.
Methods This study is a retrospective analysis of the data of patients who underwent primary coronary artery bypass surgery. During
the period from April 2003 to September 2005 a total of 64 patients underwent OPCAB procedure for critical LMCS. During the
same period 10 patients underwent CABG on Cardio Pulmonary Bypass (CPB). The age range was 36–77yrs. The sex distribution
was M: F 53∶10. Ten patients were done as emergency. 2 of them were on Intra Aortic Balloon Pump (IABP) support preoperatively.
10 patients were high risk with a Euro score of ≥5.
Results Left Internal Mammary Artery (LIMA) was used in 78% of cases. Average grafts per patient was 2.96. The median ventilation
time was 5.91 hrs. New IABP insertion in postoperative period was required in 1 patient. One patient was reexplored for bleeding.
There was one perioperative myocardial infarction. 57% of patients did not need any blood transfusion. There was no conversion
to CPB. There was no operative mortality. Inotropes were used in ten cases.
Conclusions OPCAB is a safe method of revascularization in patients with critical LMCS. Preoperative IABP is useful in patients with cardiogenic
shock. However, there is a place for CPB in patients needing additional procedures like Mitral Valve repair (MV repair) or
Dor's procedure or when the vessels are very diffusely diseased. Those patients who are unstable despite IABP support may
be managed by Beating heart On Pump (BHOP) technique. 相似文献