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81.
Matthew R. Peacock Nishant K. Shah Alik Farber Su Yeon Lee Jeffrey A. Kalish Denis Rybin Gheorghe Doros Jeffrey J. Siracuse 《Journal of vascular surgery》2017,65(5):1344-1353
Objective
Patients undergoing lower extremity bypass (LEB) are at high risk of perioperative complications that can lead to a cascade of secondary complications. Our goal was to understand the association of index complications with secondary complications after LEB.Methods
The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) database from 2005 to 2012 was used to analyze secondary complications after five index complications after LEB: deep/organ space surgical site infection, urinary tract infection (UTI), myocardial infarction (MI), pneumonia, and acute renal failure (ARF). Index cohorts were developed with 5:1 propensity matching for comparison. This score was based on preoperative variables and event-free days.Results
We evaluated 20,230 LEB patients. Postoperative index surgical site infection increased the risk of secondary ARF (odds ratio [OR], 4.0; 95% confidence interval [CI], 1.1-15.0), pneumonia (OR, 2.7; 95% CI, 1.0-7.4), UTI (OR, 3.1; 95% CI, 1.3-7.5), cardiac arrest (OR, 4.4; 95% CI, 1.6-12.2), wound disruption (OR, 10.5; 95% CI, 6.7-16.6), unplanned intubation (OR, 5.1; 95% CI, 2.0-12.8), prolonged ventilation (OR, 5.9; 95% CI, 2.0-17.6), sepsis (OR, 16.2; 95% CI, 10.2-25.6), and mortality (OR, 3.5; 95% CI, 1.7-7.1). Postoperative index UTI was associated with pneumonia (OR, 5.6; 95% CI, 2.7-11.6), sepsis (OR, 7.8; 95% CI, 5.1-11.8), and mortality (OR, 2.7; 95% CI, 1.3-5.3). Postoperative index MI was associated with secondary ARF (OR, 8.7; 95% CI, 3.8-20.1), pneumonia (OR, 4.9; 95% CI, 2.7-8.8), cardiac arrest (OR; 7.4; 95% CI; 4.0-13.5), deep venous thrombosis (OR, 3.9; 95% CI, 1.7-9.1), unplanned intubation (OR, 12.2; 95% CI, 7.3-20.3), prolonged intubation (OR, 12.2; 95% CI, 6.4-23.2), sepsis (OR, 2.2; 95% CI, 1.2-3.8), and mortality (OR, 5.6; 95% CI, 3.6-8.5). Postoperative index pneumonia was associated with secondary ARF (OR, 25.5; 95% CI, 3.0-219.3), MI (OR, 7.6; 95% CI, 3.2-18.0), UTI (OR, 4.3; 95% CI, 2.0-9.0), cardiac arrest (OR, 5.2; 95% CI, 2.0-13.2), deep venous thrombosis (OR, 7.7; 95% CI, 2.1-27.4), unplanned intubation (OR, 14.7; 95% CI, 8.3-26.1), prolonged ventilation (OR, 26.0; 95% CI, 11.8-56.9), sepsis (OR, 7.2; 95% CI, 4.0-12.8), and mortality (OR, 6.0; 95% CI, 3.7-10.0). Last, postoperative index ARF was associated with increased risk of secondary pneumonia (OR, 7.16; 95% CI, 2.6-20.0), cardiac arrest (OR, 15.5; 95% CI, 1.6-150.9), unplanned intubation (OR, 6.2; 95% CI, 2.3-16.8), prolonged ventilation (OR, 8.8; 95% CI, 3.4-22.4), and mortality (OR, 8.8; 95% CI, 3.4-22.4).Conclusions
A postoperative index complication after LEB is significantly more likely to lead to serious secondary complications. Prevention and early identification of index complications and subsequent secondary complications could decrease morbidity and mortality. 相似文献82.
Jeffrey J. Siracuse Brianna M. Krafcik Alik Farber Jeffrey A. Kalish Andrew McChesney Denis Rybin Gheorghe Doros Mohammad H. Eslami 《Journal of vascular surgery》2017,65(4):1023-1028
Objective
Although endovascular repair of ruptured abdominal aortic aneurysms (rAAAs) is increasingly more prevalent and may yield better results, open repair of rAAAs is still commonly performed. Our goal was to assess the contemporary practice patterns and outcomes of open repair of rAAA.Methods
The 2011-2014 American College of Surgeons National Surgical Quality Improvement Program targeted open AAA database was queried for all rAAAs. Patient characteristics, presentation, aneurysm details, and operative details were analyzed to identify factors that may affect outcome in this population of patients.Results
We identified 404 patients who underwent open repair of rAAA. The average age was 72 ± 9.4 years, and 76.2% were male. There were 230 (56.9%) patients who presented with hypotension. The operative approach was retroperitoneal in 16.3% of cases. The proximal extents of the aneurysms were infrarenal (52.5%), juxtarenal (24.3%), pararenal (4.2%), and suprarenal (8.2%). The distal extents were aortic (38.6%), common iliac artery (34.2%), and external or internal iliac artery (8.9%). Renal, visceral, and lower extremity revascularization was performed in 6.4%, 2.2%, and 7.9% of patients, respectively. Thirty-day mortality was 35.6%, and postoperative complications included cardiac (18.3%), pulmonary (42.3%), wound complications (6.7%), acute renal failure (17.3%), and ischemic colitis (9.4%). Postoperative length of stay was 13.1 ± 12.7 days, and 30-day readmission was 4.5%. Predictors of 30-day mortality were transperitoneal approach (odds ratio [OR], 3.3; 95% confidence interval [CI], 1.38-7.89; P < .001), hypotension at presentation (OR, 2.03; 95% CI, 1.2-3.56; P = .007), and age (OR, 1.05; 95% CI, 1.02-1.09; P = .001). Transperitoneal approach also increased the risk of postoperative cardiac complications (OR, 3.25; 95% CI, 1.01-10.4; P = .047). Postoperative pulmonary complications were predicted by chronic obstructive pulmonary disease (OR, 2.06; 95% CI, 1.07-3.94; P = .03) and hypotension at presentation (OR, 1.77; 95% CI, 1.06-2.96; P = .03).Conclusions
The majority of contemporary open rAAA repairs were performed for infrarenal aneurysms. Transperitoneal approach, hypotension, and chronic obstructive pulmonary disease were associated with higher mortality and postoperative complications. Thirty-day mortality after rAAA was lower compared with historical data. 相似文献83.
Gloria Y. Kim Peter F. Lawrence Rameen S. Moridzadeh Kate Zimmerman Alberto Munoz Kuauhyama Luna-Ortiz Gustavo S. Oderich Juan de Francisco Jorge Ospina Santiago Huertas Leonardo R. de Souza Thomas C. Bower Steven Farley Hugh A. Gelabert Marcus R. Kret E. John Harris Giovanni De Caridi Francesco Spinelli Alik Farber 《Journal of vascular surgery》2017,65(6):1673-1679
Objective
This study examined the relationship between two new variables, tumor distance to base of skull (DTBOS) and tumor volume, with complications of carotid body tumor (CBT) resection, including bleeding and cranial nerve injury.Methods
Patients who underwent CBT resection between 2004 and 2014 were studied using a standardized, multi-institutional database. Demographic, perioperative, and outcomes data were collected. CBT measurements were determined from computed tomography, magnetic resonance imaging, and ultrasound examination.Results
There were 356 CBTs resected in 332 patients (mean age, 51 years; 72% female); 32% were classified as Shamblin I, 43% as Shamblin II, and 23% as Shamblin III. The mean DTBOS was 3.3 cm (standard deviation [SD], 2.1; range, 0-10), and the mean tumor volume was 209.7 cm3 (SD, 266.7; range, 1.1-1642.0 cm3). The mean estimated blood loss (EBL) was 257 mL (SD, 426; range, 0-3500 mL). Twenty-four percent of patients had cranial nerve injuries. The most common cranial nerves injured were the hypoglossal (10%), vagus (11%), and superior laryngeal (5%) nerves. Both Shamblin grade and DTBOS were statistically significantly correlated with EBL of surgery and cranial nerve injuries, whereas tumor volume was statistically significantly correlated with EBL. The logistic model for predicting blood loss and cranial nerve injury with all three variables—Shamblin, DTBOS, and volume (R2 = 0.171, 0.221, respectively)—was superior to a model with Shamblin alone (R2 = 0.043, 0.091, respectively). After adjusting for Shamblin grade and volume, every 1-cm decrease in DTBOS was associated with 1.8 times increase in risk of >250 mL of blood loss (95% confidence interval, 1.25-2.55) and 1.5 times increased risk of cranial nerve injury (95% confidence interval, 1.19-1.92).Conclusions
This large study of CBTs demonstrates the value of preoperatively determining tumor dimensions and how far the tumor is located from the base of the skull. DTBOS and tumor volume, when used in combination with the Shamblin grade, better predict bleeding and cranial nerve injury risk. Furthermore, surgical resection before expansion toward the base of the skull reduces complications as every 1-cm decrease in the distance to the skull base results in 1.8 times increase in >250 mL of blood loss and 1.5 times increased risk of cranial nerve injury. 相似文献84.
Arnon TI Achdout H Levi O Markel G Saleh N Katz G Gazit R Gonen-Gross T Hanna J Nahari E Porgador A Honigman A Plachter B Mevorach D Wolf DG Mandelboim O 《Nature immunology》2005,6(5):515-523
Human cytomegalovirus, a chief pathogen in immunocompromised people, can persist in a healthy immunocompetent host throughout life without being eliminated by the immune system. Here we show that pp65, the main tegument protein of human cytomegalovirus, inhibited natural killer cell cytotoxicity by an interaction with the activating receptor NKp30. This interaction was direct and specific, leading to dissociation of the linked CD3zeta from NKp30 and, consequently, to reduced killing. Thus, pp65 is a ligand for the NKp30 receptor and demonstrates a unique mechanism by which an intracellular viral protein causes general suppression of natural killer cell cytotoxicity by specific interaction with an activating receptor. 相似文献
85.
86.
Neonatal acute myocardial infarction (MI) is a rare event, with a high mortality rate. Early recognition and intensive care management can be successful, and it requires a high index of suspicion in cases of unknown cardiogenic shock. The lack of access to cardiac catheterization should not delay management. Furthermore, there is great potential for myocardial regeneration to occur in surviving neonates with MI, emphasizing the importance of early recognition and management. The present report describes a neonate with an anatomically normal heart and coronary arteries who developed clinical, laboratory and electrocardiographic features of MI, and was managed successfully with fluid resuscitation, inotropic drugs and vasodilators. 相似文献
87.
88.
David S. Blondheim Ronen Beeri Micha S. Feinberg Mordehay Vaturi Sarah Shimoni Wolfgang Fehske Alik Sagie David Rosenmann Peter Lysyansky Lisa Deutsch Marina Leitman Rafael Kuperstein Ilan Hay Dan Gilon Zvi Friedman Yoram Agmon Yossi Tsadok Noah Liel-Cohen 《Journal of the American Society of Echocardiography》2010,23(3):258-264
89.
90.
Thomas W. Cheng Alik Farber Scott R. Levin Mahmoud B. Malas Karan Garg Virendra I. Patel Ahmed Kayssi Denis Rybin Rebecca B. Hasley Jeffrey J. Siracuse 《Journal of the American College of Surgeons》2021,232(6):856-863
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