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31.
Konno aortoventriculoplasty in children and adolescents: from prosthetic valves to the Ross operation 总被引:2,自引:0,他引:2
BACKGROUND: In children with complex multilevel left ventricular outflow tract obstruction (LVOTO), the Konno aortoventriculoplasty is used to enlarge the aortic root and increase the size of the aortic valve implanted. We present our experience with the evolution of this surgical approach from prosthetic valves to the Ross operation. METHODS: Between March 1982 and July 2000, 60 patients (36 males and 24 females) had 72 Konno aortoventriculoplasties (prosthetic valve and Konno group [57 patients; redo, 12] and Ross-Konno group [15 patients]). The patients' ages ranged from 5 days to 18 years (mean, 8.2 years). The underlying anatomic diagnoses were congenital aortic stenosis and LVOTO in 51 patients, coarctation of the aorta with bicuspid aortic valve in 13, severe aortic insufficiency associated with a ventricular septal defect in 8, interrupted aortic arch in 6, mitral stenosis in 6, atrioventricular septal defect in 5, and endocarditis in 3. There was no statistical difference in age or diagnosis between the two groups. The prosthetic valve group included 42 mechanical valves, 9 homografts, and 6 xenografts. RESULTS: Follow-up ranged from 10 months to 18.5 years (mean, 9.7 years) in the prosthetic valve and Konno group compared with 5 months to 3.7 years (mean, 2.1 years) in the Ross-Konno group (p < 0.05). There were 10 early deaths and four late deaths in the prosthetic valve and Konno group as compared with one early death and two late deaths in the Ross-Konno group (p = not significant). Reoperations for LVOTO and aortic valve replacement were significantly higher in the prosthetic valve and Konno group as opposed to the Ross-Konno group (16 vs 0, p < 0.05) mainly because of the biological valve and Konno subgroup. There were no statistical differences in reexploration for bleeding, pacemaker insertion, and reoperations for indications other than LVOTO and aortic valve replacement between the two groups. CONCLUSIONS: The Konno aortoventriculoplasty is a good surgical option for complex LVOTO. Patients with a prosthetic valve and Konno carry a high rate of reoperation. Early operative results with the Ross-Konno operation seem promising. 相似文献
32.
PURPOSE: an analysis of the mortality epidemiology in low-intensity warfare. BASIC PROCEDURES: we retrospectively reviewed all cases of Israeli soldiers killed in small-scale warfare during 1996-1998, using field data, hospital charts and autopsy reports. Data on injury pattern, offending munitions and time of death were analyzed. MAIN FINDINGS: in the study period, 106 soldiers were killed. Penetrating trauma was the common injury mechanism (95%) most frequently due to claymore bombs and gunshot bullets. The percentage dying in the prehospital phase and in the first 30-min were 77 and 88%, respectively. The average injury severity score (ISS) was 42.5. Seriously injured body regions were thorax (38%), head (24%), abdomen and pelvis (13%) and neck (12%). CONCLUSIONS: there is no trimodal death distribution in military trauma. Most casualties of low-scale conflicts die very early after injury. Most fatal injuries involve the head and trunk regions. The distribution of injury depends on the type of assaulting munitions. 相似文献
33.
34.
dl-N-(2-Hydroxy-3-napthyloxypropyl)-N′-dansylethylenediamine, dansyl analogue of propranolol (DAPN) is a novel fluorescent β-adrenergic antagonist with high affinity to β-receptors. The distribution pattern of DAPN fluorescence was studied in the rat central nervous system subsequent to its intravenous administration to living rats. DAPN distinctly labels specific regions and cells in the central nervous system (CNS). Highly dense DAPN fluorescence was observed in the pyramidal cell layer of the hippocampus, the granule cell layerof the dentate gyrus, the basal layers of the piriform cortex and the neocortex, the cerebellar Purkinje cell layer, and the spinal α-motoneurons. Pretreatment of control rats withdl- andl-propranolol markedly decreased the intensity and density of DAPN fluoresence in the tissue sections, whereas prior administration ofd-propranolol had almost no effect. Pretreatment with large doses of reserpine did not alter the pattern of DAPN fluorescence. These findings were identical to those observed with another fluorescent β-blocker, 9-aminoacridino-propranolol (9-AAP). Our data suggest that fluorescent β-adrenergic antagonists may be used in vivo for the direct probing of the β-receptors within the mammalian CNS. 相似文献
35.
The isolated form of femoral bowing is an important differential diagnosis of campomelia. Therefore, knowledge of isolated anomalies is fundamental for prenatal diagnosis, especially for the differential diagnosis from severe syndromes. Four cases are presented to discuss the differential diagnosis of femoral bowing including a review of the literature. We report four newborn babies with unilateral bowing and shortening of the femur. Three had no further anomaly; one child had additional abnormalities due to coumarin embryopathy. The radiological findings were shortened femora with bowing and varus deformity and cortical thickening on the concave side. All other parts showed normal bone structure. The aetiology of femoral bowing is unknown. Early damage of the cartilaginous model followed by remodelling with thickening on the concave side of the bone similar to the healing of malaligned fractures is suspected. The isolated form of femoral bowing without any other anomalies has to be differentiated from complex and more often severe congenital syndromes such as campomelia. Postpartum radiological examination should be reduced to a single exposure of the affected limb and follow-up should be done by clinical examination. 相似文献
36.
Erez E Dagan O Georghiou GP Gelber O Vidne BA Birk E 《The Annals of thoracic surgery》2004,77(2):484-487
BACKGROUND: Aortopulmonary window is a rare congenital heart defect commonly associated with other cardiac anomalies. Although single institutional experience is low, several surgical techniques have been reported. The purpose of this study is to describe our approach to the management of aortopulmonary window and its associated lesions. METHODS: Between February 1996 and November 2002, 13 patients underwent repair of aortopulmonary window. The age range went from 4 days to 5.5 months (mean 42 +/- 52 days), with 9 patients younger than 1 month old. The weight range was from 1.9 to 6.7 kg (mean 3.5 +/- 1.2 kg). Concomitant cardiac anomalies were present in 11 patients. The major additional anomalies were interruption of aortic arch in 4 patients and tracheal stenosis in 1 patient. Initial diagnoses were made using two-dimensional echocardiography only. RESULTS: There was one postoperative death. In general, patients with aortopulmonary window and additional major defects had a prolonged intensive care unit and hospital stay when compared with the other patients. Follow-up time ranged from 2 months to 6.8 years (mean of 2.5 +/- 2.2 years). There were no reoperations and no late deaths. Transcatheter balloon dilatation of the repaired aortic arch was required in 1 patient and of the right pulmonary artery in another. All other patients had good flow to both pulmonary arteries. No residual shunts were detected at the aortopulmonary window site, and pulmonary pressures were normal. CONCLUSIONS: Aortopulmonary window may be effectively diagnosed with echocardiography. Early surgical treatment (neonatal period, if possible) is safe and associated with the best long-term results, even in the presence of other cardiac anomalies. Complete separation and reconstruction of both aorta and pulmonary arteries under direct vision may prevent recurrence and distortion of adjacent structures. 相似文献
37.
Inguinal hernia: Challenging the traditional indication for surgery in asymptomatic patients 总被引:3,自引:0,他引:3
Gil?OhanaEmail author Igor?Manevwitch Ruben?Weil Yedidia?Melki Dan?Seror Eldad?Powsner Zeev?Dreznik 《Hernia》2004,8(2):117-120
Background: It is generally accepted that most inguinal hernias should be operated on electively in order to avoid the high morbidity and mortality associated with incarceration and small bowel obstruction. The present study reassesses the indication for surgery in asymptomatic inguinal hernia patients. Methods: We analyzed profiles, separately, for elective and emergency inguinal herniorrhaphies and compared the morbidity and mortality rates. Results: Two hundred randomly selected elective hernia repairs were compared with 67 incarcerated cases. Postoperative complications were more common following emergency (23.9%) than elective repair (10.5%); however, in both groups, minor complications predominated. The mortality rate in the incarcerated group (6%) was clearly linked with a high preoperative American Society of Anesthesiologists (ASA) score. A bowel resection rate of 4.5% was found in the incarcerated cases, which was not correlated with mortality. Conclusions: Patients with asymptomatic inguinal hernia and unfavorable medical conditions should be recommended an elective repair, preferably under local anesthesia, to avoid the high mortality associated with an emergency operation. 相似文献
38.
The current report describes a female patient with Takayasus arteritis who was hospitalized because of respiratory complaints and a ventilation-perfusion (V/P) scan demonstrating severe perfusion defects with normal ventilation. Her symptoms and V/P scan results were initially interpreted as massive pulmonary embolism, but a spiral computed tomography (CT) of the chest and a repeated lung scan indicated inflammatory involvement of the pulmonary artery accounting for the positive lung scan study. Review of her medical records from 17 years ago revealed that similar symptoms and a positive V/P scan were the initial features of her disease. 相似文献
39.
Abstract. Accumulating data indicate that oxidative stress (OS)
plays a major role in the pathogenesis of multiple sclerosis
(MS). Reactive oxygen species (ROS), leading to OS, generated in
excess primarily by macrophages, have been implicated as
mediators of demyelination and axonal damage in both MS and
experimental autoimmune encephalomyelitis (EAE), its animal
model. ROS cause damage to cardinal cellular components such as
lipids, proteins and nucleic acids (e. g., RNA, DNA), resulting
in cell death by necrosis or apoptosis. In addition, weakened
cellular antioxidant defense systems in the central nervous
system (CNS) in MS, and its vulnerability to ROS effects may
increase damage. Thus, treatment with antioxidants might
theoretically prevent propagation of tissue damage and improve
both survival and neurological outcome. Indeed, several
experimental studies have been performed to see whether dietary
intake of several antioxidants prevents or reduces the
progression of EAE. Although a few antioxidants showed some
efficacy in these studies, little information is available on
the effect of treatments with such compounds in patients with
MS. Well-designed clinical studies using antioxidant intake, as
well as investigations based on larger cohorts studied over a
longer periods of time, are needed in order to assess whether
antioxidant intake together with other conventional treatments,
might be beneficial in treating MS. 相似文献
40.
Arab Israeli women are subject to unique social stresses deriving from their status as part of an ethno-political minority and from their position as women in a patriarchal community. Collectively, their health profiles rate poorly in comparison to Jewish Israeli women or to women in the vast majority of developed countries. OBJECTIVES: To examine the experiences of Arab Israeli women in the contemporary Israeli healthcare system, following implementation of the National Health Insurance Law (NHIL). METHODS: The study combined quantitative and qualitative research methodologies. A telephone survey utilizing a structured questionnaire was conducted during August-September 1998 among a random national sample of 849 women, with a response rate of 83%. Between the months of January and July of 2000, qualitative data was attained via participant-observation, long and short semi-structured interviews, and focus groups in one large Muslim Arab Israeli village. FINDINGS: Arab Israeli women in the national survey reported poorer self-assessed health, lower rates of care by a woman primary care physician, lower satisfaction ratings for primary care physicians and more frequently foregoing medical care than did native or immigrant Jewish Israeli women. Three major factors contributing to Arab Israeli women's healthcare experiences were elucidated by the qualitative study: (1) the threat of physical and social exposure (2) difficulties in communicating with male physicians and (3) the stifling effect of family politics and surveillance on healthcare. DISCUSSION: We discuss our findings in relation to structural changes associated with the recent reform of the Israeli health care system. We conclude by suggesting policy measures for better adapting primary care services to the needs of Arab Israeli women, and note the relevance to other systems that aim to provide service to cultural and ethno-political minorities, in which healthcare delivery is shaped by unique local circumstances. 相似文献