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981.
982.
Airway hyperreactivity: assessment with helical thin-section CT 总被引:1,自引:0,他引:1
983.
James Belyea Robert Hart Jonathan Trites SM Taylor 《CANADIAN JOURNAL OF PLASTIC SURGERY》2010,18(4):e53-e54
A whistle deformity is defined as a deficiency in the vertical length of the lip so that the free margins of the upper and lower lips do not meet normally, giving the appearance of whistling. This is a common secondary deformity of the vermilion in patients with cleft lip. A case involving a 61-year-old man who developed a whistle deformity as a result of two wedge resections and postoperative radiotherapy for treatment of squamous cell carcinoma of the lower lip is presented. Hyaluronic acid-based tissue filler and autologous microfat transplantation to the lower lip were used for definitive management of the patient’s whistle deformity. After one year of follow-up, the patient was pleased with the overall result and noted marked improvement of his oral competence and overall appearance of the lip. The present case demonstrates that microfat transplantation is a viable option for correcting a whistle deformity, not only after surgery, but also following adjuvant radiotherapy – both of which potentially reduce graft viability secondary to decreased vascularity of the recipient site. 相似文献
984.
The painful total hip arthroplasty requires careful evaluation and investigation. This is usually focused on the prosthesis and adjacent anatomical structures. We present a case report of a 64-year-old man who had a Birmingham hip resurfacing procedure for primary osteoarthritis. His hip pain worsened following the procedure and was under systematic investigation for this. Subsequent investigation for vascular disease revealed a total infrarenal aortic occlusion. An aortobifemoral bypass improved the hip pain and function dramatically, and the patient now has an excellent quality of life. 相似文献
985.
SM Flexer MB Peter AC Durham-Hall JR Ausobsky 《Annals of the Royal College of Surgeons of England》2014,96(3):229-233
Introduction
Acute cholecystitis is among the most common general surgical presentations. There is a cohort of patients who develop systemic sepsis and complications of acute cholecystitis. These patients are often elderly and co-morbid. Conservative management with percutaneous cholecystostomy has been shown to be a safe and effective management option in the acute setting. However, there is currently no consensus for the further management of these patients. In particular, there is a paucity of data on readmission rates and subsequent operative or non-operative management.Methods
A retrospective study was carried out of patients treated with a percutaneous cholecystostomy for biliary sepsis over a three-year period in a UK teaching hospital. Outcome measures were subsequent operative or conservative management, conversion rates, operative complications and readmission rates.Results
Twenty-five patients had a percutaneous cholecystostomy for the treatment of acute biliary sepsis. The median follow-up duration was 35 months. Thirteen patients (52%) had operative treatment. In the operative group, 6/13 had a laparoscopic cholecystectomy, 2/13 had a planned open cholecystectomy, 2/13 had abandoned procedures and 3/13 had a converted procedure. Complications in the operative group included: postoperative mortality (1/13), common bile duct injury requiring drainage and endoscopic stenting (1/13) and one patient required readmission with recurrent pain. In the non-operative group, 5/12 patients were readmitted with biliary sepsis, 5/12 had no readmissions, 1/12 died in the community and 1/12 was readmitted with biliary colic.Conclusions
Percutaneous cholecystostomy is a recognised treatment modality for elderly, co-morbid patients with biliary sepsis. Nevertheless, the readmission rate in this group is relatively high at 5/12 (42%). Patients who undergo subsequent operative management have a conversion rate of 3/13 (23%) and a significant complication rate of 2/13 (15%). The further management of patients having undergone percutaneous cholecystostomy requires careful consideration on an individual case basis. The P-POSSUM (Portsmouth Physiological and Operative Severity Score for the enUmeration of Mortality and morbidity) may aid decision making. 相似文献986.
VS Karthikeyan SC Sistla D Ram SM Ali N Rajkumar G Balasubramaniam MS Sanker 《Annals of the Royal College of Surgeons of England》2014,96(1):e01-e02
Spontaneous choledochoduodenal fistulas (CDFs) are rare. The most common aetiology is penetrating duodenal ulcers, observed in 80% of cases. Even in areas where acid peptic disease is common, tuberculosis should be considered as a cause, especially in developing countries like India, where tuberculosis is common. The management of CDF due to acid peptic disease is predominantly surgical while healing of tuberculous CDF has been reported with antitubercular treatment. A preoperative diagnosis of tuberculous CDF by endoscopic biopsy from the duodenal ulcer or image guided fine needle aspiration if abdominal lymph nodes are present can eliminate the need for surgery and achieve a cure with antitubercular treatment. The CDF in this case was due to caseation of periduodenal lymph nodes rupturing into the duodenum and the bile duct. 相似文献
987.
Abdominal compartment syndrome is a surgical emergency caused by a raised intra-abdominal pressure, which may lead to respiratory, cardiovascular and renal compromise. It is most commonly seen in post-operative and trauma patients and it has a variety of causes. Tension pneumoperitoneum (TP) is a rare cause of abdominal compartment syndrome most often seen after gastrointestinal endoscopy with perforation.We present the case of a fit 52-year-old experienced female diver who developed TP and shock following a routine training dive to 27m. Following accidental inhalation of water, she had an unstaged ascent and, on reaching the surface, developed severe acute abdominal pain and distension. She was brought to our emergency department by air ambulance for assessment. Clinical and radiological examination revealed a shocked patient with dramatic free intra-abdominal gas and signs of abdominal compartment syndrome, which was treated with needle decompression. Symptoms and signs resolved quickly with no need for further surgical intervention. TP is a surgical emergency where surgery can be avoided with prompt diagnosis and treatment. 相似文献
988.
Endotoxin induces downregulation of tumor necrosis factor receptors on circulating monocytes and granulocytes in humans 总被引:2,自引:0,他引:2
van der Poll T; Calvano SE; Kumar A; Braxton CC; Coyle SM; Barbosa K; Moldawer LL; Lowry SF 《Blood》1995,86(7):2754-2759
Leukocytes rapidly lose their surface receptors for tumor necrosis factor (TNF) after exposure to various stimuli in vitro. To assess the effect of endotoxin on cellular TNF receptors in humans in vivo, binding of biotinylated TNF to circulating monocytes and granulocytes was determined by fluorescence-activated cell sorter analysis in six healthy subjects after intravenous injection of endotoxin (lot EC-5, 20 U/kg). Endotoxin administration was associated with a transient decrease in monocyte TNF receptors, reaching a nadir after 2 hours (P < .0001), and a more sustained decrease in granulocyte TNF receptors (P < .001). Although the decrease in cellular TNF receptors coincided with increases in soluble TNF receptors types I and II, no correlations were observed between trough monocyte or granulocyte TNF receptors and peak plasma concentrations of soluble TNF receptors. Stimulation of human whole blood with endotoxin resulted in reduced expression of both type I and type II TNF receptors on monocytes and granulocytes. Endotoxin induces downmodulation of monocyte and granulocyte TNF surface receptors in humans in vivo, which may represent a mechanism to reduce excessive activity of TNF during systemic infection. 相似文献
989.
Trump D; Farren B; Wooding C; Pang JT; Besser GM; Buchanan KD; Edwards CR; Heath DA; Jackson CE; Jansen S; Lips K; Monson JP; O'Halloran D; Sampson J; Shalet SM; Wheeler MH; Zink A; Thakker RV 《QJM : monthly journal of the Association of Physicians》1996,89(9):653-669
Multiple endocrine neoplasia type 1 (MEN1) is an autosomal dominant
disorder characterized by the combined occurrence of parathyroid,
pancreatic islet and anterior pituitary tumours. To facilitate a screening
programme for MEN1, we investigated 709 people (364 males and 345 females,
age range 1-84 years) from 62 MEN1 families, and 36 non- familial MEN1
patients. Of those investigated, 220 (95 males and 125 females, age range
8-79 years) suffered from MEN1. Parathyroid, pancreatic and pituitary
tumours occurred in 95%, 41% and 30% of the patients, respectively.
Parathyroid tumours were the first manifestation of MEN1 in 87% of
patients, and amongst the pituitary and pancreatic tumours,
somatotrophinomas and gastrinomas were more common in patients above the
age of 40 years, whilst insulinomas occurred more frequently in patients
below the age of 40 years. Biochemical screening indicated that the
penetrance of MEN1 by the ages of 20, 35 and 50 years was 43%, 85% and 94%,
respectively, and that the development of MEN1 was confined to first-degree
relatives in 91% of patients and to second-degree relatives in 9% of
patients. These findings have helped to define a proposed screening
programme for MEN1.
相似文献
990.
Efficacy of oral iron supplementation is not enhanced by additional intravenous iron during autologous blood donation 总被引:2,自引:0,他引:2
SM Kasper ; H Lazansky ; C Stark ; M Klimek ; R Laubinger ; U Borner 《Transfusion》1998,38(8):764-770
BACKGROUND: The study compared the efficacy of oral iron combined with intravenous iron supplementation to that of oral iron supplementation alone in increasing the preoperative production of hemoglobin (Hb) in autologous blood donors with normal iron stores. STUDY DESIGN AND METHODS: One hundred eight iron-replete patients who were scheduled for donation of 3 units of autologous blood at weekly intervals were randomly assigned to receive, in a double-blind fashion, no iron supplementation (placebo, Group 1), oral iron supplementation (285.6 mg of elemental iron/day, Group 2), or oral iron plus intravenous iron supplementation (285.6 mg of elemental iron/day orally plus 102.5 mg of elemental iron/week intravenously, Group 3). The amount of Hb produced during the 21-day study period was determined by the total amount of Hb donated minus the change in the amount of circulating Hb between the first donation (Day 0) and the poststudy examination (Day 21). RESULTS: Hb production did not differ significantly in the two iron-supplemented groups (oral iron, 85 +/− 36 g; oral plus intravenous iron, 74 +/− 43 g). The patients in the oral iron group produced a significantly greater amount of Hb than those in the placebo group (85 +/− 36 g vs. 52 +/− 41 g, p < 0.01). CONCLUSION: Oral iron supplementation increased the production of Hb in autologous blood donors more than placebo did. Additional intravenous iron did not lead to a further increase in preoperative Hb production. 相似文献