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61.
Bettex DA Schmidlin D Bernath MA Prêtre R Hurni M Jenni R Chassot PG Schmid ER 《Anesthesia and analgesia》2003,97(5):1275-1282
Transesophageal echocardiography (TEE) is a monitoring and diagnostic tool for the care of children undergoing cardiac surgery. We analyzed reports from 865 routine TEE examinations performed between January 1994 and March 2002 in patients younger than 17-yr-old who were undergoing surgery for congenital heart disease. Patients' median age was 36 mo (range, 1 day-16 yr). The primary end-point of the study was the incidence of surgical and medical management decisions changed as a result of TEE findings; secondary end-points were diagnostic impact (diagnostic exclusions and new diagnoses) and surgical outcome. Fifty percent of the examinations were performed by anesthesiologists with an advanced level of training in perioperative TEE; all of the examiners had an experience of >or=>500 TEE examinations. Supervision by an anesthesiologist with an advanced level of training was requested in 36.7% of cases; supervision by a cardiologist was requested in 3.8%. Surgical alterations of management were reported in 12.7% of cases and included the need for a repeat bypass run in 7.3%; medical alterations of management were required in 19.4% of cases. We observed a diagnostic impact of TEE in 18.5% of cases and a suboptimal but acceptable surgical outcome in 27.6%; TEE findings predicted postoperative difficulties in 4.0%. Our results confirm the utility of routine TEE to assess repair of congenital heart defects. Furthermore, this service was competently performed by a regular team of cardiac anesthesiologists appropriately trained in TEE. IMPLICATIONS: Transesophageal echocardiography (TEE) is an essential monitoring and diagnostic device for the care of children undergoing cardiac surgery. The surgical and medical impact of TEE is demonstrated in a large series of patients. This service can be performed by appropriately trained cardiac anesthesiologists. 相似文献
62.
Bronchogenic cysts arise from an abnormal budding of the ventral diverticulum of the foregut or the tracheobronchial tree during embryogenesis. Rarely they develop within the pericardium. Symptoms of intrapericardial bronchogenic cysts such as chest pain, shortness of breath and arrhythmias can vary according to the location of the cyst, its size and compression of heart and vessels. In this case report we present a young women in whom the diagnosis of an intrapericardial bronchogenic cyst was made by echocardiography and later was approved intraoperatively. 相似文献
63.
Schmidlin D Bettex D Bernard E Germann R Tornic M Jenni R Schmid ER 《British journal of anaesthesia》2001,86(4):497-505
Transoesophageal echocardiography (TOE) has gained widespreadacceptance among cardiac anaesthetists as a tool to facilitateperi-operative decision-making. This observational study analysesthe impact of TOE and its inter-observer variability on intra-operativepatient management during cardiac and major vascular surgery.From June 1996 to December 1998, standardized reports were obtainedfrom 11 anaesthetists in 1891 adult cardiac and vascular surgerypatients undergoing routine biplane or multiplane TOE. Inter-observervariability and the difference between variables of interestwere tested using the chi-squared test or factorial analysisof variance as appropriate. TOE examinations were performedbefore and after the operation; 1673 (88.5%) patients underwentcardiopulmonary bypass (CPB), and 218 (11.5%) patients had surgerywithout CPB, including 42 (2.2%) coronary revascularizations.In 923 patients (49%), TOE provided additional information thatinfluenced the patients therapy. In 968 patients (51%),TOE had only minor or no impact on clinical decision-making.In two patients (0.10%) the scheduled operation was not performed,and in another two patients the TOE examination led to majorcomplications. Observer-dependent variables were: implicationsof TOE for intra-operative decision-making (P<0.0001), estimationof image quality (P<0.0001), pre-operative left ventricularfractional area change (FAC) (P=0.0026), difference betweenpre-operative FAC and post-operative FAC (P=0.033), and requestsfor supervision (P<0.0001). There was no significant differencein the case mix between observers. TOE had an important impacton intra-operative patient management. Inter-observer variabilitywas significant for several variables but not for the frequencyof additional surgical procedures. Br J Anaesth 2001; 86: 497505 相似文献
64.
65.
Joan McMeeken Barry Stillman Ian Story Peter Kent Jenni Smith 《Physiotherapy research international》1999,4(1):55-67
Background and Purpose. Rheumatoid arthritis frequently results in functional impairment. This study investigated the effect of a specific exercise regimen on function. Method. A randomized controlled assessor-blinded (N = 36) compared the effect of knee extensor and f lexor muscle training on pain, the timed up and go (TUG) test and the Health Assessment Questionnaire in subjects with non-acute rheumatoid arthritis. Results. Knee extensor and flexor muscle training increased isokinetic torques at speeds of 60°/sec?1 and 120°/sec?1 as measured by an isokinetic dynamometer (p = 0.02–0.003). The experimental group experienced a reduction in pain (p = 0.03), an improvement in TUG time (p = 0.01) and in function as measured by the Health Assessment Questionnaire (p = 0.04). Conclusions. Specific knee muscle training can be administered safely in people with non-acute rheumatoid arthritis, and may produce functional benefits. 相似文献
66.
Abstract In this prospective study a series of 89 patients with subarachnoid haemorrhage (SAH), most of whom had a “good” neurological outcome, were interviewed 10 weeks and 12 monts following their SAH about changes in psychosocial functioning since their SAH, and the presence of symptoms, such as excessive fatigue, that can influence psychosocial functioning. Information was also gathered from close relatives whenever possible. Data about a range of “SAH factors”, including site of aneurysm, patient clinical grade, and vasospasm, were also gathered at the time of hospitalisation, and subjects were graded according to the Glasgow Outcome Scale (GOS) at each follow-up assessment. Statistical analyses to see whether these factors were predictive of later psychosocial impairment were carried out. A high proportion of subjects demonstrated some mild to moderate psychosocial impairments at 10 weeks and, although recovery occurred in some areas over the next 8 months, 86% of subjects still suffered from excessive fatigue and 55% from hypersensitivity to noise at the 12-month assessment. Of the subjects who were employed at the time of their SAH and had a good neurological outcome, 59% were either unemployed or were working reduced hours at the 12-month follow-up. Overall the GOS was not sensitive to psychosocial impairment, as 87% of the subjects had a GOS of “1” at both 10 weeks and 12 months. The small number of subjects who demonstrated vasospasm or had a poor neurological grade on discharge from hospital and at follow-up were more likely to report changes in temperament, leisure activities, and social behaviour at follow-up. 相似文献
67.
68.
Results of surgery for irreversible moderate to severe mitral valve regurgitation secondary to myocardial infarction. 总被引:6,自引:0,他引:6
Reza Tavakoli Alberto Weber Hanspeter Brunner-La Rocca Dominique Bettex Paul Vogt Rene Pretre Rolf Jenni Marko Turina 《European journal of cardio-thoracic surgery》2002,21(5):818-824
OBJECTIVE: Moderate to severe irreversible mitral regurgitation secondary to myocardial infarction is an independent risk factor for reduced long-term survival. Late effects of correction of mitral incompetence concomitant with coronary artery bypass grafting (CABG) are less well known and the choice of mitral valve procedure is still debated. METHODS: From 1988 to 1998, 93 consecutive patients (mean age 63+/-9 years) were treated for moderate to severe irreversible mitral regurgitation secondary to myocardial infarction; 84 were in NYHA functional class III-IV and 19 were in cardiogenic shock. Thirty-seven patients underwent emergency surgery. Perioperative intraaortic balloon pump (IABP) was necessary in 33 patients. Follow-up ranged from 6 months to 12 years (mean 51 months+/-41). RESULTS: Mitral valve was repaired in 30 patients and replaced in 63. Replacement was preferably performed in patients with major displacement of papillary muscle and in patients with acute papillary muscle rupture. CABG (3.4 distal anastomoses) was performed in all patients and was complete in 92%. Early mortality was 15% (14/93). Multivariable analysis identified need for IABP (P=0.005) and COPD (P=0.02) as risk factors for early death. Emergency surgery had only a trend (P=0.15) for increased mortality; age, low ejection fraction, repair vs. replacement had no influence. Actuarial survival rates at 1, 5 and 10 years were 81, 65 and 56%, respectively. Late survival was similar in patients with replacement or repair (P=0.46). At last follow-up, all but one patient were in NYHA functional class I or II. CONCLUSIONS: Combined mitral valve procedure and myocardial revascularization, as complete as possible, for moderate to severe mitral regurgitation secondary to myocardial infarction achieve satisfactory early and late outcome despite the increased operative mortality. Acute papillary muscle rupture, severe restriction of the mitral valve by major displacement of the papillary muscle are better managed by valve replacement. 相似文献
69.
Release of pig leukocytes and reduced human NK cell recruitment during ex vivo perfusion of HLA‐E/human CD46 double‐transgenic pig limbs with human blood 下载免费PDF全文
Gisella Puga Yung Anjan K. Bongoni Amandine Pradier Natacha Madelon Maria Papaserafeim Riccardo Sfriso David L. Ayares Eckhard Wolf Nikolai Klymiuk Andrea Bähr Mihai A. Constantinescu Esther Voegelin David Kiermeir Hansjörg Jenni Robert Rieben Jörg D. Seebach 《Xenotransplantation》2018,25(1)
Background
In pig‐to‐human xenotransplantation, interactions between human natural killer (NK) cells and porcine endothelial cells (pEC) are characterized by recruitment and cytotoxicity. Protection from xenogeneic NK cytotoxicity can be achieved in vitro by the expression of the non‐classical human leukocyte antigen‐E (HLA‐E) on pEC. Thus, the aim of this study was to analyze NK cell responses to vascularized xenografts using an ex vivo perfusion system of pig limbs with human blood.Methods
Six pig forelimbs per group, respectively, stemming from either wild‐type (wt) or HLA‐E/hCD46 double‐transgenic (tg) animals, were perfused ex vivo with heparinized human blood for 12 hours. Blood samples were collected at defined time intervals, cell numbers counted, and peripheral blood mononuclear cells analyzed for phenotype by flow cytometry. Muscle biopsies were analyzed for NK cell infiltration. In vitro NK cytotoxicity assays were performed using pEC derived from wt and tg animals as target cells.Results
Ex vivo, a strong reduction in circulating human CD45 leukocytes was observed after 60 minutes of xenoperfusion in both wt and tg limb groups. NK cell numbers dropped significantly. Within the first 10 minutes, the decrease in NK cells was more significant in the wt limb perfusions as compared to tg limbs. Immunohistology of biopsies taken after 12 hours showed less NK cell tissue infiltration in the tg limbs. In vitro, NK cytotoxicity against hCD46 single tg pEC and wt pEC was similar, while lysis of double tg HLA‐E/hCD46 pEC was significantly reduced. Finally, circulating cells of pig origin were observed during the ex vivo xenoperfusions. These cells expressed phenotypes mainly of monocytes, B and T lymphocytes, NK cells, as well as some activated endothelial cells.Conclusions
Ex vivo perfusion of pig forelimbs using whole human blood represents a powerful tool to study humoral and early cell‐mediated rejection mechanisms of vascularized pig‐to‐human xenotransplantation, although there are several limitations of the model. Here, we show that (i) transgenic expression of HLA‐E/hCD46 in pig limbs provides partial protection from human NK cell‐mediated xeno responses and (ii) the emergence of a pig cell population during xenoperfusions with implications for the immunogenicity of xenografts. 相似文献70.
Petteri Rinne Sanna Hellberg Max Kiugel Jenni Virta Xiang-Guo Li Meeri Käkelä Kerttuli Helariutta Pauliina Luoto Heidi Liljenbäck Harri Hakovirta Maria Gardberg Anu J. Airaksinen Juhani Knuuti Antti Saraste Anne Roivainen 《Molecular imaging and biology》2016,18(1):99-108