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71.
Clemens Aigner Guenther Winkler Peter Jaksch Gernot Seebacher Gyorgy Lang Sharokh Taghavi Wilfried Wisser Walter Klepetko 《European journal of cardio-thoracic surgery》2005,27(5):757-761
OBJECTIVE: Standard lung donor criteria have been established on opinions and individual experiences rather than on existing evidence. Since the scarcity of donor organs is one of the major limitations to lung transplantation, extension of donor lung criteria might considerably increase the donor pool. This study therefore evaluates the outcome, achieved with the use of extended donors versus standard donors and aims to redefine lung donor criteria. METHODS: We performed a retrospective analysis of 98 consecutive primary lung transplantations from 94 donors from 1/2001 to 12/2002. Donors were classified as extended if they fulfilled at least one criteria: age >55 years, PaO(2) at FiO(2)/PEEP 5 <300mmHg, tobacco history >20 pack years, inhalative drug abuse, presence of infiltration on chest X-ray or purulent secretions at bronchoscopy. Recipients were stratified in two groups according to whether they received a 'standard' or 'extended' organ. Postoperative complications, extubation time, ICU and hospital stay and survival were compared. RESULTS: Twenty-three (24.5%) donors were extended. Twenty-six recipients (26.55%) received organs from extended donors. Differences in intubation times (12+/-2 days standard vs. 14+/-5 days extended, P=0.70), ICU stay (16+/-2 days standard vs. 18+/-5 days extended, P=0.74) and hospital stay (38+/-4 days standard vs. 40+/-6 days extended, P=0.71) were not statistically significant. Postoperative bleeding rates were comparable (n=14 standard vs. n=3 extended) as well as bronchial anastomotic complications (n=7 standard vs. n=3 extended). Three months survival was 88.89% in the standard group vs. 92.31% in the extended group. One year survival is comparable as well with 81.94 vs. 84.62%, respectively. CONCLUSIONS: The use of lung donors who fail to meet standard criteria does not impair short and medium term results compared to standard lung donors. The impact on long term development of BOS has yet to be evaluated. The strict application of standard lung donor criteria excludes a considerable number of lungs potentially suitable for transplantation, thus liberalisation of donor criteria might help to overcome donor shortage. 相似文献
72.
73.
Jürgen Treckmann Andreas Paul Georgios C. Sotiropoulos Hauke Lang Arzu Özcelik Fuat Saner Christoph E. Broelsch 《Journal of gastrointestinal surgery》2008,12(2):313-318
Introduction Delayed massive hemorrhage induced by pancreatic fistula after pancreaticoduodenectomy is a rare but life-threatening complication.
The purpose of this study was to analyze the clinical course of patients with late hemorrhage, with or without sentinel bleeding,
to better define treatment options in the future.
Material and Methods From April 1998 to December 2006, 189 pancreaticoduodenectomies were performed. Eleven patients, including two patients referred
from other hospitals, were treated with delayed massive hemorrhage occurring 5 days or more after pancreaticoduodenectomy.
Sentinel bleeding was defined as minor blood loss via surgical drains or the gastrointestinal tract with an asymptomatic interval
until development of hemorrhagic shock. The clinical data of patients with bleeding episodes were analyzed retrospectively.
Results Eight of the 11 patients had sentinel bleeding, and seven of them had it at least 6 h before acute deterioration. Seven out
of 11 patients died, five out of eight with sentinel bleeding. No differences could be detected between patients with or without
sentinel bleeding before delayed massive hemorrhage. The only difference found was that non-surviving patients were significantly
older than surviving patients. Delayed massive hemorrhage is a common cause of death after pancreaticoduodenostomy complicated
by pancreatic fistula formation. The observation of sentinel bleeding should lead to emergency angiography and dependent from
the result to emergency relaparotomy to increase the likelihood of survival. 相似文献
74.
Alberto J Espay Danielle M Andrade Richard A Wennberg Anthony E Lang 《Epileptic Disord》2005,7(3):227-230
Angelman syndrome is a neurogenetic disorder resulting in refractory epilepsy and profound psychomotor retardation in its most prevalent form, caused by deletion of maternal chromosome 15q11-13. We report the case of a 29-year-old, mentally retarded man with unusual electroencephalographic changes during periods of atypical absence status epilepticus, a previously unreported manifestation of the usually milder, drug-responsive epilepsy associated with Angelman syndrome due to the UBE3A mutation.[Published with video sequences]. 相似文献
75.
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77.
Unaltered immunoglobulin expression in hybridoma cells modified by targeting of the heavy chain locus with an integration vector.
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Chimeric antibodies against the murine T-cell antigen Thy-1.2 were generated in amounts sufficient for in vivo studies by substituting the constant gene segments via homologous recombination in the hybridoma cell. We show that an integration vector targets the heavy chain locus at high frequency even in a non-isogenic situation. Using this vector type, for the first time expression rates were obtained that were identical to the parental hybridoma. The use of the gpt selection marker seems to be crucial for efficient expression, and may overcome a recently claimed drawback of vector integration. A chimeric antibody produced by gene targeting was characterized in vitro and in vivo. 相似文献
78.
Urs Brägger Urs Häfeli Beat Huber Christoph H. F. Hämmerle Niklaus P. Lang 《Clinical oral implants research》1998,9(4):218-224
In most of the studies on long-term radiographic evaluations of crestal bone levels adjacent to dental implants, no baseline radiographs taken immediately post-surgically had been obtained.The aim of this study was to test the reproducibility of a simple radiographic method for linear measurements of changes in bone levels and to evaluate changes in crestal bone levels adjacent co non-submerged ITI® implants 1 year following the surgical procedure. From 128 patients enrolled in a clinical and radiographic longitudinal study 40 patients also had radiographs taken immediately postsurgically. They were, however, not obtained as “identical” images. The radiographs were mounted onto slides and projected on a screen. Mesially and distally from 57 implants triplicate linear measurements of the distance implant shoulder to bone crest were taken, using known dimensions of the implants as internal reference distances. The median difference of 213 (out of 228 possible) duplicate measurements was 0.00 mm (ranging from ?1.72 mm to +1.47 mm when comparing the second co the third reading). Some 81% of the double measurements were within ±0.5 mm and the precision was 0.30 mm. In the immediate postoperative radiographs the median mesial bone level was located at 2.07 mm (distally 2.19 mm) from the implant shoulder. A statistically significant amount of bone loss in the first year was observed mesially (median=?0.78 mm) and distally (0.85 mm)(Wilcoxon matched pairs signed rank test ±0.001). No statistically significant influence of the implant location, the implant length, type of the implant (screw; cylinder) was observed (Kruskal-Wallis P>0.05).The age of the patients was not correlated significantly to the amount of bone loss observed. In conclusion, methodological limitations existed when evaluating linear bone changes in non-identical radiographs using reference dimensions of the implants. The amount of postsurgical bone loss estimated in other studies was confirmed when using an immediate postoperative radiograph as a baseline. 相似文献
79.
用高速离心、分段盐析、亲和层析、超滤和阴离子交换层析法,从牛胎盘中分离纯化出一种肝细胞生长因子。结果表明,此因子的最终得率为0.005mg/g牛胎盘,其分子量约为99000u,它能强烈刺激原代培养大鼠肝细胞的DNA合成。提示利用自制的亲和层析凝胶,通过此提纯流程可以得到一种肝细胞生长因子。 相似文献
80.
Jonathan C. Craig Les M. Irwig James Christie Albert Lam Ella Onikul John F. Knight Premala Sureshkumar L. Paul Roy 《Pediatric nephrology (Berlin, Germany)》1997,11(4):455-459
Variability in the interpretation of micturating cystourethrography by paediatric radiologists for the diagnosis of vesicoureteric
reflux in children was evaluated. All 265 micturating cystourethrograms (MCUs) that were available from 304 consecutive children
aged 0.5 – 61 months – who were investigated after their first urine infection between 1993 and 1995 as part of a prospective
cohort study – were selected for interpretation. Three experienced paediatric radiologists from the same department independently
interpreted the MCUs according to the grading system of the International Reflux Study in Children, from grades 0 to V, with
the presence of intrarenal reflux also noted. Apart from being informed that urine infection was the indication for the MCU,
no other clinical information was given to the radiologists. The indices of variability used were the percentage of agreement
and the kappa statistic, expressed as a percentage. Both measures were weighted with integers representing the number of categories
from perfect agreement. Disagreement was analysed for children and kidneys. For the diagnosis of vesicoureteric reflux in
individual patients, including grade, the percentage of agreement was 96% – 97% (kappa 90% – 91%) and the weighted percentage
of agreement was 96% – 98% (weighted kappa 93% – 94%). The same high level of agreement was present for individual kidneys,
with a percentage of agreement of 97% – 98% (kappa 89% – 92%) and a weighted percentage of agreement of 98% – 99% (kappa 94% – 95%).
There was near perfect agreement in the interpretation of radiological micturating cystourethrography among three experienced
paediatric radiologists for the diagnosis and grade of vesicoureteric reflux. Any variations in the medical care of children
suspected of having vesicoureteric reflux are not explained by differences in the reporting of this diagnostic test.
Received June 19, 1996; received in revised form November 1, 1996; accepted December 6, 1996 相似文献