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Björn-Christian Link Emre F. Yekebas Dean Bogoevski Asad Kutup Gerhard Adam Jakob R. Izbicki Gerrit Krupski 《Journal of gastrointestinal surgery》2007,11(2):166-170
Symptomatic biliary leakage following major upper abdominal surgery is a severe complication resulting in increased morbidity
and mortality. Treatment options usually include either endoscopic intervention or surgical revision. These options may be
burdened by a high perioperative risk for the patient (e.g., patients with severe disease) or simply may not be possible (e.g.,
nonpreserved gastroduodenal passage). In the past, percutaneous transhepatic cholangiodrainage did only seem to be a viable
option for patients with dilated bile ducts. Here, we present our experience in a consecutive series of patients with symptomatic
biliary leakage following major upper abdominal surgery and without dilation of the biliary system that underwent percutaneous
transhepatic cholangiodrainage. Percutaneous transhepatic cholangiodrainage was feasible in 15 of 18 patients (83.3%). The
procedure was technically not possible in three patients (16.7%). In 10 of the 15 patients (66.6%) with feasible percutaneous
transhepatic cholangiodrainage, biliary leakage was definitely controlled without the need for surgical revision. Depending
on the experience with the interventional procedure, percutaneous transhepatic cholangiodrainage should be considered as an
alternative for treatment of symptomatic biliary leakage instead of immediate reoperation.
Presented at the Digestive Disease Week 2005 (DDW), Chicago, IL, May 14–19, 2005 (poster presentation). 相似文献
963.
Isidoro Di Carlo Elia Pulvirenti Adriana Toro Giuseppe Corsale 《World journal of surgery》2009,33(3):520-525
Background Laparoscopic cholecystectomy is now indisputably the gold standard for managing most gallbladder diseases. However, subversion
of the Calot triangle anatomy cannot always be managed by laparoscopy and often requires a laparotomy conversion. This report
discusses our patients treated with our personal technique.
Methods Patients undergoing subtotal cholecystectomy performed by the same surgeon with a personal technique from January 1999 to
December 2007 were considered for the present study. Sex, age, symptoms, co-morbidities, diagnostic modality, time between
hospitalization and surgery, length of postsurgical hospitalization, morbidity and mortality, and follow-up were assessed.
Results Four men and six women, aged 23 to 88 years, were included. Every patient had symptoms of acute cholecystitis. Four patients
had had symptoms for an average of 2.5 days and six for an average of 5.1 h. All patients were studied by ultrasonography,
and seven underwent computed tomography. The operation was performed within 48 h in all patients. The average hospital stay
from surgery to discharge was different for patients who underwent primary open cholecystectomy (10 days, range 5–16 days)
and those having a conversion after a laparoscopic attempt (7.8 days, range 4–16 days). During the postoperative period only
one patient presented a self-limiting biliary leak. No postoperative mortality occurred. At follow-up, any recurrences of
stone in the biliary tract or newly formed pouch were recorded.
Conclusions The results suggest that this new approach can be considered effective in every instance of subversion of the normal anatomy
of Calot’s triangle. 相似文献
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Piero Volpi Luca Marinoni Corrado Bait Marco Galli Matteo Denti 《Knee surgery, sports traumatology, arthroscopy》2007,15(8):1028-1034
Lateral unicompartmental knee arthroplasty (UKA) is a valid alternative treatment in the event of arthritis confined to the
lateral compartment. This paper examines its indications, technique and short to medium-term results. A total of 159 Miller–Galante
cemented UKA prostheses (Zimmer, Warsaw, Indiana) were implanted consecutively (131 medial and 28 lateral) by the same surgeon.
This study investigates 28 lateral UKAs in 27 patients. Twenty-five implants in 24 patients (including a subject operated
bilaterally) were followed up for 12–60 months. Three patients were discarded on account of to short a follow-up period. The
Hospital for Special Surgery (HSS) knee score was used to compare the pre- and post-operative results of the lateral UKA patients.
The HSS score improved from a pre-op mean of 59.92 (range 48–68) to 88.04 (range 71–95) at the last follow-up. There was a
positive increase in the pain, function and ROM components of the score. The lateral UKA prosthesis can be regarded as a sound
alternative to total knee replacement. Correct patient selection on the basis of optimum surgical indications, however, is
essential.
No benefits of funds were received in support of the study. 相似文献
969.
Peter R Loewenson Marjorie Ireland Michael D Resnick 《The Journal of adolescent health》2004,34(3):209-215
PURPOSE: To assess reasons for choosing not to have sexual intercourse among two groups: virgins (primary abstainers) and already sexually experienced youth (secondary abstainers). METHODS: 73,464 Minnesota ninth- and twelfth-grade adolescents completed the 1998 Minnesota Student Survey. Respondents identified reasons for abstinence from a checklist from which they could nominate all relevant items. Reasons for each group were analyzed using Chi-square with a conservative criterion value (p <.001) owing to large sample size. Logistic regression was used to examine the associations of gender, grade, and their interactions, with reasons for abstinence. RESULTS: Sixty-six percent reported never having had intercourse (primary abstainers). Among sexually experienced youth, 7.8% reported choosing not to have intercourse (secondary abstainers). Fear of pregnancy was the reason endorsed most often, more by girls than by boys (OR = 26 for primary abstainers, 6.9 for secondary abstainers). Fear of other adverse consequences, such as sexually transmitted infections, parental disapproval, or fear of getting caught, were generally selected by more girls than boys, and by more primary than secondary abstainers. Similarly, more girls and primary abstainers than boys or secondary abstainers generally selected statements reflecting normative beliefs on youth or their friends having intercourse. CONCLUSIONS: Fear of adverse consequences and normative beliefs about the appropriateness of having sexual intercourse were most frequently endorsed as important reasons by both groups of abstainers. 相似文献
970.
Introduction The authors report a case of interhemispheric ependymal cyst accompanied with agenesis of the corpus callosum in a fetus.
Discussion Routine ultrasound and subsequent magnetic resonance imaging of a 20-year-old woman at 33 weeks and 1 day of gestation detected
a large interhemispheric cystic lesion in the fetal cranial cavity. Caesarian section was carried out at 36 weeks because
of the progressive enlargement of the fetal head. The cyst was multiloculated and a cyst peritoneal shunt placement resulted
in collapse of the drained cyst components followed by enlargement of others. After wrack-a-mole-like shunt revisions, open
surgery was performed at the age of 2 years. Cyst walls were fenestrated and the cavities were communicated with each other
and eventually with the lateral ventricle. Pathological diagnosis of the cyst wall was ependymal cyst. The boy is now 3 years
old, and growing without apparent developmental delay or recurrence. Current concept and management policy of the interhemispheric
cyst accompanied with agenesis of the corpus callosum is reviewed. 相似文献