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41.
Background/Purpose: The most important aspects in management of pyriform sinus malformations are awareness of the diagnosis, familiarity with the clinical manifestations, and complete surgical excision of the entire tract. Pyriform sinus anomalies are the least common branchial apparatus malformations and present anatomically as sinus tracts with or without cystic dilatation. The clinical presentations can include lateral neck mass, thyroid abscess, suppurative thyroiditis, retropharyngeal abscess, neonatal airway obstruction, and even carcinoma. Recurrent symptoms after surgery suggest incomplete identification and excision of the tract. Methods: Cadaveric dissections were performed to show both the proposed embryologic course and clinical manifestations of third and fourth branchial apparatus pyriform sinus anomalies. Results: Illustrations and digital camera images of the cadaveric models are presented to explain the course of pyriform sinus fistula tracts. Conclusions: The authors discuss 3 case presentations of pyriform sinus anomalies with emphasis on their proposed embryologic origin and anatomic basis for surgical management. Surgical excision is the mainstay of therapy. Understanding the embryologic basis for pyriform sinus malformations aids in recognition of the diagnosis despite the myriad of clinical presentations. Laryngoscopy with sinus cannulation facilitates removal of the entire sinus tract with preservation of the recurrent and superior laryngeal nerves. 相似文献
42.
Handel M Winkler J Hörnlein RF Northoff H Heeg P Teschner M Sell S 《Acta orthopaedica Scandinavica》2001,72(3):270-272
We determined interleukin-6 (IL-6) concentrations in collected shed drainage blood intended for retransfusion in a prospective study in 81 patients after total knee replacement. We found large increases in IL-6 levels, averaging 6.5 (SD 3.9) ng/mL, in shed blood collected in the first 6 postoperative hours. 3 patients had febrile reactions after collected blood was retransfused. The IL-6 levels in the drainage blood of these patients were very high (9.6-13.4 ng/mL). In the blood collected after 6 hours, IL-6 concentrations increased to 47 (SD 33) ng/mL (p < 0.001). These results suggest a relation between increased interleukin-6 concentrations in shed drainage blood and the occurrence of febrile reactions after retransfusion of such blood. 相似文献
43.
BACKGROUND: The critical part of any operation involving a proximal gastric resection is the esophageal anastomosis. Leakage from this anastomosis is one of the main reasons for postoperative morbidity and death after gastrectomy. Application of the double-stapling technique affords many of the same advantages that it does for low rectal tumors, especially in obese patients with narrow costal margins. METHODS: A new technique for esophagojejunostomy after total gastrectomy for gastric cancer is described. RESULTS: This technique has been used in 3 patients. At a follow-up of 22 months, there have been no anastomotic leaks or evidence of clinical stenoses. CONCLUSIONS: This technique minimizes manipulation and dissection around the distal esophagus. Not only does this make the operation easier, but it also allows for a longer proximal resection margin. Possibly this will result in lower rates of esophageal breakdown. 相似文献
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Priv.-Doz. Dr. H. Hochrein Dr. R. Sell Prof. Dr. K. W. Schneider 《Basic research in cardiology》1965,46(1-4):232-245
Zusammenfassung Mit Hilfe desHamiltonschen Herzminutenvolumens wurde über die nachWollheim undLange modifizierteVierordtsche Formel der Faktork berechnet. Es ergab sich in 96 untersuchten Fällen ein funktioneller Zusammenhang zwischenk und dem Quotienten aus den einfach zu bestimmenden Kreislaufgrößen, Blutmenge und Kreislaufzeit. Bei Herz-kreislaufgesunden und kompensierten Hypertonikern erwies sich dieser QuotientBM/Ct umgekehrt proportional, bei dekompensierten Herzkranken direkt proportional dem Faktork. Aus der Regression kann, bei linearer Abhängigkeit, der Faktork jeweils berechnet werden, wenn das Blutvolumen und die Kreislaufzeit bekannt sind. Daraus kann dann über den errechneten variablen Faktork und den gemessenen Größen Blutvolumen und Kreislaufzeit auf einfache Weise ein dem derHamiltonschen Indikatorverdünnungsmethode entsprechendes Herzminutenvolumen errechnet werden. Bei Herz-Kreislaufgesunden und dekompensierten Herzkranken liegt eine gute Relation mit einer mittleren Abweichung von weniger ±10% vor. Bei kompensierten Hypertonikern dagegen stimmen die nach beiden Methoden errechneten Herzminutenvolumina im Mittel sehr gut überein, jedoch zeigen die über den Faktork bestimmten Herzminutenvolumina eine geringere Streuung, d. h. die bei derHamiltonschen Methode gefundenen großen und ganz kleinen Werte ergeben sich nach der Faktor-k-Methode nicht.Es werden die möglichen Gründe für dieses abweichende Verhalten diskutiert, wobei die Diskrepanz zwischen Umlaufzeit und Kreislaufzeit bei unkontrollierten Belastungszuständen ohne steady state und ein präinsuffizientes Kreislaufverhalten die funktionellen Beziehungen des Faktorsk stören können.Trotzdem handelt es sich bei der beschriebenen einfachen, den Patienten wenig belastenden Methode um eine exakte Messung des Herzminutenvolumens, die sich aus einer komplizierten Methode entwickelt hat und im Ergebnis dieser auch entspricht.
Mit 7 Abbildungen und 3 Tabellen 相似文献
Summary Factork was calculated by the aid ofHamilton's cardiac output in accordance toVierordt's formula modified byWollheim andLange.In examinations of 96 patients a correlation betweenk and the simple calculated values of blood-volume (BM) and circulation-time (ct) was observed. In normal subjects and in patients with a compensated hypertension the quotientBM/Ct was found to be reciprocal to factork, while in patients with heart-failure it was directly proportional. In a linear dependence factork can be calculated by regression function when bloodvolume and circulation-time are known. By the aid of calculated factork and the evaluated blood-volume and circulation-time, one obtains a cardiac output which is equivalent to that ofHamiltons method. In normal subjects and in patients with heart-failure an average deviation of less than ±10% was found. In compensated hypertensives the average values of both cardiac-outputs are corresponding. But in calculating cardiac-output by aid of factork the values show less deviation in comparison with those of theHamilton method. This means that the high and the low values calculated byHamilton's method are not found with the factork-method.The reasons for this deviating behaviour are discussed. The discrepancy between circulation-time in total and in part in an uncontrolled and unsteady loading-state and in a state preceeding failure, may disturb functional relation with factork. Nevertheless we have an exact method for calculating cardiac output in a simple way which is less troublesome for patients.
Mit 7 Abbildungen und 3 Tabellen 相似文献
46.
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48.
We describe the clinical, radiological and neuropathological findings in an adult AIDS patient presenting with ventriculitis and hydrocephalus as the primary manifestations of cerebral toxoplasmosis. Clinical symptoms including fever, headache, changes in mental status and focal neurological deficits were non-specific. Cranial computed tomography showed a subtile ventricular dilatation whereas magnetic resonance imaging disclosed triventricular hydrocephalus due to stenosis of the aqueduct and a periventricular nodular rim of high signal intensity on T2- and proton density-weighted images. This rim also showed a slight enhancement on post-contrast T1-weighted images. Focal intracerebral lesions could not be delineated, neither by neuroimaging nor by pathology. Neuropathological examination showed severe ventriculitis with large ependymal and subependymal necrosis as well as dilatation of the lateral and the third ventricle. The only microorganism demonstrated at histology in the central nervous system was Toxoplasma gondii. We conclude that ventriculitis and hydrocephalus without any focal parenchymal lesion may be the only manifestations of CNS toxoplasmosis. It is important to recognize this unusual form of presentation of cerebral toxoplasmosis in order to perform specific therapy. 相似文献
49.
Masi JN Newitt D Sell CA Daldrup-Link H Steinbach L Majumdar S Link TM 《AJR. American journal of roentgenology》2005,184(6):1754-1761
OBJECTIVE: The purpose of our study was to determine the optimal concentration of a gadolinium-based contrast agent (gadodiamide) for direct MR arthrography at 3 T compared with 1.5 T in an in vitro study. CONCLUSION: Optimized concentrations of gadolinium-based contrast agents for MR arthrography are similar at 3 and 1.5 T, although a slightly greater dilution may be useful at 3 T. Signal-to-noise ratio peak levels are significantly reduced by adding an iodinated contrast agent, relatively significantly more at 3 T than at 1.5 T. 相似文献
50.
No difference between two doses of diclofenac in prophylaxis of heterotopic ossifications after total hip arthroplasty 总被引:2,自引:0,他引:2
BACKGROUND: In a monocentric, randomized, placebo-controlled double-blind study, we investigated the efficacy of two doses of diclofenac-cholestyramine for the prevention of heterotopic ossification (HO). PATIENTS: The study comprised 245 patients undergoing total hip arthroplasty (THA). RESULTS: With 150 mg cholestyramine-bound diclofenac (2 x 1 capsule Voltaren resinate) daily during a postoperative period of 14 days, 19% of patients showed slight HO (Brooker grade 1), and no patient had more severe ossifications (grades 2-4). In the group receiving 75 mg daily (1 x 1 capsule), 17% of patients showed grade 1 HO and 4% grade 2 HO. No patient had grades 3-4 HO. No differences in clinical results were seen between the two groups 6 months after THA. INTERPRETATION: Since the rate of adverse gastrointestinal events was lower (23% versus 38%, p = 0.02) in the group receiving the lower dose, we recommend it. 相似文献