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41.
Laparoscopic repair of large paraesophageal hiatal hernia 总被引:8,自引:0,他引:8
Dahlberg PS Deschamps C Miller DL Allen MS Nichols FC Pairolero PC 《The Annals of thoracic surgery》2001,72(4):1125-1129
BACKGROUND: The objective of this study was to analyze our initial results after laparoscopic repair of large paraesophageal hiatal hernias. METHODS: Between October 1997 and May 2000, 37 patients (23 women, 14 men) underwent laparoscopic repair of a large type II (pure paraesophageal) or type III (combined sliding and paraesophageal) hiatal hernia with more than 50% of the stomach herniated into the chest. Median age was 72 years (range 52 to 92 years). Data related to patient demographics, esophageal function, operative techniques, postoperative symptomatology, and complications were analyzed. RESULTS: Laparoscopic hernia repair and Nissen fundoplication was possible in 35 of 37 patients (95.0%). Median hospitalization was 4 days (range 2 to 20 days). Intraoperative complications occurred in 6 patients (16.2%) and included pneumothorax in 3 patients, splenic injury in 2, and crural tear in 1. Early postoperative complications occurred in 5 patients (13.5%) and included esophageal leak in 2, severe bloating in 2, and a small bowel obstruction in 1. Two patients died within 30 days (5.4%), 1 from delayed splenic bleeding and 1 from adult respiratory distress syndrome secondary to a recurrent strangulated hiatal hernia. Follow-up was complete in 31 patients (94.0%) and ranged from 3 to 34 months (median 15 months). Twenty-seven patients (87.1%) were improved. Four patients (12.9%) required early postoperative dilatation. Recurrent paraesophageal hiatal hernia occurred in 4 patients (12.9%). Functional results were classified as excellent in 17 patients (54.9%), good in 9 (29.0%), fair in 1 (3.2%), and poor in 4 (12.9%). CONCLUSIONS: Laparoscopic repair of large paraesophageal hiatal hernias is a challenging operation associated with significant morbidity and mortality. More experience, longer follow-up, and further refinement of the operative technique is indicated before it can be recommended as the standard approach. 相似文献
42.
Biomarkers for lysosomal storage disorders: identification and application as exemplified by chitotriosidase in Gaucher disease 总被引:1,自引:0,他引:1
Johannes M Aerts Marielle J van Breemen Anton P Bussink Karen Ghauharali Richard Sprenger Rolf G Boot Johanna E Groener Carla E Hollak Mario Maas Suzanne Smit Huub C Hoefsloot Age K Smilde Johannes PC Vissers Sheryas de Jong Dave Speijer Chris G de Koster 《Acta paediatrica (Oslo, Norway : 1992)》2008,97(S457):7-14
43.
Wang JF; Bashir M; Engelsberg BN; Witmer C; Rozmiarek H; Billings PC 《Carcinogenesis》1997,18(2):371-375
Chromium (Cr) is a human carcinogen and a potent DNA damaging agent.
Incubation of DNA with CrCl3 resulted in dose-dependent binding of Cr to
DNA and, at concentrations >20 microM, altered the electrophoretic
mobility of a 100 bp oligonucleotide. We also demonstrate that high
mobility group (HMG) proteins 1 and 2 bind Cr-damaged DNA (Cr-DNA). Protein
binding was lesion density-dependent, with maximal binding to DNA treated
with 100 microM CrCl3. HMG2 binds to Cr-DNA with a calculated Kd of
approximately 10(-9) M. These proteins also bound DNA obtained from
chromate-treated cells. These results suggest that the covalent attachment
of Cr to DNA induces alterations in DNA structure which are recognized by
HMG1 and HMG2. Therefore, these proteins may function as Cr-damaged DNA
recognition proteins in vivo and as a consequence of binding, may play a
role in directing the cellular response to Cr-DNA adduct formation.
相似文献
44.
NA Bridges JA Christopher PC Hindmarsh CG Brook 《Archives of disease in childhood》1994,70(2):116-118
The aetiology of 197 girls and 16 boys presenting with sexual precocity was reviewed. Ninety one girls and four boys had central precocious puberty (M:F 23:1); a cause was identified in all the boys but in only six girls. All boys with precocious puberty need detailed investigation; in girls investigation should be based on clinical findings, particularly the consonance of puberty. 相似文献
45.
46.
Effectiveness of screening aqueous contrast swallow in detecting clinically significant anastomotic leaks after esophagectomy 总被引:4,自引:0,他引:4
Tirnaksiz MB Deschamps C Allen MS Johnson DC Pairolero PC 《European surgical research. Europ?ische chirurgische Forschung. Recherches chirurgicales européennes》2005,37(2):123-128
BACKGROUND: Aqueous contrast swallow study is recommended as a screening procedure for the evaluation of esophageal anastomotic integrity following esophagectomy. The aim of this study was to assess the accuracy of water-soluble contrast swallow screening as a predictor of clinically significant anastomotic leak in patients with esophagectomy. PATIENTS AND METHODS: The records of 505 consecutive patients undergoing esophagectomy in Mayo Clinic from January 1991 through December 1995 were retrospectively reviewed. 464 (92%) patients had water-soluble contrast swallows performed in the early postoperative period (median postoperative day 7, range 4-11 days). RESULTS: A total of 39 radiological leaks were obtained but only 17 of these had clinical signs of anastomotic leakage. Furthermore, 25 patients who had normal swallow study developed a clinical anastomotic leak. There were therefore 22 (4.7%) false positive and 25 (5.4%) false negative results giving values for the specificity, sensitivity and false negative error rate of the radiological examination of 94.7, 40.4, and 59.5% respectively. Aspiration of the contrast agent was noted on fluoroscopy in 30 (6.5%) patients. Only 2 (0.4%) patients developed aqueous contrast agent-caused aspiration pneumonia. There was no procedure-related mortality. CONCLUSION: While radiological assessment of esophageal anastomoses in the early postoperative period using aqueous contrast agents appears to be a relatively safe procedure, the poor sensitivity and high false negative error rate of this technique, when performed on postoperative day 7 and in a series with clinical anastomotic leak rate of 9%, is insufficient for it to be worthwhile as a screening procedure. 相似文献
47.
48.
49.
Chest wall reconstruction 总被引:4,自引:0,他引:4
The use of the End-to-End Anastomosis (EEA) circumferential stapler for reconstruction following resection of the esophagus and stomach for carcinoma of the cardia is reported here in 9 consecutive patients with fifteen anastomoses performed with this unit. The technical aspects of the EEA stapler are emphasized. Two frequent problems associated with this type of operation, namely, stenosis or leak at the suture line, are completely avoided by the use of this stapler unit. Its use is recommended. 相似文献
50.