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991.
Bilateral continuous paravertebral block used for postoperative analgesia in an infant having bilateral thoracotomy 总被引:3,自引:0,他引:3
We describe the successful postoperative pain management in an 11-month-old infant who underwent bilateral thoracotomy, using continuous infusions of bupivacaine into two directly placed paravertebral catheters. Haemodynamic parameters and pain scores were measured 1–2 h for 60 h while the infusions were continued and, intermittently, blood samples were taken for subsequent measurement of serum bupivacaine concentrations. The technique provided effective pain relief and the infant required no other analgesia postoperatively. There were no adverse haemodynamic consequences or complications relating to either catheter placement or drug infusions. Serum concentrations of bupivacaine remained below toxic levels throughout the study period, though accumulation did occur. 相似文献
992.
993.
T. BICHEL MD I. SPAHR-SCHOPFER MD M. BERNER MD E. JAEGGI MD Y. VELKOVSKI MD B. FRIEDLI MD A. KALANGOS PhD MD B. FAIDUTTI MD & J.-C. ROUGE MD 《Paediatric anaesthesia》1997,7(4):335-339
Two cases of very difficult weaning from cardiopulmonary bypass after cardiac surgery in children with pulmonary hypertension and ventricular dysfunction are reported. Children fail to respond to conventional therapy combining nitrovasodilators and inotropic support and react successfully to combined inhaled nitric oxide (NO) and epinephrine or left atrial infused norepinephrine. Postoperative NO inhalation must be prolonged and no toxicity appears. Pulmonary endothelial function recovers only after several days. 相似文献
994.
Stephen S. Burkhart MD 《Operative Techniques in Sports Medicine》1997,5(4):204-214
Arthroscopic repair of rotator cuff tears is now possible. By using the biomechanical principles of margin convergenceand the balance of force couples, even large cuff defects can be repaired. Suture anchors are particularly suitable for arthroscopic repairs, and a corkscrew anchor design lends itself to a trans-tendon approach 相似文献
995.
Dr. Harvey I. Pass MD Karen Kranda RN Barbara K. Temeck MD Irwin Feuerstein MD Seth M. Steinberg PhD 《Annals of surgical oncology》1997,4(3):215-222
Background: We analyzed morbidity and mortality, sites of recurrence, and possible prognostic factors in 95 (78 male, 17 female) patients
with MPM on phase I–III trials since 1990. A debulking resection to a requisite, residual tumor thickness of ≤ 5 mm was required
for inclusion.
Methods: Preoperative tumor volumes were determined by three-dimensional reconstruction of chest computerized tomograms. Pleurectomy
(n=39) or extrapleural pneumonectomy (EPP; n=39) was performed. Seventeen patients could not be debulked. Preoperative EPP
platelet counts (404,000) and mean tumor volume (491 cm3) were greater than that seen for pleurectomy (344,000, 114 cm3).
Results: Median survival for all patients was 11.2 months, with that for pleurectomy 14.5 months, that for EPP 9.4 months, and that
for unresectable patients 5.0 months. Arrhythmia (n=14; 15%) was the most common complication, and there were two deaths related
to surgery (2.0%). Tumor volume of >100 ml, biphasic histology, male sex, and elevated platelet count were associated with
decreased survival (p<0.05). Both EPP and pleurectomy had equivalent recurrence rates (27 of 39 [69%] and 31 of 39 [79%],
respectively); however, 17 of 27 EPP recurrences as opposed to 28 of 31 pleurectomy recurrences were locoregional (p2=0.013).
Conclusions: Debulking resections for MPM can be performed with low operative mortality. Size and platelet count are important preoperative
prognostic parameters for MPM. Patients with poor prognostic indicators should probably enter nonsurgical, innovative trials
where toxicity or response to therapy can be evaluated.
Presented at the 49th Annual Cancer Symposium of The Society of Surgical Oncology, Atlanta, Georgia, March 21–24, 1996. 相似文献
996.
KAREN ROETMAN MD LEILA WELBORN MD RAAFAT HANNALLAH MD ROBERT FINK MD JANET NORDEN MSN & REGINA O'DONNELL BA 《Paediatric anaesthesia》1997,7(5):391-397
This study compared recovery characteristics and postoperative ventilatory function when halothane, fentanyl or combination of halothane and fentanyl in addition to N2O were used for intraoperative anaesthesia in term infants undergoing hernia repair as outpatients. Sixty-six full term ASA PS I infants ages 1–12 months were studied. All received inhalation induction with N2O, O2 and halothane, followed by intravenous atropine and atracurium, tracheal intubation, and controlled ventilation. For anaesthesia maintenance, patients were randomized into one of three groups. Group I received 70% N2O, 30% O2 and halothane. Group II received 70% N2O, 30% O2, halothane and 2 μg·kg?1 fentanyl. Group III received 70% N2O, 30% O2 and 10 μg·kg?1 fentanyl. Awakening times were similar in all three groups, however, Group I patients had significantly shorter recovery and discharge times than those of Group II and III. None of the patients experienced postoperative apnoea or periodic breathing. One patient in Group III experienced two brief episodes of bradycardia not associated with apnoea or arterial desaturation (Spo 2 >90% for greater than 30 s). Decreased Spo 2 occurred less frequently in Group I (5.9%) compared to Group II (22.7%) and Group III (19.0%) patients, however, the group differences were not significant. Transcutaneous CO2 (TcCO2) values were not statistically different among the three groups. Pain scores were initially lower in Groups II and III, but at 120 min the differences were not significant. Postoperative apnoea was not observed in this study. Spo 2 <90% and TcCO2 >9 kPa (70 mmHg) was more common in infants receiving 2 and 10 μg·kg?1 fentanyl than in infants receiving halothane and nitrous oxide anaesthesia. Infants <3 months old did not have a higher incidence of Spo 2 <90% or significantly higher TcCO2 values when compared to infants >3 months old. Fentanyl in doses used in this study did not prolong awakening time but did prolong recovery and discharge times in outpatient infants. 相似文献
997.
998.
999.
Dislocation after hemiarthroplasty of the hip: a comparison of the dislocation rate after posterior and lateral approaches to the hip. 下载免费PDF全文
We compared the 3-month dislocation rate for hip hemiarthroplasties inserted via the posterior and direct lateral routes. In all, 2906 primary hemiarthroplasties, performed between 1986 and 1992 in four hospitals on a training hospital rotation, were analysed. The posterior approach was used in 1656 (57%) and the lateral in 1250 (43%). The groups were otherwise comparable. The overall dislocation rate for the posterior approach was 9.0% (149/1656), whereas that for the direct lateral approach was 3.3% (41/2150). The difference is statistically highly significant. In addition, we analysed the dislocation rate for each approach in the three broad groups of surgical trainee. For senior registrars, there was no statistical difference in the dislocation rate. However, for registrars and senior house officers, there were statistically highly significant differences in the dislocation rate for posterior and direct lateral approaches (8.4% vs 3.3% and 14.2% vs 3.6%, respectively). We conclude that, because of the high mortality associated with dislocation of a hemiarthroplasty, the posterior approach for this operation should now be abandoned, especially by surgical trainees early in their careers. 相似文献
1000.
P Emery MD FRCP R Luqmani MD MRCP C Gordon MA MRCP 《International journal of clinical practice》1994,48(2):82-86
SUMMARY Disease-modifying antirheumatic drugs are used in virtually all patients with established rheumatoid arthritis. An increasingly large number of new drugs is now available. Furthermore, old therapies are being used in novel ways. Treatment is now begun earlier and patients are rarely left untreated. This report summarises recent developments regarding the drugs currently in use and those that may be available in the near future. 相似文献