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991.
Zsolt Balogh Cino Bendinelli Timothy Pollitt Rosemary A. Kozar Frederick A. Moore 《European journal of trauma and emergency surgery》2008,34(4):369-377
Postinjury abdominal compartment syndrome (ACS) has evolved during the 1980s together with the introduction of damage control
surgery (DCS) principles. DCS made it possible to salvage severely injured trauma patients who previously would have exsanguinated
due to uncontrollable coagulopathic bleeding. These patients had severe hemorrhagic shock; their abdomens were tightly packed
and had ongoing massive resuscitation. ACS is a lethal complication of the damage control patients. For today the pathophysiological
characteristics of ACS are described, the intra-abdominal pressure is measured on many intensive care units. Postinjury ACS
(primary and secondary) is one of the better characterized etiological types of ACS: risk factors, diagnostic criteria, independent
predictors and preventive strategies are all well documented. Since the mortality of full-blown postinjury ACS is still unacceptably
high and does not seem to improve with earlier decompression, prevention is the recommended strategy to decrease the morbidity
and mortality. Open abdomen is one of the important preventive strategies but it is not free from morbidity and mortality.
With aggressive open abdomen management in postinjury ACS these complications can be minimized. More importantly, timely hemorrhage
control and hemostatic resuscitation are the likely solutions for more efficient prevention of the postinjury ACS. 相似文献
992.
Kavin G. Shah Derry Rajan Jeffrey Nicastro Ernesto P. Molmenti Gene Coppa 《The Indian journal of surgery》2012,74(2):146-148
Bariatric surgery has been demonstrated to be an effective treatment for morbid obesity. The purpose of this study is to investigate
the incidence of pre- and post-operative deep venous thrombosis (DVT) in Lap-Band surgical patients. This study group comprised
56 consecutive patients who underwent Lap-Band surgery. Mean age and body mass index were 38 years (range: 18–64 years) and
50.9 kg/m2 (range: 53–74 kg/m2), respectively. All the patients were screened with duplex ultrasonography pre- and post-operatively. There were no iliac,
femoral, or popliteal vein thromboses detected at any given point of time. No patient had any clinical signs or symptoms of
DVT post-operatively. There were no observable differences attributable to DVT prophylaxis. This data suggest that in the
setting of chemical and mechanical prophylaxis, the incidence of DVT in patients undergoing Lap-Band surgery at an established
bariatric centre is minimal. 相似文献
993.
Hai-Tao Chen Quan-Cai Cai Jian-Ming Zheng Xiao-Hua Man Hui Jiang Bin Song Gang Jin Wei Zhu Zhao-Shen Li 《Annals of surgical oncology》2012,19(3):464-474
Background
Delta-like ligand 4 (DLL4)-Notch signaling plays a key role in tumor angiogenesis, but its prognostic value in patients with pancreatic ductal adenocarcinoma (PDAC) remains unclear. Our aim was to determine whether high DLL4 expression is correlated with poor prognosis after curative resection for PDAC.Methods
Surgical specimens obtained from 89 patients with PDAC were immunohistochemically assessed for DLL4 and vascular endothelial growth factor receptor 2 (VEGFR-2) expression. Prognostic significance of DLL4 expression was evaluated by Kaplan–Meier method and Cox regression. The correlations of DLL4 expression with VEGFR-2 expression, tumor stage, and lymph node metastasis were examined by chi-square test and multivariate logistic regression.Results
There were 38 (42.7%) and 51 patients who showed high and low DLL4 expression, respectively. Survival curves showed that patients with low DLL4 expression had a significantly better survival than those with high DLL4 expression (P < .001). Multivariate survival analysis demonstrated that high DLL4 expression was independently associated with both reduced overall survival (hazard ratio [HR] 2.24; 95% confidence interval [95% CI] 1.14–4.38) and reduced progression-free survival (HR 2.37; 95% CI 1.22–4.60). Multivariate logistic regression analyses showed that high DLL4 expression was independently associated with both advanced tumor stage (odds ratio [OR] 6.84; 95% CI 2.42–9.36) and lymph node metastasis (OR 3.27; 95% CI 1.04–10.34). We also found a positive correlation between DLL4 and VEGFR-2 expression (P < .001).Conclusions
High DLL4 expression is significantly associated with poor prognosis for surgically resected PDAC, advanced tumor stage, and lymph node metastasis. Application of adjuvant therapy targeting DLL4-Notch signaling may improve prognosis.994.
PURPOSE: We report our experience of diagnosing and treating hepatic angiomyolipoma (HAML), a rare benign mesenchymal tumor. METHODS: We analyzed retrospectively the clinicopathologic, radiological, and operative data of 25 patients who underwent surgery for HAML at our institute between November 2001 and May 2006. RESULTS: Most patients (20/25) were asymptomatic and had normal liver function. Ultrasonography (US) showed a heterogeneous hyperechoic mass in 13 of 23 patients, precontrast computed tomography (CT) showed that all of 12 lesions scanned were hypodense, and magnetic resonance imaging (MRI) showed hypointensity on T1-weighted images and hyperintensity on T2-weighted images in most (5/6) lesions. Marked enhancement in the arterial phase was seen in 10 of 12 lesions on CT scans and in 6 of 6 lesions on MRI scans. All tumors were composed of varying proportions of smooth muscle, adipose tissue, and blood vessels, and showed positive immunohistochemical staining for HMB-45. All patients underwent partial hepatectomy and there was no evidence of recurrence after a median follow-up of 43 months. CONCLUSION: The radiological features of HAML vary according to its histological components. The definitive diagnosis of HAML is challenging and depends on the presence of HMB-45-positive myoid cells. Hepatic angiomyolipoma is treated effectively with surgery and the prognosis is good. 相似文献
995.
996.
997.
In order to explore the expression of PI-3K in T lymphocytes of asthmatic rats and the relationship between PI-3K and activation of T lymphocytes, 24 Wistar rats were randomly divided into 4 groups: normal control group, asthmatic one-week group, asthmatic two-week group and asth-matic four-week group. T cells were purified from blood of each rat and the expression of PI-3K was observed by immunocytochemical fluorescence staining, the semiquantitative fluorescence intensity was measured by HPIAS-2000 analytic software, and the expression of IL-4 in supernatants was de-tected by ELISA. The results showed that the fluorescence intensity of T lymphocytes in asthmatic groups was significantly higher than that in normal control (P<0.001), indicating that the expression of PI-3K in T lymphocytes of asthmatic rats was significantly higher than that in those of normal controls, and the difference between acute and chronic stage asthmatic groups was significant (P<0.05). The expression levels of IL-4 protein in supernatants of asthmatic T lymphocytes were sig-nificantly higher than those in the normal controls (P<0.05). There was a significant positive correla-tion between the expression of PI-3K in T lymphocytes and the IL-4 protein expression in super-natants (r=0.583, P<0.01). It was suggested that PI-3K signal pathway may participate in the proc-esses of activation and other cytological effects of asthmatic T lymphocytes, thus may play an impor-tant roles in the pathogenesis of asthma. 相似文献
998.
999.
Whether inhibiting the activity of nuclear factor (NF)-κB potentiates cisplatin-induced apoptosis in non-small cell lung cell line A549 cells was investigated. The recombinant plasmid pcDNA3.1(+)/IκBα expressing IκBα was constructed. The in vitro cultured A549 cells were transfected with pcDNA3.1 (+)/IκBα alone, or pcDNA3.1(+)/IκBα combined with cisplatin. The mitochondrial membrane potential (△ψm) was determined by rhodamine 123, the activity of caspase-3 was tested by colorimetric assay, and cell apoptosis was detected by flow cytometry with the annexin V/propidium iodide assay. The results showed that the activity of NF-κB in A549 cells was inhibited by transfecting pcDNA3.1(+)/IκBα. Transfection of pcDNA3.1(+)/IκBα alone did not promote apoptosis. Treatment of cisplatin alone had a little effect on cell apoptosis. Transfection of pcDNA3.1(+)/IκBα combined with cisplatin treatment significantly induced apoptosis of A549 ceils. It was concluded that inhibiting the activity of NF-κB potentiated cisplatin-induced apoptosis of A549 cells. 相似文献
1000.
Ferrero A Viganò L Polastri R Muratore A Eminefendic H Regge D Capussotti L 《World journal of surgery》2007,31(8):1643-1651
Background The future remnant liver (FRL) limit for safe major hepatectomy with low risk of postoperative liver failure has not yet been
well defined.
Methods Between April 2000 and September 2004, every patient scheduled for major hepatectomy in our institution underwent CT-volumetry
of FRL. Patients with FRL <25% underwent portal vein embolization (PVE). Exclusion criteria were PVE, associated vascular
resection and liver cirrhosis. The FRL was correlated with short-term results in patients with normal liver (group A) and
those with impaired liver function secondary to neoadjuvant chemotherapy or cholestasis (bilirubin >2 mg/100 ml) (group B).
Liver dysfunction was defined as both PT <50% and serum bilirubin level >5 mg/100 ml for three or more consecutive days.
Results A total of 119 patients were analyzed, 72 in group A and 47 in group B. The FRL value was the only significant risk factor
for postoperative liver dysfunction in the univariate and multivariate analysis (p = 0.009). The FRL did not correlate with postoperative mortality and morbidity. Bilirubin and prothrombin time (PT) on days
3 and 7 were significantly correlated to FRL in both groups. In group A, patients with postoperative liver dysfunction had
a FRL<30% (3 versus 0; p = 0.005). According to receiving operator characteristic (ROC) curve analysis, a FRL value of 26.5% predicted postoperative
liver dysfunction with 66.7% sensitivity, 97.1% specificity, 50% positive predictive value (PPV), and 98.5% negative predictive
value (NPV). In group B, patients with postoperative liver dysfunction had a FRL <35% (4 versus 0; p = 0.027). According to ROC curve analysis, a FRL value of 31.05% predicted postoperative liver dysfunction with 75% sensitivity,
79.1% specificity, 25% PPV, and 97.1% NPV.
Conclusions Hepatectomy can be considered safe when FRL is >26.5% in patients with healthy liver and >31% in patients with impaired liver
function. 相似文献