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101.
102.
Chad G. Ball Andrew W. Kirkpatrick Matthew Smith Robert H. Mulloy Leonard Tse Ian B. Anderson 《European journal of trauma and emergency surgery》2007,33(5):550-552
Abstract We report a case of SMV injury in a critically ill patient. The patient was a 19-year-old woman involved in a motor vehicle
collision. Her injuries included grade II splenic and renal lacerations, devascularized and lacerated right and transverse
colon, a transected transverse mesocolon, a massive shear injury of her abdominal wall, and two partial SMV transections.
At initial damage control laparotomy, the SMV was ligated, the devascularized bowel resected and a temporary abdominal closure
applied. At re-operation, a mesocaval shunt using saphenous vein was employed. The shunt failed and the patient required a
saphenous vein jump graft. Although visceral vascular injuries are rare, ligation of the SMV in a damage control situation
is acceptable. This case study is the first to discuss appropriate treatment when interruption to a patient's collateral visceral
venous drainage limits the surgeon’s ability to ligate. In these situations, bypass shunts may be successful. 相似文献
103.
104.
Henry Cisneros 《AIDS and behavior》2007,11(2):7-8
For persons battling HIV/AIDS a stable place to live may decide the length and quality of life itself. It is nearly impossible for a person on the streets to engage in a needed continuous AIDS treatment regimen when the very basic question of where that person will rest his or her head when darkness comes in just a few hours is unresolved. When danger lurks on the streets, when cold numbs the limbs, when tiredness overwhelms the mind, when fear breaks the spirit, a place to call home would make all the difference. 相似文献
105.
106.
Christian Waydhas Dieter Nast-Kolb Steffen Ruchholtz 《European journal of trauma and emergency surgery》2007,33(2):170-175
Abstract
Objective: To define the diagnostic accuracy of clinical examination in patients with impaired consciousness or endotracheal intubation
to detect pelvic ring fractures and to identify those with severe bleeding.
Methods: Included in this prospective data collection with retrolective data analysis were a consecutive series of blunt trauma victims
with either a Glasgow Coma Scale ≤ 13 or tracheal intubation. Clinical examination comprised testing for stability of the
iliac wings.
Results: From 784 subjects (injury severity score 23.3 ± 17.4) 93 patients (11.9%) were found to have a pelvic ring fracture. Clinical
instability of the pelvic ring was found in 42 patients. There was only one false positive. Fifty-two fractures could not
be identified by clinical examination, including nine fractures (17%) that required surgical fracture stabilization (sensitivity
of clinical examination 44.1%). Seventeen fractures (18.3%) were associated with a blood loss larger than 20% of circulating
blood volume. Sixteen of those were identified by clinical instability of the pelvic ring (sensitivity 94.1%, specificity
97.0%, positive predictive value 38.1%, negative predictive value 99.9%).
Conclusions: Clinical examination for stability of the pelvis in this selected group of patients missed a significant number of pelvic
ring fractures including fractures that require surgical stabilization. The finding of a clinically unstable identifies most
of the patients with the pelvic ring fracture being a major source of bleeding. A stable pelvis makes pelvic ring fracture
as being the source of bleeding quite unlikely. 相似文献
107.
目的应用显微手术夹闭、血管内栓塞和栓塞后手术夹闭3种治疗方法,探讨治疗颅内破裂动脉瘤的安全有效方案。方法显微手术瘤颈夹闭30个动脉瘤,栓塞34个动脉瘤,栓塞后夹闭15个动脉瘤。结果夹闭组30个完全夹闭,无复发,死亡率6%(2/30)。栓塞组完全闭塞率70.6%(24/34),复发率17.6%(6/34),死亡率11.8%(4/34)。栓塞后手术组15个完全夹闭,无复发,死亡率6.7%(1/15)。治疗结束用GOS评价,1个月后3组良好率分别为80.0%、79.4%和80.0%;半年后良好率分别为90.0%、88.2%和86.7%。结论显微手术瘤颈夹闭术仍然是治疗破裂动脉瘤的有效方法,具有1次治疗彻底和复发率低的优势,并可作为栓塞失败的补救手段。 相似文献
108.
脊柱复合性损伤的救治风险与早期治疗 总被引:3,自引:1,他引:2
目的评估脊柱复合性损伤的特点和救治风险,探讨风险控制与最佳治疗的方法。方法采用AIS、ISS、TRISS及APACHEⅡ等评分方法对273例脊柱复合性损伤患者进行定量评价与救治分类,并依据伤后的损伤分级、参数评定及计量评分等指标进行量化分析和统计处理。结果颈椎合并伤115例,胸椎合并伤141例,胸腰椎合并伤294例,腰骶椎合并伤181例;患者的救治风险和脊椎伤的治疗选择或手术时机与其合并伤的解剖伤势及由此所构成的整体伤情密切相关(P<0.01或<0.05);高风险性伤员往往综合伤势严重,生存概率(Ps)趋低,并发症和死亡率高(P<0.01或<0.05)。结论脊柱脊髓损伤常合并有严重的多发伤,高危伤情不仅可增加其救治风险和脊柱伤的处理难度,且还易于丧失手术最佳时机。分类救治对伤员的风险控制和脊柱伤的专科治疗是有益的。 相似文献
109.
The antiparasitic drug, suramin, has antiproliferative effects in human carcinoma cells. It has been suggested that this occurs through blockade of growth factor-receptor interactions. Three types of evidence that suramin rapidly inhibits cellular respiration or disrupts cellular energy balance in intact cells of the human prostate carcinoma cell line, DU145, are presented. Beginning at approximately 10(-4) M, suramin rapidly causes dose-dependent inhibition of tetrazolium conversion by mitochondrial dehydrogenases in intact cells, demonstrating an inhibition of respiration. This effect is reversed by exchange with suramin-free media but not by pretreatment with serum, epidermal growth factor, insulin-like growth factor I, acidic and basic fibroblast growth factors, or calcium. Rhodamine 123 (10 micrograms/ml) uptake by mitochondria in intact DU145 cells is inhibited in the presence of 10(-3) M suramin. Treatment with 10(-4)-10(-3) M suramin causes the loss of rhodamine 123 from cells with mitochondria prestained with rhodamine 123, indicating that suramin is acting as an ionophore or respiratory poison. Also shown by electron microscopy are progressive toxic changes in mitochondria of DU145 cells within 1 h after treatment with 10(-4) M suramin. These data indicate that in intact DU145 cells 10(-4) M suramin rapidly disrupts cellular energy balance or respiration as seen by three studies of mitochondrial state. Disruption of energy balance or respiration represents a likely antiproliferative mechanism, as is thought to be a primary mechanism for the action of suramin in parasitic diseases. This proposed mechanism of action for suramin can explain the most prominent observed clinical toxicities of nephrotoxicity, adrenal toxicity, coagulopathy, and demyelinating neuropathy. 相似文献
110.