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991.
Takahiko Misao Kanji Minamoto Hideharu Nakano Masataka Yamane Yosuke Yamamoto Katashi Satoh 《General thoracic and cardiovascular surgery》2005,53(6):309-312
A 64-year-old female was found to have localized ground-glass opacity (GGO) in the middle lobe on a chest computed tomography (CT) for screening. Middle lobectomy with video-assisted thoracoscopic surgery (VATS) was undertaken, and pathological diagnosis was a bronchioloalveolar carcinoma (BAC) in stage IA. A follow-up CT a year following the surgery revealed localized GGO in area S6 of the left lung. However, it disappeared during the gravitation-dependent gradient in the observation period. The patient was scanned again under prone position to exclude the gravitational effect, resulting in definite detection of the GGO. Left extended S6 segmentectomy with VATS was performed, and pathological diagnosis was a BAC in stage IA. As GGO existing in a gravitation-dependent area may be masked by the gravitation-dependent density, a change of the scanning position may lead to a proper detection of the tumor for the diagnosis of BAC. 相似文献
992.
Kimihiro Shimizu Yoshimi Otani Takashi Ibe Osamu Kawashima Mituhiro Kamiyoshihara Yasuo Morishita 《General thoracic and cardiovascular surgery》2005,53(1):39-41
Late-onset chylothorax occurred 49 days after right lower lobectomy for lung cancer in a 76-year-old man. Chylothorax was successfully managed by conservative treatment with chest tube drainage and an enteral low-fat diet. Chylothorax may occur in the late period after pulmonary resection and systematic mediastinal lymph node dissection for lung cancer, for which conservative management is the treatment of choice. 相似文献
993.
This retrospective study summarizes our experience based on treating 62 patients with trigeminal neuralgia treated with microvascular decompression. All patients had typical trigeminal neuralgia symptoms, with 24 of them (38%) having failed to benefit from other previous treatment paradigms. We excluded subjects with atypical and/or secondary forms of trigeminal neuralgia. Follow-up duration ranged from 5 months to 10 years 6 months, with recurrence being identified in three patients (4.8%).We found that the superior cerebellar artery is the leading offending vessel in our cases (33.9%; 21 patients). Interestingly, seven patients (11.3%) underwent an early reoperation 12-48 h later after the first operation was deemed ineffective. This subgroup recovered satisfactorily following isolation of the pathogenic vessels. Overall, no mortality was observed in our patients, and the only permanent morbidity outcome was a case of facial nerve palsy (1.6%). We conclude that microvascular decompression and its reapplicaiton for patients who showed no pain relief immediately after the first decompression are safe and effective treatments for trigeminal neuralgia. 相似文献
994.
Elsawaf A Mastronardi L Roperto R Bozzao A Caroli M Ferrante L 《Neurosurgical review》2009,32(2):215-224
The objective of this study is to evaluate the effect of anterior cervical discectomy and fusion (ACDF) on the motion of the cervical spine and dynamic stress (tendency to kyphosis) on adjacent segments and on the overall spinal alignment which may predispose to symptomatic disc diseases at other levels. Twenty consecutive patients underwent ACDF with a mean follow-up of 28 months (range 13-38). Preoperative and postoperative clinical assessments were done by using the neck disability index (NDI) and the Japanese Orthopedic Association (JOA) score. In all cases, at the last follow-up control, a neuro-radiographic assessment [cervical spine static and dynamic X-ray and magnetic resonance imaging (MRI)] was done. The angle of the operated disc space, the disc space angle of contiguous segments, and their range of motion (ROM) and the kyphotic Cobb angle (C2-7) were measured by computer software. The study was done at Sant'Andrea Hospital, Rome, Italy in the period from November 2003 to November 2005. We observed that: the mean Cobb angle improved significantly (p < 0.001) from 3.4 degrees (kyphosis) to postoperative 14.5 degrees . This normalization of angle showed a direct effect on improvement of myelopathic patients, but it had a statistically nonsignificant effect on adjacent segments degeneration (ASD). The mean segmental ROM of adjacent segments did not show significant instability. The mean was 11.1 degrees at upper and 10.2 degrees at lower levels (close to normal). In six cases, the ROM was higher than normal: five of these patients demonstrated symptomatic adjacent segment pathology. Postoperative improvement of mean JOA and NDI scores was statistically significant (p < 0.001). Anyway, symptomatic ASD was observed in five patients (20%): in four of them, the higher disc spaces and in one, the lower disc spaces were involved. In four cases, the preoperative MRI showed slight and asymptomatic disc degeneration at the same levels involved subsequently. This ASD was significantly related to the increased ROM at the segments involved. Follow-up X-rays showed solid fusion with absence of movement in all but one case (at 13-month follow-up), who showed slight movement in the operated level in spite of clinical improvement. The follow-up MRI showed, in all cases, good decompression in the treated levels. Compensatory increase in ROM of the contiguous motion segments in patients subjected to ACDF may lead to ASD especially in those cases with asymptomatic adjacent subclinical degenerative disease. If these preliminary results will be confirmed by larger series, it could be reasonable in young selected patients with soft disc herniation to adopt total disc arthroplasty instead of fusion after cervical micro-discectomy. 相似文献
995.
İbrahim Halil Kurt 《Surgery today》2009,39(5):381-386
Cardiac failure is among the most significant conditions associated with acute coronary syndrome. In ischemic heart disease,
serious hemodynamic problems are reported in patients with left ventricular dysfunction during the acute phase despite mechanical
revascularization. Several positive inotropic agents in addition to intra-aortic balloon pump (IABP) are required to support
patients with impaired left ventricular pump function during this phase. Intravenous inotropic agents, beta-mimetics, and
phosphodiesterase inhibitors lead to increases in the incidence of arrhythmia and myocardial O2 consumption owing to their effect of increasing intracellular calcium amount, although they produce rapid hemodynamic improvements
in cardiac failure. This causes severe problems particularly in cardiac failure of ischemic origin. Recently, levosimendan,
a calcium-sensitizing agent with cardioprotective properties, is being used alone or in combination with IABP in cases with
severe left ventricular systolic dysfunction during mechanical revascularization procedures (percutaneous coronary interventions,
coronary bypass surgery). This review includes studies with levosimendan in cases not recovering due to myocardial stunning
in the acute phase despite mechanical approaches applied. 相似文献
996.
Koskinen E Paavolainen P Eskelinen A Harilainen A Sandelin J Ylinen P Tallroth K Remes V 《Archives of orthopaedic and trauma surgery》2009,129(5):617-624
Aim The purpose of our study was to evaluate retrospectively the mid-term results of the Miller-Galante II (Zimmer, Warsaw, USA)
unicondylar knee arthoplasty (UKA).
Method The study included 46 patients with medial UKAs. Mean follow-up time was 7.0 years (range 2.7–13.1 years).
Results Survival rate of the prosthesis was 86.6% (95% CI 73.7–99.6) at 7 years. The mean clinical and functional Knee Society Scores
had increased from 51 and 62 points preoperatively to 76 and 93 points (P < 0.001) postoperatively. Five of the 46 knees were revised because of excessive wear of the polyethylene liner, and three
due to progression of the osteoarthritis in the lateral compartment of the knee.
Conclusion Survival of this fixed-bearing UKA was not as good as previously reported and polyethylene wear seems to be a more common
problem than previously assumed. 相似文献
997.
Min-Ho Song Tomohiro Nakayama Keisuke Hattori Shigeru Miyachi 《General thoracic and cardiovascular surgery》2009,57(1):40-42
Effort angina of a 70-year-old man was diagnosed as due to triple coronary vessel disease, and he was scheduled to undergo
coronary artery bypass surgery. Preoperative carotid duplex scan revealed more than 75% stenosis of the right internal carotid
artery, which was functionally proven to be significantly ischemic on brain single photon emission computed tomography. Although
he was neurologically asymptomatic, we chose staged surgery for fear of stroke during coronary artery bypass surgery. He had
successful carotid artery stenting first by neurosurgeons; then, 2 months later he underwent uneventful coronary artery bypass
surgery. This experience prompted us to report the case. 相似文献
998.
Chronic allograft nephropathy (CAN) is the leading cause of renal allograft loss in paediatric renal transplant recipients.
CAN is the result of immunological and nonimmunological injury, including acute rejection episodes, hypoperfusion, ischaemia
reperfusion, calcineurin toxicity, infection and recurrent disease. The development of CAN is often insidious and may be preceded
by subclinical rejection in a well-functioning allograft. Classification of CAN is histological using the Banff classification
of renal allograft pathology with classic findings of interstitial fibrosis, tubular atrophy, glomerulosclerosis, fibrointimal
hyperplasia and arteriolar hyalinosis. Although improvement in immunosuppression has led to greater 1-year graft survival
rates, chronic graft loss remains relatively unchanged and opportunistic infectious complications remain a problem. Protocol
biopsy monitoring is not current practice in paediatric transplantation for CAN monitoring but may have a place if new treatment
options become available. Newer immunosuppression regimens, closer monitoring of the renal allograft and management of subclinical
rejection may lead to reduced immune injury leading to CAN in the paediatric population but must be weighed against the risk
of increased immunosuppression and calcineurin inhibitor nephrotoxicity. 相似文献
999.
Filip Fencl Jan Janda Květa Bláhová Zdeněk Hříbal Jitka Štekrová Alena Puchmajerová Tomáš Seeman 《Pediatric nephrology (Berlin, Germany)》2009,24(5):983-989
Adults with autosomal dominant polycystic kidney disease (ADPKD) and PKD1 mutations have a more severe disease than do patients with PKD2 mutations. The aim of this study was to compare phenotypes between children with mutations in the PKD1/PKD2 genes. Fifty PKD1 children and ten PKD2 children were investigated. Their mean age was similar (8.6 ± 5.4 years and 8.9 ± 5.6 years).
Renal ultrasound was performed, and office blood pressure (BP), ambulatory BP, creatinine clearance and proteinuria were measured.
The PKD1 children had, in comparison with those with PKD2, significantly greater total of renal cysts (13.3 ± 12.5 vs 3.0 ± 2.1,
P = 0.004), larger kidneys [right/left kidney length 0.89 ± 1.22 standard deviation score (SDS) vs 0.17 ± 1.03 SDS, P = 0.045, and 1.19 ± 1.42 SDS vs 0.12 ± 1.09 SDS, P = 0.014, successively] and higher ambulatory day-time and night-time systolic BP (day-time/night-time BP index 0.93 ± 0.10
vs 0.86 ± 0.05, P = 0.021 and 0.94 ± 0.07 vs 0.89 ± 0.04, P = 0.037, successively). There were no significant differences in office BP, creatinine clearance or proteinuria. Prenatal
renal cysts (14%), hypertension defined by ambulatory BP (27%) and enlarged kidneys (32%) were observed only in the PKD1 children.
This is the first study on genotype–phenotype correlation in children with ADPKD. PKD1 children have more and larger renal
cysts, larger kidneys and higher ambulatory BP than do PKD2 children. Renal cysts and enlarged kidneys detected prenatally
are highly specific for children with PKD1. 相似文献
1000.
Sarah J. Swartz Karen W. Eldin M. John Hicks Daniel I. Feig 《Pediatric nephrology (Berlin, Germany)》2009,24(6):1187-1192
Immunoglobulin (Ig) M nephropathy is defined by electron-dense mesangial deposits and mesangial IgM visible by immunofluorescence
(IF) without other histopathologic and immunofluorescent microscopic abnormalities. Certain patients have only immuno-positive
(IgM+) IF. Children presenting with steroid-dependent or steroid-resistant nephrotic syndrome have a high prevalence of IgM+
IF with or without electron-dense deposits. We reviewed the clinical course of children with steroid-dependent or steroid-resistant
nephrotic syndrome who underwent renal biopsy at Texas Children‘s Hospital from 1989 to 2006 to further characterize IgM+
IF in children with nephrotic syndrome. Of the 55 children with steroid-resistant or -dependent minimal change disease (MCD),
23 had IgM+ IF. Of these 23 children, 61% had microscopic hematuria at presentation, 48% (11/23) were steroid-dependent, and
48% (11/23) steroid-resistant (one underwent biopsy prior to steroid therapy). We compared the efficacy of adjuvant treatment
with cyclophosphamide and cyclosporine: 18% initially treated with cyclophosphamide obtained remission, while 55% had no response;
83% obtained subsequent remission with cyclosporine. Of those initially treated with cyclosporine, 88% obtained complete or
partial remission. IgM+ IF may be surrogate marker for the severity of MCD. Based on our results, children with MCD and IgM+
IF have a better response to cyclosporine than cyclophosphamide. 相似文献