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161.
Kim J Ahmad SA Lowy AM Buell JF Pennington LJ Soldano DA James LE Matthews JB Hanto DW 《The American surgeon》2003,69(9):815-819
The Harmonic Scalpel (HS) is frequently used for hepatic resection. Yet, no current study addresses its utility compared to conventional methods. We reviewed our experience with this device to determine if it decreased perioperative complications when compared to the traditional clamp crushing technique. One hundred forty-nine anatomic hepatic resections were performed at our institution from September 1992 to February 2002. Patients were divided into two groups based on the technique of resection: HS [53% (n = 79)] versus clamp crushing [47% (n = 70)]. Use of the HS was associated with a shorter mean operative time (357 +/- 15.0 vs. 404 +/- 19.1 min; p = 0.05) and a trend toward decreased blood loss (1211 +/- 125.5 vs. 1411 +/- 180.7 mL; P = NS) and transfusion requirements (2.6 +/- 0.5 vs. 1.7 +/- 0.3 units; P = 0.10). However, use of the HS was associated with a significant increase in biliary fistulas [24% (n = 19) vs. 7% (n = 5); P = 0.01]. Use of the Harmonic Scalpel was associated with decreased operative time and a trend toward decreased blood loss and transfusion requirements. Its use was also associated with a significant increase in the incidence of postoperative bile leaks, and, therefore, surgeons must be vigilant during liver parenchymal transection when using this device. 相似文献
162.
Carlton C. Barnett Jr Jamil Ahmad Jeffrey E. Janis Joshua A. Lemmon Kevin C. Morrill Robert N. McClelland 《American journal of surgery》2008,196(6):1000-1002
Hemicorporectomy involves amputation of the pelvis and lower extremities by disarticulation through the lumbar spine with concomitant transection of the aorta, inferior vena cava, and spinal cord, as well as creation of conduits for diversion of the urinary and fecal streams. A review of the literature reveals that the surgical technique has been relatively unchanged since 1960. The standard anterior to posterior approach is associated with significant blood loss and morbidity, likely contributing to lengthy hospital stay. Herein, we describe our back-to-front approach to hemicorporectomy, involving early division of the vertebral structures and spinal cord, pre-empting engorgement of Batson's plexus, thus minimizing blood loss. In addition, this approach greatly improves exposure of the pelvic vessels, allowing for a technically less challenging and safer procedure. 相似文献
163.
Cadet ER Hsu JW Levine WN Bigliani LU Ahmad CS 《Journal of shoulder and elbow surgery / American Shoulder and Elbow Surgeons ... [et al.]》2008,17(1):73-77
This study investigated whether a relationship exists between greater tuberosity osteopenia and chronicity of rotator cuff tears. In a retrospective study, anteroposterior radiographs of 28 shoulders in 27 patients who had undergone surgical repair for rotator cuff tears were reviewed. Greater tuberosity osteopenia scores were created using National Institutes of Health digital image software. There was no significant difference in the mean age between patients with minimal to mild rotator cuff tear retraction (63.1 +/- 6.14 years) and patients with moderate to severe rotator cuff tear retraction (63.4 +/- 9.76 years; P = .77). Of the 13 patients with minimal to mild rotator cuff tear retraction, 10 (77%) were women and 3 (23%) were men. Of 14 patients (50%) with moderate to severe rotator cuff tear retraction, 7 were men and 7 were women. The mean greater tuberosity osteopenia score in the 15 patients with moderate to severe retraction (0.48 +/- 0.095) was significantly less than the greater tuberosity osteopenia score in the 13 patients with minimal to mild retraction (0.58 +/- 0.135; P < .05). Furthermore, the mean greater tuberosity osteopenia score in 6 patients with chronic retracted rotator cuff tears (0.48 +/- 0.125) was significantly less than in the 6 patients with acute minimally retracted tears (0.64 +/- 0.119, P < .05). There were significantly greater osteopenic changes in the greater tuberosity in patients with chronic retracted rotator cuff tears. The greater tuberosity osteopenia may affect anchor pullout strength and the healing biology that influences overall rotator cuff repair healing rates. 相似文献
164.
Nerve transection is commonly followed by the development of neuroma at the proximal stump. It can be very painful especially
at exposed sites. It may arise spontaneously or after mechanical irritation. Neuroma and its high recurrence rate might be
resisting problems to treat. Various treatment modalities for neuroma and its recurrence have been proposed, but none has
provided satisfactory results. The present study was conducted to evaluate the neodymium:yttrium aluminum garnet (Nd:YAG)
laser (1,064 nm) nerve transection technique for prevention of neuroma formation. There were 48 facial nerves out of 24 Rex
rabbits divided into two equal groups. The 24 left-sided facial nerves at group A were subjected to Nd:YAG laser for nerve
transection, while the 24 right-sided facial nerves at group B were subjected to scalpel nerve transection. The results were
grossly and histopathologically evaluated. Grossly, laser-transected nerves showed an infrequent incidence of neuroma formation.
Histopathologically, laser-transected nerves showed photothermal degenerative changes of the axons and myelin sheaths with
intact perineurium and endoneurium. No Schwann cell hyperactivity could also be elicited among laser-transected nerves. Nd:YAG
laser was found to be an effective tool that could be applied, whenever it is possible, for division of major nerves to prevent
the formation of the subsequent stump neuroma. Moreover, this technique should be considered during treatment of well-established
neuroma to prevent the challenging reported high incidence of recurrence. 相似文献
165.
Ahmad M Krishnan A Kelman E Allen V Bargman JM 《International urology and nephrology》2008,40(3):815-819
Listeria monocytogenes (LM) is one of the rare microorganisms causing peritonitis in peritoneal dialysis (PD) patients. We report a sporadic case of peritonitis caused by LM in a young female PD patient with lupus receiving corticosteroid therapy, who presented with abdominal pain, cloudy PD effluent, nausea, and conjunctivitis. The effluent showed a high PD effluent white cell count and monocytosis, and gram staining showed gram-positive bacilli in single or short chains and PD effluent culture grew LM. She was treated successfully with beta lactum antibiotics. LM peritonitis should be suspected if a patient presents with gram-positive bacilli and monocytosis in dialysis effluent. 相似文献
166.
Lung and heart-lung transplantation in patients with end-stage cystic fibrosis: the Stanford experience 总被引:5,自引:0,他引:5
Vricella LA Karamichalis JM Ahmad S Robbins RC Whyte RI Reitz BA 《The Annals of thoracic surgery》2002,74(1):13-7; discussion 17-8
BACKGROUND: Bilateral lung (BLTx) and heart-lung transplantation have gained wide acceptance as treatment of end-stage lung disease from cystic fibrosis. We reviewed our 13-year experience with thoracic transplantation for cystic fibrosis with an operative approach that favors use of cardiopulmonary bypass for BLTx. METHODS: Sixty-four patients with cystic fibrosis underwent heart-lung transplantation (n = 22, 34.4%) or BLTx (n = 42, 65.6%) between 1988 and 2000. Mean age and weight at transplantation were 29 +/- 8 years and 51 +/- 11 kg, respectively. Mean follow-up for survivors was 4.4 +/- 3.6 years. Immunosuppression regimen included cyclosporine, tapered corticosteroids, azathioprine, and induction therapy with OKT3 (murine monoclonal antibodies) or rabbit antithymocyte globulin. Cardiopulmonary bypass was used in all but 5 patients (7.8%). However, in 8 (19%) of the 42 patients having BLTx, only the grafting of the second lung was performed with cardiopulmonary bypass. RESULTS: The operative mortality rate was 1.6%. The actuarial survival rates at 1 year, 3 years, 5 years and 10 years were 93.2%, 77.7%, 61.8%, and 48.1%, respectively, with no significant difference between BLTx and heart-lung transplantation. The major hospital complications were pneumonia (n = 11, 17.2%) and bleeding (n = 8, 12.5%). Clinically significant reperfusion injury was observed in 6 patients, 3 of whom required reintubation. Freedom from acute lung rejection beyond 1 year was 47.7%. One patient underwent late retransplantation, and 4 required bronchial stenting. Obliterative bronchiolitis accounted for eight (50.0%) of 16 late deaths. CONCLUSIONS: Though postoperative bleeding and pneumonia are still of concern, satisfactory early and intermediate-term results can be expected in patients undergoing BLTx or heart-lung transplantation for cystic fibrosis. Cardiopulmonary bypass can be used for BLTx with no adverse impact on intermediate and long-term outcomes. 相似文献
167.
Lee TG Ahmad TS 《Foot & ankle international / American Orthopaedic Foot and Ankle Society [and] Swiss Foot and Ankle Society》2007,28(9):984-990
BACKGROUND: The response of chronic plantar fasciitis to any treatment is unpredictable. Autologous blood might provide cellular and humoral mediators to induce healing in areas of degeneration, the underlying pathology in plantar fasciitis. This study compared the efficacy of intralesional autologous blood with corticosteroid injection for plantar fasciitis present for more than 6 weeks. METHODS: A prospective, randomized, controlled, observer-blinded study was done over a period of 6 months. Sixty-four patients were randomly allocated to either the autologous blood or corticosteroid treatment group. All patients were assessed for the worst pain daily on visual analogue scale (VAS) and tenderness threshold (TT) at the plantar fascia origin using a pressure algometer before treatment, and at 6 weeks, 3 months, and 6 months after treatment. A p value of 0.05 was considered significant. RESULTS: Data were complete for 61 patients. The reduction in VAS and increase in TT for both groups was significant over time (p < 0.0001). At 6 weeks and 3 months, the corticosteroid group had significantly lower VAS than the autologous blood group (p < 0.011 and p < 0.005, respectively), but the difference was not significant at 6 months. The corticosteroid group had significantly higher TT than the autologous blood group at 6 weeks, 3 months and 6 months (p < 0.003, p < 0.003, p < 0.008, respectively). Although the trends were different, repeated-measures F test of both VAS and TT showed no significant difference in improvement between the groups over time. CONCLUSIONS: Intralesional autologous blood injection is efficacious in lowering pain and tenderness in chronic plantar fasciitis, but corticosteroid is more superior in terms of speed and probably extent of improvement. 相似文献
168.
The purpose of this study was to examine the effect of sperm preparation by density gradient on the intra-individual variation in sperm motility. Patients presenting for density gradient (DG) sperm preparation were analyzed retrospectively. Patients who had more than one preparation were included. The variation within each patient was studied using the coefficient of variation (CV = standard deviation/mean x 100). Density gradient preparation resulted in a reduction in the CV of sperm motility (CV motility before DG: 19.8 +/- 15.82% vs. CV motility after DG: 15.9 +/- 17.97%, p < 0.001). However, CV of sperm concentration (44.2 +/- 26.51%) and CV progressively motile sperm (49.2 +/- 28.48%) remained very high after DG. This variability should be reflected in counseling patients undergoing intrauterine insemination. 相似文献
169.
Ahmad M 《International urology and nephrology》2007,39(2):629-633
Continuous ambulatory peritoneal dialysis (CAPD) is being used only in limited number of patients with renal failure due to
multiple myeloma, despite having better preservation of hemoglobin, higher clearance of paraproteins, and higher chances of
recovery of renal function than maintenance hemodialysis. We are reporting our short-term experience of five patients with
multiple myeloma who presented with renal failure and required long term continuous ambulatory peritoneal dialysis for the
treatment of uremia. 相似文献
170.
Faried A Kimura H Faried LS Usman N Miyazaki T Kato H Yazawa S Kuwano H 《Annals of surgical oncology》2007,14(2):960-967
Background Tumor markers whose antigenic determinants have been demonstrated to consist of carbohydrates are probably one of the most
extensive tools that have been used in routine cancer diagnosis. In this study, the relevance of carbohydrate antigen expression
profile was examined in esophageal squamous cell carcinoma together with prognosis in 130 patients.
Methods The expression of carbohydrate antigens was estimated immunohistochemically by anti–sialyl Lewis a (sialyl Lea) and anti–sialyl Lewis x (sialyl Lex) monoclonal antibodies, and correlation between their staining and clinicopathological status was examined. In addition,
the correlation of both carbohydrate antigens expression was evaluated with microvessel density (MVD).
Results Expressions of sialyl Lewis antigens and MVD were associated with several clinicopathological features that reflect the tumor
aggressiveness in esophageal cancer. The 5-year survival rate of patients was found to be associated with expression of sialyl
Lea and sialyl Lex antigens and with MVD; thus, all of them were revealed to be independent prognostic factors.
Conclusions Combination of these factors offered a better prediction of prognosis of esophageal squamous cell carcinoma. Further, carbohydrate
antigens represent a promising target for therapeutic approaches against the disease. 相似文献