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61.
Yacoubian V Jyrala A Kay GL 《Texas Heart Institute journal / from the Texas Heart Institute of St. Luke's Episcopal Hospital, Texas Children's Hospital》2006,33(4):452-454
There are many choices for neurologic protection for aortic arch surgery. Although numerous investigators have challenged the efficacy of retrograde cerebral perfusion, we have had good results with our application of this technique. We performed a retrospective review of 8 consecutive patients who underwent surgery from 1 June 2001 through 31 March 2003; the age range was 33 to 97 years. All patients required circulatory arrest and underwent retrograde cerebral perfusion with use of a tourniquet on the patients' left and right arms above the elbow to direct retrograde flow to the brain. Moderate hypothermia (around 24 degrees C nasopharyngeal) was used; circulatory arrest time ranged from 27 to 63 minutes. There was 1 late hospital death due to multiple-organ system failure. There were no neurologic complications (stroke or temporary neurologic dysfunction). There was no substantive neurologic or renal dysfunction in this cohort, in which moderate hypothermia was used. These results are comparable to those reported in the literature for similar patients. We conclude that, for patients who require circulatory arrest, directed retrograde cerebral perfusion at moderate nasopharyngeal hypothermia gives results comparable to those reported with other techniques. 相似文献
62.
Prediction of soft-tissue injuries in Schatzker II tibial plateau fractures based on measurements of plain radiographs 总被引:2,自引:0,他引:2
Gardner MJ Yacoubian S Geller D Pode M Mintz D Helfet DL Lorich DG 《The Journal of trauma》2006,60(2):319-23; discussion 324
BACKGROUND: Split-depression fractures of the lateral tibial plateau (Schatzker II) are associated with a significant risk of capsuloligamentous and meniscal injury. We hypothesized that the amount of fracture depression and widening on anteroposterior (AP) plain radiographs would correlate with the incidence of injury to these structures on magnetic resonance imaging (MRI). METHODS: Sixty-two consecutive patients with Schatzker II tibial plateau fractures had a knee x-ray series and MRI preoperatively. AP plain radiographs were measured for lateral joint line depression and condylar widening, and MRIs were evaluated for injury to soft-tissue structures around the knee. For each structure, the threshold of depression and widening that led to the greatest disparity in soft-tissue injury was determined. Multiple logistic regressions were applied to calculate whether depression and/or widening above the thresholds were predictive for injury to individual soft-tissue structures. RESULTS: When depression was greater than 6 mm and widening was greater than 5 mm, lateral meniscal injury occurred in 83% of fractures, compared with 50% of fractures with less displacement (p < 0.05). When either depression or widening was at least 8 mm, medial meniscal injury occurred more frequently (depression 53%, p < 0.05; widening 78%, p < 0.05; versus neither 15%). Lateral collateral ligament and posterior cruciate ligament tears were not seen with minimally displaced fractures (< 4 mm), but the incidence of injury approached 30% with increasing displacement. CONCLUSIONS: Due to the limited availability of MRI in some centers, correlation of lateral condylar depression and widening, as measured on plain radiographs, to injury of various soft-tissue structures may be extremely helpful in planning open or arthroscopic treatment methods. Using these guidelines, Schatzker II fractures with depression or widening approaching 5 mm deserve heightened vigilance in diagnosing and treating these concomitant soft-tissue injuries. 相似文献
63.
Intramedullary fixation of tibial shaft fractures using an expandable nail: early results of 54 acute tibial shaft fractures 总被引:8,自引:0,他引:8
Steinberg EL Geller DS Yacoubian SV Shasha N Dekel S Lorich DG 《Journal of orthopaedic trauma》2006,20(5):303-9; discussion 315-6
OBJECTIVE: To evaluate and present our experience using the expandable nail system for the treatment of acute tibial shaft fractures. DESIGN: Retrospective study. SETTING: Two level-1 trauma centers-University teaching hospitals. METHODS: Fifty-four consecutive patients were treated by this nail system for acute tibial shaft fracture. Two nail diameters were used, 8.5 mm and 10 mm. Operation, hospitalization and healing times, reaming versus nonreaming, isolated versus multiple injuries, and reoperations were recorded and analyzed statistically. RESULTS: Follow-up was obtained either until fracture healing or for a minimum of 1 year with an average of 14 months (12 to 24). All fractures healed in an average time of 72 days (21 to 204). The average healing times for patients treated with 8.5-mm and 10-mm nails were 77.2 days (27 to 204) and 63.4 days (21 to 121), respectively. Average operative time was 103 minutes (40 to 185) if reamed and 56 minutes (30 to 80) if unreamed. Average healing times were 65.4 days (21 to 190) if reamed and 79.5 days (42 to 204) if unreamed. There were 11 complications (20.4%) related to the nailing: 3 deep infections, 2 superficial infections, 2 bone shortenings of 1 cm secondary to nail protrusion in the knee, 1 compartment syndrome, 1 fracture propagation, 1 distal malalignment, and 1 delayed union. Hardware was removed in 6 patients (3 infections, 2 patients' request and 1 protrusion into the knee), and 1 additional patient underwent exchange nailing due to a delayed union. CONCLUSIONS: The expandable nail offers the theoretical advantages of improved load sharing and rotational control without the need for interlocking screws. This study demonstrates satisfactory healing and alignment for the treatment of tibial shaft fractures using this device. However, caution must be exercised when using this nail in cases of significant comminution and in cases where the fracture pattern involves the more proximal or distal aspect of the tibial shaft. 相似文献
64.
Peters RJ Kelder SH Meshack A Yacoubian GS McCrimmons D Ellis A 《Substance use & misuse》2005,40(4):563-571
Recent drug-use monitoring among Houston adolescents has detected a concoction of cigarettes or marijuana sticks laced with embalming fluid and PCP ("fry"). To shed light on this mixture, the current pilot study used a qualitative approach to investigate relevant beliefs and norms associated with fry initiation and perceived addiction among 38 youth who were attending outpatient and inpatient drug-user treatment programs in the spring of 2003. Respondents perceived that addiction to fry could occur as early as initial consumption, and the majority of participants indicated that their second fry event occurred either the same day as their initial use or the next day. In addition, fry use was perceived to have extremely dangerous consequences. Youth stated that users have impaired motor skills, hallucinations, long-term mental health problems, incoherent behavior, paranoia, and aggressive behaviors. Implications for these results are discussed. 相似文献
65.
Twenty eight patients with penetrating injuries to the heart and/or the great vessels are presented. These constituted 9% of all penetrating chest injuries during the period between April 1975 and November 1976. The injuries were confined to the cardio-vascular system in 3 patients only. Twelve patients presented with signs of cardiac tamponade, of whom 2 succumbed intra-operatively due to ventricular fibrillation. Eight patients required respiratory support immediately after operation, of whom one died eventually due to extra-cardiac injuries. The mortality rate in this series was 11%. The remaining 25 survivors have resumed their regular life activities after discharge from the hospital. In none of the cases was the heart-lung machine used for repair. 相似文献
66.
Talene A. Yacoubian MD PhD Yu-Hua Dean Fang PhD Adam Gerstenecker PhD Amy Amara MD PhD Natividad Stover MD Lauren Ruffrage MS Christopher Collette BS Richard Kennedy MD PhD Yue Zhang PhD Huixian Hong MD PhD Hongwei Qin PhD Jonathan McConathy MD PhD Etty N. Benveniste PhD David G. Standaert MD PhD 《Movement disorders》2023,38(5):743-754