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51.
Dittmar Böckler Hardy Schumacher Klaus Klemm Marcel Riemensperger Philipp Geisbüsch Drosos Kotelis Harry Rotert Jens-Rainer Allenberg 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(6):715-723
OBJECTIVES: to report our experience with hybrid vascular procedures in patients with pararenal and thoracoabdominal aortic pathologies. METHODS: 68 patients were treated for thoracoabdominal aortic pathologies between October 1999 and February 2004; 19 patients (16 men; mean age 68, range 40-79) with high risk for open thoracoabdominal repair were considered to be candidates for combined endovascular and open repair. Aortic pathologies included five thoracoabdominal Crawford I aneurysms, one postdissection expanding aneurysm, three symptomatic plaque ruptures (Crawford IV), five combined thoracic descending and infrarenal aneurysms with a healthy visceral segment, three juxtarenal or para-anastomotic aneurysms, and two patients with simultaneous open aortic arch replacement and a rendezvous maneuver for thoracic endografting. Commercially available endografts were implanted with standardized endovascular techniques after revascularization of visceral and renal arteries. RESULTS: Technical success was 95%. One patient developed a proximal type I endoleak after chronic expanding type B dissection and currently is waiting conversion. Nine patients underwent elective, five emergency and five urgent (within 24 h) repair. 17 operations were performed simultaneously, and 2 as a staged procedure. Postoperative complications include two retroperitoneal hemorrhages, and one patient required long-term ventilation with preexisting subglottic tracheal stenosis. Thirty-day mortality was 17% (one multiple organ failure, one secondary rupture after open aortic arch repair, one myocardial infarction). Paraplegia or acute renal failure were not observed. Total survival rate was to 83% with a mean follow-up of 30 months. CONCLUSIONS: Midterm results of combined endovascular and open procedures in the thoracoabdominal aorta are encouraging in selected high risk patients. Staged interventions may reduce morbidity. 相似文献
52.
Steven Z George John D Childs Deydre S Teyhen Samuel S Wu Alison C Wright Jessica L Dugan Michael E Robinson 《BMC musculoskeletal disorders》2007,8(1):92
Background
There are few effective strategies reported for the primary prevention of low back pain (LBP). Core stabilization exercises targeting the deep abdominal and trunk musculature and psychosocial education programs addressing patient beliefs and coping styles represent the current best evidence for secondary prevention of low back pain. However, these programs have not been widely tested to determine if they are effective at preventing the primary onset and/or severity of LBP. The purpose of this cluster randomized clinical trial is to determine if a combined core stabilization exercise and education program is effective in preventing the onset and/or severity of LBP. The effect of the combined program will be compared to three other standard programs. 相似文献53.
54.
55.
Fady K. Balaa T. Clark Gamblin Allan Tsung J. Wallis Marsh David A. Geller 《Journal of gastrointestinal surgery》2008,12(2):338-343
Background Application of linear stapling devices for extrahepatic vascular control in liver surgery has been well-established. However,
the technique for use of stapling devices in hepatic parenchymal transection is not well defined.
Purpose To describe the safety and efficacy of our technique for use of vascular stapling devices in hepatic parenchymal transection
during open right hepatic lobectomy is the purpose of this study.
Methodology We reviewed our experience with 101 consecutive open right hepatic lobectomies performed by a single surgeon between January
2003 and July 2006, in which vascular staplers were utilized for the parenchymal transection phase.
Results Of the 101 patients who underwent resection, 53 (52%) were female. The mean age was 58 years. Malignant disease was the indication
for resection in the majority of patients (88%). Of those with cancer, 78% (69 of 89) had metastatic colorectal cancer, 6%
(5 of 89) had metastatic neuroendocrine tumor, 4% (4 of 89) had hepatocellular carcinoma, 4% (4 of 89) had cholangiocarcinoma,
and the remaining 8% were other metastatic cancers. Twelve patients (12%) underwent resection for hepatic adenoma or symptomatic
benign disease (FNH or hemangioma). Forty-eight patients (48%) underwent a major ancillary procedure at the time of hepatic
resection. Thirty-nine patients (39%) had a nonanatomic wedge resection of a left lobe lesion, 27 patients (27%) had one or
more lesions treated with radiofrequency ablation (RFA), and 6 patients (6%) were treated with a synchronous bowel resection.
The median total operative time was 336 min (range 155–620 min). A Pringle maneuver for temporary vascular inflow occlusion
was utilized in all cases, with a median time of 9 min (range 4–17 min). Ten patients (10%) required blood transfusion during
surgery or in the postoperative period. The maximum transfusion was 2 U of packed red blood cells (PRBC) in seven patients
and 1 U of PRBC in three patients. The mean nadir postoperative hematocrit was 28.2. All patients with malignant disease had
tumor-free margins at the completion of the procedure. The average hospital length of stay was 6.0 days. One patient (1%)
developed a clinically significant bile leak requiring a postoperative endoscopic retrograde cholangiography (ERCP). No patient
required reoperation. The 30 and 60-day postoperative survival was 100%.
Conclusion These findings indicate that application of vascular stapling devices for parenchymal transection in major hepatic resection
is a safe technique, with low transfusion requirements and minimal postoperative bile leak. The technique allows for rapid
transection of the entire right hepatic lobe in under 10 min. Short video clips of the technique will be demonstrated.
Presented at the 2007 American Hepato–Pancreato–Biliary Association, Las Vegas, Nevada, April 19–22, 2007 (oral presentation/video
presentation). 相似文献
56.
CASE REPORT: A 12-year-old boy who had a history of Kawasaki disease 9 years ago experienced a subarachnoid hemorrhage by ruptured right posterior cerebral artery aneurysm. On day 1 operation, as the aneurysm was very fragile and bled easily, two intraoperative ruptures, including a very premature rupture, were encountered. As a result, a left hemiparesis especially severe in the left hand was caused by the right anterior thalamic infarction due to the occlusion of a thalamo-perforating artery arising near the neck of the aneurysm. DISCUSSION: The histopathological examination of the intraoperative excised aneurysmal dome disclosed the thickening of the endothelial inner due to the endothelial hypertrophy and the invasion of inflammatory cells. This finding of the aneurysm was partially mimicking the finding of the coronary artery of the patients with Kawasaki disease. The combination of cerebral aneurysm and Kawasaki disease has never been reported until now, and the etiology of the aneurysm of this patient is unclear. 相似文献
57.
Background
The telomeric region of mouse chromosome 12 has previously shown frequent allelic loss in murine lymphoma. The Bcl11b gene has been identified and suggested as a candidate tumor suppressor gene within this region. In this study, we aimed to elucidate whether Bcl11b is mutated in lymphomas with allelic loss, and whether the mutations we detected conferred any effect on cell proliferation and apoptosis. 相似文献58.
59.
Daniela Klitscher Lars P. Müller Pol Rommens 《European journal of trauma and emergency surgery》2007,33(1):69-73
Abstract 10 embalmed cadaver forearms and wrists were dissected to determine the anatomical course of the superficial branch of the
radial nerve in the distal forearm. The superficial radial nerve bifurcated in two branches at a mean of 54,7 mm proximal
to the radial styloid. From the styloid process of the radius, the mean distance to the closest dorsal branch of the superficial
radial nerve was 3,5 mm and the mean distance to the closest volar branch was 9,8 mm. The mean distance between the closest
branch of the superficial radial nerve and Lister?s tubercle was 16,4 mm. The crossing point between the nerve and the cephalic
vein was located at a mean of 54,3 mm proximal to the styloid process. At the level of styloid process the mean distance between
the closest dorsal branch of the superficial radial nerve and the first dorsal compartment was 15,2 mm and between the closest
volar branch and the first dorsal compartment 4,4 mm. Detailed knowledge of anatomic characteristics of the superficial branch
of the radial nerve may help prevent injury during operations and treat traumatic lesions of the nerve. Because of great variations
in the course of the superficial radial nerve we could not define an absolute safe zone for surgical procedures on the distal
forearm. Iatrogenic lesions of the superficial radial nerve are described complications of percutaneous procedures. Therefore
open surgical approaches are recommended.
Daniela Klitscher and Lars Peter Müller contributed equally to this work. 相似文献
60.