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991.
Background We conducted a comprehensive analysis of the epidemiology of trauma deaths in our urban county during a one-year period a
decade ago. In the interim we have implemented a statewide trauma system, initiated a number of injury-prevention programs,
and have had a major public effort to reduce drug traffic and related gangs. Consequently, we have reassessed the regional
trauma mortality to ascertain the impact of these measures and to search for new injury patterns.
Methods Trauma deaths occurring within our urban county from January 1 through December 31, 2002 were reviewed for mechanism, demographics,
and cause of fatal injury; cases were identified using death certificates from the Colorado Department of Public Health. We
compared these data to the trauma fatalities occurring during 1992.
Results During the 2002 study period, there were 420 injury-related deaths. Most of the patients were men (296 patients, 70%), with
a mean age of 47.3 years (median age, 42 years). The three predominant mechanisms of fatal injury were transport-related (180
patients, 43%), intentional (99 patients, 24%), and falls (86 patients, 20%). Comparison between 1992 and 2002 showed significant
increases in the percentage of transport-related and fall-related deaths, and a significant reduction in intentional fatal
injuries. There was also a shift in the percentage of deaths occurring in the first 24 h to delayed times. The death rate
per capita in Denver County declined from 0.081 in 1992 to 0.060 in 2002.
Conclusions Along with a decrease in the per capita death rate, the major mechanisms of patient’s deaths changed substantively over the
decade 1992–2002; there was a shift from intentional injuries to transport-related deaths as the predominant etiology of trauma
related deaths. Recognition of such injury patterns will direct future injury-prevention efforts and coordination of citywide
trauma care. 相似文献
992.
Surgical Resection of Hilar Cholangiocarcinoma: Analysis of Survival and Postoperative Complications
Background Surgery is the only potentially curative treatment for hilar bile duct cancer. This study sought to evaluate the efficacy
and feasibility of surgical management of hilar bile duct carcinoma, including radical hepatectomy, at a single institution.
Methods We performed a retrospective review of 49 consecutive patients who underwent surgery at our hospital between 1990 and 2003.
Results Altogether, 44 of 49 patients underwent radical hepatectomy combined with caudate lobectomy and lymphadenectomy. One and four
patients underwent partial hepatectomy or bile duct resection, respectively. No patients underwent preoperative portal vein
embolization. The 5-year survival rate was 39.7%, with a median survival time of 3.75 years. The postoperative morbidity and
mortality rates were 46.8% and 2.0%, respectively. Cox’s proportional hazard model revealed that lymph node status and the
residual tumor factor were independent prognostic factors. Multivariate analysis revealed that preoperative hyperbilirubinemia,
postoperative complications, and extended surgical procedures were independently associated with postoperative hyperbilirubinemia.
After potentially curative resection, 39.4% of patients suffered from disease recurrence. In 60% of the total cases, the sites
of recurrence were distant metastases.
Conclusion Surgery, including radical hepatectomy combined with caudate lobectomy and lymph node dissection, is a feasible, effective
treatment for hilar bile duct cancer. 相似文献
993.
Objectives Currently available studies show controversial data between the symptoms of the lower urinary tract and the volume of the
prostate gland. The objective of the present study is to evaluate the relationship between the score of the lower urinary
tract symptoms assessed according to the International Prostate Symptoms Score (IPSS) and the total (TV) and transitional
(TZV) zone volume of the prostate and transitional prostate zone index (TZI).
Materials and methods From 223 men with a mean age of 59.3 years (varying from 50 to 75), the scores of lower urinary tract symptoms, measured by
the IPSS and TV and TZV, determined by transrectal ultrasonographies, were obtained. Furthermore, the TZI was determined in
all cases by the TZV to TV rate of the prostate. The relationship between TV, TZV, and TZI and the data obtained using the
symptoms score was statistically determined.
Results The TV of the prostate were 25.5 ± 10.3, 25.0 ± 9.3, and 28.9 ± 13.5 g in individuals with mild, moderate, and severe symptoms,
respectively (P = 0.15). Similarly, there was no significant difference when the TZV (7.6 ± 6.3, 7.6 ± 5.8, and 9.6 ± 6.8 g, respectively;
P = 0.22) and the TZI (0.26 ± 0.1, 0.27 ± 0.1, and 0.30 ± 0.1, respectively; P = 0.33) were compared in the groups of men with mild, moderate, and severe symptoms of urinary difficulty. However, the quality
of life (QoL) scores presented progressively worse values (1.7 ± 1.3, 3.1 ± 1.4, and 4.4 ± 1.2) as the severity of the lower
urinary tract symptoms became worse (P < 0.001). The Pearson correlation coefficient between the TV (r = 0.15; P = 0.02), TZV (r = 0.16; P = 0.02), and the TZI (r = 0.14; P = 0.03) with the prostate symptom scores showed low values although they were positive and statistically significant. The
highest correlation was observed when the QoL related to urinary symptoms and symptom scores (r = 0.61; P < 0.001) was analyzed.
Conclusions A low correlation was found between the score lower urinary tract symptoms assessed by IPSS and the different volumes of the
prostate gland (TV, TZV) and prostate TZI, and, on the other hand, an inverse correlation between the intensity of urinary
symptoms and QoL, supporting the idea of multifactorial aspects related to the genesis of urinary symptoms in men. 相似文献
994.
Sheashaa HA Bakr MA Fouda MA El-Dahshan KF Ismail AM Sobh MA Ghoneim MA 《International urology and nephrology》2007,39(1):317-319
Background/Aims The aim of this work is to determine the long-term therapeutic benefit(s) of daclizumab induction therapy with triple immunosuppressive
protocols including prednisolone, cyclosporine microemulsion (CsA), and mycophenolate mofetil (MMF) in the living related
donor kidney transplantation.
Methods Twenty-one adult recipients of their first kidney allograft were allocated to receive daclizumab with triple immunosuppressive
therapy (steroids, CsA, and MMF). They were compared to 50 recipients of their first grafts who received a maintenance triple
immunosuppressive therapy (steroids, CsA, and azathioprine). The patients were followed up for 5 years.
Results Daclizumab group significantly experienced a marked reduction of acute rejection (7/21) when compared to the control group
(31/50) with subsequent significant reduction of cumulative steroids doses at the end of 5 years. The overall incidence of
post-transplant complications was comparable among the two treatment groups. There was no significant difference in patients
and graft survival; 5-year patient and graft survival were 95.3%, 85.7% for daclizumab and 96%, 88% for control group, respectively.
Conclusions Although prophylactic daclizumab with triple immunosuppressive protocol including MMF have drastically reduced the incidence
of acute rejections, the graft and patient survival are unchanged in this long-term follow up. 相似文献
995.
Tamura A Takahara Y Mogi K Katsumata M 《General thoracic and cardiovascular surgery》2007,55(2):53-56
Mediastinal irradiation has been reported to induce cardiac diseases such as pericardial disease, accelerated arteriosclerosis
of the coronary arteries, valvular disease, conduction abnormalities, and calcification of the aorta. We experienced four
cases of radiation-induced valvular disease. All patients had histories of radiation therapy and had aortic valve disease.
All patients had marked fibrosis of the mediastinum and hypertrophy of pericardium. The aortic valve leaflets were tricuspid
and fibrotic with focal dystrophic calcification and markedly thickened. In the pathological findings, certain rheumatic endocarditis
changes such as endocardial reduplication and vascularization were not found in all aortic valves. The mechanism of radiation-induced
cardiac disease is not clear. However, those changes seem to progress very slowly. Thus, long-term follow-up care is particularly
important for patients undergoing radiation therapy. Fortunately, today's irradiation techniques are much less harmful; therefore,
radiation-induced cardiac disease will likely become more rare in the future. 相似文献
996.
Biancari F Salenius JP Heikkinen M Luther M Ylönen K Lepäntalo M 《World journal of surgery》2007,31(1):217-225
Background The aim of the present study was to develop a risk-scoring method for prediction of immediate postoperative outcome after
infrainguinal surgical revascularization for critical limb ischemia.
Methods The Finnvasc registry included data on 3,925 infrainguinal surgical revascularization procedures. This database was randomly
divided into a derivation and a validation data set of similar sizes.
Results In the overall series, 30-day postoperative mortality and major amputation rates were 3.1% and 6.3%, respectively. The 30-day
postoperative mortality and/or limb-loss rate was 9.2%. Diabetes, coronary artery disease, foot gangrene, and urgent operation
were independent predictors of 30-day postoperative mortality and/or major lower-limb amputation. A risk score was developed
by assigning 1 point each to the latter risk factors. In the derivation data set, the 30-day postoperative mortality/amputation
rates in patients with scores of 0, 1, 2, 3, and 4 were 7.7%, 6.4%, 11.1%, 20.4%, and 27.3%, respectively, (P < 0.0001); mortality rates were 1.3%, 2.3%, 4.1%, 7.7%, and 12.1%, respectively, (P < 0.0001); and major amputation rates were 6.4%, 4.3%, 7.1%, 12.7%, and 18.2%, respectively, (P < 0.0001). In the validation data set, the 30-day postoperative mortality/amputation rates in patients with scores of 0,
1, 2, 3, and 4 were 4.8%, 7.5%, 10.1%, 15.9%, and 22.2%, respectively, (P < 0.0001); mortality rates were 0.7%, 2.3%, 4.2%, 5.5%, and 14.8%, respectively, (P < 0.0001); and major amputation rates were 4.6%, 5.3%, 6.4%, 11.0%, and 14.0%, respectively (P = 0.011).
Conclusions This simple risk-scoring method can be useful to stratify the immediate postoperative outcome of patients undergoing infrainguinal
surgical revascularization for critical lower-limb ischemia. 相似文献
997.
Hansson S Svedhem A Wennerström M Jodal U 《Pediatric nephrology (Berlin, Germany)》2007,22(9):1321-1325
There are few reports on urinary tract infections caused by Haemophilus influenzae or Haemophilus parainfluenzae in children. The true incidence is not known, since bacteria of Haemophilus species do not grow in standard urine culture media. With the objective of investigating the occurrence and character of
urinary tract infections (UTIs) caused by Haemophilus bacteria in children, we searched the files of our UTI clinic. Over a 24-year period 36 children with Haemophilus spp. bacteriuria were identified out of a total of more than 5,000 UTI episodes. There was a significant gender difference
in that Haemophilus influenzae dominated in girls and Haemophilus parainfluenzae in boys. With one exception, all children had important urinary tract abnormalities, such as malformation, gross reflux or
bladder dysfunction. Permanent renal damage was seen in 25. We conclude that growth of Haemophilus bacteria in urine is associated with serious urinary tract abnormalities. The inability of bacteria of the Haemophilus species to grow in standard media commonly used for culture of uropathogens suggests that the true frequency of these strains
as a cause of urinary tract infections is underestimated. 相似文献
998.
Background: Abdominal lipectomy is becoming an increasingly common surgical procedure in patients with esthetic deformities
resulting from massive weight loss induced by bariatric surgery. Sometimes a midline incisional hernia coexists with the pendulus
abdomen. Herein presented is a technique to perform a retromuscular mesh repair of the incisional hernia while sparing the
umbilicus.
Methods: The abdominal lipectomy with concomitant retro-muscular mesh repair of a midline incisional hernia is done sparing
the vascular supply of the umbilicus on one side only.
Results: 5 consecutive women with pendulus abdomen resulting from bariatric surgery-induced massive weight loss and concomitant
midline incisional hernia underwent abdominal lipectomy and incisional hernia mesh repair. Mean BMI was 28.6 kg/m2 (range 26–35), one patient was a smoker, and another had type 2 diabetes requiring oral hypoglycemic agents. Two patients
had had a previous incisional hernia repair with intraperitoneal mesh. One patient had partial necrosis of the umbilicus and
another experienced necrosis of only the epidermis that recovered fully.
Conclusions: The umbilicus can be safely spared during abdominal lipectomy with concomitant midline incisional hernia mesh
repair. Recurrent incisional hernia and common risk factors for wound healing such as diabetes and obesity increase the risk
of umbilical necrosis. 相似文献
999.
1000.
Konrad Seller Dieter Wahl Alexander Wild Rüdiger Krauspe Erich Schneider Berend Linke 《European spine journal》2007,16(7):1047-1054
A lot of new implant devices for spine surgery are coming onto the market, in which vertebral screws play a fundamental role.
The new screws developed for surgery of spine deformities have to be compared to established systems. A biomechanical in vitro
study was designed to assess the bone–screw interface fixation strength of seven different screws used for correction of scoliosis
in spine surgery. The objectives of the current study were twofold: (1) to evaluate the initial strength at the bone–screw
interface of newly developed vertebral screws (Universal Spine System II) compared to established systems (product comparison)
and (2) to evaluate the influence of screw design, screw diameter, screw length and bone mineral density on pullout strength.
Fifty-six calf vertebral bodies were instrumented with seven different screws (USS II anterior 8.0 mm, USS II posterior 6.2 mm,
KASS 6.25 mm, USS II anterior 6.2 mm, USS II posterior 5.2 mm, USS 6.0 mm, USS 5.0 mm). Bone mineral density (BMD) was determined
by quantitative computed tomography (QCT). Failure in axial pullout was tested using a displacement-controlled universal test
machine. USS II anterior 8.0 mm showed higher pullout strength than all other screws. The difference constituted a tendency
(P = 0.108) when compared to USS II posterior 6.2 mm (+19%) and was significant in comparison to the other screws (+30 to +55%,
P < 0.002). USS II posterior 6.2 mm showed significantly higher pullout strength than USS 5.0 mm (+30%, P = 0.014). The other screws did not differ significantly in pullout strength. Pullout strength correlated significantly with
BMD (P = 0.0015) and vertebral body width/screw length (P < 0.001). The newly developed screws for spine surgery (USS II) show higher pullout strength when compared to established
systems. Screw design had no significant influence on pullout force in vertebral body screws, but outer diameter of the screw,
screw length and BMD are good predictors of pullout resistance. 相似文献