Hintergrund: Verschiedene Indikationen für glask?rperchirurgische Eingriffe bei Komplikationen der diabetischen Retinopathie haben sich
etabliert. Jedoch gibt es wenig Daten zu der Frage, in welchen Situationen auf einen Eingriff wegen aussichtsloser funktioneller
Prognose verzichtet werden sollte.
Material und Methode: Die Krankengeschichten von 389 Patienten, die zwischen 1990 und 1994 in unserer Klinik wegen Komplikationen der diabetischen
Retinopathie vitrektomiert worden sind, wurden retrospektiv analysiert. Die Nachbeobachtung betrug mindestens 6 Monate, im
Median 26 Monate. Mit multivariaten, logistischen Regressionsanalysen wurden Faktoren ermittelt, die mit schlechten postoperativen,
funktionellen Ergebnissen korrelieren. Ein mathematisches Modell wurde entwickelt, welches die Einsch?tzung der Prognose für
verschiedene Ausgangssituationen erlaubt.
Ergebnisse: Bei 45 Augen (12%) stieg der postoperative Visus nicht über 1/50. Risikofaktoren waren Ablatio der Makula, Ausdehnung der
Ablatio, Rubeosis und Dauer der Visusminderung. ?hnliche Risikofaktoren gelten auch für Revisionsoperationen. Bei einem Auge
mit totaler Traktionsablatio von über 6 Monaten Dauer und Rubeosis liegt die berechnete Wahrscheinlichkeit für einen postoperativen
Visus über 1/50 lediglich bei 2%.
Schlu?folgerungen: Bei totaler Traktionsablatio, insbesondere bei Rubeosis und l?ngerem Bestehen der Ablatio, ist die Prognose extrem schlecht.
Auf operative Ma?nahmen sollte hier verzichtet werden.
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OBJECTIVE--To identify prognostic factors in a consecutive series of patients with bleeding oesophageal varices and develop an optimum regimen of treatment. DESIGN--Retrospective review. SETTING--I Department of Surgery, University Hospital, Vienna, Austria. PATIENTS--301 consecutive patients with bleeding oesophageal varices. OUTCOME MEASURES--Median survival and survival at one year after sclerotherapy alone (n = 213), or sclerotherapy with portosystemic shunt (n = 54), Hassab's devascularisation (n = 29), or liver transplantation (n = 5). RESULTS--Prognosis was dependent on the severity of liver damage at the start of treatment. Median survival for Child's class A was 47 months, for Child's class B 54 months, and for Child's class C 2 months. The overall one year survival for patients in Child's class C was 33%, for sclerotherapy alone 28%, and for sclerotherapy and portosystemic shunt 42%, Hassab's devascularisation 50%, and liver transplantation 80%. CONCLUSION--Despite the small number of patients who underwent liver transplantation and their poor initial prognosis (Child's class C, n = 4; class B, n = 1) our results suggest that liver transplantation should be considered for the treatment of patients with end stage cirrhosis and bleeding varices. 相似文献
Background: Atelectasis, an important cause of impaired gas exchange during general anesthesia, may be eliminated by a vital capacity maneuver. However, it is not clear whether such a maneuver will have a sustained effect. The aim of this study was to determine the impact of gas composition on reappearance of atelectasis and impairment of gas exchange after a vital capacity maneuver.
Methods: A consecutive sample of 12 adults with healthy lungs who were scheduled for elective surgery were studied. Thirty minutes after induction of anesthesia with fentanyl and propofol, the lungs were hyperinflated manually up to an airway pressure of 40 cmH2 O. FI sub O2 was either kept at 0.4 (group 1, n = 6) or changed to 1.0 (group 2, n = 6) during the recruitment maneuver. Atelectasis was assessed by computed tomography. The amount of dense areas was measured at end-expiration in a transverse plane at the base of the lungs. The ventilation-perfusion distributions (V with dot A/Q with dot) were estimated with the multiple inert gas elimination technique. The static compliance of the total respiratory system (Crs) was measured with the flow interruption technique.
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