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121.
The use of a large synthetic mesh for laparoscopic repair of significant ventral abdominal wall defects may be accompanied
by technical difficulties resulting from improper orientation and positioning of the mesh over the defect. We suggest a technique
based on initial fixation of the mesh center to the central point of the defect, and subsequent centrifugal attachment of
the mesh to the abdominal wall. This technique is advantageous because it leads to precise orientation and positioning of
the synthetic patch and to significant reduction of the time needed for its reinforcement over and around the defect.
Received: 25 September 1998/Accepted: 27 November 1998 相似文献
122.
(Received for publication on Dec. 8, 1997; accepted on July 7, 1998) 相似文献
123.
Shiomi H Hase T Matsuno S Izumi M Tatsuta T Ito F Kishida A Tani T Kodama M 《Surgery today》1999,29(12):1280-1284
An 18-year-old male was admitted to our Emergency Department with a traumatic abdominal wall hernia (TAWH) of the left lower
quadrant (LLQ) after suffering hypogastric blunt injury and urogenital lacerations in a motorcycle accident. Upright chest
X-ray showed a small amount of right infradiaphragmatic free air, and a computed tomographic (CT) scan demonstrated an abdominal
wall hernia. At surgery, no impairment was found in the digestive tract, and an abdominal herniorrhaphy was performed. It
is suggested that the free air had passed through a connection between the scrotal laceration and the contralateral abdominal
defect via the subcutaneous space and was palpated as emphysema. This is a new type of TAWH, which suggests that blunt abdominal
trauma may result in negative pressure in the subcutaneous and peritoneal cavity, and this could reflect the pathophysiology
of TAWH. 相似文献
124.
125.
How often is extracorporeal membrane oxygenation needed in cases of congenital diaphragmatic hernia?
M. C. Soto Beauregard J. Murcia L. Lassaletta S. Salas J. Quero J. A. Tovar 《Pediatric surgery international》1996,11(8):528-531
Some newborns with congenital diaphragmatic hernia (CDH) and severe pulmonary hypertension cannot be saved by conventional treatment and may obtain some benefit from extracorporeal membrane oxygenation (ECMO) as a bridging measure until adequate hematosis is possible. Early prediction of the insufficiency of optimal assistance is still unclear; we reviewed our recent experience with CDH patients in an attempt to evaluate the real need for ECMO in our institution. Between 1987 and 1994, 47 newborns with CDH manifested in the first 24 h were treated with maximal ventilatory assistance (including high-frequency ventilation in 12 cases) and vasoactive drugs prior to surgical repair. In order to summarize the ventilatory and blood-gas parameters, we determined oxygenation index (OI) and ventilatory index (VI) and compared the results in survivors and nonsurvivors. Overall survival was 60% (2 cases of Fryns' syndrome were excluded from analysis). OI was 10.3±5.7 (mean ± SD) for survivors and 46.2 ± 37.8 for nonsurvivors (P < 0.01). VI was 460.9±303 and 1,532±500.6, respectively (P <0.01). Bayesian analysis and receiver operating characteristic curves enabled us to select a threshold value of OI of 20 as the best means of predicting survival in our current conditions (sensitivity: 0.7, specificity: 0.83). The generally accepted figure of 40 had a sensitivity of 1 but a specificity of only 0.44. For VI, the best threshold value was 1,100 (sensitivity: 0.93, specificity: 0.94), whereas the generally used figure of 1,000 had 0.89 and 1, respectively. According to our results, with our current management conditions, approximately 50% of our CDH patients might have obtained some benefit from ECMO. 相似文献
126.
Late-presenting congenital diaphragmatic hernia (CDH) is often difficult to diagnose and delay in treatment is common. Seven patients were operated beyond the newborn period for left-sided Bochdaleck hernia. Their age ranged from 1 month to 9 years. Six of them became symptomatic within the 1st year of life (1 week to 9 months of age). Either feeding difficulties or recurrent respiratory infections were initially present. In all of them chest X-rays were performed but delay in diagnosis ranged from 1 week to 5 years. All diaphragmatic defects could be closed by an abdominal approach without postoperative complications. Clinical symptoms disappeared postoperatively. In children with respiratory complaints or feeding difficulties one should be aware of late presenting CDH. A careful analysis of chest films and searching for connecting bowel segments passing through the diaphragmatic defect may help to avoid incorrect diagnosis and undesirable delay in treatment. Confusion with pneumonia or pneumothorax can be diminished by placing a feeding tube and instillation of contrast material. Ultrasound should be used supportively in all suspected diseases of the diaphragm. 相似文献
127.
128.
Umbilical hernia (UH) is a common condition in infants and young children, especially in those of Afro-Caribbean origin.
Spontaneous closure occurs in a majority of cases before the age of 4 years unless the neck of the sac is greater than 2 cm
in diameter. Complications are rare, and conservative management is therefore advised during this time. We present three cases
of incarcerated UH in boys under 4 years old, all of whom presented with small-bowel obstruction. Interestingly, in two of
them undigested vegetable matter in the small bowel appeared to have precipitated the obstruction. A survey of the literature
suggests that the incidence of this complication is approximately 1:1,500 UHs. We conclude that the present policy of expectant
management is safe for the vast majority of children, but parents and general practitioners should be aware of the small risk
and early symptoms of incarceration.
Accepted: 30 September 1997 相似文献
129.
130.
急性颅脑损伤脑疝51例临床分析 总被引:2,自引:0,他引:2
目的:探讨急性颅脑损伤脑疝的临床特点及各种影响预后的因素,以提高急性颅脑损伤脑疝的诊断和治疗水平,降 低其病死率.方法:对 2000~ 2003年收治的 51例急性颅脑损伤合并脑疝患者的临床资料进行回顾性分析.结果: 收治的急性颅脑损伤合并脑疝患者 51例通过手术或非手术治疗方法,死亡 33例,住院病人病死率高达 64.7%.主要 死亡原因:颅内血肿及脑挫裂伤后脑水肿引起的 ICP增高形成脑疝和原发性或继发性脑干伤;其次是各种严重的并 发症.结论:急性颅脑损伤引起脑疝伤残、病死率极高,其预后与 GCS计分、瞳孔变化、损伤类型、年龄大小、手术时 机及手术指征的掌握密切相关. 相似文献