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61.
Tass H Malik Iain A Bruce Gerard Kelly Richard T Ramsden Shakeel R Saeed 《Skull base》2007,17(4):235-238
In cases of cerebrospinal fluid (CSF) rhinorrhea following lateral skull base surgery, fibrosis and fibrin formation resulting from meningitis has been postulated as a mechanism of spontaneously resolving the CSF leak. This study was undertaken to explore any possible relationship between the cessation of CSF leak and meningitis. A retrospective study at a tertiary referral center of 232 consecutive patients was performed. Out of a total of 232 procedures, 29 patients developed CSF rhinorrhea, of whom 7 subsequently developed meningitis. Bacteria were isolated in CSF obtained at lumbar puncture in 5 cases, with the CSF analysis in the remaining 2 cases suggesting aseptic meningitis. Conservative treatment failed to stop the CSF rhinorrhea in 6 of 7 cases. In this study, the development of meningitis did not appear to aid in the resolution of the CSF rhinorrhea. We conclude that surgical intervention should not be delayed in the expectation that meningitis and conservative interventions may promote CSF leak resolution. 相似文献
62.
Robotic-assisted heller myotomy versus laparoscopic heller myotomy for the treatment of esophageal achalasia: multicenter study 总被引:3,自引:0,他引:3
Santiago Horgan M.D. Carlos Galvani M.D. Maria V. Gorodner M.D. Pablo Omelanczuck M.D. Fernando Elli M.D. Federico Moser M.D. Luis Durand M.D. Miguel Caracoche M.D. Jorge Nefa M.D. Sergio Bustos M.D. Phillip Donahue M.D. Pedro Ferraina M.D. 《Journal of gastrointestinal surgery》2005,9(8):1020-1030
Laparoscopic Heller myotomy (LHM) has become the standard treatment option for achalasia. The incidence of esophageal perforation
reported is about 5%–10%. Robotically assisted Heller myotomy (RAHM) is emerging as a safe alternative to LHM. Data comparing
the two approaches are scant. The aim of this study was to compare RAHM with LHM in terms of efficacy and safety for treatment
of achalasia. A total of 121 patients underwent surgical treatment of achalasia at three institutions. A retrospective review
of prospectively collected perioperative data was performed. Patients were divided into two groups: group A (RAHM), 59 patients,
and group B (LHM), 62 patients. All the operations were completed using minimally invasive techniques. There were 63 women
and 58 men, with a mean age of 45 ±19 years (14–82 years). Fifty-one percent of patients in group A and 95% of patients in
group B reported weight loss. Duration of symptoms was equal for both groups. Dysphagia was the main complaint in both groups
(P = NS). There was no difference in preoperative endoscopic treatment in both groups (44% versus 27%, P = NS). Operative
time was significantly shorter for LHM in the first half of the experience (141 ± 49 versus 122 ± 44 minutes, P < .05). However,
in the last 30 cases there was no difference in operative time between the groups (P = NS). Intraoperative complications (esophageal
perforation) were more frequent in group B (16% versus 0%). The incidence of postoperative heartburn did not differ by group.
There were no deaths. At 18 and 22 months, 92% and 90% of patients had relief of their dysphagia. This study suggests that
RAHM is safer than LHM, because it decreases the incidence of esophageal perforation to 0%, even in patients who had previous
treatment. At short-term follow-up, relief of dysphagia was equally achieved in both groups.
Presented at the Forty-Sixth Annual Meeting of The Society for Surgery of the Alimentary Tract, Chicago, Illinois, May 14–18,
2005 (oral presentation).
This study was supported in part by a grant provided by Intuitive Surgical, Inc. and Ethicon Endo-Surgery, Inc. 相似文献
63.
64.
Steven Elia Peter Liu Carol Chrusciel Alan Hilgenberg Charrisios Skourtis Demetrios Lappas 《Journal canadien d'anesthésie》1989,36(1):2-8
Global coronary blood flow and metabolism were measured in seven patients on the first postoperative day following coronary
revascularization to test the hypothesis that tracheal extubation produces adverse haemodynamic responses akin to those observed
during tracheal intubation. Regional coronary flow and metabolic measurements were made in five of the seven patients. Extubation
from a continuous positive airway pressure (CPAP) of 5 cm H2O was associated with a statistically significant rise in cardiac index from 3.44 ± 0.23 L · min-1 · m-2 to 3.73 ± 0.15L·min-1 ·m-2 related to an increase in stroke index, without significant changes in heart rate, mean arterial and pulmonary capillary
wedge pressure. Consequently the changes in myocardial oxygen consumption (8.52 ± 0.55 to 8.85 ± 0.93 ml · min-1) and coronary blood flow (172 ± 18 to 179 ± 17 ml·min-1) were less prominent than those reported during intubation, where substantial rises in myocardial oxygen consumption and
coronary flow occurred. Two patients experienced cardiac lactate production but there were no changes in systemic or coronary
haemodynamics, nor were there clinical or electrocardiographic signs of ischaemia. We conclude that extubation does not appear
to be associated with adverse systemic or coronary haemodynamic responses in patients following coronary bypass grafting.
However, the revascularized myocardium may remain vulnerable to anaerobic metabolism in the immediate postoperative period.
Pour savoir si comme ľintubation, ľextubation de la trachée provoque des perturbations hémodynamiques, on a mesuré le métabolisme
et la circulation coronarienne globale chez sept patients, au lendemain ďun pontage aorto-coronarien. On a aussi calculé les
valeurs régionales de ces mêmes variables pour cinq ďentre eux. Ľindex cardiaque de 3.44 ± 0.23 L · min-1 · m-2 sous pression positive en respiration spontanée (CPAP) de 5 cm. H2O s’est élevé à 3.73 ± 0.15 L · min-1 · m-2 post-extubation avec une augmentation significative du volume ďéjection. La fréquence cardiaque et les pressions artérielles
moyennes et capillaires pulmonaires n’ont pas changé. Ainsi ľaugmentation de la consommation ďoxygène du myocarde de 8.52
± 0.55 à 8.85 ± 0.93 ml · min-1 et celle du flot coronarien de 172 ± 18 à 179 ± 17 ml · min-1 ont été moindres que celles, importantes, déjà observées lors de ľintubation. On a noté chez deux patients une production
de lactate par le myocarde, sans changement de ľhémodynamic systémique et coronarienne non plus que de signe clinique ou électrocardiographique
ďischémie. Donc, après un pontage coronarien, ľextubation ne semble pas causer ďeffet néfaste sur les circulations systémique
et coronarienne, toutefois, le myocarde revascularisé peut demeurer sensible au métabolisme anaérobique. 相似文献
65.
目的总结4例活体部分小肠移植术后早期并发症(1月内)的防治办法,为进一步开展活体小肠移植提供经验。方法4例活体部分小肠移植术后1月内,早期并发症重点在于防治吻合血管血栓、出血、感染、排斥反应、移植肠功能障碍等。结果3例移植受体术后1月内分别发生出血倾向、急性排斥反应、感染、移植肠功能障碍等并发症,但经及时准确的诊断与治疗得以好转,移植肠存活及功能均良好。结论注重活体部分小肠移植术后对于早期并发症的预防及治疗,对于患者预后有重要意义。 相似文献
66.
Masahiko Harano Masatoshi Eto Motonobu Nakamura Yoshihiro Hasegawa Motonori Kano Akito Yamaguchi Seiji Naito 《International journal of urology》2007,14(2):112-117
OBJECTIVE: To assess the functional results, health-related quality of life (QOL) outcomes, and complications in patients with an ileal neobladder in comparison to those with cutaneous diversion (ileal conduit and cutaneostomy). METHODS: Between September 1992 and February 2003, we consecutively performed an ileal neobladder (the Studer method) in 30 patients and cutaneous diversion in 38 patients. In August 2004, questionnaires were mailed to 54 patients. The questionnaire included the validated health-related quality of life (QOL) questionnaire, SF-36 General Health Survey, and a urinary incontinence questionnaire. We also evaluated the functional results in patients with an ileal neobladder and the postoperative complications in patients with both urinary diversions. RESULTS: The data from 41 patients (21 ileal neobladder procedures and 20 cutaneous diversions) were available for the analysis. No differences in the overall QOL were observed between the two groups. Complete daytime and night-time urinary continence was achieved in the 21 patients (100%) and 13 patients (61.9%), respectively. The mean value of the maximum flow rate was 15 +/- 12 mL/min in the 21 neobladder patients. There were 19 early complications in 18 patients (60.0%) and seven late complications in six patients (20.0%) with an ileal neobladder. However, there were 15 early complications in 14 patients (36.8%) and eight late complications in six patients (15.8%) with cutaneous diversions. CONCLUSION: The findings regarding the health-related QOL and the frequency of complications in the neobladder group and those in the cutaneous diversion group were similar. However, the functional results and the status of urinary continence in the neobladder patients were satisfactory. 相似文献
67.
This case describes a rare complication of prostaglandin analogue eye drops used for treatment of primary open angle glaucoma. Though increase in the number, size and pigmentation of eyelashes is well‐known, this case shows extensive hair growth in malar region, which can be unacceptable. This complication can be one of the causes of discontinuation of prostaglandin analogue therapy. 相似文献
68.
A single observer reviewed 842 of the 917 known diabetic patients registered with 40 GPs in the Poole area. Fifty-nine per cent (493) of those reviewed submitted a timed overnight urine collection to measure albumin excretion rate (AER) and overnight albumin/creatinine ratio (ON-Alb/Creat); 43 samples were excluded because of urinary tract infection and/or proteinuria. A random urine sample was obtained in 607 diabetic patients to measure the random albumin/creatinine ratio (R-Alb/Creat); 68 specimens were excluded because of infection and/or proteinuria, and in a further 10 samples urinary creatinine was not measured. Stepwise multiple regression analyses found significant associations with the following variables: for AER, blood glucose (p = 0.001), smoking category (p = 0.002), sex (p = 0.034), and systolic blood pressure (p = 0.035); for R-Alb/Creat, blood glucose (p = 0.001), retinopathy (p = 0.004), systolic blood pressure (p = 0.004), diastolic blood pressure (p = 0.015), coronary artery disease (p = 0.02), sex (p = 0.034), and vibration sense (p = 0.038). Interestingly, glycosylated haemoglobin was not a significant determinant of albuminuria in either analysis. 相似文献
69.
妊娠合并急性阑尾炎的临床特点 总被引:1,自引:0,他引:1
报告妊娠期急性阑尾炎31例,占急性阑尾炎的063%,占女性急性阑尾炎的156%。手术治疗58%。阑尾穿孔226%,其中完全流产、先兆流产、低位肠瘘各32%。本病特点为:早期:症状、体征与一般病人相似,但恶心、呕吐易被误认为是妊娠反应;中期:疼痛和压痛部位向上向内移位;晚期:腹痛和压痛位于右上腹或右侧腹部,易被误认为子宫收缩痛。本病炎症容易播散,可发生早产、流产或孕妇死亡。应早期确诊,及时手术。 相似文献
70.
HEINER LANGENFELD AXEL KREIN MICHAEL KIRSTEIN LUDWIG BINNER† EUROPEAN PEA CLINICAL INVESTIGATION GROUP 《Pacing and clinical electrophysiology : PACE》1998,21(11):2187-2191
The peak endocardial acceleration (PEA, unit g) shows a near correlation with myocardial contractility during the isometric systolic contraction of the heart (dP/dtmax), with sympathetic activity and, thus, with physiological heart rate modulation. The (Biomechanical Endocardial Sorin Transducer (BEST) sensor is incorporated in the tip of a pacing lead and measures PEA directly near the myocardium. In an international study, the lead was implanted with the dual chamber pacemaker Living-1 (Sorin) in 105 patients. The behavior of the PEA signal was tested under conditions of physical and mental stress and during daily life activities by 24-hour recordings of PEA (PEA Holter) at 1 to 2 months and approximately 1 year after implantation. Implantation of the BEST lead was performed without complications in all patients. The sensor functioned properly in the short- and long-term in 98% of patients. Although PEA values differed from patient to patient, the values closely reflected the variations in sympathetic activity due to physical and mental stress in each patient. During exercise and during daily life activities a close correlation between PEA and heart rate was observed among patients with normal sinus rhythm. Peak endocardial acceleration allows a nearly physiological control of the pacing rate. 相似文献