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91.
INTRODUCTION
Abdominal free flap breast reconstruction is regarded as the gold standard method of post-mastectomy breast reconstruction by many. It is a major surgery which can be associated with varied systemic complications. To date, there have been no reports of cerebrovascular complications in the literature which examine the possible relation between thromboembolism and patent foramen ovale (PFO) in patients undergoing microvascular breast reconstruction.PRESENTATION OF CASE
A 54-year old female with a pre-existing PFO developed a stroke following bilateral mastectomies and immediate free flap breast reconstruction on postoperative day 5. This was attributed to an air embolus caused by central venous pressure line removal. After uneventful intra and early postoperative periods, the patient had collapsed suddenly on day 5 and become unresponsive immediately following the removal of a central venous line. Brain magnetic resonance imaging confirmed a cerebrovascular accident. This resolved within 48 h following therapeutic heparinisation. A clinical diagnosis of paradoxical embolism was made and she was subsequently referred to the cardiologists for angiographic closure of the PFO.DISCUSSION
The case study herein reported gives an account that PFO can have considerable health implications in the early postoperative period and conceivably intraoperatively in patients undergoing major reconstructive surgeries.CONCLUSION
Surgeons and cardiologists should be aware of this cerebrovascular complication secondary to PFO following major reconstructive surgery such as microvascular breast reconstruction. It also serves to challenge microvascular surgeons to reconsider routine use of central venous pressure lines in free flap patients who might otherwise have good peripheral vessels for postoperative fluid and antibiotic administration. 相似文献92.
93.
改良原代大鼠脑微血管内皮细胞的培养方法及鉴定 总被引:1,自引:0,他引:1
目的 改良原代大鼠脑微血管内皮细胞分离培养方法。方法 选取4~6周龄SD大鼠6只,经开颅取脑、漂洗剪碎、过筛、牛血清白蛋白密度梯度离心、Ⅱ型胶原酶及胶原酶-分散酶两次连续酶消化后进行原代培养。通过细胞形态学观察和第Ⅷ因子免疫细胞化学染色鉴定所培养的目的细胞。结果 体外培养12~24 h后,细胞以贴壁的脑微血管段为中心,放射状向外周移行,并逐渐扩大成团簇状;细胞融合后则呈典型的单层、扁平、“铺路石样”镶嵌式排列。第Ⅷ因子免疫细胞化学染色检测,胞质呈棕红色,表达为阳性,阳性细胞率达99%以上。结论 改良方法能够成功高效分离培养出原代大鼠脑微血管内皮细胞。 相似文献
94.
Yueming Li Xuru Xu Shuping Weng Chuan Yan Jianwei Chen Rongping Ye 《Journal of digital imaging》2020,33(6):1365
The objective of this study was to determine the clinical value of computed tomography (CT) image-based texture analysis in predicting microvascular invasion of primary hepatocellular carcinoma (HCC). CT images of patients with HCC from May 2017 to May 2019 confirmed by surgery and histopathology were retrospectively analyzed. Image features including tumor margin, tumor capsule, peritumoral enhancement, hypoattenuating halo, intratumoral arteries, and tumor-liver differences were assessed. All patients were divided into microvascular invasion (MVI)–negative group (n = 34) and MVI-positive group (n = 68). Preoperative CT images were further imported into MaZda software, where the regions of interest of the lesions were manually delineated. Texture features of lesions based on pre-contrast, arterial, portal, and equilibrium phase CT images were extracted. Thirty optimal texture parameters were selected from each phase by Fisher’s coefficient (Fisher), classification error probability combined with average correlation coefficient (POE+ACC), and mutual information (MI). Finally, receiver operating characteristic curve analysis was performed. The results showed that the Edmonson-Steiner grades, tumor size, tumor margin, and intratumoral artery characteristics were significantly different between the two groups (P = 0.012, < 0.001, < 0.001, = 0.003, respectively). There were 58 parameters with significant differences between the MVI-negative and MVI-positive groups (P < 0.001 for all). Among them, 12, 14, 17, and 15 parameters were derived from the pre-contrast phase, arterial phase, portal phase, and equilibrium phase respectively. According to the ROC analysis, optimal texture parameters based on the pre-contrast, arterial, portal, and equilibrium phases were 135dr_GLevNonU (AUC, 0.766; the cutoff value, 1055.00), Vertl_RLNonUni (AUC, 0.764; the cutoff value, 5974.38), 45dgr_GLevNonU (AUC, 0.762; the cutoff value, 924.34), and Vertl_RLNonUni (AUC, 0.754; the cutoff value, 4868.80), respectively. Texture analysis of preoperative CT images may be used as a non-invasive method to predict microvascular invasion in patients with primary hepatocellular carcinomas, and further to guide the treatment and evaluate prognosis. The most valuable parameters were derived from the gray-level run-length matrix. 相似文献
95.
目的 报道并分析腓肠神经营养血管皮瓣修复前足创面的临床疗效。 方法 选取5例肿瘤患者高位截肢的下肢标本,冲洗和灌注后,剥离体被组织摄X线片,观察腓肠神经营养动脉链内、腓动脉穿支间及这些穿支与动脉链间的真性吻合连接。临床行腓肠神经营养血管皮瓣修复前足创面52例。 结果 标本观察发现,腓肠神经营养动脉链内从踝间线至腘窝横纹、腓动脉远端2~3个穿支间及这些穿支与动脉链间均通过真性吻合连接。临床研究中皮瓣成活42例;部分坏死10例,予以1例Ⅱ期缝合、8例植皮、1例局部皮瓣转位后残留创面愈合。 结论 腓肠神经营养动脉链内、腓动脉远端2~3个穿支间及这些穿支与动脉链间的真性吻合连接,是腓肠神经营养血管皮瓣存活长度较长的血管解剖学基础,该皮瓣是修复前足创面的一种较好方法。 相似文献
96.
97.
Ju-Yeun Lee Yul Hee Kim Nam-Joon Yi Hyang Sook Kim Hye Suk Lee Byung Koo Lee Hyeyoung Kim Young Rok Choi Geun Hong Kwang-Woong Lee Kyung-Suk Suh 《Clinical and molecular hepatology》2014,20(2):192-203
Background/Aims
The most commonly used immunosuppressant therapy after liver transplantation (LT) is a combination of tacrolimus and steroid. Basiliximab induction has recently been introduced; however, the most appropriate immunosuppression for hepatocellular carcinoma (HCC) patients after LT is still debated.Methods
Ninety-three LT recipients with HCC who took tacrolimus and steroids as major immunosuppressants were included. Induction with basiliximab was implemented in 43 patients (46.2%). Mycophenolate mofetil (MMF) was added to reduce the tacrolimus dosage (n=28, 30.1%). The 1-year tacrolimus exposure level was 7.2 ± 1.3 ng/mL (mean ± SD).Results
The 1- and 3-year recurrence rates of HCC were 12.9% and 19.4%, respectively. Tacrolimus exposure, cumulative steroid dosages, and MMF dosages had no impact on HCC recurrence. Induction therapy with basiliximab, high alpha fetoprotein (AFP; >400 ng/mL) and protein induced by vitamin K absence/antagonist-II (PIVKA-II; >100 mAU/mL) levels, and microvascular invasion were significant risk factors for 1-year recurrence (P<0.05). High AFP and PIVKA-II levels, and positive 18fluoro-2-deoxy-d-glucose positron-emission tomography findings were significantly associated with 3-year recurrence (P<0.05).Conclusions
Induction therapy with basiliximab, a strong immunosuppressant, may have a negative impact with respect to early HCC recurrence (i.e., within 1 year) in high-risk patients. 相似文献98.
目的:研究三叉神经痛患者微血管减压术后卡马西平戒断反应的发生情况,并对可能的相关因素进行探讨。方法:对90例诊断为原发性三叉神经痛并行微血管减压术的患者手术前、后进行卡马西平血药浓度测定,观察术后临床表现,评估术后卡马西平戒断反应的发生情况,并对患者的一般情况(年龄、性别、病程),血管压迫情况(部位、程度),术中及术后情况(手术时间、术后疗效、并发症),卡马西平服药情况(服药时间、服药剂量、手术前、后卡马西平血药浓度、术后血药浓度降低值)各可能因素进行分析,采用SAS16.2软件包对结果进行χ2或Fisher检验。结果:术后卡马西平戒断反应的发生率为28.9%,戒断反应的症状主要包括失眠、烦躁、手足震颤、幻觉和剧烈头痛。术前有无卡马西平服用史(P=0.0001)、服药剂量(P=0.0277)和术后血药浓度下降多少(P=0.0213)与戒断反应的发生呈显著相关。结论:术前大剂量使用卡马西平和术后血药浓度大幅度下降,是导致发生三叉神经痛患者微血管减压术后出现卡马西平戒断反应的重要因素。 相似文献
99.
糖尿病骨质疏松(DOP)作为糖尿病(DM)主要慢性并发症,起病隐匿,发病机制复杂,与高血糖状态、氧化应激、相关细胞因子、激素水平变化、降糖药物的使用等多种因素综合作用有关,病情缠绵难愈,严重影响患者生命质量。中医学认为DOP病位在骨,与肾脾肝脏腑功能失常,进而导致气虚血瘀密切相关,治疗多立足于调补脏腑、行气化瘀,使骨得其养从而改善症状。本文基于络病理论,针对DOP骨络脏腑亏虚、邪瘀阻络的主要病机,探讨络虚通补法在防治糖尿病骨质疏松DOP中的应用,以期为临床防治DOP提供更多思路与理论参考。 相似文献
100.