主动脉夹层腔内覆膜支架术围手术期护理及观察

目的探讨腔内覆膜支架术治疗主动脉夹层围手术期护理要点。方法回顾分析17例主动脉夹层患者的临床资料。结果本组患者均顺利度过围手术期,无一例手术死亡。结论加强围手术期的护理能提高手术成功率,减少并发症的发生。     

Vessel wall MRI for suspected isolated basilar artery dissection

Isolated basilar artery dissection is an uncommon intracranial vasculopathy with a poor prognosis. Digital subtraction angiography is considered the definitive modality for diagnosis. Vessel wall MRI (VW-MRI) is an emerging non-invasive technique for assessing the structural integrity of intracranial vessel walls and lumina. Recently, a small number of studies have described the vessel wall patterns of intracranial artery dissection. However, studies on vessel wall imaging of isolated basilar artery dissection remain limited. We describe a patient with suspected isolated spontaneous basilar artery dissection diagnosed using VW-MRI.     

Risk factors for delayed bleeding from endoscopic submucosal dissection of gastric neoplasms

Abstract

Objective. Delayed bleeding is a major complication of endoscopic submucosal dissection (ESD) of gastric neoplasms. We aimed to clarify risk factors for delayed bleeding from ESD. Material and methods. This study included 447 patients in whom 544 gastric neoplasms were resected by ESD between April 2006 and March 2011 in Yamaguchi University Hospital. We analyzed risk factors for delayed bleeding from ESD in relation to various clinical and pathological factors. Results. En bloc resection rate was 95.4% (519/544), and curative resection rate was 87.8% (477/544). Delayed bleeding occurred in 7.0% (38/544) and perforation occurred in 1.8% (10/544) of patients. Univariate analysis revealed platelet count (Plt) <15 × 10⁴/μl (p = 0.013), prothrombin time (PT) <70% (p = 0.044), resected size ≥50 mm (p = 0.038), and positive/indeterminate lateral margin (p = 0.012) to be risk factors for delayed bleeding. Multivariate analysis showed that Plt <15 × 10⁴/μl (odds ratio [OR], 2.62; 95% confidence interval [CI]: 1.17–5.53, p = 0.020) and positive/indeterminate lateral margin (OR, 5.45; 95% CI: 1.39–17.95, p = 0.018) were independent risk factors for delayed bleeding. Conclusions. Low Plt, low PT, large resected size, and positive/indeterminate lateral margin were significant risk factors for delayed bleeding from ESD. Patients with these risk factors must be carefully observed for signs of delayed bleeding.     

Lymph node retrieval in colorectal cancer resection specimens: national standards are achievable,and low numbers are associated with reduced survival

Objectives The current guidelines identify the retrieval of at least 12 lymph nodes as crucial for accurate staging of colorectal cancer. We set out to review our figures from a single centre to see whether this standard has been met, and to examine for factors which may influence the number of lymph nodes retrieved. The influence of a low lymph node harvest on survival in patients with Dukes’ A and B cancers was specifically investigated. Method Data were collected from all patients with colorectal cancer undergoing resectional surgery from our prospectively compiled database between June 1998 and May 2007. A multivariate analysis was performed to identify factors resulting in low lymph node yields in those patients undergoing formal resection. Survival analyses were performed in patients with Dukes’ A and B cancers to assess whether a low lymph node yield negatively impacted on survival. Results A total of 2449 patients underwent formal resection and were included in the analysis. The median lymph node retrieval was 13 nodes (range 0–136). On multivariate analysis, preoperative chemo‐radiotherapy, operation type, specimen length and patient age all independently influenced lymph node retrieval. Patient gender, ethnicity, operative mode, operative team and consultant presence had no influence. Survival in patients with Dukes’ A and B cancers was significantly reduced if <12 nodes were sampled. Conclusions As a unit, we are achieving the national standard for lymph node harvest. This standard was maintained whether the surgeon performing the surgery was a consultant or a trainee, and also when the surgery was performed in the emergency setting. These data support the concept of 12 nodes being required for accurate staging.