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141.
Summary. In recent years the continuity equation has been established as a valuable non-invasive method for calculating aortic valve area. The continuity equation cannot be used if there is calcification or sub-valvular stenosis in the left ventricle-outflow tract, because the area of the outflow trace is not circular in those cases. The authors have tested the value of a non-invasive variant of the Gorlin formula, as an alternative method of identifying severe aortic stenosis. They examined 32 consecutive patients with aortic stenosis with both methods. Seventeen patients had severe stenosis (valve area^0–7 cm2), calculated by the continuity equation. The other 15 patients had moderate stenosis (valve area 0–7–1–0 cm2). Using the non-invasive variant of the Gorlin formula, the authors were able to identify 16 of the 17 cases with severe stenosis, thus showing that the method is useful for identifying severe aortic stenosis. (P<0–001 by x2-test). 相似文献
142.
We studied 100 patients who underwent an isolated aortic valve replacement (AVR) between 1974 and 1991. The patients were divided into the following two groups and compared: group A, which consisted of 40 patients operated on before 1978 who underwent continuous left coronary perfusion with blood; and group B, which consisted of 60 patients operated on after 1979 in whom St. Thomas solution was used in combination with topical cardiac cooling. Moreover, we divided the group B patients into two subgroups: group Bl, who underwent AVR before 1986 during which we administered St. Thomas solution with ice slush every 30 min; and group B2, who had AVR after 1986 in which we used St. Thomas solution with a cold saline (4°C) solution and treated with a small amount of slushed ice every 15 min. The incidence of supraventricular tachycardias was 15% in group A, 50% in group BI, and 15% in group B2. The severity of preoperative New York Heart Association (NYHA) functional class, the type of valve lesions, cardiothoracic ratio, left ventricular function, aortic clamp time, bypass time, and use of drugs did not correlate with the incidence of supraventricular tachycardias in either group A or B. In group B2 patients, we paid a lot of attention to cooling the right atrium as well as the left ventricle by immersing the whole heart using a 4°C saline solution, which led to a remarkable reduction of the incidence of supraventricular tachycardia. This fact indicates that right atrial preservation is one of the most important factors for reducing the incidence of supraventricular tachycardia. 相似文献
143.
P. J. Arumugam T. V. Chandrasekaran A. R. Morgan J. Beynon N. D. Carr 《Colorectal disease》2003,5(3):218-221
Introduction There have been many surgical techniques described for the treatment of pilonidal sinuses. Recurrent disease causes significant morbidity particularly with time from work. Aim To assess the rhomboid flap's role in promoting one‐stage primary healing in pilonidal disease and to evaluate the morbidity and recurrence. Methods Fifty‐three patients were prospectively recruited of which 27 had previous multiple abscess formation requiring surgical drainage from their pilonidal disease, although none had acute disease at the time of surgery. By using the transposition flap, we were able to obliterate the natal cleft and therefore the rolling action of the buttocks between the cleft in these patients and thereby remove one of the factors involved in pilonidal disease. Hospital stay, healing time, wound infection, wound breakdown and recurrence were noted. Results There were 47 males and 6 females with a median age of 28 years (range 16–64 years). Median follow‐up was 24 months (range 3–36 months). Post‐operative morbidity involved superficial wound infection in 7 (13%) which settled with out‐patient dressings. There were four recurrences (7%), two occurred between the flap and the anal canal, and the other two in the flap margin needing intervention. All the patients healed their wounds and the median healing time was 14 days. Conclusion As this condition affects a predominantly young population causing significant time off from work, we feel that the Rhomboid Flap is useful for difficult cases in that it allows early return to full activity and does not necessitate prolonged postoperative care. 相似文献
144.
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146.
A. Emmermann C. Zornig D. M. Lloyd M. Peiper C. Bloechle C. E. Broelsch 《Surgical endoscopy》1997,11(7):734-736
Background: Between 1991 and November 1994, 18 patients with large, solitary, nonparasitic liver cysts underwent laparoscopic deroofing;
the last 13 of them also received an omental transposition flap in addition.
Methods: Using three to four trocars, the cystic contents were first aspirated, and the cyst derooted widely using diathermia. An
omental transposition flap was fashioned and stapled into the cyst cavity itself.
Results: Postoperative complications included one case of pulmonary atelectasis. Another patient developed a subhepatic bile collection
which was aspirated percutaneously. On average, patients were discharged on the 4th (2–14) postoperative day. Follow-up was
performed with abdominal ultrasound for 2–43 months (mean 19 months). There were two early cyst recurrences, both in cases
without an omental transposition flap (overall recurrence rate, 11%; in patients with omental flap, 0).
Conclusions: Deroofing in combination with an omental transposition flap is a safe and effective therapy for symptomatic solitary liver
cysts and can be performed using minimal-access surgical techniques.
Received: 19 January 1996/Accepted: 26 August 1996 相似文献
147.
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149.
Camilla Nyboe Jonas A. Funder Morten H. Smerup Hans Nygaard J. Michael Hasenkam 《European journal of cardio-thoracic surgery》2006,29(6):1008-1013
Objective: Mechanical heart valves can cause thromboembolic complications, possibly due to abnormal flow patterns that produce turbulence downstream of the valve. The objective of this study was to investigate whether three different bileaflet valve designs would exhibit clinically relevant differences in downstream turbulent stresses. Methods: Three bileaflet mechanical heart valves (Medtronic Advantage®, CarboMedics© Orbis™ Universal and St. Jude Medical® Standard) were implanted into 19 female 90 kg pigs. Blood velocity was measured during open chest conditions in the cross sectional area downstream of the valves with 10 MHz ultrasonic probes connected to a modified Alfred® Pulsed Doppler equipment. As a measure of turbulence, Reynolds normal stress (RNS) was calculated at three different cardiac output ranges (3–4, 4.5–5.5, 6–7 L/min). Results: Data from 12 animals were obtained. RNS correlated with increasing cardiac outputs. The highest instantaneous RNS observed in these experiments was 47 N/m2, and the mean RNS taken spatially over the cross sectional area of the aorta during systole was between 3 N/m2 and 15 N/m2. In none of the cardiac output ranges RNS values exceeded the lower critical limit for erythrocyte or thrombocyte damage for any of the valve designs. Conclusions: Reynolds normal stress values were below 100 N/m2 for all three valve designs and the difference in design was not reflected in generation of turbulence. Hence, it is unlikely that any of the valve designs causes flow induced damage to platelets or erythrocytes. 相似文献
150.
目的 探讨不同方案缺血预处理(ischemic preconditioning,IPC)对大鼠横形腹直肌肌皮瓣(transverse rectus abdominis musculocutaneous flap,TRAM)移植后再灌注损伤的影响。方法选取雄性Wistar大鼠90只,建立TRAM模型,随机分为对照组和实验组,对照组10只,无需预处理过程,持续缺血4h后,恢复肌皮瓣血供;实验组分为8个亚组,每组10只,以微血管夹阻断腹壁下血管5min,再恢复血流5min,处理1次为sIPC5/5组,处理2次为bIPC5/5组,依次为sIPC5/10组(缺血5min/再灌注10min1次)、bIPC5/10组(缺血5min/再灌注10min2次)、sIPC10/5组(缺血10min/再灌注5min 1次)、bIPC 10/5组(缺血10min/再灌注5min2次)、sIPC10/10组(缺血10min/再灌注10min1次)、bIPC10/10组(缺血10min/再灌注10min2次),其余实验步骤与对照组相同;每组肌皮瓣恢复血供4h后,取3只处死取材,测定肌组织含水量及HE染色镜检观察骨骼肌组织结构,其余动物于术后第7天判断皮瓣成活情况,计算成活面积百分比。结果恢复血供12h后,各实验组肌皮瓣两侧边缘部分肿胀,色泽黯淡,较对照组肿胀范围小,程度轻;光镜下见各实验组肌纤维轻度肿胀,染色均一,肌纤维结构尚完整,胞核呈梭形,无明显肿胀。对照组肿胀明显,部分肌纤维断裂。各实验组与对照组相比肌组织水含量明显减少(P〈0.001),皮瓣成活面积提高了2~3倍(P〈0.001)。两次预处理对肌皮瓣成活面积的影响与相应的单次预处理比较,差异有统计学意义(P〈0.05)。结论IPC可明显减轻大鼠TRAM再灌注损伤程度,其保护效应受缺血/再灌注时间、处理次数等因素的影响。 相似文献