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Tim Strate Claus Schneider Emre Yekebas Wolfram T Knoefel Christian Bloechle Jakob R Izbicki 《Journal of investigative surgery》2003,16(1):13-21
This study was devised to identify sepsis-relevant parameters that early and reliably predict a lethal outcome in intra-abdominal sepsis. In 18 Duroc pigs, peritonitis was induced through standardized gastrotomy. Twelve hours later the defect was oversewn and the abdominal cavity lavaged thoroughly. Sepsis relevant parameters were measured before initiating therapy, and 30 min later animals were extubated and observed for a period of 6 days under adequate analgesia with free access to water and food. All parameters were correlated with survival postoperatively. In the treatment group, 7 out of 18 pigs (39%) died within the observation period. Endotoxin level at 30 min after initiation of therapy [17.9 EU/mL (+/- 12.1) vs. 110.9 EU/mL (+/- 21); p <.001] and Delta pHi [0.015 (+/- 0.011) vs. -0.039 (+/- 0.013); p =.016] were identified as the two parameters with highest predictive power regarding mortality in a multivariate analysis. In conclusion measurement of endotoxin and gastric tonometry should gain wider clinical application in septic patients. 相似文献
4.
Björn-Christian Link Emre F. Yekebas Dean Bogoevski Asad Kutup Gerhard Adam Jakob R. Izbicki Gerrit Krupski 《Journal of gastrointestinal surgery》2007,11(2):166-170
Symptomatic biliary leakage following major upper abdominal surgery is a severe complication resulting in increased morbidity
and mortality. Treatment options usually include either endoscopic intervention or surgical revision. These options may be
burdened by a high perioperative risk for the patient (e.g., patients with severe disease) or simply may not be possible (e.g.,
nonpreserved gastroduodenal passage). In the past, percutaneous transhepatic cholangiodrainage did only seem to be a viable
option for patients with dilated bile ducts. Here, we present our experience in a consecutive series of patients with symptomatic
biliary leakage following major upper abdominal surgery and without dilation of the biliary system that underwent percutaneous
transhepatic cholangiodrainage. Percutaneous transhepatic cholangiodrainage was feasible in 15 of 18 patients (83.3%). The
procedure was technically not possible in three patients (16.7%). In 10 of the 15 patients (66.6%) with feasible percutaneous
transhepatic cholangiodrainage, biliary leakage was definitely controlled without the need for surgical revision. Depending
on the experience with the interventional procedure, percutaneous transhepatic cholangiodrainage should be considered as an
alternative for treatment of symptomatic biliary leakage instead of immediate reoperation.
Presented at the Digestive Disease Week 2005 (DDW), Chicago, IL, May 14–19, 2005 (poster presentation). 相似文献
5.
Abstract Aggressive behaviour is rarely observed as an ictal semiology. Ictal aggression can occur in lesions of frontal and limbic
structures. In limbic structure lesions, the main mechanism of aggressive behaviour is hyperactivity; whereas frontal lesions
may cause aggressive behaviour with an indirect mechanism in which the suppression on limbic system is lost. Here we present
a patient with ictal aggression. In this case a right frontoparietal epileptiform focus was detected during the postictal
period. Magnetic resonance imaging showed cortical dysplasia on the right inferior frontal gyrus. The seizures disappeared
completely after pharmacological treatment. 相似文献
6.
S. Doğru-Abbasoğlu G. Aykaç-Toker H. A. Hanagasi H. Gürvit M. Emre M. Uysal 《Neurological sciences》2007,28(1):31-34
Abstract Alzheimer's disease (AD) is defined pathologically by the presence of β-amyloid plaques, neurofibrillary tangles and extensive
neuronal loss. Evidence indicates that increased DNA damage may contribute to neuronal loss in AD. Recently, it has been shown
that in AD neurons have a reduced capacity for some types of DNA repair. Polymorphisms in DNA repair genes may be associated
with differences in repair efficiency of DNA damage. Variants of several DNA repair genes, including the base excision repair
gene XRCC1, have been described previously. We hypothesised that Arg194Trp polymorphism of XRCC1 gene may contribute to genetic susceptibility for AD. In order to test this hypothesis, we investigated
Arg194Trp polymorphism at the XRCC1 gene in the DNA samples of 98 patients with AD and 95 healthy subjects. The frequency of the Trp allele was more pronounced among cases (11.2%) compared with controls (5.8%). On combining the homozygous and heterozygous
variants of each codon, the variants seemed to be at twofold risk of AD, although the risk estimates were not statistically
significant (OR=1.95, 95% CI 0.88–4.34, p=0.09). In addition, the 194Trp allele revealed a borderline significance (OR=2.05, 95% CI 0.96–4.37, p=0.056). According to our results, it may be speculated that the polymorphic variants of XRCC1 codon 194 have a role in the
development of AD. 相似文献
7.
Recommendations for the diagnosis and management of Alzheimer's disease and other disorders associated with dementia: EFNS guideline 总被引:4,自引:0,他引:4
G. Waldemar B. Dubois M. Emre J. Georges I. G. McKeith M. Rossor P. Scheltens P. Tariska B. Winblad 《European journal of neurology》2007,14(1):e1-e26
The aim of this international guideline on dementia was to present a peer-reviewed evidence-based statement for the guidance of practice for clinical neurologists, geriatricians, psychiatrists, and other specialist physicians responsible for the care of patients with dementia. It covers major aspects of diagnostic evaluation and treatment, with particular emphasis on the type of patient often referred to the specialist physician. The main focus is Alzheimer's disease, but many of the recommendations apply to dementia disorders in general. The task force working group considered and classified evidence from original research reports, meta-analysis, and systematic reviews, published before January 2006. The evidence was classified and consensus recommendations graded according to the EFNS guidance. Where there was a lack of evidence, but clear consensus, good practice points were provided. The recommendations for clinical diagnosis, blood tests, neuroimaging, electroencephalography (EEG), cerebrospinal fluid (CSF) analysis, genetic testing, tissue biopsy, disclosure of diagnosis, treatment of Alzheimer's disease, and counselling and support for caregivers were all revised when compared with the previous EFNS guideline. New recommendations were added for the treatment of vascular dementia, Parkinson's disease dementia, and dementia with Lewy bodies, for monitoring treatment, for treatment of behavioural and psychological symptoms in dementia, and for legal issues. The specialist physician plays an important role together with primary care physicians in the multidisciplinary dementia teams, which have been established throughout Europe. This guideline may contribute to the definition of the role of the specialist physician in providing dementia health care. 相似文献
8.
Jürgen Treckmann Andreas Paul Georgios C. Sotiropoulos Hauke Lang Arzu Özcelik Fuat Saner Christoph E. Broelsch 《Journal of gastrointestinal surgery》2008,12(2):313-318
Introduction Delayed massive hemorrhage induced by pancreatic fistula after pancreaticoduodenectomy is a rare but life-threatening complication.
The purpose of this study was to analyze the clinical course of patients with late hemorrhage, with or without sentinel bleeding,
to better define treatment options in the future.
Material and Methods From April 1998 to December 2006, 189 pancreaticoduodenectomies were performed. Eleven patients, including two patients referred
from other hospitals, were treated with delayed massive hemorrhage occurring 5 days or more after pancreaticoduodenectomy.
Sentinel bleeding was defined as minor blood loss via surgical drains or the gastrointestinal tract with an asymptomatic interval
until development of hemorrhagic shock. The clinical data of patients with bleeding episodes were analyzed retrospectively.
Results Eight of the 11 patients had sentinel bleeding, and seven of them had it at least 6 h before acute deterioration. Seven out
of 11 patients died, five out of eight with sentinel bleeding. No differences could be detected between patients with or without
sentinel bleeding before delayed massive hemorrhage. The only difference found was that non-surviving patients were significantly
older than surviving patients. Delayed massive hemorrhage is a common cause of death after pancreaticoduodenostomy complicated
by pancreatic fistula formation. The observation of sentinel bleeding should lead to emergency angiography and dependent from
the result to emergency relaparotomy to increase the likelihood of survival. 相似文献
9.
Ozkan Cem Dilek Emre Tezulas 《Oral surgery, oral medicine, oral pathology, oral radiology, and endodontics》2007,103(2):e22-e25
The narrowing of an extraction site often becomes problematic when attempting to restore the space with a conventional wide-diameter implant. A woman is presented who was treated with a square head, mini-dental implant-supported fixed denture for a maxillary with a narrowed edentulous area, with a mesiodistal width of 5 mm. The implant, with a diameter of 2.4 mm, was inserted without reflecting the mucoperiosteal flap and was loaded immediately. During 12 months of follow-up, there has been no bone resorption and no inflammation observed around the implant. In conclusion, in terms of both clinical and aesthetic criteria, small diameter, mini-dental implants can be successfully used as an alternative to treatment with fixed partial dentures. 相似文献
10.
M Emre Celebi Hassan A Kingravi Bakhtiyar Uddin Hitoshi Iyatomi Y Alp Aslandogan William V Stoecker Randy H Moss 《Computerized medical imaging and graphics》2007,31(6):362-373
In this paper a methodological approach to the classification of pigmented skin lesions in dermoscopy images is presented. First, automatic border detection is performed to separate the lesion from the background skin. Shape features are then extracted from this border. For the extraction of color and texture related features, the image is divided into various clinically significant regions using the Euclidean distance transform. This feature data is fed into an optimization framework, which ranks the features using various feature selection algorithms and determines the optimal feature subset size according to the area under the ROC curve measure obtained from support vector machine classification. The issue of class imbalance is addressed using various sampling strategies, and the classifier generalization error is estimated using Monte Carlo cross validation. Experiments on a set of 564 images yielded a specificity of 92.34% and a sensitivity of 93.33%. 相似文献