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排序方式: 共有1034条查询结果,搜索用时 31 毫秒
1.
Justine Royle Rachel Williamson Mark Strachan Marie O’Donnell Simon Jackson Thanos Argryopoulos Alan McNeill 《British journal of medical & surgical urology》2009,2(5):204-207
Emphysematous pyelonephritis is a severe life-threatening infection which continues to carry significant morbidity and mortality. We present a case recently managed at our institution by laparoscopic nephrectomy. The patient survived, and in comparison to some of the more conventionally managed patients in the literature, made an extremely speedy recovery. We would advocate this option to be seriously considered when patients are suitable and appropriately trained surgeons are available. 相似文献
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Does off-pump coronary artery bypass reduce the incidence of post-operative atrial fibrillation? A question revisited. 总被引:3,自引:0,他引:3
Thanos Athanasiou Omer Aziz Omar Mangoush Sharif Al-Ruzzeh Sujit Nair Vitali Malinovski Roberto Casula Brian Glenville 《European journal of cardio-thoracic surgery》2004,26(4):701-710
Atrial fibrillation (AF) is the most common post-operative complication in patients undergoing coronary artery bypass grafting, with an increased incidence associated with advancing age. This study aims to determine whether off-pump coronary artery bypass (OPCAB) reduces the incidence of AF in a generalized population (mean age <70 years). A meta-analysis was performed including all randomised and propensity score matched non-randomised studies published between 2001 and 2003 reporting a comparison between the two techniques in a generalised patient group (average age <70 years). The primary outcome of interest was post-operative AF. Sensitivity analysis was performed to evaluate consistency of the calculated treatment effect. Fourteen studies fulfilled our inclusion criteria, including a total of 16,505 subjects. The incidence of AF was 19% (1612/8265) in the off-pump group versus 24% (1976/8240) in the on-pump group. When considering only the 11 randomised studies (2207 subjects), we found a significant reduction in the incidence of post-operative AF in the off-pump group using a random-effect model (odds ratio (OR)=0.60, 95% confidence interval (CI)=0.45-0.82, and chi-square of heterogeneity=18.02, P=0.05). Sensitivity analysis highlighted one randomised study causing funnel plot asymmetry, exclusion of which resulted in a significant reduction in the incidence of post-operative AF in the off-pump group (OR=0.71, 95% CI=0.57-0.90), with a non-significant heterogeneity of 3.91 (P=0.92). When only studies of high quality were considered (898 patients), no significant difference was seen between on and off-pump groups (OR=0.78, 95% CI=0.57-1.07, and heterogeneity=0.53, P=0.91). This may be due to small number of patients in this group. Our results suggest that although OPCAB surgery may reduce the incidence of post-operative AF in a generalised population (age <70 years) this finding is not clearly supported by high quality randomised trials. Although previous evidence suggests that the incidence of post-operative AF is reduced in an elderly population (>70 years) with off-pump surgery, our results show that the evidence is less clear in a younger population group. The question of whether off-pump surgery in this patient group results in a lower rate of post-operative AF remains to be answered by further high quality randomised research. 相似文献
4.
Rachel M Massey Oliver J Warren Michal Szczeklik Sophie Wallace Daniel R Leff John Kokotsakis Ara Darzi Thanos Athanasiou 《Journal of cardiothoracic surgery》2007,2(1):26-9
The use of a skeletonized internal thoracic artery in coronary artery bypass graft surgery has been shown to confer certain
advantages over a traditional pedicled technique, particularly in certain patient groups. Recent reports indicate that radial
and gastroepiploic arteries can also be harvested using a skeletonized technique. The aim of this study is to systematically
review the available evidence regarding the use of skeletonized radial and gastroepiploic arteries within coronary artery
bypass surgery, focusing specifically on it's effect on conduit length and flow, levels of endothelial damage, graft patency
and clinical outcome. Four electronic databases were systematically searched for studies reporting the utilisation of the
skeletonization technique within coronary revascularisation surgery in humans. Reference lists of all identified studies were
checked for any missing publications. There appears to be some evidence that skeletonization may improve angiographic patency,
when compared with pedicled vessels in the short to mid-term. We have found no suggestion of increased complication rates
or increased operating time. Skeletonization may increase the length of the conduit, and the number of sequential graft sites,
but no clear clinical benefits are apparent. Our study suggests that there is not enough high quality or consistent evidence
to currently advocate the application of this technique to radial or gastroepiploic conduits ahead of a traditional pedicled
technique. 相似文献
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Thomas Modine Christophe Decoene Sharif Al-Ruzzeh Thanos Athanasiou Pierre Poivre Annie Pol Georges Fayad 《European journal of cardio-thoracic surgery》2005,27(2):289-295
OBJECTIVE: Dobutamine is commonly used to improve ventricular performance in cardiac surgery. The aim of this prospective randomised controlled study was to assess the effectiveness of using low doses of dobutamine during off-pump coronary artery bypass (OPCAB) surgery in order to reduce haemodynamic compromise due to heart displacement. METHODS: Thirty-two patients undergoing elective coronary artery bypass grafting (CABG) surgery using OPCAB technique for more than two vessels were approached and recruited. We analysed the changes in the thoracic aortic blood flow (TABF) during OPCAB using transoesophageal Doppler and by other conventional monitoring methods as cardiac output, invasive pulmonary and radial pressures and mixed venous oxygen saturation. RESULTS: The two groups were similar in preoperative characteristics. No postoperative complications were observed in the study patients. The heart rate, right atrial pressure, cardiac output measured by thermodilution and TABF changed significantly during the procedure. Also significant changes in descending thoracic aortic diameter were observed. The postoperative creatinine was significantly lower in the dobutamine group (P=0.04). Dobutamine was found responsible for the improvement in the descending TABF (P=0.006). CONCLUSIONS: This study showed that intra-operative intravenous infusion of dobutamine at 5 microg/kg per min in routine OPCAB patients safely increased cardiac output even without such changes been detected by conventional monitoring methods. 相似文献
8.
The synthesis and localization of alternatively spliced fibronectin EIIIB in resting and thrombin-treated megakaryocytes 总被引:1,自引:1,他引:0
There are several species of alternatively spliced fibronectin (FN). One of these, FN EIIIB, is primarily present in embryonic and in proliferating and migrating cells and is believed to be important for cell maturation. We have studied the synthesis, localization, and secretion of this FN isoform in isolated guinea pig megakaryocytes, nonmegakaryocytic bone marrow cells, and platelets. There was 7.5 times more general FN in megakaryocytes than in nonmegakaryocytic cells based on the analysis of equivalent amounts of protein. FN EIIIB was detected by Western blotting in megakaryocytes but not in nonmegakaryocytic cells present in bone marrow. Neither megakaryocytes nor platelets secreted FN EIIIB, while megakaryocytes secreted 25.3% +/- 4.6% general FN and platelets secreted about 61% general FN in response to thrombin. Analysis of immunostained cells by confocal microscopy revealed that FN EIIIB had been redistributed to the surface of megakaryocytes in response to thrombin. Synthesis was studied by metabolic labeling, and megakaryocytes were shown to synthesize FN and FN EIIIB. Thus, megakaryocytes and platelets are among a small number of adult cells and tissues that synthesize and contain FN EIIIB. The expression of FN EIIIB on the megakaryocyte surface may influence migration and maturation. 相似文献
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