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排序方式: 共有129条查询结果,搜索用时 15 毫秒
1.
Bhandari M Schemitsch EH Adili A Lachowski RJ Shaughnessy SG 《Journal of orthopaedic trauma》1999,13(8):526-533
OBJECTIVE: This study was designed to examine the effect of pulsatile irrigation on microscopic bone architecture and its time-dependent efficacy in removing adherent slime-producing bacteria from cortical bone. DESIGN: Using an in vitro model, ten-millimeter transverse cut sections from five human tibiae were contaminated with Staphylococcus aureus and subjected to either high pressure pulsatile lavage (HPPL; seventy pounds per square inch, normal saline) or low pressure pulsatile lavage (LPPL; fourteen pounds per square inch, normal saline) or served as controls. Alteration of bony architecture was quantified by using a previously described ordinal scale and histomorphometric analysis of each transverse cut section of tibia. To assess the time-dependent effectiveness of pulsatile lavage in removing adherent bacteria from bone, ten-millimeter transverse cut sections from ten canine tibiae were contaminated with S. aureus and subjected to high or low pressure pulsatile lavage immediately or after one, three, or six hours. Scanning electron microscopy and bacterial cultures were used to assess the removal of adherent bacteria. RESULTS: HPPL resulted in significantly greater macroscopic damage than was seen with LPPL or in controls (ANOVA, p < 0.001). Histomorphometry revealed that HPPL was associated with significantly larger and more numerous fissures or defects in the cortical bone when compared with low pressure irrigation (p < 0.001). However, high and low pressure lavage were associated with similar degrees of periosteal separation from the cortical bone surface (p = 0.87). Both high and low pressure lavage were effective in removing adherent bacteria from bone at three hours irrigation delay, but only high pressure lavage removed adherent bacteria from bone at six hours delay. CONCLUSION: In this in vitro study, compared with HPPL, LPPL led to less structural damage and was equally effective in removing bacteria within three hours debridement delay; however, the efficacy of LPPL at six hours debridement delay is questionable. This finding may have clinical significance in the development of infection following open tibial fractures. 相似文献
2.
Organ injuries associated with femoral fractures: implications for severity of injury in motor vehicle collisions 总被引:3,自引:0,他引:3
OBJECTIVE: To determine if motor vehicle collisions (MVCs) resulting in femoral fractures were associated with a different injury severity and pattern of injury compared with crashes in which victims did not sustain femoral fractures. METHODS: Retrospective review of seriously injured motor vehicle occupants admitted to a regional trauma unit (Hamilton General Hospital) during a 69-month period (April 1991 to December 1996) for whom detailed crash details were known. RESULTS: Data for 733 motor vehicle occupants with Injury Severity Scores greater than 12 were available; 112 occupants (15.3%) sustained femoral fractures, and 621 occupants (84.7%) did not sustain femoral fractures. Victims with femoral fractures had a significantly higher mean Injury Severity Score (29.4 compared with 25.3 for non-femoral fracture group; p<0.001). The femoral fracture group had a higher incidence of bowel (p<0.012) and hemopneumothorax (p<0.02) injuries as well as an increased incidence of upper and lower extremity (p<0.001) and pelvic (p<0.05) fractures. CONCLUSION: The presence of a femoral fracture is strongly associated with the pattern and severity of injuries sustained by occupants in MVCs. A high index of suspicion is warranted in identifying associated organ injuries in MVC victims with concomitant femoral fractures. 相似文献
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Ravi Krupa Killen Annabel Alexander Angus Bell-Davies Frances Biganiro Sebintu James Brazeal Aurelia Butoyi Jean Marie Vianney Diaz Fabio Edgardo Drabile Romeo Fanny Marvin Fernie Lucila Gunawardana Shannon Hartley Emma Hawu Yolisa N. Hendron Holly Joseph Stephanie Alcine Lamahewage Ananda Mahagedera Ruwantha Manirambona Emery Morisho Benjamin Kitambala Muchunu Patrick Niyukuri Alliance Ntaganda Edmond Orliacq Francisco Orliacq Josefina Wobenjo Adili Young Pablo Lakhoo Kokila Ford Kathryn 《World journal of surgery》2022,46(3):476-485
World Journal of Surgery - The Global Initiative for Children's Surgery (GICS) group produced the Optimal Resources for Children’s Surgery (OReCS) document in 2019, listing standards of... 相似文献
6.
Prof. Dr. T. Schmitz-Rixen F. Adili R. Bauersachs I. Eichler J. Hoffmann J. Klocker J. Kobba T. Petzold H. Wenk R.T. Grundmann 《Gef?sschirurgie》2014,19(7):667-674
Background
The direct thrombin inhibitor argatroban is available for parenteral antithrombotic treatment of patients with heparin-induced thrombocytopenia type II (HIT II).Method
Experiences with argatroban were exchanged in a workshop based on case reports and a survey of experts. The aim was to define the indications and modalities for administration of argatroban in vascular surgery.Results
The recommended body weight-related therapeutic intravenous (i.v.) dosage of argatroban is 0.5–2 µg/kg/min. The therapy can be monitored by the activated partial thromboplastin time (aPTT) with a target value of a 1.5-fold to 3-fold prolongation of the aPTT. A dose reduction is required in patients with compromised liver function. If anticoagulation is only to be carried out intraoperatively, the administration of a bolus immediately before clamping of the vessels (e.g. carotid artery or aorta) is possible (bolus of 5–15 mg depending on body weight, preferred 10 mg). The treatment can then be continued with an infusion of 0.5–2 µg/kg/min, whereby the daily dosage has to be considered (for a 70 kg patient approximately 50–200 mg).Conclusion
Uncertainties exist in the administration of argatroban. The dosages recommended here have a substantial range depending on the cardiac function of the patient, liver function and whether the patient needs intensive care unit (ICU) treatment. The dosages should then be rechecked. The Research Committee of the German Society for Vascular Surgery therefore proposes that in the future HIT II patients should be recorded in a register. Due to the rare incidence of the disease all surgical ICUs are invited to participate. 相似文献7.
Background
In recent years vascular surgery in Germany has become established as an independent surgical discipline. Apart from open vascular reconstruction, vascular surgeons nowadays also perform endovascular procedures. In this context, the requirements for physicians undergoing training in vascular surgery as well as for the clinical teachers have changed and require an adjustment of the vascular training program (Advanced training regulation WBO).Material and method
Analysis of the framework conditions for education in vascular surgery according to the current training program curriculum (WBO), assessment of the results of published surveys and official statistical evaluation with discussion on basic research and expert recommendations.Results
The goal of the WBO is to communicate clinical knowledge as well as practical operative skills in authorized training facilities. In this respect personnel and infrastructural requirements have to be fulfilled which are, however, not exactly defined in the WBO. The requirements that have to be met by the clinical trainers are also not sufficiently defined. Furthermore, a regular evaluation of the individual training qualification is not required and only few decisive training programs for trainers exist. To what extent these factors influence the quality of vascular surgery training is currently unknown.Conclusions
The requirements for physicians undergoing training in vascular surgery have been changed in recent years and need an adjustment of the current training program (WBO) in order to guarantee high-quality education. 相似文献8.
9.
Jasmina Sterz Sebastian H. Hoefer Maren Janko Bernd Bender Farzin Adili Teresa Schreckenbach 《Medical teacher》2019,41(4):417-421
AbstractIntroduction: Curriculum mapping shows concordances and differences between the intended and the taught curriculum. To our knowledge, no previous studies describe the effects that this mapping has on the curriculum. The aim of the present study is to map the content of a lecture series in surgery to the National Catalogue of Learning Objectives in Surgery and analyze the effects this mapping has on the content of the following lecture series.Methods: All lecturers in the lecture series were directly observed by a minimum of two reviewers and learning objectives and the level of competence were documented. After the lecture series, the results were visualized within the catalog of learning objectives and were sent to the lecturers. In the following lecture series, learning objectives were documented correspondingly.Results: In the first lecture series, 47% of the learning objectives were taught. After the mapping, the number of learning objectives that were taught increased to 59% (p?<?0.001). The increase was found in all surgical disciplines and in all levels of competences without any changes in the average duration of the lectures.Conclusions: The presented method for mapping a curriculum effectively increased the number of taught learning objectives without requiring longer lecture durations. 相似文献
10.
背景:封堵器封堵房间隔缺损具有明确的功能性、安全性和高效性等优势。 目的:运用实时三维超声心动图技术评价房间隔缺损封堵器对左心结构和二尖瓣环运动的影响。 方法:纳入37例确诊为继发孔型房间隔缺损患者,其中男20例,女17例,年龄20-60岁,根据缺损大小及边缘硬度选择对称封堵器进行封堵治疗,分别于封堵前1d、封堵后1个月、封堵后3个月行常规及实时三维超声心动图检查。 结果与结论:选入的37例患者中,有4例因获得的三维超声图像质量欠佳未列入统计,最终33例获得满意的实时三维超声心动图图像并进入分析结果,33例术后封堵器位置均良好。封堵后1,3个月的左心室舒张末期容积、左心室收缩末期容积、左心房舒张末期容积、左心房收缩末期容积均较封堵前增加(P<0.05),且封堵后3个月效果更显著(P<0.05);3个时间点二尖瓣环位移、左心室射血分数相比无差异。封堵器型号与左心房容积变化率、左心室容积变化率呈正相关,心内膜垫残端与二尖瓣环位移无相关性。表明封堵器封堵房间隔缺损可增加左心房、左心室容量,对二尖瓣瓣环运动无影响。 相似文献