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Surgically uncorrectable tricuspid valve disease in children is rare. However, when it happens the surgical options are very limited. Tricuspid valve replacement using a mechanical valve or stented bioprosthesis is impractical. Use of homografts in the “anatomic position” has its limitations. We report here the use of an extracardiac homograft connection between the right atrium and right ventricle in a 16-month-old boy in whom severe tricuspid valve stenosis developed after surgical repair of a complex ventricular septal defect associated with dextrocardia and anomalous systemic venous drainage. The patient remains well receiving no cardiac medication 12 months after the procedure. 相似文献
3.
Twenty of 26 (77%) consecutive patients undergoing ileogastrostomy, performed by the same surgeon (IGMC) between February
1989 and May 1992, responded to a mailed quality of life survey. Average present weight was reported as 50.9 kg less than
a mean preoperative weight of 139.7 kg. Mean time of follow-up was 24.75 months. When comparing perceptions before and after
surgery, several quality of life improvements were noted in the areas of vocation, relationships, emotional well-being and
physical well-being. Post-surgery, jobs were rated more satisfying, eating habits improved, self-image and self-confidence
increased and body disparagement declined. Satisfaction with sexual relations increased, as did frequency. In general, relations
with partners, co-workers and friends seemed to improve. Exercise also increased significantly. In contrast, foul flatus,
bloating, and bowel movements regularly hampered activities or caused embarassment when in public. Despite these physical
side-effects, we observed that a large majority of persons undergoing ileogastrostomy noted significant improvements in quality
of life. 相似文献
4.
A retrospective study of all ileogastrostomy procedures (n=26) performed in 1993 by one surgeon (IGMC) was carried out to investigate the hypothesis that Helicobacter pylori may be implicated in certain severe cases of postoperation nausea and diarrhea. Ten of 26 persons (38.5%) displayed nausea
and notable diarrhea (greater than or equal to ten bowel movements per day), seven of which warranted upper GI investigation.
One hundred per cent (seven of seven) of these persons were found to possess H. pylori upon C-14 breath test. In four of six cases eradication therapy (1 g amoxicillin b.i.d./20 mg omeprazole b.i.d. for 2 weeks)
corresponded with a resolution of severe nausea and diarrhea (one additional case involved omeprazole use only), suggesting
that H. pylori should be considered as a possible cause of these symptoms post-ileogastrostomy. Additionally, in four of seven cases persons
were re-tested (C-14 breath analysis) at least 1 month post-therapy and in this group three persons were found to be free
of the organism. All three cases of notable diarrhea and nausea resolved with treatment, providing the strongest evidence
for a possible association between infection and these symptoms. 相似文献
5.
J. Byrne MB BCh FRCSI J. W. Hallett Jr. MD C. F. Kollmorgen MD M. M. Gayari BS W. Davies MD FRCSC 《Annals of vascular surgery》1996,10(2):156-165
Our aim was to examine the feasibility of a totally laparoscopic insertion of a bifurcated aortofemoral bypass graft in a canine model and to compare the surgical results with those in control animals undergoing standard grafting and laparoscopic-assisted bypass procedures. Using a six-port approach, we exposed and cross clamped the aorta, tunneled a bifurcated Dacron graft, and performed an end-to-end aortic anastomosis while maintaining pneumoperitoneum by means of CO2. Proximal anastomoses were performed with 4/0 double-ended continuous Prolene sutures and distal anastomoses were performed through standard groin incisions. Total operating and aortic cross-clamp times were measured as was the total blood loss for each procedure. Clinical outcome was also documented. Eight female laboratory-bred hounds underwent successful totally laparoscopic aortobifemoral bypass grafting, eight underwent open grafting, and eight underwent laparoscopic-assisted bypass. Mean operating time was 193 minutes in the animals undergoing totally laparoscopic insertion vs. 156 minutes in the open group and 180 minutes in the laparoscopic-assisted group. Aortic cross-clamping time was also significantly longer at 87 minutes vs. 43 minutes (p < 0.001)=" in=" the=" totally=" laparoscopic=" group,=" but=" blood=" loss=" was=" less.=" all=" eight=" laparotomy=" and=" laparoscopic-assisted=" dogs=" were=" still=" alive=" with=" no=" complications=" at=" 28=" days,=" whereas=" three=" of=" the=" eight=" in=" the=" totally=" laparoscopic=" group=" showed=" evidence=" of=" temporary=" paraplegia.=" this=" experimental=" study=" demonstrates=" that=" a=" totally=" laparoscopic=" approach=" can=" be=" used=" to=" insert=" a=" bifurcated=" aortofemoral=" bypass=" with=" a=" proximal=" end-to-end=" anastomosis=" but=" currently=" does=" not=" save=" time=" and=" may=" increase=" the=" risk=" of=" neurologic=">Presented at the Twentieth Annual Meeting of the Peripheral Vascular Surgery Society, New Orleans, La., June 10, 1995. 相似文献
6.
A recent review of the results of gastroplasties done at the University of Alberta Hospital showed that there was a high incidence
of late weight loss failure. Therefore a new operation, gastroplasty/distal gastric bypass, has been performed on 263 patients.
This operation results in a profound (mean greatest percentage excess weight loss of 87% at approximately 2 years) and lasting
weight loss (mean final percentage excess weight loss of 78%) at 4 years, range 2-7.5 years post-operatively. Only 0.9% of
patients failed to maintain at least a 40% excess weight loss. The operation achieves its effect through a moderate restriction
that permits patients to eat normal table food from the time of discharge and with a mild malabsorption that is not ordinarily
associated with diarrhea or notable deficiencies. Certain patients required debanding of the stoma and others developed staple-line
eventration. Neither of these events after long-term follow-up resulted in weight loss failure nor in other serious side-effects.
It is concluded that moderate failure of the gastroplasty stoma and staple line does not necessarily result in weight loss
failure, because the malabsorptive portion of the operation remains intact. Low hemoglobin occurred in 16% of cases and deficiency
of serum iron in 34%; a much smaller number of patients had chronic or intermittent deficiencies of these entities. Correction
was easily achieved with oral replacement. Deficiencies in albumin, calcium, phosphorus and folate were rarely seen and minimal
elevation of serum AST values occurred in just over 1% of patients. Chronic deficiencies or elevations were not seen in these
patients. Stomal ulcer occurred in 6% of patients and bleeding associated with stomal ulcer in 1%. Half the patients with
ulcer were managed with H2 blockers, the other half with vagotomy. Both forms of treatment when individualized effectively prevent re-ulceration. 相似文献
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