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1.
Comprehensive evidence regarding the treatment of non-anaemic iron deficiency in patients undergoing valvular heart surgery is lacking. This study aimed to investigate the association between non-anaemic iron deficiency and postoperative outcomes in these patients. We retrospectively analysed 321 patients of which 180 (56%) had iron deficiency (defined as serum ferritin < 100 ng.ml-1 or < 300 ng.ml-1 with transferrin saturation < 20%). While the iron-deficient group had lower pre-operative haemoglobin levels than the non-iron deficient group (median (IQR [range]) 134 (127–141 [120–172]) g.l-1, 143 (133–150 [120–179]) g.l-1, p = 0.001), there was no between-group difference in allogeneic red blood cell transfusion. Median (IQR [range]) days alive and out of hospital at postoperative day 90 was 1 day shorter in the iron-deficient group (80 (77–82 [9–85]) days vs. 81 (79–83 [0–85]) days, p = 0.026). In multivariable analysis, only cardiopulmonary bypass duration (p = 0.032) and intra-operative allogeneic red blood cell transfusion (p = 0.011) were significantly associated with reduced days alive and out of hospital at postoperative day 90. Iron deficiency did not exert any adverse influence on secondary outcomes except length of hospital stay. Our findings indicate that non-anaemic iron deficiency alone is not associated with adverse effects in patients undergoing valvular heart surgery when it does not translate into an increased risk of allogeneic transfusion. 相似文献
2.
H J Kim C H Kang Y T Kim S-W Sung J H Kim S M Lee C-G Yoo C-T Lee Y W Kim S K Han Y-S Shim J-J Yim 《The European respiratory journal》2006,28(3):576-580
Although surgical lung resection could improve prognosis in some patients with multidrug-resistant tuberculosis (MDR-TB), there are no reports on the optimal candidates for this surgery. The aim of the present study was to elucidate the prognostic factors for surgery in patients with MDR-TB. Patients who underwent lung resection for the treatment of MDR-TB between March 1993 and December 2004 were included in the present study. Treatment failure was defined as greater than or equal to two of the five cultures recorded in the final 12 months of treatment being positive, any one of the final three cultures being positive, or the patient having died during treatment. The variables that affected treatment outcomes were identified through univariate and multivariate logistic regression analysis. In total, 79 patients with MDR-TB were included in the present study. The treatment outcomes of 22 (27.8%) patients were classified as failure. A body mass index <18.5 kg x m(-2), primary resistance, resistance to ofloxacin and the presence of a cavitary lesion beyond the range of the surgical resection were associated with treatment failure. Low body mass index, primary resistance, resistance to ofloxacin and cavitary lesions beyond the range of resection are possible poor prognostic factors for surgical lung resection in multidrug-resistant tuberculosis patients. 相似文献
3.
Kyu-Won Shim Tae-Gon Kim Chang-Ok Suh Jae-Ho Cho Chul-Joo Yoo Joong-Uhn Choi Jung-Hee Kim Dong-Seok Kim 《Child's nervous system》2007,23(10):1155-1161
Object A radiation dose of 40–50 Gy is able to produce a cure rate of more than 90% in intracranial pure germinoma. However, many
attempts have been made to reduce the dose and volume of radiation without compromising the disease control rate because of
the toxicity of irradiation. This retrospective study is intended to provide the physician with an appropriate therapeutic
strategy.
Materials and methods We reviewed a series of 10 recurrent germinomas among 117 germinomas diagnosed histologically or clinically between 1979 and
2002. These patients involved underwent three different treatment modalities; radiation alone (N = 71), chemotherapy alone (N = 9), and combined therapy (N = 37). The 10-year overall and relapse-free survival rates were 97 and 93% in the radiation alone group, 89 and 67% in the
chemotherapy alone group, and 92 and 92% in the combined therapy group, respectively. As expected, both radiation therapy
and combined therapy were effective in controlling the disease. Tumor recurrence was closely related to the volume of radiation
but not to the dose of radiation. If the tumor bed and craniospinal axis were fully covered, the radiation dose might be reduced.
Chemotherapy alone showed earlier recurrence and a higher tumor recurrence rate. In the case of combined therapy, chemotherapy
was useful in reducing the radiation dose but revealed some toxicity (death of two patients).
Conclusions The investigation of a possible further dose reduction seems worthwhile. Radiation therapy alone with a dose of less than
40 Gy should be compared with ongoing chemotherapeutic protocols combined with low-dose irradiation. 相似文献
4.
Bronchial stenosis due to endobronchial tuberculosis: successful treatment with self-expanding metallic stent. 总被引:30,自引:0,他引:30
J K Han J G Im J H Park M C Han Y W Kim Y S Shim 《AJR. American journal of roentgenology》1992,159(5):971-972
Endobronchial tuberculosis is present in 10-40% of patients with active pulmonary tuberculosis, and more than 90% of the patients with endobronchial tuberculosis have some degree of bronchial stenosis. The primary treatment for tuberculous bronchial stenosis is antituberculous chemotherapy combined with steroids, but some patients do not respond well, and more aggressive treatment is needed to restore the patency of the involved bronchus. Balloon dilatation of tuberculous bronchial stenosis has been reported to be successful. However, in our experience, balloon dilatation of the stenotic segment has not significantly improved patients' clinical symptoms except in those with very short segmental stenosis. We describe a case of tuberculous bronchial stenosis that was successfully treated with Gianturco self-expanding metallic stents. 相似文献
5.
Interactions between mivacurium and pancuronium 总被引:1,自引:0,他引:1
We have compared the dose-response relationships of mivacurium, pancuronium
and their combination, and examined the interactions by isobolographic and
fractional analyses. We studied 70 adult patients during nitrous
oxide-fentanyl-propofol anaesthesia. The dose-response curves were
determined by probit analysis. The ED95 and ED50 values for mivacurium were
84.2 (95% confidence interval 80.2-88.1) micrograms kg- 1 and 46.2
(40.2-52.1) micrograms kg-1, respectively. Corresponding values for
pancuronium were 68.5 (63.7-73.2) micrograms kg-1 and 40.7 (35.5-45.9)
micrograms kg-1, respectively. Isobolographic and fractional analyses of
the mivacurium-pancuronium combination demonstrated a synergistic
interaction. An additional 30 patients were allocated randomly to receive
either mivacurium 84.2 micrograms kg-1 (n = 15) or pancuronium 68.5
micrograms kg-1 (n = 15). When the first twitch (T1) of TOF recovered to
25%, each patient received mivacurium 46.2 micrograms kg-1. The times after
administration of mivacurium until T1 25% in the mivacurium-pancuronium
group were 6.4 (3.5-9.4) min and 49.8 (44.7-54.9) min, respectively (P <
0.0001). We conclude that the combination of mivacurium and pancuronium was
synergistic and after pancuronium-induced neuromuscular block, mivacurium
became a longer acting agent than the shorter agent.
相似文献
6.
Seong-Woong Kim Kyu-Won Shim Nick Plesnila Yong-Oock Kim Joong-Uhn Choi Dong-Seok Kim 《Child's nervous system》2007,23(2):201-206
Objects We designed several distraction devices and applied these instruments in 14 patients with varying types of craniosynostosis.
The aim of this report is to clarify the advantages and disadvantages of these surgical methods and to discuss current concepts
for the surgical strategy in the treatment of craniosynostosis.
Methods From January 2000 to July 2005, 28 patients with craniosynostosis were retrospectively analyzed. Surgical treatment was performed
on 14 patients using the distraction method with internal distraction devices that we designed, in which 5 patients had plagiocephaly,
3 brachycephaly, and 6 scaphocephaly. All patients underwent preoperative and postoperative evaluations, which included the
patient’s neurological state, and three-dimensional CT.
Results With distraction devices, the time required for the surgery could be shortened almost 3 1/3 h; the bleeding during the surgery
was decreased with reduced requirement of more than 200 ml of blood transfusion as compared with remodeling surgery. Postoperatively
achieved distraction distances varied from 30.0 to 47.5 mm (mean, 42.99 mm). The average increased volume percent of cranium
in distraction surgery group was 20.9% (range, −11.5 to 58.9%) after full distraction.
Conclusion With distraction surgery, satisfactory cranial volume expansion and aesthetically pleasing morphological states were achieved
in all cases, and the efficacy was statistically significantly high as compared with remodeling method. 相似文献
7.
8.
E Jung H-S Won S-K Kim J-Y Shim P R Lee A Kim J K Kim 《Ultrasound in obstetrics & gynecology》2006,27(5):562-565
Fetal thrombosis of the dural sinus is an extremely rare congenital cerebrovascular condition that is potentially fatal. We report a case of dural sinus thrombosis diagnosed by prenatal ultrasonography and fetal magnetic resonance imaging (MRI) in the second trimester. The thrombosis showed partial resolution during pregnancy and resolved spontaneously after birth without neurological complications. This is the first report of spontaneous postnatal resolution, and may provide helpful information on the natural history and prenatal counseling of fetal thrombosis of the dural sinus. 相似文献
9.
10.
123I-MIBG myocardial scintigraphy as a noninvasive screen for the diagnosis of coronary artery spasm
Jong-Won Ha Jong-Doo Lee Yangsoo Jang Namsik Chung June Kwan Se-Joong Rim Young-Joon Lee Won-Heum Shim Seung-Yun Cho Sung-Soon Kim 《Journal of nuclear cardiology》1998,5(6):591-597
Background It has been suggested that the sympathetic nervous system might play an important role in the development of coronary artery
spasm. However, no cardiac imaging modality has been able to demonstrate abnormal sympathetic innervation in patients with
coronary artery spasm. The purpose of this study was to assess the presence and location of abnormal sympathetic innervation
using iodine 123-metaiodobenzylguanidine (123I-MIBG) single photon emission computed tomography (SPECT) and to evaluate the clinical efficacy of 123I-MIBG SPECT as a noninvasive screening test in patients with coronary artery spasm.
Methods and Results Coronary arteriography and a provocative test with intravenous administration of ergonovine maleate were performed in 26 patients
(20 men, 6 women, mean age 48.2±12.0 years, range 20 to 67 years) who were suspected of having a coronary artery spasm. The
subjects were divided into 2 groups: group 1 (n=18) comprised subjects with negative provocative provocative test result,
and group 2 (n=8) comprised subjects with negative provocative test results. Ten healthy subjects served as controls. No abnormal
MIBG uptake was observed in the control subjects. Abnormal sympathetic nervous innervation using 123I-MIBG SPECT was observed either as a reduced uptake or a defective pattern in the perfused areas in 13 of the 18 regions
supplied by vessels of ergonovine-induced vasospasm. Normal sympathetic innervation, as evidenced by normal 123I-MIBG uptake, was noted in all of the 60 segments of normal vessel territories. Reduced uptake of 123I-MIBG was not detected in the perfused areas of 5 vasospasm-induced vessels (perfusion territory of left anterior descending
coronary artery [LAD] and the right coronary artery [RCA] in 2 and 3 patients, respectively). The sensitivity and specificity
of 123I-MIBG for detection of coronary artery spasm were 72.2% (95% confidence interval, [CI] 55% to 89%) and 100%, respectively.
The positive predictive and negative predictive values were 100% and 92.3% (95% CI 91% to 93%), respectively.
Conclusion
123I-MIBG SPECT is a feasible method to evaluate noninvasively and localize the territories of coronary arteries with spasm.
Invasive diagnostic coronary arteriography with ergonovine provocation test may be unnecessary for diagnosis of coronary artery
spasm in patients with typical resting pain, negative exercise test or normal thallium perfusion scan results, but showing
abnormalities in 123I-MIBG SPECT.
Presented in part at the European Association of Nuclear Medicine Congress, September 1996, Copenhagen, Denmark. 相似文献