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Resuscitation skills after Helping Babies Breathe training: a comparison of varying practice frequency and impact on retention of skills in different types of providers. Int Health 2019; 10:163-171. [PMID: 29618017 DOI: 10.1093/inthealth/ihy017] [Citation(s) in RCA: 45] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/21/2017] [Accepted: 02/20/2018] [Indexed: 11/12/2022] Open
Abstract
Background Helping Babies Breathe (HBB), a basic neonatal resuscitation curriculum, improves early neonatal mortality in low-resource settings. Our goal was to determine retention of resuscitation skills by different cadres of providers using the approved HBB Spanish translation in a rural clinic and community hospital in Honduras. Methods Twelve clinic and 37 hospital providers were trained in 1 d HBB workshops and followed from July 2012 to February 2014. Resuscitation skills were evaluated by objective structured clinical evaluations (OSCEs) at regular intervals. Clinic providers practiced monthly, whereas hospital providers were randomized to monthly practice for 6 months vs three consecutive practices at 3, 5 and 6 months. Results In the rural clinic, follow-up OSCE assessment showed rapid loss of skills by 1 month after HBB training. For all providers, repeated monthly testing resulted in improvements and maintenance of OSCE performance. In the community hospital, over all time points, the group with monthly OSCEs had 2.9 greater odds of passing compared with the group who practiced less frequently. Physicians were found to have 4.3 times greater odds of passing compared with nurses. Conclusions Rapid loss of resuscitation skills occurs after an initial training. Repeated practice leads to retention of skills in all types of providers. Further investigation is warranted to determine the clinical correlation of neonatal outcomes after HBB training.
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Cardiac Tamponade from Coronary Artery Injury after Laparoscopic Anti-Reflux Surgery. Am Surg 2017; 83:e23-e25. [PMID: 28234116] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/06/2023]
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4
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Cardiac Perforation by Migrated Fractured Strut of Inferior Vena Cava Filter Mimicking Acute Coronary Syndrome. Heart Lung Circ 2016; 26:e11-e13. [PMID: 27670585 DOI: 10.1016/j.hlc.2016.07.017] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/09/2015] [Revised: 03/13/2016] [Accepted: 07/31/2016] [Indexed: 11/28/2022]
Abstract
We present a rare late complication after inferior vena cava filter (IVC) placement. A 52-year-old woman with an IVC presented with sudden onset of chest pain. Cardiac catheterisation and echocardiography revealed an embolised IVC filter strut penetrating the right ventricle. Endovascular retrieval was considered but deemed unsafe due to proximity to the right coronary artery and concern for migration to pulmonary circulation. Urgent removal of the strut was performed via sternotomy. The postoperative course was uneventful. Two weeks later, she was asymptomatic. Minimally invasive approaches have been described for retrieval of intact IVC filters that have migrated to the right heart but not for embolised filter fragments. We recommend traditional sternotomy as the preferred method of retrieval as it limits the likelihood of further migration or trauma.
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RR8. An Updated Report on 30-Day Outcomes After Carotid Revascularization in the Society for Vascular Surgery Vascular Registry (SVS-VR)®. J Vasc Surg 2014. [DOI: 10.1016/j.jvs.2014.03.210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/25/2022]
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6
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Conservative management of intraoperative tracheal injury during cardiac operations. Ann Thorac Surg 2014; 97:1425-7. [PMID: 24694420 DOI: 10.1016/j.athoracsur.2013.07.066] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/12/2013] [Revised: 06/25/2013] [Accepted: 07/01/2013] [Indexed: 01/07/2023]
Abstract
Iatrogenic intraoperative tracheal injuries are rare in cardiac operations. Management of this complication is not well described because of the low incidence and lack of reported cases. We present an 82-year-old woman who sustained a tracheal injury during aortic valve replacement. Soft tissue coverage of the trachea was obtained, the original cardiac operation was completed, and she was otherwise managed conservatively. She recovered without further complication and was discharged home 1 week after the surgical procedure.
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Tratamiento quirúrgico de la enfermedad valvular cardiaca de predominio izquierdo, en un hospital de referencia nacional de Lima, Perú. Rev Peru Med Exp Salud Publica 2014. [DOI: 10.17843/rpmesp.2013.303.276] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022] Open
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8
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[Surgical treatment for left-sided heart valve disease in a national reference hospital in Lima, Peru]. Rev Peru Med Exp Salud Publica 2013; 30:415-422. [PMID: 24100815] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2013] [Accepted: 08/07/2013] [Indexed: 06/02/2023] Open
Abstract
OBJECTIVES To describe the preoperative, intraoperative and postoperative characteristics of patients with left-sided heart valve disease treated in the thoracic and cardiovascular surgery service of a national reference hospital; as well as to describe the occurrence of thromboembolic and bleeding events in these patients. MATERIALS AND METHODS A retrospective longitudinal study was carried out, which included 185 patients who underwert surgery between 1999 and 2006 at the Hospital Nacional Dos de Mayo (Lima, Peru). The patients were divided into 4 groups: patients with mitral commissurotomy; with aortic valve replacement; with mitral valve replacement and with double valve replacement. T-student test, Chi-square test, analysis of variance and Bonferroni test were used. The survival analysis took into account the severe thromboembolic and bleeding events and a follow-up period of 7 years was set. RESULTS The average durations of disease was 4.6 years. The most frequent etiology was rheumatic valve disease (74.6%). Hospital mortality was 3.8%, the most frequent cause of death was low cardiac output syndrome associated to multiple organ failure. The incidence of ischemic events (thrombosis or embolization) in patients who had a long-term valve replacement (more than 6 months) was 3.2%, and the incidence of bleeding events was 4.3%. CONCLUSIONS The results of surgical treatment for left-sided heart valve disease in Peru are favorable. The rate of complications and hospital mortality rate, as well as the long-term thromboembolic and bleeding events are comparable to those reported in the world literature.
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Gibbs distribution analysis of temporal correlations structure in retina ganglion cells. ACTA ACUST UNITED AC 2011; 106:120-7. [PMID: 22115900 DOI: 10.1016/j.jphysparis.2011.11.001] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2011] [Revised: 09/24/2011] [Accepted: 11/03/2011] [Indexed: 11/18/2022]
Abstract
We present a method to estimate Gibbs distributions with spatio-temporal constraints on spike trains statistics. We apply this method to spike trains recorded from ganglion cells of the salamander retina, in response to natural movies. Our analysis, restricted to a few neurons, performs more accurately than pairwise synchronization models (Ising) or the 1-time step Markov models (Marre et al., 2009) to describe the statistics of spatio-temporal spike patterns and emphasizes the role of higher order spatio-temporal interactions.
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Abstract
We present a patient with aortoesophageal fistula that occurred years after an acute type B aortic dissection that was treated medically. This patient developed aneurysmal dilatation of the chronically dissected aorta, which finally eroded into the esophagus. Endovascular management with the placement of a stent graft was performed, but the patient ultimately died of multiorgan failure and possible myocardial infarction.
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Conversion of Tunneled Hemodialysis Catheter into HeRO Device Can Provide Immediate Access for Hemodialysis. Vasc Endovascular Surg 2010; 44:687-90. [DOI: 10.1177/1538574410377122] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
Patients with central venous occlusion who are ‘‘tunneled catheter dependent’’ are a challenge for hemodialysis access. A relatively new option for them is the hemodialysis reliable outflow (HeRO) device that can be totally implanted subcutaneously. However, patients still require a tunneled hemodialysis catheter that is used until the HeRO device is mature, 4 to 6 weeks later. Here, we describe a conversion of an existing tunneled hemodialysis catheter into a HeRO device, which was combined with a ‘‘self-sealing’’ Flixene graft. This allowed almost immediate use of the HeRO device without the need for placement of a catheter.
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Staged approach for surgical management of external iliac vein aneurysm associated with traumatic femoral arteriovenous fistula. Vasc Endovascular Surg 2009; 43:617-21. [PMID: 19828589 DOI: 10.1177/1538574409345024] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Aneurysms of the iliac vein are rare. They can occur in association with arteriovenous fistulae located elsewhere. Here, we present a 30-year-old man who developed a large left external iliac vein aneurysm in association with a chronic traumatic arteriovenous fistula in the left thigh. Less than 25 cases of iliac vein aneurysms have been reported in the last 40 years. The presentation and treatment of this condition has been heterogeneous. We suggest that adequate surgical treatment can be offered in a staged approach: aneurysm resection with reconstruction should be done first, followed by closure of the arteriovenous fistula 6 months later.
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Percutaneous Endovascular Management of Occluded HeRO Dialysis Access Device. Vasc Endovascular Surg 2009; 44:44-7. [DOI: 10.1177/1538574409347394] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
The Hemodialysis Reliable Outflow (HeRO) device is a novel alternative for dialysis access in patients with no suitable veins in the upper extremities. We placed a HeRO device in a 67-year-old woman with end-stage renal disease and 2 months later, it was being used for hemodialysis. After 1 month of uneventful use, the device thrombosed and it was rescued with a percutaneous endovascular approach. The device remains patent 6 months after the intervention.
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Persistent nonhealing skin fistulous tract after congenital diaphragmatic hernia repair. Can J Surg 2009; 52:E75-E76. [PMID: 19503656 PMCID: PMC2689738] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/27/2023] Open
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Abstract
Hydatid cyst can simultaneously affect the liver and lung. Some patients might have additional comorbidities that can make management more challenging. Here, we present a 10-year-old boy with hepatopulmonary hydatid cysts and severe mitral regurgitation, who was successfully managed with a staged surgical approach treating the lung first, followed by the liver and finally, the heart.
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Absence of brain involvement and factors related to positive serology in a prospective series of 61 cases with pulmonary hydatid disease. Am J Trop Med Hyg 2008; 79:84-88. [PMID: 18606768 PMCID: PMC2621271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
A prospective series of 65 patients with surgically confirmed lung cystic hydatid disease was evaluated in terms of their radiologic characteristics, serologic response, and presence of cysts in other organs. Cysts were mostly single and located in lower lung lobes. Liver compromise was found in 34% of the patients. Despite a systematic search, no patient showed brain cysts in this series. Twelve patients had previous hydatid disease: six in the liver and eight in the lung (two had involvement of both organs in the past). Serology using bovine cyst fluid in an immunoblot assay was 85% sensitive. Serologic response was not associated with number or cyst or compromise of other organs but was clearly associated to the presence of at least one complicated cyst. Cyst status in terms of complications should be described to allow appropriate assessment of serologic evaluations.
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Human Hydatid Disease in Peru Is Basically Restricted to Echinococcus granulosus Genotype G1. Am J Trop Med Hyg 2008. [DOI: 10.4269/ajtmh.2008.79.89] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Human hydatid disease in Peru is basically restricted to Echinococcus granulosus genotype G1. Am J Trop Med Hyg 2008; 79:89-92. [PMID: 18606769 PMCID: PMC2621270] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/26/2023] Open
Abstract
A molecular PCR study using DNA from 21 hydatid cysts was performed to determine which strain type is responsible for human infection in Peru. The mitochondrial cytochrome c oxidase subunit 1 (CO1) gene was amplified in 20 out of 21 samples, revealing that all but 1 sample (19/20, 95%) belonged to the common sheep strain (G1). The remaining samples belonged to the camel strain (G6). The G1 genotype was most frequently found in human cases of cystic hydatid disease (CHD) in Peru. Local control measures should focus primarily on decreasing dog and sheep infection rather than intermediate reservoirs.
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Absence of Brain Involvement and Factors Related to Positive Serology in a Prospective Series of 61 Cases with Pulmonary Hydatid Disease. Am J Trop Med Hyg 2008. [DOI: 10.4269/ajtmh.2008.79.84] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
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Surgical management of Aspergillus colonization associated with lung hydatid disease. Ann Thorac Cardiovasc Surg 2008; 14:116-118. [PMID: 18414351] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/06/2007] [Accepted: 05/08/2007] [Indexed: 05/26/2023] Open
Abstract
Colonization with Aspergillus sp. usually occurs in previously formed lung cavities. Cystectomy is a widely used surgical technique for hydatid lung disease that can also leave residual cavities and potentially result in aspergilloma. We present two cases of this rare entity and a case with Aspergillus sp. colonization of an existing ruptured hydatid cyst.
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A Large Pediculated Myxoma of the Left Ventricle Causing Outflow Obstruction in a Young Man. J Am Soc Echocardiogr 2007; 20:1413.e1-3. [PMID: 17624730 DOI: 10.1016/j.echo.2007.04.013] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2007] [Indexed: 11/18/2022]
Abstract
We report a case of a large mobile myxoma of the left ventricle that caused obstruction of the outflow tract. Transthoracic and transesophageal echocardiography defined the extent and location of the mass providing crucial information for surgical treatment, which was successful.
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Total anomalous pulmonary venous return and Mayer-Rokitansky-Kuster-Hauser syndrome. Int J Cardiol 2007; 128:e104-6. [PMID: 17689726 DOI: 10.1016/j.ijcard.2007.05.083] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/16/2007] [Accepted: 05/26/2007] [Indexed: 11/28/2022]
Abstract
We present an adult woman with total anomalous pulmonary venous return (TAPVR) and Mayer-Rokitansky-Kuster-Hauser syndrome that was diagnosed intraoperatively during a planned atrial secundum defect closure. Surgical repair of TAPVR was performed with good outcome.
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Fungal arthritis of the knee caused by Candida parapsilosis in a kidney transplant recipient. J Clin Rheumatol 2007; 8:147-50. [PMID: 17041344 DOI: 10.1097/00124743-200206000-00006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Fungal arthritis is a rare infection usually caused by Candida species. Candida parapsilosis has emerged as a new pathogen and has been implicated in several cases of fungal arthritis, mostly associated with a joint prosthesis or after arthrocentesis. We report an unusual case of fungal arthritis of the knee caused by this organism in a 38-year-old female kidney transplant recipient, who had no previous invasive procedures on her knee. Systemic and intraarticular antifungal therapy combined with surgical debridement proved to be an effective treatment of this clinically difficult condition. To our knowledge, this case is the first report of fungal arthritis caused by C. parapsilosis in a transplant recipient. The multimodality approach used in the treatment of this patient should be considered in similar forms of fungal arthritis in immunocompromised patients.
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Hemoptysis in a healthy young man after a stab wound to the chest. Respiration 2007; 75:221-3. [PMID: 17536185 DOI: 10.1159/000103241] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/15/2007] [Accepted: 03/01/2007] [Indexed: 11/19/2022] Open
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Surgical management of giant superior mesenteric artery aneurysm. Ann Vasc Surg 2007; 21:219-21. [PMID: 17349367 DOI: 10.1016/j.avsg.2006.06.017] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2005] [Revised: 05/28/2006] [Accepted: 06/09/2006] [Indexed: 11/20/2022]
Abstract
The superior mesenteric artery (SMA) is an uncommon location of aneurysm formation. This entity is potentially lethal and should be treated once a diagnosis is made. When the aneurysm reaches a large size, there is a high risk of rupture and surgical treatment should not be delayed, although it can be technically demanding because there is a significant portion of bowel at risk for ischemia. Here, we describe our approach for the management of a giant SMA aneurysm.
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Late onset angina after penetrating cardiac injury adjacent to a coronary artery. THE JOURNAL OF TRAUMA 2006; 60:1344-6. [PMID: 16766982 DOI: 10.1097/01.ta.0000220366.67505.2f] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/10/2023]
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Neonatal heart transplantation to a physiologic single lung. J Heart Lung Transplant 2006; 25:362-4. [PMID: 16507434 DOI: 10.1016/j.healun.2005.09.020] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2005] [Revised: 09/13/2005] [Accepted: 09/22/2005] [Indexed: 11/20/2022] Open
Abstract
Heart transplantation to a physiologic single lung in patients with congenital heart disease is associated with good outcome in teenagers and young adults, but its clinical feasibility has not been reported in neonates and young infants. We describe the clinical and hemodynamic course in a neonate with hypoplastic left heart syndrome who underwent primary heart transplantation to a single functioning right lung.
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Coronary Artery Revascularization After Chest Wall Reconstruction With Rectus Abdominis Myocutaneous Flap. Ann Thorac Surg 2006; 81:732-5. [PMID: 16427890 DOI: 10.1016/j.athoracsur.2004.10.044] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/07/2004] [Revised: 10/19/2004] [Accepted: 10/22/2004] [Indexed: 11/30/2022]
Abstract
The standard incision for a cardiac operation is a median sternotomy. In special situations, alternative approaches are needed. We report a 53-year-old woman who required coronary artery bypass grafting 10 days after chest wall reconstruction with a transverse rectus abdominis myocutaneous flap. We describe our technique, which allowed us to preserve the flap and resulted in good functional and aesthetic outcome.
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Metastatic Meningioma to the Liver Successfully Treated with a Wedge Resection and Radiation Therapy: Report of a Case. Surg Today 2005; 35:82-5. [PMID: 15622471 DOI: 10.1007/s00595-004-2849-7] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2003] [Accepted: 05/18/2004] [Indexed: 11/26/2022]
Abstract
Meningiomas account for approximately 15%-20% of all primary brain tumors. Metastatic meningiomas are rare. Less than 100 cases of extracranial metastatic meningiomas have been reported in the literature. An unusual case of metastatic meningioma to the liver successfully treated by a surgical resection and radiation therapy is presented.
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Hypoplastic left heart syndrome with intact atrial septum associated with deletion of the short arm of chromosome 18. Cardiovasc Pathol 2003; 12:102-4. [PMID: 12684167 DOI: 10.1016/s1054-8807(02)00163-1] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
We report on a female newborn with deletion of the short arm of the chromosome 18 (del 18p) and hypoplastic left heart syndrome (HLHS) with intact atrial septum. Several forms of congenital heart disease (CHD) are found in 10% of patients with this chromosomal abnormality, although HLHS has not been reported yet. Interesting coronary artery anomalies, as well as the presence of pulmonary lymphangiectasia, were found in our patient and were contributors to her fatal outcome. Del 18 p must be considered when evaluating a patient with characteristic phenotypical anomalies and HLHS with intact atrial septum.
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Abstract
Heparin is the standard agent used for systemic anticoagulation during cardiopulmonary bypass in cardiac operations. Alternatives are needed when patients with heparin-induced thrombocytopenia type II are encountered. We present a patient with a clinical picture of heparin-induced thrombocytopenia type II who was effectively anticoagulated with bivalirudin, a direct thrombin inhibitor, during cardiopulmonary bypass for a cardiac operation.
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Abstract
BACKGROUND Surgical wound infection and intra-abdominal abscess remain common infectious complications after appendectomy, especially in the setting of a perforated or gangrenous appendix. We therefore developed a clinical protocol for the management of appendicitis to decrease postoperative infectious complications. METHODS Between January 1, 1999, and December 31, 1999, 206 patients with appendicitis were treated on protocol. Retrospectively, the charts were reviewed for all protocol patients as well as for 232 patients with appendicitis treated in the year prior to protocol initiation. Data were collected on surgical wound infections and intra-abdominal abscesses. RESULTS There were significantly fewer infectious complications in the protocol group than in the nonprotocol group (20 [9%] versus 8 [4%]; P <0.05). In patients with a perforated or gangrenous appendix, the infectious complication rate was reduced from 33% to 13% (P <0.05). CONCLUSIONS The incidence of infectious complications after appendectomy can be significantly reduced with a standardized approach to antibiotic therapy and wound management.
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Abstract
Isolated spontaneous renal artery dissection is a rare condition that can result in renal parenchymal loss and severe hypertension. Although several risk factors have been identified in association with renal artery dissection, the natural history is not well defined. The rarity and nonspecific presentation of the disease often lead to diagnostic delay. That, coupled with the anatomic limitations imposed by dissection into small branch arteries, frequently precludes successful revascularization. Over a 12-month period, four cases of spontaneous renal artery dissection (SRAD) were treated at a single institution. The patients (ages 44-58 years) presented with acute onset of abdominal/flank pain, fever, and hematuria. Diagnostic work-up included an abdominal CT scan revealing segmental renal infarction. Angiographic evaluation was diagnostic for renal artery dissection in all cases. In one case there was evidence of fibromuscular dysplasia (FMD), and in a second there was acute dissection superimposed upon atherosclerotic disease. Diagnosis was made within 12-72 hr of the onset of symptoms. All patients were managed expectantly with anticoagulation. Two patients were known to have a history of hypertension prior to admission. All four patients have required antihypertensive treatment following dissection, but the condition has been easily controlled. Renal function has remained stable in all cases. None of the four cases required exploration. Two of the four patients underwent repeat angiographic evaluation for recurrent symptoms of pain. In the case of the patient with FMD, a new dissection was seen in the contralateral renal artery, and in the second, repeat angiogram revealed proximal remodeling of the dissected artery. Management strategies for SRAD include surgical revascularization, endovascular intervention, and observation with or without anticoagulation. The available literature does not demonstrate a clear benefit of treatment with any of these modalities. In the short term, the combination of anticoagulation and expectant management appears to produce satisfactory outcomes for this difficult problem.
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Abstract
INTRODUCTION We present our experience in the management of penetrating pancreatic injuries, focusing on factors related to complications and death. METHODS Retrospective trauma registry-based analysis of 62 consecutive patients with penetrating pancreatic injuries during an 11-year period. Overall injury severity was assessed by the injury severity score (ISS) and the penetrating abdominal trauma index (PATI). Pancreatic injuries were graded according to the American Association for the Surgery of Trauma (AAST) Organ Injury Scaling (OIS). Complications were characterised using standardised definitions. Mortality was recorded as early (within 48 h after admission) and late (after 48 h). RESULTS Thirty patients suffered gunshot wounds and 24 had grade I pancreatic injuries. Shotgun and gunshot wounds were more destructive than stab wounds (higher PATI, number of intraabdominal injuries and mortality). Seventeen patients died. Most deaths occurred within 1 h after admission due to massive bleeding and severe associated injuries. Only one death was potentially related to the pancreatic injury. Mortality rate also correlated with pancreatic injury grading. Sixty-one patients had associated intraabdominal injuries. Combined pancreaticoduodenal injuries were present in 13 patients, and five died. Simple drainage was the most common procedure performed. Pancreas-related complications were found in 12 out of 47 patients who survived more than 48 h; intraabdominal abscess (n=7) that was associated with colon injuries, and pancreatic fistula (n=5). CONCLUSION An approach based on injury grade and location is advised. Routine drainage is recommended; distal resection is indicated in the presence of main duct injury, and the management of severe injuries will be tailored according to the overall physiologic status, presence of associated injuries, and duodenal viability. Morbidity and mortality is mainly due to associated injuries.
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Clinical Manifestations of Gastrointestinal Granulocytic Sarcoma Requiring Surgical Treatment. Am Surg 2001. [DOI: 10.1177/000313480106700810] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
Granulocytic sarcoma is a rare extramedullary soft-tissue tumor of granulocytic lineage with an incidence of 3 to 5 per cent in patients with acute myelogenous leukemia. The most common sites of involvement are bone, soft tissue, lymph nodes, and skin. Here we report three unusual cases of granulocytic sarcoma involving the gastrointestinal tract that required surgical intervention.
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Clinical manifestations of gastrointestinal granulocytic sarcoma requiring surgical treatment. Am Surg 2001; 67:764-6. [PMID: 11510579] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/21/2023]
Abstract
Granulocytic sarcoma is a rare extramedullary soft-tissue tumor of granulocytic lineage with an incidence of 3 to 5 per cent in patients with acute myelogenous leukemia. The most common sites of involvement are bone, soft tissue, lymph nodes, and skin. Here we report three unusual cases of granulocytic sarcoma involving the gastrointestinal tract that required surgical intervention.
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Abstract
A case of isolated dissection of the superior mesenteric artery is presented here. This rare condition was confirmed angiographically in a 46-year-old man with persistent abdominal pain. He was treated initially with anticoagulation alone. One year later, he developed recurrent symptoms and had radiologic documentation of progression of the condition. Operative repair was performed and recovery was uneventful. This case demonstrates a failure of the nonoperative approach to this rare condition and suggests that disease progression may be inevitable. Early surgical correction may ease operative management.
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Abstract
We report a rare case of traumatic abdominal wall hernia caused by persistent and severe cough. We believe this is the first reported case of such an entity. We present computed tomography findings and a pertinent review of the literature.
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Bilateral facial nerve paralysis after high voltage electrical injury. THE JOURNAL OF BURN CARE & REHABILITATION 1999; 20:307-8. [PMID: 10425593 DOI: 10.1097/00004630-199907000-00006] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
A case of bilateral facial nerve paralysis of a patient who received a high voltage electrical burn is presented. This is an extremely unusual neurologic condition and has not been previously reported in association with electrical injuries. The patient regained nearly complete neurologic function several months after the incident.
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Abstract
The present report describes the isolation and genetic characterization of the porcine apolipoprotein E (apo-E) gene. A single positive recombinant phage clone containing a 10.7-kb insert was isolated from a porcine genomic library, and a 4.2-kb fragment was subcloned and sequenced. The 4.2-kb fragment contained the entire apo-E gene in addition to upstream and downstream sequences (GenBank accession no. 470240). The porcine apo-E gene is made up of four exons and three introns, and encodes a preapo-E protein comprised of a signal peptide of 18 amino acids and a mature protein of 299 amino acids. The porcine apo-E gene contains a (CG)13 microsatellite marker within intron three. This microsatellite is moderately polymorphic, and at least four alleles were evident at this locus among 10 animals from each of the Yorkshire, Hampshire, Landrace and Duroc breeds. Finally, localization of the porcine apo-E gene to chromosome 6 band q2.1 was determined by fluorescent in situ hybridization and confirmed by genetic linkage analysis.
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Abstract
We present a review of 240 patients with penetrating thoracic injuries seen in a period of 10 years at a general university hospital in Lima, Peru. The majority of the patients were young males who suffered stab wounds (76.2 per cent). The most frequent symptoms were thoracic pain (N = 202) and dyspnoea (N = 138); and the commonest physical findings were diminished respiratory sounds (N = 192) and tachypnoea (N = 167). Haemopneumothorax (N = 92), haemothorax (N = 81) and pneumothorax (N = 59) were the most frequent lesions. Cardiac lesions were present in 11 patients. The commonest extrathoracic associated lesions was penetrating abdominal injury (N = 43). The majority of the patients only required tube thoracostomy as definitive therapy (N = 143). There were 31 thoracotomies and 54 laparotomies. The most frequent complications were respiratory (N = 34) and neurological (N = 8). Gunshot wounds were more destructive than stab wounds. The first group of patients had a longer hospital stay (11.7 and 7.25 days), longer time with tube thoracostomy (5.98 and 4.18 days), more injured abdominal organs (3.8 and 2.38 organs) and higher mortality (7.01 per cent and 3.82 per cent) than the second group. The overall mortality was 4.58 per cent. The patients with a cardiac lesion had a higher mortality (27.27 per cent) than those who did not (3.49 per cent).
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