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Radiologe. 2000 Sep;40(9):821-5.
[Reconstructive endovascular treatment procedures in the area of the a. subclavia and its branches]
[Article in German]
Waggershauser T, Herrmann K, Reiser M.
Institut fur Klinische Radiologie, Ludwig-Maximilians-Universitat Munchen, Klinikum Grosshadern.
PURPOSE: Principles, methods and results of percutaneous therapy in acute and chronic vascular alterations of the subclavian artery and its branches. MATERIAL AND METHODS: 17 arteries in 15 patients have been treated. The patients suffered from stenoses (n = 6), occlusions (n = 7), aneurysms, (n = 2) or acute hemorrhage (n = 2). The lesions were located in the subclavian artery (n = 8), the axillary artery (n = 4) or the vertebral artery (n = 5). In all cases the procedures were performed via via a transfemoral approach. Balloon angioplasty was employed in 13 cases, in 6 cases bare stents and in 4 cases grafted stents were implanted. In one case additionally local lysis was performed. RESULTS: Primary technical success was achieved in all cases. No catheter complications did occur. In 13 Patients complete follow-up examinations could be performed. The life-threatening acute hemorrhages were stopped without recurrent bleeding. The aneurysms could be completely excluded without endoleaks. In 4 Patients of the stenosis-group re-stenosis occurred and following stent-implantation one occlusion after 6 months was observed. 8 patients are without clinical symptoms since the intervention. CONCLUSION: Stenotic and occlusive vascular alterations as well as aneurysms and the acute hemorrhage in supraaortic arteries can be effectively and safely treated by endovascular techniques using percutaneous groin access.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11056974&dopt=Abstract hemorrhage
Folia Neuropathol. 2000;38(2):55-9.
The influence of the intraventricular hemorrhage on the intracranial pressure and hemodynamic changes in the experimental intracerebral hemorrhage in the rabbits.
Karwacki Z, Kowianski P, Morys J, Dziewiatkowski J, Suchorzewska J.
Department of Anesthesiology and Intensive Therapy, Medical University of Gdansk, Poland.
The experimental model of the intracerebral hematoma in the rabbit was used for the investigation of the changes of the intracranial pressure and selected hemodynamic parameters. The study was performed on 13 adult rabbits, divided into two groups receiving 1 ml (group I--6 animals) and 2 ml (group II--7 animals) of fresh arterial blood, respectively. The monitoring of the intracranial pressure (ICP), the mean arterial blood pressure (MABP), the heart rate (HR), the end-tidal CO2 concentration (ETCO2) and the body temperature was measured every minute in the hematoma production phase and every 5 minutes for the consecutive three hours. The volume of the hematoma was calculated according to Cavalieri formula, with the use of the system for the automatic picture analysis. The mean volume of the intraparenchymal part of the hematoma in group I was higher than in the group II. However, in all the representatives of the second group the evidence of the intraventricular hemorrhage was present. The dynamics of the ICP, MABP and HR changes differed significantly in both groups during the period of the observation. On the basis of the physiological and morphological observations we conclude that the changes of ICP remain the most sensitive and valuable parameter during the early course of the intracerebral hemorrhage. Coexistence of the rapid ICP, MABP and HR changes must be always regarded as the possible sign of the intraventricular hemorrhage.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11057036&dopt=Abstract hemorrhage
Pediatr Surg Int. 2000;16(7):505-9.
Blunt abdominal trauma in children: epidemiology, management, and management problems in a developing country.
Ameh EA, Chirdan LB, Nmadu PT.
Department of Surgery, Ahmadu Bello University Teaching Hospital, Zaria, Nigeria.
Trauma is the leading cause of death in children in developed countries. In tropical Africa, it is only beginning to assume importance as infections and malnutrition are controlled. In developed countries, the availability of advanced imaging modalities has now reduced the necessity for laparotomy to less than 10% following blunt abdominal trauma (BAT) in children. This report reviews the epidemiology, management, and unnecessary laparotomies for pediatric BAT in a developing country in a retrospective review of 57 children aged 15 years or less at the Ahmadu Bello University Teaching Hospital, Zaria, Nigeria over 12 years. The average age was 9 years and the male-female ratio 3.8:1. Seventy-four percent (74%) of abdominal injuries in children were due to blunt trauma. The commonest causes of injury were road traffic accidents (RTA) (57%), 88% in pedestrians and 59% in children aged 5-9 years. Falls were the cause of trauma in 36%, 60% of them aged 10-15 years. Other causes of injury were sports in 5% and animals in 2%. Diagnosis was clinical, supported by diagnostic peritoneal lavage or paracentesis. Two patients had ultrasonography, and none had computed tomography. Fifty-three patients had a laparotomy, 2 died before surgery, 1 was managed nonoperatively, and in 1 surgery was declined. There were 34 splenic injuries, 20 treated by splenic preservation, splenectomy in 13, and non-operative in 1. Fourteen gastrointestinal injuries were treated in 12 patients. Of 9 hepatic injuries, 4 were minor and were left untreated, 3 were repaired, 1 was packed to arrest hemorrhage, and a lacerated accessory liver was excised. Four injuries to the urinary tract (bladder contusion 2, bladder rupture 1, ruptured hydronephrotic kidney 1) were treated accordingly. There were 4 retroperitoneal hematomas associated with other intra-abdominal injuries and 2 pancreatic contusions. One lacerated gallbladder was treated by cholecystectomy and a ruptured left hemidiaphragm was repaired transperitoneally. In retrospect, 27 (51%) patients could have been managed by observation (splenic injury 20, liver injury 5, bladder contusion 2) using advanced imaging modalities. One patient developed an intra-abdominal abscess following splenorrhaphy. The average hospital stay was 17 days. Mortality was 8 (14.5%) from gastric perforation (3), liver injury (2), splenic injury (1), and 2 patients died before surgery. BAT in this population results predominantly from RTA in pedestrians. Laparotomy may be avoided in 51% of cases if advanced imaging modalities are readily available.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11057553&dopt=Abstract hemorrhage
Laryngoscope. 2002 Nov;112(11):1940-4.
'Defatting' tracheotomy in morbidly obese patients.
Gross ND, Cohen JI, Andersen PE, Wax MK.
Department of Otolaryngology-Head and Neck Surgery, Oregon Health and Sciences University, Portland 97201, USA.
OBJECTIVES/HYPOTHESIS: Standard-sized tracheostomy tubes often fit morbidly obese patients poorly because of increased submental and anterior cervical girth. The surgeon has two options to overcome this problem: Modify the tracheostomy tube to fit the patient or recontour the neck to accommodate a standard tube. The purpose of the study was to assess the safety and morbidity of the latter technique, the "defatting" tracheotomy. STUDY DESIGN: Retrospective cohort study of 23 patients treated between 1994 and 2001 with cervical lipectomy and tracheotomy. METHODS: Medical charts were reviewed for indications, demographics, body mass index, tracheotomy-related complications, and decannulation results. RESULTS: The average age of patients was 50 years (age range, 34-77 y). The mean preoperative body mass index was 55.9 (range, 39.2-73.5). Indications for the procedure were respiratory failure requiring chronic ventilation in 16 patients (70%) and obstructive sleep apnea in 7 (30%). Four patients died postoperatively from causes unrelated to tracheotomy. The mean follow-up time of survivors was 23 months. The overall tracheotomy-related complication rate was 43%. Four patients developed wound infections in the perioperative period, one patient developed a neck abscess, and one patient required neck exploration for control of hemorrhage. Four patients (22%) developed late complications including tracheitis (1), neck abscess (1), and stenosis of the tracheocutaneous tract (2). Eight patients (44%) ultimately had decannulation. CONCLUSIONS: Defatting tracheotomy is a safe technique that allows for the placement of a standard tracheostomy tube in morbidly obese patients. It is associated with a high rate of minor infectious complications. Even so, we think that cervical lipectomy with tracheostomy tube placement is the preferred surgical option for this patient population.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=12439159&dopt=Abstract hemorrhage
Crit Care Med. 2000 Oct;28(10):3498-504.
Does early infusion of red blood cells after trauma and hemorrhage improve organ functions?
Jarrar D, Wang P, Knoferl MW, Ba ZF, Cioffi WG, Bland KI, Chaudry IH.
Center for Surgical Research and Department of Surgery, Brown University School of Medicine and Rhode Island Hospital, Providence, USA.
OBJECTIVE: Early management of trauma victims includes control of bleeding and rapid restoration of intravascular volume. However, it remains controversial whether infusion of blood products is superior to crystalloids alone. Therefore, it was the aim of the present study to determine whether resuscitation with red blood cells plus lactated Ringer's solution (RL) is more effective than RL alone in improving the cardiovascular and hepatocellular functions after trauma and severe hemorrhage. DESIGN: Prospective study. SETTING: Laboratory. SUBJECTS: Sprague-Dawley rats. INTERVENTIONS AND MEASUREMENTS: Male adult rats were anesthetized and underwent a laparotomy to induce tissue trauma before hemorrhage. The animals were then bled to and maintained at a mean arterial pressure of 40 mm Hg until 40% of the maximal bleed-out (MB) volume was returned in the form of RL, and were then resuscitated with either four times the volume of MB with RL or washed red blood cells (RBC) (-45% the volume of MB) in three times the volume of RL over 60 mins. Various in vivo heart performance variables, cardiac output, and hepatocellular function (ie, the maximum velocity and the overall efficiency of indocyanine green clearance) were determined at 4 hrs after resuscitation. Hemoglobin, systemic oxygen delivery, circulating blood volume, and plasma levels of interleukin-6 were also measured. MAIN RESULTS: At 4 hrs after RL resuscitation, heart performance, cardiac output and hepatocellular function were significantly depressed and plasma levels of interleukin-6 were significantly increased. Although infusion of RBC significantly increased mean arterial pressure, hemoglobin, and oxygen delivery compared with animals resuscitated with RL only, infusion of RBC did not further improve the depressed cardiovascular and hepatocellular functions under such conditions. CONCLUSION: Because infusion of RBC and RL resuscitation do not improve organ functions compared with RL resuscitation without RBC, it appears that pharmacologic agents in addition to fluid resuscitation are needed to restore cardiovascular and hepatocellular functions after trauma and hemorrhage.
Online source: www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=11057807&dopt=Abstract hemorrhage
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