ABSTRACT
Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN), for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.
Subject(s)
Adult , Aged , Humans , Emergency Service, Hospital , Endotoxins , Extracorporeal Membrane Oxygenation , Hemodynamics , Hemoperfusion , Nephrectomy , Polymyxin B , Pyelonephritis , Shock, SepticABSTRACT
Conventional medical therapies have not been very successful in treating adults with refractory septic shock. The effects of direct hemoperfusion using polymyxin B and veno-arterial extracorporeal membrane oxygenation (ECMO) for refractory septic shock remain uncertain. A 66-year-old man was admitted to the emergency department and suffered from sepsis-induced hemodynamic collapse. For hemodynamic improvement, we performed direct hemoperfusion using polymyxin B. Computed tomography scan of this patient revealed emphysematous pyelonephritis (EPN), for which he underwent emergent nephrectomy with veno-arterial ECMO support. To the best of our knowledge, this is the first report of successful treatment of EPN with refractory septic shock using polymyxin B hemoperfusion and nephrectomy under the support of ECMO.
Subject(s)
Adult , Aged , Humans , Emergency Service, Hospital , Endotoxins , Extracorporeal Membrane Oxygenation , Hemodynamics , Hemoperfusion , Nephrectomy , Polymyxin B , Pyelonephritis , Shock, SepticABSTRACT
PURPOSE: The purpose of this study was to present the results after functional reconstruction of the digits using palmaris longus tendocutaneous arterialized venous free flap in digits with compound defects. METHODS: This study is based on 29 cases of palmaris longus tendocutaneous arterialized venous free flaps harvested from the ipsilateral wrist for the reconstruction of compound defect of the digits. Over the past 10 years, we performed in 17 cases of complex defects of extensor tendon on dorsum of the digits, 7 cases of collateral ligament of the proximal or distal interphalangeal joint and 5 cases of flexor tendon defect with soft tissue defect on the palmar aspect of the digits. We assessed survival rate of the flaps and functional recovery of the digits. RESULTS: All free flaps completely survived except one with completele necrosis and another one with 50% necrosis. In cases of extensor tendon defect, the mean total active range of motion of the digits was 180degrees, in cases of flexor tendon reconstruction, it was 165degrees. In reconstruction of collateral ligament of interphalangeal joint of the thumb and digits, flexion and extension was within normal range and we got very good results without instability in all 7 cases. CONCLUSION: Palmaris longus tendocutaneous arterialized venous free flaps are very useful for reconstruction of composite defect of the digits with extensor or flexor tendons as well as collateral ligaments.
Subject(s)
Collateral Ligaments , Free Tissue Flaps , Joints , Necrosis , Range of Motion, Articular , Reference Values , Survival Rate , Tendons , Thumb , WristABSTRACT
A series of 4 patients with aneurysm of distal anterior cerebral artery(DACA), operated with microtechniques, is reviewed. Because the incidence of aneurysms in this location was only 2 to 4% of that of total aneurysm, little expericences on surgical management of this aneurysm have been reported. An aneurysm in this location is difficult to approach surgically because of their multiplicity, characteristically broad and sclerotic base, with small subarachnoid space in the interhemispheric fissure. We surgically treated DACA aneurysms of 4 cases through the interhemispheric approach via the unilateral frontal paramedian craniotomy on the nondominant side.
Subject(s)
Humans , Aneurysm , Anterior Cerebral Artery , Craniotomy , Incidence , Intracranial Aneurysm , Subarachnoid SpaceABSTRACT
The authors attempted to analyse the factors influencing the mortality involved in aneurysm surgery based on 38 cases of intracranial surgery for anterior communicating aneurysms, and obtained the following conclusion. 1. The surgical results are much better when the aneurysm surgery is delayed over one week after the occurrence of aneurysmal rupture, if there is no evidence of intracerebral hematoma. Administration of a massive dosage of epsilon aminocaproic acid in the waiting period prior to aneurysm surgery seems to be effective for preventing recurrence of bleeding from the aneurysm. 2. The direction of the anterior communicating aneurysm should be clearly visualized on a cerebral angiogram so that the most effective aneurysmal approach can be selected in surgery. 3. Microsurgery and hypotension in aneurysm surgery minimize brain damage in the exposure of aneurysm and provide accurate isolation of the aneurismal neck from the parent vessel in aneurysmal neck ligation. 4. Proximal ligation of the anterior cerebral artery is also an effective procedure to prevent recurrent hemorrhage from anterior communicating aneurysm.