ABSTRACT
Objective To evaluate the effects of autologous blood withdrawal-reinfusion on inflam-matory responses of patients undergoing cardiac surgery with different time courses of cardiopulmonary by-pass(CPB). Methods A total of 120 patients, aged 18-70 yr, of American Society of Anesthesiologists physical status Ⅱ-Ⅳ, were divided into 2 groups(n=60 each)using a random number table: autologous blood withdrawal-reinfusion group(ABWR group)and non-autologous blood withdrawal-reinfusion group (NABWR group). Each group was further divided into 3 subgroups(n=20 each)according to the expected time of CPB: long time course(>120 min)subgroup(L subgroup), medium time course(>60 min-≤120 min)subgroup(M subgroup)and short time course(≤60 min)subgroup(S subgroup). In group ABWR, after the end of CPB and after heparin was reversed with protamine, blood shed from the surgical field and left in the autologous blood recycling machine pipeline after the end of CPB was collected, filtra-ted, washed, concentrated and reinfused. After the end of CPB, blood left in the autologous blood recy-cling machine pipeline was directly kept in the storage bag and partially or totally reinfused in group NAB-WR. Before operation and at 1, 6, 24 and 48 h after the end of CPB, blood samples were collected for de-termination of serum tumor necrosis factor-alpha(TNF-α), interleukin-6(IL-6)and IL-10 concentrations by enzyme-linked immunosorbent assay. Results Compared with ABWR-S subgroup, the serum TNF-α and IL-6 concentrations were significantly increased at each time point after the end of CPB(P<005), and no significant change was found in serum IL-10 concentrations in ABWR-L and ABWR-M subgroups (P>005). There were no significant differences in serum TNF-α, IL-6 and IL-10 concentrations between ABWR-L subgroup and ABWR-M subgroup(P>005). Compared with NABWR subgroup of the same time course, the serum TNF-α concentration was significantly decreased at each time point after the end of CPB, the serum IL-6 concentration was decreased at 6-48 h after the end of CPB(P<005), and no significant change was found in serum IL-10 concentrations in ABWR-L subgroup(P>005); the serum TNF-α con-centration was significantly decreased at 1 h after the end of CPB, and the serum IL-6 concentration was de-creased at 6 and 24 h after the end of CPB in ABWR-M subgroup(P<005); no significant difference was found in the serum concentrations of TNF-α, IL-6 or IL-10 at each time point after the end of CDB in AB-WR-S subgroup(P<005). Conclusion With prolongation of the time courses of CPB, the efficacy of autologous blood withdrawal-reinfusion in inhibiting inflammatory responses of patients undergoing cardiac surgery is more significant.
ABSTRACT
Objective:To investigate the distribution and drug resistance of anaerobic bacteria in the patients with oral and maxillofacial infection.Methods:Aerobic and anaerobic bacteria cultures from 61 specimens of pus from the patients with oral and maxillofacial infection in the Department of Oral and Maxillofacial Surgery,Peking University School of Stomatology were identified.The culture type was evaluated by API 20A kit and drug resistance test was performed by Etest method.The clinical data and antibacterial agents for the treatment of the 61 cases were collected,and the final outcomes were recor-ded.Results:The bacteria cultures were isolated from all the specimens,with aerobic bacteria only in 6 cases (9 .8%),anaerobic bacteria only in 7 cases (1 1 .5%),and both aerobic and anaerobic bacteria in 48 cases (78.7%).There were 55 infected cases (90.2%)with anaerobic bacteria,and 81 anaero-bic bacteria stains were isolated.The highest bacteria isolation rate of Gram positive anaerobic bacteria could be found in Peptostreptococcus,Bifidobacterium and Pemphigus propionibacterium.No cefoxitin, amoxicillin/carat acid resistant strain was detected in the above three Gram positive anaerobic bacteria. The highest bacteria isolation rate of Gram negative anaerobic bacteria could be detected in Porphy-romonas and Prevotella.No metronidazole,cefoxitin,amoxicillin/carat acid resistant strain was found in the two Gram negative anaerobic bacteria.In the study,48 patients with oral and maxillofacial infection were treated according to the results of drug resistance testing,and the clinical cure rate was 81 .3%. Conclusion:Mixed aerobic and anaerobic bacteria cultures are very common in most oral and maxillofa-cial infection patients.Anaerobic bacteria culture and drug resistance testing play an important role in clinical treatment.
ABSTRACT
Objective:To compare the surgical outcomes between arthroscopic coracoclavicular ligament reconstruction and open modified Weaver-Dunn procedure for the treatment of acromioclavicular joint dis-locations.Methods:From January 2011 to June 2012, 63 consecutive patients with acromioclavicular joint dislocations who were treated with either arthroscopic coracoclavicular ligament reconstruction or open modified Weaver-Dunn procedure were retrospectively reviewed after the final follow-up.There were 49 men and 14 women with a mean age of (40.3 ±10.6) years.The mean time from injury to surgery was (10.3 ±5.3) d.According to the Rockwood classification, there were 45 patients with type V injury and 18 patients with typeⅢinjury.All the patients with typeⅢinjury claimed high level of sport activi-ty.The patients were divided into the arthroscopic surgery group (32 cases) or the open surgery group (31 cases) depending on the type of the surgery that each patient had taken.All the patients were rou-tinely followed up after the surgery.The visual analogue score ( VAS ) , American shoulder and elbow surgeons( ASES) score and University of California Los Angeles( UCLA) score were employed to evaluate the postoperative shoulder function.The postoperative radiographs of both shoulders were taken for each patient to evaluate the loss of reduction of the acromioclavicular joint.Re sults:The mean follow-up time was (29.6 ±6.0) months ( range:24 to 43 months) .No significant difference was found between the arthroscopic surgery group and the open surgery group with regard to the patient’ s age [(41.0 ±10.5) years vs.(38.0 ±10.8) years], gender (male/female,24/8 vs.25/6), classification (Ⅴ/Ⅲ,22/10 vs. 23/8), time from injury to surgery [(10.6 ±4.9) d vs.(10.1 ±5.7) d], dominant involvement (19/32 vs.17/31)and mean follow-up time [(29.8 ±6.4) months vs.(29.5 ±5.5) months], P>0.05.At the end of the last follow-up, no significant difference was noted between the two groups regarding the mean forward elevation [(164.4 ±17.2) degrees vs.(162.6 ±12.9) degrees], mean external rotation [(60.9 ±17.0) degrees vs.(57.3 ±15.8) degrees], mean internal rotation [(T12 ±3 vertebrae) vs. (T12 ±3 vertebrae)], mean ASES scores (96.0 ±5.1 vs.94.5 ±3.8)and UCLA scores (34.2 ±1.5 vs. 33.7 ±1.4), P>0.05.The rate of loss of reduction was significantly lower in the arthroscopic surgery group (1/32) compared with the open surgery group (7/31, P=0.026).Conclusion:Surgical treatment for acromioclavicular joint dislocations with either arthroscopic reconstruction or open modified Weaver-Dunn procedure could yield good results with no significant difference between the two groups as for the postoperative shoulder function.The rate of loss of reduction was lower in the arthroscopic surgery group compared with that of the open surgery group.
ABSTRACT
ObjectiveTo discuss the effect of surgical procedure and interventional procedure on coronary arterial fistula.Methods The clinical data of 25 cases of coronary arterial fistula were retrospectively analyzed.Seven cases received surgical procedures,18 cases received interventional procedures.ResultsOf the 7 cases with surgical procedures,coronary arterial fistula shunt disappeared in 6 cases after review of echocardiography,coronary arterial aneurysms was found in 1 case who had limited residual flow.Of the 18 cases with interventional procedures,12 cases were completely cured,2 cases had limited residual flow,4 cases did not succeeded.ConclusionsSurgical procedures and interventional procedures on coronary arterial fistula are safe and efficient.The choice of method should be based on the specific situation.
ABSTRACT
Objective To compare the therapeutic efficacy and procedure related complications between endoscopic sphincterotomy (EST) and surgery in treatment for choledocholithiasis concomitant with liver cirrhosis. Methods The data of patients with choledocholithiasis concomitant with cirrhosis who underwent EST (n = 139 ) or surgery (n =98 ) for stone clearance from August 1985 to May 2008,were retrospectively analyzed and compared. Results The success rates of complete stone clearance in EST and surgery groups were 95% and 100%,respectively. There was a significant difference in the rate of procedure-related complications between EST and surgery groups ( 16. 5% vs. 62. 2%,P ＜ 0. 01 ),as well as the mortality rate (5.0% vs. 24. 5% ). When patients were further grouped according to Child-Pugh liver function classification,a significant difference in rate of procedure-related complications was detected between 2 groups in patients of Child-Pugh B and C,as well as the mortality rate in patients of Child-Pugh C. Conclusion For patients with choledocholithiasis concomitant with liver cirrhosis,EST,with a stone clearance rate at 95%,is superior to surgery with a significant reduction in risk of procedure-related complication and mortality rate.
ABSTRACT
Objective To study the treatment of a or toiliac occlusive disease and prevention and management of early complications. Methods From Mar 1998 to Mar 2005, 83 aortoiliac arterial occlusion patients were treated with embolectom y by Forgaty catheter as the main therapy for acute occlusion. In cases of chron ic occlusion percutaneous transluminal angioplasty and stenting, prosthesis graf t bypass surgery as well as proximal endovascular procedure combining with dista l arterial reconstructions were adopted on case to case basis. Results There was acute aortoiliac occlus ion in 14 cases, 6 cases (42.9%) suffered from early complications after embole ctomy, with mortality of 7.1%. In chronic aortoiliac occlusion of 69 cases,va rious complications developed in 16 cases(23.2%),of which aortoiliac arteri al stent placement in 17 cases with complications of 23.5%;prosthesis bypass in 23 cases, with complications of 30.4%, and mortality of 4.3%;aortoili ac stenting combining with femoral-popliteal bypass in 29 cases(58 legs)with complications in 5 cases(17.2%). Conclusion The expansion and development of minimally invasive tech niques along with minimal invasive surgery may reduce surgical risks,decrease m obidity and mortality rate.