ObjectiveTo analyze the relationship between image development types and delay time in computed tomography urography (CTU) examination and to investigate the value of choosing reasonable delay time to get the best images. MethodWe collected the data of 62 patients who underwent multi-slice CTU examination without fully developed images within 8 minutes from January 2010 to May 2014. There were 35 unilateral and 27 bilateral delayed imaging patients with a total of 89 cases. According to the degree of imaging development after the delayed 8 minutes, we divided it into 4 levels as follows:level 0 (no development), levelⅠ (light development), levelⅡ (partial development) and levelⅢ (full development). LevelⅢ was not included in this study. For level 0 to levelⅡ, we delayed scan for 15 to 1 440 minutes. ResultsAs the imaging development degree decreased, the delay time obviously extended. LevelⅡ could be fully displayed after 15 to 150 minutes of delayed scan. LevelⅠ could be fully displayed after 150 to 720 minutes. Level 0 still had no imaging development after 120 minutes, so there was no need to continue scanning. ConclusionsSelecting appropriate delay time of CTU based on the type of delayed imaging development can avoid unnecessary repeated delay scans, get the best development images, and estimate the kidney secretion functions, which is most helpful for accurate diagnosis of urinary system related diseases.
Delayed encephalopathy due to acute carbon monoxide poisoning (DEACMP) is a serious complication of acute carbon monoxide poisoning. Patients with DEACMP often present with cognitive impairment, abnormal mental behavior, extrapyramidal system symptoms, pyramidal system symptoms, and may also have focal cortical dysfunction, which is closely related to the poor prognosis of the patients. Current research shows that the occurrence of DEACMP is related to multiple factors such as immune disorders, and glucocorticoids can exert certain therapeutic effects through immunosuppression. This article reviews the risk factors of DEACMP, the clinical research progress and possible mechanisms of glucocorticoid treatment for DEACMP, providing more references for the clinical treatment of DEACMP.
ObjectiveTo analyze risk factors of gastric paralysis following pancreaticoduodenectomy so as to offer help for prevention and treatment of gastric paralysis. MethodDomestic and international literatures about gastric paralysis following pancreaticoduodenectomy were collected, diagnostic criteria, risk factors, and the latest progress of gastric paralysis were summarized. ResultsGastric paralysis is one of the most common postoperative complications following pancreaticoduodenectomy. It might be caused by many risk factors, such as operation method, gastrointestinal anastomosis, abdominal complications, chronic hyperglycemia, and excess infusion, etc. ConclusionsAlthough definition of gastric paralysis by ISGPS is widely adopted, it fails to distinguish gastric paralysis from impaired gastric function related to other postoperative complications and it might result in an overestimation of its true morbidity. The risk factors of occurrence of gastric paralysis are still in controversy and results of research in different centers are not same, more prospective randomized controlled trials are needed.
Objective To investigate the surgical technique and effectiveness of volar locking plates for senile delayed distal radius fractures. Methods Between October 2014 and September 2015, 25 cases of delayed distal radius fractures were treated by volar locking plates. There were 3 males and 22 females with an average age of 73 years (range, 65-87 years). Injury was caused by tumble in 19 cases and by traffic accident in 6 cases. All the cases had closed fracture. According to the AO classification, 10 cases were rated as type A2, 7 cases as type A3, 3 cases as type B3, and 5 cases as type C1. The manual reduction and plaster immobilization were performed in 18 cases first, but reduction failed; no treatment was given in 7 cases before surgery. The time from injury to surgery was from 33 to 126 days (mean, 61 days). Preoperatively, the volar tilting angle was (–16.0±3.1)°; the ulnar inclining angle was (10.8±7.0)°; the radial shortening was (11.2±3.6) mm; the wrist range of motion was (41.0±7.5)° in flexion and was (42.0±6.3)° in extension; and the grip strength was 33.0%±3.1% of normal side. Results All incisions healed primarily, and no postoperative complication occurred. The patients were followed up 1-1.5 years (mean, 1.3 years). The X-ray films showed that fracture union was achieved in all the patients, with the mean healing time of 9.2 weeks (range, 8-12 weeks); the displacement of the articular surface was less than 1 mm. At last follow-up, the volar tilting angle was (13.1±3.2)°; the ulnar inclining angle was (21.9±4.6)°; the radial shortening was (2.0±1.1) mm; the wrist range of motion was (52.0±11.7)° in flexion and was (65.0±4.8)° in extension; and the grip strength was 84.0%±4.2% of normal side; all showed significant difference when compared with preoperative ones (P<0.05). According to the Gartland and Werley score, the results were excellent in 15 cases, good in 6 cases, fair in 2 cases, and poor in 2 cases at last follow-up; the excellent and good rate was 84%. Conclusion By the good design of the volar locking plate and the command of surgical techniques, good effectiveness can be achieved in the treatment of senile delayed distal radius fracture.
ObjectiveTo investigate the effect of delayed sternal closure (DSC) on sternal wound debridement after pediatric cardiac surgery. MethodsWe retrospectively analyzed clinical data of 491 pediatric patients underwent DSC in Guangdong General Hospital between June 2009 and June 2014. There were 333 males and 158 females with age of 1 day to 153.37 (5.68±17.24) months. The rate of sternal wound debridement between the DSC patients and the non-DSC patients was compared. ResultsA total of 454 pediatric patients with DSC initiated in the operation room. And 37 patients with DSC initiated in intensive care unit after emergency sternotomy. A total of 392 patients with delayed sternal closure were discharged. Eight patients gave up treatment for family reasons and 91 patients died. Patients with DSC had higher incidence of sternal wound debridement than the patients with non-DSC did (χ2=6.693, P=0.010). ConclusionDSC is an effective treatment for children with severe cardiac surgery, while it causes higher incidence of sternal wound debridement.
The implantation of biventricular assist device (BiVAD) is more challenging than that of left ventricular assist device for the interaction in the process of multiple input and output. Besides, ventricular assist device (VAD) often runs in constant speed (CS) mode in clinical use and thus BiVAD also faces the problems of low pulsation and imbalance of blood volume between systemic circulation and pulmonary circulation. In this paper, a delay assist mode for a VAD by shortening the support time of VAD was put forward. Then, the effect of the delay mode on cardiac output, pulsation and the function of the aortic valve was observed by numerical method and the rules of hemodynamics were revealed. The research showed that compared with VAD supported in CS mode, the VAD using delay mode in systolic and diastolic period proposed in this paper could meet the demand of cardiac output perfusion and restore the function of the arterial valves. The open ratio of aortic valve (AV) and pulmonary valve (PV) increased with the time set in delay mode, and the blood through the AV/PV helped to balance the left and the right cardiac volume. Besides, delay mode also improved the pulsation index of arterial blood flow, which is conducive to the recovery of the ventricular pulse function of patients.
Objective To determine risk factors of delayed recovery of consciousness after aortic arch surgery underdeep hypothermic circulatory arrest （DHCA） and antegrade selective cerebral perfusion （ASCP）. Methods We retrospectively analyzed clinical data of 113 patients who underwent aortic arch surgery under DHCA＋ASCP in the Affiliated Drum Tower Hospital， Medical School of Nanjing University from October 2004 to April 2012. According to whether they regained consciousness within 24 hours after surgery， all the 113 patients were divided into normal group （73 patients including 55 males and 18 females with their average age of 48.1±10.9 years） and delayed recovery group （40 patients including 29 males and 11 females with their average age of 52.2±11.4 years）. Risk factors of delayed recovery of consciousness after surgery were evaluated by univariate analysis and multivariate logistic regression analysis. Results Nine patients （8.0%） died postoperatively， including 5 patients with multi-organ failure， 2 patients with heart failure， 1 patient with mediastinal infection， and 1 patient with pulmonary hemorrhage. There were 7 deaths （17.5%） in the delayed recovery group and 2 deaths （2.7%） in the normal group， and the in-hospital mortality of the delayed recovery group was significantly higher than that of the normal group （P=0.016）. A total of 94 patients （including 65 patients in the normal group and 29 patients in the delayed recovery group） were followed up for 4-95 months. Eight patients （including 5 patients in the normal group and 3 patients in the delayed recovery group） died during follow-up， including 2 patients with stroke， 3 patients with heart failure， 2 patients with pulmonary hemorrhage and 1 patient with unknown cause. Ten patients were lost during follow-up. Univariate analysis showed that age （P=0.042）， hypertension （P=0.017）， emergency surgery （P=0.001）， cardiopu- lmonary bypass （CPB） time （P=0.007）， aortic cross-clamp time （P=0.021）， and blood transfusion（P=0.012）were risk factors of delayed recovery of consciousness after aortic arch surgery. Multivariate logistic regression showed that emergency surgery （P=0.005） and CPB time＞240 minutes （P=0.000） were independent risk factors of delayed recovery of consciousness after aortic arch surgery. Conclusion Delayed recovery of consciousness after aortic arch surgery is attributed to a combination of many risk factors. Correct patient diagnosis， lesion site and involved scope should be made clear preoperatively in order to choose appropriate surgical strategies. During the surgery， strengthened brain protection， shortened operation time， improved surgical techniques， and perioperative stable circulation maintenance are all important measures to prevent delayed recovery of consciousness after aortic arch surgery.
rough the ultramicroscopic observation on muscle and microcirculation, Group A,where a largeamount of DXM combined with heporin was given svstematically and locally into the femoral artery of the severed limb before replantation, and in Group B only heporin was given, and Group C and D ascontrol.The results showed that if the hormone and heparin were administred in large dosage, it wasadvantageous to reduce the tissues from reperfusion injury during delayed replantation.
Acute carbon monoxide poisoning is a common and frequently occurring disease in winter and spring in China, with high disability and mortality. Delayed encephalopathy is a serious sequela after the pseudo-convalescence. Its mechanism is complex, including environmental and genetic factors, hypoxia and energy metabolism disorder, cytotoxicity and oxygen free radical damage, immune disorder and inflammatory activation, neurotransmitter disorder, brain parenchymal changes, vascular and hemorheological abnormalities, calcium overload, and cell apoptosis. At present, methods for predicting delayed encephalopathy in acute carbon monoxide poisoning include detailed inquiry of medical history, laboratory examination of relevant indicators, electrophysiological examination, brain imaging examination, and evaluation scale prediction. This review summarizes the research status of the pathogenesis and early prediction methods of delayed encephalopathy in acute carbon monoxide poisoning, with a view to providing reference for future research directions.
ObjectiveTo analyze the risk factors for delayed sternal closure (DSC) in the operation for the neonates with congenital heart defects. MethodsWe retrospectively analyzed the case notes of the 203 neonates with congenital heart defect in our hospital between January 2010 and June 2014. There were 152 males and 51 females at age of 0-28 (17.68±8.62) days. The relative factors were analyzed by univariate and multivariate logistic regression. ResultsThese factors significantly correlated with DSC in univariate analysis:age at operation, premature, low weight (weight≤2.5 kg) at operation/weight at operation, RACHS-1, mechanical ventilation before operation, continuous use of intravenous cardiovascular drugs before operation, CPB time, aortic clamping time, total circulatory arrest with profound hypothermia. The results of logistic regression analysis showed that weight at operation/low weight, pre-operative mechanical ventilation, total circulatory arrest with profound hypothermia were independent risk factors for DSC. ConclusionWeight at operation/low weight, pre-operative mechanical ventilation, and total circulatory arrest with profound hypothermia are the independent risk factors for DSC in the operation for the neonates with congenital heart defects.