Percutaneous transluminal angioplasty was used to treat 101 patients with saphenous vein bypass graft stenosis at a mean of 50.1 months (range 2 to 196) after coronary artery bypass surgery. The ...patients presented between March 1981 and April 1987. A total of 107 saphenous vein grafts were dilated at 117 sites.
The primary success rate was 91.8%. The incidence of cardiac complications was 7.1%. There were no cardiac complications in 53 patients with grafts implanted <36 months before angioplasty (Group 1). The 48 patients with grafts implanted for >36 months (Group 2) had a 12.5% incidence rate of myocardial infarction, a 4% incidence rate of emergent bypass surgery and a 4% incidence rate of death for an overall cardiac complication rate of 14.9% (p < 0.01).
Follow-up was obtained at a mean of 16.8 ± 13.9 months (range 1 to 54) in 87 patients (97% of successful cases). Repeat coronary angiography was performed in 49 patients and revealed restenosis in 30 patients (61.2%), with no difference in recurrence rates for proximal, mid or distal graft sites. Clinical recurrence (defined as recurrence of symptoms, myocardial infarction, repeat angioplasty, surgery or death) was 33.1% for Group 1 patients and 64.1% for Group 2 patients (p < 0.01).
The complication and recurrence rates of saphenous vein graft angiography are significantly higher when performed for late (>36 months) vein graft failure. All therapeutic options should be carefully examined before proceeding with angioplasty for saphenous vein graft stenosis in this type of patient.
Conventional techniques result in chordee correction in the majority of patients. However, some with extensive chordee require further treatment to correct persistent extraordinary penile curvature. ...Our practice has been to treat this condition with interpositional dermal grafting. We review our experience with this procedure.
During a 5-year period dermal grafts harvested from the nonhair-bearing inguinal skin fold were placed in 51 patients with a mean age of 29 months. The primary diagnosis was penoscrotal or perineal hypospadias in 36 patients (hypospadias cripple in 4), the exstrophy-epispadias complex in 3, mid shaft or distal hypospadias with severe chordee in 10 and chordee without hypospadias in 2. A total of 49 patients (96%) underwent staged urethroplasty.
One graft was placed in 29 patients (57%), 9 (18%) received 1 graft and underwent a Nesbit plication, (14%) received 2 grafts, 5 (10%) received 2 grafts and underwent dorsal plication, and 1 (2%) received 3 grafts. Second stage urethral reconstruction was done using a Thiersch-Duplay tube in the majority of cases. In 5 patients mild residual chordee was easily corrected at the time of second stage repair.
In a staged repair the first priority of the initial stage is to achieve a straight phallus. While our experience indicates that a single dermal graft is sufficient in approximately 57% of cases, when it does not result in complete straightening, we have had success with placing additional graft(s) and/or performing dorsal plication. We believe that the additional penile length achieved with dermal grafting results in a dependent phallus and cosmesis preferable to that of plication only.
Índice de inmunidad-inflamación sistémica en sepsis Lagunas-Alvarado; Mijangos-Huesca, FJ; Terán-González, JO ...
Revista de la Asociación de Medicina Interna de México,
06/2017, Letnik:
33, Številka:
3
Journal Article
Recenzirano
Odprti dostop
Resumen ANTECEDENTES: se han estudiado índices de pronóstico de inflamación basados en células periféricas como predictores de disfunción endotelial, riesgo cardiovascular y mortalidad. En 2014 se ...desarrolló el índice de inmunidad-inflamación sistémica (IIS) que se ha propuesto como factor de pronóstico y de seguimiento en cáncer. OBJETIVO: determinar si existe modificación del índice de inmunidad-inflamación sistémica (IIS) en pacientes con sepsis. MATERIAL Y MÉTODO: estudio retrospectivo que incluyó aleatoriamente a pacientes hospitalizados de 2013 a 2015. Se verificó la homogeneidad de poblaciones demostrando que no existía diferencia estadística entre la edad y comorbilidades (distribución Kolmogorov-Smirnov), frecuencia de comorbilidades (χ2). Se calculó el IIS con la citometría hemática de ingreso. Se compararon las medias del IIS de pacientes con sepsis y sin sepsis (Wilcoxon) y se determinó si había correlación entre el IIS y sepsis (coeficiente de correlación biserial puntual). RESULTADOS: se incluyeron 242 pacientes (128 con sepsis, edad promedio de 70.1 años y 114 sin sepsis, edad promedio de 69.7 años). La media del índice de inmunidad-inflamación sistémica (IIS) en pacientes con sepsis fue 4444.06x109, en pacientes sin sepsis fue de 3013.94x109. Se demostró que existe correlación estadísticamente significativa entre el IIS y sepsis (rbp= 0.150253625, p=0.05), se demostró que la media del IIS fue significativamente más elevada en pacientes con sepsis (W=5,097, p=0.00001). CONCLUSIONES: el índice de inmunidad-inflamación sistémica (IIS), un índice innovador que ha mostrado mejor efectividad para describir el desequilibrio de inmunidad e inflamación, se propone como una herramienta que puede ser útil en pacientes con sepsis; sin embargo, se requieren estudios futuros para comprobar su potencial pronóstico y de seguimiento.
THE continuous administration of beta-adrenergic—antagonist drugs induces a sustained decrease in portal pressure in patients with cirrhosis.
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As a result, these drugs have been used to ...prevent gastrointestinal bleeding, a leading cause of death in patients with portal hypertension. There are published reports of four randomized clinical trials of beta-adrenergic—antagonist drug treatment — two using propranolol
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and two using nadolol
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— to prevent a first episode of gastrointestinal bleeding due to portal hypertension in patients with cirrhosis.
The percentages of patients who had no bleeding and the survival rates were dissimilar in these four trials. In two studies, the treatment . . .
Haziness at sites of balloon angioplasty is believed to represent plaque fractures or platelet deposition. The etiology of haziness adjacent to coronary stents remains uncertain. This study examines ...the prevalence and etiology of "peri-stent" haziness following high-pressure deployment. Consecutive patients undergoing coronary stenting and intravascular ultrasound imaging were included. Haziness was defined as nonhomogeneous contrast density and/or indistinct vessel borders by consensus of 2 observers. Patients were excluded if angiography revealed an obvious cause of haziness (thrombus, dissection). Matched control segments without haziness were selected for comparison. The most diseased site within the reference segment was identified by ultrasound. Lumen and plaque areas, percent plaque area, and plaque echo density were assessed. Haziness was identified within 31 segments in 30 patients (15% of 201 angiograms examined). At hazy sites, ultrasound revealed a large percent plaque area in 15, dissections in 14, and near-normal findings in 2 segments. In the absence of dissection, percent plaque area and lumen area step-down from the stent to the diseased reference were greater than controls (percent plaque area 64 +/- 12% vs 56 +/- 10%, p = 0.04 and lumen step-down 35 +/- 20% vs 13 +/- 25%, p = 0.006). With dissections, percent plaque area and lumen step-down were not different from controls (p = 0.13 and 0.30, respectively), but underlying plaques were more frequently echolucent (64% vs 23%, p = 0.02). Thus, in this study, peri-stent haziness was evident in 15% of patients after high-pressure coronary stent deployment. Etiologies identified by intravascular ultrasound included unrecognized reference plaque and angiographically occult dissections.
A total of 33 patients age 35 years or younger underwent percutaneous transluminal coronary angioplasty (PTCA) at The Cleveland Clinic Foundation between January 1981 and October 1987. Arteriography ...showed one-, two-, and three-vessel disease in 16, 12, and 5 patients, respectively. Twenty-four patients (73%) had functional Class 3 or 4 angina and 17 (52%) had unstable angina. PTCA was performed in one vessel each in 22 patients and in multiple vessels in 11 patients. Of 47 vessels, 44 (94%) were successfully dilated. There were no deaths, emergency bypass procedures, or myocardial infarctions during hospitalization. At a mean follow-up of 30 months, there were two late deaths, nine repeat PTCA procedures, one coronary bypass, and one nonfatal myocardial infarction. Due to the progressive nature of coronary artery disease in the young adult, PTCA appears to be a good therapeutic modality for selected patients in this age group.
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