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简介：静脉的thromboembolism(VTE)作为深静脉血栓(DVT)和肺的栓塞(PE)被表明，代表死亡，残疾，和不快的一个重要原因。他们是各种各样的外科的过程的经常的复杂并发症。变老的人口和更严重地受伤的病人的幸存可以在损伤病人建议thromboembolism的增加的风险。在风险挑战医生扩展了人口的理解小心地检验风险因素让VTE识别能得益于预防的高风险的病人。基于证据的风险因素的精确知识在预言并且阻止手术后的DVT是重要的，并且能为appropriatethromboprophylaxis使用被合并到一个决定支持系统。在一张高风险的损伤人口的DVT预防的标准使用在下导致DVT的发生。VTE的发生在亚洲是普通的。评估包括实验室测试，Doppler测试和phlebography。屏蔽Dopplersonography应该在所有非常受伤的病人上为监视被执行识别DVT。D暗淡是一个有用标记在损伤外科病人监视预防。开始预防的最佳的调子以前在2hours之间并且在外科以后的10个小时，而是PE的风险继续因为几weeks.Thromboprophylaxis为预防包括毕业压缩袜子和抗凝剂。抗凝剂包括Warfarin，它属于维生素K对手，unfractionatedheparin，低分子的重量肝磷脂，因素Xa间接禁止者Fondaparinux，和口头的IIainhibitorMelagatran和ximelagatran。Recombinant人的solublethrombomodulin是一个新、高度有效的antithrombotic代理人。在选择损伤病人的venacaval过滤器的预防放置可以减少PE的发生。为预防劣等的静脉cava过滤器插入的指示与多重损害，关上的头损害，骨盆的破裂，脊骨破裂，多重长骨头破裂，和出席谨慎包括延长固定。多重损伤的病人在为DVT的增加的风险，但是也在流血，和肝磷脂的使用的增加的风险可以被禁忌。连续压缩设备(SCD)是为DVT预防的一种选择。压缩设备向足够的DVTprophylaxis提供低失败率和没有设�

简介：Venousmalformations(VMs)areproblematiccommonvascularmalformationsthatarechallengingevenforexperiencedphysicians.Severaltreatmentsareavailableincludingsclerotherapy,surgery,laserorcombinationsoftheseprocedures.Asnoneoftheseisspecific,westillneedtherapiesthatwouldallowtocurethesepatientswithoutcomplications.Hopefully,theunravelingofthecausativedefectsofVMswillgiveusnewtoolsforthemanagementofthisdifficultcondition.

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简介：ＩＶＣＲＥＣＯＮＳＴＲＵＣＴＩＯＮＯＦＴＨＥＤＯＧＳＷＩＴＨＤＡＣＲＯＮＳＥＥＤＥＤＷＩＴＨＡＵＴＯＬＯＧＯＵＳＶＥＮＯＵＳＦＲＡＧＭＥＮＴＳＩＶＣＲＥＣＯＮＳＴＲＵＣＴＩＯＮＯＦＴＨＥＤＯＧＳＷＩＴＨＤＡＣＲＯＮＳＥＥＤＥＤＷＩＴＨＡＵＴＯＬＯＧＯ...

简介：ObjectivesWedidaretrospectivestudytosummarizethesurgicalexperienceofanomalouspulmonaryvenousdrainage(APVD)correctionanddiscusseffectivewayofimprovingthesurgicaloutcome.MethodsFromJanuary1985toMay2008,127patients[56menand71women,aged14-55yearswithanaverageof(26.79±10.62)years]withAPVDunderwentsurgicaltreatments.Amongthem,13patientshadsimplepartialAPVDwithintactatrialseptum,104patientshadpartialAPVDwithatrialseptaldefectand10patientshadtotalAPVD.Seventy-onepatientsofthemaccompaniedwithothercardiacanomalieswhichwerealsocorrectedintheiroperations.ResultsOneearlyoperativedeathduetoseverelowcardiacoutputsyndrome(LCOS)developedpostoperatively,whichresultedinamortalityrateof0.78%.Amongotherpatients,10patientscomplicatedwithLCOS,11patientswitharrhythmia,7patientswithacuterenalfailureand4patientswithpoorwoundhealing,alldischargedfromhospitalaftertreatment.Postoperativeechocardiographyreexaminationrevealed1caseofmildresidualshuntinatrialseptumbutwithoutpulmonaryveinstenosis.ConclusionForrightatrialandventricleenlargedpatientswithorwithoutpulmonaryhypertension,surgeonsshouldbevigilanceofaccompaniedAPVDwhetheratrialseptaldefectsexistornot.Aslongasnocontraindicationsarefound,surgicaltreatmentshouldbeperformedonceaccuratediagnosisisobtained.

简介：AIM:Todeterminethecorrelationbetweenthehepaticvenouspressuregradientandtheendoscopicgradeofesophagealvarices.METHODS:FromSeptember2009toMarch2013,atotalof176measurementsofhepaticvenouspressuregradient(HVPG)weredonein146patients.EachtransjugularHVPGwasmeasuredtwice,firstusinganendwholecatheter(EH-HVPG),andthenusingaballooncatheter(B-HVPG).TheHVPGwascomparedwiththeendoscopicgradeofesophagealvarices(accordingtothegeneralrulesforrecordingendoscopicfindingsofesophagogastricvarices),whichwasrecordedwithinamonthofthemeasurementofHVPG.RESULTS:Thestudyincluded110menand36women,withameanageof56.1years(range,43-76years).Thetechnicalsuccessrateofthepressuremeasurementswas100%andtherewerenocomplicationrelatedtotheprocedures.MeanHVPGwas15.3mmHgasmeasuredusingtheendholecathetermethodand16.5mmHgasmeasuredusingtheballooncathetermethod.MeanHVPG(bothEHHVPGandB-HVPG)wasnotsignificantlydifferentamongpatientswithdifferentcharacteristics,includingsexandcomorbidfactors,exceptforcaseswithhepatocellularcarcinoma(B-HVPG,P=0.01;EH-HVPG,P=0.02).Portalhypertension(>12mmHgHVPG)occurredin66%ofpatientsaccordingtoEH-HVPGand83%ofpatientsaccordingtoB-HVGP,andsignificantlycorrelatedwithChild’sstatus(B-HVPG,P<0.000;EHHVGP,P<0.000)andesophagealvariesobserveduponendoscopy(EH-HVGP,P=0.003;B-HVGP,P=0.006).Onehundredandthirty-fiveendoscopieswereperformed,ofwhich15showednormalfindings,27showedgrade1endoscopicesophagealvarices,49showedgrade2varices,and44showedgrade3varices.WhencomparingendoscopicesophagealvaricealgradesandHVPGusingunivariateanalysis,thePvaluewas0.004forEH-HVPGand0.002forB-HVPG.CONCLUSION:BothEH-HVPGandB-HVPGshowedapositivecorrelationwiththeendoscopicgradeofesophagealvarices,withB-HVPGshowingastrongercorrelationthanEH-HVPG.

简介：BackgroundPleuraleffusionaftertheFontanoperationcontributessignificantlytomorbidityandprolongedhospitalization.Thepurposeofthepresentstudywastoinvestigatewhetherchesttubesplacedindifferentcavitiesduringthesurgerywouldcontributetothedrainageandalsotoevaluateriskfactorsofthoracicdrainagewithcentralvenouscatheteraftertotalcavopulmonaryconnectionintheeraofthecentralvenouscatheter.MethodsFromJanuary2009toJune2012,109consecutivepatientsunderwenttotalcavopulmonaryconnectionatGuangdongGeneralHospital.With102patientsforinvestigation,preoperative,intraoperativeandpostoperativefactorswereobtained.Thoracicdrainagewithcentralvenouscatheterwaswhenevernecessary.Durationofchesttubedrainageandtimeofthoracicdrainagewithcentralvenouscatheteraddeduptototaldurationofpleuraldrainage.BinarylogisticregressionusingforwardLRmethodwasappliedfortheanalysisoftheriskfactorsforthoracicdrainagewithcentralvenouscatheter.ResultsAftertotalcavopulmonaryconnection,comparedwithchesttubesplacedinsinglepleuralcavitywithorwithoutpericardialorretrosternalcavity,thoseinbothpleuralcavitiesseemedtohavethechanceoflongerhospitalstay(P=0.028).Noothersignificantdifferenceswereobtainedinfactorsofventilationtime,extubatedcentralvenouspressureinsuperiorvenacava,ICUstay,totaldurationofpleuraldrainage.Sildenafilwasthepreventivefactorforreducingcentralvenouspressureandpreventingfrompostoperativepleuraleffusion.ConclusionsAftertotalcavopulmonaryconnection,patientswithtubesplacedinbothpleuralcavitieswouldnothavethechanceofshortertotaldurationofpleuraldrainageandsurprisinglyturnsouttohavelongerhospitalstay.Sildenafilisapreventivefactorforthoracicdrainagewithcentralvenouscatheter.

简介：AbstractObjective:Acute pancreatitis (AP) results in systemic inflammatory responses and activates coagulation pathways. We intend to investigate the risk and hospital outcomes of acute venous thromboembolisms (VTE) in patients with AP.Methods:We retrospectively analyzed patients with AP from 2016 to 2019 using the National Inpatient Sample database. Primary outcome was the effect of VTE on the length of stay, inpatient costs, and mortality. Hierarchical multivariate logistic regression models were built using univariate screens.Results:The study included 909,354 weighted discharges with AP. 2.1% of cases had an acute VTE. The length of stay was 5.9 days longer in the hospital of AP patients with VTE compared to AP with no VTE (P <.001). Total hospital charge per patient was $71,914 in patients with VTE compared to AP with no VTE (P < .001). Mortality was higher in AP patients with VTE compared to AP with no VTE (adjusted odds ratio [AOR] 4.2, 95% confidence interval [CI]: 3.4-5.3, P <.001). AP was associated with an increased VTE risk during inpatient stay (AOR 1.06, 95% CI 1.04-1.1, P <.001) There was an increased association of lower and upper extremity deep venous thrombosis with AP without necrosis (AOR 6.9, 95% CI 6.4-7.4, P <.001) and AP with infected necrosis (AOR 12.2, 95% CI 10.6-14.1, P <.001) but not in AP without necrosis (AOR 0.77, 95% CI 0.74-0.81, P <.001).Conclusion:VTE in AP increases length of stay and inpatient costs. The prognosis is poor in such patients, with increased inpatient mortality compared to no VTE. AP with necrosis can increase chances of all VTE subtypes; however, AP without necrosis does not increase upper and lower extremity VTE risk.

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简介：AbstractPurpose:Venous thromboembolism (VTE) is a major health issue among hip fracture patients. This study aimed to develop an information platform based on a mobile application and then evaluate whether information platform-based nursing could improve patient's drug compliance and reduce the incidence of VTE in hip fracture patients.Methods:This study retrospectively analyzed hip fracture patients who were treated with conventional prevention and intervention methods for VTE (control group) between January 2008 and November 2012, and prospectively analyzed hip fracture patients who were treated with nursing intervention based on the information platform (study group) between January 2016 and September 2017. All the patients included in the both groups were hip fracture patients who had an age over 50 years, treated with surgery, and hospitalized ≥ 48 h. Patients were excluded if they admitted to hospital due to old fractures, had a severe bleeding after 72 h of admission, diagnosed with any type of VTE, or refused to participate in the study. The information platform was divided into medical, nursing, and patient interface. Based on the information platform, medical practitioners and nurses could perform risk assessments, monitoring management and early warnings, preventions and treatments, health educations, follow-up, and other aspects of nursing interventions for patients. This study compared essential characteristics, drug compliance, VTE occurrence, and mean length of hospitalization between the two groups. Besides, a subgroup analysis was performed in the study group according to different drug compliances. SPSS 18.0 software (IBM Corp., NY, and USA) was used for statistical analysis.Results:Altogether 1177 patients were included in the control group, and 491 patients in the study group. Regarding baseline data, patients in the study group had more morbidities than those in the control group (p < 0.05). The difference of drug compliance between the two groups was statistically significant (p < 0.001): 761 (64.7%) of the patients in the control group and only 30 (6.1%) patients in the study group had poor drug compliance. In terms of VTE, 10.7% patients (126/1177) in the control group had VTE, and the rate in the study group was 7.1% (35/491), showing a statistically significant difference (p = 0.02). Moreover, the average length of hospitalization in the study group was also significantly lower than that in the control group (10.4 days vs. 13.7 days, p < 0.001). Subgroup analyses of the study group showed that the incidence of VTE in patients with poor, partial, and good compliances were 56.7% (17/30), 5.8% (10/171), and 2.8% (8/290), respectively, revealing a significantly huge difference (p < 0.001).Conclusions:Poor drug compliance leads to higher VTE occurrence. The information platform-based nursing can effectively improve the compliance of hip fracture patients and thus considerably reduce the incidence of VTE. The mobile application may be an effective tool to prevent VTE in hip fracture patients.

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简介：瞄准：探索门静脉的影响，并且为PVA的临床的申请建立一个理论基础在门以后的血液动力学的变化仙子上的静脉的动脉血化(PVA)胆汁的脉管的丛(PVP)词法结构和肝的病理。方法：Sprague-Dawley老鼠随机被划分成控制和PVA组。在PVA以后，门静脉的血液动力学的变化和hepatohilarPVP的词法结构用Doppler超声，肝功能测试，墨水灌注透明性管理和计算机的三维的重建被观察微可视化，和病理学的检查从胆汁管墙和肝在织物上被执行。结果：在PVA以后，门静脉的代表性的区域和血流被增加，并且增加随着时间的过去变得更重要，在某个范围。如果在PVA限制流动的措施没被采用，高血流将导致肝内门静脉和它的分支的膨胀，在大桶集成通信适配器内膜在骨胶原和纤维退化增加。除了glutamic焦葡萄酸转氨酶(通用终端)，另外的肝功能测试是正常的。结论：有某个流动和氧含量的血为充满PVP并且遇见胆汁管墙的需氧量是重要的。在PVA以后，维持有在arterialized门静脉的高氧含量和高流动的血可以由并行管倒流充满PVP的hepatohilar胆汁管墙的正常形态学是解剖基础。限制血流的一项足够的措施在PVA是必要的。

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简介：AbstractIntroduction:Obstructed total anomalous pulmonary venous connection (TAPVC) is one of the commonest seen emergencies in pediatric cardiology centers.Case presentation:Our case was diagnosed to have this anomaly, showing early respiratory distress resulting from severe pulmonary congestion. Palliative stenting of the obstruction was done, which helped in stabilizing the debilitated hemodynamics of the baby before surgery, thus a good surgical outcome and prognosis are expected.Conclusion:This intervention may be listed as a vital measurement in the preoperative cardiac stabilization plan for infants with obstructed TAPVC.

简介：ＬＩＮＥＤＣＡＶＡＬ－ＩＬＩＡＣＶＥＮＯＵＳＰＲＯＳＴＨＥＳＥＳＷＩＴＨＣＵＬＴＵＲＥＤＡＵＴＯＬＯＧＯＵＳＥＮＤＯＴＨＥＬＩＡＬＣＥＬＬＳＩＮＮＯＮ－ＨＵＭＡＮＰＲＩＭＡＴＥＬＩＮＥＤＣＡＶＡＬ－ＩＬＩＡＣＶＥＮＯＵＳＰＲＯＳＴＨＥＳＥＳＷＩＴＨＣ...

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简介：AbstractIncidence of inadvertent arterial puncture secondary to central venous catheter insertion is not common with an arterial puncture rate of <1%. This is due to the advancements and wide availability of ultrasound to guide its insertion. Formation of arteriovenous fistula after arterial puncture is an unexpected complication. Till date, only five cases (including this case) of acquired arteriovenous fistula formation has been described due to inadvertent common carotid puncture. The present case is a 26-year-old man sustained traumatic brain injuries, chest injuries and multiple bony fractures. During resuscitative phase, attempts at left central venous catheter via left internal jugular vein under ultrasound guidance resulted in inadvertent puncture into the left common carotid artery. Surgical neck exploration revealed that the catheter had punctured through the left internal jugular vein into the common carotid artery with formation of arteriovenous fistula. The catheter was removed successfully and common carotid artery was repaired. Postoperatively, the patient recovered and clinic visits revealed no neurological deficits. From our literature review, the safest method for removal is via endovascular and open surgical removal. The pull/push technique (direct removal with compression) is not recommended due to the high risk for stroke, bleeding and hematoma formation.

简介：ＣＨＡＮＧＥＳＯＦ６－Ｋ－ＰＧＦ１ａＲＥＬＥＡＳＥＦＲＯＭＴＨＥＬＵＭＩＮＡＬＳＵＲＦＡＣＥＯＦＤＡＣＲＯＮＳＥＥＤＥＤＷＩＴＨＡＵＴＯＬＯＯＵＳＶＥＮＯＵＳＴＩＳＳＵＥＦＲＡＧＭＥＮＴＳＣＨＡＮＧＥＳＯＦ６－Ｋ－ＰＧＦ１ａＲＥＬＥＡＳＥＦＲＯＭＴＨ...