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A Chronic Constrictive Tuberculous Pericarditis Case With Large Calcific Pericardial Deposits 慢性缩窄性结核性心包炎伴大量钙化沉积1例
Pub Date : 2008-12-31 DOI: 10.5580/5ad
U. Yetkin, K. Erguneş, M. Bademci, B. Ozcem, A. Gürbüz
The frequency of tuberculous pericarditis has diminished in recent years. Large calcific pericardial deposits are specific signs for pericardial tuberculosis. In this study we’re presenting a case of chronic constrictive tuberculous pericarditis with large calcific pericardial deposits. Conventional open pericardiectomy via the median sternotomy , which enables a safer, wider, and more effective approach.
结核性心包炎的发病率近年来有所下降。大量钙化性心包沉积是心包结核的特殊征象。在本研究中,我们报告一例慢性缩窄性结核性心包炎伴大量钙化性心包沉积。经胸骨正中切开术的传统开放心包切开术更安全、更宽、更有效。
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引用次数: 0
Surgical Management of a Patient with Small Aorta Syndrome: Report of a case and review of the literature 小主动脉综合征患者的外科治疗:1例报告及文献复习
Pub Date : 2008-12-31 DOI: 10.5580/196b
M. Dumantepe, A. Gullu, Gurkun Komurcu, K. Ak, A. Yilmaz
Small aorta syndrome (SAS) is defined as a syndrome of peripheral obliterating arterial disease characterized by aortoiliac steno-occlusion. It typically occurs in young women of small stature with relatively typical risk factors. We present here, a 51year-old female with 2-year history of bilateral intermittent claudication who was referred to our clinic and diagnosed as having SAS. The patient was successfully treated by aortic thromboendarterectomy and inverted “Y” dacron patchplasty. Additionally, we discussed this topic with the current literature knowledge.
小主动脉综合征(SAS)是一种以髂主动脉狭窄闭塞为特征的外周闭塞性动脉疾病综合征。它通常发生在身材矮小的年轻女性身上,具有相对典型的危险因素。我们在此报告一位51岁的女性,患有2年的双侧间歇性跛行病史,她被转介到我们诊所并被诊断为SAS。患者通过主动脉血栓动脉内膜切除术和倒“Y”型涤纶修补术成功治疗。此外,我们还结合目前的文献知识对这个话题进行了讨论。
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引用次数: 0
Study To Compare The Effect Of Supine Lying Position Along With Mobilization Over Half Lying Position Head Up 45 Degree In Patients Following Open Heart Surgery 心脏直视手术后仰卧位与头部抬高45度半卧位运动效果的比较研究
Pub Date : 2008-12-31 DOI: 10.5580/2ac
I. Wani, Suhail Sangeen, Q. Khan, Muddasir Wani, Z. Shah, A. Banerjee, D. Balsaree
Effect of body positioning on lung volumes and capacities have been well established over past three decades with supine lying being the least physiological and standing the most physiological position. This study with same subject cross over design aims to compare the effect of supine lying position along with mobilization over half lying position in subjects following open heart surgery in relation to heart rate, blood pressure, partial pressure of oxygen and carbon dioxide. 30 subjects who underwent open heart surgery between 15 January 2005 to 30 January 2006 were studied.12 patient out of 30 patients studied underwent mitral valve replacement,7 patients underwent coronary artery bypass grafting ,3 patients underwent aortic valve replacement ,2 patients have undergone left atrial myxoma excision ,3 patients have undergone ventricular septal closure and 1 each have undergone atrial septal defect closure,left atrial clot excision and repair of tetralogy of fallot .Significant changes were observed between HLrr with Serr (p < .005) while non significant changes were observed in other compared variables. The overall result of this study indicate that the half lying position (Hi) is equally effective as supine lying with mobilization. Thus the null hypothesis is accepted.
在过去的三十年里,体位对肺容量和容量的影响已经得到了很好的证实,仰卧是最不符合生理的姿势,站立是最符合生理的姿势。本研究采用同一受试者交叉设计,旨在比较心内直视手术后仰卧位和半卧位下活动对心率、血压、氧分压和二氧化碳的影响。本研究对2005年1月15日至2006年1月30日期间接受心脏直视手术的30名受试者进行了研究。30例患者中,12例患者行二尖瓣置换术,7例患者行冠状动脉旁路移植术,3例患者行主动脉瓣置换术,2例患者行左心房黏液瘤切除术,3例患者行室间隔闭合术,1例患者行房间隔缺损闭合术、左房块切除及法洛四联症修复术。HLrr与Serr差异有统计学意义(p < 0.005),差异无统计学意义在其他比较变量中观察到。本研究的总体结果表明,半卧位(Hi)与仰卧位一样有效。因此,零假设被接受。
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引用次数: 1
Digital ischemia of the upper limb:Our systematic treatment protocol 上肢手指缺血:我们的系统治疗方案
Pub Date : 2008-12-31 DOI: 10.5580/fd
U. Yetkin, B. Ozpak, Aykut Şahin, I. Yurekli, A. Gürbüz
Upper limb digital ischemia is an unusual clinical entity.In this study we present the subject of digital ischemia of the upper limb and our systematic treatment protocol approach. INTRODUCTION Symptomatic upper extremity digital ischemia is an uncommon disorder reflecting diverse etiologies (1). The evaluation and treatment of our practical application for digital ischemia is demonstrated through illustrative cases. The relative rarity of vascular disorders of the arm accounts for unfamiliarity with upper extremity diagnostic testing on the part of even experienced vascular clinicians (2). Upperextremity digital ischemia needs a high index of suspicion in cases with unknown or unproven primary focus of the emboli. Prompt recognition and early consultation seem necessary to prevent or reduce the extent of the amputation (3). CASE PRESENTATION One of our cases was a 72-year-old male who had undergone coronary bypass surgery 7 years ago at our institution. He was admitted to our clinic with complaints of discoloration and pain in the 2 finger of his left hand, started 5 days ago (Figure 1). Figure 1 Figure 1 His physical examination revealed that all the peripheral pulses were palpable. Clinical examination shows a negative Allen test. His serological tests identified no pathological finding. Duplex scanning revealed no proximal source of emboli and arterial obstruction sign. Transthoracic echocardiography showed no cardiac foci for peripheral emboli. Avoidance of cold and other conservative treatment modalities were initiated. Our medical treatment strategy was as follows: Digital ischemia of the upper limb:Our systematic treatment protocol
上肢手指缺血是一种罕见的临床症状。在这项研究中,我们提出了上肢数字缺血的主题和我们系统的治疗方案方法。症状性上肢手指缺血是一种罕见的疾病,其病因多样(1)。本文通过实例说明我们对手指缺血的实际应用的评估和治疗。上肢血管疾病相对罕见,即使是经验丰富的血管临床医生也不熟悉上肢诊断测试(2)。对于栓塞原发灶未知或未经证实的病例,上肢手指缺血需要高度怀疑。及时识别和早期咨询对于预防或减少截肢的程度似乎是必要的(3)。病例介绍我们的一个病例是72岁的男性,7年前在我们的机构接受了冠状动脉搭桥手术。患者因5天前开始的左手2指变色和疼痛而入院(图1)。体格检查显示所有外周脉搏均可触及。临床检查显示艾伦试验阴性。他的血清学检查未发现病理发现。双相扫描未见近端栓子源及动脉阻塞征象。经胸超声心动图显示外周栓子未见心脏病灶。开始避免感冒和其他保守治疗方式。我们的医疗策略如下:上肢手指缺血:我们的系统治疗方案
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引用次数: 0
Is It True Bilateral Internal Thoracic Artery Harvest for Coronary Artery Bypass Grafting Increase the Risk of Mediastinitis 冠状动脉旁路移植术中切除双侧胸内动脉真的会增加纵隔炎的风险吗
Pub Date : 2008-12-31 DOI: 10.5580/e2b
E. Hijazi
Summary: The single internal thoracic artery (SITA) has been used almost exclusively as a pedicled graft. Many publications report that bilateral pedicled internal thoracic artery (ITA) grafting increases the risk of mediastinitis. Recently in order to gain the additional length, increase the number of arterial anastomoses and decrease the occurrence of deep sternal infections, there has been an increasing popularity of bilateral use of the skeletonized internal thoracic artery (ITA) for CABG. The aim of this article is to review English literature from multicenter and different cardiac surgeon's experiences regarding this fact. We used terms bilateral mammary harvesting, harvesting of bilateral mammary, mediastinitis and related keywords to search MEDLINE, other literature databases and article reference lists for English-language single versus bilateral internal mammary artery for coronary artery bypass grafting that were published from 1990 – December, 2007. Current available evidence shows that skeletonized BITA grafting carries an acceptable risk of deep sternal infection but is not recommended for repeat CABG or for patients with chronic obstructive pulmonary disease (COPD). Skeletonized BITA grafting can be safely applied in almost every patient. All cardiac surgeons should be trained efficiently in using skeletonized BITA.
摘要:单胸内动脉(SITA)几乎完全被用作带蒂移植物。许多出版物报道双侧带蒂胸椎内动脉(ITA)移植术增加了纵隔炎的风险。近年来,为了获得额外的长度,增加动脉吻合口的数量和减少胸骨深部感染的发生,双侧使用骨化胸内动脉(ITA)进行CABG越来越受欢迎。本文的目的是回顾多中心和不同心脏外科医生在这方面的经验的英文文献。我们使用术语双侧乳腺切除、双侧乳腺切除、纵隔炎及相关关键词检索MEDLINE、其他文献数据库和发表于1990年至2007年12月的英文单侧与双侧乳腺内动脉冠状动脉搭桥手术的文章参考列表。现有证据表明,骨化BITA移植具有可接受的胸骨深部感染风险,但不推荐用于重复CABG或慢性阻塞性肺疾病(COPD)患者。骨化BITA移植几乎可以安全地应用于所有患者。所有的心脏外科医生都应该接受有效的培训,学会使用骨架式BITA。
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引用次数: 0
Our medical treatment protocol for symptomatic distal ulnar artery occlusion 我们的医学治疗方案对症尺远动脉闭塞
Pub Date : 2008-12-31 DOI: 10.5580/1bf
U. Yetkin, B. Ozpak, T. Goktogan, I. Yurekli, A. Gürbüz
Arterial occlusive disease of the upper extremity is a rare entity.In this study ,we report our medical treatment protocol for symptomatic distal ulnar artery occlusion. INTRODUCTION The vascular patterns of the palmar arches and their interconnecting branches present a complex and challenging area. Improvements in microsurgical techniques have made a better understanding of vascular patterns and vessel diameters more important (1). CASE PRESENTATION Our case was a 72-year-old male. He was suffering from pain in the left hand and discoloration and coldness of the tips of 3, 4 and 5 digits for one month. Physical examination revealed no ulceration of this non-dominant hand (Figures 1&2). Only the left ulnar arterial pulse was detectable with sonic Doppler device and the remaining pulses were easily palpable. Clinical examination shows a positive Allen test for ulnar artery occlusion. Figure 1 Figure 1 Our medical treatment protocol for symptomatic distal ulnar artery occlusion 2 of 4 Figure 2 Figure 2 His past medical history was significant for Type 2 Diabetes Mellitus for 8 years that was regulated with oral antidiabetic agents. He also was an ex-smoker who quit smoking 10 years ago. Selective left upper extremity DSA revealed patent left subclavianaxillarybrachialand radial arteries (Figures 3&4). Figure 3 Figure 3 Figure 4 Figure 4 Ulnar artery was occluded at distal segment. Moreover, palmar arch was invisible and metacarpal arteries were occluded at multiple levels (Figures 5&6). Figure 5 Figure 5 Our medical treatment protocol for symptomatic distal ulnar artery occlusion 3 of 4 Figure 6 Figure 6 Taking these findings into account, our medical treatment strategy was as follows: Figure 7 He completed the late period after the onset of therapy with this ambulatory treatment protocol. His complaints of pain and discoloration completely faded away. His sensorimotor neurological status is normal. DISCUSSION Arterial occlusive disease of the upper extremity is most often due to posttraumatic occlusion of the ulnar artery. An embolic source of the ischemia should be considered most strongly when sudden ischemia or vasospasm is associated with atrial fibrillation or follows a myocardial infarction. Connective tissue disorders and several arteridities are infrequent causes of upper-extremity occlusive disease (2). Because damage to either the radial or the ulnar artery in the form of laceration or thrombosis can occur with no or minimal symptoms due to adequate collateral circulation, the prevalence of asymptomatic occlusions is unknown (3). Increased sympathetic tone from reflex vasospasm in the face of otherwise adequate collateral vessels may decrease perfusion sufficiently to cause ischemic symptoms and signs(3,4). Isolated ulnar artery occlusion is seldom the cause of digital tip necrosis (3). Only 5% of normal subjects had ulnar artery dominance in all digits(5). Arteriography still remains the reference standard for the evaluation of vascular
上肢动脉闭塞性疾病是一种罕见的疾病。在这项研究中,我们报告了我们对症状性尺远动脉闭塞的医学治疗方案。掌弓的血管形态及其相互连接的分支是一个复杂而具有挑战性的领域。显微外科技术的进步使得更好地了解血管形态和血管直径变得更加重要(1)。病例介绍:我们的病例是一位72岁的男性。他的左手疼痛,3、4、5指指尖变色、发冷,持续了一个月。体格检查显示这只非优势手没有溃疡(图1和2)。超声多普勒仪仅检测到左尺动脉脉搏,其余脉搏均可触及。临床检查显示尺动脉阻塞艾伦试验阳性。图1图1我们对症状性尺远动脉闭塞的治疗方案2 / 4图2图2他有8年的2型糖尿病病史,并使用口服降糖药进行调节。他也是10年前戒烟的前烟民。选择性左上肢DSA显示左侧锁骨下腋窝肱动脉和桡动脉未闭(图3和4)。图3图3图4图4尺动脉远段闭塞。此外,掌弓不可见,掌骨动脉在多个层面被闭塞(图5&6)。图5图5我们对症状性尺远动脉闭塞的药物治疗方案3 of 4图6图6考虑到这些发现,我们的药物治疗策略如下:图7他在开始治疗后的后期使用这种门诊治疗方案。他对疼痛和变色的抱怨完全消失了。他的感觉运动神经系统状态正常。上肢动脉闭塞性疾病最常见的原因是创伤后尺动脉闭塞。当突然缺血或血管痉挛与心房颤动或心肌梗死相关时,栓塞性缺血应被强烈考虑。结缔组织疾病和几种动脉是上肢闭塞性疾病的罕见病因(2)。由于侧支循环充足,桡动脉或尺动脉损伤可表现为撕裂或血栓形成,但无症状或症状极轻。无症状闭塞的患病率尚不清楚(3)。面对充足的侧支血管时,反射性血管痉挛引起的交感神经张力增加可能导致灌注减少,从而引起缺血性症状和体征(3,4)。孤立的尺动脉闭塞很少是导致指尖坏死的原因(3)。只有5%的正常受试者在所有手指中都有尺动脉优势(5)。动脉造影仍然是评估血管功能不全的参考标准(3)。动脉造影可用于识别上肢栓塞及其来源,并应包括主动脉弓、锁骨下近端动脉和指动脉的研究(6)。杨建军,杨建军,杨建军。掌深和掌浅弓的动脉形态。临床骨科杂志2001;(3):1-6。2. 齐默尔曼NB。上肢血管闭塞性疾病。手科学1993;9(1):139-50。3.陈建平,张建平。尺动脉闭塞症的治疗。中华手外科杂志[J]; 2008;33(9):1628- 1631。4. 科曼LA,史密斯BT,波拉克FE,史密斯TL,波拉克D,罗素GB。末梢交感神经切除对微循环的影响。中华手外科杂志1995;20:709-17。5. Kleinert JM, Fleming SG, Abel CS, Firrell J.正常指桡尺动脉优势。中华手外科杂志1989;14:504-8。6. 梅曼MH,布克斯坦JJ,伯恩斯坦EF。数字缺血:栓塞与原发性动脉疾病的血管造影鉴别。杨建军,刘建军,刘建军,等。中国生物医学工程学报,2011;30(6):1107 - 1107。我们对症状性尺远端动脉闭塞的医疗方案4 / 4作者资料:CVS教授,心血管外科(CVS),伊兹密尔·阿塔图尔克培训和研究医院Berkan OZPAK CVS住院医师,心血管外科(CVS),伊兹密尔·阿塔图尔克培训和研究医院Tayfun GOKTOGAN CVS专家,心血管外科(CVS),伊兹密尔·阿塔图尔克培训和研究医院Ismail YUREKLI CVS专家,心血管外科(CVS),伊兹密尔·阿塔图尔克培训和研究医院Ali GURBUZ诊所主任,副主任。伊兹密尔·阿塔图尔克培训和研究医院心血管外科(CVS) CVS教授
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引用次数: 0
Idiopathic deep venous thrombosis of the right upper extremity and our medical strategy 右上肢特发性深静脉血栓形成和我们的医疗策略
Pub Date : 2008-12-31 DOI: 10.5580/b24
U. Yetkin, T. Goktogan, Aykut Şahin, I. Yurekli, A. Gürbüz
Upper extremity deep vein thrombosis is a rare thrombotic disorder. Ultrasonography is the primary imaging modality for the diagnosis of upper extremity thrombosis.In this paper we present an idiopathic deep venous thrombosis of the right upper extremity and our medical strategy.
上肢深静脉血栓形成是一种罕见的血栓性疾病。超声检查是诊断上肢血栓形成的主要影像学手段。在本文中,我们提出了特发性深静脉血栓的右上肢和我们的医疗策略。
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引用次数: 0
Mitral valve repair in a case with very large giant left atrial organised thrombus 巨大左房有组织血栓二尖瓣修复1例
Pub Date : 2008-12-31 DOI: 10.5580/189d
C. Özbek, U. Yetkin, Tevfik Güne, A. Çall, A. Gürbüz
Large left atrial mural thrombus is usually observed with mitral valve disease.This mass has risks of sudden circulatory collapse and systemic embolization. The aim of mitral valve repair is to obtain a component mitral valve with the largest possible nonstenotic orifice and this repair represents a beter alternative than valve replacement.In this study ,we report a patient in whom a very large and organised thrombus in the left atrium with mitral valve stenosis and our successful surgical removal therapy.We considered the emergent surgery for the large left atrial mural thrombus. This approach at the time is the best treatment option. Mitral valve repair is now clearly established that restoration of a normal mitral valve function with reconstructive surgery is preferable to replacement with a device,whether bioprosthetic or mechanical.
大的左心房附壁血栓常见于二尖瓣病变。这个肿块有突然循环衰竭和全身栓塞的危险。二尖瓣修复的目的是获得一个具有尽可能大的非狭窄孔的二尖瓣,这种修复是比瓣膜置换术更好的选择。在这项研究中,我们报告了一位左心房有非常大的有组织血栓并二尖瓣狭窄的患者,我们成功地进行了手术切除治疗。我们考虑紧急手术治疗大面积左心房附壁血栓。这种方法在当时是最好的治疗选择。二尖瓣修复现在已经明确地确定,用重建手术恢复正常的二尖瓣功能优于用装置替代,无论是生物假体还是机械装置。
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引用次数: 1
Endarterectomy for diffuse right coronary artery disease 弥漫性右冠状动脉病变的动脉内膜切除术
Pub Date : 2008-12-31 DOI: 10.5580/bd7
U. Yetkin, T. Goktogan, B. Ozpak, A. Gürbüz
Coronary endarterectomy has become a safe procedure.In this study ,we report a case that we applied a successful endarterectomy for diffuse right coronary artery disease.
冠状动脉内膜切除术已成为一种安全的手术。在本研究中,我们报告一例成功应用动脉内膜切除术治疗弥漫性右冠状动脉疾病。
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引用次数: 0
Cardiac Injuries Due To Blunt Trauma 钝性外伤引起的心脏损伤
Pub Date : 2008-12-31 DOI: 10.5580/106e
U. Yetkin, smail Yürekli, S. Bayrak, C. Özbek, brahim Özsöyler, A. Gürbüz
Blunt cardiac trauma develops frequently following motor-vehicle accidents and its mortality rate is high. Early use of echocardiography for the initial assessment of severely injured patients has facilitated to detect the associated cardiac injuries. Fast transportation, urgent diagnostic workup and immediate surgical intervention to these patients with well-trained teams are very important and this approach will improve their survival. INTRODUCTION AND BRIEF HISTORY Although cardiac injuries have been known since ancient era, their surgical interventions couldn't have been possible until 19th century. In 16th century, Fabricius reported that cardiac injuries resulted in sudden death and that it was impossible to treat these injuries; even an attempt made to treat was unnecessary. First case with cardiac injury was reported by Oluff Borch. First case with myocardial contusion was defined Akenside in 1764. Pericardiocentesis as a treatment modality for cardiac injury was first recommended by Riolanus in 1649. But first successful pericardiocentesis was performed in 1829 by Larrey. Suturing a cardiac wound was first recommended by Roberts in 1881. Between years 1882 and 1885, surgical correction of cardiac wounds in experimental animals were reported. In 1897, Rehn reported the first successful repair of a penetrating cardiac wound (1).
钝性心脏创伤多发于机动车事故,死亡率高。早期使用超声心动图对严重损伤患者进行初步评估,有助于发现相关的心脏损伤。在训练有素的团队中,快速的运输、紧急的诊断检查和立即的手术干预对这些患者非常重要,这种方法将提高他们的生存率。虽然心脏损伤自古以来就为人所知,但直到19世纪才有可能进行手术干预。16世纪,法布里修斯报告说,心脏损伤会导致猝死,而且这种损伤是无法治疗的;甚至尝试治疗都是不必要的。第一例心脏损伤报告由Oluff Borch。第一例心肌挫伤于1764年被定义为Akenside。1649年,里奥兰纳斯首次推荐心包穿刺作为心脏损伤的治疗方式。但第一次成功的心包穿刺术是在1829年由拉里进行的。1881年,罗伯茨首次建议缝合心脏伤口。1882年至1885年间,有实验动物心脏伤口手术矫正的报道。1897年,Rehn报道了首例心脏穿透性伤口的成功修复(1)。
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引用次数: 1
期刊
The Internet Journal of Thoracic and Cardiovascular Surgery
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