Current surgery最新文献_第4页

Intestinal Fatty Acid Binding Protein (I-FABP) for the Detection of Strangulated Mechanical Small Bowel Obstruction 肠脂肪酸结合蛋白(I-FABP)检测绞窄性机械性小肠梗阻

Current surgery Pub Date : 2006-09-01 Epub Date: 2006-09-10 DOI: 10.1016/j.cursur.2006.05.006

Daniel R. Cronk MD , Troy P. Houseworth MD , Daniel G. Cuadrado MD , Garth S. Herbert MD , Patrick M. McNutt PhD , Kenneth S. Azarow MD

{"title":"Intestinal Fatty Acid Binding Protein (I-FABP) for the Detection of Strangulated Mechanical Small Bowel Obstruction","authors":"Daniel R. Cronk MD , Troy P. Houseworth MD , Daniel G. Cuadrado MD , Garth S. Herbert MD , Patrick M. McNutt PhD , Kenneth S. Azarow MD","doi":"10.1016/j.cursur.2006.05.006","DOIUrl":"10.1016/j.cursur.2006.05.006","url":null,"abstract":"<div><h3>Objective</h3><p>Intestinal fatty acid binding protein (I-FABP), a protein released by necrotic enterocytes, is a useful marker for the detection of ischemia from mechanical small bowel obstruction.</p></div><div><h3>Design</h3><p>Validation cohort.</p></div><div><h3>Setting</h3><p>Academic medical center.</p></div><div><h3>Participants</h3><p>Cohort of 21 patients admitted with a clinical diagnosis of mechanical small bowel obstruction. Plasma and urine samples were collected from patients upon hospital admission and again immediately before laparotomy if surgical intervention was delayed.</p></div><div><h3>Results</h3><p>Plasma and urine I-FABP levels (pg/ml by enzyme-linked immunosorbent assay) in patients found to have small bowel necrosis at the time of laparotomy were compared with those without significant ischemia upon laparotomy and those that did not require laparotomy and, by default, did not have small bowel ischemia. A positive test was defined as 1000-pg/ml I-FABP in urine and 100-pg/ml I-FABP in plasma. Small bowel necrosis was confirmed in 3 of 21 enrolled patients. Urine I-FABP levels were positive in 3 of 3 patients with necrosis and 3 of 18 patients without necrosis (sensitivity 100%, specificity 83%, PPV 50%, NPV 100%). Plasma I-FABP levels were positive in 3 of 3 patients with necrosis and 4 of 18 patients without necrosis (sensitivity 100%, specificity 78%, PPV 43%, NPV 100%).</p></div><div><h3>Conclusions</h3><p>I-FABP is a sensitive marker for ischemia in mechanical small bowel obstruction. Additional work should be done to validate I-FABP in a variety of clinical settings and to develop a rapid I-FABP laboratory assay.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 5","pages":"Pages 322-325"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.05.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26252033","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 94

Preparing for the In-Service Examination 准备在职考试

Current surgery Pub Date : 2006-09-01 Epub Date: 2006-09-10 DOI: 10.1016/j.cursur.2006.04.005

Paul S. Vietzen MD

引用次数: 1

Adenocarcinoma of the Distal Pancreas Presenting as an Intrathoracic Mass 胰腺远端腺癌表现为胸内肿块

Current surgery Pub Date : 2006-09-01 Epub Date: 2006-09-10 DOI: 10.1016/j.cursur.2006.05.002

Bradley Hart MD , Richard Erickson MD , Christen LeBlanc MD , Staci Hix-Hernandez MD , Mohsen Shabahang MD

引用次数: 1

The Risk of Carotid Endarterectomy in Patients with Chronic Renal Insufficiency 慢性肾功能不全患者颈动脉内膜切除术的风险

Current surgery Pub Date : 2006-09-01 Epub Date: 2006-09-10 DOI: 10.1016/j.cursur.2006.06.006

Ahmad Tarakji MD, Amy McConaughy PA-C, Gary G. Nicholas MD

{"title":"The Risk of Carotid Endarterectomy in Patients with Chronic Renal Insufficiency","authors":"Ahmad Tarakji MD, Amy McConaughy PA-C, Gary G. Nicholas MD","doi":"10.1016/j.cursur.2006.06.006","DOIUrl":"10.1016/j.cursur.2006.06.006","url":null,"abstract":"<div><h3>Objective</h3><p>Carotid endarterectomy (CEA) has been associated with less favorable outcome in patients with chronic renal insufficiency (CRI). The authors compared results of CEA in the presence and absence of CRI at their institution over a 5-year period.</p></div><div><h3>Design/setting/participants</h3><p>This article is a retrospective review of 1351 patients who underwent CEA between 1998 and 2004. Chronic renal insufficiency was present in 143 patients. Renal insufficiency was graded as <em>mild</em> (creatinine 1.6-2.9 mg/dL) or <em>severe</em> (creatinine ≥3.0 mg/dL or on hemodialysis). The composite endpoint was stroke or death within 30 days postoperatively. The results were compared with 150 consecutive patients having CEA in the absence of renal insufficiency between 2002 and 2003.</p></div><div><h3>Results</h3><p>For the 143 patients with CRI, the composite endpoint was 9.0%, whereas the composite endpoint for the 150 control patients without CRI was 2.6% (p = 0.032). For patients with severe CRI (creatinine ≥3.0 or on hemodialysis), the composite endpoint was 19.0% (p = 0.08). For those with mild CRI (creatinine 1.6-2.9), the composite endpoint was 7.3% (p = 0.06).</p></div><div><h3>Conclusions</h3><p>Chronic renal insufficiency is associated with increased incidence of stroke, myocardial infarction, and death after CEA. For patients with advanced CRI, carotid artery stenting (CAS) or aggressive medical management may be alternative treatment options.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 5","pages":"Pages 326-329"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.06.006","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26251956","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 22

A New World 新世界

Current surgery Pub Date : 2006-09-01 Epub Date: 2006-09-10 DOI: 10.1016/j.cursur.2006.06.013

John A. Weigelt MD (Editor-in-Chief, Current Surgery)

引用次数: 99

Current surgery Pub Date : 2006-09-01 Epub Date: 2006-09-10 DOI: 10.1016/j.cursur.2006.02.007

Sherwin Schrag MD

引用次数: 0

Right Lower Quadrant Pain in a Young Adult Male 一例年轻成年男性右下腹疼痛

Current surgery Pub Date : 2006-09-01 Epub Date: 2006-09-10 DOI: 10.1016/j.cursur.2006.06.009

CAPT Shaun M. Gifford MC, USAF , CAPT Jonathan Bowman MC, USAF , LTC W. Brian Perry MC, USAF , Melanie Richards MD

引用次数: 4

The Challenges of Patient Advocacy on the Wards: Reflections from a Third-Year Medical Student 病人在病房倡导的挑战:来自一个三年级医学生的思考

Current surgery Pub Date : 2006-09-01 Epub Date: 2006-09-10 DOI: 10.1016/j.cursur.2006.06.001

Rose Kakoza III MS

引用次数: 2

Delivering Value-Added Results: One Program’s Perspective 交付增值结果:一个程序的视角

Current surgery Pub Date : 2006-09-01 Epub Date: 2006-09-10 DOI: 10.1016/j.cursur.2006.04.007

Ava E. Fulbright BA

引用次数: 0

Effects of Recombinant Activated Factor VII in Traumatic Nonsurgical Intracranial Hemorrhage 重组活化因子7在外伤性非手术颅内出血中的作用

Current surgery Pub Date : 2006-09-01 Epub Date: 2006-09-10 DOI: 10.1016/j.cursur.2006.04.013

Christopher E. White MD, Amber E. Schrank MD, Toney W. Baskin MD, John B. Holcomb MD

{"title":"Effects of Recombinant Activated Factor VII in Traumatic Nonsurgical Intracranial Hemorrhage","authors":"Christopher E. White MD, Amber E. Schrank MD, Toney W. Baskin MD, John B. Holcomb MD","doi":"10.1016/j.cursur.2006.04.013","DOIUrl":"10.1016/j.cursur.2006.04.013","url":null,"abstract":"<div><h3>Objective</h3><p>To determine whether treatment with recombinant activated factor VII (rFVIIa) will prevent progression of bleeding in nonsurgical hemorrhagic traumatic brain injury (TBI).</p></div><div><h3>Methods</h3><p>Chart review from the trauma registry of a level 1 trauma center between January 1, 2002 and December 31, 2004 identified 2 patients who received rFVIIa for progressive hemorrhagic TBI. These patients were given a single dose of rFVIIa (120 mcg/kg) after a repeat head computed tomography (CT) scan showed worsening of intracranial bleeding. Pre-rFVIIa and post-rFVIIa coagulation parameters and postintervention CT scans were performed. A matched convenience sample was drawn from the institution’s trauma registry reflecting similar injury patterns.</p></div><div><h3>Results</h3><p>The 2 patients who received rFVIIa were ages 61 and 79 years; the patients in the matched convenience sample were 57 and 63 years. Both sets of patients comprised 1 man and 1 woman who had suffered blunt trauma, including hemorrhagic TBI, and were matched according to age, gender, and injury severity score (ISS). During their hospital course, repeat CT scans documented worsening of intracranial hemorrhage in both cohorts. In the rFVIIa patients, follow-up CT showed overall improvement of head injury compared with the convenience sample. The rFVIIa patients also saw an appreciable decrease in both prothrombin time (PT) and international normalized ratio (INR).</p></div><div><h3>Conclusions</h3><p>In hemorrhagic TBI, rFVIIa has the potential to limit or even halt the progression of bleeding that would otherwise place growing pressure on the brain. A prospective, randomized multicenter trial is planned to elucidate this hypothesis.</p></div>","PeriodicalId":75762,"journal":{"name":"Current surgery","volume":"63 5","pages":"Pages 310-317"},"PeriodicalIF":0.0,"publicationDate":"2006-09-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://sci-hub-pdf.com/10.1016/j.cursur.2006.04.013","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"26252031","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 19