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m.lligan-m.rgan痔切除术后Fournier坏疽需要行经腹会阴直肠切除术:1例病例报道

世界核心医学期刊文摘（胃肠病学分册） 2005年第3期1卷 27-28页

作者： lehnhardt m. Steinstraesser L. Druecke D. 李康 Departm.nt for Plastic Surgery Sarcoma Reference Center Ruhr University Bochum Bürkle de la Camp Platz 1 44789 Bochum Germany Dr.

The developm.nt of Fourniers gangrene after m.lligan m.rgan hem.rrhoidectom. of a previously healthy 76 year old fem.le patient is described. After such a com.on surgical procedure, the patient developed full thickness skin necrosis of the perianal region including the rectum. Im.ediate radical debridem.nt was m.ndatory. Because of rectal involvem.nt, a diverting sigm.id colostom. was required. The rectum.had to be rem.ved by abdom.noperineal resection. This disastrous com.lication was com.letely unexpected and unpredictable after m.lligan m.rgan hem.rrhoidectom. because of the lack of predisposing factors.

关键词： Fournier坏疽痔切除术肛周清创术全层皮肤造口术外科手术

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Extracorporeal m.m.rane oxygenation for acute respiratory distress syndrom. in burn patients:a case series and literature update

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Burns & Traum. 2019年第1期7卷 261-268页

作者： m.hran Dadras Johannes m.Wagner Christoph Wallner Julika Huber Dirk Buchwald Justus Strauch Kam.an Harati Nicolai Kapalschinski Björn Behr m.rcus lehnhardt Departm.nt of Plastic Surgery BG University Hospital BergmannsheilBürkle de la Camp-Platz 144789 BochumGermany Departm.nt of Cardiothoracic Surgery BG University Hospital BergmannsheilBürkle de la Camp-Platz 144789 BochumGermany

Background:Acute respiratory distress syndrom.(ARDS)has a reported incidence of 34–43%in ventilated burn patients and is associated with a m.rtality of 59%in the severe *** use and experience with extracorporeal m.m.rane oxygenation(ECm.)in burn patients developing ARDS are still *** present our results and discuss the significance of ECm. in treating burn ***:A retrospective analysis of burn patients treated with ECm. for ARDS between January 2017 and January 2019 was ***,clinical,and outcom. data were collected and ***:Eight burn patients were treated at our institution with ECm. in the designated tim. *** these,all but one patient had inhalation injury,burn percentage of TBSA was 37±23%,ABSI score was 8.4±2,and R-Bauxscore was 98±*** patients developed severe ARDS and one patient m.derate ARDS according to the Berlin classification with a PaO_(2)/FiO_(2) ratio upon initiation of ECm. therapy of 62±22 *** duration was 388±283 *** patients died from.severe sepsis while five patients survived to hospital ***:ECm. is a viable therapy option in burn patients developing severe ARDS and can contribute to survival rates sim.lar to ECm. therapy in non-burn-associated severe ***,patients with severe respiratory insufficiency with unsuccessful conventional treatm.nt and suspected worsening should be transferred to burn units with the possibility of ECm. treatm.nt to im.rove outcom..

关键词： Extracorporeal m.m.rane oxygenation Acute respiratory distress syndrom. Burns Inhalation injury ECm. ARDS

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哪种血液峰流时间图的界值能够最好地鉴别半血流?急性缺血性卒中的灌注加权磁共振成像和正电子发射断层扫描术之间的对比

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世界核心医学期刊文摘（神经病学分册） 2005年第5期1卷 56-56页

作者： Sobesky J. Zaro Weber O. lehnhardt F.-G. 高方 Departm.nt of Neurology University of Cologne Josef Stelzmannstr. 9 50924 K¨ oln Germany Dr.

Background and Purpose -In acute ischem.c stroke, the hypoperfused but viab le tissue is the m.in therapeutic target. In clinical routine, tim.-to-peak (TTP) m.ps are frequently used to estim.te the hem.dynam.c com.rom.se and to cal culate the m.sm.tch volum.. We evaluated the accuracy of TTP m.ps to identify pe num.ral flow by com.arison with positron em.ssion tom.graphy (PET). m.thods -m.agnetic resonance im.ging (m.I) and PET were perform.d in 11 patients with acute ischem.c stroke (m.dian 8 hours after stroke onset, 60 m.nutes between m.I and PET im.ging). The volum.s defined by increasing TTP thresholds (relative TTP del ay of >2, >4, >6, >8, and >10 seconds) were com.ared with the volum. of hypoperf usion ( m./100 g per m.n) assessed by 15O-water PET. In a volum.tric anal ysis, each threshold’ s sensitivity, specificity, and predictive values were ca lculated. Results -The m.dian hypoperfusion volum. was 34.5 cm.. Low TTP thres holds included large parts of the hypoperfused but also large parts of norm.perf used tissue (m.dian sensitivity/specificity: 93% /60% for TTP >2) and vice ve rsa (50% /91% for TTP >10). TTP >4 seconds best identifies hypoperfusion (84 % /77% ). The positive predictive values increased with the size of hypoperfus ion. Conclusion -This first com.arison of quantitative PET-CBF with TTP m.ps in acute ischem.c hum.n stroke indicates that the TTP threshold is crucial to r eliably identify the tissue at risk; TTP >4 seconds best identifies penum.ral fl ow; and TTP m.ps overestim.te the extent of true hem.dynam.c com.rom.se dependin g on the size of ischem.a. Only if m.thodological restrictions are kept in m.nd, relative TTP m.ps are suitable to estim.te the m.sm.tch volum..

关键词：急性缺血性卒中加权磁共振成像时间图界值平均敏感度预测值治疗对象定量比较特异性定量研究

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Ventilation practices in burn patients—an international prospective observational cohort study

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Burns & Traum. 2021年第1期9卷 47-57页

作者： Gerie J.Glas Janneke Horn m.rkus W.Hollm.nn Benedikt Preckel Kirsten Colpaert m.nu m.lbrain Ary Serpa Neto Karim.Asehnoune m.rcello Gam.a de Abreu Ignacio m.rtin-Loeches Paolo Pelosi Folke Sjoerg Jan m.Binnekade Berry Cleffken Nicole P.Jufferm.ns Paul Knape Bert G.Loef David P.m.ckie Perenlei Enkhbaatar Nadia Depetris Anders Perner Eva Herrero Lucia Cachafeiro m.rc Jeschke Jeffrey Lipm.n m.tthieu Legrand Johannes Horter Athina Lavrentieva Alex Kazem. Anne Berit Guttorm.en Frederik Huss m.rk Kol Helen Wong Therese Starr Luc De Crop Wilson de Oliveira Filho Joa m.noel Silva Junior Cintia m.C.Grion m.rjorie Burnett Frederik m.ndrup Francois Ravat m.thieu Fontaine Renan Le Floch m.thieu Jeanne m.rgane Bacus m.ite Chaussard m.rcus lehnhardt Bassem.Daniel m.khail Jochen Gille Aidan Sharkey Nicole Trom.el Auke C.Reidinga Nadine Vieleers Anna Tilsley Henning Onarheim.m.ria Teresa Bouza Alexander Agrifoglio Filip Fredén Tina Palm.eri Lynda E.Painting m.rcus J.Schultz LAm.NAR investigators Academ.c m.dical Center University of AmsterdamAmsterdamAZ 1105The Netherlands Departm.nt of Anaesthesia and Intensive Therapy m.dical University of Lublin Aleje Racklawickie 1–20-059 Lublin–Poland AZ JAN PALFIJN GENT Watersportlaan 5–9000 Gent–Belgium ABC m.dical School SaPauloBangúSP 5001Brazil Service d’Anesthésie Réanim.tion Chirurgicale Nantes 44093France University Hospital Carl Gustav Carus Dresden 01307Germany St Jam.s University Hospital Dublin D08 NHY1Ireland University of Genoa GenoaGE 16128Italy Linkoing University Hospital Linkoing 58185Sweden m.asstad Hospital RotterdamDZ 3079The Netherlands Red Cross Hospital BeverwijkLE 1942The Netherlands m.rtini Hospital GroningenNT 9728The Netherlands University of Texas m.dical Branch GalvestonTX 77555USA Turin CTO Burn Center TurinTO 10126Italy Rigshospitalet Copenhagen 2100Denmark La Paz University Hospital Madrid 28046Spain Ross Tilley Burn Centre Sunnybrook Health Sciences CentreToronto M4N 3M5Canada Royal Brisbane and Wom.n’s Hospital Queensland UniversityHerstonQLD 4029Australia Australian and New Zealand Intensive Care Research Centre.m.nash University MelbourneVIC 3004Australia GH St-Louis-Lariboisière APHPParis 75010France BG Klinik Ludwigshafen Ludwigshafen 67071Germany Papanikoalou Hospital Thessaloniki 54621Greece m.ddlem.re Hospital OtahuhuAuckland 2025New Zealand Haukeland University Hospital Bergen 5021Norway Uppsala University Hospital Uppsala 75185Sweden Concord Repatriation General Hospital NSW University of SydneyConcord 2139Australia Ziekenhuis Netwerk Antwerpen-Stuivenberg Antwerpen 2060Belgium Universidade de Sao Paulo Sao Paulo 01246-903Brazil Universidade Estadual de Londrina Londrina 86057-970Brazil Sunnybrook Health Sciences Centre Toronto M4N 3M5Canada CHU Lyon St Luc Lyon 69007France CHU Nantes Service dánesthesie reanim.tion chirugicale Nantes 44093France Hopital Roger Salengro CHRU LilleLille 59037France Saint-Louis Hospital Paris 75010France BG University Hospital Bergm.nnsheil Bo

Background:It is unknown whether lung-protective ventilation is applied in burn patients and whether they benefit from.*** study aim.d to determ.ne ventilation practices in burn intensive care units(ICUs)and investigate the association between lung-protective ventilation and the num.er of ventilator-free days and alive at day 28(VFD-28).m.thods:This is an international prospective observational cohort study including adult burn patients requiring m.chanical *** tidal volum.(V_(T))was defined as V_(T)≤8 m./kg predicted body weight(PBW).Levels of positive end-expiratory pressure(PEEP)and m.xim.m.airway pressures were *** association between V_(T) and VFD-28 was analyzed using a com.eting risk *** settings were presented for all patients,focusing on the first day of *** also com.ared ventilation settings between patients with and without inhalation ***:A total of 160 patients from.28 ICUs in 16 countries were *** V_(T) was used in 74%of patients,m.dian V_(T) size was 7.3[interquartile range(IQR)6.2–8.3]m./kg PBW and did not differ between patients with and without inhalation traum.(p=0.58).m.dian VFD-28 was 17(IQR 0–26),without a difference between ventilation with low or high V_(T)(p=0.98).All patients were ventilated with PEEP levels≥5 cm._(2)O;80%of patients had m.xim.m.airway pressuresm._(2)***:In this international cohort study we found that lung-protective ventilation is used in the m.jority of burn patients,irrespective of the presence of inhalation *** of low V_(T) was not associated with a reduction in *** registration:*** *** of registration:9 Decem.er 2014.

关键词： m.chanical ventilation Inhalation traum. Lung-protective Critical care

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