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Surgical management of ruptured mycotic aortic aneurysm induced by Klebsiella pneumoniae

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Chinese Medical Journal 2019年第1期132卷 89-91页

作者： Sang Dong Kim Jeong Kye Hwang In Sung Moon Sun Cheol Park Department of Surgery Division of Vascular and Transplant SurgeryCollege of MedicineThe Catholic University of KoreaSeoul 06591Korea

To the Editor:A 63-year-old male patient was referred from a local clinic for diffuse abdominal pain for 1 day and ruptured abdominal aortic aneurysm (rAAA) in computed tomography (CT).He denied any medical history of hypertension,diabetes mellitus,hepatitis or pneumonia.The patient’s blood pressure was 100/70 mmHg with a pulse rate of 105 beats/min and a body temperature of 37.1℃.The Abdomen was mildly distended with diffuse pain and tenderness.

关键词： Klebsiella pneumoniae Surgical management ruptured mycotic aortic aneurysm induced

Factors determining the side of approach for clipping ruptured anterior communicating artery aneurysm via supraorbital eyebrow keyhole approach

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Chinese Journal of Traumatology 2020年第1期23卷 20-24页

作者： Robin Bhattarai Chao-Feng Liang Chuan Chen Hui Wang Teng-Chao Huang Ying Guo Department of Neurosurgery Third Affiliated Hospital of Sun Yat-Sen UniversityGuanzhou 510000China

Purpose:The purpose of this study was to review the microsurgical anatomy and clipping of ruptured anterior communicating artery(AComA)aneurysms and to plan and avoid complications before operation.Methods:A total of 523 cases of cerebral aneurysms admitted to the neurosurgery department of the Third Affiliated Hospital of Sun Yat-Sen University from September 2010 to October 2018 were analyzed retrospectively.Among them,85 patients had ruptured AComA aneurysms.This study was limited to 85 of these cases,whose satisfactory preoperative angiographic diagnostic films can be retrieved from the hospital database system because of the need for detailed review.Results:We performed supraorbital eyebrow keyhole approach(SOEK)craniotomy in 85 patients to clip 85 AComA aneurysms,in the setting of subarachnoid hemorrhage(SAH).Patients’mean age was(52.69±9.94)years(range,28e78 years).The proportions of small,medium and large aneurysms were 83.5%,15.3%,and 1.2%,respectively.The average size of the aneurysms was(5.07±2.36)mm.There were 77.8% of patients with inferior aneurysms and 81.3% of patients with superior aneurysms achieved good results.There was a significant correlation between A1 dominance and operation method(p<0.001).There was no significant relationship between surgical approach and aneurysm projection or A2 plane(p=0.157&p=0.318).Conclusion:Regardless of whether the A2 plane is open or closed,the A1 dominant side is still a better choice for accessing AComA aneurysms to avoid dangerous premature bleeding.

关键词： Anterior communicating artery Aneurysm projection Clipping ruptured aneurysm Surgical approach

Bioengineered magnetoferritin nanozymes for pathological identification of high-risk and ruptured atherosclerotic plaques in humans

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Nano Research 2019年第4期12卷 863-868页

作者： Tao Wang Jiuyang He Demin Duan Bing Jiang Peixia Wang Kelong Fan Minmin Liang Xiyun Yan Department of Neurosurgery Peking University Third Hospital Beijing 100191 China Savaid Medical School University of Chinese Academy of Sciences Beijing 100049 China Key Laboratory of Protein and Peptide Pharmaceutical Institute of Biophysics Chinese Academy of Sciences Beijing 100101 China

Atherosclerotic plaque rupture results in thrombus formation and vessel occlusion, and is the leading cause of death worldwide. There is a pressi ng need to identify plaque vuln erability for the treatment of carotid and coronary artery diseases. Nano materials with en zyme-like properties have attracted significant interest by providing biological, diagnostic and prognostic information about the diseases. Here we showed that bioe ngin eered mag netoferritin nan oparticles (M-HFn NPs) functionally mimic peroxidase en zyme and can intrin sically recog nize plaque-infiltrated active macrophages, which drive atherosclerotic plaque progression and rupture and are significantly associated with the plaque vulnerability. The M-HFn nanozymes catalyze the oxidation of colorimetric substrates to give a color reaction that visualizes the recognized active macrophages for one-step pathological identification of plaque vulnerability. We examined 50 carotid endarterectomy specimens from patients with symptomatic carotid disease and demonstrated that the M-HFn nanozymes could distinguish active macrophage infiltration in ruptured and high-risk plaque tissues, and M-HFn staining displayed a significant correlation with plaque vulnerability (r= 0.89, P< 0.0001).

关键词： atherosclerosis high-risk plaques ruptured plaques magnetoferritin nanoparticles nanozymes pathological diagnosis

Peritonitis secondary to ruptured splenic abscess:A grave complication of typhoid fever

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Asian Pacific Journal of Tropical Medicine 2012年第12期5卷 1004-1006页

作者： Peter George Ashfaq Ahmed Roshan Maroli Leo Francis Tauro Department of Medicine Father Muller Medical CollegeMangalore-575002India Department of Surgery Father Muller Medical CollegeMangalore-575002India

Splenic abscesses are increasingly being identified,possibly due to widespread use of imaging modalities in clinical practice.The commonest clinical features are high grade fever and exclusively localised left upper quadrant abdominal pain.These symptoms are similar to most infectious diseases prevalent in the tropics,making imaging by ultrasonography or computer tomography a necessity in the diagnosis.There are reports from different geographic areas on splenic abscesses associated with typhoid fever.We reported ruptured splenic abscess presenting with peritonitis as a rare and grave complication of typhoid fever.

关键词： Splenic abscess Typhoid fever Widal test Peritonitis ruptured splenic abscess Ultrasonography Computer tomography

Survival outcome of patients with spontaneously ruptured hepatocellular carcinoma treated surgically or by transarterial embolization

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World Journal of Gastroenterology 2013年第28期19卷 4537-4544页

作者： Young-Joo Jin Jin-Woo Lee Seoung-Wook Park Jung Il Lee Don Haeng Lee Young Soo Kim Soon Gu Cho Yong Sun Jeon Kun Young Lee Seung-Ik Ahn Department of Internal Medicine Inha University Hospital Inha University School of Medicine Incheon 400-711 South Korea Department of Internal Medicine Yonsei University College of Medicine Seoul 120-752 South Korea Department of Internal Medicine and Center for Advanced Medical Education by Brain Korea 21 Project Inha University School of Medicine and Utah-Inha DDS and Advanced Therapeutics Research Center Incheon 400-711 South Korea Department of Radiology Inha University Hospital Inha University School of Medicine Incheon 400-711 South Korea Department of Surgery Inha University Hospital Inha University School of Medicine Incheon 400-711 South Korea

AIM: To evaluate clinical outcomes of patients that underwent surgery, transarterial embolization (TAE), or supportive care for spontaneously ruptured hepatocellular carcinoma (HCC). METHODS: A consecutive 54 patients who diagnosed as spontaneously ruptured HCC at our institution between 2003 and 2012 were retrospectively enrolled. HCC was diagnosed based on the diagnostic guidelines issued by the 2005 American Association for the Study of Liver Diseases. HCC rupture was defined as disruption of the peritumoral liver capsule with enhanced fluid collection in the perihepatic area adjacent to the HCC by dynamic liver computed tomography, and when abdominal paracentesis showed an ascitic red blood cell count of > 50000 mm 3 /mL in bloody fluid. RESULTS: Of the 54 patients, 6 (11.1%) underwent surgery, 25 (46.3%) TAE, and 23 (42.6%) supportive care. The 2-, 4and 6-mo cumulative survival rates at 2, 4 and 6 mo were significantly higher in the surgery (60%, 60% and 60%) or TAE (36%, 20% and 20%) groups than in the supportive care group (8.7%, 0% and 0%), respectively (each, P < 0.01), and tended to be higher in the surgical group than in the TAE group. Multivariate analysis showed that serum bilirubin (HR = 1.09, P < 0.01), creatinine (HR = 1.46, P = 0.04), and vasopressor requirement (HR = 2.37, P = 0.02) were significantly associated with post-treatment mortality, whereas surgery (HR = 0.41, P < 0.01), and TAE (HR = 0.13, P = 0.01) were inversely associated with posttreatment mortality. CONCLUSION: Post-treatment survival after surgery or TAE was found to be better than after supportive care, and surgery tended to provide better survival benefit than TAE.

关键词： ruptured hepatocellular carcinoma Surgery Transarterial embolization

The Presence but not the Location of an Appendicolith Affects the Success of Interval Appendectomy in Children with ruptured Appendicitis

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Surgical Science 2011年第2期2卷 39-44页

作者： Iyore A. James Stephen Druhan Donna A. Caniano Gail E. Besner 不详

Purpose: To determine whether the presence and/or location of an appendicolith can predict failure of initial non-operative management in children with ruptured appendicitis. Methods: A retrospective chart review of pediatric patients presenting with ruptured appendicitis was performed. Patients in whom the intent to treat was with initial non-operative management and interval appendectomy (IA) were selected (n = 117). One patient was excluded due to the presence of both intraluminal and extraluminal appendicoliths. Children who failed initial non-operative management were assigned to the “failure” group (n = 22). Children that improved and underwent elective IA were assigned to the “success” group (n = 94). Age, gender, duration of symptoms, presence of an appendicolith, appendicolith location (intraluminal/extraluminal), presence of a drainable abscess, and complications were reviewed. Results: There was an overall 18.8% failure rate for IA. Patients with an appendicolith had a 41.7% failure rate, and patients without an appendicolith had a 13% failure rate (p = 0.003). Patients with intraluminal or extraluminal appendicoliths each had a 41.7% failure rate. The presence or absence of a drainable in-tra-abdominal abscess did not affect the failure rate. Children in the failure group presented to the hospital earlier (6.57 ± 2.59 vs. 10.02 ± 7.21 days;p = 0.030). Conclusions: The presence of an appendicolith increases the likelihood of failure of initial non-operative management of ruptured appendicitis in children;however, the location of the appendicolith is not a predictor of failure.

关键词： ruptured Appendicitis Failure Non-Operative Management Appendicolith

Comparison between laparoscopic surgery and laparotomy for the treatment of acute ruptured ectopic pregnancy

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Journal of Acute Disease 2017年第3期6卷 97-100页

作者： Miao Zhou Department of Obstetrics and Gynecology Pangang Group General HospitalPanzhihuaSichuan Province617000

Objective: To study the stress reaction after laparoscopic surgery and laparotomy for the treatment of acute ruptured ectopic pregnancy. Methods: 68 patients with acute ruptured ectopic pregnancy who received emergency surgical treatment in Pangang Group General Hospital between July 2013 and September 2016 were selected and analyzed retrospectively, including 29 patients with laparoscopic surgery and 39 patients with laparotomy who were included in the laparoscopy group and laparotomy group respectively. Before operation as well as 1d and 3d after operation, serum was collected to detect biochemical indexes and stress hormones. Results: 1d and 3d after operation, serum Alb, AST, ALT, BUN, Scr and UA levels were not significantly different between laparoscopy group and laparotomy group (P>0.05);serum NE (149.65±17.58 vs. 186.61±23.52, 162.32±20.15 vs. 295.86±28.97 pg/ml), E (135.28±19.85 vs. 179.55±22.52, 152.11±18.52 vs. 231.38±29.58 pg/ml), ACTH (3.88±0.49 vs. 5.12±0.82, 4.39±0.52 vs. 6.58±0.92 pmol/L), Cor (177.64±20.12 vs. 224.59±35.55, 185.21±22.12 vs. 289.45±41.28 ng/ml), Ins (12.21±1.86 vs. 17.58±2.52, 18.95±2.68 vs. 27.61±4.12 IU/mL), PRA (1.65±0.25 vs. 2.18±0.35, 1.73±0.21 vs. 2.55±0.47ng/ml), AngⅡ (44.12±7.64 vs. 59.63±7.92, 52.27±7.95 vs. 76.12±9.35 pg/ml) and ALD (155.22±19.76 vs. 205.62±24.52, 189.10±22.58 vs. 316.85±42.85 pg/ml) levels of laparoscopy group were significantly lower than those of laparotomy group (Pruptured ectopic pregnancy causes less adrenal stress reaction and RAAS system stress reaction, and the overall level of trauma is lower than that of laparotomy.

关键词： ruptured ectopic pregnancy Laparoscope Stress reaction Adrenal glands Renin - angiotensin - aldosterone

Clipping versus Coiling in ruptured Aneurysms of the Anterior Cerebral Circulation

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Open Journal of Modern Neurosurgery 2020年第1期10卷 88-104页

作者： Farrag Mohammad Takashi Horiguchi Katsuhiro Mizutani Kazunari Yoshida Department of Neurosurgery Keio University School of Medicine Tokyo Japan Department of Neurosurgery Faculty of Medicine Assiut University Assiut Egypt

Objective: To evaluate and compare the outcomes of microsurgical clipping and endovascular coiling of ruptured anterior cerebral circulation aneurysms. Methods: The current study retrospectively included 61 patients presented with subarachnoid hemorrhage (SAH), treated by clipping or coiling for ruptured aneurysms located in anterior circulation. Anatomic outcome and post-operative ischemic events were evaluated. The primary clinical outcomes were evaluated as operative complications while the secondary clinical outcome was evaluated by modified Rankin scale (mRS) at discharge. Results: Of 61 ruptured aneurysms, 47 and 14 were treated by surgery and coiling, respectively. The average follow-up duration was 19.1 ± 18.6 months for clipping and 21.7 ± 14.8 months for coiling. Complete occlusion was greater in surgery group (80.8%) than endovascular group (21.4%). Re-growth occurred in 2 cases of the coiling group only. Ischemic events were encountered in both groups;silent ones were higher in coiling group (21.4%) than in clipping group (6.3%), while symptomatic ones were higher in the clipping group (49%). Good outcome (mRS 0 - 2) was 51% and 71.4% after clipping and coiling respectively. Postoperative hospital period was longer after clipping (P = 0.04). Conclusions: For anterior circulation ruptured aneurysms, both treatments are feasible, coiling showed lower rate of morbidity while clipping results were better regarding durability and recurrence. Coil embolization may be preferred, which is the current point proved by the RCT like ISAT, but if you choose the patients carefully and find out the optimal candidate for the clipping, the clipping is still enough feasible as a mainstream.

关键词： Anterior Circulation SAH Clipping Coiling ruptured Aneurysms

The “Brain Stress Timing” phenomenon and other misinterpretations of randomized clinical trial on aneurysmal subarachnoid hemorrhage

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Neural Regeneration Research 2019年第8期14卷 1364-1366页

作者： Rafael Martinez-Perez Natalia Rayo Agustin Montivero Jorge Marcelo Mura Division of Neurosurgery Institute of Clinical Neurosciences Universidad Austral de Chile Valdivia Chile Division of Cerebrovascular and Skull Base Neurosurgery Institute of Neurosurgery Dr Asenjo Santiago Chile Western University London ON Canada

Clipping and coiling are currently the two alternatives in treatment of ruptured cerebral aneurysms. In spite of some meritorious analysis, further discussion is helpful to understand the actual state of art. Retreatment and rebleeding rates clearly favors clipping, although short-term functional outcome seems to be beneficial for clipping, while this different is not such if we perform the comparison at a longer follow up. Longterm follow ups and cost analysis are mandatory to have a clear view of the current picture in treatment of subarachnoid hemorrhage. Treatment strategy should be made by a multi-disciplinary team in accredited centers with proficient experience in both techniques.

关键词： sAH subarachnoid hemorrhage coiling clipping ruptured aneurysm timing intracranial