Coronary Artery Disease/complications* ; Death, Sudden, Cardiac/etiology* ; Humans ; Myocardial Ischemia/diagnosis*

Duodenal injury is a serious abdominal organ injury. Duodenal fistula is one of the most serious complications in gastrointestinal surgery, which is concerned for its critical status, difficulty in treatment and high mortality. Thoracic and abdominal compound closed injury and a small part of open injury are common causes of duodenal injury. Iatrogenic or traumatic injury, malnutrition, cancer, tuberculosis, Crohn's disease etc. are common causes of duodenal fistula, however, there has been still lacking of ideal diagnosis and treatment by now. The primary treatment strategy of duodenal fistula is to determine the cause of disease and its key point is prevention, including perioperative parenteral and enteral nutrition support, improvement of hypoproteinemia actively, avoidance of stump ischemia by excessive separate duodenum intraoperatively, performance of appropriate duodenum stump suture to ensure the stump blood supply, and avoidance of postoperative input loop obstruction, postoperative stump bleeding or hematoma etc. Once duodenal fistula occurs, a simple and reasonable operation can be selected and performed after fluid prohibition, parenteral and enteral nutrition, acid suppression, enzyme inhibition, anti-infective treatment and maintaining water salt electrolyte and acid-base balance. Double tube method, duodenal decompression and peritoneal drainage can reduce duodenal fistula-related complications, and then reduce the mortality, which can save the lives of patients.
Abdominal Injuries ; complications ; Anti-Infective Agents ; therapeutic use ; Decompression, Surgical ; Digestive System Surgical Procedures ; adverse effects ; methods ; Drainage ; Duodenal Diseases ; diagnosis ; etiology ; prevention & control ; therapy ; Duodenum ; blood supply ; injuries ; surgery ; Enteral Nutrition ; Humans ; Hypoproteinemia ; therapy ; Intestinal Fistula ; diagnosis ; etiology ; prevention & control ; therapy ; Ischemia ; prevention & control ; Nutritional Support ; Parenteral Nutrition ; Postoperative Complications ; prevention & control ; therapy ; Suture Techniques ; Thoracic Injuries ; complications

No abstract available.
Adult ; Brain Ischemia/diagnosis/*etiology ; Cerebral Angiography ; Fatal Outcome ; Female ; Humans ; Hyperventilation/complications ; Moyamoya Disease/*complications/diagnosis/therapy ; Risk Factors ; Stroke/diagnosis/*etiology ; Thyroid Crisis/*complications/diagnosis/therapy

OBJECTIVETo investigate the clinical and imaging characteristics of acute hypoxic-ischemic brain injury (HIBI) due to perinatal sentinel events in neonates.

METHODSForty-six neonates with acute HIBI who were admitted between January 2004 and May 2013, and who had a history of major cardiopulmonary resuscitation, were enrolled in the study. They were classified into full-term and preterm infants to analyze the clinical and imaging characteristics.

RESULTSAmong full-term infants, the incidence rates of white matter injury, cortical injury, basal ganglia /thalamic injury, and brain stem injury were 95%, 90%, 75%, and 65%, respectively; among preterm infants, the incidence rates of white matter injury, cortical injury, basal ganglia/thalamic injury, and brain stem injury were 73%, 23%, 19%, and 15%, respectively. Compared with full-term infants, preterm infants had a significantly lower incidence of gray matter injury in the cortex, basal ganglia/thalamus, and brain stem (P<0.05). About 46% of all subjects had multiple organ dysfunction. The 20 full-term infants with HIBI had typical clinical manifestations; 19 (95%) of them had moderate or severe neonatal encephalopathy, with mixed lesions on magnetic resonance imaging (MRI), and moderate or severe basal ganglia/thalamic injury was found in 68% of these patients. Multiple organ dysfunction, various abnormal neurological manifestations, and arterial blood pH less than 7.1 were closely related to moderate or severe brain injury.

CONCLUSIONSWhite matter injury is the most common type of HIBI. Gray matter injury can be found in preterm infants, but the incidence is lower than that in full-term infants. Moderate or severe neonatal encephalopathy is mainly manifested as basal ganglia/thalamic injury on MRI. Evaluation of multiple organ dysfunction and abnormal neurological manifestations and early blood gas analysis are very important for the diagnosis of neonatal HIBI.

Acute Disease ; Brain ; pathology ; Female ; Humans ; Hypoxia-Ischemia, Brain ; diagnosis ; etiology ; pathology ; Infant, Newborn ; Magnetic Resonance Imaging ; Male

PURPOSE: Cerebral ischemic lesions are frequently observed after carotid artery stenting (CAS), and anti-platelet agents are used to prevent stent thrombosis and peri-procedural complications. However, despite the premedication, cerebral ischemic lesions are observed, suggesting that they may rather be related to anti-platelet resistance. We, therefore, investigated the effects of anti-platelet resistance on the development of cerebral ischemic lesions after CAS. MATERIALS AND METHODS: We retrospectively reviewed patients who received CAS and selected patients for whom brain MRI was performed within 24 hours after CAS and for whom anti-platelet resistance was checked. Anti-platelet resistance was examined by the VerifyNow system. We analyzed the correlation between anti-platelet resistance and cerebral ischemic lesions detected on follow-up MRI. RESULTS: Among 76 patients, 45 (59.2%) developed new ischemic lesions after CAS. Twelve (15.8%) patients showed aspirin resistance and 50 (65.8%) patients showed clopidogrel resistance. Patients with a new ischemic lesion demonstrated a significantly greater frequency of clopidogrel resistance than those who had no new ischemic lesion (82.2% versus 41.9%, p=0.001). The frequency of aspirin resistance was not significantly different between the groups of patients with and without new ischemic lesions (20.0% versus 9.7%, p=0.340). In multivariate analysis, clopidogrel resistance was a significant risk factor for post-procedural cerebral ischemia. CONCLUSION: Anti-platelet resistance can be used to predict new ischemic lesions after CAS. Anti-platelet resistance should be evaluated in all patients prior to CAS to prevent ischemic complications related to CAS.
Aged ; Aspirin/*therapeutic use ; Brain Ischemia/diagnosis/*etiology ; Carotid Arteries/*surgery ; *Drug Resistance ; Female ; Humans ; Male ; Middle Aged ; Multivariate Analysis ; Platelet Aggregation Inhibitors/*therapeutic use ; Retrospective Studies ; Stents/*adverse effects

No abstract available.
Adult ; Arteriovenous Shunt, Surgical/*adverse effects ; Female ; Humans ; Ischemia/diagnosis/*etiology/surgery ; Ligation ; Peripheral Nervous System Diseases/diagnosis/*etiology/surgery ; *Renal Dialysis ; Reoperation ; Treatment Outcome ; Upper Extremity/*blood supply

OBJECTIVECerebral infarction (CI) is one of severe diseases of central nervous system in neonates, and some infants with CI could have poor prognosis in the long term. This study aimed to analyze the clinical data and prognosis of all neonatal cases with cerebral infarction in recent years and to help future clinical work.

METHODTotally 58 neonatal cases with CI admitted to NICU of the hospital from January 1999 to December 2010 were included in this study. We analyzed all clinical data and prognosis by retrospective analysis.

RESULTSFifty-two term babies and six preterm babies were included. There were altogether 51 cases with asphyxia and 7 with hemorrhagic cerebral infarction. Perinatal hypoxia-ischemia was the most common high-risk factor and it accounted for 46.6%. Seizure was the most frequent initial symptom and the most common clinical manifestation (accounted for 77.6%), and it was followed by intermittent cyanosis, apnea and lethargy. Cerebral CT scan and magnetic resonance imaging were major methods to help to make the diagnosis and they also had close relation with prognosis. Diffusion weighted imaging was very helpful to diagnose infarction in early stage. Left middle cerebral artery was the most common artery to be involved. Supportive therapy and symptomatic treatment were the main methods in the acute stage of neonatal cerebral infarction. Those babies with poor prognosis mostly had large infarction involving cerebral hemisphere, thalamus and basal ganglia.

CONCLUSIONSNeonatal cerebral infarction was a severe brain injury affecting long tern nervous system prognosis. Perinatal hypoxia was the most common high-risk factor and seizure was the most frequent initial symptom. Diffusion weighted imaging was valuable to diagnose infarction in early stage. Most of infants with poor prognosis had large infarction involving hemisphere, thalamus and basal ganglia. Early diagnosis with brain imaging would be helpful for rehabilitation therapy and improving prognosis.

Brain ; diagnostic imaging ; pathology ; Cerebral Infarction ; diagnosis ; etiology ; pathology ; therapy ; Cerebral Palsy ; etiology ; Humans ; Hypoxia-Ischemia, Brain ; complications ; Incidence ; Infant ; Infant, Newborn ; Magnetic Resonance Imaging ; Male ; Prognosis ; Radiography ; Retrospective Studies ; Risk Factors ; Seizures ; etiology ; Ultrasonography, Doppler, Color

INTRODUCTIONThe relationship between electrocardiograph (ECG) changes and troponin levels after the emergency orthopaedic surgery are not well characterised. The aim of this study was to determine the correlation between ECG changes (ischaemia or arrhythmia), troponin elevations perioperatively and cardiac complications.

MATERIALS AND METHODSOne hundred and eighty-seven orthopaedic patients over 60 years of age were prospectively tested for troponin I and ECGs were performed on the fi rst 3 postoperative mornings or until discharge.

RESULTSThe incidences of pre- and postoperative troponin elevation were 15.5% and 37.4% respectively, the majority were asymptomatically detected. Most of the patients who sustained a troponin rise did not have any concomitant ECG changes (51/70 or 72.9%). Postoperative ECG changes were noted in 18.4% (34/185) and of those with ECG changes, slightly more than half (55.9%) had a troponin elevation. Most ECG changes occurred on postoperative day 1 and were non-ST elevation in type. ECG changes occurred more frequently with higher troponin levels. Postoperative troponin elevation (P = 0.018) and not preoperative troponin level (P = 0.060) was associated with ECG changes on univariate analysis. Two premorbid factors were predictors of postoperative ECG changes using multivariate logistical regression; age [odds ratio (OR), 1.05; 95% CI, 1.005 to 1.100, P = 0.029) and sex OR, 2.4; 95% CI, 1.069 to 5.446, P = 0.034). Twenty patients sustained postoperative cardiac complications; 9 (45%) were associated with ECG changes and 16 (80%) with postoperative troponin elevation. Pre- or postoperative troponin elevation better predicted cardiac complications compared with preoperative ECG changes.

CONCLUSIONElectrocardiograph changes do not necessarily accompany troponin elevations after the emergency orthopaedic surgery but are more likely to have higher troponin levels. The best predictor of postoperative cardiac complications is troponin elevation.

Aged ; Aged, 80 and over ; Arrhythmias, Cardiac ; blood ; diagnosis ; etiology ; mortality ; Biomarkers ; blood ; Electrocardiography ; Female ; Humans ; Logistic Models ; Male ; Middle Aged ; Multivariate Analysis ; Myocardial Ischemia ; blood ; diagnosis ; etiology ; mortality ; Orthopedic Procedures ; Postoperative Complications ; blood ; diagnosis ; etiology ; mortality ; Postoperative Period ; Preoperative Period ; Prospective Studies ; ROC Curve ; Risk Factors ; Single-Blind Method ; Troponin I ; blood

We measured the ankle-brachial index (ABI) and brachial-ankle pulse wave velocity (baPWV) and ABI in 97 ischemic stroke patients and 93 control subjects to investigate the relationship between baPWV, ABI and risk factors of ischemic stroke. The stroke patients were grouped according to the results of MRA and Carotid artery color Doppler ultrasound. The correlation of baPWV and ABI to the arteriosclerosis was discussed. There was a significant difference in the patients with hypertension, diabetes mellitus, baPWV and ABI between ischemic stroke patients and control subjects. baPWV was the most sensitive risk factor for ischemic stroke. ABI and diabetes mellitus were the relatively sensitive risk factors for ischemic stroke. baPWV were found to have a positive correlation with common carotid arteriosclerosis (gamma=0.215, P=0.048), while ABI had a negative correlation with intracranial arteriosclerosis (gamma=-0.237, P<0.05). BaPWV and ABI may closely relate to severity of ischemic stroke. Simple measurements of baPWV and ABI in patients could be a useful tool for evaluating the risk of ischemic stroke.
Aged ; Ankle ; blood supply ; Ankle Brachial Index ; Arteriosclerosis ; physiopathology ; Blood Flow Velocity ; Brachial Artery ; physiopathology ; Brain ; blood supply ; pathology ; Brain Ischemia ; complications ; Carotid Arteries ; physiopathology ; Female ; Humans ; Male ; Middle Aged ; Pulsatile Flow ; Pulse ; Risk Factors ; Stroke ; diagnosis ; etiology ; physiopathology

A 60-year-old woman who had experienced two episodes of amaurosis fugax in her right eye presented with vision loss. Two weeks earlier, at a private clinic, she was diagnosed with impending central retinal vein occlusion (CRVO) of the right eye and received an intravitreal injection of bevacizumab. Two weeks after this injection she was diagnosed with ischemic CRVO. At 11-weeks post-presentation, extremely ischemic features were observed with fluorescein angiographic findings of severe vascular attenuation and extensive retinal capillary obliteration. At 22-weeks post-presentation she was diagnosed with neovascular glaucoma; she experienced no visual improvement over the following several months.
Antibodies, Monoclonal/*administration & dosage ; Disease Progression ; Female ; Fluorescein Angiography ; Glaucoma, Neovascular/complications ; Humans ; Injections, Intraocular ; Ischemia/diagnosis/*etiology/physiopathology ; Middle Aged ; Retinal Vein Occlusion/*complications/*drug therapy/physiopathology ; *Retinal Vessels ; Vascular Endothelial Growth Factor A/antagonists & inhibitors ; Visual Acuity/drug effects ; Vitreous Body