Abstract:
:The management of impaired respiratory gas exchange in patients with nonuniform posttraumatic and septic adult respiratory distress syndrome (ARDS) contains its own therapeutic paradox, since the need for volume-controlled ventilation and PEEP in the lung with the most reduced compliance increases pulmonary barotrauma to the better lung. A computer-based system has been developed by which respiratory pressure-flow-volume relations and gas exchange characteristics can be obtained and respiratory dynamic and static compliance curves computed and displayed for each lung, as a means of evaluating the effectiveness of ventilation therapy in ARDS. Using these techniques, eight patients with asymmetrical posttraumatic or septic ARDS, or both, have been managed using simultaneous independent lung ventilation (SILV). The computer assessment technique allows quantification of the nonuniform ARDS pattern between the two lungs. This enabled SILV to be utilized using two synchronized servo-ventilators at different pressure-flow-volumes, inspiratory/expiratory ratios, and PEEP settings to optimize the ventilatory volumes and gas exchange of each lung, without inducing excess barotrauma in the better lung. In the patients with nonuniform ARDS, conventional ventilation was not effective in reducing shunt (QS/QT) or in permitting a lower FIO2 to be used for maintenance of an acceptable PaO2. SILV reduced per cent v-a shunt and permitted a higher PaO2 at lower FIO2. Also, there was x-ray evidence of ARDS improvement in the poorer lung. While the ultimate outcome was largely dependent on the patient's injury and the adequacy of the septic host defense, by utilizing the SILV technique to match the quantitative aspects of respiratory dysfunction in each lung at specific times in the clinical course, it was possible to optimize gas exchange, to reduce barotrauma, and often to reverse apparently fixed ARDS changes. In some instances, this type of physiologically directed ventilatory therapy appeared to contribute to a successful recovery.
journal_name
Ann Surgjournal_title
Annals of surgeryauthors
Siegel JH,Stoklosa JC,Borg U,Wiles CE 3rd,Sganga G,Geisler FH,Belzberg H,Wedel S,Blevins S,Goh KCdoi
10.1097/00000658-198510000-00004subject
Has Abstractpub_date
1985-10-01 00:00:00pages
425-39issue
4eissn
0003-4932issn
1528-1140journal_volume
202pub_type
杂志文章abstract:OBJECTIVE:To determine whether adjuvant chemotherapy (AC) after neoadjuvant chemoradiation and esophagectomy is associated with improved overall survival for patients with locally advanced esophageal cancer, and to evaluate how pathologic disease response to neoadjuvant treatment impacts this effect. BACKGROUND:Neoadj...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001954
更新日期:2017-08-01 00:00:00
abstract:OBJECTIVES:We recently reported increased CD4 CD25 T regulatory (Treg) activity after burn injury in mice. This study sought to determine if Tregs mediate the reduction in TH1-type immunity after serious injury in man and if Treg function is altered by injury. METHODS:Peripheral blood was withdrawn from 19 consenting ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000239031.06906.1f
更新日期:2006-10-01 00:00:00
abstract:OBJECTIVE:To assess the authors' hypothesis that with modern techniques, the current risks of repair for both complete and partial atrioventricular canal (AVC) are equal. SUMMARY BACKGROUND DATA:Repair of complete AVC in infancy has traditionally carried a substantial mortality. In contrast, partial AVC has been consi...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-200210000-00014
更新日期:2002-10-01 00:00:00
abstract:OBJECTIVE:This study aims to evaluate whether graduates of integrated vascular surgery residency (IVSR) programs achieve similar surgical outcomes in clinical practice as compared to graduates of vascular surgery fellowships (VSF). SUMMARY BACKGROUND DATA:Early sub-specialization through IVSR programs decreases the to...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004706
更新日期:2020-12-18 00:00:00
abstract:OBJECTIVE:To describe the field of surgical innovation from a historical perspective, applying new findings from research in technology innovation. BACKGROUND:While surgical innovation has a rich tradition, as a field of study it is embryonic. Only a handful of academic centers of surgical innovation exist, all of whi...
journal_title:Annals of surgery
pub_type: 历史文章,杂志文章,评审
doi:10.1097/01.sla.0000242706.91771.ce
更新日期:2006-11-01 00:00:00
abstract:BACKGROUND:Experience with minimal access, transoral/transmural endoscopic drainage/debridement of walled-off pancreatic necrosis (WOPN) after necrotizing pancreatitis is limited. We sought to determine outcome using this technique. METHODS:Retrospective analysis. RESULTS:From 1998 to 2006, 53 patients underwent tran...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000254366.19366.69
更新日期:2007-06-01 00:00:00
abstract::Current treatment modalities for thrombotic thrombocytopenic purpura (TTP) include plasmapheresis (PP), splenectomy, steroids, dextran, other antiplatelet agents, and vinca alkaloids. Prior to the development of PP and use of multimodality treatment for TTP, mortality rates exceeded 50%. This report reviews 11 patient...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198509000-00007
更新日期:1985-09-01 00:00:00
abstract:BACKGROUND:Surgery is the criterion standard for the treatment of severe burns and of late sequels after ingestion of corrosive agents, but long-term outcome is unknown. METHODS:Patients who underwent surgery between 1987 and 2006, for the treatment of severe caustic burns (group I, n = 268) or of late sequels (group ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3182583fb2
更新日期:2012-12-01 00:00:00
abstract:OBJECTIVE:To assess our long-term complications from complete axillary lymph node dissection (AXLND) in patients with breast cancer. SUMMARY BACKGROUND DATA:Complete AXLND as part of the surgical therapy for breast cancer has come under increased scrutiny due the use of the sentinel lymph node (SLN) biopsy technique t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/01.sla.0000129358.80798.62
更新日期:2004-07-01 00:00:00
abstract:INTRODUCTION:Advances in molecular biology have led to the identification of potential markers of prognostic and therapeutic importance in human cancers. HER-2 testing and targeted therapy now represents a critical cornerstone in the management of breast cancer. The objectives of the current study were to determine the...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181dbb77e
更新日期:2010-06-01 00:00:00
abstract:OBJECTIVE:To critically review the theoretical and actual risks and benefits of accelerated partial breast irradiation (APBI) after breast-conserving surgery. SUMMARY BACKGROUND DATA:Because of rapid evolution of radiation therapy techniques related to brachytherapy and three-dimensional conformal radiation therapy, A...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/01.sla.0000114219.71899.13
更新日期:2004-03-01 00:00:00
abstract:OBJECTIVE:The outcome of pelvic exenteration was compared in patients with locally advanced primary (LAP) cancer and recurrent rectal cancer (RRC). BACKGROUND:There are few reports comparing the results of pelvic exenteration for primary advanced rectal cancer and RRC. METHODS:Consecutive patients undergoing pelvic e...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31828a0d22
更新日期:2014-02-01 00:00:00
abstract:OBJECTIVE:To evaluate readmissions following laparoscopic adjustable gastric banding (LAGB), laparoscopic sleeve gastrectomy (LSG), and laparoscopic Roux-en-Y gastric bypass (LRYGB). BACKGROUND:Few studies have evaluated national readmission rates for primary bariatric surgery with national, bariatric-specific data. ...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/SLA.0000000000002079
更新日期:2018-01-01 00:00:00
abstract:OBJECTIVE:The objective of this study is to determine the characteristics and frequency of intraoperative safety threats and resilience supports using a human factors measurement tool. BACKGROUND:Human factors analysis can provide insight into how system elements contribute to intraoperative adverse events. Empiric ev...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003616
更新日期:2019-10-04 00:00:00
abstract:OBJECTIVE:Evaluate current risk factors for mortality and morbidity in patients undergoing the Fontan procedure at a single institution in the current era. SUMMARY BACKGROUND DATA:An emphasis on early relief of volume and pressure overload culminating in the Fontan procedure has improved patient outcomes for patients ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181858286
更新日期:2008-09-01 00:00:00
abstract:OBJECTIVE:Mycophenolate mofetil (MM) is a new immunosuppressive agent that reversibly inhibits guanine nucleotide synthesis and DNA replication. Its activity is highly selective for T and B lymphocytes. Two open-label multicenter trials of MM in renal transplantation have been performed. This report summarizes the resu...
journal_title:Annals of surgery
pub_type: 临床试验,杂志文章,多中心研究,随机对照试验
doi:10.1097/00000658-199305010-00007
更新日期:1993-05-01 00:00:00
abstract::Extracorporeal Membrane Oxygenation (ECMO) has been available to neonates with respiratory failure at the University of Michigan School of Medicine since June 1981. In order to evaluate the impact of this type of pulmonary support, a retrospective analysis of 50 neonates with posterolateral congenital diaphragmatic he...
journal_title:Annals of surgery
pub_type: 杂志文章,评审
doi:10.1097/00000658-198902000-00014
更新日期:1989-02-01 00:00:00
abstract:OBJECTIVE:On November 23, 1992, the first endovascular stent graft (ESG) repair of an aortic aneurysm was performed in North America. Following the treatment of this patient, we have continued to evaluate ESG over the past 10 years in the treatment of 817 patients. SUMMARY AND BACKGROUND DATA:Abdominal (AAA) or thorac...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究
doi:10.1097/01.sla.0000090473.63393.e9
更新日期:2003-10-01 00:00:00
abstract::Twenty-four patients with intra-peritoneal infections were studied sequentially to evaluate neutrophil chemotaxis, spontaneous migration, and chemiluminescence. In six patients, infection was due to spontaneous disease processes and 18 others, infection was a sequel of intra-abdominal operation. In the patients studie...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198107000-00003
更新日期:1981-07-01 00:00:00
abstract:OBJECTIVE:To determine if 5-year surgeon cumulative and annual volumes predict improved early postoperative outcomes in patients with rectal cancer. BACKGROUND:Operative experience has been shown to effect surgical outcomes. The differential role of cumulative versus annual volume has not yet been explored for rectal ...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000001672
更新日期:2017-01-01 00:00:00
abstract::Despite the widespread recognition of coartation of the aorta there are still many patients in whome the diagnosis is not made. A simple clinical test which is useful in making the diagnosis in infants and adults, is described. It depends upon the differential color changes between fingers and toes after releasing a m...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197611000-00014
更新日期:1976-11-01 00:00:00
abstract::Diminished poststenotic pressure and flow accompanied experimental application of multiple subcritical arterial stenoses in series. Effects of additional stenoses, causing equivalent constrictions, were cumulative in a nonlinear fashion. Seven-hundred-twenty measurements were performed using 10 cm ileofemoral canine a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-197711000-00020
更新日期:1977-11-01 00:00:00
abstract:OBJECTIVE:The current pathological lymph node (pN) staging is based on the number of positive lymph nodes but does not take into consideration characteristics of the involved lymph nodes itself. The current study aims to examine the prognostic value of extracapsular lymph node involvement (EC-LNI) and intracapsular lym...
journal_title:Annals of surgery
pub_type: 杂志文章,多中心研究,随机对照试验
doi:10.1097/SLA.0000000000001463
更新日期:2015-11-01 00:00:00
abstract::A clinical program in liver transplantation was begun at UCLA in 1984 after a period of laboratory investigation. The first 100 orthotopic liver transplants (OLT) were performed in 83 patients (43 adults and 40 children) between February 1, 1984 and November 1, 1986. Donors and recipients were matched only for size an...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-198710000-00001
更新日期:1987-10-01 00:00:00
abstract:OBJECTIVE:The authors determined whether caloric restriction (CR) either acutely or chronically, alters heat shock protein 70 (hsp70) gene expression in the gut. SUMMARY BACKGROUND DATA:Caloric restriction prolongs the life span and delays age-related disease (e.g., cancer) in mammals; the mechanisms responsible for t...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199605000-00015
更新日期:1996-05-01 00:00:00
abstract:OBJECTIVE:To determine the impact of tumor characteristics and treatment approach on (1) local recurrence, (2) scoliosis development and (3) patient-reported quality of life in children with sarcoma of the chest wall. SUMMARY BACKGROUND DATA:Children with chest wall sarcoma require multimodal therapy including chemoth...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000004579
更新日期:2020-11-04 00:00:00
abstract:BACKGROUND:The risk of metastatic spread among patients with early-stage pancreatic neuroendocrine tumors has not been well established. The authors sought to evaluate whether the new TNM staging systems proposed by the American Joint Committee on Cancer (AJCC) and European Neuroendocrine Tumor Society (ENETS) are prog...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e31824e6108
更新日期:2012-08-01 00:00:00
abstract:OBJECTIVE:To evaluate the accuracy of touch imprint and frozen section analysis of sentinel nodes after neoadjuvant chemotherapy. SUMMARY BACKGROUND DATA:Intraoperative evaluation of the sentinel node can determine the need for axillary dissection at the time of initial operation and therefore spare the patient a seco...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0b013e3181ba845c
更新日期:2010-02-01 00:00:00
abstract:OBJECTIVE:This study determined how scar formation develops in a non-human primate model of fetal skin repair. SUMMARY BACKGROUND DATA:A transition from healing scarlessly to healing with scar formation characterizes skin repair in rat and sheep fetuses. New knowledge of the regulatory processes occurring in the fetal...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/00000658-199304000-00011
更新日期:1993-04-01 00:00:00
abstract:OBJECTIVES:To develop and validate a classification of sleeve gastrectomy leaks able to reliably predict outcomes, from protocolized computed tomography (CT) findings and readily available variables. SUMMARY OF BACKGROUND DATA:Leaks post sleeve gastrectomy remain morbid and resource-consuming. Incidence, treatments, a...
journal_title:Annals of surgery
pub_type: 杂志文章
doi:10.1097/SLA.0000000000003984
更新日期:2021-01-19 00:00:00