Journal of the Chinese Medical Association : JCMA
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For intensive care unit (ICU) patients with gastrointestinal dysfunction and in need of total parenteral nutrition (TPN) support, the benefit of additional enteral feeding is not clear. This study aimed to investigate whether combined TPN with enteral feeding is associated with better outcomes in surgical intensive care unit (SICU) patients. ⋯ In SICU patients receiving TPN, patients who could be fed enterally more than 10% of total calories had better clinical outcomes than patients receiving less than 10% of total calorie intake from enteral feeding. Enteral feeding should be given whenever possible in severely ill patients.
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We evaluated adverse ischemic events as early surgical results of microsurgical clipping of 44 and 34 posterior communicating artery (PComA) aneurysms through the pterional transsylvian and pretemporal transclinoidal approach, respectively, between January 2007 and October 2010. ⋯ The pretemporal transclinoidal approach achieved better visualization of the vital neurovascular structures surrounding PComA aneurysms, which might be a key improvement in lowering the risk of intraoperative aneurysm rupture and obtaining significantly satisfactory immediate surgical results in the microsurgical clipping of PComA aneurysms, especially ruptured ones.
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Femoral artery pseudoaneurysm is a rare complication but with increasing frequency nowadays due to the advances of endovascular intervention. Rare cases of brachial or popliteal artery pseudoaneurysms had ever been reported and the predictive factors of failed ultrasound-guided compression repair (UGCR) are controversial. ⋯ UGCR is a safe and cost-effective therapy for treating peripheral pseudoaneurysms of not only femoral artery, but also brachial artery and popliteal artery. We considered the width of the pseudoaneurysm neck to be the predictive factor of technical success.
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Treatment options for nonunion of the femoral shaft fracture after intramedullary nail fixation are controversial. The methods of exchanging an existing nail with a larger-sized nail, dynamization, removal of the nail followed by plating, and bone grafting have all been reported. From those options, exchange nailing seems to be the most popular choice. In our study, we used plate augmentation and bone grafting with retention of the nail. The purpose of our study was to evaluate the effectiveness of this method in treating femoral shaft nonunion after open reduction and internal fixation with intramedullary nail fixation. ⋯ Plate augmentation with retention of the nail with autologous bone grafting may be an effective and reliable alternative in treating nonunion of the femoral shaft fracture after open reduction and internal fixation with intramedullary nail.
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Circulatory assist devices are applied to support patients with end-stage heart failure or circulatory collapse. Extracorporeal membrane oxygenation (ECMO) and ventricular assist device (VAD) are the two devices that are commonly used in these situations. However, in patients undergoing ECMO, complications occur more frequently and are more severe than in those with VAD, especially in patients with coagulopathy. The cause of coagulopathy is seldom reported; therefore, the current prospective study was designed to compare the coagulation status between patients who received ECMO and bridged VAD thereafter. ⋯ Coagulopathy of patients with VAD improved after bridging from ECMO, which can be attributed to improved coagulation factor and platelet function. Thus, bleeding complications are reduced.