Authors from Iran compare various outcomes between laparoscopic and open donor nephrectomy in kidney transplantation; they carried out a large comparative trial, and found that laparoscopic donor nephrectomy gave better donor satisfaction and morbidity, with equivalent graft outcome. OBJECTIVE: To compare the graft survival, donor and recipient outcome, donor satisfaction, and complications of laparoscopic (LDN) and open donor nephrectomy (ODN) in kidney transplantation. PATIENTS AND METHODS: In a randomized controlled trial, 100 cases each of LDN and ODN were compared. We modified the standard LDN procedure to make it less expensive. RESULTS: The mean (sd) operative duration was 152.2 (33.9) min for ODN and 270.8 (58.5) min for LDN, and the mean duration of kidney warm ischaemia was 1.87 min for ODN and 8.7 min for LDN. Only one LDN required conversion to ODN because of bleeding. The mean follow-up in the LDN and ODN groups was not significantly different (406.1 vs 403.8 days). The mean (sd) score for donor satisfaction was 17.3 (3.5) for ODN and 19.6 (1.0) for LDN. The rate of ureteric complications was 2% for ODN and none for LDN. As determined by serum creatinine levels at 3, 21-30, 90, 180 and 365 days after surgery, graft function was not significantly different between ODN and LDN. Long-term graft survival was 93.8% for LDN and 92.7% for ODN. CONCLUSIONS: Compared to ODN, LDN was associated with greater donor satisfaction, less morbidity and equivalent graft outcome. 相似文献
BACKGROUND AND PURPOSE: Hydrocephalus is a frequent and potentially serious complication of neurocysticercosis. Its treatment often requires ventricular shunting. The complication rate is high due to obstruction or material infection, which may justify endoscopic third ventriculostomy (ETV). OBSERVATION: We report a case of obstructive hydrocephalus in a 46-year-old man in the context of racemose cysticercosis, presenting with headaches and transient disorders of consciousness. Imaging showed cystic lesions of the cisterna magna, responsible for hydrocephalus which was treated effectively by ETV. Treatment with albendazole decreased the volume of the cisterna magna cysts. RESULTS: The patient was followed for 6 years after ETV with no recurrence of hydrocephalus despite two more symptomatic episodes of the disease with extension of the cysts into the lumen of the fourth ventricle and into the perispinal subarachnoid spaces, effectively treated by albendazole each time. CONCLUSIONS: Treatment of obstructive hydrocephalus secondary to cerebral racemose cysticercosis by ETV seems to be an effective and safety technique. The role of ETV should be evaluated in this indication. 相似文献
Christopher Dye, DPhil; Catherine J. Watt, DPhil; Daniel M. Bleed, MD; S. Mehran Hosseini, MD; Mario C. Raviglione, MD
JAMA. 2005;293:2767-2775.
Context The United Nations Millennium Development Goals(MDGs) are stimulating more rigorous evaluations of the impactof DOTS (the WHO-recommended approach to tuberculosis controlbased on 5 essential elements) and other possible strategiesfor tuberculosis (TB) control.
Objective To evaluate the prospects for detecting 70%of new sputum smearpositive cases and successfully treating85% of these by the end of 2005, for reducing TB incidence,and for halving TB prevalence and deaths globally between 1990and 2015, as specified by the MDGs.
Data Sources TB case notifications (1980-2003) from DOTSand non-DOTS programs and cohort treatment outcomes (1994-2002)reported annually to the World Health Organization (WHO) byup to 200 countries, TB death registrations, and prevalencesurveys of infection and disease.
Study Selection Case notification series that reflecttrends in incidence, treatment outcomes from DOTS cohorts, deathstatistics from countries with WHO-validated vital registrationsystems, and national prevalence surveys of infection and disease.
Data Extraction Case reports, treatment outcomes, prevalencesurveys, and death registrations from WHO's global TB databasecovering 1990-2003 to estimate TB incidence, prevalence, anddeath rates through 2015 for 9 epidemiologically different worldregions.
Data Synthesis TB incidence increased globally in 2003,but incidence, prevalence, and death rates were approximatelystable or decreased in 7 of 9 regions. The exceptions were regionsof Africa with low (<4% in adults 15-49 years) and high rates(4%) of HIV infection. The global detection rate of new smear-positivecases by DOTS programs increased from 11% in 1995 to 45% in2003 (with the lowest case-detection rates in Eastern Europeand the highest rates in the Western Pacific) and could reach60% by 2005. More than 17 million patients were treated in DOTSprograms between 1994 and 2003, with overall treatment successrates more than 80% since 1998. In 2003, overall reported treatmentsuccess was 82%, with much variation among regions. The highestrates were reported in the Western Pacific region (89%) andlowest rates in African countries with high and low HIV infectionrates (71% and 74%, respectively), in established market economies(77%), and in Eastern Europe (75%). To halve the prevalencerate by 2015, TB control programs must reach global targetsfor detection (70%) and treatment success (85%) and also reducethe incidence rate by at least 2% annually. To halve the deathrate, incidence must decrease more steeply, by at least 5% to6% annually.
Conclusion Reduction of TB incidence, prevalence, anddeaths by 2015 could be achieved in most of the world, but thechallenge will be greatest in Africa and Eastern Europe.
Quadriceps tendon ruptures are relatively unusual injuries caused by direct or more frequently indirect trauma. Since complete ruptures lead to loss of active extension of the knee joint, operative treatment is usually indicated. Several techniques are described in the literature. However, relatively little is known about the functional outcome after operative treatment of acute quadriceps tendon ruptures. We present a new operative technique using a 1.3-mm PDS cord passed through a transverse drill hole in the proximal pole of the patella. We operated ten consecutive cases of complete quadriceps tendon ruptures with the technique described between January 2000 and June 2003. Eight of ten patients were evaluated after a mean follow-up time of 38 months by physical examination, IKDC Subjective score, Lysholm and Tegner score as well as an isokinetic test of the quadriceps strength. No complications were noted in this period. The average postoperative scores were 87 (IKDC), 98 (Lysholm), and 4.5 (Tegner). Isokinetic testing showed an average of 25% quadriceps strength deficit. The operative treatment of complete quadriceps tendon ruptures using a PDS cord through a drill hole in the patella is a safe and effective technique permitting functional postoperative treatment. 相似文献
Summary. Complete nucleotide sequence of the Iranian strain of tomato yellow leaf curl virus (TYLCV-IR) was determined and compared with some begomoviruses. The complete sequence of TYLCV-IR clustered together with TYLCV and TYLCV-MId from Israel. A similar relationship holds when the deduced amino acid sequences of V1, V2, C2 and C3 and nucleotide sequences of IR, and RIR were compared. In contrast, phylogenetic analyses of amino acid sequences of C4, C1, and nucleotide sequences of LIR revealed that TYLCV-IR clustered with TLCIRV and two Indian species: ToLCBV- [Ban4], and ToLCKV. The phylogenetic analyses, Recombination Detection Program analyses, and sequence alignment survey provided evidence of the occurrence of recombination between an Israeli TYLCV-MId, as major parent, and TLCIRV, as minor parent. In this recombination event, a region (from nt 2149 to 2766) of TYLCV-MId genome were replaced with corresponding genome sequences of TLCIRV (RDP P-value = 5.976 × 10–72), which include LIR, C4, and N-terminal of C1. Infectivity of the cloned TYLCV-IR genome was demonstrated by successful agroinoculation of tomato (Lycopersicon esculentum) and other plant species. The disease was transmitted by the natural vector Bemisia tabaci from agroinoculated plants to test plants, reproducing in this way the full biological cycle and proving that the genome of TYLCV-IR consists of only one circular single-stranded DNA molecule. 相似文献
In order to identify Helicobacter in gallstones of Iranian patients with biliary disease, gallstone and bile samples from 33 patients were subjected to rapid urease test, culture and Multiplex PCR using primers based on 16s rRNA and isocitrate dehydrogenase genes for the identification of Helicobacter genus and H. pylori respectively. This PCR was also done on bile samples from 40 autopsied gallbladders with normal pathology (control group). In 18.1% of stone and 12.1% of bile samples, H. pylori DNA was detected using PCR. Rapid urease and culture tests were negative for all samples. The PCR was negative in the control group. In conclusion, H. pylori DNA was detected in stone samples of Iranian patients with gallstones but we are not sure of their viability. To clarify the clinical role of Helicobacter in gallbladder diseases, studies using accurate tests on larger patient and control groups are needed to ascertain whether this microorganism is an innocent bystander or active participant in gallstone formation. 相似文献
The combination of optic atrophy and dystonia has been etiologically associated with mitochondrial DNA (mtDNA) mutations. We report here on the complete mtDNA sequence from the proband of a consanguineous family exhibiting "mitochondrial-like" optic atrophy and dystonia. A candidate tRNA(Gly) mutation was identified that was unique to the family. However, the mutation was homoplasmic in both affected and unaffected family members and we were unable to demonstrate a biochemical defect in patient mitochondria. Hence, it is unlikely that a mtDNA mutation accounts for the phenotype in this family. 相似文献