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111.
Adriano Rizzi Gaetano Rocco Mario Robustellini Gerolamo Rossi Claudio Della Pona Giuseppe Vertemati 《World journal of surgery》1997,21(5):488-491
n
= 8), multidrug resistance
or noncompliance to the medical treatment (
n
= 11),
parenchymal sequelae (
n
= 3), suspected cancer
(
n
= 5), and for the correction of postpneumonectomy
bronchopleural fistula and empyema (
n
= 1). On
admission, eight patients presented with sputum positivity (28.6%).
Similar to previous series, tubercular predilection for upper lobes was
confirmed (21/28, 75%); accordingly, upper lobectomy through an
extrapleural approach was the most common procedure (16/28, 57.1%).
Atypical segmental resections or segmentectomies were performed in
seven patients (25%), whereas a bilobectomy was necessary in another
three patients (10.7%) and a completion pneumonectomy in one (3.6%).
Additional procedures were an open-window thoracostomy with
transpericardial closure of the main bronchus and a tailored
thoracoplasty. No operative mortality was reported. Healing was
achieved in 26 patients (93%). Bleeding, either from the chest wall or
hilar dissection, was the only reported intraoperative complication.
Median blood loss, inclusive of early postoperative collections from
chest tubes, reached 1330 ml (range 100–3700 ml). Major postoperative
complications included recurrent disease (2/28, 7%) in sputum-positive
patients and segmental pulmonary embolism (3.5%). Causes of minor
morbidity were air leaks resulting in residual space undergoing
spontaneous resolution (18%), wound breakdown (14%), and, fever
(11%). This limited series confirms the therapeutic value of the
surgical treatment of postprimary tuberculosis, provided that correct
indications, adequate pre- and postoperative medical coverage, and
meticulous technique are applied. 相似文献
112.
G Camussi L Biancone E L Iorio L Silvestro R Da Col C Capasso F Rossano L Servillo C Balestrieri M A Tufano 《Kidney international》1992,42(6):1309-1318
Porins, a family of hydrophobic proteins located in the outer membrane of the cell wall of gram-negative bacteria and lipopolysaccharide (LPS), were shown to stimulate the synthesis of platelet activating factor (PAF), a phospholipid mediator of inflammation and endotoxic shock, by cultured human glomerular mesangial cells (MC). The synthesis of PAF induced by porins was rapid (peak at 20 min) and independent either from contamination by LPS or from generation of an endotoxin-induced cytokine such as tumor necrosis factor (TNF) since it was not prevented by cycloheximide, an inhibitor of protein synthesis or anti-TNF blocking antibodies. LPS also stimulated PAF synthesis by MC. However, the kinetic of PAF synthesis induced by LPS was biphasic with an early and transient peak at 10 minutes and a second and sustained peak at three to six hours. This second peak required an intact protein synthesis and was prevented by anti-TNF antibodies, suggesting the dependency on LPS-induced synthesis of TNF. Experiments with labeled precursors demonstrated that in MC, either after stimulation with porins or LPS, PAF was synthesized via the remodeling pathway that involves acetylation of 1-0-alkyl-sn-glyceryl-3-phosphorylcholine (2-lyso-PAF) generated from 1-0-alkyl-2-acyl-sn-glyceryl-3-phosphorylcholine by phospholipase A2 (PLA2) activity. Porins and LPS, indeed, induced PLA2-dependent mobilization of [14C]-arachidonic acid that was inhibited by p-bromodiphenacylbromide (PBDB). PBDB, an inhibitor of PLA2, also blocked PAF synthesis by preventing the mobilization of 2-lyso-PAF, the substrate for PAF-specific acetyltransferase.(ABSTRACT TRUNCATED AT 250 WORDS) 相似文献
113.
114.
115.
The goal of this classification of bone defects related to dental implant placement is to help clinicians accurately discuss proposed treatment regimens and organize treatment for clinical correction. A further goal of this effort to categorize bone defects requiring bone augmentation for implant placement is to standardize terminology to allow for more accurate dental communication. The 5 most encountered categories of bony defects are described. 相似文献
116.
Carlo. Montoli MD Marco De Pietri MD Sara Barbieri MD Fabio DAngelo MD 《The Journal of foot and ankle surgery》2004,43(5):321-326
Total extrusion of the talus without recovery of the bone is a very unusual injury. The authors present a case of a 25-year-old man who sustained an open total enucleation of the talus in a motorcycle accident. The talus was not recovered at the scene of the accident. An immediate tibiocalcaneal stabilization was performed by using an external fixator. In the postoperative period, a polymicrobic infection was observed and treated with parenteral antibiotics. Nine months after injury, the patient developed an infection of both the empty space and the distal third of the tibia. A wound debridement with tibial sequestrectomy and insertion of gentamicin-impregnated polymethylmethacrylate beads was performed. Three months later, after multiple negative bacteriologic examinations, a tibiocalcaneal arthrodesis with staples and autogenous bone graft was performed. Because of a pseudoarthrosis, the patient underwent a revision of the arthrodesis by retrograde tibiocalcaneal nailing, achieving clinical and radiographic success. The definitive treatment of total enucleation of the talus is still controversial because of its rarity and the high rate of complications, such as avascular necrosis, osteomyelitis, and ankle stiffness. In this case, without recovery of the talus, retrograde nailing afforded good stability by bypassing the bone defects. 相似文献
117.
†Francesco Mari Carlo Di Bonaventura ‡Nicola Vanacore Jinane Fattouch Anna Elisabetta Vaudano Gabriella Egeo †Alfredo Berardelli †Mario Manfredi Massimiliano Prencipe †Anna Teresa Giallonardo 《Epilepsia》2006,47(S5):64-67
Summary: Purpose: Psychogenic nonepileptic seizures (PNES) are episodes that may resemble epileptic seizures (ES) but are not associated with abnormal electrical discharges in the brain. Video-EEG recording of a typical episode is considered the best diagnostic tool available. PNES are, however, also documented in patients with epilepsy (PNES/ES). The purpose of this study was to assess this comorbid population, focusing on the differences between patients with PNES/ES and patients with PNES alone.
Methods: We reviewed 110 PNES episodes, occurring spontaneously or induced by means of suggestion techniques, recorded in our video-EEG laboratory over a period of eight years. We identified two subgroups of patients, consisting of 85 PNES cases and 25 PNES/ES cases, and assessed any differences in their characteristics by reviewing a number of variables (age, sex, clinical features, antiepileptic therapy, age of onset, time to diagnosis, pathological history, and length of follow-up).
Results: The comparison between the two subgroups revealed that PNES/ES patients displayed some statistically significant differences when compared with PNES alone patients, i.e., younger age, a higher percentage of spontaneously activated events, a shorter disease duration, a longer time to PNES diagnosis, and a lower percentage lost at follow-up.
Conclusions: This study confirms that PNES is a common, though probably underestimated, occurrence in epilepsy services. Our results shed light on some different characteristics between PNES and PNES/ES patients. 相似文献
Methods: We reviewed 110 PNES episodes, occurring spontaneously or induced by means of suggestion techniques, recorded in our video-EEG laboratory over a period of eight years. We identified two subgroups of patients, consisting of 85 PNES cases and 25 PNES/ES cases, and assessed any differences in their characteristics by reviewing a number of variables (age, sex, clinical features, antiepileptic therapy, age of onset, time to diagnosis, pathological history, and length of follow-up).
Results: The comparison between the two subgroups revealed that PNES/ES patients displayed some statistically significant differences when compared with PNES alone patients, i.e., younger age, a higher percentage of spontaneously activated events, a shorter disease duration, a longer time to PNES diagnosis, and a lower percentage lost at follow-up.
Conclusions: This study confirms that PNES is a common, though probably underestimated, occurrence in epilepsy services. Our results shed light on some different characteristics between PNES and PNES/ES patients. 相似文献
118.
Distribution of paresthesias in Carpal Tunnel Syndrome reflects the degree of nerve damage at wrist.
Pietro Caliandro Giuseppe La Torre Irene Aprile Costanza Pazzaglia Irene Commodari Pietro Tonali Luca Padua 《Clinical neurophysiology》2006,117(1):228-231
OBJECTIVE: To verify whether the distribution of paresthesias in patients with Carpal Tunnel Syndrome (CTS) is related to the degree of the neurophysiological involvement. METHODS: We performed a cross-sectional study and retrospectively evaluated 163 patients who referred to our electromyography lab and to which a clinical and electrophysiological diagnosis of CTS was made. We divided the patients into two groups: (1) patients complaining of paresthesias at the hand as a whole and (2) patients with paresthesias in the territory of the median nerve. We referred to the distribution of paresthesias at the hand as GLOVE and to the distribution in the territory of the median nerve as MEDIAN. We compared the neurophysiological impairment in GLOVE and MEDIAN distributions. Moreover, we performed multiple regression analysis to evaluate which clinical-neurophysiological variables determined GLOVE and MEDIAN distribution. RESULTS: In our sample, 70.4% of patients had GLOVE distribution and 29.6% of patients MEDIAN distribution. The risk of presenting MEDIAN distribution increases about twice (OR = 2.07; 95% IC: 1.51-2.83) for each unitary increment of neurophysiological class. CONCLUSIONS: The distribution of paresthesias reflects the degree of nerve damage at wrist; patients suffering of SEV/EXT CTS present MEDIAN distribution. SIGNIFICANCE: Our data have important clinical implications because they strongly suggest that we have to consider the possibility of a severe neurophysiological involvement of the median nerve at wrist in patients complaining of MEDIAN distribution. 相似文献
119.
Functional signatures of protective antiviral T-cell immunity in human virus infections 总被引:9,自引:0,他引:9
Alexandre Harari Valérie Dutoit Cristina Cellerai Pierre-Alexandre Bart Renaud A. Du Pasquier & Giuseppe Pantaleo 《Immunological reviews》2006,211(1):236-254
Summary: The most common human viruses have different abilities to establish persistent chronic infection. Virus‐specific T‐cell responses are critical in the control of virus replication and in the prevention of disease in chronic infection. A large number of phenotypic markers and a series of functions have been used to characterize virus‐specific CD4+ and CD8+ T‐cell responses, and these studies have shown great phenotypic and functional heterogeneity of the T‐cell responses against different viruses. The heterogeneity of the T‐cell response has been proposed to be specific to each virus. However, over the past 2 years, several studies have provided evidence that the phenotypic and functional heterogeneity of CD4+ and CD8+ T‐cell responses is predominantly regulated by the levels of antigen load. The levels of antigen load modulate the phenotypic and functional patterns of the T‐cell response within the same virus infection. Furthermore, the functional characterization of virus‐specific CD4+ and CD8+ T‐cell responses has identified signatures of protective antiviral immunity. Polyfunctional, i.e. interleukin‐2 and interferon‐γ (IFN‐γ) secretion and proliferation, and not monofunctional, i.e. IFN‐γ secretion, CD4+ and CD8+ T‐cell responses represent correlates of protective antiviral immunity in chronic virus infections. 相似文献
120.
Treatment of Status Epilepticus in Adults: Guidelines of the Italian League Against Epilepsy 总被引:2,自引:1,他引:1
Fabio Minicucci †Giancarlo Muscas ‡Emilio Perucca §Giuseppe Capovilla Federico Vigevano ¶Paolo Tinuper 《Epilepsia》2006,47(S5):9-15
Summary: Status epilepticus (SE) is a medical emergency which can lead to significant morbidity and mortality and requires prompt diagnosis and treatment. SE is differentiated into generalized or partial SE on the basis of its electro-clinical manifestations. The guidelines for the management of SE produced by the Italian League against Epilepsy also distinguish three different stages of SE (initial, established and refractory), based on time elapsed since the onset of the condition and responsiveness to previously administered drugs. Treatment should be started as soon as possible, particularly in generalized convulsive SE, and should include general support measures, drugs to suppress epileptic activity and, whenever possible, treatments aimed at relieving the underlying (causative) condition. Benzodiazepines are the first line antiepileptic agents, and i.v. lorazepam is generally preferred because it is associated with a lower risk of early relapses. If benzodiazepines fail to control seizures, i.v. phenytoin is usually indicated, though i.v. phenobarbital or i.v. valproate may also be considered. Refractory SE requires admission to an intensive care unit (ICU) to allow adequate monitoring and support of respiratory, metabolic and hemodynamic functions and cerebral electrical activity. In refractory SE, general anesthesia may be required. Propofol and thiopental represent first line agents in this setting, after careful assessment of potential risks and benefits. 相似文献