共查询到20条相似文献,搜索用时 109 毫秒
1.
Montebugnoli L Frini F Gissi DB Gabusi A Cervellati F Foschini MP Marchetti C 《Lasers in medical science》2012,27(1):205-210
Laser excision has been used with increasing success to treat oral leukoplakia. The aim of the present study was to evaluate
whether clinical healing of a leukoplakia after laser surgery is associated with a normal functional status of the new epithelium
and whether pathological alterations in these parameters are related to the risk of local recurrence. The study population
consisted of 13 consecutive patients with oral leukoplakia in which clinical healing was achieved after laser therapy using
an Nd:YAG laser (Model 6000, Laser Sonics, Cooper Laser Sonics). At the end of the therapy, all patients underwent a second
biopsy of the clinically healthy tissue. Epithelial cell turnover was evaluated before and after laser surgery by Ki67 protein
expression, and positive staining of more than 20% was considered abnormal. All patients were followed on a monthly basis.
Eight patients had abnormally high Ki67 values before laser therapy (mean 27.4 ± 6.2%), but the levels decreased significantly
after treatment (17.6 ± 8.5%; t = 2.6, p < 0.05). High Ki67 values persisted in three patients, and local recurrences in the new epithelium was observed in two of
these patients. Kaplan–Meier statistics showed that the between-group difference was statistically significant (Chi square
7.3; p < 0.01). In conclusion, this is the first prospective study to show that clinical healing of leukoplakia treated by laser
surgery may be accompanied by altered cell turnover in 20% of the cases. Ki67, as a marker of proliferative status, may be
a prognostic indicator in the mucosa replacing the lesion. 相似文献
2.
Purpose
Inhibition of tumor proliferation rate based on bromodeoxyuridine labelling index (BrdUrdLI), S-phase fraction (SPF) and MIB-1 labelling index (MIB-1 LI) as an early rectal cancer response to preoperative radiotherapy (RT). 相似文献3.
Background In this prospective study, we followed patients after laparoscopic adjustable gastric banding for morbid obesity who underwent
abdominoplasty for body contouring. Our purposes were: 1) to determine if a significant relationship between cigarette smoking
and postoperative wound infections existed, 2) the relative risk conferred by cigarettes and 3) a cut-off value for the increased
risk.
Methods Patients scheduled for body contouring abdominoplasty were considered eligible. We excluded those with ongoing clinical infections,
recent antibiotic administration, those within 1 year from their bariatric surgery and those with systemic diseases. Smokers
were asked to stop smoking at least 4 weeks before surgery.
Results Since November 2004, we recruited 60 patients. Postoperative infections were present in 25% (n = 15) of patients and 86.7%
of these (n = 13) were superficial. All except one occurred in smokers (P = 0.0001): 47% of smokers and 3% of nonsmokers developed infections. Significant differences between infections vs infection-free
patients were present for the number of cigarettes smoked per day (P < 0.001), years of smoking (P < 0.001), overall estimated cigarettes smoked and the number of pack years (P = 0.001). A cut-off value of ∼62,000 overall estimated cigarettes (8.5 pack years) distinguished between infections vs infection-free
patients (6.2% false positives and 7.1% false negatives). Relative risk conferred by smoking was 14 (95% confidence intervals
13.3–16.7).
Conclusions The incidence of infections in postbariatric patients undergoing body contouring abdominoplasties is 25%. The relative risk
conferred by smoking was 14 and the cut-off value was 62,000 overall cigarettes (8.5 pack years). 相似文献
4.
Christoph Ausch Veronika Buxhofer-Ausch Ulrike Olszewski Rudolf Schiessel Emil Ogris Wolfgang Hinterberger Gerhard Hamilton 《Journal of gastrointestinal surgery》2009,13(11):2020-2026
Soluble cytokeratin 18 fragments (M30, M65) are released from human cancer cells during cell death and hold potential as biomarkers
in colorectal cancer characterized by frequent metastatic spread. A total of 62 colorectal cancer and 27 control patients
were included in the study. M65 (necrosis and apoptosis) and M30 (apoptosis) were quantified preoperatively (n = 62) and postoperatively (n = 31) using specific enzyme-linked immunosorbent assays. Presence of disseminated tumor cells (DTC) in the bone marrow was
assessed by staining of A45-B/B3-positive cells in aspirates. M65 was significantly elevated in patients with International
Union against Cancer stage I and IIA tumors compared to controls. A subgroup (19/31) exhibited a significant (p < 0.05) decrease of M65 after tumor surgery (503.9 ± 230.7 to 342.6 + 94.8 U/l; −32.0 ± 16.5%), in contrast to 12 patients
who revealed higher M65 levels postoperatively (386.5 ± 128.5 to 519.1 ± 151 U/l; +37.4 ± 32.3%). DTC in bone marrow were
found in 10% (2/19) of patients with decreasing and 50% (6/12) of the patients with increasing M65 serum concentrations after
surgery (p = 0.028). In conclusion, M65 as marker is likely to be valuable to identify patients with a high incidence of systemic disease. 相似文献
5.
Purpose To determine if Noguchi's classification can be evaluated accurately by frozen-section diagnosis before limited surgery.
Methods We performed frozen-section diagnosis in 31 of 343 patients who underwent excision of primary lung cancer at our hospital
between 1993 and 2004. All 31 patients had pulmonary adenocarcinoma, with a tumor diameter of ≦20 mm. There were 20 men and
11 women, ranging in age from 42 to 79 years (mean, 63.2 years). We assessed the rate of correct Noguchi's classification
by categorizing all lesions into the following three groups on the basis of tumor diameter: ≤10 mm, 11–15 mm, and 16–20 mm.
Results The overall rate of correct frozen-section diagnosis during surgery was 67.7%; being 100%, 41.7%, and 70% in the ≦10 mm, 11–15 mm,
and 16–20 mm groups, respectively.
Conclusion Limited surgery for primary lung cancer can be performed when the tumor diameter is ≦10 mm, by confirming it as either type
A or B according to Noguchi's classification, using frozen-section diagnosis. Thus, examination of frozen sections might be
an important diagnostic procedure before intentional limited surgery for lung cancer. 相似文献
6.
Intra-operative quick insulin assay to confirm complete resection of insulinomas guided by selective arterial calcium injection (SACI) 总被引:1,自引:0,他引:1
Oliver Gimm Evelyn König Phuong Nguyen Thanh Michael Brauckhoff Wolfram Karges Henning Dralle 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(6):679-684
Background and aims Insulinomas are rare endocrine disorders. Pre-operatively, conventional imaging techniques often fail to localise the tumor.
In addition, due to the lack of quick insulin assays, intra-operative confirmation of complete resection was impossible until
recently.
Materials and methods Six patients with biochemical evidence of an insulinoma underwent pre-operative localisation studies and selective arterial
calcium injection (SACI). In addition, insulin was measured before surgery and every 10–15 min after resection of the tumor
using a quick insulin assay.
Results Pre-operative localisation studies identified the tumor correctly as follows: endosonography: three of four, magnetic resonance
imaging: two of four and SACI: six of six. Tumors in the head and body were enucleated while those in the tail were resected
(n = 2, each). Those three patients, in whom magnetic resonance imaging and/or endosonography could localise the tumors pre-operatively,
underwent laparoscopic surgery while the remaining three patients underwent open surgery. Intra-operatively, insulin dropped
to normal levels within 20 min in all cases. After a follow-up of 0.8–3 years, all patients remained biochemically cured.
Conclusions Pre-operatively, SACI appears to be a very sensitive localisation technique and may be most helpful in guiding the surgeon
if conventional imaging techniques fail to localise the tumor. Complete removal of an insulinoma can be reliably predicted
using a quick insulin assay.
This paper was presented at the 2nd Biennial Meeting of the European Society of Endocrine Surgeons (ESES), May 18–20, 2006,
Krakow, Poland. 相似文献
7.
Background Obstructive sleep apnea syndrome (OSAS) is present in 44% of patients scheduled for bariatric surgery. Respiratory dysfunction
associated with this syndrome is attributable to chronic obstructive pulmonary disease (COPD) and/or obesity hypoventilation
syndrome (OHS).We studied the long-term effect of bariatric surgery on weight loss, on the respiratory comorbidities associated
with obesity, and on the need for non-invasive positive pressure ventilation.
Methods We followed a sample of patients with respiratory co-morbidity scheduled for open Capella Roux-en-Y gastric bypass (RYGBP)
over 5-years. Patients who were positive for polysomnographic studies and required continous positive airway pressure (CPAP)
before surgery were included. All patients were subjected to the same anesthetic and surgical protocols. At 1 year after surgery,
polysomnographic studies were performed and arterial blood gases and pulmonary function were tested.
Results Of the 209 patients scheduled for bariatric surgery during the study period, 105 had respiratory co-morbidity. Of these, 30
required CPAP-BiPAP treatment before surgery and were included in our study. Surgery took 128 minutes (range 70 to 210 minutes).
Tracheal extubation in the operating theater was possible for 26 patients (86.7%). During the early postoperative period,
7 patients (23.3%) presented respiratory complications. Length of hospitalization was 6.87 days (range 4 to 11 days). At 1
year after RYGBP, patients presented significant weight loss and improvement of hypoxemia (from 73.3 ± 10.6 to 90.5 ± 11.5,
P = 0.000), hypercarbia (from 44.5 ± 5.7 to 40.6 ± 4.9, P = 0.005), and in spirometric (P = 0.004) and polysomnographic results
(P = 0.001). CPAP-BiPAP treatment after weight loss was necessary in only 14% of patients (P = 0.001).
Conclusions Weight loss after RYGBP improved arterial blood gases, respiratory tests and polysomnographic studies. CPAP treatment can
be withdrawn in most patients. 相似文献
8.
Palazuelos-Genis T Mosti M Sánchez-Leenheer S Hernández R Garduño O Herrera MF 《Obesity surgery》2008,18(1):1-4
Background Weight loss in patients undergoing gastric bypass should be primarily from fat mass (FM), minimizing the fat-free mass (FFM)
loss. The aim of this study was to analyze changes in body weight and body composition during the first postoperative year
in 50 morbidly obese patients undergoing a Laparoscopic Roux-en-Y gastric bypass (LRYGBP) at the Obesity Clinic of the ABC
Medical Center.
Methods Patient’s weight and body composition were obtained before surgery and 1 year later using bioelectrical impedance analysis
(BIA). Weight, FM, FMM, and total body water (TBW) were measured before and 1 year after surgery. Changes in body composition
were particularly analyzed.
Results There were 29 females and 21 males with mean age of 41 ± 12 years. Mean BMI before surgery and 1 year after surgery was 44.4 ± 7.4 kg/m2 and 28.3±4.3 kg/m2, respectively. The percentage of excess body weight loss at the 1-year period was 86% for women and 79.6% for men. The percentage
of FM before surgery was 47.7 ± 5.1, and 1 year later it was 28.8 ± 8. The percentage of FFM was 66.5 ± 16.5 before surgery
and 58.3 ± 13 at 1 year.
Conclusions There is a significant weight loss in patients undergoing LRYGBP. Weight loss mainly occurs as a consequence of reduction
in the FM with less impact on the FFM. 相似文献
9.
Pathologic Correlation Study of Microwave Coagulation Therapy for Hepatic Malignancies Using a Three-Ring Probe 总被引:4,自引:0,他引:4
Perry Shen Kim R. Geisinger Ronald Zagoria Edward A. Levine 《Journal of gastrointestinal surgery》2007,11(5):603-611
Microwave coagulation therapy (MCT) for the ablation of unresectable hepatic malignancies is a promising alternative to radiofrequency
and cryoablation techniques. There are few data on the clinical effectiveness of MCT. In vivo pathologic evaluation of ablated
tumor tissue is not well described for the three-ring microwave probe. The study design was a prospective trial enrolling
patients with resectable hepatic malignancies. Lesions underwent in vivo MCT with the three-ring probe prior to liver resection.
Gross and histologic evaluations of the tumor were performed, including nicotinamide adenine dinucleotide (NADH) vital staining.
A total of nine patients with metastatic colon cancer were enrolled and had NADH stains performed of their pathologic specimens.
The median size of the metastasis being ablated was 3.5 cm (range, 1.5–12.3). Fifty-six percent of the tumors demonstrated
evidence of spontaneous coagulative necrosis on immediate histologic examination. The median dimensions of the ablation zones
were 5 cm (range, 3–7) × 4.5 cm (range, 2.5–5.2) × 4.2 cm (range, 2–5) with a 5-min ablation at 60 W. The median ablation
volume was 50.6 cm3 (range, 9–78). NADH vital staining was performed of the ablation zones with 100% absence of staining in the tumor tissue
and in benign hepatic parenchyma, which is consistent with irreversible cellular damage. In conclusion, in vivo MCT of hepatic
malignancies with the three-ring probe produces nonviable tumor cells after a 5-min ablation. The ablation time is significantly
shorter than other available ablative techniques. Immediate histologic exam produces some evidence of coagulative necrosis.
Further study of this promising technology is warranted.
Poster presentation at the Society of Surgical Oncology annual meeting, March 24, 2006, San Diego, CA. 相似文献
10.
Cell proliferation of human bladder tumors determined by BrdUrd and Ki-67 immunostaining 总被引:10,自引:0,他引:10
The cell proliferation of bladder tumors was assessed in situ using BrdUrd (bromodeoxyuridine) and Ki-67 immunostaining. BrdUrd is incorporated into S-phase cells, and Ki-67 monoclonal antibody recognizes a nuclear antigen present in proliferating, but not resting cells. The percentage of labeled cells was expressed as the labeling index (LI). The average BrdUrd LI obtained applying this method to normal epithelium and to transitional cell carcinoma were 4.1% and 13.1%, respectively, while the Ki-67 LI had average values of 6.2% and 17.8%, respectively. Labeled cells were distributed throughout both the basal and surface layers of transitional cell carcinoma. In general, the value of the BrdUrd LI was correlated to that of the Ki-67 LI. A relatively large fraction of labeled cells was found in high grade or invasive tumors. Bladder tumors with lymph node involvement had higher LI than those without. In addition, a high frequency of S-phase cells within tumor tissue appeared to indicate a great potential for malignancy and thus a poor prognosis. These findings indicate that immunostaining with BrdUrd and Ki-67 may be useful tools for easy and quick evaluation of proliferating cells in bladder tumors. 相似文献
11.
Marcus Lehnhardt Adrien Daigeler Heinz H. Homann Vanessa Schwaiberger Ole Goertz Cornelius Kuhnen Hans U. Steinau 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2009,394(2):313-320
Background Undifferentiated pleomorphic sarcoma/NOS (not otherwise specified; former pleomorphic and storiform MFH) of the extremities
is a common malignant soft tissue tumor in adults. The objective of this study is to determine prognostic factors for the
outcome after surgical treatment with respect to the recent developments in classification.
Methods From 1996 to 2004, 140 undifferentiated pleomorphic sarcomas/NOS were identified out of 1,200 soft tissue sarcomas of the
extremities that were treated at our institution and recorded in a prospective database. Overall survival (OS) and isolated
local recurrence (ILR) were determined by Kaplan–Meier analysis. All tumors were retrospectively analyzed regarding prognostic
factors of the disease, including patient’s background (primary or recurrent), histological grade (G2/G3), adjuvant chemotherapy
and radiotherapy, size (T1–2) and depth of the tumor, and surgical margins (R0, R1, R2).
Results In 123 patients, a wide resection was performed (limb-sparing surgery). In nine patients, an amputation was necessary. The
overall 5-year survival rate was 72% (median follow up: 52 months). There was a significant difference between the group presenting
with primary tumors (5-year survival: 84%, p < 0.05) and recurrent tumors (5-year survival: 62%, p < 0.05). Isolated local recurrence occurred in 36 patients.
Conclusions In terms of OS and ILR, primary or recurrence, negative surgical margins, size and grading had a highly significant influence,
whereas the site of surgery and adjuvant chemotherapy, adjuvant radiation and tumor depth did not. Prognosis for patients
with undifferentiated pleomorphic sarcoma of the extremities depends predominantly on adequate wide resection of the primary
tumor.
Marcus Lehnhardt and Adrien Daigeler contributed equally to the study. 相似文献
12.
P. Vogel U. Bolder M. N. Scherer H.-J. Schlitt K.-W. Jauch 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2009,394(2):331-337
Background/Aims Soft tissue sarcomas (STS) are rare tumors. General treatment is difficult while multimodality treatment strategies are more
and more common. In these strategies, surgical resection of the primary tumor is essential to achieve local control of the
tumor. In certain cases, complex resections (CR) including multivisceral and/or vascular resection are needed to achieve resection
with tumor-free margins. In this study, we evaluated retrospectively the overall prognosis, morbidity, and mortality of patients
treated for STS at our university hospital.
Patients/Methods Between 1992 and 2000, 24 of 154 patients with STS received multivisceral resection and four of 154 underwent vascular resection.
To determine the influence of CR on overall prognosis, we compared n = 19 patients after CR with a matched control group after simple tumor resection (SR). To determine surgical morbidity and
mortality the whole study group was used (n = 154, SR n = 126, CR n = 28).
Results The median follow up for all patients was 6.89 years (mean 5.64 years SD 4.3) with no difference between the groups (CR vs
SR: 5.4 SD 4.8 vs 5.9 SD 3.9 years; p = 0.711). Patients receiving CR had a similar overall prognosis (mean survival 9.9 years), morbidity (10.7%) and mortality (0%) compared
to patients with SR (mean survival 8.5 years; morbidity 10.3%; mortality 3.96%).
Conclusions Multivisceral resection and/or vascular resection with tumor-free margins can be achieved with the same overall prognosis,
same morbidity and mortality as SR. This has to be taken into account when evaluating the treatment strategy in patients with
STS. 相似文献
13.
Matilde De Simone Michele M. Ciulla Ugo Cioffi Luca Poggi Barbara Oreggia Roberta Paliotti Fiorenzo Botti Alberto Carrara Fiorenza Agosti Alessandro Sartorio Ettore Contessini-Avesani 《Journal of gastrointestinal surgery》2007,11(10):1361-1364
Aim
This study investigates the effects of surgery on collagen turnover in patients affected by Crohn’s disease (CD).
Methods
Fifteen patients affected by active CD, assessed according to the Crohn’s disease activity index, and confirmed by histology,
with different pharmacological treatments, were enrolled in the study. N-Terminal propeptide of type III collagen was assessed
on peripheral blood before and 6 months after surgery, as an index of collagen turnover. A control group of 15 healthy age-
and sex-matched subjects was also studied.
Results
In CD patients peripheral N-terminal propeptide of type III collagen serum levels were significantly higher than in controls
before surgery (5.0 ± 1.8 vs 2.7 ± 0.7 μg/l, respectively; p = 0.0001). Six months after these values were significantly reduced (from 5.0 ± 1.8 to 3.1 ± 0.8 μg/l; p = 0.003). Independently on the pretreatment regimen and the duration of the disease, an improvement in the patients’ symptoms
was observed.
Conclusions
The surgical resection of the affected intestinal segment in CD patients seems to be able to break down the collagen synthesis
processes. Peripheral N-terminal propeptide of type III collagen could be seen as an additive marker to clinical and endoscopic
observations after surgery. 相似文献
14.
Background An essential outcome criterion of obesity surgery besides weight loss is the improvement of medical and psychological health
status. Both dimensions influence quality of life. This study evaluates depressive symptoms, self-esteem and health-related
quality of life 2 years after bariatric surgery.
Methods 149 patients (47 males (32%), 102 females (68%), mean age 38.8 ± 10.3 years) were assessed by standardized questionnaires
before and 1 and 2 years after gastric restrictive surgery.
Results Mean BMI pre-surgery was 51.3 ± 8.4 kg/m2. BMI decreased significantly to 38.6 ± 6.8 kg/m2 at 1 year and to 37.9 ± 7.4 kg/m2
at 2 years after surgery. Statistical analyses revealed a significant decrease in depressive symptoms and a significant improvement
in selfesteem and the physical dimension of health-related quality of life. Pre-surgery, 40.5% (n = 62) of the patients suffered from depressive symptoms of clinical relevance. These depressive symptoms persisted in 17.7%
(n = 27) 1 year and in 16.4% (n = 25) 2 years after surgery.
Conclusion Parallel with a considerable weight loss after bariatric surgery, important aspects of mental health such as depressive symptoms
and selfesteem improved significantly. These effects appear 1 year after surgery, but do not seem to change considerably afterwards. 相似文献
15.
Baik SH Kim NK Lee CH Lee KY Sohn SK Cho CH Kim H Pyo HR Rha SY Chung HC 《Surgery today》2007,37(6):455-459
Purpose Gastrointestinal stromal tumors (GISTs) rarely originate in the rectum. We investigated the clinicopathologic characteristics
of rectal GISTs.
Methods We analyzed the medical records of seven patients who underwent surgery for GIST of the rectum between 1998 and 2003.
Results There were two men and five women with a median age of 55 years (range, 41–72 years) at the time of diagnosis. The median
follow-up period was 23 months (range, 7–75 months). The chief symptoms were hematochezia, constipation, and anal pain. All
patients underwent curative resection; in the form of abdominoperineal resection in five patients, transanal excision in one,
and Hartmann's operation with prostatectomy in one. The median tumor size was 6.6 cm (range, 1–12 cm). Four patients received
adjuvant radiation therapy. Local recurrence developed in two patients; 54 months and 23 months after surgery, respectively.
Conclusion The common symptoms of rectal GIST were the same as those of other rectal tumors. Curative surgical resection should be done,
but further studies are necessary to investigate better adjuvant treatment strategies for patients with rectal GISTs 相似文献
16.
Purpose The purpose of this study was to evaluate the effects of quazepam, a long-acting hypnotic, as a preoperative night medication
in comparison with brotizolam, a shortacting hypnotic.
Methods Two hundred patients (aged 30 to 70 years) admitted for elective general anesthesia at various hospitals were enrolled. Quazepam
15 mg, 30 mg, or 45 mg, or brotizolam 0.25 mg (40 patients each), was administered orally at 9 p.m. in the evening of the
day before surgery. The control group (40 patients) did not receive any drugs. The quality of night sleep between the night
during hospitalization and the night before surgery was compared by using a questionnaire. In the first 8 patients who received
quazepam 15 mg, 30 mg, and 45 mg, the plasma concentrations of quazepam and its metabolites were measured 12 h after the drug
administration, when the patients were brought into the operating room.
Results In all the drug-administered groups, the speed of falling asleep, sleeping state, and feeling of freshness in the morning
improved compared to the previous night and compared to the control group; the frequency of nocturnal awakening and dreaming
decreased, and the total duration of sleep the night before surgery increased. Total duration of sleep was significantly longer
in the groups with quazepam 30 mg and 45 mg than in the control and brotizolam 0.25 mg groups. No patients were drowsy with
plasma concentrations of quazepam of 30 to 65 ng·ml−1.
Conclusion The preoperative night hypnotics, quazepam and brotizolam improved sleep before surgery. As a preoperative night hypnotic,
quazepam 30 mg and 45 mg increased the total duration of sleep compared to brotizolam 0.25 mg. 相似文献
17.
Gastro-Esophageal Reflux and Esophageal Motility Disorders in Morbidly Obese Patients before and after Bariatric Surgery 总被引:6,自引:6,他引:0
Merrouche M Sabaté JM Jouet P Harnois F Scaringi S Coffin B Msika S 《Obesity surgery》2007,17(7):894-900
Background Obesity is a predisposing factor to gastro- esophageal reflux disease (GERD), but esophageal function remains poorly studied
in morbidly obese patients and could be modified by bariatric surgery.
Methods Every morbidly obese patient (BMI ≥40 kg/m2 or ≥35 in association with co-morbidity) was prospectively included with an evaluation of GERD symptoms, endoscopy, 24-hour
pH monitoring and esophageal manometry before and after adjustable gastric banding (AGB) or Roux-en-Y gastric bypass (RYGBP).
Results Before surgery, 100 patients were included (84 F, age 38.4 ± 10.9 years, BMI 45.1 ± 6.02 kg/m2), of whom 73% reported GERD
symptoms. Endoscopy evidenced hiatus hernia in 39.4% and esophagitis in 6.4%. The DeMeester score was pathological in 53.3%;
69% of patients had lower esophageal sphincter (LES) pressure <15 mmHg and 7 had esophageal dyskinesia. BMI was significantly
related to the DeMeester score (P = 0.018) but not to LES tone or esophageal dyskinesia. Postoperative data were available in 27 patients (AGB n = 12/60, RYGBP
n = 15/36). The DeMeester score (normal <14.72) was significantly decreased after RYGBP (24.8 ± 13.7 before vs 5.8 ± 4.9 after;
P < 0.001) but tended to increase after AGB (11.5 ± 5.1 before vs 51.7 ± 70.7 after; P = 0.09), with severe dyskinesia in 2 cases. Conclusion: GERD and LES incompetence are highly prevalent in morbidly obese
patients. Preliminary postoperative data show different effects of RYGBP and AGB on esophageal function, with worsening of
pH-metric data with occasional severe dyskinesia after AGB. 相似文献
18.
Eric H. Jensen Anasooya Abraham Elizabeth B. Habermann Waddah B. Al-Refaie Selwyn M. Vickers Beth A. Virnig Todd M. Tuttle 《Journal of gastrointestinal surgery》2009,13(4):722-727
Background Radical resection is recommended for selected patients with gallbladder (GB) cancer. We sought to determine whether radical
resection improves survival for patients with early-stage cancer and to evaluate surgeon compliance with current treatment
recommendations.
Patients and methods Patients with stage 0, I, or II GB cancer who underwent surgical resection were identified from the Surveillance, Epidemiology,
and End Results (SEER) tumor registry from 1988 through 2004. Patients were classified by surgical procedure performed (simple
vs. radical resection) and adjuvant treatment given (radiation therapy [RT] vs. no RT). Unadjusted and adjusted overall survival
(OS) and cancer-specific survival (CSS) were compared.
Results Of the 4,631 patients who underwent surgery for early-stage GB cancer from 1988 through 2004, 4,188 (90.4%) underwent cholecystectomy
alone and 443 (9.6%) underwent radical surgery including hepatic resection. The proportion of patients having radical surgery
for T1b, T2, and T3 cancers was 4.5%, 5.6%, and 16.3%, respectively. For patients with T1b/T2 cancer, radical resection was
associated with significant improvement in adjusted CSS (p = 0.01) and OS (p = 0.03). For patients with T3 cancers, we noted no improvement in CSS or OS. Survival for patients with node-positive disease
(stage 2b) was universally poor and not improved by radical resection. For all patients who underwent radical resection, node
negativity, female sex, age <70, low grade, and RT predicted improved CSS and OS.
Conclusions Despite a significant survival advantage for patients with T1b/T2 GB cancer who undergo radical resection, this treatment
is significantly underutilized. Ensuring delivery of recommended surgical treatment is vital to improving outcomes for patients
with this disease. 相似文献
19.
Gómez JM Vilarrasa N Masdevall C Pujol J Solano E Soler J Elio I Gallart L Vendrell J 《Obesity surgery》2009,19(3):345-350
Background The mechanisms by which increased body weight influence bone mass density (BMD) are still unknown. The aim of our study was
to analyze the relationship between anthropometric and body composition variables, insulin growth factor-I (IGF-I), adiponectin
and soluble tumor necrosis factor-α receptors (sTNFR) 1 and 2 with BMD in two cohorts of morbid obese patients, before and
after bypass surgery.
Methods The first cohort included 25 women aged 48 ± 7.6 years studied before bypass surgery. The second included 41 women aged 46 ± 9.2 years,
12 months after surgery. We studied anthropometric variables obtained from whole body DEXA composition analysis. Serum IGF-I,
intact serum parathyroid hormone, 25-hydroxivitamin D3, plasma adiponectin concentrations, sTNFR1, sTNFR2 concentrations were measured.
Results In the first cohort, the BMI was 44.5 ± 3.6 kg/m2, parathyroid hormone, IGF-I, and adiponectin concentrations were lower, and sTNFR1 concentrations were higher than in the
second cohort. In the multiple regression analysis, BMD remained significantly associated with body fat percentage (β −0.154,
p = 0.01), lean mass (β 0.057, p = 0.016) and phosphate concentration (β 0.225, p = 0.05). In the second cohort, BMI was 31 ± 5.1 kg/m2. In the multiple regression analysis, BMD remained significantly associated with lean mass (β 0.006, p = 0.03).
Conclusion The inverse correlation found between body fat and BMD in the first cohort indicates morbid obesity increases the risk of
osteoporosis and we found a positive correlation with lean and fat mass before bariatric surgery and with lean mass after
bypass surgery. 相似文献
20.
Kubo S Tanaka H Takemura S Yamamoto S Hai S Ichikawa T Kodai S Shinkawa H Shuto T Hirohashi K 《Surgery today》2007,37(4):285-290
Purpose Interferon therapy suppresses the development of hepatocellular carcinoma (HCC) and tumor recurrence after a resection of
HCC in patients with chronic hepatitis C. However, the value of a liver resection and which method is best for the treatment
of HCC detected after successful interferon therapy remains to be clarified. The risk factors for tumor recurrence after a
liver resection for HCC detected after successful interferon therapy were investigated to determine the appropriate operative
method for such HCC.
Methods Risk factors including the clinicopathologic findings and the operative methods for tumor recurrence were evaluated by univariate
and multivariate analyses in 24 patients who underwent liver resection for HCC detected after successful interferon therapy
(sustained viral response or biochemical response).
Results According to a univariate analysis, large tumor (>2 cm, P = 0.0326), multiple tumors (P = 0.0372), nonanatomic resection (P = 0.0103), and positive surgical margin (<5 mm of a free surgical margin, P = 0.0245) were possible risk factors for short tumor-free survival time after surgery. A multivariate analysis showed that
large tumor (P = 0.0407), nonanatomic resection (P = 0.0215), and positive surgical margin (P = 0.0253) were independent risk factors for a short tumor-free survival time after surgery.
Conclusion An anatomic resection with an appropriate surgical margin (≥5 mm of a free surgical margin) is recommended for patients with
HCC detected after successful interferon therapy. 相似文献