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951.
Prospective randomized trial of end-to-end versus side-to-side biliary reconstruction after orthotopic liver transplantation 总被引:7,自引:0,他引:7
Davidson BR Rai R Kurzawinski TR Selves L Farouk M Dooley JS Burroughs AK Rolles K 《The British journal of surgery》1999,86(4):447-452
BACKGROUND: Biliary reconstruction is the Achilles heel of liver transplantation. Side-to-side anastomosis of donor and recipient bile duct has been claimed to be superior to end-to-end anastomosis in uncontrolled studies. Methods: A total of 100 consecutive patients undergoing orthotopic liver transplantation were randomized after commencement of the transplant procedure to end-to-end or side-to-side anastomosis. No T tube drainage was employed. Endoscopic retrograde cholangiography was performed 2 weeks after transplantation and findings were reported by an experienced endoscopist as normal, leak or stricture. Median follow-up was 53 (range 35-63) months. RESULTS: Patient age, sex, the graft preservation time and indication for transplantation were similar in both groups. Sixty patients received end-to-end and 40 side-to-side anastomosis. Ten patients randomized to side-to-side anastomosis had an end-to-end procedure. The total number of biliary complications was similar in both groups (end-to-end 32 per cent versus side-to-side 30 per cent) as were the number of leaks (17 versus 18 per cent) and biliary strictures (15 versus 12 per cent). There was no difference in the number of biliary complications that required interventional treatment (22 per cent in both groups). CONCLUSION: Side-to-side and end-to-end biliary anastomosis at liver transplantation are equally effective. 相似文献
952.
Preoperative magnetic resonance staging of rectal cancer with an endorectal coil and dynamic gadolinium enhancement 总被引:8,自引:0,他引:8
Drew PJ Farouk R Turnbull LW Ward SC Hartley JE Monson JR 《The British journal of surgery》1999,86(2):250-254
BACKGROUND: The aim of the study was to assess the value of endorectal coil magnetic resonance imaging (MRI) with gadolinium enhancement in the preoperative staging of rectal cancer. METHODS: In addition to standard evaluation, patients with rectal lesions were assessed by MRI obtained with a pelvic phased-array coil in combination with an endorectal coil. RESULTS: The study group comprised 29 patients with rectal cancer staged with an endorectal coil who had surgery without preoperative adjuvant therapy. In addition to standard T1- and T2-weighted images, dynamic contrast-enhanced images were acquired in all patients. Considerable interobserver variation was noted, particularly for pathological tumour stage pT1 or pT2 (kappa = 0.36). Compared with pathological findings, endorectal MRI correctly staged nine patients, overstaged 16 and understaged four. Whilst lymph node metastases were accurately detected in 70 per cent of patients, the positive predictive value was only 58 per cent. CONCLUSION: MR staging of rectal cancer with an endorectal coil and gadolinium enhancement is inaccurate for early tumours (stage T1 or T2) and is associated with a considerable degree of interobserver variation for individual scan sequences. 相似文献
953.
Minimally invasive plate osteosynthesis: does percutaneous plating disrupt femoral blood supply less than the traditional technique? 总被引:27,自引:0,他引:27
O Farouk C Krettek T Miclau P Schandelmaier P Guy H Tscherne 《Journal of orthopaedic trauma》1999,13(6):401-406
OBJECTIVES/HYPOTHESIS: Proximal and distal femur fractures have traditionally been treated with open reduction and internal fixation through a standard lateral approach. New, "minimally invasive" internal fixation techniques, however, have been developed in an effort to devascularize the bone less than the traditional method. The purpose of this study was to determine whether a minimally invasive percutaneous plating technique better preserves bone vascularity relative to the traditional method by comparing the effect of the two approaches on the blood supply of the distal femur using silicone arterial dye injection in a cadaveric model. STUDY DESIGN/METHODS: Ten fresh human cadavers underwent lateral conventional plate osteosynthesis (CPO) through a standard lateral approach on one side and minimally invasive plate osteosynthesis (MIPO) through two three-centimeter incisions on the contralateral side. After injection of silicone dye, a dissection was performed bilaterally to identify the femoral perforating and nutrient arteries. RESULTS: All MIPO specimens showed intact perforating and nutrient arteries, whereas the CPO specimens had a variable incidence of vessel disruption. The MIPO group demonstrated better periosteal perfusion in each of the cadavers and improved medullary perfusion in 70 percent of the MIPO specimens compared with the CPO specimens. CONCLUSION: A percutaneous minimally invasive plating technique disrupts the femoral blood supply less than the traditional open method. Such minimally invasive methods may be more advantageous biologically than the traditional method. 相似文献
954.
Bazarbashi S Raja MA El Sayed A Ezzat A Ibrahim E Kattan S Kardar A Peracha A Lindstedt E Hanash K 《Journal of surgical oncology》2000,74(3):181-184
BACKGROUND AND OBJECTIVE: Evaluate the efficacy and toxicity of alternating intravesical instillation of Bacillus Calmette-Guerin(BCG) and Interferon alpha2-b (IFN) in the treatment and prevention of recurrence of superficial transitional cell carcinoma (TCC) of the urinary bladder. METHODS: Patients with Ta, T1 tumors and carcinoma in situ, either recurrent (TaG1, T1G1) or primary/recurrent TaG2 TaG3, T1G2, T1G3 and Tis (T: Tumor stage, G: grade) are eligible. All patients received intravesical BCG 81 mg on Weeks 1, 3, 5 and 7 and IFN 100 million units on Weeks 2, 4, 6 and 8. Cystoscopy performed 4 weeks after completion of therapy, and every 3 months thereafter. RESULTS: There was a total of 37 patients. Thirteen had TaG2, 13 T1G2, 1 T1G1, 4 TaG1, 1 TaG3, 3 T1G3 and 7 Tis (5 concurrent with other above tumors). Index lesion cleared in 7/10 patients. With a median follow-up of 26.2 month, 22 patients (59%) failed above therapy. Median time to treatment failure was 7 months. Seven, 6 and 9 patients recurred at a higher, lower and same stage or grade respectively. No grade 3 or 4 toxicity was encountered. CONCLUSIONS: Alternating intravesical BCG and IFN is effective and well tolerated therapy for superficial TCC of urinary bladder. 相似文献
955.
Ezzat AA Ibrahim EM Stuart RK Ajarim D Bazarbashi S El-Foudeh MO Rahal M Al-Sayed A Berry J 《Medical oncology (Northwood, London, England)》2000,17(1):39-46
Purpose CHOP is the standard regimen currently used in the management of the majority of patients with aggressive non-Hodgkin's lymphoma
(NHL). However, CHOP only produces 30–35% long-term survival. We hypothesized that adding high-dose tamoxifen, which is known
to have multiple drug resistance-modulatory effects, to the CHOP regimen could increase the response rate, and consequently
enhance the survival of patients with NHL.
Patients and Methods In a prospective, controlled, and randomized study, eligible adult patients with aggressive NHL were randomized between CHOP
only (Group I), or CHOP plus high-dose tamoxifen (Group II). The primary aim was to assess the effect of tamoxifen on complete
response (CR) rate, with the secondary evaluation of tamoxifen potential impact on survival. The interim analysis of this
study is presented.
Results Fifty-one and forty-seven evaluable patients were randomized to Group I and Group II, respectively. The median age of all
patients was 53y (range 18–78y). The two groups had comparable distributions of the pretreatment prognostic variables. The
CR for patients in Group I was 80% (41 patients) as compared with 74% (35 patients) in Group II (P=0.48). Likewise, there was no apparent difference in the partial remission rates between the two groups (6% vs 15%, respectively).
Of patients who initially attained CR, 15 (37%) and 10 (29%) subsequently relapsed in Groups II and I respectively (P=0.45). The NHL International Prognostic Index (IPI) was the only factor that predicted attaining CR. At the time of this
interim analysis, the actuarial-estimated overall survival (OS) probability (±S.E.) for the entire population at 5 y was 58%
(±6) with no survival difference between the two groups (P=0.51). Only attaining CR and the IPI predicted OS probability. The probability of remaining event-free at 5 y (±SE) for those
achieving CR was 72% (±9), and there was no significant difference between the two treatment groups (P=0.68). Toxicity profile was similar in the two groups.
Conclusion Based on this interim analysis, combining high-dose tamoxifen, as used in this study, with the CHOP regimen has failed to
have any favorable effect on the outcome of patients with aggressive NHL, and therefore cannot be recommended for future trials. 相似文献
956.
The effect of Schistosoma mansoni infection on drug-metabolizing enzymes was investigated before and after treatment of S. mansoni-infected male albino mice with the antibilharzial drug praziquantel (CAS 55268-74-1). The drug was given in a total dose of 1000 mg/kg, and was administered at 500 mg/kg of body weight for two consecutive days each of 500 mg/kg of body weight. The drug was given 49 days after infection with 80 Egyptian strains of S. mansoni cercariae/mouse. The hepatic content of cytochrome P-450, cytochrome b-5 and NADPH cytochrome P-450 reductase were determined at 4, 8, 24, 72 h, one and two weeks after the second dose of treatment. The enzymes were determined in the microsomal fraction after homogenization and ultracentrifugation at 105,000 x g. The results indicate a marked decrease of most enzymes in the infected groups compared to normal controls. Two weeks after treatment there was an improvement of the level of most enzymes towards the normal values. The levels of liver function tests were also improved. Concerning the oogram pattern, there was a rapid change even after 8 h after the second dose of treatment. It was concluded that the antibilharzial drug could be considered as a safe drug with a rapid onset of action. 相似文献
957.
Ezzat F. Saad 《The Laryngoscope》1980,90(8):1371-1377
The purpose of this study is to assess the incidence of palatal underdevelopment in children undergoing tonsillectomy and adenoidectomy. Signs of underdevelopment were found in 24 out of 1,500 consecutive children admitted for tonsil and adenoid surgery (1.6%). Bifid uvula was found in 15 children (1%). Five palates showed deficiency in length or thickness (0.33%) and submucous cleft palate was found in 4 children (0.27%). The palatopharyngeal sphincter was often compensated and adequate. Middle ear disease attributable to Eustachian tube dysfunction, with or without infection, was found in the majority of the children with underdeveloped palate. Tonsil and adenoid surgery was modified according to the palatopharyngeal condition. 相似文献
958.
Evidence for growth hormone (GH) autoregulation in pituitary somatotrophs in GH antagonist-transgenic mice and GH receptor-deficient mice 下载免费PDF全文
Asa SL Coschigano KT Bellush L Kopchick JJ Ezzat S 《The American journal of pathology》2000,156(3):1009-1015
Growth hormone (GH) modulates the hypothalamic release of somatostatin and GH-releasing hormone; however, there has been no evidence of GH autoregulation on the pituitary somatotroph. To determine the effects of GH on its own regulation, we examined the pituitaries of giant transgenic mice expressing a GH agonist (E117L), dwarf transgenic mice expressing a GH antagonist (G119K), and dwarf mice devoid of the GH receptor/binding protein (GHR/BP). In the E117L transgenic mice, the number and distribution of pituitary GH-immunoreactive cells were unchanged from nontransgenic littermate controls; an ultrastructural examination revealed typical, densely granulated somatotrophs. In contrast, the pituitaries of the G119K mice contained both moderately granulated somatotrophs and a sparsely granulated (SG) population with well-developed synthetic organelles and a distinct juxtanuclear globular GH-staining pattern. GHR/BP-deficient mice exhibited a marked reduction in the intensity of cytoplasmic GH immunoreactivity; however, prominent GH staining in the juxtanuclear Golgi was seen. GH-immunoreactive cells were increased in number, and the reticulin network pattern was distorted; stains for proliferating cell nuclear antigen confirmed mild hyperplasia. Electron microscopy showed that the somatotrophs were hyperactive SG cells with prominent endoplasmic reticulum membranes, large Golgi complexes, and numerous mitochondria. These findings are consistent with synthetic and secretory hyperactivity in pituitary somatotrophs due to the reduced GH feedback regulation. The changes are most striking in animals that are devoid of GHR/BP and less marked in animals expressing a GH antagonist; both models had reduced insulin-like growth factor-I levels, but the more dramatic change in the GHR/BP animals can be explained by abrogated GH signaling. This represents the first evidence of direct GH feedback inhibition on pituitary somatotrophs, which may have implications for the use of GH analogs in different clinical settings. 相似文献
959.
Mohamed Salaheldien Mohamed Alayat Ashraf Abdelaal Mohamed Omar Farouk Helal Osama Ahmed Khaled 《Lasers in medical science》2016,31(4):687-694
The aim of the study was to investigate the effect of high-intensity laser therapy (HILT) in treatment of patients with chronic neck pain (CNP) on cervical range of motion (ROM), pain, and functional activity. Sixty male patients participated in this study with mean (SD) age of 35.47 (4.18) years. Patients were randomly assigned into two groups and treated with HILT plus exercise (HILT?+?EX) and placebo laser plus exercise (PL?+?EX) in groups 1 and 2, respectively. The outcomes measured were cervical ROM, pain level by visual analog scale (VAS), and functional activity by neck disability index (NDI) score. Statistical analyses were performed to compare the differences between baseline and post-treatment. The level of statistical significance was set as p?<?0.05. Cervical ROM significantly increased after 6 weeks of treatment in all groups. VAS and NDI results showed significant decrease post-treatment in both groups. HILT?+?EX effectively increased cervical ROM and decreased VAS and NDI scores after 6 weeks of treatment compared to PL?+?EX. HILT?+?EX is an effective physical therapy modality for patients with CNP compared to PL?+?EX therapy. The combination of HILT?+?EX effectively increased cervical ROM, functional activity, and reduced pain after 6 weeks of treatment. 相似文献
960.
Franz Schaefer Bernd Hoppe Therese Jungraithmayr Günter Klaus Lars Pape Mourad Farouk Janet Addison Nick Manamley Karel Vondrak 《Pediatric nephrology (Berlin, Germany)》2016,31(3):443-453