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941.
Mensink PB van Petersen AS Kolkman JJ Otte JA Huisman AB Geelkerken RH 《Journal of vascular surgery》2006,44(2):277-281
INTRODUCTION: Controversy continues about the mere existence of the celiac artery compression syndrome. Earlier results of treatment of unselected patients groups showed varying, mostly disappointing, results. The recently introduced gastric exercise tonometry test is able to identify patients with actual gastrointestinal ischemia. We prospectively studied the use of gastric exercise tonometry as a key criterion for revascularization treatment in patients with otherwise unexplained abdominal complaints and significant stenosis of the celiac artery by compression of the arcuate ligament. METHODS: Patients were prospectively selected using abdominal artery angiography and gastric exercise tonometry. Patients with a significant compression of the celiac artery, typical abdominal complaints, and abnormal tonometry were considered for revascularization. RESULTS: Over a 7-year period, 43 patients with significant celiac artery compression were included in this study, and 30 patients were diagnosed as ischemic. Twenty-nine patients had revascularization, 22 (76 %) had a trunk release only. After a median follow-up of 39 months, 83% of patients were free of symptoms. The repeated tonometry after treatment improved in 100% of patients free of symptoms, compared with 25% in patients with persistent complaints after revascularization. CONCLUSIONS: The results of this study suggest that the celiac axis compression syndrome exists and that the actual ischemia can be detected by gastric exercise tonometry and treated safely, with success. 相似文献
942.
Purkayastha S Chow A Athanasiou T Cambaroudis A Panesar S Kinross J Tekkis P Darzi A 《World journal of surgery》2006,30(9):1713-1721
Purpose This study was designed to evaluate the diagnostic accuracy of serum procalcitonin (PCT) for the diagnosis of severity in
acute pancreatitis (AP), compared with routine clinical, biochemical, radiological, and combination severity scoring systems.
Methods Quantitative meta-analysis was performed on prospective studies, comparing serum PCT, against validated scoring systems for
diagnosing severe AP. The sensitivity, specificity, and diagnostic odds ratio were calculated for each study. Summary receiver
operating characteristic (SROC) curves and subgroup analysis were undertaken. Study quality and heterogeneity were evaluated.
Meta-regression meta-analysis was used to evaluate the effect of using serum PCT in the diagnostic accuracy severity scoring
in AP.
Results Summary receiver operating characteristic analysis of nine studies showed an overall sensitivity and specificity of 74% (range:
66%–81%) and 83% (range: 79%–87%), respectively. Overall unweighted area under the curve (AUC) was 0.91 (DOR = 16.26 95% CI:
5.68–46.60), demonstrating significant heterogeneity (Q-value = 25.32; P = 0.001). When high-quality studies alone were evaluated, there was an increase in the overall sensitivity (89%); however,
specificity was similar (82%), with an overall unweighted AUC of 0.94 (DOR 41.46, 95% CI: 17.95–95.80), with no significant
heterogeneity. Meta-regression analysis confirmed the significant effect of study quality on the diagnostic accuracy of severity
scoring using serum PCT (P = 0.025).
Conclusions The use of PCT for severity scoring in AP has a moderate sensitivity but higher specificity. However, the overall accuracy
for predicting severity in AP is high. The prognosis of severity, especially early on (<48 hours from onset of symptoms),
and the evaluation of potential infectious complications of AP may be the most useful factors to assess in subsequent clinical
trials to identify its exact application in clinical practice in the management of AP. 相似文献
943.
OBJECTIVE: To investigate and compare patterns of practice in prostate cancer management in Australia and New Zealand from 1995 to 2000, as there are insufficient randomized trials to guide clinicians in the management of prostate cancer. SUBJECTS AND METHODS: This study represents the two largest published surveys of Australian and New Zealand clinicians dealing with prostate cancer. We sent structured questionnaires on the management of prostate cancer patients to 804 urologists, radiation oncologists and medical oncologists in Australia and New Zealand in December 2000. We compared responses to a similar survey of 579 specialist clinicians in 1995. RESULTS: The response rates were 56% in 1995 and 62% in 2000. In the management of clinically localized disease, the proportion recommending surgery or radiotherapy remained relatively constant between 1995 and 2000, although there was an increase in the use of brachytherapy and adjuvant hormonal therapy, and a reduced tendency to treat pelvic nodes. In the treatment of locally advanced disease, there was an increased use of hormonal treatment and local radiotherapy, with a reduction in the use of total androgen blockade and orchidectomy. In managing positive margins after prostatectomy, there was a clear lack of consensus, with a wide variety of treatment options proposed. CONCLUSIONS: Practice has changed in several areas in 2000 compared to 1995, but not all changes were influenced by the publication of randomized trials or evidence-based guidelines. 相似文献
944.
Kengne AP Dzudie AI Fezeu LL Mbanya JC 《The international journal of lower extremity wounds》2006,5(1):64-68
Diabetic foot ulceration and gangrene are preventable long-term complications of diabetes mellitus. This cross-sectional study was conducted to evaluate the impact of secondary foot complications on hospital admission and activities of the diabetes service of Yaoundé Central Hospital (YCH). A total of 207 patient files were included in this study, the period of which was from November 1999 to October 2000, 1 year of activity of the inpatient department of the Diabetes and Endocrine Unit of YCH. General characteristics of the patients were considered, the reason for their admission, the duration of their hospitalization in the service, and the outcome. The diabetic foot problem was the second most common cause of hospital admission in 27 (13%) patients. Secondary foot complication was the associated cause of mortality in 19.3% of cases of death (6 out of 31) in this study. The highest duration of hospitalization was recorded in patients with foot problems (29.4+/-5.4 days), the finding being statistically significant. Foot problems accounted for 0.25% of bed occupancy for the selected period. Five patients underwent amputation because of foot problems. A high rate of hospital discharge upon request was recorded among patients with foot problems (25% of the cases). This study suggests that diabetic foot is the second biggest cause of hospital admission in this setting; however, it is the main cause of prolonged hospital stay and bed occupancy. 相似文献
945.
946.
Trahan S Erickson-Johnson MR Rodriguez F Aubry MC Cheville JC Myers JL Oliveira AM 《The American journal of surgical pathology》2006,30(10):1326-1329
Pulmonary hamartoma is a benign neoplasm that rarely recurs or undergoes malignant transformation. Herein, we report a 48-year-old woman with a history of an incomplete excised nonchondroid pulmonary hamartoma presenting as an indolent tumor recurrence. Excision of the tumor revealed a well-differentiated liposarcoma arising from the hamartomatous component. Fluorescence in situ hybridation analysis for HMGA2 and MDM2 was performed on both hamartomatous and liposarcomatous component. MDM2 and HMGA2 amplification were found in a subset of stromal cells in the hamartomatous component and in most cells of the well-differentiated liposarcoma. No rearrangement HMGA2 was found in the pulmonary hamartoma component. These findings suggest that the formation of the 12q14-q15 chromosome amplicon, the characteristic cytogenetic finding of well-differentiated liposarcomas and the structural genomic component of the supernumerary ring and giant rod chromosomes, occurred before the morphologic changes characteristic of these malignant adipose tissue tumors and likely represents a very early molecular event in their development. 相似文献
947.
Dual-plane implant positioning for capsular contracture of the breast in combination with mastopexy 总被引:1,自引:0,他引:1
Objective: This study aims at combined surgical therapy options concerning patients with a clinically relevant and long-established capsular contracture following subglandular breast augmentation in a glandular ptotic breast. Methods: This is a review of 23 patients with capsular contracture. Three patients had a revision surgery for capsular contracture and implant dislocation before. The mean implant duration in the case of the twenty patients without any previous revision was 96 months. A revision implant has been re-located in a dual-plane position and further corrective surgery was carried out to adapt the glandular ptotic breast. Between 2001 and 2003, a chart review was performed on all patients for capsular contracture and ptotic breast by using the technique presented in this study. Results: In each case, the operation was performed as a one-stage procedure. The procedure included the following steps: Removal of the implant and total capsulectomy, preparation of an inferior de-epithelialised skin pedicle above the inframammary crease, release of the inferior origins of the pectoralis major muscle, creation of a new implant pocket by continuous connection of the inferior muscle border with the cranial edge of the inferior skin pedicle (dual-plane), adaptation of the soft-tissue/skin envelope by closing the cranial V over the implant coverage, preservation of the areola by creating a cranial or cranial medial pedicle. There was a follow-up for a period of up to 48 months, and any complication that occurred was documented. At follow-up period, all patients who had been implanted with a new implant pocket were free of a clinically relevant capsular contracture. Conclusions: In the cases of a severe capsular contracture and glandular-ptotic breasts, we presented the surgical corrections of the parenchyma/skin envelop as a one-stage procedure following the establishment of a new implant pocket. 相似文献
948.
Kazunori Nishimura Andre Bieniarz Robert M. Nakamura Gere S. diZerega 《Surgery today》1983,13(2):159-163
Oxidized regenerated cellulose (ORC) is widely used to cover the denuded mesothelium and to promote hemostasis. We evaluated
ORG in a rabbit model to assess the potential for adhesion reduction after uterine trauma and intestinal anastomosis. After
surgery, a second laparotomy was done on postoperative day 7 for macroscopic evaluation of adhesion formation. The traumatized
uterine horns wrapped in ORC had more numerous and higher grade adhesions compared with the non-surgical left, intact horns.
However, when compared to the contralateral uterine horn which underwent trauma without ORG, a significant decrease in the
grade of adhesion formation was noted. Rabbits undergoing intestinal anastomosis had the most pronounced degree of adhesion
formation. Typically, the area of healing was encapsulated in a fibrin clot with adhesions attached to adjacent viscera. When
ORC remained between the lesion and adjacent organs during mesothelial regeneration, adhesion formation decreased. However,
the soft, gelatinous mass of ORC was also an effective nidus for clot formation. Where post-and intra-operative ooze produced
a fibrin clot in the ORC, dense adhesions formed. 相似文献
949.
950.
Separation of Specific Initiation Factors Involved in the Translation of Myosin and Myoglobin Messenger RNAs and the Isolation of a New RNA Involved in Translation 总被引:9,自引:2,他引:7 下载免费PDF全文
Stuart M. Heywood Doris S. Kennedy Andre J. Bester 《Proceedings of the National Academy of Sciences of the United States of America》1974,71(6):2428-2431
Two messenger specific factors, phosphocellulose fractions 3 and 4, have been isolated from the initiation factor 3 fraction of red muscle initiation factors by chromatography on phosphocellulose. When added to a reticulocyte cell-free system containing both myoglobin and myosin mRNAs, phosphocellulose fraction 3 is found to specifically stimulate the synthesis of myoglobin while phosphocellulose fraction 4 is found to specifically stimulate the synthesis of myosin. In addition, a new RNA, isolated from the initiation factor 3 fraction, is shown to specifically inhibit the translation of heterologous mRNAs. 相似文献