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101.
102.
Michelle Lucinda DeOliveira M.D. Tarcisio Triviño M.D. Ph.D. Gaspar de Jesus Lopes Filho M.D. Ph.D. 《Journal of gastrointestinal surgery》2006,10(8):1140-1143
Carcinoma of the papilla of Vater is classified as periampullary cancer representing 5% of all gastrointestinal tract malignancies.
Early and accurate diagnosis is important for those patients with a tumor of the papilla, as the prognosis is more favorable
than in other periampullary neoplasms. Endoscopically obtained biopsies from suspicious papillae can detect an early tumor,
although even for skilled pathologists it is often difficult to differentiate carcinomas from noninvasive lesions on the basis
of forceps biopsies. The purpose of this study was to assess the preoperative diagnostic accuracy of duodenoscopy appearance
and biopsy in all cases with suspicion of tumor. Thirty patients with suspicion of carcinoma of the papilla of Vater and with
final diagnosis established by pancreatoduodenectomy were included in this retrospective study. In each case, a comparison
was made between endoscopic biopsy and duodenoscopic appearance. Duodenoscopic appearance sensitivity and accuracy for malignancy
were 86% and 83%, respectively, whereas endoscopic biopsy sensitivity and accuracy were 65% and 67%, respectively. Although
preoperative diagnosis of carcinoma of the papilla of Vater is useful for making therapeutic decisions, the diagnostic value
of the endoscopic appearance was superior to endoscopic biopsy in this series.
Presented at the 2003 American Hepato-Pancreato-Biliary Association Congress, Miami, Florida, February 27-March 3, 2003.
Supported by FADA-CAPES/PROP 200J (M.L.D.). 相似文献
103.
Balloon occlusion of the internal carotid artery in 40 cases of giant intracavernous aneurysm: technical aspects,cerebral monitoring,and results 总被引:13,自引:2,他引:11
V. Vazquez Añon A. Aymard Y. P. Gobin A. Casasco D. Rüffenacht M. H. Khayata E. Abizanda A. Redondo J. J. Merland 《Neuroradiology》1992,34(3):245-251
Summary We have studied the results of carotid occlusion in the treatment of giant intracavernous carotid artery (ICA) aneurysms in 40 patients. Clinical, angiographic, Doppler and cerebral blood flow (CBF) criteria for tolerance of occlusion are discussed. The patients had headaches (47.5%), cranial nerve compression (87.5%), decreased visual acuity (20%), ruptured aneurysm (15%) and 5% were asymptomatic. Balloon occlusion tests were performed under light sedation anaesthesia: a successful test required perfect clinical tolerance and adequate angiographic collateral circulation in arterial, parenchymatous, and venous phases. Additional criteria include xenon 133 CBF measurements, and transcranial Doppler sonography of the middle cerebral artery. According to these criteria, 5 patients did not tolerate test occlusion and required an extra-intracranial (EC-IC) bypass. Mean follow-up was 4.7 years. All patients were radiologically cured of their ancurysm, and in 35 the symptoms resolved, although 3 had persistent ocular motor nerve palsies, and in 4 visual defects were unchanged. Complications were 1 permanent and 3 transient neurological deficits. Balloon occlusion of the ICA is an effective, reliable form of treatment for intracavernous giant aneurysm and should replace surgical ligation of the cervical carotid artery. With CBF or Doppler monitoring, the risk of neurological deficit is diminished. EC-IC bypass prior to ICA occlusion is indicated if test occlusion is not tolerated. 相似文献
104.
Two new cases of prostatic blue nevus are studied with routine histological, immunohistochemical and ultrastructural methods. Both cases showed a chronic lower urinary tract obstruction due to a benign prostatic hyperplasia with spindle-shaped stromal cells loaded with melanin pigment. These cells were positive for S-100 and negative for HMB-45 antibodies, being, to the best of our knowledge, the first time that this antibody has been tested in prostatic pigmented lesions. The electron-microscopy study was performed in the first case, confirming the nature of these pigmented cells as melanocytes derived from the neural crest showing melanosomes in all the stages of differentiation and without complete basal cell membrane. The histogenesis of pigmented lesions of the prostate and the differences between blue nevus and melanosis are discussed, and the literature is reviewed. 相似文献
105.
J. Sanchez Burson J. Graña Gil M. Rosales Rodriguez A. Atanes Sandoval C. Alonso Blanco F. Galdo Fernandez 《Clinical rheumatology》1992,11(2):261-264
Summary We have studied the characteristics of arthritis present in 32 patients with Behçet's disease (BD), and how this arthritis is related to the HLA markers class I. 84% of the patients presented arthritis, the most common being monoarthritis as the initial presentation, and oligoarthritis in subsequent episodes. In 63% of the cases, the development was in episodes of acute/subacute arthritis. We found statistically significant association between antigens B-5 and B-51, and the group with BD, with a relative risk of 3.89 and 4.71 respectively. The attempt to relate markers B-5, B-51 and B-27 to the presence of arthritis as well as to its manifestation and further development was not conclusive. 相似文献
106.
Mete Isikoglu Kemal Ozgur Sergio Oehninger Sebahat Ozdem Murat Seleker 《Gynecological endocrinology》2006,22(5):256-260
BACKGROUND: We aimed to determine whether serum concentrations of anti-Müllerian hormone (AMH) can be used as a tool for prediction of the efficacy of sperm retrieval. METHODS: This was a prospective cohort observational study. AMH levels were determined in 47 men presenting for infertility evaluation. Group 1 consisted of 24 infertile patients diagnosed with non-obstructive azoospermia. Group 1 was further divided into two subgroups. The patients with spermatozoa in their testicular samples constituted group 1a (n = 13), while the patients with absence of spermatozoa constituted group 1b (n = 11). Twenty-three normozoospermic fertile men constituted group 2. Serum AMH was measured before obtaining testicular specimens. RESULTS: Testicular spermatozoa were recovered in 13 out of the 24 patients (54%). Demographic characteristics of the three groups were similar. The difference between serum AMH levels among the three groups did not reach statistical significance. CONCLUSIONS: We speculated that although AMH is secreted predominantly into the seminiferous tubules, studying serum samples might be more advantageous than seminal plasma because the presence of seminal proteases could influence AMH levels in the latter. However, our results did not demonstrate differences in serum concentrations of AMH between the studied groups. Studies with extended patient populations focusing on seminal plasma concentrations of AMH are warranted. 相似文献
107.
Everson L. A. Artifon Airton Z. Rodrigues Sergio Marques Bhawna Halwan Paulo Sakai Claudio Bresciani Atul Kumar 《Journal of gastrointestinal surgery》2007,11(12):1686-1691
Background Exploratory laparoscopy is commonly undertaken in patients with highly suspicious biliary and pancreatic lesions to facilitate
diagnosis and staging cancer is present. If an unresectable tumor is identified, a second endoscopic procedure may be required
do deploy a self-expandable metal stent (SEMS) for palliation. As endoscopic retrograde cholangio pancreatography (ERCP) may
be unsuccessful in up to 20% of patients, we evaluated the feasibility and safety of deployment of self-expandable metal stents
at the same time as the initial laparoscopy.
Patients and Methods A total of 23 eligible patients (8 male and 15 female) with malignant obstruction of the common bile duct underwent deployment
of SEMS at laparoscopy. Primary outcome measure was the successful laparoscopic deployment of stent and secondary outcome
measure was complications rates.
Results Indications for stent deployment were unresectable pancreatic cancer in 18, cholangiocarcinoma in two, neuroendocrine tumor
in one and ampullary adenocarcinoma in two patients. The median age was 73 years (range 49–93). Twenty-two of 23 stents were
deployed successfully: 17 stents were deployed transcystically and five via a choledochotomy. Median times for laparoscopic
exploration and SEMS deployment were 165 min (range 105–230) and 20 min (range 10–50), respectively. Pre- and post-procedures
median total bilirubin were 9.4 mg/dl (range 5.4–17.5) and 4.0 (range 2.6–7.1). The median size of the pancreatic mass was
3 cm (range 2–5 cm) and that of the common bile duct (CBD) from 9.2 mm (range 7.2–17.4). The mean duration of laparoscopy
was 170 min (range 120–230 min) and that for stent deployment 23 min (range 10–50 min). Complications included bleeding, obstruction,
and wound infection. Bleeding occurred on day 7 in two patients and on day 30 in one patient; bleeding occurred at the gastrojejunal
anastomosis site and was successfully treated with endoscopic hemostasis. A total of three stent obstructions were identified:
one each at 60, 90, and 120 days follow-up. All complications were successfully managed endoscopically. There were a total
of seven deaths, six as a result of progressive cancer and one of surgical wound infection and ensuing complications.
Conclusion This study demonstrates that laparoscopic deployment of self-expandable metal bile duct stents is feasible and safe. This
option appears to be a reasonable option in patients with inoperable malignant obstruction of the distal common bile duct. 相似文献
108.
Delvys Rodríguez-Abreu Marta Llanos Muñoz Mariano Provencio Pulla Antonio Rueda Domínguez Dolores Isla Casado 《Clinical & translational oncology》2010,12(11):760-764
Follicular lymphoma (FL) is the second most common subtype of non-Hodgkin’s lymphoma (NHL) in the Western world. FL constitutes the most frequent indolent lymphoma, well characterized by its clinical presentation related to nodal involvement and its morphologic and biologic features. It is often managed as an incurable disease. However, several active therapeutic approaches from the ‘wait and watch” strategy to the allogeneic transplantation are available for management of patients with FL and clearly have changed the natural history of this disease, achieving a long-term disease-free survival. Therapeutic decision is mostly conditioned by patient’s characteristics, stage, histological grade, tumor burden, and risk-predicting factors. This article try to summarizes the diagnosis and treatment of this heterogeneous group of patients. 相似文献
109.
Sergio Luís Blay Sergio Baxter Andreoli Fábio Leite Gastal 《Annals of clinical psychiatry》2007,19(3):169-174
BACKGROUND: The main purpose of this study is to investigate the association of disturbed sleep, chronic physical pain and psychiatric morbidity in people aged 60 years and over. METHODS: A population-based random sample of 7040 household residents aged 60 years and over, was examined in a face-to-face interview. Painful medical conditions were assessed through questions evaluating medical treatment, hospitalizations, and consultations for medical problems. Disturbed sleep was assessed through questions concerning the presence of sleeping problems in the past 4 weeks. RESULTS: The overall prevalence of disturbed sleep is 33.7% (95% CI: 32.5-34.8) and the 6-month prevalence of any chronic pain was 76.2% (95% CI: 74.2-78.2%). A substantial burden of disturbed sleep is associated with the presence of physical pain morbidity, 42.5% for back pain to 49.7% for headaches. The prevalence of pain among persons with disturbed sleep ranges from 25.8% for gastrointestinal pain to 54.6% for joint pain. The presence of comorbid pain and disturbed sleep has an important disability impact as assessed by socioecomomic/professional data, health care utilization, self-rated health and physical activity. In logistic regression models, headaches, psychiatric morbidity, rural origin, Caucasians, self-rated health and number of chronic pain conditions were significantly associated with disturbed sleep after controlling for demographic variables and comorbidities. Age has a negative effect on sleep complaints. CONCLUSIONS: Disturbed sleep is highly comorbid with other pain conditions particularly headaches and psychiatric morbidity in later life. The combination of pain and disturbed sleep leads to important role disability and increased utilization of medical services. 相似文献
110.
Homid Fahandezh-Saddi Díaz Antonio Ríos-Luna Eduardo García-Rey Ma Jesus Rodea Butragueño Manuel Villanueva-Martinez Ma Elena Cantero-Yubero Miguel del Cerro-Gutiérrez 《European journal of orthopaedic surgery & traumatology : orthopedie traumatologie》2007,17(1):105-109
Treatment of chronic osteomyelitis of distal tibia is complex. It often requires the association of antibiotic therapy and a surgical procedure. This consists of exhaustive debridement of infected bone and soft tissue which must have adequate cutaneous coverage and vascular supply which enables creating a barrier to microorganisms and greater resistance to infection. Free or pedicled muscular flaps have been the techniques most often used for this type of lesions. Free flaps require a precise microsurgical technique and prolonged surgery. Pedicled muscular flaps do not provide sufficient coverage and vascularisation of the distal tibia for large size defects. The fasciocutaneous flap has been used for the treatment of coverage defects in the perimalleolar area and the heel. We report the utility of this flap as management of chronic osteomyelitis of the distal third of the tibia with complete healing of the infection and correct cutaneous coverage without complications. 相似文献