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Giant cavernous hemangiomas: Diagnosis and surgical strategies 总被引:4,自引:0,他引:4
Prof. Mario Lise M.D. Gianpietro Feltrin M.D. Pier Paolo Da Pian M.D. Diego Miotto M.D. Pier Luigi Pilati M.D. Leopoldo Rubaltelli M.D. Donatella Zane M.D. 《World journal of surgery》1992,16(3):516-520
From January, 1972 to June, 1989, 51 patients with liver hemangiomas (32 females and 19 males, mean age 35 years) were evaluated for surgical treatment. Diameters of the masses were 5 cm to 20 cm (median 8.5 cm). Nine of the patients had already been treated for cancer. Twenty-two (43.1%) of the 51 patients were symptomatic and 29 (56.9%) patients were asymptomatic. In 34 patients (66.7%) a definite diagnosis of hemangioma was made by scintiscan and/or ultrasound and/or computed tomography and/or angiography while in the remaining 17 (33.3%) patients the diagnosis was uncertain. The most common indications for resection were the presence of a symptomatic angioma, a symptomatic mass with an uncertain diagnosis, and/or lack of a definite pre-operative diagnosis. Surgery was performed on 25 patients. Ten anatomic and 15 atypical resections or enucleations were performed. There were no postoperative deaths. Two further patients, operated for probable hemangioma, were found to have primary hepatic malignancies. In the 26 unresected patients, no complications were observed during follow-up. In 3 patients, hemangioma enlargement was detected by ultrasound, but there were no symptoms. As cavernous liver hemangiomas are now more reliably diagnosed and their natural history is usually uneventful, surgery can be avoided in most cases. However, when a non-resection policy is adopted, an exact diagnosis is essential in order to rule out primary or metastatic cancer. Surgical exploration and treatment should be limited to symptomatic or complicated cases as well as to patients with an uncertain diagnosis.
Resumen Cincuenta y un pacientes con hemangiomas del higado (32 mujeres y 19 hombres, edad promedio 35 años) fueron valorados en cuanto a tratamiento quirúrgico en el período enero 1972 a junio de 1989; el diámetro de las lesiones oscilo entre 5 y 20 cm (promedio 8.5 cm). Nueve de los pacientes ya habían sido tratados por cáncer; 22/51 (43.1%) estaban sintomáticos y 29/51 (56.9%) eran asintomáticos. En 34/51 (66.7%) se hizo el diagnóstico definitivo de hemangioma mediante escintigrafia y/o ultrasonido y/o tomografía computadorizada y/o angiografia, en tanto que en los otros 17 pacientes (33.3%) el diagnóstico resultó incierto. Las indicaciones más comunes para resección fueron: presencia de un angioma sintomático, una masa asintomática con diagnóstico incierto y/o ausencia de diagnóstico preoperatorio definitivo. Se practicó cirugía en 25/51 pacientes, habiéndose realizado 10 resecciones anatómicas y 15 resecciones atípicas o enucleaciones. No hubo muertes postoperatorias. Otros dos pacientes operados por probable hemangioma demostraron tener neoplasias malignas hepáticas primarias. En los 26 pacientes no resecados no se observaron complicaciones durante el seguimiento; en tres casos se detectó ensanche del hemangioma en el examen con ultrasonido, pero no se presentaron síntomas. Puesto que actualmente los hemangiomas cavernosos del hígado pueden ser diagnosticados con mayor certeza y puesto que su historia natural generalmente está libre de complicaciones es posible evitar la cirugía en la mayoría de los casos. Sin embargo, cuando se pretenda adoptar una política de no resección es esencial establecer el diagnóstico exacto para excluir la posibilidad de un cáncer primario o metastásico. La exploración y el tratamiento quirúrgicos debe permanecer limitados a los hemangiomas sintomáticos o complicados, y en ningún caso deben significar riesgo para el paciente.
Résumé De Janvier 1972 à Juin 1989, 51 patients ayant un hémangiome du foie (32 femmes et 19 hommes, âge moyen 35 ans) ont été examinés en vue d'une exérèse chirurgicale. Le diamètre de la lésion variait entre 5 et 20 cm (médiane = 8.5 cm). Neuf des patients avaient déjà été traités pour un cancer; 22/51 (43.1%) étaient symptomatiques alors que 29/51 (56.9%) étaient asymptomatiques. Chez 34/51 patients (66.7%), le diagnostic définitif d'hémangiome a été confirmé par scintigraphie et/ou échographie et/ou tomodensitométrie, alors que chez les 17 autres (33.3%), le diagnostic était uncertain. Les indications d'une résection les plus fréquentes étaient: la présence d'un angiome symptomatique, une masse symptomatique avec un diagnostic uncertain, et/ou absence de diagnostic définitif préopératoire. Vingt-cinq des 51 patients ont été opérés. Il y a eu 10 résections anatomiques et 15 résections atypiques ou énucléations. Il n'y a pas eu de mortalité postopératoire. Deux autres patients, traités pour ce que l'on soupçonnait être une probalbe hémangiome du foie, avaient en fait un cancer hépatique. Chez les 26 patients non résequés, il n'y avait pas eu de complication. Chez trois patients, on a mis en évidence une augmentation de volume par l'échographie, mais ces modifications ne s'accompagnait d'aucune symptomatologie. Comme on peut faire le diagnostic d'hémangiome carverneux du foie avec plus de fiabilité qu'avant, et comme on sait que leur histoire naturelle est généralement bénigne, on peut le plus souvent surseoir à l'exérèse chirurgicale. Cependant, il importe de toujours faire le diagnositc avec certitude, de façon à éliminer un cancer primitif ou sécondaire du foie.相似文献
14.
Transurethral resection versus transurethral incision of the prostate. A prospective randomized study 总被引:1,自引:0,他引:1
In this ongoing study, patients with an estimated prostate size of no more than 20 gm are randomized to undergo either transurethral resection of the prostate (TURP) or transurethral incision (TUIP) at the 6 o'clock position. To date, 93 patients have been included, and 3 months postoperatively, 80 to 90 per cent of the patients in each group reported improvement. There was also a significant decrease in symptom scores and a significant increase in maximum urinary flow rate, with great variation within each group but without difference between the groups. In both groups, there appears to be some deterioration over time. Operating time, estimated blood loss, time to catheter removal postoperatively, and duration of postoperative hospital stay were all significantly in favor of TUIP. Loss of ejaculation was reported by 37 per cent of patients after TURP and by 13 per cent after TUIP (not statistically significant). There was no difference between the groups in the need for further surgery. Therefore, TUIP is recommended as an alternative to TURP in patients with small prostates. 相似文献
15.
Lynn McIntyre Edwin G. Belzer Lise Manchester Wade Blanchard Suzanne Officer A. Catherine Simpson 《The Journal of school health》1996,66(3):132-137
ABSTRACT: The Dartmouth Health Promotion Study was a longitudinal, quasi-experimental field study with a qualitative research arm, designed to learn whether coordinating school health instruction, health services, and a healthful environment enhanced the program's effect on the heart health and mental health of children. The research strategy — the Coordinated Approach — was applied to approximately 300 children in each of two cohorts in grades four to six attending nine trial schools; a further 600 children attended 10 comparison schools in Dartmouth and nine distal comparison schools. Although the qualitative analysis demonstrated that positive feelings were engendered in most areas of the study, when either the classroom or the individual was used as the unit of analysis, the Coordinated Approach did not have a more favorable effect on the heart or mental health of children than did the standard school health program. Thus, the effect of an existing school health program was not directly enhanced through coordinating its components. 相似文献
16.
Cecilia Johnsson Gunnar Tufveson Lise Binderup Alex Karlsson-Parra 《Xenotransplantation》1997,4(3):186-193
Abstract: The vitamin D analogue MC 1288 (20-epi-1α,25-dihydroxycholecalciferol) effectively postpones rejection of cardiac, intestinal, skin, and aortic allografts. MC 1288 binds to the vitamin D receptor and is thus assumed to exert its immunosuppressive effects via the same mechanisms as 1α,25-dihydroxycholecalciferol, the active form of vitamin D. 1α,25-Dihydroxycholecalciferol has been demonstrated to inhibit the production of various cytokines (interleukin-2, interferon-γ, granulocyte macrophage colony-stimulating factor, and interleukin-12) and to prevent B lymphocyte secretion of immunoglobulins. In the present study MC 1288 was evaluated for its ability to prevent rejection of mouse-to-rat cardiac xenografts, alone and in combination with 15-deoxyspergualin (DSG). Combined treatment with MC 1288 (given days -1 to 9) and DSG (given day -1 and onward) postponed rejection from day 3.0 (untreated recipients) until day 19.5. In rats treated with MC 1288 or DSG as monotherapy, rejection occurred after 3.0 and 7.5 days, respectively. Functioning grafts, obtained on day 9 from recipients treated with MC 1288 and DSG in combination, displayed an almost normal morphology without any obvious deposition of immunoglobulins in the vessels of the grafts and with just a few infiltrating cells. Thus, we have demonstrated synergistic actions of MC 1288 and DSG in delaying rejection of xenografts. Analysis of cellular infiltration, immunoglobulin deposition and graft survival times in the various treatment groups indicate a combined inhibitory effect of these two drugs on the level of macrophage effector function, direct or indirect via T lymphocytes, as well as on antibody production. 相似文献
17.
Dual activity maps in primate visual cortex produced by different temporal patterns of zif268 mRNA and protein expression
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Avi Chaudhuri Jonathan Nissanov Sylvie Larocque Lise Rioux 《Proceedings of the National Academy of Sciences of the United States of America》1997,94(6):2671-2675
The inducible nature of the immediate-early genes (IEGs) c-fos and zif268 allows their products to be used as activity markers in the brain. The utility of such markers in general is restricted because they can resolve only neurons activated by a single stimulus. To overcome this limitation, we have developed a double-label technique that exploits the dissimilar time course of zif268 mRNA and protein induction, allowing them to be separately induced by two different stimuli and independently stained to provide a visual display of neurons that are responsive to each stimulus. Two powerful features of this new imaging technique—the possibility of staining separate populations of activated neurons and the ability to visualize them at the cellular level—should extend IEG applications in biological activity mapping. 相似文献
18.
Lower tract localisation studies have been the gold standard in diagnosing various kinds of prostatitis. Four clinical categories are recognised: acute and chronic bacterial prostatitis, nonbacterial prostatitis, and prostatodynia. In acute bacterial prostatitis Gram-negative bacteria are the most common pathogens isolated. The roles of Gram-positive bacteria in chronic bacterial prostatitis and of Chlamydia trachomatis in nonbacterial prostatitis are contentious. Treatment of these various forms of prostatitis has been a challenge to the clinician. The lack of penetration of various drugs into the prostatic tissue, because of poor lipid solubility, ionisation, protein binding, and unfavourable pH gradients from the plasma to the prostatic fluid, may be the main reasons for poor results. The minimum inhibitory concentration (MIC) of antibacterial drugs used, and the concentration of drugs actually obtained in the prostate, combined with the influence of pH and inoculum size, and the effect of prostatic fluid and prostatic extracts on MIC are important factors in determining at least the theoretical efficacy of various drugs in the treatment of prostatitis. The new fluoroquinolone ofloxacin, the first quinolone to be approved for the treatment of chronic bacterial prostatis, has excellent penetration into human prostate and high in vitro activity in human urine and prostatic tissue. From a theoretical standpoint, ofloxacin should be ideal in the treatment of chronic bacterial prostatis. Comparative studies have shown its superiority to carbenicillin. Several noncomparative studies have also been reported. The initial results are promising, but further investigations are needed. 相似文献
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Petra M.C. Callenbach Lise P.M. Pels Paul G.H. Mulder Wim H.J.P. Linssen Rob H.J.M. Gooskens Jan L. van der Zwan Oebele F. Brouwer For the SUM Trial Group 《European journal of paediatric neurology》2007,11(6):325-330
About 4-10% of children and adolescents suffer from migraine. In the last few years, several studies have been performed to assess the efficacy and safety of triptans for the acute treatment of migraine in children and adolescents. Only sumatriptan nasal spray has been approved for the treatment of acute migraine with or without aura in adolescents aged 12-17 years in Europe. This review describes the results of the studies with sumatriptan nasal spray that have been performed in children and adolescents, including a study performed in the Netherlands. 相似文献