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91.
Clinical Impact of Tumour Involvement of the Anastomotic Doughnut in Oesophagogastric Cancer Surgery
K Sillah EA Griffiths SA Pritchard R Swindell CM West R Page IM Welch 《Annals of the Royal College of Surgeons of England》2009,91(3):195-200
INTRODUCTION
Published colorectal cancer surgery data suggest no role for the analysis of the anastomotic doughnuts following anterior resection. The usefulness of routine histological analysis of the upper gastrointestinal doughnut is not clear. Our study assessed the impact of cancer involvement of the doughnut on clinical practice. Factors associated with doughnut involvement and the effect on patients'' survival were also analysed.PATIENTS AND METHODS
The clinicopathological details of 462 patients who underwent potentially curative oesophagogastrectomy for cancer with a stapled anastomosis between 1994 and 2006 in two specialist centres were retrospectively analysed. Univariate, multivariate and survival analyses were carried out.RESULTS
Approximately 5% of doughnuts (22 of 462) were histologically involved with cancer. Microscopic involvement of the proximal resection margin, local lymph node metastasis and lymphatic invasion within the main resected specimen were independently associated with doughnut involvement (all P < 0.05). However, these three factors taken together failed to predict doughnut involvement. Doughnut involvement was an independent adverse prognostic factor for overall survival (P = 0.0013).CONCLUSIONS
In contrast to findings in colorectal surgery, doughnut involvement with cancer appears to have useful prognostic information following oesophagogastrectomy. Routine histological analysis of upper gastrointestinal doughnuts is justified. Doughnut involvement could potentially strengthen the indications for adjuvant therapy in the future. 相似文献92.
Long-term changes in weight loss and obesity-related comorbidities after Roux-en-Y gastric bypass: a primary care experience 总被引:3,自引:0,他引:3
BACKGROUND: Long-term results of Roux-en-Y gastric bypass (RYGB) are nonexistent in the veterans affairs (VA) population. We compare excess weight loss (EWL) success and medical comorbidity changes between the VA and non-VA population after RYGB. METHODS: Retrospective review of consecutive subjects undergoing RYGB from 1997 to 2002 at the Los Angeles VA. Weight and comorbidity data were collected every 6 and 12 months, respectively. RESULTS: Fifty-nine subjects were included; 54%, 58%, 46.8%, and 44.1% of subjects achieved EWL >50% at years 1 to 4. Hypertension resolved in 23%, 30%, and 32% at months 12 to 36. Obstructive sleep apnea resolved in 37%, 48%, 48%, 44%, and 60% at months 12 to 60. Diabetes mellitus resolved in 86%, 84%, 79%, and 80% at months 12 to 48. Improvements in the lipid panel were observed by month 12 and maintained thereafter. CONCLUSIONS: EWL and proportion of subjects with resolved hypertension and obstructive sleep apnea are inferior to the non-VA population. Nevertheless, improvements in measures of success are maintained in the VA population. 相似文献
93.
Clinical correlates of low-risk variants in FGFR2, TNRC9, MAP3K1, LSP1 and 8q24 in a Dutch cohort of incident breast cancer cases 总被引:1,自引:1,他引:0
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Huijts PE Vreeswijk MP Kroeze-Jansema KH Jacobi CE Seynaeve C Krol-Warmerdam EM Wijers-Koster PM Blom JC Pooley KA Klijn JG Tollenaar RA Devilee P van Asperen CJ 《Breast cancer research : BCR》2007,9(6):R78-9
Introduction
Seven SNPs in five genomic loci were recently found to confer a mildly increased risk of breast cancer.Methods
We have investigated the correlations between disease characteristics and the patient genotypes of these SNPs in an unselected prospective cohort of 1,267 consecutive patients with primary breast cancer.Results
Heterozygote carriers and minor allele homozygote carriers for SNP rs889312 in the MAP3K1 gene were less likely to be lymph node positive at breast cancer diagnosis (P = 0.044) relative to major allele homozygote carriers. Heterozygote carriers and minor allele homozygote carriers for SNP rs3803662 near the TNCR9 gene were more likely to be diagnosed before the age of 60 years (P = 0.025) relative to major allele homozygote carriers. We also noted a correlation between the number of minor alleles of rs2981582 in FGFR2 and the average number of first-degree and second-degree relatives with breast cancer and/or ovarian cancer (P = 0.05). All other disease characteristics, including tumour size and grade, and oestrogen or progesterone receptor status, were not significantly associated with any of these variants.Conclusion
Some recently discovered genomic variants associated with a mildly increased risk of breast cancer are also associated with breast cancer characteristics or family history of breast cancer and ovarian cancer. These findings provide interesting new clues for further research on these low-risk susceptibility alleles. 相似文献94.
Rebecca A. Judd Kathleen B. Digre Judith EA Warner Susan F. Schulman Bradley J. Katz 《Neuro-ophthalmology (Aeolus Press)》2013,37(3):49-54
This study assessed photophobia in patients with benign essential blepharospasm (BEB), and determined the impact of blepharospasm on activities of daily living. Utilizing a patient–researcher collaborative approach, this study was conducted in partnership with the Benign Essential Blepharospasm Research Foundation. Of 316 respondents, 94% reported light sensitivity and 25% reported severe activity limitations. Photophobia appears to be more prominent in BEB than previously thought. Light exacerbates and triggers symptoms that compromise quality of life by affecting daily activities. Collaboration with self-advocates can be an effective way to conduct questionnaire-based research. The authors recommend development of other studies that use this type of partnership. 相似文献
95.
EA van Straaten L Koster-Kamphuis IM Bovee-Oudenhoven R van der Meer P-Ph Forget 《Acta paediatrica (Oslo, Norway : 1992)》1999,88(5):528-531
BACKGROUND: Nitric oxide (NO) production catalyzed by iNOS (inducible NO synthase) is thought to take place mainly in macrophages after activation by inflammatory mediators. NO is subsequently oxidized to nitrite and nitrate, which are excreted in urine. The concentration of inflammatory mediators in small bowel biopsy specimens from patients with coeliac disease is increased. The latter could induce increased NO production by stimulation of intestinal macrophage iNOS, resulting in high levels of urinary NO oxidation products, nitrite and nitrate (NOx). AIM: In the present study we evaluated the urinary NOx/creatinine ratios in children with active coeliac disease (n = 22), coeliac disease patients on a gluten-free diet (n = 9), healthy (n = 11) and sick control children (n = 18). METHODS: The Griess reagent method was used for measuring urinary NOx. RESULTS: Median NOx/creatinine ratios of active coeliac disease patients, coeliac disease patients on a gluten-free diet, healthy and sick control patients were 1.21, 0.19, 0.10 and 0.13 mmol/mmol, respectively. All active coeliac disease patients showed increased NOx/ creatinine ratios. Urinary NOx/creatinine ratios of the active coeliac disease patients were significantly higher than those of healthy controls (p < 0.0001), sick controls (p < 0.0001) and coeliac disease patients on a gluten-free diet (p < 0.0001). CONCLUSION: The urinary NOx/creatinine ratio is increased in patients with active coeliac disease and reverts to normal on a gluten-free diet. 相似文献
96.
A V Starikov A F Romanova S P Beschastnaia T I Belaia 《Anesteziologiia i reanimatologiia》1990,(4):16-17
Extracorporeal detoxication techniques (hemosorption, plasmapheresis and plasma exchange) were used in a complex therapy of 55 patients with hemolytic disorders of different etiology. The results of clinical and laboratory studies confirm the efficacy of plasmapheresis. Skin surfaces and mucosa became less icteric, the size of the spleen and liver diminished, the levels of free hemoglobin, bilirubin and circulating immune complexes decreased, blood toxicity reduced. Unlike hemosorption, plasmapheresis and plasma exchange had no unfavourable effects on blood cells. 相似文献
97.
The EuroQoL EQ-5D and MOS SF-36 are two generic quality of life measures that differ significantly in their design (the former being an index and the latter a profile). Both have been extensively used in evaluating interventions in acute disease. This study tested their comparative performance in a survey of patients with relapsing-remitting multiple sclerosis (MS).
METHODS: 309 patients with diagnosed relapsing-remitting MS were identified through the records of 5 specialist centers in North West England. Patients were contacted by telephone by a specialist MS nurse and asked to complete a set of questionnaires distributed by mail. The questionnaire booklet reproduced the English version of SF-36, together with the EQ-5D and a self completion form of the Barthel. Minimal additional background information was obtained from all respondents; 4 weeks following their completion of the initial booklet, a second identical booklet was sent to the first 200 initial respondents. Patients in this re-test sub-group were asked whether their health status had improved, deteriorated, or remained unchanged over the intervening period.
RESULTS: Of the 200 patients in the test/re-test subgroup, 144 (72%) replied on both occasions. Paired t-tests for the PCS, MCS, and general health perception scores on the SF-36 failed to generate comprehensive evidence of reliability. The weighted index form of the EQ-5D and the visual analogue scale self-ratings provided superior evidence of reliability. Standardized response means for both measures confirmed this general pattern.
CONCLUSION: EQ-5D performs satisfactorily as a generic measure of health-related quality of life in patients with MS. 相似文献
METHODS: 309 patients with diagnosed relapsing-remitting MS were identified through the records of 5 specialist centers in North West England. Patients were contacted by telephone by a specialist MS nurse and asked to complete a set of questionnaires distributed by mail. The questionnaire booklet reproduced the English version of SF-36, together with the EQ-5D and a self completion form of the Barthel. Minimal additional background information was obtained from all respondents; 4 weeks following their completion of the initial booklet, a second identical booklet was sent to the first 200 initial respondents. Patients in this re-test sub-group were asked whether their health status had improved, deteriorated, or remained unchanged over the intervening period.
RESULTS: Of the 200 patients in the test/re-test subgroup, 144 (72%) replied on both occasions. Paired t-tests for the PCS, MCS, and general health perception scores on the SF-36 failed to generate comprehensive evidence of reliability. The weighted index form of the EQ-5D and the visual analogue scale self-ratings provided superior evidence of reliability. Standardized response means for both measures confirmed this general pattern.
CONCLUSION: EQ-5D performs satisfactorily as a generic measure of health-related quality of life in patients with MS. 相似文献
98.
Analysis was made of the correlation between the clinical manifestations of hypothyrosis and thyroid calcium-regulating activity. In diffuse enlargement of the thyroid gland the employment of mathematical analysis of hypothyrosis symptoms and thyrotropin-releasing hormone test promoted the early diagnosis of hypothyrosis and helped to reveal its pathogenesis (primary, hypophyseal, hypothalamic). In primary hypothyrosis, when the basal level of thyrotropin and its reaction to TRH was increased, depressed levels of parathormone and thyroxin-binding globulin were observed. A tendency towards elevation in the production of calcitonin was recorded in all mild forms of the disease. 相似文献
99.
H. J. Stein M.D. W. K. H. Kauer M.D. H. Feussner M.D. J. R. Siewert M.D. EA.C.S. 《Journal of gastrointestinal surgery》1998,2(4):333-341
Bile reflux has been implicated in the pathogenesis and malignant degeneration of Barrett’s esophagus, but clinical studies
in patients with adenocareinoma arising in Barrett’s esophagus are lacking. Ambulatory esophageal measurement of acid and
bile reflux was performed with the previously validated fiberoptic bilirubin monitoring system (Bilitec) combined with a pH
probe in 20 asymptomatie volunteers, 19 patients with gastroesophageal reflux disease (GERD) but no mucosal injury, 45 patients
with GERD and erosive esophagitis, 33 patients with GERD and Barrett’s esophagus, and 14 patients with early adenocarcinoma
arising in Barrett’s esophagus. Repeat studies were done in 15 patients under medical acid suppression and 16 patients after
laparoscopie Nissen fundoplication. The mean esophageal bile exposure time showed an exponential increase from GERD patients
without esophagitis to those with erosive esophagitis and benign Barrett’s esophagus and was highest in patients with early
carcinoma in Barrett’s esophagus (P <0.01). Pathologic esophageal bile exposure was documented in 18 (54.5%) of 33 patients
with benign Barrett’s esophagus and 11 (78.6%) of 14 patients with early adenoearcinoma in Barrett’s esophagus. Nissen fundoplieation
but not medical acid suppression resulted in complete suppression of bile reflux. Bile reflux into the esophagus is particularly
prevalent in patients with Barrett’s esophagus and early cancer. Bile reflux into the esophagus can be completely suppressed
by Nissen fundoplication but not medical acid suppression alone. (J GASTROINTEST SURG 1998;2:333-341.)
Presented at the Thirty-Eighth Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington, D.C., May 11–14,
1997 相似文献
100.
Leeksma OC; Meijer-Huizinga F; Stoepman-van Dalen EA; van Ginkel CJ; van Aken WG; van Mourik JA 《Blood》1986,67(5):1460-1467
Concentrations of plasma fibrinopeptide A (FPA) were measured by radioimmunoassay in 50 patients with venous thromboembolism or disseminated intravascular coagulation or both. A consistent discrepancy was observed in values obtained with two anti-FPA antisera. Analysis of extracts from plasma of these patients by high-performance liquid chromatography (HPLC) revealed the presence of a phosphorylated and an unphosphorylated form of the A peptide. Differences in concentrations of FPA measured with the two antisera could be accounted for by their different reactivity with phosphorylated FPA (FPA-P). The differences were abolished by treatment with alkaline phosphatase. A good correlation was observed between the FPA-P content of free A- peptide material and of fibrinogen in plasma as determined by HPLC (r = .88, P less than .001, n = 11). In patients with elevated FPA levels, the mean FPA-P content of fibrinogen was significantly higher (P less than .002, n = 13) than in patients with normal FPA levels (n = 8) and in healthy controls (n = 14). Phosphorus in fibrinogen did not correlate with fibrinogen degradation products or fibrinogen levels and became normal on adequate anticoagulation. Therefore, blood-clotting activation may lead to a high phosphate content of fibrinogen and of free FPA in plasma. 相似文献