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71.
72.
Ben Lakhal R Aissaoui L Jeddi R Ayari B Ben Abid H Belhadj Ali Z Gouider E Meddeb B Hafsia R Hafsia A 《La Tunisie médicale》2005,83(5):296-299
The present work focuses on the therapeutic efficacy and the toxicity of alpha interferon in patients younger than age 18 years. 5 patients younger than 18 years were treated and followed up between 1990 and 1999 at the department of haematology (Aziza Othmana Hospital) Hydroxyurea was given as initial treatment to all patients. After a median period of 8 months, these patients received alpha interferon (5 millions units/m2 once). Six months after the beginning of the alpha interferon a complete hematologic response was obtained in all patients. The median overall survival was of 66 months: 3 patients are still alive (2 patients in an advanced stage and one patient in chronic phase) and 2 patients died after transformation. The most common reported side effects of alpha interferon were asthenia, weight loss, fever, myalgia, chills and headaches--these toxic manifestations were mild and were noticed in all our patients. Myelosuppression was noted in two patients. Interferon is well tolerated in patients younger than age years 18 old, with CML. It may offer an alternative to bone marrow transplantation in children in the chronic phase of CML without histocompatible donor. The role of new agents such as STI 571 needs to be evaluated as well. 相似文献
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In this study we reviewed our experience of hydatid disease of the lung and the liver and discussed the safety and the follow-up
results of the one-stage operation. Between 1990 and 2004, 142 patients with pulmonary hydatid disease underwent operation
in our clinic. Of these, 27 (19%) patients had cysts located on the dome of the liver, treated with phrenotomy through a right
thoracotomy. Hydatid cysts located in the lungs were managed by means of cystotomy. For liver cysts, cystotomy and the inversion
of the cavity with sutures was the surgical method of choice, and a drain was left in place. The pulmonary cysts of 12 (8.4%)
patients were bilateral and 5 (3.5%) patients had prior surgical treatment of hepatic (n = 1) or pulmonary (n = 4) hydatid cysts. The liver cysts were approached transdiaphragmatically after the lung cysts were excised in 27 (19%)
patients. In patients with pulmonary cysts, cystotomy, with or without capitonnage was performed on 123 (86.6%) patients,
and wedge resection was performed on 11 (7.7%), segmentectomy was performed on 6 patients (4.2%), and lobectomy was performed
on 2 (1.4%) patients. There was no mortality, and only a small number of complications were encountered: empyema in 3, excessive
biliary drainage in 2, and bronchopleural fistula in only 1. We suggest that the extraction of pulmonary and hepatic cysts
simultaneously through the transthoracic route is a useful and safe surgical technique. This technique also prevents the need
for a second operation. 相似文献
75.
BACKGROUND: Hydatid disease of the lungs is still a serious health problem for some Mediterranean countries. The best surgical therapy for the treatment of this disease is still unclear. In this clinical retrospective study, we aimed to investigate whether capitonnage is an effective therapy method for a pulmonary hydatid cyst or not. METHODS: Between 1990 and 2004, 89 patients (49 male and 40 female) each with a pulmonary hydatid cyst were treated surgically. The patients were divided into two groups based on whether capitonnage was carried out (group 1, n = 44) or not (group 2, n = 45). Cystotomy and the closure of the bronchial openings were carried out in both groups. The results were assessed in two groups during a 1 year follow-up period. The groups were comparable with regards to their clinical, operative and demographic characteristics. RESULTS: There was no mortality, and no significant difference in hospitalisation time between the two groups. It was 8.2 +/- 3.2 days for group 1 and 8 +/- 3.1 days for group 2 (P = 0.89). The most serious complications were restricted bronchopleural fistula (only one patient in group 2), empyema (only one patient in group 1 and two patients in group 2), and prolonged air leak (five patients in group 1 and six patients in group 2). These results were not valuable statistically (P = 1.00, P = 1.00 and P = 0.78, respectively). CONCLUSIONS: We conclude that it is not an advantage to carry out capitonnage when treating pulmonary hydatid cysts. 相似文献
76.
Beyrouti ML Abid M Beyrouti R Ben Amar M Gargouri F Frikha F Affes N Boujelbene S Ghorbel A 《Presse medicale (Paris, France : 1983)》2005,34(5):385-390
Sarcomas of the small intestine are rare, clearly differentiated, malignant, mesenchymatous tumours that can be of smooth muscle, Schwann cell or fibroblastic origin. From a clinical point of view, the pain and abdominal mass are the 2 types of symptoms that frequently reveal the disease. In rare cases, sarcomas of the small intestine are manifested by an acute complication. No imaging method can clearly confirm the diagnosis. Before immunohistochemistry, differential diagnosis was made on undifferentiated mesenchymatous "stromal" tumours, which are also rare. Exeresis must be complete and without perforation of the tumour because of the risk of locoregional relapse. The benefits provided by chemotherapy and radiotherapy are limited because of the low mitotic activity of the tumour cells and its weak vascularisation. Long-term survival is limited by poor prognosis criteria: high grade malignancy, size greater than 5 cm, tumour extension, perforation of the tumour, quality of surgical resection and histological type. 相似文献
77.
Therapeutic, prophylactic, and preresection applications of laparoscopic gastric and biliary bypass for patients with periampullary malignancy 总被引:1,自引:0,他引:1
Hamade AM Al-Bahrani AZ Owera AM Hamoodi AA Abid GH Bani Hani OI O'Shea S Lee SH Ammori BJ 《Surgical endoscopy》2005,19(10):1333-1340
Background Laparoscopic bypass surgery for the palliation of gastric and biliary obstruction is associated with a rapid recovery. This
study aimed to extend its application to other aspects in the management of patients with periampullary cancer.
Methods Between 2001 and 2004, 21 patients (median age, 68 years) underwent laparoscopic gastric (n = 8), biliary (n = 5), and combined gastric and biliary (n = 8) bypass. In addition to its therapeutic role (n = 12), indications included a concomitant prophylactic gastric (n = 3) and biliary (n = 2) bypass as well as pre- 1 Whipple’s relief of deep jaundice at the time of staging laparoscopy (n = 3). Construction of the biliary bypass to the gallbladder (n = 11) or bile duct (n = 2) was based on preoperative imaging.
Results All procedures were completed laparoscopically. The median operating times for gastric, biliary, and combined bypass were
75, 60, and 130 min, respectively. The addition of a prophylactic bypass did not significantly prolong the operating time,
as compared with a single therapeutic bypass. One patient died postoperatively of aspiration pneumonia. The postoperative
hospital stay (median, 4 days) was not significantly influenced by the type of bypass. No recurrence of or new obstructive
symptoms developed during the follow-up period after a therapeutic or prophylactic bypass.
Conclusions Applications of laparoscopic gastric and biliary bypass can safely be expanded to include a prophylactic role and preresection
relief of obstructive jaundice. Prophylactic bypass surgery does not prolong operating time or hospital stay significantly
and prevents future onset of obstructive symptoms. 相似文献
78.
Ghafoor AU Martin TW Gopalakrishnan S Viswamitra S 《Journal of clinical anesthesia》2005,17(8):640-649
PURPOSE: Anesthesiologists are often involved in the early management and resuscitation of patients who have sustained cervical spine injuries (CSIs). The most crucial step in managing a patient with suspected CSI is the prevention of further insult to the cervical spine (C-spine). In this review, important factors related to initial management, diagnosis, airway and anesthetic management of patients with CSI are presented. SOURCE: Medline search was performed to seek out the English-language literature using the following phrases and keywords: spine trauma; cervical spine; airway management after CSI. PRINCIPAL FINDINGS: Cervical spine injury occurs in up to 3% to 6% of all patients with trauma. The initial management of a patient with potential spine injury requires a high degree of suspicion for CSI so that early stabilization of the spine can be used to prevent further neurological damage. Diagnostic radiology has a critical role to play; however, clinical evaluation is equally important in excluding CSI in a conscious and cooperative patient. Although in-line stabilization reduces the movement at C-spine, traction causes clinically significant distraction and should be avoided. CONCLUSION: A high level of suspicion and anticipation are the major components of decision making and management in a patient with CSI. Endotracheal intubation using the Bullard laryngoscope may have some advantages over other techniques as it causes less head and C-spine extension than the conventional laryngoscope, and this results in a better view. However, the current opinion is that oral intubation using a Macintosh blade after intravenous induction of anesthesia and muscle relaxation along with inline stabilization is the safest and quickest way to achieve intubation in a patient with suspected CSI. In summation caution, close care and maintenance of spinal immobilization are more important factors in limiting the risk of secondary neurological injury than any particular technique. 相似文献
79.
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