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21.
22.
23.
24.
n
= 9) should be regarded as a palliative measure. Within a short period, CT-guided aspiration led to recurrence of symptoms
in seven of our patients. Standard treatment of NPHC is fenestration with widest possible excision of the cystic wall, which
can be performed laparoscopically (
n
= 10) or by the conventional surgical mode (
n
= 54). One patient was initially operated by the laparoscopic technique but developed bleeding, which necessitated conversion
to the open mode. Three patients underwent synchronous laparoscopic cholecystectomy. Recurrence rates were similar: 11% in
the laparoscopically treated group and 13% in the group that underwent conventional open surgery. Conventional surgical treatment
was always successful in cases of solitary cysts. However, in cases of multiple cysts measuring more than 5 cm, conventional
surgery was followed by recurrence of symptoms in 26% of patients (7/27), who then had to undergo a second operation. Partial
resection of the liver (
n
= 9) was successfully performed in cases of polycystic disease (
n
= 5) with concomitant enlargement of the organ as well as in cases of large solitary cysts of the left lobe of the liver (
n
= 4). In patients in whom we found that the cysts communicated with the ductal system (
n
= 3), we performed a cystojejunostomy to drain the bile. The complication rate was low. In addition to frequent postoperative
ascites, which necessitated no further intervention, we observed infectious complications in four patients. Twenty patients
(22%) expired during a mean follow-up period of 6.2 years. Interestingly, deaths were frequently associated with malignancy
(11/20). After fenestration of multiple cysts measuring > 5 cm, the patients are at high risk for recurrence. Hence partial
resection of the liver is an excellent therapeutic alternative in selected patients with polycystic disease and massive enlargement
of the organ in whom the disease could not be controlled by simple fenestration. The results of this study show that laparoscopic
fenestration should replace the conventional surgical technique as the gold standard in cases of NPHC because the laparoscopic
technique is less stressful for the patient and is associated with a rate of success similar to that of the conventional technique. 相似文献
25.
26.
William R. Reinus M.D. Franz J. Wippold II M.D. Kavita K. Erickson M.D. 《Emergency radiology》1994,1(2):81-84
We studied clinical predictors of cranial computed tomography (CT) abnormalities in patients with acute or acutely worsened
headache. Data were collected from chart review of 333 consecutive patients presenting to an emergency department and who
were clinically selected for cranial CT. Patients with a positive neurologic examination were at 10.7 times greater risk for
a positive CT than the rest of the sample (p<1.5 – 10−10). Using only neurologic examination to select patients for CT would have missed 30.3% of the positive scans. The amnesia,
depressed sensorium, and hypertension variables had CT yields approximating 10% or greater even in the presence of a negative
neurologic examination. Together with a positive neurologic examination, these variables detected 87.9% of the patients in
this sample with positive scans; their absence had a negative predictive value of 98.0%. Of the four patients with positive
scans who would have been missed using this strategy, one was discharged directly from the emergency department anyway and
the other three developed positive neurologic examinations within 24 hours. One died of causes unrelated to the intracranial
pathology. Positive neurologic examination, hypertension, history of amnesia, or a depressed sensorium provide reasonable
initial guidelines to select for CT patients with an acute headache. 相似文献
27.
28.
29.
The cytologic diagnosis of malignancy is frequently straightforward. For difficult cases, multiple immunostains and immunostain panels have been investigated without consensus. beta-human chorionic gonadotropin (hCG) has been reportedly expressed in malignancies, but not in normal tissue. HCG also has been reported as a specific marker of metastases in serous fluids when detected with laboratory assays. We investigated the clinical utility of hCG in this cytologic setting. A total of 97 cases of benign and malignant effusions were studied. Each case was immunostained with monoclonal hCG using the avidin-biotin technique and diaminobenzidine as a chromogen. Additionally, a mucicarmine stain was performed on most cases. Cases were evaluated for hCG expression and mucin in a blinded fashion. After the cases were reviewed, the diagnoses were unblinded and staining patterns were evaluated. Of the 47 benign cases studied, 23 (49%) exhibited immunoreactivity to hCG in at least 5% of mesothelial cells present. In contrast, 28 of 44 (64%) adenocarcionomas exhibited a similar degree of immunostaining. In all, 21 (48%) of the adenocarcinomas were also positive for mucin; five of these mucin-positive cases were negative for hCG. The combination of mucin and hCG detected 33 of 44 (75%) adenocarcinomas. We conclude that hCG lacks the specificity for malignant cells to be of clinical use in effusion cytology. 相似文献
30.
In the century or so since the birth of the research-based pharmaceutical industry, there has never been a more demanding time. The most pressing issue facing virtually all big pharmaceutical companies today is research and development productivity. Despite huge investments in research and development, the number of new medicines cleared for market has declined. On the other hand, there has never been a more exciting time to do healthcare research. New sciences and technologies are opening up radically new perspectives and opportunities for the future. Medical practice is undergoing a historic shift towards more personalized medicine. Over the next 10 years we can expect significant progress in the treatment of major diseases. 相似文献