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61.
62.
Kimberly A. Varker Edward W. Martin Dori Klemanski Bryan Palmer Manisha H. Shah Mark Bloomston 《Journal of gastrointestinal surgery》2007,11(12):1680-1685
Background
Transarterial chemoemobolization (TACE) is commonly used to treat metastatic carcinoid tumors; however, the management of
progressive disease is less clear. We sought to determine if patients with disease progression after TACE would benefit from
repeat TACE.
Methods
The records of 27 patients undergoing repeat TACE for radiologic or symptomatic progression after TACE for metastatic carcinoid
were reviewed and compared to 122 undergoing first TACE. Overall and progression-free survivals were estimated by the Kaplan–Meier
method.
Results
Mean disease-free interval after first TACE was 11.8 months. Radiologic response was observed in 61% compared to 82% after
first TACE (p = 0.058); hormone response in 64% compared to 80% (p = 0.159); and symptomatic response in 77% compared to 92% (p = 0.053). The complication rate after repeat TACE was lower than after first TACE (p = 0.03). Median overall survival was similar after repeat (28.1 months) and first TACE (33.3 months) (p = 0.53). Progression-free survival was shorter after repeat TACE but not significantly so. No factor examined could predict
survival after repeat TACE.
Conclusion
Repeat TACE for patients with hepatic carcinoid metastases failing first TACE or having evidence of disease progression is
safe and offers a viable treatment option.
Presented at the 48th Annual Meeting of The Society for Surgery of the Alimentary Tract, Washington, DC, May, 2007. 相似文献
63.
Cholangiocarcinomas (CC) frequently demonstrate lymphatic spread. We investigated lymph node (LN) counts after resection of
extrahepatic CC and survival based on the SEER 1973–2004 database. Out of 20,068 CC patients, 1,518 individuals were selected
based on M0 stage and at least one LN examined. Primary cancer sites included gallbladder (29%), extrahepatic bile ducts (26%),
and intrapancreatic/ampullary bile ducts (45%); 42% of patients were LN-positive. The median number of LNs examined was four
(range 1–39). Median survival was 37 months for LN-negative and 16 months for LN-positive cancers. Multivariate prognostic
variables were the number of positive LNs, primary site, age (all at p < 0.0001), gender (p = 0.002), size (p = 0.005), T category (p = 0.009), and total LN count (or number of negative LNs obtained, p = 0.01). The impact of total LN counts was seen in LN-negative (median survival, 1 vs 10 or more LNs examined: 27 vs 51 months,
p = 0.002) and LN-positive disease (10 vs 22 months, p < 0.0001). Survival prediction of extrahepatic CCs is strongly influenced by total LN counts and numbers of negative LNs
obtained. Although the resulting incremental benefit is small, dissection and examination of 10 or more LNs should be considered
for curative intent resections. 相似文献
64.
65.
Vertebral body replacement system Synex in unstable burst fractures of the thoracic and lumbar spine
U. Vieweg 《Journal of orthopaedics and traumatology》2007,8(2):64-70
A prospective longitudinal study was performed to evaluate the vertebral body replacement system Synex associated with posterior
fixation in unstable burst fractures of the lumbar and thoracic spine. Within 24 months, we treated 28 patients (average age,
41 years; range, 22–64 years; 14 women, 14 men) with acute unstable burst fractures without osteoporosis of the thoracolumbar
region (n=16) and the thoracic (n=3) as well as the lumbar (n=9) spine in two stages (primary dorsal transpedicular stabilization and secondary vertebral body replacement). The complications
were analyzed and the postoperative follow-up result was evaluated regarding stability, bone fusion, correction loss, pain
and neurological status. One patient showed a transient irritation of the lumbosacral plexus and one patient had a superficial
wound infection (complication rate, 7.1%). At the follow-up examination (mean follow-up, 13 months) only in two cases a minimal
loss of correction (<5°) was measured. Radiologically, 27 patients showed secure bone fusions and all patients had stability
of the osteosynthesis. Most of the patients stated no or just slight pain at follow-up. Only two patients with pain to a medium
degree had to take painkillers. The vertebral body replacement system Synex seems to be a good alternative for vertebral body
replacement in unstable burst fractures of the thoracic and lumbar spine since at present follow-up it shows a high rate of
bone fusion and minimal loss of correction. 相似文献
66.
67.
Javairiah Fatima Scott G. Houghton Michael G. Sarr 《Journal of gastrointestinal surgery》2007,11(8):1052-1056
Small bowel transplantation (SBT) is associated with poorly understood enteric dysfunction. The study of SBT in mice is hindered
by the technical difficulty of orthotopic SBT in the mouse. Our aim was to develop an easy preparation of extrinsic denervation
of the entire jejunoileum in mice as a model of orthotopic SBT. All neurolymphatic tissues accompanying the superior mesenteric
artery (SMA) and vein (SMV) were ligated just distal to the middle colic vessels. The SMA and SMV were then stripped of investing
adventitia, and the mesentery to jejunum and colon were transected radially. Jejunum and colon were not transected and reanastomosed.
To confirm extrinsic denervation 1, 3, and 6 months later, segments of small bowel were stained for protein gene product 9.5
(PGP9.5) and tyrosine hydroxylase (TH). Tyrosine hydroxylase immunoreactive intensity was then quantified using a semiquantitative
analysis. Immunohistochemical fluorescence showed persistence of PGP9.5 immunoreactivity confirming enteric nerves in jejunoileum;
however, there was no TH immunoreactivity in jejunoileum in denervated mice despite the expected preservation of TH immunoreactivity
in the still-innervated duodenum at 1 month. At 3 months, sparse immunoreactivity for TH was present, and by 6 months, reinnervation
of TH-containing nerves appeared similar to controls. Quantification of intensity at each time-point further confirmed this
trend. This technique in the mouse accomplishes a complete extrinsic denervation of jejunoileum early postoperatively (1 and
3 months); reinnervation occurs by 6 months. This is an easily learned murine model of orthotopic SBT.
Presented at the American Gastroenterological Association during Digestive Disease Week in Los Angeles, CA, as a poster presentation
on May 23 2006. Abstract published in GastroenterologyE 2006; 130:A604. 相似文献
68.
Marcelo W. Hinojosa Zuri A. Murrell Viken R. Konyalian Steven Mills Ninh T. Nguyen Michael J. Stamos 《Journal of gastrointestinal surgery》2007,11(11):1423-1430
Few studies have examined outcomes of laparoscopic and open sigmoid colectomy performed at US academic centers. Using ICD-9
diagnosis and procedural codes, data was obtained from the University HealthSystem Consortium (UHC) Clinical Database of 10,603
patients who underwent laparoscopic or open sigmoid colectomy for benign and malignant disease between 2003–2006. A total
of 1,092 patients (10.3%) underwent laparoscopic sigmoid colectomy. Laparoscopic sigmoid colectomy was associated with a significantly
shorter length of stay (5.4 vs 7.4 days), lower overall complication rate (19.7 vs 26.0%), lower 30-day readmission rate (3.4
vs 4.6), and a lower hospital cost ($13,814 vs $15,626). When a subset analysis of malignant and benign groups was performed,
a significantly shorter length of stay in both the malignant laparoscopic group (6.4 ± 6.4 vs 7.8 ± 6.6 days) and in the benign
laparoscopic groups (5.1 ± 3.5 vs 7.2 ± 7.6) exists. A lower wound complication rate (2.1 vs 5.5%, malignant and 4.0 vs 6.1,
benign) is also evident. Laparoscopic sigmoid colectomy was associated with a shorter length of stay, less complications,
and a lower 30-day readmission rate. The shorter length of stay and wound infection rate maintain significance when comparing
laparoscopic vs open sigmoid resections for malignant and benign disease.
Presented at the 48th annual meeting of the Society for Surgery of the Alimentary Tract at Digestive Disease Weak, Washington,
DC, May 21st 2007.
The information contained in this article was based on the Clinical Data Base provided by the University HealthSystem Consortium. 相似文献
69.
Inguinal hernia is a known complication after radical retropubic prostatectomy (RRP). We have investigated whether other types
of lower midline incision surgery in males increase the risk of inguinal hernia. Male patients operated with open prostatectomy
for benign prostate hyperplasia (n = 95), pelvic lymph node dissection for staging of prostate cancer (n = 88), or cystectomy for bladder cancer (n = 76) were identified and were sent questionnaires in which they were asked about postoperative inguinal hernia morbidity.
Two-hundred and seventy-one men operated with RRP had previously received a similar questionnaire. The answers were compared
with those from a control group of 953 men who had not undergone surgery. Annual attributional hernia morbidity and Kaplan–Meier
hernia-free survival were calculated. The cumulative incidence of post-operative inguinal hernia and annual attributional
hernia morbidity after the respective surgical procedures were clearly higher during the early years post-operation than for
nonoperated patients. Inguinal hernia is a common postoperative complication in males after all the lower midline incision
surgery investigated. 相似文献
70.
Ayman Agha Gabriel Glockzin Matthias Woenckhaus Wolfgang Dietmaier Igors Iesalnieks Hans J. Schlitt 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》2007,392(6):671-677
Background Insular thyroid carcinoma was described as a tumor with aggressive behavior, and patients usually present themselves with
an advanced tumor stage. Whether the insular component is an independent factor for poor prognosis remains unclear. Therefore,
in the present study, we compared the survival of patients with advanced insular, follicular, and papillary thyroid cancer.
Materials and methods The clinical behavior of tumors in three groups of patients with T4 thyroid carcinoma—8 patients with insular, 11 patients
with follicular, and 21 patients with papillary thyroid carcinomas—was compared. Disease-free survival and disease-specific
death were analyzed statistically. Cox regression analysis was used to evaluate the influence of histotype and other prognostic
factors.
Results At 3 years, survival was 37.5% (mean 26 months) among patients with insular thyroid carcinoma, 80% (mean 59 months) among
those with follicular, and 89% (mean 126 months) among those with papillary thyroid carcinomas (p = 0.007). Disease-free survival in patients without initial distant metastasis was worst in patients with insular thyroid
carcinoma (20%) compared to those with follicular (75%) and those with papillary thyroid carcinomas (71%).
Conclusion Patients with advanced insular thyroid carcinoma have a poorer outcome in comparison to patients with similar advanced stage
who have follicular or papillary thyroid carcinoma. 相似文献