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11.
Rodrigo O Perez Angelita Habr-Gama Igor Proscurshim Fábio G Campos Desiderio Kiss Joaquim Gama-Rodrigues Ivan Cecconello 《Journal of gastrointestinal surgery》2007,11(11):1431-8; discussion 1438-40
BACKGROUND: The role of local excision for pT2 distal rectal cancer has been challenged because of the observation of high rates of lymph node metastases and local failure. However, neoadjuvant chemoradiation therapy (CRT) has led to increased local disease control and significant tumor downstaging, possibly decreasing rates of lymph node metastases. In this setting, a possible role for local excision of ypT2 has been suggested. METHODS: A total of 401 patients with distal rectal cancer underwent neoadjuvant CRT. Tumor response assessment was performed after at least 8 weeks from CRT completion. One hundred and twelve patients with complete clinical response were not immediately operated on and were excluded from the study, and 289 patients with incomplete clinical response were managed by radical surgery. Patients with final pathological stage ypT2 were analyzed to determine the risk of unfavorable pathological features that could represent unacceptable risk for local failure after local excision. RESULTS: Eighty-eight (30%) patients had ypT2 rectal cancer. Final ypT status was not associated with pretreatment radiological staging (p = 0.62). ypT status was significantly associated with the risk of lymph node metastases, risk of perineural and vascular invasion, and recurrence (p = 0.001). Lymph node metastases were present in 19% of patients with ypT2 rectal cancer. The risk of lymph node metastases in ypT2 was associated with the presence of perineural invasion (47% vs 4%; p = <0.001), vascular invasion (59% vs 6%; p < 0.001), and decreased mean interval CRT surgery (12 vs 18 weeks; p < 0.001), but not with mean tumor size (3.2 vs 3.1 cm; p = 0.8). Disease-free and overall survival rates were significantly better for patients with ypT2N0 (p = 0.02 and 0.006, respectively). Fifty-five (63%) patients with ypT2 had at least one unfavorable pathological feature for local excision (lymph node metastases, vascular or perineural invasion, mucinous type or tumor size >3 cm). CONCLUSION: Lymph node metastases were present in 19% of patients with ypT2 and were significantly associated with poor overall and disease-free survival rates. The risk of lymph node metastases could not be predicted by radiological staging or tumor size. Radical surgery should be considered the standard treatment option for ypT2 rectal cancer after CRT. 相似文献
12.
The intercostal hernia of the lung is a very rare extraordinary disease that requires operation because of the complaints
and potential complications. The authors review cases of their operations and analyze the subsequence and treatment. Three
patients have been treated for intercostal lung hernia in our treatment. The causes of this disease were a previous thoracotomy
in one case and fits of coughing in the other two cases. The diagnosis was set up on the grounds of the specific clinical
symptoms, thoracic X-ray and CT scan. The hernia was dissolved with percostal stitches and with the suture of the thoracic
musculature in two cases. Plastic operation of the thoracic wall by implanting a polypropylene surgical mesh (Prolen, Ethicon,
Johnson & Johnson) was performed in the case of the third patient and later in the first two patients due to recrudescence.
In one case the authors were constrained to resect the dystelectasial lung in the hernial sac. The three patients had been
operated five times. Relapse of hernia was detected in two patients, in whom the intercostal space had been reconstructed
with percostal stitches. We did not detect any relapsing in those two patients at 33 and 66 months after the second operation
with mesh implantation. The third patient who got mesh implant immediately did not relapse 12 months after the operation.
Intercostal lung hernia is an indication of operation. A plastic operation of the thoracic wall combined with the implantation
of a surgical mesh is recommended to close the hernial orifice, which is suitable for treating both primary and relapsed hernias.
Recurrence is rare in those patients treated with this method. 相似文献
13.
A series of N-(phosphonoacetyl)-dipeptide derivatives was synthesized for pharmacological testing as antihypertensive compounds. Several of these compounds demonstrated a moderate antihypertensive effect in Wistar spontaneous hypertensive rats (SHR) with p.o. dosing. ACE inhibition by the compounds was studied using ACE from rat plasma and lung. Inhibitors containing esterified C-termini are pro-drugs and showed activity only for plasma ACE. 相似文献
14.
M.S. Ågren U. Ostenfeld M.E. Crawford K. Kiss Y. Gong C. Gluud A. FriisMøller F. Kallehave K. Raffn L.N. Jorgensen 《Wound repair and regeneration》2005,13(2):A1-A27
Extended healing time and lack of documented effective treatments of sacrococcygeal pilonidal disease create substantial problems. Locally applied zinc oxide has been reported to promote wound healing. We have compared topical zinc oxide (3%) with placebo meshes for pilonidal wounds healing by secondary intention in a randomized, double‐blind, placebo‐controlled multicenter trial. Sixty‐four consecutive patients, 53 males, aged between 18 and 60 years (median 26 years) with excised pilonidal wounds were centrally randomized to local zinc oxide (30 mg/g, n = 33) or to placebo (n = 31) mesh treatment. Patients were followed with strict recording of beneficial and harmful effects. The median healing times were 54 days (42–71 days, interquartile range, n = 33) for the zinc group and 62 days (55–82 days, n = 31) for the placebo group. This difference was not statistically different (p = 0.32). Based on Cox regression analysis initial wound volume influenced healing negatively (p = 0.016) while smoking (p = 0.011) was associated with faster wound healing. Significantly (p < 0.01) more placebo (n = 12) than zinc oxide‐treated patients (n = 3) needed antibiotics postoperatively. Although topical zinc oxide increased (p < 0.001) wound fluid zinc levels (1830 ± 405 μM, mean ± SEM) compared with placebo (3.1 ± 1.6 μM) serum‐zinc levels did not differ significantly between the zinc (13.5 ± 0.4 μM) and placebo (12.8 ± 0.4 μm) groups on postoperative day 7. No adverse events were recorded. Topical zinc oxide treatment did not accelerate time to closure of open pilonidal wounds but was associated with reduced antibiotic usage. 相似文献
15.
Neuronal dense-core vesicles provide a mechanism whereby peptide messengers are secreted in discrete quanta. Here we report on the capacity of rat hypophysiotrophic corticotropin releasing factor-41 neurons to alter the peptide content as well as the size of dense-core vesicles after removal of glucocorticoid negative feedback by adrenalectomy. We demonstrate, using quantitative immunoelectron microscopy, that long-term adrenalectomy induces a progressive increase in the ratio of vasopressin to corticotropin releasing factor-41-immunoreactive sites in the dense-core vesicle compartment. The intravesicular concentration of vasopressin appeared to be the variable parameter while that of the corticotropin releasing factor-41 remained stable at all survival times after adrenalectomy. Moreover, observations for up to 5 weeks indicate that adrenalectomy results in a progressive increase in the mean volume of dense-core vesicles to about three times normal. These results suggest that the quantal size and the composition of dense-core vesicles are subject to long-term modulation. The capacity of corticotropin releasing factor-41 neurons to alter dense-core vesicles could enhance or diminish the efficacy of the hypothalamohypophyseal communication underlying physiological adaptation to stress, as well as pathological changes. 相似文献
16.
Zoltán Závaczki János Sz?ll?si Sándor A Kiss Sándor Koloszár Imre Fejes László Kovács Attila Pál 《Magnesium research》2003,16(2):131-136
A randomized, placebo-controlled clinical pilot study was performed in order to examine the effect of magnesium-orotate in male idiopathic infertility. Ten males were treated daily for 90 consecutive days with 3000 mg magnesium-orotate (Magnerot) tablets (Group M). As a control, ten other males were treated in the same way with placebo (Group P). Conventional microscopic sperm characteristics (sperm concentration, motility ratio, total number of motile sperm cells, normal morphology ratio), plus total and ionized magnesium levels in seminal plasma and blood serum were evaluated both prior to treatment and on day 90, at the conclusion of the study. No significant changes in sperm characteristics, blood ionized or total Mg, or ejaculate total Mg levels were detected. However, ejaculate ionized Mg levels increased in Group M from 0.18 +/- 0.05 to 0.30 +/- 0.05 (mmol/l; mean +/- SD, p < 0.05). Within the observation period of 3 months, one pregnancy occurred in the partner of a male from Group M. In conclusion, magnesium-orotate treatment at a dose of 3000 mg/day leads neither to a significant improvement of sperm variables nor does it increase the pregnancy rates of female partners of treated males as compared to those of controls. Thus, magnesium-orotate treatment was not shown to be effective therapy for idiopathic male infertility. 相似文献
17.
Binet I; Bock A; Vogelbach P; Gasser T; Kiss A; Brunner F; Thiel G 《Nephrology, dialysis, transplantation》1997,12(9):1940-1948
Background. The growing shortage of cadaver kidneys,
the limited possibilities to expand the living related donor pool and the
good results obtained in our centre with poorly matched cadaver kidneys,
led us in 1991 to begin accepting highly motivated, unrelated, living
kidney donors who had a strong emotional bond with the recipients.
Methods. Between 1 January 1991 and 1 January 1996, 46
potential living kidney donors and their emotionally related recipients
were evaluated. Twenty-three cases were accepted for renal transplantation
after thorough somatic and psychological evaluation. The mean
post-transplant follow-up until 1 April 1996 was of 28±3 months.
Compatible blood groups and a negative cross-match were mandatory, but no
minimal HLA matching was required. Results. There was
a 50% drop-out rate following the initial screening. The main reasons for
not performing transplantation were immunological contraindications in 39%
of the cases, somatic in 30.5%, psychological in 26% and socioeconomic in
4.5%. In the accepted group of recipients, 48% (11/23) received transplants
without chronic dialysis. Donor survival was 91%; two deaths unrelated to
nephrectomy occurred 1 year after donation. The 2-year actuarial recipient
and graft survivals were 100% and 91% respectively, compared to 99%
(recipients) and 93% (grafts) in the non-HLA-identical living related
kidney transplant group, and to 93% (recipients) and 83% (grafts) in the
cadaver kidney transplant group. Recipient rehabilitation was completed
after 4±1 months. Emotionally related donors returned to work
5±2 weeks after nephrectomy, and no donor regretted his
decision, even in the case of failure. Conclusions.
Kidney transplantation from emotionally related living donors represents a
valuable option, allowing more patients with end-stage renal disease to
avoid chronic dialysis. Recipient and graft outcome were superior to
cadaver kidney transplantation. Motivated and emotionally related donors
should be allowed to donate one of their kidneys provided that they are
carefully selected and thoroughly informed. 相似文献
18.
Laparoscopic appendectomy] 总被引:2,自引:0,他引:2
We have performed the first laparoscopic appendectomy in Hungary. Laparoscopic appendectomy is a new, minimally invasive method in abdominal surgery. We consider it a worthwhile alternative to classical appendectomy. 相似文献
19.
M.V. Ugrumov M.S. Mitskevich B. Halsz J. Kiss N.A. Borisova 《International journal of developmental neuroscience》1986,4(2):101-111
Structure and permeability of the ependymal lining the infundibular recess were studied in perinatal rats with silver impregnation, electron microscopy, radioautography, and tracer techniques. According to our data basal processes of ependymal cells reach the primary portal plexus linking the 3rd ventricle and the hypophysial portal system all through the perinatal period. After birth, some of the processes penetrate into the perivascular space of the primary portal plexus and abut there on the endothelium of capillaries. Ependymal cells of fetuses and neonates are joined by specialized junctions (tight junctions, gap junctions and zonulae adhaerentes). Intraventricularly injected ionic lanthanum crosses the ependymal lining of fetuses both trans- and extra-cellularly everywhere in the infundibular recess. By postnatal day 9 only the rostral portion of the recess remains readily permeable. Caudally, extracellular leakage becomes highly restricted, apparently due to the appearance of circumferential tight junctions. Finally, [3H]dopamine seems to penetrate through the ependymal lining in the same way as ionic lanthanum entering the portal capillaries. These findings suggest that the adenohypophysiotropic neurohormones can penetrate from the cerebrospinal fluid into the portal circulation from the very beginning of the establishment of the hypothalamo-hypophysial functional relationships during ontogenesis. 相似文献
20.