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31.
32.
We report on the evolution in concept and techniques that allowed us to improve the treatment of spigelian hernia, operable in day surgery in 90% of cases and through a preperitoneal and recently a preperitoneal and subfascial prosthetic repair (PHS). Background data. We propose an innovative use of the PHS mesh for spigelian hernia repair. With this new implementation, we confront the standard surgical technique and its postoperative period. Methods. From January 1992 to March 2004, we performed 2,500 hernia surgical operations, including 32 spigelian hernia repairs (1.3% of total case series). The first surgical approach used for 20 of these 32 patients (62.5% of total spigelian hernias), all electively operated on, was a classical preperitoneal repair (Wantz), performed when possible by size of defect and weight (Body Mass Index) of the patient, under local anesthesia and on a day-surgery basis. Our new modified technique takes place through the insertion of a PHS large-type mesh, whose bottom underlay portion lies flat in the preperitoneal space with the connector obliterating the hernial orifice and with the overlay portion lying on the internal oblique muscle, covered by the aponeurosis of the external oblique muscle. Results. Our modification to the classical technique consisted only in the application of a product, such as the PHS, in a hernia defect, which presented with an orifice of the size of the connector and, therefore, was easily repairable with the use of the PHS device. This approach is easier than the preperitoneal approach, its always suitable for local anaesthesia, and it gives a more comfortable postoperative period. The surgical approach may be performed completely in day surgery. Conclusions. We believe that spigelian hernia surgical repair should always be performed by means of a preperitoneal prosthesis under local anaesthesia when the patients clinical and physical conditions allow for it, always in day surgery, and using the PHS mesh when the hernia defect size fits with the connector diameter. This last possibility seems to be easier and more comfortable for the patient in the postoperative period. 相似文献
33.
34.
Salaniponi FM Gausi FK Chimzizi RB Harries AD 《Transactions of the Royal Society of Tropical Medicine and Hygiene》2004,98(4):251-254
Low case detection rates of new smear-positive pulmonary tuberculosis (PTB) patients globally are a cause for concern. The aim of this study was to determine for patients registered for TB in Malawi the number and percentage who lived in a neighbouring country and the registration, recording and reporting practices for these 'foreign' patients. All 44 non-private hospitals, which register and treat all TB patients in the public health sector in Malawi, were visited. Ten (23%) hospitals in 2001 and 14 (32%) in 2002 maintained a separate register for cross-border TB cases. Patients recorded in these registers were not formally reported to the Malawi National TB Programme (NTP), the neighbouring country's NTP, nor to WHO. They therefore constitute missing cases. In Malawi, the number of cross-border new smear-positive PTB cases was 77 in 2001 and 91 in 2002, constituting about 3% of missing smear-positive cases in those hospitals that maintain cross-border registers and about 1% of missing cases nationally. 相似文献
35.
Hargreaves NJ Kadzakumanja O Phiri S Lee CH Tang X Salaniponi FM Harries AD Squire SB 《Transactions of the Royal Society of Tropical Medicine and Hygiene》2001,95(4):402-408
The National TB Control Programme of Malawi registers and treats large numbers of patients with chronic cough for smear-negative pulmonary tuberculosis (PTB). Smear-negative PTB is diagnosed according to clinical and radiographic criteria, as mycobacterial cultures are not routinely available. In an area of high HIV seroprevalence there is a concern that other opportunistic infections apart from TB, such as Pneumocystis carinii, may be missed owing to lack of diagnostic facilities. The aims of this study were to investigate (i) the extent of P. carinii pneumonia (PCP) in patients about to be registered for smear-negative PTB; (ii) whether there were any clinical or radiological features that could help identify PCP in the absence of more detailed investigations; and (iii) the treatment outcome of PCP patients. A cohort of 352 patients who were about to be started on treatment for smear-negative PTB were investigated further in 1997-99 by clinical assessment, HIV testing and bronchoscopy. HIV sero-prevalence was 89% (278/313). A total of 186 patients underwent bronchoscopy and bronchoalveolar lavage, and PCP was diagnosed by indirect immunofluorescence or polymerase chain reaction in 17 (9%) of this subgroup. Dyspnoea was significantly more common in PCP cases compared to non-PCP cases (RR 1.35; 95% CI 1.24-1.48; P = 0.008), but discrimination between the groups was difficult using clinical criteria alone. The outcome of PCP cases was poor despite management with high-dose co-trimoxazole and secondary co-trimoxazole prophylaxis, with a median survival of 4 months (25-75% range: 2-12 months). 相似文献
36.
Oberyszyn TM; Conti CJ; Ross MS; Oberyszyn AS; Tober KL; Rackoff AI; Robertson FM 《Carcinogenesis》1998,19(3):445-455
The beta2 integrin (CD 18/CD 11 a, b, c) family of proteins mediate
adherence of leukocytes to vascular endothelium and the associated ligand,
intercellular adhesion molecule-1 (ICAM-1; CD 54), interacts with beta2
integrin proteins to allow transendothelial migration of leukocytes into
sites of inflammation. The present study examines the function of these
proteins in a murine model of acute cutaneous inflammation induced
following topical application of 12-O- tetradecanoylphorbol-13-acetate
(TPA) to the dorsal epidermis of SENCAR mice and in a model of skin
multistage carcinogenesis. At 24 h following topical application of TPA to
the dorsal epidermis of mice, dermal leukocytes expressed higher levels of
beta2 integrin protein compared with the lower levels of beta2 integrin
protein expression by peripheral blood leukocytes. ICAM-1 protein was
localized to epidermal keratinocytes and vascular endothelium in
TPA-treated skin and to proliferating papilloma cells. Intravenous (i.v.)
injection of either 50 microg anti-beta2 integrin antibody alone or in
combination with anti-ICAM-1 antibody significantly inhibited both
TPA-stimulated neutrophil infiltration into the dermis (P < 0.001) and
myeloperoxidase (MPO) activity (P < 0.03 anti-beta2 integrin antibody; P
< 0.01 anti- beta2 integrin + ICAM-1 adhesion molecule antibodies), but
had no effect on TPA-induced epidermal hyperplasia. In addition, injection
of either anti-ICAM-1 adhesion molecule antibody alone (P < 0.004) or in
combination with anti-beta2 integrin antibody (P < 0.001) significantly
inhibited TPA-induced production of 7,8-dihydroxy-2'-deoxyguanosine (8-
OHdG) immunoreactive proteins by epidermal keratinocytes. Beta2
integrin/ICAM-1 adhesion molecules work in concert to regulate migration,
retention and functional activation of leukocytes within the dermis during
TPA-induced skin inflammation and within stromal tissue of papillomas that
form during multi-stage carcinogenesis. Agents that inhibit these
receptor/ligand interactions may be useful in defining the roles of
specific cell populations in cutaneous inflammation and multistage
carcinogenesis and may also have potential as anti-promoting and
anti-progression agents.
相似文献
37.
在马拉维利隆圭城区发展社会-经济指标监测对结核病服务的利用程度 总被引:1,自引:0,他引:1
贺晓新 《结核与肺部疾病杂志》2007,2(1):1-6
目的:为马拉维国家结核病控制规划(NTP)发展对局部地区适用的贫穷测量指标,通过建立现有结核病人的社会-经济学结构图,以评价不同社会-经济学群组对结核病服务的利用程度.设计:通过对1998年马拉维综合家庭调查的数据进行回归分析,建立关于贫穷的定量测量替代指标.通过对利隆圭城区贫民区和非贫民区进行关于贫穷的定量评价,以建立社会-经济学状态的关键指标.采用定量和定性指标对参与横断面研究的179名结核病人进行社会-经济学状态的评价.结果:贫穷的替代测量指标和定性指标显示了相似的对病人贫穷状态评价的能力.利用定量和定性指标对病人进行贫穷评价的贫穷率分别是78%和70%.地理分析显示60%的病人来自非贫民区,只有15%(26/139)来自贫民区.结论:本研究建立了利用贫穷替代测量指标和定性指标监测结核病服务利用可及性的策略.这对于发展循证的贫民优先的公平结核病服务而言,是关键的第一步. 相似文献
38.
Transition metal complexes containing vanadium IV have been shown to
modulate the cellular redox potential and catalyse the generation of
reactive oxygen intermediates (ROI). Since sperm function is exquisitely
susceptible to ROI, we examined the effects of stable chelate complexes of
vanadocenes on human sperm motility. We synthesized seven structurally
distinct chelate complexes of bis(cyclopentadienyl)vanadium(IV) with
bidentate ligands [i.e. vanadocene acetylacetonato monotriflate (VDacac),
vanadocene hexafluoro acetylacetonato monotriflate (VDHfacac), vanadocene
N-phenyl benzohydroxamato monotriflate (VDPH), vanadocene acethydroxamato
monotriflate (VDH), vanadocene catecholate (VDCAT), vanadocene bipyridino
ditriflate (VDBPY), and vanadocene dithiocarbamate monotriflate (VDDTC)],
and evaluated their spermicidal activity using computer-assisted sperm
analysis (CASA; Hamilton-Thorne). All seven chelate complexes of vanadocene
elicited potent spermicidal activity at micromolar concentrations (EC50
values: 3.9-106 microM) without affecting the sperm acrosome integrity. The
catecholate and acetylacetonate complexes of vanadocene were the most
active and the bipyridyl complex the least active with an order of efficacy
VDCAT > VDacac > VDDTC > VDPH > VDH > VDHfacac > VDBPY.
The spermicidal activity of chelate complexes of vanadocenes was rapid and
irreversible since the treated spermatozoa underwent apoptosis, as
determined by the flow cytometric analysis of mitochondrial membrane
potential, surface annexin V binding assay, in-situ nick-end labelling of
sperm nuclei, and confocal laser scanning microscopy. These results provide
unprecedented evidence that chelate complexes of vanadocene with bidentate
ligands have spermicidal and apoptosis inducing properties. These
vanadocene complexes, especially VDacac, may be useful as contraceptive
agents.
相似文献
39.
40.
神经生长因子对小鼠突触体内Ca^2+水平的调节作用 总被引:3,自引:1,他引:3
观察了多次海马内微注射NGF对小鼠突触体内游离钙水平的影响,并在离体情况下观察NGF对EGTA和CaCl2分别造成突触体内低钙和高钙状态的调节作用。结果如下:(1)在体实验表明,一定剂量的NGF可显著降低老年小鼠海马突触体内游离钙水平(P<005);(2)离体实验表明,当突触体游离钙水平降低时,适当剂量的NGF具有升高游离钙水平的作用;而突触体内游离钙水平升高时,则NGF有降低游离钙水平的作用。提示NGF对游离钙水平的双向调节作用可能是NGF改善老年性记忆衰退的作用机制。 相似文献