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991.
992.
Objective: The purpose of the study was to correlate between effect of pre-neoadjuvant chemotherapy (NACT) and post-NACT clinical, sonographic and pathologic features of the tumor and axillary lymph nodes (ALNs) and to raise the possibility of applying the concept of sentinel lymph node biopsy (SLNB) in patients with initially positive ALNs before NACT. Methods: A prospective study of 50 female patients with locally advanced breast cancer (LABC) with clinically palpable.and cytologically (under ultrasonographic guidance) positive ALNs. All patients received NACT and then referred for ultrasono- graphic assessment of the axilla regarding any detectable sonographic criteria of metastatic deposits in ALNs as well as the tumor size in relation to its prechemotherapy size, All patients were then subjected either to modified radical mastectomy or breast conserving surgery. The clinical, sonographic and pathological response of the tumor and the ALNs were documented, classified and correlated with each other. Results: Patients' mean age was 47.7±9.1 years. The mean clinical tumor size was 6.7 ± 1.4 cm; stage IliA that was presented in 32 patients (64%) and IIIB was presented in 18 patients (36%). Chemotherapy was given for a median of 4 cycles, there was reduction of the mean clinical tumor size from 6.7 ± 1.4 cm to 4.3 ± 2.7 cm (P 〈 0.001). Clinical response was complete in 5 (10%) tumors, complete pathological tumor response (post-neoadjuvant) was detected in 6 (16%) of patients. Complete clinical nodal response (post-neoadjuvant) in 23 (46%) axillae, on sonographic assessment of the axilla, response was complete in 17 (34%) axillae. Complete pathological nodal response occurred in 16 (32%) axillae. Out of 17 axillae that showed complete sonographic response 11 axillae showed complete pathological nodal response (P 〈 0.001). Conclusion: Formal axillary lymph node dissection can be avoided and replaced by SLNB post NACT in patients with L 相似文献
993.
Carcinoma of the fourth part of the duodenum: Report of a case 总被引:1,自引:0,他引:1
Primary carcinoma of the duodenum is rare, accounting for only 0.35% of all gastrointestinal carcinomas, and carcinoma of the fourth part of the duodenum constitutes approximately 10% of duodenal carcinomas. Since the predominant symptoms of tumors in this part of duodenum are related to upper intestinal obstruction, the diagnosis is usually made late. We report the case of a 66-year-old man who presented with anemia, weight loss, and upper intestinal obstruction, and was found to have advanced primary carcinoma of the fourth part of the duodenum by upper gastrointestinal series and computed tomography (CT). A review of the literature indicates that survival, which is related to nodal status, the grade of the tumor, and surgical results, seems to be longer in patients with carcinoma in this part of the duodenum compared to those with carcinomas in other parts of the duodenum. Moreover, segmentary resection has been reported to achieve a favorable outcome. 相似文献
994.
Ozkoç G Akpinar S Hersekli MA Ozalay M Uysal M Tandoğan NR 《Archives of orthopaedic and trauma surgery》2003,123(10):555-557
Case studied Median nerve entrapment is a rare, serious complication of elbow dislocation. We report a Type 4 median nerve entrapment after elbow dislocation in a 10-year-old boy. Radiologically Matev's sign and a new radiological finding—a sclerotic tunnel at the lateral side of the olecranon—were seen.Treatment The patient was treated by excising the damaged segment and reanastomosing the nerve 13 months after the injury. 相似文献
995.
Role of a hyaluronate-based membrane in the prevention of peritonitis-induced adhesions 总被引:4,自引:0,他引:4
Ali M. Ghellai M.D. Arthur F. Stucchi Ph.D. Daniel J. Lynch B.S. Kevin C. Skinner V.M.D. M. Jude Colt B.A. James M. Becker M.D. F.A.C.S. 《Journal of gastrointestinal surgery》2000,4(3):310-315
Adhesions remain a significant postoperative complication of abdominal surgery; however, recent evidence suggests that physical
barriers may reduce their incidence. Although these adhesion prevention barriers are efficacious when used under aseptic conditions,
little is known about their use in the presence of peritonitis, which is associated with an increased incidence of abdominal
adhesions. A sodium hyaluronate and carboxymethylcellulose bioresorbable membrane (HA membrane) has been shown recently to
reduce postoperative adhesions in several animal models and in two clinical trials. To investigate the efficacy of HA membrane
in the presence of peritonitis, generalized peritonitis was induced in rats by either cecal ligation and puncture (CLP) or
cecal ligation (CL) alone. The ceca were resected after 12 hours, and animals were randomly assigned to receive or not receive
HA membrane applied to the cecum. At day 7, abdominal adhesions and abscesses were scored. In the presence of peritonitis,
HA membrane did not significantly reduce the number or tenacity of adhesions. A trend toward increased abscess formarion was
associated with HA membrane in the CL group. Although HA membrane has been shown to reduce the incidence and severity of abdominal
adhesions under aseptic conditions, this study demonstrates that it is not efficacious in preventing abdominal adhesions in
the presence of peritonitis. The association between HA membrane and abscess formation in the presence of experimental peritonitis
requires further investigation.
Supported by the Genzyme Corporation, Cambridge, Mass.
Presented at the Fortieth Annual Meeting of The Society for Surgery of the Alimentary Tract, Orlando, Fla., May 16–19, 1999. 相似文献
996.
Cadili A Turnbull R Hervas-Malo M Ghosh S Chyczij H 《Vascular and endovascular surgery》2012,46(6):455-459
Introduction: It has been demonstrated that endovascular repair of arterial disease results in reduced perioperative morbidity and mortality compared to open surgical repair. The rates of complications and need for reinterventions, however, have been found to be higher than that in open repair. The purpose of this study was to identify the predictors of endograft complications and mortality in patients undergoing endovascular abdominal aortic aneurysm (AAA) repair; specifically, our aim was to identify a subset of patients with AAA whose risk of periprocedure mortality was so high that they should not be offered endovascular repair. Methods: We undertook a prospective review of patients with AAA receiving endovascular therapy at a single institution. Collected variables included age, gender, date of procedure, indication for procedure, size of aneurysm (where applicable), type of endograft used, presence of rupture, American Society of Anesthesiologists (ASA) class, major medical comorbidities, type of anesthesia (general, epidural, or local), length of intensive care unit (ICU) stay, and length of hospital stay. These factors were correlated with the study outcomes (overall mortality, graft complications, morbidity, and reintervention) using univariate and multivariate logistic regression. Results: A total of 199 patients underwent endovascular AAA repair during the study period. The ICU stay, again, was significantly correlated with the primary outcomes (death and graft complications). In addition, length of hospital stay greater than 3 days, also emerged as a statistically significant predictor of graft complications in this subgroup (P = .024). Survival analysis for patients with AAA revealed that age over 85 years and ICU stay were predictive of decreased survival. Statistical analysis for other subgroups of patients (inflammatory AAA or dissection) was not performed due to the small numbers in these subgroups. Conclusions: Patients with AAA greater than 85 years of age are at a greater risk of mortality following endovascular repair. In addition, patients who are expected to require postprocedure ICU admission are also at an increased risk of mortality following endovascular repair. 相似文献
997.
Perioperative and short‐term outcomes of Retzius‐sparing robot‐assisted laparoscopic radical prostatectomy stratified by gland size 下载免费PDF全文
998.
Tumour necrosis factor (TNFalpha) as a novel therapeutic target in symptomatic corticosteroid dependent asthma 总被引:9,自引:0,他引:9
Howarth PH Babu KS Arshad HS Lau L Buckley M McConnell W Beckett P Al Ali M Chauhan A Wilson SJ Reynolds A Davies DE Holgate ST 《Thorax》2005,60(12):1012-1018
BACKGROUND: Tumour necrosis factor alpha (TNFalpha) is a major therapeutic target in a range of chronic inflammatory disorders characterised by a Th1 type immune response in which TNFalpha is generated in excess. By contrast, asthma is regarded as a Th2 type disorder, especially when associated with atopy. However, as asthma becomes more severe and chronic, it adopts additional characteristics including corticosteroid refractoriness and involvement of neutrophils suggestive of an altered inflammatory profile towards a Th1 type response, incriminating cytokines such as TNFalpha. METHODS: TNFalpha levels in bronchoalveolar lavage (BAL) fluid of 26 healthy controls, 42 subjects with mild asthma and 20 with severe asthma were measured by immunoassay, and TNFalpha gene expression was determined in endobronchial biopsy specimens from 14 patients with mild asthma and 14 with severe asthma. The cellular localisation of TNFalpha was assessed by immunohistochemistry. An open label uncontrolled clinical study was then undertaken in 17 subjects with severe asthma to evaluate the effect of 12 weeks of treatment with the soluble TNFalpha receptor-IgG1Fc fusion protein, etanercept. RESULTS: TNFalpha levels in BAL fluid, TNFalpha gene expression and TNFalpha immunoreative cells were increased in subjects with severe corticosteroid dependent asthma. Etanercept treatment was associated with improvement in asthma symptoms, lung function, and bronchial hyperresponsiveness. CONCLUSIONS: These findings may be of clinical significance in identifying TNFalpha as a new therapeutic target in subjects with severe asthma. The effects of anti-TNF treatment now require confirmation in placebo controlled studies. 相似文献
999.
Mohammed Ali Kazem 《The surgeon》2017,15(2):93-97
Background
Predictive tools in cancer management are used to predict different outcomes including survival probability or risk of recurrence. The uptake of these tools by clinicians involved in cancer management has not been as common as other clinical tools, which may be due to the complexity of some of these tools or a lack of understanding of how they can aid decision-making in particular clinical situations.Aims
The aim of this article is to improve clinicians' knowledge and understanding of predictive tools used in cancer management, including how they are built, how they can be applied to medical practice, and what their limitations may be.Methods
Literature review was conducted to investigate the role of predictive tools in cancer management.Results
All predictive models share similar characteristics, but depending on the type of the tool its ability to predict an outcome will differ. Each type has its own pros and cons, and its generalisability will depend on the cohort used to build the tool. These factors will affect the clinician's decision whether to apply the model to their cohort or not.Conclusions
Before a model is used in clinical practice, it is important to appreciate how the model is constructed, what its use may add over and above traditional decision-making tools, and what problems or limitations may be associated with it. Understanding all the above is an important step for any clinician who wants to decide whether or not use predictive tools in their practice. 相似文献1000.
Masao Yamasaki MD PhD Junya Ako MD Yasuhiro Honda MD Ali Hassan MD Bon Koo MD PhD Alexandre Abizaid MD Peter Fitzgerald MD PhD Robert Whitbourn MD 《Catheterization and cardiovascular interventions》2008,72(1):47-51
This report describes the first‐in‐man experience with a novel 0.014‐in. guidewire‐based, self‐expanding stent delivery system designed for small or tortuous coronary arteries that may be difficult to access with conventional stent‐delivery systems. © 2008 Wiley‐Liss, Inc. 相似文献