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81.
Ventral hernia repair: a study of current practice 总被引:5,自引:5,他引:0
Ventral wall hernias are common; despite this, there are no guidelines on the best surgical management. The aim of this study
was to examine the types of repair in use for abdominal wall hernias in the West of Scotland over a 3-month period. Data were
gathered on 120 patients. There were 60 incisional, 32 umbilical, and 28 epigastric hernias. The main indication for repair
was pain (78%), while 12 patients (10%), presented acutely with incarceration or strangulation. The most common method of
repair was sutured (55%), followed by mesh (29%) and Mayo repair (16%). There was no correlation between use of mesh and hernia
size or whether repair was for a recurrent hernia. Surgical practice varies widely in the repair of ventral wall hernias.
Clinical trials are required to establish the best method of repair for this common condition.
Electronic Publication 相似文献
82.
McCullough JA Evoy D Sweeney KJ Meyers C Ravi N Keeling N Byrne PJ Reynolds JV 《Irish journal of medical science》2003,172(3):132-135
Background Gastric carcinoma is a significant cause of death in Ireland. Surgery offers the best option of cure, but the five-year survival
following resection remains dismal at 10–15%. Experience from Japan and from some Western units suggest that an extended (D2)
lymphadenectomy in association with gastrectomy increases the prospect of cure, but concern about the morbidity and mortality
of this operation and lack of evidence from randomised studies has limited its acceptance.
Aims This study reports the experience of a specialist upper gastrointestinal unit with D2 gastrectomy in a four-year audit.
Methods Sixty-two resections were performed for gastric cancer. Results Nineteen patients were deemed unsuitable for the D2 procedure
and underwent a more limited lymphadenectomy (DO or D1). Forty-three patients underwent D2 resection, 12 with an oesophagogastrectomy,
22 with total gastrectomy and nine with a sub-total distal resection. Eight patients undergoing D2 resection had extended
resections, five with splenectomy and three with a distal pancreatectomy. Post-operative complications occurred in 31% of
patients. Thirty-day and 90-day mortality were zero. Median survival was 822 days in the D2 group (range 120–1,320).
Conclusions These results show that a D2 gastrectomy can be performed with a low morbidity and mortality and a median survival of greater
than two years. 相似文献
83.
Background The contribution of dysmotility to dysphagia in oesophageal cancer is unclear.
Aim To examine oesophageal motility in patients with oesophageal carcinoma and to assess the effect of chemoradiotherapy on motility.
Methods Stationary manometry and 24-hour pH-metry were performed in 12 patients with oesophageal carcinoma and one week following
completion of chemoradiotherapy using 5-fluorouracil (5-FU), cisplatin and 40Gy radiotherapy.
Results All patients had abnormal motility prior to treatment. Peristalsis was impaired in 11 patients with a mean (SD) of 25% (9)
of waves normally propagated. Eight patients had 20% or more simultaneous waves. Following chemoradiotherapy, the percentage
of waves normally propagated increased from 25% (9) to 52% (10) (p < 0.03) and normal peristalsis was restored in four patients.
The percentage of simultaneous waves decreased from 38% (11) to 21.6% (10) (p=0.129) while the percentage of dropped or increased
waves decreased from 20% (11) to 8.3% (4) (p=0.264).
Conclusions Oesophageal motility is disturbed in oesophageal cancer. Dysphagia in oesophageal cancer may be partly explained by oesophageal
dysmotility. This is improved by chemotherapy. 相似文献
84.
Compensatory cortical activation observed by fMRI during a cognitive task at the earliest stage of MS 总被引:2,自引:0,他引:2
Audoin B Ibarrola D Ranjeva JP Confort-Gouny S Malikova I Ali-Chérif A Pelletier J Cozzone P 《Human brain mapping》2003,20(2):51-58
Recent functional magnetic resonance imaging (fMRI) studies have suggested that functional cortical changes seen in patients with early relapsing-remitting multiple sclerosis (MS) can have an adaptive role to limit the clinical impact of tissue injury. To determine whether cortical reorganization occurs during high cognitive processes at the earliest stage of multiple sclerosis (MS), we performed an fMRI experiment using the conventional Paced Auditory Serial Addition Test (PASAT) as paradigm in a population of ten patients with clinically isolated syndrome suggestive of multiple sclerosis (CISSMS). At the time of the fMRI exploration, mean disease duration was 6.8 +/- 3.3 months. We compared these results to those obtained in a group of ten education-, age-, and sex-matched healthy controls. Subjects were explored on a 1.5 T MRI system using single-shot gradient-echo EPI sequence. Performances of the two groups during PASAT recorded inside the MR scanner were not different. Statistical assessment of brain activation was based on the random effect analysis (between-group analysis two-sample t-test P < 0.005 confirmed by individual analyses performed in the surviving regions P < 0.05 Mann Whitney U-test). Compared to controls, patients showed significantly greater activation in the right frontopolar cortex, the bilateral lateral prefrontal cortices, and the right cerebellum. Healthy controls did not show greater activation compared to CISSMS patients. The present study argues in favor of the existence of compensatory cortical activations at the earliest stage of MS mainly located in regions involved in executive processing in patients performing PASAT. It also suggests that fMRI can evidence the active processes of neuroplasticity contributing to mask the clinical cognitive expression of brain pathology at the earliest stage of MS. 相似文献
85.
Cuppen JG Van den Brink PJ Camps E Uil KF Brock TC 《Aquatic toxicology (Amsterdam, Netherlands)》2000,48(2-3):233-250
Effects of chronic application of the fungicide Derosal(R) (active ingredient carbendazim) were studied in indoor macrophyte-dominated freshwater microcosms. The concentrations (0, 3.3, 33, 100, 330 and 1000 μg/l) were kept at a constant level for 4 weeks. This paper is the first of a series of two, and describes the fate of carbendazim and its effects on water quality parameters, breakdown of POM, and responses of macroinvertebrates. Carbendazim proved very persistent in the water layer. Values for t(12) varied between 6 and 25 weeks, and decreased with the treatment level. Significant effects on water quality parameters (DO, pH, alkalinity, conductivity) could not be demonstrated. After 4 weeks of incubation, the breakdown of Populus leaves was significantly slower at the two highest carbendazim concentrations. The macroinvertebrate community was seriously affected by carbendazim application, with Oligochaeta, Turbellaria, Hirudinea and some Crustacea as the most sensitive groups. The snail Bithynia decreased in numbers, but other gastropods increased in numbers. Safety factors as proposed by the Uniform Principles (European Union) for the risk assessment of pesticides, to be multiplied with toxicity data of the standard test species (Daphnia, fish, algae), appeared to ensure adequate protection of sensitive populations present in the microcosms. 相似文献
86.
87.
Lidocaine has been used in treatment of patients with refractory headache. Personal observations of neuropsychiatric toxicity in these patients led us to review our cases and the literature systematically for lidocaine side-effects, especially neuropsychiatric symptoms. In our series of 20 patients, side-effects were observed in all, the most frequent being neuropsychiatric (75%) and cardiological (50%). When reviewing published series on intravenous lidocaine use, reports of side-effects range from 0 to 100%, with neuropsychiatric symptoms being reported in 1.8–100%. Thirty-six case reports of lidocaine-induced psychiatric symptoms were also analysed. Psychiatric symptoms of toxicity were similar in most patients, despite their differing ages, pathologies, co-therapies and lidocaine dosages. In conclusion, lidocaine neuropsychiatric toxicity has a well-recognized stereotypical clinical presentation that is probably unrecognized in headache series. As lidocaine represents an emerging alternative therapy in headache, particularly in short-lasting unilateral neuralgiform headache attacks with conjunctival injection and tearing, clinicians and patients should be aware of the extent of this problem. 相似文献
88.
89.
Gabriella M van Dijk Cindy Veenhof Francois Schellevis Harry Hulsmans Jan PJ Bakker Henk Arwert Jos HM Dekker Guus J Lankhorst Joost Dekker 《BMC musculoskeletal disorders》2008,9(1):95
Background
This study aims to contribute to the knowledge of the influence of comorbidity in OA. The objectives of the study were (i) to describe the prevalence of comorbidity and (ii) to describe the relationship between comorbidity (morbidity count, severity and the presence of specific diseases) and limitations in activities and pain in elderly patients with knee or hip OA using a comprehensive inventory of comorbidity. 相似文献90.
WS Lee PJ McKiernan J de Ville de Goyet MS Tanner PR John 《Acta paediatrica (Oslo, Norway : 1992)》2001,90(11):1352-1355
A 16-y-old boy who had undergone bone marrow transplantation for relapsed acute lymphoblastic leukaemia developed liver cirrhosis and refractory ascites, which did not respond to salt restriction, diuretics and abdominal paracentesis. Liver transplantation was not feasible because of poor nutritional status, pre-existing renal dysfunction and uncertainty about the prognosis of his leukaemia. The patient underwent a successful transjugular intrahepatic portosystemic shunt (TIPS), with immediate resolution of ascites, enabling cessation of diuretics and improvement in nutritional status. At 24 mo following TIPS there has been no re-accumulation of ascites. CONCLUSION: TIPS may have a role in the management of refractory ascites secondary to liver cirrhosis in selected children. 相似文献