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991.
Sheashaa HA Bakr MA Fouda MA El-Dahshan KF Ismail AM Sobh MA Ghoneim MA 《International urology and nephrology》2007,39(1):317-319
Background/Aims The aim of this work is to determine the long-term therapeutic benefit(s) of daclizumab induction therapy with triple immunosuppressive
protocols including prednisolone, cyclosporine microemulsion (CsA), and mycophenolate mofetil (MMF) in the living related
donor kidney transplantation.
Methods Twenty-one adult recipients of their first kidney allograft were allocated to receive daclizumab with triple immunosuppressive
therapy (steroids, CsA, and MMF). They were compared to 50 recipients of their first grafts who received a maintenance triple
immunosuppressive therapy (steroids, CsA, and azathioprine). The patients were followed up for 5 years.
Results Daclizumab group significantly experienced a marked reduction of acute rejection (7/21) when compared to the control group
(31/50) with subsequent significant reduction of cumulative steroids doses at the end of 5 years. The overall incidence of
post-transplant complications was comparable among the two treatment groups. There was no significant difference in patients
and graft survival; 5-year patient and graft survival were 95.3%, 85.7% for daclizumab and 96%, 88% for control group, respectively.
Conclusions Although prophylactic daclizumab with triple immunosuppressive protocol including MMF have drastically reduced the incidence
of acute rejections, the graft and patient survival are unchanged in this long-term follow up. 相似文献
992.
Tamura A Takahara Y Mogi K Katsumata M 《General thoracic and cardiovascular surgery》2007,55(2):53-56
Mediastinal irradiation has been reported to induce cardiac diseases such as pericardial disease, accelerated arteriosclerosis
of the coronary arteries, valvular disease, conduction abnormalities, and calcification of the aorta. We experienced four
cases of radiation-induced valvular disease. All patients had histories of radiation therapy and had aortic valve disease.
All patients had marked fibrosis of the mediastinum and hypertrophy of pericardium. The aortic valve leaflets were tricuspid
and fibrotic with focal dystrophic calcification and markedly thickened. In the pathological findings, certain rheumatic endocarditis
changes such as endocardial reduplication and vascularization were not found in all aortic valves. The mechanism of radiation-induced
cardiac disease is not clear. However, those changes seem to progress very slowly. Thus, long-term follow-up care is particularly
important for patients undergoing radiation therapy. Fortunately, today's irradiation techniques are much less harmful; therefore,
radiation-induced cardiac disease will likely become more rare in the future. 相似文献
993.
Biancari F Salenius JP Heikkinen M Luther M Ylönen K Lepäntalo M 《World journal of surgery》2007,31(1):217-225
Background The aim of the present study was to develop a risk-scoring method for prediction of immediate postoperative outcome after
infrainguinal surgical revascularization for critical limb ischemia.
Methods The Finnvasc registry included data on 3,925 infrainguinal surgical revascularization procedures. This database was randomly
divided into a derivation and a validation data set of similar sizes.
Results In the overall series, 30-day postoperative mortality and major amputation rates were 3.1% and 6.3%, respectively. The 30-day
postoperative mortality and/or limb-loss rate was 9.2%. Diabetes, coronary artery disease, foot gangrene, and urgent operation
were independent predictors of 30-day postoperative mortality and/or major lower-limb amputation. A risk score was developed
by assigning 1 point each to the latter risk factors. In the derivation data set, the 30-day postoperative mortality/amputation
rates in patients with scores of 0, 1, 2, 3, and 4 were 7.7%, 6.4%, 11.1%, 20.4%, and 27.3%, respectively, (P < 0.0001); mortality rates were 1.3%, 2.3%, 4.1%, 7.7%, and 12.1%, respectively, (P < 0.0001); and major amputation rates were 6.4%, 4.3%, 7.1%, 12.7%, and 18.2%, respectively, (P < 0.0001). In the validation data set, the 30-day postoperative mortality/amputation rates in patients with scores of 0,
1, 2, 3, and 4 were 4.8%, 7.5%, 10.1%, 15.9%, and 22.2%, respectively, (P < 0.0001); mortality rates were 0.7%, 2.3%, 4.2%, 5.5%, and 14.8%, respectively, (P < 0.0001); and major amputation rates were 4.6%, 5.3%, 6.4%, 11.0%, and 14.0%, respectively (P = 0.011).
Conclusions This simple risk-scoring method can be useful to stratify the immediate postoperative outcome of patients undergoing infrainguinal
surgical revascularization for critical lower-limb ischemia. 相似文献
994.
Hansson S Svedhem A Wennerström M Jodal U 《Pediatric nephrology (Berlin, Germany)》2007,22(9):1321-1325
There are few reports on urinary tract infections caused by Haemophilus influenzae or Haemophilus parainfluenzae in children. The true incidence is not known, since bacteria of Haemophilus species do not grow in standard urine culture media. With the objective of investigating the occurrence and character of
urinary tract infections (UTIs) caused by Haemophilus bacteria in children, we searched the files of our UTI clinic. Over a 24-year period 36 children with Haemophilus spp. bacteriuria were identified out of a total of more than 5,000 UTI episodes. There was a significant gender difference
in that Haemophilus influenzae dominated in girls and Haemophilus parainfluenzae in boys. With one exception, all children had important urinary tract abnormalities, such as malformation, gross reflux or
bladder dysfunction. Permanent renal damage was seen in 25. We conclude that growth of Haemophilus bacteria in urine is associated with serious urinary tract abnormalities. The inability of bacteria of the Haemophilus species to grow in standard media commonly used for culture of uropathogens suggests that the true frequency of these strains
as a cause of urinary tract infections is underestimated. 相似文献
995.
Background: Abdominal lipectomy is becoming an increasingly common surgical procedure in patients with esthetic deformities
resulting from massive weight loss induced by bariatric surgery. Sometimes a midline incisional hernia coexists with the pendulus
abdomen. Herein presented is a technique to perform a retromuscular mesh repair of the incisional hernia while sparing the
umbilicus.
Methods: The abdominal lipectomy with concomitant retro-muscular mesh repair of a midline incisional hernia is done sparing
the vascular supply of the umbilicus on one side only.
Results: 5 consecutive women with pendulus abdomen resulting from bariatric surgery-induced massive weight loss and concomitant
midline incisional hernia underwent abdominal lipectomy and incisional hernia mesh repair. Mean BMI was 28.6 kg/m2 (range 26–35), one patient was a smoker, and another had type 2 diabetes requiring oral hypoglycemic agents. Two patients
had had a previous incisional hernia repair with intraperitoneal mesh. One patient had partial necrosis of the umbilicus and
another experienced necrosis of only the epidermis that recovered fully.
Conclusions: The umbilicus can be safely spared during abdominal lipectomy with concomitant midline incisional hernia mesh
repair. Recurrent incisional hernia and common risk factors for wound healing such as diabetes and obesity increase the risk
of umbilical necrosis. 相似文献
996.
997.
Konrad Seller Dieter Wahl Alexander Wild Rüdiger Krauspe Erich Schneider Berend Linke 《European spine journal》2007,16(7):1047-1054
A lot of new implant devices for spine surgery are coming onto the market, in which vertebral screws play a fundamental role.
The new screws developed for surgery of spine deformities have to be compared to established systems. A biomechanical in vitro
study was designed to assess the bone–screw interface fixation strength of seven different screws used for correction of scoliosis
in spine surgery. The objectives of the current study were twofold: (1) to evaluate the initial strength at the bone–screw
interface of newly developed vertebral screws (Universal Spine System II) compared to established systems (product comparison)
and (2) to evaluate the influence of screw design, screw diameter, screw length and bone mineral density on pullout strength.
Fifty-six calf vertebral bodies were instrumented with seven different screws (USS II anterior 8.0 mm, USS II posterior 6.2 mm,
KASS 6.25 mm, USS II anterior 6.2 mm, USS II posterior 5.2 mm, USS 6.0 mm, USS 5.0 mm). Bone mineral density (BMD) was determined
by quantitative computed tomography (QCT). Failure in axial pullout was tested using a displacement-controlled universal test
machine. USS II anterior 8.0 mm showed higher pullout strength than all other screws. The difference constituted a tendency
(P = 0.108) when compared to USS II posterior 6.2 mm (+19%) and was significant in comparison to the other screws (+30 to +55%,
P < 0.002). USS II posterior 6.2 mm showed significantly higher pullout strength than USS 5.0 mm (+30%, P = 0.014). The other screws did not differ significantly in pullout strength. Pullout strength correlated significantly with
BMD (P = 0.0015) and vertebral body width/screw length (P < 0.001). The newly developed screws for spine surgery (USS II) show higher pullout strength when compared to established
systems. Screw design had no significant influence on pullout force in vertebral body screws, but outer diameter of the screw,
screw length and BMD are good predictors of pullout resistance. 相似文献
998.
Nikolaos Kanakaris Nikolaos Tsoutseos 《European journal of trauma and emergency surgery》2007,33(3):297-296
Abstract Posttraumatic synostosis of the forearm bones is a rare but serious complication following fixation or even conservative treatment
of adult forearm fractures. This is the second report in the English literature of such a complication at the pin-track site
following external fixation of proximal forearm fractures. A 36-year-old male patient sustained an open fracture of his proximal
right forearm after a road traffic accident. It was managed by external fixation of the ulna and plate fixation of the radius.
At follow-up, a type 3 radio-ulnar synostosis at the pin-track site became evident, which was treated after 20 months with
surgical resection of the bony bridge to regain the rotatory motion of his forearm.
An erratum to this article is available at . 相似文献
999.
Kolev Y Uetake H Iida S Ishikawa T Kawano T Sugihara K 《Annals of surgical oncology》2007,14(10):2738-2747
Background Many studies have shown that angiogenesis plays an important role in the process of cancer development and progression. Vascular
endothelial growth factor (VEGF) has a potent angiogenic activity, and cyclooxygenase-2 (COX-2) supports angiogenesis by regulated
production of angiogenic factors, including VEGF. The purpose of this study was to examine the expression of VEGF in combination
with COX-2 and CD34, their correlation with various clinicopathological factors, and their prognostic significance in human
gastric carcinoma.
Methods Specimens from 169 patients with different grade and stage gastric carcinoma were investigated by immunohistochemistry for
COX-2 and VEGF expression. Tumor microvessel density was assessed with CD34 immunostaining. Correlations between the expression
of VEGF, COX-2, CD34, and various clinicopathological factors were studied. The effect of these proteins on patient survival
was determined.
Results COX-2 and VEGF were positively expressed in 36.7% and 50.3% of the patients, respectively. Positive correlation was found
between VEGF and COX-2 and between VEGF and CD34. VEGF expression was correlated with depth of invasion; metastatic lymph
nodes; lymphatic and venous invasion; and tumor, node, metastasis system stage. Patients with positive staining for VEGF showed
far lower disease-free (64.9% vs. 81.3%) and overall (58.3% vs. 76.9%) survival rates than VEGF-negative patients. In multivariate
analysis, only tumor location, depth of invasion, and lymph node metastasis were shown to be independent prognostic factors.
Conclusions VEGF expression correlates with angiogenesis and tumor progression and is a valuable prognostic factor in patients with gastric
carcinoma. 相似文献
1000.
Background Breast carcinoma is the most frequently diagnosed malignancy in women of the North America. The combination of breast-conservation
surgery and radiotherapy has become a standard of treatment for most breast cancers. It is critical to obtain clear margins
to minimize local recurrence. The literature suggests that intraoperative touch preparation cytology (IOTPC) can be useful
in evaluation of margins. Invasive lobular carcinoma (ILC) accounts for 10% to 15% of all breast cancers. Obtaining clear
margins in ILC can be more challenging. Literature shows the positive margin rate for ILC to be as high as 60%. This report
describes our experience with IOTPC for margin assessment in ILC by a single surgeon at Beth Israel Medical Center. The purpose
of this study is to determine whether IOTPC is reliable for ILC.
Methods A prospective review of 73 patients who underwent breast-conservation surgery with the use of IOTPC for margin assessment
at Beth Israel Medical Center was performed. Pathology revealed ILC in 12 of these patients (16.4%), who are the subjects
of this study. The lumpectomy specimens were oriented by the surgeon intraoperatively and were submitted fresh to pathology
for cytologic assessment. IOTPC consisted of touching the corresponding margin onto the glass slide. The principle of this
technique is that if cancer cells are present, they will stick to the slide, whereas fat cells will not. Six slides were prepared
for each lumpectomy specimen. Air-dried samples were stained immediately by the Diff-Quik method and examined under the microscope
by a cytopathologist.
Results Twelve patients with ILC underwent breast-conservation surgery with IOTPC for assessment of 72 margins. Ten patients had lobular
carcinoma only, and the remaining two patients had a combination of lobular and ductal carcinoma. There was a correlation
between IOTPC and final pathology in 60 of 72 margins, which accounted for 83.3% of the cases. IOTPC for assessment of margins
in patients undergoing breast-conservation surgery for ILC has a sensitivity of 8.3%, specificity of 98.3%, positive predictive
value of 50%, and negative predictive value of 84.3%.
Conclusions On the basis of our experience, IOTPC is of limited value for intraoperative assessment of margins for ILC.
Poster presentation at the Sixth Annual Meeting of the American Society of Breast Surgeons, March 16–20, 2005, Los Angeles,
California. 相似文献