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排序方式: 共有3346条查询结果,搜索用时 15 毫秒
41.
Eugenio Brunocilla Cristian Pultrone Remigio Pernetti Riccardo Schiavina Giuseppe Martorana 《International journal of urology》2012,19(8):783-785
We describe our technique for preservation of the smooth muscular internal (vesical) sphincter and proximal urethra during radical retropubic prostatectomy. The first steps of the prostatectomy reflect the standard retropubic prostatectomy; whereas for the final phases, the procedure continues in an anterograde manner with incision of the fibers of the detrusor muscle at the insertion of the ventral surface of the base of the prostate. At this level, the inner circular muscle of the bladder neck forms a sphincteric ring of smooth muscle that covers the longitudinally‐oriented smooth muscle component of the urethra that extends distally to the verumontanum; these two proximal structures represent the internal sphincter that envelops and locks the proximal urethra. A blunt dissection is continued until the ring‐shaped vesical sphincter is separated from the prostate and the longitudinally‐oriented smooth muscle component of the urethral musculature is identified. The base of the prostate is then gently separated from the urethra and from the bladder until the maximal length of the urethral musculature is isolated and preserved. Finally, a urethra‐urethral anastomosis is carried out and the ventral stitches are placed through the circular fibres of the bladder neck. In all cases we carry out circumferential biopsies of the proximal urethra and of the base of the prostate. The described technique is a feasible and safe method for preservation of the internal urethral sphincter. Despite the enthusiasm regarding our positive functional results, further studies with larger series are required to confirm these findings. 相似文献
42.
Torrente Y Belicchi M Pisati F Pagano SF Fortunato F Sironi M D'Angelo MG Parati EA Scarlato G Bresolin N 《Cell transplantation》2002,11(1):25-34
Stem cell populations have been shown to be extremely versatile: they can generate differentiated cells specific to the tissue in which they reside and descendents that are of different germ layer origin. This raises the possibility of obtaining neuronal cells from new biological source of the same adult human subjects. In this study, we found that epidermal growth factor (EGF) and basic fibroblast growth factor (bFGF) cooperated to induce the proliferation, self-renewal, and expansion of neural stem cell-like population isolated from several newborn and adult mouse tissues: muscle and hematopoietic tissues. This population, in both primary culture and secondary expanded clones, formed spheres of undifferentiated cells that were induced to differentiate into neurons, astrocytes, and oligodendrocytes. Brain engraftment of the somatic-derived neural stem cells generated neuronal phenotypes, demonstrating the great plasticity of these cells with potential clinical application. 相似文献
43.
Spontaneous hepatic hydatid cyst rupture into the biliary tract is unusual. The authors describe a case of a 62-year-old man with a hepatic hydatid cyst, showing that it is possible to confirm rupture into the biliary system with cholangiography-MRI. Surgical treatment remains the best form of management. Endoscopic management is a therapeutic possibility in all cases in which surgery is contraindicated. In the case observed endoscopic sphinctererotomy resolved the biliary obstruction, while the hydatid cyst was treated by transbiliary irrigation with scolicidal solutions and pharmacological therapy. The treatment permitted complete clinical resolution of the hepatic hydatosis. 相似文献
44.
Gastric Cancer Precursor Lesions and Helicobacter pylori Infection in Patients with Partial Gastrectomy for Peptic Ulcer 总被引:3,自引:0,他引:3
Giuliani A Caporale A Demoro M Benvenuto E Scarpini M Spada S Angelico F 《World journal of surgery》2005,29(9):1127-1130
The mucosa of the gastric stump is considered at greater risk of dysplastic and neoplastic changes than that of the intact
stomach. The combination of enteric reflux and Helicobacter pylori infection may have a synergistic damaging effect on the
mucosa of the gastric remnant, both producing and increasing mucosal proliferation. The aim of this study was to assess whether
the occurrence of H. pylori infection in the remnant mucosa of partially gastrectomized subjects for peptic ulcer disease is associated with an increase
of the mucosal precursor lesions of malignancy. A series of 151 subjects who underwent partial gastrectomy for peptic ulcer
disease were submitted to upper digestive endoscopy for long-term surveillance. Biopsy specimens of the gastric stump were
tested for the occurrence of H. pylori infection and for the presence of precancerous mucosal lesions. The prevalence of H. pylori colonization in the remnant stomach was less than 30% and similar in subjects with different time intervals between gastrectomy
and endoscopy. Age at surgery (χ2: p = 0.03) and H. pylori infection (χ2: p = 0.002) were significantly associated with the grading of mucosal lesions. The prevalence of normal mucosa was 10 times
higher in H. pylori-negative patients as in H. pylori-positive ones (22.0% vs. 2.4%), and the prevalence of intestinal metaplasia was four times higher in H. pylori-positive patients than in H. pylori-negative ones (19.6% vs. 4.6%). We concluded that H. pylori infection may play a causal role in the development of gastric lesions in the operated stomach. 相似文献
45.
Alessandro Cucchetti MD Fabio Piscaglia MD Eugenio Caturelli MD Luisa Benvegnù MD Marco Vivarelli MD Giorgio Ercolani MD Matteo Cescon MD Matteo Ravaioli MD Gian Luca Grazi MD Luigi Bolondi MD Antonio Daniele Pinna MD 《Annals of surgical oncology》2009,16(2):413-422
The presence of cirrhosis is the only risk factor that is advocated for recurrence of hepatocellular carcinoma (HCC) 2 years
after hepatic resection compared with noncirrhotic control subjects; however, data for cohorts of exclusively patients with
cirrhosis are lacking. This study was designed to assess risk factors and annual incidence of early (<2 years) and late (>2 years)
recurrence after resection of cirrhosis and to compare these findings with those of patients with cirrhosis enrolled in HCC
surveillance programs (HCC occurrence). Data from 204 patients with cirrhosis resected for HCC and 150 surveilled for cirrhosis
were retrospectively collected and compared using propensity score matching to overcome biases of nonrandomized study. Risk
factors for early recurrence (incidence = 21.8%/year) were higher serum alpha-fetoprotein (AFP) levels, poorly differentiated
tumor, and presence of microvascular invasion (P < 0.05). Risk factors for both late recurrence (18.4%/year) and HCC occurrence (3.3%/year) were male gender, older age, and
higher serum transaminase levels; multiple primary tumors and higher AFP were additional risk factors for late recurrence
and HCC occurrence respectively (P < 0.05). After propensity adjustment, resected patients with less than two risk factors for late recurrence showed an annual
incidence of HCC (6.2%/year) similar to that of surveilled patients with ≥2 risk factors (5.8%/year; P = 0.898). Early and late recurrence of HCC for patients with cirrhosis after resection have distinct risk factors. Annual
incidence of HCC 2 years or more after resection may be similar to that of general patients because the same risk factors
are involved; assessment of these characteristics could be useful in tailoring clinical management. 相似文献
46.
Paola Pisani Maria Daniela Renna Francesco Conversano Ernesto Casciaro Marco Di Paola Eugenio Quarta Maurizio Muratore Sergio Casciaro 《World journal of orthopedics》2016,7(3):171-181
Osteoporosis is a silent disease without any evidence of disease until a fracture occurs. Approximately 200 million people in the world are affected by osteoporosis and 8.9 million fractures occur each year worldwide. Fractures of the hip are a major public health burden, by means of both social cost and health condition of the elderly because these fractures are one of the main causes of morbidity, impairment, decreased quality of life and mortality in women and men. The aim of this review is to analyze the most important factors related to the enormous impact of osteoporotic fractures on population. Among the most common risk factors, low body mass index; history of fragility fracture, environmental risk, early menopause, smoking, lack of vitamin D, endocrine disorders(for example insulin-dependent diabetes mellitus), use of glucocorticoids, excessive alcohol intake, immobility and others represented the main clinical risk factors associated with augmented risk of fragility fracture. The increasing trend of osteoporosis is accompanied by an underutilization of the available preventive strategies and only a small number of patients at high fracture risk are recognized and successively referred for therapy. This report provides analytic evidences to assess the best practices in osteoporosis management and indications for the adoption of a correct healthcare strategy to significantly reduce the osteoporosis burden. Early diagnosis is the key to resize the impact of osteoporosis on healthcare system. In this context, attention must be focused on the identification of high fracture risk among osteoporotic patients. It is necessary to increase national awareness campaigns across countries in order to reduce the osteoporotic fractures incidence. 相似文献
47.
Deianira Luciani Matteo Cadossi Federico Tesei Eugenio Chiarello Sandro Giannini 《La Chirurgia degli Organi di Movimento》2008,92(3):155-160
Background Viscosupplementation, with hyaluronan derivates injected into the intra-space of osteoarthritic joints, is now widely used
for the treatment of knee osteoarthritis. This study evaluates the results in terms of pain and disability of intra-articular
injections of hyaluronan derivates into the ankle joint in patients suffering from grade II primary or secondary osteoarthritis
of the ankle.
Methods Twenty-one patients with a painful ankle and radiographic evidence of grade II osteoarthritis had three weekly intra-articular
injections of 2 ml of hylan G-F 20 (10 mg/ml) into the ankle joint. The primary clinical outcome measurement was the ankle
osteoarthritis score (AOS) at the baseline, and at 6, 12 and 18 months.
Results Significant improvement of the AOS from baseline was seen after 6 months (p=0.0001). This improvement was maintained over time with no further changes at 12- and 18-month follow-ups. Regarding pain,
the AOS improved over time from the baseline to the 18-month follow up and became statistically significant at the 12- and
18-month follow-ups (p<0.05). 相似文献
48.
Ivascau C Buklas D Massetti M Sabatier R LePage O Neri E Babatasi G Khayat A 《The Annals of thoracic surgery》2005,79(1):348-351
Peri-anastomotic graft stenosis is a possible complication of coronary artery bypass graft operations. Early failure of myocardial revascularization may result from graft stenosis with inherent difficulties in perioperative diagnosis and subsequent management. We report the case of a 58-year-old man who experienced early preanastomotic left internal thoracic artery bypass stenosis that progressively resolved during a 2-year period without reoperation or interventional angioplasty. Although the mechanisms underlying graft stenosis remain unclear, this case emphasizes the role of repeated coronary angiography in the choice of treatment. 相似文献
49.
Immediate breast reconstruction with definitive anatomical implants after skin-sparing mastectomy. 总被引:3,自引:0,他引:3
One-stage breast reconstruction with definitive implants was the original method of breast reconstruction. It gave a round breast with a fixed shape. Lack of skin after mastectomy was the main concern who led to the development of techniques to provide 'new' breast skin such as autogenous reconstruction and tissue expanders. This made the use of definitive implants almost obsolete. Since skin-sparing mastectomy (SSM) basically removes the mammary gland and the nipple-areolar complex preserving almost all mammary skin, it makes the use of definitive implants in immediate breast reconstruction possible again. Moreover, the advent of anatomically shaped implants overcomes the drawback of round shape: the anatomical implant with hyperprojected lower pole and short upper pole matches very well the profile of a real breast. The authors report their experience in 36 immediate breast reconstruction after SSM with short upper pole-hyperprojected silicone gel prostheses carried out between October 2001 and October 2003. In most cases SSM is performed through a circumareolar incision. Axillary dissection is preferably performed through the same incision. The anatomical implant is placed in a submuscular position superiorly and in a subfascial pocket inferiorly. Because of skin redundancy and easy distension of subfascial tissue in the inferior pole of the breast, the implant fills the skin of the inferior mammary pole without needing any skin expansion. Whenever possible, the skin incision is closed with a purse-string suture. The skin will look very wrinkled at the end of the surgery, but it will flatten out in a few weeks. The contralateral breast is simultaneously corrected, if needed. Outcome was assessed by evaluation of photographs performed by the authors, by the patients themselves and by a blinded group of surgeons who evaluated breast volume and shape, breast symmetry, and overall outcome. More than 90% of each of these parameters was scored as good or excellent. Complication rates was low with a 8.3% rate. The use of definitive implants in immediate breast reconstruction after SSM is a one-stage breast reconstruction with low morbidity and very good results, and it is associated with high level of patient and surgeon satisfaction. 相似文献
50.
Eugenio Neri Lucio Barabesi Dimitrios Buklas Luca A. Vricella Antonio Benvenuti Enrico Tucci Carlo Sassi Massimo Massetti 《European journal of cardio-thoracic surgery》2005,28(6):857-863
Objective: Increased dimension of the aortic root and proximal aorta is considered a significant risk factor for catastrophic events that involve the ascending aorta. The objective of this study was to determine the possible correlation between pre-dissection aortic diameter and the occurrence of Stanford type A aortic dissection. Methods: Samples of dissected ascending aortas were obtained from 220 patients at the time of their operation. Two groups were identified: patients with connective tissue disorders (Group 1, n = 94) and those without (Group 2, n = 126). Measurements of the true (intimal) lumen were conducted and extrapolated as reliable approximation of pre-dissection aortic diameter. The possible association of intimal diameter with anthropometric and demographic data was analyzed. Results: Median aortic diameter was, respectively, 41.8 and 41.3 mm for patients with and without connective tissue disorders (41.4 mm for the entire cohort). Data analysis indicated that 57% of patients had aortic diameter above 40 mm, while patients with frank aneurysm accounted only for 10%; this proportion was higher in Group 1 compared to Group 2 (17.2% vs 4.7%). Poor or no correlation was demonstrated between aortic size and any of the anthropometric or demographic variables essayed. Significant subgroup differences were found among patients with a history of cigarette smoking, hypertension, diabetes, chronic renal insufficiency, and bicuspid aortic valve. Conclusion: Although aortic diameter remains a strong indication for preventive surgery in patients with inherited connective tissue disorders, acute aortic dissection occurs rarely in the setting of true ascending aortic aneurysms, and despite normal or near-normal aortic size in more than one-third of subjects. Dissection superimposing on small aortic diameters can be regarded as an expression of substantial functional tissue susceptibility to aortic catastrophic events. 相似文献