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41.
Tahlil A. Warsame B.S.E. R.D.C.S. Opal E. Keen R.D.C.S. Farouk Mookadam M.D. Hari P. Chaliki M.D. 《Echocardiography (Mount Kisco, N.Y.)》2009,26(9):1082-1083
Echogenicity within the left atrioventricular groove can be due to many conditions, such as mitral annular calcification, abscess, dilated coronary sinus, and aneurysm of the left circumflex coronary artery. However, in a patient who has no systemic symptoms, a bright, round echodensity with central echolucency and smooth borders in the mitral annulus is characteristic of liquefaction necrosis of a calcified mitral annulus. We report the occurrence of this rare manifestation in a 60-year-old patient who presented with myocardial infarction. 相似文献
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OBJECTIVE: To evaluate our policy of managing priapism for the success rate of the treatments, potency afterward, complications, and the risk factors responsible for erectile dysfunction in these patients. PATIENTS AND METHODS: The study included 50 patients (mean age 37.1 years, range 22-66) with a diagnosis of priapism (1981-1999). Their records were reviewed; 35 patients were available for a long-term evaluation. Factors assessed were the duration of priapism, history of previous recurrent attacks, possible underlying causes (e.g. haematological disorders, medications or trauma), relation to sexual stimulation, pain, and any attempt at previous management. A complete blood screen and blood gases were assessed in corporal aspirates. Duplex ultrasonography was used in all impotent patients at their follow-up. Early and late complications were reviewed, and patients asked about their erectile function before priapism, and any recurrence. RESULTS: The median (range) duration of priapism was 48 (6-240) h; almost half the patients presented > 48 h after the onset of priapism. Sixteen patients (32%) reported a history of previous recurrent attacks, of whom seven had a history of previous treatments. The main cause of priapism was idiopathic or intracavernosal injection with papaverine. All patients were initially treated by corporal blood aspiration and injection with ephedrine; if this failed or if the priapism was prolonged (> 48 h) various shunts were used. The hospital stay was significantly shorter among patients with papaverine-induced or brief priapism. In the long-term follow-up of 35 patients (mean 66.4 months, range 3-220) only 15 (43%) reported preserved erectile function, and this was more likely in patients with brief priapism (< 48 h). Eight patients (23%) reported subsequent recurrent attacks of priapism; all were managed successfully as they presented shortly after their onset. Penile fibrosis was detected in 20 patients (57%), and was significantly more common in those with prolonged priapism (> 48 h) or from causes other than papaverine. The 20 impotent men evaluated by Doppler ultrasonography had severe echo-dense penile fibrosis and high end-diastolic velocities suggesting veno-occlusive incompetence in all except two. In five men with shunts cavernosography showed extensive venous leakage irrespective of site of the shunt. MRI in five patients with penile fibrosis showed heterogeneous areas of low signal intensity, corresponding with haemosiderin deposition and fibrosis. On univariate analysis the final result of management (complete detumescence or not), the duration of priapism and the presence of penile fibrosis significantly influenced erectile function. On multivariate logistic regression only the first remained significant. CONCLUSIONS: Low-flow priapism for > 48 h, failure to maintain complete detumescence after management, and marked penile fibrosis during the follow-up are the most significant risk factors responsible for erectile dysfunction, with failure to achieve complete detumescence the most detrimental. 相似文献
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Preoperative concurrent chemotherapy and radiation therapy in cervix cancer: preliminary results 总被引:2,自引:0,他引:2
Kochbati L Ben Ammar CN Benna F Hechiche M Boussen H Besbes M Ben Abdallah M Rahal K Ben Ayed F Ben Romdhane K Maalej M 《La Tunisie médicale》2005,83(3):146-149
This is a retrospective study of patients treated for cervix cancer staged IB2, IIA or IIB with bulky tumor (> 4cm). Treatment was concurrent radiotherapy (45Gy with 1,8Gy daily fraction) and chemotherapy (5 cycles of Platinum 40mg/m2/week). All patients underwent Brachytherapy (15Gy on the reference isodose according to Paris system) followed by surgery (radical abdominal hysterectomy and bilateral pelvic lymphadenectomy: Piver 3) Between October 1999 and December 2002, forty five patients were treated in this protocol. Median age was 46 years (21- 68). Histology was squamous cell carcinoma in 93% and glandular carcinoma in 7%. Average external radiation dose was 44Gy (20-50). Ninety three percent of patients had at least 3 cycles of chemotherapy and 46,5% received the planned 5 cycles. On the operative specimens, there was 62,5% complete response and only 7 pelvic node involvement (17,5%). Four postoperative complications were noted (one vascular injury, one urinary fistula, one phlebitis and one lymph collection). Preoperative combined radiotherapy and chemotherapy in the early bulky stages of uterine cervix cancer is well tolerated and "gives" a high rate of sterilisation. There was no increase in surgical morbidity. 相似文献
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Groves AM Cullum I Syed R Nagabushan N Kayani I Pakzad F Ell PJ 《Nuclear medicine communications》2005,26(2):137-139
BACKGROUND AND AIM: According to the report of the Intercollegiate Standing Committee on Nuclear Medicine, the UK requires 40-60 positron emission tomography (PET) machines in the next decade (Intercollegiate Standing Committee on Nuclear Medicine). Positron Emission Tomography: a Strategy for Provision in the UK. London: Royal College of Physicians of London; 2003, pp. 1-9). This figure is based mainly on patients receiving only one examination and restricting the clinical indication to three primary diagnoses. The aim of this study was to assess the appropriateness of this figure and the assumptions made in the Intercollegiate report on UK PET provision. METHODS: We examined retrospectively our institution's entire PET and PET/computed tomography (CT) database, which spans 4 years and 9 months. We recorded the number of patients who received repeat examinations. RESULTS: Reports were available for 3354 PET/CT or PET-only studies; 418 of 2268 patients (18.4%) received at least one repeat PET/CT examination. The three main indications for PET examination in the Intercollegiate report only accounted for approximately 60% of the examinations undertaken. CONCLUSION: Our records suggest that basing the UK's future PET provision on a single examination and on three clinical indications only is no longer realistic. 相似文献
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We treated surgically 14 patients with symptomatic complete dislocation of the acromioclavicular joint. The surgical procedure included reconstruction of the coracoclavicular ligament using the coracoacromial ligament as substitute, reconstruction of the acromioclavicular ligament, and imbrications of the deltotrapezius aponeurosis over the top of the distal clavicle. A temporary tension band between the clavicle and acromion was used to stabilize the joint. Two patients were lost to follow-up. Twelve patients were followed for an average of 20 (18–60) months. Functional outcome was assessed according to modified UCLA acromioclavicular rating scale. The results were excellent in eight patients, good in three, and fair in one. In one patient, there was loosening of the temporary fixation with subluxation of the clavicle.
Résumé Nous avons traité chirurgicalement 14 malades présentant une luxation acromioclaviculaire complète. La technique chirurgicale a inclus la reconstruction du ligament coracoclaviculaire en utilisant le ligament coraco-acromial, la reconstruction du ligament acromioclaviculaire, et la fixation de laponévrose deltotrapezienne sur le sommet de la clavicule distale. Une fixation temporaire entre la clavicule et lacromion a été utilisé pour se stabiliser larticulation. Deux malades ont été perdus de vue. Douze malades ont été suivis en moyenne 20 (18–60) mois. Le résultat fonctionnel a été établi daprès le score acromioclaviculaire UCLA modifié. Les résultats étaient excellents pour huit malades, bon pour trois, et passable pour un. Dans un cas il y a eu échec de la fixation temporaire avec subluxation de la clavicule.相似文献