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131.
Reconstruction after gastrectomy and quality of life 总被引:30,自引:0,他引:30
Klaus Buhl M.D. Thomas Lehnert M.D. Peter Schlag M.D. Christian Herfarth M.D. 《World journal of surgery》1995,19(4):558-564
To evaluate quality of life and functional results following surgery for gastric cancer we studied 104 patients with no evidence of disease at a minimum of 12 months postoperatively. Patients were treated with total gastrectomy and jejunal pouch reconstruction according to Hunt-Lawrence-Rodino (n=59) or simple esophagojejunostomy (n=24) and distal subtotal gastrectomy (n=21). No significant differences were found between total gastrectomy with pouch reconstruction and distal gastric resection with respect to dumping or heartburn, whereas patients with total gastrectomy and restoration with esophagojejunostomy suffered from both. The latter group of patients also had reduced nutritional status. Although there is a lack of a proper definition of quality of life, all instruments applied to its measurement indicated improved results for patients with pouch reconstruction and those after distal gastrectomy, but we could not state any significant differences. We conclude that in terms of postoperative functional results as well as quality of life distal gastric resection has no advantage over total gastrectomy with pouch reconstruction; hence a reduction of surgical radicality in an attempt to improve postoperative results is not justified. Pouch reconstruction should be considered the treatment of choice for reconstruction after total gastrectomy.
Resumen Con miras a evaluar la calidad de la vida y los resultados funcionales luego de cirugía por cáncer gástrico, estudiamos 104 pacientes que se encontraban libres de enfermedad a un mínimo de 12 meses postoperatorios. Los pacientes fueron tratados con gastrectomía total y reconstrucción con una bolsa yeyunal de tipo Hunt-Lawrence-Rodino (n=59) o simple esofagoyeyunostomía (n=24) y gastrectomía subtotal distal (n=21). No se encontraron diferencias significantivas entre los pacientes sometidos a gastrectomía total con reconstrucción con bolsa yeyunal y los sometidos a resección distal con respecto a dumping o pirosis, en tanto que los pacientes sometidos a gastrectomía total y restauración mediante esofagoyeyunostomía exhibieron ambos síntomas. Además, los últimos desarrollaron deterioro de su estado nutricional. Aparte de la falta de una adecuada definición de calidad de la vida, todos los parámetros aplicados para su medición demostraron mejores resultados en los casos de gastrectomía total con reconstrucción con bolsa yeyunal y en los casos de gastrectomía distal, pero sin que pudiéramos hallar diferencias significativas. Nuestra conclusión es que en términos de los resultados funcionales postoperatorios así como de calidad de la vida, la resección gástrica distal no tiene ventaja sobre la operación con reconstrucción con bolsa yeyunal y que no se justifica una reducción de la radicalidad quirúrgica con el objeto de mejorar los resultados postoperatorios. La reconstrucción con bolsa yeyunal debe ser considerada como el procedimiento de elección en la gastrectomía total.
Résumé Afin d'évaluer la qualité de vie et les résultats fonctionnels après chirurgie pour cancer gastrique, nous avons étudié 104 patients qui semblaient guéris à 12 mois. Les patients ont eu soit une gastrectomic totale suivie ou de la confection d'un néogastre jéjunal selon le procédé de Hunt-Lawrence-Rodino (n=59) ou une simple anastomose oesojéjunale (n=24), soit d'une gastrectomie distale subtotale (n=21). Il n'y avait aucune différence significantive entre la gastrectomie totale suivie de reconstruction par néogastre et la gastrectomie distale subtotale en ce qui concerne le dumping syndrome ou le reflux, alors que les patients qui avaient eu une gastrectomie totale suivie d'anastomose oesojéjunale avaient les deux. Chez ces derniers, on a également noté une certaine malnutrition. En dépit du manque de définition précise de la qualité de vie, tous les moyens utilisés pour la mesurer ont indiqué um meilleur résultat pour les patients ayant eu une reconstruction avec néogastre par rapport à la gastrectomie distale, sans toutefois atteindre la signification statistique. Nous concluons qu'en terme de résultats fonctionnels postopératoires ainsi que de la qualité de vie, la gastrectomie distale ne présente aucun avantage par rapport à la gastrectomie totale suivie de néogastre, et une réduction dans l'importance de l'intervention pour améliorer les résultats fonctionnels n'est pas justifiée. La confection d'un néogastre doit être la méthode de reconstruction de choix après gastrectomie totale.相似文献
132.
Kirsten Hierholz Wolfgang Baus Klaus Müller-Sievers Bernd Kober 《Strahlentherapie und Onkologie》1999,31(4):616-619
Hintergrund: Ein Multileafkollimator stellt durch die Vielzahl der Lamellen sehr viel höhere Ansprüche an die Konstanzprüfverfahren als ein konventionelles Blendensystem. Zur täglichen Kontrolle der Lamellenpositionierung wird ein Qualitssicherungskonzept vorgestellt. Methode: Zwei Feldkonfigurationen, die bei maximaler Öffnung der Blockblenden sowohl maximale Öffnung als auch "Overtravel" einzelner Lamellen enthalten, werden in täglichem Wechsel online vom Verifikationssystem zum Linearbeschleuniger übertragen. Im Lichtfeld des Linearbeschleunigers erfolgt eine visuelle Kontrolle der Lamellenpositionen mit Hilfe eines speziellen Prüfkörpers. Abschließend wird die Lamellenpositionierung mittels eines Electronic-Portal-Imaging-Systems dokumentiert und nach Überlagerung eines Gitters mit einer Referenzaufnahme verglichen. Ergebnisse: Die Methode stellt eine schnelle und effektive Möglichkeit dar, die Funktionsfähigkeit des gesamten Systems durch Simulation des "Routinebetriebs" zu überprüfen. Schlußfolgerung: Der Arbeits- und Zeitaufwand für die Qualitätssicherung an einem Multileafkollimator unterscheidet sich nur unwesentlich von dem eines konventionellen Blendensystems. Background: In comparison to a conventional collimator, a multileaf collimator demands a great deal of quality assurance procedures due to its large number of leaves. A concept for daily quality assurance is presented, mainly concerning the positioning accuracy of the leaves. Material and Methods: Two leaf configurations including maximal opening as well as overtravel of single leaves, at a maximal opening of the jaws, are transmitted online in daily exchange from our record- and verify system to the linac. Aiming at a special test phantom a visual control of the positioning accuracy is performed. The leaf positioning is documented by an electronic portal imaging system and is compared with a reference shot by superposition of a grid. Results: This method of quality assurance offers a fast and effective possibility to guarantee the proper function of the whole system by simulating the routine treatment situation. Conclusions: Compared to a conventional collimator only a slightly greater workload is needed for quality assurance of a multileaf collimator. 相似文献
133.
134.
Grünewald V Höfner K Thon WF Kuczyk MA Jonas U 《Restorative neurology and neuroscience》1999,14(2-3):189-193
Temporary electrical stimulation using anal or vaginal electrodes and an external pulse generator has been a treatment modality for urinary urge incontinence for nearly three decades. In 1981 Tanagho and Schmidt introduced chronic electrical stimulation of the sacral spinal nerves using a permanently implanted sacral foramen electrode and a battery powered pulse generator for treatment of different kinds of lower urinary tract dysfunction, refractory to conservative treatment. At our department chronic unilateral electrical stimulation of the S3 sacral spinal nerve has been used for treatment of vesi-courethral dysfunction in 43 patients with a mean postoperative follow up of 43,6 months. Lasting symptomatic improvement by more than 50 % could be achieved in 13 of 18 patients with motor urge incontinence (72,2 %) and in 18 of the 21 patients with urinary retention (85,7 %). Implants offer a sustained therapeutic effect to treatment responders, which is not achieved by temporary neuromodulation. Chronic neuromodulation should be predominantly considered in patients with urinary retention. Furthermore in patients with motor urge incontinence, refusing temporary techniques or in those requiring too much effort to achieve a sustained clinical effect. Despite high initial costs chronic sacral neuromodulation is an economically reasonable treatment option in the long run, when comparing it to the more invasive remaining therapeutic alternatives. 相似文献
135.
Michaela Braun Andreas Kage Klaus Heimann U. Schraermeyer 《Albrecht von Graefes Archiv fur klinische und experimentelle Ophthalmologie》1999,237(1):67-71
· Background: Many successful pigment epithelium transplantation studies involving pink-eyed Royal College of Surgeons (RCS)
dystrophic rats showed highly pigmented transplanted cells forming a double layer with slightly pigmented cells, attached
to Bruch’s membrane. Since it is not clear whether transplanted pigmented cells can displace retinal pigment epithelial (RPE)
host cells from Bruch’s membrane, we suggested that RPE cells of RCS dystrophic rats can phagocytize melanin granules, possibly
derived from perished transplanted cells. · Methods: In a series of three experiments, RPE cells of nine pink-eyed, 2-month-old RCS dystrophic rats were isolated by trypsinization and mechanical dissection and cultivated in Dulbecco’s modified
Eagles’ medium. These cells were then fed with melanin granules, isolated from bovine RPE cells, double-trypsinized after
phagocytosis and viewed by light and electron microscopy. We also transplanted iris pigment epithelial (IPE) cells of 20-day-old
Long-Evans rats into the subretinal space of pink-eyed RCS dystrophic rats of the same age, shown in light-microscopic photography
after 42 days. · Results: Living RPE cells were heavily pigmented after feeding with isolated melanin granules in all three
experiments as viewed by light microscopy. In addition, we identified melanin granules phagocytized by dystrophic RPE cells
in electron microscopy. After transplantation of pigmented IPE cells into the subretinal space of pink-eyed RCS dystrophic
rats’ eyes, a layer of slightly pigmented cells was seen on Bruch’s membrane below the transplanted IPE cells, shown in light
microscopy. · Conclusion: We have shown by phagocytosis assay that dystrophic RPE cells can take up melanin granules in vitro.
Our results assume that pigmented cells in transplantation studies, found as a monolayer, attached to Bruch’s membrane, cannot
automatically be identified as transplanted cells. Instead, the possibility of perished transplanted cells serving as melanin
donors for RPE host cells must be taken into consideration.
Received: 11 March 1998 Revised version received: 5 May 1998 Accepted: 26 May 1998 相似文献
136.
R. Bültmann Marie Trendelenburg Florin Tuluc Henning Wittenburg Klaus Starke 《Naunyn-Schmiedeberg's archives of pharmacology》1999,359(4):339-344
In order to assess the consequences of a concomitant blockade of P2X-receptors and ecto-nucleotidases, effects of 13 P2-receptor
antagonists were investigated on contractions of the rat vas deferens elicited by α,β-methylene ATP (α,β-MeATP) and ATP and
on the removal of ATP from the incubation medium by vas deferens tissue.
Increasing concentrations of all antagonists reduced and finally abolished contractions elicited by α,β-MeATP (3 μM), with
IC50-values ranging from 1.1 to 100 μM. Pyridoxalphosphate-6-azophenyl-2’,4’-disulphonate (PPADS), 6-azophenyl-4-amino-5-hydroxy-naphthalene-1,3-disulphonate
(NH02), 4,4’-diisothiocyanatostilbene-2,2’-disulphonate (DIDS) and uniblue A also progressively reduced and finally abolished
contractions elicited by ATP (1 mM). 8,8’-[Carbonylbis(imino-3,1-phenylenecarbonyl-imino)]-bis-(1,3,5-naphthalenetrisulphonate)
(NF023), sura- min, pyridoxalphosphate-6-azophenyl-2’,5’-disulphonate (iso-PPADS), trypan blue and reactive blue 19, in contrast,
caused only partial blockade, by 34–43% maximally; reactive blue 2 and reactive red 2 had no effect; and 6,6’-(1,1’-biphenyl-4,4’-diylbisazo)-bis-4-amino-5-hydroxy-naphtha-lene-1,3-disulphonate
(NH01) and Evans blue even enhan- ced the response to ATP. For antagonists causing full or partial inhibition, the IC50-values against ATP were close to those against α,β-MeATP. All antagonists attenuated the removal of ATP, with IC25%-values ranging from 0.8 μM to >320 μM.
The results confirm the frequent combination, in one antagonist molecule, of P2-receptor blockade and blockade of ecto-nucleotidases.
This dual action underlies the effect of such compounds on contractions of the vas deferens elicited by ATP which, for certain
substances (e.g., suramin, reactive blue 2), can be explained by a simple model in which the antagonist simultaneously blocks
the degradation of ATP and a single contraction-mediating receptor (P2X1). Several observations, however, do not conform with this model, and the existence of multiple contraction-mediating receptors
for ATP or multiple, pharmacologically distinct ecto-nucleotidases has to be considered.
Received: 23 October 1998 / Accepted: 11 January 1999 相似文献
137.
K.J. Wirth E. Klaus H.C. Englert B.A. Schölkens W. Linz 《Naunyn-Schmiedeberg's archives of pharmacology》1999,360(3):295-300
Ventricular fibrillation (VF) is a major cause of sudden cardiac death in which myocardial ischemia plays a leading role. During ischaemia activation of ATP-sensitive potassium channels (K(ATP)) occurs, leading to potassium efflux from cardiomyocytes and shortening of the action potential favoring the genesis of ventricular fibrillation. In confirmation of this concept the sulfonylurea glibenclamide, which stimulates insulin release by inhibition of pancreatic K(ATP) channels, has been shown to inhibit VF in different models of ischaemia by inhibition of myocardial K(ATP) channels. HMR 1883 (1-[15-12-(5-chloro-o-anisamido)ethyl]-methoxyphenyl]sulfonyl]-3-m ethylthiourea) was designed as a cardioselective K(ATP) channel blocker. The aim of this study was to show that with this compound it is possible to separate the antifibrillatory from the insulin-releasing effect for the treatment of patients at risk of ischaemia-induced arrhythmias and sudden death. In the present study HMR 1883 reduced VF in Sprague-Dawley rats during prolonged ischaemia and also diminished mortality and the duration of VF in a separate reperfusion experiment at 3 mg/kg and 10 mg/kg with no effect on blood glucose or insulin. Glibenclamide, which was antifibrillatory at 0.3 mg/kg and 1 mg/kg, increased plasma insulin and lowered blood glucose already at a dose as low as 0.01 mg/kg. In conclusion, based on its antifibrillatory action and the absence of significant pancreatic effects at therapeutic doses, HMR 1883 is of potential clinical utility for the prevention of severe arrhythmias in patients with ischaemic heart disease. 相似文献
138.
Thomas Dierks Stefan Barta Lothar Demisch Klaus Schmeck Ekkehart Englert Andrea Kewitz Konrad Maurer Fritz Poustka 《Psychopharmacology》1999,146(1):101-107
Rationale: The intensity dependence of the auditory evoked potentials (AEP) has been suggested to be a specific biological marker of
central serotonergic activity. Objective: While previous studies used circumstantial evidence to support this hypothesis, we manipulated (decreased) cerebral levels
of serotonin directly by using tryptophan depletion. Methods: Twelve healthy young subjects were investigated using placebo and two different amino acid mixtures in a double blind cross
over design on three different occasions. AEPs recorded during tryptophan depletion were analyzed by dipole analysis and regional
sources using methods published in the literature. Results: For none of the mixtures a significant effect of tryptophan depletion was found. There was a trend towards reduced intensity
dependency after tryptophan depletion, especially in the right hemisphere. This reduction correlated with the amount of reduced
tryptophan in plasma. Conclusions: The results indicate, in contrast to earlier indirect studies, that the intensity dependence of AEPs is not a specific marker
of central serotonergic activity.
Received: 8 March 1999 / Final version: 25 May 1999 相似文献
139.
Dr. Exacustodian Păuşescu M.D. Nikolaus Mendler M.D. Klaus Gebhardt V.D. Fritz Sebening M.D. 《World journal of surgery》1978,2(1):109-117
This is a report of a study aimed at putting into practice a new theory for hypothermic preservation of viable organs. A perfusion fluid elaborated according to this theory was applied in preservation of the heart, and resulted in storage of the heart for up to 72 hours with preservation of its functions (rhythm, presystolic ventricular pressure, systolic ventricular pressure, cardiac work, coronary blood pressure, sensitivity to drugs) and its morphology. An important finding was that repeated heart storage for 24 hours alternating with functional testing for 5–7 hours could be performed without irreversible alterations of cardiac function and fine structure. Furthermore, during functional testing following storage the hearts consistently demonstrated improvement of function in time, suggesting that the preserved myocardial tissues were able to rapidly achieve metabolic reequilibration. The results of this study provide the possibility of developing a system for efficient ex vivo heart conditioning before transplantation.
Supported by the German Heart Center, Munich, and the German Academy Department for Foreign Scientific Relationships, Bonn. 相似文献
Résumé Nous avons testé la valeur d'une nouvelle théorie sur la préservation d'organes en hypothermie. Un liquide de perfusion conforme à cette théorie a été utilisé pour la préservation cardiaque. Il permet de conserver le coeur pendant 72 heures, sans altérations de ses fonctions (rythme, pression ventriculaire pré-systolique et systolique, travail cardiaque, pression coronaire, sensibilité aux médicaments) ni de sa morphologie. De plus, le coeur peut-être, à plusieurs reprises, conservé pendant 24 heures, avec des intervalles de reprise fonctionnelle de 5–7 heures, sans que sa fonction ni sa structure fine ne soient altérées de façon irréversible. Enfin, l'étude fonctionnelle montre qu'après conservation la fonction cardiaque s'améliore avec le temps, suggérant donc une rééquilibration métabolique rapide du tissu myocardique. Les résultats de cette étude permettront la mise au point d'un système efficace de conservation cardiaque ex-vivo en vue de la transplantation.
Supported by the German Heart Center, Munich, and the German Academy Department for Foreign Scientific Relationships, Bonn. 相似文献
140.
Heinz Werner Seifert Georg Klingmüller Klaus Tschubel 《Archives of dermatological research》1978,261(2):163-173
Zusammenfassung Bei einem 47 jährigen Patienten entwickelten sich am rechten Bein mehrere rasch wachsende Tumoren von distal nach proximal. Histologisch und elektronenmikroskopisch zeigten die Tumorzellen morphologische Besonderheiten, die für ihre histiocytäre Provenienz sprechen. Auffallend war die große Anzahl polymorpher cytoplasmatischer Membranstrukturen und großer Vacuolen, die massenhaft kleine Vesikel enthielten. Diese Strukturen werden als transformierte multivesiculäre Körper gedeutet; ihre Entstehung vollzieht sich im Rahmen einer bizarr übersteigerten Membranaktivierung einer malignen Zellrasse. Bemerkenswert ist die rasche und völlige Remission durch Radiotherapie.
Auszugsweise vorgetragen beim 4th European Meeting on Electron Microscopy Applied on Cutaneous Pathology, Heidelberg, 6. und 7. Mai 1977: Multivesicular Vacuolization in Malignant Histiocytoma. 相似文献
Multivesicular vacuolization in malignant histiocytoma of the skin
Summary A 47-year-old patient developed several rapidly growing tumours in his right leg. Histologic and electron microscopic examination revealed morphological characteristics suggesting the histiocytic origin of the tumour cells. An important finding was the striking number of pleomorphic membraneous inclusions and large vacuoles containing numerous small vesicles. These cytoplasmic inclusions are interpreted as transformed multivesicular bodies. Their formation may be an expression of an increased and bizarre membraneous activity of a malignant cell race. Radiotherapy resulted in a remarkably rapid and complete remission.
Auszugsweise vorgetragen beim 4th European Meeting on Electron Microscopy Applied on Cutaneous Pathology, Heidelberg, 6. und 7. Mai 1977: Multivesicular Vacuolization in Malignant Histiocytoma. 相似文献