单用静脉大豆油脂肪乳剂对比联合应用鱼油脂肪乳剂的肠外营养对消化道肿瘤术后患者结局影响的随机、对照、双盲、多中心临床研究(摘要)

部分回顾性临床研究观察到在营养液配方中添加特异的药理营养素可能降低术后并发症,缩短术后恢复时间,但仍缺乏较大样本、前瞻性、多中心、随机对照临床研究的证据.近年来,药理营养素在肿瘤患者综合治疗中可能发挥的作用逐渐受到重视.本研究前瞻性观察了静脉用鱼油脂肪乳剂对消化道肿瘤术后患者结局和免疫功能的影响.     

Ultrasound-guided aspiration of hydrosalpinges is associated with improved pregnancy and implantation rates after in-vitro fertilization cycles

Previous reports have shown that the presence of hydrosalpinges may have a detrimental effect on in-vitro fertilization (IVF) outcomes and salpingectomy has been recommended by some authors as a means of improving IVF pregnancy rates. Our first objective was to determine the effect of hydrosalpinges diagnosed by ultrasound on IVF outcomes in our clinic. Our second objective was to examine the effects of aspiration of hydrosalpinges at the time of oocyte retrieval on IVF outcomes. Women with hydrosalpinges (n=34) were compared with women who had tubal disease but no hydrosalpinges (n=124) and were found to have a reduced clinical pregnancy rate (18 % versus 37%, P=0.053), a reduced ongoing pregnancy rate (15 versus 34%, P=0.051), and a reduced implantation rate (7 versus 18%, P=0.003) after IVF procedures. Among women with hydrosalpinges present, 16 had their hydrosalpinges aspirated at the time of oocyte retrieval and 18 did not. Aspiration of hydrosalpinges was associated with a higher clinical pregnancy rate (31 versus 5%, P=0.07), a higher ongoing pregnancy rate (31 versus 0%, P=0.015), and a higher implantation rate (14 versus 1%, P=0.015). This study confirms the association between the presence of hydrosalpinges and poor IVF outcomes. We find that aspiration of hydrosalpinges at the time of oocyte retrieval leads to improved pregnancy rates and may be an acceptable alternative to salpingectomy for treatment of these patients.      

Metastatic testicular teratoma invading the inferior vena cava

We report a case of a teratoma thrombus within the inferior vena cava subsequent to chemotherapy for embryonal carcinoma of the testis. A review of the literature indicates that intracaval metastases occur in approximately 1 per cent of the patients with bulky retroperitoneal disease. Seminoma and embryonal carcinoma have been identified previously within the inferior vena cava, and teratoma is now added to that list. The potential lethality of teratoma owing to local growth alone is underscored by its intracaval presence in this case. We recommend close inspection of the inferior vena cava at operation for bulky disease to exclude an intracaval thrombus, as well as complete excision of all residual masses following chemotherapy for testis cancer.     

The periodontal ligament injection: histologic effects on the periodontium in monkeys

This study was made to determine if periodontal tissues were damaged by the periodontal ligament injection, and if so, whether there would be subsequent repair. A no. 30-gauge needle was wedged into the crestal periodontal ligament space, and solutions were injected under maximum pressure. Injected areas were examined at 0, 10, and 25 days postinjection. Histologic evaluation indicated that the disruption was very slight and was confined to the crestal area. This minimal damage showed rapid repair, indicating that the technique results in minor changes in the periodontium.     

The presence of "creeping attachment" in human gingiva.

Standardized photography was used to determine the presence of "creeping attachment" after free autogenous graft procedures on localized areas of root recessions. "Creeping attachment" occurred in all seven experimental teeth with an average of 0.89 +/- 0.46 mm and a range of 0.38--0.61 mm during a period of 1 year. The results encourage the use of grafts over exposed root surface in an attempt for gingival coverage.     

Obstructed calycocystostomy site in association with a transplanted kidney: percutaneous management

We have used advanced endourologic techniques in the treatment of an obstructed lower-pole calycocystostomy site. The unusual clinical course that led to this problem and the interventional treatment used are discussed.     

Vertebral osteomyelitis: assessment using MR

Thirty-seven patients who were clinically suspected of having vertebral osteomyelitis were prospectively evaluated with magnetic resonance (MR), radiography, and radionuclide studies. These findings were correlated with the final clinical, microbiologic, or histologic diagnoses. Based on the results of these latter studies, 23 patients were believed to have osteomyelitis. MR examinations consisted of at least a sagittal image (TE = 30 msec, TR = 0.5 sec) and an image obtained at TE = 120 msec, TR = 2-3 sec. All patients underwent radiographic and MR examinations, 36 underwent technetium 99m-HDP bone scanning, and 20 patients underwent gallium 67 scanning. Nineteen patients underwent both bone and gallium scanning. The imaging studies were reviewed independently by investigators blinded to the final diagnoses. MR had a sensitivity of 96%, specificity of 92%, and accuracy of 94%. Combined gallium and bone scan studies (19 cases) had a sensitivity of 90%, specificity of 100%, and accuracy of 94%. Bone scans alone had a sensitivity of 90%, specificity of 78%, and accuracy of 86%. Plain radiographs had a sensitivity of 82%, specificity of 57%, and accuracy of 73%. The MR appearance of vertebral osteomyelitis in this study was characteristic, and MR was as accurate and sensitive as radionuclide scanning in the detection of osteomyelitis.     

Effect of gingival wall on resistance to probing forces

Abstract This study was conducted to determine whether the gingival tissue lateral 10 the periodontal sulcus contributes resistance to the advancement of a periodontal probe tip into the sulcus under different applied pressures. An electromechanical device was used to advance a probe tip 0.6 mm in diameter into the facial sulcus at a constant speed until resisting forces of 0.70 N were encountered. The device registered the resisting force and probe advancement simultaneously. The gingiva of all 2nd incisors, 2nd premolars, and 1st molars of 4 young adult male beagle dogs were tested. After the first measurement, the buccal gingiva of experimental sites were incised mesiodistally from the gingival margin to the alveolar crest and the sulcus was reprobed. 2 experimental and control quadrants were selected randomly resulting in 6 sets of both experimental and control data from each animal. The data were analyzed with analysis of variance. The analysis demonstrated significant variation from site to site, and dog to dog; therefore, only changes between the 1st and 2nd probings at the same sites could be compared. Less variability of probing distance in different animals occurred at higher forces; however, the incision had a significant effect on probing distance at these forces. The pressure at which probing distance had less variability among animals and least affected when the gingival sulcular wall was incised was estimated to be 106 N/cm². This corresponds to 30 g force on the 0.6 mm diameter probe.