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51.
一、简介 随着内镜治疗技术的发展.传统外科手术处理疾病的方式发生了变革。由于具有低侵袭性的特点,内镜治疗已成为某些疾病,如胆总管结石和早期胃癌的标准治疗手段。内镜治疗的范围已扩展至腹膜腔。操作时发生穿孔有引发腹膜炎的危险,是内镜操作最严重的并发症:因此,如何安全地通过胃壁行可曲式内镜操作是我们面临的主要挑战。自2000年首次报道内镜经胃腹腔镜检查获成功以来,研究者们对这一问题十分关注,并进行了大量探索和研究。本文对经胃腔外手术或天然入口穿腔内镜手术(NOTES)概念的发展和现状作一讨论。  相似文献   
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BackgroundThe risk of device thrombosis and device-oriented clinical outcomes with bioresorbable vascular scaffold (BVS) was reported to be significantly higher than with contemporary drug-eluting stents (DESs). However, optimal device implantation may improve clinical outcomes in patients receiving BVS. The current study evaluated mid-term safety and efficacy of Absorb BVS with meticulous device optimization under intravascular imaging guidance.MethodsThe SMART-REWARD and PERSPECTIVE-PCI registries in Korea prospectively enrolled 390 patients with BVS and 675 patients with DES, respectively. The primary endpoint was target vessel failure (TVF) at 2 years and the secondary major endpoint was patient-oriented composite outcome (POCO) at 2 years.ResultsPatient-level pooled analysis evaluated 1,003 patients (377 patients with BVS and 626 patients with DES). Mean scaffold diameter per lesion was 3.24 ± 0.30 mm in BVS group. Most BVSs were implanted with pre-dilatation (90.9%), intravascular imaging guidance (74.9%), and post-dilatation (73.1%) at proximal to mid segment (81.9%) in target vessel. Patients treated with BVS showed comparable risks of 2-year TVF (2.9% vs. 3.7%, adjusted hazard ratio [HR], 1.283, 95% confidence interval [CI], 0.487–3.378, P = 0.615) and 2-year POCO (4.5% vs. 5.9%, adjusted HR, 1.413, 95% CI, 0.663–3.012, P = 0.370) than those with DES. The rate of 2-year definite or probable device thrombosis (0.3% vs. 0.5%, P = 0.424) was also similar. The sensitivity analyses consistently showed comparable risk of TVF and POCO between the 2 groups.ConclusionWith meticulous device optimization under imaging guidance and avoidance of implantation in small vessels, BVS showed comparable risks of 2-year TVF and device thrombosis with DES.Trial RegistrationClinicalTrials.gov Identifier: NCT02601404, NCT04265443  相似文献   
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In this study, we introduce DIY guide-needle-assisted conjunctivodacryocystorhinostomy (CDCR), in which a guide needle helps in measuring the initial Jones tube length for insertion and reduces unnecessary handling for tube changes. Three CDCR procedures were conducted in which the length of the Jones tube was calculated using a 22-gauge DIY guide needle, and a prospective study of tube position change and migration, (a major cause of CDCR failure) was done. Wound healing was almost complete within 4 weeks postoperatively in the osteotomy site, but in cases of partial middle turbinectomy, a little more time was necessary. There was a slight change in Jones tube position in the nasal cavity compared with the expected position of original tube tip, but no tube migration from the caruncle fixation position had occurred by the final follow-up time. This guide-needle-assisted CDCR has multiple advantages, such as easy measurement of the proper initial tube size, utilization of the initial needle path, and easy replacement of tubes. Finally, this approach to CDCR can be readily applied because it uses materials ordinarily found in hospitals to create the devices needed for the procedure, so there is no additional cost.  相似文献   
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BACKGROUND: We retrospectively analysed the outcomes of conservative management of Peyronie's disease and determined the factors predicting successful outcome. METHODS: The study involved 31 patients with Peyronie's disease who were treated at our institute between 1985 and 2003. We assessed the efficacy of vitamin E for the improvement of the symptoms, and the factors which contributed to successful outcome with conservative management using multivariate analysis. RESULTS: There was no statistically significant difference in the relief rate between the vitamin E and no-medication groups. The overall estimated relief rate was 67.5% at 2 years from presentation. The multivariate analysis revealed plaque size to be the only significant factor predicting the relief from all symptoms in patients with conservative management. The rate was 100% in patients having a plaque size of 20 mm or smaller and 20.0% in those having a size of larger than 20 mm (P=0.005). CONCLUSIONS: We could not confirm the benefit of vitamin E for Peyronie's disease. Plaque size was the only significant factor predicting the relief from all symptoms. Patients with larger plaque might fail to respond to the conservative management.  相似文献   
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Abstract. Leung, A., McArthur, R., McMillan, D., Ko, D., Deacon, J., Parboosingh, J. and Lederis K. (the Divisions of Paediatrics, Pharmacology and Obstetrics, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada). Circulating antidiuretic hormone during labour and in the newborn. Acta Paediatr Scand, 69: 505, 1980.—Using a high specificity radioimmunoassay, antidiuretic hormone (ADH) concentrations were measured in the plasma of 33 expectant mothers during labour, in cord arterial and venous plasma of their infants at the time of delivery (19 delivered vaginally; 14 delivered by Cesarean section) and in the plasma of the same infants in the first few days of life. Extremely high concentrations of ADH (about 50 times higher than adult basal concentrations) were present in cord arterial blood indicating active fetal production of ADH. Plasma ADH decreased rapidly within an hour after birth and usually fell to adult basal levels during the first day of life. Stressed babies and babies subjected to difficult deliveries had higher plasma levels of ADH.  相似文献   
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