The survival of low birthweight infants £2000g born in the central Queensland area during the years 1979 to 1991 was examined. Five hundred and sixty such infants were either delivered at one of the two Rockhampton obstetric units (Rockhampton Base Hospital and the Mater Misericordiae Hospital) or retrieved from outlying central Queensland areas. Both hospitals had intensive care nurseries capable of ventilation and infants were transferred to tertiary centres only for cardiac or surgical treatment. The study involved all liveborn infants', including those with lethal malformations and all deaths up to the time of discharge. Survival rates were as follows: £500 g 0%, 501 £750 g 30%, 751 £1000 g 51%, 1001 ± 1500 g 79%, 1501 £2000g 93%. The survival of Aboriginal infants and outborn infants were found to be essentially the same as the overall group. 相似文献
Background: Between September 1992 and September 1996, we performed 88 VATS (video-assisted thoracic surgery) lobectomies and two VATS
pneumonectomies.
Methods: The indications for surgery were 68 cases of lung cancer, nine cases of bronchiectasis, six cases of tuberculosis, and seven
cases of benign lesions. Of the 68 cases of lung cancer, 36 were treated by VATS lobectomy with extended lymph node dissection
for clinical stage I lung cancer, making full use of recently developed devices for thoracoscopic surgery, such as roticulating
endoscissors, miniretractors, endoclips, and harmonic scalpels.
Results: Twenty-four lymph nodes were resected on average (range, 10 to 51) by VATS. This number was comparable to lymph nodes resected
in open thoracotomy during the same period. Among the 36 patients who underwent extended lymph node dissection, 20 showed
no lymph node metastasis postoperatively (stage I), while 16 had N1 or N2 cancer. All patients with stage I cancer have survived
4 to 36 months (median: 17 months) with no signs of recurrence.
Conclusions: This survival of stage I lung cancer after VATS is comparable to that of open thoracotomy. We thus believe that VATS lobectomy
with extended lymph node dissection can be an alternative to standard posterolateral thoracotomy for stage I lung cancer.
Received: 10 May 1996/Accepted: 19 November 1996 相似文献
In cases with otherwise clinically typical Guillain-Barré syndrome (GBS), pronounced cerebrospinal fluid (CSF) pleocytosis or the mere presence of CSF-polymorphonuclear granulocytes should alert the physician to consider alternative diagnoses. Therefore, we retrospectively studied the neuropathology of central and peripheral nervous system in two cases with a CSF cell count of more than 50/microl and in three cases with a significant proportion of polymorphonuclear granulocytes in the CSF sediment. All cases fulfilled the required criteria for the diagnosis of GBS, the duration from onset to death ranged from 4 to 100 days. Neuropathological investigations included routine staining procedures and immunohistochemistry for antigens of glial and haematopoetic cells as well as for products of relevant neurotropic viruses. Demyelinating polyradiculitis was present in four cases, in one patient with a survival time of 4 days the type of damage to myelinated fibres was unclassifiable. In the central nervous system a consistent finding was diffuse activation of microglia, only one case showed mild meningeal and lower brainstem inflammation. Viral products were generally absent. In summary, the neuropathological findings confirm that marked CSF pleocytosis or the presence of polymorphonuclear granulocytes does not rule out the diagnosis of GBS. 相似文献
As a model system for mucocutaneous lymph node syndrome (MCLS), we have advocated and used mice which had been rendered tolerant to Streptococcus pyogenes-associated antigens by neonatal infection with group A fteta-hemolytic streptococci, because these mice have shown a variety of peculiar bioimmunological characteristics bearing a striking resemblance to those of MCLS patients. The results of our current investigations reaffirmed the reliability of the animal model by indicating that mice subjected to neonatal infection with 5. pyogenes , or inoculation with streptococcal pyrogenic exotoxin (SPE) in Freund's adjuvant, were perfect counterparts of patients with MCLS on account of their platelet activation and hyperaggregability in response to provocative treatment, which are familiar findings in this disease. 相似文献
Background. The “elephant trunk” technique, using a free-floating vascular prosthesis, was originally described to facilitate a subsequent operation on the downstream aorta. We developed an additional refinement of this technique, called the “bidirectional elephant trunk.” This option may represent an interesting tool in more complex aortic operations, especially when the descending aorta has to be replaced first in patients with concomitant pathology of the ascending aorta or of the aortic arch.
Methods. The initial operation is performed through a left thoracotomy. The proximal elephant trunk is created by invaginating the future aortic arch graft into the descending aortic graft. The proximal anastomosis between the doubled graft and the proximal descending aorta is performed first. During construction of the distal anastomosis, a distal elephant trunk may be inserted likewise. If the aortic arch and ascending aorta have to be replaced later, this second step is performed through a median sternotomy. The free-floating arch graft is pulled out of the proximal descending aorta with a nerve hook, unfolded, and used for total arch replacement.
Results. This technique was used successfully in 3 patients without mortality. No major complications were observed excepted persistent hoarseness in a patient with preoperative paresis of the recurrent nerve. No perfusion problems due to the unfolding of the free-floating graft occurred during the second operation.
Conclusions. The bidirectional elephant trunk technique is an interesting option that may be suitable for patients presenting with a complex pathology of the whole thoracic aorta when the descending segment has to be replaced first. 相似文献
A lymph node metastasis in the neck or parotid region from an unknown primary melanoma is an uncommon occurrence. Out of a total of 300 patients with head and neck melanoma treated at the Netherlands Cancer Institute between 1976 and 1992, 17 (5.7%) presented in this way. The most common site for metastatic lymph nodes (18 nodes in 17 patients) was level V (n= 7), followed by the parotid region (n= 4), level II (n= 4), level III (n= 2), and level IV (n= 7). Two patients had local excision of the neck node metastasis only, while the remaining 15 patients underwent more extensive surgical treatment. The 5-year disease-specific survival rate in this group was 48%, with a median survival of 36 months, which is more or less similar to the prognosis of stage II melanoma of the head and neck with a known, surgically treated primary tumour. No relation was found between disease-free interval and sex, the number of positive lymph nodes or the duration of symptoms. 相似文献
To assess the reproducibility and image quality of immediate postgadolinium chelate spoiled gradient-echo MRI in demonstrating disease of the abdominal aorta. All patients (27 patients: 21 men, 6 women) with substantial disease of the abdominal aorta, who underwent abdominal MR examinations at 1.5 T between 1991 and 1995, were entered in the study. Patients were referred for evaluation of suspected aortic disease (14 patients) or other abdominal diseases (13 patients). Three experienced investigators manually measured luminal and external aortic wall diameters and rated image quality, definition of inner and outer walls, extent of disease, and presence of other abdominal abnormalities, in an independent fashion. A cardiovascular surgeon then rated all studies to determine whether clinical management could be based on the MR findings alone. There was 98 to 99% agreement in measurements of luminal and external wall diameter between the three investigators. Overall image quality was rated as good in 77.8 to 88.9% of patients. A total of 31 additional nonaortic abdominal abnormalities were detected by all observers. The cardiovascular surgeon rated 25 of 27 studies as adequate to determine clinical management based on MR findings alone. Immediate postgadolinium spoiled gradient-echo MRI is a reproducible technique for the demonstration of abdominal aortic disease and possesses good image quality. Advantages of this technique include simultaneous evaluation of other nonvascular diseases of the abdomen, short examination time, and easy implementation as part of routine abdominal MRI scanning protocol. 相似文献
Based upon detailed dissections of the lymphatic system in adult cadavers, the lymphatic drainage of the gallbladder was divided
into three pathways: (1) The cholecystoretropancreatic pathway, which had two routes, one running spirally from the anterior
surface of the common bile duct to the right rear, and the other running almost straight down from the posterior surface of
the common bile duct. These routes converged at the principal retroportal node at the posterior surface of the head of the
pancreas. (2) The cholecysto-celiac pathway; this was the route running to the left through the hepatoduodenal ligament to
reach the celiac nodes. (3) The cholecysto-mesenteric pathway; this was the route running to the left in front of the portal
vein to connect with the nodes at the superior mesenteric root. The cholecysto-retropancreatic pathway can be regarded as
the main pathway, and the principal retroportal node appeared to be critical as the main terminal node in the visceral lymphatic
system of the gallbladder. These three pathways converged with the abdomino-aortic lymph nodes near the left renal vein, and
the nodes in the interaortico-caval space were considered to be of particular importance.
Offprint requests to: M. Ito 相似文献