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21.
Early laparoscopic cholecystectomy for acute cholecystitis 总被引:4,自引:0,他引:4
Background: The timing of laparoscopic cholecystectomy for acute cholecystitis remains controversial.
Methods: One hundred ninety-four patients with acute cholecystitis were reviewed. The conversion rates for the various number of days
of symptoms before surgery were analyzed. The conversion rate dramatically increased from 3.6% for those patients with 4 days
of symptoms to 26% for those patients with 5 days of symptoms. The mean number of days of symptoms prior to surgery in those
patients who underwent successful laparoscopic cholecystectomy was 4.1 as compared to 8.0 in those patients who required open
cholecystectomy (p < 0.0001). Based on this data the patients were divided into two groups. Group 1 consisted of 109 patients who underwent
laparoscopic cholecystectomy within 4 days of onset of symptoms and group 2 consisted of 85 patients who underwent laparoscopic
cholecystectomy after more than 4 days following onset of symptoms.
Results: The conversion rate from laparoscopic to open cholecystectomy was 15%. The conversion rate for group 1 was 1.8% as compared
to 31.7% for group 2 (p < 0.0001). Indications for conversion were inability to identify the anatomy secondary to inflammatory adhesions (68%), cholecystoduodenal
fistula (18%), and bleeding (14%). The major complication rate for group 1 was 2.7% as compared to 13% for group 2 (p= 0.007). The mortality rate for all patients with attempted laparoscopic cholecystectomy for acute cholecystitis was 1.5%.
The average procedure time for group 1 was 100 ± 37 min vs 120 ± 55 min in group 2. The average number of postoperative hospital
days in group 1 was 5.5 ± 2.7 days as compared to 10.8 ± 2.7 days in group 2.
Conclusions: We advocate early laparoscopic cholecystectomy within 4 days of onset of symptoms to decrease major complications and conversion
rates. This decreased conversion rate results in decreased length of procedure and hospital stay.
Received: 28 March 1996/Accepted: 12 September 1996 相似文献
22.
Elizabeth Landerholm 《Early child development and care》1994,101(1):13-22
The computer use of two classrooms of kindergarten aged children in private school in Chicago were compared for variance in terms of the age and sex of the children, for variance by classroom, and for variance in the software selected. The major statistical method used was analysis of variance. There were two dependent variables: total frequency of computer use and the difference between the frequency in the first half and that in the second half (in order to examine the changing pattern of computer use in the two classrooms). There was no significant difference in computer use by sex or age, but there was a significant difference in the frequency of computer by classroom in the second half of the project compared to the first half. There was no significant difference in the software selected. 相似文献
23.
目的:探讨肝外胆管癌的诊断和治疗的体会。方法:回顾性总结手术治疗的32例肝外胆管癌的临床资料、手术方式、手术并发症及生存率,并复习相关文献资料。结果:本组病例获根冶性切除14例,姑息切除2例,胆道引流术16例;手术并发症10例(31.3%),手术死亡1例(3.1%)。其中22例获定期随访,存活一年以上的有12例(12/22),至今存活8例。结论:早期诊断、正确的评估、合理的术式选择能提高疗效。降低手术并发症及死亡率。 相似文献
24.
贺光照 《重庆医科大学学报》1992,(2)
本文根据34例电击伤临床资料,分析早期处理与病人全身情况、局部损伤愈合以及并发症的关系.并讨论间生态组织的处理原则.结果表明:伤后1天内与伤后3天以上就诊的病人比较,前者全身情况良好,创面感染率低,局部损伤用皮瓣或(和)皮片覆盖效果满意,并发症及截肢率均较低 相似文献
25.
Masaki Shinoda Tsuyoshi Yamaguchi Yoshimi Tanaka Osamu Sato Sin Kobayashi Yutaka Suzuki 《Child's nervous system》1992,8(4):219-221
Single photon emission computerized tomography (SPECT) is now widely used as one of the tools in evaluating cerebral blood flow (CBF). The authors report the CBF changes in childhood hydrocephalus. Five pediatric cases studied by 123I-IM SPECT in children are presented. The authors counted radioactivities both in early and delayed images in each patient, and calculated the reabsorption ratio (RR). Two negative-RR cases and three positive-RR cases were found. All of the negative-RR patients had a poor prognosis, while all of the positive-RR patients had a favorable outcome. 相似文献
26.
Vickie E. Lake 《Early child development and care》2003,173(5):509-518
This qualitative study that allowed children to be the dominant voice examined children's stories of hope. Twenty-nine kindergarten children through to third graders were interviewed using familiar school items: story board, pictures, puppets, and so on. One elementary school, located in a large southwestern metropolitan city, was selected for this study. Data was coded and prominent themes emerged illustrating that children are much more moral than many adults give them credit for. Approximately one-half of the stories shared focused not on the children's wants or “hopes”, but on others - classmates, friends, family, or extended relatives. The findings support research that highlights the issues of care, concern, and compassion that are a priority for young children. 相似文献
27.
H. J. C. M. Sterenborg M. Motamedi R. F. Wagner Jr M. Duvic S. Thomsen S. L. Jacques 《Lasers in medical science》1994,9(3):191-201
The feasibility of using in vivo autofluorescence for the diagnosis of skin cancer was evaluated. In vivo fluorescence measurements
were performed on healthy human volunteers, and patients with different types of benign and malignant skin tumours. Fluorescence
spectra as well as fluorescence images were acquired. The excitation-emission matrix of normal skin (n=3) showed a broad peak at the shortest excitation wavelength (365 nm) and at 440 nm fluorescence wavelength, smoothly decreasing
towards longer excitation and fluorescence wavelengths. Non-melanoma skin tumours (n=31) and control skin excited with 375 nm showed a broad fluorescence band from 400 to 700 nm, peaking around 436 nm. No significant
differences in measurements between tumours and the corresponding control sites were found. A large spatial variation in the
fluorescence intensity was observed both in the tumours and in the control sites. Standard deviations found ranged from 0.15
to 1.5 times the mean fluorescence. Fluorescence images, excited with 375 nm and taken with an image intensified CCD camera,
on eight malignant melanomas and eight benign pigmented lesions did not indicate any fluorescence intensity distribution specific
to the malignancy of the lesion. Neither the shape of the fluorescence spectra, nor the spatial distribution of the fluorescence
intensity showed any signature specific to the histopathological nature of the lesions investigated. Optical diagnostics of
skin tumours using the autofluorescence does not seem to be feasible at the present time. 相似文献
28.
E. Wallenböck T. Diethart M. Plecko B. Fuchs 《Langenbeck's archives of surgery / Deutsche Gesellschaft fur Chirurgie》1994,379(2):76-79
Zusammenfassung Den Vorteilen einer osteosynthetischen Versorgung einer Fraktur mit sofortiger Aufnahme seiner Funktion, stehen die aus der Literatur bekannten Komplikationen gegenüber. Diese und unsere eigenen unbefriedigenden Ergebnisse nach der operativen Versorgung von Radiusköpfchenfrakturen ließen uns zu einer prospektiven randomisierten Studie einer primär funktionellen Behandlung unter Verzicht auf eine äußere oder innere Stabilisierung greifen. Seit Dezember 1991 haben wir im UKH-Graz bis einschließlich Dezember 1992 insgesamt 70 Patienten nach einem strikten Behandlungskonzept, unter Zuhilfenahme der Computertomographie zur Verlaufsbeobachtung versorgt. Die in 91% der Fälle als sehr gut and gut einzustufenden Frühergebnisse sowie das fehlende Auftreten einer, wie bei operativer Versorgung möglichen Komplikation, ebenso die zusätzlich deutlich frühere Arbeitsfähigkeit bzw. deutlich kürzere, wenn auch aufwendigere Behandlungszeit, lassen uns diese Verfahren nicht nur in unserem Hans weiterführen, sondern können wir auch weiter empfehlen.
Experience with internal fixation of fractures of the head of the radius
The advantages of internal fixation of fractures, with the possibility of immediate resumption of the function of the fractured bone, are in contrast to the well-known complications described in the literature. These complications and our own unsatisfactory results after surgical treatment of fractures of the head of the radius induced us to carry out a randomized prospective study of primary functional treatment of such fractures without external or internal stabilization. From December 1991 through December 1992, a total of 70 patients were treated according to a strict treatment protocol at the Graz Hospital for Accident Surgery, and CT was used for observation of the healing process. The positive early results, which in 91% of all cases were classified as very good or good, the lack of complications that sometimes follow surgical treatment, the markedly earlier recovery of the patient's working capacity, and the clearly shorter — albeit somewhat more expensive — treatment period required have led us to continue using this method at our hospital and also to recommend its use elsewhere.相似文献
29.
Anna Gasinska Jan Skolyszewski Tadeusz Popiela Piotr Richter Zbigniew Darasz Krystyna Nowak Joanna Niemiec Beata Biesaga Agnieszka Adamczyk Krzysztof Bucki Krzysztof Malecki Marian Reinfuss Teresa Kowalska 《Journal of gastrointestinal surgery》2007,11(4):520-528
Purpose Assessment of tumor proliferation rate using Bromodeoxyuridine labeling index (BrdUrdLI) as a possible predictor of rectal
cancer response to preoperative radiotherapy (RT).
Methods and material Ninety-two patients were qualified either to short RT (5 Gy/fraction/5 days) and surgery about 1 week after RT (schedule I),
or to short RT and 4–5 weeks interval before surgery (schedule II). Tumor samples were taken twice from each patient: before
RT and at the time of surgery. The samples were incubated with BrdUrd for 1 h at 37°C, and the BrdUrdLI was calculated as
a percentage of BrdUrd-labeled cells.
Results Thirty-eight patients were treated according to schedule I and 54 patients according to schedule II. Mean BrdUrdLI before
RT was 8.5% and its value did not differ between the patients in the two compared groups. After RT tumors showed statistically
significant growth inhibition (reduction of BrdUrdLI). As the pretreatment BrdUrd LI was not predictive for early clinical
and pathologic tumor response, prognostic role of the ratio of BrdUrdLI after to BrdUrdLI before RT was considered. The ratios
were calculated separately for fast (BrdUrd LI > 8.5%) and slowly (BrdUrd LI ≤ 8.5%) proliferating tumors and correlated with
overall treatment time (OTT, i.e., time from the first day of RT to surgery). One month after RT, accelerated proliferation
was observed only in slowly proliferating tumors.
Conclusions Pretreatment BrdUrdLI was not predictive for early clinical and pathologic tumor response. The ratio after/before RT BrdUrdLI
was correlated to inhibition of proliferation in responsive tumors.
The paper was presented at ECCO 13, October 30 to November 03, 2005 in Paris, France 相似文献
30.