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BACKGROUND: Formation of urinary stones in a continent urostomy (Indiana pouch) has been described as a late complication. Management of a patient with symptomatic multiple large stones and review of the literature are outlined. CASE REPORT: A 32-year-old woman presented with recurrent urinary tract infections and pyelonephritis 6 years after a total pelvic exenteration and creation of a continent urostomy for central recurrent carcinoma of the cervix after radical pelvic radiation. Multiple large stones were found to be the underlying etiology. Laparotomy, enterocystotomy, and removal of stones were performed without apparent complication. CONCLUSION: It is recommended that for single calculi or multiple small stones, electroshock wave lithotripsy or the percutaneous endoscopic approach be considered. For larger stones the use of laparotomy and enterocystostomy may be appropriate. 相似文献
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Altman AD Nelson G Nation J Chu P Ghatage P 《Journal d'obstetrique et gynecologie du Canada》2011,33(10):1031-1037
Vacuum assisted closure and negative pressure (NP) dressings are innovative forms of wound management used in multiple fields of medicine, including surgery. We review here the current literature in this area relevant for the gynaecologist. Negative pressure dressings increase blood flow to the wound, decrease bacterial counts, decrease tension on wound edges, and increase the formation of granulation tissue. Until recently, use of NP dressings has been contraindicated in wounds that have been previously radiated or that have necrotic tissue, an infection, an open fistula, an underlying malignancy, or an exposed blood vessel. In this review, we discuss the use of negative pressure for the treatment of abdominal wounds, including those associated with dehiscence, fistula, and prior radiation. We also discuss the use of NP dressings in gynaecologic oncology, including the vulvar and perineal areas. Finally, we outline the basics of applying NP dressings, and discuss pressure settings, "foam counts," debridement, and interface dressings to optimize the benefits of vacuum dressings. When used in the appropriate setting, NP dressing is a unique and important modality of treatment in gynaecology. 相似文献
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Gandhi PS Chen Z Mathews FS Di Cera E 《Proceedings of the National Academy of Sciences of the United States of America》2008,105(6):1832-1837
Allostery is a common mechanism of regulation of enzyme activity and specificity, and its signatures are readily identified from functional studies. For many allosteric systems, structural evidence exists of long-range communication among protein domains, but rarely has this communication been traced to a detailed pathway. The thrombin mutant D102N is stabilized in a self-inhibited conformation where access to the active site is occluded by a collapse of the entire 215–219 β-strand. Binding of a fragment of the protease activated receptor PAR1 to exosite I, 30-Å away from the active site region, causes a large conformational change that corrects the position of the 215–219 β-strand and restores access to the active site. The crystal structure of the thrombin-PAR1 complex, solved at 2.2-Å resolution, reveals the details of this long-range allosteric communication in terms of a network of polar interactions. 相似文献
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Tzimopoulou S Cunningham VJ Nichols TE Searle G Bird NP Mistry P Dixon IJ Hallett WA Whitcher B Brown AP Zvartau-Hind M Lotay N Lai RY Castiglia M Jeter B Matthews JC Chen K Bandy D Reiman EM Gold M Rabiner EA Matthews PM 《Journal of Alzheimer's disease : JAD》2010,22(4):1241-1256
Here we report the first multi-center clinical trial in Alzheimer's disease (AD) using fluorodeoxyglucose positron emission tomography ([18F]FDG-PET) measures of brain glucose metabolism as the primary outcome. We contrasted effects of 12 months treatment with the PPARγ agonist Rosiglitazone XR versus placebo in 80 mild to moderate AD patients. Secondary objectives included testing for reduction in the progression of brain atrophy and improvement in cognition. Active treatment was associated with a sustained but not statistically significant trend from the first month for higher mean values in Kiindex and CMRgluindex, novel quantitative indices related to the combined forward rate constant for [18F]FDG uptake and to the rate of cerebral glucose utilization, respectively. However, neither these nor another analytical approach recently validated using data from the Alzheimer's Disease Neuroimaging Initiative indicated that active treatment decreased the progression of decline in brain glucose metabolism. Rates of brain atrophy were similar between active and placebo groups and measures of cognition also did not suggest clear group differences. Our study demonstrates the feasibility of using [18F]FDG-PET as part of a multi-center therapeutics trial. It suggests that Rosiglitazone is associated with an early increase in whole brain glucose metabolism, but not with any biological or clinical evidence for slowing progression over a 1 year follow up in the symptomatic stages of AD. 相似文献
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McMeekin S Patel R Verschraegen C Celano P Burke J Plaxe S Ghatage P Giurescu M Stredder C Wang Y Schmelter T 《British journal of cancer》2012,106(1):70-76
Background:
Sagopilone is the first fully synthetic epothilone in clinical development and has demonstrated promising preclinical activity. This phase I/II, prospective, open-label trial investigated the efficacy and safety of sagopilone plus carboplatin in patients with recurrent platinum-sensitive ovarian cancer (OC).Methods:
In phase I (dose-escalation stage), patients with OC recurring at least 6 months after platinum-containing chemotherapy received 3-h infusions of sagopilone (initial dose of 12 mg m−2) followed by carboplatin every 3 weeks, for 2–6 treatment courses. Patients enrolled in phase II received 3-h infusions of 16 mg m−2 sagopilone. Efficacy was assessed using modified Response Evaluation Criteria in Solid Tumors (modRECIST) and Gynecologic Cancer InterGroup CA125 criteria. The safety and tolerability of sagopilone were also evaluated.Results:
In all, 45 patients received sagopilone at 12 mg m−2 or 16 mg m−2. There were 29 confirmed tumour responses (21 modRECIST and 8 CA125) across both treatment groups, indicating that the primary objective of the study was reached. The main adverse events (AEs) reported were peripheral neuropathy (75.6%), fatigue (71.1%) and nausea (64.4%). Grade ⩾3 AEs occurred in 35 patients (77.8%). No deaths related to the study drug were reported.Conclusion:
Sagopilone in combination with carboplatin was effective and toxicities were manageable in patients with recurrent platinum-sensitive OC. 相似文献8.
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Daliah Tsoref Stephen Welch Susie Lau James Biagi Katia Tonkin Lee Ann Martin Susan Ellard Prafull Ghatage Laurie Elit Helen J. Mackay Ghassan Allo Ming-Sound Tsao Suzanne Kamel-Reid Elizabeth A. Eisenhauer Amit M. Oza 《Gynecologic oncology》2014