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1.
Hand-assisted laparoscopic nephroureterectomy for upper urinary tract transitional cell carcinoma. 总被引:1,自引:0,他引:1
Jay D Raman Michael A Palese Casey K Ng Stephen A Boorjian Douglas S Scherr Joseph J Del Pizzo R Ernest Sosa 《JSLS, Journal of the Society of Laparoendoscopic Surgeons》2006,10(4):432-438
OBJECTIVE: We report our experience with hand-assisted laparoscopic nephroureterectomy (HALN) for upper urinary tract transitional cell carcinoma and compare our results with a contemporary series of open nephroureterectomy (ON) performed at our institution. METHODS: Between August 1996 and May 2003, 90 patients underwent nephroureterectomy for upper-tract transitional cell carcinoma (TCC). Thirty-eight patients underwent HALN, while 52 had an ON. End-points of comparison included operative time, estimated blood loss (EBL), intraoperative and postoperative complications, length of hospital stay, pathologic grade and stage of tumor, and tumor recurrence. RESULTS: The mean patient age was 72.3 and 70.6 years in the ON and HALN groups, respectively. Mean operative duration was 243 minutes (ON) and 244 minutes (HALN), with an EBL of 478mL in the open group versus 191 mL in the hand-assisted group (P<0.001). No intraoperative complications occurred, but postoperative complications occurred in 4% and 11% of the ON and HALN groups, respectively (P=0.21). The mean hospital duration was 7.1 days (ON) versus 4.6 days (HALN) (P<0.01). No difference existed in the pathologic grade or stage distribution of urothelial tumors between the 2 groups. The mean follow-up was 51.0 months in the ON group and 31.7 months in the HALN group. Recurrence of urothelial carcinoma occurred in 50% of patients who underwent ON and 40% treated by HALN (P=0.38) at a median interval of 9.1 and 7.7 months, respectively, after surgery. CONCLUSION: Hand-assisted laparoscopic nephroureterectomy is an effective modality for the treatment of upper urinary tract urothelial carcinoma. Patients benefited from less intraoperative blood loss and a shorter hospitalization with an equivalent intermediate-term oncologic outcome compared with that of the open approach. 相似文献
2.
Kiran VEERAPEN Raman N. ASOKAN Vimalah RATHAKRISHNAN 《International journal of rheumatic diseases》2004,7(2):97-107
Aims: To create a clinical and radiological profile of patients with symptomatic osteoarthritis of the knee in Malaysia. Methods: One hundred consecutive patients presenting with symptomatic knee osteoarthritis at a private rheumatology clinic were profiled for demographic and clinical features. Anteroposterior weight‐bearing, skyline and lateral knee X‐rays were taken. Statistical Package for Social Sciences was used for data analysis. Results: Women predominated (93%). Fifty‐eight percent of the patients reported bilateral knee pain. Difficulty in walking, climbing and squatting was high (85%, 97% and 93% respectively). Patients with knee pain had a higher BMI than controls. Radiological abnormality, related to osteoarthritis was present in 97%. Osteophytes were generally tricompartmental while joint space narrowing was less evident in the lateral tibiofemoral joint than in the medial tibiofemoral joint and the patellofemoral joint. Almost half (49%) the patients manifested radiological varus deformity The severity of radiological abnormality increased with age. Although patients with unilateral pain had milder radiological abnormality, it tended to be bilateral. Clinically detectable hip abnormality and nodal osteoarthritis were uncommon, as was radiological chondrocalcinosis. Conclusions: Patients presenting with symptomatic knee osteoarthritis to a rheumatology service had a high degree of disability, radiological abnormality and varus deformity. Radiological abnormalities were essentially bilateral and tricompartmental. 相似文献
3.
4.
R Raman 《Singapore medical journal》1989,30(1):94-96
A hypothesis is put forward based on clinical observations and treatment modalities in vasomotor non-allergic rhinitis (V.M.R.) and primary atrophic rhinitis (P.A.R.). The hypothesis postulates that (1) V.M.R. and P.A.R. are two diseases at the ends of an autonomic spectrum (2) The anterior nasal aperture, its dimensions and sensory receptors play a vital role in the etiopathogenesis of both the conditions through reflex autonomic action. 相似文献
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6.
Jaishankar Raman Anand Dixit Gil Bolotin Valluvan Jeevanandam 《European journal of cardio-thoracic surgery》2006,30(2):347-352
BACKGROUND: Complex ventricular reconstruction (CVR) is now being employed increasingly thanks to the pioneering work of Dor. However, little is known about the failure mode of CVR. We present experience from three centres with CVR and an analysis of the failure modes. METHODS: Between January 1997 and February 2005, 284 patients underwent CVR in three centres in Australia and USA. All of the procedures were performed as adjuncts to coronary artery surgery and/or valvular surgery. Patients were followed-up clinically and/or echocardiographically. Failure modes were classified as fatal or non-fatal. Non-fatal failure mode (NFM) was defined as either persistent heart failure, recurrence of LV scar, need for ventricular assistance, persistent ventricular arrhythmia, or a combination. RESULTS: Operative mortality rate (OMR) was 8% (23 deaths). This fatal failure mode was most related to urgency of surgery and cardiogenic shock in 15 patients (5.3% of OMR), stroke in 5 patients (1.8%) or postoperative bi-ventricular failure (1%). Non-fatal failure modes accounted for morbidity in 26 patients (9%). This was predominantly due to persistent septal dyskinesis in 7 patients (2.46%), persistent mitral regurgitation in 5 (1.8%), postoperative ventricular tachycardia in 4 (1.4%), sub-optimal myocardial protection in 4 (1.4%) use of a large, stiff patch in 4 (1.4%). One hundred and ninety-nine of the surviving 261 patients (76%) were in NYHA Class I. CONCLUSIONS: Complex ventricular reconstruction is a robust technique that has lasting benefit. Failure modes have been identified and could be minimized by appropriate patient and procedure selection. 相似文献
7.
Vishwa Prakash Raman Tandon Raghav Mantri 《Journal of plastic, reconstructive & aesthetic surgery》2006,59(10):1102-1104
Supragaleal placement of tissue expander for management of alopecia of scalp excludes tough galeal layer so that easier and faster expansion of scalp may be achieved. 相似文献
8.
J. K. Thomas K. N. Brahmadattan M. K. Lalitha R. Raman 《Indian journal of otolaryngology and head and neck surgery》1993,45(2):80-86
A correlative study of the clinical findings and radiographic findings, antral lavage, bacterial flora, and antibacterial therapy was done on forty five patients with fifty six radiographically abnormal antra. Twenty six patients, thirty two maxillary antra were followed up after treatment. Clinically, purulent nasal discharge, fever, pus in the middle meatus and sinus tenderness, radiographically opacity and fluid levels, purulent or mucoid return on antral lavage yielded a significantly high positive bacterial culture justifying the treatment with antibiotics. The common organisms isolated were haemophilus influezae and streptococcus pneumonia. Mucosal thickening as observed radiographically may be an intermediary sign either in the development or in the recovery of maxillary sinusitis. 相似文献
9.
Various 2-(4-biphenoxymethyl)-5-arylamino-1,3,4-oxadiazoles were synthesized by cyclization of the corresponding 1-(4-biphenoxyacetyl)-4-substituted thiosemicarbazides. These compounds were characterized by their elemental analyses and infrared, mass, and nuclear magnetic resonance spectral data. All substituted thiosemicarbazides (100 mg/kg, ip) and cyclized substituted oxadiazoles (100 mg/kg, ip) possessed anti-inflammatory activity, as reflected by their ability to provide protection against carrageenin-induced edema in the rat paw which ranged from 28 to 68% and 36 to 76%, respectively. Cyclization of the substituted thiosemicarbazides, in general, resulted in an increase in the anti-inflammatory activity of their corresponding substituted oxadiazoles, with the exception of those containing 2,4-dimethyl and 3,4-dimethyl substituents in their molecular structure. Hydrocortisone (10 mg/kg, ip) and oxyphenbutazone (40 mg/kg, ip) were used as the standard reference drugs and these provided 45 and 53% protection, respectively. All compounds (1 mM) possessed antiproteolytic activity and the in vitro inhibition of trypsin-induced hydrolysis of bovine serum albumin ranged from 13 to 75% for substituted thiosemicarbazides and 39 to 70% for substituted oxadiazoles. There was no relationship between the anti-inflammatory activity of substituted thiosemicarbazides and substituted oxadiazoles and their antiproteolytic effectiveness. The low toxicity of these compounds was reflected by their high approximate LD50 values, ranging from 500 to 1000 mg/kg. 相似文献
10.
G V Raman 《Journal of human hypertension》1987,1(3):237-238
A patient with a 12 hour history of headache, breathlessness and hypotension developed acute renal failure necessitating haemodialysis for 12 days. During recovery she developed hypertension, tachycardia and facial flushing. Investigations revealed a right adrenal phaeochromocytoma. Whilst postural hypotension is common in phaeochromocytoma, profound shock with acute renal failure is rare. This may have been precipitated by concomitant drug therapy, myocardial necrosis or by necrosis within the tumour. 相似文献