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1.
Peter Marhofer Malachy Columb Phil M. Hopkins Manfred Greher Daniela Marhofer Max R. Levi Bienzle Markus Zeitlinger 《British journal of anaesthesia》2019,122(4):525-531
Background
The efficacy of dexamethasone in extending the duration of local anaesthetic block is uncertain. In a randomised controlled triple blind crossover study in volunteers, we tested the hypothesis that neither i.v. nor perineurally administered dexamethasone prolongs the sensory block achieved with ropivacaine.Methods
Ultrasound-guided ulnar nerve blocks (ropivacaine 0.75% wt/vol, 3 ml, with saline 1 ml with or without dexamethasone 4 mg) were performed on three occasions in 24 male volunteers along with an i.v. injection of saline 1 ml with or without dexamethasone 4 mg. The combinations of saline and dexamethasone were as follows: control group, perineural and i.v. saline; perineural group, perineural dexamethasone and i.v. saline; i.v. group, perineural saline and i.v. dexamethasone. Sensory block was measured using a VAS in response to pinprick testing. The duration of sensory block was the primary outcome and time to onset of sensory block the secondary outcome.Results
All 24 subjects completed the trial. The median [inter-quartile range (IQR)] duration of sensory block was 6.87 (5.85–7.62) h in the control group, 7.37 (5.78–7.93) h in the perineural group and 7.37 (6.10–7.97) h in the i.v. group (P=0.61). There was also no significant difference in block onset time between the three groups.Conclusion
Dexamethasone 4 mg has no clinically relevant effect on the duration of sensory block provided by ropivacaine applied to the ulnar nerve.Clinical trial registration
DRKS, 00014604; EudraCT, 2018-001221-98. 相似文献2.
Laureano Fernández-Cruz Rebeca Cosa Laia Blanco Sammy Levi Miguel-Angel López-Boado Salvador Navarro 《Journal of gastrointestinal surgery》2007,11(12):1607-1622
Laparoscopic pancreatic surgery (LPS) has seen significant development but much of the knowledge refers to small and benign
pancreatic tumors. This study aims to evaluate the feasibility, safety, and long-term outcome of the laparoscopic approach
in patients with benign, premalignant, and overt malignant lesions of the pancreas. This study, currently, is the largest
single center experience worldwide. One hundred twenty-three consecutive patients underwent laparoscopic pancreatic surgery
from April 1998 to April 2007, 20 patients with cysts or pseudocysts for acute and chronic pancreatitis, laparoscopic pancreatic
drainage was performed, and were excluded from the analysis. The 103 patients were divided based on preoperative diagnosis:
group I, inflammatory tumors for chronic pancreatitis (eight patients); group II, cystic pancreatic neoplasms (29 patients);
group III, intraductal papillary mucinous neoplasms (10 patients); group IV, neuroendocrine pancreatic tumors (NETs) (43 patients);
and group V ductal adenocarcinoma (13 patients). The median tumor size was 5.3 cm. Pathologic data include R
0 or R
1 resection (transection margins on the specimen were inked). Perioperative data, postoperative complications, and resection
modalities were compared using statistical analysis. Long-term outcomes were analysed by tumor recurrence and patient survival.
The overall conversion rate was 7%. Laparoscopic distal pancreatic resection was performed in 82 patients (79.6%). Laparoscopic
spleen-preserving distal pancreatectomy (Lap SPDP) was performed in 52 patients (63.7%), but with splenic vessels preservation
in 22% and without splenic vessels preservation in 41.5%. Laparoscopic en-bloc splenopancreatectomy (Lap SxDP) was performed
in 30 patients (36.6%) and laparoscopic enucleation (Lap En) in 20 patients (19.4%). There was no mortality. The overall complication
rate was 25.2, 16.7, and 40% after Lap SPDP, Lap SxDP, and Lap En, respectively. The overall morbidity rate was significantly
higher (p > 0.05) in the group of Lap SPDP without splenic vessels preservation comparing with Lap SPDP with splenic vessels preservation
because of the occurrence of splenic complications (20.6%). The overall pancreatic fistulas was 7.7, 10, and 35% after Lap
SPDP, Lap SxDP, and Lap En, respectively; the severity of fistula was significantly higher in the Lap En group (p > 0.05). The mean hospital stay was within 1 week in all groups, except in the group of ductal adenocarcinoma, which is 8 days.
In this series, 27 patients (26.2%) had malignant disease. R
0 resection was achieved in 90% of ductal adenocarcinoma and 100% for other malignant tumors. The median survival for ductal
adenocarcinoma patients was 14 months. This series demonstrates that LPS is feasible and safe in benign-appearing and malignant
lesions of the pancreas. 相似文献
3.
Z. Levi R. Hazazi I. Kedar-Barnes E. Hodak E. Gal E. Mor Y. Niv J. Winkler 《American journal of transplantation》2007,7(2):476-479
Little is known about the effects of immunosuppression on patients with hereditary nonpolyposis colorectal cancer (HNPCC). We describe a kidney transplant recipient with unrecognized Muir-Torre syndrome in whom the administration of a tacrolimus-based regimen led to the eruption of multiple sebaceous tumors. The patient was later found to harbor an MSH2 mutation. Switching to a sirolimus-based regimen resulted in arrest of the disease. When the patient was switched back to tacrolimus, new facial lesions rapidly appeared. Switching again to sirolimus resulted again in halting the appearance of new lesions. This finding is in line with the known antiangiogenic activity of sirolimus and reports on the regression of cutaneous Kaposi's sarcoma in kidney transplant recipients switched from another immunosuppressive regimen to sirolimus. Further studies on the potential use of sirolimus for the treatment of de novo tumors in immunosuppressed kidney transplant recipients with HNPCC are warranted. 相似文献
4.
C Cislaghi E Negri C La Vecchia F Levi 《Revue d'épidémiologie et de santé publique》1990,38(3):237-243
A method of graphic representation of time factors in cancer mortality is presented, based on different tonalities of grey applied to the surface of the matrix defined by various age-specific rates. It is illustrated using mortality data from cancers of the mouth or pharynx, oesophagus, larynx and lung in Italian and Swiss males. Progressively more complex regression surface equations are defined, on the basis of two independent variables (age and cohort) and a dependent one (each age-specific rate). General patterns of trends were thus identified, showing important similarities in cohort and period effects, but also noticeable differences in time-related factors in mortality from various neoplasms of the upper digestive and respiratory tract. For instance, there were declines in mortality from cancers of the mouth or pharynx in the oldest age groups, whereas rates were appreciably upwards at younger and middle age, particularly in Italy. Likewise, cancers of the oesophagus and, chiefly, of the larynx were substantially increasing, on a cohort basis, in oldest Italian males. Temporal pattern for laryngeal cancer in Italy was similar to that of lung cancer, thus suggesting that (cigarette) smoking has a greater impact on this cancer site as compared with alcohol. However, it is difficult to explain, on this basis alone, the totally diverging pattern for cancer of the larynx (downwards) and of the lung (upwards) observed among older Swiss males. These examples indicate that trend surface models are a useful summary guide to illustrate and understand the general patterns of age, period and cohort effects in cancer mortality. 相似文献
5.
Mutated recombinant human heavy-chain ferritins and myelosuppression in vitro and in vivo: a link between ferritin ferroxidase activity and biological function. 总被引:5,自引:0,他引:5 下载免费PDF全文
H E Broxmeyer S Cooper S Levi P Arosio 《Proceedings of the National Academy of Sciences of the United States of America》1991,88(3):770-774
Human heavy-chain (H-) ferritin muteins obtained by oligonucleotide site-directed mutagenesis, together with wild-type recombinant human H- and light-chain (L-) ferritins, were evaluated for in vitro effects on the suppression of human bone marrow myeloid progenitor cells and for in vivo effects on marrow and splenic myelopoiesis in C3H/HeJ mice. The 10 H-ferritin muteins exhibited alterations of various regions of the molecule, including ones exposed on the outer surface, on the inner cavity, and on the hydrophilic and hydrophobic channels and of the four-alpha-helix bundle forming the subunit structure. They were stable and were electrophoretically analogous to wild-type H-ferritin. The muteins showed in vitro and in vivo myelosuppressive activity analogous to wild type, except for mutein 222, which was totally inactive and which lacked ferroxidase activity. Recombinant human L-ferritin, devoid of ferroxidase activity, was also inactive as a suppressor. The results demonstrate that H-ferritin myelosuppressive and ferroxidase activities are linked. One possibility is that ferroxidase activity may interfere with the cellular uptake of transferrin iron that is needed for cell proliferation, an interpretation consistent with the presently described ability of hemin to overcome H-ferritin suppressive effects. 相似文献
6.
7.
Superior vena caval obstruction: a 10-year experience 总被引:3,自引:0,他引:3
One hundred and fifty-nine patients with symptoms of superior vena caval obstruction who presented to two major hospitals over a 10-year period, from 1970 to 1979, were reviewed. Lung cancer was the most common histological diagnosis. The most common symptoms were dyspnoea and a feeling of fullness in the head. The most common physical findings were dilatation of the neck or chest wall veins, or oedema of the face and arms. Superior mediastinal widening was the most common radiological abnormality. No significant morbidity was associated with any diagnostic procedure. Only patients with lymphoma had a significantly longer survival period, both from the diagnosis of the disease, and from the onset of the symptoms of superior vena caval obstruction. There is no evidence that superior vena caval obstruction is an absolute medical emergency. Appropriate diagnostic steps should be undertaken to establish the histological diagnosis. The prognosis for some tumour types may be improved by combined modality therapy (chemotherapy plus radiotherapy). 相似文献
8.
M Feinmesser L Tell H Levi 《Audiology : official organ of the International Society of Audiology》1989,28(5):268-271
A longitudinal study was performed on Jewish children with moderately-severe to profound hearing impairment born in Jerusalem during a period of 15 years (1967-1982), and the data on consanguineous matings among their parents were analyzed. These data were estimated in relation to the records obtained in an earlier survey performed on Jewish deaf children during the years 1955-1964. The rate of consanguinity among the parents of hearing-impaired children was much lower in the present survey than in the earlier one in both the Ashkenazi (Central and Eastern European origin) and the non-Ashkenazi (Asian-African origin) group. It is assumed that there is a better understanding of the genetic risk in consanguineous unions, especially when a disability such as hereditary deafness is involved. 相似文献
9.
Deep vein thrombosis and fibrinolysis. Defective urokinase type plasminogen activator release. 总被引:1,自引:0,他引:1
M Levi A W Lensing H R Büller P Prandoni G Dooijewaard S Cuppini J W ten Cate 《Thrombosis and haemostasis》1991,66(4):426-429
In the present study 57 consecutive patients with a first episode of venographically proven deep vein thrombosis were investigated to evaluate the release of tissue-type plasminogen activator (t-PA) and of urokinase-type plasminogen activator (u-PA) in response to DDAVP stimulation as well as the resting plasminogen activator inhibitor (PAI) concentration, comparing this to the results obtained in 66 similar patients with a clinical suspicion of thrombosis but with a normal venogram. All assays were performed without knowledge of the patient's status. Four patients in the deep vein thrombosis-group (7%) had an absent u-PA antigen response upon DDAVP infusion, while a normal response was observed in all control subjects. Patients and controls showed similar increases in t-PA antigen level upon DDAVP. High resting PAI antigen levels were encountered in 5 patients in the deep vein thrombosis-group (9%) and in 6 subjects in the control group (9%). The results from this controlled study indicate that a defective release of u-PA may occur in patients with deep vein thrombosis and may have pathogenetic significance. Furthermore it is concluded that elevation of PAI levels cannot be considered as a specific risk factor for venous thrombosis. 相似文献
10.
A prospective randomized trial of single-agent versus combination chemotherapy in meningeal carcinomatosis 总被引:3,自引:0,他引:3
Forty-four patients with documented meningeal carcinomatosis (small-cell lung carcinoma [SCLC], 29%; breast carcinoma, 25%) were treated in a prospective randomized trial with intrathecal methotrexate (MTX) 15 mg or MTX plus cytosine arabinoside (Ara-C) 50 mg/m2. Most patients received intrathecal hydrocortisone (HC) each treatment to minimize arachnoiditis. Overall response was 55%. Seven patients achieved complete response. Response to MTX was superior to combined MTX/Ara-C, but not significantly so (61% v 45%; P greater than .10). Response was more frequent if drugs were administered via Ommaya reservoir than by lumbar puncture (65% v 48%; P greater than .10). Concurrent radiotherapy to the CNS was associated with significantly better response (73% v 35%; P less than .05). Small-cell lung carcinoma patients showed the best response (69%). Overall median survival for the whole group was 8 weeks, but responders fared better than nonresponders (median survival, 18 v 7 weeks; P less than .05). Nausea and vomiting were the most common toxicities encountered (45%), but rarely proved limiting. An unusual, previously undocumented reaction to intrathecal HC was noted. MTX is moderately effective in nonleukemic meningeal carcinomatosis, but the addition of Ara-C does not appear to improve results. Pretreatment factors did not predict outcome in this trial. 相似文献