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1.
Daisuke Kubota Chizuru Takishima Ken-ichi Ishii Takahiro Kawamura Tomoko Matsumoto Yasuhiro Itsui Eriko Okada Seishin Chin Shinya Oooka Kiichiro Tsuchiya Akihiro Araki Naoya Sakamoto Tatsuya Miyata Takanori Kanai Mamoru Watanabe 《Nihon Shokakibyo Gakkai zasshi》2006,103(9):1044-1049
A 23-year-old man was admitted for treatment of acute exacerbation of ileitis and perianal abscess caused by Crohn's disease. After incision and drainage of the abscess, coupled with antibiotic therapy, 6-mercaptopurine (6-MP) was commenced. His white blood cell (WBC) count on day 12 after initiation of 6-MP was not decreased. However, on day 24 he was re-admitted because of severe myelosuppression (WBC: 300/microl), which was complicated by the recurrence of the perianal abscess. Myelosuppression was prolonged and required the administration of granulocyte colony stimulating factor (G-CSF). G-CSF was continued for 17 days to achieve recovery of his WBC count to a normal level. 相似文献
2.
Hung-Yen Chin Min-Chi Chen Yu-Hung Liu Kuo-Hwa Wang 《International urogynecology journal》2006,17(6):631-635
The aim of this study was to assess the impact of delivery on the pelvic floor and whether cesarean section (C/S) can prevent pelvic floor injury. Five hundred thirty nine women were divided into three groups according to the delivery method adopted: elective C/S, emergent C/S, and vaginal delivery. A urinary incontinence questionnaire survey was conducted around 1 year postpartum. Emergent C/S may be a major risk factor for postpartum urinary incontinence and interfere with the benefit of elective C/S for preventing pelvic floor injury. Hence, not all C/S deliveries can reduce the likelihood of postpartum urinary incontinence. The key lies in whether the C/S is performed before labor. 相似文献
3.
Outcomes at 3 years of a prospective pilot study of Campath-1H and sirolimus immunosuppression for renal transplantation 总被引:2,自引:0,他引:2
Rolf N. Barth Christina A. Janus Christine A. Lillesand Nancy A. Radke John D. Pirsch Bryan N. Becker Luis A. Fernandez L. Thomas Chin Yolanda T. Becker Jon S. Odorico Anthony M. D''Alessandro Hans W. Sollinger Stuart J. Knechtle 《Transplant international》2006,19(11):885-892
Campath-1H (alemtuzumab) induction was used for renal transplantation in combination with sirolimus as immunosuppression. We previously reported a high (28%) rate of early rejection with this regimen, and now report 3-year outcomes. Twenty-nine patients were recipients of either deceased donor or non-HLA (Human Leukocyte Antigen) identical living donor primary renal allografts. Clinical parameters including infection, malignancy, kidney function, and kidney histology were followed prospectively for 3 years. Three-year cumulative graft and patient survival were 96% and 100%, respectively. Twenty patients were maintained on steroid-free immunosuppressive regimens, and 15 patients were maintained on monotherapy for immunosuppression (12 on sirolimus). No serious infectious complications were observed and two patients developed basal cell skin cancer. The 3-year results of our initial pilot study demonstrate good graft (96%) and patient (100%) outcomes. Campath-1H induction has yielded a high proportion of patients maintained on immunosuppressive monotherapy (57%) without serious infectious- and no malignancy-related complications. The reported regimen yielded novel insights into both Campath-1H and sirolimus therapy in renal transplantation. Because of the higher incidence of early rejection, we recommend a modified strategy of immunosuppression including a brief course of a calcineurin inhibitor. 相似文献
4.
Abstract: Background: Identification of risk drinking in expectant fathers may be helpful as an important part of efforts to minimize maternal alcohol use, and as an opportunity to inform them about a problematic practice during a critical developmental stage for the couple. The purpose of this study was to evaluate the T‐ACE screening questionnaire, which asks about t olerance to alcohol, being a nnoyed by other's comments about drinking, attempts to c ut down, and having a drink first thing in the morning (“ e ye‐opener”), in the male partners of pregnant women who themselves were T‐ACE positive. Methods: Two hundred fifty‐four male partners were asked to complete the T‐ACE embedded in a health survey, the Alcohol Use Disorders Identification Test (AUDIT), and other questions about their alcohol use in the past 30 days when their pregnant partners had a median gestation of 11.5 weeks (T1). After delivery, male partners again completed the T‐ACE and quantity‐frequency questions (T2). The predictive ability of the T‐ACE and AUDIT was compared, using risk drinking (>4 drinks/day or >14 drinks/week) as the criterion standard. Results: A substantial minority of male partners had risk drinking, 31 percent at T1 and 25 percent at T2. Although the AUDIT was better than the T‐ACE as an independent predictor of risk drinking, the latter was most accurate when the tolerance threshold exceeded 2 drinks, the same established for pregnant women. The sensitivity (T1 = 84.6%, T2 = 82.8%) and specificity (T1 = 43.8%, T2 = 51.1%) of the T‐ACE at this threshold compared favorably with those of the AUDIT at the standard cut point of 8. Conclusions: The T‐ACE may be a practical way for clinicians to identify risk drinking in both pregnant women and expectant fathers. (BIRTH 33:2 June 2006) 相似文献
5.
丹尼尔·秦 《中华医学教育杂志》2002,(4):3
<西太平洋地区本科医学教育指导原则>为医学院校提供了基准和质量改进的努力方向,并将有助于实现可持续的课程改革.本次会议将是中国在改善本科医学教育质量上迈出的重要一步.世界卫生组织愿与中国政府合作并提供支持. 相似文献
6.
Oren N Gottfried Steven Chin H Christian Davidson William T Couldwell 《Skull base》2007,17(5):317-324
The authors present a case of amyloid infiltration involving the trigeminal nerve that mimicked a malignant cavernous sinus tumor with perineural tumor infiltration. A 64-year-old man presented with trigeminal nerve numbness. Imaging revealed a plaque-like enhancing lesion along the right lateral cavernous sinus extending anteriorly into Meckel's cave and involving the proximal V2 and V3 branches of the trigeminal nerve. The patient underwent an extradural frontotemporal craniotomy with middle fossa exposure of the cavernous sinus to diagnose and treat the presumed malignant cavernous sinus tumor. A reddish mass involving the lateral dural wall of the cavernous sinus was resected. The gasserian ganglion, V2, and V3, the latter of which was biopsied, were enlarged. Permanent histopathological studies showed microscopic eosinophilic, amorphous material, which stained positive for Congo red, and an absence of neoplastic cells. The final diagnosis was amyloidoma. Thus, amyloidomas can involve the trigeminal nerve or ganglia and should be considered in the differential diagnosis of a cavernous sinus lesion mimicking a tumor. Patients may have symptomatic improvement of trigeminal neuropathy with resection of the amyloidoma outside the nerve capsule that is compressing the nerve, while resection of the lesion from within the capsule may result in permanent trigeminal nerve dysfunction. 相似文献
7.
8.
Daisuke Kubota Takanori Kanai Fumiro Yui Tomoko Matsumoto Takahiro Kawamura Yasuhiro Itsui Eriko Okada Seishin Chin Shinya Ooka Masakazu Nagahori Kiichiro Tsuchiya Akihiro Araki Naoya Sakamoto Tatsuya Miyata Mamoru Watanabe 《Nihon Shokakibyo Gakkai zasshi》2007,104(1):42-46
A 44-year-old women developed marked myopathy one year earlier, when she was treated with intravenous prednisolone for acute severe exacerbation of ulcerative colitis. When she was admitted to our hospital for another severe exacerbation, intravenous cyclosporine A was administered as monotherapy because she could not tolerate corticosteroid. The treatment was successful and she obtained complete remission. Cyclosporine A monotherapy is considered to be a valuable alternative to proctocolectomy for severe ulcerative colitis patients who cannot tolerate corticosteroid. 相似文献
9.
The authors present the case of a 43-year-old women who underwent a laparoscopic gastric bypass in 2003 for morbid obesity.
They report that 2 years later, she had maintained significant weight loss, but had developed acute abdominal pain, followed
by nausea and emesis. In the emergency room, she had diffuse tenderness, tachycardia, and leukocytosis. After initial resuscitation,
a computed tomography was performed, which showed free air above the liver and thickened small bowel loops. She was brought
emergently to the operating room for laparoscopy. At surgery, turbid fluid and inflamed small bowel loops were seen. A perforated
marginal ulcer was discovered in the Roux limb, approximately 2 cm distal to the gastrojejunal anastomosis. The perforation
was oversewn primarily and patched with omentum. The repair was tested by intraoperative endoscopy. A gastrostomy tube also
was placed within the gastric remnant for enteral access. The patient did extremely well postoperatively, and had an uneventful
postoperative course. She was discharged on postoperative day 4. The gastrostomy tube was removed at 1 month, and at this
writing, she remains well since surgery. An upper endoscopy at 2 months was completely normal, and the Helicobacter pylori test results were negative. The gastric pouch had not significantly enlarged since initial surgery, as indicated by both
endoscopy and barium study. Marginal ulcer is reported to be 0.6% to 16% after laparoscopic gastric bypass [1]. Etiologies include gastrogastric fistula, excessively large gastric pouch containing antral mucosa, H. pylori infection, nonsteroidal antiinflammatory use, and smoking [2]. Unfortunately, none of these applied to the reported patient. Because her exact etiology remains unknown, she at this writing
continues to receive proton pump inhibitor therapy.
Electronic supplementary material The online version of this article (doi: ) contains supplementary material, which is available to authorized users. 相似文献
10.
The goal of the present study is to develop a technique for laparoscopic aortobifemoral bypass.Piglets weighing between 60 and 78 kg were anesthetized with halothane. The lateral retroperitoneal approach was preferred to the more familiar anterior transperitoneal approach and was successfully completed in 19 piglets. The piglets were placed in the right lateral decubitus position. The first port (2 cm) was inserted halfway between the tip of the 12th rib and the iliac crest. Four other trocars were placed in the retroperitoneum after balloon inflation had allowed creation of a space which permitted visualization of the aorta from the left renal artery down to the aorto-iliac junction. After evacuation of the retropneumoperitoneum, the cavity was maintained using an abdominal lift device and a retractor.Using this approach, we performed four aortobifemoral bypasses (end-to-end aortic anastomosis) after conventional intravenous heparinization (100 IU/kg) in less than 4 h. Blood loss did not exceed 250 ml and the hematocrit remained stable. Postmortem evaluation of the grafts revealed they were positioned as in a conventional bypass, their limbs having followed in the created retroperitoneal tunnels along the path of the native arteries. No mortality occurred before sacrifice of the animals. We believe that this first performed series of totally retroperitoneal laparoscopic aortobifemoral bypasses in the porcine model is useful in preparation for human application due to the anatomical similarities in the periaortic region. 相似文献