迁移性咽和颈段食管异物4例

目的：探讨迁移性咽和颈段食管异物的临床特征、诊断及治疗方法。方法：对位于腔壁内的异物，应尽量选用内镜下切开黏膜取出；若异物已移至腔外，则采用颈侧切开术。结果：4例患者均顺利取出异物，3例无并发症发生，1例声带麻痹。结论：颈部薄层CT扫描是证实异物迁移的重要手段，并对手术时定位异物有重要价值；食入异物出现迁移者，可产生致命性并发症，应及时处理。     

Factors related to sexual health in Chinese women with breast cancer in Hong Kong

Aim: To examine the association between a broad array of characteristics and sexuality in breast cancer patients in Hong Kong. Method: We collected data on demographic and clinical factors, psychosocial well‐being, quality of life (QOL), body image and sexual health of breast cancer patients presented to the Department of Clinical Oncology, Prince of Wales Hospital from November 2005 to February 2006. Results: More than 40% of Chinese breast cancer patients experienced moderate problems in sexual health. Their medical treatment had a greater influence on their sexual functioning in a change in their social activities, whereas more support from their partner predicted less influence. The presence of a child and more support from their partner predicted greater sexual satisfaction. Undergoing the menopause related to a longer time to resume sexual activity after cancer treatment. A change of relationship with their partner and a loss of self‐confidence were strong predictors of sexual problems influencing their QOL. Patients who had experienced a change in their relationship with their partner or had greater sexual problems were more likely to perceive greater benefit from professional intervention on sexual problem. Conclusion: An improvement in their intimate relationships and enhanced psychosocial functioning should improve the sexual health of Chinese women with breast cancer.     

Malfunction of an Active Fixation J-Shaped Screw-In Atrial Electrode Lead: A Case Report

Active fixation leads, using active grasping devices, ensure good postoperative lead fixation, long-term performance, and make possible later lead removal on demand. However, these delicate designs have not been without practical difficulties. We present two cases of fixation stylet fracture during helix extension and retraction maneuver respectively with resultant lead inoperability and abandonment. The fixed leads could be removed by torquing the entire lead counterclockwise.     

FUNCTION OF THE HYPOTHALAMO-HYPOPHYSIAL-THYROID AXIS IN CHRONIC RENAL FAILURE

Hypothalamo-hypophysial-thyroid function has been studied in twenty-five patients with chronic renal failure. Eight were receiving conservative treatment, nine peritoneal dialysis and eight haemodialysis. All were clinically euthyroid. Total thyroxine (T4) and triiodothyronine (T3) levels were reduced but free T4 levels were normal, while free T3 was reduced in patients with the most severe renal failure. It is suggested that the binding of thyroid hormones by the transport proteins is reduced and that peripheral conversion of T4 to T3 is impaired in renal failure. The thyrotrophin response to thyrotrophin-releasing hormone (TRH) is reduced in renal failure but this reduction is probably independent of alterations in thyroid hormone metabolism. Growth hormone was released by TRH in seven of the patients studied, possibly as a result of protein malnutrition.     

Hand-assisted laparoscopic and open living donor nephrectomy in Korea

BACKGROUND: We compared the results of hand-assisted laparoscopic living donor nephrectomy (LLDN) and conventional open living donor nephrectomy (OLDN). METHODS: The clinical data on 49 hand-assisted LLDN and 21 OLDN on the left side performed at two institutions in Korea from January 2001 to February 2003 were reviewed. Demographic data of donors and recipients were similar in the two groups. RESULTS: There was one conversion to an open procedure due to bleeding in the LLDN group. The median operation times (180 min in LLDN versus 170 min in OLDN) and warm ischemic times (2.5 min in LLDN versus 2.0 min in OLDN) in the two groups were similar. The estimated mean blood loss, duration of hospital stay and complication rate was also similar in the two groups. The LLDN group reported less pain (visual analog scale) postoperatively (4.1 versus 5.3), but this was not significant (P=0.058). The time to oral intake in the LLDN group was significantly longer by an average of 1 day (P=0.001). Return to work was sooner in the LLDN group (4.0 weeks versus 6.0 weeks; P=0.026). The recipient graft function was equivalent between the two groups. Hand-assisted LLDN appears to be a safe and effective alternative to OLDN. CONCLUSION: Our findings suggest that this technique may give the ability provide grafts of similar quality to OLDN, while extending to the donors the advantages of a traditional LLDN procedure.     

Long-Term Clinical Outcomes and Stent Thrombosis of Sirolimus-Eluting Versus Bare Metal Stents in Patients with End-Stage Renal Disease: Results of Korean Multicenter Angioplasty Team (KOMATE) Registry

Background: There are still controversies about long-term clinical outcomes of sirolimus-eluting stents (SES) versus bare metal stents (BMS) implantation in patients with end-stage renal diseases (ESRD).
Objective: To compare long-term outcomes in patients with (ESRD) following SES versus BMS implantation.
Methods: Between March 2003 and July 2005, a total of 54 patients (80 lesions) with ESRD undergoing SES implantation [SES-ESRD] were enrolled and compared with 51 patients (54 lesions) with ESRD receiving BMS during the same periods [BMS-ESRD] in the Korean Multicenter Angioplasty Team Registry. The primary outcome was the composite of death, myocardial infarction (MI), or any stent thrombosis (ST) according to the Academic Research Consortium definition during a 3-year follow-up.
Results: The cumulative 3-year rate of composite of death, MI, or ST of the SES-ESRD group (24%) was nearly similar with that of the BMS-ESRD group (24%, P = 1.000). The 3-year rates of death (26% vs. 24%, P = 0.824) or MACE (37% vs. 43%, P = 0.331) in the SES-ESRD did not differ significantly from those in the BMS-ESRD. However, the SES-ESRD showed a sustained lower 3-year TVR rate (9%), compared with BMS-ESRD (24%, P = 0.042). The rate of any ST in SES-ESRD was not significantly higher than that in the BMS-ESRD (17% vs. 14%, P = 0.788). There was no significant difference in the rate of late or very late ST between SES-ESRD (15%) versus BMS-ESRD group (10%, P = 0.557).
Conclusions: SES did not increase the risks for death, MI, or any ST in patients with ESRD during the long-term follow-up, compared with BMS.     

Efficacy of Dose Escalation of Tamsulosin for the Treatment of Lower Urinary Tract Symptoms

Objectives: The aim of this study was to compare the efficacy of low (0.2 mg) and intermediate (0.4 mg) dose tamsulosin in treating lower urinary tract symptoms (LUTS). Methods: Patients were treated with low‐dose tamsulosin for an initial run‐in period of 12 weeks, then divided into two groups based on their clinical improvement. Patients were measured for objective parameters of peak flow rate and postvoid residual urine volume, as well as subjective symptom scores and perceived patient benefit of treatment. The items were then integrated as the LUTS Outcome Score to determine dose increase or maintenance. Overall outcome was determined at 36 weeks. Results: One hundred and seventy‐four patients were enrolled and started on 0.2 mg tamsulosin treatment. One hundred and fifty‐five patients completed the 36‐week study. Sixty patients required dose increase to 0.4 mg at the 12th week. Baseline characteristics showed that a patient who would benefit from 0.4 mg dosage had higher age, daytime frequency, and lower peak urine flow rate. Patients receiving both 0.2 and 0.04 mg both showed improved clinical outcome measures. Higher improvement was found in voiding component symptom scores and urine flow rate improvement in patients receiving an increased dose. Conclusion: Both low‐ and intermediate‐dose tamsulosin are effective treatment regimens. Increasing from low to intermediate dose should follow assessment of both objective and subjective improvements.