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A case report of a 10-year-old child with a central fracture-dislocation of the hip, managed by open reduction is presented, with a long-term result. The rarity of this injury in children is discussed, with the possible complications of inadequate joint congruity and potential growth injury. 相似文献
3.
M M Pinto L H Bernstein R A Rudolph D A Brogan M Rosman 《Archives of pathology & laboratory medicine》1992,116(6):626-631
In our previous study, the combination of the concentrations of carcinoembryonic antigen (CEA) and CA125 and the findings from cytological examination in 189 benign and malignant pleural and peritoneal effusions was useful in the diagnosis/classification of malignant effusions. Sensitivity of CEA (level, greater than 5 ng/mL) was 68%; specificity was 99% for the diagnosis of malignant effusions secondary to carcinoma of the lung, breast, gastrointestinal tract, and mucinous carcinoma of the ovary. Sensitivity of CA125 (level, greater than 5000 U/mL) was 85%; specificity was 96% for the diagnosis of malignant effusions in carcinoma of the ovary, fallopian tube, and endometrium. We now expanded the study to include 840 pleural and peritoneal effusions (benign, n = 520; malignant, n = 320) and analyzed the data by the statistical method of Rudolph and colleagues. Based on new cutoff values, ie, CEA level at 6.3 ng/mL and CA125 level at 3652 U/mL, the sensitivities for detection of malignant effusions secondary to carcinomas of the lung, breast, and gastrointestinal tract and mucinous carcinoma of the ovary varied between 75% and 100%; specificity was 98%. Sensitivity of CA125 for detection of malignant effusions from müllerian epithelial carcinoma was 71%; specificity was 99%. The elevated CEA fluid level alone helped to diagnose malignant effusions of the gastrointestinal tract in 54%, breast in 19%, and lung in 16%. The high CA125 fluid level was predictive of müllerian epithelial carcinoma. Adjunctive use of CEA and CA125 levels in fluid enhances the sensitivity of cytological diagnosis and may be predictive of the primary site in patients who present with carcinoma of an unknown primary source. 相似文献
4.
Randomized trial comparing the Prolene Hernia System, mesh plug repair and Lichtenstein method for open inguinal hernia repair 总被引:8,自引:0,他引:8
Nienhuijs SW van Oort I Keemers-Gels ME Strobbe LJ Rosman C 《The British journal of surgery》2005,92(1):33-38
BACKGROUND: Most surgeons favour the use of a mesh for open inguinal hernia repair as it has a low recurrence rate. Procedures used most frequently are the Lichtenstein method, mesh plug repair and the Prolene Hernia System. The choice of technique may be influenced by the effects on postoperative pain and quality of life. METHODS: A total of 334 patients were allocated blindly and at random to receive one of these three meshes for open hernia repair. Quality of life was assessed with the Short Form 36 and pain by a visual analogue scale 14 days, and 3 and 15 months after surgery. RESULTS: Operative complications were rare and comparable between the groups. Long-term follow-up was completed by questionnaire in 95.8 per cent of patients. There were no significant differences in pain parameters between the three meshes; overall, 43.3 per cent of patients reported some form of groin pain. The severity of the chronic pain correlated with a higher pain score in the first 2 weeks after surgery (P < 0.001). A significant reduction in scores for role emotional (short term) and vitality (long term) quality of life domains was found in patients who had a Lichtenstein repair. CONCLUSION: These short- and long-term results did not show any clinically significant difference in postoperative pain and quality of life between the three types of mesh hernia repair. Severe early postoperative pain reliably predicted the likelihood of persisting chronic groin pain. 相似文献
5.
Zorcolo L Rosman AS Restivo A Pisano M Nigri GR Fancellu A Melis M 《Annals of surgical oncology》2012,19(9):2822-2832
Background
Complete pathologic response (CPR) after neoadjuvant chemoradiotherapy (combined modality treatment, CMT) for rectal cancer seems associated with improved survival compared to partial or no response (NPR). However, previous reports have been limited by small sample size and single-institution design.Methods
A systematic literature review was conducted to detect studies comparing long-term results of patients with CPR and NPR after CMT for rectal cancer. Variables were pooled only if evaluated by 3 or more studies. Study end points included rates of CPR, local recurrence (LR), distant recurrence (DR), 5-year overall survival (OS), and disease-free survival (DFS).Results
Twelve studies (1,913 patients) with rectal cancer treated with CMT were included. CPR was observed in 300 patients (15.6%). CPR and NPR patient groups were similar with respect to age, sex, tumor size, distance of tumor from the anus, and stage of disease before treatment. Median follow-up ranged from 23 to 46?months. CPR patients had lower rates of LR [0.7% vs. 2.6%; odds ratio (OR) 0.45, 95% confidence interval (CI) 0.22?C0.90, P?=?0.03], DR (5.3% vs. 24.1%; OR 0.15, 95% CI 0.07?C0.31, P?=?0.0001), and simultaneous LR?+?DR (0.7% vs. 4.8%; OR 0.32, 95% CI 0.13?C0.79, P?=?0.01). OS was 92.9% for CPR versus 73.4% for NPR (OR 3.6, 95% CI 1.84?C7.22, P?=?0.002), and DFS was 86.9% versus 63.9% (OR 3.53, 95% CI 1.62?C7.72, P?=?0.002).Conclusions
CPR after CMT for rectal cancer is associated with improved local and distal control as well as better OS and DFS. 相似文献6.
H. T. Brandsma B. M. E. Hansson T. J Aufenacker D. van Geldere F. M. van Lammeren C. Mahabier P. Steenvoorde T. S. de Vries Reilingh R. J. Wiezer J. H. W. de Wilt R. P. Bleichrodt C. Rosman 《Hernia》2016,20(4):535-541
Purpose
Parastomal hernia (PSH) is a common complication after colostomy formation. Recent studies indicate that mesh implantation during formation of a colostomy might prevent a PSH. To determine if placement of a retromuscular mesh at the colostomy site is a feasible, safe and effective procedure in preventing a parastomal hernia, we performed a multicentre randomized controlled trial in 11 large teaching hospitals and three university centres in The Netherlands.Methods
Augmentation of the abdominal wall with a retromuscular light-weight polypropylene mesh (Parietene Light?, Covidien) around the trephine was compared with traditional colostomy formation. Patients undergoing elective open formation of a permanent end-colostomy were eligible. 150 patients were randomized between 2010 and 2012. Primary endpoint of the PREVENT trial is the incidence of parastomal hernia. Secondary endpoints are morbidity, pain, quality of life, mortality and cost-effectiveness. This article focussed on the early results of the PREVENT trial and, therefore, operation time, postoperative morbidity, pain, and quality of life were measured.Results
Outcomes represent results after 3 months of follow-up. A total of 150 patients were randomized. Mean operation time of the mesh group (N = 72) was significantly longer than in the control group (N = 78) (182.6 vs. 156.8 min; P = 0.018). Four (2.7 %) peristomal infections occurred of which one (1.4 %) in the mesh group. No infection of the mesh occurred. Most of the other infections were infections of the perineal wound, equally distributed over both groups. No statistical differences were discovered in stoma or mesh-related complications, fistula or stricture formation, pain, or quality of life.Conclusions
During open and elective formation of an end-colostomy, primary placement of a retromuscular light-weight polypropylene mesh for prevention of a parastomal hernia is a safe and feasible procedure.The PREVENT trial is registered at: http://www.trialregister.nl/trialreg/admin/rctview.asp?TC=2018.7.
Background: There is a growing interest in the use of local anaesthesia for inguinal hernia repair. It certainly seems to
be an acceptable alternative for the elderly. Supporting intravenous sedation, however, still requires monitoring, anaesthetic
personnel and some preparations for the patient. Therefore we set up a feasibility study of hernia repair under local anaesthesia
without intravenous sedation or monitoring in elderly patients. Method: A total of 62 patients (aged 65 years or more) with
unilateral inguinal hernia received a Mesh Plug Repair. Prospectively collected data included procedure-related complications
and information on pain and quality of life as measured by Short Form 36. Results: No procedure-related complications were
noted. Comparing the preoperative scores, the SF-36 on day 14 (n=61) did not differ significantly. After a median follow-up of ten months (n=54), significantly higher scores were found for scales of physical and emotional role and pain (all p<0.05). Twenty-two patients reported some form of pain (40.7%). 94.4% of the patients would recommend the procedure when asked.
Conclusion: The results of this study indicated that Mesh Plug Repair performed under unmonitored local anaesthesia with no
intravenous sedation is a feasible alternative for elderly patients. It has advantages for the medical organization without
disadvantages for the patient. 相似文献
8.
Colonoscopic perforations: a review of 30,366 patients 总被引:2,自引:0,他引:2
Background Although the incidence of perforation after endoscopic procedures of the colon is low, the rising number of procedures could
pose relevant health problems. Recognizing risk factors and optimizing treatment may reduce perforation incidence and the
probability of (severe) complications. This study aimed to determine perforation frequency and the management of endoscopic
colonoscopic perforation.
Methods A retrospective review of patient records was performed for all patients with iatrogenic colonic perforations after sigmoido/colonoscopy
between 1990 and 2005. The patients’ demographic data, endoscopic procedural information, perforation location, therapy, and
outcome were recorded.
Results In the 16-year period, 30,366 endoscopic colonic procedures were performed. In total, 35 colonic perforations occured (0.12%).
All the patients underwent a laparotomy: for primary repair in 18 cases (56%), for resection with anastomosis in 8 cases (25%),
and for resection without anastomosis in 6 cases (19%). In three patients (8.6%), no perforation was found. The postoperative
course was uncomplicated in 21 cases (60%) and complicated in 14 cases (40%), including mortality for 3 patients (8.6% resulting
from perforations and 0.01% resulting from total endoscopic colon procedures). The relative risk ratio of colonoscopic and
sigmoidoscopic procedures for perforations was 4. Therapeutic procedures show a delay in presentation and diagnosis compared
with diagnostic procedures. Of the 35 perforations, 26 (74%) occurred in the sigmoid colon.
Conclusion Iatrogenic colonic perforation is a serious but rare complication of colonoscopy. A perforation risk of 0.12% was found. The
perforation risk was higher for colonoscopic procedures than for sigmoidoscopic procedures. The sigmoid colon is the area
at greatest risk for perforation. Immediate operative management, preferably primary repair and sometimes resection, appears
to be a good strategy for most patients. 相似文献
9.
Meghan Milburn MD Martin Rosman MD Charles Mylander PhD Lorraine Tafra MD FACS 《The breast journal》2013,19(4):357-364
Oncotype DX has been criticized for not providing significantly more prognostic information than histopathologic analysis. Oncotype DX was validated in cohorts that included poor prognostic factors (HER2‐positive, low‐estrogen receptor [ER] expression), raising the question: if patients with known high recurrence rates are excluded, is the Recurrence Score (RS) still valid? Our purpose was to determine if RS can be predicted with readily available measures. One hundred and twenty samples from August 2006 to November 2010 that underwent Oncotype DX testing were analyzed. Data included RS, ER, progesterone receptor (PR), HER2, and Ki67 status by immunohistochemistry (IHC). IHC data were used to create two linear regression models to predict RS. SAS's JMP‐7 was used for statistical analysis. When comparing Oncotype DX‐ and IHC‐derived ER and PR values, there were 21 discordant samples. The linear regression model PRS‐F created with IHC data (ER, PR, HER2, Ki67) from all samples (n = 120) had an adjusted R2 = 0.60 indicating a good model for predicting RS. The PRS‐R model was built without low‐ER and HER2‐positive samples (n = 110). It had an adjusted R2 = 0.38 indicating poor prediction of RS. Oncotype DX data showed good concordance with IHC for ER‐ and PR‐expression in this cohort. Low‐ER samples had high RS. After removing low‐ER and HER2‐positives, calculating RS with PRS‐R from remaining data showed poor predictive power for RS (adjusted R2 = 0.38). This result questions whether RS is prognostic in this subgroup (who would most benefit from further clarification of recurrence risk) and independent of pathology, or is simply producing random RS values. Data bases available to Genomic Health can resolve this issue. 相似文献
10.