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1.
Hyun Jong Choi Jong Ho Moon Yun Nah Lee Hyun Su Kim Ji Su Ha Tae Hoon Lee Sang‐Woo Cha Young Deok Cho Sang‐Heum Park 《Digestive endoscopy》2015,27(7):772-775
Direct peroral cholangioscopy (POC) using an ultra‐slim upper endoscope is one modality of POC for intraductal endoscopic evaluation and treatment of the bile duct. Choledochoduodenostomy (CDS) is one modality of biliary bypass surgery that provides a new route to the bile duct. We carried out direct POC using an ultra‐slim upper endoscope without the use of accessories in 10 patients (four sump syndromes, three bile duct strictures and three intrahepatic duct stones) previously undergoing surgical CDS. Direct POC was successful in all patients. The use of an intraductal balloon catheter was required in one patient for advancement of the endoscope into the bile duct. Distal bile ducts with sump syndromes were cleared using baskets and water irrigation under direct POC. Cholangiocarcinoma was diagnosed in one patient with hilar bile duct stricture after cholangioscopic evaluation and a targeting forceps biopsy under direct POC. Intrahepatic duct stones were successfully extracted after intraductal fragmentation under direct POC. Oozing bleeding occurred during intraductal lithotripsy but stopped spontaneously. Direct POC using an ultra‐slim upper endoscope without the assistance of accessories can easily be carried out in patients undergoing CDS. 相似文献
2.
Comparative outcomes of vascular access in patients older than 70 years with end-stage renal disease
Deokbi Hwang Sujin Park Hyung-Kee Kim Seung Huh 《Journal of vascular surgery》2019,69(4):1196-1206.e5
Objective
The advantage of arteriovenous fistulas (AVFs) in older patients requiring dialysis is controversial. We reviewed our vascular access experience in patients ≥70 years of age (older group) compared with younger patients.Methods
We analyzed consecutive patients who underwent access surgery between 2013 and 2016. Primary success (PS) and primary patency (PP) data were analyzed between the older and younger groups before and after propensity score matching of the patients' characteristics and access composition. PS was defined as the achievement of access function that was amenable to two sessions of successful cannulation without early occlusion or maturation failure requiring revision. PP was defined as the time with uninterrupted patency without intervention.Results
A total of 594 consecutive accesses were created among 563 patients, of whom 119 were allocated into each group after propensity score matching. In the whole cohort, 193 accesses (32.5%) were performed in older patients. AVFs were performed in 130 (67.4%) older patients and 293 (73.1%) younger patients. Regarding AVFs, the PS rate (83.6% in the older group vs 94.3% in the younger group; P = .001) and the overall PP at 6 and 12 months (73.1% and 57.1%, respectively, in the older group vs 86.7% and 77.7%, respectively, in the younger group; P = .009) were lower in the older group than in the younger group. However, no differences were found in the PS and PP rates for arteriovenous grafts between groups. Regarding the AVF location, the PS rate for forearm AVFs was significantly lower in the older group than in the younger group (76% vs 93%; P < .001); however, the PS rate of the upper arm was not different between the groups (94% vs 97%; P = .425). In the patients with PS, the PP rate of AVFs was similar between the two groups. In the older group with forearm AVFs, the median diameter of the radial artery was larger in the patients with PS than in the patients without PS (2.20 mm with PS vs 2.00 mm without PS; P = .008). The propensity score matching results demonstrated similar trends for the whole cohort, with lower PS (P = .042) and PP rates (P = .023) for AVF in the older group.Conclusions
The outcomes after AVF were poorer in the older group than in the younger group, which was primarily due to unsatisfactory outcomes in patients with forearm AVFs. Thus, stricter criteria, especially regarding the radial artery diameter, should be applied for forearm AVFs in older patients, and additional research is necessary to delineate the risk factors for primary failure. 相似文献3.
4.
Post-transplantation diabetes is better controlled after conversion from prednisone to deflazacort: a prospective trial in renal transplants 总被引:2,自引:0,他引:2
Yu Seun Kim Myoung Soo Kim Soon Il Kim Seung Kil Lim Ho Yung Lee Dae Suk Han Kiil Park 《Transplant international》1997,10(3):197-201
It is well known that long-term use of steroids plays a decisive role in the development of glucose intolerance and diabetes
mellitus (DM). Deflazacort, an oxazoline derivative of prednisolone, has been introduced as a potential substitute for conventional
steroids in order to ameliorate glucose intolerance. We initiated a randomized study of conversion from prednisone to deflazacort
in kidney transplantation (Tx) recipients presenting with pre-Tx or post-Tx DM to ascertain whether or not the switch to deflazacort
would ameliorate the diabetic state. Forty-two recipients in the conversion group were compared with 40 patients on prednisone
(the control group) in a prospective manner. The dose reduction of insulin or oral blood glucose-lowering agents, the adequacy
of glucose control, and the development of side effects were the criteria for evaluating outcome. In the conversion group,
patients were switched to deflazacort at a dose ratio of 6 mg deflazacort to 5 mg prednisone. During the mean follow-up period
of 13.2 months, neither graft dysfunction nor acute rejection developed in the conversion group. Improvement in blood glucose
control in the conversion group was noted. When the conversion group was stratified into pre- or post-Tx DM, promising effects
were clearly evident in the post-Tx DM patients. More than 50 % dose reduction of blood glucose-lowering agents was possible
in 42.3 % of post-Tx DM patients. In conclusion, it was readily possible to control blood glucose better in post-Tx DM recipients
without seriously affecting the immunosuppressive activity after conversion to deflazacort.
Received: 20 August 1996 Received after revision: 25 November 1996 Accepted: 6 December 1996 相似文献
5.
6.
Detailed Diurnal Rhythm of Sensitivity to Melatonin Injections in Turkish Hamsters, Mesocricetus brandti 总被引:1,自引:0,他引:1
A diurnal rhythm of sensitivity to exogenous melatonin was defined in adult male Turkish hamsters, Mesocricetus brandti. Melatonin was administered daily by subcutaneous injections (15 micrograms in 0.1 ml 10% ethanolic saline) for 10 weeks in animals exposed to 16 L:8 D. As in golden and Djungarian hamsters, two periods of melatonin sensitivity were identified. The first, in late afternoon, persisted for 6 hr, from 7 hr to 1 hr before lights off. The second period was briefer, of only 2 hr duration in the late night, terminating at the time of lights on. Melatonin injections given during these sensitive periods promoted testicular regression in most animals; melatonin administered at other times of the day was without effect on testicular function in most animals of these groups. Gonadal regression induced by properly timed melatonin injections was rapid, in many groups nearly complete in 6 to 7 weeks. The results are discussed in relation to the function of pineal melatonin in photoperiodic time measurement in hamsters. 相似文献
7.
Seung Min Lee Seung Kyung Hann Soo II Chun Seung Hung Lee Yoon-Kee Park 《The Journal of dermatology》1994,21(2):106-110
A 25-year-old female has had brown to erythematous telangiectatic patches and grouped papules on her face, neck, arm, and trunk since childhood following B.C.G. vaccination. Histopathologically, the lesions consisted of hyperkeratosis, slight acanthosis, tuberculoid granulomas with some Langerhans type giant cells in the mid-dermis. Although various forms of cutaneous tuberculosis after B.C.G. vaccination have been reported, it was difficult for us to assign the patient's skin lesion to any specific disease entity. Remission of her cutaneous lesions occurred clinically and histopathologically after treatment with isoniazid and rifampin. 相似文献
8.
A technique to repair clefts of the primary palate is described. This technique is a combination of several surgical methods previously reported to which some modifications have been added. The advantages of this technique are compared with those associated with other surgical methods. A more natural result is obtained with this technique: The undesirable vestibular fistula is avoided and a deeper buccal sulcus is achieved. The criteria in the management of the nose and orbicular muscle is analyzed. 相似文献
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