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1.
H J Kim C H Kang Y T Kim S-W Sung J H Kim S M Lee C-G Yoo C-T Lee Y W Kim S K Han Y-S Shim J-J Yim 《The European respiratory journal》2006,28(3):576-580
Although surgical lung resection could improve prognosis in some patients with multidrug-resistant tuberculosis (MDR-TB), there are no reports on the optimal candidates for this surgery. The aim of the present study was to elucidate the prognostic factors for surgery in patients with MDR-TB. Patients who underwent lung resection for the treatment of MDR-TB between March 1993 and December 2004 were included in the present study. Treatment failure was defined as greater than or equal to two of the five cultures recorded in the final 12 months of treatment being positive, any one of the final three cultures being positive, or the patient having died during treatment. The variables that affected treatment outcomes were identified through univariate and multivariate logistic regression analysis. In total, 79 patients with MDR-TB were included in the present study. The treatment outcomes of 22 (27.8%) patients were classified as failure. A body mass index <18.5 kg x m(-2), primary resistance, resistance to ofloxacin and the presence of a cavitary lesion beyond the range of the surgical resection were associated with treatment failure. Low body mass index, primary resistance, resistance to ofloxacin and cavitary lesions beyond the range of resection are possible poor prognostic factors for surgical lung resection in multidrug-resistant tuberculosis patients. 相似文献
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3.
Kyu-Won Shim Tae-Gon Kim Chang-Ok Suh Jae-Ho Cho Chul-Joo Yoo Joong-Uhn Choi Jung-Hee Kim Dong-Seok Kim 《Child's nervous system》2007,23(10):1155-1161
Object A radiation dose of 40–50 Gy is able to produce a cure rate of more than 90% in intracranial pure germinoma. However, many
attempts have been made to reduce the dose and volume of radiation without compromising the disease control rate because of
the toxicity of irradiation. This retrospective study is intended to provide the physician with an appropriate therapeutic
strategy.
Materials and methods We reviewed a series of 10 recurrent germinomas among 117 germinomas diagnosed histologically or clinically between 1979 and
2002. These patients involved underwent three different treatment modalities; radiation alone (N = 71), chemotherapy alone (N = 9), and combined therapy (N = 37). The 10-year overall and relapse-free survival rates were 97 and 93% in the radiation alone group, 89 and 67% in the
chemotherapy alone group, and 92 and 92% in the combined therapy group, respectively. As expected, both radiation therapy
and combined therapy were effective in controlling the disease. Tumor recurrence was closely related to the volume of radiation
but not to the dose of radiation. If the tumor bed and craniospinal axis were fully covered, the radiation dose might be reduced.
Chemotherapy alone showed earlier recurrence and a higher tumor recurrence rate. In the case of combined therapy, chemotherapy
was useful in reducing the radiation dose but revealed some toxicity (death of two patients).
Conclusions The investigation of a possible further dose reduction seems worthwhile. Radiation therapy alone with a dose of less than
40 Gy should be compared with ongoing chemotherapeutic protocols combined with low-dose irradiation. 相似文献
4.
A. P. C. Yim 《Surgical endoscopy》1995,9(11):1184-1188
The author reports his personal experience on the management of anterior mediastinal masses using video-assisted thoracoscopic surgery (VATS) at a single institution. From August 1993 to March 1995, 24 patients (14 males and 10 females ranging in age from 9 to 76 years old) with anterior mediastinal masses were diagnosed or treated by VATS. This consisted of 11 biopsies and 13 resections (11 thymectomies and 2 thymic cystectomies). Seven biopsies were performed for primary histological diagnosis (four non-Hodgkin's lymphoma, two metastatic carcinoma, one yolk sac tumor) and four biopsies were performed to detect residual tumors following chemotherapy. Complete thymectomy was accomplished in all 11 cases by examination of the thymic bed and resected specimen. We have reserved this approach for resection of benign masses only. Adequate biopsy for histological diagnosis was obtained in all 11 cases to guide further management. There was no surgical mortality or intraoperative complications. The median postoperative hospital stay for the entire group was 3 days. We conclude that VATS for resection or biopsy of an anterior mediastinal mass is technically feasible and provides an alternative to the conventional approaches in selected patients. 相似文献
5.
A. P. C. Yim 《Internal medicine journal》1997,27(2):156-159
Abstract Background: Within a short period of time, video assisted thoracoscopic surgery (VATS) has revolutionised the practice of thoracic surgery. Most of the existing literature, however, is concentrated on the technical aspects.
Aims: We examined the impact of VATS on our practice and its implications.
Methods: We reviewed our thoracic case load two years before and two years after the introduction of VATS in our hospital.
Results: We have witnessed a rapid and progressive increase in our thoracic case load since the introduction of VATS. With increased experience, proportionally more cases were performed using VATS compared to conventional surgical access. The increased case load covered a wide range of thoracic diseases with the majority for spontaneous pneumothorax and pleural diseases.
Conclusion: The higher case load is due to increased referrals which at least partly reflect earlier acceptance by both the patients and their physicians for surgical intervention. The changing indications for surgery and the high cost associated with VATS, however, could place extra demand on the healthcare, especially for some countries in Asia. Cost containment is therefore a high priority here. More research is greatly needed in this area. 相似文献
Aims: We examined the impact of VATS on our practice and its implications.
Methods: We reviewed our thoracic case load two years before and two years after the introduction of VATS in our hospital.
Results: We have witnessed a rapid and progressive increase in our thoracic case load since the introduction of VATS. With increased experience, proportionally more cases were performed using VATS compared to conventional surgical access. The increased case load covered a wide range of thoracic diseases with the majority for spontaneous pneumothorax and pleural diseases.
Conclusion: The higher case load is due to increased referrals which at least partly reflect earlier acceptance by both the patients and their physicians for surgical intervention. The changing indications for surgery and the high cost associated with VATS, however, could place extra demand on the healthcare, especially for some countries in Asia. Cost containment is therefore a high priority here. More research is greatly needed in this area. 相似文献
6.
7.
Seong-Woong Kim Kyu-Won Shim Nick Plesnila Yong-Oock Kim Joong-Uhn Choi Dong-Seok Kim 《Child's nervous system》2007,23(2):201-206
Objects We designed several distraction devices and applied these instruments in 14 patients with varying types of craniosynostosis.
The aim of this report is to clarify the advantages and disadvantages of these surgical methods and to discuss current concepts
for the surgical strategy in the treatment of craniosynostosis.
Methods From January 2000 to July 2005, 28 patients with craniosynostosis were retrospectively analyzed. Surgical treatment was performed
on 14 patients using the distraction method with internal distraction devices that we designed, in which 5 patients had plagiocephaly,
3 brachycephaly, and 6 scaphocephaly. All patients underwent preoperative and postoperative evaluations, which included the
patient’s neurological state, and three-dimensional CT.
Results With distraction devices, the time required for the surgery could be shortened almost 3 1/3 h; the bleeding during the surgery
was decreased with reduced requirement of more than 200 ml of blood transfusion as compared with remodeling surgery. Postoperatively
achieved distraction distances varied from 30.0 to 47.5 mm (mean, 42.99 mm). The average increased volume percent of cranium
in distraction surgery group was 20.9% (range, −11.5 to 58.9%) after full distraction.
Conclusion With distraction surgery, satisfactory cranial volume expansion and aesthetically pleasing morphological states were achieved
in all cases, and the efficacy was statistically significantly high as compared with remodeling method. 相似文献
8.
The fibula free flap has become an established flap for mandible reconstruction when vascularized bone is desirable. Recreating mandibular contour, providing soft tissue coverage, and restoring masticatory function are equally important in mandible reconstruction, and these can be provided by the fibula osteoseptocutaneous flap. This article is a summary of the anatomy, indications, and operative technique of the fibula osteoseptocutaneous flap accumulated from 49 consecutive mandible reconstructions. © 1994 Wiley-Liss, Inc. 相似文献
9.
10.
Should cervical ultrasonography be a routine staging investigation for lung cancer patients with impalpable cervical lymph nodes? 总被引:3,自引:0,他引:3
Alan D L Sihoe Tak Wai Lee Anil T Ahuja Anthony P C Yim 《European journal of cardio-thoracic surgery》2004,25(4):486-491
OBJECTIVES: Detection of cervical N3 lymph nodes is currently not a routine preoperative investigation for lung cancer patients. We designed a study to assess if the frequency and accuracy of detection of metastatic cervical lymph nodes using cervical ultrasonography (US) and fine needle aspiration (FNA) justify their routine use in all lung cancer patients with impalpable cervical lymph nodes. METHODS: Fifty patients with suspected and potentially operable non-small cell lung cancer were enrolled. Patients with palpable cervical lymph nodes were excluded. In addition to routine preoperative investigations, all patients received cervical US to determine the presence of cervical lymph nodes. Nodes suspicious of harboring malignancy according to a specific set of sonographic criteria (which include shape, echogenicity, nodal architecture, and vascular patterns) were subjected to biopsy by ultrasound-guided FNA. RESULTS: Normal cervical lymph nodes were detected by cervical US in 30 patients (60%). Cervical lymph nodes suspicious of harboring malignancy were detected in 10 patients (20%). FNA confirmed cervical nodal metastasis in four of these patients (8%). The TNM staging of two patients (4%) was revised up to stage IIIb as a result, excluding them from further surgery. Cost analysis suggests this technique to be cost-effective when used as a routine preoperative investigation to exclude patients from unnecessary surgical intervention. No mortality or complications were encountered in all patients. CONCLUSIONS: Cervical US and FNA is a safe and cost-effective method of evaluating the status of impalpable cervical lymph nodes in lung cancer patients. Further study is warranted to establish the role of cervical US and FNA in lung cancer staging algorithms. 相似文献