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1.
A behavior modification program designed to eliminate drug abuse among young addicts is described. Of 89 clients (31 female) treated, 21 were discharged as planned and 68 terminated prematurely. Approximately one third of the total sample was drug free at each follow-up interview up to 2 yr following termination. Among those completing the program and receiving normal discharge the success rate was much higher (80%). An analysis of relapse attitudes revealed greater drug craving and higher perceived relapse-provoking power of stimuli among those clients continuing to use hard drugs. No significant differences between drug-free and drug-using clients were found at follow-up with regard to improvement on work and social competence variables. Problems with partner relationships showed no improvement and some exacerbation during follow-up. Drug-free clients showed more improvement on number of constructive leisure time activities than did drug users. The causal direction of relationship between drug use and other life problems is uncertain. The importance of aftercare is emphasized. 相似文献
2.
J.Y. Choi J.H. Jung J.G. Kwon S. Shin Y.H. Kim H.J. Jang D.J. Han 《Transplantation proceedings》2017,49(5):977-981
Background
To overcome a shortage of donors, cadaveric pediatric en bloc kidneys can be used to expand the donor pool. Recent evidence shows that en bloc kidney transplantation (EBKT) has better outcomes than standard-criteria deceased adult donor kidney transplantation. We reviewed our experiences of EBKT and their outcomes.Methods
From September 1996 to January 2016, 15 EBKTs were performed in Asan Medical Center. The characteristics of donors and recipients were analyzed. Graft survival was analyzed by means of serum creatinine levels.Results
Nine male and 6 female donors were used. The mean age and body weight of donors was 2.79 years (range, 0.25–14) and 13.14 kg (range, 5.5–35). The mean weight of en bloc kidneys was 117.43 g (range, 36–146). Recipient median age was 39.13 years and body weight was 49.47 kg. Ureteral anastomosis was performed by means of side-to-side anastomosis and then bladder anastomosis in 9 patients and by bladder patch anastomosis in 4 patients. Serum creatinine levels at discharge and latest follow-up were 0.97 mg/dL (range, 0.7–1.54) and 0.89 mg/dL (range, 0.44–2.58). Delayed graft function developed in 3 patients and clinical rejection developed in 2 patients. We performed graftectomy on post-operative day 1 because of graft thrombosis. The rest maintained their graft function well. Graft survival was comparable with that of kidney transplantation from standard donors.Conclusions
EBKT showed excellent graft function and outcomes at our center. As an approach to expand the donor pool and improve graft utilization, EBKT is acceptable and should be more widely used. 相似文献3.
Mechteld C. de Jong Rianne C.J. Beckers Victor van Woerden Julie M.L. Sijmons Marc H.A. Bemelmans Ronald M. van Dam Cornelis H.C. Dejong 《HPB : the official journal of the International Hepato Pancreato Biliary Association》2018,20(7):631-640
Background
The feasibility of the liver-first approach for synchronous colorectal liver metastases (CRLM) has been established. We sought to assess the short-term and long-term outcomes for these patients.Methods
Outcomes of patients who underwent a liver-first approach for CRLM between 2005 and 2015 were retrospectively evaluated from a prospective database.Results
Of the 92 patients planned to undergo the liver-first strategy, the paradigm could be completed in 76.1%. Patients with concurrent extrahepatic disease failed significantly more often in completing the protocol (67% versus 21%; p = 0.03). Postoperative morbidity and mortality were 31.5% and 3.3% following liver resection and 30.9% and 0% after colorectal surgery. Of the 70 patients in whom the paradigm was completed, 36 patients (51.4%) developed recurrent disease after a median interval of 20.9 months. The median overall survival on an intention-to-treat basis was 33.1 months (3- and 5-year overall survival: 48.5% and 33.1%). Patients who were not able to complete their therapeutic paradigm had a significantly worse overall outcome (p = 0.03).Conclusion
The liver-first approach is feasible with acceptable perioperative morbidity and mortality rates. Despite the considerable overall-survival-benefit, recurrence rates remain high. Future research should focus on providing selection tools to enable the optimal treatment sequence for each patient with synchronous CRLM. 相似文献4.
5.
Introduction
Previous studies of the safety of renal autotransplantation (RAT) have been limited by a lack of evidence. Because of the influence of the opposite kidney, it is difficult to evaluate actual renal function. This study evaluated the actual results of RAT by collecting only cases involving a solitary kidney.Methods
Between September 1, 1999, and November 30, 2015, 9 RAT procedures were performed in 9 patients with a solitary kidney. We retrospectively evaluated medical data collected prospectively. Renal function was evaluated using the creatinine level and the estimated glomerular filtration rate (eGFR).Results
The indications for RAT differed among the nin9e study patients. Five patients had complex renovascular problems, 2 were treated for partial nephrectomy, 1 was had a radically resected ureter due to ureteral cancer, 1 patient underwent RAT for the preservation of renal function during suprarenal-type abdominal aortic aneurysm repair. The mean cold ischemic time was 116.66 minutes (range, 21–256), and the mean follow-up duration was 54.2 months (range, 1 to 184). There were no significant decreases in eGFR until 12 months except 1 patient who underwent RAT with partial nephrectomy due to renal cell cancer.Conclusions
We report stable renal function after RAT in patients with solitary kidney. Postoperative complications were rare. This is evidence for the safety of RAT. 相似文献6.
Background
The aim of this study was to identify the risk factors for structural recurrence with a focus on lymph node–related factors and to determine the optimal cutoff size of lymph node micrometastases in patients with pathologic N1a classical papillary thyroid carcinoma.Methods
We included patients who underwent total thyroidectomy with central compartment lymph node dissection for classic papillary thyroid carcinoma with pathologic N1a classification.Results
A total of 398 patients were followed up for a median of 131 months. Structural recurrence occurred in 17.3% of patients (69/398). The multivariate analysis reported the following independent risk factors for structural recurrence: tumor size >1.95 cm, bilaterality, lymphatic and/or vascular invasion, a maximum diameter of the metastatic lymph node focus >3.5 mm, distribution of metastatic lymph node foci size >3.0 mm, and ≥4 metastatic lymph nodes.Conclusion
The newly proposed cutoff of 3.5 mm for a definition of lymph node micrometastasis in pathologic N1a papillary thyroid carcinoma patients can reclassify the risk estimates of structural recurrence, thus modifying postoperative management plans and follow-up strategies. 相似文献7.
8.
Peter de Jong Marjolijn Burggraaf 《Clinica chimica acta; international journal of clinical chemistry》1983,132(1):63-71
A direct method for the determination of inorganic phosphate, bromide, nitrate and sulphate in 100 μl serum is described. After a 10-fold dilution, the sample is directly injected into an ion Chromatograph without further pretreatment. The method described is highly accurate, and reproducible over longer periods. The serum concentrations of the four above-mentioned anions have been determined in 20 male and 20 female normal persons and found to be in agreement with the results of earlier studies. 相似文献
9.
Hyeon Wook Ahn Jong Keun Seon Eun Kyoo Song Chan Jin Park Hong An Lim 《Arthroscopy》2019,35(6):1736-1742
10.
The ethical aspects of the distribution of resources for health care at the macro level deserve more study than they hitherto received. The socio-medical and economic policy implications of four distribution principles are reviewed: the utilitarian, the egalitarian, the equal access and the libertarian. Policy in welfare states is primarily based on the equal access principle. Economic factors have led to policy proposals in libertarian and utilitarian directions; competition, cost-sharing, cost-effectiveness and individual responsibility are central to the discussion. The authors conclude that it remains to be seen whether these alternatives produce the results expected. They recommend more comprehensive examination of the practical and political feasibilities of a more egalitarian policy. 相似文献