Background: The safety and efficacy of Seprafilm (Genzyme Corporation, Cambrid ge, Mass) in adult surgery patients have been established. The aim of this study was to evaluate the safety and efficacy of Seprafilm in p...Background: The safety and efficacy of Seprafilm (Genzyme Corporation, Cambrid ge, Mass) in adult surgery patients have been established. The aim of this study was to evaluate the safety and efficacy of Seprafilm in pediatric surgical pati ents. Methods: One hundred twenty-two pediatric abdominal surgery patients were enrolled. Sixty-seven patients received Seprafilm application. Of these patien ts, 18 again received Seprafilm at abdominal closure during a second surgery, an d of the 18, 4 received Seprafilm at closure after a third surgery. Of the 55 co ntrol patients who did not receive Seprafilm, 14 had a second surgery, and of th ese 14 patients, 4 had a third surgery. Adverse events, operation time, and bloo d loss were compared with assessed Seprafilm safety. Seprafilm efficacy evaluati ons included incidence and severity of adhesions in those patients who required relaparotomy. Results: The incidence (Seprafilm, 40.9%; control, 82.4%) and se verity (Seprafilm: 59.1%, grade 0; control: 17.6%, grade 0) of adhesions under the abdominal incision site were significantly reduced in the Seprafilm group ( P = .007 and P = .0009, respectively). In addition, mean relaparotomy operation time was significantly shorter for Seprafilmpatients (P = .004). At relaparotomy , blood loss/body weight ratio for Seprafilm patients compared with control pati ents showed a trend toward but did not reach significance (P = .09). Conclusions : Decreased incidence and severity of postsurgical adhesions with Seprafilmin pe diatric patientsmay lead to reduction of the risks associated with subsequent op eration.展开更多
Background/Purpose: Neuroblastoma (NB) detected by mass screening (MS) usually shows favorable prognosis and sometimes regresses spontaneously.Therefore, the authors started an observation program for these patients t...Background/Purpose: Neuroblastoma (NB) detected by mass screening (MS) usually shows favorable prognosis and sometimes regresses spontaneously.Therefore, the authors started an observation program for these patients to avoid overtreatment.In this study, the authors analyzed the profile of NB resected after observation to elucidate the nature of NB detected by MS.Methods: Between 1994 and 2004, 22 NB patients matched the following criteria and entered the observation program after obtaining informed consent: stage I or II, less than 5 cm in diameter, and without involvement of large vessels or organs.If increase in size, elevation of tumor markers, or evidence of metastasis was observed, the tumor was immediately resected.Results: Thirteen (59%) of 22 cases showed spontaneous regression.In the remaining 9 cases, tumors were resected because of parents’request, increase in size, and/or elevation of tumor markers.Four tumors had at least one unfavorable biologic feature, and 3 of them had more than 2.According to Shimada’s system, 2 had unfavorable histology.One was diploid tumor, 3 had 1p deletion, and Trk-A expression was low in 4 tumors.All patients survived without evidence of recurrence.Conclusions: The observation program has shown that at least one third of the NB detected by MS regressed spontaneously.On the other hand, MS may detect some cases with unfavorable tumor in early stage, which benefit from screening.展开更多
Background: We describe a patient with chronic,refractory idiopathic thrombocytopenic purpura (ITP) who developed massive vitreoretinal hemorrhages in both eyes. Methods: A 49-year-old woman complained of an acute dec...Background: We describe a patient with chronic,refractory idiopathic thrombocytopenic purpura (ITP) who developed massive vitreoretinal hemorrhages in both eyes. Methods: A 49-year-old woman complained of an acute decrease of vision,and ophthalmoscopy revealed bilateral preretinal and subretinal hemorrhages around the optic disc. Her platelet counts were less than 5000/μ l in spite of repetitive administration of corticosteroids and immunoglobulins with splenectomy for the chronic refractory ITP. One month later,she developed massive vitreoretinal hemorrhages bilaterally,and vision decreased to hand-motion. Results: Vitrectomy was performed on both eyes after medical treatment to increase platelet counts. The intraretinal hemorrhages were absorbed from the area around the disc and vision recovered to 20/100 in the right eye and 20/2000 in the left after one month. Conclusion: Massive vitreoretinal hemorrhages can develop in patients with chronic refractory ITP,and vitrectomy can be beneficial for this condition.展开更多
To report breakage of a 25 gauge vitreous cutter during vitreous surgery. Int erventional case report. A 60 year old woman was referred for management of an epiretinal membrane at the macula. Visual acuity was 20/100 ...To report breakage of a 25 gauge vitreous cutter during vitreous surgery. Int erventional case report. A 60 year old woman was referred for management of an epiretinal membrane at the macula. Visual acuity was 20/100 in the affected lef t eye. Vitreous surgery using a 25 gauge vitrectomy system was carried out with a combination of conventional cataract surgery. The vitreous cutter was lodged within the sclerotomy cannula after peripheral vitrectomy and was pulled togethe r with the cannula. The cannula was reinserted by trocar, but as the floating pe eled epiretinal membrane was dissected with the vitreous cutter, the tip of the cutter was broken and was aspirated with the membrane. Stereoscopic microscopy a nd scanning electron microscopy demonstrated that the edge that had broken at th e cutter port was smooth. Although 25 gauge instruments remain useful, care sho uld be taken against rare surgical complications related to their fragility.展开更多
To compare vitreous concentrations of triamcinolone acetonide (TA) achieved by prior therapeutic intravitreal and subtenon injections. Interventional case ser ies. Vitreous samples were collected from patients who req...To compare vitreous concentrations of triamcinolone acetonide (TA) achieved by prior therapeutic intravitreal and subtenon injections. Interventional case ser ies. Vitreous samples were collected from patients who required vitreous surgery , six having received a subtenon injection of TA and another six, an intravitrea l injection. Vitreous concentrations of TA were measured by high-performance li quid chromatography. Vitreous concentrations of TA after intravitreal injection were 1.22 ±.0.24 μg/ml, significantly higher than those after subtenon injecti on ( < 0.001 μg/ml, P=0.003). Vitreous concentrations of TA after subtenon inje ction and TA-assisted vitrectomy performed in a few patients to visualize the t ransparent vitreous gel were 0.20 ±0.11 μg/ml, an intermediate amount between these two groups. Much higher vitreous concentrations of TA after intravitreal i njection than subtenon injection may accelerate therapeutic effect when intravit real injections are given to reduce macular edema. Subtenon injections of TA may act via the sclera as opposed to the vitreous.展开更多
Background/Aims:Human invariant natural killer T(iNKT) cells express a TCR Vα 24-Jα Q paired with Vβ 11 and are activated by a surrogate ligand,α-galactosylceramide(α GalCer) .The iNKT cells are involved in the r...Background/Aims:Human invariant natural killer T(iNKT) cells express a TCR Vα 24-Jα Q paired with Vβ 11 and are activated by a surrogate ligand,α-galactosylceramide(α GalCer) .The iNKT cells are involved in the regulation of anti-viral immune responses;however,little is known about their roles in hepatitis C virus(HCV) infection.Methods:We compared the frequency of peripheral iNKT cells and their cytokine producing capacity reactive to α GalCer between chronically HCV-infected patients and healthy subjects.Cytokine production of freshly isolated iNKT cells were analyzed by ELISPOT.Activated iNKT cells were obtained by culture with α GalCer-loaded dendritic cells(DCs) and re-stimulated with them for the measurement of cytokine production.Results:The frequencies of iNKT cells were not different between HCV-infected patients and healthy subjects.The number of fresh IFN-γ-producing iNKT cells reactive to α GalCer was not different between the patients and controls,whereas fresh iNKT cells produced negligible amounts of Th2 cytokines regardless of HCV infection.In response to α GalCer,expanded iNKT cells from the patients secreted IFN-γ comparable in amount to controls,whereas they released significantly more IL-13 than cells from controls.Conclusions:Activated iNKT cells from HCV-infected patients gain more ability to secrete IL-13 than those from healthy subjects.展开更多
A patient with unilateral upper medial medullary infarction presented with contralateral paralysis of the pharyngeal constrictor muscle in association with lemniscal sensory loss, pyramidal insufficiency, and central ...A patient with unilateral upper medial medullary infarction presented with contralateral paralysis of the pharyngeal constrictor muscle in association with lemniscal sensory loss, pyramidal insufficiency, and central facial palsy on the same side. Individual differences in supranuclear control of the pharyngeal muscles may explain this rare occurrence. The combination of these signs is described as a syndrome of upper medial medullary lesion.展开更多
文摘Background: The safety and efficacy of Seprafilm (Genzyme Corporation, Cambrid ge, Mass) in adult surgery patients have been established. The aim of this study was to evaluate the safety and efficacy of Seprafilm in pediatric surgical pati ents. Methods: One hundred twenty-two pediatric abdominal surgery patients were enrolled. Sixty-seven patients received Seprafilm application. Of these patien ts, 18 again received Seprafilm at abdominal closure during a second surgery, an d of the 18, 4 received Seprafilm at closure after a third surgery. Of the 55 co ntrol patients who did not receive Seprafilm, 14 had a second surgery, and of th ese 14 patients, 4 had a third surgery. Adverse events, operation time, and bloo d loss were compared with assessed Seprafilm safety. Seprafilm efficacy evaluati ons included incidence and severity of adhesions in those patients who required relaparotomy. Results: The incidence (Seprafilm, 40.9%; control, 82.4%) and se verity (Seprafilm: 59.1%, grade 0; control: 17.6%, grade 0) of adhesions under the abdominal incision site were significantly reduced in the Seprafilm group ( P = .007 and P = .0009, respectively). In addition, mean relaparotomy operation time was significantly shorter for Seprafilmpatients (P = .004). At relaparotomy , blood loss/body weight ratio for Seprafilm patients compared with control pati ents showed a trend toward but did not reach significance (P = .09). Conclusions : Decreased incidence and severity of postsurgical adhesions with Seprafilmin pe diatric patientsmay lead to reduction of the risks associated with subsequent op eration.
文摘Background/Purpose: Neuroblastoma (NB) detected by mass screening (MS) usually shows favorable prognosis and sometimes regresses spontaneously.Therefore, the authors started an observation program for these patients to avoid overtreatment.In this study, the authors analyzed the profile of NB resected after observation to elucidate the nature of NB detected by MS.Methods: Between 1994 and 2004, 22 NB patients matched the following criteria and entered the observation program after obtaining informed consent: stage I or II, less than 5 cm in diameter, and without involvement of large vessels or organs.If increase in size, elevation of tumor markers, or evidence of metastasis was observed, the tumor was immediately resected.Results: Thirteen (59%) of 22 cases showed spontaneous regression.In the remaining 9 cases, tumors were resected because of parents’request, increase in size, and/or elevation of tumor markers.Four tumors had at least one unfavorable biologic feature, and 3 of them had more than 2.According to Shimada’s system, 2 had unfavorable histology.One was diploid tumor, 3 had 1p deletion, and Trk-A expression was low in 4 tumors.All patients survived without evidence of recurrence.Conclusions: The observation program has shown that at least one third of the NB detected by MS regressed spontaneously.On the other hand, MS may detect some cases with unfavorable tumor in early stage, which benefit from screening.
文摘Background: We describe a patient with chronic,refractory idiopathic thrombocytopenic purpura (ITP) who developed massive vitreoretinal hemorrhages in both eyes. Methods: A 49-year-old woman complained of an acute decrease of vision,and ophthalmoscopy revealed bilateral preretinal and subretinal hemorrhages around the optic disc. Her platelet counts were less than 5000/μ l in spite of repetitive administration of corticosteroids and immunoglobulins with splenectomy for the chronic refractory ITP. One month later,she developed massive vitreoretinal hemorrhages bilaterally,and vision decreased to hand-motion. Results: Vitrectomy was performed on both eyes after medical treatment to increase platelet counts. The intraretinal hemorrhages were absorbed from the area around the disc and vision recovered to 20/100 in the right eye and 20/2000 in the left after one month. Conclusion: Massive vitreoretinal hemorrhages can develop in patients with chronic refractory ITP,and vitrectomy can be beneficial for this condition.
文摘To report breakage of a 25 gauge vitreous cutter during vitreous surgery. Int erventional case report. A 60 year old woman was referred for management of an epiretinal membrane at the macula. Visual acuity was 20/100 in the affected lef t eye. Vitreous surgery using a 25 gauge vitrectomy system was carried out with a combination of conventional cataract surgery. The vitreous cutter was lodged within the sclerotomy cannula after peripheral vitrectomy and was pulled togethe r with the cannula. The cannula was reinserted by trocar, but as the floating pe eled epiretinal membrane was dissected with the vitreous cutter, the tip of the cutter was broken and was aspirated with the membrane. Stereoscopic microscopy a nd scanning electron microscopy demonstrated that the edge that had broken at th e cutter port was smooth. Although 25 gauge instruments remain useful, care sho uld be taken against rare surgical complications related to their fragility.
文摘To compare vitreous concentrations of triamcinolone acetonide (TA) achieved by prior therapeutic intravitreal and subtenon injections. Interventional case ser ies. Vitreous samples were collected from patients who required vitreous surgery , six having received a subtenon injection of TA and another six, an intravitrea l injection. Vitreous concentrations of TA were measured by high-performance li quid chromatography. Vitreous concentrations of TA after intravitreal injection were 1.22 ±.0.24 μg/ml, significantly higher than those after subtenon injecti on ( < 0.001 μg/ml, P=0.003). Vitreous concentrations of TA after subtenon inje ction and TA-assisted vitrectomy performed in a few patients to visualize the t ransparent vitreous gel were 0.20 ±0.11 μg/ml, an intermediate amount between these two groups. Much higher vitreous concentrations of TA after intravitreal i njection than subtenon injection may accelerate therapeutic effect when intravit real injections are given to reduce macular edema. Subtenon injections of TA may act via the sclera as opposed to the vitreous.
文摘Background/Aims:Human invariant natural killer T(iNKT) cells express a TCR Vα 24-Jα Q paired with Vβ 11 and are activated by a surrogate ligand,α-galactosylceramide(α GalCer) .The iNKT cells are involved in the regulation of anti-viral immune responses;however,little is known about their roles in hepatitis C virus(HCV) infection.Methods:We compared the frequency of peripheral iNKT cells and their cytokine producing capacity reactive to α GalCer between chronically HCV-infected patients and healthy subjects.Cytokine production of freshly isolated iNKT cells were analyzed by ELISPOT.Activated iNKT cells were obtained by culture with α GalCer-loaded dendritic cells(DCs) and re-stimulated with them for the measurement of cytokine production.Results:The frequencies of iNKT cells were not different between HCV-infected patients and healthy subjects.The number of fresh IFN-γ-producing iNKT cells reactive to α GalCer was not different between the patients and controls,whereas fresh iNKT cells produced negligible amounts of Th2 cytokines regardless of HCV infection.In response to α GalCer,expanded iNKT cells from the patients secreted IFN-γ comparable in amount to controls,whereas they released significantly more IL-13 than cells from controls.Conclusions:Activated iNKT cells from HCV-infected patients gain more ability to secrete IL-13 than those from healthy subjects.
文摘A patient with unilateral upper medial medullary infarction presented with contralateral paralysis of the pharyngeal constrictor muscle in association with lemniscal sensory loss, pyramidal insufficiency, and central facial palsy on the same side. Individual differences in supranuclear control of the pharyngeal muscles may explain this rare occurrence. The combination of these signs is described as a syndrome of upper medial medullary lesion.
