Anal fistulas are a common manifestation of Crohn's disease(CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the ...Anal fistulas are a common manifestation of Crohn's disease(CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently em-ployed. However, at the moment, none of these tech-niques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medi-cal therapy and those causing disabling symptoms. Ut-most attention should be paid to correcting the balance between eradication of the fistula and the preservationof fecal continence.展开更多
AIM:To investigate the clinical features and survival of patients treated for cholangiocarcinoma in our institution and to analyze the factors affecting their survival.METHODS:This retrospective cohort study assessed ...AIM:To investigate the clinical features and survival of patients treated for cholangiocarcinoma in our institution and to analyze the factors affecting their survival.METHODS:This retrospective cohort study assessed patients diagnosed with cholangiocarcinoma between January 1997 and December 2007 at the University Malaya Medical Centre in Malaysia.The clinical data and associated outcomes were collected using a structured proforma.RESULTS:Of the 69 patients diagnosed with cholangiocarcinoma,38 (55%) were male;mean patient age was 61 years.Twelve patients (17%) had intrahepatic,38 (55%) had perihilar and 19 (28%) had distal tumors.Only 12 patients underwent curative surgery,including seven R0 resections.Only one patient died within 30 d after surgery.The overall median survival was 4 mo,whereas the median survival of R0 resected patients was 16 mo.The overall 1-,2-and 3-year cumulative survival rates were 67%,17% and 17%,respectively.Survival rates were significantly associated with curative resection (P=0.002),intrahepatic tumor (P=0.003),negative margin status (P=0.013),early tumor stage (P=0.016),higher tumor differentiation (P=0.032) and absence of jaundice (P=0.038).Multivariate analysis showed that tumor location was a significant independent predictor of patient survival.CONCLUSION:Curative,margin-negative resection of early stage,well-differentiated intrahepatic tumors is associated with improved patient survival.展开更多
AIM:To compare natural orifice transluminal endoscopic surgery (NOTES) vs standard laparoscopic ovariectomy in mini pigs with respect to technical aspects,complications and parameters of systemic inflammatory response...AIM:To compare natural orifice transluminal endoscopic surgery (NOTES) vs standard laparoscopic ovariectomy in mini pigs with respect to technical aspects,complications and parameters of systemic inflammatory response.METHODS:This was a randomized,experimental,survival study.Ten female mini pigs underwent NOTES transgastric ovariectomy (NOTES group) and ten female mini pigs underwent laparoscopic ovariectomy (LAP group).A "percutaneous endoscopic gastrostomy" approach with guidewire and sphincterotome was used for gastrotomy creation.The ovary was resected using standard biopsy forceps and a snare.The access site was closed using a "KING" closure with a single endoloop and several clips.In the laparoscopic group,a three-port laparoscopy and an ovariectomy were performed with the use of standard laparoscopic devices.C-reactive protein (CRP),white blood count and interleukin (IL)-6 plasma levels were used as indicators of systemic inflammatory response.All animals were euthanized 28 d after surgery.RESULTS:All animals survived without complications.The mean procedure time was 41.3 min ± 17.6 min (NOTES group) and 25.7 min ± 5.25 min (LAP group,P < 0.02).Postmortem examinations demonstrated that 50% and 70% of animals were free of any complications in the NOTES and LAP groups,respectively.The remaining animals developed minor complications (adhesions) in a comparable frequency between the two groups.In the NOTES group,one animal developed a small intramural gastric abscess close to the gastrotomy site.A minor serous exudate that was present in 50% and 40% of the animals in the NOTES and laparoscopy groups,respectively,was not considered a complication.In both groups CRP levels increased significantly on the 2nd and 7th postoperative days (POD) and returned to normal after 28 d.On POD 2,an increase of CRP level was significantly higher in the NOTES group compared to the LAP group.Values of IL-6 did not differ from baseline values in either of the groups postoperatively.Interestingly,the platelet count decreased significantly on POD 2,but returned close to baseline values on POD 7 and PODs 28-30.CONCLUSION:Both NOTES and laparoscopic ovariectomies had a similar frequency of minor complications.However,the NOTES technique produced an increased systemic inflammatory response on POD 2.展开更多
Surgical tumor resection is a common approach to cancer treatment.India Ink tattoos are widely used to aid tumor resection by localizing and mapping the tumor edge at the surface.However,India Ink tattoos are easily o...Surgical tumor resection is a common approach to cancer treatment.India Ink tattoos are widely used to aid tumor resection by localizing and mapping the tumor edge at the surface.However,India Ink tattoos are easily obscured during electrosurgical resection,and fade in intensity over time.In this work,a novel near-infrared(NIR)fluorescent marker is introduced as an alternative.The NIR marker was made by mixing indocyanine green(ICG),biocompatible cyanoacrylate,and acetone.The marking strategy was evaluated in a chronic ex vivo feasibility study using porcine tissues,followed by a chronic in vivo mouse study while compared with India Ink.In both studies,signal-to-noise(SNR)ratios and dimensions of the NIR markers and/or India Ink over the study period were calculated and reported.Electrocautery was performed on the last day of the mouse study after mice were euthanized,and SNR ratios and dimensions were quantified and compared.Biopsy was performed at all injection sites and slides were examined by a pathologist.The proposed NIR marker achieved(i)consistent visibility in the 26-day feasibility study and(ii)improved durability,visibility,and biocompatibility when compared to traditional India Ink over the six-week period in an in vivo mouse model.These effects persist after electrocautery whereas the India Ink markers were obscured.The use of a NIR fluorescent presurgical marking strategy has the potential for intraoperative tracking during long-term treatment protocols.展开更多
This article summarized the nursing problems and corresponding nursing strategies of 18 cases of external diaphragm pacemakers in the application of elderly patients with lung cancer after thoracic surgery. Timely psy...This article summarized the nursing problems and corresponding nursing strategies of 18 cases of external diaphragm pacemakers in the application of elderly patients with lung cancer after thoracic surgery. Timely psychological care, correct operation, close observation and infection prevention during treatment can effectively optimize the use of external diaphragm pacemakers, improve respiratory muscle function, and the quality of life after lung cancer surgery in elderly patients.展开更多
In this descriptive review we look at the role of surgery for advanced ovarian cancer at other timepoints apart from the initial cytoreduction for front-line therapy or interval cytoreductive surgery after neoadjuvant...In this descriptive review we look at the role of surgery for advanced ovarian cancer at other timepoints apart from the initial cytoreduction for front-line therapy or interval cytoreductive surgery after neoadjuvant chemotherapy. The chief surgical problem to face after primary treatment is recurrent ovarian cancer. Of far more marginal concern are the second-look surgical procedures or the palliative efforts intended to resolve the patient's symptoms with no curative intent. The role of surgery in recurrent ovarian cancer remains poorly defi ned. Current data, albeit from non-randomized studies, nevertheless clearly support surgical cytoreduction in selected patients, a rarely curative expedient that invariably yields a marked survival advantage over chemotherapy alone. Despite these fi ndings, some consider it too early to adopt secondary cytoreduction as the standard care for patients with recurrent ovarian cancer and a randomized study is needed. Two ongoing randomized trials(Arbeitsgemeinschaft Gynkologische Onkologie-Desktop Ⅲ and Gynecologic Oncology Group 213) intend to verify the role of secondary cytoreduction for platinum-sensitive ovarian cancer compared with chemotherapy considered as standard care for these patients. We await the results of these two trials for a defi nitive answer to the matter.展开更多
In this study, the interaction between diode laser radiation and chicken soft tissue was studied in vitro by a high-speed digital video camera. We used a diode laser with a wavelength of （980 ±10）nm and average...In this study, the interaction between diode laser radiation and chicken soft tissue was studied in vitro by a high-speed digital video camera. We used a diode laser with a wavelength of （980 ±10）nm and average power of 10 W. The diode laser was operated in continuous wave （CW） and pulsed modes. In CW mode, the average laser radiation power was 10 W; in pulsed mode, the average laser radiation power was I0 W and the peak power was 20 W. Diode laser radiation was delivered to soft tissue （chicken meat） using a quartz optical fiber with either a clear distal end （clear tip） or a distal end containing an optothermal converter （hot tip）. Application of the diode laser in pulsed mode resulted in crater depths and areas of collateral damage in soft tissue about 1.6 times greater than those observed in CW mode at treatment with the clear tip. Significant differences in the crater depth and collateral damage width of chicken meat were not found after hot-tip treatment with the diode laser in CW and pulsed modes. Soft tissue treated with the hot tip showed crater depths about 3.4 times greater than those observed after treatment with the clear tip. Hot tip treatment further resulted in collateral damage widths about 2.7 times lower than those obtained after treatment with the clear tip.展开更多
文摘Anal fistulas are a common manifestation of Crohn's disease(CD). The first manifestation of the disease is often in the peri-anal region, which can occur years before a diagnosis, particularly in CD affecting the colon and rectum. The treatment of peri-anal fistulas is difficult and always multidisciplinary. The European guidelines recommend combined surgical and medical treatment with biologic drugs to achieve best results. Several different surgical techniques are currently em-ployed. However, at the moment, none of these tech-niques appear superior to the others in terms of healing rate. Surgery is always indicated to treat symptomatic, simple, low intersphincteric fistulas refractory to medi-cal therapy and those causing disabling symptoms. Ut-most attention should be paid to correcting the balance between eradication of the fistula and the preservationof fecal continence.
文摘AIM:To investigate the clinical features and survival of patients treated for cholangiocarcinoma in our institution and to analyze the factors affecting their survival.METHODS:This retrospective cohort study assessed patients diagnosed with cholangiocarcinoma between January 1997 and December 2007 at the University Malaya Medical Centre in Malaysia.The clinical data and associated outcomes were collected using a structured proforma.RESULTS:Of the 69 patients diagnosed with cholangiocarcinoma,38 (55%) were male;mean patient age was 61 years.Twelve patients (17%) had intrahepatic,38 (55%) had perihilar and 19 (28%) had distal tumors.Only 12 patients underwent curative surgery,including seven R0 resections.Only one patient died within 30 d after surgery.The overall median survival was 4 mo,whereas the median survival of R0 resected patients was 16 mo.The overall 1-,2-and 3-year cumulative survival rates were 67%,17% and 17%,respectively.Survival rates were significantly associated with curative resection (P=0.002),intrahepatic tumor (P=0.003),negative margin status (P=0.013),early tumor stage (P=0.016),higher tumor differentiation (P=0.032) and absence of jaundice (P=0.038).Multivariate analysis showed that tumor location was a significant independent predictor of patient survival.CONCLUSION:Curative,margin-negative resection of early stage,well-differentiated intrahepatic tumors is associated with improved patient survival.
文摘AIM:To compare natural orifice transluminal endoscopic surgery (NOTES) vs standard laparoscopic ovariectomy in mini pigs with respect to technical aspects,complications and parameters of systemic inflammatory response.METHODS:This was a randomized,experimental,survival study.Ten female mini pigs underwent NOTES transgastric ovariectomy (NOTES group) and ten female mini pigs underwent laparoscopic ovariectomy (LAP group).A "percutaneous endoscopic gastrostomy" approach with guidewire and sphincterotome was used for gastrotomy creation.The ovary was resected using standard biopsy forceps and a snare.The access site was closed using a "KING" closure with a single endoloop and several clips.In the laparoscopic group,a three-port laparoscopy and an ovariectomy were performed with the use of standard laparoscopic devices.C-reactive protein (CRP),white blood count and interleukin (IL)-6 plasma levels were used as indicators of systemic inflammatory response.All animals were euthanized 28 d after surgery.RESULTS:All animals survived without complications.The mean procedure time was 41.3 min ± 17.6 min (NOTES group) and 25.7 min ± 5.25 min (LAP group,P < 0.02).Postmortem examinations demonstrated that 50% and 70% of animals were free of any complications in the NOTES and LAP groups,respectively.The remaining animals developed minor complications (adhesions) in a comparable frequency between the two groups.In the NOTES group,one animal developed a small intramural gastric abscess close to the gastrotomy site.A minor serous exudate that was present in 50% and 40% of the animals in the NOTES and laparoscopy groups,respectively,was not considered a complication.In both groups CRP levels increased significantly on the 2nd and 7th postoperative days (POD) and returned to normal after 28 d.On POD 2,an increase of CRP level was significantly higher in the NOTES group compared to the LAP group.Values of IL-6 did not differ from baseline values in either of the groups postoperatively.Interestingly,the platelet count decreased significantly on POD 2,but returned close to baseline values on POD 7 and PODs 28-30.CONCLUSION:Both NOTES and laparoscopic ovariectomies had a similar frequency of minor complications.However,the NOTES technique produced an increased systemic inflammatory response on POD 2.
基金This work is spported by the National Istitutes of Health under award rumbers 1RO1BB020610 and R21EB024707spprted by the Intramua Research Progam of the National Insites of Health,Natioial Cancer Istitutet Center for Cancer Reearch.
文摘Surgical tumor resection is a common approach to cancer treatment.India Ink tattoos are widely used to aid tumor resection by localizing and mapping the tumor edge at the surface.However,India Ink tattoos are easily obscured during electrosurgical resection,and fade in intensity over time.In this work,a novel near-infrared(NIR)fluorescent marker is introduced as an alternative.The NIR marker was made by mixing indocyanine green(ICG),biocompatible cyanoacrylate,and acetone.The marking strategy was evaluated in a chronic ex vivo feasibility study using porcine tissues,followed by a chronic in vivo mouse study while compared with India Ink.In both studies,signal-to-noise(SNR)ratios and dimensions of the NIR markers and/or India Ink over the study period were calculated and reported.Electrocautery was performed on the last day of the mouse study after mice were euthanized,and SNR ratios and dimensions were quantified and compared.Biopsy was performed at all injection sites and slides were examined by a pathologist.The proposed NIR marker achieved(i)consistent visibility in the 26-day feasibility study and(ii)improved durability,visibility,and biocompatibility when compared to traditional India Ink over the six-week period in an in vivo mouse model.These effects persist after electrocautery whereas the India Ink markers were obscured.The use of a NIR fluorescent presurgical marking strategy has the potential for intraoperative tracking during long-term treatment protocols.
文摘This article summarized the nursing problems and corresponding nursing strategies of 18 cases of external diaphragm pacemakers in the application of elderly patients with lung cancer after thoracic surgery. Timely psychological care, correct operation, close observation and infection prevention during treatment can effectively optimize the use of external diaphragm pacemakers, improve respiratory muscle function, and the quality of life after lung cancer surgery in elderly patients.
文摘In this descriptive review we look at the role of surgery for advanced ovarian cancer at other timepoints apart from the initial cytoreduction for front-line therapy or interval cytoreductive surgery after neoadjuvant chemotherapy. The chief surgical problem to face after primary treatment is recurrent ovarian cancer. Of far more marginal concern are the second-look surgical procedures or the palliative efforts intended to resolve the patient's symptoms with no curative intent. The role of surgery in recurrent ovarian cancer remains poorly defi ned. Current data, albeit from non-randomized studies, nevertheless clearly support surgical cytoreduction in selected patients, a rarely curative expedient that invariably yields a marked survival advantage over chemotherapy alone. Despite these fi ndings, some consider it too early to adopt secondary cytoreduction as the standard care for patients with recurrent ovarian cancer and a randomized study is needed. Two ongoing randomized trials(Arbeitsgemeinschaft Gynkologische Onkologie-Desktop Ⅲ and Gynecologic Oncology Group 213) intend to verify the role of secondary cytoreduction for platinum-sensitive ovarian cancer compared with chemotherapy considered as standard care for these patients. We await the results of these two trials for a defi nitive answer to the matter.
文摘In this study, the interaction between diode laser radiation and chicken soft tissue was studied in vitro by a high-speed digital video camera. We used a diode laser with a wavelength of （980 ±10）nm and average power of 10 W. The diode laser was operated in continuous wave （CW） and pulsed modes. In CW mode, the average laser radiation power was 10 W; in pulsed mode, the average laser radiation power was I0 W and the peak power was 20 W. Diode laser radiation was delivered to soft tissue （chicken meat） using a quartz optical fiber with either a clear distal end （clear tip） or a distal end containing an optothermal converter （hot tip）. Application of the diode laser in pulsed mode resulted in crater depths and areas of collateral damage in soft tissue about 1.6 times greater than those observed in CW mode at treatment with the clear tip. Significant differences in the crater depth and collateral damage width of chicken meat were not found after hot-tip treatment with the diode laser in CW and pulsed modes. Soft tissue treated with the hot tip showed crater depths about 3.4 times greater than those observed after treatment with the clear tip. Hot tip treatment further resulted in collateral damage widths about 2.7 times lower than those obtained after treatment with the clear tip.
