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1.
Objective: This study was aimed at evaluating and comparing the quality of life in patients who underwent laparo-scopic and open cholecystectomy for chronic cholecystolithiasis. Methods: The study included 25 patients with laparoscopic cholecystectomy (LC group) and 26 with open cholecystectomy (OC group). The quality of life was measured with the Gastrointestinal Quality of Life Index (GLQI) preoperatively, thereafter regularly at 2, 5, 10 and 16 weeks after the operation. Results: The mean preoperative overall GLQI scores were 112.5 and 110.3 in LC and OC group respectively (P>0.05). In the LC group, the mean overall GLQI score reduced slightly to 110.0 two weeks after the operation (P>0.05). The LC group showed significant improvement in overall score and in the aspects of symptomatology, emotional and physiological status from 5 to 16 weeks postoperatively. In the OC group, the GLQI score reduced to 102.0 two weeks after surgery (P<0.05). Significant reductions were shown in the aspects of symptomatology, physiological and social status. The GLQI scores returned to the preoperative level of 115.6 ten weeks after the operation (P>0.05). The patients experienced significant improvements of GLQI sixteen weeks after OC operation (P<0.01-0.05). Within the 10 postoperative weeks, the LC group had significantly higher GLQI scores than the OC group (P<0.05). Conclusions: LC can improve the quality of life postoperatively better and more rapidly than OC. The assessment of quality of life assessment is a valid method for measuring the effects of surgical treatment.  相似文献   

2.
Objective: This study was aimed at evaluating and comparing the quality of life in patients who underwent laparo-scopic and open cholecystectomy for chronic cholecystolithiasis. Methods: The study included 25 patients with laparoscopic cholecystectomy (LC group) and 26 with open cholecystectomy (OC group). The quality of life was measured with the Gastrointestinal Quality of Life Index (GLQI) preoperatively, thereafter regularly at 2, 5, 10 and 16 weeks after the operation. Results: The mean preoperative overall GLQI scores were 112.5 and 110.3 in LC and OC group respectively (P>0.05). In the LC group, the mean overall GLQI score reduced slightly to 110.0 two weeks after the operation (P>0.05). The LC group showed significant improvement in overall score and in the aspects of symptomatology, emotional and physiological status from 5 to 16 weeks postoperatively. In the OC group, the GLQI score reduced to 102.0 two weeks after surgery (P<0.05). Significant reductions were shown in the aspects of symptomatology, physiological and social status. The GLQI scores returned to the preoperative level of 115.6 ten weeks after the operation (P>0.05). The patients experienced significant improvements of GLQI sixteen weeks after OC operation (P<0.01-0.05). Within the 10 postoperative weeks, the LC group had significantly higher GLQI scores than the OC group (P<0.05). Conclusions: LC can improve the quality of life postoperatively better and more rapidly than OC. The assessment of quality of life assessment is a valid method for measuring the effects of surgical treatment.  相似文献   

3.
Objective: Malignant middle cerebral artery (MCA) infarction is characterized by mortality rate of up to 80%. The aim of this study was to determine the value of decompressive craniectomy in patients presenting malignant MCA infarction compared with those receiving medical treatment alone. Methods: Patients with malignant MCA infarction treated in our hospital between January 1996 and March 2004 were included in this retrospective analysis. The National Institute of Health Stroke Scale (NIHSS) was used to assess neurological status on admission and at one week after surgery. All patients were followed up for assessment of functional outcome by the Barthel index (BI) and modified Rankin Scale (RS) at 3 months after infarction. Results: Ten out of 24 patients underwent decompressive craniectomy. The mean interval between stroke onset and surgery was 62.10 h. The mortality was 10.0% compared with 64.2% in patients who received medical treatment alone (P<0.001). The mean NIHSS score before surgery was 26.0 and 15.4 after surgery (P<0.001). At follow up, patients who underwent surgery had significantly better outcome with mean BI of 53.3, RS of 3.3 as compared to only 16.0 and 4.60 in medically treated patients. Speech function also improved in patients with dominant hemispherical infarction. Conclusion: Decompressive craniectomy in patients with malignant MCA infarction improves both survival rates and functional outcomes compared with medical treatment alone. A randomized controlled trial is required to substantiate those findings.  相似文献   

4.
Objective： To evaluate the efficacy and the indication of basic fibroblast growth factor （bFGF） in the treatment of exposure of orbital implants. Design： Retrospective and observational case series. Methods： We reviewed 41 patients （41 eyes） suffering exposure of orbital implants from Jan. 2000 to June 2006. The study group patients with mild exposure received combined treatment with bFGF and antibiotic drops, and while the control group patients with mild exposure were treated with antibiotic drops only. The study group patients with moderate and severe exposure received combined treatment with bFGF and antibiotic drops, and after 2 months they were subjected to amniotic membrane transplantation, while the control group patients with moderate and severe exposure underwent amniotic membrane transplantation after using antibiotic drops. Observation of the growth of conjunctival epithelium and comparison of the healing rate of the two groups. Results： The healing rates of the mild, moderate and severe exposure study group were 100% and 92.3%. The healing rates of the mild, moderate and severe exposure control group were 55.6% and 66.7% respectively. The difference of the healing rates of the mild exposure study group and the control group was significant （P=-0.033）. And the difference of the healing rates of the moderate and severe exposure study group and the control group was not significant （P=-0.167）. Conclusion： bFGF may promote obviously the healing of orbital implant exposure, particularly it can be the first choice for the treatment of mild degree exposure. For the moderate and severe cases, it can be administered before surgical repair to enhance neovascularization and will tend to increase the success rate of surgical repair.  相似文献   

5.
Malignant gliomas are the most devastating tumors in clinical practice and nave poorest survival, Immunological treatment of such patients may likely increase the survival and quality of life. Dendritic cells （DCs）, most potent antigen presenting cells in combination with oral chemotherapeutic agents may be tried for patients giving consent to such treatment. We have successfully combined the two therapies in an adult male patient who was on downhill course after being operated on once with post operation chemotherapy and radiotherapy for glioma in the left parietal area. He received five dendritic cell therapy vaccines in combination with oral chemotherapy and responded dramatically having near normal quality of life for an additional five months with this regime, increasing the survival after operation to 11 months. This therapy is continuing with radiological betterment of the lesion. The DCs are matured with antigen extracted from wax embedded tissue at 6th day of culture. We feel that the treatment can be given to more number of patients to establish its efficacy for the dreaded cancer glioblastoma multiforme.  相似文献   

6.
Objective:Percutaneous coronary intervention(PCI) triggers an acute inflammatory response,while sirolimus is known to have anti-inflammatory properties;the inflammatory system response to PCI after sirolimus-eluting stent placement remains unclear.The purpose of this study is to determine the changes in high sensitive C-reactive protein(hs-CRP) and apelin after PCI procedure and drug-eluting stent implantation in patients with and without reduced left ventricular systolic function.Methods:Forty-eight consecutive patients undergoing PCI at the Beijing Anzhen Hospital between July and September 2006 were recruited.Sirolimus-eluting stents were employed in all patients.Blood samples were drawn immediately before and 24 h after the procedure.Plasma hs-CRP and apelin levels were determined by enzyme immunoassay.Results:Paired t-test revealed a significant increase in both hs-CRP and apelin post-procedure(P=0.006 and P0.0001,respectively).Patients with reduced left ventricular ejection fraction(LVEF) had significantly lower baseline apelin levels compared to those with normal ventricular function [(46.8±10.8) vs.(72.0±8.4) pg/ml,P0.001].However,apelin increased to a level similar to the level of those with normal left ventricular systolic function 24 h after the PCI procedure [(86.7±11.6) vs.(85.1±6.1) pg/ml,P=0.72].Conclusions:hs-CRP and apelin levels increased after PCI and sirolimus-eluting stent implantation.Patients with impaired left ventricular systolic function had significantly lower baseline apelin levels,which increased significantly after PCI.  相似文献   

7.
A clinical study of the efficacy of topical corticosteroids on dry eye   总被引：2，自引：0，他引：2  
Objective： To evaluate the effect of topical corticosteroid for treatment of moderate or severe dry eye. Methods： Sixty eyes of 30 patients with moderate or severe dry eye, who were not sensitive to artificial tears, were treated with 0.1% fluorometholone eye drops. Subjective symptom and objective tests were used to evaluate the efficacy of treatment before and after application of 0.1% fluorometholone eye drops for 1 week and 1 month. Side effects were also evaluated. Results： After 1 week of treatment, subjective symptoms were improved in all dry eye patients; objective tests were improved in all dry eye patients 1 month after treatment, and the difference was significant. Conclusion： Topical corticosteroid drops can rapidly and effectively relieve the symptoms and signs of moderate or severe dry eye.  相似文献   

8.
The objective of this study was to investigate the endosonographic appearance of gastric linitis plastica(GLP) and to study the usefulness of endoscopic ultrasonography(EUS) for the T and N staging of GLP.EUS examinations of 55 patients with histologically proven GLP were retrospectively studied.In all patients,EUS showed that lesions involved at least one-third of the circumference of the stomach.Based on the findings of the EUS,the 55 patients were divided into two groups.There were 32(58.2%) patients in the first group.EUS of this group showed that the five sonographic layers had disappeared and had been replaced by a hypoechogenic thickening of the gastric wall.There were 23(41.8%) patients in the second group.EUS of this group showed that the first three sonographic layers were blurred and thickened,and the fourth layer was significantly thickened.The full thickness of the gastric wall was significantly thicker in first than in the second group of patients(P<0.01).The incidence of perigastric lesions was significantly higher in the first than in the second group of patients(P<0.01).Results for the 15 patients following preoperative EUS were compared postoperatively with histopathologic findings for T and N staging.The overall diagnostic accuracy of the T stage was 73.3% and of the N stage was 60.0%.In eight patients,we used EUS to assess a therapeutic response.No response was observed in five patients and a partial response in three.EUS images of GLP are characteristic.EUS is helpful in diagnosing GLP and for assessing the T and N stages.  相似文献   

9.
Objective: To determine the range of body temperature in a group of healthy Chinese term neonates over the first 72 hours of life and to assess the influence of body weight, gestational age and route of delivery. Method: All 200 consecutive cases of neonates delivered at our hospital from March to August 2001 were included in this retrospective study. Temperatures were measured immediately after delivery, after 30 minutes, 1 hour, 2 hours, 8 hours and 15 hours and on the 2nd and 3rd day. Axillary temperatures ranging from 36.5 oC to 37 oC were regarded as normal. No cases of maternal fever or systemic infection of the newborns were discovered. All infants were discharged in good general condition. Results: The mean rectal temperature at birth was 37.19 ℃. The lowest average temperature was reached at 1 hour after delivery (36.54 ℃) with a significant difference between natural delivery (36.48 ℃) and section (36.59 ℃) (P<0.05). Temperature subsequently rose to 36.70 ℃ at 8 hours and 36.78 ℃ at 15 hours (P<0.05). Hypothermia was seen in 51.8% and hypothermia in 42.5% of the patients. On the 3rd day after delivery, 96% of all temperatures were in the normal range. A significant relation was found between hypothermia and both low birth weight (P<0.001) and low gestational age (P<0.05). Conclusion: The reference range presently used did not include all physiological temperatures in the first 72 hours of life. Considering other factors, such as birth weight, route of delivery, gestational age and body temperature on the 2nd and 3rd day of life, may help to correctly assess the significance of temperatures beyond the reference range.  相似文献   

10.
Background: Allogeneic blood transfusion-induced immunomodulation (TRIM) and its adverse effect on the prognosis of patients treated surgically for cancer remain complex and controversial. However, the potential risk associated with allogeneic blood transfusion has heightened interest in the use of autologous blood transfusion. In the present study, the serum concentrations of neopterin, interferon-gamma (IFN-γ), T lymphocyte subsets (CD3 , CD4 , CD8 , CD4 /CD8 ) and a possible association between these variables were investigated. The purpose was to further evaluate the effect of autologous versus allogeneic blood transfusion on immunological status in patients undergoing surgery for gastric cancer. Methods: Sixty ASA I～II (American Society of Anesthesiologists) patients undergoing elective radical resection for stomach cancer were randomly allocated to receive either allogeneic blood transfusion (n=30) or autologous blood transfusion (n=30). Serum concentrations of the neopterin, IFN-γ and T lymphocyte subsets in the recipients were measured before induction of anesthesia, after operation, and on the 5th postoperative day. Results: Both two groups, serum neopterin, IFN-γ, percentages of T-cell subsets (CD3 , CD4 ), and CD4 /CD8 ratio had significantly decreased after operation, but decreased more significantly in group H (receiving allogeneic blood transfusion) than those in group A (receiving autologous whole blood transfusion) (P<0.05). On the 5th postoperative day, serum neopterin, IFN-γ, CD3 , CD4 T-cells, and CD4 /CD8 ratio returned to the baseline values in group A. In contrast, the above remain decreasing in group H, where there were no significant relations between serum neopterin and IFN-γ. Conclusion: Perioperative surgical trauma and stress have an immunosuppressive impact on gastric cancer patients. Allogeneic blood transfusion exacerbates the impaired immune response. Autologous blood transfusion might be significantly beneficial for immune-compromised patients in the perioperative period, clearly showing its superiority over allogeneic blood transfusion.  相似文献   

11.
We observed in a pilot study that there was a transient elevation of brain natriuretic peptide （BNP） level shortly after the transplantation in the patient with ischemic heart failure, which is unexplainable by the simultaneous increase of the cardiac output and six-minute walk distance. Similar findings were observed in the phase I trial. We postulated on the basis of the finding of Fukuda in vitro that this transient elevation of BNP level against the improvement of cardiac function and exercise capacity might indicate cardiomyogenesis in patients after mesenchymal stem cell transplantation. Further study is warranted to verify the hypothesis.  相似文献   

12.
Objective:Although drug-eluting stent(DES) implantation is the primary treatment modality for bare-metal stent(BMS) in-stent restenosis(ISR),little is known about the efficacy and safety profile of DES in the treatment of DES-ISR.The goal of this study was to compare the clinical outcomes following DES treatment for BMS-ISR and DES-ISR.Methods:Rates of major adverse cardiac events(MACE) were compared in 97 consecutive patients who underwent DES implantation for the treatment of ISR(56 BMS-ISR and 41 DES-ISR) from January 2004 to December 2008.Results:Baseline clinical and procedural characteristics were comparable,except that the DES used in the BMS-ISR group was longer and had a larger diameter.The length of follow-up was(28.60±1.96) and(20.34±1.54) months for the BMS-ISR and DES-ISR groups,respectively.One patient(1.8%) experienced non-cardiac mortality and one(1.8%) had target-vessel revascularization(TVR) in the BMS-ISR group.In the DES-ISR group,three patients(7.3%) died of sudden death with a documented acute ST-segment elevation myocardial infarction,and three suffered TVR(7.3%).Kaplan-Meier analysis indicated that cumulative survival probability and MACE-free probability were both significantly lower for the DES-ISR group(log rank test P=0.047 and P=0.005,respectively).In Cox regression analysis,DES-ISR remained an independent predictor for future MACE occurrence after adjustment for other factors(compared with BMS-ISR,risk ratio(RR)=8.743,95% confidence interval(CI) 1.54-49.54,P=0.014).Switching to a different type of DES to treat DES-ISR did not improve the prognosis.Conclusion:DES-ISR patients had a poorer prognosis than BMS-ISR patients after DES therapy.  相似文献   

13.
Objective: To investigate the role of 99mTc-TRODAT-1 SPECT in diagnosis and assessing severity of idiopathic Parkinson's disease (PD). Methods: Thirty-eight patients with primary, tentative diagnosis of PD and eighteen age-matched normal controls were studied with 99mTc-TRODAT-1 SPECT imaging. The regions of interests (ROIs) were drawn manually on cerebellum (CB), occipital cortex (OC) and three transverse plane slice-views of striatums, the semiquantitative BG (background)/[(OC CB)/2] were then calculated. Results: A lower uptake of 99mTc-TRODAT-Ⅰ in striatums were displayed in thirty-six out of thirty-eight PD patients by visual inspection, compared to controls. In twenty-four PD cases with HYS (Hoehn and Yahr scale) stage I, a greater loss of DAT uptake was found in striatum and its subregions contralateral striatum to the affected limbs than in the same regions of the controls, although the striatal uptake was bilaterally reduced. Using Spearman correlation analysis showed that the reduction of the uptake ratios significantly correlated with the UPDRS in striatum and all its subregions in the PD group (P＜0.05), a similar change was also found in the putamen by using the rating scale of Hoehn and Yahr (P＜0.05).However, analysis of variance (ANOVA) did not show any relationship between the decreasing uptake of 99mTc-TRODAT-1 and increasing severity of PD patients, although the specific uptake of 99mTc-TRODAT-Ⅰ was continuously decreased in the striatum by visual inspection with the progress of PD from HYS stage Ⅰ to Ⅲ. Conclusion: 99mTc-TRODAT- 1 SPECT imaging may serve as a useful method for improving the correct diagnosis of PD. In assessing the role of99mTc-TRODAT- 1 SPECT in disease severity of PD, UPDRS can offer a comprehensive index, although the Hoehn and Yahr assessment may be available in part.  相似文献   

14.
Although cardiac rupture (CR) is a fatal mechanical complication of acute myocardial infarction (AMI), to date no predictive model for CR has been described. CR has common pathological characteristics with major bleeding. We aimed to investigate the relationship between the risk factors of major bleeding and CR. A total of 10 202 consecutive AMI patients were recruited, and mechanical complications occurred in 72 patients. AMI patients without CR were chosen as control group. Clinical characteristics including bleeding-related factors were compared between the groups. The incidences of free wall rupture (FWR), ventricular septal rupture (VSR), and papillary muscle rupture (PMR) were 0.39%, 0.21%, and 0.09%, respectively, and the hospital mortalities were 92.5%, 45.5%, and 10.0%, respectively. Female proportion and average age were significantly higher in the groups of FWR and VSR than in the control group (P<0.01); higher white blood cell count and lower hemoglobin were found in all CR groups (P<0.01). Compared to the control group, patients with CR were more likely to receive an administration of thrombolysis [26.39% vs. 13.19%, P<0.05], and were less likely to be treated with primary percutaneous coronary intervention (PCI) [41.67% vs. 81.60%, P<0.05]. The major bleeding scores (integer scores) of FWR, VSR, and PMR were (17.70±7.24), (21.91±8.33), and (18.60±7.88), respectively, and were significantly higher than that of the control group (11.72±7.71) (P<0.05). A regression analysis identified age, increased heart rate, anemia, higher white blood cell count, and thrombolysis as independent risk factors of CR, most of which were major bleeding-related factors. The patients with CR have a significantly higher risk of hemorrhage compared to the group without CR. Risk of CR after AMI is related to the risk of hemorrhage.  相似文献   

15.
Two case reports of emergent anesthesia of critical tracheal stenosis are presented. The use of extracorporeal circu-lation may be a lifesaving method for these patients. Two patients both with severe lower tracheal stenosis were admitted with severe inspiratory dyspnea. The first patient had a tracheal tube inserted above the stenosis in the operating room, but ventilation was unsatisfactory, high airway pressure and severe hypercarbia developed, therefore extracorporeal circulation was immediately initiated. For the second patient, we established femoral-femoral cardiopulmonary bypass prior to induction of anaesthesia, and intubated above the tracheal tumor orally under general anesthesia, then adjusted the endotracheal tube to appropriate depth after the tumor had been resected. The patient was gradually weaned from cardiopulmonary bypass. The two patients all recovered very well after surgery. Surgery is lifesaving for patients with critical tracheal stenosis, but how to ensure effective gas exchange is crucial to the anesthetic management. Extracorporeal circulation by the femoral artery and femoral vein cannulation can gain good gas exchange even if the trachea is totally obstructed. Therefore, before the induction of anesthesia, we should assess the site and degree of obstruction carefully and set up cardiopulmonary bypass to avoid exposing the patient to unexpected risks and the anesthesiologist to unexpected challenges.  相似文献   

16.
With the rapid development of economy and improvement position of English as an international language in our country,English teaching draw a lot of attention nowadays.In traditional English teaching,it's the teachers who manipulate everything in class,where students are seen as receivers of knowledge.Therefore,it lacks cooperation between teachers and students.Students have no opportunity to apply what they have learnt in class to practical communications.In this teachers-centered class,students are not able to bring themselves into full play,which explains the low quality of English teaching in some schools and students fail to communicate with others after many years' learning.Based on the theory of Communicative Approach,the paper analyses its advantages and existing problems in application and proposes some strategy of improving students'Communicative Competence.  相似文献   

17.
Midpalatal corticotomy-assisted rapid maxillary expansion(MCRME)is a minimally invasive treatment of maxillary transverse deficiency(MTD)in young adults.However,the effect of MCRME on respiratory function still needs to be determined.In this study,we evaluated the changes in maxillary morphology and the upper airway following MCRME using computational fluid dynamics(CFD).Twenty patients with MTD(8 males,12 females;mean age 20.55 years)had cone-beam computed tomography(CBCT)images taken before and after MCRME.The CBCT data were used to construct a threedimensional(3 D)upper airway model.The upper airway flow characteristics were simulated using CFD,and measurements were made based on the CBCT images and CFD.The results showed that the widths of the palatal bone and nasal cavity,and the intermolar width were increased significantly after MCRME.The volume of the nasal cavity and nasopharynx increased significantly,while there were no obvious changes in the volumes of the oropharynx and hypopharynx.CFD simulation of the upper airway showed that the pressure drop and maximum velocity of the upper airway decreased significantly after treatment.Our results suggest that in these young adults with MTD,increasing the maxillary width,upper airway volume,and quantity of airflow by MCRME substantially improved upper airway ventilation.  相似文献   

18.
Previously, both primary and secondary anti-D alloimmunizations induced by "Asian type" DEL (RHD1227A allele) were observed in two incidents. We investigated how often these alloimmunization events occur. The transfusions of any D-negative patients were investigated in the First Affiliated Hospital of Xi’an Jiaotong University Medical College, China, during the entire 2009. The antigens of D, C, c, E, and e were routinely serotyped. The "Asian type" DEL variant was genotyped and the RHD heterozygote was determined through two published methods. The changes in anti-D levels were monitored by the indirect antiglobulin test (IAT) and flow cytometry. Thirty D-negative transfused patients were included in the study. We focused on 11 recipients who were transfused with packed red blood cells (RBCs) from DEL donors at least one time. Of those 11 recipients, seven were anti-D negative before transfusion and four were anti-D positive (one patient with an autoantibody). One of the seven pre-transfusion anti-D negative patients produced a primary-response anti-D after being transfused with 400 ml of DEL blood twice. All four pre-transfusion antibody positive patients were not observed hemoglobin (Hb) levels increased, as expected after transfusions. Two patients had an increase in anti-D from 1:8 to 1:64 by IAT, which was also shown by flow cytometry. None of the patients experienced an acute hemolytic episode. Our data indicated that the primary anti-D induced by DEL transfusion or the secondary anti-D elevated by DEL in a truly D-negative patient might not be unusual. We suggest that a truly D-negative childbearing-aged woman should avoid DEL transfusion to protect her from primary anti-D allosensitization. In addition, anti-D positive recipients should also avoid DEL red cell transfusion due to the delayed hemolytic transfusion reaction (DHTR).  相似文献   

19.
Objective： To test the effects of corrective spectacles in hyperopic amblyopic children with heterophoria. Methods： Visual acuity, refraction and the amount of heterophoria on near （33 cm） fixation were measured before and after 3 weeks of spectacle-wearing in 30 hyperopic amblyopic children with heterophoria. The control group consisted of 20 emmetropic children age-matched to the patients. Results： Uncorrected eyes displayed hyperopic amblyopia accompanied by heterophoria. Corrective spectacles not only attenuated the hyperopia and amblyopia, but also changed the heterophoria to orthophoria. The amount of heterophoria before wearing spectacles was significantly different from that in emmetropic children; but after correction with spectacles, it was the same as that in the emmetropic controls. Conclusion： Correction with spectacles is effective for the treatment of heterophoria in hyperopic children with amblyopia.  相似文献   

20.
This early spring, my father and I went to visit Shantou in Guangdong Province. One afternoon, we went to visit the seabeach. The wind was warm, but strong. The wave struck the large stones which stood in the water firmly and made loud noise. The surface of stones was smooth because of the waters striking them year after year.I admired the strength of nature！  相似文献   

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