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1.
1986 ̄1997年收治的4例由慢性肛瘘演变而来的肛门粘液腺癌,对其临床表现,诊断治疗进行了探讨,认为肛瘘及其相关的肛腺是这种罕见肿瘤的原发部位,反复发作的慢性炎症刺激和疤痕组织变异为诱发肛瘘癌变的主要原因,临床确诊依靠瘘管及相关肿瘤的病理活检、治疗采用根治性手术,辅以化疗或放疗。  相似文献   

2.
慢性肛瘘癌变:附6例临床分析   总被引:1,自引:0,他引:1       下载免费PDF全文
目的:了解慢性肛瘘癌变的临床病理特征。方法:回顾性总结1996—2005年收治的6例由慢性肛瘘演变而来的肛管癌的临床和病理资料。结果:男5例,女1 例;中位年龄55岁。有慢性肛瘘病史15~30年;反复发作的慢性炎症刺激为肛瘘癌变的主要诱因。肿瘤确诊依靠瘘管及周围肿块的病理学活检。其中3例伴有腹股沟淋巴结转移。所有患者均行腹会阴联合根治术, 3例同时行腹股沟淋巴结清扫, 术后均辅以化疗。3例患者生存期在5 年以上,1例已存活3年,1例存活1年, 1例手术1年后死于肺转移。结论:肛瘘继发癌变,病程发展慢,恶性程度相对较低,但易被漏诊。治疗应采用以腹会阴根治性切除术为主的综合治疗。  相似文献   

3.
1临床资料本组男2例,女2例;年龄10个月~22岁,平均11.5岁。表现为左上腹胀痛3例,粘液便1例,血便2例,大便变形2例。可见肠型3例,4例肠鸣音均活跃。直肠指检发现囊性肿块2例,肛门直肠部畸形2例。4例均行钡剂灌肠X线摄片,1例见半圆形充盈缺损...  相似文献   

4.
肛管直肠恶性黑色素瘤误诊7例分析   总被引:2,自引:0,他引:2  
肛管直肠恶性黑色素瘤是一种少见的高度恶性肿瘤,临床上极易误诊。我院自1990年以来共收治7例均误诊,现报告如下。 临床资料 本组男2例,女5例;年龄32~75岁,平均52岁。全部病例均经病理证实。其中误诊为血栓性外痔2例,直肠息肉2例,直肠癌3例。入院时双侧腹股沟淋巴结肿大2例。主要临床症状为便血、便频、肛门坠痛,排便时肿物脱出。出现症状至确诊时间为1~26个月,平均6.5个月。此7例入院时直肠指检均触及结节及肿块,其最大直径占肠腔周径1/3~1/2;直肠镜检见肿块均位于肛管与直肠邻近齿状线处,3…  相似文献   

5.
胃肠粘膜相关恶性淋巴瘤8例报告   总被引:2,自引:0,他引:2  
1995~1998年作者共收治胃肠粘膜相关恶性淋巴瘤(malignantlymphomaofmucosaassociatedlymphoidtissue,MALT-ML)8例。报告如下。1 临床资料本组病变发生在胃4例,结肠3例,直肠1例。胃MALT-ML4例。其中男1例,53岁;女3例,年龄分别为40、51和71岁。临床表现上腹部不适和疼痛,时间为2个月至3年余。术前均行胃镜检查,3例报告该病,1例可疑。血常规1例贫血,3例正常。4例均未触及浅表肿大淋巴结。术中查肝脾均正常,仅1例局部淋巴结…  相似文献   

6.
经括约肌或尾骨入路的直肠肿瘤局部切除术   总被引:3,自引:1,他引:3  
本文报道9例低恶性或良性的直肠肿瘤行局部切除术的结果。其中广基无蒂绒毛状腺瘤6例,距肛缘4~9cm,肿瘤直径2.0~3.5cm;类癌2例.肿瘤距肛缘7cm,直径0.5~0.8cm;血管瘤1例,肿瘤距肛缘4cm,大小为2.5cm×5cm。经肛门前括约肌局部切除4例,经尾骨局部切除4例,经尾骨及括约肌局部切除1例。术后无肛门失禁及复发。作者认为经肛门括约肌或尾骨入路的肿瘤局部切除术对于距肛缘10cm以下的直肠低恶性或良性肿瘤是较理想的手术方式。  相似文献   

7.
肛门狭窄是肛门成形术后常见的并发症。本文总结我院1987~1996年经骶尾部手术治疗严重肛门狭窄的资料。1临床资料11一般资料本组男5例,女1例。年龄9~11个月3例,1~2岁3例。6例均为先天性直肠肛门闭锁术后并发严重肛门狭窄。其中高位型1例,中...  相似文献   

8.
挂线治疗高位复杂肛瘘及直肠粘膜下瘘65例   总被引:1,自引:0,他引:1  
我们近年来共治疗高位肛瘘、直肠粘膜下瘘65例,全部应用挂线法,现总结如下。1临床资料11一般资料本组男49例,女16例,年龄21~68岁,病程4个月~21年,11例曾经2次以上手术治疗。12临床表现特点121高位肛瘘中外口位于肛门左前或右前位...  相似文献   

9.
尿路复合性恶性肿瘤(附21例报告)   总被引:4,自引:0,他引:4  
报告21例尿路复合性恶性肿瘤,位于肾盂2例,膀胱19例。主要临床表现为血尿,绝大多数病人伴有尿路刺激症状。低分化的移行细胞癌(TCC)与继发性复合肿瘤有密切关系。21例中1例为TCC复合肉瘤,11例为TCC复合鳞癌,7例为TCC复合腺癌,2例为腺癌复合鳞癌。本组2例肾盂肿瘤分别行肾输尿管全长加膀胱袖口状切除术和肾部分切除术,术后存活6个月和1年;膀胱肿瘤14例行膀胱部分切除术,已生存3年4例,1年2例,未满1年2例,3例1~2年内死亡,失访3例;2例根治性膀胱全切术已生存5年和3年以上;3例行TURBt,已生存3年1例,15年1例,未满1年1例。对尿路复合性恶性肿瘤的组织学、临床和病理特征进行了讨论。  相似文献   

10.
马蹄形肛瘘,手术治疗难度较大.术后容易肛门变形,甚至括约肌功能受损,导致大便失控,肠粘液外溢及直肠粘膜脱垂等后遗症。1992年3月至1999年12月,我科采用切开、挂线、对口引流、压垫四步操作法进行治疗,效果满意。现小结如下。1临床资料1.1一般资料:本组76例中,男68例,女8例,年龄最大80岁,最小20岁,平均44岁;病程最长15年,最短6个月,以1~3年为最多,占86%。肛瘘管道盘绕肛管而生.形如马蹄状,称之为马蹄形肛瘘。内口居于后中齿线隐窝部,为后马蹄形肛瘘,内口居于前中齿线隐窝部,为前…  相似文献   

11.
Background : We investigated the vasopressor hormone response following mesenteric traction (MT) with hypotension due to prostacyclin (PGI2) release in patients undergoing abdominal surgery with a combined general and epidural anesthesia. Methods : In a prospective, randomized, placebo-controlled study we administered 400 mg ibuprofen (i.v.) in 42 patients scheduled for abdominal surgery. General anesthesia was combined with epidural anesthesia (T4-L1). Before as well as 5, 15, 30, 45, and 90 min after MT we recorded plasma osmolality, hemodynamics and measured 6-keto-PGFlα (stabile metabolite of PGI2), TXB2 (stabile metabolite of thromboxane A2) active renin, and arginine vasopressin (AVP) plasma concentrations by radioimmunoassay. Catecholamine levels were assessed by high-pressure liquid chromatography (HPLC) with electrochemical detection. Results : Following MT, arterial hypotension occurred along with a substantial PGI2 release. This was completely abolished by ibuprofen administration. Although plasma levels of 6-keto-PGF (1133 (708) vs. 60 (3) ng/L, median (median absolute deviation), P=0.0001, placebo vs. ibuprofen) remained significantly elevated, blood pressure was restored within 30 min after MT in the placebo group. At the same point in time plasma concentrations of TXB2 (164 (87) vs. 58 (1) ng/L, P=0.0001), epinephrine (46 (33) vs. 14 (6) ng/L, P=0.001), AVP (41 ± (18) vs. 12 (7) ng/L, P=0.0004), and active renin (27 (12) vs. 12 (4) ng/L, P = 0.001) were significantly higher in placebo-treated patients. Conclusion : Under combined general and epidural anesthesia arterial hypotension following MT due to endogenous PGI2 release is associated with enhanced release of AVP, active renin, epinephrine and thromboxane A2, presumably contributing to hemodynamic stability within 30 min after MT.  相似文献   

12.
Background: Halothane inhibits in vitro and in vivo activity of cytochrome P-450 (CYP) 2E1. There are several fluorinated volatile anaesthetics besides halothane, and most of them are defluorinated by CYP2E1. It is unclear whether other fluorinated anaesthetics inhibit the in vivo activity of CYP2E1.
Methods: We compared the inhibitory effects of therapeutic concentrations of four inhalational anaesthetics, halothane, enflurane, isoflurane, and sevoflurane, on chlorzoxazone metabolism in rabbits receiving artificial ventilation.
Results: All four inhalational anaesthetics decreased arterial blood pressure and increased plasma chlorzoxazone concentration. However, no significant differences in the plasma chlorzoxazone concentration were found between the four anaesthetics. The estimated chlorzoxazone clearance increased after beginning inhalation with all four agents, but no significant difference in clearance was noted between agents.
Conclusions: At therapeutic concentrations, the in vivo inhibitory effect on chlorzoxazone metabolism was similar for all four inhalational anaesthetics examined, even though their chemical characteristics and extent of hepatic metabolism differ considerably.  相似文献   

13.
Don Dame 《Artificial organs》1996,20(5):613-617
Abstract: Virtually all blood pumps contain some kind of rubbing, sliding, closely moving machinery surfaces that are exposed to the blood being pumped. These valves, internal bearings, magnetic bearing position sensors, and shaft seals cause most of the problems with blood pumps. The original teaspoon pump design prevented the rubbing, sliding machinery surfaces from contacting the blood. However, the hydraulic efficiency was low because the blood was able to "slip around" the rotating impeller so that the blood itself never rotated fast enough to develop adequate pressure. An improved teaspoon blood pump has been designed and tested and has shown acceptable hydraulic performance and low hemolysis potential. The new pump uses a nonrotating "swinging" hose as the pump impeller. The fluid enters the pump through the center of the swinging hose; therefore, there can be no fluid slip between the revolving blood and the revolving impeller. The new pump uses an impeller that is comparable to a flexible garden hose. If the free end of the hose were swung around in a circle like half of a jump rope, the fluid inside the hose would rotate and develop pressure even though the hose impeller itself did not "rotate"; therefore, no rotating shaft seal or internal bearings are required.  相似文献   

14.
Abstract: A variety of protein-bound or hydrophobic substances, accumulating as a result of pathologic conditions such as exogenous or endogenous intoxications, are removed poorly by conventional detoxification methods because of low accessibility (hemodialysis), insufficient adsorption capabilities (hemosorption), low efficiency (peritoneal dialysis), or economic limitations (high-volume plasmapheresis). Combining advantages of existing methods with microspheric technology, a module-based system was designed. Major operating parameters of the latter can be modified to allow for adjustment to individual clinical situations. An extracorporeal blood circuit including a plasmafilter is combined with a secondary high-velocity plasma circuit driven by a centrifugal pump. Different microspheric adsorbers can be combined in one circuit or applied in sequence. Thus, a prolonged treatment can be tailored using specially designed selective adsorber materials. Comparing this system with existing methods (high-flux hemodialysis, molecular adsorbent recycling system), results from our in vitro studies and animal experiments demonstrate the superior efficiency of substance removal.  相似文献   

15.
Background: The duration of action of muscle relaxants is poorly correlated to the rate of decay of their plasma concentration. The plasma concentration of mivacurium may rapidly decrease below its active concentration because of the extensive hydrolysis of mivacurium. By inflating a tourniquet on one upper limb for 3 min after the administration of atracurium, mivacurium or vecuronium, we studied the influence of the initial decline of their plasma concentration on their effect. Methods: In 50 patients anaesthetised with thiopental, isoflurane and fentanyl, the effect of bolus doses of 0.15 or 0.25 mg . kg?1 mivacurium (MIV 15, MIV 25), 0.3 or 0.5 mg . kg?1 atracurium (ATR 30, ATR 50) and 0.06 or 0.1 mg . kg?1 vecuronium (VEC 06, VEC 10) were measured on both arms (evoked response of the adductor pollicis to train-of-four stimulation every 12 s), a tourniquet being applied on one arm just before and during 3 min after the muscle relaxant bolus. Results: Tourniquet inflation of 3 min almost abolished the neuromuscular effect of mivacurium. In the vecuronium groups and in the ATR 50 group, tourniquet inflation did not modify the maximum degree of depression of the twitch response. Also, the duration of action of vecuronium was unaffected by the tourniquet. In the ATR 30 group, times to return of the twitch response to 25% (duration 25%) and 75% (duration 75%) of control response were significantly shorter in the cuffed arm, 23 min vs 27 min, and 41 min vs 45 min, respectively. In the ATR 50 group, only duration 25% was significantly shorter in the cuffed arm (41 min vs 45 min). Conclusion: The results suggest that the rate of decline of the plasma concentration of mivacurium is so rapid, that a very low and almost clinically ineffective concentration is present as soon as 3 min after its administration. The results also indicate that the recovery from a mivacurium-induced neuromuscular blockade is not influenced by the rate of decay of its plasma concentration in patients with genotypically normal plasma cholinesterase.  相似文献   

16.
Abstract: Membrane processes play a pivotal and enabling role in modern replacement therapy for acute and chronic organ failure and in the management of immunologic diseases. In fact, virtually all contemporary extracorporeal blood purification methods employ membrane devices, and the next generation of artificial organs and tissue engineering therapies are almost certain to be similarly grounded in membrane technology. In this short essay, we comment on the similarities and differences among synthetic membranes and their natural counterparts and also provide a critical overview of the demographics and technology of hemodialysis, hemofiltration, apheresis, oxygenation, and emerging membrane technologies and applications.  相似文献   

17.
Background : Our objective was to determine whether administration of propranolol or verapamil modifies the hemodynamic adaptation to continuous positive-pressure ventilation (CPPV), in particular the regional distribution of cardiac output (CO).
Methods : General hemodynamics and regional blood flows assessed by microsphere technique (15 (μm) were recorded in 16 anesthetized pigs during spontaneous breathing (SB) and CPPV with 8 cm H2O end-expiratory pressure (CPPV8) before and after intravenous administration of propranolol (0.3 mg · kg−1 followed by 0.15 mg · kg−1 · h−1, n=8) or verapamil (0.1 mg · kg−1 followed by 0.3 mg · kg−1 · h−1, n=8).
Results : CPPV8 depressed CO by 25% without shifts in its relative distribution with the exception of a noteworthy increase in adrenal perfusion. Propranolol increased arterial blood pressure, and due to a fall in heart rate, CO dropped by 25%. The kidneys and, to a lesser extent, the splanchic region and central nervous system received increased fractions of the remaining CO at the expense of skeletal muscle flow. Similar patterns were seen during SB and CPPV8 such that the combination of propranolol and CPPV8 depressed CO by 50%. The circulatory effects of verapamil were less evident but myocardial perfusion tended to increase.
Conclusions : The combination of propranolol or verapamil with CPPV does not result in any specific hemodynamic interaction in anesthetized pigs, except that the combined effect of propranolol and CPPV may severely reduce CO.  相似文献   

18.
Background : Inhibitory effects of volatile anaesthetics on platelet aggregation have been demonstrated in several studies. However, the influence of volatile anaesthetics on intracoronary platelet adhesion has not been elucidated so far.
Methods : Isolated hearts of guinea pigs were perfused with buffer in the absence or presence of volatile anaesthetics (0.5 and 1 MAC) at constant coronary flow rates of 5 ml/min for 25 min, then 1 ml/min for 30 min and again 5 ml/min for 10 min. Before, during and after low-flow perfusion, a bolus of human platelets was applied into the coronary system. To simulate thrombogenic conditions, 0.3 U/ml human thrombin was infused during low-flow perfusion and reperfusion. The number of platelets sequestered to the endothelium was calculated from the difference between coronary in- and output of platelets. The myocardial production of lactate and consumption of pyruvate and coronary perfusion pressure were also determined.
Results : At a flow rate of 5 ml/min only about 3% of the applied platelets did not emerge from the coronary system, in any group. In contrast, 13.1±1.2% (mean±SEM) of infused platelets became adherent in low-flow perfusion in the control group without anaesthetic. The adherence was reduced with each 1 MAC isoflurane (to 6.2±1.2%), sevoflurane (to 4.4±0.9%) or halothane (to 3.2±1.5%) (each P <0.05 vs. control). Volatile anaesthetic, 0.5 MAC, did not inhibit platelet adhesion to a statistically significant extent in any case. Perfusion pressure and metabolic parameters were not statistically different between the control and the hearts exposed to anaesthetics.
Conclusion : Volatile anaesthetics in a concentration of 1 MAC can reduce the adhesion of platelets in the coronary system under reduced flow conditions. This action does not arise from vasodilation or inhibition of ischaemic stress.  相似文献   

19.
Background: Obesity is increasing globallly, including in the formerly "Eastern Bloc" countries. Methods: A survey was made of obesity and bariatric surgery. Results: In the 8 East and Central European countries studied, with total population 300 million, roughly 43% of the population was overweight (BMI 25-30), 23% obese (BMI > 30), with about 15 million people morbidly obese (BMI > 40). From 0-10 morbidly obese individuals/100,000/year undergo bariatric surgery. Conclusion: Most countries were found to provide inadequate treatment for obesity.The majority of the morbidly obese are not treated effectively. However, health-care awareness of obesity and bariatric surgeons are slowly increasing.  相似文献   

20.
Abstract: Numerous articles have been published on the multiple use of dialyzers and on the effect of different reprocessing chemicals and techniques on the dialyzer biocompatibility and performance. The results often appear contradictory, especially those comparing standard biocompatibility parameters. Despite this confusion, a discerning review of the published works allows certain limited conclusions to be drawn. Reprocessing of used hemodialyzers changes the biocompatibility profile of a dialyzer as defined by the parameters complement activation. leukopenia, and cytokine release. The effect of reprocessing depends on the chemicals and reprocessing technique applied and also on the type of membrane polymer being subjected to the reprocessing procedure. Reports of pyrogenic reactions indicate that the flux of the membrane also influences how suitable it is for safe reuse. An increased risk of allergic and pyrogenic reactions appears to be associated with dialyzer reuse. Furthermore, there has been a lack of investigations into the immunologic effect of the layer of adsorbed and chemically altered proteins that remains on the inner surface of reprocessed dialyzers. We conclude that the clinical benefit of dialyzer reuse cannot be generally accepted from a biocompatibility point of view.  相似文献   

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