检索结果-南通市图书馆

A Resection of the Giant First Left Rib Tumor and Chest Wall Reconstruction by Transmanubrial Osteomuscular sparing Approach

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Open Journal of Thoracic Surgery 2015年第3期5卷 35-42页

作者： Takanori Ayabe Masaki Tomita Hiroki Mori Eiichi Chosa Kunihide Nakamura Division of Thoracic and Breast Surgery Department of Surgery Faculty of Medicine University of Miyazaki Miyazaki Japan

A 64-year-old female had noticed an 11 × 6 cm mass growing on her left first rib. We performed a resection of the first and second ribs and a reconstruction of the chest wall. A thoracotomy was performed at the anterolateral second intercostal space. The second rib cartilage was divided at the left parasternum. Based on a transmanubrial osteomuscular sparing approach, the left-upper part of the sternum and the first rib cartilage were both cut at the left clavicular-sternum joint. The posterior parts of the two ribs involving the tumor were resected at the transverse process of the vertebral bone by tearing off the anterior, middle, and posterior scalene muscles, subclavicular artery and vein. The defect size of the thorax was 15 × 9 cm, which was reconstructed by covering with a polytetrafluoroethylene dual mesh (Dual mesh, Gore tex, 2 mm). The major pectoral muscle flap was used to cover the mesh. The postoperative pathological examination diagnosed a poorly differentiated fibrosarcoma. Eventually, she had palliative therapy for the postoperative metastatic chest wall. She died 14 months after the operation.

关键词： Surgery Transmanubrial Osteomuscular sparing Approach Fibrosarcoma The First Rib Tumor Chest Wall Reconstruction

Calcineurin inhibitor sparing strategies in renal transplantation, part one: Late sparing strategies

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Transplantation 2014年第2期4卷 57-80页

作者： Andrew Scott Mathis Gwen Egloff Hoytin Lee Ghin Pharmacy Department Monmouth Medical CenterLong BranchNJ 07740United States School of Pharmacy University of ConnecticutStorrsCT 06268United States

Kidney transplantation improves quality of life and reduces the risk of mortality. A majority of the success of kidney transplantation is attributable to the calcineurin inhibitors(CNIs), cyclosporine and tacrolimus, and their ability to reduce acute rejection rates. However, longterm graft survival rates have not improved over time, and although controversial, evidence does suggest a role of chronic CNI toxicity in this failure to improve outcomes. Consequently, there is interest in reducing or removing CNIs from immunosuppressive regimens in an attempt to improve outcomes. Several strategies exist to spare calcineurin inhibitors, including use of agents such as mycophenolate mofetil(MMF), mycophenolate sodium(MPS), sirolimus, everolimus or belatacept to facilitate late calcineurin inhibitor withdrawal, beyond 6 mo post-transplant; or using these agents to plan early withdrawal within 6 mo; or to avoid the CNIs all together using CNI-free regimens. Although numerous reviews have been written on this topic, practice varies significantly between centers. This review organizes thedata based on patient characteristics(i.e., the baseline immunosuppressive regimen) as a means to aid the practicing clinician in caring for their patients, by matching up their situation with the relevant literature. The current review, the first in a series of two, examines the potential of immunosuppressive agents to facilitate late CNI withdrawal beyond 6 mo post-transplant, and has demonstrated that the strongest evidence resides with MMF/MPS. MMF or MPS can be successfully introduced/maintained to facilitate late CNI withdrawal and improve renal function in the setting of graft deterioration, albeit with an increased risk of acute rejection and infection. Additional benefits may include improved blood pressure, lipid profile and serum *** has less data directly comparing CNI withdrawal to an active CNI-containing regimen, but modest improvement in short-term renal function

关键词： Kidney transplantation Calcineurin inhibitor Withdrawal sparing Cyclosporine Tacrolimus Renal function Graft survival

Risk factors and outcomes of delayed graft function in renal transplant recipients receiving a steroid sparing immunosuppression protocol

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

World Journal of Transplantation 2017年第1期7卷 34-42页

作者： Michelle Willicombe Anna Rizzello Dawn Goodall Vassilios Papalois Adam G Mc Lean David Taube Imperial College Kidney and Transplant Centre Hammersmith Hospital

AIM To analyse the risk factors and outcomes of delayed graft function(DGF) in patients receiving a steroid sparing protocol. METHODS Four hundred and twenty-seven recipients of deceased donor kidney transplants were studied of which 135(31.6%) experienced DGF. All patients received monoclonal antibody induction with a tacrolimus based, steroid sparing immunosuppression *** Five year patient survival was 87.2% and 94.9% in the DGF and primary graft function(PGF) group respectively, P = 0.047. Allograft survival was 77.9% and 90.2% in the DGF and PGF group respectively, P < 0.001. Overall rejection free survival was no different between the DGF and PGF groups with a 1 and 5 year rejection free survival in the DGF group of 77.7% and 67.8% compared with 81.3% and 75.3% in the PGF group, P = 0.19. Patients with DGF who received IL2 receptor antibody induction were at significantly higher risk of rejection in the early post-transplant period than the group with DGF who received alemtuzumab induction. On multivariate analysis, risk factors for DGF were male recipients, recipients of black ethnicity, circulatory death donation, preformed DSA, increasing cold ischaemic time, older donor age and dialysis *** Alemtuzumab induction may be of benefit in preventing early rejection episodes associated with DGF. Prospective trials are required to determine optimal immunotherapy protocols for patients at high risk of DGF.

关键词： Allograft failure Deceased donors Delayed graft function Cold ischaemic time Rejection Steroid sparing Alemtuzumab

Skin sparing Mastectomy in Locally Advanced Breast Cancer: A Possibility?

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Surgical Science 2012年第4期3卷 226-231页

作者： Vijayashree Murthy K. S. Gopinath Anand Krishna Department of Surgical Oncology Bangalore Institute of Oncology Bangalore India

Breast cancer is the second most common cause of cancer death in women in India in spite of advances in the adjuvant treatment of breast cancer. Locally advanced breast cancer (LABC) still represents the major presenting picture in many urban and rural institutions in our country. Skin sparing Mastectomy (SSM) and primary reconstruction is a popular option for patients with breast cancer. There are similar local and distant recurrences in SSM compared to the traditional non-skin sparing mastectomy. A 57-year-old lady presented with a locally advanced left breast cancer. After undergoing neoadjuvant chemotherapy and a PET-CT to accurately detect residual disease in breast and axilla, she underwent skin sparing mastectomy with nipple-areola complex preservation and primary reconstruction with silicon prosthesis implant over a latissimus dorsi myocutaneous flap for primary reconstruction. SSM in LABC has not been reported in the literature so far. This patient is disease free for the past 24 months.

关键词： Skin sparing Mastectomy Locally Advanced Breast Cancer Primary Reconstruction

Functional Outcomes after Triceps Splitting versus Triceps sparing Approach for Extra-Articular Distal Humerus Fractures

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Open Journal of Orthopedics 2018年第3期8卷 85-94页

作者： Jagdeep Singh Anoop Kalia Anshul Dahuja Kapil Bansal Department of Orthopaedics Guru Gobind Singh Medical College and Hospital Faridkot India

Aim: To compare the functional outcome as well as elbow range of motion (ROM) after triceps splitting and triceps sparing approach for AO/OTA TYPE A distal humerus fractures. Materials and Methods: This is a prospective study done at our center between 2011 and 2014. A total of 50 patients presented with extra articular distal humerus fracture (AO/OTA 13 A2, 13A3). Exclusion criteria removed 16 patients from the study while 2 patients died due to medical comorbidities before the final follow up. Out of the remaining 32 patients, they were divided into two groups: triceps splitting (15 patients) and triceps sparing (17 patients). Elbow ROM, along with Disabilities of the Arm, Shoulder and Hand questionnaire scores, was compared between the two groups. Results: Triceps sparing group had greater elbow flexion (140.0 ± 4.0) compared to triceps splitting group (126.0 ± 10.0) with p Conclusion: As compared to triceps splitting approach, triceps sparing approach results in better elbow ROM with less extension contracture, however both approaches result in similar functional outcome.

关键词： Triceps sparing Triceps Splitting Extension Contracture

Dose Reduction to the Scalp with Hippocampal sparing Is Achievable with Intensity Modulated Radiotherapy

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

International Journal of Medical Physics, Clinical Engineering and Radiation Oncology 2014年第3期3卷 176-182页

作者： Matthew Witek Yelena Vahknenko Joshua Siglin Amy Harrison Ying Xiao Haison Lui David Andrews Wenyin Shi Department of Neurosurgery Thomas Jefferson University Hospital Philadelphia USA Department of Radiation Oncology Thomas Jefferson University Hospital Philadelphia USA

We evaluated the feasibility of combined hippocampal- and scalp-sparing intensity-modulated radiotherapy (IMRT) plans. This study included 7 patients who received conventional palliative whole brain radiation treatment (WBRT) for brain metastasis. The brain, hippocampus, and scalp were contoured and replanned with intensity modulated radiation therapy. The prescription dose was 30 Gray (Gy) in 10 fractions with hippocampus and normal structure constraints per the Radiation Therapy Oncology Group (RTOG) 0933 protocol. Further planning was done to minimize the scalp dose while maintaining the dose constraints for the hippocampus. Dose volume histograms were obtained from conventional opposed lateral fields, IMRT and compared. Planning target volume (PTV) coverage for all plans fell within the RTOG 0933 critical structure acceptable variation category. When compared to traditional opposed lateral fields, the IMRT plan with combined hippocampal- and scalp-sparing constraints was able to significantly reduce the max and mean scalp dose as well as the percentage of scalp receiving 10 and 20 Gy by 46% and 35%, respectively, while maintaining acceptable RTOG 0933 hippocampal dose variations. We conclude that acceptable PTV coverage and sparing of the scalp and hippocampus can be accomplished using a 9-field non-coplanar IMRT plan. Prospective study is warranted to understand the impact on radiation-induced alopecia.

关键词： Hippocampal Scalp sparing WBRT IMRT

Tissue sparing Surgery and Its Relevance within Hip Prosthesis

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Open Journal of Orthopedics 2014年第8期4卷 226-230页

作者： T. Villa F. Pipino A. Corradi Policlinico di Monza Monza Italy

The total hip replacement rationale, since 1960 when it was introduced by Sir Charnley, has been modified and evolved until nowadays thanks to laboratory research and clinical trials. This evolution followed a guideline whose milestones are: 1) the surgical approach and implantation technique (ex: detachment of the greater trochanter);2) to use or not to use cement;3) the evolution of materials (titanium, ceramic, x-linked polyethylene);4) the identification of the debris-disease rather than the cement-disease;5) studies focused on bone-prosthesis interaction and biological phenomena related. Between those studies, the authors consider crucial the introduction of tissue sparing surgery and femoral neck preserving rationale, concepts to which they have devoted their scientific research and clinical experience for over the last 30 years, from 1980 to nowadays.

关键词： Hip Prosthesis Tissue sparing Surgery (TSS) Femoral Neck Preserving (CFP) Mini-Prosthesis

Usefulness of Free Nipple-Areola Complex Graft for Nipple Malposition after Nipple sparing Mastectomy

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Modern Plastic Surgery 2012年第4期2卷 87-90页

作者： Kyoichi Matsuzaki Department of Plastic and Reconstructive Surgery Kawasaki Municipal Tama Hospital Kawasaki Japan

Purpose: This article identifies the advantage and disadvantage of a free nipple areola complex graft (FNACG) for nipple malposition which resulted from tissue-expander insertion and subsequently replaced with an implant after nipple sparing mastectomy (NSM). Methods: The subjects were three such patients treated using FNACG and who were followed up for at least one year postoperatively. The surgical outcome was assessed for symmetry of nipple-areola position, graft take, depigmentation, and shrinkage. Results: In all patients, the graft was accurately transferred to a position to achieve symmetry with the unaffected breast, and there was complete graft take in the areola by simple surgical design and techniques. No depigmentation of the areola was observed. The size of the areola was almost unchanged after grafting in two patients, but areolar shrinkage occurred in one other patient. There was complete graft take in the nipple in one patient and no depigmentation of the nipple was observed. Necrosis occurred at the tip of the nipple in two other patients. These patients had depigmentation, and the height of nipples decreased in proportion to the level of necrosis. Conclusion: FNACG can be a useful method if its advantages and disadvantages are well considered.

关键词： High-Riding Nipple Nipple Areola Complex Graft Nipple sparing Mastectomy Nipple Malposition Nipple Transposition

Aesthetic Outcome after Nipple sparing Mastectomy for Cancer Patient Egyptian Pattern

在线全文

维普期刊数据库

学校读者我要写书评

暂无评论

Advances in Breast Cancer Research 2017年第2期6卷 68-80页

作者： Ahmed Farahat Tarek Hashem Abdalwahab R. Abdalwahab Tamer M. Manie Nelly H. Alieldin Hassan Abdallah Department of Surgical Oncology National Cancer Institute Cairo University Cairo Egypt Department of Statistics National Cancer Institute Cairo University Cairo Egypt

Background: Recent advances in breast reconstruction and the introduction of oncoplastic techniques have resulted in significant improvement in quality of life and psychological well-being of most patients. Nipple sparing mastectomy is a surgical technique that removes breast tissue while preserving the native skin envelope, infra-mammary fold and the NAC, which allows immediately reconstructed breasts to have an excellent cosmetic outcome. Aim: Our primary end point was for objective assessment of aesthetic outcome after NSM via more accurate new method and subsiding bias in that assessment and the secondary end point was for evaluating the influence of incision choice and recommending which incision is the best for each patient putting in mind cup size, degree of ptosis and body mass index of Egyptian patients. Methods: Starting January 2013 to November 2015, 74 patients with breast cancer underwent NSM with immediate reconstruction using LD flap with or without implant augmentation. Results: Incisions used are elliptical (37.8%), lateral (27%), peri-areolar (21.6%) and infra-mammary (13.5%). In 81.1% of the patients, the procedure was performed using extended LD flaps only, while in the remaining 18.9% the flaps were augmented using implant insertion. Axillary dissection was done in 68.9% of patients and SLN in 24.3% of patients. Overall aesthetic results were done by patient self-assessment, assessment by the surgeon, assessment by professional plastic breast surgeon and assessment by onco-plastic surgeon, and this was followed by statistical analysis of the agreement between the plastic surgeon and the onco-plastic surgeon. Conclusion: NSM is safe, feasible and offers adequate oncologic results along with excellent cosmetic outcome. Choice of incision and reconstruction should be tailored to suit each patient. Breast cancer patients can benefit from sound resection and enjoy a sense of wholeness.

关键词： Nipple sparing Mastectomy Approach Incision Aesthetic Assessment