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1.
BACKGROUND AND STUDY AIMS: Endoscopic resection of large colorectal adenomas is still not a standard procedure, treatment with a high diathermic snare is considered as difficult and risky, and the main disadvantage of laser vaporization is the unavailability of histological evaluation. We studied a combined technique that enjoys the benefits of both techniques and avoids the disadvantages and risks of each. PATIENTS AND METHODS: In a prospective study, we combined the techniques of high-frequency snare resection as a preparatory method and Nd: YAG laser vaporisation as a second-stage treatment. In 72 patients, we resected 79 adenomas, most of them in the rectum (81.0%) and with a tubulovillous histology (69.6%), with a mean volume of 9.4 cm3 (1.5-29.0 cm3) and a base diameter ranging from 20 mm to 80 mm. RESULTS: After using the combined technique of preparatory mucosectomy as a first step and laser vaporization as the second step, follow-up evaluation was possible in 50 out of 72 patients (69.4%). Fourteen patients had a local relapse of adenoma (28.0%), with dysplasia histologically of the same grade or a lower one compared to the original grade, after a mean of 1.4 years. Since these local recurrences were diagnosed at a size of a few millimeters (less than 3 mm), a further session of laser treatment eliminated the material completely without complications. No colorectal carcinomas were observed. CONCLUSIONS: The high clinical long-term success of our combined electro-laser resection is not only a result of complete endoscopic adenoma resection, but also of a strong control regimen. This technique is applicable to the treatment of large colorectal adenomas with curative intent.  相似文献   

2.
Guidelines of good clinical practice regulate controlled clinical studies. Goal of the study, type of treatment and possible side effects have to be explained. The physician faces problems, if the study includes a "no treatment group". Referring to the literature and based on our own experience with tumor patients, several criteria are proposed to optimize the recruitment of patients. Important points are: Explanations should be given by an experienced doctor. He must be informed about the study and therapeutic alternative treatments. The atmosphere for the talk must be quiet. The participation of a person whom the patient trusts is desirable. The necessity of the study must be explained. Randomization in different study groups should be discussed without any preference. Prognosis should be explained without any detailed statistical data. Form of treatment, possible side effects and control examinations have to be discussed. The family physician's cooperation should be stressed. Personal autonomy in the patient's decision to participate in the study must be emphasized. Enough time for reflection must be granted before the final decision. It must be assured that the patient receives the same medical attention even after rejecting the study. These recommendations might help to avoid major mistakes which are harmful for the doctor-patient-relationship and further tumor therapy. A good initial discussion forms the basis for effective cooperation during tumor treatment. It may counteract the personal fear and negative reports in media of being "a guinea pig". The patient will appreciate the efforts of the doctor to provide optimal therapy. Furthermore, he will realize that such studies are necessary to improve future therapies.  相似文献   

3.
The technique spontaneously or siphoned after cholecystokinin stimulation. Our technique of cell collection within the region of the duodenum, the pancreas and the bile-ducts have been optimal performed by duodenoscopical methods. From the papilla of Vater, the cell brush abrasion is used. Pancreatic secretions are obtained by praepapillary drainage with a catheter after secretin stimulation or siphoned after canulation of the ductus Wirsungianus. Bile is obtained wth the same technique of material collection and processing is described. Characteristical tumor cell findings of the papilla of Vater, of the pancreas and the bile ducts are demonstrated and the cytodiagnostic's position within the tumor recognition in this area is discussed. We think the tumor cell search with the described duodenoscopical techniques as indicated in following cases: 1. suspicion of carcinoma of papilla of Vater, 2.obstructve jaundice, 3. in search of carcinoma of the pancreas.  相似文献   

4.
Fifty-seven adenomas containing adenocarcinoma were removed endoscopically from the colons of 56 patients (36 males and 20 females) with a mean age of 64.5 years. The 13 polyps containing carcinoma in situ were satisfactorily treated by endoscopic resection. In 29 cases, the carcinoma had invaded the head, neck or stalk of the polyp. The outcome was good in every case, including one involving invasion of the resection margin. Follow-up or intraoperative studies disclosed the presence of residual lesion in only 4 patients out of 15 with submucosal invasion. All four had invaded resection margins and incomplete endoscopic excision. Endoscopic polypectomy is a suitable therapeutic option for most colonic adenomas containing a carcinoma provided a complete resection is achieved with wide resection margins, particularly in those cases in which the submucosa is not reached.  相似文献   

5.
One of the clinical and experimental investigations performed in the urological clinic of the Moscow Medical University and Research Institute of Urology aimed at elucidation of Ho-YAG-laser potential in endoscopic lithotripsy (EL). Russian Ho-YAG laser surgical units CTH-10 and LLT-3 with wave length 2.09 mu were employed. The studies showed that the developed laser units satisfied relevant medical and technical requirements. Low depth of laser impulse penetration (0.4 mm) obtained at EL warrants safety of the adjacent tissues which is essential in crushing fixed ureteroliths in the presence of severe inflammation in the ureteral wall. The conclusion is made that Ho-YAG laser EL is an effective treatment of ureteroliths. Further tests for EL efficacy in affections of the upper urinary tracts are advocated to define a proper place of EL in endoscopic urology.  相似文献   

6.
The results of gut endoscopic examination in 460 patients with duodenal ulcer disease concurrent with its chronic obstruction (CI) are adduced. Direct and indirect endoscopic signs of duodenal CI are revealed in 399 (86.73%) of patients. Endoscopic criteria of the CI stage determination are described: duodenal stenosis, pyloric sphincter deformity and insufficiency, reflux-gastritis and the gastrostasis signs while satisfactory pyloric passability.  相似文献   

7.
From January 1988 to December 1990, 44 previously untreated patients with squamous cell carcinomas (SCCs) of the true vocal cord (33 T1a, 11 Tis) underwent carbon dioxide laser excision. The mean follow-up was 28 months (range, 12 to 44 months). Endoscopic excisional biopsy was the primary treatment in 38 of the 44 patients, whereas postoperative radiotherapy was added in 6 cases in which the pathology report showed positive margins. Recurrent vocal cord SCC developed in 8 (18%) of the cases, with an average interval of 17.8 months. Re-treatment consisted of a second laser excision in 4 cases, radiotherapy in 1, hemilaryngectomy in 1, and total laryngectomy in 2. The definitive cure rate with endoscopic excisional biopsy for the patients originally treated with laser excision alone was 94.7% (36/38). Endoscopic laser treatment for selected glottic SCC proves to be an excellent alternative to radiotherapy or open neck surgery.  相似文献   

8.
In the management of esophageal cancer, endoscopy has evolved from a tool used to provide biopsy confirmation of suspected tumor to an integral part of the staging and ongoing treatment of patients. Endoscopic ultrasound is currently the most accurate means for T and N staging. Improved endoscopic techniques like dye staining and aggressive biopsy protocols can identify very early stage tumors in high-risk groups and allow curative surgery. Patients with early-stage tumors who are not surgical candidates can also be treated with endoscopic mucosectomy, photodynamic therapy, or Nd:YAG laser and still have a chance of long-term cure. Palliation of advanced tumors remains the major role of endoscopy in patients with esophageal cancer. A variety of techniques have proven effective over the years, including dilatation, laser, and rigid prostheses. Newer developments like bipolar probes, injection therapy, photodynamic therapy, and brachytherapy offer potential applications. The development and continuing improvements in both coated and uncoated expandable metal stents have been perhaps the greatest recent advance in endoscopic palliation of malignant dysphagia and esophagorespiratory fistulas. With the increasing array of endoscopic treatments and palliative techniques, emphasis must be placed on considering functional status; tumor characteristics like stage, location, and shape; patient wishes; and local expertise in tailoring treatment plans for each situation.  相似文献   

9.
Pancreas divisum is the most frequent congenital ductal anomaly of the pancreas: it occurs in 5-10% of the population. In the majority of patients, this congenital anomaly is of no clinical importance. In a certain subset of patients, however, pancreas divisum is clinically important as a cause of abdominal pain, acute recurrent pancreatitis or chronic obstructive pancreatitis. The authors, experience on endoscopic drainage of the minor papilla is reported. In the history of patient 1., three episodes of recurrent pancreatitis and permanent upper abdominal pain were explored. ERP revealed a pancreas divisum and a mild irregularity and dilation of the dorsal pancreatic duct. A 7 F stent (length: 6 cm) was implanted in the dorsal pancreatic duct following a papillotomy on the stenotic minor papilla. A repeated Lundh test revealed a 58% improvement in the exocrine pancreatic function. No recurrence of pancreatitis has been observed in spite of the moderate continuous abdominal pain. In patient 2., ERP demonstrated a pancreas divisum and a severely dilated dorsal pancreatic duct as causes of the previous permanent abdominal pain. An 8 F stent (length: 5 cm) was inserted through the minor papilla without endoscopic sphincterotomy. A significant improvement in exocrine pancreatic function (70%) ensued. No abdominal pain has since been observed. In conclusion, dorsal pancreatic duct stenting (mainly in cases involving a dilated pancreatic duct) seems to have a beneficial effect in patients with both recurrent acute pancreatitis or chronic obstructive pancreatitis evoked by pancreas divisum.  相似文献   

10.
BACKGROUND/AIMS: Endoscopic therapy of chronic obstructive pancreatitis is an indubitable contribution to patients which brings immediate pain relief, enables an increased caloric food intake and improves the quality of patient's life. The authors describe their experience in a set of 42 subjects, in whom endoscopic papillotomy of the pancreatic duct was carried out after diagnosis of chronic obstructive pancreatitis. MATERIAL AND METHODS: Endoscopic papillotomy was performed in 42 patients. In 17 patients, papillotomy was followed by the drainage of the pancreatic duct. RESULTS: The treatment led to disappearance or significant decrease of the epigastric pain in 85.7% patients shortly after the treatment; in 47.1% of patients the painless period lasted for further 24 months after the therapy. Increase in body weight of about 2 kg occurred in 53% of treated subjects during the 2 years since the therapy. Complications in treatment, such as acute pancreatitis in 3 patients and bleeding in 2 were mastered conservatively. CONCLUSION: Endoscopic therapy of chronic pancreatitis is an alternative approach of managing the algic form of chronic obstructive pancreatitis. Changes in the area of Vater papilla, pathological content of pancreatic duct, structure or complications of chronic pancreatitis could be solved endoscopically with a minimum burden on patient. According to the experience of the authors, endoscopic papillotomy of pancreatic duct with contingent drainage led to the pain disappearence nearly in 50% of patients in the set of 42 subjects 24 months after the performance. This fact was followed with an increase in body weight in more than 50% of treated subjects. Minimum of complications put the endoscopic therapy among relatively safe and at the same time effective approach to chronic pancreatitis.  相似文献   

11.
AIM: It was the of this study to assess the value of the 99mTc-MIBI scintigraphy in SPECT technique in the preoperative lateral location of small parathyroid adenoma (PTA). METHODS: 25 consecutive patients (8 male, 17 female, mean age 63 +/- 13 years) with the established diagnosis of primary hyperparathyroidism and non-diagnostic ultrasonography were scanned preoperatively. After a thyroid examination to exclude radionuclide accumulating thyroid adenoma, planar and tomographic images were acquired 20 min. and 120 min. after i.v. injection of 740 MBq 99mTc-MIBI using a 3 head gamma camera (Picker Prism 3000). The first 10 patients underwent an additional 201Tl/99mTc subtraction scintigraphy in a 2 days protocol. RESULTS: All patients had small, solitary PTA (< 1 g). 201Tl/99mTc subtraction scintigraphy (n = 10) showed only a sensitivity of 50%. Using planar MIBI-scintigraphy lateral location of PTA was possible in 18 cases (sensitivity: 72%). There was an increase in sensitivity up to 96% using the SPECT technique and the 3D display (volume-rendered reprojection). CONCLUSION: In contrast to 201Tl/99mTc subtraction scintigraphy, which showed only a low sensitivity, a reliable lateral location of small PTA was obtained using the tomographic 99mTc-MIBI scintigraphy. This method offers e.g. the possibility for the surgeon to perform an unilateral parathyroidectomy.  相似文献   

12.
Twenty-three patients with a post-operative biliary leak were treated by various endoscopic methods and results were analyzed. Leaks occurred at the cystic duct in 13 patients, at the common duct in 6 patients, and at an anomalous branch of the right hepatic duct in 4 patients. Treatments included sphincterotomy alone (4 patients), stent alone (6 patients), sphincterotomy and stent (12 patients), and sphincterotomy and nasobiliary drainage catheter (1 patient). Five patients also had supplemental percutaneous catheter drainage of a biloma. All treatments were completed successfully in the absence of major morbidity, and permanent closure of the leak occurred in 100% of cases. Endoscopic therapy for patients with a post-operative biliary leak is safe and effective and should be recommended before surgical re-exploration.  相似文献   

13.
OBJECTIVE: To evaluate endoscopic CO2 laser vaporization as a treatment of small glottic laryngeal carcinomas selected by means of video laryngo-stroboscopy. DESIGN: Prospective. SETTING: ENT department, University hospital, Free University Amsterdam. METHODS: Patients with a small glottic laryngeal carcinoma (stage Tis or T1a), were selected by means of video-laryngo-stroboscopy for a single stage endoscopic CO2 laser vaporization treatment as an alternative for radiotherapy. They were followed up for at least 24 months. RESULTS: Three of the 46 patients (6%) developed a local recurrence within 2 years; one of these could be treated once more with the CO2 laser, the other two were irradiated. None of these patients developed metastases in cervical lymph nodes or distant metastases. Most patients (41, 89%) assessed their voices after CO2 laser vaporization as normal or almost normal. Slight dysphonia was reported by five patients (11%). No serious dysphonia or aphonia occurred. CONCLUSION: Endoscopic CO2 laser vaporization, compared with radiotherapy or more extensive surgery, constitutes an adequate treatment for selected patients with small glottic laryngeal carcinomas. As a result of this treatment, it will be possible to preserve the larynx in more patients.  相似文献   

14.
One hundred and twenty-four patients (mean age: 70 years) with a villous tumour of the rectum (n = 98) or the colon (n = 26) were treated by laser therapy from 1985 to 1991. Initial complete eradication was obtained in 93.5% of cases with a median time of 16 months. Using multivariate analysis, the tumor size (> 4 cm) only was predictive of eradication (P < 0.001). At 6 and 12 months, the actuarial eradication rates were 91 and 98% for small tumours versus 45 and 74% for larger tumours respectively. The actuarial recurrence rates were 10.5, 23, and 37% at 6, 12 and 24 months, and no longer increased after 3 years. No predictive factor of recurrence was isolated by multivariate analysis. Seven complications (5.6%) and 4 malignant transformations (3.4%) occurred. This study confirms the efficiency and low morbidity of laser therapy, especially in patients with small tumors, less than 4 cm in size.  相似文献   

15.
BACKGROUND: Colorectal cancer is the third most common cancer in the world, arising mostly from pre-existing adenomatous polyps (adenomas) of the large bowel. Patients with colorectal adenomas are at increased risk of colorectal cancer because of a high recurrence rate for adenomas. We followed a cohort of 1490 patients with rectal adenomas to determine whether recurrence might be related to pathologic characteristics of the initial adenomas. METHODS: The patients were identified in Haining County, China, from 1977 through 1978 by means of examination with a 15-cm rigid sigmoidoscope. They were followed by endoscopic examination at years 2, 4, 6, 11, and 16 after their initial polypectomy. New adenomas in the rectum were identified in 280 patients in these follow-up examinations. RESULTS: Statistically significant twofold to threefold elevated risks of metachronous (recurrent) adenomas were observed for patients who had more than two initial adenomas or whose most advanced initial adenoma was more than 1.0 cm in size, was of villous/tubulovillous type, or showed moderate to severe dysplasia. Much stronger associations were observed for advanced metachronous neoplasms, which are defined as cancers or adenomas with severe dysplasia, with multivariate adjusted relative risks (95% confidence interval) of 4.2 (1.8-9.9) for a large initial adenoma (>1.0 cm), 8.1 (4.2-15.6) for villous/tubulovillous architecture, and 14.4 (5.0-41.3) for severe dysplasia. In particular, patients who had a large (>1.0 cm) adenoma with severe dysplasia at baseline had a relative risk of 37 (7.8-174.7) of developing advanced metachronous neoplasms compared with patients who had small adenoma(s) with mild dysplasia. CONCLUSIONS: The risk of metachronous adenomas is closely related to the pathology of initial adenomas, thus allowing identification of a high-risk group of adenoma patients for close surveillance after their initial polypectomy.  相似文献   

16.
In this study, we examined the effects of recombinant bovine gamma interferon (rIFN-gamma) and nitric oxide (NO) on the interaction of M. avium subsp. paratuberculosis with bovine monocytes. Monocytes pretreated with rIFN-gamma exhibited slightly increased phagocytosis of M. avium subsp. paratuberculosis and modest inhibition of the intracellular growth of this microorganism. The number of viable intracellular bacilli decreased earlier in rIFN-gamma-pretreated monocytes than in control monocytes. After infection with M. avium subsp. paratuberculosis, NO was not constitutively released, but NO release from infected monocytes was induced by treatment with rIFN-gamma or with rIFN-gamma and lipopolysaccharide (LPS). Release of nitric oxide was inhibited by addition of N(G)-monomethyl-L-arginine; however, inhibition of nitric oxide did not alter the pattern of intracellular survival of M. avium subsp. paratuberculosis in rIFN-gamma-treated bovine monocytes. Although chemically generated nitric oxide killed M. avium subsp. paratuberculosis in a cell-free system in vitro, the amount of nitric oxide required was far greater than that released from infected monocytes stimulated with rIFN-gamma and LPS. Our data suggest that rIFN-gamma activates M. avium subsp. paratuberculosis-infected bovine monocytes to release nitric oxide but only modestly increases antimycobacterial activity of monocytes against this organism. This may be due, in part, to the fact that the amount of nitric oxide produced by rIFN-gamma-activated bovine monocytes is insufficient to kill intracellular M. avium subsp. paratuberculosis bacilli in vitro.  相似文献   

17.
OBJECTIVE: To evaluate whether push enteroscopy of the small bowel (PES), undertaken after extensive previous investigations in suspected intestinal bleeding from an uncertain site, chronic diarrhoea or lymphoma of the small intestine, contributes to the diagnosis, and to ascertain the results of PES and its clinical significance. PATIENTS AND METHODS: 56 consecutive patients (29 men, 27 women; mean age 63 years) were investigated prospectively. The main indications for PES were the search for the source of intestinal bleeding in 79% of patients (group A), chronic diarrhoea or tropical sprue in 16% (group B) and search for tumour of lymphoma in 5% (group C). PES was always performed in fasting patients under sedation/analgesia using a video PES, which contrary to catheter enteroscopy provides a channel for intervention. RESULTS: In group A 27% of patients were found to have lesions, in particular angiodysplasias, or (in once case) leiomyoma. Half of these patients were successfully treated endoscopically without later surgical intervention being required (mean follow-up of six months). In the other half operation became necessary, either because the disease itself indicated it or the bleeding persisted, the source being in the more distant small intestine and thus not accessible to endoscopic intervention: only 50% of the length of the small intestine proved to be within reach of the instrument. No abnormalities were discovered in patients of groups B and C. CONCLUSION: In cases of gastrointestinal bleeding from an uncertain source PES should be performed first, because in many cases it may obviate surgical intervention. But PES seems to contribute little of diagnostic value in other indications.  相似文献   

18.
Laboratory studies suggest that substantial amounts of polychlorinated biphenyls are rapidly volatilized from wet contaminated solids during water evaporation. If significant losses also occur during field activities, potential analytical, global, and health implications should be considered in the design and monitoring of remedial actions and the handling of contaminated solids.  相似文献   

19.
Many patients with colorectal cancer are not amenable to curative resection at the time of presentation. Nevertheless, palliative resection still remains as the treatment of choice in the majority of patients. A small group of patients that are poor candidates for surgical resection may benefit from some non-surgical palliative procedures to relieve their symptoms. Electrocoagulation, cryosurgery and radiotherapy are some of the non-surgical procedure used and they are associated with high morbidity and mortality. The use of Neodymium: Yttrium-Aluminium-Garnet (Nd:YAG) laser photoablation to palliate patients with advanced colorectal carcinoma is well documented. It is associated with relatively low morbidity and perioperative mortality. It requires no anaesthesia and is the only non-surgical procedure that can be safely carried out above the peritoneal reflection. Nd:YAG laser had been used in some centres as a preresectional procedure in patient presenting with high grade obstruction. It allows proper bowel preparation followed by primary excision and anastomosis. As a palliative procedure, most patients showed rapid improvement in obstructive symptoms, bleeding and rectal discharge. The size of the lesion and circumferential extent of the tumour base correlate well with the response rate. Most patients remained asymptomatic before they succumb to the advanced disease. In our series, good palliation of obstructive symptoms was achieved in all obstructive cases with one laser treatment, bleeding tumours required an average of two sessions for complete haemostasis. In conclusion, Nd:YAG laser therapy is a safe and efficacious means for palliation of obstructive symptoms and bleeding in advanced rectal carcinoma.  相似文献   

20.
Some patients with Peutz-Jeghers syndrome may be disturbed by the appearance of lentigines. Such patients require management of their lentigines as well as their gastro-intestinal polyps. We describe ruby laser therapy of labial lentigines in two children with Peutz-Jeghers syndrome. The response to treatment was excellent and no sequelae or recurrence of the lesions was noted. CONCLUSION: Our experience suggests that ruby laser therapy is safe and a suitable approach for the treatment of labial lentigines in children with Peutz-Jeghers syndrome.  相似文献   

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