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31.
    
BACKGROUND: Surgeons are often called upon to perform pancreaticoduodenectomy for either suspicion of malignancy or symptoms due to benign disease. Perioperative morbidity and mortality following pancreaticoduodenectomy have decreased markedly over the last 2 decades. In response, many surgical centers advocate expanding the indications for pancreaticoduodenectomy to include lesions other than periampullary carcinoma. PATIENTS AND METHODS: A retrospective review of medical records for 108 patients undergoing pancreaticoduodenectomy for benign disease at The Johns Hopkins Medical Institutions over 100 months was completed. The subset of patients with a histopathologic diagnosis of chronic pancreatitis was identified and compared with patients undergoing pancreaticoduodenectomy for other benign conditions. RESULTS: The mortality rate for the present series was less than 1%. Perioperative complications, the majority of which were self-limited, occurred in 51% of patients. The most common complication was delayed gastric emptying. Pancreatic anastamotic leak occurred in 18% of patients and developed significantly more frequently in patients with benign diseases other than chronic pancreatitis (31% versus 8%, P < 0.05). CONCLUSION: Among appropriately selected patients, the rates of perioperative mortality and serious morbidity are low, and concerns about mortality and morbidity should not prevent an aggressive approach to surgical resection in patients with benign disease.  相似文献   
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Actinobacillus actinomycetemcomitans has been strongly implicated in the etiology of localized juvenile periodontitis. Techniques used in the identification of this periodontal pathogen include cultural, biochemical, immunological and DNA hybridization analysis. In this study, we report the use of polymerase chain reaction (PCR) to amplify unique sequences of A. actinomycetemcomitans. Specific oligonucleotide primers LKT2 and LKT3 were designed to hybridize to the A. actinomycetemcomitans lktA gene, which encodes leukotoxin, a putative A. actinomycetemcomitans virulence factor. The LKT2 and LKT3 primers amplified lktA-specific sequences from all 12 A. actinomycetemcomitans strains tested. In another set of experiments, 13 other bacterial species, most of which are normal residents of the oral cavity, were tested with these primers. These PCR amplifications also contained 2 additional primers, RRN4 and RRN5, which served as positive controls; RRN4 and RRN5 were designed to amplify specific sequences of eubacterial 16S ribosomal DNA (rDNA). PCR amplifications of all bacterial species tested, including A. actinomycetemcomitans, yielded 16S rDNA-specific DNA fragments. Furthermore, each bacterial species tested, with the exception of A. actinomycetemcomitans, failed to amplify lktA sequences. The LKT and RRN primers were used in further PCR experiments to detect A. actinomycetemcomitans directly from gingival fluid samples. The results clearly demonstrate the simplicity, rapidity, specificity and accuracy of the LKT primers in the identification of A. actinomycetemcomitans.  相似文献   
33.
We describe a 32 year old male with a distal 6p24.3-->pter deletion. He has specific developmental anomalies of the anterior chamber of the eye and a cleft uvula which is consistent with the recent localisation of genes for iris development and orofacial clefting to distal 6p. In addition he has progressive sensorineural deafness and this may localise a gene for deafness to this region. We conclude that a refined distal 6p deletion syndrome exists and includes a characteristic facial appearance with hypertelorism, downward slanting palpebral fissures, tented mouth, smooth philtrum, palatal malformation, ear anomalies, anterior chamber eye defects, progressive sensorineural deafness, cardiac defects, abdominal herniae, small external genitalia, and motor and speech delay.  相似文献   
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In April and May 1996, two cases of PDA ligation were performed firstly in Turkey by the method of video assisted thoracoscopic surgery (VATS) in Dokuz Eylül Medical Faculty, Thoracic and Cardiovascular Surgery Department. There was not any complication in these patients in the postoperative period and they were discharged on the second day in symptom-free condition by the detection of closed ductus in their echocardiographic examination. Between February 1993 and October 1996, a total of 46 patients have undergone interventional application by VATS. While in six of these patients the procedure could not be manipulated because of massive pleural fibrosis, there was no mortality or morbidity among the patients, and they were discharged on average on the second day. The ratio of complications, such as bleeding, air leak, arrhythmia and empyema are so low in these operations, and hospital stay, with return to work time are shorter than with the open technique.  相似文献   
36.
To develop polymer systems with improved lithographic resist properties, terpolymers of methyl methacrylate/methacrylonitrile/methyl α-chloroacryate (MMA/MCN/MCA), methyl methacrylate/methacrylonitrile/α-chloroacrylonitrile (MMA/MCN/ACAN), and methyl methacrylate/methacrylonitrile/vinylidene chloride (MMA/MCN/VDC) were prepared by emulsion polymerization. Also one methyl methacrylate/ methyl α-chloroacylate/α-chloroacrylonitrile (MMA/MCA/ ACAN) terpolymer was prepared. The radiation susceptibilities of these terpolymers were measured using the 60Coγ-irradiation method. Molecular weights were determined both by membrane osmometry and gel permeation chromatography. All terpolymers exhibited higher radiation-degradation susceptibilities than poly(methyl methacrylate). The Gs values did not follow the general trend, previously observed with MCN/MCA copolymers, of being directly proportional to the respective terpolymer compositions. In some cases, the addition of small quantities of α-chlorine-containing monomers caused Gx to increase. This observation greatly differs from those observed for copolymer systems such as MMA/MCA, MCN/MCA, MMA/ ACAN, etc. studied previously. Terpolymerization gives highly soluble polymers especially suitable for wet development by many solvents. This is an important consideration for polymers with high mole fractions of methacrylonitrile (MCN) or vinylidene chloride (VDC) which are rendered soluble in development solvents. The electron-beam sensitivities were obtained for samples of three classes of the terpolymers and they were higher than that of PMMA. For example, at 20Kev a 62/34/4 MMA/MCN/MCA terpolymer exhibited a sensitivity of 1.3 × 10?5 coulombs cm?2 at l/lo = 1. The introduction of ACAN narrows the working range for positive resist behavior. For example MMA/MCN/ACAN(41/40/19) has a sensitivity of 8.3 × 10?6 coulombs cm?2 at l/l0 = 0.6 but it crosslinks at 1 ? 1.3 × 10? coulombs cm2. The MMA/MCN/VDC(21/76/3) polymer was about 25 times more sensitive than PMMA (7 × 10?6 C cm?2 at l/l0=1).  相似文献   
37.
A male aged 47 years with gross autonomic insufficiency as part of the Shy-Drager syndrome is described. He did not sweat normally when warmed, and his circulatory responses to mental arithmetic, the Valsalva manoeuvre, and head-up tilt were abnormal indicating severe sympathetic failure. During head-up tilt there was a rise in plasma renin activity and plasma aldosterone. It is argued that plasma renin activity is not dependent on sympathetic nervous activity and may be mediated by renal baroreceptors. These rises may help sustain the blood pressure in such patients during repeated head-up tilts. Infusions of L-noradrenaline and angiotension produced greater hypertension, and injections of isoprenaline greater hypotension than in controls. Although it is difficult to exclude the possibility that one factor in this may be hypersensitivity of receptors in blood vessel walls, the principal factor is likely to be the absence of those baroreflexes of which the efferent pathways are in the sympathetic nervous system.  相似文献   
38.
A simplified technique for selective abdominal angiography utilizing the Simmons Femoral-Cerebral catheter is described. The technique affords a rapid simple approach to selective and superselective catheterization of the celiac, superior mesenteric and inferior mesenteric arteries.  相似文献   
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The formation of androgen-binding protein (ABP) by cultured Sertoli cells, prepared from testes of immature rats, is increased when androgens or follicle-stimulating hormone (FSH) are present in the medium. Testosterone and 5alpha-dihydrotestosterone are equally effective in stimulating the synthesis and secretion of ABP, but non-androgenic steroids examined (progesterone, 17beta-estradiol and corticosterone) are without influence. Maximal increases are observed when androgens are added at the time of cell plating. Cells maintained in culture medium devoid of hormones become progressively less sensitive to subsequent addition of testosterone or FSH. Data are discussed in relation to the sites of androgen requirements for spermatogenesis.  相似文献   
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