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Learning on the Web. Case 6: aortic valve replacement in the elderly. A 90 year old man was found at home by his daughter, slumped at the bottom of his stairs. He recalled quite severe tight central chest pain associated with breathlessness and sweating while going up stairs which was not relieved by taking a spray of sublingual glyceryl trinitrate (GTN). He sensed that he was "about to die" before collapsing with loss of consciousness. He was sent to the accident and emergency department (emergency room) of his local hospital by ambulance. The patient had a five year history of angina pectoris that limited him to one flight of stairs within the house and light housework only. Over the two weeks preceding his admission to hospital he had experienced increasing frequency of these symptoms and used his GTN spray more often than usual. He had not smoked for over 50 years and there were no other risk factors for cardiovascular disease. There was no other notable past medical history and he was otherwise fit, living completely independently. The significance of these signs and symptoms, the diagnosis, and the short and long term treatment of these problems are discussed in an interactive case presentation. | [
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Learning on the Web. Case 7: recurrent pleural effusions, resistant atrial arrhythmias, and abnormal liver function tests: general medicine or cardiology? A 65 year old man presented with recurrent pleural effusions. Repeated pleural fluid examination and pleural biopsy were unremarkable. Pericardial calcification was noted on admission and attributed to an uncomplicated episode of pericarditis 30 years previously. His symptoms and signs were not thought not to be associated with the heart. While awaiting an open pleural biopsy the patient was admitted with a further pleural effusion, jaundice, resistant atrial arrhythmias, and dyspnoea. Hepatic investigations including autoantibody screen and transjugular liver biopsy were normal. The significance of these signs and symptoms, the diagnosis, and the management of these problems are discussed in an interactive case presentation. | [
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Urotensin-II and cardiovascular diseases. Urotensin-II (U-II) is a vasoactive factor with pleiotropic effects. U-II exerts its activity by binding to a G-protein-coupled receptor termed UT. U-II and its receptor are highly expressed in the cardiovascular system. Increased U-II plasma levels have been reported in patients with cardiovascular disease of varying etiologies. We and others have shown that U-II and UT expression is elevated in both clinical and experimental heart failure and atherosclerosis. U-II induces cardiac fibrosis by increasing fibroblast collagen synthesis. In addition, U-II induces cardiomyocyte hypertrophy and increased vascular smooth muscle cell proliferation. We have shown that U-II antagonism using a selective U-II blocker, SB-611812 reduces neointimal thickening and increases lumen diameter in a rat restenosis model of carotid artery angioplasty. These findings suggest an important role for U-II in cardiovascular dysfunction and remodeling. | [
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[Infiltrative pulmonary tuberculosis: course and efficiency of treatment]. The purpose of the investigation was to study the course of and the efficiency of treatment for new-onset infiltrative pulmonary tuberculosis. Two hundred and two patients with this condition were examined. Among the 202 patients, 15 (7.4%), 49 (24.3%), and 46 (22.8%) patients had lobular, rounded, and cloud-like infiltrates, respectively. 31 (15.3%) patients had periscissuritis and 61 (30.2%) had lobitis. The extent of infiltrative pulmonary tuberculosis within 1 segment was encountered in 19.3% and more frequently in the presence of rounded and lobular infiltrates; the specific process in 2 segments was detected in 24.3% of cases and more frequently when rounded and cloud-like infiltrates were observed. In periscissuritis and lobitis, the process occupied 1 lobe in 87.1 and 44.3% of cases, respectively, and 2 lobes or more in 34 (55.7%) patients. Infiltrates were located in the upper lobe in 167 (82.7%) patients, in Segment IV in 21 (10.4%), Segment IX in 6 (3%), Segment X in 5 (2.5%). The signs of lung tissue decay were detected in 140 (69.3%) persons. Decay cavities of less than 2 cm, 2-4 cm, and more than 4 cm in diameter were found in 56 (40%), 62 (44.3%), and 22 (15.7%) patients, respectively. Mycobacterium tuberculosis (MTB) was detected in 13.3, 46.9, 54.4, 70.9, and 83.6% of the patients who had lobular, rounded, and cloud-like infiltrates, periscissuritis, and lobitis, respectively. The drug-sensitive MBT population was seen in 58.4% of the patients; the drug-resistant MBT population was detected in 18.1% of the patients: in 14.3% with a lobular infiltrate, in 10% with a rounded infiltrate, in 28.6% with a cloud-like one, in 21.4% with perscissuritis, and in 15.7% with lobitis. Multi-drug MBT resistance was ascertained in 3.5% of the patients. Bacterial isolation ceased in 100% of the patients with a lobular infiltrate after 1-month therapy, in 47.8 and 52.2% of those with a rounded infiltrate after 1- and 2-month therapy, respectively, in two thirds and one third of the patients with a cloud-like infiltrate after 1- and 2-month therapy, respectively, in 45.4 and 31.8% of those with periscissuritis after 1- and 2-month therapy, respectively, and in 45.1 and 11.8% of cases of lobitis after 1- and 4-month therapy, respectively. | [
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[X-ray features of disseminated pulmonary tuberculosis at late stages of HIV infection]. The paper analyzes the results of a study of X-ray features of disseminated pulmonary tuberculosis in HIV infection on the basis of a retrospective analysis of the case histories of 65 HIV-infected patients with disseminated pulmonary tuberculosis and 60 patients with disseminated tuberculosis without HIV infection, who have been followed up in the Krasnodar Territory. X-ray changes characteristic for patients with disseminated tuberculosis in HIV infection and their difference from those with disseminated tuberculosis without HIV infection have been ascertained, which assists in timely establishing the diagnosis of tuberculosis in HIV infection. | [
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[Thirty years' experience in following up patients with nonspecific respiratory diseases]. The paper sums up the work of the Diagnosis Department of the Central Research Institute of Tuberculosis, Russian Academy of Medical Sciences in the past 30 years. It also presents the results of examinations, treatment, and follow-ups of 5000 patients with sarcoidosis, exogenous allergic alveolitis, pulmonary tuberculosis of questionable activity, pneumonia, benign and malignant tumors, respiratory malformations, systemic vasculitis, pulmonary eosinophilia, lymphogranulomatosis, and rare lung diseases. | [
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"end": 359,
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{
"begin": 362,
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"end": 390,
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},
{
"begin": 393,
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"end": 414,
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},
{
"begin": 442,
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"end": 450,
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},
{
"begin": 453,
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"end": 458,
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},
{
"begin": 464,
"chunks": "malignant tumors",
"confidences": "0.81210005",
"end": 479,
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},
{
"begin": 482,
"chunks": "respiratory malformations",
"confidences": "0.54975",
"end": 506,
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},
{
"begin": 509,
"chunks": "systemic vasculitis",
"confidences": "0.7696",
"end": 527,
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},
{
"begin": 530,
"chunks": "pulmonary eosinophilia",
"confidences": "0.90785",
"end": 551,
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},
{
"begin": 554,
"chunks": "lymphogranulomatosis",
"confidences": "0.7662",
"end": 573,
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},
{
"begin": 580,
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"end": 583,
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},
{
"begin": 585,
"chunks": "lung diseases",
"confidences": "0.38045",
"end": 597,
"entities": "Disease_Syndrome_Disorder"
}
] | 5 |
[On the morphological diagnosis of drug-resistant pulmonary tuberculosis]. The intraoperative samples taken from 15 patients with acutely progressive drug-resistant fibrocavernous pulmonary tuberculosis were studied. There were typical signs of granulomatosis inflammation, a predominance of an exudative tissue reaction, and an extensive vascular bed lesion. Two types of perifocal cellular infiltrates were identified. Mononuclear infiltrates with epithelioid cellular transformation along the periphery were defined as specified. Nonspecific infiltrates were composed of foam macrophages-lipophages and they reflected lipid metabolic disturbances. In addition, the severity of the process was determined by an extensive specific bronchial lesion of all generations. A morphological study of the samples could reveal the tissue and cellular features of respiratory organs in drug-resistant tuberculosis and identify the diagnostically significant signs of specific and nonspecific inflammation. | [
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] | [] | [
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{
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"begin": 421,
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"begin": 533,
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"begin": 621,
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{
"begin": 713,
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{
"begin": 732,
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{
"begin": 771,
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{
"begin": 823,
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"end": 828,
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},
{
"begin": 855,
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"end": 872,
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{
"begin": 877,
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"begin": 892,
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"end": 903,
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{
"begin": 958,
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},
{
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{
"begin": 983,
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"confidences": "0.6642",
"end": 994,
"entities": "Symptom"
}
] | 6 |
Genetic and pharmacological basis for therapeutic inhibition of beta- and gamma-secretases in mouse models of Alzheimer's memory deficits. Alzheimer's disease (AD) is a dementing neurodegenerative disorder for which effective disease-modifying therapeutic treatments have not yet been developed. Genetic and molecular biological studies provide accumulating evidence supporting the hypothesis that the production of amyloid-beta (Abeta) peptides, especially neurotoxic Abeta42, is central to the pathophysiology of AD--the 'amyloid cascade' hypothesis. Abeta is proteolytically generated from a type I integral membrane amyloid precursor protein by the sequential action of two enzymes, called beta- and gamma-secretase, in reference to their cleavage sites at the N- and C-terminals, respectively. Given the strong association between Abeta and AD, the strategies to inhibit the production of Abeta, the first step of the amyloid cascade, should prove beneficial as truly disease-modifying therapeutic approaches for the treatment of AD. Recent advances in genetic strategies including knockouts, transgenics and virus-delivered small interfering RNAs and the development of potent and specific small-molecule inhibitors have opened a new window to test the impacts of beta- and gamma-secretase inhibition in vivo. Since cognitive deficits are at the heart of AD, one of the most important challenges is to determine the therapeutic potential of secretase-inhibiting approaches for AD-related memory deficits, linking perspectives through the prism of molecular/pathological events and those through behavioral and neurophysiological manifestations. I review recent progress in this field, with special focus on the functional consequences of beta- and gamma-secretase inhibition and altered amyloid neuropathology in mouse models of AD memory deficits. | [
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] | [] | [
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{
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{
"begin": 169,
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{
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{
"begin": 772,
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{
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{
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{
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},
{
"begin": 1352,
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"begin": 1835,
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"confidences": "0.4604667",
"end": 1852,
"entities": "Disease_Syndrome_Disorder"
}
] | 7 |
[Non-traumatic pathology of the shoulder: medical treatment]. Recently published meta-analyses emphasized weak methodology of clinical research evaluating medical treatment of non-traumatic shoulder pathology. Experts recommend medical treatment as the first step in the management of rotator cuff tendinopathies, the focus of this review. This step precedes surgical treatment of rotator cuff tear with the objective of recovering passive motion of the shoulder. It can be the unique therapeutic phase of rotator cuff tear or simple tendinopathy when clinical results match functional needs of the patient. Therefore, the physician prior treatment has to establish a lesion diagnostic, which is necessary to propose an appropriate strategy. Medical treatment includes NSAID, local injections of corticosteroids and physiotherapy with the double objective of a painless shoulder and normal range of motion. In case rotator cuff calcifying tendinitis, medical treatment is specific with first NSAID and local injections of cortico-sterods, second needle aspiration and third arthroscopic removal, which remains the gold-standard procedure when other treatments failed. | [
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}
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{
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{
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{
"begin": 870,
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"end": 877,
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{
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{
"begin": 1074,
"chunks": "arthroscopic removal",
"confidences": "0.74835",
"end": 1093,
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}
] | 8 |
[Non traumatic pathology of the shoulder: when to perform surgery?]. Non traumatic pathology of the shoulder was broken down in four entities: (1) articular stiffness are best treated with rehabilitation and an arthroscopic arthrolysis is rarely recommended; (2) rotator cuff pathology is represented by calcifying and non calcifying tendinitis, partial and full thickness rotator cuff tears; surgical treatment is performed nowadays under arthroscopy; after 50 years old, surgery is indicated after failure of conservative treatment; (3) glenohumeral osteoarthritis and arthritis are best treated with prosthesis; the results are now comparable to hip arthroplasty; (4) chronic acromio-clavicular pathology is usually treated conservatively. | [] | [] | [
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The role of SEMS in malignant and benign colon obstruction. SEMS are highly valuable in the management of pati-ents with malignant colon obstruction with high technical and clinical success. Currently, their role is in colon deco-mpression as a bridge before surgery and in the palliative management of inoperative patients. SEMS appear to be more effective and less costly than emergency surgery. SEMS should be avoided in benign strictures. More data is needed in reference to the role of plastic expandable stents in the management of patients with benign colon strictures. | [
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Cytoreductive approach to peritoneal carcinomatosis originated from colorectal cancer: Turkish experience. Peritoneal carcinomatosis (PC) in contrast to lymph nodes and liver metastases was assumed as a terminal condition with no curative treatment options having a 5 to 9 months median survival rate until recently. Today, in properly selected patients, curative surgical treatment of PC is possible like resection of lymph nodes and liver metastases. Between 1996 and 2005, 29 patients who underwent cytoreductive surgery combined with intraperitoneal chemotherapy for PC originated from colorectal cancer (CRC) were analysed prospectively at the Department of Surgery in Dokuz Eylul University Hospital. Mean age was 54 year (range, 23-75 years). There was no peroperative mortality in 29 patients. The morbidity rate was 41% (12/29) and 6 (20%) patients required reoperation(s) for major complications. Mean and median survival time was 34 and 21 months, respectively. The overall 1-year, 3-year, and 5-year survival rates were 72%, 13%, and 7%, respectively. Mean survival time was 56 months in patients with peritoneal cancer index (PCI) < 10, and 22 months in patients with PCI > 10 (P = 0.075). The mean survival time was 62 months in patients with complete cytoreduction (CC)-0 score, 21 months in patients with CC-1 score, and 7 months in patients with CC-2 and 3 scores. Patients who had CC-0 score had better survival than patients having CC-1 and CC-2 scores (P = 0.003 and P = 0.000, respectively). Patients who had CC-0 and 1 scores had better survival than patients with CC-2 score (P = 0.000). The overall 1-year, 3-year, and 5-year survival rates for patients with CC-0 score were 87%, 37%, and 25%, respectively. There was a positive correlation between the PCI and CC score (P = 0.001, correlation coefficient = 0.585 with correlation is significant at level 0.01). Cytoreductive approach combined with intraperitoneal chemotherapy and systemic chemotherapy prolongs survival in selected patients with PC of CRC with acceptable morbidity and mortality. Prognosis is better in patients with limited disease and in whom complete cytoreduction is achieved. In patients with PC of CRC, the key issue is to select the patients in whom complete cytoreduction is feasible. Better patient assessment with new diagnostic tools such as (PET)-CT or PET-magnetic resonance imaging will be used to detect more precisely the patients with low tumor burden in the new feature. | [
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Radiofrequency surgery--novel techniques in the treatment of ano-rectal disease. BACKGROUND Radiofrequency surgery is a method of utilizing high frequency (3.8 to 4MHz) radio wave energy to incise, excise, or coagulate tissues. Radiofrequency (RF) is a relatively new modality that is being used for ano-rectal surgeries with increasing frequency. As the RF energy is applied, frictional heating of tissues results, with cell death occurring at temperatures between 60 and 100 degrees C. OBJECTIVE This paper discusses author's clinical experience with radiofrequency for various ano-rectal pathologies namely hemorrhoids, anal fistula, anal polyps, sinuses and anal papillae. A Ellman dual frequency radiofrequency generator was used to carry out the procedures. This study is intended to be somewhat of a "how we do it" manual, explaining the principles of radiofrequency. CONCLUSION Radiofrequency proctological procedures are simple to perform with many advantages over the more traditional techniques. The procedures take less operative time, the postoperative recovery is accelerated and the incidences of complications are negligible. | [
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{
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"chunks": "ano-rectal surgeries",
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"end": 319,
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{
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{
"begin": 612,
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{
"begin": 625,
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{
"begin": 639,
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"end": 649,
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{
"begin": 652,
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"confidences": "0.9478",
"end": 658,
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},
{
"begin": 664,
"chunks": "anal papillae",
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"end": 676,
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},
{
"begin": 681,
"chunks": "Ellman dual frequency radiofrequency generator",
"confidences": "0.64912",
"end": 726,
"entities": "Medical_Device"
},
{
"begin": 861,
"chunks": "radiofrequency",
"confidences": "0.6174",
"end": 874,
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},
{
"begin": 879,
"chunks": "CONCLUSION Radiofrequency proctological procedures",
"confidences": "0.51325",
"end": 928,
"entities": "Procedure"
}
] | 12 |
The role of cytology in the diagnosis of benign and malignant anal lesions. Squamous cell carcinoma is a rather infrequent neoplasm of the gastrointestinal tract. Nevertheless its frequency is increasing lately especially in high risk groups of the population infected from HIV or HPV viruses. Squamous cell carcinoma is a slowly and locally growing neoplasm which metastasizes in advanced stages. Its diagnosis must be accomplished by the least traumatic examinations possible. In our study we reviewed our five years experience that included 116 cases. In 89 of them cytological material from ulcerated positions of the anal region was examined. In the rest 27 cytological material was obtained by fine needle aspiration of subcutaneous or submucosal anal lesions. All 116 case reports were retrospectively evaluated. Cytological evaluation revealed 29 cases of normal anal epithelium, 13 granulomas, 12 cases of HPV infection, 28 anal squamous intraepithelial lesions (ASIL), 17 post radiation injuri-es of the anal mucosa and 17 carcinomas. The neoplasms were further subclassified in 12 well differentiated squamous cell carcinomas, 4 cloacogenic carcinomas and 1 leiomyosarcoma. Histological examination followed the initial cytological diagnosis in 75 cases. The correlation between cytological and histological reports did not reveal any false negative or any false positive result. The agreement between histological and cytological evaluation was absolute. Cytological examination is proved to be an easily accessible and totally reliable, low cost diagnostic method, not requiring any kind of anesthesia. It is well accepted by the patients and of paramount clinical utility for the initial diagnostic assessment, the long-term follow up after treatment of anal cancer patients. It is also valuable for the differential diagnosis among benign, premalignant and malignant anal lesions. | [
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{
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{
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{
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{
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{
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{
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{
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{
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{
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{
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{
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{
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{
"begin": 508,
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{
"begin": 544,
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{
"begin": 595,
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{
"begin": 622,
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{
"begin": 700,
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{
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{
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{
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{
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{
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{
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{
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{
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{
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{
"begin": 1033,
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},
{
"begin": 1049,
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{
"begin": 1089,
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"confidences": "0.635",
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{
"begin": 1112,
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"confidences": "0.9009333",
"end": 1135,
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},
{
"begin": 1140,
"chunks": "cloacogenic carcinomas and 1 leiomyosarcoma",
"confidences": "0.8436",
"end": 1182,
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},
{
"begin": 1185,
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{
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{
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{
"begin": 1306,
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{
"begin": 1352,
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"confidences": "0.8075",
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{
"begin": 1374,
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"confidences": "0.5121",
"end": 1381,
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},
{
"begin": 1413,
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"confidences": "0.9789",
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{
"begin": 1430,
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{
"begin": 1457,
"chunks": "absolute",
"confidences": "0.693",
"end": 1464,
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},
{
"begin": 1467,
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"confidences": "0.9138",
"end": 1489,
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},
{
"begin": 1604,
"chunks": "anesthesia",
"confidences": "0.9954",
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},
{
"begin": 1768,
"chunks": "anal cancer",
"confidences": "0.76185",
"end": 1778,
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},
{
"begin": 1847,
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"confidences": "0.9527",
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},
{
"begin": 1855,
"chunks": "premalignant",
"confidences": "0.7864",
"end": 1866,
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},
{
"begin": 1872,
"chunks": "malignant",
"confidences": "0.2609",
"end": 1880,
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},
{
"begin": 1882,
"chunks": "anal lesions",
"confidences": "0.21489999",
"end": 1893,
"entities": "Symptom"
}
] | 13 |
The T/G mutation in exon 8 of hMSH2 gene in the sporadic colon cancer patients. The DNA mismatch repair (MMR) system guards against genomic instability, therefore the mutations in the human MMR genes cause the majority of the hereditary nonpolyposis colorectal cancer (HNPCC) and a small percentage of the sporadic colon cancer. hMSH2 is one of MMR genes involved in the correction of mispairing during replication and its mutations are associated with both--microsatellite instability and the hereditary and sporadic colon tumourgenesis. The aim of this study was to analyse the T/G mutation (codon 458) in exon 8 of hMSH2 gene in the sporadic colon cancer cells. We also examined the relationship between the T/G mutation of hMSH2 gene, and the selected prognostic factors such as Dukes' stage, histological grade and lymph node metastasis. We analysed samples of tumour from 75 patients with sporadic colorectal cancers. The mutation in the hMSH2 gene ware determined by the RFLP-PCR. We found T/G mutation in exon 8 of hMSH2 gene in 5 patients (6,7%). There was no statistically significant difference between this mutation and selected clinical parameters. The results of our studies revealed that mutations of hMSH2 gene may lead to development of colorectal cancer. No dependence between the mutation of hMSH2 gene and clinical parameters, suggests that the mutation of hMSH2 gene may have a critical significance for the first steps of carcinogenesis in colon epithelial. | [
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{
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{
"begin": 820,
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{
"begin": 866,
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{
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{
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{
"begin": 1444,
"chunks": "carcinogenesis in colon epithelial",
"confidences": "0.59282506",
"end": 1477,
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}
] | 14 |
Management of T1 carcinoma of the lower third rectum. The earliest invasive carcinoma of colon and rectum is an invasion into the submucosa. For the TNM classification, these lesions are T1 Nx Mx. They present as an adenoma with invasive carcinoma, or a frank carcinoma. Local excision for T1 carcinoma of the rectum can be curative if the lesion is accessible for an adequate excision and if the lesion has not spread to the lymph nodes or distant metastasis. The key to success in local excision is selecting the lesions that have low risk of metastasis. | [] | [] | [
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{
"begin": 545,
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"confidences": "0.9884",
"end": 554,
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}
] | 15 |
Holistic approach to chronic constipation. By "holistic approach" (greek "olos" = "all") we mean a clinical approach which is not only confined to the diseased segment of the body, say the inert large bowel or the spastic pelvic floor in case of constipation, but takes under consideration the whole "mind and body complex", which is a unique indivisible entity. According to a prospective study carried out in our Unit and under press in Colorectal Disease, 66% of the patients with obstructed defecation suffer either from anxiety or depression, thus showing the major role played by an altered psyche in the etiology of their constipation. | [
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] | [] | [
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] | 16 |
Recto-vaginal/urethral fistula: repair with gracilis muscle transposition. UNLABELLED This study was designed to assess the efficacy of gracilis muscle transposition in repairing recto-vaginal and rectourethral fistula. All patients had fecal diversion as a preliminary or concurrent step to fistula repair. Success was defined as healed fistula after stoma closure. RESULTS Six females and four males underwent gracilis muscle transposition from 1999 to 2006. Gracilis muscle transposition is a viable option for repairing fistulas between the urethra, vagina and the rectum, especially after failed perineal or trans-anal repair. It is associated with low morbidity and good success rate. Underlying Crohn's disease and previous radiation are associated with poor prognosis. | [
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] | 17 |
Colon polyposis syndromes. Indications to surgery. Familial polyposis syndromes create a group of hereditary syndromes of gastrointestinal tumours. We shall focus on those, touching mostly large bowels and need radical surgery. | [
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] | 18 |
Treatment results of colorectal cancer--10-years series of UMC Ljubljana (1991 - 2000). UNLABELLED In Slovenia the incidence of colorectal cancer is growing rapidly. In 1998 1022 new cases were registered. Our study compares results of two groups of patients with colorectal cancer. Patients and methods. In the period from 1.1.1991 to 31.12.2000 1478 patients with a colorectal carcinoma underwent potentially curative resection. We divided them in two groups, one operated in the first 5-years and second in later 5-years period. 5-years survival was estimated with Kaplan-Meier statistical analysis. Patients who died within 30 days after the operation were censored. Differences in survival curves between both groups were assessed by the log rank test. RESULTS We resected 1478 /1599 (92,4%) patients. There was 913 (61,7%) patients resected with colon cancer and 528 (35,8%) with rectal cancer and 37 (2,5%) with sinhronius tumors. R0 resection was performed in 1174 (79,4%) patients, R1 in 29 (2,0%), and R2 in 273 (18,5%) patients. Postoperative mortality rate in resected patients was 5,48% (81/1478), in the group with paliative operations was 17,35% (21/121). Overall five-years survival rate was 54,9% (56,18% for colon cancer and 52,4% for rectal cancer Five-years survival rate for the patients with radical resection (R0) was 66,54% for colon cancer and 59,47% for rectal cancer. CONCLUSION 5-years survival for R0-resected patients with colon cancer was in the last period from 1996 to 2000 statistically significantly better compared with the period from 1991 to 1995 (76% vs 60%) in stage I (p = 0,04048) and in stage III (p = 0,01842). 5-years survival for R0-resected patients with rectal cancer was significantly better in the same period (63% vs 55%) (p = 0,03627) in stage III (p = 0,01663). | [
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"confidences": "0.94515",
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},
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"confidences": "0.6067",
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"end": 1468,
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},
{
"begin": 1498,
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"confidences": "0.999",
"end": 1501,
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{
"begin": 1506,
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"confidences": "0.7309",
"end": 1509,
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{
"begin": 1576,
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"confidences": "0.9991",
"end": 1579,
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{
"begin": 1584,
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"confidences": "0.9983",
"end": 1587,
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},
{
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"confidences": "0.9611",
"end": 1718,
"entities": "Oncological"
}
] | 19 |
Straight and colonic J-pouch reconstruction after low anterior resection. PURPOSE A complication after restorative rectal surgery with a straight anastomosis is low-anterior resection syndrome with a postoperatively deteriorated anorectal function. The colonic J-reservoir is sometimes used with the purpose of reducing these symptoms. An alternative method is to use a simple side-to-end anastomosis or a coloplasty. MATERIAL AND METHODS Three-hundred fiftyseven patients with rectal cancer undergoing total mesorectal excision (TME). Three-hundred (84.0%) received a low anterior resection with primary anastomosis and colo-rectal n = 194 (64.6%) or colo-anal anastomosis n = 106 (35.3%). A colonic pouch using the descending colon was created in 24 patients and in 75 patients respectively. Surgical results and complications were recorded. Patients were followed with a functional evaluation at 6 and 12 months postoperatively. RESULTS Patient characteristics in both groups were very similar regarding gender, age, tumor level, and Dukes' stages. A large proportion of the patients received short-term preoperative radiotherapy (72%). There was no significant difference in surgical outcome between the 2 techniques with respect to anastomotic height, perioperative blood loss, postoperative complications, reoperations, hospital stay or pelvic sepsis rates except the anastomotic stricture rate in the colonic J-Pouch group after coloanal anastomosis (p < 0.02). CONCLUSIONS These data show that either a colonic J-pouch or a straight anastomosis performed on the descending colon in low-anterior resection with TME are methods that can be used with similar expected surgical and functional results. | [
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{
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{
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{
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{
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{
"begin": 1100,
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{
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{
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{
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"confidences": "0.35315",
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{
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"confidences": "0.71070004",
"end": 1557,
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},
{
"begin": 1576,
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"confidences": "0.80885",
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{
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{
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"chunks": "TME",
"confidences": "0.9543",
"end": 1626,
"entities": "Procedure"
}
] | 20 |
Endorectal ultrasound (ERUS) in pelvic disorders. Endorectal ultrasound (ERUS) imaging is a complex process using electronic devices to control ultrasound waves and produce images of anatomic structures. It is a simple, cheep and well-tolerated procedure that provides excellent images of rectal and anal canal wall and pelvic floor muscles together with surrounding organs and tissues. The direct imaging of anal canal and pelvic floor muscles with surrounding tissues allows one to identify sphincter defects, anorectal abscesses and fistulas as well as great variety of benign and malignant pathology of the pelvis. Basically, techniques for ERUS are very similar, but there are some slight modifications regarding equipment, indications, and localization of pathologic process. We describe the technique, indications, results and pitfalls of ERUS with the Bruel and Kjaer type 1850 endosonic probe with 7 and 10 MHz transducers in benign pelvic disorders. | [
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"end": 543,
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{
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"end": 578,
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{
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{
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"end": 900,
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{
"begin": 935,
"chunks": "benign pelvic disorders",
"confidences": "0.29346666",
"end": 957,
"entities": "Disease_Syndrome_Disorder"
}
] | 21 |
[Laparoscopic surgery of colon cancer. State of art and literature review]. Over the past decade advances in laparoscopic surgery have revolutionized the surgical approach to many diseases. Although the first case series on laparoscopic segmental colectomy in patient with sigmoid cancer was described in 1991, this technique has not been readily accepted. Despite reduced morbidity and improved convalescence after laparoscopic surgery for benign disorders, surgeons have been sceptical about similar advantages of laparoscopic colectomy for cancer. The safety of the procedure has been questioned because of early reports of port-site metastases and there has been uncertainty about whether minimally invasive surgery for colonic malignancies would achieve adequate oncologic resection. Open surgical resection of the primary tumor, until just recently, has been widely considered the most effective treatment of colon cancer. The adherence to the principles of complete abdominal exploration, high ligation of mesenteric vessels, lymphnodal clearance and adequate bowel resection margins is essential. Several randomized trials were initiated in the early 1990s to compare the short- and long-term outcomes of patients undergoing minimally invasive and conventional open surgery for colon cancer. Today the results of this large multiinstitutional randomized trials have been reported. This review examines recent data from randomized, controlled trials and meta-analysis, that report the short- and long-term outcomes after laparoscopic colectomy for cancer. | [
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{
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},
{
"begin": 1555,
"chunks": "cancer",
"confidences": "0.9941",
"end": 1560,
"entities": "Oncological"
}
] | 22 |
[The BIB intragastric balloon]. INTRODUCTION Since 1998, we adopted in our clinical practice for obesity treatment the new intragastric balloon (BioEnterics Intragastric Balloon, BIB), it has the characteristics of an "ideal gastric balloon" (Workshop Tarpon Springs, 1987). MATERIALS AND METHODS Since March 1998 we have placed by endoscopic approach 518 BIB in 480 patients affected by first, second and severe morbid obesity; 124 male and 356 female, mean age 41.6 years (18-72), mean weight Kg 116.9 (67-229), mean BMI 42 Kg/m2 (27.34-81.14). All our patients underwent to diet of 1000 Kcal/day and treatment with antisecretory drugs. RESULTS The mean weight lost was Kg 14.69 and the mean reduction in BMI was 5.11 Kg/m2. Weight loss was greater in male severe obese (BMI > 40). Weight was accompanied by an improvement of the disease associated with obesity, in particular diabetes, hypertension and sleep apnoea. DISCUSSION AND CONCLUSION The best indication for BIB were: morbidly obese patients (BMI > 40) and super-obese patients (BMI > 50) in preparation for bariatric operation; obese patients with BMI 35-40 with co-morbilities in preparation for bariatric surgery; obese patients with BMI < 30 only in a multidisciplinary approach patients with BMI 30-35 with a chronic disease otherwise unresolved. | [
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{
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},
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},
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] | 23 |
[Acute acalculous cholecystitis: pathophysiology and treatment]. The absence of reliable correlation between clinical features and pathological evolution and the molteplicity of risk factors, often related to various pathophysiological pathways, make of acute acalculous cholecystitis a clinical entity well distinct from other affecting gallbladder. In spite of the slight incidence, its occurrence among serious multiple trauma patients may reach 90%. The arguability of diagnostic criteria and the missed or delayed recognition, then affecting timing of surgery are important in determining morbidity and mortality of this condition. The Authors reviewed 16 patients operated for acute acalcolous cholecystitis. US, although sometimes underestimate the severity of affection and cause false negatives, had been the first choice investigation because of its rapidity, facility of execution and repeatability. TC adds subsequent information when US images were doubtful and reveleated pericholecystic involvement more carefully. Hepatobiliary scintigraphy has high diagnostic accuracy but needs of too long execution time. Reasons of early cholecystectomy lay on clinical and experimental evidences that focal or diffuse ischemic damage of gallbladder's wall may affect natural history of the illness and infectious overwhelming is a late event. Surgical intervention has been performed in 16 patients, must within 24 hours. Morbility has been very low, mortality scored 18.7%. | [
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] | 24 |
Blunt trauma to the extrahepatic biliary tract. A multicenter study. BACKGROUND/AIMS Blunt trauma to the extrahepatic biliary tract is a rare and challenging injury The purpose of this paper is to review our experience of these injuries, with special reference to their clinical presentation. PATIENTS AND METHODS In a retrospective multicenter study of the records of a trauma-admitting in three hospitals, seven patients with blunt extrahepatic biliary tract trauma were identified, one with combined gallbladder and common bile duct injuries and six with a ruptured gallbladder. RESULTS Except for the patient with the common bile duct injury developing peritoneal signs during observation and being operated 24 hours post-admission, all other patients underwent early laparotomy for shock, peritonitis or positive diagnostic peritoneal lavage (DPL) caused by associated injuries. The common bile duct injury was treated with suture repair over a T tube and the gallbladder injuries with cholecystectomy, except for two cases in which a cholecystostomy was performed. CONCLUSIONS In patients with blunt trauma, especially to the right upper quadrant, a high index of suspicion and liberal use of diagnostic studies to exclude an isolated extrahepatic biliary tract injury is recommended. | [
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[Endo-arthroscopically assisted surgery of selected orthopaedic conditions: technique and results]. The minimally invasive and arthroscopically assisted surgery is a new therapeutic resource in the surgical treatment of degenerative and prosthetic orthopaedic pathology; in the field of neoplastic one it is just dawning. In this work the AA. report the technique and results of the arthroscopically assisted percutaneous arthrodesis of the ankle and of the arthroscopically assisted percutaneous curettage of epiphyseal chondroblastoma (E.C.) and osteoid osteoma (O.O.) of skeleton. From 1992 to 2002 they treated 12 selected cases: 4 affected by E.C., 3 located at proximal tibia and 1 at proximal humerus, in patients aged from 13 to 16 years and evaluated at a follow-up ranging from 7 to 3 years, with a 75% of good results; 4 affected by osteoid osteoma of proximal femur (2) and tibia (2), in patients aged from 13 to 18 years, evaluated at a follow-up ranging from 12 to 3 years with very good results (75%); 4 cases of ankle'painful stiffness, with 1 case of severe weightbearing instability, in patients aged from 17 to 75 years, evaluated at final bone fusion, radiographically observed at a average of 3.2-month follow-up from operation. All cases were treated by MIS criteria under accurate radiographic and CT-3D pre-operative planning, endoscopic (trans-osseous tunnels) and/or arthroscopic (ankle arthrodesis) continuous assistance under fluoroscopy. Two cases received cortico-cancellous bone autografts. All neoplastic cases had histologic confirmation by excision biopsy. They report 2 cases of failure, 1 in the E.C. series (25%) and 1 among the O.O. (25%), respectively at 6 and 12 months from the operation. In conclusion the authors report good results in 75% of cases together with very good aestheticism, well accepted by patients, and with articular function not minimally altered by the technique. | [
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{
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"chunks": "at 6 and 12 months",
"confidences": "0.35068",
"end": 1708,
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}
] | 26 |
[Mucinous cystoadenocarcinoma of the appendix. A case report]. CASE REPORT The Authors report a case of a 66-years-old male patient with mucinous cystoadenocarcinoma of the appendix. Preoperative diagnosis was appendiceal mucocele. At laparatomy was revealed the presence of a large mass of the appendix involving the caecum. No mucinous ascites was present and no mucinous implants on the peritoneum surface. Operation consisted in appendectomy and resection of the caecum bottom. Hystology revealed diagnosis of mucinous cystoadenocarcinoma of the appendix. After two weeks patient underwent right hemicolectomy, he is alive without disease at 36 months follow up. Mucinous cystic neoplasms of the appendix is an uncommon disease that is rarely suspected before surgery. CONCLUSIONS The Authors stress the importance of an appropriate surgical treatment. Right hemicolectomy appears to be the appropriate treatment with aggressive debulking when mucinous cystoadenocarcinoma is associated with pseudomyxoma peritonei. The role of chemotherapy in the treatment of patients with appendiceal cancers remains controversial. No controlled data on the efficacy of adjuvant chemotherapy are available. All patients with any form of appendiceal tumor appear to have an increased incidence of synchronous and metachronous neoplasms, especially in the gastrointestinal tract, and should be investigated and followed up appropriately. | [
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"confidences": "0.41009998",
"end": 1367,
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}
] | 27 |
Multiple meningiomas induced by cranial irradiation. The role of radiation in the induction of central nervous system tumours has repeatedly been documented. Meningiomas induced by low doses of cranial irradiation have been described in many series of cases, but meningiomas induced by high doses of irradiation have still been reported in a limited number of cases. We report the case of a 25-year-old man who presented multiple meningiomas and who had received therapeutic dose of irradiation for a 4th ventricle ependymoma when he was 8 years old. | [
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{
"begin": 538,
"chunks": "8 years old",
"confidences": "0.81970006",
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] | 28 |
Abdominal aortic aneurysm and concomitant malignancy: what treatment? UNLABELLED The association of neoplasm and abdominal aortic aneurysm (AAA), although rare, may represents a therapeutic dilemma. MATERIALS AND METHODS Between January 1990 and December 2004 in our departement 127 patients were submitted because of an AAA, in 8 cases there was an association with a neoplasm, in the greater part being a colon cancer. In 3 cases we performed a one stage surgery, in 1 case the chose was for a two stage surgery, for 3 patients we opted for an endovascular treatment by an endograft, in 1 case a pancreatic cancer was diagnosed 3 months after the prosthetic replacement of an AAA and there were no surgical indications because of the patient was in an advanced neoplastic stage. RESULTS There weren't any prosthetic infection or more serious complications. The endovascular treatments were performed successfully without complications after few days being followed by cancer's resection. DISCUSSION In case of this association the prognosis is related to neoplasm's stage. Timing depednds on the pathology that has the higher risk of short-term complication. Since Nineties author's reports in Literature about one stage surgery are more frequent, while now endovascular methods open new chances. CONCLUSIONS One stage surgery is a safe option in case of association between AAA and cancer. We think that a good porpouse is the use of a vascular endograft in aneurysmal treatment followed, after few days, by cancer's resection. | [
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"begin": 1393,
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"confidences": "0.9578",
"end": 1398,
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},
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"confidences": "0.82895",
"end": 1464,
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},
{
"begin": 1469,
"chunks": "aneurysmal treatment",
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"end": 1488,
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{
"begin": 1500,
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"confidences": "0.4678",
"end": 1513,
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{
"begin": 1519,
"chunks": "cancer's resection",
"confidences": "0.81554997",
"end": 1536,
"entities": "Procedure"
}
] | 29 |
[Transrectal ultrasonography by rotating feeler in the perianal fistulae/abscesses surgery. Anatomo-functional description]. INTRODUCTION Anal fistula represents a big topically subject above all as regards the complex correlated surgical implications. The transectal ultrasonography (TUS) is the first help for a careful, cheep, poorly invasive diagnosis. MATERIALS AND METHODS From September 2002 to December 2003 we submitted TUS 53 patient with clinical diagnosis of perianal fistula abscesses and 27 patients, already subordinates to surgical intervention for perianal fistulae/abscesses, which only presented perianal pain without clear signs of perianal pathology (48 males and 15 females). RESULTS TUS diagnosis and surgical confirmation of abscess and/or anal fistulae in all the patients; in the 27 patients, in whom at clinician exam was not clear an abscess, it was diagnosed in 21 patients (6 positive-false). DISCUSSION The obtained data show the validity of this methodical diagnostics and its importance for a correct surgical management. The 7.2% of discovered positive-false (surgical response: scary tissue), they are to charge to the objective technical dfficulty with discriminating scary outcomes; in confirmation of that the datum that in all these cases the patients had already been submitted to previous ano-rectal surgery. CONCLUSIONS Surgery of the anal abscesses and fistulas, for effective being, must stay in balance between aggressiveness and safeguards surgery. Surgery, to be correct, cannot leave out of consideration TUS: a valid tool in the Pre-operatory diagnosis, but also in the Post-operatory phase to highlight possible recidivisms. | [
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}
] | 30 |
Laparoscopic treatment of a solitary fibrous tumor of the greater omentum presenting as spontaneous haemoperitoneum. A 24-year-old man was admitted at the emergency department with a lower quadrant abdominal pain and a slight hypoglycaemia. Abdominal ultrasonography showed the presence of a fluid peritoneal collection and a 3.2 x 2.5 cm hypoisoechogenic mass closed to the left iliac vessels with an echo-color-Doppler pattern similar to that of a hamartoma. CT examination confirmed the hypothesis of a vascular tumour. Although an abdominal angiography added no new information to establish a preoperative diagnosis, it showed a well vascularized mass. The patient underwent laparoscopy that revealed a bleeding mass of the great omentum. Laparoscopic stapled resection of the greater omentum was carried out. The solid lesion consisted of spindle-shaped cells, but no atypical cells were observed. The histological findings were diagnostic of a benign solitary fibrous tumor, an extremely rare neoplasm for a long time considered to be an exclusively thoracic lesion. This is the first case of a solitary fibrous tumor presenting as haemoperitoneum and the first time it was removed laparoscopically. The patient is disease-free at the 2-year follow-up. | [
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Dealing with trichomoniasis. Trichomoniasis is a common but less well known sexually transmitted infection affecting men and women. In men it is often asymptomatic and goes undetected. In women it can produce a profuse, frothy, unpleasant-smelling vaginal discharge with pruritus and soreness which is sometimes confused with vulvo-vaginal candidiasis (thrush) and bacterial vaginosis. Women often mistakenly treat themselves for thrush with no result. Diagnosis is by laboratory culture and treatment is with metronidazole. Partner notification and treatment should be undertaken. Trichomoniasis often coexists with chlamydia and gonorrhoea. It can have consequences for reproduction, including low birth weight and preterm labour, and has been found to be a co-factor in the transmission of HIV. It is therefore mandatory to ensure prompt and appropriate treatment for all patients diagnosed with trichomoniasis. | [
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{
"begin": 617,
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{
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"confidences": "0.355",
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{
"begin": 696,
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"confidences": "0.20486666",
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{
"begin": 717,
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"confidences": "0.56895",
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{
"begin": 793,
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"begin": 899,
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"confidences": "0.9843",
"end": 912,
"entities": "Disease_Syndrome_Disorder"
}
] | 32 |
Ovulatory failure, fertility preservation and reproductive strategies in the setting of gynecologic and non-gynecologic malignancies. The advances in assisted reproductive technology over time have paralleled the insights gained into the natural history of different gynecologic malignancies. Subgroups of young patients with early stage ovarian cancer, endometrial carcinoma and cervical carcinoma may be considered to be at relatively low risk of recurrence and may be treated conservatively with the aim to preserve fertility when this is of prime concern. Unilateral adnexectomy with preservation of the contralateral ovary and uterus may be appropriate for some patients with epithelial ovarian cancers, and certainly should be the procedure of choice for those young women with borderline tumors and early stage sex cord-stromal and malignant germ cell tumors. Administration of high-dose progestins may obviate the need for immediate hysterectomy in a young patient with a well-differentiated endometrial carcinoma desirous of childbearing. The performance of vaginal radical trachelectomy in conjunction with laparoscopic pelvic lymphadenectomies has emerged as a real breakthrough for a highly select group of young women with early invasive tumors of the cervix. In this review, we also discuss reproductive strategies for women who experience chemotherapy-induced ovulatory failure and also address the potential for ovarian cortex cryopreservation and transplantation, and uterine transplantation, all of which are looming on the horizon. | [
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"begin": 839,
"chunks": "malignant germ cell tumors",
"confidences": "0.90897506",
"end": 864,
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{
"begin": 885,
"chunks": "high-dose",
"confidences": "0.7089",
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{
"begin": 895,
"chunks": "progestins",
"confidences": "0.9373",
"end": 904,
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{
"begin": 941,
"chunks": "hysterectomy",
"confidences": "0.9843",
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{
"begin": 980,
"chunks": "well-differentiated endometrial carcinoma",
"confidences": "0.65356666",
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{
"begin": 1034,
"chunks": "childbearing",
"confidences": "0.5547",
"end": 1045,
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{
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"confidences": "0.60433334",
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{
"begin": 1225,
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{
"begin": 1236,
"chunks": "early invasive",
"confidences": "0.65335",
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"begin": 1251,
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"confidences": "0.82335",
"end": 1270,
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{
"begin": 1333,
"chunks": "women",
"confidences": "0.9753",
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},
{
"begin": 1354,
"chunks": "chemotherapy-induced",
"confidences": "0.6035",
"end": 1373,
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},
{
"begin": 1375,
"chunks": "ovulatory failure",
"confidences": "0.40429997",
"end": 1391,
"entities": "Disease_Syndrome_Disorder"
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{
"begin": 1428,
"chunks": "ovarian cortex cryopreservation",
"confidences": "0.4334",
"end": 1458,
"entities": "Procedure"
},
{
"begin": 1464,
"chunks": "transplantation",
"confidences": "0.9978",
"end": 1478,
"entities": "Procedure"
},
{
"begin": 1485,
"chunks": "uterine transplantation",
"confidences": "0.83875",
"end": 1507,
"entities": "Procedure"
}
] | 33 |
Telomerase activity and the subunit of telomerase in hydatidiform mole and their relationship with the development of postmolar tumor. OBJECTIVES To investigate the pattern of telomerase activity and the subunit of telomerase in normal placentae and GTD, and to determine the prognostic significance of telomerase activity and the subunit of telomerase in GTD. METHODS Telomerase activity human telomerase (hTERT) and human telomerase (hTR) expression were analyzed in the initial uterine evacuation specimen of 63 hydatidiform moles (HMs), 42 normal human placental tissues, 17 malignant gestational trophoblastic tumors, primary cultures of normal villi and JAR cell lines by use of the polymerase chain reaction-based telomeric repeat amplification protocol (TRAP) assay and reverse transcription-polymerase chain reaction (RT-PCR) methods. RESULTS Telomerase activity was 100% in primary cultures of normal villi and JAR cell lines and in less than 60-day early placental villi, while only 9.1% in greater than 60-day placental villi, 27% in HMs and 58% in malignant trophoblastic tumors. High levels of hTR could be found in all groups. hTR expression was detected in all cases of < 60-day placental villi, in 72.7% > 60-day placental villi, in 87.3% in HMs and 100% in malignant trophoblastic tumors. Telomerase activity and hTERT expression had significant differences among the groups. Telomerase activity was associated with serum hCG levels but not related to other clinical risk factors. CONCLUSIONS Telomerase activity may be correlated with the development of trophoblastic tumors, and hTERT may be a useful diagnostic marker for detecting the existence of malignant trophoblastic cells. | [
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"end": 984,
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"begin": 1026,
"chunks": "placental villi",
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"end": 1040,
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"begin": 1065,
"chunks": "malignant trophoblastic tumors",
"confidences": "0.9186333",
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"begin": 1112,
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},
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},
{
"begin": 1438,
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"confidences": "0.6638333",
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},
{
"begin": 1579,
"chunks": "trophoblastic tumors",
"confidences": "0.84365",
"end": 1598,
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},
{
"begin": 1605,
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"confidences": "0.9697",
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{
"begin": 1676,
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"confidences": "0.47636667",
"end": 1704,
"entities": "Oncological"
}
] | 34 |
Influence of diabetes mellitus and nodal distribution in endometrial cancer and correlation to clinico-pathological prognostic factors. OBJECTIVE The aim of this study was to describe the relationships between the distribution of nodal disease, clinico-pathological patterns and recurrence and survival in surgically staged cases of endometrial cancer. METHODS Charts were abstracted from patients with endometrial carcinoma from 1985 to 1995. Data on clinicopathologic variables, adjuvant treatment, site of recurrence and survival were collected. The chi square test was used to test associations between variables. The Kaplan-Meier method was used for survival analysis and Cox's proportional hazards model for multiple regression analysis. RESULTS Sixty-nine out of 181 patients underwent lymph node dissection. Twenty-three had pelvic lymph node dissection, 23 underwent pelvic and paraaortic lymph node dissection and 20 patients had lymph node sampling. The median count of removed lymph nodes was 22.4. Fifty-four lymph node dissections showed negative lymph nodes and in 15 cases there was a minimum of one positive lymph node. Overall survival was in correlation to nodal involvement with a p value of 0.0017. Patients with lymph node involvement showed significantly more recurrence than patients with negative lymph nodes (p = 0.003). The depth of myometrial invasion correlated with lymph node metastasis (p = 0.01) and patients with additional diabetes mellitus showed significantly more nodal involvement (p = 0.02). CONCLUSION Endometrial cancer showed pelvic lymph node (PLN) and paraaortic lymph node (PALN) involvement. Under-diagnosis of the disease might result if there was only a PLN, but with or without PALN involvement there was no significant difference in overall survival or recurrence. There was an univariate correlation between lymph node involvement and diabetes. | [
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