• 【以铂类为基础的化疗治疗的转移性或复发性宫颈癌患者的预后和预测因素。】 复制标题 收藏 收藏
    DOI:10.1186/s12885-017-3435-x 复制DOI
    作者列表:Karageorgopoulou S,Kostakis ID,Gazouli M,Markaki S,Papadimitriou M,Bournakis E,Dimopoulos MA,Papadimitriou CA
    BACKGROUND & AIMS: BACKGROUND:Recognizing resistance or susceptibility to the current standard cisplatin and paclitaxel treatment could improve therapeutic outcomes of metastatic or recurrent cervical cancer. METHODS:Forty-five tissue samples from patients participating in a phase II trial of cisplatin and ifosfamide, with or without paclitaxel were collected for retrograde analysis. Immunohistochemistry and genotyping was performed to test ERCC1, III β-tubulin, COX-2, CD4, CD8 and ERCC1 (C8092A and N118 N) and MDR1 (C3435T and G2677 T) gene polymorphisms, as possible predictive and prognostic markers. Results were statistically analyzed and correlated with patient characteristics and outcomes. RESULTS:Patients with higher levels of ERCC1 expression had shorter PFS and OS than patients with low ERCC1 expression (mPFS:5.1 vs 10.2 months, p = 0.027; mOS:10.5 vs. 21.4 months, p = 0.006). Patients with TT in the site of ERCC1 N118 N and GT in the site of MDR1 G2677 T polymorphisms had significantly longer PFS (p = 0.006 and p = 0.027 respectively). ERCC1 expression and the ERCC1 N118 N polymorphism remained independent predictors of PFS. Interestingly, high III beta tubulin expression was associated with chemotherapy resistance and fewer responses [5/20 (25%)] compared to lower III β-tubulin expression [15/23 (65.2%)] (p = 0.008). Finally, ΙΙΙ β-tubulin levels and chemotherapy regimen were independent predictors of response to treatment. CONCLUSIONS:ERCC1 expression proved to be a significant prognostic factor for survival in our metastatic or recurrent cervical cancer population treated with cisplatin based chemotherapy. ERCC1 N118 N and MDR1 G2677 T polymorphism also proved of prognostic significance for disease progression, while overexpression of III β-tubulin was positively correlated with chemotherapy resistance.
    背景与目标:
  • 【颈椎压迫性脊髓病: 融合是主要的预后指标吗?】 复制标题 收藏 收藏
    DOI:10.3171/spi.2007.6.6.3 复制DOI
    作者列表:Sorar M,Seçkin H,Hatipoglu C,Budakoglu II,Yigitkanli K,Bavbek M,Kars HZ
    BACKGROUND & AIMS: OBJECT:A variety of factors may affect the neurological improvement in patients with cervical compression myelopathy (CCM) after surgery. The aim of this study was to report and discuss the prognostic factors in a group of patients with insufficient decompression of the spinal canal. METHODS:A prospective follow up and analysis of 20 consecutive patients with CCM treated between 2000 and 2002 was performed. All patients were surgically treated via an anterior approach, either by anterior cervical discectomy and fusion with instrumentation or by cervical corpectomy and fusion with instrumentation. The surgical results were examined using the modified Japanese Orthopaedic Asssociation disability scale, with reference to the findings of magnetic resonance imaging, computed tomography, and radiography. Seventeen patients (85%) experienced a 50% or more recovery rate as calculated using the Hirabayashi formula during the follow-up period (mean 32.5 months), despite a persistently narrow spinal canal and permanent or increased intramedullary high-intensity signal after surgery. CONCLUSIONS:Results of the study showed that patients with CCM benefited from anterior cervical discectomy and fusion with instrumentation or cervical corpectomy and fusion with instrumentation procedures despite insufficient decompression of the spinal canal. Fusion of the affected level(s) might be the reason for the acquired high recovery rates. The authors also conclude that the neurological improvement is not correlated with the reversal of or decrease in the intramedullary high-intensity signal change after surgery.
    背景与目标:
  • 【肉毒杆菌毒素在宫颈和颌面部疾病中的治疗用途: 循证综述。】 复制标题 收藏 收藏
    DOI:10.1016/j.tripleo.2007.02.004 复制DOI
    作者列表:Ihde SK,Konstantinovic VS
    BACKGROUND & AIMS: INTRODUCTION:The role of botulinum toxin as a therapeutic agent for several conditions is expanding. We sought to determine if botulinum toxin is safe and effective in treating patients with cervical dystonia and maxillofacial conditions. Our purpose was to establish a safety and efficacy profile to determine whether or not this treatment may be used prophylactically in patients undergoing dental implant therapy. METHODS:We performed a systematic search of the literature to identify randomized clinical trials evaluating patients treated with botulinum toxin as an adjunct to dental implant therapy, maxillofacial conditions including temporomandibular disorders (TMD), and cervical dystonia. RESULTS:Four randomized controlled trials (RCTs) met our search criteria in the area of cervical dystonia and chronic facial pain. No RCTs were identified evaluating dental implant therapy. Patients with cervical dystonia exhibited significant improvements in baseline functional, pain, and global assessments compared to placebo. Adverse events were mild and transient with numbers needed to harm (NNH) ranging from 12 to 17. Patients with chronic facial pain improved significantly from baseline in terms of pain compared to placebo. Rates of adverse events were less than 1%. CONCLUSION:Botulinum toxin appears relatively safe and effective in treating cervical dystonia and chronic facial pain associated with masticatory hyperactivity. No literature exists evaluating its use in dental implantology. Randomized clinical trials are warranted to determine its safety and efficacy in dental implantology and other maxillofacial conditions such as bruxism.
    背景与目标:
  • 4 Cervical spine and shoulder pain. 复制标题 收藏 收藏

    【颈椎和肩部疼痛。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Hawkins RJ,Bilco T,Bonutti P
    BACKGROUND & AIMS: :The complex problem of combined neck and shoulder pain was investigated in 26 operations in 13 patients who had a shoulder procedure (subacromial decompressions or rotator cuff repairs) and an anterior cervical spine fusion. This select group of complex patients illustrates the diagnostic studies required to determine whether the pain comes primarily from the cervical spine, shoulder, or both. Good pain relief was accomplished after 24 of the 26 surgical procedures (average follow-up, 4.3 years). In the 13 patients, eight presented with nearly equal neck and shoulder pain as the chief complaint, whereas in the remaining five patients, the initial complaint was predominantly neck pain with only minor shoulder involvement. The shoulder pain became more significant after the anterior cervical fusion in these five patients. This study emphasizes the need for a careful evaluation of patients with combined neck-shoulder pain syndrome in a systematic approach allowing appropriate treatment.
    背景与目标: : 在13例接受肩部手术 (肩峰下减压或肩袖修复) 和颈椎前路融合术的患者中,对26例颈肩疼痛的复杂问题进行了研究。这一组复杂的患者说明了诊断研究,以确定疼痛是否主要来自颈椎,肩膀或两者。在26次外科手术中的24次 (平均随访4.3年) 后,疼痛缓解良好。在13例患者中,有8例的颈部和肩部疼痛几乎是主要主诉,而在其余5例患者中,最初的主诉主要是颈部疼痛,仅轻微的肩部受累。在这五名患者中,颈椎前路融合后,肩部疼痛变得更加明显。这项研究强调需要以系统的方法对合并颈肩疼痛综合征的患者进行仔细评估,以进行适当的治疗。
  • 【上下颈脊髓损伤患者尿动力学结果的比较。】 复制标题 收藏 收藏
    DOI:10.1038/sc.2013.83 复制DOI
    作者列表:Sayılır S,Ersöz M,Yalçın S
    BACKGROUND & AIMS: STUDY DESIGN:Retrospective study. OBJECTIVES:To analyze the neurogenic bladder characteristics and treatment approaches in patients with upper and lower cervical spinal cord injury (SCI) in order to make proper and reasonable decisions to the relevant patients. SETTING:Rehabilitation center in Ankara, Turkey. METHOD:Ninety patients with cervical SCI were included. The urodynamic analyses of the patients were conducted retrospectively by using the urodynamic laboratory records. The patients were divided into two groups as the upper cervical SCI (UCSCI) group (C1-C5) and lower cervical SCI (LCSCI) group (C6-C8). RESULTS:In this study, 82 male (91.1%) and 8 (8.9%) female patients were included. There were 51 UCSCI patients with the mean age of 34.2 ± 16.1 years and 39 LCSCI patients with the mean age of 30.4 ± 12.5 years. Detrusor overactivity and preservation of the bladder-filling sensation were significantly more frequent in the UCSCI group than in the LCSCI group (P=0.048, P=0.000 respectively). Moreover, there were statistically significant differences between the groups regarding the bladder-emptying methods, residual volume and the frequency of anticholinergic and alpha blocker use (all P<0.05). No significant difference was found between the groups regarding the frequency of autonomic dysreflexia, detrusor hypocompliancy and the bladder-storage and -emptying disorders (all P>0.05). CONCLUSION:Our results demonstrate that there are differences in the upper and lower SCI cases in terms of neurogenic bladder characteristics and treatment approaches.
    背景与目标:
  • 【粪肠球菌性心内膜炎引起的齿状突突和颈椎炎的败血症坏死: 第一份报告。】 复制标题 收藏 收藏
    DOI:10.1532/HSF98.20071151 复制DOI
    作者列表:Mosquera V,Campos V,Valle JV,Juffé A
    BACKGROUND & AIMS: :We describe a 75-year-old male patient who developed a general syndrome, with a fever of 39 degrees C, weight loss, and cervical pain, during the month following a urological procedure. The presence of positive blood cultures for Enterococcus faecalis, aortic vegetations, and severe aortic regurgitation observed with echocardiogram confirmed the diagnosis of infective endocarditis (IE). Magnetic resonance imaging of the spinal cord showed significant erosion and irregularities of the odontoid apophysis, with hyperintensity of bone marrow in T2-weighted images because of edema and inflammation. These findings suggested an infective necrosis of the odontoid apophysis. Despite the common occurrence of rheumatologic manifestations in IE, with prevalence rates of 25% to 44%, spondylodiscitis is rarely observed (5%-13%). The lumbar region is the most commonly involved. We found only one other reported case of cervical spondylodiscitis. The case we describe is the first report of septic necrosis of the odontoid apophysis associated with IE.
    背景与目标: : 我们描述了一名75岁的男性患者,该患者在泌尿外科手术后的一个月内出现了一般综合征,发热39摄氏度,体重减轻和宫颈疼痛。超声心动图观察到粪肠球菌,主动脉植被和严重的主动脉反流的阳性血培养物证实了感染性心内膜炎 (IE) 的诊断。脊髓的磁共振成像显示出齿状突突的明显侵蚀和不规则,由于水肿和炎症,T2-weighted图像中的骨髓强度高。这些发现表明齿状突突的感染性坏死。尽管IE中常见的风湿病表现,患病率为25% 至44%,但很少观察到椎间盘炎 (5%-13%)。腰部是最常见的累及部位。我们只发现了另外一例颈椎炎病例。我们描述的病例是与IE相关的齿状突突的败血性坏死的首次报道。
  • 【球囊扩张与Amplatz扩张用于肾造瘘道扩张。】 复制标题 收藏 收藏
    DOI:10.1089/end.2007.0167 复制DOI
    作者列表:Gönen M,Istanbulluoglu OM,Cicek T,Ozturk B,Ozkardes H
    BACKGROUND & AIMS: PURPOSE:In this study, we present our experience using balloon and Amplatz dilatation to establish a percutaneous tract. We also discuss advantages and risk factors of both techniques. MATERIALS AND METHODS:We retrospectively reviewed medical records of 229 patients who had undergone 235 percutaneous nephrolithotomy procedures. The nephrostomy tract had been dilated using a balloon (42 patients) or Amplatz (187 patients) dilator. Total operating time, preoperative and postoperative hemoglobin concentrations, number of tracts required, stone burden, blood transfusion rates, tract dilatation failures, and the cost of the dilatation system were compared between the groups. RESULTS:There were no statistically significant differences in operative time (85.7+/-43.2 v 86.3+/-41.2 minutes; P=0.42), preoperative hemoglobin concentration (14.1+/-1.1 v 13.8+/-1.4 mg/dL; P= .153), postoperative hemoglobin concentration (11.6+/-1.7 v 11.2+/-1.5 mg/dL; P= .601), or blood transfusion rate (18.6% v 21.3%; P= .687) between the two groups. Also, there were no differences in failure rates between the two groups. CONCLUSIONS:The Amplatz dilator is comparable with the balloon dilator with regard to efficacy, speed, and safety. The Amplatz dilator is more cost-effective than the balloon dilator. However, kidney hypermobility may be a significant problem during Amplatz dilatation.
    背景与目标:
  • 【土耳其农村地区护士对乳腺癌和宫颈癌危险因素和筛查行为的认识。】 复制标题 收藏 收藏
    DOI:10.1111/j.1365-2354.2007.00856.x 复制DOI
    作者列表:Yaren A,Ozkilinc G,Guler A,Oztop I
    BACKGROUND & AIMS: :Breast and cervical cancer are the most common causes of cancer mortality among women worldwide, but actually they are largely preventable diseases. There is limited data on breast and cervical cancer knowledge, screening practices and attitudes of nurses in Turkey. A self-administered questionnaire was used to investigate the knowledge and attitude of nurses on risk factors of the breast and cervical cancer as well as screening programmes such as breast self-examination (BSE), clinical breast examination, mammography (MMG) and papanicolaou (pap) smear test. In total, 125 out of 160 nurses participated in the study (overall response rate was 80.6%). The risk factors and symptoms of breast cancer was generally well known, except for early menarche (23.2%) and late menopause (28.8%). For cervical cancer, the correct risk factors mostly indicated by the nurses were early age at first sexual intercourse (56%), smoking (76%), multiple sexual partners (71.2%). As for screening methods, it was believed that BSE was a beneficial method to identify the early breast changes (84.8%) and MMG was able to detect the cancer without a palpable mass (57.6%). Little was known about the fact that women should begin cervical cancer screening approximately 3 years after the onset of sexual intercourse (23.2%) and if repeated pap smear test were normal, it could be done every 2-3 years. Most of the nurses considered that MMG decreases the mortality in breast cancer (65.6%) and also believed that pap smear test decreases the mortality in cervical cancer (75.2%). Despite high level of knowledge of breast cancer risk factors, symptoms and screening methods, inadequate knowledge of cervical cancer screening method were found among nurses.
    背景与目标: : 乳腺癌和宫颈癌是全世界女性癌症死亡的最常见原因,但实际上它们在很大程度上是可以预防的疾病。土耳其有关乳腺癌和宫颈癌知识,筛查实践和护士态度的数据有限。采用自编问卷调查护士对乳腺癌和宫颈癌危险因素的知识和态度,并进行乳房自我检查 (BSE),临床乳房检查,乳房x线检查 (MMG) 和巴氏涂片检查等筛查计划。总共160名护士中有125名参加了研究 (总有效率为80.6%)。除初潮早期 (23.2%) 和绝经晚期 (28.8%) 外,乳腺癌的危险因素和症状通常是众所周知的。对于宫颈癌,护士指出的正确危险因素主要是初次性交年龄早 (56%),吸烟 (76%),多性伴侣 (71.2%)。至于筛选方法,认为BSE是识别早期乳房变化的有益方法 (84.8%),并且MMG能够在没有可触及肿块的情况下检测癌症 (57.6%)。对于女性应在性交开始后大约3年开始进行宫颈癌筛查 (23.2%),并且如果重复的巴氏涂片检查正常,则每2-3年进行一次,这一事实知之甚少。大多数护士认为MMG可以降低乳腺癌的死亡率 (65.6%),并且还认为子宫颈抹片检查可以降低宫颈癌的死亡率 (75.2%)。尽管对乳腺癌危险因素,症状和筛查方法的了解程度很高,但护士对宫颈癌筛查方法的了解不足。
  • 【4号染色体的缺失与宫颈癌的发展有差异: slit2作为候选肿瘤抑制基因的证据。】 复制标题 收藏 收藏
    DOI:10.1007/s00439-007-0375-6 复制DOI
    作者列表:Singh RK,Indra D,Mitra S,Mondal RK,Basu PS,Roy A,Roychowdhury S,Panda CK
    BACKGROUND & AIMS: :The aim of this study was to locate the candidate tumor suppressor genes (TSGs) loci in the chromosomal 4p15-16, 4q22-23 and 4q34-35 regions associated with the development of uterine cervical carcinoma (CA-CX). Deletion mapping of the regions by microsatellite markers identified six discrete areas with high frequency of deletions, viz. 4p16.2 (D1: 40%), 4p15.31 (D2: 35-38%), 4p15.2 (D3: 37-40%), 4q22.2 (D4: 34%), 4q34.2-34.3 (D5: 37-59%) and 4q35.1 (D6: 40-50%). Significant correlation was noted among the deleted regions D1, D2 and D3. The deletions in D1, D2, D5 and D6 regions are suggested to be associated with the cervical intraepithelial neoplasia (CIN), and deletions in the D2, D3, D5 and D6 regions seems to be associated with progression of CA-CX. The deletions in the D2 and D6 regions showed significant prognostic implications (P = 0.001; 0.02). The expression of the candidate TSG SLIT2 mapped to D2 region gradually reduced from normal cervix uteri -->CIN --> CA-CX. SLIT2 promoter hypermethylation was seen in 28% CIN samples and significantly increased with tumor progression (P = 0.04). Significant correlation was seen between SLIT2 deletion and its promoter methylation (P = 0.001), indicating that both these phenomena could occur simultaneously to inactivate this gene. Immunohistochemical analysis showed reduced expression of SLIT2 in cervical lesions and CA-CX cell lines. Although no mutation was detected in the SLIT2 promoter region (-432 to + 55 bp), CC and AA haplotypes were seen in -227 and -195 positions, respectively. Thus, it indicates that inactivation of SLIT2-ROBO1 signaling pathway may have an important role in CA-CX development.
    背景与目标: : 这项研究的目的是在与子宫颈癌 (ca-cx) 发展相关的4p15-16、4q22-23和4q34-35染色体区域中定位候选肿瘤抑制基因 (tsg) 位点。通过微卫星标记对区域进行的缺失映射确定了六个具有高缺失频率的离散区域,即。4p16.2 (D1: 40%),4p15.31 (D2: 35-38%),4p15.2 (D3: 37-40%),4q22.2 (D4: 34%),4q34.2-34.3 (D5: 37-59%) 和4q35.1 (D6: 40-50%)。在删除的区域D1,D2和d3之间注意到显着的相关性。建议D1,D2,D5和D6区域的缺失与宫颈上皮内瘤变 (CIN) 有关,而D2,D3,D5和D6区域的缺失似乎与ca-cx的进展有关。D2和D6区的缺失显示出显著的预后意义 (P = 0.001; 0.02)。定位于D2区域的候选TSG SLIT2的表达从正常宫颈->CIN-> CA-CX逐渐减少。在28% CIN样品中观察到SLIT2启动子高甲基化,并且随着肿瘤进展而显着增加 (P = 0.04)。SLIT2缺失与其启动子甲基化之间存在显著相关性 (P = 0.001),表明这两种现象可以同时发生以使该基因失活。免疫组织化学分析显示,宫颈病变和ca-cx细胞系中SLIT2的表达降低。尽管在SLIT2启动子区域 (-432至 + 55 bp) 中未检测到突变,但在-227和-195位置分别观察到CC和AA单倍型。因此,这表明SLIT2-ROBO1信号通路的失活可能在ca-cx的发育中起重要作用。
  • 【颈椎前路微椎间盘切除术伴或不伴融合。】 复制标题 收藏 收藏
    DOI:10.1097/BSD.0b013e31802f80c8 复制DOI
    作者列表:Oktenoglu T,Cosar M,Ozer AF,Iplikcioglu C,Sasani M,Canbulat N,Bavbek C,Sarioglu AC
    BACKGROUND & AIMS: BACKGROUND:Anterior cervical microdiscectomy (ACD) is commonly applied in the surgical treatment of cervical disc herniation. However, following discectomy procedure to perform a fusion process is still controversial. Therefore, a controlled, multicentric, prospective, randomized study was designed. MATERIAL AND METHOD:Totally 20 patients were operated. Eleven patients were operated with applying simple anterior microdiscectomy technique. Nine patients were operated via ACD and fusion with a semirigid plate technique. Preoperative and postoperative [immediate; postoperative first day and postoperative 1 y (mean 13.95 mo)] computed tomography studies and plain x-rays were obtained. The cervical disc and bilateral neural foramen heights of the operated level and adjacent segments were calculated. Pain assessment was performed using visual analog pain scale. Mann-Whitney statistical analysis method was applied to compare the outcomes for both groups. RESULTS:Satisfactory result was achieved in both groups. The pain scores for major complaint (arm pain) were decreased significantly in all patients after surgery regardless of the type of technique applied. The improvement in neck pain scores was significant only in patients who were treated with fusion procedure. There were no significant changes in disc height and neural foramen height measurements for both groups in adjacent levels in immediate and 1-year postoperative periods. The patients who were operated with simple ACD technique showed no significant decrease at postoperative first day in disc height and neural foramen height. However, the 1-year postoperative radiologic studies showed a significant decrease in disc height and neural foramen dimensions compared with preoperative values. The patients who were treated with fusion process showed a significant increase in disc height and nonsignificant increase in neural foramen heights at immediate postoperative study. However, with time, all dimensions showed significant decrease compared with preoperative values. CONCLUSIONS:ACD technique offers satisfactory outcome regardless of whether fusion process is applied or not. Fusion with semirigid plate offers an advantage at operated level in immediate postoperative period in regard of disc height and neural foramen height. However, semirigid anterior plates by definition do not stop subsidence and the advantage that is offered by this technique is not persistent. On the other hand, to apply fusion process with semirigid plate system offers significantly less narrowing in disc height compared with simple ACD technique.
    背景与目标:
  • 【通过环形电外科手术成功处理了由于囊性宫颈子宫内膜异位症破裂而导致的大量出血。】 复制标题 收藏 收藏
    DOI:10.1016/j.fertnstert.2007.04.011 复制DOI
    作者列表:Iwase A,Goto M,Kurotsuchi S,Harata T,Kaseki S,Kikkawa F
    BACKGROUND & AIMS: OBJECTIVE:To report a case of cystic cervical endometriosis that caused a massive hemorrhage due to rupture of a cyst and successful management with a loop electrosurgical excision procedure (LEEP). DESIGN:Case report. SETTING:University Hospital. PATIENT:A 37-year-old nulliparous woman. INTERVENTION(S):Medical management including surgical treatment. MAIN OUTCOME MEASURE(S):Clinical follow-up and pathologic diagnosis. RESULT(S):A hemorrhagic cystic cervical mass was excised with emergent LEEP. The mass was found to be cervical endometriosis. There was no evidence of recurrence until 1 year after excision. CONCLUSION(S):Cystic formation of cervical endometriosis--like ovarian endometrioma, which causes a massive hemorrhage due to rupture--is extremely rare, although cervical endometriosis is generally asymptomatic. Hysterectomy is considered in such cases but can be avoided via LEEP that incorporates partial excision of the uterine cervix.
    背景与目标:
  • 12 Risk of cervical cancer after HPV vaccination. 复制标题 收藏 收藏

    【HPV疫苗接种后发生宫颈癌的风险。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Markman M
    BACKGROUND & AIMS: :It will likely be more than 20 years before there is unequivocal evidence available that HPV vaccination decreases the incidence of invasive cervical cancer. However, existing data strongly suggests that as many as 440,000 cervical cancer cases and 220,000 deaths due to this malignancy will be prevented with the establishment of an effective worldwide HPV immunization program.
    背景与目标: : 可能需要20多年的时间才能有明确的证据表明HPV疫苗可以降低浸润性宫颈癌的发生率。然而,现有数据强烈表明,通过建立有效的全球HPV预防接种计划,将预防多达440,000例宫颈癌病例和由于这种恶性肿瘤导致的220,000死亡。
  • 【急性颈内动脉闭塞引起的中风: 治疗结果和预后预测因素。】 复制标题 收藏 收藏
    DOI:10.1001/archneurol.2012.2569 复制DOI
    作者列表:Seet RC,Wijdicks EF,Rabinstein AA
    BACKGROUND & AIMS: BACKGROUND:Previous studies have not distinguished patients with acute cervical internal carotid artery (ICA) occlusions from those with intracranial occlusions and often consider them together in the same cohort. OBJECTIVES:To evaluate the outcomes of patients with stroke from acute cervical ICA occlusion treated with intravenous thrombolysis or primary endovascular procedures and to identify early predictors of functional recovery among these patients. DESIGN:Retrospective study. SETTING:Academic hospital. PATIENTS:We studied patients with ischemic stroke who received intravenous thrombolysis or endovascular treatment for acute cervical ICA occlusion at St Mary's Hospital, Mayo Clinic, Rochester, Minnesota. We evaluated the associations of vascular risk factors, severity of stroke, arterial recanalization, presence of tandem occlusions, and collateral distal flow with functional recovery at 90 days after stroke. MAIN OUTCOME MEASURES:Favorable functional recovery (Modified Rankin Scale score, 0-2). RESULTS:We identified 21 patients (median age, 67 years; median National Institutes of Health Stroke Scale score at presentation, 13), of whom 13 patients received intravenous thrombolysis and 8 patients underwent primary endovascular treatment. Three patients who received intravenous thrombolysis underwent rescue endovascular treatment. Favorable functional recovery (Modified Rankin Scale score, 0-2) was observed in 7 patients who received intravenous thrombolysis and in 1 patient who underwent primary endovascular treatment. Good collateral distal flow and intracranial tandem occlusions were observed in 6 patients and 12 patients, respectively. Good collateral distal flow, observed more frequently in cigarette smokers, was associated with favorable functional recovery (odds ratio, 20; 95% CI, 2-242; P = .02). CONCLUSIONS:Intravenous thrombolysis should be administered as first-line treatment in patients with early acute cervical ICA occlusion. Treatment benefits are accentuated in patients with better collateral circulation.
    背景与目标:
  • 【前路颈椎融合器的前瞻性随机多中心临床评估。】 复制标题 收藏 收藏
    DOI:10.1097/00007632-200010150-00017 复制DOI
    作者列表:Hacker RJ,Cauthen JC,Gilbert TJ,Griffith SL
    BACKGROUND & AIMS: STUDY DESIGN:A prospective, concurrently controlled, randomized, multicenter trial of an anterior Bagby and Kuslich cervical fusion cage (BAK/C; Sulzer Spine-Tech, Minneapolis, MN) for treatment of degenerative disc disease of the cervical spine. OBJECTIVES:To report clinical results with maximum 24-month follow-up of fusions performed with the BAK/C fusion cage. SUMMARY OF BACKGROUND DATA:Threaded lumbar cages have been used during the past decade as a safe and effective surgical solution for chronic disabling low back pain. Threaded cages have now been developed for use in anterior cervical interbody fusions to obviate the need for allografts or autogenous bone grafting procedures while providing initial stability during the fusion process. METHODS:Patients with symptomatic cervical discogenic radiculopathy were treated with either anterior cervical discectomy with uninstrumented bone-only fusion (ACDF) or BAK/C fusion cage(s). Independent radiographic assessment of fusion was made and patient-based outcome was assessed by visual analog pain scale and a Short Form (SF)-36 Health Status Questionnaire. RESULTS:Data analysis included 344 patients at 1 year and 180 at 2 years. When the two cage groups (hydroxya, patite-coated or noncoated) were compared with the ACDF group, similar outcomes were noted for duration of surgery, hospital stay, improvements in neck pain and radicular pain in the affected limb, improvements in the SF-36 Physical Component subscale and Mental Component subscale, and the patients' perception of overall surgical outcome. Symptom improvements were maintained at 2 years. A greater percentage of patients with ACDF needed an iliac crest bone harvest than did BAK/C patients (67% vs.- 3%). Successful fusion for one-level procedures at 12 months was 97.9% for the BAK/C groups and 89.7% for the ACDF group (P < 0.05). The complication rate for the ACDF group was 20.4% compared with an overall complication rate of 11.8% with BAK/C. There was no difference in complications that necessitated a second operative procedure. CONCLUSIONS:These results demonstrate that outcomes after a cervical fusion procedure with a threaded cage are the same as those of a conventional uninstrumented bone-only anterior discectomy and fusion with a low risk of complications and rare need for autogenous bone graft harvest.
    背景与目标:
  • 【宫颈鳞癌及相关癌前病变中VEGF和CD105的免疫表达。】 复制标题 收藏 收藏
    DOI: 复制DOI
    作者列表:Stepan D,Simionescu C,Stepan A,Muntean M,Voinea B
    BACKGROUND & AIMS: :In this study, we analyzed the VEGF and CD105 immunoexpression in 24 cervical squamous cell carcinomas and CIN associated lesions with different degrees. For both lesions, MVD values were higher in patients who had associated risk factors. VEGF and MVD expression increased in both categories for high-grade lesions, respectively CIN III lesions compared with CIN I/II and poorly differentiated carcinomas compared with well-differentiated ones. Also, there was a statistically significant association between VEGF and MVD in poorly differentiated carcinoma and CIN III. The study indicated that analyzed markers were specific for both early and advanced stages of cervical angiogenesis. Maximum values of VEGF and MVD in CIN III designate this lesion as critical to the progression of neoplasia.
    背景与目标: : 在这项研究中,我们分析了24种不同程度的宫颈鳞状细胞癌和CIN相关病变中的VEGF和CD105免疫表达。对于这两个病变,具有相关危险因素的患者的MVD值较高。高级别病变的两类VEGF和MVD表达均增加,分别是CIN III病变与CIN I/II相比,以及低分化癌与高分化癌相比。此外,在低分化癌和CIN III中,VEGF和MVD之间具有统计学上的显着相关性。研究表明,分析的标记物对宫颈血管生成的早期和晚期都具有特异性。CIN III中VEGF和MVD的最大值表示该病变对肿瘤的进展至关重要。

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