Annales chirurgiae et gynaecologiae最新文献

Background and aims: To evaluate the efficacy, safety and tolerability of finasteride administered for 24 months following successful balloon dilatation in patients with benign prostatic hyperplasia (BPH).

Patients and methods: 75 patients with moderate to severe symptoms of benign prostatic hyperplasia were first treated with balloon dilatation. After a 4-week placebo runin period, 64 patients with successful dilatation and over 50 % reduction in symptoms were randomized to receive either finasteride (33 pts.) at 5 mg/day or placebo (31 pts.) for 24 months. Altogether 12 patients dropped out at some stage, and the final analysis hence included 27 patients in the finasteride group and 25 patients in the placebo group.

Results: The symptom scores increased by an average of 3.2 points in the finasteride group and 4.4 points in the placebo group during two years. The mean maximum flow in the finasteride group remained constant: 13.7 ml/s at baseline and 13.9 ml/s at 24 months. In the placebo group the mean maximum flow decreased from 13.3 ml/sec to 11.2 ml/s. During the two-year study period, neither of the groups displayed any changes in residual urine. The above mentioned changes were not statistically significant, however. Prostate volume and serum PSA were significantly lower in the finasteride group (p < 0.001). The groups did not differ with regard to side-effects.

Conclusions: On the basis of the findings, BPH patients with moderate to severe symptoms can be treated with balloon dilatation. The effect of balloon dilatation is quick, and it alleviates the patients' symptoms immediately. Finasteride treatment maintains the positive effect of balloon dilatation. This combination of treatment is tolerated well and side-effects are rare. The favourable effect of balloon dilatation was maintained for at least two years. Finasteride treatment diminished significantly both prostate volume and serum prostate-specific antigen after balloon dilatation compared to placebo treatment.

Background and goals: The purpose of this study was to characterize the biologic determinants that affect the behavior of invasive lobular carcinoma of the breast.

Material and methods: A prospectively accrued data base containing 9,619 breast cancer cases was queried for specific pathological features. From this data base, 390 patients with invasive lobular carcinoma of the breast treated and followed at any of these three centers: San Carlos Hospital, Doce de Octubre Hospital or The Jimenez Diaz Foundation in Madrid (Spain) were reviewed and results, in terms of overall survival and disease-free survival were recorded for a long-term follow-up of 206 months (17 years).

Results: The parameters that showed an important statistical influence on survival were the stage at diagnosis, the tumor size and nodal status, as well as the tumor grade. Age showed a limited influence, and multicentricity, or the type of surgical procedure had no statistical impact on survival.

Conclusions: Our analysis specifies the clinico-pathological features that influence the prognosis of invasive lobular carcinoma of the breast, and confirms that conservative therapy may be an appropriate treatment for this type of cancer.

Background and aims: Arterial chemoembolisation with lipiodol and a cytotoxic drug is reported to give equivocal results in irresectable primary hepatocellular cancer (HCC). In order to further elucidate the possible response to this treatment, we analysed the results of all patients with irresectable HCC treated with chemoembolisation at our hospital.

Material and methods: 58 consecutive patients with HCC were treated with lipiodolepirubicin chemoembolisation between February 1988 - October 1994 and followed until death or October 1998.

Results: The average survival was 11.7 months and median survival was 6 months. 17 patients had only one treatment mostly due to death within 6 weeks after the first treatment. Patients with an open portal system at inclusion (50% of all) were found to have significantly increased survival after 6 and 12 months compared to those with portal obstruction. The subgroup of patients displaying a decrease in tumour size as judged by repeated CT scan 6 months after inclusion had significantly increased survival; all survived more than 12 months (median survival 30 months).

Conclusions: Chemoembolisation with lipiodol-epirubicin may have an impact on survival on selected patients with irresectable hepatocellular cancer. The treatment may justifiably be offered patients with an open portal venous system and without liver failure.

Aims: Gradual elaboration of the operation technique for transplantation of ileal segments in the cervical esophagus. Comparison of clinical, histomorphological and biometric characteristics of ileal segments in the case of different types of autotransplantation.

Material and methods: The experimental investigation on autografting segments of the ileum (both flap and tubular variants) of the cervical esophagus was carried out on 87 dogs. There were five groups of dogs and five different operating techniques were used proceeding gradually from a simple one to a more complicated one.

Results: The successful esophagoplasty in dogs (87) needed multi-stage modelling for the elaboration is a more efficient surgical technique. Morphological factors of the graft in the relationship with the duration of graft ischaemia and the duration of the follow-up period (1-372 days) were analysed.

Conclusions: The use of ileum transplants is slightly more recommendable compared to jejunum transplants. Unfortunately even employing this method the results show moderate effect.

Maniatopoulos et al. reported the formation of calcified bone-like tissue when rat bone marrow cells were cultured in the presence of dexamethasone and beta-glycerophosphate. We have succeeded to construct the in vitro cultured bone on the porous framework of hydroxyapatite ceramics (HA). After 2 weeks of the culture, the construct showed the existence of mineralized collagen fibers on the surface of HA determined by Scanning Electron Microscopy. The construct also demonstrated high alkaline phosphatase (ALP) activity together with noticeable level of osteocalcin. The results indicate that the construct consisted of thin layer of bone matrix covered hydroxyapatite surface and abundant bone forming active osteoblasts. After the in vivo implantation of the construct, volume of the matrix increased and obvious bone tissue was detected by ordinal microscopy even one-week after implantation and its high osteogenic activity was maintained for a long term (one year). The in vivo bone is biologically active tissue evidenced by Northern blot analysis of the implanted construct which showed ALP and osteocalcin mRNA expression comparable to those of normal cancellous bone. These results demonstrate that the in vitro fabricated cultured bone/HA construct can possess new bone forming capability in in vivo situations. We have also succeeded to fabricate the construct using aged human marrow cells and the construct showed thick lamellar bone formation after the in vivo implantation. Based on these findings, we propose alternative approach for bone reconstruction surgery using the autogenous cultured bone/HA construct. Importantly, we can fabricate the implantable autogenous bone tissue derived from patient's marrow cells and the cells can be obtained by needle aspiration without damaging the patient's normal tissue.

Background: As an audit of patients undergoing laparoscopic cholecystectomy this study not only reports the short term results, but attempted to assess the long term effect of the operation on the symptom profiles of the patients.

Methods: Three hundred unselected consecutive patients underwent elective laparoscopic cholecystectomy from January 1991 to July 1994. Short term outcome was analysed by reviewing patient files for operation details, postoperative morbidity, complications, and gallbladder histology. Long term (median 2 years) outcome was evaluated by a detailed postal questionnaire. Symptomatic benefit ratios (BR) accruing from the laparoscopic removal of the gallbladder were calculated.

Results: Twelve operations (4.0%) were converted to open surgery and were excluded from long term outcome analyses. Median operation time was 93 (range 40-245) minutes. There were no deaths. Overall morbidity was 13 %. Median postoperative hospital stay was 2 days (range 1-18 days) and median time-off work 15 days (range 2-49 days). The overall response rate to the questionnaire was 87%. Only one of the 261 patients (0.4%) suffered from recurrent common bile duct stones so far. As shown by the benefit ratios the symptoms most effectively relieved by laparoscopic cholecystectomy were biliary pain (0.97), nausea (0.95), vomiting (0.96) and jaundice (0.94). Most patients with diarrhoea (0.70) and heartburn (0.66) felt relief. Constipation (0.39) and food intolerance (0.57) were unaffected. Most patients (90%) felt that the operation-initiating symptom had disappeared and 98 percent of the patients considered that they had obtained overall symptomatic improvement by the operation.

Conclusions: Laparoscopic cholecystectomy appears to be a safe and effective way of treating the most common symptoms related to gallstone disease.