AIM:To evaluate the clinical,radiological and microbiological properties of abdominal tuberculosis (TB) and to discuss methods needed to get the diagnosis. METHODS:Thirty-one patients diagnosed as abdominal TB between...AIM:To evaluate the clinical,radiological and microbiological properties of abdominal tuberculosis (TB) and to discuss methods needed to get the diagnosis. METHODS:Thirty-one patients diagnosed as abdominal TB between March 1998 and December 2001 at the Gastroenterology Department of Kartal State Hospital, Istanbul,Turkey were evaluated prospectively.Complete physical examination,medical and family history,blood count erythrocyte sedimentation rate,routine biochemical tests, Mantoux skin test,chest X-ray and abdominal ultrasonography (USG) were performed in all cases,whereas microbiological examination of ascites,upper gastrointestinal endoscopy,colonoscopy or barium enema,abdominal tomography,mediastinoscopy,laparoscopy or laparotomy were done when needed. RESULTS:The median age of patients (14 females,17 males) was 34.2 years (range 15-65 years).The most frequent symptoms were abdominal pain and weight loss. Eleven patients had active pulmonary TB.The most common abdominal USG findings were ascites and hepatomegaly.Ascitic fluid analysis performed in 13 patients was found to be exudative and acid resistant bacilli were present in smear and cultured only in one patient with BacTec (3.2%).Upper gastrointestinal endoscopy yielded nonspecific findings in 16 patients.Colonoscopy performed in 20 patients showed ulcers in 9 (45%),nodules in 2 (10%) and,stricture,polypoid lesions,granulomatous findings in terminal ileum and rectal fistula each in one patient (5%). Laparoscopy on 4 patients showed dilated bowel loops, thickening in the mesentery,multiple ulcers and tubercles on the peritoneum.Patients with abdominal TB were divided into three groups according to the type of involvement. Fifteen patients (48%) had intestinal TB,11 patients (35.2%) had tuberculous peritonitis and 5 (16.8%) tuberculous lymphadenitis.The diagnosis of abdominal TB was confirmed microbiologically in 5 (16%) and histo- pathologically in 19 patients (60.8%).The remaining nine patients (28.8%) had been diagnosed by a positive response to antitub展开更多
AIM:To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis. METHODS:The records of 11 patients (4 males,7 females, mean age ...AIM:To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis. METHODS:The records of 11 patients (4 males,7 females, mean age 39 years,range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed. RESULTS:Ascites was present in all cases.Other common findings were weight loss (81%),weakness (81%),abdominal mass (72%),abdominal pain (72%),abdominal distension (63%),anorexia (45%) and night sweat (36%).The average hemoglobin was 8.2 g/dL and the average FAR was 50 mm/h (range 30-125).Elevated levels of cancer antigen CA-125 were determined in four patients.Abdominal ultrasound showed abnormalities in all cases:ascites in all,tuboovarian mass in five,omental thickening in 3,and enlarged lymph nodes (mesenteric,para-aortic) in 2.CT scans showed ascites in all,pelvic mass in 5,retroperitoneal lymphadenopathy in 4,mesenteric stranding in 4,omental stranding in 3, bowel wall thickening in 2 and mesenteric lymphadenopathy in 2.Only one patient had a chest radiograph suggestive of a new TB lesion.Two had a positive family history of pulmonary TB.None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two.Laparotomy was performed in 6 cases,laparoscopy in 4 and ultrasound- guided fine needle aspiration in 2.In those patients subjected to operation,the findings were multiple diffuse involvement of the visceral and parietal peritoneum,white ‘miliary nodules’or plaques,enlarged lymph nodes,ascites, ‘violin string’fibrinous strands,and omental thickening. Biopsy specimens showed granulomas,while ascitic fluid showed numerous lymphocytes.Both were negative for acid-fast bacilli by staining.PCR of ascitic fluid was positive for Mycobactenum tuberculosis ( M.tuberculosis) in all cases. CONCLUSION:Abdominal TB should be considered in all cases with ascites.Our experience sug展开更多
AIM: To evaluate whether postoperative radiotherapy is an alternative to neck lymph node surgery and if it provides a survival benefit for those receiving two-field, chest and abdomen, lymphadenectomy.
提出了一种基于节点主观信任度的分布式多路径路由协议(distributed protocol for multipath routing based on node’s subjective trust degree,NSTD-DPMR)。在利用主观信任度对中间节点的恶意程度进行评估的基础上,分布式计算出源端...提出了一种基于节点主观信任度的分布式多路径路由协议(distributed protocol for multipath routing based on node’s subjective trust degree,NSTD-DPMR)。在利用主观信任度对中间节点的恶意程度进行评估的基础上,分布式计算出源端节点发送数据的最佳速率,以及各中间节点的最佳转发速率。仿真实验表明,协议NSTD-DPMR能够在将恶意中间节点对数据传输的危害降低到最低程度的同时,最大化目的端节点接收到的正常数据,保证了路由的安全性和有效性,且协议的复杂度较低。展开更多
Background:In China,the esophageal cancer is the most common tumor type,and the main treatment is still surgical treatment.Over the past decade,thoracic laparoscopy combined with esophageal cancer resection and neck a...Background:In China,the esophageal cancer is the most common tumor type,and the main treatment is still surgical treatment.Over the past decade,thoracic laparoscopy combined with esophageal cancer resection and neck anastomosis-McKeown minimally invasive esophagectomy(MIE)has gained interest and known as a minimally invasive surgery for the middle esophageal cancer.However,the safety and operability of McKeown MIE remains to be confirmed clinically.The purpose of this article is to examine the clinical safety and operability of McKeown MIE,and compare the security and outcomes of McKeown MIE and Ivor-Lewis esophagectomy.Materials and methods:The clinical data of 312 patients with middle esophageal cancer in Sir Run Run Shaw Hospital from January 2013 to December 2018 were retrospectively analyzed.Among them,176 patients underwent Ivor-Lewis esophagectomy and 136 patients underwent McKeown MIE.Patients'demographics and perioperative outcomes were comparable between the two groups.Results:There were no significant differences in terms of operative time,postoperative hospital stay,restore fluid diet time,pathology,tumor node metastasis staging between the two groups.In the McKeown MIE group,the intraoperative blood loss was less than that in the Ivor-Lewis group(116.54±80.99 ml vs 152.78±115.35 ml,p=0.001).The total number of lymph nodes and the number of lymph nodes dissection in bilateral recurrent laryngeal nerves were more than those in the Ivor-Lewis group(30.04±14.08 vs 27.51±11.34,p=0.039;5.74±4.27 vs 1.80±2.68,p<0.001).There were no significant differences in the incidence of complications.The overall survival for the McKeown MIE group was higher than the Ivor-Lewis group(p=0.013)and no significant difference was found on disease-free survival.Conclusion:McKeown MIE is safe and operational for middle esophageal cancer,which is consistent with the principle of tumor radicalization.展开更多
AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/ T1b esophageal neoplasms. METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane...AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/ T1b esophageal neoplasms. METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane Library, from 1997 up to January 2011 was performed. An analysis was carried out, pooling the effects of outcomes of 4241 patients enrolled in 80 retrospective studies. For comparisons across studies, each reporting on only one endoscopic method, we used a random effects meta-regression of the log-odds of the outcome of treatment in each study. "Neural networks" as a data mining technique was employed in order to establish a prediction model of lymph node status in superficial submucosal esophageal carcinoma. Another data mining technique, the "feature selection and root cause analysis", was used to identify the most impor-tant predictors of local recurrence and metachronous cancer development in endoscopically resected patients, and lymph node positivity in squamous carcinoma (SCC) and adenocarcinoma (ADC) separately in surgically resected patients. RESULTS: Endoscopically resected patients: Low grade dysplasia was observed in 4% of patients, high grade dysplasia in 14.6%, carcinoma in situ in 19%, mucosal cancer in 54%, and submucosal cancer in 16% of patients. There were no significant differences between endoscopic mucosal resection and endoscopic submucosal dissection (ESD) for the following parameters: complications, patients submitted to surgery, positive margins, lymph node positivity, local recurrence and metachronous cancer. With regard to piecemeal resection, ESD performed better since the number of cases was significantly less [coefficient: -7.709438, 95%CI: (-11.03803, -4.380844), P < 0.001]; hence local recurrence rates were significantly lower [coefficient: -4.033528, 95%CI: (-6.151498, -1.915559),P < 0.01]. A higher rate of esophageal stenosis was observed following ESD [coefficient: 7.322266, 95%CI: (3.810146, 10.83439), P < 0.001]. A significantly greater number of SCC patients wer展开更多
文摘AIM:To evaluate the clinical,radiological and microbiological properties of abdominal tuberculosis (TB) and to discuss methods needed to get the diagnosis. METHODS:Thirty-one patients diagnosed as abdominal TB between March 1998 and December 2001 at the Gastroenterology Department of Kartal State Hospital, Istanbul,Turkey were evaluated prospectively.Complete physical examination,medical and family history,blood count erythrocyte sedimentation rate,routine biochemical tests, Mantoux skin test,chest X-ray and abdominal ultrasonography (USG) were performed in all cases,whereas microbiological examination of ascites,upper gastrointestinal endoscopy,colonoscopy or barium enema,abdominal tomography,mediastinoscopy,laparoscopy or laparotomy were done when needed. RESULTS:The median age of patients (14 females,17 males) was 34.2 years (range 15-65 years).The most frequent symptoms were abdominal pain and weight loss. Eleven patients had active pulmonary TB.The most common abdominal USG findings were ascites and hepatomegaly.Ascitic fluid analysis performed in 13 patients was found to be exudative and acid resistant bacilli were present in smear and cultured only in one patient with BacTec (3.2%).Upper gastrointestinal endoscopy yielded nonspecific findings in 16 patients.Colonoscopy performed in 20 patients showed ulcers in 9 (45%),nodules in 2 (10%) and,stricture,polypoid lesions,granulomatous findings in terminal ileum and rectal fistula each in one patient (5%). Laparoscopy on 4 patients showed dilated bowel loops, thickening in the mesentery,multiple ulcers and tubercles on the peritoneum.Patients with abdominal TB were divided into three groups according to the type of involvement. Fifteen patients (48%) had intestinal TB,11 patients (35.2%) had tuberculous peritonitis and 5 (16.8%) tuberculous lymphadenitis.The diagnosis of abdominal TB was confirmed microbiologically in 5 (16%) and histo- pathologically in 19 patients (60.8%).The remaining nine patients (28.8%) had been diagnosed by a positive response to antitub
文摘AIM:To analyze the experience within our hospital and to review the literature so as to establish the best means of diagnosis of abdominal tuberculosis. METHODS:The records of 11 patients (4 males,7 females, mean age 39 years,range 18-65 years) diagnosed with abdominal tuberculosis in Harran University Hospital between January 1996 and October 2003 were analyzed retrospectively and the literature was reviewed. RESULTS:Ascites was present in all cases.Other common findings were weight loss (81%),weakness (81%),abdominal mass (72%),abdominal pain (72%),abdominal distension (63%),anorexia (45%) and night sweat (36%).The average hemoglobin was 8.2 g/dL and the average FAR was 50 mm/h (range 30-125).Elevated levels of cancer antigen CA-125 were determined in four patients.Abdominal ultrasound showed abnormalities in all cases:ascites in all,tuboovarian mass in five,omental thickening in 3,and enlarged lymph nodes (mesenteric,para-aortic) in 2.CT scans showed ascites in all,pelvic mass in 5,retroperitoneal lymphadenopathy in 4,mesenteric stranding in 4,omental stranding in 3, bowel wall thickening in 2 and mesenteric lymphadenopathy in 2.Only one patient had a chest radiograph suggestive of a new TB lesion.Two had a positive family history of pulmonary TB.None had acid-fast bacilli (AFB) in the sputum and the tuberculin test was positive in only two.Laparotomy was performed in 6 cases,laparoscopy in 4 and ultrasound- guided fine needle aspiration in 2.In those patients subjected to operation,the findings were multiple diffuse involvement of the visceral and parietal peritoneum,white ‘miliary nodules’or plaques,enlarged lymph nodes,ascites, ‘violin string’fibrinous strands,and omental thickening. Biopsy specimens showed granulomas,while ascitic fluid showed numerous lymphocytes.Both were negative for acid-fast bacilli by staining.PCR of ascitic fluid was positive for Mycobactenum tuberculosis ( M.tuberculosis) in all cases. CONCLUSION:Abdominal TB should be considered in all cases with ascites.Our experience sug
基金Supported by grant from Doctoral Startup Project of Liaoning Provincial Science and Technology Department,No.20121133
文摘AIM: To evaluate whether postoperative radiotherapy is an alternative to neck lymph node surgery and if it provides a survival benefit for those receiving two-field, chest and abdomen, lymphadenectomy.
文摘提出了一种基于节点主观信任度的分布式多路径路由协议(distributed protocol for multipath routing based on node’s subjective trust degree,NSTD-DPMR)。在利用主观信任度对中间节点的恶意程度进行评估的基础上,分布式计算出源端节点发送数据的最佳速率,以及各中间节点的最佳转发速率。仿真实验表明,协议NSTD-DPMR能够在将恶意中间节点对数据传输的危害降低到最低程度的同时,最大化目的端节点接收到的正常数据,保证了路由的安全性和有效性,且协议的复杂度较低。
文摘Background:In China,the esophageal cancer is the most common tumor type,and the main treatment is still surgical treatment.Over the past decade,thoracic laparoscopy combined with esophageal cancer resection and neck anastomosis-McKeown minimally invasive esophagectomy(MIE)has gained interest and known as a minimally invasive surgery for the middle esophageal cancer.However,the safety and operability of McKeown MIE remains to be confirmed clinically.The purpose of this article is to examine the clinical safety and operability of McKeown MIE,and compare the security and outcomes of McKeown MIE and Ivor-Lewis esophagectomy.Materials and methods:The clinical data of 312 patients with middle esophageal cancer in Sir Run Run Shaw Hospital from January 2013 to December 2018 were retrospectively analyzed.Among them,176 patients underwent Ivor-Lewis esophagectomy and 136 patients underwent McKeown MIE.Patients'demographics and perioperative outcomes were comparable between the two groups.Results:There were no significant differences in terms of operative time,postoperative hospital stay,restore fluid diet time,pathology,tumor node metastasis staging between the two groups.In the McKeown MIE group,the intraoperative blood loss was less than that in the Ivor-Lewis group(116.54±80.99 ml vs 152.78±115.35 ml,p=0.001).The total number of lymph nodes and the number of lymph nodes dissection in bilateral recurrent laryngeal nerves were more than those in the Ivor-Lewis group(30.04±14.08 vs 27.51±11.34,p=0.039;5.74±4.27 vs 1.80±2.68,p<0.001).There were no significant differences in the incidence of complications.The overall survival for the McKeown MIE group was higher than the Ivor-Lewis group(p=0.013)and no significant difference was found on disease-free survival.Conclusion:McKeown MIE is safe and operational for middle esophageal cancer,which is consistent with the principle of tumor radicalization.
文摘AIM: To investigate potential therapeutic recommendations for endoscopic and surgical resection of T1a/ T1b esophageal neoplasms. METHODS: A thorough search of electronic databases MEDLINE, Embase, Pubmed and Cochrane Library, from 1997 up to January 2011 was performed. An analysis was carried out, pooling the effects of outcomes of 4241 patients enrolled in 80 retrospective studies. For comparisons across studies, each reporting on only one endoscopic method, we used a random effects meta-regression of the log-odds of the outcome of treatment in each study. "Neural networks" as a data mining technique was employed in order to establish a prediction model of lymph node status in superficial submucosal esophageal carcinoma. Another data mining technique, the "feature selection and root cause analysis", was used to identify the most impor-tant predictors of local recurrence and metachronous cancer development in endoscopically resected patients, and lymph node positivity in squamous carcinoma (SCC) and adenocarcinoma (ADC) separately in surgically resected patients. RESULTS: Endoscopically resected patients: Low grade dysplasia was observed in 4% of patients, high grade dysplasia in 14.6%, carcinoma in situ in 19%, mucosal cancer in 54%, and submucosal cancer in 16% of patients. There were no significant differences between endoscopic mucosal resection and endoscopic submucosal dissection (ESD) for the following parameters: complications, patients submitted to surgery, positive margins, lymph node positivity, local recurrence and metachronous cancer. With regard to piecemeal resection, ESD performed better since the number of cases was significantly less [coefficient: -7.709438, 95%CI: (-11.03803, -4.380844), P < 0.001]; hence local recurrence rates were significantly lower [coefficient: -4.033528, 95%CI: (-6.151498, -1.915559),P < 0.01]. A higher rate of esophageal stenosis was observed following ESD [coefficient: 7.322266, 95%CI: (3.810146, 10.83439), P < 0.001]. A significantly greater number of SCC patients wer
