Background & Aims: Percutaneous radiofrequency ablation is a recently introduced treatment for hepatocellular carcinoma, whereas ethanol injection is now a standard therapy. We compared their long- term outcomes. ...Background & Aims: Percutaneous radiofrequency ablation is a recently introduced treatment for hepatocellular carcinoma, whereas ethanol injection is now a standard therapy. We compared their long- term outcomes. Methods: Two hundred thirty- two patients with hepatocellular carcinoma who had 3 or fewer lesions, each 3 cm or less in diameter, and liver function of Child- Pugh class A or B were entered onto a randomized controlled trial. The primary end point was survival, and the secondary end points were ove- rall recurrence and local tumor progression. Results: One hundred eighteen patients were assigned to radiofrequency ablation and 114 to ethanol injection. The number of treatment sessions was smaller (2.1 times vs 6.4 times, respectively, P < .0001) and the length of hospitalization was shorter (10.8 days vs 26.1 days, respectively, P < .0001) in radiofrequency ablation than in ethanol injection. Four- year survival rate was 74% (95% CI: 65% - 84% ) in radiofrequency ablation and 57% (95% CI: 45% - 71% ) in ethanol injection. Radiofrequency ablation had a 46% smaller risk of death (adjusted relative risk, 0.54 [95% CI: 0.33- 0.89], P = .02), a 43% smaller risk of overall recurrence (adjusted relative risk 0.57 [95% CI: 0.41- 0.80], P = .0009), and an 88% smaller risk of local tumor progression (relative risk, 0.12 [95% CI: 0.03- 0.55], P = .006) than ethanol injection. The incidence of adverse events was not different between the 2 therapies. Conclusions: Judging from higher survival but similar adverse events, radiofrequency ablation is superior to ethanol injection for small hepatocellular carcinoma.展开更多
Purpose: Fecal incontinence caused by a weak or disrupted internal anal sphincter is common but there has been no effective treatment. This prospective study evaluates the medium-term clinical effects of an injectable...Purpose: Fecal incontinence caused by a weak or disrupted internal anal sphincter is common but there has been no effective treatment. This prospective study evaluates the medium-term clinical effects of an injectable silicone biomaterial, PTPTM (Bioplastique), used to augment the internal anal sphincter. Method: Eighty-two patients (64 females; median age, 66 years) with severe fecal incontinence and a low anal resting pressure caused by internal anal sphincter dysfunction (defect, n = 11; intact, n = 71) were randomized to PTPTM injection into intersphincteric space and internal anal sphincter with (Group A, n = 42) or without (Group B, n = 40) guidance by endoanal ultrasound. Both groups were similar in terms of age, gender, past anorectal surgery,duration of follow-up (median,6 months; range, 1-12 months), and baseline continence score. Sixty-two percent of Group A and 55 percent of Group B had prolonged pudendal nerve terminal motor latency. Results: There was no significant complication. Two patients in Group A and four patients in Group B noted minor discomfort at injection sites. At one month postprocedure, endoanal ultrasound confirmed retention of silicone biomaterial without migration. In both groups, fecal continence was significantly improved by PTPTM implants 1 month after injection, but continued to improve significantly for up to 12 months in Group A and 6 months in Group B (P< 0.001). Improvement in fecal continence and maximum anal resting pressure was significantly greater in Group A, in whom injection was guided by endoanal ultrasound, than in Group B. At three months after injection, significantly more Group A patients than Group B patients achieved >50 percent improvement in Wexner’s continence score (69 percent vs. 40 percent; P=0.014). Ninety-three percent of Group A and 92 percent of Group B had >50 percent improvement in global quality of life scores (visual analog scale). At a median followup of 6 months, all domains of the fecal incontinence quality of life scale improved significantly in both groups; however, the physical function and mental health scores of Short Form-12 only improved in Group A. A prolonged pudendal nerve terminal motor latency had no effect on functional outcome in either group. Conclusion: Injection of silicone biomaterial provided amarked improvement in fecal continence and quality of life in patients with internal sphincter dysfunction, despite the presence of pudendal neuropathy.展开更多
To compare vitreous concentrations of triamcinolone acetonide (TA) achieved by prior therapeutic intravitreal and subtenon injections. Interventional case ser ies. Vitreous samples were collected from patients who req...To compare vitreous concentrations of triamcinolone acetonide (TA) achieved by prior therapeutic intravitreal and subtenon injections. Interventional case ser ies. Vitreous samples were collected from patients who required vitreous surgery , six having received a subtenon injection of TA and another six, an intravitrea l injection. Vitreous concentrations of TA were measured by high-performance li quid chromatography. Vitreous concentrations of TA after intravitreal injection were 1.22 ±.0.24 μg/ml, significantly higher than those after subtenon injecti on ( < 0.001 μg/ml, P=0.003). Vitreous concentrations of TA after subtenon inje ction and TA-assisted vitrectomy performed in a few patients to visualize the t ransparent vitreous gel were 0.20 ±0.11 μg/ml, an intermediate amount between these two groups. Much higher vitreous concentrations of TA after intravitreal i njection than subtenon injection may accelerate therapeutic effect when intravit real injections are given to reduce macular edema. Subtenon injections of TA may act via the sclera as opposed to the vitreous.展开更多
The objective of the study was to evaluate the efficacy of intramuscular penicillin: mixture of benzyl penicillin and procain penicillin (2 MU x 2 times daily) and intravenous benzyl penicillin (4 MU x 6 times daily) ...The objective of the study was to evaluate the efficacy of intramuscular penicillin: mixture of benzyl penicillin and procain penicillin (2 MU x 2 times daily) and intravenous benzyl penicillin (4 MU x 6 times daily) in the treatment of hospitalized adult patients with erysipelas.A prospective randomized unicentric trial was conducted.In total, 112 patients entered the study; 57 in the intramuscular group and 55 patients in the intravenous group completed the trial.The failure rate was 14%for intramuscular group and 20%for the intravenous group (P = 0.40).Local complications such as of the leg abscesses were observed in the two groups (intravenous 9.1%, intramuscular 7%; P = 0477).Of the patients treated with intravenous benzyl penicillin, 25.5%presented complications related to the route (venitis).Intramuscular penicillin should be considered an effective and well-tolerated treatment of erysipelas in adult patients.展开更多
文摘Background & Aims: Percutaneous radiofrequency ablation is a recently introduced treatment for hepatocellular carcinoma, whereas ethanol injection is now a standard therapy. We compared their long- term outcomes. Methods: Two hundred thirty- two patients with hepatocellular carcinoma who had 3 or fewer lesions, each 3 cm or less in diameter, and liver function of Child- Pugh class A or B were entered onto a randomized controlled trial. The primary end point was survival, and the secondary end points were ove- rall recurrence and local tumor progression. Results: One hundred eighteen patients were assigned to radiofrequency ablation and 114 to ethanol injection. The number of treatment sessions was smaller (2.1 times vs 6.4 times, respectively, P < .0001) and the length of hospitalization was shorter (10.8 days vs 26.1 days, respectively, P < .0001) in radiofrequency ablation than in ethanol injection. Four- year survival rate was 74% (95% CI: 65% - 84% ) in radiofrequency ablation and 57% (95% CI: 45% - 71% ) in ethanol injection. Radiofrequency ablation had a 46% smaller risk of death (adjusted relative risk, 0.54 [95% CI: 0.33- 0.89], P = .02), a 43% smaller risk of overall recurrence (adjusted relative risk 0.57 [95% CI: 0.41- 0.80], P = .0009), and an 88% smaller risk of local tumor progression (relative risk, 0.12 [95% CI: 0.03- 0.55], P = .006) than ethanol injection. The incidence of adverse events was not different between the 2 therapies. Conclusions: Judging from higher survival but similar adverse events, radiofrequency ablation is superior to ethanol injection for small hepatocellular carcinoma.
文摘Purpose: Fecal incontinence caused by a weak or disrupted internal anal sphincter is common but there has been no effective treatment. This prospective study evaluates the medium-term clinical effects of an injectable silicone biomaterial, PTPTM (Bioplastique), used to augment the internal anal sphincter. Method: Eighty-two patients (64 females; median age, 66 years) with severe fecal incontinence and a low anal resting pressure caused by internal anal sphincter dysfunction (defect, n = 11; intact, n = 71) were randomized to PTPTM injection into intersphincteric space and internal anal sphincter with (Group A, n = 42) or without (Group B, n = 40) guidance by endoanal ultrasound. Both groups were similar in terms of age, gender, past anorectal surgery,duration of follow-up (median,6 months; range, 1-12 months), and baseline continence score. Sixty-two percent of Group A and 55 percent of Group B had prolonged pudendal nerve terminal motor latency. Results: There was no significant complication. Two patients in Group A and four patients in Group B noted minor discomfort at injection sites. At one month postprocedure, endoanal ultrasound confirmed retention of silicone biomaterial without migration. In both groups, fecal continence was significantly improved by PTPTM implants 1 month after injection, but continued to improve significantly for up to 12 months in Group A and 6 months in Group B (P< 0.001). Improvement in fecal continence and maximum anal resting pressure was significantly greater in Group A, in whom injection was guided by endoanal ultrasound, than in Group B. At three months after injection, significantly more Group A patients than Group B patients achieved >50 percent improvement in Wexner’s continence score (69 percent vs. 40 percent; P=0.014). Ninety-three percent of Group A and 92 percent of Group B had >50 percent improvement in global quality of life scores (visual analog scale). At a median followup of 6 months, all domains of the fecal incontinence quality of life scale improved significantly in both groups; however, the physical function and mental health scores of Short Form-12 only improved in Group A. A prolonged pudendal nerve terminal motor latency had no effect on functional outcome in either group. Conclusion: Injection of silicone biomaterial provided amarked improvement in fecal continence and quality of life in patients with internal sphincter dysfunction, despite the presence of pudendal neuropathy.
文摘To compare vitreous concentrations of triamcinolone acetonide (TA) achieved by prior therapeutic intravitreal and subtenon injections. Interventional case ser ies. Vitreous samples were collected from patients who required vitreous surgery , six having received a subtenon injection of TA and another six, an intravitrea l injection. Vitreous concentrations of TA were measured by high-performance li quid chromatography. Vitreous concentrations of TA after intravitreal injection were 1.22 ±.0.24 μg/ml, significantly higher than those after subtenon injecti on ( < 0.001 μg/ml, P=0.003). Vitreous concentrations of TA after subtenon inje ction and TA-assisted vitrectomy performed in a few patients to visualize the t ransparent vitreous gel were 0.20 ±0.11 μg/ml, an intermediate amount between these two groups. Much higher vitreous concentrations of TA after intravitreal i njection than subtenon injection may accelerate therapeutic effect when intravit real injections are given to reduce macular edema. Subtenon injections of TA may act via the sclera as opposed to the vitreous.
文摘The objective of the study was to evaluate the efficacy of intramuscular penicillin: mixture of benzyl penicillin and procain penicillin (2 MU x 2 times daily) and intravenous benzyl penicillin (4 MU x 6 times daily) in the treatment of hospitalized adult patients with erysipelas.A prospective randomized unicentric trial was conducted.In total, 112 patients entered the study; 57 in the intramuscular group and 55 patients in the intravenous group completed the trial.The failure rate was 14%for intramuscular group and 20%for the intravenous group (P = 0.40).Local complications such as of the leg abscesses were observed in the two groups (intravenous 9.1%, intramuscular 7%; P = 0477).Of the patients treated with intravenous benzyl penicillin, 25.5%presented complications related to the route (venitis).Intramuscular penicillin should be considered an effective and well-tolerated treatment of erysipelas in adult patients.
