Rectovaginal fistula(RVF) continues to be the most difficult perianal manifestation of Crohn's disease to treat.This devastating and disabling complication has a significant impact on patients' quality of life...Rectovaginal fistula(RVF) continues to be the most difficult perianal manifestation of Crohn's disease to treat.This devastating and disabling complication has a significant impact on patients' quality of life and presents unique management challenges.Current therapeutic approaches include many medical therapeutics and surgical treatments with a wide range of success rates reported.However,current evidence is lacking to support any recommendation.The choice of repair depends on various patient and disease factors and basic surgical tenets.In this article,we review the current options to consider in the treatment of Crohn's-related RVF,and try to evaluate their effects on fistulae closure and quality of life.展开更多
OBJECTIVE To evaluate the applicability of combined therapyand the prognostic factors in patients with carcinoma of thecervical stump (CCS).METHODS The clinical records of 60 CCS patients whounderwent combined treatme...OBJECTIVE To evaluate the applicability of combined therapyand the prognostic factors in patients with carcinoma of thecervical stump (CCS).METHODS The clinical records of 60 CCS patients whounderwent combined treatment in our hospital during a periodfrom January 2000 to December 2007, were collected andretrospectively analyzed. The prognostic factors were studiedusing univariate analysis. Analytical evaluation of the independentprognostic factors was performed using COX proportionalhazardsregression model.RESULTS The 1-, 3- and 5-year survival rates of the 60 patientswere 95%, 78% and 68%, respectively, with a median survivaltime of 32 months. Univariate survival analysis showed thatthese independent prognostic factors included positive pelviclymph nodes (P = 0.001), lymphovascular tumor embolus (P =0.001), and adjuvant chemotherapy (P = 0.011). In the 60 cases,postoperative local recurrence in the pelvic cavity occurred in1 and distant metastasis in 3. Related complications, such asradiocystitis, recto-vaginal fistula and vesico-vaginal fistula werefound in 6 of the total cases (10%). The serum levels of squamousepithelium antigen detected before and after treatment weresignificantly different (P = 0.000). The incidence of CCS is low;however, the disease is difficult to cure due to the high incidenceof complications and to the frequency of distant metastasis.Therefore, individualized treatment is needed. Complications fromsubtotal hysterectomy (STH) should be treated and controlledaggressively. Careful follow-up as well as close monitoring andobservation for significant symptoms in the postoperative coursewill enhance clinical outcome.CONCLUSION Cancer of the cervical stump has a lowmorbidity and severe complications, and most recurrences aredistant metastases. Because it is difficult to cure, there is a needto design a treatment regimen for each individual patient basedon the factors deemed as high risk. The surgical indications forsubtotal uterine resection should be followed and close follow-upafter surgery should be maintained.展开更多
文摘Rectovaginal fistula(RVF) continues to be the most difficult perianal manifestation of Crohn's disease to treat.This devastating and disabling complication has a significant impact on patients' quality of life and presents unique management challenges.Current therapeutic approaches include many medical therapeutics and surgical treatments with a wide range of success rates reported.However,current evidence is lacking to support any recommendation.The choice of repair depends on various patient and disease factors and basic surgical tenets.In this article,we review the current options to consider in the treatment of Crohn's-related RVF,and try to evaluate their effects on fistulae closure and quality of life.
文摘OBJECTIVE To evaluate the applicability of combined therapyand the prognostic factors in patients with carcinoma of thecervical stump (CCS).METHODS The clinical records of 60 CCS patients whounderwent combined treatment in our hospital during a periodfrom January 2000 to December 2007, were collected andretrospectively analyzed. The prognostic factors were studiedusing univariate analysis. Analytical evaluation of the independentprognostic factors was performed using COX proportionalhazardsregression model.RESULTS The 1-, 3- and 5-year survival rates of the 60 patientswere 95%, 78% and 68%, respectively, with a median survivaltime of 32 months. Univariate survival analysis showed thatthese independent prognostic factors included positive pelviclymph nodes (P = 0.001), lymphovascular tumor embolus (P =0.001), and adjuvant chemotherapy (P = 0.011). In the 60 cases,postoperative local recurrence in the pelvic cavity occurred in1 and distant metastasis in 3. Related complications, such asradiocystitis, recto-vaginal fistula and vesico-vaginal fistula werefound in 6 of the total cases (10%). The serum levels of squamousepithelium antigen detected before and after treatment weresignificantly different (P = 0.000). The incidence of CCS is low;however, the disease is difficult to cure due to the high incidenceof complications and to the frequency of distant metastasis.Therefore, individualized treatment is needed. Complications fromsubtotal hysterectomy (STH) should be treated and controlledaggressively. Careful follow-up as well as close monitoring andobservation for significant symptoms in the postoperative coursewill enhance clinical outcome.CONCLUSION Cancer of the cervical stump has a lowmorbidity and severe complications, and most recurrences aredistant metastases. Because it is difficult to cure, there is a needto design a treatment regimen for each individual patient basedon the factors deemed as high risk. The surgical indications forsubtotal uterine resection should be followed and close follow-upafter surgery should be maintained.
