PubMed · 186643
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B Datnow, W W Daniel. 1976-11-29. Polycystic nephroblastoma.. https://pubmed.ncbi.nlm.nih.gov/186643/
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BACKGROUND: Significant progress has been made in clinical small bowel transplantation over the last decade mainly due advances in biotechnology and new immunosuppressive regiments. This transplantation has now been indicated to treat special cases of intestinal failure. AIM: This review highlights recent developments in the area of small bowel transplantation. MATERIAL AND METHODS: Over 600 reports on clinical and experimental small bowel transplantation were reviewed. Aspects concerning research development, different immunosuppressive strategies, patient and graft monitoring, and improvements in surgical techniques are discussed. RESULTS: About 700 small bowel transplantation were performed in 55 transplant centers, 44% intestine-liver, 41% isolated intestinal graft and 15% multivisceral transplantation. Rejection and infection are the main limitation of this procedure. Actual 5 years post transplantation graft survival of the total international experience is 46% for isolated intestinal graft, 43% for combined intestine-liver and nearly 30% for multivisceral transplantation. Higher graft and patient survival are seen at the more experienced centers. In a series of 165 intestinal transplantation at University of Pittsburgh, PA, USA, actuarial patient survival was reported to be over 75% at one year, 54% at 5 years and 42% at 10 years. Over 90% patients from Pittsburgh program resume an unrestricted oral diet. CONCLUSION: Small bowel transplantation has advanced from an experimental strategy to a feasible alternative for patients with permanent intestinal failure. Further refinements in graft acceptance, immunosuppressive regiments, infection management and prophylaxis, surgical techniques as well as appropriated patient referral and selection are crucial to improve outcomes.
This paper describes our first attempts to develop a method for the objective assessment of quality in substitution voices. The objective analysis deals with acoustic parameters characterising short voice and speech samples like a sequence of isolated vowels, a sequence of VCV and CVCVCV syllables, a short sentence, etc. A database of 113 registrations from 68 patients (53 total laryngectomy patients with tracheo-esophageal speech, 14 total laryngectomy patients with esophageal speech and 5 patients with partial frontolateral laryngectomy) and 6 registrations from healthy control persons was collected. Each registration consisted of seven speech utterances and was subjected to an acoustic analysis as well as to a perceptual evaluation, the latter involving eight parameters like "overall impression", "tonicity", etc. Since the goal of our work is to find out the best acoustical measurement for supporting perception and making it precise, it seemed logical to strive for a perceptually based acoustic analysis. We therefore performed the analysis by means of a peripheral auditory model with a built-in fundamental frequency (pitch) extractor. From the frame-level outputs (a frame is 10 ms) of the analyser, global objective parameters, such as (1) the percentage of voiced frames, (2) the average voicing evidence, (3) the voicing length distribution and (4) the fundamental frequency jitter, were computed for the different speech utterances. So as to reduce the parameter variability arising from the nature of the speech utterances (e.g., the presence of pauses in the signal, errors caused by the pitch extractor, etc.), the objective parameters were computed using non-standard averaging schemes involving energy weighting and frame selection. A statistical analysis of the objective parameters confirms that the quality of tracheo-esophageal speech is superior to that of esophageal speech, but inferior to that of normal speech and speech with the preservation of one vocal fold. Correlations between the objective parameters and the perceptual parameters are moderate.
PURPOSE: To describe the natural history of mucosal changes, in particular the development of telangiectases in the rectum, after radiotherapy (RT) for prostate cancer. METHODS AND MATERIALS: Twenty patients undergoing local-field, nonconformal RT for prostate cancer underwent flexible sigmoidoscopy every 6 months for up to 3 years after RT completion. Telangiectasis was scored as absent, single, multiple, or multiple confluent. The site and circumferential extent were also documented. The patients filled in a diary to document the symptoms they were experiencing, including rectal bleeding. RESULTS: Of the 20 patients, 12 developed multiple telangiectases, and 10 of these had rectal bleeding, which in all cases was mild. Telangiectasis was most commonly seen between 4 (anorectal junction) and 8 cm from the anal verge. In 5 patients, 4 of whom had multiple telangiectases, spontaneous resolution occurred. CONCLUSION: Late radiation effects in the rectum do not appear to be permanent in all cases. This first prospective prolonged evaluation may provide an explanation for the observation that rectal bleeding resolves in a large proportion of patients with mild symptoms after RT. The reasons for improvement in the late radiation changes in the rectum compared with the permanent changes seen in organs such as the skin are unknown.