SEARCH · PubMed Health

Results for “Extended”

Explore indexed PubMed citations for clinical trials, systematic reviews and public health research. Read source abstracts and follow each citation to its original PubMed record.

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 163 records · Page 9Linked to original sources

PubMed2006

Effect of semen collection in extender solution on the characteristics of goat spermatozoa.

The objective of this experiment was to investigate whether the motility parameters and acrosome integrity of goat ejaculated spermatozoa are affected by collecting semen into tubes containing an extender, and thereby determine the significance of reducing contact between seminal plasma and the sperm membrane at ejaculation. Semen were collected from three goats into tubes containing 0, 1 or 10 ml extender, or collected into tubes containing 10 ml extender supplemented with 0.1, 1 or 5% BSA. Sperm motion parameters were evaluated immediately after collection, after washing, and during a 3-h thermal resistance test. Acrosome integrity was assessed using FITC-PNA staining. Semen collection into tubes containing 10 ml extender produced higher sperm motility, progressive motility, and acrosome integrity than that using a smaller volume of extender. Furthermore, collection into 5% BSA-containing extender exhibited higher sperm characteristics and maintained high sperm motility and progressive motility throughout incubation. In conclusion, semen collection into tubes with a large volume of extender, especially extender containing higher concentrations of BSA, improved the quality of ejaculated spermatozoa, strongly suggesting that the in vitro functional characteristics of the spermatozoa were abruptly modified by flash sperm contact with accessory sex gland fluid at ejaculation.

Acrosome↗

PubMed2006

Extended outpatient civil commitment and treatment utilization.

OBJECTIVE: This study considers four hypotheses regarding the impact of extended involuntary outpatient commitment orders on services utilization. METHOD: All Victorian Psychiatric Case Register (VPCR) patients who had extended (180+ day) outpatient commitment orders in the nine year study period and a matched treatment compliant comparison group with extended periods of outpatient care (N = 1182), both with at least two years of post-episode experience, were evaluated. Pre/post episode utilization was compared via paired t tests with individuals as their own controls. Logistic and OLS regression as well as repeated measures ANOVA via the GLM SPSS program and post hoc t tests were used to evaluate between group and across time differences. RESULTS: Extended episodes of care for both groups were associated with reduced use of hospitalization and increases in outpatient services. Extended orders did not promote voluntary participation in the post-period. Outpatient services during the extended episode for those on orders were raised to the level experienced by the treatment compliant comparison group and maintained at that level via subsequent renewal of orders throughout the patients' careers. OLS regression results indicate that approximately six community care service days were required for those on orders to achieve a one-day reduction in hospital utilization following the extended episode. CONCLUSION: Outpatient commitment for those on extended orders in the Victorian context enables a level of community-based services provision, unexpected in the absence of this delivery system, which provides an alternative to hospitalization.

Adult↗

PubMed1996

Extended therapy with ipratropium is associated with improved lung function in patients with COPD. A retrospective analysis of data from seven clinical trials.

OBJECTIVE: Bronchodilators are routinely used in the long-term therapy of patients with COPD. These drugs are generally evaluated for their short-term bronchodilatory effects. Long-term and short-term benefits, however, are not necessarily equivalent. We evaluated, therefore, the effects of extended therapy with inhaled bronchodilators in patients with COPD. DESIGN: Data were obtained from seven clinical trials in which ipratropium was compared with a beta-agonist over a 90-day treatment interval. This comprised all the available data from clinical trials performed for registration of ipratropium and included 1,445 evaluable patients. Results of pulmonary function tests were evaluated prior to and after short-term administration of bronchodilator both before and after the 90-day treatment period. In addition, data were analyzed after stratification for smoking status and for lung function. RESULTS: Long-term therapy with ipratropium resulted in improvement in baseline (ie, before short-term administration of bronchodilator) FEV1 (28 mL; p < 0.01) and FVC (131 mL; p < 0.01), while long-term therapy with beta-agonist resulted in no significant change in FEV1 (1-mL decline; p > 0.2) or in FVC (20-mL improvement; p > 0.2). The improvement in baseline function in the ipratropium-treated patients was most marked in ex-smokers (average duration of abstinence, 9 years). Short-term administration of ipratropium following the 90-day treatment interval resulted in similar response in average FEV1 (6 mL more improvement after the extended therapy; p > 0.2) and an increased response in average FVC (44 mL more improvement after extended therapy; p < 0.01). In contrast, extended therapy with beta-agonist resulted in significantly less response to the short-term administration of beta-agonist for both FEV1 (49 mL less response; p < 0.0001) and FVC (74 mL less response; p < 0.0001). Assessed as the percentage of patients who achieved a 15% improvement in lung function, most patients responded to both treatments both before and after extended therapy. There was, however, a significant decline in the number of patients who responded after extended therapy, and this was more marked for the beta-agonist treated group. CONCLUSION: Long-term benefits of bronchodilator therapy appear to differ from short-term effects. Extended administration of ipratropium appears to be associated with improved baseline lung function and perhaps with improvement in the response to acute bronchodilation. Extended administration of beta-agonist, in contrast, appears to have little effect on baseline lung function, but may decrease response to acute bronchodilation.

Adrenergic beta-Agonists↗

PubMed2002

Effect of seminal plasma concentration and various extenders on postthaw motility and glass wool-Sephadex filtration of cryopreserved stallion semen.

OBJECTIVE: To compare the effect of semen extender and seminal plasma on postthaw motility and filtration through a glass wool-Sephadex (GWS) filter for frozen stallion semen. SAMPLE POPULATION: 7 stallions from which we collected > or = 3 ejaculates/stallion. PROCEDURES: 4 experiments were conducted to evaluate postthaw quality of frozen stallion semen. Kenney extender was compared with glucose-EDTA extender by use of various dilution rates that resulted in differing concentrations of seminal plasma. Stallions known to produce semen with poor postthaw quality were used to investigate whether a particular extender or dilution rate could improve ability of such semen to survive freeze-thaw procedures. RESULTS: Use of Kenney extender as the centrifugation extender significantly improved postthaw motility and GWS filtration, compared with glucose-EDTA. Extending semen at a dilution of 1:3 was significantly better than 1:1 for both motility and GWS filtration. In addition, including seminal plasma at a concentration of 5% in the cryopreserved semen resulted in significantly higher yield of spermatozoa after GWS filtration, compared with complete removal of SP or use of seminal plasma at 25%. Lastly, semen with poor postthaw quality had significantly improved postthaw quality in regard to motility and GWS filtration when semen was frozen with seminal plasma at a concentration of 5%, compared with semen frozen with seminal plasma at a concentration of 25%. CONCLUSIONS AND CLINICAL RELEVANCE: Use of Kenney extender at a high dilution (> or = 1:3) immediately after collection of semen can improve postthaw quality of frozen stallion semen.

Animals↗

PubMed2003

Extended field-of-view sonography: advantages in abdominal applications.

OBJECTIVE: To show the advantages of extended field-of-view sonography in abdominal applications. METHODS: Thirty-one cases were prospectively analyzed in our study. Extended field-of-view images were obtained when the radiologist decided that they would offer potential advantages for the examination. When extended field-of-view scanning was used, the radiologist determined prospectively whether it was useful according to several categories. Images were obtained with a 2- to 5-MHz curved array transducer or 4- to 9- and 5- to 12-MHz linear array transducers. RESULTS: Extended field-of-view sonography provided several potential benefits over conventional sonography in the abdominal area. The advantages of extended field-of-view sonography were better demonstration of the spatial relationship between lesions and adjacent normal structures in 18 cases (58%), accurate quantification of sizes or volumes of large organs or lesions in 16 (52%), better display of the extended and tubular structures in 6 (19%), usefulness for clinical consultations in 7 (23%), and documentation comparable with that of computed tomography or magnetic resonance imaging in 10 (32%). CONCLUSIONS: Extended field-of-view sonography provided the anatomic context of the lesion in its surroundings and allowed precise measurement and tracing of the extended and tubular structures. The method has notable advantages and clinical applications.

Abdomen↗

PubMed2004

[Significance of extended radical resection for cancer of pancreatic head].

OBJECTIVE: To evaluate the significance of extended radical resection in the treatment of pancreatic head cancer and its indication. METHODS: Between Jan. 1995 and Dec. 1998, 56 patients with pancreatic head cancer were retrospectively reviewed, among whom 35 were treated by the Whipple operation and 21 received the extended radical resection during the same interval. RESULTS: There was no significant difference between the mortality and morbidity rate of complication, though with more patients having higher clinical stages in the extended radical resection group. The 1-, 2- and 3-year survival rates were 84.8%, 62.8%, 39.9% in the extended radical resection group and 70.8%, 47.6%, 17.2% in the Whipple operation group with significant difference between the two groups. The total mortality rate was 51.4% in Whipple group and 42.9% in extended radical resection group with significant difference between the two. The 3-year cumulative rate of death from local recurrence decreased from 37.4% in the Whipple group to 23.8% in the extended radical operation group. Patients who survived for more than 3 years were only those in clinical stage (SC)1 in the Whipple group whereas they were found both in patients who had had CS1, CS2 lesions and also in some who had CS3 lesions in the extended radical resection group. CONCLUSION: The extended radical operation does benefit patients with pancreatic head carcinoma in CS1, CS2 and in a part of CS3 without too extensive exrtra-pancreatic invasion.

Aged↗

PubMed1988

[Metabolic and nutritional management after extended radical operation for pancreatobiliary carcinoma].

The physiology after extended radical operation in patients with pancreatobiliary carcinomas and the metabolic and nutritional management were studied. Twenty-four patients who underwent pancreatoduodenectomy with extended dissection were compared with 17 patients with semi-extended dissection and 44 patients with limited or no dissection. Extended dissection meant complete dissection of the nerve plexus around the superior mesenteric artery and para-aortic node dissection. The frequency of defecation (2.7 times/day) and the blood osmolarity in the extended dissection group were significantly higher than those in the other groups during the first week after operation. The level of serum protein was significantly lower in the extended dissection group. Insulin dosage during the first 14 days after surgery was significantly greater in the extended dissection group, yet no difference was recognized in the amount of glucose administered among the 3 groups. The conclusion was as follows; frequent diarrhea, a large amount of lymph loss and increased urine volume due to an osmotic diuresis were the main causes of volume loss. So a large volume of fluid containing a high concentration of protein should be injected immediately after extended dissection to normalize serum osmotic pressure. Because of increased insulin requirement and decreased endogenous insulin production, the administration of large amount of glucose immediately after operation should be undertaken carefully.

Biliary Tract Neoplasms↗

PubMed1995

[Results of follow-up of surgical treatment of complicated acetabulum fractures with extended approaches].

Extended approaches are indicated for complex acetabular fractures. The advantage of extended approaches is the simultaneous exposure of both columns of the acetabulum; disadvantages are the wide exposure of the soft tissue and a high rate of heterotopic ossification. Muscle weakness and necrosis of the muscle have been described. Although there is good exposure with an extended approach, the indication for it is restricted. Between 1972 and 1993, 688 patients with acetabular fractures were treated at the Trauma Department of the Hannover Medical School; 322 had open reduction and internal fixation. Thirty-five patients (10%) were treated with an extended approach. In a retrospective study of 24 patients treated with an extended approach between 1985 and 1993, perioperative data, long-term clinical outcome and radiological outcome were investigated. The aim of the study was to compare the outcome of two groups treated using either the classical extended iliofemoral approach or the Maryland modification. Eleven patients were treated with the extended iliofemoral approach, 13 with the Maryland approach. There were no significant differences in age, type of accident, fracture classification, time to operation, time of operation and blood loss. The postoperative X-ray was anatomic or nearly anatomic in 22 cases; 2 patients had a dislocation of more than 2 mm. The main complications were hematomas and seromas. In both groups we found one thrombosis and one nerve injury with partial recovery. Twenty patients were followed up at least 2 years after trauma, 8 after extended iliofemoral approach and 12 after Maryland approach.(ABSTRACT TRUNCATED AT 250 WORDS)

Acetabulum↗

PubMedDate not supplied

Extended cholecystectomy for carcinoma of the gall bladder.

Resection was performed in 158 (70%) out of 227 patients with carcinoma of the gall bladder treated over 22 years between 1971 and 1993; 59 had simple cholecystectomy, 66 extended cholecystectomy (including 2 cm wedge resection of the liver at the gall bladder bed and regional lymphadenectomy in the hepatoduodenal ligament, behind the superior part of the pancreatic head and in the common hepatic artery region) and 33 had a more extended operation. Staging as proposed by the Japanese Society of Biliary Surgery (JSBS) was followed. Simple cholecystectomy was performed in 35 patients with stage I, 6 with stage II, 6 with stage III and 11 with stage IV disease while extended cholecystectomy was performed in 28 patients with stage I, 11 with stage II, 12 with stage III and 14 patients with stage IV disease. Survival was calculated using Kaplan - Meier method and log rank test was used for analysis of survival rates. The cumulative 5 year survival after extended cholecystectomy was 79% in stage I, 64% in stage II, 44% in stage III and 8% in stage IV. There was no difference in survival between stage I and II but survival in stage I was significantly better than that in stage III (p = 0.05). There was no statistically significant difference in survival after extended or simple cholecystectomy in stage I disease although incidence of recurrence was less after extended than after simple cholecystectomy (7% vs 17%). Extended cholecystectomy produced better survival than simple cholecystectomy in stage II disease (p = 0.04) but there was no difference between extended and simple cholecystectomy in stage III and IV disease. Retrospective analysis was performed to identify significant prognostic indicators. The significant factors for pior survival were N2, Hinf 1, Binf 1 and invasive cancer.

Cholecystectomy↗

PubMedDate not supplied

Anatomical limit of extended cholecystectomy for gallbladder carcinoma involving the neck of the gallbladder.

BACKGROUND: Extended cholecystectomy is the common operation for gallbladder carcinoma. When extended cholecystectomy is performed, the liver bed can be generously resected from the fundus to the body of the gallbladder; however, the thickness of the liver parenchyma to be removed is limited to the neck of the gallbladder. There have been few reports providing convincing data with regard to how thick the liver can be anatomically resected by extended cholecystectomy. METHODS: The thickness of the liver tissue actually resected at the time of extended cholecystectomy and that potentially resected by extended cholecystectomy were measured in 24 clinical and 25 autopsy cases, respectively, to assess the anatomical limit of extended cholecystectomy. RESULTS: The mean anatomical distances from the neck of the gallbladder to the right hepatic duct and to the bifurcation of the anterior and posterior branch of the right hepatic duct were only 1.6 and 5.9 mm, respectively. The distance from the gallbladder to the bifurcation of the superior and inferior branch of the right anterior hepatic duct, and to the root of the right anterior inferior hepatic duct were 11.2 mm2, and 12.8 mm3, respectively (123:p < 0.05). The actual width of the liver excised by extended cholecystectomy was 5.2 mm at the neck, 11.7 mm at the body, and 8.1 mm at the fundus of the gallbladder, respectively. These results indicate that the neck of the gallbladder is anatomically close to the hepatic hilum including the right hepatic duct and portal vein. CONCLUSIONS: Surgical strategy for gallbladder carcinoma should be considered to rely not only upon the depth of invasion but also upon the site of gallbladder tumor. When gallbladder carcinoma involves the muscle layer or further at the neck of the organ, more extensive hepatectomy than extended cholecystectomy should be considered.

Adult↗

PubMedDate not supplied

Extender components and surfactants affect boar sperm function and membrane behavior during cryopreservation.

To determine how the individual components of extenders affected boar sperm function and membrane structure and to test a new surfactant's cryoprotective ability, boar sperm were cryopreserved in straws in BF5 extender plus or minus egg yolk plus or minus glycerol plus or minus a surfactant (Orvus ES Paste [OEP] or various concentrations of Pluronic F-127). After thawing, sperm function and fluidity of the isolated head plasma membrane (HPM) were determined. Total motility and adenosine triphosphate content (a measure of viability) were superior postthaw in sperm extended in egg yolk plus glycerol (P < 0.05); neither surfactant improved function. Egg yolk plus any other ingredients improved normal acrosome morphology, whereas a combined measure of motility and normal acrosome morphology was better in the presence of 0.33% OEP or 0.1% Pluronic F-127 (P < 0.05 vs. controls). Head plasma membrane was isolated from freshly collected spermatozoa and spermatozoa cryopreserved in the various extenders. Membrane fluidity was monitored with the probes cis-parinaric acid (cPNA), transparinaric acid (tPNA), and 1,6-diphenyl-1 ,3,5-hexatriene (DPH). The cPNA and the DPH monitor the fluidity of gel and liquid-crystalline areas of the membrane, whereas the tPNA preferentially monitors the gel-phase domains of the membrane. Additionally, DPH monitors the hydrophobic core of the bilayer. In the HPM from fresh sperm, the fluidity of each domain changed over time in a manner unique to that domain, and the behavior of the DPH domain varied among boars. The fluidity dynamics of each domain responded uniquely to cryopreservation. The cPNA domain was unaffected, the tPNA domain was altered by four of the eight extenders, and all extenders affected the fluidity of the DPH domain. Membrane structure was significantly correlated with cell function for sperm cryopreserved in extenders that preserved viability and motility. Sperm cryopreserved in egg yolk plus glycerol plus either OEP or 0.1% Pluronic F-127 functioned best when the bulk domains were less fluid initially and the gel domain solidified more slowly. Therefore, the behavior of domains in the HPM of boar spermatozoa is affected by cryopreservation and is related to the postthaw function of boar sperm cryopreserved in different extenders.

Adenosine Triphosphate↗

PubMed2000

Treatment of persistent corneal epithelial defect with extended wear of a fluid-ventilated gas-permeable scleral contact lens.

PURPOSE: To report treatment of persistent corneal epithelial defects unresponsive to other therapies by extended wear of a fluid-ventilated gas-permeable scleral contact lens. METHODS: In this retrospective study, 14 eyes of 13 consecutive patients referred for the treatment of persistent corneal epithelial defects that failed to heal with conventional therapies or developed epithelial defects after penetrating keratoplasty for persistent corneal epithelial defects were fitted with an extended-wear gas-permeable scleral lens. These included seven eyes of six patients with Stevens-Johnson syndrome and seven eyes of seven patients who did not have Stevens-Johnson syndrome. Twelve eyes had undergone recent penetrating keratoplasty. All 14 eyes were fitted with a gas-permeable scleral contact lens designed to avoid the intrusion of air bubbles under its optic. An antibiotic and corticosteroid were added to the lens fluid reservoir or instilled before each lens insertion in 12 of 14 eyes. The lenses were worn continuously except for brief periods of removal for purposes of cleaning, replacement of the lens fluid reservoir, and examination and photography of the cornea. RESULTS: Five of the seven persistent corneal epithelial defects associated with Stevens-Johnson syndrome healed. The persistent corneal epithelial defects of four of these eyes re-epithelialized within 7 days, and a fifth healed in 27 days of gas-permeable scleral lens extended wear. A sixth persistent corneal epithelial defect that failed to heal initially re-epithelialized after a subsequent penetrating keratoplasty and gas-permeable scleral lens extended wear. The seventh eye healed after 3 days of gas-permeable scleral lens extended wear, but the persistent corneal epithelial defect subsequently recurred. Three of seven non-Stevens-Johnson syndrome persistent corneal epithelial defects re-epithelialized within 36 hours, 6 days, and 36 days, respectively. Of the six (six of 14) persistent corneal epithelial defects that failed to heal with a gas-permeable scleral lens extended wear, one subsequently healed after multiple amniotic membrane grafts. Microbial keratitis occurred in four eyes (four of 14) and graft failure in one eye, all of which required repeat penetrating keratoplasty. CONCLUSION: Extended wear of an appropriately designed gas-permeable scleral contact lens was effective in promoting the healing of persistent corneal epithelial defects in some eyes that failed to heal after other therapeutic measures. Re-epithelialization appears to be aided by a combination of oxygenation, moisture, and protection of the fragile epithelium afforded by the scleral lens. However, microbial keratitis represents a significant risk.

Adolescent↗

PubMed1994

Extended wear soft contact lenses induce corneal epithelial changes.

The purpose of this study was to determine the corneal epithelial alterations induced by various types of contact lenses. By employing the specular microscope, the corneal epithelia of 60 patients who had worn contact lenses for more than 1 year were re-examined along with 15 myopic controls. The morphological changes in aphakic patients who changed from extended wear soft to extended wear rigid gas permeable lenses were also studied. The mean cell area of the corneal epithelium was 621.5 (SD 92.5) microns 2 for daily wear rigid gas permeable lenses (n = 15), 645.8 (98.1) microns 2 for daily wear soft lenses (n = 15), and 634.7 (88.6) microns 2 for extended wear rigid gas permeable lenses (n = 15), none of which differed significantly from the control value of 610.5 (98.1) microns 2. Only the extended wear soft lens group (n = 15) showed significantly enlarged epithelia (806.1 (50.1) microns 2, p < 0.01 versus the other groups). The epithelium partially returned to normal after changing from extended wear soft lenses to extended wear rigid gas permeable ones. The corneal epithelium showed increased cell area only with extended wear soft contact lenses which are known to pose a risk for corneal infection.

Adult↗

PubMed1991

Assessing the risks of extended wear.

Risks associated with contact lens wear vary in the literature with respect to identity and severity. To more adequately portray these risks, a meta-analysis of complications was performed, using (1) contact lens package inserts; (2) reports of complications in nonreferral populations of extended-wear patients; (3) reports of complications for contact lens wearers seen in emergency rooms; (4) reports of corneal ulceration in referral populations of contact lens wearers; and (5) studies comparing daily- and extended-wear patients in terms of ulcerative keratitis. Total complication rates for extended wear of rigid and hydrogel lenses ranged from 7% to 31% of eyes over corresponding mean wearing durations of 12 to 22 months. Mean corneal ulceration rates were 0.44% and 0.21% per eye per year for the extended wear of hydrogel and rigid contact lenses, respectively. The risk of ulcerative keratitis among hydrogel extended-wear patients was 4.2 times that of hydrogel daily-wear patients, and rigid lens extended wear entailed roughly half of the risk of ulcerative keratitis of hydrogel extended wear. When applied to contact lens wearers in the United States, these risks indicate an estimated incidence of ulcerative keratitis greater than 71,000 cases per year, averaging approximately 1.7 ulcerations annually for each eye care practitioner in the United States.

Aphakia, Postcataract↗

PubMed2000

Low-molecular-weight heparin prophylaxis using dalteparin extended out-of-hospital vs in-hospital warfarin/out-of-hospital placebo in hip arthroplasty patients: a double-blind, randomized comparison. North American Fragmin Trial Investigators.

BACKGROUND: No randomized trials have directly evaluated the need for extended out-of-hospital thromboprophylaxis for patients who have hip arthroplasty in the United States or Canada. The uncertainty as to the need for extended prophylaxis in North American patients is complicated by early hospital discharge, resulting in a short thromboprophylaxis interval. METHODS: To resolve this uncertainty, we performed a randomized double-blind trial in 569 patients who underwent hip arthroplasty comparing the use of dalteparin sodium started immediately before surgery or early after surgery and extended out-of-hospital to an overall interval of 35 days with the use of warfarin sodium in-hospital and placebo out-of-hospital. RESULTS: For patients with interpretable venograms in the preoperative, postoperative, and combined dalteparin groups, new proximal vein thrombosis out-of-hospital was observed in 1.3%, 0. 7% (P =.04), and 1.0% (P =.02) of patients, respectively, compared with 4.8% in the in-hospital warfarin/out-of-hospital placebo group. The respective overall cumulative frequencies of all deep vein thrombosis were 30 (17.2%) of 174 patients (P<.001), 38 (22.2%) of 171 (P =.003), and 68 (19.7%) of 345 (P<.001) in the dalteparin groups compared with 69 (36.7%) of 188 for the in-hospital warfarin/out-of-hospital placebo group. For proximal deep vein thrombosis, the respective frequencies were 5 (3.1%) of 162 (P =.02), 3 (2.0%) of 151 (P =.007), and 8 (2.6%) of 313 (P =.002) compared with 14 (9.2%) of 153. No major bleeding occurred during the extended prophylaxis interval. CONCLUSIONS: Extended dalteparin prophylaxis resulted in significantly lower frequencies of deep vein thrombosis compared with in-hospital warfarin therapy. Despite in-hospital thromboprophylaxis, patients having hip arthroplasty in the United States and Canada remain at moderate risk out-of-hospital. The number needed to treat provides a public health focus; only 24 to 28 patients require extended prophylaxis to prevent 1 new out-of-hospital proximal vein thrombosis. Recent studies demonstrate that asymptomatic deep vein thrombi cause the postphlebitic syndrome; thus, extended out-of-hospital prophylaxis will lessen the burden to both the patient and society.

Anticoagulants↗

PubMed2003

Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy.

HYPOTHESIS: An aggressive strategy that includes extended lymphadenectomy and vein resection may improve the results of surgical treatment of pancreatic head cancer. DESIGN: Nonrandomized control trial. SETTING: Tertiary care referral center. PATIENTS: The study included 149 consecutive patients undergoing macroscopically curative resection for periampullary adenocarcinoma from January 1, 1988, to December 31, 1998. INTERVENTIONS: A standard resection was performed in 122 cases; an extended lymphadenectomy in 37. Twenty-four patients underwent venous resection. MAIN OUTCOME MEASURES: Data on surgical mortality, morbidity, and postoperative outcome, pathological findings, and long-term survival were analyzed. RESULTS: In-hospital and 60-day operative mortality was 5.4%. Morbidity was 37.5%. Mortality, morbidity, and postoperative stay were nonsignificantly modified by extended lymphadenectomy or venous resection. Extended resection permitted the identification of a significantly higher percentage of nodal metastases beyond the peripancreatic node groups. In patients undergoing vein resection, a significantly higher rate of positive retroperitoneal margin was found. In the 100 patients with ductal adenocarcinoma, the median overall survival and the 5-year actuarial survival rate were 15 months and 8.4%, respectively. A trend toward a better survival was observed in the first 2 years after operation in the extended resection group compared with the standard resection group. Nodal status was the most powerful predictor of overall survival by multivariate analysis. CONCLUSIONS: Extended lymphadenectomy and vein resection did not adversely affect postoperative mortality and morbidity. Patients who required a vein resection were less likely to receive a microscopically curative pancreatectomy. Extended resection permitted better pathological staging and was associated with an early advantage in survival, but long-term survival was possible only in patients with favorable prognostic factors.

Adenocarcinoma↗

PubMed2007

Localization of motoneurons that extend axons through the ventral rami of cervical nerves to innervate the trapezius muscle: a study using fluorescent dyes and 3D reconstruction method.

It has been suggested that in addition to motor axons, which extend directly into the spinal accessory nerve (SAN), ventral rami-associated motor fibers of cervical nerves also innervate the trapezius muscle. Using fluorescent dye labeling and 3D reconstruction in adult rats, this study clarifies the localization of motoneurons, which extend axons either directly through the SAN or through the ventral rami of cervical nerves to innervate the trapezius. DiI or DiI and DiO were used to label the ventral rami of cervical nerves entering the SAN, as well as branches of the SAN. We show that motoneurons whose axons pass through the ventral rami of cervical nerves and then enter the SAN, and those extending axons directly through the SAN are distributed within the same area. The neurons that extend axons through the SAN had a greater diameter than those axons that pass through the cervical nerves en route to the trapezius muscle. In addition, the axons that ultimately extend through the SAN exit the spinal cord dorsolaterally, while those that pass through the cervical nerves extend out the spinal cord through the ventral roots. We presume that the neurons that extend axons through the SAN are mainly alpha-motoneurons and that those projecting axons through the cervical nerves to the trapezius are mainly gamma-motoneurons. Taken together, these results could explain why patients in whom the SAN was used to treat brachial plexus injury retain some control of the trapezius muscle.

Animals↗

PubMed1991

Extended resection in the treatment of colorectal cancer.

Between 1975 and 1990, 525 patients underwent resection of colorectal cancer in our unit. Of these, 38 had tumour invading adjacent structures and underwent an extended resection. Overall, there were 67 cases treated palliatively. Of these, three were in the group of 38 having an extended resection. When the groups of radical not extended (n = 423) and radical extended resections (n = 35) were compared, respective values for mortality (1.9% vs 0) and morbidity (12.8% vs 11.3%) were not different. Respective local recurrence rates (13% vs 26%) were significantly greater after extended resection. Five-year survival after extended resection was 30%, no different from the general survival rate for standard resections for T2-3 node-positive tumours. Extended resection is thus a safe and important approach for locally advanced tumours.

Adult↗