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Sample records for adequate surgical margins

  1. Importance of surgical margins in rectal cancer.

    Mukkai Krishnamurty, Devi; Wise, Paul E

    2016-03-01

    Distal resection margin (DRM) and circumferential resection margin (CRM) are two important considerations in rectal cancer management. Although guidelines recommend a 2 cm DRM, studies have shown that a shorter DRM is adequate, especially in patients receiving neoadjuvant chemoradiation. Standardization of total mesorectal excision has greatly improved quality of CRM. Although more patients are undergoing sphincter-saving procedures, abdominoperineal resection is indicated for very distal tumors, and pelvic exenteration is often necessary for tumors involving pelvic organs. PMID:27094456

  2. Determining Adequate Margins in Head and Neck Cancers: Practice and Continued Challenges.

    Williams, Michelle D

    2016-09-01

    Margin assessment remains a critical component of oncologic care for head and neck cancer patients. As an integrated team, both surgeons and pathologists work together to assess margins in these complex patients. Differences in method of margin sampling can impact obtainable information and effect outcomes. Additionally, what distance is an "adequate or clear" margin for patient care continues to be debated. Ultimately, future studies and potentially secondary modalities to augment pathologic assessment of margin assessment (i.e., in situ imaging or molecular assessment) may enhance local control in head and neck cancer patients. PMID:27469263

  3. The tissue shrinkage phenomenon on surgical margins in oral and oropharyngeal squamous cell carcinoma

    David González-Ballester

    2016-01-01

    Aim: One of the most important factors associated with recurrence rate and overall survival is the status of surgical margin of resection free of disease. However, sometimes, the margins measured intra-operatively at the time of surgery differ of those measured by the pathologist in the histopathologic analysis. Faced with this dilemma, a literature review of the best available evidence was conducted in an attempt to determine how the phenomenon of tissue shrinkage may influence on the surgical margin of resection in patients undergoing oral and oropharyngeal squamous cell carcinoma (SCC).Methods: An electronic and manual search was conducted by one reviewer. A combination of controlled Medical Subjects Headings and keywords were used as search strategy. Inclusion and exclusion criteria were established.Results: Finally, after an exhaustive selection process, four articles fulfilled the inclusion criteria and were analyzed. All articles reported a decrease of surgical margin after resection. The tumor site and tumor stage seem to influence in degree of margin shrinkage.Conclusion:Tissue shrinkage on surgical margins of resection in oral SCC is a tangible phenomenon. There is a significant discrepancy between margins measured intraoperatively previous to resection and margins measured by pathologist after histologic processing. The highest percentage of retraction occurs at the time of resection. Margin shrinkage based on tumor site and tumor stage should be considered by any oncologic surgeon to ensure adequate margins of resection cleared of tumor.

  4. Influence of radiation dose on positive surgical margins in women undergoing breast conservation therapy

    multivariate analysis, margin status and menopausal status had prognostic significance for local tumor control and DFS. Conclusion: Patients with positive surgical margins have a higher risk of local tumor recurrence and worse survival when undergoing BCT. Higher doses of radiation are unable to provide an adequate level of local control in patients with positive margins

  5. Molecular markers in the surgical margin of oral carcinomas

    Bilde, Anders; von Buchwald, Christian; Dabelsteen, Erik;

    2009-01-01

    . METHODS: Formalin-fixed, paraffin-embedded surgical specimens from 16 consecutive patients with oral SCC and a clear surgical margin were obtained. The margin was analysed by immunohistochemistry for p53, p16, Chk2, Laminin-5 and glycosylated oncofetal fibronectin. RESULTS: Two patterns of p53 expression......BACKGROUND: Local or regional lymph node recurrence is the most common pattern of treatment failure in oral squamous cell carcinoma (SCC). The local recurrence rate is 30% even when the surgical resection margin is diagnosed as tumour free. Accumulation of genetic changes in histologically normal...... were found in the histologically normal epithelium in the surgical resection margin. One was characterized by no protein expression in the majority of cells, except for small clusters of basal and parabasal cells with nuclear staining. The other was characterized by p53 expression in the nuclei of most...

  6. Surgical resection margins after breast-conserving surgery: Senonetwork recommendations.

    Galimberti, Viviana; Taffurelli, Mario; Leonardi, Maria Cristina; Aristei, Cynthia; Trentin, Chiara; Cassano, Enrico; Pietribiasi, Francesca; Corso, Giovanni; Munzone, Elisabetta; Tondini, Carlo; Frigerio, Alfonso; Cataliotti, Luigi; Santini, Donatella

    2016-06-01

    This paper reports findings of the "Focus on Controversial Areas" Working Party of the Italian Senonetwork, which was set up to improve the care of breast cancer patients. After reviewing articles in English on the MEDLINE system on breast conserving surgery for invasive carcinoma, the Working Party presents their recommendations for identifying risk factors for positive margins, suggests how to manage them so as to achieve the highest possible percentage of negative margins, and proposes standards for investigating resection margins and therapeutic approaches according to margin status. When margins are positive, approaches include re-excision, mastectomy, or, as second-line treatment, radiotherapy with a high boost dose. When margins are negative, boost administration and its dose depend on the risk of local recurrence, which is linked to biopathological tumor features and surgical margin width. Although margin status does not affect the choice of systemic therapy, it may delay the start of chemotherapy when further surgery is required. PMID:27103209

  7. Optimal Surgical Safety Margin for Facial Basal Cell Carcinoma

    Olimpiu Hârceagă; Corina Baican; Rodica Cosgarea

    2014-01-01

    Objectives. The major objective of this study is to establish optimal surgical margin for facial primary basal cell carcinoma smaller than 2.3 cm in diameter. Recommendations for this type of skin tumors are for 4 mm surgical margin, but on the face there is a tendency to use smaller margins, for example 2-3 mm.Material and Method. 38 patients with 40 primary facial basal cell carcinoma of less than 2.3 cm in diameter, nonsclerodermiform types, were included in the study. All tumors were init...

  8. [Surgical margin status in hepatectomy for liver tumors].

    Salloum, C; Castaing, D

    2008-12-01

    It is admitted that only complete tumor clearance with negative surgical margins provides benefit for patients undergoing surgery for hepatobiliary malignancies. For hepatocellular carcinoma, since micrometastases disseminate via portal venous branches, anatomic resection is preferred over non-anatomic resection in liver resection carried out with curative intent. Thus, an anatomic liver resection with a wider resection margin theoretically gives a higher potential for cure. However, preserving non-tumorous liver parenchyma is an important consideration, especially in cirrhotic liver resection to decrease the incidence of postoperative liver failure. The optimal liver resection margin is still controversial. It seems that a resection margin of 2 cm is associated with a decreased postoperative recurrence rate and improved survival outcomes especially for hepatocellular carcinoma interventional treatment of intrahepatic cholangiocarcinoma, hepatic resection, whenever technically possible, should be enforced. Expected narrow hepatic resection margins should not exclude patients from potentially curative surgery, and should not be used as a reason to establish palliative treatment instead since R1 resection is compatible with long-term survival. Aggressive hepatic surgery could and should therefore be performed if the peri-operative mortality is low. For hilar cholangiocarcinoma, surgical radicality has been shown in multivariate analyses of multiples studies to be the only parameter with a significant impact on survival. Extended right-side hepatectomies seems to give the best oncologic results. A predicted margin of < 1 cm after resection of hepatic colorectal metastases should not be used as an exclusion criterion for resection and will not impair patients' prognosis. Resection should be performed whatever the width of the surgical margin, rather than not performing the resection at all. PMID:19091652

  9. Molecular markers in the surgical margin of oral carcinomas

    Bilde, A.; Buchwald, C. von; Dabelsteen, E.;

    2009-01-01

    basal cells. The expression of p16 was confined to small groups of cells in the basal cell layer whereas Chk2 was only seen in one case. Upregulation of the stromal proteins, Laminin-5 or glycosylated oncofetal fibronectin, was only seen at regions of invasion. CONCLUSION: Small groups of cells......BACKGROUND: Local or regional lymph node recurrence is the most common pattern of treatment failure in oral squamous cell carcinoma (SCC). The local recurrence rate is 30% even when the surgical resection margin is diagnosed as tumour free. Accumulation of genetic changes in histologically normal...

  10. Studies on correlation of positive surgical margin with clinicopathological factors and prognoses in breast conserving surgery

    Out of 484 cases with breast conserving surgery between April 1989 and March 1999, surgical procedures of 34 cases were changed to total mastectomy due to positive surgical margins. In this study we evaluated a clinical significance of surgical margin in relation to clinicopathological factors and prognoses. Ninety-nine cases (20.5%) had positive margins that were judged when cancer cells existed within 5 mm from margin. In multivariate analysis of factors for surgical margin, EIC-comedo status, ly, located site, proliferative activity, and age were significant and independent factors. Regarding local recurrence, positive margin, age, ER and proliferative activity were significant factors in multivariate analysis, especially in cases not receiving postoperative radiation therapy. Radiation therapy may be beneficial for patients with positive surgical margin. And patients with breast recurrence alone had significantly higher survival rates. Therefore, it is suggested that surgical margin may not reflect survival, although it is a significant factor for local recurrence. (author)

  11. Adequate margin definition for scanned particle therapy in the incidence of intrafractional motion

    Advanced 4D dose calculations (4DDCs) for scanned particle therapy show that in the incidence of motion, it is insufficient to use target contours defined on one reference CT phase. ICRU Report 62 (ICRU 1999 ICRU Report 62 (Bethesda, MD: ICRU)) advises that variations in size, shape and position of CTVs relative to anatomic reference points have to be considered for internal target volumes (ITVs). In addition to geometrical margin adaption, changes of water equivalent path length have to be considered for particle therapy. Different ITV concepts have been applied to six representative patients (liver and lung indications) based on 4DCT. Geometrical ITVs (gITV) were calculated by combining deformed CTVs over all motion phases. To take into account path length changes, range adapted ITVs (raITV) were established as the union of range adapted CTVs in all phases. For gated delivery, gatgITVs and gatraITVs were calculated. Extensive 4DDCs have been performed for two exemplary patients to illustrate that neither re-scanning nor gating can sufficiently compensate for motion effects if no appropriate margins are employed and to evaluate the effectiveness of gITVs and raITVs. CTVs significantly differ from gITVs and raITVs in size (up to a factor 2 in volume). But also raITVs and gITVs differ significantly in size and are spatially displaced, particularly for lung patients. raITVs show a strong field dependence in shape. All volumes are reduced in size when gating is applied and considered during margin adaption. 4D dose distributions show big improvements when gITV or raITV are used compared to CTVs. However, the use of either gITVs or raITVs do not result in significant differences. If raITVs are used, slightly better target coverage is gained at the cost of more healthy tissue exposure. Our results emphasize that adapted target volumes have to be used for scanned particle therapy in the presence of motion. However, even though gITVs and raITVs differ significantly in

  12. Adequate margin definition for scanned particle therapy in the incidence of intrafractional motion

    Knopf, Antje-Christin; Boye, Dirk; Lomax, Antony; Mori, Shininchiro

    2013-09-01

    Advanced 4D dose calculations (4DDCs) for scanned particle therapy show that in the incidence of motion, it is insufficient to use target contours defined on one reference CT phase. ICRU Report 62 (ICRU 1999 ICRU Report 62 (Bethesda, MD: ICRU)) advises that variations in size, shape and position of CTVs relative to anatomic reference points have to be considered for internal target volumes (ITVs). In addition to geometrical margin adaption, changes of water equivalent path length have to be considered for particle therapy. Different ITV concepts have been applied to six representative patients (liver and lung indications) based on 4DCT. Geometrical ITVs (gITV) were calculated by combining deformed CTVs over all motion phases. To take into account path length changes, range adapted ITVs (raITV) were established as the union of range adapted CTVs in all phases. For gated delivery, gat_gITVs and gat_raITVs were calculated. Extensive 4DDCs have been performed for two exemplary patients to illustrate that neither re-scanning nor gating can sufficiently compensate for motion effects if no appropriate margins are employed and to evaluate the effectiveness of gITVs and raITVs. CTVs significantly differ from gITVs and raITVs in size (up to a factor 2 in volume). But also raITVs and gITVs differ significantly in size and are spatially displaced, particularly for lung patients. raITVs show a strong field dependence in shape. All volumes are reduced in size when gating is applied and considered during margin adaption. 4D dose distributions show big improvements when gITV or raITV are used compared to CTVs. However, the use of either gITVs or raITVs do not result in significant differences. If raITVs are used, slightly better target coverage is gained at the cost of more healthy tissue exposure. Our results emphasize that adapted target volumes have to be used for scanned particle therapy in the presence of motion. However, even though gITVs and raITVs differ significantly in

  13. Buccal mucosa carcinoma: surgical margin less than 3 mm, not 5 mm, predicts locoregional recurrence

    Most treatment failure of buccal mucosal cancer post surgery is locoregional recurrence. We tried to figure out how close the surgical margin being unsafe and needed further adjuvant treatment. Between August 2000 and June 2008, a total of 110 patients with buccal mucosa carcinoma (25 with stage I, 31 with stage II, 11 with stage III, and 43 with Stage IV classified according to the American Joint Committee on Cancer 6th edition) were treated with surgery alone (n = 32), surgery plus postoperative radiotherapy (n = 38) or surgery plus adjuvant concurrent chemoradiotherapy (n = 40). Main outcome measures: The primary endpoint was locoregional disease control. The median follow-up time at analysis was 25 months (range, 4-104 months). The 3-year locoregional control rates were significantly different when a 3-mm surgical margin (≤3 versus >3 mm, 71% versus 95%, p = 0.04) but not a 5-mm margin (75% versus 92%, p = 0.22) was used as the cut-off level. We also found a quantitative correlation between surgical margin and locoregional failure (hazard ratio, 2.16; 95% confidence interval, 1.14 - 4.11; p = 0.019). Multivariate analysis identified pN classification and surgical margin as independent factors affecting disease-free survival and locoregional control. Narrow surgical margin ≤3 mm, but not 5 mm, is associated with high risk for locoregional recurrence of buccal mucosa carcinoma. More aggressive treatment after surgery is suggested

  14. Clinical effect of a positive surgical margin after hepatectomy on survival of patients with intrahepatic cholangiocarcinoma

    Yeh, Chun-Nan; Hsieh, Feng-Jen; Chiang, Kun-Chun; Chen, Jen-Shi; Yeh, Ta-Sen; Jan, Yi-Yin; Chen, Miin-Fu

    2015-01-01

    Background Several unfavorable prognostic factors have been proposed for peripheral cholangiocarcinoma (PCC) in patients undergoing hepatectomy, including gross type of tumor, vascular invasion, lymph node metastasis, a high carbohydrate antigen 19-9 level, and a positive resection margin. However, the clinical effect of a positive surgical margin on the survival of patients with PCC after hepatectomy still needs to be clarified due to conflicting results. Methods A total of 224 PCC patients who underwent hepatic resection with curative intent between 1977 and 2007 were retrospectively reviewed. Eighty-nine patients had a positive resection margin, with 62 having a microscopically positive margin and 27 a grossly positive margin (R2). The clinicopathological features, outcomes, and recurrence pattern were compared with patients with curative hepatectomy. Results PCC patients with hepatolithiasis, periductal infiltrative or periductal infiltrative mixed with mass-forming growth, higher T stage, and more advanced stage tended to have higher positive resection margin rates after hepatectomy. PCC patients who underwent curative hepatectomy had a significantly higher survival rate than did those with a positive surgical margin. When PCC patients underwent hepatectomy with a positive resection margin, the histological grade of the tumor, nodal positivity, and chemotherapy significantly affected overall survival. Locoregional recurrence was the most common pattern of recurrence. Conclusion A positive resection margin had an unfavorable effect on overall survival in PCC patients undergoing hepatectomy. In these patients, the prognosis was determined by the biology of the tumor, including differentiation and nodal positivity, and chemotherapy increased overall survival. PMID:25552905

  15. Clinical effect of a positive surgical margin after hepatectomy on survival of patients with intrahepatic cholangiocarcinoma

    Yeh CN

    2014-12-01

    Full Text Available Chun-Nan Yeh,1 Feng-Jen Hsieh,1 Kun-Chun Chiang,1 Jen-Shi Chen,2 Ta-Sen Yeh,1 Yi-Yin Jan,1 Miin-Fu Chen1 1Department of General Surgery, 2Department of Medical Oncology, Chang Gung Memorial Hospital, Chang Gung University, Taoyuan, Taiwan Background: Several unfavorable prognostic factors have been proposed for peripheral cholangiocarcinoma (PCC in patients undergoing hepatectomy, including gross type of tumor, vascular invasion, lymph node metastasis, a high carbohydrate antigen 19-9 level, and a positive resection margin. However, the clinical effect of a positive surgical margin on the survival of patients with PCC after hepatectomy still needs to be clarified due to conflicting results. Methods: A total of 224 PCC patients who underwent hepatic resection with curative intent between 1977 and 2007 were retrospectively reviewed. Eighty-nine patients had a positive resection margin, with 62 having a microscopically positive margin and 27 a grossly positive margin (R2. The clinicopathological features, outcomes, and recurrence pattern were compared with patients with curative hepatectomy. Results: PCC patients with hepatolithiasis, periductal infiltrative or periductal infiltrative mixed with mass-forming growth, higher T stage, and more advanced stage tended to have higher positive resection margin rates after hepatectomy. PCC patients who underwent curative hepatectomy had a significantly higher survival rate than did those with a positive surgical margin. When PCC patients underwent hepatectomy with a positive resection margin, the histological grade of the tumor, nodal positivity, and chemotherapy significantly affected overall survival. Locoregional recurrence was the most common pattern of recurrence. Conclusion: A positive resection margin had an unfavorable effect on overall survival in PCC patients undergoing hepatectomy. In these patients, the prognosis was determined by the biology of the tumor, including differentiation and nodal

  16. Detection of breast surgical margins with optical coherence tomography imaging: a concept evaluation study

    Savastru, Dan; Chang, Ernest W.; Miclos, Sorin; Pitman, Martha B.; Patel, Ankit; Iftimia, Nicusor

    2014-05-01

    This study aimed to evaluate the concept of using high-resolution optical coherence tomography (OCT) imaging to rapidly assess surgical specimens and determine if cancer positive margins were left behind in the surgical bed. A mouse model of breast cancer was used in this study. Surgical specimens from 30 animals were investigated with OCT and automated interpretation of the OCT images was performed and tested against histopathology findings. Specimens from 10 animals were used to build a training set of OCT images, while the remaining 20 specimens were used for a validation set of images. The validation study showed that automated interpretation of OCT images can differentiate tissue types and detect cancer positive margins with at least 81% sensitivity and 89% specificity. The findings of this pilot study suggest that OCT imaging of surgical specimens and automated interpretation of OCT data may enable in the future real-time feedback to the surgeon about margin status in patients with breast cancer, and potentially with other types of cancers. Currently, such feedback is not provided and if positive margins are left behind, patients have to undergo another surgical procedure. Therefore, this approach can have a potentially high impact on breast surgery outcome.

  17. Risk factors for and consequences of inadequate surgical margins in oral squamous cell carcinoma

    Lawaetz, Mads; Homøe, Preben

    2014-01-01

    OBJECTIVE: The purpose of this study was to examine which factors are associated with inadequate surgical margins and to assess the postoperative consequences. STUDY DESIGN: A retrospective cohort of 110 patients with oral squamous cell carcinoma treated with surgery during a 2-year period was ex...

  18. A new method of assessing the surgical margin in rectal carcinoma—using nonlinear optical microscopy

    Li, Lianhuang; Chen, Zhifen; Kang, Deyong; Deng, Tongxin; Jiang, Liwei; Zhou, Yi; Liu, Xing; Jiang, Weizhong; Zhuo, Shuangmu; Guan, Guoxian; Chi, Pan; Chen, Jianxin

    2016-06-01

    Nowadays, surgical resection is still the most effective treatment strategy for rectal carcinoma and one of the most important factors affecting whether the operation is successful or not is the surgical margin determination, especially in the distal rectal carcinoma which should take the sphincter-preserving issue into consideration. However, until recently no reliable evaluation method has been developed for this purpose. There are some shortcomings in intraoperative negative surgical margin assessment such as either lack of enough detailed information of biological tissues or the fact that it is time-consuming. Multiphoton microscopy (MPM)—nonlinear optical microscopy, which is based on the nonlinear optical process two-photon excited fluorescence (TPEF) and second harmonic generation (SHG), has the ability to label freely and noninvasively visualize tissue micro-architecture at the sub-cellular level. The advantage of providing high contrast and high resolution biomedical image in real time makes MPM have a wide range of applications in life sciences. In this study, we introduced MPM to identify the boundary between normal and abnormal rectal tissues. MPM images clearly exhibit biological tissue microstructure and its morphological changes in the regions of our interest, which enable it to determine the surgical margin in rectal carcinoma. It can be foreseen that once MPM imaging system is used in clinical examination, it will greatly improve the accuracy of surgical resection.

  19. Surgical Margins and the Risk of Local-Regional Recurrence After Mastectomy Without Radiation Therapy

    Purpose: Although positive surgical margins are generally associated with a higher risk of local-regional recurrence (LRR) for most solid tumors, their significance after mastectomy remains unclear. We sought to clarify the influence of the mastectomy margin on the risk of LRR. Methods and Materials: The retrospective cohort consisted of 397 women who underwent mastectomy and no radiation for newly diagnosed invasive breast cancer from 1998-2005. Time to isolated LRR and time to distant metastasis (DM) were evaluated by use of cumulative-incidence analysis and competing-risks regression analysis. DM was considered a competing event for analysis of isolated LRR. Results: The median follow-up was 6.7 years (range, 0.5-12.8 years). The superficial margin was positive in 41 patients (10%) and close (≤2 mm) in 56 (14%). The deep margin was positive in 23 patients (6%) and close in 34 (9%). The 5-year LRR and DM rates for all patients were 2.4% (95% confidence interval, 0.9-4.0) and 3.5% (95% confidence interval, 1.6-5.3) respectively. Fourteen patients had an LRR. Margin status was significantly associated with time to isolated LRR (P=.04); patients with positive margins had a 5-year LRR of 6.2%, whereas patients with close margins and negative margins had 5-year LRRs of 1.5% and 1.9%, respectively. On univariate analysis, positive margins, positive nodes, lymphovascular invasion, grade 3 histology, and triple-negative subtype were associated with significantly higher rates of LRR. When these factors were included in a multivariate analysis, only positive margins and triple-negative subtype were associated with the risk of LRR. Conclusions: Patients with positive mastectomy margins had a significantly higher rate of LRR than those with a close or negative margin. However, the absolute risk of LRR in patients with a positive surgical margin in this series was low, and therefore the benefit of postmastectomy radiation in this population with otherwise favorable features

  20. Surgical Margins and the Risk of Local-Regional Recurrence After Mastectomy Without Radiation Therapy

    Childs, Stephanie K. [Harvard Radiation Oncology Program, Boston, Massachusetts (United States); Chen Yuhui [Department of Biostatistics and Computational Biology, Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Duggan, Margaret M. [Department of Surgery, Faulkner Hospital, Boston, Massachusetts (United States); Department of Surgery, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Golshan, Mehra [Department of Surgery, Brigham and Women' s Hospital, Boston, Massachusetts (United States); Pochebit, Stephen [Department of Pathology, Faulkner Hospital, Boston, Massachusetts (United States); Wong, Julia S. [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States); Bellon, Jennifer R., E-mail: jbellon@lroc.harvard.edu [Department of Radiation Oncology, Brigham and Women' s Hospital and Dana-Farber Cancer Institute, Boston, Massachusetts (United States)

    2012-12-01

    Purpose: Although positive surgical margins are generally associated with a higher risk of local-regional recurrence (LRR) for most solid tumors, their significance after mastectomy remains unclear. We sought to clarify the influence of the mastectomy margin on the risk of LRR. Methods and Materials: The retrospective cohort consisted of 397 women who underwent mastectomy and no radiation for newly diagnosed invasive breast cancer from 1998-2005. Time to isolated LRR and time to distant metastasis (DM) were evaluated by use of cumulative-incidence analysis and competing-risks regression analysis. DM was considered a competing event for analysis of isolated LRR. Results: The median follow-up was 6.7 years (range, 0.5-12.8 years). The superficial margin was positive in 41 patients (10%) and close ({<=}2 mm) in 56 (14%). The deep margin was positive in 23 patients (6%) and close in 34 (9%). The 5-year LRR and DM rates for all patients were 2.4% (95% confidence interval, 0.9-4.0) and 3.5% (95% confidence interval, 1.6-5.3) respectively. Fourteen patients had an LRR. Margin status was significantly associated with time to isolated LRR (P=.04); patients with positive margins had a 5-year LRR of 6.2%, whereas patients with close margins and negative margins had 5-year LRRs of 1.5% and 1.9%, respectively. On univariate analysis, positive margins, positive nodes, lymphovascular invasion, grade 3 histology, and triple-negative subtype were associated with significantly higher rates of LRR. When these factors were included in a multivariate analysis, only positive margins and triple-negative subtype were associated with the risk of LRR. Conclusions: Patients with positive mastectomy margins had a significantly higher rate of LRR than those with a close or negative margin. However, the absolute risk of LRR in patients with a positive surgical margin in this series was low, and therefore the benefit of postmastectomy radiation in this population with otherwise favorable

  1. Soft tissue sarcomas of the distal lower extremities: A single-institutional analysis of the prognostic significance of surgical margins in 120 patients.

    Harati, Kamran; Kirchhoff, Pascal; Behr, Björn; Daigeler, Adrien; Goertz, Ole; Hirsch, Tobias; Lehnhardt, Marcus; Ring, Andrej

    2016-08-01

    Soft tissue sarcomas (STS) arising in the distal lower extremities pose a therapeutic challenge due to concerns of functional morbidity. The impact of surgical margins on local recurrence‑free survival (LRFS) and overall survival (OS) still remains controversial. The aim of this study was to identify prognostic indicators of survival and functional outcome in patients with STS of the distal lower extremities through a long‑term follow‑up. Between 1999 and 2014, 120 patients with STS of the foot, ankle and lower leg were treated surgically at our institution. The median follow‑up was 6.3 years. The results reveal that the 5‑year estimate of the OS rate was 80.0% [95% confidence interval (CI): 69.6‑87.1] for the entire series. Surgical margins attained at the resection of the primary tumor did not influence OS significantly [5‑year OS: R0 80.5% (69.7‑87.9) vs. R1 74.1% (28.9‑93.0); P=0.318]. Within the R0 subgroup, negative surgical margin widths ≤1 and >1 mm led to similar outcomes, as well as ≤5 and >5 mm, respectively. In the multivariate analysis, significant adverse prognostic features included male gender and age >60 years at the time point of primary diagnosis. In conclusion, the data from this study could not underscore the long‑term benefit of negative margins achieved at the resection of the primary tumor. Surgical efforts should aim at function‑sparing resections when feasible with negative margins. Here, close negative margins seem to be adequate. PMID:27278861

  2. Estimation of adequate setup margins and threshold for position errors requiring immediate attention in head and neck cancer radiotherapy based on 2D image guidance

    We estimated sufficient setup margins for head-and-neck cancer (HNC) radiotherapy (RT) when 2D kV images are utilized for routine patient setup verification. As another goal we estimated a threshold for the displacements of the most important bony landmarks related to the target volumes requiring immediate attention. We analyzed 1491 orthogonal x-ray images utilized in RT treatment guidance for 80 HNC patients. We estimated overall setup errors and errors for four subregions to account for patient rotation and deformation: the vertebrae C1-2, C5-7, the occiput bone and the mandible. Setup margins were estimated for two 2D image guidance protocols: i) imaging at first three fractions and weekly thereafter and ii) daily imaging. Two 2D image matching principles were investigated: i) to the vertebrae in the middle of planning target volume (PTV) (MID-PTV) and ii) minimizing maximal position error for the four subregions (MIN-MAX). The threshold for the position errors was calculated with two previously unpublished methods based on the van Herk’s formula and clinical data by retaining a margin of 5 mm sufficient for each subregion. Sufficient setup margins to compensate the displacements of the subregions were approximately two times larger than were needed to compensate setup errors for rigid target. Adequate margins varied from 2.7 mm to 9.6 mm depending on the subregions related to the target, applied image guidance protocol and early correction of clinically important systematic 3D displacements of the subregions exceeding 4 mm. The MIN-MAX match resulted in smaller margins but caused an overall shift of 2.5 mm for the target center. Margins ≤ 5mm were sufficient with the MID-PTV match only through application of daily 2D imaging and the threshold of 4 mm to correct systematic displacement of a subregion. Adequate setup margins depend remarkably on the subregions related to the target volume. When the systematic 3D displacement of a subregion exceeds 4 mm, it

  3. Hyperspectral imaging for cancer surgical margin delineation: registration of hyperspectral and histological images

    Lu, Guolan; Halig, Luma; Wang, Dongsheng; Chen, Zhuo G.; Fei, Baowei

    2014-03-01

    The determination of tumor margins during surgical resection remains a challenging task. A complete removal of malignant tissue and conservation of healthy tissue is important for the preservation of organ function, patient satisfaction, and quality of life. Visual inspection and palpation is not sufficient for discriminating between malignant and normal tissue types. Hyperspectral imaging (HSI) technology has the potential to noninvasively delineate surgical tumor margin and can be used as an intra-operative visual aid tool. Since histological images provide the ground truth of cancer margins, it is necessary to warp the cancer regions in ex vivo histological images back to in vivo hyperspectral images in order to validate the tumor margins detected by HSI and to optimize the imaging parameters. In this paper, principal component analysis (PCA) is utilized to extract the principle component bands of the HSI images, which is then used to register HSI images with the corresponding histological image. Affine registration is chosen to model the global transformation. A B-spline free form deformation (FFD) method is used to model the local non-rigid deformation. Registration experiment was performed on animal hyperspectral and histological images. Experimental results from animals demonstrated the feasibility of the hyperspectral imaging method for cancer margin detection.

  4. A gene signature in histologically normal surgical margins is predictive of oral carcinoma recurrence

    Brown Dale

    2011-10-01

    Full Text Available Abstract Background Oral Squamous Cell Carcinoma (OSCC is a major cause of cancer death worldwide, which is mainly due to recurrence leading to treatment failure and patient death. Histological status of surgical margins is a currently available assessment for recurrence risk in OSCC; however histological status does not predict recurrence, even in patients with histologically negative margins. Therefore, molecular analysis of histologically normal resection margins and the corresponding OSCC may aid in identifying a gene signature predictive of recurrence. Methods We used a meta-analysis of 199 samples (OSCCs and normal oral tissues from five public microarray datasets, in addition to our microarray analysis of 96 OSCCs and histologically normal margins from 24 patients, to train a gene signature for recurrence. Validation was performed by quantitative real-time PCR using 136 samples from an independent cohort of 30 patients. Results We identified 138 significantly over-expressed genes (> 2-fold, false discovery rate of 0.01 in OSCC. By penalized likelihood Cox regression, we identified a 4-gene signature with prognostic value for recurrence in our training set. This signature comprised the invasion-related genes MMP1, COL4A1, P4HA2, and THBS2. Over-expression of this 4-gene signature in histologically normal margins was associated with recurrence in our training cohort (p = 0.0003, logrank test and in our independent validation cohort (p = 0.04, HR = 6.8, logrank test. Conclusion Gene expression alterations occur in histologically normal margins in OSCC. Over-expression of the 4-gene signature in histologically normal surgical margins was validated and highly predictive of recurrence in an independent patient cohort. Our findings may be applied to develop a molecular test, which would be clinically useful to help predict which patients are at a higher risk of local recurrence.

  5. Influence of surgical margins on overall survival after resection of intrahepatic cholangiocarcinoma

    Tang, Haowen; Lu, Wenping; Li, Bingmin; Meng, Xuan; Dong, Jiahong

    2016-01-01

    Abstract Background: Surgical resection is shown to present the best chance of cure in the treatment of intrahepatic cholangiocarcinoma (ICC). However, the appropriate length of the negative margin remains unclear. The aim of the present meta-analysis was to investigate whether a clear margin of 10 mm or more (≥10 mm) conferred any survival benefit over a margin of less than 10 mm (Web of Science, EMBASE, and the Cochrane Library were systematically searched to identify eligible studies published in English from the initiation of the databases to February 2016. Overall survival rates were pooled by using the hazard ratio and the corresponding 95% confidence interval (CI). Random-effect models were utilized because of between-study heterogeneity. Results: Six studies (eight cohorts) reporting on 712 patients were analyzed: 269 (37.80%) were in the 10 mm or more negative margin group, and 443 (62.20%) were in the less than 10 mm negative margin group. The pooled hazard ratio for the less than 10 mm group was found to be 1.59 (95% CI: 1.09–2.32) when this group was compared with the 10 mm or more group (reference), with moderate between-study heterogeneity (I2 = 45.30%, P = 0.07). Commensurate results were identified by sensitivity analysis. Conclusion: The result of this meta-analysis suggests a long-term survival (overall survival) advantage for negative margins of 10 mm or more in comparison with negative margins less than 10 mm for patients undergoing surgical resection of ICC. PMID:27583880

  6. A gene signature in histologically normal surgical margins is predictive of oral carcinoma recurrence

    Oral Squamous Cell Carcinoma (OSCC) is a major cause of cancer death worldwide, which is mainly due to recurrence leading to treatment failure and patient death. Histological status of surgical margins is a currently available assessment for recurrence risk in OSCC; however histological status does not predict recurrence, even in patients with histologically negative margins. Therefore, molecular analysis of histologically normal resection margins and the corresponding OSCC may aid in identifying a gene signature predictive of recurrence. We used a meta-analysis of 199 samples (OSCCs and normal oral tissues) from five public microarray datasets, in addition to our microarray analysis of 96 OSCCs and histologically normal margins from 24 patients, to train a gene signature for recurrence. Validation was performed by quantitative real-time PCR using 136 samples from an independent cohort of 30 patients. We identified 138 significantly over-expressed genes (> 2-fold, false discovery rate of 0.01) in OSCC. By penalized likelihood Cox regression, we identified a 4-gene signature with prognostic value for recurrence in our training set. This signature comprised the invasion-related genes MMP1, COL4A1, P4HA2, and THBS2. Over-expression of this 4-gene signature in histologically normal margins was associated with recurrence in our training cohort (p = 0.0003, logrank test) and in our independent validation cohort (p = 0.04, HR = 6.8, logrank test). Gene expression alterations occur in histologically normal margins in OSCC. Over-expression of the 4-gene signature in histologically normal surgical margins was validated and highly predictive of recurrence in an independent patient cohort. Our findings may be applied to develop a molecular test, which would be clinically useful to help predict which patients are at a higher risk of local recurrence

  7. Towards intraoperative surgical margin assessment and visualization using bioimpedance properties of the tissue

    Khan, Shadab; Mahara, Aditya; Hyams, Elias S.; Schned, Alan; Halter, Ryan

    2015-03-01

    Prostate cancer (PCa) has a high 10-year recurrence rate, making PCa the second leading cause of cancer-specific mortality among men in the USA. PCa recurrences are often predicted by assessing the status of surgical margins (SM) with positive surgical margins (PSM) increasing the chances of biochemical recurrence by 2-4 times. To this end, an SM assessment system using Electrical Impedance Spectroscopy (EIS) was developed with a microendoscopic probe. This system measures the tissue bioimpedance over a range of frequencies (1 kHz to 1MHz), and computes a Composite Impedance Metric (CIM). CIM can be used to classify tissue as benign or cancerous. The system was used to collect the impedance spectra from excised prostates, which were obtained from men undergoing radical prostatectomy. The data revealed statistically significant (p<0.05) differences in the impedance properties of the benign and tumorous tissues, and between different tissue morphologies. To visualize the results of SM-assessment, a visualization tool using da Vinci stereo laparoscope is being developed. Together with the visualization tool, the EIS-based SM assessment system can be potentially used to intraoperatively classify tissues and display the results on the surgical console with a video feed of the surgical site, thereby augmenting a surgeon's view of the site and providing a potential solution to the intraoperative SM assessment needs.

  8. Risk factors associated with positive surgical margins following radical prostatectomy for clinically localized prostate cancer

    Røder, Martin Andreas; Thomsen, Frederik Birkebæk; Christensen, Ib Jarle;

    2014-01-01

    OBJECTIVE: The aim of this study was to evaluate the impact of preoperative and surgical parameters, including nerve-sparing technique, on the risk of positive surgical margins (PSM) following radical prostatectomy for clinically localized prostate cancer. MATERIAL AND METHODS: A prospective...... positive biopsies for cancer (PPB), surgeon and surgical technique. RESULTS: The overall rate of PSM was 31.4%. The risk of PSM depended (p value for Wald χ(2)) on PSA (p < 0.0001), PPB (p = 0.003), nerve-sparing surgery (p = 0.03) and the surgeon (p < 0.0001). For every doubling of PSA, the risk of PSM...... consecutive single-institution Danish cohort of 1148 patients undergoing RP between 1995 and 2011 was investigated. To analyse the impact of covariates on risk of PSM, a multivariate logistic regression model was used, including cT category, biopsy Gleason score, prostate-specific antigen (PSA), percentage...

  9. Standardized and reproducible methodology for the comprehensive and systematic assessment of surgical resection margins during breast-conserving surgery for invasive breast cancer

    The primary goal of breast-conserving surgery (BCS) is to completely excise the tumor and achieve 'adequate' or 'negative' surgical resection margins while maintaining an acceptable level of postoperative cosmetic outcome. Nevertheless, precise determination of the adequacy of BCS has long been debated. In this regard, the aim of the current paper was to describe a standardized and reproducible methodology for comprehensive and systematic assessment of surgical resection margins during BCS. Retrospective analysis of 204 BCS procedures performed for invasive breast cancer from August 2003 to June 2007, in which patients underwent a standard BCS resection and systematic sampling of nine standardized re-resection margins (superior, superior-medial, superior-lateral, medial, lateral, inferior, inferior-medial, inferior-lateral, and deep-posterior). Multiple variables (including patient, tumor, specimen, and follow-up variables) were evaluated. 6.4% (13/204) of patients had positive BCS specimen margins (defined as tumor at inked edge of BCS specimen) and 4.4% (9/204) of patients had close margins (defined as tumor within 1 mm or less of inked edge but not at inked edge of BCS specimen). 11.8% (24/204) of patients had at least one re-resection margin containing additional disease, independent of the status of the BCS specimen margins. 7.1% (13/182) of patients with negative BCS specimen margins (defined as no tumor cells seen within 1 mm or less of inked edge of BCS specimen) had at least one re-resection margin containing additional disease. Thus, 54.2% (13/24) of patients with additional disease in a re-resection margin would not have been recognized by a standard BCS procedure alone (P < 0.001). The nine standardized resection margins represented only 26.8% of the volume of the BCS specimen and 32.6% of the surface area of the BCS specimen. Our methodology accurately assesses the adequacy of surgical resection margins for determination of which

  10. Expression of Osteopontin in Oral Squamous Cell Carcinoma and its Surgical Margins-An Immunohistochemical Study

    Narasimhan, Malathi; Thiyagarajan, Muthukumar; Munuswamy, Balu David; Jayamani, Logeswari

    2015-01-01

    Introduction Despite the advances in the treatment modalities offered for oral squamous cell carcinoma. The recurrence rate of it still remains quite high. Early detection of recurrence will improve the outcome and the survival of the patient. Osteopontin, a transformation–related phosphorylated protein in epithelial cells has been closely related with tumourigenesis. This study was undertaken to explore the potential of OPN as a tumour marker of recurrence in OSCC. Aim To analyse the expression of Osteopontin (OPN) in Oral Squamous Cell Carcinoma (OSCC), patient matched tumour free surgical margins and normal oral mucosa and to correlate with local & loco regional recurrence. Materials and Methods Twenty cases each of formalin fixed paraffin embedded blocks of histopathologically diagnosed cases of OSCC, patient matched tumour free surgical margins and normal oral mucosal tissues were obtained from the archives of the Oral Pathology & Microbiology Department, Faculty of Dental Sciences, SRU and Govt. Arignar Anna Memorial Cancer Hospital, Kancheepuram. Immunohistochemical analysis was performed with an antibody to Osteopontin protein. Patients with secondary tumours and those treated with chemotherapy and radiotherapy were excluded from this study. Results The expression of OPN was elevated in 95% of tumours & 55% of histologically tumour free margin samples. There was negative OPN expression in normal mucosal samples. The result of the study was statistically analysed using Pearson chi-square test and was found to be statistically significant. Conclusion OPN can be used as a diagnostic marker in Oral Squamous Cell Carcinoma. In the tumour free surgical margins, elevated levels of OPN may predict a significantly increased risk of recurrence. PMID:26675878

  11. Positive Surgical Margins in Soft Tissue Sarcoma Treated With Preoperative Radiation: Is a Postoperative Boost Necessary?

    Purpose: For patients with an extremity soft tissue sarcoma (STS) treated with preoperative radiotherapy and surgically excised with positive margins, we retrospectively reviewed whether a postoperative radiation boost reduced the risk of local recurrence (LR). Methods and Materials: A total of 216 patients with positive margins after resection of an extremity STS treated between 1986 and 2003 were identified from our institution's prospectively collected database. Patient demographics, radiation therapy parameters including timing and dose, classification of positive margin status, reasons for not administering a postoperative boost, and oncologic outcome were collected and evaluated. Results: Of the 216 patients with a positive surgical margin, 52 patients were treated with preoperative radiation therapy alone (50 Gy), whereas 41 received preoperative radiation therapy plus a postoperative boost (80% received 16 Gy postoperatively for a total of 66 Gy). There was no difference in baseline tumor characteristics between the two groups. Six of 52 patients in the group receiving preoperative radiation alone developed a LR compared with 9 of 41 in the boost group. Five-year estimated LR-free survivals were 90.4% and 73.8%, respectively (p = 0.13). Conclusions: We found that including the postoperative radiation boost after preoperative radiation and a margin-positive excision did not provide an advantage in preventing LR for patients treated with external beam radiotherapy. Given that higher radiation doses placed patients at greater risk for late complications such as fracture, fibrosis, edema, and joint stiffness, judicious avoidance of the postoperative boost while maintaining an equivalent rate of local control can reduce the risk of these difficult-to-treat morbidities.

  12. Effects of the antituberculous drug ethambutol on zinc absorption, turnover and distribution in rats fed diet marginal and adequate in zinc

    King, A.B.; Schwartz, R.

    1987-04-01

    Ethambutol, (CH/sub 3/CH/sub 2/-CH(CH/sub 2/OH)-NH-CH/sub 2/)/sub 2/ (EMB), is an oral antituberculous agent that is administered therapeutically over extended time periods. It has chelating properties and may affect mineral metabolism. Male weanling Sprague-Dawley rats received 0, 400 or 600 mg EMB per kilogram body weight daily by gavage for 30 d. They were fed a casein-based diet with either adequate (49 ppm) or marginal (11 ppm) zinc. Both adequate-Zn (AZn) and marginal-Zn (MZn) rats receiving EMB showed alopecia and dose-dependent reductions in feed intake, weight gain and feed efficiency. None of these changes was seen in rats fed the MZn diet without EMB. Serum and tissue zinc levels were similar in rats not receiving EMB, regardless of the dietary zinc level. Serum zinc was consistently lower in AZn and MZn rats receiving EMB than in rats without EMB. Apparent zinc absorption, measured by /sup 65/Zn balance, was higher in AZn rats receiving EMB than in AZn rats without EMB. Thus, changes in absorption could not account for lower serum zinc levels in EMB-treated rats. However, /sup 65/Zn turnover was also higher in EMB groups. This suggests that EMB may have increased urinary zinc losses resulting in reduced circulating zinc and a consequent increase in zinc absorption.

  13. Molecular assessment of surgical-resection margins of gastric cancer by mass-spectrometric imaging.

    Eberlin, Livia S; Tibshirani, Robert J; Zhang, Jialing; Longacre, Teri A; Berry, Gerald J; Bingham, David B; Norton, Jeffrey A; Zare, Richard N; Poultsides, George A

    2014-02-18

    Surgical resection is the main curative option for gastrointestinal cancers. The extent of cancer resection is commonly assessed during surgery by pathologic evaluation of (frozen sections of) the tissue at the resected specimen margin(s) to verify whether cancer is present. We compare this method to an alternative procedure, desorption electrospray ionization mass spectrometric imaging (DESI-MSI), for 62 banked human cancerous and normal gastric-tissue samples. In DESI-MSI, microdroplets strike the tissue sample, the resulting splash enters a mass spectrometer, and a statistical analysis, here, the Lasso method (which stands for least absolute shrinkage and selection operator and which is a multiclass logistic regression with L1 penalty), is applied to classify tissues based on the molecular information obtained directly from DESI-MSI. The methodology developed with 28 frozen training samples of clear histopathologic diagnosis showed an overall accuracy value of 98% for the 12,480 pixels evaluated in cross-validation (CV), and 97% when a completely independent set of samples was tested. By applying an additional spatial smoothing technique, the accuracy for both CV and the independent set of samples was 99% compared with histological diagnoses. To test our method for clinical use, we applied it to a total of 21 tissue-margin samples prospectively obtained from nine gastric-cancer patients. The results obtained suggest that DESI-MSI/Lasso may be valuable for routine intraoperative assessment of the specimen margins during gastric-cancer surgery. PMID:24550265

  14. Gigapixel surface imaging of radical prostatectomy specimens for comprehensive detection of cancer-positive surgical margins using structured illumination microscopy

    Wang, Mei; Tulman, David B.; Sholl, Andrew B.; Kimbrell, Hillary Z.; Mandava, Sree H.; Elfer, Katherine N.; Luethy, Samuel; Maddox, Michael M.; Lai, Weil; Lee, Benjamin R.; Brown, J. Quincy

    2016-06-01

    Achieving cancer-free surgical margins in oncologic surgery is critical to reduce the need for additional adjuvant treatments and minimize tumor recurrence; however, there is a delicate balance between completeness of tumor removal and preservation of adjacent tissues critical for normal post-operative function. We sought to establish the feasibility of video-rate structured illumination microscopy (VR-SIM) of the intact removed tumor surface as a practical and non-destructive alternative to intra-operative frozen section pathology, using prostate cancer as an initial target. We present the first images of the intact human prostate surface obtained with pathologically-relevant contrast and subcellular detail, obtained in 24 radical prostatectomy specimens immediately after excision. We demonstrate that it is feasible to routinely image the full prostate circumference, generating gigapixel panorama images of the surface that are readily interpreted by pathologists. VR-SIM confirmed detection of positive surgical margins in 3 out of 4 prostates with pathology-confirmed adenocarcinoma at the circumferential surgical margin, and furthermore detected extensive residual cancer at the circumferential margin in a case post-operatively classified by histopathology as having negative surgical margins. Our results suggest that the increased surface coverage of VR-SIM could also provide added value for detection and characterization of positive surgical margins over traditional histopathology.

  15. Radiation therapy for patients of malignant salivary gland tumors with positive surgical margins

    Purpose: Surgery is an essential part of treatment for tumors of the salivary gland, yet there is increasing evidence in the literature supporting the necessity of adjuvant radiation therapy. The patients described in this report were selected to receive postoperative radiation therapy because they were found to have positive margins. A total of 17 patients with malignant tumors originating from the major salivary glands seen between 1970 and 1988 who were treated with surgery and postoperative radiation therapy were reviewed. All patients had positive surgical margins and the overall local control at five years was 65%. Classified by T-stage, local control was obtained in all two patients for T1 disease, in five of six for T2, in four of six for T3, and in none of three for T4. At five years, the ratio of patients free of distant metastases was two of two for T1 lesion, four of six for T2, three of six for T3, and none of three for T4. Five-year survival was obtained in all eight patients with T1 and T2 lesions, four of six for T3, and one of three for T4. Patients with neck nodal metastases present in the neck at admission did worse than those with negative nodes, with 0% (none of three patients) free of locoregional recurrence vs. 71% (eleven of 14), 0% (none of three) free of distant metastases vs. 63% (nine of 14), and 0% (none of three) survival at five years vs. 93% (13 of 14). It was concluded that postoperative radiation therapy for patients with positive surgical margins was effective for T1 and T2 disease. However, patients with T3 and T4 disease require more aggressive therapy. Patients with nodal metastases in the neck at admission tended to have distant metastases and had poor prognoses

  16. Detection of breast positive surgical margins with fluorescence-guided microscopy imaging (Conference Presentation)

    Iftimia, Nicusor V.; Preda, Dorin; Park, Jesung; Antalek, Mitchell

    2016-03-01

    We present a novel technology based on a high sensitivity/specificity cancer targeting agent and of a novel fluorescence-guided microscopy (FGM) scheme for intraoperative assessment of surgical margins in breast cancer patients. Cancer cells are targeted using an optically silent peptide substrate coupled to a near infrared (NIR) fluorochrome that is cleaved by highly mediated breast cancer enzymes, like urokinase-type plasminogen activator (uPA), to become highly fluorescent when excited by a NIR laser beam. A FGM instrument is used to localize cancer-suspect areas on the lumpectomy specimen and visualize tissue morphology at the sub-cellular scale, such that a trained pathologist can read these images in real-time and confirm or rule-out cancer presence. The proposed technology will enable efficient assessment of surgical specimens during surgery, when it is mostly needed, and therefore help the clinician to determine if additional tissue excision is needed or not. The preliminary testing of this technology on breast surgical specimens will be discussed.

  17. Radical prostatectomy and positive surgical margins: tumor volume and Gleason score predicts cancer outcome

    La Roca, Ricardo L.R. Felts de, E-mail: Ricardo@delarocaurologia.com.br [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil); Fonseca, Francisco Paula da, E-mail: fpf@uol.com.br [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Divisao de Urologia. Dept. de Cirurgia Pelvica; Cunha, Isabela Werneck da; Bezerra, Stephania Martins, E-mail: iwerneck@gmail.com, E-mail: stephaniab@gmail.com [Hospital do Cancer A.C. Camargo, Sao Paulo, SP (Brazil). Dept. de Patologia

    2013-07-01

    Introduction: positive surgical margins (PSMs) are common adverse factors to predict the outcome of a patient submitted to radical prostatectomy (PR). However, not all of these men will follow with biochemical (BCR) or clinical (CR) recurrence. Relationship between PSMs with these recurrent events has to be correlated with other clinicopathological findings in order to recognize more aggressive tumors in order to recommend complementary treatment to these selected patients. Materials and methods: we retrospectively reviewed the outcome of 228 patients submitted to open retropubic RP between March 1991 and June 2008, where 161 had and 67 did not have PSMs. Minimum follow-up time was considered 2 years after surgery. BCR was considered when PSA {>=} 0.2 ng/ml. CR was determined when clinical evidence of tumor appeared. Chi-square test was used to correlate clinical and pathologic variables with PSMs. The estimated 5-year risk of BCR and CR in presence of PSMs was determined using the Kaplan-Meier method and compared to log-rank tests. Results: from the total of 228 patients, 161 (71%) had PSMs, while 67 (29%) had negative surgical margins (NSMs). Prostatic circumferential margin was the most common (43.4%) site. Univariate analysis showed statistically significant (p < 0.001) associations between the presence of PSMs and BCR, but not with CR (p = 0.06). Among 161 patients with PSMs, 61 (37.8%) presented BCR, while 100 (62.8%) did not. Predicting progression-free survival for 5 years, BCR was correlated with pathological stage; Gleason score; pre-treatment PSA; tumor volume in specimen; capsular and perineural invasion; presence and number of PSMs. RC correlated only with angiolymphatic invasion and Gleason score. Considering univariate analyses the clinicopathological factors predicting BCR for 5 years, results statistically significant links with prostate weight; pre-treatment PSA; Gleason score; pathological stage; tumor volume; PSMs; capsular and perineural

  18. Radical prostatectomy and positive surgical margins: tumor volume and Gleason score predicts cancer outcome

    Introduction: positive surgical margins (PSMs) are common adverse factors to predict the outcome of a patient submitted to radical prostatectomy (PR). However, not all of these men will follow with biochemical (BCR) or clinical (CR) recurrence. Relationship between PSMs with these recurrent events has to be correlated with other clinicopathological findings in order to recognize more aggressive tumors in order to recommend complementary treatment to these selected patients. Materials and methods: we retrospectively reviewed the outcome of 228 patients submitted to open retropubic RP between March 1991 and June 2008, where 161 had and 67 did not have PSMs. Minimum follow-up time was considered 2 years after surgery. BCR was considered when PSA ≥ 0.2 ng/ml. CR was determined when clinical evidence of tumor appeared. Chi-square test was used to correlate clinical and pathologic variables with PSMs. The estimated 5-year risk of BCR and CR in presence of PSMs was determined using the Kaplan-Meier method and compared to log-rank tests. Results: from the total of 228 patients, 161 (71%) had PSMs, while 67 (29%) had negative surgical margins (NSMs). Prostatic circumferential margin was the most common (43.4%) site. Univariate analysis showed statistically significant (p < 0.001) associations between the presence of PSMs and BCR, but not with CR (p = 0.06). Among 161 patients with PSMs, 61 (37.8%) presented BCR, while 100 (62.8%) did not. Predicting progression-free survival for 5 years, BCR was correlated with pathological stage; Gleason score; pre-treatment PSA; tumor volume in specimen; capsular and perineural invasion; presence and number of PSMs. RC correlated only with angiolymphatic invasion and Gleason score. Considering univariate analyses the clinicopathological factors predicting BCR for 5 years, results statistically significant links with prostate weight; pre-treatment PSA; Gleason score; pathological stage; tumor volume; PSMs; capsular and perineural

  19. Intraoperative Assessment of Surgical Margins of Oral Squamous Cell Carcinoma Using Frozen Sections: A Practical Clinicopathological Management for Recurrences

    Shun Miyota

    2014-01-01

    Full Text Available Background. Local recurrence remains a challenging clinical issue for the treatment of oral squamous cell carcinoma (SCC. We analyzed retrospectively how effective the frozen section technique (FS was against recurrences of oral SCC. Methods. We screened 343 surgical samples from 236 patients who had oral SCC, carcinoma in situ (CIS, or epithelial dysplasia, and we followed up their clinical outcomes for at least 5 years. Histopathological states of surgical margins were compared between FS and surgical materials in relapse and relapse-free groups, respectively. Results. Among the 236 patients, 191 were classified into the relapse-free group, and 45 into the relapse group. FS was more frequently performed in the relapse-free group (128/191 than in the relapse group (83/152. Histopathologically, moderate dysplasia or CIS (borderline malignancies and SCC were recognized in 55 samples of the relapse-free group and in 57 of the relapse group. For those surgical margins with borderline malignancies, additional incisions were performed in 38 of the 55 relapse-free cases, which reduced to 20 from the 38 margins with borderline malignancies (47.4% reduction, and in 39 of the 57 relapse cases, which reduced to only 3 of 39 (7.7% reduction. Conclusions. The intraoperative assessment of surgical margins by FS is essential in preventing recurrences of oral mucosal malignancies.

  20. Risk of biochemical recurrence and positive surgical margins in patients with pT2 prostate cancer undergoing radical prostatectomy

    Røder, Martin Andreas; Thomsen, Frederik Birkebæk; Berg, Kasper Drimer; Christensen, Ib Jarle; Brasso, Klaus; Vainer, Ben; Iversen, Peter

    2014-01-01

    BACKGROUND AND OBJECTIVE: To investigate risk factors associated with positive surgical margins (PSM) and biochemical recurrence (BR) in organ confined tumors (pT2) after radical prostatectomy (RP) for localized prostate cancer (PCa). METHODS: Between 1995 and 2011, 1,649 patients underwent RP at...

  1. Radical prostatectomy and positive surgical margins: relationship with prostate cancer outcome

    Ricardo L. R. Felts de La Roca

    2014-06-01

    Full Text Available Introduction Positive surgical margins (PSMs are an adverse factor that may predict a worse outcome in patients submitted to radical prostatectomy (RP. However, not all of these cases will evolve to biochemical (BCR or clinical (CR recurrence, therefore relationship between PSMs and these recurrent events has to be correlated with other clinical and pathologic findings to indicate complementary treatment for selected patients. Materials and Methods Of 1250 patients submitted to open retropubic radical prostatectomy (RRP, between March 1991 and June 2008, the outcome of 161 patients with PSMs and of 67 without PSMs as a control group, comprising a total of 228 cases were retrospectively reviewed. A minimum follow-up time of 2 years after surgery was considered. BCR was determined when PSA ≥ 0.2ng/mL. CR was determined whenever there was clinical evidence of tumor. Chi-square test was used to correlate clinical and pathologic variables with PSMs. Time interval to biochemical recurrence was analyzed by the Kaplan-Meier product limit analysis using the log-rank test for comparison between groups. Univariate and multivariate Cox stepwise logistic regression models were used to identify significant predictors of risk of shorter intervals to BCR. Results Prostate circumference margin was the most common site with 78 cases (48.44%. Regarding the outcome of 228 cases from both groups, BCR occurred in 68 patients (29.82%, and CR in 10 (4.38%. Univariate analysis showed statistically significant associations (p < 0.001 between presence of PSMs with BCR, but not with CR (p = 0.05. At follow-up of the 161 patients with PSMs, only 61(37.8% presented BCR, while 100 (62.8% did not. BCR correlated with pathologic stage; Gleason score; preoperative PSA; tumor volume in the specimen; capsular and perineural invasion; presence and number of PSMs. CR correlated only with angiolymphatic invasion and Gleason score. Considering univariate analysis of clinical and

  2. Pancreatic Neuroendocrine Tumors With Involved Surgical Margins: Prognostic Factors and the Role of Adjuvant Radiotherapy

    Purpose: Pancreatic neuroendocrine tumors (pNET) are rare neoplasms associated with poor outcomes without resection, and involved surgical margins are associated with a worse prognosis. The role of adjuvant radiotherapy (RT) in these patients has not been characterized. Methods and Materials: We retrospectively evaluated 46 consecutive patients with positive or close (<1 mm) margins after pNET resection, treated from 1983 to 2010, 16 of whom received adjuvant RT. Median RT dose was 50.4 Gy in 1.8-Gy fractions; half the patients received concurrent chemotherapy with 5-fluorouracil or capecitabine. No patients received adjuvant chemotherapy. Cox multivariate analysis (MVA) was used to analyze factors associated with overall survival (OS). Results: Median age at diagnosis was 56 years, and 52% of patients were female. Median tumor size was 38 mm, 57% of patients were node-positive, and 11% had a resected solitary liver metastasis. Patients who received RT were more likely to have larger tumors (median, 54 mm vs. 30 mm, respectively, p = 0.002) and node positivity (81% vs. 33%, respectively, p = 0.002) than those not receiving RT. Median follow-up was 39 months. Actuarial 5-year OS was 62% (95% confidence interval [CI], 41%–77%). In the group that did not receive RT, 3 patients (10%) experienced local recurrence (LR) and 5 patients (18%) developed new distant metastases, while in the RT group, 1 patient (6%) experienced LR and 5 patients (38%) developed distant metastases. Of all recurrences, 29% were LR. On MVA, male gender (adjusted hazard ratio [AHR] = 3.81; 95% CI, 1.21–11.92; p = 0.02) and increasing tumor size (AHR = 1.02; 95% CI, 1.01–1.04; p = 0.007) were associated with decreased OS. Conclusions: Long-term survival is common among patients with involved-margin pNET. Despite significantly worse pathologic features among patients receiving adjuvant RT, rates of LR between groups were similar, suggesting that RT might aid local control, and merits further

  3. Pancreatic Neuroendocrine Tumors With Involved Surgical Margins: Prognostic Factors and the Role of Adjuvant Radiotherapy

    Arvold, Nils D. [Harvard Radiation Oncology Program, Harvard Medical School, Boston, MA (United States); Willett, Christopher G. [Department of Radiation Oncology, Duke University Medical Center, Durham, NC (United States); Fernandez-del Castillo, Carlos [Department of Surgery, Massachusetts General Hospital, Boston, MA (United States); Ryan, David P. [Department of Medicine, Massachusetts General Hospital, Boston, MA (United States); Ferrone, Cristina R. [Department of Surgery, Massachusetts General Hospital, Boston, MA (United States); Clark, Jeffrey W.; Blaszkowsky, Lawrence S. [Department of Medicine, Massachusetts General Hospital, Boston, MA (United States); Deshpande, Vikram [Department of Pathology, Massachusetts General Hospital, Boston, MA (United States); Niemierko, Andrzej [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States); Allen, Jill N.; Kwak, Eunice L.; Wadlow, Raymond C.; Zhu, Andrew X. [Department of Medicine, Massachusetts General Hospital, Boston, MA (United States); Warshaw, Andrew L. [Department of Surgery, Massachusetts General Hospital, Boston, MA (United States); Hong, Theodore S., E-mail: Tshong1@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Boston, MA (United States)

    2012-07-01

    Purpose: Pancreatic neuroendocrine tumors (pNET) are rare neoplasms associated with poor outcomes without resection, and involved surgical margins are associated with a worse prognosis. The role of adjuvant radiotherapy (RT) in these patients has not been characterized. Methods and Materials: We retrospectively evaluated 46 consecutive patients with positive or close (<1 mm) margins after pNET resection, treated from 1983 to 2010, 16 of whom received adjuvant RT. Median RT dose was 50.4 Gy in 1.8-Gy fractions; half the patients received concurrent chemotherapy with 5-fluorouracil or capecitabine. No patients received adjuvant chemotherapy. Cox multivariate analysis (MVA) was used to analyze factors associated with overall survival (OS). Results: Median age at diagnosis was 56 years, and 52% of patients were female. Median tumor size was 38 mm, 57% of patients were node-positive, and 11% had a resected solitary liver metastasis. Patients who received RT were more likely to have larger tumors (median, 54 mm vs. 30 mm, respectively, p = 0.002) and node positivity (81% vs. 33%, respectively, p = 0.002) than those not receiving RT. Median follow-up was 39 months. Actuarial 5-year OS was 62% (95% confidence interval [CI], 41%-77%). In the group that did not receive RT, 3 patients (10%) experienced local recurrence (LR) and 5 patients (18%) developed new distant metastases, while in the RT group, 1 patient (6%) experienced LR and 5 patients (38%) developed distant metastases. Of all recurrences, 29% were LR. On MVA, male gender (adjusted hazard ratio [AHR] = 3.81; 95% CI, 1.21-11.92; p = 0.02) and increasing tumor size (AHR = 1.02; 95% CI, 1.01-1.04; p = 0.007) were associated with decreased OS. Conclusions: Long-term survival is common among patients with involved-margin pNET. Despite significantly worse pathologic features among patients receiving adjuvant RT, rates of LR between groups were similar, suggesting that RT might aid local control, and merits further

  4. The Effect of the Surgical Margins on the Outcome of Patients with Head and Neck Squamous Cell Carcinoma: Single Institution Experience

    To assess the impact of close or positive surgical margins on the outcome, and to determine whether margin status influence the recurrence rate and the overall survival for patients with head and neck cancers. Records from 1996 to 2001 of 413 patients with primary head and neck squamous cell carcinoma (SCC) treated with surgery as the first line treatment were analysed. Of these patients, 82 were eligible for the study. Patients were followed up for 5 years. Patients with margins between 5-10 mm had 50% recurrence rate (RR), those with surgical margins between 1-5 mm had RR of 59% and those with positive surgical margins had RR of 90% (P=0.004). The 5-year survival rates were 54%, 39% and 10%, respectively (P=0.002). Unsatisfactory surgical margin is an independent risk factor for recurrence free survival as well as overall survival regardless of the other tumor and patient characteristics

  5. Does Breast Magnetic Resonance Imaging Combined With Conventional Imaging Modalities Decrease the Rates of Surgical Margin Involvement and Reoperation?

    Lai, Hung-Wen; Chen, Chih-Jung; Lin, Ying-Jen; Chen, Shu-Ling; Wu, Hwa-Koon; Wu, Yu-Ting; Kuo, Shou-Jen; Chen, Shou-Tung; Chen, Dar-Ren

    2016-01-01

    Abstract The objective of this study was to assess whether preoperative breast magnetic resonance imaging (MRI) combined with conventional breast imaging techniques decreases the rates of margin involvement and reexcision. Data on patients who underwent surgery for primary operable breast cancer were obtained from the Changhua Christian Hospital (CCH) breast cancer database. The rate of surgical margin involvement and the rate of reoperation were compared between patients who underwent conventional breast imaging modalities (Group A: mammography and sonography) and those who received breast MRI in addition to conventional imaging (Group B: mammography, sonography, and MRI). A total of 1468 patients were enrolled in this study. Among the 733 patients in Group A, 377 (51.4%) received breast-conserving surgery (BCS) and 356 (48.6%) received mastectomy. Among the 735 patients in Group B, 348 (47.3%) received BCS and 387 (52.7%) received mastectomy. There were no significant differences in operative method between patients who received conventional imaging alone and those that received MRI and conventional imaging (P = 0.13). The rate of detection of pathological multifocal/multicentric breast cancer was markedly higher in patients who received preoperative MRI than in those who underwent conventional imaging alone (14.3% vs 8.6%, P < 0.01). The overall rate of surgical margin involvement was significantly lower in patients who received MRI (5.0%) than in those who received conventional imaging alone (9.0%) (P < 0.01). However, a significant reduction in rate of surgical margin positivity was only observed in patients who received BCS (Group A, 14.6%; Group B, 6.6%, P < 0.01). The overall BCS reoperation rates were 11.7% in the conventional imaging group and 3.2% in the combined MRI group (P < 0.01). There were no significant differences in rate of residual cancer in specimens obtained during reoperation between the 2 preoperative imaging groups

  6. Reduced Circumferential Resection Margin Involvement in Rectal Cancer Surgery: Results of the Dutch Surgical Colorectal Audit

    Gietelink, L.; Wouters, M.W.; Tanis, P.J.; Deken, M.M.; Berge, M.G. Ten; Tollenaar, R.A.; Krieken, J.H.J.M. van; Noo, M.E. de

    2015-01-01

    BACKGROUND: The circumferential resection margin (CRM) is a significant prognostic factor for local recurrence, distant metastasis, and survival after rectal cancer surgery. Therefore, availability of this parameter is essential. Although the Dutch total mesorectal excision trial raised awareness ab

  7. 18F-FDG uptake at the surgical margin after hepatic resection: Patterns of uptake and differential diagnosis

    To evaluate the patterns of 18F-FDG uptake at the surgical margin after hepatectomy to identify features that may differentiate benign and malignant uptake. Patients who had undergone a PET/CT after hepatectomy were identified. Delay between resection and PET/CT, presence of uptake at the surgical margin, pattern of uptake, and maximal standardized value were recorded. The PET/CT findings were correlated with contrast-enhanced CT or MRI. There were 26 patients with increased 18F-FDG uptake; uptake was diffuse in seven and focal in 19. Diffuse uptake was due to inflammation in all cases. Focal uptake was due to recurrence in 12 and inflammation in seven cases. Defining a focal pattern only as a positive for malignancy yielded 100 % sensitivity, 87 % specificity, 37 % false positive rate. As expected, SUVmax was significantly higher for recurrence than inflammation, but did overlap. Contrast-enhanced CT allowed differentiation between malignant and benign uptake in all cases. F-FDG uptake after hepatectomy does not equate to recurrence and yields a high false positive rate. Diffuse uptake did not require additional evaluation in our sample. Focal uptake, however, may be due to recurrence; differentiating benign and malignant nodular uptake relies on optimal contrast-enhanced CT or MRI. (orig.)

  8. {sup 18}F-FDG uptake at the surgical margin after hepatic resection: Patterns of uptake and differential diagnosis

    Peungjesada, Silanath [University New Mexico, Department of Radiology, Albuquerque, NM (United States); Aloia, Thomas A. [University of Texas MD Anderson Cancer Center, Department of Surgical Oncology, Unit 444, Houston, TX (United States); Fox, Patricia [University of Texas MD Anderson Cancer Center, Department of Biostatistics, Unit 1411, Houston, TX (United States); Chasen, Beth [University of Texas MD Anderson Cancer Center, Department of Nuclear Medicine, Unit 1483, Houston, TX (United States); Shin, Sooyoung; Loyer, Evelyne M. [University of Texas MD Anderson Cancer Center, Department of Diagnostic Radiology, Unit 1473, Houston, TX (United States); Baiomy, Ali [Cairo University, National Cancer Center, Cairo (Egypt)

    2015-08-15

    To evaluate the patterns of {sup 18}F-FDG uptake at the surgical margin after hepatectomy to identify features that may differentiate benign and malignant uptake. Patients who had undergone a PET/CT after hepatectomy were identified. Delay between resection and PET/CT, presence of uptake at the surgical margin, pattern of uptake, and maximal standardized value were recorded. The PET/CT findings were correlated with contrast-enhanced CT or MRI. There were 26 patients with increased 18F-FDG uptake; uptake was diffuse in seven and focal in 19. Diffuse uptake was due to inflammation in all cases. Focal uptake was due to recurrence in 12 and inflammation in seven cases. Defining a focal pattern only as a positive for malignancy yielded 100 % sensitivity, 87 % specificity, 37 % false positive rate. As expected, SUV{sub max} was significantly higher for recurrence than inflammation, but did overlap. Contrast-enhanced CT allowed differentiation between malignant and benign uptake in all cases. F-FDG uptake after hepatectomy does not equate to recurrence and yields a high false positive rate. Diffuse uptake did not require additional evaluation in our sample. Focal uptake, however, may be due to recurrence; differentiating benign and malignant nodular uptake relies on optimal contrast-enhanced CT or MRI. (orig.)

  9. The relation of gingival thickness to dynamics of gingival margin position pre- and post-surgically

    Kharidhi Laxman Vandana; Ira Gupta

    2016-01-01

    Background: To evaluate the gingival margin position (GMP) before and after open flap debridement in different gingival thickness (GT). Materials and Methods: Twenty-seven healthy patients with moderate to advanced adult periodontitis were included in a randomized control clinical trial. A calibrated UNC-15 periodontal probe, an occlusal onlay stent was used for clinical measurements recorded at baseline, 3 month, 6 month, and 16 month. The changes in the GMP were studied at midbuccal (Mi-B),...

  10. The impact of surgical margin status and use of an interstitial implant on T1,T2 oral tongue cancers after surgery

    Purpose: In patients with T1,T2 oral tongue carcinoma treated with surgical resection, postoperative radiation therapy (RT) is required especially when surgical margins contain tumors. Irradiation techniques include external beam, interstitial implants, or a combination of the two modalities. We investigated whether positive surgical margin remains a poor prognostic factor after radiation therapy, and the contribution of interstitial implants to disease control. Methods and Materials: Between 1972 and 1989, 55 patients were treated postoperatively at the Mallinckrodt Institute of Radiology for T1,T2 squamous cell carcinomas of the oral tongue. Surgeries included 26 wide excisions or excisional biopsies and 29 composite resections or hemiglossectomies. Thirty-nine patients received external radiation therapy alone and 16 patients had an interstitial implant (ISI) as part of the treatment. The minimum follow-up is 4 years. Results: At 2 and 5 years, the overall survivals for all patients were 82 and 68%. The disease-free survivals (DFS) were 82 and 70%, respectively. There was no significant difference in the pattern of failure and DFS when stratified by the status of surgical margins and the type of the surgical procedure. Local control was achieved in 15 of 18 patients when surgical margins were involved by tumor and in 29 of 37 patients without tumor involving margins (p > 0.05). Ten of 18 (56%) patients with tumor involving resection margins were treated with ISL, whereas only 3 of 33 (9%) of those with negative margins received ISI. Local control was achieved in 32 of 39 patients treated with external beam RT alone, and 13 of 16 patients who received interstitial implant (p > 0.05). Four patients treated with ISI developed persistent soft tissue ulceration and mandibular bone exposures. Conclusions: Postoperative radiation therapy converted the ominous outcome of patients with tumor involving surgical margins. Patients with positive surgical margins were often

  11. Imaging of surgical margin in pancreatic metastasis using two-photon excited fluorescence microscopy

    Chen, Jing; Hong, Zhipeng; Chen, Hong; Chen, Youting; Xu, Yahao; Zhu, Xiaoqin; Zhuo, Shuangmu; Shi, Zheng; Chen, Jianxin

    2014-09-01

    Two-photon excited fluorescence (TPEF) microscopy, has become a powerful tool for imaging unstained tissue samples at subcellular level in biomedical research. The purpose of this study was to determine whether TPEF imaging of histological sections without H-E staining can be used to identify the boundary between normal pancreas and pancreatic metastasis from renal cell carcinoma (RCC). The typical features such as the significant increase of cancerous nests, the absence of pancreatic ductal, the appearance of cancer cells were observed to present the boundary between normal pancreas and pancreatic metastasis from RCC. These results correlated well with the corresponding histological outcomes. With the advent of clinically miniaturized TPEF microscopy and integrative endoscopy, TPEF microscopy has the potential application on surgical location of pancreatic metastasis from RCC in the near future.

  12. The relation of gingival thickness to dynamics of gingival margin position pre- and post-surgically

    Kharidhi Laxman Vandana

    2016-01-01

    Full Text Available Background: To evaluate the gingival margin position (GMP before and after open flap debridement in different gingival thickness (GT. Materials and Methods: Twenty-seven healthy patients with moderate to advanced adult periodontitis were included in a randomized control clinical trial. A calibrated UNC-15 periodontal probe, an occlusal onlay stent was used for clinical measurements recorded at baseline, 3 month, 6 month, and 16 month. The changes in the GMP were studied at midbuccal (Mi-B, mesiobuccal (MB, and distobuccal sites. GT was measured presurgically, transgingivally at Mi-B and interdental sites, divided into 2 groups: Group 1 (thin and Group 2 (thick. Results: In GT of ≤1 mm group, the statistically significant apical shift of GMP led to gingival recession at all study sites in the early postsurgical period of 1 and 3 months. During 6 and 16 months, the apical shift of GMP coincided with the Chernihiv Airport at Mi-B site (6 months, MB site (16 months. The gingival recession was obvious at Mi-B sites (16 months. In the GT of >1 mm, the statistically significant apical shift of GMP did not cause gingival recession at any sites throughout postsurgical (1, 3, 6, and 16 months period. Conclusion: Thin gingiva showed apical shift of GMP leading to gingival recession as compared to thick gingiva postsurgically.

  13. The relation of gingival thickness to dynamics of gingival margin position pre- and post-surgically

    Vandana, Kharidhi Laxman; Gupta, Ira

    2016-01-01

    Background: To evaluate the gingival margin position (GMP) before and after open flap debridement in different gingival thickness (GT). Materials and Methods: Twenty-seven healthy patients with moderate to advanced adult periodontitis were included in a randomized control clinical trial. A calibrated UNC-15 periodontal probe, an occlusal onlay stent was used for clinical measurements recorded at baseline, 3 month, 6 month, and 16 month. The changes in the GMP were studied at midbuccal (Mi-B), mesiobuccal (MB), and distobuccal sites. GT was measured presurgically, transgingivally at Mi-B and interdental sites, divided into 2 groups: Group 1 (thin) and Group 2 (thick). Results: In GT of ≤1 mm group, the statistically significant apical shift of GMP led to gingival recession at all study sites in the early postsurgical period of 1 and 3 months. During 6 and 16 months, the apical shift of GMP coincided with the Chernihiv Airport at Mi-B site (6 months), MB site (16 months). The gingival recession was obvious at Mi-B sites (16 months). In the GT of >1 mm, the statistically significant apical shift of GMP did not cause gingival recession at any sites throughout postsurgical (1, 3, 6, and 16 months) period. Conclusion: Thin gingiva showed apical shift of GMP leading to gingival recession as compared to thick gingiva postsurgically. PMID:27143829

  14. Correlation of Beta-2 Adrenergic Receptor Expression in Tumor-Free Surgical Margin and at the Invasive Front of Oral Squamous Cell Carcinoma

    Bravo-Calderón, Diego Mauricio; Lauand, Gustavo Amaral; Assao, Agnes; Suárez-Peñaranda, José-Manuel; Pérez-Sayáns, Mario; García-García, Abel; Marana, Aparecido Nilceu; Nonogaki, Suely; Lauris, José Roberto Pereira; Kowalski, Luiz Paulo

    2016-01-01

    Background. The beta-2 adrenergic receptor is expressed by neoplastic cells and is correlated with a wide spectrum of tumor cell mechanisms including proliferation, apoptosis, angiogenesis, migration, and metastasis. Objectives. The present study aimed to analyze the expression of the beta-2 adrenergic receptor (β2-AR) in tumor-free surgical margins of oral squamous cell carcinomas (OSCC) and at the invasive front. Sixty-two patients diagnosed with OSCC, confirmed by biopsy, were selected for the study. The clinicopathological data and clinical follow-up were obtained from medical records and their association with β2-AR expression was verified by the chi-square test or Fischer's exact test. To verify the correlation of β2-AR expression in tumor-free surgical margins and at the invasive front of OSCCs, Pearson's correlation coefficient test was applied. Results. The expression of β2-AR presented a statistically significant correlation between the tumor-free surgical margins and the invasive front of OSCC (r = 0.383; p = 0.002). The immunohistochemical distribution of β2-AR at the invasive front of OSCC was also statistically significant associated with alcohol (p = 0.038), simultaneous alcohol and tobacco consumption (p = 0.010), and T stage (p = 0.014). Conclusions. The correlation of β2-AR expression in OSCC and tumor-free surgical margins suggests a role of this receptor in tumor progression and its expression in normal oral epithelium seems to be constitutive. PMID:27042179

  15. Pilot study of intraoperative digital imaging with the use of a mammograph for assessment of bone surgical margins in the head and neck region

    Aim: To investigate alternative possibilities for the intraoperative evaluation of surgical margins after bone resection utilizing more conventional hospital infrastructure technologies. Materials and methods: A small pilot study was performed using digital mammograph imaging intraoperatively on 16 surgical specimens of bone tumours or malignancies with bone infiltration of the head and neck area, with the aim of evaluating the resection margins. Results: In thirteen cases the intraoperative specimen images indicated clinically complete excision. In two cases incomplete resection or close proximity of margins was detected, which required additional resection. Conclusions: The results indicated that intraoperative specimen radiography can prove useful in evaluating completeness of excision. The significance of intraoperative assessment of surgical margin is of paramount importance when immediate reconstruction is performed. This proposed method is cheap, easy to perform and fast. Its cost–benefit ratio is superior than that of any other available technique. Intraoperative analysis of specimens with digital mammography imaging can potentially become a useful tool for immediate evaluation of osseous margins after resection

  16. Risk of Local Failure in Breast Cancer Patients With Lobular Carcinoma In Situ at the Final Surgical Margins: Is Re-excision Necessary?

    Sadek, Betro T.; Shenouda, Mina N.; Abi Raad, Rita F. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Niemierko, Andrzej [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Statistics Section, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Keruakous, Amany R. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Goldberg, Saveli I. [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Statistics Section, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States); Taghian, Alphonse G., E-mail: ataghian@partners.org [Department of Radiation Oncology, Massachusetts General Hospital, Harvard Medical School, Boston, Massachusetts (United States)

    2013-11-15

    Purpose: To compare the outcome of patients with invasive breast cancer both with and without lobular carcinoma in situ (LCIS)-positive/close surgical margins after breast-conserving treatment. Methods and Materials: We retrospectively studied 2358 patients with T1-T2 invasive breast cancer treated with lumpectomy and radiation therapy from January 1980 to December 2009. Median age was 57 years (range, 24-91 years). There were 82 patients (3.5%) with positive/close LCIS margins (<0.2 cm) and 2232 patients (95.7%) with negative margins. A total of 1789 patients (76%) had negative lymph nodes. Patients who received neoadjuvant chemotherapy were excluded. A total of 1783 patients (76%) received adjuvant systemic therapy. Multivariable analysis (MVA) was performed using Cox's proportional hazards model. Results: The 5-year cumulative incidence of locoregional recurrence (LRR) was 3.2% (95% confidence interval [CI] 2.5%-4.1%) for the 2232 patients with LCIS-negative surgical margins (median follow-up 104 months) and 2.8% (95% CI 0.7%-10.8%) for the 82 patients with LCIS-positive/close surgical margins (median follow-up 90 months). This was not statistically significant (P=.5). On MVA, LCIS-positive margins after the final surgery were not associated with increased risk of LRR (hazard ratio [HR] 3.4, 95% CI 0.5-24.5, P=.2). Statistically significant prognostic variables on Cox's MVA for risk of LRR included systemic therapy (HR 0.5, 95% CI 0.33-0.75, P=.001), number of positive lymph nodes (HR 1.11, 95% CI 1.05-1.18, P=.001), menopausal status (HR 0.96, 95% CI 0.95-0.98, P=.001), and histopathologic grade (grade 3 vs grade 1/2) (HR 2.6, 95% CI 1.4-4.7, P=.003). Conclusion: Our results suggest that the presence of LCIS at the surgical margin after lumpectomy does not increase the risk of LRR or the final outcome. These findings suggest that re-excision or mastectomy in patients with LCIS-positive/close final surgical margins is unnecessary.

  17. Clinical implications of determination of safe surgical margins by using a combination of CT and 18FDG-positron emission tomography in soft tissue sarcoma

    Yoshioka Takako

    2011-07-01

    Full Text Available Abstract Background To determine safe surgical margins for soft tissue sarcoma, it is essential to perform a general evaluation of the extent of tumor, responses to auxiliary therapy, and other factors preoperatively using multiple types of diagnostic imaging. 18F-fluorodeoxyglucose positron emission tomography/computed tomography (FDG-PET/CT is a tool for diagnostic imaging that has recently spread rapidly in clinical use. At present, the roles played by FDG-PET/CT in determination of margins for surgical resection of sarcoma are unclear. The present study was undertaken to explore the roles of FDG-PET/CT in determination of surgical margins for soft tissue sarcoma and to examine whether PET can serve as a standard means for setting the margins of surgical resection during reduced surgery. Methods The study involved 7 patients with sarcoma who underwent surgery in our department and in whom evaluation with FDG-PET/CT was possible. Sarcoma was histologically rated as MFH in 6 cases and leiomyosarcoma in 1 case. In all cases, sarcoma was superficial (T1a or T2a. The tumor border was defined by contrast-enhanced MRI, and SUVs were measured at intervals of 1 cm over a 5-cm long area from the tumor border. Mapping of viable tumor cells was carried out on whole-mount sections of resected tissue, and SUVs were compared with histopathological findings. Results Preoperative maximum SUVs (SUV-max of the tumor averaged 11.7 (range: 3.8-22.1. Mean SUV-max was 2.2 (range: 0.3-3.8 at 1 cm from the tumor border, 1.1 (0.85-1.47 at 2 cm, 0.83 (0.65-1.15 at 3 cm, 0.7 (0.42-0.95 at 4 cm, and 0.64 (0.45-0.82 at 5 cm. When resected tissue was mapped, tumor cells were absent in the areas where SUV-max was below 1.0. Conclusions Our findings suggest that a safe surgical margin free of viable tumor cells can be ensured if the SUV cut-off level is set at 1.0. FDG-PET/CT is promising as a diagnostic imaging technique for setting of safe minimal margins for surgical

  18. 喉癌外科切缘研究所引发的思考%Reflections on the Institute of Surgical Margins in Laryngeal Cancer

    王斌全; 余艳萍

    2013-01-01

    喉癌以手术为主要治疗方式,喉功能保留手术已被学界公认,实施该术式的关键是要恰当把握喉癌外科切缘,对喉癌外科切缘的认识和研究经历了一个发展的过程,笔者依据质量互变规律、发展的观点、实践的观点、矛盾的普遍性和特殊性之间的辩证关系等哲学原理提出了喉癌外科切缘评价体系,该体系包括:喉癌黏膜切缘的置信区间、喉癌黏膜下切缘的确定及基底浸润特征的评价.%Laryngeal carcinoma to surgery for the main treatment of way, throat function retain surgery has be academic recognized, the implementation of the operation type key is to appropriate grasp laryngeal carcinoma surgical cut margin of, to laryngeal carcinoma surgical cut margin of know and study on experience a development process, the author based on the quality each other change law of, and development view, and practice view, and contradiction universal and the particularity of dialectical relationship such as philosophy principle made laryngeal carcinoma surgical cut margin of evaluation of system, the system including : laryngeal carcinoma mucosa cut margin of confidence interval, and laryngeal carcinoma mucosa cut margin of determine and the evaluation of basement invasion features.

  19. The efficacy of postoperative radiation therapy in patients with carcinoma of the buccal mucosa and lower alveolus with positive surgical margins

    Badakh Dinesh

    2005-01-01

    Full Text Available PURPOSE: A retrospective analysis to determine the efficacy of postoperative radiation therapy, in patients of carcinoma of the buccal mucosa and lower alveolus with pathologically verified positive surgical margins (PSM. MATERIALS AND METHODS: Ninety-four patients were analysed, who underwent surgery plus postoperative radiation therapy. Twenty-nine patients (31% had PSM. Other pathological factors like nodal stage, number of nodes, bone involvement etc. were also analysed. RESULTS: Disease free survival (DFS of patients with a PSM was significantly worse when compared with those with negative surgical margins (NSM. Poor DFS was also observed for variables like nodal stage, number of nodes and extranodal extension and radiation dose. In multivariate analysis only two variables showed significant impact on DFS, those were surgical margins and number of nodes. CONCLUSION: To conclude in our study median dose of 60 Gy in PSM patients was not able to improve DFS and showed poor results as compared with NSM patients. There is also evidence from other studies, to suggest that post-operative radiation doses upto 60 Gy may not be sufficient to overcome this poor prognostic factor. To overcome this poor prognostic group patients, we in our institution are now employing radiation dose intensification and altered fractionation in an effort to imrove our results. In physically fit patients we are trying to administer concomitant chemotherapy along with radiation treatment.

  20. Optical characterization of lesions and identification of surgical margins in pancreatic metastasis from renal cell carcinoma by using two-photon excited fluorescence microscopy

    Two-photon excited fluorescence (TPEF) microscopy has become a powerful instrument for imaging unstained tissue samples in biomedical research. The purpose of this study was to determine whether TPEF imaging of histological sections without hematoxylin-eosin (H-E) stain can be used to characterize lesions and identify surgical margins in pancreatic metastasis from renal cell carcinoma (RCC). The specimens of a pancreatic metastasis from RCC, as well as a primary RCC from a patient, were examined by TPEF microscopy and compared with their corresponding H-E stained histopathological results. The results showed that high-resolution TPEF imaging of unstained histological sections of pancreatic metastasis from RCC can reveal that the typical morphology of the tissue and cells in cancer tissues is different from the normal pancreas. It also clearly presented histopathological features of the collagenous capsule, which is an important boundary symbol to identify normal and cancerous tissue and to instruct surgical operation. It indicated the feasibility of using TPEF microscopy to make an optical diagnosis of lesions and identify the surgical margins in pancreatic metastasis from RCC. (paper)

  1. Optical characterization of lesions and identification of surgical margins in pancreatic metastasis from renal cell carcinoma by using two-photon excited fluorescence microscopy

    Chen, Jing; Hong, Zhipeng; Chen, Hong; Chen, Youting; Xu, Yahao; Zhu, Xiaoqin; Zhuo, Shuangmu; Shi, Zheng; Chen, Jianxin

    2014-11-01

    Two-photon excited fluorescence (TPEF) microscopy has become a powerful instrument for imaging unstained tissue samples in biomedical research. The purpose of this study was to determine whether TPEF imaging of histological sections without hematoxylin-eosin (H-E) stain can be used to characterize lesions and identify surgical margins in pancreatic metastasis from renal cell carcinoma (RCC). The specimens of a pancreatic metastasis from RCC, as well as a primary RCC from a patient, were examined by TPEF microscopy and compared with their corresponding H-E stained histopathological results. The results showed that high-resolution TPEF imaging of unstained histological sections of pancreatic metastasis from RCC can reveal that the typical morphology of the tissue and cells in cancer tissues is different from the normal pancreas. It also clearly presented histopathological features of the collagenous capsule, which is an important boundary symbol to identify normal and cancerous tissue and to instruct surgical operation. It indicated the feasibility of using TPEF microscopy to make an optical diagnosis of lesions and identify the surgical margins in pancreatic metastasis from RCC.

  2. Biliary intraepithelial neoplasia (BilIN) is frequently found in surgical margins of biliary tract cancer resection specimens but has no clinical implications.

    Matthaei, Hanno; Lingohr, Philipp; Strässer, Anke; Dietrich, Dimo; Rostamzadeh, Babak; Glees, Simone; Roering, Martin; Möhring, Pauline; Scheerbaum, Martin; Stoffels, Burkhard; Kalff, Jörg C; Schäfer, Nico; Kristiansen, Glen

    2015-02-01

    Biliary tract cancers are aggressive tumors of which the incidence seems to increase. Resection with cancer-free margins is crucial for curative therapy. However, how often biliary intraepithelial neoplasia (BilIN) occurs in resection margins and what its clinical and therapeutic implications might be is largely unknown. We reexamined margins of resection specimens of adenocarcinoma of the biliary tree including the gallbladder for the presence of BilIN. When present, it was graded. The findings were correlated with clinicopathological parameters and overall survival. Complete examination of the resection margin could be performed on 55 of 78 specimens (71%). BilIN was detected in the margin in 29 specimens (53%) and was mainly low-grade (BilIN-1; N = 14 of 29; 48%). In resection specimens of extrahepatic cholangiocarcinoma, BilIN was most frequent (N = 6 of 8; 75%). BilIN was found in the resection margin more frequently in extrahepatic cholangiocarcinomas (P = 0.007) and in large primary tumors (P = 0.001) with lymphovascular (P = 0.006) and perineural invasion (P = 0.049). Patients with cancer in the resection margin (R1) had a significantly shorter overall survival than those with resection margins free of tumor (R0) irrespective of the presence of BilIN (R0 vs R1; P < 0.001) or BilIN grade (BilIN-positive vs BilIN-negative, P = 0.6, and BilIN-1 + 2 vs BilIN-3, P = 0.58). BilIN is frequently found in the surgical margin of resection specimens of adenocarcinoma of the biliary tract. Hepatopancreatobiliary surgeons will be confronted with this recently defined entity when an intraoperative frozen section of a resection margin is requested. However, this diagnosis does not require additional resection and in the intraoperative evaluation of resection, the emphasis should remain on the detection of residual invasive tumor. PMID:25425476

  3. The Influence of Hospital Volume on Circumferential Resection Margin Involvement: Results of the Dutch Surgical Colorectal Audit.

    Gietelink, Lieke; Henneman, Daniel; van Leersum, Nicoline J; de Noo, Mirre; Manusama, Eric; Tanis, Pieter J; Tollenaar, Rob A E M; Wouters, Michel W J M

    2016-04-01

    This population-based study evaluates the association between hospital volume and CRM (circumferential resection margin) involvement, adjusted for other confounders, in rectal cancer surgery. A low hospital volume (CRM involvement (odds ratio = 1.54; 95% CI: 1.12-2.11). PMID:25790120

  4. Urinary Bladder Leiomyosarcoma: Primary Surgical Treatment.

    Slaoui, Hakim; Sanchez-Salas, Rafael; Validire, Pierre; Barret, Eric; Rozet, François; Galiano, Marc; Cathelineau, Xavier

    2014-07-01

    Cases of bladder leiomyosarcoma represent 0.1% of all nonurothelial tumors. We present a case report of a 73-year-old man who underwent a radical cystoprostatectomy for a high-grade bladder leiomyosarcoma with an ileal diversion. The patient recovered uneventfully and no surgical margins were verified in final pathology. Early follow-up at 3 months shows no signs of computed tomography recurrence and adequate adaptation to ileal diversion. Although bladder sarcomas were once thought to have a grim prognosis, recent studies suggest that adequate surgical treatment is able to achieve optimal cancer control outcomes. PMID:26839792

  5. Urinary Bladder Leiomyosarcoma: Primary Surgical Treatment

    Hakim Slaoui

    2014-07-01

    Full Text Available Cases of bladder leiomyosarcoma represent 0.1% of all nonurothelial tumors. We present a case report of a 73-year-old man who underwent a radical cystoprostatectomy for a high-grade bladder leiomyosarcoma with an ileal diversion. The patient recovered uneventfully and no surgical margins were verified in final pathology. Early follow-up at 3 months shows no signs of computed tomography recurrence and adequate adaptation to ileal diversion. Although bladder sarcomas were once thought to have a grim prognosis, recent studies suggest that adequate surgical treatment is able to achieve optimal cancer control outcomes.

  6. Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

    Moran, Meena S. [Department of Therapeutic Radiology, Yale School of Medicine, Yale University, New Haven, Connecticut (United States); Schnitt, Stuart J. [Department of Pathology, Harvard Medical School, Boston, Massachusetts (United States); Giuliano, Armando E. [Department of Surgery, Cedars Sinai Medical Center, Los Angeles, California (United States); Harris, Jay R. [Department of Radiation Oncology, Harvard Medical School, Boston, Massachusetts (United States); Khan, Seema A. [Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois (United States); Horton, Janet [Department of Radiation Oncology, Duke University Medical Center, Durham, North Carolina (United States); Klimberg, Suzanne [Department of Surgery, University of Arkansas for Medical Sciences, Fayetteville, Arkansas (United States); Chavez-MacGregor, Mariana [Department of Medical Oncology, University of Texas MD Anderson Cancer Center, Houston, Texas (United States); Freedman, Gary [Department of Radiation Oncology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania (United States); Houssami, Nehmat [School of Public Health, Sydney Medical School, University of Sydney, Sydney, New South Wales (Australia); Johnson, Peggy L. [Advocate in Science, Susan G. Komen, Wichita, Kansas (United States); Morrow, Monica, E-mail: morrowm@mskcc.org [Breast Service, Department of Surgery, Memorial Sloan-Kettering Cancer Center, New York, New York (United States)

    2014-03-01

    Purpose: To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs.

  7. Society of Surgical Oncology–American Society for Radiation Oncology Consensus Guideline on Margins for Breast-Conserving Surgery With Whole-Breast Irradiation in Stages I and II Invasive Breast Cancer

    Purpose: To convene a multidisciplinary panel of breast experts to examine the relationship between margin width and ipsilateral breast tumor recurrence (IBTR) and develop a guideline for defining adequate margins in the setting of breast conserving surgery and adjuvant radiation therapy. Methods and Materials: A multidisciplinary consensus panel used a meta-analysis of margin width and IBTR from a systematic review of 33 studies including 28,162 patients as the primary evidence base for consensus. Results: Positive margins (ink on invasive carcinoma or ductal carcinoma in situ) are associated with a 2-fold increase in the risk of IBTR compared with negative margins. This increased risk is not mitigated by favorable biology, endocrine therapy, or a radiation boost. More widely clear margins than no ink on tumor do not significantly decrease the rate of IBTR compared with no ink on tumor. There is no evidence that more widely clear margins reduce IBTR for young patients or for those with unfavorable biology, lobular cancers, or cancers with an extensive intraductal component. Conclusions: The use of no ink on tumor as the standard for an adequate margin in invasive cancer in the era of multidisciplinary therapy is associated with low rates of IBTR and has the potential to decrease re-excision rates, improve cosmetic outcomes, and decrease health care costs

  8. The differentiation of malignant and benign human breast tissue at surgical margins and biopsy using x-ray interaction data and Bayesian classification

    Worldwide, about 1.3 million women are diagnosed with breast cancer annually with an estimated 465,000 deaths. Accordingly, there is a need for high accuracy and speed in diagnosis of lesions suspected of being cancerous. This study assesses the interaction data collected from low energy x-rays within breast tissue samples. Trace element concentrations are assessed using x-ray fluorescence, as well as electron density, and molecular structure which are examined using incoherent and coherent scatter, respectively. Our work to date has shown that such data can provide a quantitative measure of certain tissue characterising parameters and hence, through appropriate modelling, could be used to classify samples for uses such as surgical margin detection and biopsy examination. The parameters used in this study for comparing the normal and tumour tissue sample populations are: levels of elements Ca, Cu, Fe, Br, Zn, Rb, K; the area, FWHM and amplitude from peaks fitted to the coherent scatter profile that are associated with fat, fibre and water content; the ratio of the Compton and coherent scatter peak area, FWHM and amplitude from the incoherent scatter profile. The novelty of the approach to this work lies in the fact that the classification process does not rely on one source of data but combines several measurements, the data from which in this application are modelled using a method based on Bayesian classification. The reliability of the classifications was assessed by its application to diagnostically known data that was not itself included in the thresholds determination. The results of the classification of over 70 breast tissue samples will be presented in this study. Bayesian modelling was carried out using selected significant parameters for classification resulting in 71% of normal tissue samples (n=35) and 66% of tumour tissue samples (n=35) being correctly classified when using all the samples. Bayesian classification using the same variables on all

  9. Risk and timing of biochemical recurrence in pT3aN0/Nx prostate cancer with positive surgical margin – A multicenter study

    Background and purpose: Positive surgical margins (PSM) after radical prostatectomy have been shown to be associated with impaired outcome. In pT3pN0 patients with PSM either immediate radiotherapy or clinical and biological monitoring followed by salvage radiotherapy is recommended by the latest guidelines of the European Association of Urology. Materials and methods: A retrospective, multicenter study of eight urological centers was conducted on 536 prostatectomy patients with pT3aN0/NxR1 tumors and no neoadjuvant/adjuvant therapy. A pathological re-review of all prostate specimens was performed. Association of clinical and pathological features with biochemical recurrence (BCR) was analyzed using univariate and multivariate analysis. Results: With 48 months median follow-up, BCR occurred in 39.7%. Preoperative PSA value, performance of pelvic lymph node dissection and Gleason score were significantly associated with BCR. In multivariate analysis, Gleason score was the only independent prognostic factor (p < 0.001) for BCR. Five-year BCR-free survival rates were 74%, 70%, 38%, and 51% with Gleason score 6, 3 + 4 = 7a, 4 + 3 = 7b, and 8–10, respectively. Conclusions: In pT3aN0/NxR1 patients with no adjuvant/neoadjuvant treatment, Gleason Score permits independent prediction of the risk for BCR. These findings could help to estimate and discuss the individual risk for BCR with our patients on an individual basis

  10. Motion tracking to enable pre-surgical margin mapping in basal cell carcinoma using optical imaging modalities: initial feasibility study using optical coherence tomography

    Duffy, M.; Richardson, T. J.; Craythorne, E.; Mallipeddi, R.; Coleman, A. J.

    2014-02-01

    A system has been developed to assess the feasibility of using motion tracking to enable pre-surgical margin mapping of basal cell carcinoma (BCC) in the clinic using optical coherence tomography (OCT). This system consists of a commercial OCT imaging system (the VivoSight 1500, MDL Ltd., Orpington, UK), which has been adapted to incorporate a webcam and a single-sensor electromagnetic positional tracking module (the Flock of Birds, Ascension Technology Corp, Vermont, USA). A supporting software interface has also been developed which allows positional data to be captured and projected onto a 2D dermoscopic image in real-time. Initial results using a stationary test phantom are encouraging, with maximum errors in the projected map in the order of 1-2mm. Initial clinical results were poor due to motion artefact, despite attempts to stabilise the patient. However, the authors present several suggested modifications that are expected to reduce the effects of motion artefact and improve the overall accuracy and clinical usability of the system.

  11. Mastectomy -- The Surgical Procedure

    Full Text Available ... Surgical Biopsies Assessing Margins after Breast Surgery Pathology Reports Pathology Reports Contents of a Pathology Report Factors That Affect Prognosis & Treatment Factors That Affect ...

  12. An Adequate Margin of Breast Conserving Surgery for Ductal Carcinoma in Situ: A Meta Analysis%乳腺导管原位癌保乳手术最佳切缘距离的系统评价

    叶长生; 姚广裕; 李学瑞; 陈睿婷

    2011-01-01

    much higher in ac - celerated phase/blast crisis. Conventional cytogenetic analysis is helpful to the diagnosis of CML and analysis of the pro -gress. On the basis of conventional cytogenetic analysis , FISH analysis technology can significantly promote the diagnosis rate and the accuracy in detection of chromosomal ahnormalities , and is effective in the detection of der (9) deletions.%@@ 1 文献来源 Dunne C, Burke JP, Morrow M, et al.Effect of margin status on local recurrence after breast conser-vation and radiation therapy for ductal carcinoma in situ[J].J Clin Oncol, 2009, 28 (10) : 1615-1620.

  13. Long-Term Treatment Outcome after Only Popliteal Lymph Node Dissection for Nodal Metastasis in Malignant Melanoma of the Heel: The Only “Interval Node” Dissection Can Be an Adequate Surgical Treatment

    Kentaro Tanaka

    2013-01-01

    Full Text Available We present a patient with malignant melanoma on his heel. Wide local excision was performed, along with sentinel lymph node biopsy of the inguinal and popliteal lesions. The primary site was clear of tumor at all margins; the inguinal nodes were negative, but the popliteal node was positive for metastatic melanoma. Only radical popliteal lymph node dissection was performed. The patient went on to receive adjuvant chemoimmunotherapy. There was no recurrence or complication until the long-term followup. Popliteal drainage from below the knee is uncommon, and the rate of popliteal-positive and inguinal-negative cases is estimated to be less than 1% of all melanomas. There is no established evidence about how to treat lymph nodes in these cases. Because we considered popliteal nodes as a regional, not interval, lymph node basin, only popliteal lymph node dissection was performed, and good postoperative course was achieved. The first site of drainage is the sentinel node, and the popliteal node can be a sentinel node. The inguinal node is not a sentinel node in all lower extremity melanomas. This case illustrates the importance of individual detailed investigation of lymphatic drainage patterns from foot to inguinal and popliteal nodes.

  14. The differentiation of malignant and benign human breast tissue at surgical margins and biopsy using x-ray interaction data and Bayesian classification

    Mersov, A.; Mersov, G.; Al-Ebraheem, A.; Cornacchi, S.; Gohla, G.; Lovrics, P.; Farquharson, M. J.

    2014-02-01

    Worldwide, about 1.3 million women are diagnosed with breast cancer annually with an estimated 465,000 deaths. Accordingly, there is a need for high accuracy and speed in diagnosis of lesions suspected of being cancerous. This study assesses the interaction data collected from low energy x-rays within breast tissue samples. Trace element concentrations are assessed using x-ray fluorescence, as well as electron density, and molecular structure which are examined using incoherent and coherent scatter, respectively. Our work to date has shown that such data can provide a quantitative measure of certain tissue characterising parameters and hence, through appropriate modelling, could be used to classify samples for uses such as surgical margin detection and biopsy examination. The parameters used in this study for comparing the normal and tumour tissue sample populations are: levels of elements Ca, Cu, Fe, Br, Zn, Rb, K; the area, FWHM and amplitude from peaks fitted to the coherent scatter profile that are associated with fat, fibre and water content; the ratio of the Compton and coherent scatter peak area, FWHM and amplitude from the incoherent scatter profile. The novelty of the approach to this work lies in the fact that the classification process does not rely on one source of data but combines several measurements, the data from which in this application are modelled using a method based on Bayesian classification. The reliability of the classifications was assessed by its application to diagnostically known data that was not itself included in the thresholds determination. The results of the classification of over 70 breast tissue samples will be presented in this study. Bayesian modelling was carried out using selected significant parameters for classification resulting in 71% of normal tissue samples (n=35) and 66% of tumour tissue samples (n=35) being correctly classified when using all the samples. Bayesian classification using the same variables on all

  15. The effect of interleukin-2 on canine peripheral nerve sheath tumours after marginal surgical excision: a double-blind randomized study

    Haagsman, Annika N; Witkamp, Astrid C S; Sjollema, Bart E; Kik, Marja J.L.; Kirpensteijn, Jolle

    2013-01-01

    BACKGROUND: The objective of this study was to evaluate the effect on outcomes of intraoperative recombinant human interleukin-2 injection after surgical resection of peripheral nerve sheath tumours. In this double-blind trial, 40 patients due to undergo surgical excision (

  16. A Novel Approach to the Management of Margin-positive DCIS in Nipple-sparing Mastectomy

    Hilton Becker, MD

    2014-11-01

    Full Text Available Summary: Nipple-sparing mastectomy (NSM is gaining acceptance as an oncologically sound and cosmetically superior mastectomy technique. Debate exists over the management of positive margins near the nipple-areola complex. This case report presents a novel approach to the management of margin-positive ductal carcinoma in situ in NSM. A 50-year-old white female with invasive ductal carcinoma underwent NSM. Intraoperative pathology indicated the presence of DCIS-positive retroareolar margins. Revision through a direct vertical nipple incision allowed for adequate surgical revision and pathologic evaluation of the retroareolar breast tissue while maintaining the nipple-areola skin and primary mastectomy incision. This novel approach ensures negative margins, allows superior cosmetic outcome, and improves patient autonomy in decision making. The technique may translate to NSM patients with positive retroareolar margins or false-negative margins.

  17. The amplification of c-erb-B2 in cancer-free surgical margins is a predictor of poor outcome in oral squamous cell carcinoma.

    Jelovac, D B; Tepavčević, Z; Nikolić, N; Ilić, B; Eljabo, N; Popović, B; Čarkić, J; Konstantinović, V; Vukadinović, M; Miličić, B; Milašin, J

    2016-06-01

    The tumour subtype, TNM classification, and histopathological data are sometimes not sufficient for understanding and assessing the behaviour of oral cancers. In an attempt to find additional markers of tumour biology and behaviour, this study sought to determine the incidence and consequently the relevance of c-erb-B2, c-Myc, and H-ras gene alterations in tumour-free margins of oral squamous cell carcinoma (OSCC). Fifty samples of OSCC were analyzed for c-erb-B2 and c-Myc amplification by real-time polymerase chain reaction and for H-ras point mutations by sequencing. A relatively high incidence of genetic lesions was detected: 22% of cases had c-erb-B2 and 30% had c-Myc amplification, whilst only 12% harboured H-ras mutations. Kaplan-Meier analysis and the log-rank test showed statistically significant differences in 5-year survival rates and relapse between patients with tumour margins positive for c-erb-B2 amplification and those with margins that were negative (P=0.002). H-ras and c-Myc alterations could not be associated with tumour behaviour. Molecular analysis of margins, targeting cancer genes, could identify additional, independent predictors of risk and outcome in OSCC. PMID:26708050

  18. Lands adequation in Antioquia Department

    The Colombian government programs concerning land management and adequation began since the fifties. When basic frameworks for irrigating, flood control and drainage were initially developed. Several entities have made huge investments in land adequation, that lead to the improvement of national agriculture in plain regions such as Tolima, Boyaca, Magdalena and Valle del Cauca. During the same period the region of Antioquia did not benefit from the projects, mainly due to the lack of government policies concerning land adequation. Finally, in 1983 the Himat launched the small irrigation national program, which gave solutions for water management in several countryside regions of Antioquia. Twenty-nine small water districts are now operating accounting for 3.759 ha which cover 1.510 households. Now days, thanks to the presence of more accurate policies, is the right time to improve irrigation, flood control and drainage towards to a substantial improvement in the Antioquia agricultural sector, that allows it to overcome the challenges of the next millennium. A project called Antioquia nos une 1998-2000 addresses the importance of promoting the right agricultural structure that ensures agricultural mechanization for sustainability and irrigation. On the other hand, it determines the main resources needed to promote the initiative and points out the importance of distributing them in the basis of the needs and problems of the communities

  19. [Marginalization and health. Introduction].

    Yunes, J

    1992-06-01

    sanitation. The concept of "epidemiologic heterogeneity" characterizes a pathological structure in which the poor suffer from illnesses transmitted in the air, contamination by human wastes, and malnutrition, and the wealthy suffer from disorders typical of the western industrialized countries. The poor also suffer from limited accessibility and poor quality of health care. In both Latin America and Europe, the groups most in need of adequate services have the least probability of receiving them. In most Latin American countries, the institutional configuration of health services reinforces the inequities and constitutes a mechanism of marginalization. The solution to the problem of marginalization i health and access to services will require political action, which in turn will need to be specifically adapted to the circumstances of each marginal group. PMID:1636942

  20. Margins in breast conserving surgery: A practice-changing process.

    Rubio, I T; Ahmed, M; Kovacs, T; Marco, V

    2016-05-01

    Margins in breast conserving surgery (BCS) have been a long standing subject debate. This largely arises from the absence of a consensus on what constitutes an adequate margin width, resulting in re-excision rates of 25-40% for close or positive margins and its consequent impact upon cosmesis, economic costs, patient dissatisfaction and lack of bearing on survival. Accepting that the increased risk of local recurrences (LR) has its influence on survival, the decrease in LR in BCS in the last decade have been motivated by better surgical techniques for assessing negative margins, use of targeted therapies and in general with the multimodal treatment in the management of breast cancer patients. Since the publication of the consensus guidelines on margins there has evolved a trend of changing attitudes towards re-excision. Surgeons are considering margins in the context of all factors including not only patient and tumor characteristics but also the regional and systemic treatment the patient is receiving. PMID:26880017

  1. Paramentação cirúrgica: avaliação de sua adequação para a prevenção de riscos biológicos em cirurgias - parte II: os componentes da paramentação Surgical scrub: evaluating its adequation for preventing Biological risks in surgeries. part II: the components of the surgical scrub

    Cibele Estanislau da C. Monteiro

    2000-06-01

    Full Text Available O estudo elaborou critérios de avaliação dos componentes da paramentação cirúrgica de hospitais do município de São Paulo. A maior dificuldade nessa elaboração deveu-se à inexistência de normas e consenso sobre a porosidade dos tecidos como barreira microbiológica e de contato com sangue e outros fluidos. Contudo, foi possível reconhecer aspectos positivos e problemáticos. Observou-se que existe semelhanças dos componentes entre os hospitais, no que se refere a modelo e tipo de tecido. As luvas foram os componentes com maior índice de adequação e os propés, os de maior índice de inadequação. O aspecto mais problemático referiu-se aos controles de aquisição e de reprocessamento dos componentes re-utilizáveis.The study elaborated evaluation patterns of the components of the surgical scrub in hospitals of the district of São Paulo. The most important difficulty was the lack of rules and consent on the types of the fabrics, as a microbiological and contact with blood and other fluids barrier. However, it was possible to identify positive and problematic aspects. It was observed that the components are similar among the hospitals, considering the design and the way of fabrics production. Gloves were the ones with the best quality results, while shootweares were the worst. The most problematic aspect was referred to the acquisition controls and the re-use process of the components.

  2. Surgical Guides (Patient-Specific Instruments for Pediatric Tibial Bone Sarcoma Resection and Allograft Reconstruction

    Laura Bellanova

    2013-01-01

    Full Text Available To achieve local control of malignant pediatric bone tumors and to provide satisfactory oncological results, adequate resection margins are mandatory. The local recurrence rate is directly related to inappropriate excision margins. The present study describes a method for decreasing the resection margin width and ensuring that the margins are adequate. This method was developed in the tibia, which is a common site for the most frequent primary bone sarcomas in children. Magnetic resonance imaging (MRI and computerized tomography (CT were used for preoperative planning to define the cutting planes for the tumors: each tumor was segmented on MRI, and the volume of the tumor was coregistered with CT. After preoperative planning, a surgical guide (patient-specific instrument that was fitted to a unique position on the tibia was manufactured by rapid prototyping. A second instrument was manufactured to adjust the bone allograft to fit the resection gap accurately. Pathologic evaluation of the resected specimens showed tumor-free resection margins in all four cases. The technologies described in this paper may improve the surgical accuracy and patient safety in surgical oncology. In addition, these techniques may decrease operating time and allow for reconstruction with a well-matched allograft to obtain stable osteosynthesis.

  3. Abortion - surgical

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... problem. Your pregnancy is harmful to your health (therapeutic abortion). The pregnancy resulted after a traumatic event such ...

  4. Abortion - surgical

    Suction curettage; Surgical abortion; Elective abortion - surgical; Therapeutic abortion - surgical ... Surgical abortion involves dilating the opening to the uterus (cervix) and placing a small suction tube into the uterus. ...

  5. Free left and right adequate semigroups

    Kambites, Mark

    2009-01-01

    Recent research of the author has given an explicit geometric description of free (two-sided) adequate semigroups and monoids, as sets of labelled directed trees under a natural combinatorial multiplication. In this paper we show that there are natural embeddings of each free right adequate and free left adequate semigroup or monoid into the corresponding free adequate semigroup or monoid. The corresponding classes of trees are easily described and the resulting geometric representation of fr...

  6. Real Time Investments with Adequate Portfolio Theory

    Alina Kvietkauskienė

    2015-02-01

    Full Text Available The objective of this paper is to identify investment decision makingschemes using the adequate portfolio model. This approach can be employed to project investment in stocks, using the opportunities offered by the markets and investor intelligence. It was decided to use adequate portfolio theory for investment decision making, simulation of financial markets, and optimisation of utility function. The main conclusion of article suggests investigating return on individual portfolio level. Real investment is a way to make sure of the soundness of applicable strategies.

  7. Justice and Surgical Innovation: The Case of Robotic Prostatectomy.

    Hutchison, Katrina; Johnson, Jane; Carter, Drew

    2016-09-01

    Surgical innovation promises improvements in healthcare, but it also raises ethical issues including risks of harm to patients, conflicts of interest and increased injustice in access to health care. In this article, we focus on risks of injustice, and use a case study of robotic prostatectomy to identify features of surgical innovation that risk introducing or exacerbating injustices. Interpreting justice as encompassing matters of both efficiency and equity, we first examine questions relating to government decisions about whether to publicly fund access to innovative treatments. Here the case of robotic prostatectomy exemplifies the difficulty of accommodating healthcare priorities such as improving the health of marginalized groups. It also illustrates challenges with estimating the likely long-term costs and benefits of a new intervention, the difficulty of comparing outcomes of an innovative treatment to those of established treatments, and the further complexity associated with patient and surgeon preferences. Once the decision has been made to fund a new procedure, separate issues of justice arise at the level of providing care to individual patients. Here, the case of robotic prostatectomy exemplifies how features of surgical innovation, such as surgeon learning curves and the need for an adequate volume of cases at a treatment centre, can exacerbate injustices associated with treatment cost and the logistics of travelling for treatment. Drawing on our analysis, we conclude by making a number of recommendations for the just introduction of surgical innovations. PMID:26871997

  8. Less invasive surgical treatment of traumatic thoracolumbar fractures

    Verlaan, J.J.

    2004-01-01

    Less invasive surgical treatment of traumatic thoracolumbar fractures. In this thesis various strategies were employed to evaluate the posibilities of reducing the invasiveness of the surgical treatment of traumatic thoracolumbar fractures. A systematic review of the literature suggested that adequ

  9. Volume and geometry of homogeneously adequate knots

    Bartholomew, Paige; McQuarrie, Shane; Purcell, Jessica S.; Weser, Kai

    2014-01-01

    We bound the hyperbolic volumes of a large class of knots and links, called homogeneously adequate knots and links, in terms of their diagrams. To do so, we use the decomposition of these links into ideal polyhedra, developed by Futer, Kalfagianni, and Purcell. We identify essential product disks in these polyhedra.

  10. Adequate supervision for children and adolescents.

    Anderst, James; Moffatt, Mary

    2014-11-01

    Primary care providers (PCPs) have the opportunity to improve child health and well-being by addressing supervision issues before an injury or exposure has occurred and/or after an injury or exposure has occurred. Appropriate anticipatory guidance on supervision at well-child visits can improve supervision of children, and may prevent future harm. Adequate supervision varies based on the child's development and maturity, and the risks in the child's environment. Consideration should be given to issues as wide ranging as swimming pools, falls, dating violence, and social media. By considering the likelihood of harm and the severity of the potential harm, caregivers may provide adequate supervision by minimizing risks to the child while still allowing the child to take "small" risks as needed for healthy development. Caregivers should initially focus on direct (visual, auditory, and proximity) supervision of the young child. Gradually, supervision needs to be adjusted as the child develops, emphasizing a safe environment and safe social interactions, with graduated independence. PCPs may foster adequate supervision by providing concrete guidance to caregivers. In addition to preventing injury, supervision includes fostering a safe, stable, and nurturing relationship with every child. PCPs should be familiar with age/developmentally based supervision risks, adequate supervision based on those risks, characteristics of neglectful supervision based on age/development, and ways to encourage appropriate supervision throughout childhood. PMID:25369578

  11. Surgical Exposure

    Hendra Chandra

    2015-01-01

    Surgical exposure is a surgical method to expose mucous or bone which prevent delayed or unerupted permanent crown teeth, in order to provide normal eruption and to prevent malocclusion. Surgical exposure is usually carried out on maxillary caninces as they have higher incidence of delayed eruption. Nevertheless, this procedure can also be performed on other teeth. For patient management, this procedure need cooperation betweent oral surgeon and orthodontist.

  12. Study Suggests Smaller Melanoma Excision Margins May Be Option for Some Patients

    A randomized controlled trial of patients with stage IIA–C cutaneous melanoma thicker than 2-mm found that a 2-cm surgical resection margin is sufficient and is as safe for patients as a 4-cm margin.

  13. Iron absorption from adequate Filipinos meals

    Iron absorption from adequate Filipino meals representing the three major island groups of the Philippines (Luzon, Visayas, and Mindanao) was studied using double isotope extrinsic tag method. Mean iron absorption of the one-day meal for Metro Manila was 6.6 +- 1.26%. Central Visayas, 6.3 +- 1.15% and Southern Mindanao, 6.4 +- 1.19%. Comparison between meals (breakfast, lunch, dinner) for each region as well as one-day meal for the three regions showed no significant differences (P>0.01). Correlation tests done between iron absorption and the following iron enhancers: ascorbic acid, amount of fish, meat or poultry; and inhibitors: phytic acid and tannic acid, did not give significant results. The overall average of 6.4 +- 1.20% may be used as the iron absorption level from an adequate Filipino meal. This value can be considered as one of the bases for arriving at recommended dietary allowances for iron among Filipinos instead of the 10% iron absorption assumed in 1976. (Auth.). 21 refs.; 3 tabs.; 3 annexes

  14. Iron absorption from adequate Filipino meals

    Iron absorption from adequate Filipino meals representing the three major island groups of the Philippines (Luzon, Visayas and Mindanao) was studied using double isotope extrinsic tag method. Mean iron absorption of the one-day meal for Metro Manila was 6.6 ± 1.26%, Central Visayas, 6.3 ± 1.15% and Southern Mindanao, 6.4 ± 1.19%. Comparison between meals (breakfast, lunch, dinner) for each region as well as one-day meal for the three regions showed no significant differences (P > .01). Correlation tests done between iron absorption and the following iron enhancers: ascorbic acid, amount of fish, meat or poultry and inhibitors: phytic acid and tannic acid did not give significant results. The overall bar x of 6.4 ± 1.20% may be used as the non-heme iron absorption level from an adequate Filipino meal. This value can be considered as one of the bases for arriving at recommended dietary allowances for iron among Filipinos instead of the 10% iron absorption assumed in 1976

  15. Surgical Assisting

    ... specific training over and above a degree in science, nursing, physician assisting, or another health profession. Prerequisites . Recommended eligibility requirements for admission into a surgical assisting program are: Bachelor of Science degree (or higher) Associate degree in an allied ...

  16. Is a vegetarian diet adequate for children.

    Hackett, A; Nathan, I; Burgess, L

    1998-01-01

    The number of people who avoid eating meat is growing, especially among young people. Benefits to health from a vegetarian diet have been reported in adults but it is not clear to what extent these benefits are due to diet or to other aspects of lifestyles. In children concern has been expressed concerning the adequacy of vegetarian diets especially with regard to growth. The risks/benefits seem to be related to the degree of restriction of he diet; anaemia is probably both the main and the most serious risk but this also applies to omnivores. Vegan diets are more likely to be associated with malnutrition, especially if the diets are the result of authoritarian dogma. Overall, lacto-ovo-vegetarian children consume diets closer to recommendations than omnivores and their pre-pubertal growth is at least as good. The simplest strategy when becoming vegetarian may involve reliance on vegetarian convenience foods which are not necessarily superior in nutritional composition. The vegetarian sector of the food industry could do more to produce foods closer to recommendations. Vegetarian diets can be, but are not necessarily, adequate for children, providing vigilance is maintained, particularly to ensure variety. Identical comments apply to omnivorous diets. Three threats to the diet of children are too much reliance on convenience foods, lack of variety and lack of exercise. PMID:9670174

  17. Surgical adhesives

    I. A. THOMAZINI-SANTOS

    2001-12-01

    Full Text Available The authors have performed a literature review of surgical adhesives, such as cyanoacrylate, collagen gelatin, and fibrin glue. They have included different types of commercial and non-commercial fibrin sealants and have reported on the different components in these adhesives, such as fibrinogen, cryoprecipitate, bovine thrombin, and thrombin-like fraction of snake venom.

  18. In Vivo Reflectance Confocal Microscopy of Basal Cell Carcinoma: Feasibility of Preoperative Mapping of Cancer Margins

    Pan, Zhan-Yan; Lin, Jing-Ran; Cheng, Ting-Ting; Wu, Jia-Qiang; Wu, Wen-Yu

    2012-01-01

    Reflectance confocal microscopy (RCM) images skin at cellular resolution and has shown utility for the diagnosis of nonmelanoma skin cancer in vivo. It has the potential to define lesion margins before surgical therapy. Objectives To investigate the feasibility of RCM in defining the margins of basal cell carcinoma before surgery. Methods The margins of 10 lesions were evaluated using RCM. Biopsies of the margins were used to confirm the results. A protocol was constructed to define margins. ...

  19. Multivariate Analysis on Post-conization Positive Surgical Margin in Patients with Stage Ⅲ Cervical Intraepithelial Neoplasia%宫颈上皮内瘤变Ⅲ锥切术后病理切缘阳性的多因素分析

    郭文萍; 郭红燕; 王静

    2011-01-01

    Objective To assess the high-risk factors associated with conization margin status and management options in patients with cervical intraepithelial neoplasia Ⅲ ( CIN Ⅲ ). Methods A retrospective analysis on 442 patients with CIN Ⅲ who underwent conization between January 2004 and April 2010 in our hospital. Postoperative pathological analysis showed positive surgical margin in 41 cases ( positive group ), and negative margin in the other 401 cases ( negative group ). Results Binary logistic analysis showed that positive margin is correlated with severe cervical erosion ( OR = 3. 438, 95% CI = 1. 323 - 8. 933 ), in situ carcinoma ( OR =3. 792, 95% CI = 1. 594 -9. 022) , involvement of the glands ( OR = 3. 940, 95% CI = 1. 724 - 9. 004 ) , and > 3 lesions (OR =5. 083, 95% CI =2. 192- 11. 787 ). In our patients, the 21 cases of positive margin received a second surgery, after which the rate of residual lesion was 38.1% (8/21), which was similar to that in the negative group ( 14.8% , 8/54; Z = 1. 898, P =0.058). A follow-up was achieved in 20 of the 21 positive patients, during the follow-up, 3 patients showed recurrence or persisitence of the lesion ( 15.0% ); the rate was significantly higher than that in the negative group ( 1.7% , 3/241, Z = 2. 799, P = 0.005 ).Conclusions More than 3 lesions, glands involvement, in situ carcinoma, and cervical erosion are high-risk factors of positive surgical margin in patients with CIN Ⅲ. The positive margin is associated with recurrence/persistence. If re-conization is technically impossible, simple hysterectomy is the treatment option for the patients with positive margins. The patients with CIN Ⅲ should be followed up closely, especially for those with positive margins.%目的 探讨影响宫颈上皮内瘤变Ⅲ(cervical intraepithelial neoplasia Ⅲ,CINⅢ)锥切病理切缘阳性的高危因素及进一步处理的选择. 方法 回顾性分析我院2004年1月~2010年4月442例因CIN Ⅲ住

  20. Destruction of Radiation-Resistant Micro-Organisms on Surgical Sutures by 60Co-Irradiation Under Manufacturing Conditions

    Any process adopted for producing sterile medical products must be demonstrated to produce sterility under reproducible manufacturing conditions. In addition, a margin of safety is required to guard against non-sterility due to undetected departures from standard operating practices. This study reports the results of exposure to 60Co γ-rays of surgical sutures intentionally contaminated with known radiation-resistant organisms, including St. faecalis, M. radiodurans and B. pumilus, under normal manufacturing conditions. Additionally, the results of over 20 000 sterility tests under prolonged incubation are reported to indicate that routine sterility testing of radiation-sterilized sutures is adequate to detect radiation survivors. The nature and level of the natural contaminants of surgical sutures before sterilization is tabulated and discussed from the standpoint of the safety factor inherent in the process. (author)

  1. Surgical treatments for osteoarthritis.

    de l'Escalopier, Nicolas; Anract, Philippe; Biau, David

    2016-06-01

    There are two main surgical treatments for osteoarthritis: conservative treatments, where the damaged cartilage is left in place, and radical treatments, where the cartilage is replaced by an artificial endoprosthesis; this latter procedure is termed joint arthroplasty. These treatments are only offered to symptomatic patients. Arthrodesis is yet another surgical intervention in cases of osteoarthritis. It will sacrifice the joint's articular function and is performed on small osteoarthritic joints, such as wrists and ankles, for instance. Osteoarthritis symptoms are usually the consequence of an imbalance between the load applied to a joint and the surface available to support that load. Therefore, conservative treatments will either tend to decrease the load exerted on the joint, such as in a tibial valgus osteotomy for instance, or to improve the articular surface supporting that load. Sometimes, both can be provided at the same time; the peri-acetabular osteotomy for hip dysplasia is an example of such a procedure. Conservative treatments are usually offered to young patients in order to delay, if not avoid, the need for a joint prosthesis. They are usually performed before osteoarthritis appears or at an early stage. Joint arthroplasties have overwhelmingly excellent functional results and today's research is directed towards providing rapid recovery, very long-term stability, and the assurance of a good functionality in extreme conditions. However, complications with joint arthroplasties can be serious with little, if any, reasonable salvage solution. Therefore, these procedures are offered to patients who have failed adequate medical treatment measures. PMID:27185463

  2. Continental margins: linking ecosystems

    Kelly-Gerreyn, Boris; Rabalais, Nancy; Middelburg, Jack; Roy, Sylvie; Liu, Kon-Kee; Thomas, Helmut; Zhang, Jing

    2008-01-01

    Impacts of Global, Local and Human Forcings on Biogeochemical Cycles and Ecosystems, IMBER/LOICZ Continental Margins Open Science Conference; Shanghai, China, 17–21 September 2007; More than 100 scientists from 25 countries came together to address global, regional, local, and human pressures interactively affecting continental margin biogeochemical cycles, marine food webs, and society. Continental margins cover only 12% of the global ocean area yet account for more than 30% of global oceani...

  3. Stationary surgical smoke evacuation systems.

    2001-03-01

    Two types of systems are available for evacuating the surgical smoke created by electrosurgery and laser surgery: portable and stationary surgical smoke evacuation systems. While portable systems dominate the market today, stationary systems are an alternative worth considering--even though they are still in their infancy, with fewer than 90 systems installed to date. Stationary systems represent a major commitment on the part of the healthcare facility. Several system components must be installed as part of the physical plant (for instance, within the walls), making the system a permanent fixture in the surgical suite. Installation of these systems is often carried out during building construction or major renovation--although the systems can be cost-effective even if no renovations are planned. For this Evaluation, we tested three stationary systems. All three are adequate to capture surgical smoke and evacuate it from the operating room. These systems are easy to use, are quietter than their portable counterparts, and require minimal user maintenance. They represent an excellent option for most hospitals actively evacuating surgical smoke. In this article, we discuss the factors to consider when selecting from among these systems. We also offer guidance on choosing between stationary systems and portable ones. PMID:11321758

  4. Indian Ocean margins

    Naqvi, S.W.A.

    stream_size 10 stream_content_type text/plain stream_name Carbon_Nutrient_Fluxes_Cont_Margins_2010_171.pdf.txt stream_source_info Carbon_Nutrient_Fluxes_Cont_Margins_2010_171.pdf.txt Content-Encoding ISO-8859-1 Content-Type text...

  5. "Something Adequate"? In Memoriam Seamus Heaney, Sister Quinlan, Nirbhaya

    Parker, Jan

    2014-01-01

    Seamus Heaney talked of poetry's responsibility to represent the "bloody miracle", the "terrible beauty" of atrocity; to create "something adequate". This article asks, what is adequate to the burning and eating of a nun and the murderous gang rape and evisceration of a medical student? It considers Njabulo…

  6. 40 CFR 716.25 - Adequate file search.

    2010-07-01

    ... 40 Protection of Environment 30 2010-07-01 2010-07-01 false Adequate file search. 716.25 Section... ACT HEALTH AND SAFETY DATA REPORTING General Provisions § 716.25 Adequate file search. The scope of a person's responsibility to search records is limited to records in the location(s) where the...

  7. 9 CFR 305.3 - Sanitation and adequate facilities.

    2010-01-01

    ... 9 Animals and Animal Products 2 2010-01-01 2010-01-01 false Sanitation and adequate facilities. 305.3 Section 305.3 Animals and Animal Products FOOD SAFETY AND INSPECTION SERVICE, DEPARTMENT OF... OF VIOLATION § 305.3 Sanitation and adequate facilities. Inspection shall not be inaugurated if...

  8. NASA Smart Surgical Probe Project

    Mah, Robert W.; Andrews, Russell J.; Jeffrey, Stefanie S.; Guerrero, Michael; Papasin, Richard; Koga, Dennis (Technical Monitor)

    2002-01-01

    Information Technologies being developed by NASA to assist astronaut-physician in responding to medical emergencies during long space flights are being employed for the improvement of women's health in the form of "smart surgical probe". This technology, initially developed for neurosurgery applications, not only has enormous potential for the diagnosis and treatment of breast cancer, but broad applicability to a wide range of medical challenges. For the breast cancer application, the smart surgical probe is being designed to "see" a suspicious lump, determine by its features if it is cancerous, and ultimately predict how the disease may progress. A revolutionary early breast cancer detection tool based on this technology has been developed by a commercial company and is being tested in human clinical trials at the University of California at Davis, School of Medicine. The smart surgical probe technology makes use of adaptive intelligent software (hybrid neural networks/fuzzy logic algorithms) with the most advanced physiologic sensors to provide real-time in vivo tissue characterization for the detection, diagnosis and treatment of tumors, including determination of tumor microenvironment and evaluation of tumor margins. The software solutions and tools from these medical applications will lead to the development of better real-time minimally-invasive smart surgical probes for emergency medical care and treatment of astronauts on long space flights.

  9. Organizing marginalized workers.

    Taylor, A K

    1999-01-01

    Figures from the U.S. Department of Labor show that low-wage or marginalized workers are more likely to be injured on the job and suffer more work-related medical conditions than better-paid workers. Despite an increasingly hostile organizing climate, market globalization, and corporate downsizing, significant progress has been made in organizing marginalized workers. A multifaceted, comprehensive organizing strategy, incorporating union-building strategies that include (but are not limited to) safety and health, must be used by unions to successfully organize marginalized workers and obtain the first contract. PMID:10378982

  10. Immediate implant post-surgical complications.

    Ibbott, C G; Oles, R D

    1995-03-01

    Immediate surgical implants provide a convenient means of replacing missing teeth without requiring hard tissue reduction of restoration-free potential fixed partial denture abutments. Although the procedure is described as "predictable," complications and failures do occur. This report presents four cases of immediate implant complications and their management, and discusses possible causes of the untoward results. Careful pre-operative planning, adequate surgical technique and post-surgical management, timely and suitable loading, and meticulous hygiene maintenance can serve to minimize implant complications and failures. The prospective immediate implant patient must be provided with sufficient information to allow informed consent to be given. Minimal requirements are a description of the procedures in terms the patient can understand, an explanation of potential risks and complications, and adequate disclosure of information about alternative therapies. PMID:7773849

  11. Southern African continental margin: Dynamic processes of a transform margin

    N. Parsiegla; Jacek Stankiewicz; Gohl, K.; Trond Ryberg; G. Uenzelmann-Neben;  

    2009-01-01

    Dynamic processes at sheared margins associated with the formation of sedimentary basins and marginal ridges are poorly understood. The southern African margin provides an excellent opportunity to investigate the deep crustal structure of a transform margin and to characterize processes acting at these margins by studying the Agulhas-Falkland Fracture Zone, the Outeniqua Basin, and the Diaz Marginal Ridge. To do this, we present the results of the combined seismic land-sea experiments of the ...

  12. Pickering seismic safety margin

    A study was conducted to recommend a methodology for the seismic safety margin review of existing Canadian CANDU nuclear generating stations such as Pickering A. The purpose of the seismic safety margin review is to determine whether the nuclear plant has sufficient seismic safety margin over its design basis to assure plant safety. In this review process, it is possible to identify the weak links which might limit the seismic performance of critical structures, systems and components. The proposed methodology is a modification the EPRI (Electric Power Research Institute) approach. The methodology includes: the characterization of the site margin earthquake, the definition of the performance criteria for the elements of a success path, and the determination of the seismic withstand capacity. It is proposed that the margin earthquake be established on the basis of using historical records and the regional seismo-tectonic and site specific evaluations. The ability of the components and systems to withstand the margin earthquake is determined by database comparisons, inspection, analysis or testing. An implementation plan for the application of the methodology to the Pickering A NGS is prepared

  13. Marginal Zone Lymphoma

    ... alphabetical order): • Bendamustine (Treanda) • Bortezomib (Velcade) • Chemotherapy • Fludarabine (Fludara) • Radiation (low-dose) • Rituximab (Rituxan) • Surgical excision Treatment Options for Non-gastric ...

  14. Electronic surgical record management.

    Rockman, Justin

    2010-01-01

    This paper explores the challenges surgical practices face in coordinating surgeries and how the electronic surgical record management (ESRM) approach to surgical coordination can solve these problems and improve efficiency. Surgical practices continue to experience costly inefficiencies when managing surgical coordination. Application software like practice management and electronic health record systems have enabled practices to "go digital" for their administrative, financial, and clinical data. However, surgical coordination is still a manual and labor-intensive process. Surgical practices need to create a central and secure record of their surgeries. When surgical data are inputted once only and stored in a central repository, the data are transformed into active information that can be outputted to any form, letter, calendar, or report. ESRM is a new approach to surgical coordination. It enables surgical practices to automate and streamline their processes, reduce costs, and ensure that patients receive the best possible care. PMID:20480775

  15. From Borders to Margins

    Parker, Noel

    2009-01-01

    upon Deleuze's philosophy to set out an ontology in which the continual reformulation of entities in play in ‘post-international' society can be grasped.  This entails a strategic shift from speaking about the ‘borders' between sovereign states to referring instead to the ‘margins' between a plethora...... of entities that are ever open to identity shifts.  The concept of the margin possesses a much wider reach than borders, and focuses continual attention on the meetings and interactions between a range of indeterminate entities whose interactions may determine both themselves and the types of entity...

  16. Surgical treatment for pulmonary emphysema.

    Delarue, N C; Woolf, C R; Sanders, D E; Pearson, F G; Henderson, R D; Cooper, J D; Nelems, J M

    1977-05-01

    Three in-vivo observations stimulated interest in surgical treatment for emphysema: (a) the destructive changes are rarely generalized, (b) the central portions of the lungs are frequently less seriously affected, and (c) marginal folding produces obstructive change in the more normal lung tissue. If destroyed avascular space-occupying areas can be removed, the compressed lung tissue may be stretched to fill pleural space in a functionally effective fashion. Residual elastic tissue will them maintain patency of terminal bronchioles. Preoperatively the extent of the destructive change can be defined most accurately by pulmonary angiography, and zones of functioning capilary circulation can be identified. Forty-seven patients with multifocal space-occupying emphysematous change have been treated surgically. The postoperative mortality was 21% but worthwhile long-term improvement has been obtained in 45% of patients presenting with disabling dyspnea. In these patients, surgical treatment warrants consideration if significant space occupation accompanies the bullous disease, provided alveolar vascularization can be demonstrated in the compressed adjacent normal lung tissue. Limited resections that preserve all vascularized and potentially functioning lung tissue are preferable. It is essential that obliteration of the hemithorax be obtained promptly in view of the high incidence of postoperative complications requiring secondary operative procedures, if 'leaks' and residual spaces are allowed to persist. Postoperative care in a respiratory intensive care unit is mandatory. PMID:870155

  17. Marginally Deformed Starobinsky Gravity

    Codello, A.; Joergensen, J.; Sannino, Francesco;

    2015-01-01

    We show that quantum-induced marginal deformations of the Starobinsky gravitational action of the form $R^{2(1 -\\alpha)}$, with $R$ the Ricci scalar and $\\alpha$ a positive parameter, smaller than one half, can account for the recent experimental observations by BICEP2 of primordial tensor modes....

  18. Margins in radiotherapy

    As part of the treatment prescription procedure, one has to prescribe in anatomical terms any GTV (Gross Tumor Volume) according to the general TNM-rules as well as any other tissues that are to be treated for presumed subclinical diseases. These prescriptions of one or several Clinical Target Volumes (CTVs) are based on general oncological principles, and are not related to the treatment modality. If external beam radiotherapy is being used, one has to consider special problems related to different geometric inaccuracies and uncertainties, which can be both intrafractional and interfractional. Such inaccuracies and uncertainties are due to either the position, shape and size of the patient/tissues in relation to a fix point, or to variations in beam geometry. The two different types of variations may or may not co-variate. A margin or margins for these uncertainties has to be included in the dose planning procedure, which then will evaluate a static situation, representing the CTV(s) plus geometric ''safety'' margin(s) (Planning Target Volume, PTV) and in fact not the true clinical situation. The dose distribution arrived at for this static representation will however have to be considered as representative for the CTV. This presents of course a dilemma, but one has to accept a reasonable compromise. There is no general rule on the size of the different geometric uncertainties or how they should be added up. Individual evaluations are needed. (author)

  19. "We call ourselves marginalized"

    Jørgensen, Nanna Jordt

    2014-01-01

    In recent decades, indigenous knowledge has been added to the environmental education agenda in an attempt to address the marginalization of non-western perspectives. While these efforts are necessary, the debate is often framed in terms of a discourse of victimization that overlooks the agency o...

  20. Simulation-based surgical education.

    Evgeniou, Evgenios; Loizou, Peter

    2013-09-01

    The reduction in time for training at the workplace has created a challenge for the traditional apprenticeship model of training. Simulation offers the opportunity for repeated practice in a safe and controlled environment, focusing on trainees and tailored to their needs. Recent technological advances have led to the development of various simulators, which have already been introduced in surgical training. The complexity and fidelity of the available simulators vary, therefore depending on our recourses we should select the appropriate simulator for the task or skill we want to teach. Educational theory informs us about the importance of context in professional learning. Simulation should therefore recreate the clinical environment and its complexity. Contemporary approaches to simulation have introduced novel ideas for teaching teamwork, communication skills and professionalism. In order for simulation-based training to be successful, simulators have to be validated appropriately and integrated in a training curriculum. Within a surgical curriculum, trainees should have protected time for simulation-based training, under appropriate supervision. Simulation-based surgical education should allow the appropriate practice of technical skills without ignoring the clinical context and must strike an adequate balance between the simulation environment and simulators. PMID:23088646

  1. Mastectomy -- The Surgical Procedure

    Full Text Available ... areola are also removed. The surgeon closes the skin with stitches and attaches a temporary tube so ... the margin closest to the chest wall) or skin margin contains cancer cells. In these cases, more ...

  2. Significance of margin in nephron sparing surgery for renal cell carcinoma of 4 cm or less

    LI Quan-lin; GUAN Hong-wei; WANG Fa-peng; JIANG Tao; WU Hong-chang; SONG Xi-shuang

    2008-01-01

    Background Current surgical practice for nephron sparing surgery allows at least 1 cm margin of normal tissue around the tumour.However,recent studies show that the width of the margin is not important.even simple enucleation is as effective as partial nephrectomy.We explored whether margin size has significant jmpacts on clinical outcomes in nephron sparing surgery for renal cell carcinoma of 4 cm or less.Methods Between 1998 and 2006,115 patients with sporadic,pathologically confirmed,renaI cell carcinoma 4 cm or Iass(T1a)and normal contralateral kidney were treated by nephron sparing surgery using a margin less than 5 mm.The surgical margin status was evaluated from frozen and permanent paraffin Sections.Results Mean and median tumour diameter were 3.3 cm and 3.5 cm(range 1.0-4.0).The mean margin width was 2.2 mm(median 2.0,range 0-6).In addition,114 cases had margins 5 mm or less(99.1%),97 cases(84.3%)had margin 3 mm or Iess,and 26 cases had margin zero(22.6%).None of the patients had positive surgical margins.No patients died during follow-up(mean 65 months).There were no any major surgical complications and no distant metastasis was detected.Local recurrence was detected in one case(0.9%)at a different site of the kidney.Conclusions For early Iocalized renaI cell carcinoma of 4 cm or Iess,as long as tumour is completely excised,the size of margin in nephron sparing surgery is not important.Nephron sparing surgery with 5 mm margin is enough for tumour control.It provides excellent renaI function preservation.favourable Iong term progression free survival and is not associated with an increased risk of Iocal recurrence.

  3. 13 CFR 108.200 - Adequate capital for NMVC Companies.

    2010-01-01

    ... Companies. 108.200 Section 108.200 Business Credit and Assistance SMALL BUSINESS ADMINISTRATION NEW MARKETS VENTURE CAPITAL (âNMVCâ) PROGRAM Qualifications for the NMVC Program Capitalizing A Nmvc Company § 108.200 Adequate capital for NMVC Companies. You must meet the requirements of §§ 108.200-108.230 in order...

  4. Assessing Juvenile Sex Offenders to Determine Adequate Levels of Supervision.

    Gerdes, Karen E.; And Others

    1995-01-01

    This study analyzed the internal consistency of four inventories used by Utah probation officers to determine adequate and efficacious supervision levels and placement for juvenile sex offenders. Three factors accounted for 41.2 percent of variance (custodian's and juvenile's attitude toward intervention, offense characteristics, and historical…

  5. Is the Marketing Concept Adequate for Continuing Education?

    Rittenburg, Terri L.

    1984-01-01

    Because educators have a social responsibility to those they teach, the marketing concept may not be adequate as a philosophy for continuing education. In attempting to broaden the audience for continuing education, educators should consider a societal marketing concept to meet the needs of the educationally disadvantaged. (SK)

  6. Urogynecologic Surgical Mesh Implants

    ... be used for urogynecologic procedures, including repair of pelvic organ prolapse (POP) and stress urinary incontinence (SUI). It is ... associated with surgical mesh for transvaginal repair of pelvic organ prolapse 513(e) Proposed Order for Reclassification of Surgical ...

  7. Abortion - surgical - aftercare

    ... this page: //medlineplus.gov/ency/patientinstructions/000658.htm Abortion - surgical - aftercare To use the sharing features on ... please enable JavaScript. You have had a surgical abortion. This is a procedure that ends pregnancy by ...

  8. Optimizing surgical f

    Sabry Mohamed Amin

    2016-07-01

    Conclusions: In our study both dexmedetomidine and esmolol were effective in reducing MABP, and lowering the heart rate providing dry surgical field and ensured good surgical condition during cochlear implant surgery in pediatric patients.

  9. Surgical Ventricular Reconstruction

    Full Text Available ... is being studied currently in the largest surgical trial ever conducted by the National Institutes of Health ... Heart and Lung Blood Institute, called the STITCH Trial, the Surgical Treatment for Ischemic Heart Failure. And ...

  10. Strategies for managing margins.

    2012-08-01

    Potential Medicare and Medicaid reimbursement cuts have made it critical for home health agencies to manage their gross and net operating profit margins. Agencies need to develop tools to analyze their margins and make sure they are following best practices. Try as you may, your agency might still face the question, "Why am I not meeting my budget?" Get some answers in this session from David Berman and Andrea L. Devoti. Berman is a principal at Simione Healthcare Consultants in Hamden, CT, where he is responsible for merchant acquisitions, business valuation due diligence, and oversight of the financial monitor benchmarking tool besides serving as interim chief financial officer. Devoti is chairman of the NAHC board and President & CEO of Neighborhood Health Visiting Nurse Association in West Chester PA. PMID:23074756

  11. Actively stressed marginal networks

    Sheinman, M; MacKintosh, F C

    2012-01-01

    We study the effects of motor-generated stresses in disordered three dimensional fiber networks using a combination of a mean-field, effective medium theory, scaling analysis and a computational model. We find that motor activity controls the elasticity in an anomalous fashion close to the point of marginal stability by coupling to critical network fluctuations. We also show that motor stresses can stabilize initially floppy networks, extending the range of critical behavior to a broad regime of network connectivities below the marginal point. Away from this regime, or at high stress, motors give rise to a linear increase in stiffness with stress. Finally, we demonstrate that our results are captured by a simple, constitutive scaling relation highlighting the important role of non-affine strain fluctuations as a susceptibility to motor stress.

  12. ACHIEVEMENT FOR WIRELESS COMMUNICATION USING ADEQUATE MLTI-THREDING ARCHITECTURES

    Rajeev Ranjan

    2015-08-01

    Full Text Available A major role is played in the layout and evaluation of any empirical wireless structure to manifest is the goal of this paper that counterfeit mode architectures affect counterfeit conduct, regarding structure accomplishment metrics, essentially and therefore, the excellent architecture should be explored in order to accomplish the most accurate and reliable results. It is found that the most analytical factors it is found that that actuate counterfeit mode accomplishment are counterfeit time, structure event organizing and grade of adequate. It is, also, found that counterfeit time in relation to event existence in the real structure along with the usage of modern architectural concepts such as multi-interweave technology complement analytical issues too in the advancement of an adequate counterfeit organization for wireless communications. In order to evaluate the above findings an extensive empirical review has been demeanored analysising several distinct events counterfeit organizations towards presenting the relation between channel designing collections, counterfeit time and structure accomplishment.

  13. Arabidopsis: An Adequate Model for Dicot Root Systems?

    Zobel, Richard W.

    2016-01-01

    The Arabidopsis root system is frequently considered to have only three classes of root: primary, lateral, and adventitious. Research with other plant species has suggested up to eight different developmental/functional classes of root for a given plant root system. If Arabidopsis has only three classes of root, it may not be an adequate model for eudicot plant root systems. Recent research, however, can be interpreted to suggest that pre-flowering Arabidopsis does have at least five (5) of t...

  14. Ensuring Adequate Early Childhood Development for Uganda’s Children

    Kasirye, Ibrahim

    2012-01-01

    Although Uganda has made significant progress in reducing child deaths in the past five years, the country still faces major challenges in ensuring adequate early childhood development. This briefing highlights some of the major challenges affecting children during the first five years of life with focus on: the low immunization coverage rates and vaccine availability; poor child nutritional health status; and the limited enrolment of children in Early Childhood Development Centres.

  15. Masculinity at the margins

    Jensen, Sune Qvotrup

    2010-01-01

    meaning in the subject position of the black man in order to become dangerous and sexy. Another type of reaction is resistance, which may take the form of inarticulate oppositional behaviour often aimed at female welfare state professionals or more articulate ‘street politics’ making the margin a site of...... critique although in a masculinist way. These reactions to othering represent a challenge to researchers interested in intersectionality and gender, because gender is reproduced as a hierarchical form of social differentiation at the same time as racism is both reproduced and resisted....

  16. Safety margins of containments

    The critical question in evaluating various hydrogen accidents is whether or not significant quantities of fission products are released to the atmosphere. The function of containment systems is to prevent the escape of fission products. Thus, the determination of the capacity of containment structures to function during accident conditions is important to the study of hydrogen accidents. Toward this end, the objective of the Containment Safety Margins program is the development and verification of methodologies for reliably predicting the ultimate capacity of lightwater containment structures. The program was initiated in June 1980, and this paper addresses the first phase of the program, a planning effort, which is nearly complete

  17. Amphetamine margin in sports

    Laties, V.G.; Weiss, B.

    1981-10-01

    The amphetamines can enhance athletic performance. That much seem clear from the literature, some of which is reviewed here. Increases in endurance have been demonstrated in both humans and rats. Smith and Beecher, 20 years ago, showed improvement of running, swimming, and weight throwing in highly trained athletes. Laboratory analogs of such performances have also been used and similar enhancement demonstrated. The amount of change induced by the amphetamines is usually small, of the order of a few percent. Nevertheless, since a fraction of a percent improvement can make the difference between fame and oblivion, the margin conferred by these drugs can be quite important.

  18. Quantification of the margin required for treating intraprostatic lesions.

    Studenski, Matthew T; Valenciaga, Yanisley; Abramowitz, Matthew C; Stoyanova, Radka; Bossart, Elizabeth; Dogan, Nesrin; Pollack, Alan

    2016-01-01

    Advances in magnetic resonance imaging (MRI) sequences allow physicians to define the dominant intraprostatic lesion (IPL) in prostate radiation therapy treat-ments allowing for dose escalation and potentially increased tumor control. This work quantifies the margin required around the MRI-defined IPL accounting for both prostate motion and deformation. Ten patients treated with a simultaneous integrated intraprostatic boost (SIIB) were retrospectively selected and replanned with incremental 1 mm margins from 0-5 mm around the IPL to determine if there were any significant differences in dosimetric parameters. Sensitivity analysis was then performed accounting for random and systematic uncertainties in both prostate motion and deformation to ensure adequate dose was delivered to the IPL. Prostate deformation was assessed using daily CBCT imaging and implanted fiducial markers. The average IPL volume without margin was 2.3% of the PTV volume and increased to 11.8% with a 5 mm margin. Despite these changes in vol-ume, the only statistically significant dosimetric difference was found for the PTV maximum dose, which increased with increasing margin. The sensitivity analysis demonstrated that a 3.0 mm margin ensures > 95% IPL coverage accounting for both motion and deformation. We found that a margin of 3.0 mm around the MRI defined IPL is sufficient to account for random and systematic errors in IPL posi-tion for the majority of cases. PMID:27167286

  19. The SME (site margin earthquake)

    A methodology is proposed for assessing the seismic safety margin of existing CANDU nuclear generating stations. The available seismic margin assessment approaches and the unique features of the CANDU system, were appraised. The proposed methodology includes: the characterization of the site margin earthquake, the definition of the performance criteria for the elements of a success path and determination of its seismic withstand capacity. It is proposed that the margin earthquake be established on the basis of a combined approach of using historical records and regional seismotectonic and site specific evaluations. The ability of the components and systems to withstand the margin earthquake is determined by database comparisons, inspection and analysis. (author)

  20. [Abdominal cure procedures. Adequate use of Nobecutan Spray].

    López Soto, Rosa María

    2009-12-01

    Open abdominal wounds, complicated by infection and/or risk of eventration tend to become chronic and usually require frequent prolonged cure. Habitual changing of bandages develop into one of the clearest risk factors leading to the deterioration of perilesional cutaneous integrity. This brings with it new complications which draw out the evolution of the process, provoking an important deterioration in quality of life for the person who suffers this and a considerable increase in health costs. What is needed is a product and a procedure which control the risk of irritation, which protect the skin, which favor a patient's comfort and which shorten treatment requirements while lowering health care expenses. This report invites medical personnel to think seriously about the scientific rationale, and treatment practice, as to why and how to apply Nobecutan adequately, this reports concludes stating the benefits in the adequate use of this product. The objective of this report is to guarantee the adequate use of this product in treatment of complicated abdominal wounds. This product responds to the needs which are present in these clinical cases favoring skin care apt isolation and protection, while at the same time, facilitating the placement and stability of dressings and bandages used to cure wounds. In order for this to happen, the correct use of this product is essential; medical personnel must pay attention to precautions and recommendations for proper application. The author's experiences in habitual handling of this product during various years, included in the procedures for standardized cures for these wounds, corroborates its usefulness; the author considers use of this product to be highly effective while being simple to apply; furthermore, one succeeds in providing quality care and optimizes resources employed. PMID:20143738

  1. The radiographic appearances following adequate transfusion in β-thalassaemia

    The main lesions of the skull and hand, observed in a group of hypertransfused β-thalassaemic patients, are compared with a control group of low-transfused patients. Bony abnormalities reflect the relationship between proliferating bone marrow and bone cortex, and hypertransfusion therapy will prevent development of lesions only if established early in life. If this is done, the diploe in the skull may become normal, overgrowth of facial bones is moderate, pneumatisation of the paranasal sinuses is not completely prevented, and the 'hair-brush' pattern may disappear completely. A normal appearance of the hand in adequately treated patients differentiates between prepubertal patients and adults. (orig.)

  2. Radiographic appearances following adequate transfusion in. beta. -thalassaemia

    Scutellari, P.N.; Orzincolo, C.; Bagni, B.; Franceschini, F.

    1989-01-01

    The main lesions of the skull and hand, observed in a group of hypertransfused ..beta..-thalassaemic patients, are compared with a control group of low-transfused patients. Bony abnormalities reflect the relationship between proliferating bone marrow and bone cortex, and hypertransfusion therapy will prevent development of lesions only if established early in life. If this is done, the diploe in the skull may become normal, overgrowth of facial bones is moderate, pneumatisation of the paranasal sinuses is not completely prevented, and the 'hair-brush' pattern may disappear completely. A normal appearance of the hand in adequately treated patients differentiates between prepubertal patients and adults.

  3. Evaluation of reactivity shutdown margin for nuclear fuel reload optimization

    The FORMOSA-P code is a nuclear fuel management optimization package which combines simulated annealing (SA) and nodal generalized perturbation theory (GPT). Recent studies at Electricite de France have produced good results for power peaking minimizations under multiple limiting control rod configurations. However, since the reactivity shutdown margin is not explicitly treated as an objective or constraint function, then any optimal loading patterns (LPs) are not guaranteed to yield an adequate shutdown margin (SDM). This study describes the implementation of the SDM calculation within a FORMOSA-P optimization. Maintaining all additional computational requirements to a minimum was a key consideration. (authors). 4 refs., 2 figs

  4. Manual of Surgical Instruments

    Olga Lidia Sánchez Sarría

    2014-10-01

    Full Text Available Surgical instruments are the group of tools used in surgical procedures. They are very expensive and sophisticated. Consequently, a standardized and meticulous care is essential; they should go through the decontamination, cleaning and sterilization process. These instruments are designed in order to provide surgeons with tools that help them to perform a basic surgical procedure; there are multiple variations and the design depends on their function. This paper aims at showing all surgical instruments that can be used in an operating room during surgery and are not generally included in the medical literature.

  5. Is prophetic discourse adequate to address global economic justice?

    Piet J. Naudé

    2011-06-01

    Full Text Available This article outlined key features of prophetic discourse and investigated whether this form of moral discourse adequately addresses issues of economic injustice. It is shown that the strength of prophetic discourse is its ability to denounce instances of injustice whilst at the same time announcing a God-willed alternative future. The ‘preferential option for the poor’ in Latin American liberation theologies is treated as a case study of the influence of prophetic discourse in contexts of perceived economic injustice. Also the core weaknesses of prophetic discourse are investigated, specifically its incomplete moral argument, weak moral analyses, silence on transition measures, and its inability to take a positive stance on reforms in the system from which itself benefits. In the final section it is concluded that prophetic discourse plays an indispensable role in addressing issues of global economic justice, but – taken by itself – it is not an adequate form of moral discourse to address concrete matters of justice.

  6. Adequate drainage system design for heap leaching structures.

    Majdi, Abbas; Amini, Mehdi; Nasab, Saeed Karimi

    2007-08-17

    The paper describes an optimum design of a drainage system for a heap leaching structure which has positive impacts on both mine environment and mine economics. In order to properly design a drainage system the causes of an increase in the acid level of the heap which in turn produces severe problems in the hydrometallurgy processes must be evaluated. One of the most significant negative impacts induced by an increase in the acid level within a heap structure is the increase of pore acid pressure which in turn increases the potential of a heap-slide that may endanger the mine environment. In this paper, initially the thickness of gravelly drainage layer is determined via existing empirical equations. Then by assuming that the calculated thickness is constant throughout the heap structure, an approach has been proposed to calculate the required internal diameter of the slotted polyethylene pipes which are used for auxiliary drainage purposes. In order to adequately design this diameter, the pipe's cross-sectional deformation due to stepped heap structure overburden pressure is taken into account. Finally, a design of an adequate drainage system for the heap structure 2 at Sarcheshmeh copper mine is presented and the results are compared with those calculated by exiting equations. PMID:17321044

  7. Isolated volar surgical approach for the treatment of perilunate and lunate dislocations

    Hakan Basar

    2014-01-01

    Conclusion: The clinical and radiological results of the isolated volar surgical approach were satisfactory. The dorsal approach was not needed for reduction of dislocations during operations. Our results showed that an isolated volar approach was adequate.

  8. Deriving DICOM surgical extensions from surgical workflows

    Burgert, O.; Neumuth, T.; Gessat, M.; Jacobs, S.; Lemke, H. U.

    2007-03-01

    The generation, storage, transfer, and representation of image data in radiology are standardized by DICOM. To cover the needs of image guided surgery or computer assisted surgery in general one needs to handle patient information besides image data. A large number of objects must be defined in DICOM to address the needs of surgery. We propose an analysis process based on Surgical Workflows that helps to identify these objects together with use cases and requirements motivating for their specification. As the first result we confirmed the need for the specification of representation and transfer of geometric models. The analysis of Surgical Workflows has shown that geometric models are widely used to represent planned procedure steps, surgical tools, anatomical structures, or prosthesis in the context of surgical planning, image guided surgery, augmented reality, and simulation. By now, the models are stored and transferred in several file formats bare of contextual information. The standardization of data types including contextual information and specifications for handling of geometric models allows a broader usage of such models. This paper explains the specification process leading to Geometry Mesh Service Object Pair classes. This process can be a template for the definition of further DICOM classes.

  9. Positive margins and primary decomposition

    Kahle, Thomas; Sullivant, Seth

    2012-01-01

    We study random walks on contingency tables with fixed marginals, corresponding to a (log-linear) hierarchical model. If the set of allowed moves is not a Markov basis, then there exist tables with the same marginals that are not connected. We study linear conditions on the values of the marginals that ensure that all tables in a given fiber are connected. We show that many graphical models have the positive margins property, which says that all fibers with strictly positive marginals are connected by the quadratic moves that correspond to conditional independence statements. The property persists under natural operations such as gluing along cliques, but we also construct examples of graphical models not enjoying this property. Our analysis of the positive margins property depends on computing the primary decomposition of the associated conditional independence ideal. The main technical results of the paper are primary decompositions of the conditional independence ideals of graphical models of the N-cycle a...

  10. Recognizing surgical patterns

    Bouarfa, L.

    2012-01-01

    In the Netherlands, each year over 1700 patients die from preventable surgical errors. Numerous initiatives to improve surgical practice have had some impact, but problems persist. Despite the introduction of checklists and protocols, patient safety in surgery remains a continuing challenge. This is

  11. Surgical medical record

    Bulow, S.

    2008-01-01

    A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15......A medical record is presented on the basis of selected linguistic pearls collected over the years from surgical case records Udgivelsesdato: 2008/12/15...

  12. Nuclear waste disposal: achieving adequate financing - special study

    An analysis by the Congressional Budget Office (CBO) evaluates whether the current one mill fee now charged to nuclear-electricity consumers will adequately finance the waste disposal program. The CBO found that, if the fee is adjusted annually for inflation, it should provide enough revenues to cover all program costs under all nuclear growth forecasts. If the fee is unchanged, however, the fees will be inadequate if inflation exceeds 3% annually. The report suggests two alternatives for fee revision, but makes no recommendations. The alternatives are to increase the fee only at specific intervals or to automatically adjust the fee through indexation. The report examines the effect of delaying the program, cost overruns, and alternative inflation rate and interest rate assumptions. 3 figures, 12 tables

  13. CAN A SINGLE SECURITY FRAMEWORK ADDRESS INFORMATION SECURITY RISKS ADEQUATELY?

    Walid Al-Ahmad

    2012-01-01

    Full Text Available There is no doubt that modern society depends heavily on information technology in nearly every facet of human activity. Organizations of all kinds are increasingly exposed to various kinds of risks, including information technology risks. There are many security standards and frameworks available to help organizations manage these risks. The question which one is best and can address the information security risks adequately warrants further investigation and research. The purpose of this research work is to highlight the challenges facing enterprises in their efforts to properly manage information security risks when adopting international standards and frameworks. To assist in selecting the best framework to use in risk management, the article presents an overview of the most popular and widely used standards. It then identifies some selection criteria and suggests an approach to proper implementation. A case study is used to prove the usefulness of the new model for selecting an appropriate security model to manage information security risks.

  14. Novel Bounds on Marginal Probabilities

    Mooij, Joris M.; Kappen, Hilbert J

    2008-01-01

    We derive two related novel bounds on single-variable marginal probability distributions in factor graphs with discrete variables. The first method propagates bounds over a subtree of the factor graph rooted in the variable, and the second method propagates bounds over the self-avoiding walk tree starting at the variable. By construction, both methods not only bound the exact marginal probability distribution of a variable, but also its approximate Belief Propagation marginal (``belief''). Th...

  15. The marginalization of hormesis.

    Calabrese, E J; Baldwin, L A

    2000-01-01

    Despite the substantial development and publication of highly reproducible toxicological data, the concept of hormetic dose-response relationships was never integrated into the mainstream of toxicological thought. Review of the historical foundations of the interpretation of the bioassay and assessment of competitive theories of dose-response relationships lead to the conclusion that multiple factors contributed to the marginalization of hormesis during the middle and subsequent decades of the 20th century. These factors include: (a) the close-association of hormesis with homeopathy lead to the hostility of modern medicine toward homeopathy thereby creating a guilt by association framework, and the carry-over influence of that hostility in the judgements of medically-based pharmacologists/ toxicologists toward hormesis; (b) the emphasis of high dose effects linked with a lack of appreciation of the significance of the implications of low dose stimulatory effects; (c) the lack of an evolutionary-based mechanism(s) to account for hormetic effects; and (d) the lack of appropriate scientific advocates to counter aggressive and intellectually powerful critics of the hormetic perspective. PMID:10745293

  16. Multiscale Surgical Telerobots

    Miles, R R; Seward, K P; Benett, W J; Tendick, F; Bentley, L; Stephan, P L

    2002-01-23

    A project was undertaken to improve robotic surgical tools for telerobotic minimally invasive surgery. The major objectives were to reduce the size of the tools to permit new surgical procedures in confined spaces such as the heart and to improve control of surgical tools by locating positional sensors and actuators at the end effector rather than external to the patient as is currently the state of the technology. A new compact end-effector with wrist-like flexibility was designed. Positional sensors based on MEMS microfabrication techniques were designed.

  17. Workers' marginal costs of commuting

    van Ommeren, Jos; Fosgerau, Mogens

    2009-01-01

    This paper applies a dynamic search model to estimate workers' marginal costs of commuting, including monetary and time costs. Using data on workers' job search activity as well as moving behaviour, for the Netherlands, we provide evidence that, on average, workers' marginal costs of one hour of...

  18. Dose Limits for Man do not Adequately Protect the Ecosystem

    Higley, Kathryn A.; Alexakhin, Rudolf M.; McDonald, Joseph C.

    2004-08-01

    It has been known for quite some time that different organisms display differing degrees of sensitivity to the effects of ionizing radiations. Some microorganisms such as the bacterium Micrococcus radiodurans, along with many species of invertebrates, are extremely radio-resistant. Humans might be categorized as being relatively sensitive to radiation, and are a bit more resistant than some pine trees. Therefore, it could be argued that maintaining the dose limits necessary to protect humans will also result in the protection of most other species of flora and fauna. This concept is usually referred to as the anthropocentric approach. In other words, if man is protected then the environment is also adequately protected. The ecocentric approach might be stated as; the health of humans is effectively protected only when the environment is not unduly exposed to radiation. The ICRP is working on new recommendations dealing with the protection of the environment, and this debate should help to highlight a number of relevant issues concerning that topic.

  19. Adequate peritoneal dialysis: theoretical model and patient treatment.

    Tast, C

    1998-01-01

    The objective of this study was to evaluate the relationship between adequate PD with sufficient weekly Kt/V (2.0) and Creatinine clearance (CCR) (60l) and necessary daily dialysate volume. This recommended parameter was the result of a recent multi-centre study (CANUSA). For this there were 40 patients in our hospital examined and compared in 1996, who carried out PD for at least 8 weeks and up to 6 years. These goals (CANUSA) are easily attainable in the early treatment of many individuals with a low body surface area (BSA). With higher BSA or missing RRF (Residual Renal Function) the daily dose of dialysis must be adjusted. We found it difficult to obtain the recommended parameters and tried to find a solution to this problem. The simplest method is to increase the volume or exchange rate. The most expensive method is to change from CAPD to APD with the possibility of higher volume or exchange rates. Selection of therapy must take into consideration: 1. patient preference, 2. body mass, 3. peritoneal transport rates, 4. ability to perform therapy, 5. cost of therapy and 6. risk of peritonitis. With this information in mind, an individual prescription can be formulated and matched to the appropriate modality of PD. PMID:10392062

  20. Aggressive surgical palliation for advanced girdle tumours

    Andrew Burd

    2012-01-01

    Full Text Available Background: The surgical management of advanced, incurable, malignant disease presents particular ethical and technical challenges. The clear goal is palliation and the surgical futility must be avoided. This case series presents some particular challenges in end-of-life surgery. Materials and Methods: Fifteen patients referred with advanced malignant disease involving a limb girdle were reviewed. Results: In one case, a patient pleaded for surgery after initially requesting a delay to seek treatment from a Chinese Traditional Herbalist. The increase in tumour bulk led to problems with surgery and the patient died in a hospital a few weeks later. This case illustrates ′futility′ not recognized and encountered. The remaining 14 patients exhibited positive palliation with improved quality of dying and appreciation expressed by patients, relatives and staff. Conclusion: In selected cases, with a skilled and experienced surgical team, patients with advanced malignant disease can still benefit from aggressive surgical palliation. The margin of error is small between palliation being attempted and futility being achieved. This considerably adds to the challenge of end-of-life surgery.

  1. Mastectomy -- The Surgical Procedure

    Full Text Available ... surgery. The surgeon removes all of the breast tissue. In most, but not all cases, the nipple ... margins Using a microscope, a pathologist checks the tissue removed during breast surgery. The pathologist determines whether ...

  2. Mastectomy -- The Surgical Procedure

    Full Text Available ... during breast surgery. The pathologist determines whether cancer cells are present in the rim of tissue around ... the chest wall) or skin margin contains cancer cells. In these cases, more surgery and/or radiation ...

  3. Intraoperative Switch to a Temporal Surgical Approach in 23- and 25-Gauge Microcannula-Based Sutureless Transconjunctival Vitrectomy

    Kiss, Szilárd; Vavvas, Demetrios

    2010-01-01

    Purpose: To illustrate a surgical method in which the infusion port during a three-port pars plana vitrectomy is moved intraoperatively from the traditional infra-temporal location and placed supra-nasally, thus permitting a temporal surgical approach to better tackle superior and inferior vitreoretinal pathology. Methods: Description of surgical technique. Results: When the location of the vitreoretinal pathology and/or the patient's anatomy prevents adequate visualization or surgical access...

  4. Supply versus demand: a review of application trends to Canadian surgical training programs.

    Austin, Ryan E; Wanzel, Kyle R

    2015-04-01

    Despite increases in medical school enrolment, applications to surgical residency programs in Canada have been in decline over the past decade, with an increasing number of unmatched surgical residency positions. We examined the current status of surgical residency in Canada and analyzed application trends (2002–2013) for surgical training programs across Canada. Our findings suggest that most undergraduate medical schools across Canada are having difficulty fostering interest in surgical careers. We propose that a lack of adequate early exposure to the surgical specialties during undergraduate training is a critical factor. Moving forward, we must examine how the best-performing institutions and surgical programs have maintained interest in pursuing surgical careers and adapt our recruitment methods to both maintain and grow future interest. As Mary Engelbreit said, "If you don't like something, change it; if you can't change it, change the way you think about it." PMID:25598177

  5. Surgical Ventricular Reconstruction

    Full Text Available SURGICAL VENTRICULAR RECONSTRUCTION MONTEFIORE-EINSTEIN HEART CENTER NEW YORK CITY, NEW YORK February 13, 2008 00:00:09 NARRATOR: Welcome to the Montefiore-Einstein Heart Center in ...

  6. Surgical Ventricular Reconstruction

    Full Text Available SURGICAL VENTRICULAR RECONSTRUCTION MONTEFIORE-EINSTEIN HEART CENTER NEW YORK CITY, NEW YORK February 13, 2008 00:00:09 NARRATOR: Welcome to the Montefiore-Einstein Heart Center in New York City. In ...

  7. Ambulatory Surgical Measures - Facility

    U.S. Department of Health & Human Services — The Ambulatory Surgical Center Quality Reporting (ASCQR) Program seeks to make care safer and more efficient through quality reporting. ASCs eligible for this...

  8. Surgical Ventricular Reconstruction

    Full Text Available ... Blood Institute, called the STITCH Trial, the Surgical Treatment for Ischemic Heart Failure. And that trial has ... patients that were divided essentially into three different treatment groups. All patients enrolled in the trial had ...

  9. Surgical Critical Care Initiative

    Federal Laboratory Consortium — The Surgical Critical Care Initiative (SC2i) is a USU research program established in October 2013 to develop, translate, and validate biology-driven critical care....

  10. Surgical Ventricular Reconstruction

    Full Text Available ... the STITCH Trial, the Surgical Treatment for Ischemic Heart Failure. And that trial has now looked at over ... 15 III or IV New York Heart Association heart failure. And not uncommonly have anginal symptoms as well. ...

  11. Biocompatibility of surgical implants

    Kaelble, D. H.

    1979-01-01

    Method of selecting biocompatible materials for surgical implants uses fracture mechanic relationships and surface energies of candidate materials in presence of blood plasma. Technique has been used to characterize 190 materials by parameters that reflect their biocompatibility.

  12. Surgical Ventricular Reconstruction

    Full Text Available ... five year old male with hypertension, Type II Diabetes and hypercholesterolemia, who presented to St. Barnabas Hospital ... Blood Institute, called the STITCH Trial, the Surgical Treatment for Ischemic Heart Failure. And that trial has ...

  13. Surgical Ventricular Reconstruction

    Full Text Available ... He has not been readmitted for any reasons related to heart failure. 00:41:57 ROBERT E. ... question, because it really deals with whether anything related to surgical ventricular reconstruction would add to the ...

  14. The Surgical Treatment and Outcome of Nonmetastatic Extremity Osteosarcoma with Pathological Fractures

    Zhi-Ping Deng

    2015-01-01

    Conclusions: Our study suggests that surgically treated patients with pathologic fractures in osteosarcoma have adequate local control and do not have a poorer outcome compared to patients without a fracture. Though osteosarcoma with a pathologic fracture is not a contraindication for limb salvage, appropriate case selection is important when deciding local control options to ensure adequate oncologic clearance.

  15. The rat adequately reflects human responses to exercise in blood biochemical profile: a comparative study.

    Goutianos, Georgios; Tzioura, Aikaterini; Kyparos, Antonios; Paschalis, Vassilis; Margaritelis, Nikos V; Veskoukis, Aristidis S; Zafeiridis, Andreas; Dipla, Konstantina; Nikolaidis, Michalis G; Vrabas, Ioannis S

    2015-02-01

    Animal models are widely used in biology and the findings of animal research are traditionally projected to humans. However, recent publications have raised concerns with regard to what extent animals and humans respond similar to physiological stimuli. Original data on direct in vivo comparison between animals and humans are scarce and no study has addressed this issue after exercise. We aimed to compare side by side in the same experimental setup rat and human responses to an acute exercise bout of matched intensity and duration. Rats and humans ran on a treadmill at 86% of maximal velocity until exhaustion. Pre and post exercise we measured 30 blood chemistry parameters, which evaluate iron status, lipid profile, glucose regulation, protein metabolism, liver, and renal function. ANOVA indicated that almost all biochemical parameters followed a similar alteration pattern post exercise in rats and humans. In fact, there were only 2/30 significant species × exercise interactions (in testosterone and globulins), indicating different responses to exercise between rats and humans. On the contrary, the main effect of exercise was significant in 15/30 parameters and marginally nonsignificant in other two parameters (copper, P = 0.060 and apolipoprotein B, P = 0.058). Our major finding is that the rat adequately mimics human responses to exercise in those basic blood biochemical parameters reported here. The physiological resemblance of rat and human blood responses after exercise to exhaustion on a treadmill indicates that the use of blood chemistry in rats for exercise physiology research is justified. PMID:25677548

  16. Postthrombotic Syndrome: Surgical Possibilities

    Khanna, Ajay K; Shivanshu Singh

    2011-01-01

    Postthrombotic syndrome (PTS) is a late outcome of deep vein thrombosis characterized by cramping pain, swelling, hyperpigmentation, eczema, lipodermatosclerosis, and ulceration in the leg due to increased venous outflow resistance and reflux venous flow. Newer surgical and endovascular interventions have a promising result in the management of postthrombotic syndrome. Early surgical or endovascular interventions in appropriately selected patients may decrease the incidence of recurrent ulcer...

  17. Monitoring the eye lens: which dose quantity is adequate?

    Behrens, R [Physikalisch-Technische Bundesanstalt, Bundesallee 100, D-38116 Braunschweig (Germany); Dietze, G, E-mail: rolf.behrens@ptb.d [Paracelsusstrasse 7, D-38116 Braunschweig (Germany)

    2010-07-21

    Recent epidemiological studies suggest a rather low dose threshold (below 0.5 Gy) for the induction of a cataract of the eye lens. Some other studies even assume that there is no threshold at all. Therefore, protection measures have to be optimized and current dose limits for the eye lens may be reduced in the future. The question of which personal dose equivalent quantity is appropriate for monitoring the dose to the eye lens arises from this situation. While in many countries dosemeters calibrated in terms of the dose equivalent quantity H{sub p}(0.07) have been seen as being adequate for monitoring the dose to the eye lens, this might be questionable in the case of reduced dose limits and, thus, it may become necessary to use the dose equivalent quantity H{sub p}(3) for this purpose. To discuss this question, the dose conversion coefficients for the equivalent dose of the eye lens (in the following eye lens dose) were determined for realistic photon and beta radiation fields and compared with the values of the corresponding conversion coefficients for the different operational quantities. The values obtained lead to the following conclusions: in radiation fields where most of the dose comes from photons, especially x-rays, it is appropriate to use dosemeters calibrated in terms of H{sub p}(0.07) on a slab phantom, while in other radiation fields (dominated by beta radiation or unknown contributions of photon and beta radiation) dosemeters calibrated in terms of H{sub p}(3) on a slab phantom should be used. As an alternative, dosemeters calibrated in terms of H{sub p}(0.07) on a slab phantom could also be used; however, in radiation fields containing beta radiation with the end point energy near 1 MeV, an overestimation of the eye lens dose by up to a factor of 550 is possible.

  18. Monitoring the eye lens: which dose quantity is adequate?

    Recent epidemiological studies suggest a rather low dose threshold (below 0.5 Gy) for the induction of a cataract of the eye lens. Some other studies even assume that there is no threshold at all. Therefore, protection measures have to be optimized and current dose limits for the eye lens may be reduced in the future. The question of which personal dose equivalent quantity is appropriate for monitoring the dose to the eye lens arises from this situation. While in many countries dosemeters calibrated in terms of the dose equivalent quantity Hp(0.07) have been seen as being adequate for monitoring the dose to the eye lens, this might be questionable in the case of reduced dose limits and, thus, it may become necessary to use the dose equivalent quantity Hp(3) for this purpose. To discuss this question, the dose conversion coefficients for the equivalent dose of the eye lens (in the following eye lens dose) were determined for realistic photon and beta radiation fields and compared with the values of the corresponding conversion coefficients for the different operational quantities. The values obtained lead to the following conclusions: in radiation fields where most of the dose comes from photons, especially x-rays, it is appropriate to use dosemeters calibrated in terms of Hp(0.07) on a slab phantom, while in other radiation fields (dominated by beta radiation or unknown contributions of photon and beta radiation) dosemeters calibrated in terms of Hp(3) on a slab phantom should be used. As an alternative, dosemeters calibrated in terms of Hp(0.07) on a slab phantom could also be used; however, in radiation fields containing beta radiation with the end point energy near 1 MeV, an overestimation of the eye lens dose by up to a factor of 550 is possible.

  19. Utility of frozen section analysis for fungal organisms in soft tissue wound debridement margin determination

    Zimmermann, Nives; Hagen, Matthew C.; Schrager, Jason J.; Hebbeler-Clark, Renee S.; Masineni, Sreeharsha

    2015-01-01

    Background Zygomycetes cause different patterns of infection in immunosuppressed individuals, including sino-orbito-cerebral, pulmonary, skin/soft tissue infection and disseminated disease. Infections with Zygomycetes have a high mortality rate, even with prompt treatment, which includes anti-fungal agents and surgical debridement. In some centers, clear margins are monitored by serial frozen sections, but there are no specific guidelines for the use of frozen sections during surgical debride...

  20. Morphological computed tomography features of surgically resectable pulmonary squamous cell carcinomas: Impact on prognosis and comparison with adenocarcinomas

    Koenigkam Santos, Marcel, E-mail: marcelk46@yahoo.com.br [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany); German Cancer Research Center (Deutsches Krebsforschungszentrum – DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); Department of Radiology, University Hospital of the School of Medicine of Ribeirao Preto, University of Sao Paulo, Av. Bandeirantes 3900, Campus Universitario Monte Alegre, 14048 900 Ribeirao Preto, SP (Brazil); Muley, Thomas [Chest Clinic (Thoraxklinik) at University of Heidelberg, Amalienstr. 5, 69126 Heidelberg (Germany); Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg (Germany); Warth, Arne [Institute of Pathology, Heidelberg University, Im Neuenheimer Feld 224, 69120 Heidelberg (Germany); Paula, Wagner Diniz de [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany); Department of Radiology, University of Brasilia, Brasilia (Brazil); Lederlin, Mathieu [Department of Diagnostic and Interventional Radiology, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg (Germany); Department of Thoracic and Cardiovascular Imaging, University of Bordeaux, Bordeaux (France); Schnabel, Philipp Albert [Institute of Pathology, Heidelberg University, Im Neuenheimer Feld 224, 69120 Heidelberg (Germany); Translational Lung Research Center (TLRC), Member of the German Center for Lung Research (DZL), Im Neuenheimer Feld 350, 69120 Heidelberg (Germany); Schlemmer, Heinz-Peter [German Cancer Research Center (Deutsches Krebsforschungszentrum – DKFZ), Im Neuenheimer Feld 280, 69120 Heidelberg (Germany); and others

    2014-07-15

    Objective: To characterize the morphological computed tomography (CT) features of pulmonary squamous cell carcinomas (SQCC) submitted to therapeutic resection; to correlate these features with patients’ outcomes; and to compare with pulmonary adenocarcinomas (ADC). Materials and methods: Two chest radiologists retrospectively evaluated CT exams of 123 patients with SQCC resected between 2002 and 2008. Tumors’ size, location (central vs. peripheral), shape, margins, attenuation, enhancement, presence of calcification, cavitation, internal air bronchograms and pleural tags were assigned by consensus. Prevalence of features was compared with patients’ survival data and a previously studied population of ADC surgically resected at the same time period. Results: Cavitation correlated negatively with overall (hazard ratio = 3.04), disease-specific (HR = 3.67) and disease-free survival (HR = 2.69), independent from age, gender, tumor pathological stage, size, and location. In relation to ADC, SQCC presented different shape, margins, attenuation, enhancement, with more cavitation, rare internal air bronchograms, and less pleural tags. Differences were also significant when comparing only the peripheral type of tumors. Conclusions: Cavitation at CT was an independent and negative predictive factor for SQCC. Different CT morphological features were described for SQCC and ADC. Image evaluation of lung lesions should go beyond measuring and addressing adjacent structures invasion. Adequate imaging characterization not only helps to differentiate benign versus malignant disease and to determine malignancy staging, it may also imply the histologic subtype and improve the prognostic assessment of lung cancer patients.

  1. Morphological computed tomography features of surgically resectable pulmonary squamous cell carcinomas: Impact on prognosis and comparison with adenocarcinomas

    Objective: To characterize the morphological computed tomography (CT) features of pulmonary squamous cell carcinomas (SQCC) submitted to therapeutic resection; to correlate these features with patients’ outcomes; and to compare with pulmonary adenocarcinomas (ADC). Materials and methods: Two chest radiologists retrospectively evaluated CT exams of 123 patients with SQCC resected between 2002 and 2008. Tumors’ size, location (central vs. peripheral), shape, margins, attenuation, enhancement, presence of calcification, cavitation, internal air bronchograms and pleural tags were assigned by consensus. Prevalence of features was compared with patients’ survival data and a previously studied population of ADC surgically resected at the same time period. Results: Cavitation correlated negatively with overall (hazard ratio = 3.04), disease-specific (HR = 3.67) and disease-free survival (HR = 2.69), independent from age, gender, tumor pathological stage, size, and location. In relation to ADC, SQCC presented different shape, margins, attenuation, enhancement, with more cavitation, rare internal air bronchograms, and less pleural tags. Differences were also significant when comparing only the peripheral type of tumors. Conclusions: Cavitation at CT was an independent and negative predictive factor for SQCC. Different CT morphological features were described for SQCC and ADC. Image evaluation of lung lesions should go beyond measuring and addressing adjacent structures invasion. Adequate imaging characterization not only helps to differentiate benign versus malignant disease and to determine malignancy staging, it may also imply the histologic subtype and improve the prognostic assessment of lung cancer patients

  2. Surgical aspects of melanoma therapy

    Surgery is still the most important treatment modality to guarantee the highest survival ratio of melanoma patients. The adequacy of the surgical approach is a crucial aspect in face of the initial clinical appearances of the disease. Best results are obtained with the correct treatment of primary melanomas and lymph node metastases. To reach a general consensus on the surreal indications in terms of extension and timing, a large number of randomized trials have been conducted in the last 3 - 4 decades. The rationale behind these trials, even if proposed by different institutions on different continents, has been to find the most conservative surgical approach able to guarantee the same results as those achieved with more aggressive treatment This lay behind the design of trials designed to determine the correct excision margin around primary melanomas in the most important studies. A similar approach has been followed in the preparation of several trials dedicated to the definition of the importance of performing immediate dissection of the locoregional nodes in view of the absence of clinical evidence of metastases. Ever since the sentinel node technique has become the standard treatment in a majority of institutions, the guidelines for the treatment of locoregional nodes have undergone a kind of revolution. In fact the policy of wait and see introduced by the aforementioned trials has been overridden by a more specific and selective even if a more invasive approach to obtain precise information regarding the status of clinically non-invaded locoregional nodes. The sentinel node biopsy technique makes use of a majority of scientific surgical tools, is the most conservative (when compared to elective node dissection), extremely precise and sophisticated and provides crucial data necessary to make decisions regarding the necessity to perform radical surgery, i.e. therapeutic node dissection. Radical lymph node dissection is recommended in case of confirmed regional

  3. Task Group on Safety Margins Action Plan (SMAP). Safety Margins Action Plan - Final Report

    . Chapter 3 looks at techniques for the deterministic calculation of safety margins and discusses the complementary probabilistic risk assessment techniques needed to generalize safety margins beyond design basis accidents. Chapter 4 examines the definition of safety margin, which is noted to take different meanings in different fields. For example, in civil engineering and applications that deal with the load-strength interference concept, safety margin describes the distance between the means of the load and strength probability density functions with regard to the standard deviation in both. However, in the nuclear industry, the term safety margin evolved to describe the goal of assuring the existence of adequate safety margin in deterministic calculations. Specifically, safety margin refers to keeping the value of a given safety variable under a pre-established safety limit in design basis accidents. Implicitly, safety margin in the nuclear industry is the distance from the safety limit to onset of damage. The SMAP task group fulfilled its first objective by adopting a methodology for quantifying safety margins that merges the deterministic and probabilistic approaches. The methodology described in Chapter 5 is consistent with the definition of safety margin commonly used in the nuclear industry. The metrics of this methodology quantify the change in safety over a range of accident sequences that extend beyond the design bases. However, the methodology is not described in this report to a level that would meet guidance document requirements. This is in part because methods and techniques needed to quantify safety margins in a global manner are evolving, and thus specific guidance rendered at this time would shortly become obsolete. This report presents the framework in sufficient detail to serve as the basis of an analysis and, thus, this report meets the second objective established for the SMAP group. A proof-of-concept application to further aid potential applicants

  4. Myocardial Sleeve Tissues in Surgical Lung Specimens.

    Yoshida, Akihiko; Kamata, Tsugumasa; Iwasa, Takeshi; Watanabe, Shun-ichi; Tsuta, Koji

    2015-10-01

    Left atrial myocardial extensions over the pulmonary veins (PVs), known as myocardial sleeves, are present in the physiological anatomy of most individuals. Although this structure has recently received clinical attention as a major origin of paroxysmal atrial fibrillation (AF), it has not been documented in surgical specimens. Here, we examine incidentally identified myocardial sleeve tissue in routinely processed lung resection specimens to determine its incidence and diagnostic implications. Among 694 lung resection specimens with evaluable PV margins, myocardial sleeve tissue was identified in 26 cases (3.7%). The tissue was located within the adventitia of the PVs, mostly in margin preparations, and existed outside the pericardium in the majority of cases. Carcinoma infiltration of the sleeves was evident in 6 cases. No heart injuries were observed, and no tumors invaded the heart. Preoperative electrocardiography showed sinus rhythm in all cases, whereas postoperative monitoring revealed sinus rhythm in all patients except one who showed AF and flutter. Myocardial sleeve tissue is an underrecognized incidental finding in lung resection specimens, and it is not indicative of heart injury. Cancer infiltration into this tissue indicates neither heart invasion nor, by itself, invasion into the pericardium. Although surgical transection of the myocardial sleeve did not evoke immediate arrhythmia in most cases, the overall influence of this procedure on the postsurgical risk of AF remains to be determined in further studies involving extensive rhythm assessment. PMID:26099012

  5. Steel Industry Marginal Opportunity Analysis

    none,

    2005-09-01

    The Steel Industry Marginal Opportunity Analysis (PDF 347 KB) identifies opportunities for developing advanced technologies and estimates both the necessary funding and the potential payoff. This analysis determines what portion of the energy bandwidth can be captured through the adoption of state-of-the-art technology and practices. R&D opportunities for addressing the remainder of the bandwidth are characterized and plotted on a marginal opportunity curve.

  6. Profit margins in Japanese retailing

    Potjes, J.C.A.; Thurik, Roy

    1993-01-01

    textabstractUsing a rich data source, we explain differences and developments in profit margins of medium-sized stores in Japan. We conclude that the protected environment enables the retailer to pass on all operating costs to the customers and to obtain a relatively high basic income. High service levels are positively related with high profit margins, illuminating the importance of service in Japan. Small store competition does not affect performance of medium-sized stores, because small st...

  7. Anxiety in veterinary surgical students

    Langebæk, Rikke; Eika, Berit; Jensen, Asger Lundorff;

    2012-01-01

    The surgical educational environment is potentially stressful and this can negatively affect students' learning. The aim of this study was to investigate whether veterinary students' level of anxiety is higher in a surgical course than in a non-surgical course and if pre-surgical training in a...... Surgical Skills Lab (SSL) has an anxiety reducing effect. Investigations were carried out as a comparative study and a parallel group study. Potential participants were fourth-year veterinary students who attended a surgical course (Basic Surgical Skills) and a non-surgical course (Clinical Examination...... anxiety questionnaires (Spielberger's state-trait anxiety inventory and Cox and Kenardy's performance anxiety questionnaire) were used. Anxiety levels were measured before the non-surgical course (111 students from 2009) and before live-animal surgery during the surgical course (153 students from 2009 and...

  8. Surgical wound care

    ... F for more than 4 hours Alternate Names Surgical incision care; Open wound care Images Proper hand washing References Lynn PB. Cleaning a wound and applying a dry, sterile dressing. In: Lynn PB. Taylor’s Handbook of Nursing Skills . Philadelphia, PA: Lippincott Williams and Wilkins, Wolters ...

  9. Improving surgical weekend handover

    Culwick, Caroline; Devine, Chris; Coombs, Catherine

    2014-01-01

    Effective handovers are vital to patient safety and continuity of care, and this is recognised by several national bodies including the GMC. The existing model at Great Western Hospital (GWH) involved three general surgical teams and a urology team placing their printed patient lists, complete with weekend jobs, in a folder for the on-call team to collect at the weekend. We recognised a need to reduce time searching for patients, jobs and reviews, and to streamline weekend ward rounds. A unified weekend list ordering all surgical patients by ward and bed number was introduced. Discrepancies in the layout of each team's weekday list necessitated the design of a new weekday list to match the weekend list to facilitate the easy transfer of information between the two lists. A colour coding system was also used to highlight specific jobs. Prior to this improvement project only 7.1% of those polled were satisfied with the existing system, after a series of interventions satisfaction increased to 85.7%. The significant increase in overall satisfaction with surgical handover following the introduction of the unified weekend list is promising. Locating patients and identifying jobs is easier and weekend ward rounds can conducted in a more logical and timely fashion. It has also helped facilitate the transition to consultant ward rounds of all surgical inpatients at the weekends with promising feedback from a recent consultants meeting. PMID:26734294

  10. Surgical infections with Mycoplasma

    Levi-Mazloum, Niels Donald; Prag, Jørgen Brorson; Jensen, J S;

    1997-01-01

    Mycoplasma hominis and Ureaplasma urealyticum are common inhabitants of the human genital tract. Evidence for an aetiological role in pyelonephritis, pelvic inflammatory disease, post-abortion and post-partum fever has been presented. There are sporadic reports of Mycoplasma causing serious...... extragenital infection such as septicemia, septic arthritis, neonatal meningitis and encephalitis. We review 38 cases of surgical infections with Mycoplasma....

  11. California Marginal-Cost-Pricing Project. [Analysis of methods used to quantify MCP

    None

    1979-09-01

    This report provides a detailed analysis of methods to quantify the marginal costs of electricity supply. The nine-point criteria used include measurement of marginal costs that are consistent with economic theory, and determination of the applicability of the method and results in regulatory proceedings. The report examines methods which cover a wide range of potential cost-measurement techniques, including linear-programming models of utility systems, production functions, and simple models based on identification of marginal units. These methods were generally found to be unacceptable because they do not calculate marginal costs of a specified demand increment, and do not adequately reflect the utility's planning process. Furthur research is described that will attempt to develop more-acceptable marginal-cost estimates in rate proceedings. 29 references, 21 figures, 28 tables.

  12. Alterations of the marginal soft tissue (gingival margin following periodontal therapy: A clinical study

    Gupta Ira

    2009-01-01

    Full Text Available Background and Objectives: The evaluation of gingival margin position (GMP plays a vital role in periodontal therapy and is critical in esthetic/plastic surgical procedures revolving around restorative dentistry. Comparative evaluations of GMP measurements in various periodontal therapies are scarce. Thus, the objectives of this study are to measure the alteration in the gingival margin position following various therapies, and to compare GMP alterations among different treatment modalities from the baseline to six months after therapy. Materials and Methods: The changes in GMP were studied for MB, B, DB, ML, and L sites for SRP, curettage, and flap surgery, and for MB, B, and DB sites for crown lengthening cases at the end of one, three, and six months after therapy. The results were interpreted from baseline to one, three, and six months posttreatment. Statistical Analysis : The results were subjected to statistical analysis. Paired ′t′-test was used for intra-group comparisons and intergroup comparisons were done by one-way ANOVA. Results: The GMP changed from baseline in all the sites at different time periods following various therapies. The net results after six months were an apical shift of GMP in SRP, curettage, and flap surgery, and a coronal shift of GMP in crown lengthening. Conclusion: GMP shows various patterns of alteration after various periodontal therapies. One should wait for the GMP to become stable before attempting any restorative procedure.

  13. Do Foley catheters adequately drain the bladder? Evidence from CT imaging studies

    Introduction: The Foley catheter has been widely assumed to be an effective means of draining the bladder. However, recent studies have brought into question its efficacy. The objective of our study is to further assess the adequacy of Foley catheter for complete drainage of the bladder. Materials and Methods: Consecutive catheterized patients were identified from a retrospective review of contrast enhanced and non-contrast enhanced computed tomographic (CT) abdomen and pelvis studies completed from 7/1/2011-6/30/2012. Residual urine volume (RUV) was measured using 5mm axial CT sections as follows: The length (L) and width (W) of the bladder in the section with the greatest cross sectional area was combined with bladder height (H) as determined by multiplanar reformatted images in order to calculate RUV by applying the formula for the volume (V) of a sphere in a cube:V=(π/6)⁎L⁎W⁎H). Results: RUVs of 167 (mean age 67) consecutively catheterized men (n=72) and women (n=95) identified by CT abdomen and pelvis studies were calculated. The mean RUV was 13.2 mL (range: 0.0 mL-859.1 mL, standard deviation: 75.9 mL, margin of error at 95% confidence:11.6 mL). Four (2.4%) catheterized patients had RUVs of >50 mL, two of whom had an improperly placed catheter tip noted on their CT-reports. Conclusions: Previous studies have shown that up to 43% of catheterized patients had a RUV greater than 50 mL, suggesting inadequacy of bladder drainage via the Foley catheter. Our study indicated that the vast majority of patients with Foley catheters (97.6%), had adequately drained bladders with volumes of <50 mL. (author)

  14. Do Foley catheters adequately drain the bladder? Evidence from CT imaging studies

    Avulova, Svetlana; Li, Valery J.; Khusid, Johnathan A. [Department of Urology, SUNY Downstate College of Medicine, Brooklyn, NY (United States); Choi, Woo S. [Radiology, SUNY Downstate College of Medicine, Brooklyn, NY (United States); Weiss, Jeffrey P., E-mail: johnathan.khusid@downstate.edu [Department of Urology, Weill Cornell Medical College, New York, NY (United States)

    2015-05-15

    Introduction: The Foley catheter has been widely assumed to be an effective means of draining the bladder. However, recent studies have brought into question its efficacy. The objective of our study is to further assess the adequacy of Foley catheter for complete drainage of the bladder. Materials and Methods: Consecutive catheterized patients were identified from a retrospective review of contrast enhanced and non-contrast enhanced computed tomographic (CT) abdomen and pelvis studies completed from 7/1/2011-6/30/2012. Residual urine volume (RUV) was measured using 5mm axial CT sections as follows: The length (L) and width (W) of the bladder in the section with the greatest cross sectional area was combined with bladder height (H) as determined by multiplanar reformatted images in order to calculate RUV by applying the formula for the volume (V) of a sphere in a cube:V=(π/6)⁎L⁎W⁎H). Results: RUVs of 167 (mean age 67) consecutively catheterized men (n=72) and women (n=95) identified by CT abdomen and pelvis studies were calculated. The mean RUV was 13.2 mL (range: 0.0 mL-859.1 mL, standard deviation: 75.9 mL, margin of error at 95% confidence:11.6 mL). Four (2.4%) catheterized patients had RUVs of >50 mL, two of whom had an improperly placed catheter tip noted on their CT-reports. Conclusions: Previous studies have shown that up to 43% of catheterized patients had a RUV greater than 50 mL, suggesting inadequacy of bladder drainage via the Foley catheter. Our study indicated that the vast majority of patients with Foley catheters (97.6%), had adequately drained bladders with volumes of <50 mL. (author)

  15. Is the standardized helmet technique adequate for irradiation of the brain and the cranial meninges?

    Purpose: To evaluate whether the standardized helmet technique is adequate to reliably cover the clinical target volume (whole brain including cranial meninges) during treatment planning and treatment delivery. Methods and Materials: In 21 patients undergoing irradiation of the brain in acute lymphoblastic leukemia or primary cerebral lymphoma, the coverage of the clinical target volume was checked with a repeat computed tomography (CT) in the treatment position (head fixation with face mask). The accuracy of field alignment was quantitatively assessed with sequential verification films. For each patient, linear and rotational discrepancies were measured between the simulation and first check film, and between five consecutive verification films. Results: Coverage of clinical target volume. In 11 cases (52%), the CT examinations showed that parts of the subfrontal region and midcranial fossa were not included by the field assigned under simulation. Accuracy of field alignment. For the total group of patients, all deviations were normally distributed with mean values between -1.2 mm and 1.5 mm and standard deviations of 2.9 mm to 3.7 mm for linear discrepancies, and 0.3 degrees ± 3.2 degrees for rotational discrepancies. For all patients, deviations were similar for the transition from simulation to the treatment machine and for subsequent treatment delivery, with 50% and 95% of absolute differences being less than 2.0 mm and 6.5 mm, respectively. Maximum linear deviations were less than 9.5 mm. Conclusions: The currently used helmet technique is inadequate to cover the clinical target volume. Repeat CT examinations are a useful method to delineate the clinical target volume on an individual patient basis. In addition, statistical fluctuations of field displacements up to 1.0 cm have to be considered when prescribing safety margins for reliable coverage of the clinical target volume during treatment planning and delivery

  16. Seismic margins in piping systems

    Safety-related piping systems in nuclear plants are typically designed for earthquakes using procedures that follow NRC criteria. NRC seismic criteria were developed in order to introduce conservatism or margin because of legitimate concern about uncertainties in the state of the art at the time. Analytical margin studies, extensive test programs, and the performance of piping in past earthquakes all confirm that the seismic margin in nuclear plant piping systems is typically substantial, and probably excessive. This paper concludes that the time has come to make radical changes in the criteria used for the seismic qualification of piping systems in nuclear plants. The new criteria will significantly reduce the numbers of seismic supports, restraints, and snubbers

  17. Certifying nonlocality from separable marginals

    Vértesi, Tamás; Laskowski, Wiesław; Pál, Károly F.

    2014-01-01

    Imagine three parties, Alice, Bob, and Charlie, who share a state of three qubits such that all two-party reduced states A-B, A-C, and B-C are separable. Suppose that they have information only about these marginals but not about the global state. According to recent results, there exists an example for a set of three separable two-party reduced states that is only compatible with an entangled global state. In this paper, we show a stronger result by exhibiting separable two-party reduced states A-B, A-C, and B-C, such that any global state compatible with these marginals is nonlocal. Hence, we obtain that nonlocality of multipartite states can be certified from information only about separable marginals.

  18. Management of large mediastinal masses: surgical and anesthesiological considerations

    van Boven, Wim Jan P.; Annema, Jouke T.; Eberl, Susanne; Klomp, Houke M.; de Mol, Bas A.J.M.

    2016-01-01

    Large mediastinal masses are rare, and encompass a wide variety of diseases. Regardless of the diagnosis, all large mediastinal masses may cause compression or invasion of vital structures, resulting in respiratory insufficiency or hemodynamic decompensation. Detailed preoperative preparation is a prerequisite for favorable surgical outcomes and should include preoperative multimodality imaging, with emphasis on vascular anatomy and invasive characteristics of the tumor. A multidisciplinary team should decide whether neoadjuvant therapy can be beneficial. Furthermore, the anesthesiologist has to evaluate the risk of intraoperative mediastinal mass syndrome (MMS). With adequate preoperative team planning, a safe anesthesiological and surgical strategy can be accomplished. PMID:27076967

  19. Maximum Margin Multiclass Nearest Neighbors

    Kontorovich, Aryeh; Weiss, Roi

    2014-01-01

    We develop a general framework for margin-based multicategory classification in metric spaces. The basic work-horse is a margin-regularized version of the nearest-neighbor classifier. We prove generalization bounds that match the state of the art in sample size $n$ and significantly improve the dependence on the number of classes $k$. Our point of departure is a nearly Bayes-optimal finite-sample risk bound independent of $k$. Although $k$-free, this bound is unregularized and non-adaptive, w...

  20. Safety margins in the driver

    Nilsson, Rickard

    2001-01-01

    The primary aim of this thesis is to highlight the most important features of driving and to describe the models that have attempted to conceptualise these features. The discussion focuses on the concept of "safety margin." The concept is elaborated upon in an effort to enhance its usefulness as an empirical tool in traffic research. In this study, safety margin is defined as a threshold value that informs the driver when to undertake an action to minimise the risk of a car accident. Three se...

  1. 21 CFR 801.5 - Medical devices; adequate directions for use.

    2010-04-01

    ... 21 Food and Drugs 8 2010-04-01 2010-04-01 false Medical devices; adequate directions for use. 801.5 Section 801.5 Food and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES LABELING General Labeling Provisions § 801.5 Medical devices; adequate directions for use. Adequate directions for...

  2. The Use of Rewards in Motivating Marginal Members of the Work Force.

    Porter, Lyman W.

    This paper deals with the use of rewards for on-the-job motivation toward better attendance and performance of marginal workers (those who have not been employed on a regular basis but who are presumed to be capable of becoming adequate workers). Possible rewards are 1) financial (wage increases and fringe benefits); 2) interpersonal (social…

  3. Surgically treated pulmonary stenosis

    Nielsen, Eva A; Hjortdal, Vibeke E

    additional four patients died after hospital discharge; therefore, the long-term mortality was 5%. The maximum follow-up period was 57 years, with a median of 33 years. In all, 16 patients (20%) required at least one re-intervention. Pulmonary valve replacement due to pulmonary regurgitation was the most...... re-intervention at the present stage. CONCLUSION: Surgical relief for pulmonary stenosis is efficient in relieving outflow obstruction; however, this efficiency is achieved at the cost of pulmonary regurgitation, leading to right ventricular dilatation and tricuspid regurgitation. When required......, pulmonary valve replacement is performed most frequently >20 years after the initial surgery. Lifelong follow-up of patients treated surgically for pulmonary stenosis is emphasised in this group of patients, who might otherwise consider themselves cured....

  4. Agricultural Technology and Marketing Margins in Vietnam

    Jensen, Tarp; Tarp, Finn

    2007-01-01

    This paper analyses the potential distributional impact and synergy effects from simultaneous improvements in agricultural sector productivity and reductions in trade and transportation margins. Two separate models are established to analyse (i) the interaction between agricultural technology and aggregate marketing margins in a Vietnamese context, and (ii) the relative importance of trade margins and transportation margins in explaining the importance of aggregate margins. The results show t...

  5. Radiology trainer. Surgical ambulance

    The DVD-ROM contains landmarks for fast anatomical orientation, a training mode showing the most common pathological radiological findings, a practical mode for accurate diagnosis, and textbook texts for background information. Situations encountered in surgical ambulance are simulated close to reality and in a user-friendly manner. The DVD-ROM is lavishly illustrated with more than 1600 X-ray images. (orig.)

  6. Surgical management of presbyopia

    Torricelli AA; Junior JB; Santhiago, MR; Bechara SJ

    2012-01-01

    André AM Torricelli, Jackson B Junior, Marcony R Santhiago, Samir J BecharaDivision of Ophthalmology, University of São Paulo Medical School, São Paulo, BrazilAbstract: Presbyopia, the gradual loss of accommodation that becomes clinically significant during the fifth decade of life, is a physiologic inevitability. Different technologies are being pursued to achieve surgical correction of this disability; however, a number of limitations have prevented widespre...

  7. Contributions to knowledge of the continental margin of Uruguay. Uruguayan continental margin: Physiographic and seismic analysis

    This work is about the kind of continental margins such as a )Atlantic type passive margins which can be hard or soft b) An active or Pacific margins that because of the very frequent earthquakes develop a morphology dominated by tectonic processes. The Uruguayan continental margin belongs to a soft Atlantic margin

  8. Clinical study of imaging skin cancer margins using polarized light imaging

    Samatham, Ravikant; Lee, Ken; Jacques, Steven L.

    2012-02-01

    Skin cancer is most commons type of cancer in United States that occur on sun-exposed cosmetically sensitive areas like face, neck, and forearms. Surgical excision of skin cancer is challenging as more than one-third the actual margins extend beyond the clinically determined margins. Polarized light camera (polCAM) provides images of the superficial layers of the tissue with enhanced contrast which was used to image skin cancer margins. In a NIH-funded pilot study polCAM was used to image skin cancer in patients undergoing Mohs micrographic surgery for skin cancer. Polarized light imaging utilizes the polarization properties of light to create an image of a lesion comprised only of light scattering from the superficial layers of the skin which yields a characteristic "fabric pattern" of the putative lesion and the surrounding normal tissue. In several case studies conducted with a system developed for the clinic, we have found that skin cancer disrupts this fabric pattern, allowing the doctor a new means of identifying the margins of the lesion. Data is acquired before the patient underwent surgery. The clinically determined skin cancer margins were compared with margins determined by examination of the polCAM images. The true margins were provided by the dermatophathologist on examination of the frozen sections. Our initial data suggests that the contrast due to polarization changes associated with cancerous lesions can elucidate margins that were not recognized by the surgeon under normal conditions but were later confirmed by the pathologist.

  9. Organisation of vascular surgical services: evolution or revolution?

    Michaels, J. A.; Galland, R B; Morris, P. J.

    1994-01-01

    The trend towards subspecialisation in hospital services is likely to lead to the development of vascular surgery as a separate specialty. If vascular surgery is to emerge as a high quality service then vascular emergencies--a substantial component of the workload--should be dealt with by surgeons with adequate training, and all patients should have equal access to the service. A specialist vascular surgical unit would have to be large enough to make efficient use of other services that it ne...

  10. SU-E-J-188: Theoretical Estimation of Margin Necessary for Markerless Motion Tracking

    Purpose: To estimate the margin necessary to adequately cover the target using markerless motion tracking (MMT) of lung lesions given the uncertainty in tracking and the size of the target. Methods: Simulations were developed in Matlab to determine the effect of tumor size and tracking uncertainty on the margin necessary to achieve adequate coverage of the target. For simplicity, the lung tumor was approximated by a circle on a 2D radiograph. The tumor was varied in size from a diameter of 0.1 − 30 mm in increments of 0.1 mm. From our previous studies using dual energy markerless motion tracking, we estimated tracking uncertainties in x and y to have a standard deviation of 2 mm. A Gaussian was used to simulate the deviation between the tracked location and true target location. For each size tumor, 100,000 deviations were randomly generated, the margin necessary to achieve at least 95% coverage 95% of the time was recorded. Additional simulations were run for varying uncertainties to demonstrate the effect of the tracking accuracy on the margin size. Results: The simulations showed an inverse relationship between tumor size and margin necessary to achieve 95% coverage 95% of the time using the MMT technique. The margin decreased exponentially with target size. An increase in tracking accuracy expectedly showed a decrease in margin size as well. Conclusion: In our clinic a 5 mm expansion of the internal target volume (ITV) is used to define the planning target volume (PTV). These simulations show that for tracking accuracies in x and y better than 2 mm, the margin required is less than 5 mm. This simple simulation can provide physicians with a guideline estimation for the margin necessary for use of MMT clinically based on the accuracy of their tracking and the size of the tumor

  11. Positive anterior margins in breast conserving surgery: Does it matter? A systematic review of the literature.

    Ang, Su C; Tapia, Grace; Davidson, Emily J; Kahramangil, Bora; Mak, Cindy; Carmalt, Hugh; Warrier, Sanjay

    2016-06-01

    Positive margins are associated with an increased risk of ipsilateral breast tumor recurrence (IBTR); therefore re-excision of positive margins is recommended. Involvement of anatomically non-breast margins, such as anterior margins, has been associated to a lower risk of IBTR than radial margins. Although many surgeons do not re-excise positive anterior margins (PAM); there is no consensus regarding this approach. The objective of this study is to find evidence that assesses this practice. A systemic literature review was performed through six databases from January 1995 to July 2014. Studies that discussed anatomical location of involved margins in BCS were included. Six studies were identified evaluating PAM. One study reported a 2.5% rate of IBTR in patients with non-negative margins treated with radiotherapy (of which 23% had a PAM). Another study showed 4% of residual disease after re-excision of PAM, but did not report IBTR rates. A later observational study reported that 87.5% of positive anterior and posterior margins were re-excised. One survey from America and one from the UK showed that 47% and 71% of surgeons would not re-excise PAM, respectively. A later survey in the UK reported that 43.8% of surgeons would not re-excise PAM in DCIS, whilst 29.2% would not for invasive carcinoma. Common surgical practices to not re-excise PAM contradict current guidelines that recommend obtaining negative margins to reduce the risk of IBTR. However, there is little evidence detailing the relationship between PAM and IBTR rates. Low residual disease after re-excision of PAM supports the limited benefit of re-excise this margin; however further studies are required to evaluate this topic. PMID:27060552

  12. The retained surgical sponge.

    Kaiser, C W; Friedman, S; Spurling, K P; Slowick, T; Kaiser, H A

    1996-01-01

    OBJECTIVE. A review was performed to investigate the frequency of occurrence and outcome of patients who have retained surgical sponges. METHODS. Closed case records from the files of the Medical Professional Mutual Insurance Company (ProMutual, Boston, MA) involving a claim of retained surgical sponges were reviewed for a 7-year period. RESULTS. Retained sponges occurred in 40 patients, comprising 48% of all closed claims for retained foreign bodies. A falsely correct sponge count after an abdominal procedure was documented in 76% of these claims. Ten percent of claims involved vaginal deliveries and minor non-body cavity procedures, for which no sponge count was performed. Total indemnity payments were $2,072,319, and defense costs were $572,079. In three cases, the surgeon was deemed responsible by the court despite the nursing staff's admitting liability and evidence presented that the surgeon complied completely with the standard of care. A wide range of indemnity payments was made despite a remarkable similarity of outcome in the patients studied. CONCLUSIONS. Despite the rarity of the reporting of a retained surgical sponge, this occurrence appears to be encountered more commonly than generally is appreciated. Operating teams should ensure that sponges be counted for all vaginal and any incisional procedures at risk for retaining a sponge. In addition, the surgeon should not unquestioningly accept correct count reports, but should develop the habit of performing a brief but thorough routine postprocedure wound/body cavity exploration before wound closure. The strikingly similar outcome for most patients would argue for a standardized indemnity payment being made without the need for adversarial legal procedures. PMID:8678622

  13. The Margins of Medieval Manuscripts

    Nataša Kavčič

    2011-12-01

    Full Text Available Shortly after the mid-thirteenth century, various images began to fill the margins in both religious and secular texts. Many factors influenced the emergence of this type of manuscript decoration, but it has generally been attributed to the revived interest in nature and the Gothic inclination for humorous and anecdotic detail. After highlighting other possible reasons for the occurrence of marginal illumination, this paper introduces two manuscripts from the Archiepiscopal Archives in Ljubljana. The manuscripts show numerous facial drawings affixed to some of the letters. This article addresses how to interpret such drawings and stresses that they do not necessarily function as symbolic images or images with any specific didactic value. Quite the opposite, these drawings seem not to have any meaning and are oft en merely indications of an illuminator’s sense of humor. Because of their exaggerated facial expressions, these drawings could be perceived as the true predecessors of modern caricature.

  14. Surgical Simulation and Competency.

    Kim-Fine, Shunaha; Brennand, Erin A

    2016-09-01

    Simulation in surgical training is playing an increasingly important role as postgraduate medical education programs navigate an environment of increasing costs of education, increased attention on patient safety, and new duty hour restrictions. In obstetrics and gynecology, simulation has been used to teach many procedures; however, it lacks a standardized curriculum. Several different simulators exist for teaching various routes and aspects of hysterectomy. This article describes how a formal framework of increasing levels of competencies can be applied to simulation in teaching the procedure of hysterectomy. PMID:27521885

  15. [The impact of the margin of restorations on periodontal health--a review].

    Amiri-Jezeh, Mohammad; Rateitschak, Edith; Weiger, Roland; Walter, Clemens

    2006-01-01

    The aim of this review is to point out the pathological effects after placement of subgingival crown margins or insufficiently adapted margins of restaurations. The distance between the base of the gingival sulcus and the alveolar bone crest is relatively stable in the context of periodontal health. The term "biological width" refers to the histological dimensions of epithelial and connective tissue attachment. The "biologic width" is in average 2 mm. This distance has to be respected in the case of teeth in need for restorations. From a clinical point of view a distance of at least 3 mm between the margin of restoration and the limbus alveolaris is indispensable. Several pre-prosthetic possibilities are discussed in order to maintain periodontal health. Orthodontic or surgical procedures can be used to obtain of a sufficient distance of the margin of restoration to the alveolar bone crest. PMID:16875258

  16. Margins related to equipment design

    Safety margins related to design of reactor equipment are defined according to safety regulations. Advanced best estimate methods are proposed including some examples which were computed and compared to experimental results. Best estimate methods require greater computation effort and more material data but give better variable accuracy and need careful experimental validation. Simplified methods compared to the previous are less sensitive to material data, sometimes are more accurate but very long to elaborate

  17. The Marginalized Auxiliary Particle Filter

    Fritsche, Carsten; Schön, Thomas; Klein, Anja

    2010-01-01

    In this paper we are concerned with nonlinear systems subject to a conditionally linear, Gaussian sub-structure. This structure is often exploited in high-dimensional state estimation problems using the marginalized (aka Rao-Blackwellized) particle filter. The main contribution in the present work is to show how an efficient filter can be derived by exploiting this structure within the auxiliary particle filter. Based on a multisensor aircraft tracking example, the superior performance of the...

  18. Marginalization algorithm for compositional models

    Jiroušek, Radim; Kratochvíl, Václav

    Paris: Editions EDK, 2006 - (Bouchon-Meunier, B.; Yager, R.), s. 2300-2307 ISBN 2-84254-112-X. [IPMU 2006 /11./. Paris (FR), 02.07.2006-07.07.2006] R&D Projects: GA MŠk 1M0572; GA AV ČR IAA2075302 Institutional research plan: CEZ:AV0Z10750506 Keywords : compositional model * multidimensional distribution * Bayesian network * marginalization * algorithm Subject RIV: BA - General Mathematics

  19. Micronutrient strategies for marginal areas

    Andersen, Peter

    2003-01-01

    Micronutrient deficiencies in human nutrition, especially of iron and zinc, occur often in marginal mountain regions. The main cause is poverty, resulting in low nutrient diets. Poor nutrition is one of the main causes of major health problems, especially among children. However, micronutrient deficiencies are also widespread in the farming systems of the mountains, leading to depressed crop yields, and reduced nutrition quality of staple crops. Balanced crop nutrition can at t...

  20. Surgical Management of Recurrent Nasopharyngeal Carcinoma

    Sheng-Po Hao

    2010-08-01

    Full Text Available Current standard treatment of nasopharyngeal carcinoma(NPC is either radiotherapy alone or combined chemoradiotherapy.Surgery in the form of nasopharyngectomy is usuallyonly offered when there is evidence of local recurrence or persistentdisease. Recurrent NPC (rNPC can be detected earlierwith the utilization of Epstein-Barr virus molecular diagnosis.This may result in early management with salvage surgery andhence improved survival. The facial translocation approachenhanced our ability to access the nasopharynx. Through amultidisciplinary approach with the collaboration of neurosurgeons,the surgical indication of salvage surgery is extended.This allowed improved respectability in locally advanced diseaseand involved the skull base and intracranial extensionwith reasonable morbidity and mortality. Endoscopic nasopharyngectomyis a choice for recurrent NPC with central roof orfloor lesions with minimal lateral extension. Multivariate analysis indicated that gender,parapharyngeal space involvement, surgical margin, and the modality of adjuvant therapyimpact significantly on local control. The impact on survival is indicated by the dura orbrain involvement, local recurrence and modality of adjuvant therapy. It is apparent thatrecurrent NPC patients who underwent surgery had a significantly better survival rate thanthe re-radiation therapy group.

  1. Towards intraoperative assessment of tumor margins in breast surgery using optical coherence elastography (Conference Presentation)

    Kennedy, Brendan F.; Wijesinghe, Philip; Allen, Wes M.; Chin, Lixin; Latham, Bruce; Saunders, Christobel M.; Sampson, David D.

    2016-03-01

    Surgical excision of tumor is a critical factor in the management of breast cancer. The most common surgical procedure is breast-conserving surgery. The surgeon's goal is to remove the tumor and a rim of healthy tissue surrounding the tumor: the surgical margin. A major issue in breast-conserving surgery is the absence of a reliable tool to guide the surgeon in intraoperatively assessing the margin. A number of techniques have been proposed; however, the re-excision rate remains high and has been reported to be in the range 30-60%. New tools are needed to address this issue. Optical coherence elastography (OCE) shows promise as a tool for intraoperative tumor margin assessment in breast-conserving surgery. Further advances towards clinical translation are limited by long scan times and small fields of view. In particular, scanning over sufficient areas to assess the entire margin in an intraoperative timeframe has not been shown to be feasible. Here, we present a protocol allowing ~75% of the surgical margins to be assessed within 30 minutes. To achieve this, we have incorporated a 65 mm-diameter (internal), wide-aperture annular piezoelectric transducer, allowing the entire surface of the excised tumor mass to be automatically imaged in an OCT mosaic comprised of 10 × 10 mm tiles. As OCT is effective in identifying adipose tissue, our protocol uses the wide-field OCT to selectively guide subsequent local OCE scanning to regions of solid tissue which often present low contrast in OCT images. We present promising examples from freshly excised human breast tissue.

  2. Management of asymptomatic carotid stenosis in patients undergoing general and vascular surgical procedures

    Paciaroni, M; Caso, V; Acciarresi, M; Baumgartner, R.; Agnelli, G.

    2005-01-01

    Current available data do not seem to support the strategy for carotid endarterectomy prior to surgical intervention in patients with asymptomatic carotid stenosis. However, in patients with coronary artery disease, synchronous carotid endarterectomy and coronary artery bypass grafting should be considered where there is a proven surgical risk of 60% or bilateral carotid stenosis >75% on the same side as the most severe stenosis. Clarification of the optimal strategy requires an adequately po...

  3. Surgical scar revision: An overview

    Shilpa Garg

    2014-01-01

    Full Text Available Scar formation is an inevitable consequence of wound healing from either a traumatic or a surgical intervention. The aesthetic appearance of a scar is the most important criteria to judge the surgical outcome. An understanding of the anatomy and wound healing along with experience, meticulous planning and technique can reduce complications and improve the surgical outcome. Scar revision does not erase a scar but helps to make it less noticeable and more acceptable. Both surgical and non-surgical techniques, used either alone or in combination can be used for revising a scar. In planning a scar revision surgeon should decide on when to act and the type of technique to use for scar revision to get an aesthetically pleasing outcome. This review article provides overview of methods applied for facial scar revision. This predominantly covers surgical methods.

  4. Surgical Management of Local Recurrences of Renal Cell Carcinoma

    Acar, Ömer; Şanlı, Öner

    2016-01-01

    Surgical resection either in the form of radical nephrectomy or in the form of partial nephrectomy represents the mainstay options in the treatment of kidney cancer. In most instances, resecting the tumor bearing kidney or the tumor itself provides durable cancer specific survival rates. However, recurrences may rarely develop in the renal fossa or remnant kidney. Despite its rarity, locally recurrent RCC is a challenging condition in terms of the possible management options and relatively poor prognosis. If technically feasible, wide surgical excision and ensuring negative surgical margins are the most effective treatment options. Repeat surgeries (completion nephrectomy, excision of locally recurrent tumor, or repeat partial nephrectomy) may often be complicated, and perioperative morbidity is a major concern. Open approach has been extensively applied in this context and 5-year cancer specific survival rates have been reported to be around 50%. The roles of minimally invasive surgical options (laparoscopic and robotic approach) and nonsurgical alternatives (cryoablation, radiofrequency ablation) have yet to be described. In selected patients, surgical resection may have to be complemented with (neo)adjuvant radiotherapy or medical treatment. PMID:26925458

  5. Surgical Management of Local Recurrences of Renal Cell Carcinoma

    Ömer Acar

    2016-01-01

    Full Text Available Surgical resection either in the form of radical nephrectomy or in the form of partial nephrectomy represents the mainstay options in the treatment of kidney cancer. In most instances, resecting the tumor bearing kidney or the tumor itself provides durable cancer specific survival rates. However, recurrences may rarely develop in the renal fossa or remnant kidney. Despite its rarity, locally recurrent RCC is a challenging condition in terms of the possible management options and relatively poor prognosis. If technically feasible, wide surgical excision and ensuring negative surgical margins are the most effective treatment options. Repeat surgeries (completion nephrectomy, excision of locally recurrent tumor, or repeat partial nephrectomy may often be complicated, and perioperative morbidity is a major concern. Open approach has been extensively applied in this context and 5-year cancer specific survival rates have been reported to be around 50%. The roles of minimally invasive surgical options (laparoscopic and robotic approach and nonsurgical alternatives (cryoablation, radiofrequency ablation have yet to be described. In selected patients, surgical resection may have to be complemented with (neoadjuvant radiotherapy or medical treatment.

  6. Diminishing Marginal Utility in Economics Textbooks

    Dittmer, Timothy

    2005-01-01

    Many introductory microeconomics textbook authors derive the law of demand from the assumption of diminishing marginal utility. Authors of intermediate and graduate textbooks derive demand from diminishing marginal rate of substitution and ordinal preferences. These approaches are not interchangeable; diminishing marginal utility for all goods is…

  7. [Transsexualism: indication and surgical treatment].

    Biemer, E; Kockott, G; Hartung, R

    1979-09-01

    After the diagnosis of transsexuality is well definated and recognized in most western countries, the surgical transformation of the genital area is performed. Before surgical treatment an exact psychiatric clarification is absolutely essential. The operation is the last part of a long treatment. The surgical result in the more common female transsexual is quite reasonable. The treatment of the fewer male transsexuals is not solved completely, especially the reliable techniques for penis reconstructions are not very sufficient. PMID:524996

  8. Surgical Safety Checklists : an Update

    BERGS, J.; Hellings, Johan; CLEEMPUT, Irina; SIMONS, Pascale; ZUREL, Ozhan; Vertriest, Sonja; Vandijck, Dominique

    2014-01-01

    Surgical safety checklists aim to improve patient safety by prompting the attention of the surgical team towards critical steps during the operation. The checklist's items are aimed to improve compliance with proven interventions, and to facilitate multidisciplinary communication and teamwork. Based on the current literature, corroborated by systematic reviews and meta-analysis, surgical safety checklists have a positive impact on communication and reduce postoperative complications including...

  9. [Cirrhosis and surgical risk].

    Paugam-Burtz, Catherine

    2011-01-01

    Major surgery in cirrhotic patient is associated with an increased risk of postoperative morbidity and mortality. This risk increases with the disease severity. Cirrhosis generates a wide variety of organ dysfunctions including hemostasis abnormalities, cardiocirculatory and renal dysfunctions. These modifications facilitate postoperative complications. Postoperative morbidity includes surgical site complications such as sepsis or haemorrhage and organ complications such as pneumonia, kidney injury, hepatic failure or ascite. Perioperative care in cirrhotic patient can probably be improved by various techniques such as perioperative nutritional support, intraoperative hemodynamic optimization and close postoperative monitoring. Optimal perioperative care of patients with endstage liver disease necessitates collaboration between anesthesiologists, hepatologists and surgeons in charge of the patient. Indeed, they should be aware of any discussion about possible liver transplantation. PMID:20980124

  10. Surgical education in Mexico.

    Cervantes, Jorge

    2010-05-01

    Surgical education in Mexico basically follows the same model as in the United States, with a selection process resembling the matching program. There is a 4-year training period during which residents in their third year spend 4 months as the sole surgeon in a rural community. During the senior year they are entitled to an elective period in a place of their choosing. After completion of the 4 years, residents have to present a thesis and undergo an oral examination before getting a university diploma. They are then encouraged to pass the written and oral examination of the Mexican Board of Surgery before they are fully certified to enter practice in a public or private hospital. PMID:19603225

  11. Managing margins through physician engagement.

    Sears, Nicholas J

    2012-07-01

    Hospitals should take the following steps as they seek to engage physicians in an enterprisewide effort to effectively manage margins: Consider physicians' daily professional practice requirements and demands for time in balancing patient care and administrative duties. Share detailed transactional supply data with physicians to give them a behind-the-scenes look at the cost of products used for procedures. Institute physician-led management and monitoring of protocol compliance and shifts in utilization to promote clinical support for change. Select a physician champion to provide the framework for managing initiatives with targeted, efficient communication. PMID:22788036

  12. Determination of pyrotechnic functional margin

    Bement, Laurence J.; Schimmel, Morry L.

    1993-01-01

    Following the failure of a previously qualified pyrotechnically actuated pin puller design, an investigation led to a redesign and requalification. The emphasis of the second qualification was placed on determining the functional margin of the pin puller by comparing the energy deliverable by the pyrotechnic cartridge to the energy required to accomplish the function. Also determined were the effects of functional variables. This paper describes the failure investigation, the test methods employed and the results of the evaluation, and provides a recommended approach to assure the successful functioning of pyrotechnic devices.

  13. Percutaneous Versus Surgical Tracheostomy

    Gysin, Claudine; Dulguerov, Pavel; Guyot, Jean-Philippe; Perneger, Thomas V.; Abajo, Blanca; Chevrolet, Jean-Claude

    1999-01-01

    Objective To compare surgical (SgT) and percutaneous (PcT) tracheostomies. Background Percutaneous tracheostomy has been said to provide numerous advantages over classical SgT. Methods A prospective randomized trial with a double-blind evaluation was used to compare SgT and PcT. SgT and PcT were performed according to established techniques (n = 70). The procedure was performed at the bedside in the intensive care unit in 21 cases (30%). The outcome measures were divided into procedure-related variables, perioperative complications, and postoperative complications. The procedure-related variables (location, duration, and difficulty) were evaluated by the surgeon. The perioperative and postoperative complications were divided into serious, intermediate, and minor. Perioperative and early postoperative (14 days) complications were evaluated daily by an intensive care unit nurse blinded to the technique used. Long-term postoperative complications were evaluated 3 months after decannulation by a surgeon blinded to the surgical technique. Results There were no major complications in either group. Most variables studied were not statistically different between the PcT and SgT groups. The only variables to reach statistical significance were the size of the incision (smaller with PcT, p < 0.0001), minor perioperative complications (greater with PcT, p = 0.02), and difficult cannula changes (greater with PcT; p < 0.05). Among nonsignificant differences, difficult procedures and false passages were more frequent with PcT, whereas long-term unesthetic scars were more frequent with SgT. Conclusions Both techniques are associated with a low rate of serious or intermediate complications when performed by experienced surgeons. There were more minor perioperative complications with PcT and more minor long-term complications with SgT. PMID:10561096

  14. Percentage of Adults with High Blood Pressure Whose Hypertension Is Adequately Controlled

    ... Hypertension is Adequately Controlled Percentage of Adults with High Blood Pressure Whose Hypertension is Adequately Controlled Heart disease and ... Examination Survey. Age Group Percentage of People with High Blood Pressure that is Controlled by Age Group f94q-uyye ...

  15. 40 CFR 152.20 - Exemptions for pesticides adequately regulated by another Federal agency.

    2010-07-01

    ... 40 Protection of Environment 23 2010-07-01 2010-07-01 false Exemptions for pesticides adequately... PROTECTION AGENCY (CONTINUED) PESTICIDE PROGRAMS PESTICIDE REGISTRATION AND CLASSIFICATION PROCEDURES Exemptions § 152.20 Exemptions for pesticides adequately regulated by another Federal agency. The...

  16. 75 FR 69648 - Safety Analysis Requirements for Defining Adequate Protection for the Public and the Workers

    2010-11-15

    ... SAFETY BOARD Safety Analysis Requirements for Defining Adequate Protection for the Public and the Workers... TO THE SECRETARY OF ENERGY Safety Analysis Requirements for Defining Adequate Protection for the... rule is designed to hold firmly in place. 10 CFR Part 830 imposes a requirement that a...

  17. Marginal Hepatectomy in the Rat

    Madrahimov, Nodir; Dirsch, Olaf; Broelsch, Christoph; Dahmen, Uta

    2006-01-01

    Objective: Based on the 3-dimensional visualization of vascular supply and drainage, a vessel-oriented resection technique was optimized. The new surgical technique was used to determine the maximal reduction in liver mass enabling a 50% 1-week survival rate. Background Data: Determination of the minimal liver mass is necessary in clinical as well as in experimental liver surgery. In rats, survival seems to depend on the surgical technique applied. Extended hepatectomy with removal of 90% of the liver mass was long regarded as a lethal model. Introduction of a vessel-oriented approach enabled long-term survival in this model. Methods: The lobar and vascular anatomy of rat livers was visualized by plastination of the whole organ, respectively, by corrosion casts of the portal vein, hepatic artery and liver veins. The three-dimensional models were used to extract the underlying anatomic structure. In 90% partial hepatectomy, the liver parenchyma was clamped close to the base of the respective liver lobes (left lateral, median and right, liver lobe). Piercing sutures were placed through the liver parenchyma, so that the stem of portal vein and the accompanying hepatic artery but also the hepatic vein were included. Results: A 1-week survival rate of 100% was achieved after 90% hepatectomy. Extending the procedure to 95% resection by additional removal of the upper caudate lobe led to a 1-week survival rate of 66%; 97% partial hepatectomy, accomplished by additional resection of the lower caudate lobe only leaving the paracaval parts of the liver behind, resulted in 100% lethality within 4 days. Conclusions: Using a anatomically based, vessel-oriented, parenchyma-preserving surgical technique in 95% liver resections led to long-term survival. This represents the maximal reduction of liver mass compatible with survival. PMID:16794393

  18. Challenges of Forward Naval Surgical Support for Maritime Forces.

    Chong, Si Jack; Jiang, Lei; Chow, Wei-En

    2015-08-01

    The emphasis of naval operations has shifted from conventional naval warfare since World War II to Operations Other than War such as Peace Support Operations and Humanitarian Aid and Disaster Relief. Maritime forces are increasingly deployed in distant areas of operations such as the Somali Basin and Gulf of Aden for longer durations, in a possibly higher threat environment against nonconventional threats such as in counter piracy operations. There is therefore a need to balance the challenges of providing adequate forward naval surgical support with limitations in medical manpower, logistics as well as the need for a suitable surgical platform for these deployments. This article aims to share the Republic of Singapore Navy's experience in overcoming some of these challenges. This includes the ability to deploy surgical containers onboard the Landing Ship Tank and Civil Resource vessels, and the ability to convert existing spaces onboard the endurance class Landing Ship Tank and other platforms such as the formidable class Frigate into surgical facilities. The key success factors such as the development of deep expertise in naval operational medicine, operationalization of third generation surgical stores, and enhanced interoperability among maritime forces will also be highlighted. PMID:26226532

  19. In search of the rainbow: Colored inks in surgical pathology

    Chandralekha Tampi

    2012-01-01

    Full Text Available Introduction: Although surgical pathologists are aware of the multiple advantages that coloured inks contribute to surgical pathology practice, these coloured inks are not available in India and importing them is not a viable proposition. A systematic search for locally available coloring agents was done, and resulted in identifying specific shades within a popular set of children′s hobby colors of a particular brand. They retain their bright distinct colors on paraffin blocks and sections. These paints are available all over India, and are cheap, safe, and easy to use. Coloring gross specimen excision margins with different colors, adds precision to margin examination. It allows three-dimensional microscopic reconstruction of the tumor vis-a-vis its various neighboring anatomic structures. It allows postoperative comparison of tissue planes predicted by preoperative imaging. It maintains orientation of grossed and dissected specimens, enabling the pathologist to re-visit the grossed specimen, if required, and confidently allows further sampling if necessary. Aim: A systematic search for indigenous coloring agents was carried out, which included the dyes used in the histopathology laboratory, gelatin, commercially available paints, including acrylic paints and inks. Results: The study identified specific shades within a brand of acrylic colors that are easily available and simple to use, with good results on microscopic examination. Conclusion: Colored inks lend precision to margin examination. A set of easily procurable colors are available in our country, which are easy to use, with distinct bright colors, safe, and reliable.

  20. Dynamics of the continental margins

    1990-11-01

    On 18--20 June 1990, over 70 oceanographers conducting research in the ocean margins of North America attended a workshop in Virginia Beach, Virginia. The purpose of the workshop was to provide the Department of Energy with recommendations for future research on the exchange of energy-related materials between the coastal and interior ocean and the relationship between the ocean margins and global change. The workshop was designed to optimize the interaction of scientists from specific research disciplines (biology, chemistry, physics and geology) as they developed hypotheses, research questions and topics and implementation plans. The participants were given few restraints on the research they proposed other than realistic time and monetary limits. The interdisciplinary structure of the meeting promoted lively discussion and creative research plans. The meeting was divided into four working groups based on lateral, vertical, air/sea and sediment/water processes. Working papers were prepared and distributed before the meeting. During the meeting the groups revised the papers and added recommendations that appear in this report, which was reviewed by an Executive Committee.

  1. Clinical review: surgical management of locally advanced and recurrent colorectal cancer.

    Courtney, D

    2014-01-01

    Recurrent and locally advanced colorectal cancers frequently require en bloc resection of involved organs to achieve negative margins. The aim of this review is to evaluate the most current literature related to the surgical management of locally advanced and recurrent colorectal cancer.

  2. Exactly marginal deformations from exceptional generalised geometry

    Ashmore, Anthony; Graña, Mariana; Petrini, Michela; Waldram, Daniel

    2016-01-01

    We apply exceptional generalised geometry to the study of exactly marginal deformations of $\\mathcal{N}=1$ SCFTs that are dual to generic AdS$_5$ flux backgrounds in type IIB or eleven-dimensional supergravity. In the gauge theory, marginal deformations are parametrised by the space of chiral primary operators of conformal dimension three, while exactly marginal deformations correspond to quotienting this space by the complexified global symmetry group. We show how the supergravity analysis gives a geometric interpretation of the gauge theory results. The marginal deformations arise from deformations of generalised structures that solve moment maps for the generalised diffeomorphism group and have the correct charge under the generalised Reeb vector, generating the R-symmetry. If this is the only symmetry of the background, all marginal deformations are exactly marginal. If the background possesses extra isometries, there are obstructions that come from fixed points of the moment maps. The exactly marginal de...

  3. Surgical treatment of equinus foot deformity in children with cerebral palsy (review

    Krasnov A.S.

    2011-09-01

    Full Text Available The review presents data about etiology and pathogenesis of cerebral palsy in children and its clinical manifestations. The effectiveness analysis of main surgical methods to correct equinus foot deformity in children with cerebral palsy has been conducted. The article comes to conclusion that at present surgical methods eliminating all pathologic deformity units are incompletely presented. In this connection high recurrence frequency after using traditional treatment methods is registered. Development of surgical intervention adequate to pathologic foot state in children with cerebral palsy is a perspective direction in treatment of given category of patients

  4. Surgical Responses of Medial Rectus Muscle Recession in Thyroid Eye Disease-Related Esotropia.

    Lyu, In Jeong; Lee, Ju-Yeun; Kong, Mingui; Park, Kyung-Ah; Oh, Sei Yeul

    2016-01-01

    We evaluate the surgical outcomes and surgical responses of medial rectus muscle (MR) recession patients with thyroid eye disease (TED)-related esotropia (ET). The surgical dose-response curves 1 week postoperatively and at the final visit were analyzed. Univariable and multivariable linear regression analyses were applied to investigate factors influencing surgical dose-response. A total of 43 patients with TED-related ET that underwent MR recession were included. The final success rate was 86.0% and the rate of undercorrection was 14.0%. The surgical dose-response curves of TED-related ET showed a gentle slope compared with those of standard surgical tables. In the univariable model, simultaneous vertical rectus muscle recession was the only significant factor influencing surgical dose-response of MR recession in TED-related ET (β = -0.397, P = 0.044). In a model adjusted for age, sex, type of surgery, and preoperative horizontal angle of deviation, simultaneous vertical rectus muscle recession showed marginal significance (β = -0.389, P = 0.064). The surgical dose-response curve of TED-related ET was unique. Simultaneous vertical rectus muscle recession was associated with increased surgical dose-response in TED-related ET. PMID:26796354

  5. Surgical Responses of Medial Rectus Muscle Recession in Thyroid Eye Disease-Related Esotropia.

    In Jeong Lyu

    Full Text Available We evaluate the surgical outcomes and surgical responses of medial rectus muscle (MR recession patients with thyroid eye disease (TED-related esotropia (ET. The surgical dose-response curves 1 week postoperatively and at the final visit were analyzed. Univariable and multivariable linear regression analyses were applied to investigate factors influencing surgical dose-response. A total of 43 patients with TED-related ET that underwent MR recession were included. The final success rate was 86.0% and the rate of undercorrection was 14.0%. The surgical dose-response curves of TED-related ET showed a gentle slope compared with those of standard surgical tables. In the univariable model, simultaneous vertical rectus muscle recession was the only significant factor influencing surgical dose-response of MR recession in TED-related ET (β = -0.397, P = 0.044. In a model adjusted for age, sex, type of surgery, and preoperative horizontal angle of deviation, simultaneous vertical rectus muscle recession showed marginal significance (β = -0.389, P = 0.064. The surgical dose-response curve of TED-related ET was unique. Simultaneous vertical rectus muscle recession was associated with increased surgical dose-response in TED-related ET.

  6. Evolution of surgical skills training

    Roberts, Kurt E.; Bell, Robert L.; Duffy, Andrew J

    2006-01-01

    Surgical training is changing: one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients.

  7. Towards Safe Robotic Surgical Systems

    Sloth, Christoffer; Wisniewski, Rafael

    2015-01-01

    A proof of safety is paramount for an autonomous robotic surgical system to ensure that it does not cause trauma to patients. However, a proof of safety is rarely constructed, as surgical systems are too complex to be dealt with by most formal verification methods. In this paper, we design a...

  8. Surgical innovations in canine gonadectomy

    Van Goethem, Bart

    2016-01-01

    In this thesis some recent technological developments in human surgery are evaluated for their potential use in veterinary medicine by introducing them as surgical innovations for canine gonadectomy. Barbed sutures achieve wound apposition without surgical knot tying and thus avoid knot-associated n

  9. Training of breast surgical oncologists.

    Teshome, Mediget; Kuerer, Henry M

    2016-06-01

    Breast surgical oncology is a defined sub-specialty of general surgery with focus on the surgical management of breast disease and malignancy within a multidisciplinary context. Much of the training of breast surgical oncologists in the United States exists within a fellowship training structure with oversight and approval by the Society of Surgical Oncology (SSO). Rapid continuous changes in breast oncology practice have further substantiated dedicated expertise in breast surgical oncology. Training programs are structured to develop proficiency in fellows for advanced surgical techniques and clinical decision-making as well as exposure to the multidisciplinary aspects of breast cancer management. Components of a successful program include an intense multidisciplinary curriculum, engagement in clinical research and attention to strong mentorship. National curriculum and training requirements as well as supplemental resources assist in standardizing the fellowship experience. As surgical training and the field of breast oncology continues to evolve, so do fellowship training programs to ensure high quality breast surgical oncologists equipped to deliver high quality evidence based patient care while continuing to drive future research and trainee education. PMID:27197510

  10. Breast Conservation Therapy: The Influence of Molecular Subtype and Margins

    Purpose: To evaluate treatment results and prognostic factors, especially margin status and molecular subtype, in early-stage breast cancer patients treated with breast conservation therapy (BCT). Methods and Materials: The records of 1,058 Stage I or II breast cancer patients treated with BCT (surgical excision plus radiotherapy) at Duke University Medical Center, Durham, North Carolina, from 1985–2005 were retrospectively reviewed. Conventional receptor analyses were used as surrogate markers for molecular subtype classification (luminal A, luminal B, Her2 positive, and basal like). Actuarial estimates of overall survival (OS), cause-specific survival (CSS), failure-free survival, and locoregional control (LRC) were computed by use of Kaplan-Meier plots. We analyzed prognostic variables for significance using Cox proportional hazards univariate and multivariate analysis. The study was approved by the Duke University Medical Center Institutional Review Board. Results: The median age of the patients was 56 years (range, 18–89 years). Of the patients, 80% had T1 disease and 66% N0 disease pathologically. With a median follow-up of 9.8 years, an in-breast recurrence developed in 53 patients and 10 patients had nodal failure. For all patients, the 10-year CSS rate was 94%; LRC rate, 94%; and failure-free survival rate, 88%. Luminal A patients had a CSS rate of 95% and LRC rate of 99%. Basal-type patients appeared to do worse, with regard to both CSS rate (74%) and LRC rate (76%), but the numbers were small and the difference was not statistically significant. LRC rates of patients with negative margins (widely negative, close, and extent of margin not known) were virtually identical (93%, 96%, and 94%, respectively). Those with positive margins appeared to fare slightly worse based on LRC rate (88%), but again, the numbers were small and the difference was not statistically significant. Conclusions: BCT remains the treatment of choice for early-stage breast cancer

  11. Combined Surgical Treatment of Gynecomastia

    Yordanov Y.

    2015-05-01

    Full Text Available Surgical treatment of gynecomastia could present unique challenges for the plastic surgeon. Achieving a good balance between effectiveness of the selected approach and the satisfactory aesthetic outcome often is a difficult endeavor. Optimal surgical treatment involves a combination of liposuction and direct excision. In the present study the charts of 11 patients treated with suction-assisted liposuction and direct surgical excision were retrospectively reviewed; a special emphasis is placed on the surgical technique. The mean follow-up period of the patients was 11.6 months. No infection, hematoma, nipple-areola complex necrosis and nipple retraction was encountered in this series. The combined surgical treatment of gynecomastia has shown to be a reliable technique in both small and moderate breast enlargement including those with skin excess.

  12. The value of nonuniform margins for six-field conformal irradiation of localized prostate cancer

    Purpose: Evaluate the hypothesis that by combining nonuniform margins with a technique for limiting the possible extent of posterior motion of the prostate during the delivery of six-field conformal radiotherapy (SFCRT) of the prostate, it is possible to adequately treat the clinical target volume (CTV) and minimize dose to normal structures. Methods and Materials: Serial computed tomography (CT) scans of prostate patients were taken at 0.5 cm intervals for treatment planning purposes. The initial treatment planning scans were performed with the rectum empty and the bladder full. Subsequent scans were taken at the end of the first week of treatment with the bladder full, but with no attempt to empty the rectum, to mimic the typical treatment situation. The gross tumor volume (GTV), consisting of the prostate and seminal vesicles, as well as the CTV, were defined on the CT images with the aid of a urethrogram to define the inferior border (apex) of the prostate. Variable blocking margins were designed around the CTV using the University of Michigan three dimensional (3D) treatment planning system (UM-PLAN). Isodose distributions displayed on axial, sagittal, coronal, and oblique slices were used to evaluate the adequacy of the various margins applied. Nonuniform margins varying from 0.75 cm posteriorly to 2.0 cm anteriorly and inferiorly were compared to uniform margins of 1.0, 1.5, and 2.0 cm for each patient. Dose volume histograms (DVH) were used to compare doses to the GTV, CTV, rectum, and bladder. Results: In a series of 10 patients scanned with the above protocol, treatment plans with nonuniform margins were compared with uniform margins of 1.0, 1.5, and 2.0 cm. Dose-volume histograms showed that nonuniform and 1.0 cm uniform margins deliver the lowest doses to the rectum and bladder, but the use of 1.0 cm uniform margins resulted in inadequate coverage of the CTV in 40% of the cases. The 1.5 and 2.0 cm uniform margins adequately covered the CTV but resulted

  13. Interventional neuroradiology (surgical neuroanglography)

    The applications and effectiveness of surgical neuroangiography, or interventional neuroradiology of the head, neck, spine and brain are rapidly increasing. These procedures are used in the management of a variety of vascular lesions, either preoperatively or as the primary mode of treatment. Lesions that can be approached by the endovascular route, vascular neoplasms (benign or malignant), vasculas malformations (arterial, venous, or mixed), hemangiomas, arteriovenous fistulas, vessel lacerations, and extracranial or intracranial aneurysms are discussed, as are infusion chemotherapy and angioplasties of atherosclerotic or vasospastic extracranial or intracranial vessels. The various catheters or delivery systems and embolic agents, including conventional or special microcatheters, balloon catheters of various lumens, detachable balloons of silicone and latex, open-ended guide wires, and steerable microwires, as well as various embolic agents, either particulated or liquid, and including cytotoxic agents, are described. Functional vascular anatomy of the collateral circulation is reviewed, including extracerebral to intracerebral anastomases and the supply to the transcranial nerves. The use of chemical testing with Amytal and Xylocaine and electrophysiologic monitoring for safe embolization is demonstrated

  14. Positive margins prediction in breast cancer conservative surgery: Assessment of a preoperative web-based nomogram.

    Alves-Ribeiro, Lídia; Osório, Fernando; Amendoeira, Isabel; Fougo, José Luís

    2016-08-01

    Margin status of the surgical specimen has been shown to be a prognostic and risk factor for local recurrence in breast cancer surgery. It has been studied as a topic of intervention to diminish reoperation rates and reduce the probability of local recurrence in breast conservative surgery (BCS). This study aims to validate the Dutch BreastConservation! nomogram, created by Pleijhus et al., which predicts preoperative probability of positive margins in BCS. Patients with diagnosis of breast cancer stages cT1-2, who underwent BCS at the Breast Center of São João University Hospital (BC-CHSJ) in 2013-2014, were included. Association and correlation were evaluated for clinical, radiological, pathological and surgical variables. Multivariable logistic regression and ROC curves were used to assess nomogram parameters and discrimination. In our series of 253 patients, no associations were found between margin status and other studied variables (such as age or family history of breast cancer), except for weight (p-value = 0.045) and volume (p-value = 0.012) of the surgical specimen. Regarding the nomogram, a statistically significant association was shown between cN1 status and positive margins (p-value = 0.014). No differences were registered between the scores of patients with positive versus negative margins. Discrimination analysis showed an AUC of 0.474 for the basic and 0.508 for the expanded models. We cannot assume its external validation or its applicability to our cohort. Further studies are needed to determine the validity of this nomogram and achieve a broader view of currently available tools. PMID:27326978

  15. Auditory information processing during adequate propofol anesthesia monitored by electroencephalogram bispectral index

    C. Kerssens (Chantal); J. Klein (Jan); A. van der Woerd; B. Bonke (Benno)

    2001-01-01

    textabstractMemory for intraoperative events may arise from inadequate anesthesia when the hypnotic state is not continuously monitored. Electroencephalogram bispectral index (BIS) enables monitoring of the hypnotic state and titration of anesthesia to an adequate level

  16. Fibroadenomas of the breast showing an ill-defined margin on ultrasonogram: Correlation with histopathologic findings

    Hwang, Ji Young; Choi, Hye Young; Shim, Sung Shine; Rhee, Chung Sik; Sung, Soon Hee [Ewha Womans University College of Medicine, Seoul (Korea, Republic of)

    2002-12-15

    To correlate the sonographic finding of ill-defined fibroadenoma with the histopathologic findings. Sonographic finding of forty nine surgically proven fibroadenomas were retrospectively correlated with histopathologic findings. We evaluated sonographic findings including the margin, shape, size and the echotexture of fibroadenoma. The histopathologic glandular structure, stromal type of fibroadenoma, type of the surrounding breast tissue and presence of interdigitation between fibroadenoma and the surrounding breast tissue were pathologically reviewed and analyzed statistically. Breast sonography of fibroadenomas demonstrated well-defined margin in 28 (57%) and ill-defined margin in 21 (43%) among 49 lesions. Histopathologically, the glandular structure and type of the surrounding breast tissue were not significantly different between well-defined and ill-defined fibroadenomas. The stromal type of fibroadenoma was sclerotic in 8 (29%) well-defined fibroadenomas while sclerotic in 15 (72%) of 21 ill-defined fibroadenomas,showing difference with a statistical significance between well-defined and ill-defined fibroadenomas (p<0.05). Twenty (71%) of 28 fibroadenomas with well-defined sonographic margins showed well-defined border between mass and the surrounding breast tissue, pathologically. Meanwhile, twenty (95%) of 21 fibroadenomas with ill-defined sonographic margins demonstrated interdigitation of the surrounding breast tissue and mass, exhibiting a statistical significance (p<0.005). Ill-defined margins of fibroadenomas on sonography represent the interdigitation of the surrounding breast tissue with a mass and is seen in the sclerotic stromal type of fibroadenomas.

  17. Fibroadenomas of the breast showing an ill-defined margin on ultrasonogram: Correlation with histopathologic findings

    To correlate the sonographic finding of ill-defined fibroadenoma with the histopathologic findings. Sonographic finding of forty nine surgically proven fibroadenomas were retrospectively correlated with histopathologic findings. We evaluated sonographic findings including the margin, shape, size and the echotexture of fibroadenoma. The histopathologic glandular structure, stromal type of fibroadenoma, type of the surrounding breast tissue and presence of interdigitation between fibroadenoma and the surrounding breast tissue were pathologically reviewed and analyzed statistically. Breast sonography of fibroadenomas demonstrated well-defined margin in 28 (57%) and ill-defined margin in 21 (43%) among 49 lesions. Histopathologically, the glandular structure and type of the surrounding breast tissue were not significantly different between well-defined and ill-defined fibroadenomas. The stromal type of fibroadenoma was sclerotic in 8 (29%) well-defined fibroadenomas while sclerotic in 15 (72%) of 21 ill-defined fibroadenomas,showing difference with a statistical significance between well-defined and ill-defined fibroadenomas (p<0.05). Twenty (71%) of 28 fibroadenomas with well-defined sonographic margins showed well-defined border between mass and the surrounding breast tissue, pathologically. Meanwhile, twenty (95%) of 21 fibroadenomas with ill-defined sonographic margins demonstrated interdigitation of the surrounding breast tissue and mass, exhibiting a statistical significance (p<0.005). Ill-defined margins of fibroadenomas on sonography represent the interdigitation of the surrounding breast tissue with a mass and is seen in the sclerotic stromal type of fibroadenomas.

  18. Delivering Access to Safe Drinking Water and Adequate Sanitation in Pakistan

    Faheem Jehangir Khan; Yaser Javed

    2007-01-01

    Provision of safe drinking water, adequate sanitation and personal hygiene are vital for the sustainable environmental conditions and reducing the incidence of diarrhoea, malaria, trachoma, hepatitis A & B and morbidity levels. Not having access to water and sanitation is a courteous expression for a form of deprivation that threatens life, destroys opportunity and undermines human dignity. Thus, investing in the provision of safe water supply and adequate sanitation is not only a development...

  19. Almost equal: Method of adequality from Diophantus to Fermat and beyond

    Katz, Mikhail G.; Schaps, David M.; Shnider, Steven

    2012-01-01

    We analyze some of the main approaches in the literature to the method of `adequality' with which Fermat approached the problems of the calculus, as well as its source in the parisotes of Diophantus, and propose a novel reading thereof. Adequality is a crucial step in Fermat's method of finding maxima, minima, tangents, and solving other problems that a modern mathematician would solve using infinitesimal calculus. The method is presented in a series of short articles in Fermat's collected wo...

  20. Narita Target Heart Rate Equation Underestimates the Predicted Adequate Exercise Level in Sedentary Young Boys

    Siahkouhian, Marefat; Khodadadi, Davar

    2013-01-01

    Purpose Optimal training intensity and the adequate exercise level for physical fitness is one of the most important interests of coaches and sports physiologists. The aim of this study was to investigate the validity of the Narita et al target heart rate equation for the adequate exercise training level in sedentary young boys. Methods Forty two sedentary young boys (19.07±1.16 years) undertook a blood lactate transition threshold maximal treadmill test to volitional exhaustion with continuo...

  1. Current strategies for the restoration of adequate lordosis during lumbar fusion

    Barrey, Cédric; Darnis, Alice

    2015-01-01

    Not restoring the adequate lumbar lordosis during lumbar fusion surgery may result in mechanical low back pain, sagittal unbalance and adjacent segment degeneration. The objective of this work is to describe the current strategies and concepts for restoration of adequate lordosis during fusion surgery. Theoretical lordosis can be evaluated from the measurement of the pelvic incidence and from the analysis of spatial organization of the lumbar spine with 2/3 of the lordosis given by the L4-S1 ...

  2. Lumbar posterior marginal intra-osseous cartilaginous node

    Laredo, J.D.; Bard, M.; Chretien, J.; Kahn, M.F.

    1986-03-01

    This report concerns 12 patients, eight young adults and four adolescents, presenting with lumbar or sciatic pain. This was associated with an unusual defect of the inferior and posterior edges of the vertebral bodies of L4 or L5, together with a small bony ridge protruding into the spinal canal. We found 11 similar cases in the literature, all involving adolescents except for one young adult. It has been considered to be the result of a fracture of the posterior ring apophysis in association with a herniated disc. In our cases, in the absence of any known previous trauma, the radiological features and surgical results and the similarity and frequent association with typical lesions of Scheuermann disease, all suggest a posterior marginal cartilaginous node. The inferior lumbar location and frequent association with herniated disc and sciatic nerve root compression in young patients are discussed.

  3. Entropic bounds for the quantum marginal problem

    Osborne, Tobias J

    2008-01-01

    The quantum marginal problem asks, given a set of reduced quantum states of a multipartite system, whether there exists a joint quantum state consistent with these reduced states. The quantum marginal problem is known to be hard to solve in general as it is a variant of the N-representability problem. We provide entropic bounds on the number of orthogonal solutions to the quantum marginal problem.

  4. A simple technique for tracheocutaneous fistula surgical closure

    Armando De Virgilio

    2015-10-01

    Full Text Available Tracheocutaneous fistula (TCF is commonly regarded as a pathologic complication of temporary tracheostomy, resulting from failure of the spontaneous tracheostomy closure after decannulation. The aim of the present study is to describe and to report the results of a our simple TCF closure surgical technique. Ten patients with TCF were prospectively enrolled at the Sensory Organs Department of Policlinico “Umberto I”, “Sapienza” University of Rome between February 2011 and May 2013. The surgical procedure, performed under local anesthesia, is decribed in detail. TCF surgical closure was accomplished successfully in all cases. All patients experienced regular postoperative courses during the first week without complications in terms of bleeding or airway compromise. Only 1 (10% patient required a surgical revision consisting of debriding of the margins and closure with simple sutures. The reported technique was shown to be safe, simple and feasible. However particular caution should be required in patients with chronic aspiration and cough which may cause wound dehiscence and fistula recurrence in the early post-operative period.

  5. Assessment of seismic margin calculation methods

    Kennedy, R.P.; Murray, R.C.; Ravindra, M.K.; Reed, J.W.; Stevenson, J.D.

    1989-03-01

    Seismic margin review of nuclear power plants requires that the High Confidence of Low Probability of Failure (HCLPF) capacity be calculated for certain components. The candidate methods for calculating the HCLPF capacity as recommended by the Expert Panel on Quantification of Seismic Margins are the Conservative Deterministic Failure Margin (CDFM) method and the Fragility Analysis (FA) method. The present study evaluated these two methods using some representative components in order to provide further guidance in conducting seismic margin reviews. It is concluded that either of the two methods could be used for calculating HCLPF capacities. 21 refs., 9 figs., 6 tabs.

  6. On the evaluation of marginal expected shortfall

    Caporin, Massimiliano; Santucci de Magistris, Paolo

    2012-01-01

    In the analysis of systemic risk, Marginal Expected Shortfall may be considered to evaluate the marginal impact of a single stock on the market Expected Shortfall. These quantities are generally computed using log-returns, in particular when there is also a focus on returns conditional distribution....... In this case, the market log-return is only approximately equal to the weighed sum of equities log-returns. We show that the approximation error is large during turbulent market phases, with a subsequent impact on Marginal Expected Shortfall. We then suggest how to improve the evaluation of Marginal...... Expected Shortfall by means of a second order approximation....

  7. Assessment of seismic margin calculation methods

    Seismic margin review of nuclear power plants requires that the High Confidence of Low Probability of Failure (HCLPF) capacity be calculated for certain components. The candidate methods for calculating the HCLPF capacity as recommended by the Expert Panel on Quantification of Seismic Margins are the Conservative Deterministic Failure Margin (CDFM) method and the Fragility Analysis (FA) method. The present study evaluated these two methods using some representative components in order to provide further guidance in conducting seismic margin reviews. It is concluded that either of the two methods could be used for calculating HCLPF capacities. 21 refs., 9 figs., 6 tabs

  8. [Quantum dots in oncological surgery: the future for surgical margin status].

    Marchal, F; Pic, E; Pons, T; Dubertret, B; Bolotine, L; Guillemin, F

    2008-12-01

    Quantum dots (QDs) are semi-conductor nanocrystals that emit fluorescence on excitation with a light source. They have excellent optical properties, including high brightness and resistance to photobleaching. Their spectroscopic properties can be modulated by many factors. Recent progress in developing QDs enable us to control the size, shape and surface functionality of nanoparticles for potential application in cancer imaging. QDs with near-infrared emission could be applied to identify sentinel lymph-node. Conjugation of QDs with biomolecules could be used to target tumors in vivo. This article reviewed recent developments and issues in nanotechnology with a particular focus on applications to the surgery. PMID:19091647

  9. Surgical Margins and Short-Term Results of Laparoscopic Total Mesorectal Excision for Low Rectal Cancer

    Yang, Qingqiang; Xiu, Peng; Qi, Xiaolong; Yi, Guoping; Xu, Liang

    2013-01-01

    Background and Objectives: The confines of the narrow bony pelvis make laparoscopic surgery more challenging in the treatment of low rectal cancer. Macroscopic evaluation of the completeness of the mesorectum provides detailed information about the quality of surgery. This study was performed to observe the short-term outcomes and evaluate the macroscopic quality of specimens acquired from laparoscopic total mesorectal excision versus open total mesorectal excision in patients with low rectal...

  10. ABOUT ACCOUNTING INTERPRETATION SOME MARGIN PURCHASES, SHORT SALES AND FINANCIAL INSTRUMENTS LEADING

    Kolev, Nikolay

    2014-01-01

    It is axiomatically that financial markets are not only the most sensitive, but also the most dynamic. On these markets are born daily new financial instruments, and also die exhausted attractiveness instruments. This is an ongoing process that requires adequate changes in the accounting information system of banks. This manuscript presents some views on the necessary accounting interpretation of three attractive financial operations, namely: short sales; margin purchases; lending of financia...

  11. Surgical Procedures for Vestibular Dysfunction

    ... Rated Nonprofit! Volunteer. Donate. Review. Surgical Procedures for Vestibular Dysfunction When is surgery necessary? When medical treatment ... organ (cochlea) is also sacrificed with this procedure. Vestibular nerve section A vestibular nerve section is a ...

  12. [Surgical approach in Peyronie's disease].

    Carmignani, G; De Rose, A F; Simonato, A; Galli, S; Corbu, C

    1997-02-01

    The goal of surgical treatment of Induratio Penis Plastica should be the achievement of the best aesthetic and functional result with the lowest side-effects. During the last two years different techniques have been proposed for the cases with conserved erectile function, such as Nesbit's technique, excision or incision of the plaque followed by implants of autologous (dermal, saphena vein) or heterologous (dura madre, gore-tex) patches. The criteria for the choice of the most appropriated surgical technique include the curvature degree, the plaque dimension and the penis length. In our experience 6 months after the surgical correction a remaining curvature was observed in 4/38 patients (10%), only 1 of whom needed a new surgical treatment. One case of erectile disfunction occurred, treated by intra-cavernous injection of PgE1. PMID:9181914

  13. Surgical Stress Abrogates Pre-Existing Protective T Cell Mediated Anti-Tumor Immunity Leading to Postoperative Cancer Recurrence.

    Ananth, Abhirami A; Tai, Lee-Hwa; Lansdell, Casey; Alkayyal, Almohanad A; Baxter, Katherine E; Angka, Leonard; Zhang, Jiqing; Tanese de Souza, Christiano; Stephenson, Kyle B; Parato, Kelley; Bramson, Jonathan L; Bell, John C; Lichty, Brian D; Auer, Rebecca C

    2016-01-01

    Anti-tumor CD8+ T cells are a key determinant for overall survival in patients following surgical resection for solid malignancies. Using a mouse model of cancer vaccination (adenovirus expressing melanoma tumor-associated antigen (TAA)-dopachrome tautomerase (AdDCT) and resection resulting in major surgical stress (abdominal nephrectomy), we demonstrate that surgical stress results in a reduction in the number of CD8+ T cell that produce cytokines (IFNγ, TNFα, Granzyme B) in response to TAA. This effect is secondary to both reduced proliferation and impaired T cell function following antigen binding. In a prophylactic model, surgical stress completely abrogates tumor protection conferred by vaccination in the immediate postoperative period. In a clinically relevant surgical resection model, vaccinated mice undergoing a positive margin resection with surgical stress had decreased survival compared to mice with positive margin resection alone. Preoperative immunotherapy with IFNα significantly extends survival in surgically stressed mice. Importantly, myeloid derived suppressor cell (MDSC) population numbers and functional impairment of TAA-specific CD8+ T cell were altered in surgically stressed mice. Our observations suggest that cancer progression may result from surgery-induced suppression of tumor-specific CD8+ T cells. Preoperative immunotherapies aimed at targeting the prometastatic effects of cancer surgery will reduce recurrence and improve survival in cancer surgery patients. PMID:27196057

  14. Blepharoplasty and periorbital surgical rejuvenation

    Milind Naik

    2013-01-01

    The periorbital region forms the epicenter of facial aging changes and receives highest attention from physicians and patients. The concern about visual function, clubbed with the need for hidden incisions, makes the periocular region a highly specialized surgical area, most appropriately handled by an ophthalmic plastic surgeon. The article provides an overview of cosmetic eyelid and facial surgery in the periocular region. Common aesthetic surgical procedures as well as ocular side-effects ...

  15. Surgical checklists: the human factor

    O’Connor, Paul; Reddin, Catriona; O’Sullivan, Michael; O’Duffy, Fergal; Keogh, Ivan

    2013-01-01

    Background Surgical checklists has been shown to improve patient safety and teamwork in the operating theatre. However, despite the known benefits of the use of checklists in surgery, in some cases the practical implementation has been found to be less than universal. A questionnaire methodology was used to quantitatively evaluate the attitudes of theatre staff towards a modified version of the World Health Organisation (WHO) surgical checklist with relation to: beliefs about levels of compli...

  16. Intermittent exotropia: Surgical treatment strategies

    Jai Aditya Kelkar

    2015-01-01

    Full Text Available Surgical management of intermittent exotropias (IXTs is ambiguous, with techniques of management varying widely between institutions. This review aims to examine available literature on the surgical management of IXT. A literature search was performed using PubMed, Web of Knowledge, LILACS, and the University of Liverpool Orthoptic Journals and Conference Transactions Database. All English-language papers published between 1958 and the present day were considered.

  17. Surgical innovations in canine gonadectomy

    Van Goethem, Bart

    2016-01-01

    In this thesis some recent technological developments in human surgery are evaluated for their potential use in veterinary medicine by introducing them as surgical innovations for canine gonadectomy. Barbed sutures achieve wound apposition without surgical knot tying and thus avoid knot-associated negative consequences (lengthy placement, impaired wound healing around bulky knots, and the effect of unsightly knots on cosmetics). A study in 9 dogs found that celiotomy closure was easily achiev...

  18. Undernutriton and surgical site infection

    Weimann, Arved

    2007-01-01

    There is strong evidence for the impact of nutritional status and nutritional intervention on surgical morbidity with special regard to surgical site infectious complications. Aiming on the decrease of length of hospital stay in surgery, the identification of nutritional risk patients and candidates for preoperative nutritional support has to be realized in an outpatient setting. This has to be established by improvement of health care networking. Whenever possible, nutritional support should...

  19. Regional anaesthesia and surgical morbidity

    Scott, N B; Kehlet, H

    1988-01-01

    This review assesses the results of studies examining the influence of regional anaesthesia on surgical morbidity. Morbidity appears to be reduced when procedures below the umbilicus are concerned, but evidence is less convincing for upper abdominal and thoracic procedures.......This review assesses the results of studies examining the influence of regional anaesthesia on surgical morbidity. Morbidity appears to be reduced when procedures below the umbilicus are concerned, but evidence is less convincing for upper abdominal and thoracic procedures....

  20. Surgical innovation: the ethical agenda: A systematic review.

    Broekman, Marike L; Carrière, Michelle E; Bredenoord, Annelien L

    2016-06-01

    The aim of the present article was to systematically review the ethics of surgical innovation and introduce the components of the learning health care system to guide future research and debate on surgical innovation.Although the call for evidence-based practice in surgery is increasingly high on the agenda, most surgeons feel that the format of the randomized controlled trial is not suitable for surgery. Innovation in surgery has aspects of, but should be distinguished from both research and clinical care and raises its own ethical challenges.To answer the question "What are the main ethical aspects of surgical innovation?", we systematically searched PubMed and Embase. Papers expressing an opinion, point of view, or position were included, that is, normative ethical papers.We included 59 studies discussing ethical aspects of surgical innovation. These studies discussed 4 major themes: oversight, informed consent, learning curve, and vulnerable patient groups. Although all papers addressed the ethical challenges raised by surgical innovation, surgeons hold no uniform view of surgical innovation, and there is no agreement on the distinction between innovation and research. Even though most agree to some sort of oversight, they offer different alternatives ranging from the formation of new surgical innovation committees to establishing national registries. Most agree that informed consent is necessary for innovative procedures and that surgeons should be adequately trained to assure their competence to tackle the learning curve problem. All papers agree that in case of vulnerable patients, alternatives must be found for the informed consent procedure.We suggest that the concept of the learning health care system might provide guidance for thinking about surgical innovation. The underlying rationale of the learning health care system is to improve the quality of health care by embedding research within clinical care. Two aspects of a learning health care system might

  1. Surgical problems in the excision and repair of radiated tissue

    Surgical procedures for tissues damaged by radiation are fraught with the possibility of multiple and serious complications. A knowledge of the altered pathophysiology of such tissues (chiefly diminished blood supply, fibrosis, and direct cellular reparative potential) is necessary for the surgeon to make a proper judgment. Recognition of the pathognomic signs in the skin is important. The possibility of malignant change must be kept in mind. Surgical treatment must include the excision of radiated tissues back to good blood supply, and then proper and adequate coverage by the simplest and best means. If the surrounding local tissues are so altered that they are unsuitable for coverage, structures from a distance must be used. Prior planning of the coverage before the excision pays dividends by preventing disastrous complications. (U.S.)

  2. Surgical therapy concepts for the pressure sore treatment

    Middelberg, Tim R.

    2006-08-01

    Full Text Available Limited protective sensation and reduced spontaneous mobility in bed-ridden patients and para- and quadriplegics sometimes lead to the development of decubitus ulcers, despite good care. Predisposed sites include the pelvic region and bony protruberances above the sacrum, Tuber ischiadicum, and Trochanter major. While superficial decubitus ulcers can also heal under conservative wound treatment, higher-grade ulcers can only be induced to heal using surgical means and with myocutaneous flaps from the adjacent area (M. glutaeus maximus, M. tensor fasciae latae, M. vastus lateralis, and M. biceps femoris. The advantage of myocutaneous flaps lies in their certain blood supply, high resistance to infection, and a tamponing or cushioning function over bony protruberances. However, in addition to adequate, short-term surgical treatment, it is necessary to implement an adjunct multimodal therapy concept consisting of antibiotics (which do not promote resistance-development and anti-infective treatment, intermittent pressure relief, and early rehabilitation of the patients.

  3. Evaluation of surgical skill of uvulopalato pharyngo plasty (UPPP)

    We evaluated the surgical skill of uvulopalato pharyngo plasty (UPPP) done in 35 cases in our hospital and discussed its efficacy. Our method of UPPP has three characteristics. First, a mattress suture was applied in the tonsillar bed. As a result there was no failure of the suture. Second, we made a raw surface at a little upper part of the root of the uvula and applied the mattress suture to it. This suture has efficacy of soft palate upword to the oral side. Third, no continuous suture has advantage to present scar formation. We also examined the dynamic MRI for obstructive site and images were divided some morphological obstructive pattern, and assess about efficacy of improvement rate of AHI. The efficacy was over 80% in tonsillar type. But there was 31% efficacy not only soft palate but also tongue rotation type. We concluded that the important factor to have good result of UPPP are surgical skill and adequate indication. (author)

  4. Storm tracks near marginal stability

    Ambaum, Maarten; Novak, Lenka

    2015-04-01

    The variance of atmospheric storm tracks is characterised by intermittent bursts of activity interspersed with relatively quiescent periods. Most of the poleward heat transport by storm tracks is due to a limited number of strong heat flux events, which occur in a quasi-periodic fashion. This behaviour is in contradiction with the usual conceptual model of the storm tracks, which relies on high growth rate background flows which then spawn weather systems that grow in an exponential or non-normal fashion. Here we present a different conceptual model of the atmospheric storm tracks which is built on the observation that, when including diabatic and other dissipative effects, the storm track region is in fact most of the time marginally stable. The ensuing model is a nonlinear oscillator, very similar to Volterra-Lotka predator-prey models. We demonstrate the extensions of this model to a stochastically driven nonlinear oscillator. The model produces quasi-periodic behaviour dominated by intermittent heat flux events. Perhaps most surprisingly, we will show strong evidence from re-analysis data for our conceptual model: the re-analysis data produces a phase-space plot that is very similar indeed to the phase-space plot for our nonlinear oscillator model.

  5. Evolution of surgical skills training

    Kurt E Roberts; Robert L Bell; Andrew J Duffy

    2006-01-01

    Surgical training is changing: one hundred years of tradition is being challenged by legal and ethical concerns for patient safety, work hours restrictions, the cost of operating room time, and complications. Surgical simulation and skills training offers an opportunity to teach and practice advanced skills outside of the operating room environment before attempting them on living patients.Simulation training can be as straight forward as using real instruments and video equipment to manipulate simulated "tissue" in a box trainer. More advanced,virtual reality simulators are now available and ready for widespread use. Early systems have demonstrated their effectiveness and discriminative ability. Newer systems enable the development of comprehensive curricula and full procedural simulations.The Accreditation Council of Graduate Medical Education's (ACGME) has mandated the development of novel methods of training and evaluation. Surgical organizations are calling for methods to ensure the maintenance of skills, advance surgical training, and to credential surgeons as technically competent.Simulators in their current form have been demonstrated to improve the operating room performance of surgical residents. Development of standardized training curricula remains an urgent and important agenda, particularly for minimal invasive surgery.An innovative and progressive approach, borrowing experiences from the field of aviation, can provide the foundation for the next century of surgical training,ensuring the quality of the product. As the technology develops, the way we practice will continue to evolve, to the benefit of physicians and patients.

  6. Progress in virtual reality simulators for surgical training and certification.

    de Visser, Hans; Watson, Marcus O; Salvado, Olivier; Passenger, Joshua D

    2011-02-21

    There is increasing evidence that educating trainee surgeons by simulation is preferable to traditional operating-room training methods with actual patients. Apart from reducing costs and risks to patients, training by simulation can provide some unique benefits, such as greater control over the training procedure and more easily defined metrics for assessing proficiency. Virtual reality (VR) simulators are now playing an increasing role in surgical training. However, currently available VR simulators lack the fidelity to teach trainees past the novice-to-intermediate skills level. Recent technological developments in other industries using simulation, such as the games and entertainment and aviation industries, suggest that the next generation of VR simulators should be suitable for training, maintenance and certification of advanced surgical skills. To be effective as an advanced surgical training and assessment tool, VR simulation needs to provide adequate and relevant levels of physical realism, case complexity and performance assessment. Proper validation of VR simulators and an increased appreciation of their value by the medical profession are crucial for them to be accepted into surgical training curricula. PMID:21401487

  7. From the Right of Adequate Housing to the Social Right of Adequate Housing%住宅自由权到住宅社会权之流变

    张震

    2015-01-01

    满足公民基本居住需要的住宅权是一项基本权利。面对因住宅价格和质量标准而制约公民住宅权实现的社会现实,有必要在理论上进行检视并提供解决思路。在自由权和社会权划分的理论基础上,我国《宪法》第39条规定的“住宅不受侵犯”具有社会权色彩。而且从权利社会基础和宪法解释功能的双重视角看,住宅社会权在实践中应被侧重。住宅社会权的权利功能以积极受益权为主,消极受益权为次,以国家给付义务的存在为前提。在此基础上,形成对国家权力的规范效力,并具特定内涵。%The right of adequate housing that satisfies the citizens’ basic living needs is a basic right. By the theory of division of freedom and social right, the 39th provision of our Constitution which provides that“the right of adequate housing is free from infringement”is immersed with color of social right. And from the duel perspective of the rights’social basis and the function of Constitu⁃tional interpretation, the social right of adequate housing should be emphasized in practice. The func⁃tion of social right of adequate housing is firstly the positive benefit right, and secondly the negative benefit right, in the premise of the existence of the national duty. On this basis, it forms the regula⁃tory effectiveness to the national power, and contains specific connotation.

  8. Bacterial migration through punctured surgical gloves under real surgical conditions

    Heidecke Claus-Dieter

    2010-07-01

    Full Text Available Abstract Background The aim of this study was to confirm recent results from a previous study focussing on the development of a method to measure the bacterial translocation through puncture holes in surgical gloves under real surgical conditions. Methods An established method was applied to detect bacterial migration from the operating site through the punctured glove. Biogel™ double-gloving surgical gloves were used during visceral surgeries over a 6-month period. A modified Gaschen-bag method was used to retrieve organisms from the inner glove, and thus-obtained bacteria were compared with micro-organisms detected by an intra-operative swab. Results In 20 consecutive procedures, 194 gloves (98 outer gloves, 96 inner gloves were examined. The rate of micro-perforations of the outer surgical glove was 10% with a median wearing time of 100 minutes (range: 20-175 minutes. Perforations occurred in 81% on the non-dominant hand, with the index finger most frequently (25% punctured. In six cases, bacterial migration could be demonstrated microbiologically. In 5% (5/98 of outer gloves and in 1% (1/96 of the inner gloves, bacterial migration through micro-perforations was observed. For gloves with detected micro-perforations (n = 10 outer layers, the calculated migration was 50% (n = 5. The minimum wearing time was 62 minutes, with a calculated median wearing time of 71 minutes. Conclusions This study confirms previous results that bacterial migration through unnoticed micro-perforations in surgical gloves does occur under real practical surgical conditions. Undetected perforation of surgical gloves occurs frequently. Bacterial migration from the patient through micro-perforations on the hand of surgeons was confirmed, limiting the protective barrier function of gloves if worn over longer periods.

  9. Marginal Costing Techniques for Higher Education.

    Allen, Richard; Brinkman, Paul

    The techniques for calculating marginal costs in higher education are examined in detail. Marginal costs, as defined in economics, is the change in total cost associated with producing one additional unit of output. In higher education, the most frequently selected unit of output is a full-time-equivalent student or, alternatively, a student…

  10. Tumor margin detection using optical biopsy techniques

    Zhou, Yan; Liu, Cheng-hui; Li, Jiyou; Li, Zhongwu; Zhou, Lixin; Chen, Ke; Pu, Yang; He, Yong; Zhu, Ke; Li, Qingbo; Alfano, Robert R.

    2014-03-01

    The aim of this study is to use the Resonance Raman (RR) and fluorescence spectroscopic technique for tumor margin detection with high accuracy based on native molecular fingerprints of breast and gastrointestinal (GI) tissues. This tumor margins detection method utilizes advantages of RR spectroscopic technique in situ and in real-time to diagnose tumor changes providing powerful tools for clinical guiding intraoperative margin assessments and postoperative treatments. The tumor margin detection procedures by RR spectroscopy were taken by scanning lesion from center or around tumor region in ex-vivo to find the changes in cancerous tissues with the rim of normal tissues using the native molecular fingerprints. The specimens used to analyze tumor margins include breast and GI carcinoma and normal tissues. The sharp margin of the tumor was found by the changes of RR spectral peaks within 2 mm distance. The result was verified using fluorescence spectra with 300 nm, 320 nm and 340 nm excitation, in a typical specimen of gastric cancerous tissue within a positive margin in comparison with normal gastric tissues. This study demonstrates the potential of RR and fluorescence spectroscopy as new approaches with labeling free to determine the intraoperative margin assessment.

  11. 17 CFR 41.45 - Required margin.

    2010-04-01

    ... PRODUCTS Customer Accounts and Margin Requirements § 41.45 Required margin. (a) Applicability. Each... positions held on behalf of a customer in a securities account or futures account as set forth in this... security future shall be twenty (20) percent of the current market value of such security future....

  12. 17 CFR 242.403 - Required margin.

    2010-04-01

    ...) REGULATIONS M, SHO, ATS, AC, AND NMS AND CUSTOMER MARGIN REQUIREMENTS FOR SECURITY FUTURES Customer Margin... of a customer in a securities account or futures account as set forth in this section. (b) Required... be twenty (20) percent of the current market value of such security future. (2) Offsetting...

  13. Minimal Adequate Model of Unemployment Duration in the Post-Crisis Czech Republic

    Adam Čabla

    2016-03-01

    Full Text Available Unemployment is one of the leading economic problems in a developed world. The aim of this paper is to identify the differences in unemployment duration in different strata in the post-crisis Czech Republic via building a minimal adequate model, and to quantify the differences. Data from Labour Force Surveys are used and since they are interval censored in nature, proper metodology must be used. The minimal adequate model is built through the accelerated failure time modelling, maximum likelihood estimates and likelihood ratio tests. Variables at the beginning are sex, marital status, age, education, municipality size and number of persons in a household, containing altogether 29 model parameters. The minimal adequate model contains 5 parameters and differences are found between men and women, the youngest category and the rest and the university educated and the rest. The estimated expected values, variances, medians, modes and 90th percentiles are provided for all subgroups.

  14. Thermal Margin Calculation of the CAREM-25 Core

    During the operation in steady state and anticipated operational transient of a nuclear reactor it is necessary to avoid the damage in the fuel elements induced by thermal or hydraulic effects.To satisfy that design bases safety limits are established and calculation methodologies are defined to verify them.In the particular case of the reactor CAREM-25 reactor where the core is cooled by natural circulation, it is not adequate to use directly the same calculation methodologies from typical PWR and BWR.The low cooling flow rate and not having channels in the fuel elements (open-channel fuels) produce that most of the models and computer programs typically used must be carefully validated.As result of that process, an adequate calculation procedure for this reactor type was developed.In the present work, the thermal-hydraulic design criteria of the core and the design bases, the uncertainties factors, and the thermal margin results of the core are described.Despite that the methodology of DNBR calculation is under a validation process and considering the available calculation tools, it is possible to assure that the core fulfills the safety regulations in steady state conditions

  15. Zinc Supplementation to Pregnant Rats with Adequate Zinc Nutriture Suppresses Immune Functions in their Offspring

    Background: Pronounced zinc (Zn) deficiency during pregnancy is associated with thymic and splenic atrophy and immunosuppression. However, our knowledge about consequences of marginal Zn deficiency and Zn supplementation during pregnancy on immune function in the offspring is limited. Aim: To study ...

  16. The justification of Chinese traditional thought on the right to adequate food

    Du, Gangjian; Sun, Juanjuan

    2010-01-01

    15 pages As declared by the Universal Declaration of Human right, the right to adequate food is one of fundamental contents embodying in the right to a standard of living adequate. However, the recognition of this right has developed progressively and its realization still has a long way to go. Undoubtedly, the guarantee of food supply is a fundamental way to ensure a standard living. In this aspect, early in the pre-Qin period, there have been a great number of schools of thought devoting...

  17. 21 CFR 878.4040 - Surgical apparel.

    2010-04-01

    ... and Drugs FOOD AND DRUG ADMINISTRATION, DEPARTMENT OF HEALTH AND HUMAN SERVICES (CONTINUED) MEDICAL DEVICES GENERAL AND PLASTIC SURGERY DEVICES Surgical Devices § 878.4040 Surgical apparel. (a... surgical procedures to protect both the surgical patient and the operating room personnel from transfer...

  18. [Surgical management of pancreatic cancer].

    Kim, Song Cheol

    2008-02-01

    Pancreatic cancer is a major problematic concern among all forms of gastrointestinal malignancies because of its poor prognosis. Although significant progress has been made in the surgical treatment in terms of increased resection rate and decreased treatment-related morbidity and mortality, the true survival rate still remains below 5% today. Surgical options for pancreatic cancer are based on the its unique anatomy and physiology, catastrophic tumor biology, experience of surgeon, and status of patients. Four main options exist for the surgical treatment of pancreatic cancer. These include standard "Whipple" pancreaticoduodenectomy (PD), pylorus preserving PD (PPPD), distal pancreatectomy (left-side pancreatectomy), and total pancreatectomy according to the location of tumor. Portal vein involvement by tumor is regarded as an anatomical extension of disease, and en bloc resection of portal vein with tumor is recommended if technically feasible, which is stated in 2002 AJCC tumor staging for pancreatic cancer. In comparison of the survival rates between standard and extended resection of pancreatic head cancer, no significant survival benefit was demonstrated from the prospective reports. PPPD may be superior to standard PD in respect to nutrition and quality of life without any deleterious effect upon long term survival or tumor recurrence. New surgical treatment modalities including modified extended pancreatectomy, neoadjuvant chemotherapy, and radical antegrade modular distal pancreatectomy have been tried to improve the patients' survival. However, early diagnosis and treatment remain as key factors for the cure of pancreatic cancer irrespective of various surgical trials. PMID:18349571

  19. Simulated Automobile and Rotary-Wing Aircraft Impacts: Dynamic Neck Response after Surgical Treatment for Cervical Spondylosis

    White, Nicholas Alan

    2014-01-01

    Degeneration of the cervical spine is part of the normal aging process, usually occurring without clinical symptoms. Symptomatic degeneration most often occurs in the lower cervical spine, presenting as axial neck pain, radiculopathy, myelopathy, or any combination of the three. When conservative treatment does not adequately manage these symptoms, surgical intervention may be required. The longstanding surgical treatment for cervical degeneration is arthrodesis achieved through anterior cerv...

  20. Voices from the Margins: Policy Advocacy and Marginalized Communities

    Gloria DeSantis

    2010-01-01

    Full Text Available This article aims to explore policy advocacy processes facilitated by social service nonprofit organizations (NPOs using a social justice lens. Qualitative interview results from 39 NPOs from 18 communities provide a deeper understanding of advocacy, revealing that NPOs perceive that policy advocacy is not a discrete phenomenon, that advocacy activity differs in visibility and scale, and that advocacy strategies are clearly informed by NPOs' front-line service delivery work. A typology of policy advocacy showing different advocacy types and their fluid nature is presented. The results also show that marginalized people's involvement varies depending on a diversity of influential conditions. Conclusions and implications focus on social inclusion/exclusion, the varied and fluid nature of policy advocacy, challenges for practitioners, and the complex nature of "advocacy chill. / "Les organismes sans but lucratif (OSBL de services sociaux ont pour mission de préserver la santé des communautés au moyen de défense de politiques sociales. Toutefois, peu d'études concrètes au Canada portent sur la nature des processus en cause, en particulier lorsqu'il s'agit de politiques mises en œuvre au sein de collectivités marginalisées. Cet article a pour but d'explorer sous l'angle de la justice sociale la nature des processus défense des politiques tels qu'ils sont pratiqués par les OSBL de services sociaux. Un entretien qualitatif avec 39 OSBL issues de 18 collectivités permet une meilleure compréhension des processus. Les OSBL ne conçoivent pas défense des politiques comme un phénomène discret; les activités qui y sont reliées varient en visibilité et en étendue, et les stratégies employées sont clairement influencées par les services de première ligne qu'offrent les OSBL. Nous proposons une typologie des processus défense des politiques exposant les différents types d'approches et leur nature changeante. Les résultats indiquent

  1. Marginal and happy? The need for uniqueness predicts the adjustment of marginal immigrants.

    Debrosse, Régine; de la Sablonnière, Roxane; Rossignac-Milon, Maya

    2015-12-01

    Marginalization is often presented as the strategy associated with the worst adjustment for immigrants. This study identifies a critical variable that buffers marginal immigrants from the negative effects of marginalization on adjustment: The need for uniqueness. In three studies, we surveyed immigrants recruited on university campuses (n = 119, n = 116) and in the field (n = 61). Among marginal immigrants, a higher need for uniqueness predicted higher self-esteem (Study 1), affect (Study 2), and life satisfaction (Study 3), and marginally higher happiness (Study 2) and self-esteem (Study 3). No relationship between the need for uniqueness and adjustment was found among non-marginal immigrants. The adaptive value of the need for uniqueness for marginal immigrants is discussed. PMID:25903084

  2. 21 CFR 514.117 - Adequate and well-controlled studies.

    2010-04-01

    ... adequate and well-controlled studies of a new animal drug is to distinguish the effect of the new animal... conducted: (i) Placebo concurrent control. The new animal drug is compared with an inactive preparation... control is appropriate when the use of a placebo control or of an untreated concurrent control...

  3. The Relationship between Parental Involvement and Adequate Yearly Progress among Urban, Suburban, and Rural Schools

    Ma, Xin; Shen, Jianping; Krenn, Huilan Y.

    2014-01-01

    Using national data from the 2007-08 School and Staffing Survey, we compared the relationships between parental involvement and school outcomes related to adequate yearly progress (AYP) in urban, suburban, and rural schools. Parent-initiated parental involvement demonstrated significantly positive relationships with both making AYP and staying off…

  4. A Model for Touch Technique and Computation of Adequate Cane Length.

    Plain-Switzer, Karen

    1993-01-01

    This article presents a model for the motion of a long-cane executing the touch technique and presents formulas for the projected length of a cane adequate to protect an individual with blindness against wall-type and pole-type hazards. The paper concludes that the long-cane should reach from the floor to the user's armpit. (JDD)

  5. 76 FR 51041 - Hemoglobin Standards and Maintaining Adequate Iron Stores in Blood Donors; Public Workshop

    2011-08-17

    ... HUMAN SERVICES Food and Drug Administration Hemoglobin Standards and Maintaining Adequate Iron Stores in... workshop. The Food and Drug Administration (FDA) is announcing a public workshop entitled: ``Hemoglobin... discuss blood donor hemoglobin and hematocrit qualification standards in the United States, its impact...

  6. The Unequal Effect of Adequate Yearly Progress: Evidence from School Visits

    Brown, Abigail B.; Clift, Jack W.

    2010-01-01

    The authors report insights, based on annual site visits to elementary and middle schools in three states from 2004 to 2006, into the incentive effect of the No Child Left Behind Act's requirement that increasing percentages of students make Adequate Yearly Progress (AYP) in every public school. They develop a framework, drawing on the physics…

  7. 9 CFR 2.40 - Attending veterinarian and adequate veterinary care (dealers and exhibitors).

    2010-01-01

    ... on problems of animal health, behavior, and well-being is conveyed to the attending veterinarian; (4... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Attending veterinarian and adequate veterinary care (dealers and exhibitors). 2.40 Section 2.40 Animals and Animal Products ANIMAL AND...

  8. 9 CFR 2.33 - Attending veterinarian and adequate veterinary care.

    2010-01-01

    ... animal health, behavior, and well-being is conveyed to the attending veterinarian; (4) Guidance to... 9 Animals and Animal Products 1 2010-01-01 2010-01-01 false Attending veterinarian and adequate veterinary care. 2.33 Section 2.33 Animals and Animal Products ANIMAL AND PLANT HEALTH INSPECTION...

  9. Determinants of prompt and adequate care among presumed malaria cases in a community in eastern Rwanda

    Ingabire, Chantal Marie; Kateera, Fredrick; Hakizimana, Emmanuel; Rulisa, Alexis; Muvunyi, Claude; Mens, Petra; Koenraadt, Sander; Mutesa, Leon; Vugt, Van Michele; Borne, Van Den Bart; Alaii, Jane

    2016-01-01

    Background: In order to understand factors influencing fever/malaria management practices among community-based individuals, the study evaluated psychosocial, socio-demographic and environmental determinants of prompt and adequate healthcare-seeking behaviours. Methods: A quantitative household (

  10. Influenza 2005-2006: vaccine supplies adequate, but bird flu looms.

    Mossad, Sherif B

    2005-11-01

    Influenza vaccine supplies appear to be adequate for the 2005-2006 season, though delivery has been somewhat delayed. However, in the event of a pandemic of avian flu-considered inevitable by most experts, although no one knows when it will happen-the United States would be woefully unprepared. PMID:16315443

  11. Does the new conceptual framework provide adequate concepts for reporting relevant information about performance?

    A. Brouwer; A Faramarzi; M. Hoogendoorn

    2014-01-01

    The basic question we raise in this paper is whether the 2013 Discussion Paper (DP 2013) on the Conceptual Framework provides adequate principles for reporting an entity’s performance and what improvements could be made in light of both user needs and evidence from academic literature. DP 2013 propo

  12. Perceptions of Teachers in Their First Year of School Restructuring: Failure to Make Adequate Yearly Progress

    Moser, Sharon

    2010-01-01

    The 2007-2008 school year marked the first year Florida's Title I schools that did not made Adequate Yearly Progress (AYP) for five consecutive years entered into restructuring as mandated by the "No Child Left Behind Act" of 2001. My study examines the perceptions of teacher entering into their first year of school restructuring due to failure to…

  13. How Much and What Kind? Identifying an Adequate Technology Infrastructure for Early Childhood Education. Policy Brief

    Daugherty, Lindsay; Dossani, Rafiq; Johnson, Erin-Elizabeth; Wright, Cameron

    2014-01-01

    To realize the potential benefits of technology use in early childhood education (ECE), and to ensure that technology can help to address the digital divide, providers, families of young children, and young children themselves must have access to an adequate technology infrastructure. The goals for technology use in ECE that a technology…

  14. Evaluation of safety margins of operating reactors

    The margins to acceptance criteria have been determined by conservative evaluation model calculations in the past. During the recent years an increasing interest in computational reactor safety analysis is to replace these conservative calculations by 'best estimate' calculations supplemented by uncertainty analysis of the code results. Safety margin of operating reactors is defined as the difference in physical units between the critical value of an assigned parameter associated with the failure of a system or component or with a phenomenon and the actual value of that parameter. The most important safety margins relate to physical barriers against release of radioactive material. Margin can be increased by improving analytical methods or plant equipment. Once this increased margin is identified, some of the increase can be used to improve plant performance. Computer code calculations are used to assess the values of safety margins. For this purpose a best estimate or conservative calculation is used. In case of best estimate calculation it is necessary to determine the uncertainty band when determining the safety margin. A prerequisite for this approach is, however, that qualified computer codes are available which are validated by pre- and post-test calculations of appropriate experiments. Utilities intend to minimise the cost of production and to maximise outputs of the operating plants. These goals can be achieved by technical measures, such as power up-rating, increase of maximum fuel linear heat generation rate, optimisation of fuel management with the use of high burn-ups, use of mixed (i.e. U and Pu) oxide (MOX) fuel or use of mixed cores. Such plant modifications require an in-depth safety analysis to evaluate the possible safety impact. The analysis has to consider all the consequences of the plant modifications with respect to the margins existing. The analysis must consider the core characteristics and the plant behaviour, taking into account the

  15. Weight Margins and Flexibility in Offshore Rigs

    Bjerkelund, Tim

    2013-01-01

    The subject of this paper is the use of weight margins in the design and fabrication of large offshore oilrigs. Margins are a way of increasing the freedom of choice of the designers and a method of increasing the overall flexibility and reducing risk of the project. The underlying justification of the use of margins is the riskiness of developing such a complex and technically advanced system as an oilrig.The problem evaluated is ?What consequences does the combination of practical project m...

  16. Calculation of the Cost of an Adequate Education in Kentucky: A Professional Judgment Approach

    Deborah A. Verstegen

    2004-02-01

    Full Text Available What is an adequate education and how much does it cost? In 1989, Kentucky’s State Supreme Court found the entire system of education unconstitutional-“all of its parts and parcels”. The Court called for all children to have access to an adequate education, one that is uniform and has as its goal the development of seven capacities, including: (i “sufficient oral and written communication skills to enable students to function in a complex and rapidly changing civilization . . . .and (vii sufficient levels of academic or vocational skills to enable public school students to compete favorably with their counterparts in surrounding states, in academics or in the job market”. Now, over a decade later, key questions remain regarding whether these objectives have been fulfilled. This research is designed to calculate the cost of an adequate education by aligning resources to State standards, laws and objectives, using a professional judgment approach. Seven focus groups were convened for this purpose and the scholarly literature was reviewed to provide multiple inputs into study findings. The study produced a per pupil base cost for each of three prototype school districts and an total statewide cost, with the funding gap between existing revenue and the revenue needed for current operations of $1.097 billion per year (2001-02. Additional key resource requirements needed to achieve an adequate education, identified by professional judgment panels, include: (1 extending the school year for students and teachers, (2 adding voluntary half-day preschool for three and four year olds, and (3 raising teacher salaries. This increases the funding gap to $1.23 billion and suggests that significant new funding is required over time if the Commonwealth of Kentucky is to provide an adequate and equitable education of high quality for all children and youth as directed by the State Supreme Court.

  17. Blepharoplasty and periorbital surgical rejuvenation

    Milind Naik

    2013-01-01

    Full Text Available The periorbital region forms the epicenter of facial aging changes and receives highest attention from physicians and patients. The concern about visual function, clubbed with the need for hidden incisions, makes the periocular region a highly specialized surgical area, most appropriately handled by an ophthalmic plastic surgeon. The article provides an overview of cosmetic eyelid and facial surgery in the periocular region. Common aesthetic surgical procedures as well as ocular side-effects of commonly performed periocular injections are discussed from the dermatologist′s point of view.

  18. Surgical management of ectopic pregnancy.

    Stock, Laura; Milad, Magdy

    2012-06-01

    Surgery remains an acceptable, and sometimes necessary, modality for the treatment of ectopic pregnancy. Laparoscopy is the preferred method of access, yet controversy remains regarding the optimal procedure and postoperative management. Generally, salpingostomy is employed with the goal of maintaining fertility, although data to support this tenet are lacking. In most cases, the decision to perform conservative versus radical surgery is on the basis of the patient's history, her desire for future fertility, and surgical findings. The procedures of salpingostomy and salpingectomy, techniques to prevent and control blood loss at the time of surgery, and surgical options for nontubal ectopic pregnancies are reviewed. PMID:22510627

  19. The influence of intraoperative radiation therapy (IORT) on outcome of surgically resectable adenocarcinoma of the pancreas

    Purpose/Objective: Surgical resection offers an opportunity for long term survival for patients with cancer of the pancreas. Unfavorable pathologic prognostic factors following resection of these lesions include positive surgical margins and positive lymph nodes. The purpose of this study was to analyze the influence of IORT on survival of completely resected adenocarcinomas of the pancreas in patients with these poor pathologic features. Materials and Methods: From 1988 to 1994, 391 newly diagnosed patients with carcinoma of the pancreas were seen at Thomas Jefferson University Hospital. Pre-operative work-up identified 166 patients with clinically localized disease. These patients were evaluated by the Department of Radiation Oncology for possible treatment with IORT. These patients underwent exploratory laparotomy and 26 had a complete surgical resection (i.e. Whipple procedure or total pancreatectomy) and received IORT. Mean patient age was 66 ± 2 years (range: 43-80) with 15 male and 11 female patients. All patients had histologically proven adenocarcinoma of the pancreas. IORT was delivered to the surgical tumor bed and regional lymph nodes with a median dose of 15.0 Gy (range: 10.0-20.0 Gy). Technique, field size, and energy of the electron radiation beam varied with the clinical situation and were determined by the radiation oncologist. All 26 patients received post-operative external beam radiation therapy (EBRT) with concurrent weekly 5-FU chemotherapy. Follow-up times ranged from one to 84 months (median: 15 months). Actuarial survival rates were calculated by the Life-Table Method. Patient outcome was evaluated with respect to surgical margin and pathological lymph node status. Results: The overall actuarial 2-year survival rate was 44%. The overall median survival time (MST) was 19 months. At pathological review, five of the 26 patients (19%) were found to have positive surgical margins, four of whom also had involved lymph nodes. Thus, only one

  20. Limitations of ''margin'' in qualification tests

    We have carried out investigations of polymer radiation degradation behaviors which have brought to light a number of reasons why this concept of margin can break down. First of all, we have found that dose-rate effects vary greatly in magnitude. Thus, based on high dose-rate testing, poor materials with large dose-rate effects may be selected over better materials with small effects. Also, in certain cases, material properties have been found to level out (as with PVC) or reverse trend (as with buna-n) at high doses, so that ''margin'' may be ineffective, misleading, or counterproductive. For Viton, the material properties were found to change in opposite directions at high and low dose rates, making ''margin'' inappropriate. The underlying problem with the concept of ''margin'' is that differences in aging conditions can lead to fundamental differences in degradation mechanisms

  1. 17 CFR 31.18 - Margin calls.

    2010-04-01

    ... after contact is effected in which to respond to a margin call. Twenty-four hours, excluding Saturdays... contract for a period of 5 business days at the then prevailing bid price in the case of a long...

  2. Informational and technological provision of marginal analysis

    Назаренко, Тетяна Петрівна

    2016-01-01

    Approaches of scientists towards the methods of carrying out marginal analysis have been analyzed as well as the main stages and procedures of carrying out such kind of analysis have been singled out.

  3. Echosonography and surgical therapy of facial skin tumors

    Pešić Zoran U.

    2002-01-01

    Full Text Available In the second half of the 20 century, echosonography has been used in many medical specialties. In 1992 and 1993 highfrequencies echosonography was used in the examination of irritant and allergic skin lesions in order to examine the effects of different therapeuthical agents on the skin lesions [1-4]. Hoffmann used highfrequencies echosonography in the examination of healing of skin lesions [3]. By their incidence skin tumors are the largest group of newly discovered tumors, and their usual location is on the face [5-7]. By clinical examination it is not possible to precisely determine the depth of tumor border; therefore, the radically performed surgical excision is the only correct surgical treatment. The aim of this study was to estimate the results of preoperatively performed high frequencies echosonography in order to reduce the number of incorrectly performed surgical excisions of skin tumors. The group was composed of 40 patients with 45 tumors, who first underwent echosonographic diagnostic procedure (20 MHz, Hadsund electronic, Hadsund Technology, Denmark and then surgical excision; patients in control group (45 patients with 45 tumors were only subjected to surgical excision. Excised tumors were then pathohistologically analyzed, and measurements of tumor depth progression were performed. Margins of pathohistological specimen were controlled for the presence of tumor cells. Results of measurements of tumor depth obtained by echosonography and pathohistological measurements were compared. By Jate's modification of c2 test results regarding correct and incorrect surgical excision in patients and control group were compared. By linear regression analysis results of tumor depth obtained by echosonographic and pathohistologic examinations were compared. Hypoechogen zone echosonographic results were used like criteria for tumor expansion. Results of tumor depth measurements are presented in Table 1. Linear regression analysis showed (R = 0

  4. CT of lumbar disc herniation: correlation with surgical findings

    Lee, Suk Yl; Lee, Dong Jin; Sung, Kyu Bo; Woo, Won Hyung [Korea General Hospital, Seoul (Korea, Republic of)

    1986-10-15

    CT from forty nine patients with 53 surgical disc explorations were reviewed and correlated with surgical findings. The results were as follows: 1. Frequent locations of HNP were in L4-5 (65%) and L5-S1 (31%). The most common type of HNP was paramidine type (71%). 2. Focal protrusion of the posterior margin of disc and obliteration of epidural fat pad were observed in all of cases (100%) and other common findings were indentation of epidural sac in 46 cases (96%) and compression of nerve root sleeve in 33 cases (69%). 3. Cephalad and caudad extension of protruded soft tissue density in the spinal canal was observed in 15 cases (31%) with variable degree. And more than 6mm extension were provided to be extruded disc in 9 cases. 4. Vacuum phenomenon was demonstrated in 5 cases (10%) and was accompanied with bulging annulus. 5. Forty eight herniated nucleus (HNP) were confirmed surgically in 44 patients. Misinterpretations were made in 4 instances (4 patients); 1 because of lumbar scoliosis, 1 because of spondylolisthesis, and the other 2 because of calcified posterior longitudinal ligament and bulging annulus. One case of true negative examination was central and foraminal stenosis in spinal CT. Thus, sensitivity, specificity and overall accuracy of lumbar spine CT in HNP were 92%, 100% and 92%, respectively.

  5. An information criterion for marginal structural models

    Platt, Robert W.; Brookhart, M. Alan; Cole, Stephen R.; Westreich, Daniel; Schisterman, Enrique F.

    2012-01-01

    Marginal structural models were developed as a semiparametric alternative to the G-computation formula to estimate causal effects of exposures. In practice, these models are often specified using parametric regression models. As such, the usual conventions regarding regression model specification apply. This paper outlines strategies for marginal structural model specification, and considerations for the functional form of the exposure metric in the final structural model. We propose a quasi-...

  6. The Marginalized Particle Filter in Practice

    Schön, Thomas; Karlsson, Rickard; Gustafsson, Fredrik

    2005-01-01

    The marginalized particle filter is a powerful combination of the particle filter and the Kalman filter, which can be used when the underlying model contains a linear sub-structure, subject to Gaussian noise. This paper will illustrate several positioning and target tracking applications, solved using the marginalized particle filter. Furthermore, we analyze several properties of practical importance, such as its computational complexity and how to cope with quantization effects.

  7. The marginal cost of public funds

    Kleven, Henrik Jacobsen; Kreiner, Claus Thustrup

    2006-01-01

    This paper extends the theory and measurement of the marginal cost of public funds (MCF) to account for labor force participation responses. Our work is motivated by the emerging consensus in the empirical literature that extensive (participation) responses are more important than intensive (hour...... government revenue. These revenue effects make the marginal cost of funds higher and we show numerically that the implications for MCF tend to be substantial...

  8. Marginal accuracy of temporary composite crowns.

    Tjan, A H; Tjan, A H; Grant, B E

    1987-10-01

    An in vitro study was conducted to quantitatively compare the marginal adaptation of temporary crowns made from Protemp material with those made from Scutan, Provisional, and Trim materials. A direct technique was used to make temporary restorations on prepared teeth with an impression as a matrix. Protem, Trim, and Provisional materials produced temporary crowns of comparable accuracy. Crowns made from Scutan material had open margins. PMID:2959770

  9. PENDIDIKAN ALTERNATIF UNTUK PEREMPUAN MARGINAL DI PEDESAAN

    Ratnawati Tahir

    2011-01-01

    Abstract: Alternative Education for Marginalized Women in Rural Areas. The study aims to find alter­native forms of education for marginalized women, the process of forming study groups and gender based learning process that serves the center of the development of education, leadership and a source of economic empowerment. The study uses qualitative methods, involving a group of women who have attended an al­ternative education. Researchers and informants from community leaders. The results s...

  10. Reconnection in Marginally Collisionless Accretion Disk Coronae

    Goodman, J.; Uzdensky, D.

    2008-01-01

    We point out that a conventional construction placed upon observations of accreting black holes, in which their nonthermal X-ray spectra are produced by inverse comptonization in a coronal plasma, suggests that the plasma is marginally collisionless. Recent developments in plasma physics indicate that fast reconnection takes place only in collisionless plasmas. As has recently been suggested for the Sun's corona, such marginal states may result from a combination of energy balance and the req...

  11. Energy margins in dynamic object manipulation

    Hasson, Christopher J; Shen, Tian; Sternad, Dagmar

    2012-01-01

    Many tasks require humans to manipulate dynamically complex objects and maintain appropriate safety margins, such as placing a cup of coffee on a coaster without spilling. This study examined how humans learn such safety margins and how they are shaped by task constraints and changing variability with improved skill. Eighteen subjects used a manipulandum to transport a shallow virtual cup containing a ball to a target without losing the ball. Half were to complete the cup transit in a comfort...

  12. Optimal transportation with infinitely many marginals

    Pass, Brendan, Department Of Mathematics

    2012-01-01

    We formulate and study an optimal transportation problem with infinitely many marginals; this is a natural extension of the multi-marginal problem studied by Gangbo and Swiech (1998). We prove results on the existence, uniqueness and characterization of the optimizer, which are natural extensions of the results of Gangbo and Swiech. The proof relies on a relationship between this problem and the problem of finding barycenters in the Wasserstein space, a connection first observed for finitely ...

  13. Marketing margins and agricultural technology in Mozambique

    Arndt, Channing; Jensen, Henning Tarp; Robinson, Sherman;

    2000-01-01

    Improvements in agricultural productivity and reductions in marketing costs in Mozambique are analysed using a computable general equilibrium (CGE) model. The model incorporates detailed marketing margins and separates household demand for marketed and home-produced goods. Individual simulations...... of improved agricultural technology and lower marketing margins yield welfare gains across the economy. In addition, a combined scenario reveals significant synergy effects, as gains exceed the sum of gains from the individual scenarios. Relative welfare improvements are higher for poor rural households...

  14. Investigating Mechanisms of Marginal Settlement Life Improvement

    Hamid M. Mohammadi

    2008-01-01

    Full Text Available The main purpose of this research was to investigate mechanisms to improve marginal settlement life in Koohdasht County in Lorestan province. This research was a sort of the survey studies and a questionnaire was compiled for collection of data. Statistical population of this study was included 1560 households; also sampling method was a sort of random sampling. Number of sample size was estimated 85 households. Questionnaire's reliability was confirmed through computing Cronbach's alpha coefficient which was 0.85. Face validity of questionnaire was confirmed by some Tehran university agricultural extension and education department scientific board members. Also data analyzed by WINspss 11.5. The results of research revealed that marginal area residents had not good financial situation but they undertook great supporting burden and in point of view access to services and life conditions had not good situation. Therefore improvement of life conditions of marginal settlement life such as fundamental infrastructure include communication systems and sanitation offloading system recognized as the most important mechanisms of marginal settlement improvement according to results of priority setting of marginal settlement situation mechanisms. Also the results of factor analysis showed that 7 main mechanisms were be effective in term of marginal settlement life improvement that in order to importance were included servicing and life condition improvement, credit-economic, civil and legal, control and prevention, population and migration control, infrastructures improvement and hygiene situation.

  15. NRC Seismic Design Margins Program Plan

    Recent studies estimate that seismically induced core melt comes mainly from earthquakes in the peak ground acceleration range from 2 to 4 times the safe shutdown earthquake (SSE) acceleration used in plant design. However, from the licensing perspective of the US Nuclear Regulatory Commission, there is a continuing need for consideration of the inherent quantitative seismic margins because of, among other things, the changing perceptions of the seismic hazard. A Seismic Design Margins Program Plan, developed under the auspices of the US NRC, that provides the technical basis for assessing the significance of design margins in terms of overall plant safety is discussed. The Plan also identifies potential weaknesses that might have to be addressed, and recommends technical methods for assessing margins at existing plants. For the purposes of this program, a general definition of seismic design margin is expressed in terms of how much larger that the design basis earthquake an earthquake must be to compromise plant safety. In this context, margin needs to be determined at the plant, system/function, structure, and component levels

  16. NRC Seismic Design Margins Program Plan

    Recent studies estimate that seismically induced core melt comes mainly from earthquakes in the peak ground acceleration range from 2 to 4 times the safe shutdown earthquake (SSE) acceleration used in plant design. However, from the licensing perspective of the US Nuclear Regulatory Commission, there is a continuing need for consideration of the inherent quantitative seismic margins because of, among other things, the changing perceptions of the seismic hazard. This paper discusses a Seismic Design Margins Program Plan, developed under the auspices of the US NRC, that provides the technical basis for assessing the significance of design margins in terms of overall plant safety. The Plan will also identify potential weaknesses that might have to be addressed, and will recommend technical methods for assessing margins at existing plants. For the purposes of this program, a general definition of seismic design margin is expressed in terms of how much larger that the design basis earthquake an earthquake must be to compromise plant safety. In this context, margin needs to be determined at the plant, system/function, structure, and component levels. 14 refs., 1 fig

  17. Thoracoscopy: a collaborative surgical approach.

    Brand, A F

    1995-07-01

    Perioperative nurses, surgeons, anesthesiologists, certified registered nurse anesthetists, and pharmacists are meeting the challenge of decreasing thoracic surgical patients' length of hospital stay with thoracoscopy. This innovative alternative to traditional thoracotomy procedures has been achieved through an attentive team approach using the fundamental perioperative skills of assessment, positioning, safety, and sharing of knowledge. PMID:7647761

  18. Surgical Lasers In Veterinary Medicine

    Newman, H. C.

    1987-03-01

    Veterinary medicine is a latecomer in benefiting from the advent of surgical lasers. It is ironic that although most of the basic work in lasers is carried out in animal species with which we are most conversant, veterinary medicine as a profession has not been very extensively involved.

  19. Surgical Treatment of Atrial Fibrillation

    Naghmeh Moshtaghi

    2008-12-01

    Full Text Available Atrial fibrillation is the most prevalent permanent arrhythmia. It may be associated with other cardiac pathologies which need surgical treatment. Various types of surgery including the traditional cut-sew operations and operations using different energy sources are currently in use. In comparison with medical treatment, surgery is safe, effective, and has reliable results.

  20. 17 CFR 41.47 - Withdrawal of margin.

    2010-04-01

    ... PRODUCTS Customer Accounts and Margin Requirements § 41.47 Withdrawal of margin. (a) By the customer... after such withdrawal is sufficient to satisfy the required margin for the security futures and...

  1. A Comparative Evaluation for Biologic Width following Surgical Crown Lengthening Using Gingivectomy and Ostectomy Procedure

    Kiran Kumar Ganji

    2012-01-01

    Full Text Available Surgical crown lengthening has been proposed as a means of facilitating restorative procedures and preventing injuries in teeth with structurally inadequate clinical crown or exposing tooth structure in the presence of deep, subgingival pathologies which may hamper the access for proper restorative measures. Histological studies utilizing animal models have shown that postoperative crestal resorption allowed reestablishment of the biologic width. However, very little has been done in humans. Aims. The purpose of the study was to evaluate the potential changes in the periodontal tissues, particularly the biologic width, following surgical crown lengthening by two surgical procedures before and after crown placement. Methods and Material. Twenty (20 patients who needed surgical crown lengthening to gain retention necessary for prosthetic treatment and/or to access caries, tooth fracture, or previous prosthetic margins entered the study. The following parameters were obtained from line angles of treated teeth (teeth requiring surgical crown lengthening and adjacent sites: Plaque and Gingival Indices (PI & (GI, Position of Gingival Margin from reference Stent (PGMRS, Probing depth (PD, and Biologic Width (BW. Statistical Analysis Used. Student “t” Test. Results. Initial baseline values of biologic width were 2.55 mm (Gingivectomy procedure B1 Group and 1.95 mm (Ostectomy procedure B2 Group and after surgical procedure the values were 1.15 mm and 1.25 mm. Conclusions. Within the limitations of the study the biologic width, at treated sites, was re-established to its original vertical dimension by 3 months. Ostectomy with apically positioned flap can be considered as a more effective procedure than Gingivectomy for Surgical Crown Lengthening.

  2. Surgical management of chronic pancreatitis

    Stavros Gourgiotis; Stylianos Germanos; Marco Pericoli Ridolifni

    2007-01-01

    BACKGROUND:Treatment of chronic pancreatitis (CP) is a challenging condition for surgeons. During the last decades, increasing knowledge about pathophysiology of CP, improved results of major pancreatic resections, and integration of sophisticated diagnostic methods in clinical practice have resulted in signiifcant changes in surgery for CP. DATA SOURCES:To detail the indications for CP surgery, the surgical procedures, and outcome, a Pubmed database search was performed. The abstracts of searched articles about surgical management of CP were reviewed. The articles could be identiifed and further scrutinized. Further references were extracted by cross-referencing. RESULTS: Main indications of CP for surgery are intractable pain, suspicion of malignancy, and involvement of adjacent organs. The goal of surgical treatment is to improve the quality of life of patients. The surgical approach to CP should be individualized according to pancreatic anatomy, pain characteristics, baseline exocrine and endocrine function, and medical co-morbidity. The approach usually involves pancreatic duct drainage and resection including longitudinal pancreatojejunostomy, pancreatoduodenectomy (Whipple's procedure), pylorus-preserving pancreatoduodenectomy, distal pancreatectomy, total pancreatectomy, duodenum-preserving pancreatic head resection (Beger's procedure), and local resection of the pancreatic head with longitudinal pancreatojejunostomy (Frey's procedure). Non-pancreatic and endoscopic management of pain has also been advocated. CONCLUSIONS:Surgical procedures provide long-term pain relief, a good postoperative quality of life with preservation of endocrine and exocrine pancreatic function, and are associated with low early and late mortality and morbidity. In addition to available results from randomized controlled trials, new studies are needed to determine which procedure is the most effective for the management of patients with CP.

  3. Evaluation of marginal circumference and marginal thickness changes in precrimped stainless steel crowns, after recrimping

    Afshar H

    2006-07-01

    Full Text Available Background and Aim: The need for recrimping precrimped stainless steel crowns by the dentist in clinic is controversial. This study aimed to evaluate the rate of marginal circumference and marginal thickness change of precrimped stainless steel crowns after recrimping. Materials and Methods: In this experimental study, 30 primary photos were taken from margins of 30 S.S.Cs (3M, Ni-Cr related to tooth 85 with a digital camera fixed at a determined distance. Margins of crowns were crimped by 114 and 137 pliers with a controlled force (0.2 N and then 30 secondary photos were taken in the same conditions. The circumference of crown margins in primary (group A and secondary (group B photos were assessed by a digitizer system. Comparing the circumferences of crown margins in primary and secondary photos showed a significant decrease after crimping. Thickness of 30 random points on the crown margins of a crown similar to mentioned cases was measured by SEM (×150. Then similar procedures including taking a primary photo, crimping and taking a secondary photo was done for the sample crown. After significant reduction in margin circumference, thickness of 30 other random points on the crown margin were measured by SEM. Data were analyzed by paired sample t-test with p<0.05 as the limit of significance. Results: The mean marginal circumference of precrimped stainless steel crowns was reduced by 7.3% which was significant (P<0.001. On the other hand the mean marginal thickness of sample stainless steel crown showed 18µ increase. Conclusion: According to the results of this study, marginal circumference of precrimped stainless steel crowns (3M, Ni-Cr showed a significant decrease after crimping. It is concluded that crimping the stainless steel crowns even for precrimped ones seems necessary.

  4. Enhancing entrepreneurship development in Bosnia and Herzegovina through adequate governmental financial support

    Umihanić, Bahrija; Đonlagić, Sabina; Piplica, Damir

    2016-01-01

    Entrepreneurship and SME sector is extremely important for general economic development in Bosnia and Herzegovina. In order to enhance further development of the SME sector adequate sources of financing for businesses need to be available and accessible. Entrepreneurs and owners of small and medium businesses in Bosnia and Herzegovina are facing certain challenges in obtaining finances. The issue of accessing sources of finance for SMEs in this country has remained problematic for years. Many...

  5. Impact of adequate empirical combination therapy on mortality from bacteremic Pseudomonas aeruginosa pneumonia

    Park So-Youn; Park Hyun; Moon Song; Park Ki-Ho; Chong Yong; Kim Mi-Na; Kim Sung-Han; Lee Sang-Oh; Kim Yang; Woo Jun; Choi Sang-Ho

    2012-01-01

    Abstract Background Pseudomonas aeruginosa has gained an increasing amount of attention in the treatment of patients with pneumonia. However, the benefit of empirical combination therapy for pneumonia remains unclear. We evaluated the effects of adequate empirical combination therapy and multidrug-resistance in bacteremic Pseudomonas pneumonia on the mortality. Methods A retrospective cohort study was performed at the 2,700-bed tertiary care university hospital. We reviewed the medical record...

  6. Evaluation of lymph node numbers for adequate staging of Stage II and III colon cancer

    Bumpers Harvey L

    2011-05-01

    Full Text Available Abstract Background Although evaluation of at least 12 lymph nodes (LNs is recommended as the minimum number of nodes required for accurate staging of colon cancer patients, there is disagreement on what constitutes an adequate identification of such LNs. Methods To evaluate the minimum number of LNs for adequate staging of Stage II and III colon cancer, 490 patients were categorized into groups based on 1-6, 7-11, 12-19, and ≥ 20 LNs collected. Results For patients with Stage II or III disease, examination of 12 LNs was not significantly associated with recurrence or mortality. For Stage II (HR = 0.33; 95% CI, 0.12-0.91, but not for Stage III patients (HR = 1.59; 95% CI, 0.54-4.64, examination of ≥20 LNs was associated with a reduced risk of recurrence within 2 years. However, examination of ≥20 LNs had a 55% (Stage II, HR = 0.45; 95% CI, 0.23-0.87 and a 31% (Stage III, HR = 0.69; 95% CI, 0.38-1.26 decreased risk of mortality, respectively. For each six additional LNs examined from Stage III patients, there was a 19% increased probability of finding a positive LN (parameter estimate = 0.18510, p Conclusions Thus, the 12 LN cut-off point cannot be supported as requisite in determining adequate staging of colon cancer based on current data. However, a minimum of 6 LNs should be examined for adequate staging of Stage II and III colon cancer patients.

  7. The definition of rural area as a primary solution of its adequate development

    Ivana Faltová Leitmanová; Eva Cudlínová; Milan Jílek; Renata Klufová; Ladislav Rolínek

    2009-01-01

    The realistic approach to the rural development requires primarily a consensual definition of a rural area. The selection of tools to be applied and measures to be taken to influence rural areas as well as the setting up the institutional framework would be difficult without defining the object of interest. The adequate definition of rural areas is therefore one of essential prerequisites for the effective resource allocation within the rural development policy.

  8. Towards the Full Realization of the Human Right to Adequate Food and Nutrition*

    Flavio Luiz Schieck Valente

    2014-01-01

    This article describes the conceptual evolution of the right to food into its current denomination as human right to adequate food and nutrition in the broader context of the indivisibility of human rights, women’s rights and food sovereignty. It also explores the challenges and opportunities provided by the Second International Conference on Nutrition and describes the political foundations of civil society’s engagement in the preparation and planned follow-up of the conference.

  9. Evaluating Random Mutant Selection at Class-Level in Projects with Non-Adequate Test Suites

    Parsai, Ali; Murgia, Alessandro; Demeyer, Serge

    2016-01-01

    Mutation testing is a standard technique to evaluate the quality of a test suite. Due to its computationally intensive nature, many approaches have been proposed to make this technique feasible in real case scenarios. Among these approaches, uniform random mutant selection has been demonstrated to be simple and promising. However, works on this area analyze mutant samples at project level mainly on projects with adequate test suites. In this paper, we fill this lack of empirical validation by...

  10. Ensuring adequate orientation for a new employee : case company Nestlé

    Ashtiani, Shilan

    2015-01-01

    The following thesis will concentrate on the importance of ensuring adequate orientation throughout the recruitment process and after. A new employee orientation (NEO) plan is consisted of different areas and stages to be recognized, analyzed and implemented at the factory of Nestlé. The goal for every company nowadays is to make a new employee a valued resource for their profitability. This research was commissioned by Nestlé Oy, Turku factory. The concept of new employee orientation (NE...

  11. Self-esteem, social support, and satisfaction differences in women with adequate and inadequate prenatal care.

    Higgins, P; Murray, M L; Williams, E M

    1994-03-01

    This descriptive, retrospective study examined levels of self-esteem, social support, and satisfaction with prenatal care in 193 low-risk postpartal women who obtained adequate and inadequate care. The participants were drawn from a regional medical center and university teaching hospital in New Mexico. A demographic questionnaire, the Coopersmith self-esteem inventory, the personal resource questionnaire part 2, and the prenatal care satisfaction inventory were used for data collection. Significant differences were found in the level of education, income, insurance, and ethnicity between women who received adequate prenatal care and those who received inadequate care. Women who were likely to seek either adequate or inadequate prenatal care were those whose total family income was $10,000 to $19,999 per year and high school graduates. Statistically significant differences were found in self-esteem, social support, and satisfaction between the two groups of women. Strategies to enhance self-esteem and social support have to be developed to reach women at risk for receiving inadequate prenatal care. PMID:8155221

  12. Approaches towards training in human risk management of surgical technology.

    Geissler, Norman; Machno, Andrej; Sánchez-Peralta, Luisa F; Pagador, José Blas; Sánchez-Margallo, Francisco M; Korb, Werner

    2016-04-01

    A safe application of modern surgical technology and computer-assisted surgery devices is based on an operation by adequately trained surgeons who are familiar with the benefits and limitations of the devices. We analyzed the in-depth interviews with seven Spanish and 10 German surgeons. Together with other studies, this analysis highlights the need for specific training in technological competence for surgeons. One way to train technological competence is to help surgeons understanding the basic principles of medical devices as well as explaining the basic concepts of risk analysis and risk management. Based on this premise, a stage model for risk assessment was developed and adapted for the training of surgeons. This was developed further into a train the trainer (TTT) concept, which was then evaluated for two example cases. During TTT-training, the trainers (expert surgeons) performed a risk analysis for several medical devices. Afterwards, the trainers organized a surgical workshop for surgical trainees (resident surgeons), in which high-fidelity simulators and the original medical devices were used. The results showed that the surgeons performed the risk analysis correctly with the stage model and afterwards were able to successfully apply the results in the workshop context. PMID:27096765

  13. Surgical complications of hemolytic uremic syndrome: Single center experiences

    Hooman Nakysa

    2007-01-01

    Full Text Available Purpose: To determine the prevalence, outcome and prognostic factors in children with hemolytic uremic syndrome (HUS who underwent laparotomy. Materials and Methods: The medical records of 104 patients with HUS who presented to our center between 1986 and 2003 were reviewed retrospectively. Data were analyzed using Student′s t test for comparing means, Fisher′s exact test for frequencies and Pearson′s correlation for finding the correlations. Results: 78% of cases presented with vomiting and diarrhea. Seven out of 104 needed surgical exploration. The indications of surgery were acute abdomen, severe abdominal distention and the sign of peritonitis. The findings at laparotomy were intussusceptions, perforation (colon, ileum, gangrene of entire colon, rectosigmoidal tearing, duodenal obstruction and toxic megacolon. Pathological findings were transmural infarction in two cases in which staged surgical management was performed (cecostomy, resection, later anastomosis. Four out of seven patients died because of pulmonary failure, coma and multiple organ failure ( P< 0.05 compared to those who did not need laparotomy. The patients requiring surgery were young (< 3 years, had high leukocyte count (>20000 mm 3 and low albumin level (< 3g/dl ( P< 0.05. Conclusion: Surgical complications of HUS are rare but are assorted with high mortality due to respiratory failure and multiple organ failure. Early decision of laparotomy associated with intensive care, including mechanical ventilation, adequate dialysis and ultrafiltration, are recommended.

  14. Evaluation of marginal circumference and marginal thickness changes in precrimped stainless steel crowns, after recrimping

    Afshar H; Mozafari Kojidi M

    2006-01-01

    Background and Aim: The need for recrimping precrimped stainless steel crowns by the dentist in clinic is controversial. This study aimed to evaluate the rate of marginal circumference and marginal thickness change of precrimped stainless steel crowns after recrimping. Materials and Methods: In this experimental study, 30 primary photos were taken from margins of 30 S.S.Cs (3M, Ni-Cr) related to tooth 85 with a digital camera fixed at a determined distance. Margins of crowns were crimped by 1...

  15. Marginal vitamin C status is associated with reduced fat oxidation during submaximal exercise in young adults

    Corte Corinne

    2006-08-01

    Full Text Available Abstract Background Vitamin C is a cofactor in the biosynthesis of carnitine, a molecule required for the oxidation of fatty acids. A reduction in the ability to oxidize fat may contribute to the reported inverse relationship between vitamin C status and adiposity. To examine this possibility, we conducted a preliminary trial to evaluate the impact of vitamin C status on fat oxidation during submaximal exercise. Methods Fat energy expenditure was determined in individuals with marginal (n = 15 or adequate (n = 7 vitamin C status during a submaximal, 60-minute treadmill test. Subsequently, eight of the subjects with marginal vitamin C status completed an 8-week double-blind, placebo-controlled, depletion-repletion trial with submaximal exercise testing. Results Individuals with marginal vitamin C status oxidized 25% less fat per kg body weight during the treadmill test as compared to individuals with adequate vitamin C status. Fat oxidation during exercise was inversely related to fatigue (r = -0.611, p = 0.009. Vitamin C repletion of vitamin C depleted subjects (500 mg vitamin C/d raised fat energy expenditure during exercise 4-fold as compared to depleted control subjects (p = 0.011. Conclusion These preliminary results show that low vitamin C status is associated with reduced fat oxidation during submaximal exercise. Low vitamin C status may partially explain the inverse relationship between vitamin C status and adiposity and why some individuals are unsuccessful in their weight loss attempts.

  16. Shutdown margin for high conversion BWRs operating in Th-{sup 233}U fuel cycle

    Shaposhnik, Y., E-mail: shaposhy@bgu.ac.il [NRCN – Nuclear Research Center Negev, POB 9001, Beer Sheva 84190 (Israel); Department of Nuclear Engineering, Ben-Gurion University of the Negev, POB 653, Beer Sheva 84105 (Israel); Shwageraus, E. [Department of Nuclear Engineering, Ben-Gurion University of the Negev, POB 653, Beer Sheva 84105 (Israel); Elias, E. [Faculty of Mechanical Engineering, Technion – Israel Institute of Technology, Technion City 32000, Haifa (Israel)

    2014-09-15

    Highlights: • BWR core operating in a closed self-sustainable Th-{sup 233}U fuel cycle. • Shutdown Margin in Th-RBWR design. • Fully coupled MC with fuel depletion and thermo-hydraulic feedback modules. • Thermal–hydraulic analysis includes MCPR observation. - Abstract: Several reactivity control system design options are explored in order to satisfy shutdown margin (SDM) requirements in a high conversion BWRs operating in Th-{sup 233}U fuel cycle (Th-RBWR). The studied core has an axially heterogeneous fuel assembly structure with a single fissile zone “sandwiched” between two fertile blanket zones. The utilization of an originally suggested RBWR Y-shape control rod in Th-RBWR is shown to be insufficient for maintaining adequate SDM to balance the high negative reactivity feedbacks, while maintaining fuel breeding potential, core power rating, and minimum Critical Power Ratio (CPR). Implementation of alternative reactivity control materials, reducing axial leakage through non-uniform enrichment distribution, use of burnable poisons, reducing number of pins as well as increasing pin diameter are also shown to be incapable of meeting the SDM requirements. Instead, an alternative assembly design, based on Rod Cluster Control Assembly with absorber rods was investigated. This design matches the reference ABWR core power and has adequate shutdown margin. The new concept was modeled as a single three-dimensional fuel assembly having reflective radial boundaries, using the BGCore system, which consists of the MCNP code coupled with fuel depletion and thermo-hydraulic feedback modules.

  17. Rotator Cuff Tears: Surgical Treatment Options

    .org Rotator Cuff Tears: Surgical Treatment Options Page ( 1 ) The following article provides in-depth information about surgical treatment for rotator cuff injuries, and is a continuation of the article “ ...

  18. Multimodal strategies to improve surgical outcome

    Kehlet, Henrik; Wilmore, Douglas W

    2002-01-01

    surgical procedures or require only 1 to 2 days of postoperative hospitalization. Reorganization of the perioperative team (anesthesiologists, surgeons, nurses, and physical therapists) will be essential to achieve successful fast track surgical programs. CONCLUSIONS: Understanding perioperative...

  19. Theory of margination in confined multicomponent suspensions

    Henriquez Rivera, Rafael; Sinha, Kushal; Graham, Michael

    2015-11-01

    In blood flow, leukocytes and platelets tend to segregate near the vessel walls; this is known as margination. Margination of leukocytes and platelets is important in physiological processes, medical diagnostics and drug delivery. A mechanistic theory is developed to describe flow-induced segregation in confined multicomponent suspensions of deformable particles such as blood. The theory captures the essential features of margination by describing it in terms of two key competing processes in these systems at low Reynolds number: wall-induced migration and hydrodynamic pair collisions. The theory also includes the effect of physical properties of the deformable particles and molecular diffusion. Several regimes of segregation are identified, depending on the value of a ``margination parameter'' M. Moreover, there is a critical value of M below which a sharp ``drainage transition'' occurs: one component is completely depleted from the bulk flow to the vicinity of the walls. Direct hydrodynamic simulations also display this transition in suspensions where the components differ in size or flexibility. The developed mechanistic theory leads to substantial insight into the origins of margination and will help in guiding development of new technologies involving multicomponent suspensions. This work was supported by NSF grant CBET-1436082.

  20. Inadequacy of margin in qualification tests

    Dose-rate effects are now widely known. One nuclear industry response is to use a large margin (i.e., over-dose) in qualification tests to account for this. We have carried out investigations of polymer radiation degradation behaviors which have brought to light a number of reasons why this concept of margin can break down. First of all, we have found that dose-rate effects vary greatly in magnitude. Thus, based on high dose-rate testing, poor materials with large dose-rate effects may be selected over better materials with small effects. Also, in certain cases, material properties have been found to level out (as with PVC) or reverse trend (as with buna-n) at high doses, so that margin may be ineffective, misleading, or counterproductive. For Viton, the material properties were found to change in opposite directions at high and low dose rates, making margin inappropriate. The underlying problem with the concept of margin is that differences in aging conditions can lead to fundamental differences in degradation mechanisms

  1. The Surgically Induced Stress Response

    Finnerty, Celeste C.; Mabvuure, Nigel Tapiwa; Ali, Arham; Kozar, Rosemary A.; Herndon, David N.

    2013-01-01

    The stress response to surgery, critical illness, trauma, and burns encompasses derangements of metabolic and physiological processes which induce perturbations in the inflammatory, acute phase, hormonal, and genomic responses. Hypermetabolism and hypercatabolism result, leading to muscle wasting, impaired immune function and wound healing, organ failure, and death. The surgery-induced stress response is largely similar to that triggered by traumatic injuries; the duration of the stress response, however, varies according to the severity of injury (surgical or traumatic). This spectrum of injuries and insults ranges from small lacerations to severe insults such as large poly-traumatic and burn injuries. Although the stress response to acute trauma evolved to improve chances of survival following injury, in modern surgical practice the stress response can be detrimental. PMID:24009246

  2. Emotions in veterinary surgical students

    Langebæk, Rikke; Eika, Berit; Pedersen, Lene Tanggaard;

    2012-01-01

    A surgical educational environment is potentially stressful and can negatively affect students' learning. The aim of the present study was to investigate the emotions experienced by veterinary students in relation to their first encounter with live-animal surgery and to identify possible sources...... of positive and negative emotions, respectively. During a Basic Surgical Skills course, 155 veterinary fourth-year students completed a survey. Of these, 26 students additionally participated in individual semi-structured interviews. The results of the study show that students often experienced a combination...... of emotions; 63% of students experienced negative emotions, while 58% experienced positive ones. In addition, 61% of students reported feeling excited or tense. Students' statements reveal that anxiety is perceived as counterproductive to learning, while excitement seems to enhance students' focus...

  3. The surgically induced stress response.

    Finnerty, Celeste C; Mabvuure, Nigel Tapiwa; Ali, Arham; Kozar, Rosemary A; Herndon, David N

    2013-09-01

    The stress response to surgery, critical illness, trauma, and burns encompasses derangements of metabolic and physiological processes that induce perturbations in the inflammatory, acute phase, hormonal, and genomic responses. Hypermetabolism and hypercatabolism result, leading to muscle wasting, impaired immune function and wound healing, organ failure, and death. The surgery-induced stress response is largely similar to that triggered by traumatic injuries; the duration of the stress response, however, varies according to the severity of injury (surgical or traumatic). This spectrum of injuries and insults ranges from small lacerations to severe insults such as large poly-traumatic and burn injuries. Burn injuries provide an extreme model of trauma induced stress responses that can be used to study the long-term effects of a prolonged stress response. Although the stress response to acute trauma evolved to confer improved chances of survival following injury, in modern surgical practice the stress response can be detrimental. PMID:24009246

  4. Surgical tools and medical devices

    Jackson, Mark

    2016-01-01

    This new edition presents information and knowledge on the field of biomedical devices and surgical tools. The authors look at the interactions between nanotechnology, nanomaterials, design, modeling, and tools for surgical and dental applications, as well as how nanostructured surfaces can be created for the purposes of improving cell adhesion between medical devices and the human body. Each original chapter is revised in this second edition and describes developments in coatings for heart valves, stents, hip and knee joints, cardiovascular devices, orthodontic applications, and regenerative materials such as bone substitutes. There are also 8 new chapters that address: Microvascular anastomoses Inhaler devices used for pulmonary delivery of medical aerosols Surface modification of interference screws Biomechanics of the mandible (a detailed case study) Safety and medical devices The synthesis of nanostructured material Delivery of anticancer molecules using carbon nanotubes Nano and micro coatings for medic...

  5. Surgical treatment of pathological obesity

    The obesity is the chronic non-communicable disease with a higher rate of growth in past 20 years. It is a risk factor for type 2 diabetes mellitus, high blood pressure, cardiovascular and respiratory affections, infertility, sexual and functional impotence, metabolic syndrome, load joint disorders and some types of cancer (breast, colon, prostate). The metabolic bariatric surgery is the surgical treatment more effective for the morbid obesity at long -and medium- term and not the pharmacologic treatment and the isolated diets. The aim of present historical review of the international literature on the evolution of surgical techniques of the bariatric surgery (malabsorption techniques, gastric restrictive techniques and mixed techniques), is to make available to those interested in this subject, a valuable therapeutic tool to be rationally used. (author)

  6. Surgical strategies for pediatric epilepsy

    Guan, Jian; Karsy, Michael; Ducis, Katrina

    2016-01-01

    Pediatric epilepsy is a debilitating condition that impacts millions of patients throughout the world. Approximately 20–30% of children with recurrent seizures have drug-resistant epilepsy (DRE). For these patients, surgery offers the possibility of not just seizure freedom but significantly improved neurocognitive and behavioral outcomes. The spectrum of surgical options is vast, ranging from outpatient procedures such as vagus nerve stimulation to radical interventions including hemispherectomy. The thread connecting all of these interventions is a common goal—seizure freedom, an outcome that can be achieved safely and durably in a large proportion of patients. In this review, we discuss many of the most commonly performed surgical interventions and describe the indications, complications, and outcomes specific to each.

  7. Results of surgical therapy for lung carcinoma.

    Paris, F; Padilla, J; Tarazona, V; Blasco, E; Canto, A; Pastor, J; Zarza, A G

    1979-01-01

    A series of 300 pulmonary resections in patients with lung carcinoma is presented. Total survival rate of the series since the operation, including surgical mortality, was 33% at 3 years and 24% at 5 years. The survival rate and surgical criteria were correlated, having better results when standard surgery was performed. The authors emphasize that the surgical figures of the series are of great value as the surgical indications were large and nonselective, with 85% of resectability in the thoracotomies. PMID:229985

  8. [Diagnostics and surgical treatment of lung cancer in conditions of special thoracal department for patients with purulent lung diseases].

    Deĭnega, I V; Egorov, V I; Ionov, P M; Akopov, A L

    2014-01-01

    The authors investigated features of diagnostics and surgical treatment of lung cancer which was complicated by purulent destructive process. The possibilities of radical operative intervention were considered after preliminary adequate treatment of purulent complications in 226 patients. It was noted, that the diagnostic thoracotomy should be used in doubtful cases in order to estimate the resectability of lung cancer. PMID:25306630

  9. Upper lid crease approach for margin rotation in trachomatous cicatricial entropion without external sutures

    Antonio Augusto Velasco e Cruz

    2015-12-01

    Full Text Available ABSTRACT Purpose: To describe the use of a lid crease incision for upper eyelid margin rotation in cicatricial entropion combining internal traction on the anterior lamella, tarsotomy, and tarsal overlap without external sutures. Methods: Surgical description: The main steps of the procedure consisted of exposure of the entire tarsal plate up to the eyelashes followed by tarsotomy through the conjunctiva. A double-armed 6.0 polyglactin suture was then passed through the distal tarsal fragment to the marginal section of the orbicularis oculi muscle. As the sutures were tied, the distal tarsus advanced over the marginal section, and traction was exerted on the marginal strip of the orbicularis muscle. There were no bolsters or external knots. The pretarsal skin-muscle flap was closed with a 6.0 plain gut suture. Results: We used this procedure at a tertiary hospital in Saudi Arabia from 2013 to 2014. Sixty upper lids of 40 patients (23 women and 17 men were operated on, with an age range of 44-99 years [mean ± standard deviation (SD = 70.9 ± 13.01 years]. Bilateral surgery was performed on 21 patients. Follow-up ranged from 1 to 12 months (mean 3.0 ± 2.71 months. Forty percent of the patients (24 lids had more than 3 months' follow-up. The postoperative lid margin position was good in all cases. Trichiasis (two lashes was observed in only one patient with unilateral entropion on the medial aspect of the operated lid. Conclusions: The upper lid margin can be effectively rotated through a lid crease incision with internal sutures. The technique combines the main mechanisms of the Wies and Trabut approaches and avoids the use of bolsters or external sutures, which require a second consultation to be removed. Some other lid problems, such as ptosis, retraction, or dermatochalasis, can be concomitantly addressed during the procedure.

  10. Surgical treatment of cleft lip

    Mateus Domingues Miachon; Pedro Luiz Squilacci Leme

    2014-01-01

    We performed a systematic review of the literature on the surgical treatment of cleft lip, emphasizing the prevalence, complications associated with the treatment and the points of disagreement between authors. We conducted a literature cross-sectional search that analyzed publications in books, articles and on the databases SciELO - Scientific Electronic Library Online, PubMed, of the National Center for Biotechnology Information. We conclude that: 1) the severity of the cleft will indicate ...

  11. Tattoo preservation during surgical procedures

    Tenna, Stefania; DelleFemmine,Pietro Francesco; Pendolino, Alfonso Luca; Brunetti, Beniamino; Persichetti,Paolo

    2014-01-01

    Stefania Tenna, Pietro Francesco Delle Femmine, Alfonso Luca Pendolino, Beniamino Brunetti, Paolo Persichetti Plastic Surgery Unit, University Campus Bio-Medico of Rome, University of Rome, Rome, Italy Abstract: In recent years, the number of people getting tattoos has continued to increase. Tattoos are much more than cultural fads and cosmetic complements, and nowadays often represent events that express the patient's personality without words. The presence of a tattoo in the surgic...

  12. Tattoo preservation during surgical procedures

    Tenna S; Delle Femmine PF; Pendolino AL; Brunetti B; Persichetti P

    2014-01-01

    Stefania Tenna, Pietro Francesco Delle Femmine, Alfonso Luca Pendolino, Beniamino Brunetti, Paolo Persichetti Plastic Surgery Unit, University Campus Bio-Medico of Rome, University of Rome, Rome, Italy Abstract: In recent years, the number of people getting tattoos has continued to increase. Tattoos are much more than cultural fads and cosmetic complements, and nowadays often represent events that express the patient's personality without words. The presence of a tattoo in the surgical f...

  13. Different approaches to surgical pupilloplasty

    Pina, S; Pedrosa, C; Azevedo, A.; Ramalho, M; Pêgo, P; Feijóo, B; Prieto, I

    2012-01-01

    Purpose: To describe three different minimal invasive surgical approaches for correction of traumatic and congenital pupil abnormalities. Setting/Venue: Ophthalmology Department, Prof Dr. Fernando Fonseca Hospital EPE. Amadora, Lisboa, Portugal Methods: We describe three clinical cases with pupil abnormalities from different ethiology, all submitted to pupiloplasty in order to improve visual and aesthetic outcome. First patient presented a traumatic aphakia and ectopic pupil in his righ...

  14. Surgical Anatomy of the Eyelids.

    Sand, Jordan P; Zhu, Bovey Z; Desai, Shaun C

    2016-05-01

    Slight alterations in the intricate anatomy of the upper and lower eyelid or their underlying structures can have pronounced consequences for ocular esthetics and function. The understanding of periorbital structures and their interrelationships continues to evolve and requires consideration when performing complex eyelid interventions. Maintaining a detailed appreciation of this region is critical to successful cosmetic or reconstructive surgery. This article presents a current review of the anatomy of the upper and lower eyelid with a focus on surgical implications. PMID:27105794

  15. Stereolithographic Surgical Template: A Review

    Dandekeri, Shilpa Sudesh; M K Sowmya; Bhandary, Shruthi

    2013-01-01

    Implant placement has become a routine modality of dental care.Improvements in surgical reconstructive methods as well as increased prosthetic demands,require a highly accurate diagnosis, planning and placement. Recently,computer-aided design and manufacturing have made it possible to use data from computerised tomography to not only plan implant rehabilitation,but also transfer this information to the surgery.A review on one of this technique called Stereolithography is presented in this art...

  16. Neonatal jaundice: the surgical viewpoint.

    Kling, S.

    1980-01-01

    There is good evidence that neonatal hepatitis, biliary hypoplasia, biliary atresia and choledochal cyst are different stages of one disease process for which the term infantile obstructive cholangiopathy has been suggested. Thanks to the work of Kasai and the operation of hepatic portoenterostomy the surgical outlook has greatly improved, although in North America it still leaves much to be desired. One cannot procrastinate too long in the hope that the patient's condition will improve spont...

  17. Surgical checklists: the human factor.

    O Connor, Paul

    2013-05-14

    BACKGROUND: Surgical checklists has been shown to improve patient safety and teamwork in the operating theatre. However, despite the known benefits of the use of checklists in surgery, in some cases the practical implementation has been found to be less than universal. A questionnaire methodology was used to quantitatively evaluate the attitudes of theatre staff towards a modified version of the World Health Organisation (WHO) surgical checklist with relation to: beliefs about levels of compliance and support, impact on patient safety and teamwork, and barriers to the use of the checklist. METHODS: Using the theory of planned behaviour as a framework, 14 semi-structured interviews were conducted with theatre personnel regarding their attitudes towards, and levels of compliance with, a checklist. Based upon the interviews, a 27-item questionnaire was developed and distribute to all theatre personnel in an Irish hospital. RESULTS: Responses were obtained from 107 theatre staff (42.6% response rate). Particularly for nurses, the overall attitudes towards the effect of the checklist on safety and teamworking were positive. However, there was a lack of rigour with which the checklist was being applied. Nurses were significantly more sensitive to the barriers to the use of the checklist than anaesthetists or surgeons. Moreover, anaesthetists were not as positively disposed to the surgical checklist as surgeons and nurse. This finding was attributed to the tendency for the checklist to be completed during a period of high workload for the anaesthetists, resulting in a lack of engagement with the process. CONCLUSION: In order to improve the rigour with which the surgical checklist is applied, there is a need for: the involvement of all members of the theatre team in the checklist process, demonstrated support for the checklist from senior personnel, on-going education and training, and barriers to the implementation of the checklist to be addressed.

  18. Surgical management of tubal pregnancy

    Mol, F

    2013-01-01

    The work presented in this thesis first addresses the magnitude of the clinical problem of surgically treated tubal pregnancy in The Netherlands. Next, we studied the adherence to recommendations from the Dutch guideline on diagnosis and management of ectopic pregnancy. A systematic review and meta-analysis was performed to evaluate the effectiveness of surgery, medical treatment and expectant management in terms of treatment success (i.e. complete elimination of trophoblastic tissue), financ...

  19. Surgical correction of postoperative astigmatism

    Lindstrom Richard

    1990-01-01

    The photokeratoscope has increased the understanding of the aspheric nature of the cornea as well as a better understanding of normal corneal topography. This has significantly affected the development of newer and more predictable models of surgical astigmatic correction. Relaxing incisions effectively flatten the steeper meridian an equivalent amount as they steepen the flatter meridian. The net change in spherical equivalent is, therefore, negligible. Poor predictability is the major limit...

  20. Keratometry device for surgical support

    Saia Paula; De Groote Jean-Jacques; Ventura Liliane; Faria e Sousa Sidney J

    2009-01-01

    Abstract Background High astigmatisms are usually induced during corneal suturing subsequent to tissue transplantation or any other surgery which involves corneal suturing. One of the reasons is that the procedure is intimately dependent on the surgeon's skill for suturing identical stitches. In order to evaluate the influence of the irregularity on suturing for the residual astigmatism, a prototype for ophthalmic surgical support has been developed. The final intention of this prototype is t...

  1. Postenucleation socket syndrome: surgical repair

    Ramalho, M; Pina, S.; Pedrosa, C; Santos, C.; Vaz, F; Ferreira, M.; Melo, A.

    2013-01-01

    Introduction: A contracted eye socket is a functional and cosmetic misfortune to the patient. It makes impossible to the patient to wear an eye prosthesis, but also becomes a source of chronic infection, discharge and irritation. There are several surgical techniques to deal with the postenucleation socket syndrome. Methods: Six consecutive patients with postenucleation socket syndrome underwent reconstruction of the anophthalmic socket. The cause for enucleation in 5 cases was relat...

  2. An Auto-Fluorescence guided surgical approach performed with Er:YAG laser and Nd:YAG Low Level Laser Therapy for Medication-Related Osteonecrosis of the Jaw

    Ilaria Giovannacci

    2015-08-01

    Full Text Available Medication-Related Osteonecrosis of the Jaw (MRONJ therapy remains an unresolved problem. The proposed conservative and surgical treatment regimens are associated to contradictory success rates. Surgical approach with Er:YAG laser is associated to significant better results compared to medical treatment and traditional surgical approaches. Objective: To describe a new surgical approach that couples the advantages of the Er:YAG laser and the usefulness of the AF in highlighting surgical margins. One of the difficulties encountered during surgical removal of a MRONJ is the precise individuation of necrotic bone margins. Case Report: A case of Stage III mandibular osteonecrosis treated with a new surgical approach is presented. The aim is to describe an auto-fluorescence (AF guided surgical approach performed with Er:YAG laser and Nd:YAG Low Level Laser Therapy (LLLT. After one month of follow-up, the complete mucosal healing was evident and symptoms was unobserved. Such a technique allowed a highly accurate and minimally invasive approach through the selective ablation of the non-/hypofluorescent areas. Conclusion: Taking into account the advantages of laser therapy and the possible effectiveness of the AF in highlighting surgical margins, this approach would probably achieve excellent outcomes.DOI: 10.14693/jdi.v22i2.486

  3. Surgical Treatment for Hepatocellular Carcinoma

    Ahmad A Madkhali

    2015-01-01

    Full Text Available Hepatocellular carcinoma (HCC is an epithelial tumor derived from hepatocytes; it accounts for 80% of all primary liver cancers and ranks globally as the fourth leading cause of cancer-related deaths. HCC treatment is a multidisciplinary and a multimodal task, with surgery in the form of liver resection and liver transplantation (LT representing the only potentially curative modality. However, there are variable opinions and discussions about applying these surgical options and using other supporting treatments. This article is a narrative review that includes articles published from 1984 to 2013 located by searching scientific databases such as PubMed, SCOPUS, and Elsevier, with the main keyword of hepatocellular carcinoma in addition to other keywords such as liver transplantation, liver resection, transarterial chemoembolization, portal vein embolization, bridging therapy, and downstaging. In this review, we focus mainly on the surgical treatment options offered for HCC, in order to illustrate the current relevant data available in the literature to help in applying these surgical options and to use other supporting treatment modalities when appropriate.

  4. Surgical smoke and ultrafine particles

    Nowak Dennis

    2008-12-01

    Full Text Available Abstract Background Electrocautery, laser tissue ablation, and ultrasonic scalpel tissue dissection all generate a 'surgical smoke' containing ultrafine ( Methods To measure the amount of generated particulates in 'surgical smoke' during different surgical procedures and to quantify the particle number concentration for operation room personnel a condensation particle counter (CPC, model 3007, TSI Inc. was applied. Results Electro-cauterization and argon plasma tissue coagulation induced the production of very high number concentration (> 100000 cm-3 of particles in the diameter range of 10 nm to 1 μm. The peak concentration was confined to the immediate local surrounding of the production side. In the presence of a very efficient air conditioning system the increment and decrement of ultrafine particle occurrence was a matter of seconds, with accumulation of lower particle number concentrations in the operation room for only a few minutes. Conclusion Our investigation showed a short term very high exposure to ultrafine particles for surgeons and close assisting operating personnel – alternating with longer periods of low exposure.

  5. Fighting surgical site infections in small animals

    Verwilghen, Denis; Singh, Ameet

    2015-01-01

    A diverse array of pathogen-related, patient-related, and caretaker-related issues influence risk and prevention of surgical site infections (SSIs). The entire surgical team involved in health care settings in which surgical procedures are performed play a pivotal role in the prevention of SSIs. ...

  6. Digital Margins : How spatially and socially marginalized communities deal with digital exclusion

    Salemink, Koen

    2016-01-01

    The increasing importance of the Internet as a means of communication has transformed economies and societies. For spatially and socially marginalized communities, this transformation has resulted in digital exclusion and further marginalization. This book presents a study of two kinds of marginaliz

  7. Surgical teaching program for our senior medical students: room for improvement

    Burgess A

    2014-10-01

    Full Text Available Annette Burgess,1 Caroline Wright,1 Raffi Qasabian,1 Deborah O'Mara,2 Craig Mellis1 1Central Clinical School, Sydney Medical School, University of Sydney, Sydney, NSW, Australia; 2Assessment Unit, Sydney Medical School, University of Sydney, Sydney, NSW, Australia Background: To ensure the quality of surgical teaching within our graduate entry medical program, a distinctive surgical teaching program has been developed at Sydney Medical School-Central. Spanning 2 years, the program includes lectures, small group surgical clinical tutorials, and formal student surgical grand rounds presentations, plus clinical placements and attendance in operating theaters. We sought to evaluate the effectiveness of the program. Methods: In 2013, at the completion of year 4, all graduating students (n=54 were asked to complete an open and closed-ended questionnaire regarding their experience of the surgical program. Results: A total of 44/54 (81% students completed the questionnaire. Students reported a high level of engagement with their experience in clinical tutorials, and a moderate level of engagement in surgical lectures. Students found the clinical attachment to be the least useful method of teaching, with the surgical grand rounds presentation also eliciting a poor response from students. Conclusion: While both large group lectures and small group learner-centered teaching methods were highly valued by students, changes are needed to enhance clinical attachments for students in surgical wards. The benefits of students being made to feel part of a team during their surgical clinical attachments, along with adequate inpatient contact and formative feedback, should not be underestimated. Keywords: surgery teaching, curriculum, medical program

  8. Definitive intraoperative radiotherapy for musculoskeletal sarcomas and malignant lymphoma in combination with surgical excision

    The purpose was to estimate retrospectively the outcome of patients with musculoskeletal sarcoma or malignant lymphoma treated with intraoperative radiotherapy (IORT). Between 1988 and 1999, definitive IORT in combination with surgical excision was performed in 24 patients with musculoskeletal sarcoma (malignant fibrous histiocytoma, 10; osteosarcoma, 6; liposarcoma, 2; chondrosarcoma, 1; synovial sarcoma, 1; Ewing's sarcoma, 1; angiosarcoma, 1; epithelioid sarcoma, 1; malignant schwannoma, 1; and 3 patients with malignant lymphoma. The tumor was excised by marginal margin excision, intralesional margin excision, or wide margin excision; 15-45 Gy electrons was then delivered to the affected sites. In the 8 patients without distant metastases at the first visit, 4 patients are alive 6.5-11.5 years after IORT, and 4 patients died <4.5 years after IORT. The incidence of local recurrence was 13%. In the 19 patients with distant metastases at the first visit, 3 patients are alive 2.5-6.7 years after IORT, and 16 patients died 0.2-5.7 years after IORT. The incidence of local recurrence was 45%. Complications after IORT were found in 5 patients: neuropathy, 1 patient; skin necrosis, 1 patient; myelopathy, 1 patient; enteritis ileus, 1 patient; and edema, 1 patient. IORT with a radiation dose of 15-45 Gy in combination with surgical excision appeared to be useful for local control and to be more effective in patients without distant metastases at the first visit than in patients with distant metastases. (author)

  9. Fission product margin in burnup credit analyses

    The US Department of Energy (DOE) is currently working toward the licensing of a methodology for using actinide-only burnup credit for the transportation of spent nuclear fuel (SNF). Important margins are built into this methodology. By using comparisons with a representative experimental database to determine bias factors, the methodology ensures that actinide concentrations and worths are estimated conservatively; furthermore, the negative net reactivity of certain actinides and all fission products (FPs) is not taken into account, thus providing additional margin. A future step of DOE's effort might aim at establishing an actinide and FP burnup credit methodology. The objective of this work is to establish the uncertainty to be applied to the total FP worth in SNF. This will serve two ends. First, it will support the current actinide-only methodology by demonstrating the margin available from FPs. Second, it will identify the major contributions to the uncertainty and help set priorities for future work

  10. A computational model for estimating tumor margins in complementary tactile and 3D ultrasound images

    Shamsil, Arefin; Escoto, Abelardo; Naish, Michael D.; Patel, Rajni V.

    2016-03-01

    Conventional surgical methods are effective for treating lung tumors; however, they impose high trauma and pain to patients. Minimally invasive surgery is a safer alternative as smaller incisions are required to reach the lung; however, it is challenging due to inadequate intraoperative tumor localization. To address this issue, a mechatronic palpation device was developed that incorporates tactile and ultrasound sensors capable of acquiring surface and cross-sectional images of palpated tissue. Initial work focused on tactile image segmentation and fusion of position-tracked tactile images, resulting in a reconstruction of the palpated surface to compute the spatial locations of underlying tumors. This paper presents a computational model capable of analyzing orthogonally-paired tactile and ultrasound images to compute the surface circumference and depth margins of a tumor. The framework also integrates an error compensation technique and an algebraic model to align all of the image pairs and to estimate the tumor depths within the tracked thickness of a palpated tissue. For validation, an ex vivo experimental study was conducted involving the complete palpation of 11 porcine liver tissues injected with iodine-agar tumors of varying sizes and shapes. The resulting tactile and ultrasound images were then processed using the proposed model to compute the tumor margins and compare them to fluoroscopy based physical measurements. The results show a good negative correlation (r = -0.783, p = 0.004) between the tumor surface margins and a good positive correlation (r = 0.743, p = 0.009) between the tumor depth margins.

  11. Adequate Iodine Status in New Zealand School Children Post-Fortification of Bread with Iodised Salt

    Emma Jones

    2016-05-01

    Full Text Available Iodine deficiency re-emerged in New Zealand in the 1990s, prompting the mandatory fortification of bread with iodised salt from 2009. This study aimed to determine the iodine status of New Zealand children when the fortification of bread was well established. A cross-sectional survey of children aged 8–10 years was conducted in the cities of Auckland and Christchurch, New Zealand, from March to May 2015. Children provided a spot urine sample for the determination of urinary iodine concentration (UIC, a fingerpick blood sample for Thyroglobulin (Tg concentration, and completed a questionnaire ascertaining socio-demographic information that also included an iodine-specific food frequency questionnaire (FFQ. The FFQ was used to estimate iodine intake from all main food sources including bread and iodised salt. The median UIC for all children (n = 415 was 116 μg/L (females 106 μg/L, males 131 μg/L indicative of adequate iodine status according to the World Health Organisation (WHO, i.e., median UIC of 100–199 μg/L. The median Tg concentration was 8.7 μg/L, which was <10 μg/L confirming adequate iodine status. There was a significant difference in UIC by sex (p = 0.001 and ethnicity (p = 0.006. The mean iodine intake from the food-only model was 65 μg/day. Bread contributed 51% of total iodine intake in the food-only model, providing a mean iodine intake of 35 μg/day. The mean iodine intake from the food-plus-iodised salt model was 101 μg/day. In conclusion, the results of this study confirm that the iodine status in New Zealand school children is now adequate.

  12. The Nigerian health care system: Need for integrating adequate medical intelligence and surveillance systems

    Menizibeya Osain Welcome

    2011-01-01

    Full Text Available Objectives : As an important element of national security, public health not only functions to provide adequate and timely medical care but also track, monitor, and control disease outbreak. The Nigerian health care had suffered several infectious disease outbreaks year after year. Hence, there is need to tackle the problem. This study aims to review the state of the Nigerian health care system and to provide possible recommendations to the worsening state of health care in the country. To give up-to-date recommendations for the Nigerian health care system, this study also aims at reviewing the dynamics of health care in the United States, Britain, and Europe with regards to methods of medical intelligence/surveillance. Materials and Methods : Databases were searched for relevant literatures using the following keywords: Nigerian health care, Nigerian health care system, and Nigerian primary health care system. Additional keywords used in the search were as follows: United States (OR Europe health care dynamics, Medical Intelligence, Medical Intelligence systems, Public health surveillance systems, Nigerian medical intelligence, Nigerian surveillance systems, and Nigerian health information system. Literatures were searched in scientific databases Pubmed and African Journals OnLine. Internet searches were based on Google and Search Nigeria. Results : Medical intelligence and surveillance represent a very useful component in the health care system and control diseases outbreak, bioattack, etc. There is increasing role of automated-based medical intelligence and surveillance systems, in addition to the traditional manual pattern of document retrieval in advanced medical setting such as those in western and European countries. Conclusion : The Nigerian health care system is poorly developed. No adequate and functional surveillance systems are developed. To achieve success in health care in this modern era, a system well grounded in routine

  13. Quantitative safety goals through more adequate risk management and risk assessment

    The paper offers an over view of the current regulatory background within the United States, emphasising nuclear regulation, related to the establishment of quantitative safety goals as a way to respond to the key issue of 'How safe is safe enough'. The approach described in the paper based on use of probabilistic risk assessments techniques is centred around definition of quantitative safety regions. Regions are termed: design basis, safety margin, the design capability, and safety research. The design basis region is bounded by the frequency of 10-4 per reactor year and consequences of no identifiable public injury. The frequency of 10-4 per reactor year, is associated with the total projected lifetime of a commercial US nuclear power programme. Events which have a 50% chance of happening are included in the design basis region. In the safety margin region, which extends below the design basis region, protection is provided against events whose probability of not happening during the expected course of the US nuclear power programme is within the region of 50 to 90%. Setting the lower mean frequency to this region of 10-5 per reactor year is equivalent to offering 90% assurance that an accident of given severity will not happen. (author)

  14. Family Structure Types and Adequate Utilization of Antenatal Care in Kenya.

    Owili, Patrick Opiyo; Muga, Miriam Adoyo; Chou, Yiing-Jenq; Hsu, Yi-Hsin Elsa; Huang, Nicole; Chien, Li-Yin

    2016-01-01

    Features of the health care delivery system may not be the only expounding factors of adequate utilization of antenatal care among women. Other social factors such as the family structure and its environment contribute toward pregnant women's utilization of antenatal care. An understanding of how women in different family structure types and social groups use basic maternal health services is important toward developing and implementing maternal health care policy in the post-Millennium Development Goal era, especially in the sub-Saharan Africa where maternal mortality still remains high. PMID:27214674

  15. Risk Informed Margins Management as part of Risk Informed Safety Margin Characterization

    Curtis Smith

    2014-06-01

    The ability to better characterize and quantify safety margin is important to improved decision making about Light Water Reactor (LWR) design, operation, and plant life extension. A systematic approach to characterization of safety margins and the subsequent margin management options represents a vital input to the licensee and regulatory analysis and decision making that will be involved. In addition, as research and development in the LWR Sustainability (LWRS) Program and other collaborative efforts yield new data, sensors, and improved scientific understanding of physical processes that govern the aging and degradation of plant SSCs needs and opportunities to better optimize plant safety and performance will become known. To support decision making related to economics, readability, and safety, the Risk Informed Safety Margin Characterization (RISMC) Pathway provides methods and tools that enable mitigation options known as risk informed margins management (RIMM) strategies.

  16. Marginal Stability Dynamics for Energetic Particles

    Berk, Herbert

    2009-11-01

    Marginal stability in plasmas characteristically sets a stiff limit to the range of that can be achieved. Below this limit, the system is governed by classical. Near marginal stability, however, plasmas may be subject to rapid processes, resulting in a system that hovers near marginality. This scenario emerged from nonlinear studies of energetic particle relaxation and may be to more general plasma transport. We describe results from several such which include. [1] Avalanches---Near marginal stability, an important point is whether an instability driven by resonant particles where the distribution function has ``free energy'' will cause global radial diffusion. For that,modes need to overlap. This process can be continuous or bursty, the latter having been recently observed in NSTX and DIII-D. [2] Frequency chirping---Recent simulations by Vann showed that marginal stability can be sustained when there is only one unstable linear mode, due to the mechanism of spontaneous frequency sweeping. Although a single mode near stability should not cause dramatic relaxation, nevertheless in the Vann simulations, the achievement of marginal stability induced a continual chirping of that had removed energy from the bulk of the region where the external beam to deposit free energy. The distribution was then found to hover near stability. This mechanism may apply to the n=0 GAM where frequency sweeping might be a mechanism for extracting energy from alpha particles in a burning plasma, thereby reducing the stored alpha particle pressure. One way to implement this is to have the n=0 geodesic acoustic modes (GAM) be preferentially excited, since energy rather than momentum (leading to spatial diffusion) is then primarily extracted from alpha particles.

  17. Evaluation of thermal margin for HANARO core

    During the commissioning and the start-up of the HANARO, various design parameters were confirmed and measured. For safer operation of HANARO and resolution of the CHF penalty issue which is one of unresolved licensing problems, thermal margins for normal and transient conditions were re-evaluated reflecting the commissioning and the start-up test results and the design modifications during operation. The re-evaluation shows that the HANARO meets the design criteria for ONB margin and fuel centerline temperature under normal condition. For upset condition, it also satisfies the safety limits for CHFR and fuel centerline temperature. (Author). 11 refs., 13 tabs., 4 figs

  18. Marginal fields, a variable geometry concept

    A concept from economics, ranking a field as ''marginal'' may be influenced by numerous variables. Around 20% of the reserves remaining in the North Sea are located in fields that may be termed marginal. An AFTP conference held in June 1995 in Paris examined the technological innovations and other methods used by oil companies to ''demarginalize'' a field, whether using advanced production systems or FPSO's (floating production, storage and loading systems) in concrete, not to mention the Nomad concept of multiphase systems. (author). 1 ref

  19. Seismic safety margins research program overview

    A multiyear seismic research program has been initiated at the Lawrence Livermore Laboratory. This program, the Seismic Safety Margins Research Program (SSMRP) is funded by the U.S. Nuclear Regulatory Commission, Office of Nuclear Regulatory Research. The program is designed to develop a probabilistic systems methodology for determining the seismic safety margins of nuclear power plants. Phase I, extending some 22 months, began in July 1978 at a funding level of approximately $4.3 million. Here we present an overview of the SSMRP. Included are discussions on the program objective, the approach to meet the program goal and objectives, end products, the probabilistic systems methodology, and planned activities for Phase I

  20. Endogenous Costs and Price-Cost Margins

    Zhentang ZHANG; Röller, Lars-Hendrik; Neven, Damien J

    2002-01-01

    Empirical work on price-cost margins often treats costs as exogenous. Allowing for endogenous costs when estimating price-cost margins is the topic of this paper. Methodologically, the endogenous cost model we propose leads to an additional equation that allows for the simultaneity in price setting in the product and the input market (labor in our case). In other words, the usual two-equation set-up (demand and first-order condition in the product market) is generalized to include a third equ...

  1. Algorithms for computing the multivariable stability margin

    Tekawy, Jonathan A.; Safonov, Michael G.; Chiang, Richard Y.

    1989-01-01

    Stability margin for multiloop flight control systems has become a critical issue, especially in highly maneuverable aircraft designs where there are inherent strong cross-couplings between the various feedback control loops. To cope with this issue, we have developed computer algorithms based on non-differentiable optimization theory. These algorithms have been developed for computing the Multivariable Stability Margin (MSM). The MSM of a dynamical system is the size of the smallest structured perturbation in component dynamics that will destabilize the system. These algorithms have been coded and appear to be reliable. As illustrated by examples, they provide the basis for evaluating the robustness and performance of flight control systems.

  2. Simplified surgical placement and stabilization methods for intracerebroventricular cannulas in rat lateral ventricles.

    Jho, David H; Engelhard, Herbert H; Juarez, Altair; Espat, N Joseph

    2003-10-01

    Intracerebroventricular cannulation in rat models is an efficient tool for exploring the effects of substances directly injected into the CNS, bypassing the blood-brain barrier. Techniques for surgically securing the ICV cannula require a balance between ease of application and adequate stability. The authors tested several methods of lateral ventricle cannula stabilization, especially focusing on a comparison of cyanoacrylate gel to cranioplastic cement with an anchoring bone screw. PMID:15235663

  3. 17 CFR 242.405 - Withdrawal of margin.

    2010-04-01

    ... account after such withdrawal is sufficient to satisfy the required margin for the security futures and...) REGULATIONS M, SHO, ATS, AC, AND NMS AND CUSTOMER MARGIN REQUIREMENTS FOR SECURITY FUTURES Customer Margin Requirements for Security Futures § 242.405 Withdrawal of margin. (a) By the customer. Except as...

  4. Response of cotton genotypes to boron under-b-adequate conditions

    Balanced boron (B) application is well-known to enhance the cotton production; however, the narrow range between B-deficiency and toxicity levels makes it difficult to manage. Cotton genotypes extensively differ in their response to B requirements. The adequate dose of B for one genotype may be insufficient or even toxic to other genotype. The effects of boron (B) on seed cotton yield and its various yield associated traits were studied on 10 cotton genotypes of Pakistan. The pot studies were undertaken to categorize cotton genotypes using B-deficient (control) and B-adequate (2.0 kg B ha-1) levels arranged in CRD with four repeats. The results indicated that the seed cotton yield, yield attributes and B-uptake of genotypes were comparatively decreased in B-deficient stressed treatment. Genotype NIA-Ufaq exhibited wide range of adaptation and ranked as efficient-responsive, as it produced higher seed cotton yield under both B-regimes. SAU-2 and CIM-506 were highly-efficient and remaining all genotypes were medium-efficient. Genotype Sindh-1 produced low seed cotton yield under B deficient condition and ranked as low-efficient. B-efficient cotton genotypes can be grown in B deficient soils without B application. (author)

  5. Incentives for an adequate, economic and reliable Swiss transmission grid. Final version

    This comprehensive final report for the Swiss Federal Office of Energy (SFOE) discusses incentives necessary for the implementation of an adequate, economic and reliable Swiss electricity transmission grid. As Switzerland moves towards a more liberalised and competitive electricity market, an essential task of policy makers will be to ensure that incentives are in place for the construction, maintenance and operation of adequate, economic and reliable transmission infrastructure. As well as continuing to serve the domestic market, the location of Switzerland at the centre of Europe also means that policy should embrace opportunities in servicing the developing European Internal Market by providing transit and other services. Topics discussed include the economic evaluation of transmission investment proposals, regulated transmission investment, investments in transmission lines by power merchants, power auctions and congestion management as well as inter-TSO compensation mechanisms. European regulations and practice are discussed as are access questions and transmission charges. Developments in interconnection management and harmonisation are examined. The particular characteristics of the Swiss energy system, its prices and its legal frameworks are discussed. Cross-border trading and security of supply are also discussed

  6. Incentives for an adequate, economic and reliable Swiss transmission grid. Final version

    Twomey, P.; Neuhoff, K.; Newbery, D.

    2006-11-15

    This comprehensive final report for the Swiss Federal Office of Energy (SFOE) discusses incentives necessary for the implementation of an adequate, economic and reliable Swiss electricity transmission grid. As Switzerland moves towards a more liberalised and competitive electricity market, an essential task of policy makers will be to ensure that incentives are in place for the construction, maintenance and operation of adequate, economic and reliable transmission infrastructure. As well as continuing to serve the domestic market, the location of Switzerland at the centre of Europe also means that policy should embrace opportunities in servicing the developing European Internal Market by providing transit and other services. Topics discussed include the economic evaluation of transmission investment proposals, regulated transmission investment, investments in transmission lines by power merchants, power auctions and congestion management as well as inter-TSO compensation mechanisms. European regulations and practice are discussed as are access questions and transmission charges. Developments in interconnection management and harmonisation are examined. The particular characteristics of the Swiss energy system, its prices and its legal frameworks are discussed. Cross-border trading and security of supply are also discussed

  7. Surgical management of osteoradionecrosis of the temporal bone

    Kveton, J.F.

    1988-03-01

    The surgical management of osteoradionecrosis of the temporal bone has met with limited success because of the difficulty in accurate assessment of the viability of nonnecrotic bone intraoperatively. Failure to resect all nonviable bone results in recurrence of a necrotic focus. With the use of hyperbaric oxygen therapy to stabilize marginal bone and oral tetracycline to label viable bone preoperatively, removal of all nonviable bone can be accomplished. Postoperatively, a second course of hyperbaric therapy enhances wound healing, thus assuring a successful outcome. This article details a successful systematic approach that was developed to resect a necrotic focus in the temporal bone of a 10-year-old boy who had undergone a full course of radiotherapy for treatment of a rhabdomyosarcoma.

  8. Klatskin tumor: Diagnosis, preoperative evaluation and surgical considerations.

    Molina, Víctor; Sampson, Jaime; Ferrer, Joana; Sanchez-Cabus, Santiago; Calatayud, David; Pavel, Mihai Calin; Fondevila, Constantino; Fuster, Jose; García-Valdecasas, Juan Carlos

    2015-11-01

    Hiliar cholangiocarcinoma is the most common type of cholangiocarcinoma, an represent around 10% of all hepatobiliary tumors. It is an aggressive malignancy, resectable in around 47% of the patients at diagnosis. Complete resection is the most effective and only potentially curative therapy, with a survival rate of less than 12 months in unresectable cases. Axial computerized tomography and magnetic resonance are the most useful image techniques to determine the surgical resectability. Clinically, jaundice and pruritus are the most common symptoms at diagnosis;preoperative biliary drainage is recommended using endoscopic retrograde cholangiography or percutaneous transhepatic cholangiography. Surgery using extended liver resections with an en bloc resection of the liver with vascular reconstruction is the technique with the highest survival. Complete resection with histologically negative resection margins (R0), nodal involvement and metastases are the most important prognostic factors. PMID:26298684

  9. Key Concepts for Estimating the Burden of Surgical Conditions and the Unmet Need for Surgical Care

    Bickler, Stephen; Ozgediz, Doruk; Gosselin, Richard; Spiegel, David; Hsia, Renee; Dunbar, Peter; McQueen, Kelly; Jamison, Dean; Weiser, Thomas Geoghegan

    2010-01-01

    Background: Surgical care is emerging as a crucial issue in global public health. Methodology is needed to assess the impact of surgical care from a public health perspective. Methods: A consensus opinion of a group of surgeons, anesthesiologists, and public health experts was established regarding the methodology for estimating the burden of surgical conditions and the unmet need for surgical care. Results: For purposes of analysis, we define surgical conditions as any disease state requirin...

  10. Urban poverty, access to basic services and public policies: a case study of the marginal suburbs of guayaquil, Ecuador.

    Bastiaenen M; Solf, J. J; Vos R

    1983-01-01

    ILO pub. Working paper on urban area poverty and essential services in marginal suburbs (slums) of Guayaquil, Ecuador - describes social implications of rural migration, obstacles to adequate housing and health services, and development of illegal squatter human settlements with no access to water supply, electricity, waste disposal or primary health care; stresses need for state aid to improve living conditions. Bibliography, diagram, questionnaire, statistical tables.

  11. Using dummies for surgical skills training

    Langebæk, Rikke

    2011-01-01

    Effective acquisition of a skill requires practise. Therefore it is of great importance to provide veterinary students with opportunities to practice their surgical skills before carrying out surgical procedures on live patients. Some veterinary schools let students perform entire surgical...... procedures on research animals, in order to learn the basic skills along the way. From an ethical point of view it is questionable however to use live research animals for the sole purpose of practising surgery, and also, research animals are very costly. It is therefore necessary to identify alternative...... teaching methods for veterinary surgical training. At the Department of Small Animal Clinical Sciences, Faculty of Life Sciences, a number of low fidelity, stuffed toy animal dummies was developed for the Surgical Skills Lab in order to teach 4th year students the basic surgical skills. In the Surgical...

  12. Spanish experiences with marginal and special materials on the construction of road embankments

    The use of existing materials along the alignment of a road is an essential problem within the Sustainable Development policies, which is being promoting worldwide since a long time. In the Word road Association (PIARC-AIPCR) this subject has being investigated by different Technical Committees during last decades. Additionally, the review of the article 330 Embankment of PG-3 (FOM 1382/2002) has opened the door to new non-conventional materials, as wastes and artificial materials, to be used on embankments. This could come to adequate solutions, technically, and environmentally, contributing with national legislation on valorisation policies. In this sense, the use of marginal materials and wastes con represent and important save on natural resources and dumping sites. In Spain, some experiences with marginal materials and wastes have being carried out. The work presented has consisted in compiling and analysing the experiences executed with marginal materials and wastes on Spanish road embankments. Although there are many other cases, 24 cases published with adequate information have being analysed, summarising aspects as: materials problems arrangement solutions or treatments employed. Analysing these experiences and making them public can be a way to transmit confidence, help to improve knowledge, and progress on the preparation of recommendations. This work has being carried out on the frame of the Project Geotechnical Engineering, Materials and Structures and Impact of Infrastructure in Civil engineering (TTIGEM), within the frame Program Border Cooperation Spain-External Borders (POCTEFEX); particularly in the Activity 2 related to Technology Transfer of Construction Materials, including marginal materials and wastes. (Author)

  13. Shutdown Margin for High Conversion BWRs Operating in Th-233U Fuel Cycle

    Shaposhnik, Yaniv; Elias, Ezra

    2013-01-01

    Several reactivity control system design options are explored in order to satisfy shutdown margin (SDM) requirements in a high conversion BWRs operating in Th-233U fuel cycle (Th-RBWR). The studied has an axially heterogeneous fuel assembly structure with a single fissile zone sandwiched between two fertile blanket zones. The utilization of an originally suggested RBWR Y-shape control rod in Th-RBWR is shown to be insufficient for maintaining adequate SDM to balance the high negative reactivity feedbacks, while maintaining fuel breeding potential, core power rating, and minimum Critical Power Ratio (CPR). Instead, an alternative assembly design, also relying on heterogeneous fuel zoning, is proposed for achieving fissile inventory ratio (FIR) above unity, adequate SDM and meeting minimum CPR limit at thermal core output matching the ABWR power. The new concept was modeled as a single 3-dimensional fuel assembly having reflective radial boundaries, using the BGCore system, which consists of the MCNP code coupl...

  14. Survivors in the Margins: The Invisibility of Violence Against Older Women.

    Crockett, Cailin; Brandl, Bonnie; Dabby, Firoza Chic

    2015-01-01

    Violence against older women exists in the margins between domestic violence and elder abuse, with neither field adequately capturing the experiences of older women survivors of intimate partner violence (IPV). This commentary explores this oversight, identifying how the lack of gender analysis in the elder abuse field exacerbates older survivors' invisibility when the wider violence against women (VAW) field lacks a lifespan approach to abuse. Examining the impact of generational and aging factors on how older women experience IPV, we assert that the VAW field may be overlooking a wider population of survivors than previously thought. PMID:26371877

  15. 5TH BIOTECHNOLOGICAL INVESTIGATIONS OCEAN MARGINS PROGRAM

    DR. ARTURO MASSOL, PROGRAM CHAIR; DR. ROSA BUXEDA, PROGRAM CO-CHAIR

    2004-01-08

    BI-OMP supports DOE's mission in Climate Change Research. The program provides the fundamental understanding of the linkages between carbon and nitrogen cycles in ocean margins. Researchers are providing a mechanistic understanding of these cycles, using the tools of modern molecular biology. The models that will allow policy makers to determine safe levels of greenhouse gases for the Earth System.

  16. The Silent Minority: Assimilated or Marginal?

    Howell, Gladys David

    In this paper, the concept of "invisible ethnic" is used to refer to an individual who is identified as different by dominant members of society and who is caught between an ancestral identity and culture on the one hand, and a wish to be assimilated, on the other. This concept is discussed in relation to Stonequist's "marginal man" and the social…

  17. Processes of marginalization in relation to participation

    Lagermann, Laila Colding

    2011-01-01

    This paper discusses processes of marginalization in relation to the participation of two students, Amir and Saad, in the school in Copenhagen, Denmark, which they attend but also across the school and different communities outside the school. In the paper I discuss the effect of some teachers...

  18. Shallow gas in the Iberian continental margin

    The shallow gas reservoirs in marine sediments from the Iberian margin or their escapes can be detected by using direct methods: (1) the measurement of high concentrations of methane or other hydrocarbons in the water column or sediment cores, (2) the identification of chemosynthetic communities and/or authigenic car- bonates in the seafloor, and (3) identification (using underwater videos) of pockmarks or carbonate mounds and mud volcanoes associated with the fluid escapes; or by indirect technical characterization of anomalies in acoustic records such as: (1) the presence of acoustic plumes in echo-sounders records, (2) the identification of acoustic blanking and/or acoustic turbidity in the high resolution seismic records, (3) the interpretation of reflectivity and (4) morphologies of pockmarks or seamounts in sidescan sonar and multibeam echo sounder records. This article is a compilation of acoustic-seismic, sedimentologic and morphologic evidence associated to the presence of shallow gas (accumulations or escapes) that appear in the Iberian margin and hat have been published in various papers. The description is divided into geographical sectors, beginning in the north-eastern end of the Mediterranean margin and ending at the easternmost area of the Cantabrian margin, following a clockwise direction around the Iberian Peninsula. (Author)

  19. Standard Gross Margins in the Netherlands

    Bont, de C.J.A.M.; Everdingen, van W.H.; Koole, B.

    2003-01-01

    This report contains information on the Standard Gross Margins (SGM), as they are used to classify farms and to fix the economic size of farms. Information is provided on the cal-culation, with details on the input costs and the data sources. Besides that a comparison is made between the results of

  20. Structure and tectonics of convergent plate margins

    Špičák, Aleš (ed.); Čadek, O. (ed.); Engdahl, E. R. (ed.)

    2004-01-01

    Roč. 141, č. 4 (2004), s. 241. ISSN 0031-9201 R&D Projects: GA AV ČR KSK3012103 Keywords : tectonics * subduction * convergent margins Subject RIV: DC - Siesmology, Volcanology, Earth Structure Impact factor: 2.370, year: 2004

  1. Large margin image set representation and classification

    Wang, Jim Jing-Yan

    2014-07-06

    In this paper, we propose a novel image set representation and classification method by maximizing the margin of image sets. The margin of an image set is defined as the difference of the distance to its nearest image set from different classes and the distance to its nearest image set of the same class. By modeling the image sets by using both their image samples and their affine hull models, and maximizing the margins of the images sets, the image set representation parameter learning problem is formulated as an minimization problem, which is further optimized by an expectation - maximization (EM) strategy with accelerated proximal gradient (APG) optimization in an iterative algorithm. To classify a given test image set, we assign it to the class which could provide the largest margin. Experiments on two applications of video-sequence-based face recognition demonstrate that the proposed method significantly outperforms state-of-the-art image set classification methods in terms of both effectiveness and efficiency.

  2. Negative Stress Margins - Are They Real?

    Raju, Ivatury S.; Lee, Darlene S.; Mohaghegh, Michael

    2011-01-01

    Advances in modeling and simulation, new finite element software, modeling engines and powerful computers are providing opportunities to interrogate designs in a very different manner and in a more detailed approach than ever before. Margins of safety are also often evaluated using local stresses for various design concepts and design parameters quickly once analysis models are defined and developed. This paper suggests that not all the negative margins of safety evaluated are real. The structural areas where negative margins are frequently encountered are often near stress concentrations, point loads and load discontinuities, near locations of stress singularities, in areas having large gradients but with insufficient mesh density, in areas with modeling issues and modeling errors, and in areas with connections and interfaces, in two-dimensional (2D) and three-dimensional (3D) transitions, bolts and bolt modeling, and boundary conditions. Now, more than ever, structural analysts need to examine and interrogate their analysis results and perform basic sanity checks to determine if these negative margins are real.

  3. Female Special Education Directors: Doubly Marginalized.

    Keefe, Charlotte Hendrick; Parmley, Pamela

    2003-01-01

    A qualitative study of five Texas female special education directors found that although participants achieved an administrative position, they were marginalized due to their leadership style, gender discrimination, and socialization. Participants also indicated a negative connection between being in special education administration and top-level…

  4. On the marginal stability of upwind schemes

    Gressier, J.; Moschetta, J.-M.

    Following Quirk's analysis of Roe's scheme, general criteria are derived to predict the odd-even decoupling. This analysis is applied to Roe's scheme, EFM Pullin's scheme, EIM Macrossan's scheme and AUSM Liou's scheme. Strict stability is shown to be desirable to avoid most of these flaws. Finally, the link between marginal stability and accuracy on shear waves is established.

  5. Marginal Strength of Collarless Metal Ceramic Crown

    Sikka Swati

    2010-01-01

    fracture strength at margins of metal ceramic crowns cemented to metal tooth analogs. Crowns evaluated with different marginal configurations, shoulder and shoulder bevel with 0 mm, 0.5 mm, 1 mm, and 1.5 mm, were selected. Methods. Maxillary right canine typhodont tooth was prepared to receive a metal ceramic crown with shoulder margin. This was duplicated to get 20 metal teeth analogs. Then the same tooth was reprepared to get shoulder bevel configuration. These crowns were then cemented onmetal teeth analogs and tested for fracture strength atmargin on an Instron testing machine. A progressive compressive load was applied using 6.3 mm diameter rod with crosshead speed of 2.5 mm per minute. Statisticaly analysis was performed with ANOVA, Student's “t” test and “f” test. Results. The fracture strength of collarless metal ceramic crowns under study exceeded the normal biting force. Therefore it can be suggested that collarless metal ceramic crowns with shoulder or shoulder bevel margins up to 1.5 mm framework reduction may be indicated for anteriormetal ceramic restorations. Significance. k Collarless metal ceramic crowns have proved to be successful for anterior fixed restorations. Hence, it may be subjected to more clinical trials.

  6. 12 CFR 220.4 - Margin account.

    2010-01-01

    ... Banking FEDERAL RESERVE SYSTEM (CONTINUED) BOARD OF GOVERNORS OF THE FEDERAL RESERVE SYSTEM CREDIT BY... requirement under this part shall be unavailable to satisfy any other requirement. (d) Liquidation in lieu of... liquidation is required, whichever is less. If the margin deficiency created or increased is $1000 or less,...

  7. Asymptotic approaches to marginally stable resonators.

    Nagel, J; Rogovin, D; Avizonis, P; Butts, R

    1979-09-01

    We present analytical solutions valid for large Fresnel number of the Fresnel-Kirchhoff integral equation for marginally stable resonators, for the specific case of flat circular mirrors. The asymptotic approaches used for curved mirrors have been extended to the waveguide region given by m diffraction around the mirror edge. PMID:19687883

  8. Early math intervention for marginalized students

    Overgaard, Steffen; Tonnesen, Pia Beck

    2015-01-01

    This study is one of more substudies in the project Early Math Intervention for Marginalized Students (TMTM2014). The paper presents the initial process of this substudy that will be carried out fall 2015. In the TMTM2014 project, 80 teachers, who completed a one week course in the idea of TMTM...

  9. Mundhulens mikroflora hos patienter med marginal parodontitis

    Larsen, Tove; Fiehn, Nils-Erik

    2011-01-01

    Viden om marginal parodontitis’ mikrobiologi tog for alvor fart for ca. 40 år siden. Den tidlige viden var baseret på mikroskopiske og dyrkningsmæssige undersøgelser af den subgingivale plak. Anvendelsen af de nyere molekylærbiologiske metoder har betydet, at vor viden om de ætiologiske faktorer ...

  10. Convergent Margin Structure and a Unifying Concept

    von Huene, R.; Ranero, C. R.; Scholl, D. W.

    2008-12-01

    Marine observations of the past decade resolve 3 domains of different mechanics in space that probably respond differently from each other during an earthquake cycle. Accretion is common along thickly (>1 km) sedimented trenches and slowly (fluid systems, input plate temperature, and material differences seem less important. From recent observations a unifying framework concept to aid interpretations of both accreting and eroding margins is proposed. Over a long term (Ma) the subduction channel accepts a finite amount of material. The excess amount will accrete and a shortage of trench sediment enhances erosion (Cloos and Shreve, 1988). If conditions remain consistent over ~1 Ma periods, the margin configuration becomes typically accretionary or erosional. In each margin segment the short term inter plate friction and material strength changes during the earthquake cycle as proposed by Wang and Hu, 2006. Mechanics probably changes locally during the cycle as well. K. Wang, Y. Hu, Accretionary prisms in subduction earthquake cycles: the theory of dynamic Coulomb wedge, J. Geophys. Res. 111 (2006) B06410, doi:10.1029/2005JB004094. Cloos, M., and R.L. Shreve, (1988), Subduction channel model of prism accretion, melange formation, sediment subduction, and subduction erosion at convergent plate margins: 2. Implications and discussion, Pageoph, v. 129, n. ¾ 501-545

  11. Markedly hypoplastic circumflex retroesophageal right aortic arch: MR imaging and surgical implications

    Circumflex retroesophageal right aortic arch with a markedly hypoplastic retroesophageal segment is a rare anomaly of the aortic arch. Adequate surgical management relies on precise diagnosis, which might not be feasible with echocardiography. To demonstrate the utility of MR imaging in establishing the diagnosis and to describe potential pitfalls in making the diagnosis. Three patients with a circumflex retroesophageal right aortic arch with a markedly hypoplastic retroesophageal segment were retrospectively evaluated. All patients underwent evaluation by echocardiography and MR imaging. The MR imaging consisted of 3-D MR angiography in two patients and fast gradient recalled echo with cardiac-triggered segmented acquisition in one patient. Surgical confirmation was obtained on all three patients. The arch anatomy was accurately depicted in all three patients by MR imaging and in none of the patients by echocardiography. MR imaging is extremely useful in establishing the diagnosis of markedly hypoplastic retroesophageal circumflex right aortic arch and thus helps in surgical planning. (orig.)

  12. Radiation sterilization of surgical instruments with a consideration of metal shielding on sterilization efficiency

    The feasibility of the use of radiation for sterilization of surgical instruments was evaluated. Two aspects were considered: radiation biology of relevant microorganisms, that is, bacterial spores and viruses, and shielding and radiation protection by the metal of the instruments. After proper cleaning and hot water machine washing, surgical instruments carry few, if any contaminants; however, subsequent handling increases the contamination load. Although large instruments may attenuate as much as 30% of the incident radiation, spores dried on the metal are sensitized to irradiation by some 40%. A dose of 25 kGy (2.5 Mrad) is adequate to inactivate a potential contamination load of approximately 10(7) bacterial spores or approximately 10(4) viruses. Therefore, 25 kGy will provide a high sterility assurance level, and can be recommended with a considerable degree of confidence for hospital-based sterilization of surgical instruments

  13. Surgical Ablation of Atrial Fibrillation.

    Ramlawi, Basel; Abu Saleh, Walid K

    2015-01-01

    The Cox-maze procedure for the restoration of normal sinus rhythm, initially developed by Dr. James Cox, underwent several iterations over the years. The main concept consists of creating a series of transmural lesions in the right and left atria that disrupt re-entrant circuits responsible for propagating the abnormal atrial fibrillation rhythm. The left atrial appendage is excluded as a component of the Maze procedure. For the first three iterations of the Cox- maze procedure, these lesions were performed using a surgical cut-and-sew approach that ensured transmurality. The Cox-Maze IV is the most currently accepted iteration. It achieves the same lesion set of the Cox- maze III but uses alternative energy sources to create the transmural lesions, potentially in a minimally invasive approach on the beating heart. High-frequency ultrasound, microwave, and laser energy have all been used with varying success in the past. Today, bipolar radiofrequency heat or cryotherapy cooling are the most accepted sources for creating linear lesions with consistent safety and transmurality. The robust and reliable nature of these energy delivery methods has yielded a success rate reaching 90% freedom from atrial fibrillation at 12 months. Such approaches offer a significant long-term advantage over catheter-based ablation, especially in patients having longstanding, persistent atrial fibrillation with characteristics such as dilated left atrial dimensions, poor ejection fraction, and failed catheter ablation. Based on these improved results, there currently is significant interest in developing a hybrid ablation strategy that incorporates the superior transmural robust lesions of surgical ablation, the reliable stroke prevention potential of epicardial left atrial appendage exclusion, and sophisticated mapping and confirmatory catheter-based ablation technology. Such a minimally invasive hybrid strategy for ablation may lead to the development of multidisciplinary "Afib teams" to

  14. Disc degeneration: current surgical options

    C Schizas

    2010-10-01

    Full Text Available Chronic low back pain attributed to lumbar disc degeneration poses a serious challenge to physicians. Surgery may be indicated in selected cases following failure of appropriate conservative treatment. For decades, the only surgical option has been spinal fusion, but its results have been inconsistent. Some prospective trials show superiority over usual conservative measures while others fail to demonstrate its advantages. In an effort to improve results of fusion and to decrease the incidence of adjacent segment degeneration, total disc replacement techniques have been introduced and studied extensively. Short-term results have shown superiority over some fusion techniques. Mid-term results however tend to show that this approach yields results equivalent to those of spinal fusion. Nucleus replacement has gained some popularity initially, but evidence on its efficacy is scarce. Dynamic stabilisation, a technique involving less rigid implants than in spinal fusion and performed without the need for bone grafting, represents another surgical option. Evidence again is lacking on its superiority over other surgical strategies and conservative measures. Insertion of interspinous devices posteriorly, aiming at redistributing loads and relieving pain, has been used as an adjunct to disc removal surgery for disc herniation. To date however, there is no clear evidence on their efficacy. Minimally invasive intradiscal thermocoagulation techniques have also been tried, but evidence of their effectiveness is questioned. Surgery using novel biological solutions may be the future of discogenic pain treatment. Collaboration between clinicians and basic scientists in this multidisciplinary field will undoubtedly shape the future of treating symptomatic disc degeneration.

  15. Giant choledochal calculosis: Surgical treatment

    Hasan Bektas

    2014-01-01

    Full Text Available Context: Gallstone disease is one of the most common surgical pathologies. Choledocholithiasis may occur in some of these cases and require surgical intervention. Although there are relatively non-invasive procedures such as endoscopic retrograde cholangiopancreatography (ERCP, this technique is usually unsuccessful in patients with stones larger than 10 mm. In our case, we aimed to report a giant choledochal stone (15 cm × 4.5 cm, which is rare in surgical practice and our treatment with open surgery. Case Report: The patient was a 59-year-old woman. Magnetic resonance cholangiopancreatography (MRCP had showed a hydropic gallbladder with an excessively dilated CBD and a 110 mm × 41 mm stone. In the operation, an excessively dilated CBD was seen and after choledochotomy and a very large calculus that filled CBD completely. Choledochotomy incision was carried forward and a T-tube choledochostomy with choledochoduodenostomy (CD was performed. The patient was discharged without any complications on postoperative 8 th day. Conclusion: Benign gallstone disease is a multifactorial process, with risk factors such as obesity, hemolytic diseases, diabetes mellitus, and pregnancy. Risk factors for choledocholithiasis are similar to those for gallstone disease. MRCP is a non-invasive technique in detecting choledocholithiasis. The gold standard intervention for CBD stones is ERCP. Stones in CBD may reach very considerable dimensions without causing serious symptoms. The most common symptom is jaundice. During preoperative radiological examination, giant stones may be interfered with malignancies. Surgeons should obey conventional algorithms in diagnosis and open surgery must be kept in mind in earlier stages without being too insistent on endoscopic interventions.

  16. Tattoo preservation during surgical procedures

    Tenna S

    2014-02-01

    Full Text Available Stefania Tenna, Pietro Francesco Delle Femmine, Alfonso Luca Pendolino, Beniamino Brunetti, Paolo Persichetti Plastic Surgery Unit, University Campus Bio-Medico of Rome, University of Rome, Rome, Italy Abstract: In recent years, the number of people getting tattoos has continued to increase. Tattoos are much more than cultural fads and cosmetic complements, and nowadays often represent events that express the patient's personality without words. The presence of a tattoo in the surgical field may be a problem for both the patient and the surgeon. However, the relevant literature is mostly based on complications related to application of tattoos or methods used to remove them. To date, few reports have focused on the importance of preserving a tattoo during a surgical procedure, and no organized studies could be found. The aim of this paper is to provide an overview of the range of solutions that surgeons can use to preserve tattoos during surgery. A PubMed database search was done to assess other surgeons' experience. The terms "tattoo" in combination with "incision", "surgery", "surgical", or "operative" were used as key words. Following a review of the literature, photographs of patients presenting with a tattoo in the last 5 years at University Campus Bio-Medico of Rome were identified in order to determine the frequency of patients presenting with tattoos in our department. The patients were classified according to sex, age, type of surgery, number of tattoos, and tattoo location. Specific requests to preserve tattoos were recorded. Finally, an algorithm of treatment according to tattoo dimension and location is proposed. Knowledge of all the strategies available for saving tattoos is important for plastic and cosmetic surgeons. If a tattooed area needs to be operated on, surgeons should attempt, when possible, to avoid altering the tattoo in order to maximize the final cosmetic result. Keywords: tattoo incision, body contouring, surgery

  17. [Surgical treatment of acute mediastinitis].

    Krüger, M; Decker, S; Schneider, J P; Haverich, A; Schega, O

    2016-06-01

    Despite modern intensive care management, acute mediastinitis is still associated with a high morbidity and mortality (up to approximately 40 %). Effective antibiotic therapy, intensive care management, elimination of the causative sources of infection and drainage of the affected mediastinal compartments are the cornerstones of therapy in a multidisciplinary treatment concept. Early diagnosis, prompt and uncompromising initial therapy and planned computed tomography (CT) control after the first stages of therapy in order to decide on the necessity for surgical re-interventions are essential for achieving optimal results. Knowledge of the specific anatomical characteristics is crucial for the understanding of this disease and its treatment; therefore, the current knowledge on fascial layers and interstitial spaces from the neck to the mediastinum is described and discussed. A possible foudroyant spread of the infection, especially within the posterior mediastinum, has to be anticipated. The approach to the mediastinum depends on the mediastinal compartments affected, on the causative disease and on the patient's clinical situation. The surgical approach should be adapted to the particular clinical situation of the individual patient and to the surgical experience of the surgeon. When in doubt, the more invasive approach to the mediastinum, such as bilateral thoracotomy, is recommended. An ascending mediastinitis due to pancreatitis is a very rare condition; however, as chest pains are often the main clinical sign surgeons should be aware of this differential diagnosis. An intraoperative brown-black serous fluid in the mediastinal tissue is virtually pathognomonic. The treatment results of esophageal perforation as the most frequent cause of mediastinitis have been improved by integration of various interventional procedures. Hyperbaric oxygen therapy or immunoglobulin treatment can play an auxiliary role in selected patients with acute mediastinitis. PMID

  18. Surgical treatment of cleft lip

    Mateus Domingues Miachon

    2014-06-01

    Full Text Available We performed a systematic review of the literature on the surgical treatment of cleft lip, emphasizing the prevalence, complications associated with the treatment and the points of disagreement between authors. We conducted a literature cross-sectional search that analyzed publications in books, articles and on the databases SciELO - Scientific Electronic Library Online, PubMed, of the National Center for Biotechnology Information. We conclude that: 1 the severity of the cleft will indicate the technique presenting more advantages; 2 the different approaches indicate that there is no consensus on the optimal technique; and 3 the surgeon experience contributes to choosing the best option.

  19. [Pygopagus Siamese twins. Surgical treatment].

    Rollán Villamarín, V; Ollero Fresno, J C; Alonso Calderón, J L; Ollero Caprani, J M

    1991-04-01

    A case is presented wherein a set of black female pygopagus siamese twins were successfully separated by our department in their 45th day of life. Both twins had multiple malformations: cardiopulmonary, vertebral, anorectal, genitourinary, etc. The bilateral renal absence in one of them, originated her death on the 7th postoperative day. Only nine other cases have been referred successful during the last 35 years, in a bibliographic review conducted. The associated malformations and surgical skills for treatment and separation of them, are studied: previous colostomy and effective separation at life ages, comprised between one and thirteen months. PMID:2064894

  20. Surgical navigation in oral implantology.

    Miller, Robert J; Bier, Jurgen

    2006-03-01

    The ability to generate 3-dimensional volumetric images of the maxillofacial area has allowed surgeons to evaluate anatomy before surgery and plan for the placement of implants in ideal positions. However, the ability to transfer that information to surgical reality has been the most challenging part of implant dentistry. With the advent of computer-assisted surgery, the surgeon may now navigate through the entire implant procedure with extremely high accuracy. A new portable laptop navigated system for oral implantology is discussed as an adjunct for complex implant cases. PMID:16569960

  1. Surgical Challenges of Familial Hypercholesterolemia.

    Bhoje, Amolkumar; Talwar, Sachin; Saxena, Rachit; Gharde, Parag; Choudhary, Shiv Kumar

    2016-06-01

    A 21-year-old patient with familial hypercholesterolemia presented with angina caused by ostial stenosis of the left internal mammary artery and severe calcific aortic stenosis with small aortic root 9 years after coronary revascularization. The ostium of the left internal mammary artery was enlarged using a saphenous vein patch through a left supraclavicular incision, which improved left ventricular function. Successful aortic valve replacement with posterior aortic root enlargement was subsequently performed. The surgical management of this condition is discussed briefly. PMID:27211947

  2. Laser Ultrasound Surgical Therapy (LUST)

    Danne, Marco

    2011-01-01

    In neurosurgery, especially in the field of brain tumor surgery, function-preserving and tissue-conserving surgical techniques are necessary due to the high tissue sensitivity of neural cells, i.e. a tumor removal with a tumor-free edge is not possible, functional areas need to be preserved and an efficient hemostasis is mandatory. The aim of this study were in-vitro and ex-vivo examinations to test a newly developed instrument (Laser-CUSA), which – for the first time - can transmit a com...

  3. Financial Intermediation, Monetary Uncertainty, and Bank Interest Margins Financial Intermediation, Monetary Uncertainty, and Bank Interest Margins

    Leonardo Hernández

    1992-03-01

    Full Text Available Financial Intermediation, Monetary Uncertainty, and Bank Interest Margins This paper studies a simple model of financial intermediation in order to understand how the lending-borrowing spread or interest margin charged by financial intermediaries is determined in equilibrium in a monetary economy. The main conclusion of the paper concerns the effect on the spread of changes in the distribution of monetary innovations. Thus, changes in the monetary-policy-rule followed by the Central Bank which alter the volatility of inflation will have important effects on the interest margin and also on the amount of credit available to investors. A crosssection empirical analysis strongly supports our hypothesis:

  4. Clinical implication of negative conversion of predicted circumferential resection margin status after preoperative chemoradiotherapy for locally advanced rectal cancer

    Lee, Nam Kwon [Department of Radiation Oncology, Korea University Medical Center, Korea University College of Medicine, Seoul (Korea, Republic of); Kim, Chul Yong, E-mail: kcyro@korea.ac.kr [Department of Radiation Oncology, Korea University Medical Center, Korea University College of Medicine, Seoul (Korea, Republic of); Park, Young Je; Yang, Dae Sik; Yoon, Won Sup [Department of Radiation Oncology, Korea University Medical Center, Korea University College of Medicine, Seoul (Korea, Republic of); Kim, Seon Hahn; Kim, Jin [Division of Colorectal Surgery, Department of Surgery, Korea University Medical Center, Korea University College of Medicine, Seoul (Korea, Republic of)

    2014-02-15

    Objective: To evaluate the prognostic implication of the negative conversion of predicted circumferential resection margin status before surgery in patients with locally advanced rectal cancer with predicted circumferential resection margin involvement. Methods: Thirty-eight patients (28 men, 10 women; median age, 61 years; age range, 39–80 years) with locally advanced rectal cancer with predicted circumferential resection margin involvement who underwent preoperative chemoradiotherapy followed by radical surgery were analyzed. Involvement of the circumferential resection margin was predicted on the basis of pre- and post-chemoradiotherapy magnetic resonance imaging. The primary endpoints were 3-year local recurrence-free survival and overall survival. Results: The median follow-up time was 41.1 months (range, 13.9–85.2 months). The negative conversion rate of predicted circumferential resection margin status after preoperative chemoradiotherapy was 65.8%. Patients who experienced negative conversion of predicted circumferential resection margin status had a significantly higher 3-year local recurrence-free survival rate (100.0% vs. 76.9%; P = 0.013), disease-free survival rate (91.7% vs. 59.3%; P = 0.023), and overall survival rate (96.0% vs. 73.8%; P = 0.016) than those who had persistent circumferential resection margin involvement. Conclusions: The negative conversion of the predicted circumferential resection margin status as predicted by magnetic resonance imaging will assist in individual risk stratification as a predictive factor for treatment response and survival before surgery. These findings may help physicians determine whether to administer more intense adjuvant chemotherapy or change the surgical plan for patients displaying resistance to preoperative chemoradiotherapy.

  5. Impact of Millimeter-Level Margins on Peripheral Normal Brain Sparing for Gamma Knife Radiosurgery

    Ma, Lijun, E-mail: lijunma@radonc.ucsf.edu [Department of Radiation Oncology, University of California, San Francisco, California (United States); Sahgal, Arjun [Department of Radiation Oncology, Sunnybrook Health Sciences Odette Cancer Centre, University of Toronto, Toronto, Ontario (Canada); Larson, David A.; Pinnaduwage, Dilini; Fogh, Shannon; Barani, Igor; Nakamura, Jean; McDermott, Michael; Sneed, Penny [Department of Radiation Oncology, University of California, San Francisco, California (United States)

    2014-05-01

    Purpose: To investigate how millimeter-level margins beyond the gross tumor volume (GTV) impact peripheral normal brain tissue sparing for Gamma Knife radiosurgery. Methods and Materials: A mathematical formula was derived to predict the peripheral isodose volume, such as the 12-Gy isodose volume, with increasing margins by millimeters. The empirical parameters of the formula were derived from a cohort of brain tumor and surgical tumor resection cavity cases (n=15) treated with the Gamma Knife Perfexion. This was done by first adding margins from 0.5 to 3.0 mm to each individual target and then creating for each expanded target a series of treatment plans of nearly identical quality as the original plan. Finally, the formula was integrated with a published logistic regression model to estimate the treatment-induced complication rate for stereotactic radiosurgery when millimeter-level margins are added. Results: Confirmatory correlation between the nominal target radius (ie, R{sub T}) and commonly used maximum target size was found for the studied cases, except for a few outliers. The peripheral isodose volume such as the 12-Gy volume was found to increase exponentially with increasing Δ/R{sub T}, where Δ is the margin size. Such a curve fitted the data (logarithmic regression, R{sup 2} >0.99), and the 12-Gy isodose volume was shown to increase steeply with a 0.5- to 3.0-mm margin applied to a target. For example, a 2-mm margin on average resulted in an increase of 55% ± 16% in the 12-Gy volume; this corresponded to an increase in the symptomatic necrosis rate of 6% to 25%, depending on the Δ/R{sub T} values for the target. Conclusions: Millimeter-level margins beyond the GTV significantly impact peripheral normal brain sparing and should be applied with caution. Our model provides a rapid estimate of such an effect, particularly for large and/or irregularly shaped targets.

  6. An adequate approach to image retrieval based on local level feature extraction

    Image retrieval based on text annotation has become obsolete and is no longer interesting for scientists because of its high time complexity and low precision in results. Alternatively, increase in the amount of digital images has generated an excessive need for an accurate and efficient retrieval system. This paper proposes content based image retrieval technique at a local level incorporating all the rudimentary features. Image undergoes the segmentation process initially and each segment is then directed to the feature extraction process. The proposed technique is also based on image?s content which primarily includes texture, shape and color. Besides these three basic features, FD (Fourier Descriptors) and edge histogram descriptors are also calculated to enhance the feature extraction process by taking hold of information at the boundary. Performance of the proposed method is found to be quite adequate when compared with the results from one of the best local level CBIR (Content Based Image Retrieval) techniques. (author)

  7. Adequate bases of phase space master integrals for $gg \\to h$ at NNLO and beyond

    Höschele, Maik; Ueda, Takahiro

    2014-01-01

    We study master integrals needed to compute the Higgs boson production cross section via gluon fusion in the infinite top quark mass limit, using a canonical form of differential equations for master integrals, recently identified by Henn, which makes their solution possible in a straightforward algebraic way. We apply the known criteria to derive such a suitable basis for all the phase space master integrals in afore mentioned process at next-to-next-to-leading order in QCD and demonstrate that the method is applicable to next-to-next-to-next-to-leading order as well by solving a non-planar topology. Furthermore, we discuss in great detail how to find an adequate basis using practical examples. Special emphasis is devoted to master integrals which are coupled by their differential equations.

  8. Providing for decommissioning funds: minimum conditions for adequate funding and comparative analysis

    The present contribution analyses the minimum criteria that need to be applied for adequate financial arrangements for decommissioning, as well as the possible financing mechanisms and the recommended investment policy for decommissioning funds. Furthermore, practical examples of decommissioning mechanisms in the United States of America, France, the United Kingdom, Germany, Sweden, Spain and Belgium will be studied. A question frequently asked about nuclear energy is how to deal with its impact on the environment. The issue of decommissioning of nuclear power plants, and in particular the funding of such decommissioning, is part of this discussion. The IAEA fundamental safety principles and safety requirements already make clear that radioactive waste must be managed in such a way as to avoid imposing an undue burden on future generations. The government shall make provision for the safe decommissioning of facilities, the safe management and disposal of radioactive waste arising from facilities and activities, and the safe management of spent fuel. (author)

  9. An Adequate Approach to Image Retrieval Based on Local Level Feature Extraction

    Sumaira Muhammad Hayat Khan

    2010-10-01

    Full Text Available Image retrieval based on text annotation has become obsolete and is no longer interesting for scientists because of its high time complexity and low precision in results. Alternatively, increase in the amount of digital images has generated an excessive need for an accurate and efficient retrieval system. This paper proposes content based image retrieval technique at a local level incorporating all the rudimentary features. Image undergoes the segmentation process initially and each segment is then directed to the feature extraction process. The proposed technique is also based on image?s content which primarily includes texture, shape and color. Besides these three basic features, FD (Fourier Descriptors and edge histogram descriptors are also calculated to enhance the feature extraction process by taking hold of information at the boundary. Performance of the proposed method is found to be quite adequate when compared with the results from one of the best local level CBIR (Content Based Image Retrieval techniques.

  10. Adequate Iodine Status in New Zealand School Children Post-Fortification of Bread with Iodised Salt.

    Jones, Emma; McLean, Rachael; Davies, Briar; Hawkins, Rochelle; Meiklejohn, Eva; Ma, Zheng Feei; Skeaff, Sheila

    2016-01-01

    Iodine deficiency re-emerged in New Zealand in the 1990s, prompting the mandatory fortification of bread with iodised salt from 2009. This study aimed to determine the iodine status of New Zealand children when the fortification of bread was well established. A cross-sectional survey of children aged 8-10 years was conducted in the cities of Auckland and Christchurch, New Zealand, from March to May 2015. Children provided a spot urine sample for the determination of urinary iodine concentration (UIC), a fingerpick blood sample for Thyroglobulin (Tg) concentration, and completed a questionnaire ascertaining socio-demographic information that also included an iodine-specific food frequency questionnaire (FFQ). The FFQ was used to estimate iodine intake from all main food sources including bread and iodised salt. The median UIC for all children (n = 415) was 116 μg/L (females 106 μg/L, males 131 μg/L) indicative of adequate iodine status according to the World Health Organisation (WHO, i.e., median UIC of 100-199 μg/L). The median Tg concentration was 8.7 μg/L, which was intake from the food-only model was 65 μg/day. Bread contributed 51% of total iodine intake in the food-only model, providing a mean iodine intake of 35 μg/day. The mean iodine intake from the food-plus-iodised salt model was 101 μg/day. In conclusion, the results of this study confirm that the iodine status in New Zealand school children is now adequate. PMID:27196925

  11. Surgical options in the management of well differentiated thyroid carcinoma

    Goitre is a common every day problem but cancer of the thyroid is a comparatively rare disease. It constitutes only 1.3 % of all cancers seen at the Tata Memorial Hospital. The surgeon has a central role in the management of cancer of the thyroid. All other modalities of treatment, like radioiodine therapy follow his surgery and depend on the extent of surgery performed. It is therefore important that the surgeon has a clear cut policy of management. Although surgery is the prime mode of treatment, the extent of surgery has been a matter of debate. Additionally, what constitutes adequate surgical treatment itself is highly controversial. A policy for management based on the natural history, biological behaviour of the disease and the previous treatment methods is discussed

  12. Surgical crown lengthening: a 12-month study - radiographic results

    Daniela Eleutério Diniz

    2007-08-01

    Full Text Available OBJECTIVE: The purpose of this study was to perform a radiographic follow-up evaluation after a 12-month healing period, following crown lengthening surgery. MATERIAL AND METHODS: Twenty-three periodontally healthy subjects (mean age 32.5 years that required crown lengthening surgery in premolars were recruited. In a total of 30 premolars, full thickness flaps, osseous resection, and flap suturing were performed. The restorative margin was defined in the pre-surgical phase and maintained unaltered during the healing period, serving as a reference point. Standardized bitewing radiographs were taken before and after osseous reduction, and at 2, 3, 6, and 12-month healing periods. RESULTS: Intact lamina dura was observed at both mesial and distal alveolar crests only from the 3rd month. At 12-months, all alveolar crests presented lamina dura. The overall mean distance from the restorative margin to the alveolar crest achieved after osseous resection was 3.28±0.87 mm at mesial and 2.81±0.51 mm at distal sites. No significant radiographic changes in the bone crest were observed during a 12-month healing period. CONCLUSION: The findings of this study suggest that the radiographic proximal bone level observed on bitewing radiographs following crown lengthening surgery can be used as a reference to predict the future level of the healed alveolar crest.

  13. Surgical Treatment for Giant Cell Tumor of the Thoracolumbar Spine

    Shih-Chieh Yang

    2006-02-01

    Full Text Available Background: Giant cell tumor (GCT of the bone has historically been regarded as anextremely unpredictable bone tumor. The anatomical characteristics of spinalGCT still present challenges to surgeons. Controversy remains regarding theproper treatment of patients with grade III tumors.Methods: Eleven patients with grade III GCT of the thoracolumbar spine were treatedbetween 1992 and 2002 at a medical center by the authors. Three patientswere initially treated at other institutions. Adjuvant radiotherapy wasemployed for local recurrence in these three patients. The other eight patientswere initially treated with marginal excision. The site, size, and extent ofeach lesion dictated the surgical approach.Results: Five patients had tumor recurrence. One patient, who received radiotherapy,had local relapse with malignant transformation and finally died due to disease-related complications. One patient had a recurrent tumor with multiplemetastases throughout the lung. Neurological status, measured using theAmerican Spinal Injury Association scale, of one patient was worse afterundergoing the procedure than preoperatively and three patients showedimprovement. The other seven patients were classified as with the samegrade postoperatively.Conclusion: Wide excision of GCT of the thoracolumbar spine is difficult and there is arisk of neurological deficit and spinal instability. Meticulous marginal excisionwith associated reconstruction may obtain good local control and preservefunctional spine. Early detection of recurrent GCT during intensive follow-up can allow for treatment using en bloc excision which has achievedfavorable prognoses.

  14. 40 CFR 141.522 - How does the State determine whether my system's watershed control requirements are adequate?

    2010-07-01

    ... my system's watershed control requirements are adequate? 141.522 Section 141.522 Protection of... Additional Watershed Control Requirements for Unfiltered Systems § 141.522 How does the State determine whether my system's watershed control requirements are adequate? During an onsite inspection...

  15. SURGICAL PROCEDURES IN SUSHRUTA SAMHITA

    Singh R.K

    2011-05-01

    Full Text Available The Sushruta Samhita is an Ayurvedic text, by the legendary Sushruta, foundational to Ayurvedic medicine (Indian traditional medicine, with innovative chapters mainly on surgery. There is a general impression that Sushruta Samhita is only an ancient Indian Ayurvedic text book of surgery. Sushruta Samhita contains 184 chapters and description of 1120 illnesses, 700 medicinal plants, a detailed study on anatomy, 64 preparations from mineral sources and 57 preparations based on animal sources. It still retains the land mark position in the field of surgical texts. In addition to his worldwide known work of historical significance on plastic surgery, he also made similar unique contributions on numerous aspects of medicine, such as fracture and dislocations, urinary stones, skin diseases including leprosy, Pancha Karma (Purification procedures, toxicology, pediatrics, eye diseases, psychiatry, obstetrics and gynaecology, etc. A very limited conceptual work has been performed on the selected chapters of Sushruta Samhita. Therefore a review conceptual study has been carried out on the various surgical concepts of Sushruta Samhita. Outcome of this study shows, Sushruta Samhita is written in the aphorism form and the techniques described in it are eminently in line with technical abilities of the times. It is need of the hour to explore the hidden truth by decoding the versions of the texts.

  16. Surgical infections: a microbiological study

    Santosh Saini

    2004-04-01

    Full Text Available Surgical infections are mostly polymicrobial, involving both aerobes and anaerobes. One hundred seventeen cases comprised of abscesses (n=51, secondary peritonitis (n=25, necrotizing fascitis (n=22 and wounds with devitalized tissues (n=19 were studied. The number of microorganisms isolated per lesion was highest in secondary peritonitis (2.32. The aerobe/ anaerobe ratio was 0.81 in secondary peritonitis and 1.8 in necrotizing fascitis. Most secondary peritonitis (80%, necrotizing fascitis (75% and wounds with devitalized tissues (66.7% were polymicrobial. Common microorganisms isolated in our study were E. coli, Staphylococcus aureus, Klebsiella spp., Pseudomonas aeruginosa, Bacteroides fragilis and Peptostreptococcus spp. The most effective antibiotics for S. aureus were clindamycin (79.1% and cefuroxime (70.8%. For Gram-negatives (Klebsiella spp., E. coli and Proteus spp., the most effective antibiotics were cefotaxime, ceftizoxime, amikacin and ciprofloxacin. Pseudomonas aeruginosa was maximally sensitive to amikacin (35.2% and ciprofloxacin (35.2%. The greatest degree of multidrug resistance to all the drugs was found in P. aeruginosa (52.9%, followed by Klebsiella spp. (33.3%, Proteus spp. (33.3%, E. coli (22.2%, and S. aureus (12.5%. All the anaerobes that we isolated were 100% sensitive to metronidazole and chloramphenicol, followed by clindamycin (95% to 100%. Apart from antibiotic therapy, non-antimicrobial methods, such as hyperbaric oxygen therapy and debridement also play an important role in the treatment of surgical infections.

  17. Surgical treatment for pulmonary sequestration

    We reviewed 15 patients with pulmonary sequestration. Between 1994 and 2010, 15 patients (five males and 10 females, mean age of 27.2 years old) with pulmonary sequestration were surgically treated at either of two hospitals. Clinical symptoms such as cough, fever, and hemoptysis led to a diagnosis in 13 patients, and the remaining two were incidentally diagnosed on radiograph as part of a health check. Preoperatively, aberrant arteries were identified by contrast-enhanced computed tomography (CT) in 11 cases, but not in 4 cases. Lung lobectomy was performed in 12 patients, segmentectomy in two, and resection of an extrapleural lesion in one; in 11 patients through open thoracotomy and in four using video-assisted thoracic surgery (VATS). In two of the four patients undergoing VATS, the surgical approach was converted from VATS to open thoracotomy because of thick adhesions or a large aberrant artery. Aberrant arteries were successfully occluded with a stapling device in eight patients, ligation-and-resection in six, and suturing in one case of a large aberrant artery. There was no morbidity and no mortality. In conclusion, three-dimensional CT is useful for detecting an aberrant artery in pulmonary sequestration cases, and a stapling device can be used for dividing the aberrant artery. (author)

  18. Development of best estimate analysis methods in Canada to allow quantification of safety margins

    The paper presents an outline, from the regulator's perspective, of the current situation in Canada with development of best estimate and uncertainty assessment (BE+UA) methods intended for application in the licensing safety analysis. Reasons, incentives and expectations related to development and application of the best estimate safety analysis methodology are being explored in some detail. Difficulties in attaining acceptance of this methodology for licensing applications are also discussed. Maintenance of adequate safety margins is a firmly established principle in the Canadian regulatory practice. Safety analysis is performed to demonstrate that margins are present and sufficient. Due to a variety of reasons, some of the operating CANDU reactors have been recently experiencing difficulties in compelling demonstration of adequate margins. The industry sees application of the BE+UA safety analysis as a potential way of recovering or improving safety margins and removing operational constraints. The operating power reactors in Canada have been licensed, as anywhere in the world, with the use of deterministic, conservative safety analysis methods. Until now, the conservative approach continues to be the cornerstone of safety analyses. It has been recognized, however, by both the industry and the regulator, that BE+UA methods have reached sufficient maturity to allow more accurate and realistic modelling of accident transients, thus presenting an opportunity to better quantify safety margins. It is expected that in many cases a BE+UA analysis will be able to show larger margins than it was possible to demonstrate using the conservative approach. If the BE+UA analyses predict more benign consequences of analysed events, this would facilitate resolving some of the currently outstanding safety issues and lessen economic penalties on utilities. As a consequence, the industry has started several projects aimed at the development and application of BE+UA methods and has

  19. Optimisation of Surgical Results in de-Quervain’s Disease

    B Jagannath Kamath

    2014-11-01

    Full Text Available Background: De Quervain’s disease poses more problems with respect to management than the diagnosis. Surgery is resorted to when the conservative methods fail. There are known complications of the surgical intervention. Surgeon contemplating the surgery should be aware of these and make every attempt to optimize the results and avoid the above mentioned complication. Methods: Sixty symptomatic wrists in 57 individuals suffering from de Quervain’s disease who needed surgery were studied preoperatively with ultrasound. Number of tendons and the sub septae identified in the ultrasound examination preoperatively were confirmed on the table during the surgery. The release was brought about under local anesthesia, with magnification taking care to avoid injury to the cephalic vein and superficial branch of radial nerve, not to violate the anterior margin of the sheath, thus preventing complications. A negative post release finkelstein test was ensured before the wound closure. Results: All 60 patients who underwent release for de Quervain’s disease were symptom free, satisfied and fully functional. Conclusions: De-Quervain's disease not relieved by conservative methods needs surgical release under local anesthesia with a transverse incision with Preoperative ultrasound examination for the number of tendons and subseptae. Avoiding the violation of the volar aspect of the sheath, loupe magnification, tourniquet and post release Finkelstein’s test before wound closure, will ensure optimal results.

  20. [Initial surgical management of squamous carcinoma of the vulva].

    Salazar-Báez, Israel; Salazar-Campos, Jessica E; López-Arias, Alhely; Villavicencio-Valencia, Verónica; Coronel-Martínez, Jaime; Candelaria-Hernández, Myrna; Pérez-Montiel, Delia; Pérez-Plasencia, Carlos; Rojas-García, Aurora Elizabeth; Cantú de León, David

    2016-01-01

    Vulvar cancer accounts for approximately 4% of gynecological malignancies. At the Instituto Nacional de Cancerologia in Mexico it occupies the fourth place. The purpose of this study is to assess the management of squamous carcinoma of the vulva with initial surgical treatment. It is a descriptive retrospective, observational study, from January 1, 2002 to December 31, 2012. Twenty-seven patients, clinical stages I, II, or III, initial surgical management, with at least one year of follow-up were included. In 51.85% a partial vulvectomy was performed and in 40.74% a wide excision; 66.66% underwent inguinofemoral dissection. Recurrence occurred in 25.91% of cases and the overall survival at 10 years was 63%. It is concluded that with invasion of up to 1 mm of lymph node, affection is 0%; with invasion of 1 mm and up to 5 mm this increases to 25%; an invasion of more than 5 mm implies up to 45%. Recurrence in our study was primarily distant, necessitating long-term monitoring with emphasis on symptoms to request imaging studies when suspected. Adjuvant therapy should be offered to patients with positive nodes, close or positive margins, and tumors larger than 4 cm. PMID:27335183

  1. Palliative Interventional and Surgical Therapy for Unresectable Pancreatic Cancer

    Assfalg, Volker; Hüser, Norbert; Michalski, Christoph; Gillen, Sonja; Kleeff, Jorg; Friess, Helmut, E-mail: friess@chir.med.tu-muenchen.de [Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Ismaningerstr. 22, D-81675 Munich (Germany)

    2011-02-14

    Palliative treatment concepts are considered in patients with non-curatively resectable and/or metastasized pancreatic cancer. However, patients without metastases, but presented with marginally resectable or locally non-resectable tumors should not be treated by a palliative therapeutic approach. These patients should be enrolled in neoadjuvant radiochemotherapy trials because a potentially curative resection can be achieved in approximately one-third of them after finishing treatment and restaging. Within the scope of best possible palliative care, resection of the primary cancer together with excision of metastases represents a therapeutic option to be contemplated in selected cases. Comprehensive palliative therapy is based on treatment of bile duct or duodenal obstruction for certain locally unresectable or metastasized advanced pancreatic cancer. However, endoscopic or percutaneous stenting procedures and surgical bypass provide safe and highly effective therapeutic alternatives. In case of operative drainage of the biliary tract (biliodigestive anastomosis), the prophylactic creation of a gastro-intestinal bypass (double bypass) is recommended. The decision to perform a surgical versus an endoscopic procedure for palliation depends to a great extent on the tumor stage and the estimated prognosis, and should be determined by an interdisciplinary team for each patient individually.

  2. Palliative Interventional and Surgical Therapy for Unresectable Pancreatic Cancer

    Palliative treatment concepts are considered in patients with non-curatively resectable and/or metastasized pancreatic cancer. However, patients without metastases, but presented with marginally resectable or locally non-resectable tumors should not be treated by a palliative therapeutic approach. These patients should be enrolled in neoadjuvant radiochemotherapy trials because a potentially curative resection can be achieved in approximately one-third of them after finishing treatment and restaging. Within the scope of best possible palliative care, resection of the primary cancer together with excision of metastases represents a therapeutic option to be contemplated in selected cases. Comprehensive palliative therapy is based on treatment of bile duct or duodenal obstruction for certain locally unresectable or metastasized advanced pancreatic cancer. However, endoscopic or percutaneous stenting procedures and surgical bypass provide safe and highly effective therapeutic alternatives. In case of operative drainage of the biliary tract (biliodigestive anastomosis), the prophylactic creation of a gastro-intestinal bypass (double bypass) is recommended. The decision to perform a surgical versus an endoscopic procedure for palliation depends to a great extent on the tumor stage and the estimated prognosis, and should be determined by an interdisciplinary team for each patient individually

  3. Sci—Thur PM: Planning and Delivery — 04: Respiratory margin derivation and verification in partial breast irradiation

    Quirk, S [Department of Medical Physics, Tom Baker Cancer Centre, Calgary, Alberta (Canada); Conroy, L [Department of Physics and Astronomy, University of Calgary, Calgary, Alberta (Canada); Smith, WL [Department of Oncology, University of Calgary, Calgary, Alberta (Canada)

    2014-08-15

    Partial breast irradiation (PBI) following breast-conserving surgery is emerging as an effective means to achieve local control and reduce irradiated breast volume. Patients are planned on a static CT image; however, treatment is delivered while the patient is free-breathing. Respiratory motion can degrade plan quality by reducing target coverage and/or dose homogeneity. A variety of methods can be used to determine the required margin for respiratory motion in PBI. We derive geometric and dosimetric respiratory 1D margin. We also verify the adequacy of the typical 5 mm respiratory margin in 3D by evaluating plan quality for increasing respiratory amplitudes (2–20 mm). Ten PBI plans were used for dosimetric evaluation. A database of volunteer respiratory data, with similar characteristics to breast cancer patients, was used for this study. We derived a geometric 95%-margin of 3 mm from the population respiratory data. We derived a dosimetric 95%-margin of 2 mm by convolving 1D dose profiles with respiratory probability density functions. The 5 mm respiratory margin is possibly too large when 1D coverage is assessed and could lead to unnecessary normal tissue irradiation. Assessing margins only for coverage may be insufficient; 3D dosimetric assessment revealed degradation in dose homogeneity is the limiting factor, not target coverage. Hotspots increased even for the smallest respiratory amplitudes, while target coverage only degraded at amplitudes greater than 10 mm. The 5 mm respiratory margin is adequate for coverage, but due to plan quality degradation, respiratory management is recommended for patients with respiratory amplitudes greater than 10 mm.

  4. Pediatric surgical diseases. A radiological surgical case study approach

    Radiologic evaluation of an infant or child suspected of having a surgical disease can be a complex problem. With this volume, the editors have created a book focused on pediatric imaging written by pediatricians, pediatric surgeons and pediatric radiologists. This book is a collection of over 200 case reports. The concept is a case study approach: The reader is given radiologic images (plain radiography, computed tomography, magnetic resonance imaging, ultrasonography, etc.) and the clinical history of the patient. On the basis of this information, the reader is asked to identify a diagnostic and therapeutic strategy. Each case is complemented by information on the disease affecting the patient and the management of the case shown, including therapy and follow-up. This educational text is targeted at all medical professionals faced with a variety of diagnostic and therapeutic problems affecting infants and children. (orig.)

  5. Is It Necessary to Perform Surgical Staging in Patients with Giant Immature Ovarian Teratomas Mimicking Mature Cystic Teratoma at Frozen Section

    Ismail Guler; Ahmet Turp; Cagatay Taskiran; Anıl Onan; Hayriye Tatli; Haldun Guner; Bulent Tiras

    2013-01-01

    Giant mature teratomas (>20 cm in diameters) sometimes may contain malignant immature elements or tissues. These small foci of immature tissues could be missed at frozen section resulting inadequate initial surgical intervention. There is no large series in the literature either showing the accuracy of frozen section on huge ovarian teratomas or concerning the adequate surgical approach at the initial surgery for giant immature teratomas diagnosed as mature cystic teratomas at frozen section ...

  6. Financial Intermediation, Monetary Uncertainty, and Bank Interest Margins Financial Intermediation, Monetary Uncertainty, and Bank Interest Margins

    Leonardo Hernández

    1992-01-01

    Financial Intermediation, Monetary Uncertainty, and Bank Interest Margins This paper studies a simple model of financial intermediation in order to understand how the lending-borrowing spread or interest margin) charged by financial intermediaries is determined in equilibrium in a monetary economy. The main conclusion of the paper concerns the effect on the spread of changes in the distribution of monetary innovations. Thus, changes in the monetary-policy-rule followed by the Central Bank whi...

  7. Fast SVM-based Feature Elimination Utilizing Data Radius, Hard-Margin, Soft-Margin

    Aksu, Yaman

    2012-01-01

    Margin maximization in the hard-margin sense, proposed as feature elimination criterion by the MFE-LO method, is combined here with data radius utilization to further aim to lower generalization error, as several published bounds and bound-related formulations pertaining to lowering misclassification risk (or error) pertain to radius e.g. product of squared radius and weight vector squared norm. Additionally, we propose additional novel feature elimination criteria that, while instead being i...

  8. Marginal Breaking of Conformal SUSY QCD

    Cleary, Kevin F

    2015-01-01

    We provide an example of a 4D theory that exhibits the Contino-Pomarol-Rattazzi mechanism, where breaking conformal symmetry by an almost marginal operator leads to a light pseudo-Goldstone boson, the dilaton, and a parametrically suppressed contribution to vacuum energy. We consider SUSY QCD at the edge of the conformal window and break conformal symmetry by weakly gauging a subgroup of the flavor symmetry. Using Seiberg duality we show that for a range of parameters the singlet meson in the dual theory reaches the unitarity bound, however, this theory does not have a stable vacuum. We stabilize the vacuum with soft breaking terms, compute the mass of the dilaton, and determine the range of parameters where the leading contribution to the dilaton mass is from the almost marginal coupling.

  9. Systematic mapping of the Spanish continental margin

    Acosta, Juan; Muñoz, Araceli; Uchupi, Elazar

    2012-07-01

    For economic, environmental, recreational, military, and political reasons it is critical for coastal states to have up-to-date information on their marine margins. Spain began to acquire such data 17 years ago. From 1995 to the present, the Spanish Oceanographic Institute (IEO), a research organization of the state, has carried out a systematic geological and geophysical study of the Spanish margins. Among these projects are (1) the hydrographic and oceanographic study of the Spanish Exclusive Economic Zone (EEZ) that was implemented by the Navy Hydrographic Institute (IHM); (2) the Espace Project, a study of the Spanish continental shelf; and (3) the Capesme Project, which created fisheries maps of the Mediterranean Sea. The latter two projects were carried out in collaboration with the Secretariat General of the Sea (SGM).

  10. European refiners re-adjust margins strategy

    Gonzalez, R.G. [ed.

    1996-05-01

    Refiners in Europe are adjusting operating strategies to reflect the volatilities of tight operating margins. From the unexpected availability of quality crudes (e.g., Brent, 0.3% sulfur), to the role of government in refinery planning, the European refining industry is positioning itself to reverse the past few years of steadily declining profitability. Unlike expected increases in US gasoline demand, European gasoline consumption is not expected to increase, and heavy fuel oil consumption is also declining. However, diesel fuel consumption is expected to increase, even though diesel processing capacity has recently decreased (i.e., more imports). Some of the possible strategies that Europeans may adapt to improve margins and reduce volatility include: Increase conversion capacity to supply growing demand for middle distillates and LPG; alleviate refinery cash flow problems with alliances; and direct discretionary investment toward retail merchandising (unless there is a clear trend toward a widening of the sweet-sour crude price differential).

  11. Passive target tracking using marginalized particle filter

    2007-01-01

    A marginalized particle filtering(MPF)approach is proposed for target tracking under the background of passive measurement.Essentially,the MPF is a combination of particle filtering technique and Kalman filter.By making full use of marginalization,the distributions of the tractable linear part of the total state variables are updated analytically using Kalman filter,and only the lower-dimensional nonlinear state variable needs to be dealt with using particle filter.Simulation studies are performed on an illustrative example,and the results show that the MPF method leads to a significant reduction of the tracking errors when compared with the direct particle implementation.Real data test results also validate the effectiveness of the presented method.

  12. Distributions with given marginals and statistical modelling

    Fortiana, Josep; Rodriguez-Lallena, José

    2002-01-01

    This book contains a selection of the papers presented at the meeting `Distributions with given marginals and statistical modelling', held in Barcelona (Spain), July 17-20, 2000. In 24 chapters, this book covers topics such as the theory of copulas and quasi-copulas, the theory and compatibility of distributions, models for survival distributions and other well-known distributions, time series, categorical models, definition and estimation of measures of dependence, monotonicity and stochastic ordering, shape and separability of distributions, hidden truncation models, diagonal families, orthogonal expansions, tests of independence, and goodness of fit assessment. These topics share the use and properties of distributions with given marginals, this being the fourth specialised text on this theme. The innovative aspect of the book is the inclusion of statistical aspects such as modelling, Bayesian statistics, estimation, and tests.

  13. PREPARATIVE SKIN PREPARATION AND SURGICAL WOUND INFECTION

    Anjanappa; Arjun

    2015-01-01

    BACKGROUND AND OBJECTIVE: It is an established fact now that the normal skin of healthy human beings harbours a rich bacterial fl ora. Normally considered non - pathogenic , these organisms way be a potential source of infection of the surgical wound. Approximately 20% of the resident flora is beyond the reach of surgical scrubs and antiseptics. The goal of surgical preparation of the skin with antiseptics is to remove transient and pathogenic microorganism...

  14. Do Psychological Variables Affect Early Surgical Recovery?

    Mavros, Michael N.; Athanasiou, Stavros; Gkegkes, Ioannis D.; Polyzos, Konstantinos A.; Peppas, George; Falagas, Matthew E.

    2011-01-01

    Background Numerous studies have examined the effect of psychological variables on surgical recovery, but no definite conclusion has been reached yet. We sought to examine whether psychological factors influence early surgical recovery. Methods We performed a systematic search in PubMed, Scopus and PsycINFO databases to identify studies examining the association of preoperative psychological variables or interventions with objectively measured, early surgical outcomes. Results We identified 1...

  15. The modernisation of the surgical house officer.

    Gossage, J. A.; Modarai, B.; McGuinness, C. L.; Burnand, K G

    2005-01-01

    INTRODUCTION: There have been considerable changes in the junior doctors' hours and working patterns over the last 4 years. The aim of this study was to assess the effect of these changes on the house officers' surgical experience and to obtain their opinions on the 'Hospital at Night' system, which has recently been introduced at our large teaching hospital. METHODS: A questionnaire was filled out by surgical house officers at the end of their surgical posts in 2001. The same questionnaire w...

  16. Improving surgical resection rate in lung cancer

    Laroche, C.; Wells, F; Coulden, R.; Stewart, S; Goddard, M; Lowry, E.; Price, A; Gilligan, D.

    1998-01-01

    BACKGROUND—Surgical resection is the recognised treatment of choice for patients with stage I or II non-small cell lung cancer (NSCLC). In the UK surgical resection rates have remained far lower (20%), despite the recent introduction of fast access investigation units. It remains unclear therefore why UK surgical resection rates lag so far behind those of other countries.
METHODS—A new quick access two stop investigation service was established at Papworth in November 199...

  17. Neotectonics in the northern equatorial Brazilian margin

    Rossetti, Dilce F.; Souza, Lena S. B.; Prado, Renato; Elis, Vagner R.

    2012-08-01

    An increasing volume of publications has addressed the role of tectonics in inland areas of northern Brazil during the Neogene and Quaternary, despite its location in a passive margin. Hence, northern South America plate in this time interval might have not been as passive as usually regarded. This proposal needs further support, particularly including field data. In this work, we applied an integrated approach to reveal tectonic structures in Miocene and late Quaternary strata in a coastal area of the Amazonas lowland. The investigation, undertaken in Marajó Island, mouth of the Amazonas River, consisted of shallow sub-surface geophysical data including vertical electric sounding and ground penetrating radar. These methods were combined with morphostructural analysis and sedimentological/stratigraphic data from shallow cores and a few outcrops. The results revealed two stratigraphic units, a lower one with Miocene age, and an upper one of Late Pleistocene-Holocene age. An abundance of faults and folds were recorded in the Miocene deposits and, to a minor extent, in overlying Late Pleistocene-Holocene strata. In addition to characterize these structures, we discuss their origin, considering three potential mechanisms: Andean tectonics, gravity tectonics related to sediment loading in the Amazon Fan, and rifting at the continental margin. Amongst these hypotheses, the most likely is that the faults and folds recorded in Marajó Island reflect tectonics associated with the history of continental rifting that gave rise to the South Atlantic Ocean. This study supports sediment deposition influenced by transpression and transtension associated with strike-slip divergence along the northern Equatorial Brazilian margin in the Miocene and Late Pleistocene-Holocene. This work records tectonic evidence only for the uppermost few ten of meters of this sedimentary succession. However, available geological data indicate a thickness of up to 6 km, which is remarkably thick for

  18. Gross margin accounting as a social practice

    Jack, Lisa; Collinson, M.

    2007-01-01

    It is argued that agricultural gross margin accounting (GMA) is a social phenomenon with the characteristics of an institutionalised practice. This proposition is examined using the new institutionalism in sociology theoretical framework (NIS) drawing on evidence from the literature and interviews. Underlying social, political and functional factors (termed ‘the antecedents of deinstitutionalisation’ by Oliver (1992)) and the fragmentation of business processes at the farm level, suggest that...

  19. Bioenergy production on degraded and marginal land

    Wicke, B.

    2011-01-01

    Current global energy supply is primarily based on fossil fuels and is widely considered to be unsustainable. Bioenergy is considered an important option in making future global energy more sustainable. However, increasing global trade and consumption of bioenergy in industrialised countries has been accompanied by a growing concern about the environmental, ecological, and social impacts of (modern) bioenergy production. But producing bioenergy on degraded or marginal land may avoid many of t...

  20. Marginal longitudinal semiparametric regression via penalized splines

    Al Kadiri, M.

    2010-08-01

    We study the marginal longitudinal nonparametric regression problem and some of its semiparametric extensions. We point out that, while several elaborate proposals for efficient estimation have been proposed, a relative simple and straightforward one, based on penalized splines, has not. After describing our approach, we then explain how Gibbs sampling and the BUGS software can be used to achieve quick and effective implementation. Illustrations are provided for nonparametric regression and additive models.

  1. On Marginal Problem in Evidence Theory

    Vejnarová, Jiřina

    Cham: Springer, 2014 - (Cuzzolin, F.), s. 331-338. (Lecture Notes in Artificial Intelligence . 8764). ISBN 978-3-319-11190-2. ISSN 0302-9743. [BELIEF 2014. International Conference /3./. Oxford (GB), 26.09.2014-28.09.2014] R&D Projects: GA ČR GA13-20012S Institutional support: RVO:67985556 Keywords : evidence theory * marginal problem * extension * product extension Subject RIV: BA - General Mathematics http://library.utia.cas.cz/separaty/2014/MTR/vejnarova-0439579.pdf

  2. PENDIDIKAN ALTERNATIF UNTUK PEREMPUAN MARGINAL DI PEDESAAN

    Ratnawati Tahir

    2011-11-01

    Full Text Available Abstract: Alternative Education for Marginalized Women in Rural Areas. The study aims to find alter­native forms of education for marginalized women, the process of forming study groups and gender based learning process that serves the center of the development of education, leadership and a source of economic empowerment. The study uses qualitative methods, involving a group of women who have attended an al­ternative education. Researchers and informants from community leaders. The results showed that the form of alternative education is a method of adult education or andragogy. Study groups consisted of basic literacy and functional literacy. The learning process begins with the sharing of learning, reflection on life experience and role play method. The result is 65% of participants have increased the ability of reading, writing and numeracy, and understanding of the issues of women who have confidence in the decision making of households and communities. Abstrak: Pendidikan Alternatif untuk Perempuan Marginal di Pedesaan. Penelitian ini bertujuan mengetahui bentuk pendidikan alternatif untuk perempuan marginal, proses pembentukan kelompok belajar, dan proses pembelajaran berperspektif gender yang berfungsi menjadi pusat pengembangan pendidikan, kepemimpinan, dan sumber penguatan ekonomi. Penelitian menggunakan metode kualitatif, mengambil satu kelompok perempuan yang telah mengikuti pendidikan alternatif. Informan terdiri atas tokoh masyarakat, seperti Kepala Desa, Ketua RT/RW, dan ibu rumah tangga. Hasil penelitian menunjukkan bahwa bentuk pembelajaran pendidikan alternatif adalah metode pendidikan orang dewasa atau andragogy. Pembentukan kelompok belajar terdiri atas; kelompok baca tulis dan keaksaraan fungsional. Proses pembe­lajaran dimulai dengan sharing pembelajaran, refleksi pengalaman hidup, dan metode role play. Hasilnya 65% peserta pembelajaran mengalami peningkatan kemampuan membaca, menulis, dan berhitung, serta pema

  3. Approximation of Marginal Abatement Cost Curve

    Olga Kiuila; Rutherford, Thomas F.

    2011-01-01

    Top-down models usually include piecewise-smooth functions to describe marginal cost curves, while bottom-up models describe those curves with a step function. When a bottom-up cost curve is available, we can explicitly represent this curve with a top-down model in order to replicate its shape instead of arbitrary assumptions. We propose methods to approximate a piecewise function from a step function using constant elasticity of substitution technologies. Specifically, we consider a pollutio...

  4. Surgical treatments for esophageal cancers

    Allum, William H.; Bonavina, Luigi; Cassivi, Stephen D.; Cuesta, Miguel A.; Dong, Zhao Ming; Felix, Valter Nilton; Figueredo, Edgar; Gatenby, Piers A.C.; Haverkamp, Leonie; Ibraev, Maksat A.; Krasna, Mark J.; Lambert, René; Langer, Rupert; Lewis, Michael P.N.; Nason, Katie S.; Parry, Kevin; Preston, Shaun R.; Ruurda, Jelle P.; Schaheen, Lara W.; Tatum, Roger P.; Turkin, Igor N.; van der Horst, Sylvia; van der Peet, Donald L.; van der Sluis, Peter C.; van Hillegersberg, Richard; Wormald, Justin C.R.; Wu, Peter C.; Zonderhuis, Barbara M.

    2015-01-01

    The following, from the 12th OESO World Conference: Cancers of the Esophagus, includes commentaries on the role of the nurse in preparation of esophageal resection (ER); the management of patients who develop high-grade dysplasia after having undergone Nissen fundoplication; the trajectory of care for the patient with esophageal cancer; the influence of the site of tumor in the choice of treatment; the best location for esophagogastrostomy; management of chylous leak after esophagectomy; the optimal approach to manage thoracic esophageal leak after esophagectomy; the choice for operational approach in surgery of cardioesophageal crossing; the advantages of robot esophagectomy; the place of open esophagectomy; the advantages of esophagectomy compared to definitive chemoradiotherapy; the pathologist report in the resected specimen; the best way to manage patients with unsuspected positive microscopic margin after ER; enhanced recovery after surgery for ER: expedited care protocols; and long-term quality of life in patients following esophagectomy. PMID:25266029

  5. Ocean Margins Programs, Phase I research summaries

    Verity, P. [ed.

    1994-08-01

    During FY 1992, the DOE restructured its regional coastal-ocean programs into a new Ocean Margins Program (OMP), to: Quantify the ecological and biogeochemical processes and mechanisms that affect the cycling, flux, and storage of carbon and other biogenic elements at the land/ocean interface; Define ocean-margin sources and sinks in global biogeochemical cycles, and; Determine whether continental shelves are quantitatively significant in removing carbon dioxide from the atmosphere and isolating it via burial in sediments or export to the interior ocean. Currently, the DOE Ocean Margins Program supports more than 70 principal and co-principal investigators, spanning more than 30 academic institutions. Research funded by the OMP amounted to about $6.9M in FY 1994. This document is a collection of abstracts summarizing the component projects of Phase I of the OMP. This phase included both research and technology development, and comprised projects of both two and three years duration. The attached abstracts describe the goals, methods, measurement scales, strengths and limitations, and status of each project, and level of support. Keywords are provided to index the various projects. The names, addresses, affiliations, and major areas of expertise of the investigators are provided in appendices.

  6. ROP margin improvement options for CANDU reactors

    Highlights: • ROP aging challenge related to power derating is addressed. • ROP detector layout optimization and HSP re-classification are the options explored to mitigate power derating challenge. • Significant improvement in the ROP TSP value for an aged CANDU reactor can be realized from implementing these options. - Abstract: Over the past few years, Candu Energy Inc. (a wholly owned subsidiary of SNC-Lavalin Inc., which acquired the assets of Atomic Energy of Canada Limited’s Commercial Reactor Division) has been continuously developing and evaluating various options to improve the regional overpower protection (ROP) margin in aged CANDU 600 MW (CANDU 6®) reactors. This paper presents results from applying a couple of margin improvement options to a generic aged CANDU 6 reactor, namely ROP detector layout optimization and application of a revised handswitch position designation. Application of these options requires no change to the ROP analysis methodology, statistical approach or acceptance criterion. As such, any increase in ROP margin associated with these options carries little or no licensing risk and are not expected to require more than one standard outage to implement

  7. Adequate sleep among adolescents is positively associated with health status and health-related behaviors

    Jeng Yi-Jong

    2006-03-01

    Full Text Available Abstract Background Amount of sleep is an important indicator of health and well-being in children and adolescents. Adequate sleep (AS: adequate sleep is defined as 6–8 hours per night regularly is a critical factor in adolescent health and health-related behaviors. The present study was based on a health promotion project previously conducted on adolescents in Tao-Yuan County, Taiwan. The aim was to examine the relationship between AS during schooldays and excessive body weight, frequency of visiting doctors and health-related behaviors among Taiwanese adolescents. Methods A cross-sectional study design, categorical and multivariate data analyses were used. The hypotheses investigated were: high frequency of AS is positively associated with lack of obesity and less frequent visits to doctors; and high frequency AS is positively associated with health-related behavior. Results A total of 656 boys (53.2% and girls (46.8%, ranging in age from 13–18 years were studied between January and June 2004. Three hundred and fifty seven subjects (54% reported that they slept less than the suggested 6–8 hours on schooldays. A significant negative association was found between low sleep and of the following health-related behaviors: (1 life appreciation; (2 taking responsibility for health; (3 adopting healthy diet; (4 effective stress management; (5 regular exercise; and (6 total AHP score. High frequency AS was associated with low frequencies of obesity after potential confounding factors were controlled. Junior high school adolescents reported significantly higher frequencies of AS than high school participants. Gender, family structure, home location and frequency of television watching or computer use were not significantly associated with AS. Conclusion These findings support the proposition that AS is associated with good health status and high-frequency adoption of health-related behavior. Furthermore, these findings suggest that inadequate

  8. Evolving Educational Techniques in Surgical Training.

    Evans, Charity H; Schenarts, Kimberly D

    2016-02-01

    Training competent and professional surgeons efficiently and effectively requires innovation and modernization of educational methods. Today's medical learner is quite adept at using multiple platforms to gain information, providing surgical educators with numerous innovative avenues to promote learning. With the growth of technology, and the restriction of work hours in surgical education, there has been an increase in use of simulation, including virtual reality, robotics, telemedicine, and gaming. The use of simulation has shifted the learning of basic surgical skills to the laboratory, reserving limited time in the operating room for the acquisition of complex surgical skills". PMID:26612021

  9. [SURGICAL HAND WASHING: HANDSCRUBBING OR HANDRUBBING].

    Santacatalina Mas, Roser; Peix Sagues, Ma Teresa; Miranda Salmerón, Josep; Claramunt Jofre, Marta; López López, Alba; Salas Marco, Elena

    2016-02-01

    The importance of protocols for preoperative antisepsis of the hands is given by the risk of transferring bacteria from the hands of the surgical team to the patient during surgery and it is relationship with infection of surgical wound site (SSI). Careful surgical scrub reduces the number of bacteria on the skin, but does not eliminate them completely, remaining transient microorganisms on hands after the surgical scrub. There fore if micropuncture in surgical gloves occurs, the correct preoperative preparation of hands and double gloving will be essential to reduce the risk of bacterial transmission to patients. The protocols for surgical hand antisepsis are two: Surgical scrub with antiseptic soap (hand scrubbing). Surgical scrub by rubbing alcohol (handrubbing). The hand antisepsis by rubbing with an alcohol solution has proved to be significantly more effective compared to soap solutions. We must also see that in surgical hand antisepsis with soap, you must rinse them with water. And often hospitals' taps and keys are contaminated by Pseudomonas spp., including P. aeuinosa. PMID:27101645

  10. 21 CFR 878.3300 - Surgical mesh.

    2010-04-01

    ... GENERAL AND PLASTIC SURGERY DEVICES Prosthetic Devices § 878.3300 Surgical mesh. (a) Identification... acetabular and cement restrictor mesh used during orthopedic surgery. (b) Classification. Class II....

  11. Evaluation of safe surgical treatment of peritonsillar abscess using computed tomography

    Ishii, Kasumi; Aramaki, Hajime; Arai, Yasuko; Uchimura, Kanako; Okabe, Kunihiko; Nishida, Motoko; Yoda, Keiko [Tokyo Women' s Medical Coll. (Japan). Daini Hospital

    2002-03-01

    With the development of new antimicrobial agents, the incidence of peritonsillar abscess (PTA) is on the decline. PTA is still often encountered in general practice, however, where it requires immediate diagnosis and treatment. Because the internal carotid artery runs medially to the medial parapharyngeal space, damage to nearby vascular or other structures is a surgical risk of PTA. We used contrast computed tomography (CT) from PTA patients to investigate the anatomical relationship between the abscess and parapharyngeal space, and to determine safe surgical sites. We observed 31 patients with PTA, 19 men and 12 women, between February 1997 and April 1999, all examined by contrast CT and undergoing drainage or incision. The average age was 30.7 years (range: 12-54 years). The abscess was on the right side in 20 cases and on the left side in 11. We determined the sites of the abscess and carotid artery, internal jugular vein, and surrounding soft tissue density area including nerves in the parapharyngeal space based on the angle and distance from recognizable anatomical structures in CT scans. The anterior margin of the parapharyngeal space was 29{+-}5 mm posterior from the upper posterior alveolar margin. The medial margin of that space was at 15{+-}2 deg laterally from the midline of the incisors, and 24{+-}4 mm laterally from the midline sagittal plane. The internal carotid artery was located medially to the parapharyngeal space, running on the sagittal plane containing the upper posterior alveolar margin. The distance from the anterior margin of the parapharyngeal space to the posterior wall of the PTA was 9{+-}4 mm, and the distance to the anterior wall of the abscess (including the pharyngeal mucosa) was 31{+-}5 cm. The relationship between the upper posterior alveolar margin and midline sagittal plane was useful for determining the site of the parapharyngeal space. Because the internal carotid artery is located on the same sagittal plane as the upper

  12. Surgical castration, coercion and ethics

    Ryberg, Jesper; Petersen, Thomas Søbirk

    2014-01-01

    John McMillan's detailed ethical analysis concerning the use of surgical castration of sex offenders in the Czech Republic and Germany is mainly devoted to considerations of coercion.1 This is not surprising. When castration is offered as an option to offenders and, at the same time, constitutes...... the only means by which these offenders are likely to be released from prison, it is reasonable—and close to the heart of modern medical ethics—to consider whether the offer involves some kind of coercion. However, despite McMillan's seemingly careful consideration of this question, it appears to us...... underlines that they may be detained ‘indefinitely’. And the response report of the European Committee for the Prevention of Torture and Inhumane or Degrading Treatment or Punishment (CPT) to the Czech Government also emphasises—as part of the Czech Criminal Code—the possibility of ‘security detention’ that...

  13. Surgical Management of Enterocutaneous Fistula

    Enterocutaneous (EC) fistula is an abnormal connection between the gastrointestinal (GI) tract and skin. The majority of EC fistulas result from surgery. About one third of fistulas close spontaneously with medical treatment and radiologic interventions. Surgical treatment should be reserved for use after sufficient time has passed from the previous laparotomy to allow lysis of the fibrous adhesion using full nutritional and medical treatment and until a complete understanding of the anatomy of the fistula has been achieved. The successful management of GI fistula requires a multi-disciplinary team approach including a gastroenterologist, interventional radiologist, enterostomal therapist, dietician, social worker and surgeons. With this coordinated approach, EC fistula can be controlled with acceptable morbidity and mortality.

  14. Surgical approaches to the elbow.

    Cheung, Emilie V; Steinmann, Scott P

    2009-05-01

    Surgical exposures for complex injuries about the elbow are technically demanding because of the high density of neurologic, vascular, and ligamentous elements around the elbow. The posterior approaches (ie, olecranon osteotomy, triceps-reflecting, triceps-splitting, triceps-reflecting anconeus pedicle flap, paratricipital) include techniques used to navigate the area around the triceps tendon and anconeus muscle. These approaches may be extended to gain access to the entire joint. The ulnar nerve, the anterior and posterior capsules, and the coronoid process are addressed by means of a medial approach. Lateral approaches are useful in addressing pathology at the radial head, capitellum, coronoid process, and anterior and posterior capsules. These approaches may be combined to address complex pathology in the setting of fracture fixation, arthroplasty, and capsular release. PMID:19411644

  15. Surgical treatment of acute pancreatitis

    Klose, K.J.; Neher, M.; Kuhn, F.P.; Kuemmerle, F.; Thelen, M.

    1983-03-31

    The diagnosis of acute pancreatitis is based on anamnestic, clinical and chemical data. Ultrasound and computed tomography permit direct visualisation of the pancreas and establish the diagnosis. In cases of haemorrhagic-necrotising pancreatitis they demonstrate the extent of morphological changes and permit exclusion of other causes of an acute abdomen. The imaging methods support indications for operation in cases of subtotal or total parenchymatous necrosis and in pancreatic abscesses. Conservative expectant approaches in patients with severe clinical course and slight morphological changes as well as in agreement of clinical and morphological findings are facilitated. Complete demonstration of parenchymatous and peripancreatic necroses furnishes useful additional information for total extirpation. Gallstone disease can be demonstrated or excluded preoperatively. Since introduction of ultrasound and computed tomography for the diagnosis of acute pancreatitis a marked diminution of early surgical intervention and delayed operation has been achieved.

  16. Intraoperative OCT in Surgical Oncology

    South, Fredrick A.; Marjanovic, Marina; Boppart, Stephen A.

    The global incidence of cancer is rising, putting an increasingly heavy burden upon health care. The need to effectively detect and treat cancer is one of the most significant problems faced in health care today. Effective cancer treatment typically depends upon early detection and, for most solid tumors, successful removal of the cancerous tumor tissue via surgical procedures. Difficulties arise when attempting to differentiate between normal and tumor tissue during surgery. Unaided visual examination of the tissue provides only superficial, low-resolution information and often with little visual contrast. Many imaging modalities widely used for cancer screening and diagnostics are of limited use in the operating room due to low spatial resolution. OCT provides cellular resolution allowing for more precise localization of the tumor tissue. It is also relatively inexpensive and highly portable, making it well suited for intraoperative applications.

  17. Magnetic resonance imaging analysis of surgical trans-sacral axial L5/S1 interbody fusion

    YAN Ning; HE Shi-sheng; ZHANG Hai-long; GU Guang-fei; LIU Bi-feng; LIU Yan-bin; ZHANG Li-guo; GU Xin; DING Yue; GUO Cheng-bin

    2011-01-01

    Background Trans-sacral axial L5/S1 interbody fusion (AxiaLIF), a novel surgical procedure, recently adopted in clinical practice, has excellent clinical outcomes. However, there is inadequate data on the feasibility of the approach in all adult patients and the optimal surgical approach is currently unclear; therefore, further studies are required. In order to enhance the surgical approach for AxiaLIF, prospective anatomical imaging optimization is necessary. The objective of this study was to investigate the ability of magnetic resonance imaging (MRI) to achieve an optimal procedural setting.Methods The subjects (n=40) underwent lumbosacral MRI examination. The median sagittal MRI images were analyzed and four measurement markers were defined as follows: the center of the L5/S1 disc (A), the anterior margin of the S1/2 disc space (B), the sacrococcygeal junction (C), and the coccygeal tip (D). The measurement markers were connected to each other to produce five lines (AB, AC, AD, BC, and BD), as reference lines for surgical approaches. The distance between each reference line and the anterior and posterior margins of the L5 and S1 vertebral bodies was measured to determine the safety of the respective approaches.Results In all patients, Lines AB and AC satisfied the imaging safety criteria. Line AB would result in a significant deviation from the median and was determined to be unsuitable for AxiaLIF. Line AD satisfied the imaging safety criteria in 39 patients. However, the anal proximity of the puncture point proved to be limiting. For lines BC and BD, the imaging safety criteria were satisfied in 70% and 45% of patients, respectively.Conclusions The AxiaLIF procedure is a safe technique for insertion of fusion implants in all subjects. Line AC is a favorable reference line for surgical approach and safe for all subjects, while line BC is not suitable for all subjects.

  18. Colorectal anastomosis dehiscence following radical surgical operation for rectal carcinoma

    Trifunović Bratislav

    2011-01-01

    Full Text Available Background/Aim. Colorectal cancer (CRC is one of the biggest health problems of modern humanity, especially in highly developed countries. In Serbia about 3,200 patients suffer from CRC, out of whom about 1,100 patients suffer from rectal cancer (RC, while about 2,100 patients suffer from other colon segments cancer. The aim of the study was to show the incidence genesis of one of the possible early postoperative complications regarding dehiscence of the colorectal anastomosis (CRA with a group of patients suffering from RC and operated by using sphincter-saving procedures, in the period from 1993 to 2007, and then to compare the incidence genesis of these complications with those in the published series of the reporting colorectal institutions. Methods. The research included 242 patients radically operated on for RC in a 15-year period using some of sphincter-saving procedures following by a careful analysis of the symptoms of subclinical dehyscencias not solved with the reintervention as well as of the clinically evidented dehyscencias mostly solved by reoperation. Results. With 22 (9.1% patients in the first 10 postoperative days there were early postoperative symptoms of CRA dehiscence. In 6 (2.47% of the patients there were subclinical signs of raised body temperature, less quantity of feces content, and after the conservative treatment they ended in spontaneous process of rehabilitation. In 16 (6.61% patients there was clinically evidented anastomosis dehiscence followed by abundant drainage of feces content, signs of local peritonitis, pelvic sepsis, so we had to undertake surgical intervention. Conclusion. Comparing the results of a few tenths of published studies with our results we proved that performing and operative technique of colorectal anastomosis in the patients suffered and radically surgically treated for RC, is quite adequate with the operative technique in reporting world institutions that are engaged in surgical treatment

  19. Surgical Craniotomy for Intracerebral Haemorrhage.

    Mendelow, A David

    2015-01-01

    may improve the completeness of surgical evacuation and outcomes, regardless of which surgical technique is employed. PMID:26588582

  20. Dose reduction and adequate image quality in digital radiography: a contradiction?

    Dose reduction and adequate image quality in digital radiography - a contradiction ?Digital radiography has already replaced traditional screen-film systems. Substantial improvements in both dose efficiency and spatial resolution demonstrate the rapid developments in digital radiography. Needle-detector systems have shown up to a 50% dose reduction compared to traditional screen-film systems. There is also a dose reduction capability of up to 50% comparing direct radiography (DR) systems to computed radiography (CR) systems for chest X-rays. However, despite the most recent achievements of CR technology, the dose efficiency of DR systems (caesium iodide flat-panel detector) is unparalleled. The progress in detector technology has contributed to dose reduction and improved image quality, while saving time and providing a higher examination rate. The use of dose indicators and longitudinal dose control are important to avoid substantial accidental dose increase. The dose applied to patients should fall markedly below the defined diagnostic reference levels within the European Union. Regular quality control, as well as continuous education and training of medical and technical personnel, contribute to ensure that the ALARA (as low as reasonably achievable) principle is consistently followed. (orig.)