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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

    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

  20. 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

  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. 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

  5. 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

  6. 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.

  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

    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.

  1. 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)

  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

    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

    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.

  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. 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

  20. [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

  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. 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

  7. 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.

  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. 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

  10. 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.

  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. "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...

  18. 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....

  19. 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)

  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. 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 ...

  4. 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.

  5. 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 ...

  6. 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 ...

  7. 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...

  8. 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…

  9. 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)

  10. 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.

  11. 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

  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. 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

  16. 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.

  17. 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....

  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. 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.

  13. 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

  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. 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.

  19. 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.

  20. 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

  1. 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...

  2. 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 ...

  3. 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 ...

  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. 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...

  6. 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 ...

  7. 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 ...

  8. 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 ...

  9. 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.

  10. 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 ...

  11. 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....

  12. 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. ...

  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. 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...

  16. 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

  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

    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

    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.

  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. 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

  9. 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 ...

  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. 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

  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. 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)

  16. 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

  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. 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

  19. 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...

  20. 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...

  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. 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...

  6. 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.)

  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. 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...

  17. 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

  18. 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

  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

    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.

  5. 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

  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. 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

  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. 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

  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. 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.

  1. 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.

  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. 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

  8. 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

  9. 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...

  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