Study Objectives:To evaluate the value of mouth opening during sleep for predicting surgicaloutcomes after uvulopalatopharyngoplasty (UPPP).Methods:Retrospectively,...Full Text Available
In the last two decades rectal cancer has changed from a surgically managed disease into a multidisciplinary treatment model resulting in considerable improvements in the survival and outcome. This...Full Text Available
ObjectiveWe sought to determine the clinical outcomes of patients undergoing surgical aortic valve replacement with hemodynamically confirmed severe pulmonary hypertension and aortic stenosis and compare them with the outcomes of patients not undergoing aortic valve replacement and patients undergoing aortic valve replacement with mild-to-moderate pulmonary hypertension. MethodsA total of 317 patients with severe aortic stenosis (aortic valve area 35 mm Hg) was present in 81 patients, of whom 35 (43.2%) underwent surgical aortic valve replacement. We compared the clinical outcomes of these 35 patients with the 46 patient...
Aim:Report of 125 pediatric patients of empyema thoracis treated by open decortication, highlighting the presentation, delay in referral, operative findings, the response...Full Text Available
BACKGROUNDSolid-pseudopapillary neoplasms (SPNs) are rare pancreatic tumors with malignant potential. Clinicopathologic characteristics and outcomes of patients with...Full Text Available
Hip fractures are associated with a high rate of mortality and profound temporary and sometimes permanent impairment of quality of life. Current guidelines indicate that surgeons should perform surgery...Full Text Available
Currently, the outcome of patients with intermediate-and poor-risk germ cell tumors at diagnosis is optimized by the use of risk-appropriate chemotherapy and post-chemotherapy surgical resection of...Full Text Available
ObjectiveDisc herniations at the L1-L2 and L2-L3 levels are different from those at lower levels of the lumbar spine with regard to clinical characteristics and surgicaloutcome....Full Text Available
Abstract Background:- Surgical dislocation of the hip has been developed to deal with the problems causing femoroacetabular impingement (FAI). This is a relatively recent procedure that was historically reserved for larger areas specializing in hip surgery. Methods:- We hypothesized that surgical dislocation can be used for symptomatic FAI in a typical Australasian tertiary orthopaedic centre with acceptable results. This prospective study reviews the results of 53 surgical dislocations in this setting, looking particularly at functional outcomes and early complications. Results:- There were significant improvements in the Western Ontario and McMaster University Osteoarthritis Index score at 1, 2, 3 and 4 years post-operatively. Western Ontario and McMaster University Osteoarthritis Index ...
PurposeAlthough the safety and feasibility of partial adrenalectomy in patients with von Hippel-Lindau syndrome have been established, long-term outcomes have not been examined. In this study we evaluate the recurrence and functional outcomes in a von Hippel-Lindau syndrome cohort treated for pheochromocytoma with partial adrenalectomy with a followup of at least 5 years. Materials and MethodsWe reviewed the records of patients with von Hippel-Lindau syndrome treated with partial adrenalectomy for pheochromocytoma at the National Cancer Institute. Demographic, germline mutation status, surgical indication, oncologic and functional outcome data were collected. Local recurrence was defined as radiographic evidence of recurrent tumor on the ipsilateral side of partial adrenalectomy. Patients ...
Purpose We retrospectively analyzed the results of percutaneous nephrolithotomy operations for treatment of staghorn kidney stone disease in elderly patients and compared surgical parameters and outcomes with a control group of young adult patients. Patients and method Between 2002 and 2010, 300 consecutive patients underwent percutaneous nephrolithotomy operation for treatment of staghorn kidney stone disease. Forty-five of the patients were older than 65?years and considered to be in elderly group. Thirty-seven of the patients were between the ages 18 and 36?years and considered to be the control group. Surgical parameters and outcomes were compared between groups. Results There were no significant differences between groups for stone area, operation time, difference in hemoglobin levels...
The optimal management of men with very favorable clinicopathological factors who develop biochemical recurrence (BCR) after radical prostatectomy (RP) has not been previously reported. Both local and systemic recurrences are unlikely in this cohort. This study examines their management and outcomes. Between October 2000 to March 2010, 1627 men underwent open RP by a single surgeon. In all, 448 (27.5%) met the following criteria for extremely low risk disease: preoperative PSA level <10?ng?ml?1, clinical stage T1c/T2a, Gleason score ?6, estimated cancer volume in the surgical specimen ?5% and no evidence for positive surgical margin. Undetectable PSA was defined as ?0.04?ng?ml?1. BCR was defined as PSA ?0.2?ng?ml...
PurposeTo conduct a retrospective analysis within a large university teaching hospital, comparing outcomes between patients receiving either radical surgery or radiotherapy as curative treatment for bladder cancer.Patients and MethodsBetween March 1996 and December 2000, 169 patients were treated radically for muscle-invasive bladder cancer. Data were collected from patient notes. Statistical analyses were performed using Kaplan-Meier methods and Cox proportional hazards regression analysis to compare radiotherapy and surgicaloutcome data.ResultsThere was no difference in overall, cause-specific, and distant recurrence-free survival at 5 years between the two groups, despite the radiotherapy group being older (median age, 75.3 years vs. 68.2 years). There were 31 local bladder recurrences...
The surgical management of osteoradionecrosis of the temporal bone has met with limited success because of the difficulty in accurate assessment of the viability of nonnecrotic bone intraoperatively. Failure to resect all nonviable bone results in recurrence of a necrotic focus. With the use of hyperbaric oxygen therapy to stabilize marginal bone and oral tetracycline to label viable bone preoperatively, removal of all nonviable bone can be accomplished. Postoperatively, a second course of hyperbaric therapy enhances wound healing, thus assuring a successful outcome. This article details a successful systematic approach that was developed to resect a necrotic focus in the temporal bone of a 10-year-old boy who had undergone a full course of radiotherapy for treatment of a rhabdomyosarcoma.
Background/Purpose: Peripherally inserted central venous catheters (PICCs) are commonly used for neonatal vascular access. The aim of this study was to look at PICC line complication rates and possible predictors of PICC infection in a neonatal intensive care unit. Method: This was a prospective study of 226 neonates who had PICCs on our neonatal intensive care unit between January 2006 and June 2009. Complete data was available on 218 neonates who had 294 PICC lines. Criteria for catheter-related sepsis was positive blood cultures (peripheral/central) and/or a positive catheter tip culture after removal in the presence of a clinical suspicion of line sepsis. Results: Of 218 neonates, 132 (169 lines) were medical, and 86 (125 lines) were surgical. Our PICC line infection rate was 17 infect...
Purpose Suprasellar meningiomas usually present with visual deterioration, including decreased visual acuity and/or visual field defects. Suprasellar meningiomas have a close relationship with the optic apparatus, arteries of the anterior circulation, pituitary stalk and hypothalamus, which makes safe surgical resection a challenge especially with dissection around an already compromised optic apparatus. In this report 21 patients operated on for a suprasellar meningioma over a 4-year period are reviewed. Postoperative outcome and visual recovery are evaluated, including analysis of its determinants. Methods Over a 4-year period (2002?2006), patients surgically treated for suprasellar meningiomas were included in this retrospective study. All tumors were located at the tuberculum sellae an...
BACKGROUND: Controversy exists as to whether patients with thick (Breslow depth >4 mm), clinically lymph node-negative melanoma require sentinel lymph node (SLN) biopsy. The authors examined the impact of SLN biopsy on prognosis and outcome in this patient population. METHODS: A review of the authors institutional review board-approved melanoma database identified 293 patients with T4 melanoma who underwent surgical excision between 1998 and 2007. Patient demographics, histologic features, and outcome were recorded and analyzed. RESULTS: Of 227 T4 patients who had an SLN biopsy, 107 (47%) were positive. The strongest predictors of a positive SLN included angiolymphatic invasion, satellitosis, or ulceration of the primary tumor. Patients with a T4 melanoma and a negative SLN had a significa...
Background Laparoscopic inguinal hernia repair has been around since the 1990s. A novel surgical approach known as laparoendoscopic single-site surgery (LESS) has been developed to reduce the port-related morbidities and improve the cosmetic outcomes of laparoscopic surgery, including totally extraperitoneal (TEP) inguinal hernia repair. The aim of the present study was to evaluate the safety and feasibility of the LESS TEP technique for inguinal hernia repair and compare the outcomes with the standard TEP approach. Methods Between January and May 2009, 54 consecutive healthy patients (48 men and 6 women) underwent LESS TEP inguinal hernia repair at our institute. All procedures were performed using our homemade single port for simultaneous passage of the laparoscope and instruments. The p...
Purpose: To evaluate the importance of surgical margins for local and systemic control of Ewing's sarcoma family tumors (ESFT). Methods and Materials: Between 1979 and 1999, 512 patients with ESFTs entered 4 different adjuvant and neoadjuvant studies performed at a single institution. Of these patients, 335 were treated with surgery alone (196) or surgery followed by radiotherapy at doses of 44.8 Gy (139). We compared their outcome with that of the 177 patients who were locally treated by radiotherapy at 60 Gy. Results: Local control (88.8% vs. 80.2%, p < 0.009) and 5-year disease-free survival (63.8% vs. 47.6%, p < 0.0007) were significantly better in patients treated with surgery and, among them, in those with adequate surgical margins (96.6% vs. 71,7%, p < 0.0008, and 69.6% vs. 46.3%, p < 0.0002). Nonetheless, better results were observed only in extremity tumors. Conclusions: Surgery is better than ...
Purpose: The occurrence of extraosseous Ewing's sarcoma (ES) in deep soft tissues has been well described, but cases in which this tumor occurs in a primary cutaneous or subcutaneous site have rarely been reported. The superficial variant may be less aggressive than are the more common bony and deep soft tissue counterparts with an apparently favorable outcome. A retrospective review of patients with cutaneous or subcutaneous ES was conducted to analyze outcome and patterns of failure. Methods and Materials: Between July 1985 and March 1997, 14 patients with cutaneous or subcutaneous ES were treated at St. Jude Children's Research Hospital. The median age at presentation was 16 years (range 7-21 years). Anatomic locations included trunk and pelvis (7), upper or lower extremity (4), and head and neck (3). The median size of the lesion was 3 cm (range, 1-12 cm). Thirteen had definitive surgical resections, and one had biopsy ...
The aim of this study was to compare the results of different treatment strategies for osteochondral defects (OCD) of the talus. Electronic databases from 1966 to June 2000 were systematically screened. Thirty-nine studies fulfilled our inclusion criteria. No randomized clinical trials could be identified. The results of nonoperative treatment were described in 14 studies, of excision alone in 4, of excision and curettage in 10, of excision, curettage and drilling in 21, of cancellous bone grafting in 2, of fixation in 3, and of osteochondral transplantation in 1. Good or excellent results were found in 45% of the cases. Comparison of different surgical procedures showed that excision, curettage and drilling resulted in the highest mean success rate (86%), followed by excision and curettage (76%) and excision alone (38%). From the results of this systematic review we conclude that nonoperative treatment and excision alone are not to be recommended for treatment of ...
Background. To determine total upper limb function following selective neck dissection over a mean follow-up of 1.6 years. Methods. A retrospective questionnaire study in a tertiary head and neck surgical unit. One hundred forty-eight patients who underwent selective neck dissection for head and neck cancer from January 2000 to December 2005 were invited to participate. The main outcome measure was ipsilateral upper limb dysfunction as measured by the Disability of Arm, Shoulder and Hand (DASH) questionnaire. Results. Sixty-five patients responded to the invitation to join the study from 148 invited. Despite accessory nerve conserving surgery for all the selective neck dissections studied, 23% reported no upper limb dysfunction, 54% reported mild upper limb dysfunction, 15% reported modera...
Abstract Aim- Conventional outcomes such as survival, tumour recurrence and complication rates after surgery for rectal cancer have been rigorously assessed, but the importance of maintaining quality of life (QOL) after surgery for rectal cancer has received less attention. The aim of the current study was to analyse QOL and the occurrence of pelvic dysfunction after the surgical treatment of rectal cancer. Method- Between May 2005 and May 2008, 150 patients with rectal cancer underwent abdominoperineal resection (APR) or anterior resection (AR). Seventy-four answered two preoperative questionnaires. At a follow up of 1-year, 65 were alive without sign of recurrence and answered the same questionnaires: (a) validated RAND 36-item health survey QOL questionnaire; and (b) self-administered d...
Objectives Vietnamese patients? views on healthcare are changing as surgical interventions become more commonplace, but their views on perioperative care have remained largely unstudied during this period of rapid change. This study assesses Vietnamese patients? impression of anesthesia safety and postoperative pain in relation to clinical outcomes with the aim of improving patient-centered perioperative care. Methods The study cohort consisted of 180 hospitalized patients who were followed for 24?h following abdominal surgery. The assessments of these patients on the use of anesthesia and postoperative pain were measured by means of a 5-point Likert scale survey. Perioperative events were recorded on standardized forms by medical staff. The relationship between relevant factors affecting ...
Background The Norwood procedure consists of three palliative operations, performed in neonates with hypoplastic left heart syndrome. Especially the first stage (Norwood I) is associated with the highest mortality rates in paediatric cardiac surgery (up to 25%). During surgery, the aorta is reconstructed and a systemic-to-pulmonary shunt is applied. Originally the modified Blalock-Taussig shunt was used, but recently the right-ventricle-to-pulmonary-artery shunt is increasingly being employed. We reviewed the results of our operative strategy, where an individualised choice of shunt is made. Furthermore, attempts to reduce interstage mortality (between Norwood I and II) were assessed. Methods All neonates who underwent Norwood stage I palliation from August 2004 until November 2010 were in...
Bimaxillary protrusion is prevalent among Asians and anterior segmental osteotomies are commonly used for its surgical correction. The objective of this study was to evaluate the soft tissue changes resulting from anterior segmental osteotomies. The electronic databases PubMed, Scopus and ISI Web of knowledge were searched for potentially eligible studies using a set of predetermined keywords. Full texts meeting the inclusion criteria were retrieved and their references were manually searched for additional relevant articles. The study details and outcome data of these reports were extracted using spreadsheets for comparison. The methodological quality of each study was assessed. Eleven studies met the inclusion criteria. Lateral cephalometry was used in all studies. A reduction of the lab...
Around the world there is a small industry of non-governmental organisations that provide health care in niche areas that cannot be met by national health care provision. One topic is facial deformity that can have a dramatic effect on quality of life. In this study we investigate the morbidity and outcome of a British surgical team working for a 2-week period in Ethiopia. Thirty-five patients who presented with facial deformities had 47 operations during a 2-week period. Data were recorded for a minimum of 3 weeks postoperatively. Operative techniques were classified as simple or complex. Postoperative complications were assessed and classified as major, intermediate, and minor. In addition, the character of each complication was recorded and the cause elucidated. After 3 weeks the clinic...
BackgroundAlthough benign ampullary tumors are removed endoscopically, due to their potential to progress to malignant disease, the favored treatment for adenocarcinoma is pancreaticoduodenectomy. We reviewed our institutions experience in order to identify which patients were at highest risk of disease progression following surgical resection, as well as evaluate whether localized T1 tumors are best treated by pancreaticoduodenectomy. MethodsWe retrospectively reviewed 157 patients who presented with an ampullary mass, from 2001 to 2010, and identified 51 with benign adenoma and 106 with adenocarcinoma. ResultsPatients with malignant tumors most often presented with larger tumors and jaundice, which alone was predictive of survival (OR = 67). Forty-five percent of patients with pathologic...
Equinovarus of the foot is the most common lower extremity deformity following traumatic brain injury. We evaluated outcomes of the split anterior tibialis tendon transfer (SPLATT) for correction of equinovarus in 47 patients with hemiplegic traumatic brain injury and specifically studied differences in outcomes with two tendon fixation techniques. Seventeen patients constituting Group I underwent fixation with one technique and 30 constituting Group II had another technique. Patients in both groups had appropriate procedures based on dynamic electromyography and gait analyses. Both groups were demographically comparable. All 47 feet were corrected to plantigrade position. Thirty-six of 47 patients became brace-free at final followup. There was a notable decrease in the use of ambulatory aids and ambulatory status improved in both groups. There were three fixation-related complications in Group I and none in Group II. ...
Background and purpose: Local treatment for non-metastatic Ewing's sarcoma family tumors (ESFTs) is controversial. Results achieved in a single institution in patients with ESFT of the humerus are presented. Materials and methods: Patients treated between 1983 and 2000 for ESFT of the humerus were included. The impact of local treatment (surgery, radiotherapy or both) on outcome was assessed. Results: 55 patients: 34 males (62%); 21 females (38%); mean age: 17.9 (range: 3-40). Local treatment: surgery in 27 patients (49%), radiotherapy in 17 (31%) and surgery followed by radiotherapy in 11 (20%). After a mean follow-up of 15 years (range: 7-25 years), 27 patients (49%) remained continuously disease free, 27 (49%) relapsed and one died of chemotherapy toxicity. The local recurrence rate was 13% overall: 18% (3/17) after radiotherapy, 7% (2/27) after surgery and 19% (2/11) after surgery followed by adjuvant radiotherapy (p = ns). On the contrary, the 10-year EFS ...
Purpose: To conduct a retrospective analysis within a large university teaching hospital, comparing outcomes between patients receiving either radical surgery or radiotherapy as curative treatment for bladder cancer. Patients and Methods: Between March 1996 and December 2000, 169 patients were treated radically for muscle-invasive bladder cancer. Data were collected from patient notes. Statistical analyses were performed using Kaplan-Meier methods and Cox proportional hazards regression analysis to compare radiotherapy and surgicaloutcome data. Results: There was no difference in overall, cause-specific, and distant recurrence-free survival at 5 years between the two groups, despite the radiotherapy group being older (median age, 75.3 years vs. 68.2 years). There were 31 local bladder recurrences in the radiotherapy group (24 solitary), but there was no significant difference in distant recurrence-free survival. In a more ...
Purpose: To evaluate the significance of preoperative localization of abnormal parathyroid glands to the surgicaloutcome in patients with primary hyperparathyroidism. Material and Methods: Thirty-nine patients with primary hyperparathyroidism were studied preoperatively with US (39 patients), CT (30 patients) and MR imaging (18 patients). The overall diagnostic accuracy for US was 87%, CT 66% and MR 94%. In patients with a single parathyroid adenoma US was the most cost-effective localization technique with a detection rate of 96%. CT had a lower detection rate (78%) but was of particular value for fairly large ectopic adenomas in the root of the neck. MR imaging was a good confirmatory test (93%). In patients with multiple gland disease (primary hyperplasia and multiple adenomas), no single localization study alone was sufficient. Combination of all 3 studies, however, alerted the physician to the presence of disease in more than one gland in ...
The solid-pseudopapillary tumor (SPT) of the pancreas is a rare type of exocrine pancreatic neoplasm. SPT predominantly affects young women and female children, and is usually discovered incidentally. This tumor is generally benign with a low incidence of malignancy. A 13-year-old girl was admitted to the hospital with a few weeks' history of mild abdominal pain and jaundice. On physical examination, there was no palpable mass. The laboratory tests showed increased SR, CRP, high bilirubin, amylase and lipase serum levels. Ultrasound imaging revealed a solid lesion in the region of the pancreatic head. On MRI, precise tumor localization in the head of the pancreas with pancreatic duct dilatation and compression of the common bile duct were visualized. Pancreaticoduodenectomy and cholecystectomy was performed with good clinical outcome. Microscopic and immunohistochemical studies indicated that tumor cells were typical of SPT without any signs of malignancy. After ...
The mortality in undrained abdominal abscesses is high with a mortality rate ranging between 45 and 100%. The outcome in abdominal abscesses, however, has improved due to advances in image guided percutaneous interventional techniques. The main indications for the catheter drainage include treatment or palliation of sepsis associated with an infected fluid collection, and alleviation of the symptoms that may be caused by fluid collections by virtue of their size, like pancreatic pseudocele or lymphocele. The single liver abscesses may be drained with ultrasound guidance only, whereas the multiple abscesses usually require computed tomography (CT) guidance and placement of multiple catheters. The pancreatic abscesses are generally drained routinely and urgently. Non-infected pancreatic pseudocysts may be simply observed unless they are symptomatic or cause problems such as pain or obstruction of the biliary or the gastrointestinal tract. Percutaneous routes that ...
Forty resected cases of intrahepatic cholangiocarcinoma were classified into four types according to the gross appearance; type I: mass forming type (n=8), type II: mass forming with periductal infiltrating type (n=20), type III: periductal infiltrating type (n=9) and type IV: intraductal growth type (n=3). Diagnostic features of these four types were studied. Peripheral enhancement was a common angiographic feature and tumor stains were recognized in 88%, 20%, 0%, 33%, respectively. Angiography and dynamic computed tomography (D-CT) were useful in differential diagnosis with hepatocellular carcinoma. Accuracy rate in diagnosis of portal vein involvement by angiography and D-CT was 82% and 91%, respectively. MRI was more useful in tumor detection than D-CT in cases with attenuation difference, in 55% of type II and in 75% of type III. Increase of arterial involvement, biliary tract involvement and portal vein involvement, incidence of lymph nodes metastases became higher. Spread ...
Purpose: To assess long-term outcomes following percutaneous transluminal angioplasty (PTA) of congenital aortic coarctation in adults.Methods: Seventeen patients underwent PTA for symptomatic adult coarctation of the aorta. Sixteen patients, with a mean age of 28 years (range 15-60 years), were reviewed at a mean interval after angioplasty of 7.3 years (range 1.5-11 years). Assessment included magnetic resonance imaging (MRI), Doppler echocardiography, and clinical examination. Current clinical measurements were compared with pre- and immediate post-angioplasty measurements.Results: At follow-up 16 patients were alive and well. The patient not included in follow-up had undergone surgical repair and excision of the coarctation segment following PTA. Mean brachial systolic blood pressure for the group decreased from 174 mmHg before angioplasty to 130 mmHg at follow-up (p 0.0001). The mean gradient had fallen significantly from 50.9 to 17.8 at ...
Purpose: Extrahepatic cholangiocarcinoma is a rare malignancy. Despite radical resection, survival remains poor, with high rates of local and distant failure. To clarify the role of radiotherapy with chemotherapy, we performed a retrospective analysis of resected patients who had undergone chemoradiotherapy. Methods and Materials: A total of 45 patients (13 with proximal and 32 with distal disease) underwent resection plus radiotherapy (median dose, 50.4 Gy). All but 1 patient received concurrent fluoropyrimidine-based chemotherapy. The median follow-up was 30 months for all patients and 40 months for survivors. Results: Of the 45 patients, 33 underwent adjuvant radiotherapy, and 12 were treated neoadjuvantly. The 5-year actuarial overall survival, disease-free survival, metastasis-free survival, and locoregional control rates were 33%, 37%, 42%, and 78%, respectively. The median survival was 34 months. No patient died perioperatively. Patient age #<=#60 years and perineural ...
Purpose: To evaluate the outcome of repeat stereotactic radiosurgery (SRS) for acoustic neuromas, we assessed tumor control, clinical outcomes, and the risk of adverse radiation effects in patients whose tumors progressed after initial management. Methods and Materials: During a 21-year experience at our center, 1,352 patients underwent SRS as management for their acoustic neuromas. We retrospectively identified 6 patients who underwent SRS twice for the same tumor. The median patient age was 47 years (range, 35-71 years). All patients had imaging evidence of tumor progression despite initial SRS. One patient also had incomplete surgical resection after initial SRS. All patients were deaf at the time of the second SRS. The median radiosurgery target volume at the time of the initial SRS was 0.5 cc and was 2.1 cc at the time of the second SRS. The median margin dose at the time of the initial SRS was 13 Gy and was 11 Gy at ...
SummaryWe consider the problem of estimating the effect of exposure on multiple continuous outcomes, when the outcomes are measured on different scales and are nested within multiple...Full Text Available
Arthroscopy, a minimally invasive alternative to standard open surgical techniques and now the most commonly performed orthopedic surgical procedure, was one of the greatest advances in orthopedic surgery...Full Text Available
Fires in the operating room continue to present a hazard to patients, at times with catastrophic and debilitating results. Recent data from closed claim files reveal oxygen, electrosurgical unit (ESU), and surgical drapes are common components of the fire triangle in the operating room. In this era of biotechnological sophistication, why are surgical drapes flammable? The purpose of this study was to test the flammability of different surgical drape materials and to determine the time to ignition using a bipolar ESU device in 21%, 35%, and 100% oxygen concentrations. Results show that regardless of oxygen concentration surgical drapes, when exposed to close contact with the ESU, are flammable. Time to ignition decreases with increasing concentrations of oxygen as expected. One of the surgical drapes tested was advertised to the hospital as nonflammable. Future research should focus ...
Purpose: To determine if involved field radiation (IF) is equivalent to standard whole bone radiation (SF) in local tumor control; to establish patterns of failure following treatment; and to determine response, event-free survival (EFS), and overall survival rates from multidisciplinary therapy in Ewing's sarcoma. Methods and Materials: Between 1983 and 1988, 184 children with Ewing's sarcoma were enrolled onto Pediatric Oncology Group 8346 (POG 8346). A total of 178 (97%) met eligibility criteria; 6 had pathology other than Ewing's sarcoma. Induction chemotherapy of cyclophosphamide/doxorubicin (adriamycin )(C/A) x 12 weeks was followed by local treatment either surgery or radiation therapy and C/A, dactinomycin, and vincristine for 50 weeks. Resection was advised for patients with small primary tumors if accomplished without functional loss. Forty patients were randomized to receive SF, whole bone radiation to 39.6 Gy plus a 16.2 Gy boost (total 55.8 Gy) or IF to 55.8 Gy, and the ...
Purpose: To evaluate the outcomes of patients with Ewing's sarcoma family of tumors (ESFT) treated with modern radiotherapy techniques with MRI along with optimal chemotherapy. Methods and Materials: The records of all 60 patients with ESFT who received radiation to the primary site between 1990 and 2004 were reviewed. All patients received chemotherapy, including vincristine, doxorubicin, cyclophosphamide, ifosfamide, and etoposide. Radiation was used as the sole modality for local control in 31 patients and was given either before (n = 3) or after surgical resection (n = 26) in the remainder. All patients had MRI and CT scan-based treatment planning, and 43% received intensity-modulated radiation therapy. Radiation doses ranged from 30 Gy to 60 Gy (median, 51 Gy), and 35% received hyperfractionated radiotherapy. Results: Median age was 16 years (range, 2-40 years). Because of selection bias for radiotherapy, the majority of primary tumors ...
Background: EGFR (epidermal growth factor receptor) and VEGF (vascular endothelial growth factor) inhibitors confer clinical benefit in metastatic colorectal cancer when combined with chemotherapy. An emerging strategy to improve outcomes in rectal cancer is to integrate biologically active, targeted agents as triple therapy into chemoradiation protocols. Material and methods: cetuximab and bevacizumab have now been incorporated into phase I-II studies of preoperative chemoradiation therapy (CRT) for rectal cancer. The rationale of these combinations, early efficacy and toxicity data, and possible molecular predictors for tumor response are reviewed. Computerized bibliographic searches of Pubmed were supplemented with hand searches of reference lists and abstracts of ASCO and ASTRO meetings. Results: the combination of cetuximab and CRT can be safely applied without dose compromises of the respective treatment components. Disappointingly low rates of pathologic ...
Purpose: Evaluation of the diagnostic efficacy and cost-benefit of contrast enhanced CT (CT) and MRI pre- and post-SPIO-particles in focal hepatic disease with consideration of therapeutic outcome. Results: In 34/52 (65.4%) of the cases the correct diagnosis was primarily stated by CT (sensitivity [se.] 85.2%, specificity [sp.] 44.0%). In additional 10/52 of the cases unenhanced MRI (se. 91.4%, sp. 75.0%) enabled correct diagnoses, and in another 6 cases the diagnosis was established only by SPIO-MRI (se. 100%, sp. 86.7%). Considering the possible therapeutic recommendation arising from each modality, CT would have induced needless therapy costs of 191,042 DM, unenhanced MRI of 171,035 DM, and SPIO-MRI of 7,311 DM. In comparison to the real therapy costs of 221,873 DM, this would have corresponded to an unnecessary increase of therapy costs of 86.1%, 77.1%, and 3.3%, respectively. In two cases (91 hemangioma, 1 regenerative nodule) all modalities failed, causing ...
The outcome of patients admitted to intensive care units is known to be influenced by such factors as age, previous health status, severity of disease, and diagnosis. To estimate the outcome of such...Full Text Available
ObjectiveFamily-centered bedside rounds (FCBR) are recommended to improve trainee education, patient outcomes, and family satisfaction. However, bedside teaching...Full Text Available
SUMMARYIncreasingly multiple outcomes are collected in order to characterize treatment effectiveness or to evaluate the impact of large policy initiatives. Often the multiple...Full Text Available
PurposeTo evaluate the clinical characteristics and outcomes of cataract surgery in highly myopic Korean subjects.MethodsWe retrospectively reviewed...Full Text Available
The authors reviewed the literature on psychological and psychosocial outcomes for individuals undergoing cosmetic surgery, to address whether elective cosmetic procedures improve psychological...Full Text Available
Background:High-energy fractures of posterior tibial plateau always need surgical treatment. Generally, posterior fragments of these fractures could not be exposed and reduced...Full Text Available
A 33-year-old man sustained an acute Achilles tendon rupture which was surgically repaired. Early nonweight-bearing range of motion and strengthening of the ankle and the repaired muscle unit was allowed...Full Text Available
OBJECTIVE: To increase cost-efficiency while maintaining the standard of medical care, an accelerated surgical stay program for patients having breast surgery was instituted. SUMMARY BACKGROUND DATA:...Full Text Available
BackgroundThere are various treatment options for congenital melanocytic nevus (CMN), including surgical excision, dermabrasions, curettage, laser treatment, chemical peels and cryosurgery....Full Text Available
... Tanzania, and the attack on the USS COLE. ... vis another has no bearing on the legality of the attack. If the person attacked is a combatant, the use of ...
This is a review of recently published literature on surgery in tropical Africa. It presents the current state of surgical need and surgical practice on the continent. We discuss the enormous burden of surgical pathology (as far as it is known) and the access to and acceptability of surgery. We also describe the available facilities in terms of equipment and manpower. The study looked at the effects of the human immunodeficiency virus, the role of traditional healers, anesthesia, and the economics of surgery. Medical training and research are discussed, as are medical migration out of Africa and the concept of task shifting, where surgical procedures are performed by others when surgeons are not available. It closes with recommendations for involvement and action in this area of great glob...
The purpose of this paper is to describe a technique of forced surgical rotation of the mandible used in skeletal Class II patients with deep bite and prominent chin. Posterior occlusal composite onlays combined with preoperative orthodontic treatment without anterior intrusion increase the posterior rotational component of the surgical mandibular advancement, when removed during operation. This manoeuvre allows for the surgical closure of the posterior open bite, while anteriorly the deep bite is opened. This technique avoids bimaxillary rotation surgery with dorsal impaction in mild to moderate cases. In any case, a chin setback osteotomy with compromised aesthetics can be avoided.
Surgical fires--fires that occur on or in a surgical patient--are a rare but devastating complication of surgical procedures. They can happen during almost any kind of operation and can have dire consequences for both the patient and the hospital. The risk of surgical fires can be minimized as long as everyone on the surgical team understands how fires start and what to do when they occur. It's important to recognize the interaction among ignition sources, oxidizers, and fuels--the three sides of the classic fire triangle. What's more, staff members need to be alert to "hidden" fire risks, such as unsuspected oxygen-enriched atmospheres and less-than-obvious fuels. They also need to be drilled in the correct steps for responding to fires. In this guide, we describe the elements of surgical fires, including the types of equipment and materials that make up each ...
In order to stress the role of computed tomography (CT) in the evaluation of benign spinal osteoblastoma, the authors examined by CT 10 patients with surgically and histologically proved osteoblastomas of the spine. Basing on surgical and histopathological findings CT proved to be a very important method for attesting the presence of the tumors (usually showed by radiographic examination), and specially for their staging and follow-up. CT in fact showed the real extent of the tumor into the spinal canal and towards the paraspinal soft tissues, and allowed the aerly detection of post surgical relapses. The authors conclude that CT is a primary diagnostic modality for preoperative planning and follow-up of benign osteoblastoma.
Anomalies of the urethra are uncommon. Urethrorectal fistula in horses has only been reported in foals and only in conjunction with other congenital anomalies. This report describes the diagnosis, surgical...Full Text Available
Seventy-seven patients developed retinal breaks following an episode of ocular contusion, and 65 (84.4%) of these developed rhegmatogenous retinal detachment. Surgical treatment successfully restored...Full Text Available
Current medical visualization technology intended for positional guidance in surgical applications may only ever have limited utility in the operating room due to the preexisting visual requirements of surgical practice. Additionally, visual systems impose limits as a result of their high latency, poor image resolution, problems with stereopsis and physical strain upon the user. Audio technology is relatively unexamined in the broad range of available methodologies for medical devices. The potential to translate surgical instrument position into audio feedback presents a novel solution to the human factors and engineering problems faced by visual display technology because audio technology employs a rich and as yet unburdened sensory modality. We describe an experimental system we have developed for investigating this new interface design approach using commercially available hardware. PMID:10173065
INTRODUCTIONMany surgeons will have encountered the scissors that would not cut, and the artery clip that comes off in a deep difficult location, but it would be reasonable to assume...Full Text Available
OBJECTIVE: New surgical procedures designed to assist in the treatment of peritoneal surface malignancy were sought. BACKGROUND: Decisions regarding the treatment of cancer depend on the anatomic location...Full Text Available
Background:Percutaneous tracheostomy (PT) has gained an increasing acceptance as an alternative to the conventional surgical tracheostomy (ST). In experienced hands, and with...Full Text Available
Minimally invasive parathyroidectomy is the procedure of choice for primary hyperparathyroidism due to parathyroid adenoma. Localization of the offending adenoma in minimally invasive parathyroidectomy...Full Text Available
BackgroundAlthough local excision (ampullectomy) was first described by Halsted in 1899, its adequacy as an alternative surgical treatment for the ampullary tumors is still a matter...Full Text Available
Purpose:This study investigated the penetration of lidocaine around and through a sutured incision following the application of iontophoretic and passive patches...Full Text Available
... for a stapling or division of tissue the creation of a small gastric pouch which then assists ... follow up. Laparoscopic gastric bypass entails the surgical creation of a small gastric pouch, typically about an ...
... endometriosis can be seen is by doing a laparoscopy. A laparoscopy is a surgical procedure used to look at ... of the abdomen using special scopes. During a laparoscopy, the doctor is able to take small samples ...
BACKGROUNDOpen carpal tunnel release (OCTR) is the standard procedure for the surgical treatment of carpal tunnel syndrome. With the advent of minimally invasive surgery, endoscopic...Full Text Available
BackgroundWe aimed to compare visual and refractive outcome following phacoemulsification and intraocular lens implant (IOL) and combined one-site phacotrabeculectomy.MethodWe...Full Text Available
ObjectiveTo investigate and to quantify the relationship between hospital costs and health outcomes for patients with acute myocardial infarction (AMI) in Veterans Health Administration...Full Text Available
Objective. Cervical cancer patients who had an abandoned radical hysterectomy were evaluated for preoperative clinical predictors, complication rates, and outcomes. Study...Full Text Available
BackgroundThe link between maternal factors and birth outcomes is well established. Substantial changes in society and medical care over time have influenced women's reproductive...Full Text Available
Cerebral atrophy rate is increasingly used as an outcome measure for Alzheimer's disease (AD) trials. We used the Alzheimer's disease Neuroimaging initiative (ADNI) dataset to assess if adjusting...Full Text Available
BackgroundThe optimal treatment for locally recurrent rectal cancer (LRRC) is still a matter of debate. This study assessed the outcome of LRRC patients treated with multimodality...Full Text Available
ObjectivesPericardial tamponade after cardiac surgery is difficult to diagnose, thereby rendering timing of rethoracotomy hard. We aimed at identifying factors predicting the outcome...Full Text Available
BackgroundPercutaneous endoscopic lumbar discectomy is a relatively new technique. Very few studies have reported the clinical outcome of percutaneous endoscopic discectomy in terms...Full Text Available
Purpose:The goal of this study was to use two separate databases to evaluate the clinical outcomes and the economic impact of adherence to Level I Pathways, an evidence-based oncology...Full Text Available
ObjectiveTo report the outcome of children with life-threatening asthma (LTA) admitted to a university Pediatric Intensive Care Unit (PICU).MethodsRetrospective...Full Text Available
The mouth is an obvious portal of entry to the body, and oral health reflects and influences general health and well being. Maternal oral health has significant implications for birth outcomes and infant...Full Text Available
BackgroundObtaining comprehensive health outcomes and health services utilization data on stroke patients has been difficult. This research grew out of a memorandum...Full Text Available
BackgroundControversy exists about how to effectively measure patient reported outcomes in IBS clinical trials. Pain numeric rating scales (NRS) are widely used in...Full Text Available
OBJECTIVE: The management and outcome of 138 abdominal shotgun wounds were examined over a 5-year period. SUMMARY BACKGROUND DATA: It has been proposed that exploratory laparotomy may be unnecessary...Full Text Available
PurposeTo assess the relationship between low-grade inflammation, measured as basal high sensitivity (hs)-CRP, and IVF outcome.MethodsWe recruited...Full Text Available
Although research demonstrates many negative family outcomes associated with single-parent households, little is known about processes that lead to positive outcomes for these families. Using...Full Text Available
We sought to determine the prevalence of metabolic syndrome (MS) in patients with acute myocardial infarction and its effect on clinical outcomes. Employing data from the Korea Acute Myocardial Infarction...Full Text Available
AbstractSevere pediatric traumatic brain injury (TBI) is associated with unfavorable outcomes secondary to injury from activation of the inflammatory cascade, the release of excitotoxic...Full Text Available
Much public health research has been directed to studies of cancer risks due to chemical agents. Recently, increasing attention has been given to adverse reproductive outcomes as another, shorter-term...Full Text Available
Communication problems have been implicated in many safety and quality issues, but tools to examine communication networks and their impact on patient outcomes are only beginning to become available....Full Text Available
AIMSTo evaluate and compare the risk of specific safety outcomes in patients prescribed ibuprofen and paracetamol concomitantly with those in patients prescribed ibuprofen or paracetamol...Full Text Available
Clinical features and treatment outcome were compared in depressed outpatients with and without a history of emotional and physical abuse (EPA), including childhood maltreatment. Patients were...Full Text Available
The question of whether storage of red blood cells (RBCs) alters their capacity to deliver oxygen and affects patient outcomes remains in a state of clinical equipoise. Studies of the changes...Full Text Available
IntroductionVarious multigene predictors of breast cancer clinical outcome have been commercialized, but proved to be prognostic only for hormone receptor (HR) subsets overexpressing...Full Text Available
Pneumatic dilation (PD) is an effective treatment for achalasia cardia. Outcome of PD, however, varies among different studies. Recently, some groups started considering laparoscopic myotomy to be competitive...Full Text Available
... of the utility of the terminal outcomes, ... Other stochastic topics, such as random walks, branching ... find special uses, particularly in queueing theory ...
... commands may be input from a terminal or they ... up the outcomes of the stochastic parameters corre- ... queue of subproblems to be solved, the first ...
Purpose:To report the preoperative best-corrected visual acuity (BCVA) and foveal thickness (FT) values that lead to a postoperative decimal BCVA of ≥1.0 after surgical removal...Full Text Available
Purpose: Evaluation of the diagnostic efficacy and cost-benefit of contrast enhanced CT (CT) and MRI pre- and post-SPIO-particles in focal hepatic disease with consideration of therapeutic outcome. Results: In 34/52 (65.4%) of the cases the correct diagnosis was primarily stated by CT (sensitivity [se.] 85.2%, specificity [sp.] 44.0%). In additional 10/52 of the cases unenhanced MRI (se. 91.4%, sp. 75.0%) enabled correct diagnoses, and in another 6 cases the diagnosis was established only by SPIO-MRI (se. 100%, sp. 86.7%). Considering the possible therapeutic recommendation arising from each modality, CT would have induced needless therapy costs of 191,042 DM, unenhanced MRI of 171,035 DM, and SPIO-MRI of 7,311 DM. In comparison to the real therapy costs of 221,873 DM, this would have corresponded to an unnecessary increase of therapy costs of 86.1%, 77.1%, and 3.3%, respectively. In two cases (91 hemangioma, 1 regenerative nodule) all modalities failed, causing ...
The purpose of this study was to correlate histopathological with CT findings in patients suffering from hepatocellular carcinoma (HCC) eligible for orthotopic liver transplantation (OLT), with a special focus on the antitumoral effect of transarterial chemoembolization (TACE) therapy. A total of 42 consecutive patients suffering from HCC had been treated prior to OLT by means of TACE. TACE was carried out with a mixture of Lipiodol (10-20 ml) and mitomycin C (max. dosage, 10 mg). TACE was performed at 6- to 8-week intervals. Follow-up investigation included contrast-enhanced multislice CT controls and laboratory control. Liver explants were evaluated macroscopically and microscopically to determine the number and size of the tumor lesions as well as the degree of tumor necrosis. Necrosis was investigated in H and E-stained sections. The degree of necrosis was classified as follows: 0-25%, 26-50%, 51-75%, 75-99%, and complete necrosis. Two hundred thirty-one TACE procedures (5.5 {+-} ...
BACKGROUND AND CASE STUDY: Surgical fires are rare but preventable. During facial surgery for a 68-year-old man, a fire broke out, resulting in first- and second-degree burns after a nasal cannula ignited in an oxygen-rich environment because of improper draping and tenting. DISCUSSION: Operating room (OR) fires can be prevented if any component of the "fire triangle"-fuels, ignition sources, and oxidizers-is reduced or eliminated. The use of supplemental oxygen in the OR via nasal cannulae, nebulizers, and oxygen cylinders must always considered a potential source of fire. Deficits in knowledge among the surgical team with respect to the prevention and management of surgical fires were apparent. A plan was put into place to improve fire safety education, entailing an educational program that is included in intern and resident orientation. Surgical fire safety training was also put into place for ...
This case report presents a case that underwent orthognathic treatment with anterior segmental osteotomies on both jaws. The patient was a 26-year-old female with maxillary protrusion, lip incompetence with an everted vermilion border. The overbite was +1.0mm, overjet +1.0mm. The pre-surgical orthodontic treatment included the extraction of the four first premolars and a multi-bracket treatment was started. After 12 months of pre-surgical orthodontic treatment, both the anterior maxillary and the anterior mandibular segments were retracted surgically by 5.5mm. The total treatment period was 18 months. An anterior segmental osteotomy can induce the remarkable structural changes for bimaxillary lip protrusion patients.
A long-term follow-up of a patient with beta thalassaemia with intra- and extraspinal extramedullary haematopoietic tissue compressing the spinal cord is presented. Extramedullary haematopoietic nodules are a rare cause of spinal cord compression and should be included in the differential diagnosis, especially in patients from Mediterranean countries. Treatment with radiation therapy solely failed, giving rise to the need of surgical intervention. Surgical decompression of the spine and the removal of the culprit lesion compressing the spine were performed. Postinterventional radiation therapy was applied to the spine. A relapse had to be treated again by surgical means combined with postinterventional radiation therapy. A complete relief of the symptoms and control of the lesion could be obtained.
AbstractObjective: This study examined the effectiveness of a telephone-based referral-care management (TBR-CM) intervention on psychiatric health...Full Text Available
Background:Prolonged mechanical ventilation is increasingly common. It is expensive and associated with significant morbidity and mortality. Our objective is to comprehensively characterize...Full Text Available
Increasing evidence suggests that sex differences exist in the etiology, presentation, treatment, and outcome from stroke. The reasons for these sex disparities are becoming increasingly explored, but...Full Text Available
The visual outcome, histopathology, and electrodiagnostic tests of a man with a malignant melanoma of the choroid who received foveal argon laser photocoagulation prior to enucleatiion are described....Full Text Available
The purpose of this article is to review the literature for clinical presentation, treatment, outcome and complications of using radiotherapy for the treatment of orbital lymphoma. For this, MEDLINE,...Full Text Available
OBJECTIVE: This study evaluated, in a large, heterogeneous population, the outcome of open cholecystectomy as it is currently practiced. SUMMARY BACKGROUND AND DATA: Although cholecystectomy has been...Full Text Available
Male reproductive proteins (MRPs), associated with sperm and semen, are the moieties responsible for carrying male genes into the next generation. Evolutionary biologists have focused on their...Full Text Available
Our global impact is finally receiving the scientific attention it deserves. The outcome will largely determine the future course of evolution. Human-modified ecosystems are shaped by our activities...Full Text Available
Outcome from trauma, surgery, and a variety of other medical conditions has been shown to be positively affected by providing treatment at facilities experiencing a high volume of patients with those conditions. An electronic literature search was made to identify English-language articles available through March 2011, addressing the effect of patient treatment volume on outcome for patients with subarachnoid hemorrhage. Limited data were identified, with 16 citations included in the current review. Over 60% of hospitals fall into the lowest case-volume quartile. Outcome is influenced by patient volume, with better outcome occurring in high-volume centers treating >60 cases per year. Patients treated at low-volume hospitals are less likely to experience definitive treatment. Furthermore, t...
BackgroundRecent studies have shown associations between size and body proportions at birth and health outcomes throughout the life cycle, but there are few data...Full Text Available
Background and objectives: Despite potential significance of fatigue and its underlying components in the occurrence of cardiovascular diseases, epidemiologic data showing the link are virtually limited....Full Text Available
PURPOSE: To determine the risk factors and clinical signs of Curvularia keratitis and to evaluate the management and outcome of this corneal phaeohyphomycosis. METHODS: We reviewed clinical and laboratory...Full Text Available
Governments are increasingly concerned to compare the quality and effectiveness of healthcare interventions but find this a complex matter. Crude hospital statistics can be dangerously misleading and...Full Text Available
The purpose of this study was to compare the clinical outcomes and wound complications in coccygectomy with or without subperiosteal resection. This retrospective study included 25 patients who underwent...Full Text Available
Introduction: Generally agreed outcome criteria in psychosis are required to evaluate the effectiveness of new treatment strategies. The aim of this study is to explore clinical recovery...Full Text Available
Background There is some evidence that a patient?s pre-operative condition influences short-term and long-term post-operative outcomes. The aim of the present study is to compare the physiological and operative severity score for the enumeration of mortality and morbidity (POSSUM) and modified Glasgow prognostic score (mGPS) models in the prediction of post-operative outcome, both short term and long term, in patients undergoing resection of oesophago-gastric cancer. Patients and Methods Patients who underwent curative resection for oesophago-gastric cancer from January 2005 to May 2009 and who had data to score the POSSUM, P-POSSUM, O-POSSUM and mGPS models were included in the study. Observed morbidity and mortality rates were compared with predicted outcome in different risk groups. Bot...
During 1968-77, 572 consecutive children with one or more positive urine cultures who were referred by their family doctors to one paediatric surgical outpatient clinic were investigated and prospectively...Full Text Available
The primary objective of our study is to describe urinary symptoms in women treated for endometrial cancer. We performed a cross-sectional survey of women who had undergone surgical treatment...Full Text Available
Successful management of a patient with tracheo-innominate artery erosion requires the rapid institution of specific resuscitative and operative measures. Ten patients seen at the Charity Hospital of...Full Text Available
BackgroundCaesarean section is one of the most commonly performed operations on women throughout the world. Rates have increased in recent years – about 20–25% in...Full Text Available
Pain caused by chronic pancreatitis is medically intractable and resistant to conventional interventional or surgical treatment. We report a case of spinal cord stimulation (SCS) for intractable pain...Full Text Available
Follicular unit transplant (FUT) is one of the surgical procedures which has been recently used to repigment a stable vitiligo patch. Single-hair FUT was done for a 30-year-old male with stable vitiligo...Full Text Available
BackgroundPostoperative delirium is a topic of great importance in the geriatric surgical specialty. Although antipsychotic drugs are the medications most frequently used to treat...Full Text Available
Angiosarcoma (AS) is a rare and aggressive vascular neoplasm with very poor prognosis. Patients with extensive cutaneous AS who are not surgical candidates have very limited options since there is no...Full Text Available
BackgroundHeterogeneous results for research investigating health-related quality of life (HRQL) in patients undergoing sphincter-ablating procedures for rectal cancer...Full Text Available
This is a report of surgical treatment of thoracoabdominal aortic aneurysms and aneurysms of the abdominal aorta from which the visceral vessels arise during the 18 year period from April 5, 1960,...Full Text Available
Background:Liver resection of large hepatocellular carcinomas (HCC), measuring at least 10 cm remains a controversial debate. Multiple studies on HCCs treated with surgical resection...Full Text Available
Idiopathic frozen shoulder is a common medical diagnosis for patients seeking physical therapy. Radiographic and surgical evidence exists that describes the coracohumeral ligament (CHL) as a major contributor...Full Text Available
Percutaneous endoscopic lumbar discectomy (PELD) for migrated disc herniations is technically demanding due to the absence of the technical guideline. The purposes of this study were to propose a radiologic...Full Text Available
Pain and pain-related interference with physical function have not been thoroughly studied in individuals who have undergone knee-disarticulation amputations. The principal aim of this study...Full Text Available
Background:The non-surgical management of non-melanoma skin cancers is an area requiring clinical investigation. Radiotherapy has a role in treatment for a defined subset...Full Text Available
Women experience a decline in estrogen and androgen levels after natural or surgically induced menopause, effects that are associated with a loss of sexual desire and bone mineral density. Studies in...Full Text Available
To investigate the usefulness of a newly developed magnetic resonance (MR) image-guided surgical robotic system for minimally invasive laparoscopic surgery. The system consists of MR image guidance [interactive scan control (ISC) imaging, three-dimensional (3-D) navigation, and preoperative planning], an MR-compatible operating table, and an MR-compatible master-slave surgical manipulator that can enter the MR gantry. Using this system, we performed in vivo experiments with MR image-guided laparoscopic puncture on three pigs. We used a mimic tumor made of agarose gel and with a diameter of approximately 2 cm. All procedures were successfully performed. The operator only advanced the probe along the guidance device of the manipulator, which was adjusted on the basis of the preoperative plan, and punctured the target while maintaining the operative field using robotic forceps. The position of the probe was monitored continuously with 3-D ...
Sudden unexpected postoperative hemodynamic collapse with a high mortality develops in 1–3% of patients undergoing coronary artery bypass surgery (CABG). The contribution of surgical graft complications...Full Text Available
In this paper we report a case with primarily unspecific arthralgia after surgical therapy of hallux valgus deformity and consecutive reflex sympathetic dystrophy in which MR led to the diagnosis of Lyme disease. (orig.)
and antibody responses of rhesus macaques exposed to the human gammaretrovirus XMRV. J Virol. 2011 May ;85(9):4547-57. Epub 2011 Feb 16 . PubMed Surgical staging of early...
Bone metastasis of primary colorectal cancer is uncommon. When it occurs, it is usually a late manifestation of disease and is indicative of poor prognosis. We describe a patient with multiple metachronous...Full Text Available
Disorders of the adrenal gland are rare and complex, with many potential pitfalls in their management. An understanding of embryology, anatomy, physiology and biochemistry is crucial. Surgical treatment may be required for syndromes of hormonal excess and/or suspicion of neoplasia.
In view of poor local control rates obtained with standard treatment, intraoperative radiation (IORT) using electrons was combined with external beam irradiation and surgical resection, with or without...Full Text Available
BackgroundDuring the past 2 decades, there has been a rapid proliferation of "health examination center (HEC)" across China. The effects of their services on public's health have...Full Text Available
Giant lipomas are benign soft tissue tumours. They are found relatively rarely on the posterior part of the neck. Bleeding pressure ulcer in this giant tumour is a rare presentation. Surgical interventions...Full Text Available
Four cases of unilateral giant breasts from two unrelated families are described. Three of the patients were managed surgically. It is speculated from a review of available published reports that this...Full Text Available
... Gastrointestinal Tract On the Growth and Development of Hymenolepis DiminutaKerry L. Dwinell, Paul Bass, Gordon L. Telford, ... central (CNS) nervous systems in the development of Hymenolepis diminuta usi...
Biliary obstructions are rarely caused by a foreign body and have received sparse attention. We present an unusual case with pruritis and abdominal pain caused by impacted full length surgical gauze...Full Text Available
BackgroundLung volume reduction surgery is effective at improving lung function, quality of life, and mortality in carefully selected individuals with advanced emphysema. Recently,...Full Text Available
Five children from two families presented to a regional neonatal surgical unit between 1959 and 1984 with congenital anal anomalies and other malformations resulting from an autosomal dominant inherited...Full Text Available
Objective: To further delineate the clinicopathological and radiological features of solid pseudopapillary tumor (SPT) of the pancreas and summarize the surgical therapy strategy for this tumor. Methods:...Full Text Available
Although collagen-containing implants are widely used in various surgical applications, there has been relatively little attention paid to the possibility that this type of biomaterial may undergo pathologic...Full Text Available
The diagnostic accuracy of computed tomography (CT) in several patterns of thoracic and abdominal fatty masses, has been examined. In selected cases our findings overlap the features of the recent literature. The possibility of surgical therapy in peculiar cases of adipose deposits, commonly esteemed benign, is considered.
The paper deals with sixteen cases of acetabular fractures studied with CT. After a short description of the normal CT findings, the different kind of fractures are reported. The usefulness of CT examination in evaluating acetabular fractures and their complications is confirmed both in conservative treatment and surgical approach.
beta-Endorphin-like immunoreactivity in human ventricular cerebrospinal fluid was measured with a specific radioimmunoassay. The subjects were undergoing a surgical procedure for relief of chronic intractable...Full Text Available
We report an unusual case of strangulated diaphragmatic (Morgagni) hernia resulting in ischaemia of the small and large bowel, which was initially diagnosed as a pneumonia. This case highlights the...Full Text Available
Background/AimTobacco use reduces the effect of non-surgical periodontal therapy. Host-modulation with low-dose doxycycline (LDD) might favour repair and promote...Full Text Available
An 11-year-old mare presented 36 hours after foaling with a ruptured bladder. Uroperitoneum was diagnosed on ultrasound and from the creatinine concentration of the peritoneal fluid. Bladder endoscopy...Full Text Available
Most papers appearing in the surgical literature dealing with wound ballistics concern themselves with wound management in the civilian setting. The pathophysiology of modern war wounds is contrasted with ballistic wounds commonly encountered in peacetime, but it should be noted that even in peacetime the modern terrorist may have access to sophisticated military weaponry, and that patients injured by them may fall within the catchment area of any civilian hospital. Management problems associated with both wound types are highlighted; areas of controversy are discussed. The orthodox military surgical approach to ballistic wounds is expounded and defended. PMID:1996857
The book is intended as a source of information for general practioners and for medical students doing their practical training. Efficient application of imaging methods is explained with great emphasis on practical aspects, concentrating on typical tasks to be solved for adult patients with internal disease or surgical problems. The material is arranged by various organic systems of the body. Graded diagnostics for a stepwise approach to the final diagnosis is the concept described, and is shown to be of advantage to the patient and in terms of cost and time.
There is ample historical verification of 46,XX congenital adrenal hyperplasia (CAH) patients being born with essentially male genitaliawhile outcome information is scant. Prior to glucocorticoid...Full Text Available
Objectives: To report six month outcome in patients undergoing their first pulmonary vein ablation procedure for idiopathic atrial fibrillation (AF) at a “non-pioneering”...Full Text Available
Purpose:To study the outcome of in-the-bag implanted square-edge polymethyl methacrylate (PMMA) intraocular lenses (IOL) with and without primary posterior capsulotomy in...Full Text Available
Aim: Today, MRI is an integral part of the presurgical evaluation of patients suffering from partial epilepsy. These patients frequently show focal morphological abnormalities with potential epileptogenic character and surgical resection of these lesions is associated with superior postsurgical outcome as to seizure frequency. Apart from easily detectable defects, such as post-traumatic lesions or cerebral infarction, as wide variety of mainly small abnormalities can be detected using MRI. Methods: In this study, 484 patients suffering from partial epilepsy of temporal or frontal onset were evaluated for the incidence of different lesions in this population. Results: All lesions found were included without evaluating their potential epileptogenicity, which remains to be proven using other procedures (EEG, SPECT, PET, etc.). Involvement of the hippocampal formation was a major finding in temporal lobe epilepsy, which could be detected as ...
Purpose. To validate a protocol for creating virtual models to be used in the construction of solid prototypes useful for the planning-simulation of maxillo-facial surgery, in particular for very complex anatomical and pathologic problems. To optimize communications between the radiology, engineering and surgical laboratories. Methods and materials. We studied 16 patients with different clinical problems of the maxillo-facial district. Exams were performed with multidetector computed tomography (MDCT) and single slice computed tomography (SDCT) with axial scans and collimation of 0.5-2 mm, and reconstruction interval of 1 mm. Subsequently we performed 2D multiplanar reconstructions and 3D volume-rendering reconstructions. We exported the DICOM images to the engineering laboratory, to recognize and isolate the bony structures by software. With these data the solid prototypes were generated using stereolitography. To date, surgery has been preformed on 12 patients ...
In spite of great progress in surgical treatment of anorectal malformations, fecal incontinence is still, in variable degrees, a frequent and unpleasant postsurgical sequela. The most frequent causes of incontinence are: 1) the incorrect placement of the pulled-through colon in the levator ani and sphincteric muscular complex during abdomino-perineal surgical procedures; 2) the poor development of sphinteric musculature; 3) the associated sacral anomalies. Postoperative CT helps to evaluate all the above-mentioned conditions, in view of possible new surgical procedure for improving continence (besides postoperative CT can help in choosing the more suitable surgical technique). Nine patients, aged 3 to 13 years (2 with good continence and 7 with various degrees of incontinence), were studied with pelvic postoperative CT. In the cases (2) with good continence the CT picture was: good development of ...
Background: Recent series describing the clinical presentation, response to therapy, and long-term outcome of Zollinger-Ellison syndrome are limited. Aims: To assess the clinical characteristics and long-term outcome of patients with Zollinger-Ellison syndrome. Methods: Over a 20-year period, patients with Zollinger-Ellison syndrome were enrolled in a prospective trial evaluating the efficacy of lansoprazole. Following dose stabilization, patients were followed on a 6-monthly basis with interval history, physical examination, endoscopy with gastric biopsies, gastric acid analysis and laboratory studies. Results: 72 patients (mean age 54+/-12 years, % male 58%, % Caucasian 69%) were prospectively enrolled. The clinical presentation was stereotypical for Zollinger-Ellison syndrome. Symptoms ...
PurposeTo evaluate the effect of vitrectomy timing on outcomes for patients with crystalline retained lens fragments receiving vitrectomy 3+ days after cataract surgery. DesignSystematic review and meta-analysis of retrospective interventional cases series. MethodsSearches of MEDLINE (English, 1/1/85 through 7/30/2010) and article reference lists. Articles were screened for patients with crystalline retained lens fragments after surgery for age-related cataracts, discussion of vitrectomy timing, and, for the meta-analysis, patient totals for at least 1 outcome and multiple time periods, 10+ patients, and mean follow-up ?3 months. Outcomes included visual acuity, retinal detachment, increased intraocular pressure, intraocular infection/inflammation, cystoid macular edema, and corneal...
Background Trauma centers are designated to provide systematized multidisciplinary care to injured patients. Effective trauma systems reduce patient mortality by facilitating the treatment of injured patients at appropriately resourced hospitals. Several U.S. studies report reduced mortality among patients admitted directly to a level I trauma center compared with those admitted to hospitals with less resources. It has yet to be shown whether there is an outcome benefit associated with the ?level of hospital? initially treating severely injured trauma patients in Australia. This study was designed to determine whether the level of trauma center providing treatment impacts mortality and/or hospital length of stay. Methods Outcomes were evaluated for severely injured trauma patients with an ...
Objectives The optimal timing of pyeloplasty for children diagnosed with ureteropelvic junction obstruction (UPJO) after workup for antenatal hydronephrosis is disputed. We sought to examine the potential costs and clinical outcomes of treatment protocols featuring different indications for pediatric pyeloplasty using Markov models. Methods Cost and outcomes analysis using Markov modeling was performed for three treatment algorithms: medical management, immediate pyeloplasty (during the first year of life), and pyeloplasty after no improvement on imaging. The costs were determined from the perspective of the medical institution. The variables tracked during Markov model simulation included age at resolution of UPJO, the proportion of patients with worsened hydronephrosis, the number of pye...
Systematically review risks of an infant being born with low birth weight (LBW), preterm birth (PTB) or small for gestational age (SGA) among married and unmarried women. Medline, Embase, CINAHL, and bibliographies of identified articles were searched for English language studies. Studies reporting birth outcomes of married and unmarried (single and cohabitant) were included. Two reviewers independently collected data and assessed the quality of the studies for biases in sample selection, exposure assessment, confounder, analytical, outcome assessments, and attrition. Meta-analyses were performed using random effect model for both unadjusted and adjusted data and odds ratio (OR), and 95% confidence interval (CI) were calculated. Twenty-one studies of low to moderate risk of bias were inclu...
Abstract Routinely used prognostic factors fail to predict clinical outcome in a significant proportion of breast cancer patients, implying that they can not detect some important biological characteristics. Chromosomal changes have been described in breast carcinomas for many years but their significance is not clear. We compared chromosomal changes with clinico-pathological characteristics and clinical outcome in 203 breast cancer patients with a follow-up of 9-18 years. Combining data from classical cytogenetics and flow cytometry revealed chromosomal abnormalities in 142 cases (70%). Of these, 51 (35.9%) contained two or more cytogenetically abnormal clones. Polyclonality was significantly associated with poor breast-cancer-specific survival (P = 0.03) within 5 years, independent of tu...
Abstract Objective:- This study explored 12-month outcome and its associations to social adjustment-related variables in patients with first-episode non-affective psychosis in Finland and Spain. Methods:- Forty-nine Finnish and 37 Spanish patients were evaluated at admission on various characteristics of social adjustment. Outcome was measured for 68 (79%) patients by the Brief Psychiatric Rating Scale, Global Assessment Scale, and Grip on Life. Results:- One-fourth of the patients experienced psychotic symptoms at follow-up. Sixty per-cent of the patients showed good global functioning and Grip on Life. In both patient groups, poor earlier global functioning, weak social network, poor Grip on Life, and psychological dependence on family of origin were associated with poor outcome. In the ...
This study evaluated whether differences in design of 3-dimensional polylactic acid barriers (EPi-Guide and Guidor) would influence hard tissue results in the treatment of Grade II furcations in humans. A multicenter study was conducted, using 40 patients with moderate to advanced bilateral chronic adult periodontitis of the mandibular first or second molars. After flap access, debridement, and root preparation, surgical bone level measurements were taken and membranes were placed on a random basis. Surgical reentry occurred at 1 year. Data collected from all 3 investigative centers were pooled and analyzed using an analysis of variance appropriate for a counterbalancing design. Both barrier materials resulted in significant gains of attachment level and defect reduction. The composite reduction in the vertical component of the osseous defects was greater in the sites treated with Epi-Guide as compared to those treated with Guidor; the ...
{sup 99m}Tc-N-pyridoxyl-5-methyl-tryptophan (PMT) scintigraphy, which exhibits highly specific for the diagnosis of primary hepatocellular carcinoma (HCC), was performed for recurrent HCC following non-surgical treatment. Eighty-four patients (total 351 examinations) were selected for the study. The ability of PMT scintigraphy to diagnose recurrent HCC after treatment was compared with that of computed tomography, ultrasonography and angiography. The results showed that sixty-three (75%) of 84 cases demonstrated positive findings during our follow-up period, most of the tumors initially showing positive findings remained PMT positive when they recurred and PMT studies shortly after treatment demonstrated wider tracer uptake rather than the actual tumor area. In conclusion, PMT scintigraphy for patients with HCC after non-surgical treatment exhibited high accuracy in identifying viable HCC only for tumors indicating positive findings. (author)
Ten patients with suspected islet cell tumors (seven with possible gastrinomas, three with insulinomas) underwent diagnostic evaluation with dynamic CT scanning, routine CT scanning, angiography, and sonography. Venous sampling was also performed in selected instances. Nine sites of gastrinoma and three insulinomas were confirmed surgically in eight patients. Two patients had negative surgical explorations. Routine CT demonstrated five of the nine gastrinomas and one of two insulinomas. Angiography was positive in six of nine gastrinomas and all three insulinomas. Sonography showed only two of the nine gastrinomas and two of the three insulinomas. Dynamic CT scanning demonstrated three additional lesions (two gastrinomas, on insulinoma) not visible on routine CT scanning. Although most of these lesions were visible arteriographically, dynamic CT scans at the appropriate level localized the pathology in the transverse plane and greatly aided in ...
Seventy-one patients with intestinal injury secondary to pelvic irradiation had predominantly large bowel lesions. Seventeen cases were treated conservatively and 54 came to surgery, 28 patients having more than one operation. Following this essentially salvage surgery there were more ileal than colonic anastomotic leaks. Thirty-four patients died during the follow-up period (2-12 years), 19 from recurrent malignancy, and nine as a result of continuing radiation effects. Seventy per cent of the patients who had a radiation fistula died as a result of malignancy. Of 42000 cases of pelvic malignancy treated by irradiation over the decade 1972-1982, surgical referrals for complications constituted 1.7%, with an overall radiation-related mortality of 0.2%. It is our opinion that colostomy alone has little part to play in this condition, and a policy based on excisional surgery is suggested.
Purpose The laparoscopic surgical approach to unilateral intra-abdominal testis has replaced the open approach at several large centers. There is considerable literature on experience with unilateral intra-abdominal testes but little on the management of bilateral intra-abdominal testes. We assessed the feasibility and safety of performing single setting bilateral laparoscopic orchiopexy in boys with bilateral intra-abdominal testes. Materials and Methods A single surgeon experience was reviewed. The surgical technique was similar in all cases and on each side, including infra-umbilical access, diagnostic evaluation, peritoneal mobilization lateral to the spermatic vessels and inferior to the vas deferens, gubernacular transection, and a decision for or against a Fowler-Stephens procedure ...
Objective Comorbidities predisposing cardiac surgical patients toward deep sternal wound infection, such as diabetes and obesity, are rising in the United States. Longitudinal analysis of risk factors, morbidity, and mortality was performed to assessed effects of these health trends on deep sternal wound infection rates. Methods In this retrospective analysis of all median sternotomies performed at a single institution from 1991 through 2006, demographic and surgical characteristics were identified from a prospective database. The cohort was separated into periods from 1992 through 2001 and 2002 through 2006 to identify longitudinal trends in risk factors for deep sternal wound infection. Univariate and matched multivariable analyses were performed. Results Overall, study population had in...
Two dogs were given 3.0 mCi/kg body weight of "1"0"6Ru-"1"0"6Rh and two were given 4.0 mCi/kg. At 5 days after treatment, one dog from each dose level was colectomized. The dog given the larger dose but not surgically treated was killed in extremis due to acute lower bowel injury at 18 days. The other dog, given 3.0 mCi/kg but not surgically treated, was killed in a moribund condition at 145 days after dosing. The rectum had perforated. The colectomized dogs recovered from intestinal injury and showed no radiation damage at the termination of the study.
Abstract During the past few years, laparoscopy has become the gold standard for some surgical procedures and its applications continue to expand. Because of multiple factors such as loss of tactile perception, two-dimensional visualization of the three-dimensional surgical field, and demanding bimanual hand-eye coordination, special training is required to achieve proficiency with laparoscopy. In this study, as the first step toward evidence-based development of strategies to improve the quality of laparoscopy training from brain activity and behavior relationships, a laparoscopy training simulator was developed for use in functional MRI. Experiments confirmed the functional MRI compatibility of the device. Representative behavioral and functional MRI results for two subjects showed the f...
Sentinel node (SN) scintigraphy for cervical and vulvar cancer guides the gynaecological oncologist in finding the metastatic lymph nodes during lymphadenectomy. The role of the surgical gamma probe in the sentinel node concept in gynaecological oncology is to localise (SN) both intra-operatively and transcutaneously. Intra-operative hand-held collimated gamma probes are increasingly used for detection of the sentinel lymph node. A comparative evaluation of handheld gamma probes: Neoprobe 1500, Europrobe, Gamma Finder, Gamma Ray Prospector GRP1 and GPR2 was performed using different detection methods. Laboratory tests were performed in which sensitivity, spatial resolution and angular sensitivity were evaluated. The results for each gamma probe were summarised and discussed. Awareness of a gamma probes capabilities and limitations should be considered in the appropriate selection of a device. (author)
BackgroundModern metal-on-metal hip resurfacing implants are being increasingly used for young and active patients, although the long-term outcome and failure mechanisms of these...Full Text Available
ObjectiveWe describe our clinical experiences and outcomes in patients who had thromboembolic complications occurring during endovascular treatment of intracerebral aneurysms with...Full Text Available
Transcatheter arterial chemoembolization (TACE) has become the standard treatment modality for unresectable hepatocellular carcinoma (HCC). Nonetheless, the clinical outcomes in patients with unresectable...Full Text Available
Background and objectives: The severity of anemia at which to initiate erythropoiesis-stimulating agent (ESA) treatment in nondialysis chronic kidney disease (CKD) patients is unclear. Risk of mortality,...Full Text Available
BackgroundResponse shift theory suggests that improvements in health lead patients to change their internal standards and re-assess former health states as worse than initially rated...Full Text Available
1. We have studied determinants of outcome of 7 day courses of treatment in 77 middle aged and elderly patients, in whom the general practitioner's diagnosis of urinary tract infections had been confirmed...Full Text Available
The functional outcome after stroke is unpredictable; it is not accurately predicted by clinical pictures upon hospital admission. The presence of apoptotic neurons in the ischemic penumbra and perihematoma...Full Text Available
This study describes procedures and outcomes in a functional analysis of problem behavior of 2 public school students. For a 13-year-old honors student, bizarre tacts (labeled as psychotic speech by...Full Text Available
Fetal growth restriction (FGR) is an adverse pregnancy outcome associated with significant perinatal and paediatric morbidity and mortality, and an increased risk of chronic disease later in adult life....Full Text Available
ObjectivesThe objective of this paper is to describe the complex mixed-methods design of a study conducted to assess health-related quality of life (HRQOL) outcomes...Full Text Available
Study DesignThis is a retrospective study that was done according to clinical and radiological evaluation.PurposeWe analyzed the clinical and radiological...Full Text Available
A retrospective study is presented of 83 athletes with tendo Achillis pain (TAP) treated conservatively over a 12-year period from 1976 to 1988. Local steroid injections did not contribute to an earlier...Full Text Available
BackgroundPatients’ general tendency to adhere to health care provider-recommended treatments is associated with a number of health outcomes, but whether it influences pain...Full Text Available
BackgroundAdolescents have been identified as a high-risk group for poor adherence to and defaulting from combination antiretroviral therapy (cART) care. However, data on outcomes...Full Text Available
BackgroundThere have been dramatic changes in the approach to screening for aneuploidy over the last 20 years. However, the approach to screening for other complications of pregnancy...Full Text Available
Disorders of mitochondrial fat metabolism lead to sudden death in infants and children. Although survival is possible, the underlying molecular mechanisms which enable this outcome have not yet been...Full Text Available
While research has shown that patients’ beliefs about their pain are related to pain adjustment and treatment outcomes, little is known about the beliefs of their significant others....Full Text Available
Goals of workThe goal of this study was to evaluate, at a population level, the association between specialized palliative care services (SPCS) and short- and long-term caregiver...Full Text Available
Background and objectives: The relationship between serum potassium (SK) and mortality in chronic kidney disease (CKD) has not been systematically investigated.Design, setting, participants,...Full Text Available
BackgroundSymptomatic heterotopic ossification (HO) in multiple trauma patients may lead to follow up surgery, furthermore the long-term outcome can be restricted. Knowledge of the...Full Text Available
ObjectivesTo examine the strength of the volume–outcome relationship among paramedics, a group of providers that has not been previously studied in this context. By identifying...Full Text Available
Lifetime exposure to physical activity is an important construct for evaluating associations between physical activity and disease outcomes, given the long induction periods in many chronic diseases....Full Text Available
The relationship between malaria transmission intensity and clinical disease is important for predicting the outcome of control measures that reduce transmission. Comparisons of hospital data...Full Text Available
The refractive error in 15 eyes with threshold retinopathy of prematurity treated with diode laser photocoagulation was compared with 25 eyes with the same disease severity treated by cryotherapy. Myopia...Full Text Available
SummaryRadiotherapy is used commonly in the treatment of gynecologic malignancies. Many patients experience emotional distress prior to the initiation of radiotherapy, during...Full Text Available
BackgroundIn cancer research, the association between a gene and clinical outcome suggests the underlying etiology of the disease and consequently can motivate further studies. The...Full Text Available
Thirty chemicals or substances currently undergoing long-term carcinogenicity bioassays in rodents have been used in a project to further evaluate methods and information that may have the capability...Full Text Available
BackgroundDifferent microarray studies have compiled gene lists for predicting outcomes of a range of treatments and diseases. These have produced gene lists that have little overlap,...Full Text Available
AimsTo describe nurse burnout, job dissatisfaction, and quality of care in Japanese hospitals, and to determine how these outcomes are associated with work environment...Full Text Available
OBJECTIVEModerately preterm infants (30–34 6/7 weeks’ gestational age) represent the largest population of NICU residents. Whether their clinical...Full Text Available
The objective of this study was to evaluate the effect of pregabalin in painful cervical or lumbosacral radiculopathy treated in Primary Care settings under routine clinical practice. An observational,...Full Text Available
Idiopathic pulmonary fibrosis (IPF) is a progressive disease with poor survival. The identification of therapeutic targets is essential to improving outcomes. Previous studies found that expression...Full Text Available
Background and objectives: Blacks are over-represented among dialysis patients, but they have better survival rates than whites. It is unclear if the over-representation of blacks on dialysis is due...Full Text Available
Nineteen of 69 patients undergoing coronary angioplasty required immediate coronary surgery after the procedure. Six of these operations were planned as a result of angioplasty that failed without producing...Full Text Available
Cognitive rehabilitation is an effective intervention for addressing cognitive impairments in patients with schizophrenia. Previous research has shown that the early application of Cognitive...Full Text Available
Theoretically, the outcome of World War II in Europe hung in the balance as the Allies poured onto the Normandy beachhead. Following the June 6, 1944 invasion, the Allies continue to come ashore, massively building up men and material inside the beachhead...
The identification of predictive biomarkers is at the core of modern toxicology. So far, a number of approaches have been proposed. These rely on statistical inference of toxicity response from either...Full Text Available
IntroductionTerror attacks in Southeast Asia were almost nonexistent until the 2002 Bali bomb blast, considered the deadliest attack in Indonesian history. Further attacks in 2003...Full Text Available
This 3-year longitudinal study investigated whether low-wage employment was associated with improved psychological and parenting outcomes in a sample of 178 single mothers who were employed...Full Text Available
BackgroundHigh serum uric acid concentration (hyperuricemia) has been studied for its relationship with multiple adverse health outcomes, such as metabolic syndrome. Intervention...Full Text Available
ObjectiveThis report describes initial activities of the Cancer Patient-Reported Outcomes Measurement Information System (PROMIS) Sexual Function domain group (CaPS-SF),...Full Text Available
Electronic personal health records (ePHRs) can potentially maximize access and coordination of health information and improve patient/clinician collaboration, patient self-management, and health outcomes....Full Text Available
BackgroundHealth related quality of life (HRQoL) is one of the most important outcomes to measure effectiveness of an intervention, especially for islet transplantation...Full Text Available
ContextResponse Evaluation Criteria in Solid Tumors [RECIST (unidimensional)], World Health Organization [WHO (bi-dimensional)] and European Association for Study...Full Text Available
BackgroundPregnant women are more susceptible to severe Plasmodium falciparum malaria, which can lead to poor maternal and fetal outcomes. Few data exist on the...Full Text Available
ObjectiveTo evaluate the effectiveness of a community pharmacist–based home blood pressure (BP) monitoring program.DesignTrial of a high-intensity...Full Text Available
Between 50 and 70% of patients with a terminal illness indicate a preference to remain at home for as long as possible until their death. Nevertheless, a much smaller percentage actually die at home...Full Text Available
The outcome of various osteoprogenitor-cell transplantation protocols was assessed using Col1a1-GFP reporter transgenic mice. The model requires the recipient mice to undergo lethal total body irradiation...Full Text Available
Objective To compile and evaluate the evidence on the effects on health and social outcomes of computer based peer to peer communities and electronic self support groups, used by people...Full Text Available
Abstract Aims: This study performed a systematic review and meta-analysis on glycemic control and pregnancy outcomes in women with type 1 diabetes mellitus (T1DM) treated with lispro (LP) versus regular insulin (RI) since before pregnancy. Methods: We performed a MEDLINE and EMBASE search. Abstracts (and full articles when appropriate) were reviewed by two independent researchers. Inclusion criteria were patients with T1DM, data on women treated with RI and LP since before pregnancy until delivery in the same article, at least five pregnancies in each group, and information on at least one pregnancy outcome. Quality assessment was performed using the Newcastle?Ottawa Quality Assessment Scale for cohort studies. Results: Outcome data were summarized with Revman version 5.0 (ims.cochrane.org...
The National Cancer Institute Laboratory of Human Carcinogenesis is seeking statements of capability or interest from parties interested in collaborative research to further develop, evaluate, or commercialize a gene signature for prognosis of hepatocellular carcinoma in patients.
BackgroundMany interventions found to be effective in health services research studies fail to translate into meaningful patient care outcomes across multiple contexts. Health services...Full Text Available
Equinovarus of the foot is the most common lower extremity deformity following traumatic brain injury. We evaluated outcomes of the split anterior tibialis tendon transfer (SPLATT) for correction of...Full Text Available
Objectives. Ninety-one fetuses with dilated or hypertrophic cardiomyopathy (DCM, HCM) and myocarditis were studied. Results. Group 1 “DCM”...Full Text Available
In this letter we report the outcome for the microscopic approach for the semi-magic nuclei /sup 88/Sr and /sup 90/Zr. For comparison, we have also treated the semi-phenomenological version for the Migdal and SDI force.
An application of the renormalized random phase approximation to nuclear structure is presented for the semi-magic nuclei /sup 88/Sr and /sup 90/Zr. It is reported the outcome for the microscopic approach in comparison with the semiphenomenological version for the particle-hole forces.
Inclusion of family members in the assessment of patients with chronic pain can improve outcomes. Family functioning can be assessed in four basic areas: boundaries, power, communication, and intimacy....Full Text Available
The current study investigated relations among ethnic similarity in caregiver-therapist pairs of youth participating in Multisystemic Therapy, therapist adherence, and youth long-term behavioral and criminal outcomes. Participants were 1,979 youth and families treated by 429 therapists across provider organizations in 45 sites. Relations were found, independently, and in the presence of ethnic similarity, between adherence and reductions in youth externalizing and internalizing behavior problems 1-year posttreatment and youth criminal charges 4 years posttreatment. Relations between ethnic similarity and outcomes were found only for reductions in youth externalizing behavior problems and not when adherence was included in the model. Adherence ratings were higher, however, in ethnically similar caregiver-therapist pairs, and evidence was found that this increased adherence predicted slightly better outcomes for youth. ...
Background:There is a need for simple imaging parameters capable of predicting therapeutic outcome.Methods:This retrospective study analysed 50 patients...Full Text Available
Background:This study evaluated the outcomes of patients with complex or persistent thoracobiliary fistulae following penetrating liver trauma, who underwent endoscopic biliary intervention...Full Text Available
ObjectiveAlthough endoscopic procedures for lumbar disc diseases have improved greatly, the postoperative outcomes for high grade inferior migrated discs are not satisfactory. Because...Full Text Available
IntroductionRadiotherapy outcomes might be further improved by a greater understanding of the individual variations in normal tissue reactions that determine tolerance. Most published...Full Text Available
BackgroundOne-stage implant placement has clinically acceptable treatment outcomes. Among other advantages, it may allow investigation of early wound healing. The...Full Text Available
IntroductionIn critically ill patients the relationship between the storage age of red blood cells (RBCs) transfused and outcomes are controversial. To determine if duration of RBC...Full Text Available
ObjectivesWe undertook a meta-analysis to assess outcomes for drug-eluting (DES) and bare metal stents (BMS) in percutaneous coronary intervention (PCI) for unprotected...Full Text Available
Detrended fluctuation analysis (DFA) is a recently developed technique suitable for describing scaling behavior of variability in physiological signals. The purpose of this study is to explore...Full Text Available
AIM: To compare 2 different types of covered esophageal nitinol stents (Ultraflex and Choostent) in terms of efficacy, complications, and long-term outcome.METHODS: A retrospective review of...Full Text Available
Background & objectives: Fatigue is a debilitating symptom experienced by patients undergoing dialysis, but there is only limited information on its prevalence and its association with patient...Full Text Available
PurposeWound infection after an ileostomy reversal is a common problem. To reduce wound-related complications, purse-string skin closure was introduced as an alternative to conventional...Full Text Available
ObjectiveThe purpose of this study was to compare clinical and radiological outcomes of percutaneous endoscopic lumbar discectomy (PELD) and open lumbar microdiscectomy (OLM) for...Full Text Available
Mechanism-based inhibition of cytochrome P450 (CYP) 3A4 is characterized by NADPH-, time-, and concentration-dependent enzyme inactivation, occurring when some drugs are converted by CYPs to reactive...Full Text Available
BackgroundInadequate platelet inhibition despite aspirin and clopidogrel therapy during and after a percutaneous coronary intervention is associated with an impaired clinical outcome....Full Text Available
Average human behavior in cue combination tasks is well predicted by Bayesian inference models. As this capability is acquired over developmental timescales, the question arises, how it is learned....Full Text Available
IntroductionTransfusion is a common treatment in pediatric intensive care units (PICUs). Studies in adults suggest that prolonged storage of red blood cell units is associated with...Full Text Available
Anxiety may cause adverse outcomes through physiologic pathways in patients with cardiac disease. The purpose of this dissertation was to investigate anxiety and its correlates in persons with acute myocardial infarction (AMI) and heart failure (HF). The ...
BackgroundSocial isolation affects a significant proportion of older people and is associated with poor health outcomes. The current evidence base regarding the effectiveness of...Full Text Available
Acute kidney injury (AKI) is a common clinical problem with significant clinical and economic consequences. A number of studies point to a rising incidence of AKI in the hospital and in the intensive...Full Text Available
IntroductionLaparoscopic distal pancreatectomy has been described for more than a decade now and has been considered technically feasible, safe, and with reproducible outcomes. It...Full Text Available
BackgroundDuring surgery, controlled haemostasis to prevent blood loss is vital for a successful outcome. It can be difficult to ligate vessels located deep in the abdomen. A device...Full Text Available
BackgroundHip surface replacement arthroplasty (SRA) can be an alternative for total hip arthroplasty. The short and long-term outcome of hip surface replacement arthroplasty mainly...Full Text Available
BackgroundHealth-Related Quality of Life assessment is widely used in clinical research, but rarely in clinical practice. Barriers including practical difficulties administering...Full Text Available
Abstract Background- Vitiligo, characterized by destruction of melanocytes, causes a patchy depigmentation of the skin. It has been hypothesized to have an autoimmune pathogenesis. Autoimmune disorders are more common among women and may be associated with adverse pregnancy outcomes, such as recurrent abortions, intrauterine growth restriction (IUGR), and pre-eclampsia. Objective- The purpose of this study was to investigate whether patients with vitiligo have increased rates of gestational complications. Methods- A retrospective comparative study was undertaken comparing pregnancy complications of patients with and without vitiligo. The population was composed of all singleton deliveries that occurred at the Soroka University Medical Center in Israel during the years 1988-2006. Women lack...
Hung and Quyen's model (analysis of strategic interactions between players in the game theoretic framework) is first recapitulated. Solutions to the embargo game with the seller acting as the Stackelberg leader in both periods. Then the timing coordination issue is discussed and perfect equilibrium outcomes under different structures of leader-follower in the game are compared. Numerical simulations show that the structure corresponding to alternated leadership from one period to the other yields the perfect equilibrium outcome that is Pareto improving with respect to the structure where the buyer is first mover in both periods and Pareto dominant for some specific values of the parameters embedded in the game.
Strategic management of key accounts has become an important component of many companies' sales efforts. This research introduces a strategic framework of key account performance that integrates theory from relationship marketing, key account management, and customer equity. Using the three drivers of customer equity - value equity, brand equity, and relationship equity - the framework captures both the relational outcomes (relationship commitment and trust) and financial performance outcomes (profitability and share of spend) of strategic decisions made in key account programs. Implications and future research are then discussed.
Anesthetic techniques vary widely in the endovascular repair of abdominal aortic aneurysms (EVAR). Previous studies have demonstrated the feasibility of using local anesthesia. However, the ideal anesthetic technique has not been determined. This study examines whether anesthesic technique influences the outcomes of EVAR. Data regarding demographics, risk factors, procedural characteristics, recovery characteristics, treatment complications, acute ( 0.05, ANOVA). From these results we concluded that EVAR with local anesthesia is a safe and efficacious method that may reduce recovery times and postoperative medical morbidity compared to use of genera1 or spinal/epidural anesthesia.
The OASIS Registry started annual collection of longitudinal data on patients on home parenteral nutrition (HPN) in 1984. This report describes outcome profiles on 1594 HPN patients in seven disease categories. Analysis showed clinical outcome was principally a reflection of the underlying diagnosis. Patients with Crohn's disease, ischemic bowel disease, motility disorders, radiation enteritis, and congenital bowel dysfunction all had a fairly long-term clinical outcome, whereas those with active cancer and acquired immunodeficiency syndrome (AIDS) had a short-term outcome. The long-term group had a 3-year survival rate of 65 to 80%, they averaged 2.6 complications requiring hospitalization per year, and 49% experienced complete rehabilitation. The short-term group had a mean survival of 6 months; they averaged 4.6 complications per year and about 15% experienced complete rehabilitation. The registry ...
The clinical manifestation of wounds of the heart is determined by the mode, site and size of the injury as well as the structure of the pericardial and myocardial lesion. Diagnosis can be confirmed by ECG and echocardiography. Only 20% of the patients with penetrating wounds of the heart live for more than 30 minutes. Pericardio-centesis should be used only to gain time for a safe sternotomy, cardiac decompression and suture of the wound of the heart. An aggressive surgical approach is mandatory. Cardiopulmonary bypass is necessary only to correct of concomitant lesions. PMID:1983618
The most common causes of omental sac collections (OSC) are necrotic pancreatitis (90%) and pancreatic trauma (10%). Acute OSC is a form of local peritonitis in acute pancreatitis, subacute OSC are caused by internal pancreatic fistulas. The clinical and radiological signs, enzymatic activity of the exudate, morphological features of peritonitis were investigated. Treatment of acute OSC included conservative measures, of subacute OSC-surgical procedures. PMID:9163152
A rare, true aneurysm of a branch of the right subclavian artery is described. Transcatheter coil embolization of the feeder artery was successful in obliterating blood flow into the aneurysm and the mass reduced in size. However, the aneurysm reenlarged over the next week of follow-up due to development and enlargement of the collateral vascular network. Extirpation of the aneurysm was performed. Histopathological examination revealed a true aneurysm. PMID:11833847
70 patients with squamouscell carcinoma of larynx and hypopharynx were examined by computed tomography; the TNM staging of tumors by CT, by endoscopy and by surgical operation was reviewed. CT proved to be reliable both to recognize the presence of neoplasms, with the exception of those very superficial, and their deep spreading to preepiglottic and paralaryngeal spaces, to the soft tissues of the neck and to the cartilages. Therefore CT is the examination of choice in laryngeal neoplasms staging, because it precisely completes the clinical and endoscopical informations.
Neutron activation of nitrogen and hydrogen in the body, the isotope dilution technique and the measurement of naturally radioactive potassium in the body are among the new nuclear methods, now under collaborative development by the Australian Nuclear Scientific and Technology Organization and medical specialists from several Sydney hospitals. These methods allow medical specialists to monitor the patient's response to various diets and dietary treatments in cases of cystic fibrosis, anorexia nervosa, long-term surgical trauma, renal diseases and AIDS. ills.
Neuroepithelial cysts are rare and mostly asymptomatic cerebrospinal fluid (CSF)-like cysts. We describe herein the imaging findings in five patients with neuroepithelial cysts. Two cases of proven and three of presumed neuroepithelial cysts are presented. Three of five are located in the thalamus, a location which is not characteristic for neuroepithelial cysts. In the case of incidental finding of asymptomatic neuroepithelial cyst, clinical and radiological follow-up is indicated and surgical intervention is not necessarily warranted. (orig.) With 5 figs., 6 refs.
One hundred and thirty-seven lung cancer patients (123 non-small-cell lung cancers (NSCLC), 10 small-cell lung cancers (SCLC) and four carcinoid tumours) who underwent surgery in an attempt at complete...Full Text Available
The authors describe their experience of endocavitary radiotherapy of adenomas and carcinomas of the lower rectum. The method is an alternative for patients who cannot undergo standard surgical procedure or do no want a permanent colostomy. This method is cheap, fast and causes little discomfort to the patients, gives reasonable long-term results and has low morbidity. 11 refs., 4 figs., 2 tabs.
The tapeworm Spirometra mansonoides infects man worldwide, particularly in Asian countries. Rarely, the central nervous system is involved; such a case is presented here. In the total of 12 reported cases, including the case described, the worm presented clinically as a mass suspicious for neoplasm or chronic abscess cavity. Surgical removal was invariably curative in each case. Although infrequent, the possibility of tapeworm infection should be entertained in the evaluation of intracranial masses in patients who have visited exotic locales. PMID:2191089
Chondrosarcomas are the most frequently occurring primary malignant chest wall tumors. Furthermore, the lungs serve as the most frequent sites for metastases. Pulmonary metastases from sarcomas usually...Full Text Available
Ileal dysgenesis is an uncommon condition of unknown etiology occurring in the distal ileum in the region of the vitelline duct. The CT appearance of this lesion, although not previously described to our knowledge, is characteristic. We report a patient with ileal dysgenesis who had an abdominal CT scan to evaluate chronic iron deficiency anemia and protein-losing enteropathy. Recognition of this lesion by pediatric radiologists is important; so that surgical treatment, which is simple and effective, can be initiated quickly. (orig.)
Dialdehyde cellulose (DAC) was prepared by periodate oxidation of various cellulosic materials in the form of sutures and bandages. The suitability of using DAC for making bioabsorbable sutures and antimicrobial wound dressing bandages was studied. The investigations indicated that DAC combines the requisite mechanical strength with an inherent antimicrobial nature. It was found that the oxidation of cellulose to yield DAC also rendered it bioabsorbable. The DAC was coated with different concentrations of urea formaldehyde in order to improve the mechanical properties for making sutures. PMID:3719037
In this paper we present a modeling framework for analyzing computer models with two types of variations. The paper is based on a case study of an orthopedic surgical unit, which has both controllable and uncontrollable factors. Our results show that this structure of variation can be modeled effectively with linear mixed effects models and generalized additive models. Copyright (C) 2009 John Wiley & Sons, Ltd.
The purpose of this study is to investigate the role of femoral marrow MR imaging as predictor of outcome for hemopoietic stem cell transplantation (HSCT) in beta-thalassemia major. MR imaging of the proximal femur, including T1- and T2-weighted spin echo and short-tau inversion recovery and in-phase and out-of-phase fast field echo images, was prospectively performed in 27 thalassemia major patients being prepared for HSCT. The area of red marrow and its percentage of the proximal femur were measured, and the presence of marrow hemosiderosis was assessed. Age-adjusted multivariate logistic regression was used to determine the relationship between red marrow area percentage and marrow hemosiderosis and HSCT outcome. Red area percentage were less in patients with successful (90.25{+-}4.14%) compared to unsuccessful transplants (94.54% {+-}2.93%; p=0.01). Red marrow area percentage correlated positively with duration of symptoms(r=0.428, p=0.026) ...
The main objectives were to evaluate efficacy and acceptability of a developmentally sensitive cognitive behavioral therapy for anxiety-based school refusal in adolescence. Twenty school-refusing adolescents meeting DSM-IV anxiety disorder criteria participated in a non-randomized trial, together with parents and school staff. Outcome was assessed at post-treatment and 2-month follow-up. Treated adolescents showed significant and maintained improvements across primary outcome variables (school attendance; school-related fear; anxiety), with medium to large effect sizes. Half of the adolescents were free of any anxiety disorder at follow-up. Additional improvements were observed across secondary outcome variables (depression; overall functioning; adolescent and parent self-efficacy). The treatment was rated as acceptable by adolescents, parents, and school staff, which may help explain the very low attrition rate. Social ...
Background: The outcome of acute myocardial infarction (AMI) complicated with cardiogenic shock is poor. The aim of this study was to analyse, whether upfront abciximab administration could improve the outcomes of cardiogenic shock. Methods: This multicentre open trial randomized 80 patients with AMI complicated by cardiogenic shock expected to undergo primary PCI into group A (routine upfront-pre-procedural-abciximab bolus followed by 12-h abciximab infusion) and group B (standard therapy). The study primary objective was 30-day combined outcome (death/reinfarction/stroke/new severe renal failure). Results: PCI was technically successful in 90% (A) versus 87.5% (B) patients. Abciximab was used in 100% (A) versus 35% (B). The primary endpoint occurred in 17 group A patients (42.5%) and 11 ...
In an era of unprecedented technological advancement and economic expansion, construction practice continues to evolve but construction education has not changed appreciably since the 1990s. This schism has prompted industry, government, and other key constituents to question the relevancy and efficacy of current programs. The Accreditation Board for Engineering and Technology (ABET) Engineering Criteria 2000 and the American Council for Construction Education (ACCE) emphasizes outcomes over process, and provides an opportunity for stakeholders to help universities define educational goals and objectives and design a curriculum to meet the desired outcomes. While the need for curriculum modification has been acknowledged, the industry position was amorphous and anecdotal and therefore difficult to address. Qualitative methodologies such as formal surveys and structured interviews can be used to capture and quantify industry expectations of the ...
Background 2009 pandemic influenza A(H1N1) has led to a global increase in severe respiratory illness. Little is known about kidney outcomes and dialytic requirements in critically ill patients infected with pandemic H1N1. Study Design Prospective observational study. Setting & Participants 50 patients with pandemic H1N1 admitted to any of 7 intensive care units in Manitoba, Canada, were prospectively followed. Outcome & Measurements Outcomes were kidney injury and kidney failure defined using RIFLE (risk, injury, failure, loss, end-stage disease) criteria or need for dialysis therapy. Results The pandemic H1N1 group was composed of 50 critically ill patients with pandemic H1N1 with severe respiratory syndrome (47 confirmed cases, 3 probable). Kidney injury, kidney failure, a...
In multi-organisational contexts, scenario building has been used to engage stakeholders in a critical discussion on issues of mutual importance, and to gain their support with regards to possible future responses. A review of existing literature suggests that much has been written regarding the process of scenario development and the benefits of the process, but the detailed analysis of scenario building outcomes, which encompass a large number of issues and their complex interconnections, has not been made explicit for studying and enhancing understanding of a complex societal problem. This paper presents a systematic method for analysing such complex outcomes in order to facilitate reflective thinking on important issues within the wider context for policy development. The method was em...
Abstract Toll-like receptor 2 (TLR2) is an immune sensor for gram-positive bacterial cell wall components. Single-nucleotide polymorphisms (SNPs) in the TLR2 gene that impair its function may, therefore, influence the risk and outcomes of gram-positive bacterial infections. In a cohort of 694 liver transplant recipients, we assessed the TLR2 SNP that is translated into an amino acid substitution of arginine for glutamine at position 753 (R753Q), and we found that its presence was associated with the clinical characteristics and outcomes of gram-positive bacterial infections. The proportions of patients with the TLR2 R753Q SNP did not significantly differ between those with gram-positive bacterial infections and those without gram-positive bacterial infections (9.6% versus 9.6%, P = 0.999)....
Patients with acute myocardial infarction (AMI) and diabetes mellitus, as well as patients admitted with elevated blood glucose without known diabetes, have impaired outcome. Therefore intensive glucose-lowering therapy with insulin (IGL) has been proposed in diabetic or hyperglycaemic patients and has been shown to improve survival and reduce incidence of adverse events. The current manuscript provides an overview of randomised controlled trials investigating the effect of IGL. Furthermore, systematic glucose?insulin?potassium infusion (GIK) has been studied to improve outcome after AMI. In spite of positive findings in some early studies, GIK did not show any beneficial effects in recent clinical trials and thus this concept has been abandoned. While IGL targeted to achieve normoglycaemi...
Despite advances in polymer and drug technology, the underlying stent platform remains a key determinant of clinical outcome. A clear understanding of stent design and the differences between various stent platforms are of increasing importance for the interventional cardiologist. Reduction in stent strut thickness has been associated with improved stent deliverability, improved procedural outcome, and lower rates of subsequent restenosis. Newer-generation 316L-SS stent designs have enabled reduced strut thickness while retaining radial strength and minimizing recoil, but with significant loss of radiopacity, leading to reduced visibility. Cobalt chromium alloys have enabled a reduction in stent strut thickness to around 80?90 mm while retaining modest radiopacity, but due to higher elasti...
Summary Background Pemphigus vulgaris and pemphigus foliaceus are rare, potentially life-threatening, autoimmune disorders characterized by antibodies to epidermal adhesion molecules. Clinical characteristics are painful chronic erosions of mucous membranes and of the skin. There are only few published studies on the impact of the disease on the health status (HS) of patients with these conditions. Objectives To assess the impact of disease on the HS of patients with pemphigus. Methods Fifty-eight patients enrolled at the Bullous Skin Diseases Unit of IDI-IRCCS in the period January-June 2006 were assessed for their HS using the Medical Outcomes Study 36-item short form health survey (SF-36) questionnaire and for anxiety and depression using the Institute for Personality and Ability Testin...
The article draws on interpretive frameworks from diffusion research and social network analysis to explore one particular "travelling reform"--outcomes-based education--that went global. The argument is made that by virtue of studying late adopters of a travelling reform one is examining globalisation. The cases in point for late adoption are Central Asian education systems (in particular Mongolia and Kyrgyz Republic) that borrowed outcomes-based education reforms at a time when the popularity of similar reforms were already in decline in other countries, notably in New Zealand, Australia and South Africa. The emphasis of this study is on the timing of policy borrowing, and it is suggested that more attention is given to the economics of policy borrowing. (Contains 3 notes.)
While both sperm number and quality are now recognized to be important in determining the outcome of sperm competition, very few studies have experimentally assessed the influence of these two parameters simultaneously. We studied the effect of sperm quality and number on competitive fertilization success in an internal-fertilizing fish, the guppy (Poecilia reticulata), which is characterized by high levels of sperm competition. We artificially inseminated virgin females with varying proportion of sperm from two competing males, while holding constant the total number of sperm transferred to the female. Sperm morphology and sperm swimming velocity were also determined prior to insemination. The paternity outcome of sperm competition trials was assessed through molecular analyses of the res...
The aims of this study were to identify risk factors and evaluate the association with clinical outcomes of postoperative cardiac surgery-associated acute kidney injury (CSA-AKI). Data from 2488 consecutive adult patients were analyzed. Patients were classified as having CSA-AKI based on the risk, injury, failure, loss of kidney function, and end-stage kidney disease (RIFLE) criteria using peak postoperative creatinine in the postoperative intensive care unit (ICU). Multiple stepwise logistic regression analysis was used to identify independent risk factors for CSA-AKI. CSA-AKI occurred in 584 patients (23.5%). CSA-AKI patients had significantly longer aortic cross-clamp and cardiopulmonary bypass times. Furthermore, CSA-AKI patients had higher hospital mortality (5.5% vs 1.5%, PCopyright2...
Summary Background: Red blood cell (RBC) transfusion in hemorrhagic shock is life saving. However, several clinical trials have shown that blood transfusion in the critically ill patient might be associated with adverse outcomes. Furthermore, an association between prolonged blood storage and adverse effects of RBC transfusion has been postulated. The aim of this study is to examine the effect of blood storage time on resuscitation outcome, in an animal model of hemorrhagic shock. Methods: 20 Wistar rats were phlebotomized in order to induce reversible hemorrhagic shock. Half of them were resuscitated with blood stored for a short period of time (4 days), and the other ones were resuscitated with blood stored for a prolonged time (14 days). Blood samples for hemoglobin, pH, lactate, bicarb...
Abstract Introduction.- Sling erosion/extrusion is a complication after suburethral sling insertion for female stress urinary incontinence that occurs in approximately 6% of patients. Symptoms may include vaginal discharge, infections, postcoital bleeding, and alterations of the sexual function. Little is known about the effect of sling erosion on the sexual function of the male partner. Aim.- The aim of this study was to determine male sexual function in partners of women who had undergone sling insertion for stress urinary incontinence and who developed sling erosion postoperatively. Main Outcome Measures.- Main outcome measures were the Brief Male Sexual Function Inventory (BMSFI) and visual analog scale (VAS) scores. Methods.- Male partners of patients who presented with sling erosion ...
Complex numbers are an intrinsic part of the mathematical formalism of quantum theory and are perhaps its most characteristic feature. In this article, we show that the complex nature of the quantum formalism can be derived directly from the assumption that a pair of real numbers is associated with each sequence of measurement outcomes, with the probability of this sequence being a real-valued function of this number pair. By making use of elementary symmetry conditions, and without assuming that these real number pairs have any other algebraic structure, we show that these pairs must be manipulated according to the rules of complex arithmetic. We demonstrate that these complex numbers combine according to Feynman's sum and product rules, with the modulus-squared yielding the probability of a sequence of outcomes.
The aim of this study is to clarify the relation among developmental outcome, nutritional state during the neonatal period, maturational electroencephalographic changes. Thirteen extremely low birth weight infants who completed 6- or 9-year follow-up were a subject of this study. Undernutrition was defined as enteral feeding below 100mL/kg/day at 3weeks of age. Dysmature patterns were defined as the persistence of EEG patterns 2weeks or more immature for post-conceptional age. IQ was examined at 6 and 9years of age. Body height and weight, and head circumference at 6years of age were stratified by the percentile grades. Full and verbal IQ was significantly lower in infants with undernutrition than those with normal nutrition. Among infants with undernutrition, those with persistent dysmatu...
Summary Many important moral decisions, particularly at the policy level, require the evaluation of choices involving outcomes of variable magnitude and probability. Many economic decisions involve the same problem. It is not known whether and to what extent these structurally isomorphic decisions rely on common neural mechanisms. Subjects undergoing fMRI evaluated the moral acceptability of sacrificing a single life to save a larger group of variable size and probability of dying without action. Paralleling research on economic decision making, the ventromedial prefrontal cortex and ventral striatum were specifically sensitive to the "expected moral value" of actions, i.e., the expected number of lives lost/saved. Likewise, the right anterior insula was specifically sensitive to outcome p...
Abstract:- Two motorcycle riders lost control of their vehicle, fell, and hit a guardrail, which acted as a blade and led to a rapid, fatal outcome. In one case, the high velocity of the body at the time of the impact resulted in complete detachment of the trunk. Reconstruction of the accident dynamics enabled the guardrail post to be identified as the means of injury in both cases. The two accidents occurred over a short period of time, highlighting a dangerous phenomenon that in less severe cases is presumably associated with different degrees of survivor disability. The accidents deserve mention, because a different design of the impact surface of the guardrail post might have prevented the lethal outcome. There is an urgent need for legislators to pass regulations that modify crash bar...
There are 2 models of male adjustment of sperm investment in the ejaculate in relation to sperm competition. The "risk model" predicts that as "risk" of sperm competition increases, sperm investment also increases. This prediction has been supported in many species, including mammals. The "intensity model" involves the number of competing males copulating with the same female and predicts that males will allocate the highest sperm investment at low sperm competition intensity (SCI) and then decreasing sperm investments as SCI increases. Two alternative outcomes are that sperm investment is unaffected by SCI and that sperm investment increases as SCI increases. There are studies supporting all 3 possible outcomes in relation to SCI but no data on mammals. The present paper presents the firs...
Equinovarus of the foot is the most common lower extremity deformity following traumatic brain injury. We evaluated outcomes of the split anterior tibialis tendon transfer (SPLATT) for correction of equinovarus in 47 patients with hemiplegic traumatic brain injury and specifically studied differences in outcomes with two tendon fixation techniques. Seventeen patients constituting Group I underwent fixation with one technique and 30 constituting Group II had another technique. Patients in both groups had appropriate procedures based on dynamic electromyography and gait analyses. Both groups were demographically comparable. All 47 feet were corrected to plantigrade position. Thirty-six of 47 patients became brace-free at final followup. There was a notable decrease in the use of ambulatory a...
Purpose In literature, few papers compare different hemostatic devices in laparoscopic adrenalectomy. This sequential cohort study analyzes the outcomes of laparoscopic adrenalectomy performed by different hemostatic instruments, to evaluate if any of them has any advantage over the other and as secondary endpoints, the impact of body mass index (BMI) and tumor size on the indication, and the outcome of laparoscopic adrenalectomy. Methods Forty-six patients, aged 54.6???46?years, underwent laparoscopic adrenalectomy over 5?years. Mean BMI was 27???4.8?kg/m2. Twenty-four patients had a left tumor, and 22 had a right one. Patients were divided into two groups according to the hemostatic device: Ultracision was used in 26 patients, and Ligasure was used in 20. Groups were well matched for his...
BackgroundAlthough self-expandable metal stent (SEMS) insertion is widely used for relief of malignant colorectal obstructions, the immediate technical and clinical failure rates of SEMSs and the associated risk factors remain largely unknown. ObjectiveTo identify rates and factors predictive of technical and clinical failure of SEMSs when their use is attempted for the decompression of malignant colorectal obstruction. DesignRetrospective chart review. SettingA tertiary-care academic medical center in South Korea. PatientsThis study involved a total of 412 patients with malignant colorectal obstruction in whom SEMS insertion was attempted. InterventionPlacement of colonic SEMSs. Main Outcome MeasurementsTechnical success and immediate and long-term clinical success rates. ResultsTechnical...
ObjectiveInjury is the leading cause of death among American youth, killing more 11-year-olds than all other causes combined. Children with symptoms of externalizing behavior disorders such as attention-deficit/hyperactivity disorder (ADHD) and conduct disorder (CD) may have increased risk. Our aims were to determine: (1) whether increasing symptoms of ADHD and CD associate positively with injuries among a community sample of fifth graders; and (2) whether symptoms of ADHD and CD have a multiplicative rather than additive association with injuries among the sample. MethodsData were collected from 4745 fifth graders and their primary caregivers participating in Healthy Passages, a multisite, community-based study of pediatric health risk behaviors and health outcomes. The primary outcome wa...
In the spring of 2009, the Romanian government has proposed a restructuring of the national power generation sector segment that is still owned by the state. As most of the power generation capacity is still state-owned, this restructuring will dramatically alter the competitive landscape of this sector. This paper is analyzing the rationale and principles of the restructuring as stated by government documents and officials, the assessment methodology and criteria proposed by the government, as well as the proposed final outcome of the restructuring initiative. Based on this critical assessment and the early results of the restructuring's implementation, we are able to make recommendations that can be considered for a revised restructuring approach. - Research highlights: #-># Power generation sector restructuring is proposed in 2009 by the Romanian government. #-># We assess the objectives, methodology and proposed outcome of the ...
One of the main causes of hip prostheses failure is the premature wear of its components. Wear of metal-on-metal joints is a concern due to the toxicity and biological reaction of wear debris and metallic corrosion. The main aim of the present study was to investigate the tribological and corrosion behavior of surface engineering CoCrMo alloy. Different surface conditions were obtained on surgical grade wrought CoCrMo alloy: plasma nitrided (520^oC by 7h at gas mixture of 10% N2+90% H2), PVD coated (monolayer CrN and multilayer (TiN/CrN)x3) and modified using duplex surface engineering technology (a combination of the two previous approaches: plasma nitriding followed by plasma assisted PVD). Surfaces were characterized using scanning electron microscopy, nanoindentation, AFM and scratch t...
We examined 19 patients with post-irradiation intestinal injury in the uterine cervix cancer for 12 years between 1985 and 1996. We discuss the usefulness and complications of surgery, mainly colostomy. The patients aged from 36 to 80 (average age 61) were treated, and their disease states were 12 cases of rectovaginal fistula, 2 of small intestinal fisfula, 1 of rectum posterior membranous fistula, 3 of proctostenosis, and 14 of proctitis with hemorrhage (including duplication). Surgical methods used were 18 cases of colostomy (2 cases were treated under peritoneum mirror) and 2 of enterocolostomy (including duplication). Eleven out of 19 patients who underwent surgery are alive now. Generally the post-irradiation intestinal injury was intractable, and the method of treatments were limited due to the coexistence of various diseases. The colostomy is safe and less invasive. Therefore patients with uterine cervix cancer having various complications can obtain high ...
Sprengel deformity is a congential malformation with usually unilateral elevation and medial rotation of the scapula. An omovertebral bone is generally present. Associated skeletal malformations are frequently present. Though functional impairment is mild, the cosmetic and psycho-social impairment can be considerable. The prognosis of early surgical therapy is good. The presented case also justifies surgical correction in the older child. (orig.) [German] Die Sprengel-Deformitaet ist eine angeborene Fehlbildung mit meist einseitiger Elevation und Medialrotation der Skapula. Meist ist ein Os omovertebrale vorhanden. Assoziierte skelettale Fehlbildungen sind haeufig. Obgleich funktionell wenig einschraenkend, ist die kosmetische und psycho-soziale Beeintraechtigung oft erheblich. Die Prognose der fruehen operativen Therapie ist gut. Der vorliegende Fall ermutigt zur operativen Therapie auch im hoeheren Kindesalter. (orig.)
Full text: Tumour ablation with radiofrequency (RF) energy is a relatively new procedure for the treatment of focal malignant disease. At our institution this is currently being used in the treatment of certain liver and lung lesions with the patients involved being enrolled in clinical trials. The poster describes the technique used at our institution for the placement of the radiofrequency ablation electrode using CT fluoroscopy. Criteria for patient selection are included. Complications from the procedure are described, as well as follow up appearances and results. Our results from the treatment of primary and secondary lesions in the liver correlate well with published literature. Treatment is still not as successful as surgical resection but there is significantly less morbidity. Where this method may be appropriate is when the patient is not a candidate for surgical resection. The treatment of colorectal metastases in the lung shows early ...
To define the prognostic factors after surgical resection and evaluate the effectiveness of Post Operative Radiotherapy (PORT) in cases with cholangiocarcinoma, 44 cases with proximal cholangiocarcinoma were examined. The mean observation period was 20.6 months, and the survival rates 1, 3 and 5 years after the resection were 79.9%, 59.8% and 39.3%, respectively. Univariate analysis revealed that the presence of lymph node metastasis and absence of PORT were significant poor prognostic factors. Multivariate analysis revealed that the absence of PORT was a significant poor prognostic factor. The survival rates for 1 and 3 years after the resection were 80.0% and 40.0% in the curable A/B and PORT (-) group, and 100% and 53.3% in curable C and PORT (+) group. There were no local reccurences in the pathologically classified hm2 and em2 patients who underwent PORT. Even when the surgical margin is positive for the carcinoma pathologically, it is ...
Patients with haemarthros of the knee were examined by MRI and arthroscopy to identify the bleeding source and to determine surgical or conservative therapy. A prospective study was performed on 120 patients who underwent MRI and arthroscopy, point lesions and bleeding sources were documented separately on a standardised form. Arthroscopy demonstrated a ruptured anterior cruciate ligament in 86%, meniscal tears in 55%, disruption of collateral ligaments in 17%, osteochondral lesions in 5% and tears of capsule or plicae in 13%. Disruption of cruciate ligaments caused haemorrhage in all but three cases. In contrast, only meniscal tears located very adjacent to the meniscal basement had bled. Those types of osteochondral lesions caused haemorrhage characterised on MRI by destruction of the subchondral plate and overlying cartilage. Severe lesions of the knee were diagnosed by MRI in 71% to 100%, slight lesions in 13% to 40% of the cases. Single, combined and bland ...
The primary aim was to evaluate delayed contrast-enhanced MRI in depicting perineural spread of hilar cholangiocarcinoma (CCC) and consequently to determine the capability of MRI/MRCP for staging CCC. Fifteen patients that underwent MRI/MRCP and surgical treatment were retrospectively included. Two radiologists evaluated MR images to assess delayed periductal enhancement, extent of bile duct stenosis, liver parenchymal and vascular involvement and presence of liver atrophy. An agreement between delayed enhancement of the bile duct walls and perineural neoplastic spread showed a very good correlation factor (0.93). The overall accuracy in detecting biliary neoplastic invasion was higher for delayed T1-weighted images (93.3%) than for the MRCP images (80%), and T1-delayed image increased the MR accuracy in assessing the neoplastic resectability (p < 0.05). MRI correctly predicted vascular involvement in 73% and liver involvement in 80% of the cases. The number of ...
Until recently no active treatment for advanced or metastatic gastrointestinal stroma tumors (GIST) was available. The tyrosine kinase inhibitor imatinib has revolutionized the treatment of this disease and the median overall survival now reaches 5 years. The standard dose of imatinib is 400 mg per day. Locally advanced GIST should be treated with systemic therapy prior to surgical resection. Imatinib was recently licensed for adjuvant therapy following complete surgical removal of GIST in patients with a significant risk of recurrence. (orig.) [German] Bis vor einigen Jahren existierte keine wirksame systemische Therapie fuer fortgeschrittene oder metastasierte gastrointestinale Stromatumoren (GIST). Der Tyrosinkinaseinhibitor Imatinib hat die Behandlung dieser Tumoren revolutioniert, die mediane Ueberlebenszeit liegt heute bei etwa 5 Jahren. Die Standarddosierung von Imatinib betraegt initial 400 mg/Tag. Lokal fortgeschrittene Tumoren werden ...
To analyze and review the most common focal lesions of the external auditory canal (EAC), describing the computed tomography (CT) findings. The CT images of EAC were reviewed in a series of 167 patients. Abnormal findings were recorded in 13 cases. The CT images were correlated with otoscopic and/or intraoperative findings. There were four cases of osteoma (one located outside the EAC); all of which were treated surgically, as was the one case of exostosis. Six patients presented debris in EAC, coinciding with clinical evidence of external otitis. There were two cholesteatomas derived from EAC, one of them secondary to survery to treat osteoma. On patient was diagnosed as having a basal cell carcinoma of the ear, extending to EAC, but refused to undergo surgery. Five patients presented small triangular laminae of dense bone arising from the upper wall of the EAC which were defined as abnormal variants of the fusion of the temporal squamous epithelium to the ...
The purpose of this study was to determine the feasibility of virtual endoscopy, named as ''virtual CT laparoscopy'', in the hepatobiliary system prior to laparoscopic cholecystectomy. We applied this technique to 28 patients suspected of having biliary disease. These images were compared and analyzed qualitatively based on visualization of the structures critical to operative cholangiography and surgical findings. Twenty-four patients, who underwent laparoscopic cholecystectomy, were evaluated as follows: the common bile duct and the hepatic duct were adequately visualized in 23 (96%) of the 24 patients, the cystic duct in 21 (88%), the gallbladder opacification in 20 (83%), the liver inferior surface in 20 (83%). Four patients had anatomic variations detected virtual CT laparoscopy and were proven by operative cholangiography and surgical findings. We emphasize that our new technique may contribute to the ...
To assess the potential of CT in evaluating the histological severity of acute appendicitis in comparison with surgical and pathological findings. The CT images of 75 patients with surgically proven appendicitis, including 10 cases of catarrhal, 34 of phlegmonous, and 31 of gangrenous appendicitis, were retrospectively analyzed for the following five CT findings: hazy periappendiceal densities, enlarged appendix, increased enhancement of the appendiceal wall, increased enhancement of the periappendiceal intestinal wall, and deficiency of the appendiceal wall. By comparing all the CT findings and the pathological severity of appendicitis (catarrhal, phlegmonous, and gangrenous), the prevalence of the five CT findings was calculated for each pathological category. Abnormal CT findings were noted in only one case of catarrhal appendicitis. Increased enhancement of the appendiceal wall was observed in all 29 cases of phlegmonous appendicitis ...
Described is the diagnosis for the cancer extension of cholangiocarcinoma by various imaging techniques and processes to support the current surgical procedure based on preoperative biliary drainage. The cancer tends to locally extend horizontally and/or vertically and its diagnosis is important for surgical indication. For the indication, multi-detector raw CT (MDCT) and MR cholangio-pancreatography (MRCP) are useful and particularly, the former can give multi-phase (arterial, portal and delayed) images to reconstruct multiplanar (MPR) and CT angiographic 3D images, which have made the previous invasive examinations like angiography and percutaneous transportal contrasting unnecessary. MDCT and MRCP can almost complete the diagnosis of the extension. The operative procedure is decided dependently on the site of the lesion, and of which diagnosis, whether it is hepatic hilar/on upper bile duct or middle/lower ductal, is different. MDCT-MPR and ...
The clinical courses of heterotopic ossification (HO) as a consequence of trauma and central nervous system insults have many similarities as well as dissimilarities. Detection is commonly noted at two months. The incidence of clinically significant HO is 10%-20%. Approximately 10% of the HO is massive and causes severe restriction in joint motion or ankylosis. The most common sign and symptom are decreased range of motion and pain. The locations are the proximal limbs and joints. Sites of HO about a joint may vary according to the etiology of the HO. Roentgenographic evolution of HO occurs during a six-month period in the majority of patients. Treatment modalities include diphosphonates, indomethacin, radiation, range of motion exercises, and surgical excision. Surgical timing differs according to etiology: traumatic HO may be resected at six months; spinal cord injury HO is excised at one year; and traumatic brain injury HO is removed at 1.5 ...
The clinical courses of heterotopic ossification (HO) as a consequence of trauma and central nervous system insults have many similarities as well as dissimilarities. Detection is commonly noted at two months. The incidence of clinically significant HO is 10%-20%. Approximately 10% of the HO is massive and causes severe restriction in joint motion or ankylosis. The most common sign and symptom are decreased range of motion and pain. The locations are the proximal limbs and joints. Sites of HO about a joint may vary according to the etiology of the HO. Roentgenographic evolution of HO occurs during a six-month period in the majority of patients. Treatment modalities include diphosphonates, indomethacin, radiation, range of motion exercises, and surgical excision. Surgical timing differs according to etiology: traumatic HO may be resected at six months; spinal cord injury HO is excised at one year; and traumatic brain injury HO is removed at 1.5 ...
Twenty-five patients with ovarian carcinoma who had been operated and treated with chemotherapy underwent clinical examination and CT before reintervention (second-look laparotomy) to detect the presence of eventual recurrences. The prediction of recurrence based on CT and clinical findings was compared with the surgical findings at reintervention. CT proved to be more accurate than clinical examination in detecting recurrences; this was especially true for masses in the abdominal cavity, with the exception of small peritoneal nodules. The authors suggest the use of CT for staging the patients candidate to reintervention. This might help to avoid reintervantion in patients with persistent disease and to plan treatment.
Lupus pernio of the nose is the most characteristic cutaneous lesion of sarcoidosis. It is cosmetically disfiguring and can be the cause of significant morbidity. In particular, the affected skin is often red or purple due to increased vasculature. It is particularly resistant to both surgical and medical therapy. We describe a patient with lupus pernio affecting her nose, which showed a dramatic improvement following treatment with the pulse dye laser (PDL). A biopsy taken after treatment showed the continued presence of sarcoidal granulomas. We therefore feel that treatment with the PDL is an effective tool in improving the cosmetic appearance of lupus pernio, but does not influence the underlying disease process. PMID:11360426
A 67-year-old man presented with gastrointestinal bleeding resulting from a fistula between the aortic stump and the fourth part of the duodenum 14 months after an axillobifemoral bypass, graft excision, and aortic stump closure for aortic graft infection. The patient initially refused any attempt at definitive surgical treatment so coil embolization of the aortic stump was performed via a brachial approach. Coil embolization may be a useful adjunct in the management of such difficult problems. This approach may buy time and allow careful planning of a definitive treatment or may serve as a palliative procedure in inoperable patients. PMID:15947052
Primary B-cell lymphoma of thymus is uncommon. We describe the case of a 23-year-old woman with a history of shortness of breath and distended neck veins of 1-month duration. A chest roentgenogram and computed tomographic chest scan of the showed a large anterior mediastinal mass. Tru-cut biopsy revealed primary B-cell lymphoma of thymus. She underwent chemotherapy with no symptomatic improvement. Post-chemotherapy computed tomographic scan of the chest showed no appreciable reduction in tumor size. Surgical excision was carried out with excellent results.
In order to evaluate the role of Computed Tomography (CT) in prediction of nature, staging and follow-up of soft-tessue tumors, the authors examined by CT 124 patients with soft tissue neoplasms who later underwent surgery (116 cases) or fine needle biopsy (8 cases). Comparison between CT and surgical or anatomical results showed that CT was able to correctly predict the benignancy or malignancy of the masses in 76% of cases but it was very seldom able to allow an hystological prediction. On the contrary CT was found to be a very useful tool for pre-therapeutic staging and follow-up of the tumors, because it gave many diagnostic information which influenced therapeutic choiches and strategies.
We compared the characteristics on thin-section CT images with the histological structure of thirty-four surgically resected peripheral lung lesions 30 mm or less in diameter with a greater than 50% area of GGA on thin-section CT. Pathologically, focal area of GGA corresponded to alveolar replacement growth of tumor or interstitial fibrotic thickening of inflammation. It is considered that determination of the GGA in small peripheral lung lesions on thin-section CT is useful for the diagnosis of early adenocarcinomas. (author)
A 37-year-old military mechanic presented to our institution with a chronic history of a slowly enlarging left elbow antecubital fossa mass. There was no history of other chronic illness or trauma. Magnetic resonance imaging (MRI) and excisional biopsy revealed fatty villi and synovial inflammation within the left bicipitoradial bursa, consistent with lipoma arborescens. Four years later the patient presented with a 6-month history of swelling at the antecubital fossa of the opposite elbow. Diagnostic computed tomography and MRI examinations were performed. The surgical and pathologic findings confirmed the imaging diagnosis of lipoma arborescens at the right bicipitoradial bursa. (orig.)
Trastuzumab increases survival amongst women with human epidermal growth factor receptor (HER)-2 receptor positive metastatic breast cancer, but maternal and fetal risks are associated with advanced disease and its treatment in pregnancy. We present a case of a primigravid with HER-2 positive metastatic breast cancer who received trastuzumab throughout pregnancy. She presented with cerebral metastases, requiring surgical decompression and resection. Reversible oligohydramnios developed during pregnancy. Fetal safety data on trastuzumab in pregnancy is limited, but case reports suggest a recurring pattern of (mostly reversible) oligohydramnios.
Objective: Solid pseudopapillary tumor of the pancreas (SPTP tumor) is a rare pancreatic neoplasm with low malignant potential, which usually affects female patients in the second or third decades of life. It is a non-functional, slow-growing neoplasm that very often reaches considerable size before the first symptoms appear. Symptomatology is frequently related to tumor size. Surgical excision is usually curative in most cases. Infrequently the tumor can appear in male patients or in aged women, which can make the diagnosis more difficult. Some patients develop liver metastases in the follow-up that can be resected. Our purpose is to review the radiological and pathological findings of SPTP with emphasis on these infrequent cases. Subjects and methods: The medical records and radiological findings of patients who underwent surgery for SPTP between 2000 and 2005 were retrospectively reviewed. Study eligibility required that patients had undergone ...
Objective: Solid pseudopapillary tumor of the pancreas (SPTP tumor) is a rare pancreatic neoplasm with low malignant potential, which usually affects female patients in the second or third decades of life. It is a non-functional, slow-growing neoplasm that very often reaches considerable size before the first symptoms appear. Symptomatology is frequently related to tumor size. Surgical excision is usually curative in most cases. Infrequently the tumor can appear in male patients or in aged women, which can make the diagnosis more difficult. Some patients develop liver metastases in the follow-up that can be resected. Our purpose is to review the radiological and pathological findings of SPTP with emphasis on these infrequent cases. Subjects and methods: The medical records and radiological findings of patients who underwent surgery for SPTP between 2000 and 2005 were retrospectively reviewed. Study eligibility required that patients had undergone ...
The objective was to characterize imaging findings of benign notochordal cell tumors (BNCTs). Clinical and imaging data for 9 benign notochordal cell tumors in 7 patients were reviewed retrospectively. Conventional radiographs (n = 9), bone scintigrams (n = 2), computed tomographic images (n = 7), and magnetic resonance images (n = 8) were reviewed. Eight of the 9 lesions were stained with hematoxylin-eosin and microscopically examined. There were 3 male and 4 female patients with an age range of 22 to 55 years (average age, 44 years). Two patients had two lesions at different sites. The lesions involved the cervical spine in 4 patients, the lumbar spine in 2, the sacrum in 2, and the coccyx in 1. The most common symptom was mild pain. The lesions of 2 patients were found incidentally during imaging studies for unrelated conditions. Five patients underwent surgical procedures. One patient died of surgical complications. All other patients have ...
A Zinc/Air Battery Review and Strategic Planning Meeting was held in 1993. One outcome of the meeting was recognition of the need for a report on the current status of the technology. This report contains contributions from many of the attendees at the above meeting and expresses their views on where the technology is today and what could/should be done to improve its performance.
DescriptionThis new research programme activity on Urban Atmospheric Science will deliver aspects of the NERC strategy: Next Generation Science for Planet Earth. It has been developed as part of the Environment, Pollution & Human Health theme. Research in the Environment, Pollution & Human Health theme is directed at elucidating key environmental processes that form part of a causal pathway between an environmental hazard and disease outcome, and providing a predictive capability of the risk to human heal [continued...
Ventricular septal defect after acute myocardial infarction (AMI) is a complication associated with poor outcome in the absence of intervention. We report a case of successful TEE guided transcatheter closure of a post myocardial infarction (MI) ventricular septal defect (VSD) with an Amplatzer occluder in a 79 years old male with cardiogenic shock.
Non-alcoholic fatty liver disease is a serious health problem linked to obesity and type 2 diabetes. To investigate the biological outcome and therapeutic potential of hepatic fatty acid uptake inhibition,...Full Text Available
Highlights of the meeting are briefly summarized in this paper. Most of the papers presented at the meeting dealt with remediation and pollution prevention practices. A major focus of the technical sessions was on the identification of pollution sources. Identification of exposures to specific chemicals with disease outcomes was also discussed. Other papers focused on ecological exposures and their effects on wildlife to identify the presence of contaminants. 4 refs.
Motivation is given for a technique to more thoroughly test semiconductor equipment control systems. A description is given of a simulator-based control system testing technique. Potential benefits that could be realized by using this technique in the semiconductor industry as well as benefits documented by using this technique in other industries are described. Specific requirements for using the technique in the semiconductor industry are outlined. A summary of a survey of nine commercial simulation systems is given. Finally, the outcome of the survey is compared with the requirements for using the technique.
We reported a relevant activity of the combination between sorafenib and octreotide long-acting release (LAR) in advanced hepatocellular carcinoma (HCC) patients. In this work, we have studied if oxidative...Full Text Available
Background: Markers of protein-energy wasting (PEW) and inflammation are common in chronic kidney disease (CKD) and are among the strongest predictors of mortality in dialysis patients.Objective:...Full Text Available
Perspectives from industry, academe, and the NRC are brought together in this report and used to develop a logical framework that links management and organization factors and safety in nuclear power plant performance. The framework focuses on intermediate outcomes which can be predicted by organizational and management factors, and which are subsequently linked to safety. The intermediate outcomes are efficiency, compliance, quality, and innovation. The organization and management factors can be classified in terms of environment, context, organizational governance, organizational design, and emergent processes. Initial empirical analyses were conducted on a limited set of hypotheses derived from the framework. One set of hypotheses concerned the relationships between one of the intermediate outcome variables, efficiency, as measured by critical hours and outage rate, and safety, as measured by 5 NRC indicators. Results of ...
To assess which specific morphologic features, enhancement patterns, or pharmacokinetic parameters on breast Magnetic Resonance Imaging (MRI) could predict a false-negative outcome of Proton...Full Text Available
AimsThe prevalence and importance of liver function test (LFT) abnormalities in a large contemporary cohort of heart failure patients have not been systematically evaluated.Full Text Available
Experiences with weight stigma negatively impact both psychological outcomes (e.g., body dissatisfaction, depression) and behavioral outcomes (e.g., dieting, exercise). However, not everyone is equally affected by experiences with weight stigma. This study examined whether internalized societal attitudes about weight moderated the impact of weight stigma. Adult participants (n = 111) completed measures of experiences with weight stigma, as well as two indexes of internalized societal attitudes (the moderators): Internalized anti-fat attitudes and internalization of societal standards of attractiveness. Psychological outcomes included self-esteem, body dissatisfaction, drive for thinness, and bulimic symptoms; behavioral outcomes included avoidance of exercise and self-reported exercise behavior. Weight stigma was positively correlated with body dissatisfaction, drive for thinness, and bulimic symptoms, ...
... (restricted)] 2009, Volume 39, Issue 5 523-529 Parents, peers, or school inputs: Which components of school outcomes are capitalized into house value? by Brasington, David M. & Haurin, Donald R. [Downloadable! (restricted)] 530-541 Trade liberalisation and agglomeration with firm heterogeneity: Forward and backward linkages by Okubo, Toshihiro [Downloadable! (restricted)] 542-552 Alternative measures of homeownership gaps across segregated ...
...Older Siblings by Adriaan R Soetevent & Peter Kooreman 392-415 Vocational Training and Gender: Wages and Occupational Mobility among Young Workers by Bernd Fitzenberger & Astrid Kunze 416-438 Gender Role Attitudes and the Labour-market Outcomes of Women across OECD Countries by Nicole M Fortin 439-461 Gender, Time Use, and Public Policy over ...
BackgroundSelf-management of asthma may improve asthma outcomes. The Internet has been suggested as a tool for the monitoring and self-management of asthma....Full Text Available
SummaryThe report describes successful management of 10 women in 2nd and 3rd pregnancy trimesters with EchiTab IgG antivenom after carpet viper (Echis ocellatus) envenoming. All...Full Text Available
The efficacy of a heat inactivated hepatitis B virus vaccine, containing 3 micrograms hepatitis B surface antigen (HBsAg), was studied in a high risk group of 800 susceptible homosexual men by a randomised...Full Text Available
Cystic fibrosis (CF) is a monogenic disease characterized by a high variability of disease severity and outcome that points to the role of environmental factors and modulating genes that shape the course...Full Text Available
In order to implement effective safety regulations on aging management for reactor facilities etc., the information on important technology issues, the latest technical knowledge including evaluation technology, test and research outcomes, related codes and standards, regulation information, operation experiences such as accidents and trouble, etc. with respect to aging-induced deterioration in and outside Japan and in other industries, were collected, organized and evaluated. (author)
This study prospectively assessed the outcome of 134 cemented titanium stems and serum ion levels. The stems were polished (0.1 μm Ra) with circular cross section. At the end point,...Full Text Available
Divided into diagnostic and treatment sections, this book provides a comprehensive overview of the most common medical procedures performed in modern clinical settings. Each section presents common names for the procedure; an outline of the disease or injury for which the procedure is performed; a brief review of the anatomical structures and physiological processes that are involved; staffing, equipment, and pre-procedure requirements; a detailed description of the procedure itself; and, a discussion of expected outcomes as well as potential complications. Each chapter includes a summary and
Background:Acute Coronary Syndrome (ACS) can occur in patients with prior coronary artery bypass grafting (CABG). In the Gulf Registry of acute coronary events (Gulf RACE), we identified...Full Text Available
DNA isolation procedures significantly influence the outcome of PCR-based detection of human pathogens. Unlike clinical samples, DNA isolation from food samples such as fresh and fresh-cut produce has remained a formidable task and has hampered the sensitivity and accuracy of molecular methods. We...
We performed a randomized trial to compare IVF outcomes in 54 poor responder patients undergoing a microdose leuprolide acetate (LA) protocol or a GnRH antagonist protocol incorporating a luteal phase E2 patch and GnRH antagonist in the preceding menstrual cycle. Cancellation rates, number of oocytes retrieved, clinical pregnancy rates (PR), and ongoing PRs were similar between the two groups.
Delirium occurs in up to 65% of older hip fracture patients. Developing delirium in hospital has been associated with a variety of adverse outcomes. Trials have shown that multi-component preventive...Full Text Available
We consider the problem of rotation in a homogeneous Bianchi type IX cosmological model. Studying the Wheeler-De Witt equation corresponding to this minisuperspace, and adopting a particular choice of the factor ordering, we are able to find a particular solution which is strongly peaked about isotropy. This result confirms all the previous investigations in this field, and suggests the conclusion that the machian nature of our universe is the natural, i.e. most likely, outcome of the Planck epoch. (orig.).
We consider the problem of rotation in a homogeneous Bianchi type IX cosmological model. Studying the Wheeler-De Witt equation corresponding to this minisuperspace, and adopting a particular choice of the factor ordering, we are able to find a particular solution which is strongly peaked about isotropy. This result confirms all the previous investigations in this field, and suggests the conclusion that the machian nature of our universe is the natural, i.e. most likely, outcome of the Planck epoch. (orig.).
We present our initial experience with a new biodegradable (BD) esophageal stent in two patients, one for a therapy-resistant benign esophageal stricture, and the other as a temporary measure during curative radiotherapy for oesophageal carcinoma. The BD stents need to be loaded into a conventional pull-back delivery system but are then placed in a standard fashion. Pre-dilatation should be avoided to reduce the risk of migration, however if migration occurs the stents can be left to dissolve in the stomach. The stents are radiolucent but easily identified on CT with minimal artefact and thus might even aid with radiotherapy planning. BD stents offer an exciting new strategy for therapy-resistant benign strictures as well as a supportive measure for oesophageal cancer undergoing non-surgical treatment. (orig.)
MRI (Magnetic resonance imaging) has been widely used in the diagnosis of primary carpal tunnel syndrome (CTS). However, it has had limited clinical application in diagnosing persistent or recurrent CTS. We aimed to investigate the efficacy of this imaging modality in patients who had previously undergone open carpal tunnel release without relief of symptoms, and assess the correlation of MRI with intra-operative findings upon re-exploration. MRI studies were performed on 17 wrists (16 patients) presenting with recurrent/persistent symptoms and signs of CTS in whom repeat nerve conduction studies were also performed. Surgical re-exploration was undertaken on 16 wrists in which a 100% correlation was noted between MRI and intra-operative findings of an incompletely released or re-grown tran...
PurposeThe purpose of the present study was to compare the effect of submucosal versus intramuscular administration of dexamethasone sodium phosphate on patients' quality of life after surgical removal of impacted lower third molars. Patients and MethodsA randomized, non-blind, clinical trial was planned. The sample was composed of patients requiring extraction under local anesthesia of a single partial bony impacted mandibular third molar with Class II or III and position B or C, according to the Pell and Gregory classification. The patients were randomly distributed into 1 of 3 groups: submucosal dexamethasone, intramuscular dexamethasone, and a control group that received no steroid. A modified translated questionnaire was used to assess the patients' perception regarding different qual...
Women treated of localised stages of cervix cancer have a very good prognosis. But do health care professionals have a tendency to underestimate the potential need for rehabilitation of this group? To be able to answer this question this study aimed to develop knowledge concerning these women's own perception of their health during a long period after surgical cancer treatment. A total of 398 women who underwent radical hysterectomy in the period from the 1 January 1983 to 31 December 2000 participated in the study at Aarhus University Hospital, Skejby in Denmark 2001-2003. All patients initially filled in an internally validated questionnaire. Subsequently a sample of 100 women filled in the questionnaires Short Form -36 and Sense of Coherence to evaluate their self-reported health. Analy...
AbstractBackground: A defective innate immune response may contribute to the pathogenesis of Crohn's disease (CD) and ulcerative colitis (UC). Employing a global gene expression analysis, this study was aimed at identifying specifically regulated genes within the epithelial compartment in inflammatory bowel disease (IBD). Methods: The epithelial fraction of human ileal mucosa samples from surgical specimens was obtained by laser microdissection. Gene expression was examined by global expression profiling (n = 18, Affymetrix), quantitative reverse-transcription polymerase chain reaction (RT-PCR) (n = 35), immunoblot analysis (n = 9), and immunohistochemistry (n = 25). Results: Global expression profiling revealed a pronounced downregulation of the retinoic acid-inducible gene I (RIG-I) with...
Robotic surgery will give surgeons the ability to perform essentially tremorless microsurgery in tiny spaces with delicate precision and may enable procedures never before possible on children, neonates, and fetuses. Collaboration with radiologists, engineers, and other scientists will permit refinement of image-guided technologies and allow the realization of truly remarkable concepts in minimally invasive surgery. While robotic surgery is now in clinical use in several surgical specialties (heart bypass, prostate removal, and various gastrointestinal procedures), the greatest promise of robotics lies in pediatric surgery. We will briefly review the history and background of robotic technology in surgery, discuss its present benefits and uses and those being explored, and speculate on the future, with attention to the current and potential involvement of imaging modalities and the role of image guidance. (orig.)
AbstractBackground: The aim of this study was to review an experience with retroperitoneal endoscopic adrenalectomy (REA). This is the procedure of choice for adrenal tumours at this institution. Methods: Between 1997 and 2008, 112 REAs were performed in a single university centre. Data were retrieved retrospectively from a prospectively collected database, including information on patient demographics, surgical procedure, complications and hospital stay. Results: One hundred and twelve REAs were carried out successfully in 105 patients, including seven bilateral adrenalectomies. Thirty nine patients with unilateral adrenal disease had a phaeochromocytoma, of whom 16 had multiple endocrine neoplasia syndrome type 2, 21 patients had Cushing's disease and 20 had Conn's disease. Median body m...
Recently Emma and Stupakov identified a fatal flaw in a Free Electron Laser (FEL) beam conditioning scheme. They showed that the conditioning is always accompanied by a projected transverse emittance growth that is so large as to make the beam conditioning completely impractical for short wavelength FELs. Furthermore, they provided a general proof along with evidence of computer simulation and reached a conclusion that any beam conditioner, regardless of the method, would suffer from the same constraints and limitations. In this paper, the author proposes an easy surgical removal of the fatal flaw by making a critical yet simple modification to the very scheme analyzed, thus resurrect the beam conditioning for short wavelength FELs. More generally, the also explain why a general search for removing have failed, why the concept and definition of beam conditioning.
Abstract:- Increased expression of matrix metalloproteinase (MMP)-2, -3 and -9 has been demonstrated in Crohn-s disease fistulas, but it is unknown whether these enzymes are biologically active and represent a therapeutic target. Therefore, we investigated the proteolytic activity of MMPs in fistula tissue and examined the effect of inhibitors, including clinically available drugs that beside their main action also suppress MMPs. Fistula specimens were obtained by surgical excision from 22 patients with Crohn-s disease and from 10 patients with fistulas resulting from other causes. Colonic endoscopic biopsies from six controls were also included. Total functional MMP activity was measured by a high-pressure liquid chromatography (HPLC)-based, fluorogenic MMP-substrate cleavage assay, and t...
Abstract Introduction. Spinal cord stimulation (SCS) is an effective procedure for the treatment of neuropathic extremity pain, with success rates approaching 70%. However, mechanical failures, including breakage and migration, can significantly limit the long-term effectiveness of SCS. A systematic analysis of surgical techniques was undertaken by a consensus group, coupled with extensive in vivo and in vitro biomechanical testing of system components. Methods. A computer model based on morphometric data was used to predict movement in a standard SCS system between an anchored lead and pulse generator placed in various locations. These displacements were then used to determine a realistic range of forces exerted on components of the SCS system. Laboratory fixtures were constructed to subj...
Lung cancer staging according to the TNM system is based on morphological assessment of the primary cancer, lymph nodes and metastases. All aspects of this important oncological classification are measurable with MRI. Pulmonary nodules can be detected at the clinically relevant size of 4-5 mm in diameter. The extent of mediastinal, hilar and supraclavicular lymph node affection can be assessed at the same time. The predominant metastatic spread to the adrenal glands and spine can be detected in coronal orientation during dedicated MRI of the lungs. Search focused whole body MRI completes the staging. Various additional MR imaging techniques provide further functional and clinically relevant information during a single examination. In the oncological context the most important techniques are imaging of perfusion and tumor motion. Functional MRI of the lungs complements the pure staging and improves surgical approaches and radiotherapy planning. (orig.)
Hilar cholangiocarcinoma is associated with a dismal prognosis; however, curative resection may offer a chance of cure. Various factors should be considered in the surgical planning for curative resection. These factors include extent of bile duct involvement, relationship between portal vein and tumor involvement, diffuse hepato duodenal ligament infiltration, vascular invasion, lymph node metastasis, peritoneal seeding, and hepatic volume. Using high-quality volume data from multidetector-row computed tomography (MDCT) and adequate postprocessing images, radiologists can provide various types of information, imperative for curative resection of a hilar cholangiocarcinoma. This review illustrates the role of MDCT in the preoperative workup of hilar cholangiocarcinoma.
Bariatric surgical procedures have become important therapeutic options for treatment of morbid obesity in both adults and adolescents co-morbidities of obesity such as glucose intolerance, type 2 diabetes (T2DM), metabolic syndrome, steatohepatitis, hyperlipidemia and cardiovascular disease. These co-morbidities of obesity have significant impacts on the overall quality of life of the individual and our society at large. Roux-en-Y gastric bypass (RYGB) and the relatively newer procedures of gastric banding (GB) and vertical sleeve gastrectomy (VSG) have proven to be efficacious in achieving rapid weight loss and reversing the comorbidities of obesity. Unfortunately, bariatric procedures are not without risks including micronutrient deficiency, failure to maintain lost weight, and mortalit...
Background: Intestinal failure (IF) is the dependence upon parenteral nutrition to maintain minimal energy requirements for growth and development. It may occur secondary to a loss of bowel length, disorders of motility, or both. Short bowel syndrome (SBS) is a malabsorptive state resulting from surgical resection, congenital defect, or diseases associated with loss of absorptive surface area. A particularly vexing problem is associated with whole bowel and/or segmental intestinal dysmotility. Motility disorders within the context of SBS and IF may relate to rapid intestinal transit secondary to loss of intestinal length, dysmotility associated with loss or poor antegrade peristalsis, or gastroparesis. Therapy may be classified into medical (prokinetic and antidiarrheal agents) and surgica...
Partial adrenalectomy is usually performed for the treatment of bilateral pheochromocytomas and in case of sporadic, monolateral tumors, to minimize the risk of adrenal failure, especially in younger patients. Due to the lack of consistent series, many issues such as correct surgical indications and technical aspects still need to be debated. From 2007 to 2010 we performed four unilateral partial adrenalectomies (3 aldosterone-producing adenomas and 1 cortisol-producing adenoma), and three bilateral subtotal adrenalectomies, consisting in total adrenalectomy on one side and partial adrenalectomy on the contralateral gland (3 bilateral pheochromocytomas in MEN IIa). In case of single tumor, partial adrenalectomy was carried out without adrenal vein ligation and the results were similar to t...
The technical complexity of intraoperative radiotherapy (IORT) requires modification of the standard physical and dosimetric methods used in external electron beam therapy. At the National Cancer Institute, a number of technical innovations have been integrated into ongoing clinical studies of IORT. These include: (1) an electron beam applicator system that is significantly different from other IORT systems and includes customized squircle applicators; (2) peripheral dose shields; (3) a modified surgical table replacing the standard radiation treatment couch; and (4) routine use of multiple IORT fields that necessitates field matching. The IORT applicator system and related devices and techniques are dosimetrically characterized in detail both for use in the IORT program and in order to illustrate many useful facets of electron dosimetry.
Herein we present an impact of diagnosis by enhanced multidetector-row computed tomography and magnetic resonance imaging for extrahepatic cholangiocarcinoma (ECC). Although the diagnosis against the longitudinal stromal extension and surrounding tissue invasion of ECC by multi detector row CT (MDCT) and MRI was very strict, we could not detect any superficial mucosal spread (SMS). Furthermore, the diagnosis of lymphnode metastasis by MDCT/MRI was miserable. We believe that misdiagnosis of SMS is permissible since positive mucosal but not stromal surgical margin was not a significant factor influencing the postoperative prognosis. However, further advances in imaging diagnosis for ECC is needed. (author)
The gastrointestinal transit was studied in 20 patients with loop transverse colostomies and previously normal colons. This analysis was performed through radiological observation of progression of 20 radiopaque pellets and measurements of its transit time in the various segments of the digestive tract. An evaluation of other related clinical and radiological events was carried out sentimentality's. In order to better understand the influence of the surgical procedure, the study was performed under similar dietary and supportive care conditions and standard radiological studies before and after the re-establishment of transit, thus enabling a comparison with the same individual. (author)
Therapeutic decisions are quite clear-cut for asymptomatic gallstone disease and acute cholecystitis. However, the appropriate therapeutic course for older patients with chronic cholecystitis may be less obvious. Watchful waiting may be reasonable for patients with mild and infrequent symptoms. For healthy patients, cholecystectomy is recommended if symptoms are becoming more frequent and severe. Laparoscopy may reduce the complication rate and be safely performed even in those with underlying medical illness. Oral dissolution therapy can be attempted for qualifying symptomatic patients who are at poor surgical risk or who refuse surgery. Shock wave lithotripsy and contact dissolution therapy show some promise but are currently experimental. PMID:8339941
Introduction: The orofacial clefts include 30 variant according to Tessier classification: the number 30 contain mandibular arc damage isolated or associated with damage of surrounding soft tissue. Case report: Our patient was a newborn with median mandibular cleft associated with ankyloglossia, bifid tongue and a top cervical fistula. We have not found polymalformative syndrome. The early surgical management included one time and after-effect were simple within 11months. Discussion: We point up difficulties for antenatal diagnosis and controversy about appropriate time for management of bone defect. The last physiopathologic hypotheses were explicated.
"Pillar pain" is a relatively frequent complication after surgical release of the median nerve at the wrist. Its etiology still remains unknown although several studies highlight a neurogenic inflammation as a possible cause. Pillar pain treatment usually includes rest, bracing and physiotherapy, although a significant number of patients still complain of painful symptoms two or even three years after surgery. The aim of this study was to investigate the efficacy of low-energy, flux density-focused extracorporeal shock wave therapy (ESWT) in the treatment of pillar pain. We treated 40 consecutive patients with ESWT who had pillar pain for at least six months after carpal tunnel release surgery, and to our knowledge, this is the first study that describes the use of ESWT for treating this c...
Placement of dental implants in the interforaminal region of the edentulous mandible is considered a safe and routine surgical procedure. Hemorrhage in the floor of the mouth has been reported as a rare, potentially life-threatening complication related to the placement of implants in this region. In this case report the authors present an immediate and a delayed case of massive bleeding in the floor of the mouth after implant placement. This highly vascularized region is vulnerable and bleeding can be induced easily by instrumentation, causing a vascular trauma, usually by perforation of lingual periostium. In almost all cases the expanding hematoma formation starts during surgery. The effect of the vasoconstrictive agent in the local anesthesic combined with an injury of the lingual arte...
14 surgical patients with non-hepatobiliary diseases were studied with "9"9"mTc-EHIDA imaging to evaluate the effect of total parenteral nutrition (TPN) on the hepatobiliary function. Duration of TPN ranged from 6-56 days, 10 of the 14 patients Beijing within 10 days. The results showed that: (1) 11 of 14 patients had abnormal scintigraphic features. The most prominet findings were delayed liver excretion and prolonged blood clearance time. This fact suggests that not only the rate of excretion of the bile from the liver is decreased but the uptake ability of the hepatorcyte is also impaired. (2) The effect of TPN on liver function is reversible. It was concluded that in order to prevent irreversible damage of hepatobiliary function caused by TPN, the duration of TPN should not be too long and oral intake of nutrients should be resumed as soon as possible.
Abstract A series of studies performed at our center demonstrates that gaseous microemboli (GME) remain a challenge in cardiac surgical procedures. Evaluation of novel oxygenators must address hemodynamic parameters and microemboli capture capability. The objective of this study is to compare two neonatal membrane oxygenators, the Quadrox i (MAQUET Cardiopulmonary AG, Hirrlingen, Germany) and the Capiox RX05 (Terumo Corporation, Tokyo, Japan), with respect to GME capture and hemodynamic energy delivery. The experimental circuit included a Maquet HL 20 heart lung machine, a Heater Cooler Unit HCU 30 (MAQUET Cardiopulmonary AG), a membrane oxygenator (Quadrox i Neonatal or Capiox RX05), and inch tubing from the COBE Heart/Lung Perfusion Pack (COBE Cardiovascular, Inc., Arvada, CO, USA). A Ca...
Two cases of focal nodular hyperplasia (FNH), in which ultrasound (US), computed tomography (CT), and magnetic resonance imaging (MR) studies detected an atypical hemorrhagic pattern associated with an intrahepatic arterio venous malformation (AVM) around the growths, are presented. In both cases, histology demonstrated a very early regenerative stage and necrotic-hemorrhagic areas within the lesions. In these cases, the analysis of radiological findings, surgical specimens and histology seemed to confirm the pathogenetic hypothesis suggested by Wanless: in normal liver parenchyma, a ``blood steal`` phenomenon due to congenital or acquired intrahepatic AVM could cause ischemic damage, appearing as a hemorrhagic necrotic area, the extent of which depends on the degree of residual portal supply. (orig.)
Background There is increasing recognition that lower nurse staffing levels are associated with higher morbidity and mortality among medical and surgical patients. The degree to which this applies to elderly patients with hip fractures is unclear. Questions/purposes We conducted a pilot study using administrative data as an initial step in investigating the relationship between nurse staffing levels and in-hospital mortality among elderly patients with hip fractures. Patients and Methods We retrospectively reviewed administrative data for 13,343 patients 65?years or older with a primary diagnosis of hip fracture admitted to 39 Michigan hospitals between 2003 and 2006. We used logistic regression to calculate the change in predicted probability of in-hospital death conferred by differences ...
Active contrast material extravasation can be recognized with conventional CT scanners, though it has been considered a rare finding. Helical CT seems to increase the detection rate and especially to boost the radiologist's confidence in this diagnosis. Though active bleeding is defined in severely-injured subjects requiring urgent intervention and may be associated with findings of hypovolaemic shock, it should not be considered itself as a negative prognostic factor. Contrast extravasation is due to ongoing hemorrhage and its detection is critical for urged treatment. Accurate anatomical location permits to choose surgical management or transcatheter embolization and thus decreases time consumption for precis e bleeding site identification.
Abstract Purpose: We evaluated complications of urologic laparoscopic surgery at our institution. Patients and Methods: From December 1991 to January 2009, 1017 urologic laparoscopic surgical procedures were performed in Kansai Medical University, including 277 radical prostatectomies, 13 donor nephrectomies, 74 partial nephrectomies, 158 radical nephrectomies, 55 pyeloplasties, 97 nephrouretectomies, 54 simple nephrectomies, 128 adrenalectomies, 34 varicocelectomies, and 127 other procedures. Medical records of each procedure were retrospectively evaluated. The difficulty of each procedure was classified according to the European Scoring System (ESS). Intraoperative and postoperative complications were graded according to the Satava and Clavien classifications, respectively. Results: Amon...
Sinus lifting and reconstruction of localized alveolar defects are often required after closure of a large oroantral fistula (OAF) to allow for subsequent implant installation. This study describes a combined surgical technique that involves sinus lifting, bony closure, and reconstruction of the alveolar defect at the site of an OAF. The sinus membrane was reconstructed as a continuous layer by combining the residual sinus membrane with a rotated part of oral mucosa around the OAF. Autogenous bone from the chin and/or ramus was grafted into the prepared sinus space and alveolar defect, and the graft was covered by a buccal advancement flap. This technique was used to treat 8 patients who had large OAFs in the posterior maxillary region. The treatment was successful in all cases, and the te...
In 9 over 12 patients who underwent cardiac transplantation computed tomography was performed. In 5 of them CT was obtained also before the surgical treatment. In all patients angio-CT technique was performed, while the ECG-gated technique was employed only before surgery. CT shows changes in morphology of both atria but over all of the right one, and rotation of the heart on the longitudinal axis. The conditions of the pericardium are particulary well demonstrated: in 5 cases pericardial effusion was observed, 3 times localized and 2 times diffuse. Only in 1 patient a small thrombus in the right atrium was demonstrated. CT allows the possibility to obtain simultaneously information on mediastinum, lung and pleura. Pleural effusion, pulmonary infections and mediastinal complications are easily demonstrated.
Bowel infarction is a rare and typical condition of the elderly; despite improvements in diagnostic imaging and vascular surgery, bowel infarction remains a major cause of acute abdomen, with mortality rates ranging 70-80%. Diagnosis on often late because clinical sings, laboratory data and radiologic findings are a specific. The authors investigated radiographic and particular CT patterns of intestinal infraction in 56 patients submitted to surgery within 12 hours of admission. We also report the CT findings of 5 of these patients who had reversible mesenteric ischemia. CT is more sensitive than radiography and does not exhibit the limitations of angiography (i.e., invasiveness, radiation exposure an complex organization. Therefore CT can presently be considered the method of choice in patients with suspected bowel infarction.
Colorectal cancer is the second most common cause of cancer death in the world and about half of the patients with colorectal cancer require adjuvant therapy after surgical resection. Therefore, the eradication of cancer cells via chemotherapy constitutes a viable approach to treating patients with colorectal cancer. In this study, the effects of bufalin isolated from a traditional Chinese medicine were evaluated and characterized in HT-29 and Caco-2 human colon cancer cells. Contrary to its well-documented apoptosis-promoting activity in other cancer cells, bufalin did not cause caspase-dependent cell death in colon cancer cells, as indicated by the absence of significant early apoptosis as well as poly(ADP-ribose) polymerase and caspase-3 cleavage. Instead, bufalin activated an autophagy...
Brain tumor was diagnosed by computer tomography or magnetic resonance imaging in 100 children aged 0 to 19 years. They consecutively underwent primary surgical treatment during the years 1984 to 1988. Non-neoplastic lesions and operations for residual tumors are not included. 54 tumors were localized supratentorially. 72% of these were benign og low grade malignancies. 46 tumors had an infratentorial localication. 59% of these were high grade malignancies. Children tolerate major-neurosurgical procedures better than adults and restitution is usually favourable. 42 children with high grade malignancies underwent postoperative radiotherpy. Per- and postoperative mortality in this series was 1%. 80 children are alive. 62 of these are in excellent condition after a median observation time of 40 months. 10 refs.
In recent years, Obesity (defined as Body Mass Index > 30 kg/m2) has increased its prevalence reaching epidemic levels in countries such as The United States where it has became a national health issue. In Colombia the Obesity prevalence is figured around 14%. Treatment options for Obesity include life style modifications, pharmacologist management and surgical approach (Bariatric Surgery). This article describes a patient with previous bariatric surgery, who presents abdominal pain and melena owed to isquemic process of the alimentary limb caused by an internal hernia which is a potentially lethal condition if it is not highly suspected allowing its early diagnosis and treatment
Background and objectives.Thymidylate synthase (TS) expression levels appear to be related to response to 5-fluorouracil-(5-FU)-based chemotherapy in colorectal cancer (CRC) patients. Three polymorphisms have been proposed as modulators of TS expression: a tandemly repeated sequence (2R/3R) in the 5? UTR, a SNP (G > C) within the 3R allele and a 6 bp deletion in the 3' UTR.To evaluate the influence of TS expression and polymorphisms on clinical outcome of 5-FU-treated patients we performed a comprehensive genetic analysis on 63 CRC patients.Methods.TS expression levels were analyzed in normal and tumor tissues. TS coding sequence and UTR polymorphisms were investigated on DNA from normal tissue. LOH analysis was performed to determine tumor genotype.Results.A difference in disease-free sur...
Purpose: To report outcomes of a single institution study of stereotactic body radiotherapy (SBRT) for unresectable cholangiocarcinoma. The dose-volume dependency of the observed gastrointestinal toxicity is explored. Methods and materials: Twenty-seven patients with unresectable cholangiocarcinoma (n = 26 Klatskin tumours and one intrahepatic cholangiocarcinoma (IHCC)) were treated by linac-based SBRT. The dose schedule was 45 Gy in three fractions prescribed to the isocenter. Results: The median progression-free survival and overall survival were 6.7 and 10.6 months, respectively. With a median follow-up of 5.4 years, 6 patients had severe duodenal/pyloric ulceration and 3 patients developed duodenal stenosis. Duodenal radiation exposure was higher in patients developing moderate to high-grade gastrointestinal toxicity with the difference in mean maximum dose to 1 cm"3 of duodenum reaching statistical significance. A statistically significant association between ...
In the VEGA program on radionuclide release from irradiated fuel under severe accident conditions, 10 tests in total were performed at JAEA from 1999 to 2004 under inert and steam atmospheres including the highest pressure or temperature conditions. These tests showed the increase in release rate above 2,800 K or at the fuel liquefaction and the decrease in release rate under elevated pressure, which was a first observation in the world. The data on low-volatility radionuclide release, release from MOX fuel, effect of fuel oxidation, and eutectic reaction with cladding on release were obtained from the tests. The mechanism of pressure effect on release was examined and a new release model with pressure effect was proposed. In addition, the pressure effect on source term evaluation and effectiveness of accident management measures were investigated. This article summarizes the major outcomes described above that have already been published and newly describes the ...
The movement from traditional regulatory hearings to negotiated settlements represents both a departure from cost of service regulation and a relaxation of regulatory oversight. Under negotiation parties are able to renegotiate inclusions in their cost of service while simultaneously creating a profit margin for the regulated firm where none existed under the cost of service outcome of a traditional hearing. This paper constructs a model to illustrate the existence of positive gains to pipeline and shipper from the re-allocation of expenses through time in the regulated pipeline services market in Canada. Behaviour consistent with the model is observable in anecdotal and econometric evidence gathered from the library of the National Energy Board of Canada, responsible for pipeline toll regulation in Canada. Empirical investigation by into settlement procedures in the Florida electricity market reveals similar findings; however, this analysis represents the first ...
Correct ortopedic therapy for traumas of the cervical rachis requires perfect knowledge of the spatial balance of the fracture focus. The authors belive Computed Tomography (CT) to be the most suitable, and often indispensable, method for this purpose. Twenty-four patients were examined for traumatic pathology of the cervical rachis. In 7 cases with clinically minor traumas, the negative outcome of the traditional traumas, the negative outcome of the traditional exam was considered reliable and sufficient for therapeutic purposes. The extant 17 patients were examined also by means of CT, either to better dermine the characteristics of skeletal lesions already ascertained with traditional techniques or to asses the presence of clinically-suspected osteo-articular lesions, even with negative conventional X-rays. For 9 of these patients orthopedic treatment was considered sufficient, whereas 8 patients underwent surgery and were subsequently ...
The health politics and policy communities are still struggling with the question of "what went wrong" in the 1993-94 health care reform effort. Here I identify which Americans were politically active and inactive during the health care reform debate to explore the role political participation may have had in determining the outcome of the debate. Using data from a national and California random-sample telephone surveys, and controlling for other demographic attributes, I found that those who engaged in political activity specifically related to health care reform were disproportionately more likely to be self-identified conservatives, less likely to favor an employer mandate plan, more likely to be fifty to sixty-four years old, more likely to be men, and more likely to have greater interest in and knowledge of the health care issue. Even in California, where a single-payer proposal was on the November ballot, self-identified liberals were no more likely to engage ...
Maternal exposure to ambient air pollution has increasingly been linked to adverse pregnancy outcomes. The evidence linking this exposure to congenital anomalies is still limited and controversial. This case-control study investigated the association between maternal exposure to ambient particulate matter with aerodynamic diameter less than 10 ?m (PM(10)), sulfur dioxide (SO(2)), nitrogen dioxide, nitric oxide (NO), ozone (O(3)), and carbon monoxide (CO) and the occurrence of congenital heart disease in the population of Northeast England (1993-2003). Each case and control was assigned weekly average (weeks 3-8 of pregnancy) of pollutant levels measured by the closest monitor to the mother's residential postcode. Using exposure as both continuous and categorical variables, logistic regression models were constructed to quantify the adjusted odds ratios of exposure to air pollutants and the occurrence of each outcome group. We found exposure to ...
Studies of the effectiveness of operant, relaxation, cognitive, and multimodal behavioural approaches to the treatment of chronic benign pain other than headache were evaluated. In general, the quality of the studies was poor, and most investigations lacked appropriate and adequate control conditions, outcome measures, and/or follow-ups. While outcome reports for all four behavioural treatments have been mainly positive, few data were found which conclusively demonstrate that any of the approaches are effective or that they are the treatment of choice. The data do, however, imply that behavioural approaches may help patients lead more normal and productive lives. Specifically, the literature suggests that: (1) the operant method leads to increased activity levels and decreased pain and drug intake, (2) the relaxation approach results in decreased EMG levels and some pain reductions, (3) the cognitive techniques are speculative at this time, and ...
The visual impact of wind turbines is one of the main factors affecting public acceptance of wind parks. This paper evaluates the visual impact of a wind park in Chania, Crete, using the Spanish method of evaluation. The outcomes are combined with the psychometric testing of the residents by the use of questionnaires and with the values of the Spanish method about various scenarios concerning the size of the wind park (double, half, one wind turbine). The results of the study prove that the quantification of the potential visual impact could minimize this, apparently, main reason that affects public acceptance. (author)
Background The American Association for the Study of Liver Diseases (AASLD) guidelines recommend that antibiotic prophylaxis should be instituted in any patient with cirrhosis and gastrointestinal hemorrhage, and that oral norfloxacin, intravenous ciprofloxacin, and ceftriaxone are preferable. However, the antimicrobial spectrum of the first generation of cephalosporins (cefazolin) covers a wide range of bacteria species, including community-acquired strains of Escherichia coli and Klebsiella pneumoniae, but their efficacy as prophylactic antibiotics in cirrhotic patients with acute hemorrhage was seldom warranted in the literature. This study aimed to explore the effects of cefazolin on the outcome of cirrhotic patients with acute variceal hemorrhage after endoscopic interventions. Method...
ArgoNeuT, a Liquid Argon Time Projection Chamber (LAr-TPC), has recently collected thousands of neutrino and anti-neutrino events between 0.1 and 10 GeV in the NuMI beamline at Fermilab (FNAL). Among other issues, the experiment will measure the cross section of the neutrino and anti-neutrino Charged Current Quasi-Elastic (CCQE) interaction on Ar target and analyze the vertex activity associated with such events. Outcomes from the reconstruction of the events provide the main subject of this paper.
This paper explores how an aid-funded Ph.D.-programme in mathematics education instituted in some Southern African Development Community countries measures up to issues related to research capacity development projects. The research capacity development programme is described and reflected against mutual benefit, relevance, sustainability and prioritization of the location of project funding expenditure--some of the constructs in the discourse on research capacity development initiatives. It is found that the benefits of the programme are indeed mutual; the outcomes regarding relevance and sustainability are more uncertain and the location of expenditure of the funding is not overtly in favour of the donor country.
A respected veteran among state utility regulators raises a sober warning that it may not be possible for the telecommunications industry to survive half regulated and half unregulated, which is its posture for the present. He foresees a danger that the unregulated sector may be successful in capturing all the profitable portions of the market, leaving only the unprofitable areas to the regulated sector, which will then experience serious dislocations and even system breakdowns. Avoidance of such an outcome to the deregulatory steps presently being taken will require an uncommon degree of prudence and wisdom in those state officials who remain charged with regulatory responsibility for local exchange telephone facilities and service.
With a modelling approach based on cellular automata, five observed types of plant development can be simulated. In addition, the proposed model shows a strong tendency towards the formation of patches and a high degree of dynamical and structural instability leading to limits of predictability for the asymptotic solution chosen by the system among several possible metastable patterns (multistability). Further, external fluctuations can be shown to have advantages for certain plant types. The presented model unifies the fundamental dichotomy in vegetation dynamics between determinism (understood as predictability) and disorder (chance effects) by showing the outcome of both classical theories as special cases. (author) 2 figs., 4 refs.
In the last 40 years, significant advances have been made in the understanding of the neurophysiologic processes involved in the experience of trauma and pain. This knowledge, together with the rapid growth and understanding in the behavioral health sciences, has expanded to include a much better appreciation of how these fields are converging and contribute to a process called neuroplasticity. These basic mechanisms common to all patients have important implications for clinical outcome and for improving clinical practice. This article is written for clinicians who manage patients with sacroiliac joint dysfunction, a specific type of nonspecific low back pain.
This forum showcases the work of a variety of different heritage-based centers, organizations, and projects dedicated to research, education, and preservation of tangible and intangible forms of cultural heritage. The descriptions of these centers demonstrate the diversity of heritage work being done today. The centers and projects described in the forum vary in their contexts, missions, and outcomes. Highlighted in the forum are preservation organizations, university-based heritage centers, and a global collaborative cultural heritage project. Each organization in the forum provides information about their missions and goals, their approaches or methods to heritage work, and a brief description of some of their initiatives.
A sample of garnet-biotite plagiogneiss, GBPg-1 is currently being developed as a certified reference material at the Vinogradov Institute of Geochemistry. It was used as the sample that was distributed round 7 of International Proficiency Testing Program (GeoPT7) and was analyzed by 76 geoanalytical laboratories around the world. Twenty Russian laboratories involved in the interlaboratory experiment also analyzed GBPg-1. The resultant analytical data obtained from these two experiments has allowed GBPg-1 to be certified as a state standard sample for 50 elements. It also enabled a comparison of the quality of data developed by the Russian and international geoanalytical laboratories, to optimize the outcome of this interlaboratory experiment.
This report is the second in a series of annual reports responding to congressional inquiries as to the utilization of nuclear regulatory research. NUREG-1175, ''NRC Safety Research in Support of Regulation,'' published in May 1986, reported major research accomplishments between about FY 1980 and FY 1985. This report narrates the accomplishments of FY 1986 and does not restate earlier accomplishments. Earlier research results are mentioned in the context of current results in the interest of continuity. Both the direct contributions to scientific and technical knowledge and their regulatory applications, when there has been a definite regulatory outcome during FY 1986, have been described.
The current status of at-risk and adjudicated youth with behavioral challenges provides a context for addressing needed future directions for research and practice in fields that impact this population. This context includes the myriad characteristics and complex needs of these youth, the programs and services currently available in communities and secure settings, and youth outcomes following incarceration. Recent and emerging national, state, and local initiatives and the benefits that have been realized or are anticipated from their application are presented. The challenges to achieving and sustaining these systems changes are then discussed. The paper concludes with recommendations for future research and practice, based on the issues raised in this special issue and elsewhere. (Contains 1 endnote.)
Choosing a medical device is complex and requires a transparent process based on reason, evidence and assessment of prioritized public health needs. Poor choices lead to inappropriate use or non-use of medical devices and a waste of resources.This report suggests how an agenda to improve access to appropriate medical devices could be devised from applying the crucial 4 components - Availability, Accessibility, Appropriateness, and Affordability, to the 15 global high-burden diseases and some cross-cutting issues. The results of this exercise suggest several areas of research necessary to help
Steam generator tube denting is primarily caused by build-up of corrosion products at the tubesheet and the tube support plates. The mechanism of dent growth and the identification of tubes which should be removed from service have been studied. The practical outcome has been to prevent in-service tube leaks and to avoid unnecessary plugging of large numbers of tubes. A finite element study of tubesheet deformation (of pulled leaking tubes from reactors) was undertaken. Profilometry results for characterizing dents are given. Although several modifications have been made the high resolution profilometry system performance and the results obtained have proved satisfactory. (U.K.).
Background This report describes the authors? experience with a unique endoluminal, endoscopically delivered and retrieved gastroduodenojejunal bypass sleeve, including short-term weight loss and changes in comorbidities. Methods A prospective, single-center trial was designed. The patients were morbidly obese individuals who met the National Institutes of Health criteria for bariatric surgery. The device used was a unique gastroduodenojejunal bypass sleeve secured at the esophagogastric junction with endoscopic and laparoscopic techniques and designed to create an endoluminal gastroduodenojejunal bypass. At completion of the trial, the device was explanted with endoscopic retrieval. The primary end points were safety and incidence of adverse events. The secondary outcomes included the per...
This report describes the activities conducted with DOE funds at Oregon Health Sciences University between 9/15/94 and 9/29/99. The activities fall into four major categories: Information Technology, Information Services and Support, Medical Informatics and Outcomes Research, and collaboration with other institutions. The focus of these activities was to implement and maintain a regional healthcare information network.
Knowledge management is controlling the transfer, distribution, and availability of knowledge. Traditionally, knowledge management processes are predefined; e.g. it is laid out in detail which document template, data structure, system, or work flow steps have to be used in order to manage knowledge. But knowledge management itself is complex. It is simply not possible to predefine the typical flow of work in knowledge intensive processes in advance. So rather than trying to determine the procedures it is more promising to analyze which factors can be used in order to control the outcome of t
Direct nuclear reactions are commonly understood in terms of distorted wave (DW) formalisms. In the case of a single nucleon knockout or transfer reaction the DW analysis provides a reasonable understanding of the observed data. On the other hand the predictions based on different available information inputs have been verified with the observations consistently. In the case of direct reactions involving nuclear clusters however, the DW predictions have been found to disagree with the observations in most cases. The outcome of these and other improvements in the intermediate energy nuclear phenomena involving direct reactions are highlighted. (author). 13 refs., 18 figs.
In the present work, using a pad-on-disc-type wear tester, the tribological properties of the pad next to the disk made of cast iron were investigated with changing the substance of the components. As well, micro-structural characterisation of braking pads was performed using scanning electron microscopy and also temperature outcome of the pads was examined at the temperatures of 50-400 "oC in the pressure of 1050 and 3000 kPa. Finally, the effect of environment to the pads was studied in water, salty water, oil and braking liquid media.
The use of X-ray scattering techniques in pharmaceutical science is increasing, in part through increased collaborations with the materials science community, and through increased availability of instrumentation, particularly synchrotron sources. The ability to understand not only the biopharmaceutical outcome, but also arguably, more importantly, the structural aspects of drugs and drug delivery systems, is essential to progressing pharmaceutical science; this review serves as an introduction to the major techniques and the wide range of areas in which X-ray scattering may be applied in understanding and controlling structure in pharmaceutical systems.
Lung transplantation has become an accepted option for many patients with end-stage pulmonary diseases. Anesthesia and surgery following lung transplantation may be required for various diseases that may affect both systemic organs and the transplanted graft. When a patient with a lung transplant undergoes surgery, there is the potential for interference with lung function, depending on the type of intervention and its anatomical site. Accurate preoperative evaluation, an understanding of the physiology of the transplanted lung, proper airway instrumentation, individualized management of intraoperative ventilation, and fluid balance are essential for a positive perioperative outcome.
Patients with end stage renal failure (ESRD) require renal replacement therapy in the form of dialysis or renal transplantation. There is an increasing number of people receiving maintenance dialysis as patients with ESRD are increasing faster than the supply of transplantable organs. The mortality rate on dialysis is 4-6 times that of the general population and is substantially reduced by transplantation. For the past 8 years, dialysis research has focused on improving patient outcomes and quality of life on dialysis. This review examines recent advances in haemodialysis and peritoneal dialysis in a historical context and considers future research possibilities. PMID:19329705
This article describes the design and implementation of an online diabetes self-management intervention for a sample of inner-city African Americans with diabetes. Study participants were randomly assigned to the treatment (26) and control (21) conditions. The results indicate that treatment group participants were more likely to achieve positive outcomes in terms of lowered hemoglobin A1c and body mass index measurements than were control group members. These findings support the development of telehealth interventions to promote effective chronic disease management in medically underserved communities.
Acute vertebrobasilar occlusion (VBO) is associated with a high risk of stroke and death. Although local thrombolysis may achieve recanalization and improve outcome, mortality is still between 35% and 75%. However, without recanalization the chance of a good outcome is extremely poor, with mortality rates of 80-90%. Early treatment is a fundamental factor, but detailed studies of the exact time management of the diagnostic and interventional workflow are still lacking. Data on 18 patients were retrospectively evaluated. Time periods between symptom onset, admission to hospital, time of diagnosis, and beginning of intervention were correlated with postinterventional neurological status. The Glasgow Coma Scale and National Institute of Health Stroke Scale (NIHSS) were used to examine patients before and after local thrombolysis. Additionally, multivariate statistics were applied to reveal similarities between patients with neurological ...
The primary objectives of this study were to test two utility analysis models, the Cascio-Ramos Estimate of Performance in Dollars (CREPID) model and Godkewitsch financial utility analysis model and to determine their appropriateness as tools for evaluating training. This study was conducted in conjunction with Philadelphia Electric Company's Nuclear Training Group. Job performance of nuclear maintenance workers was assessed to document the impact of the training program. Assessment of job performance covered six job performance themes. Additionally, front-line nuclear maintenance supervisors were interviewed to determine their perceptions of the nuclear maintenance training. A comparison of supervisor's perceptions and outcomes of the utility analysis models was made to determine the appropriateness of utility analysis as quantitative tools for evaluating the nuclear maintenance training program. Application of the CREPID utility analysis model ...
This study examined whether cognitive behavioural therapy (CBT) could prevent the development or worsening of panic-spectrum psychopathology and anxiety symptoms in chronic obstructive pulmonary disease (COPD). 41 patients with COPD, who had undergone pulmonary rehabilitation, were randomised to either a four-session CBT intervention condition (n = 21) or a routine care condition (n = 20). Assessments were at baseline, post-intervention, and at 6-, 12- and 18-month follow-ups. Primary outcomes were the rates of panic attacks, panic disorder and anxiety symptoms. Secondary outcomes were depressive symptoms, catastrophic cognitions about breathing difficulties, disease-specific quality of life and hospital admission rates. There were no significant differences between the groups on outcome measures at baseline. By the 18-month follow-up assessment, 12 (60%) routine care group participants had experienced at least one panic ...
Executive summary 1. Few studies have to date explained consumer attitudes and purchase decisions with regard to genetically engineered food products. However, the increased marketing of genetically engineered food products and the considerable concern that consumers seem to express with regard to the technology call for the development of a theoretical basis for research into these issues. 2. The aim of the paper is to present three models which we have developed to explain consumer attitudes, buying behaviour and attitude change with regard to genetically engineered food products. All three models build on established consumer behaviour theory and on existing and comparable research in the field. 3. Consumer attitudes toward genetic engineering in food products are explained in an attitude model that builds on Fishbein's multiattribute attitude model. The model deviates from Fishbein's model in a number of ways: there is an explicit distinction between perceived benefits and risks ...
Problems and solutions in the diagnosis and operative treatment were clarified by retrospective evaluation of cases of intramedullary tumor in which MRI and surgery had been performed. The subjects were 16 patients (21-75 years old, mean age: 45 years) whose tumor was surgically removed between 1991 and 1998. MRI was performed preoperatively, and T1-weighted images, T2-weighted images, and enhanced images were obtained. Angiography was also performed in some cases. The histological diagnosis based on the MRI findings before surgery were compared with the pathological diagnosis after the operation. In 9/16 cases (56%), the preoperative histological diagnosis based on the MR images was the same as the pathological diagnosis after the operation. In 8 of the 11 cases (73%) whose images showed clear tumor margins and well shaped the tumor, the tumors were completely removed. The concordance rate between the pathological diagnosis during and after the operation was 67%. ...
Objective: To determine whether asymptomatic bacterial vaginosis (BV) is associated with upper genital tract inflammation or bacterial colonization.Methods: Fifty nonpregnant women with intact uteri who planned to undergo gynecologic surgery and had no recent symptoms of vaginal infection were enrolled. We obtained a vaginal swab for Gram stain, endocervical swab for chlamydia and gonorrhea DNA probe testing, and Pipelle endometrial biopsy for aerobic and anaerobic cultures and histology. We correlated surgical findings and histology of available surgical specimens with the microbiologic results. The diagnosis of BV was made according to Speigel's criteria. Bacteria isolated from the uterus were classified as high virulence versus low virulence. Contingency tables were analyzed using the chi-square or Fisher Exact tests.Results: Twenty-one of 50 patients had BV on Gram stain, 3 had intermediate BV, and 3 had unreadable slides. Eleven patients ...
Retrospective analyses were performed to evaluate the therapeutic efficacy of intra-oral cone (IOC) radiation therapy for carcinoma of the oral tongue, especially about its faculty of local control and complications. Thirty-nine patients with squamous cell carcinoma of the oral tongue were treated with IOC radiation therapy alone or in combination with external irradiation. IOC radiation therapy was given not only for T1 and T2, but also for T3 tumors. Hypofractionation was used for IOC radiation therapy. The 2 year local control rates, including surgical salvage, for T1, T2, T3 and T4 were 100%, 73.3%, 40% and 0%, respectively. The 5 year actuarial survival rates for Stage I, II, III and IV were 100%, 65.3%, 35.4% and 0%, respectively. The incidences of radiation complications, i.e. soft tissue ulceration and osteoradionecrosis, were 42.9% and 2.9%, respectively. It is suggested that relatively high rate of soft tissue ulceration was due to hypofractionation. We ...
Purpose: To evaluate the results of radiotherapy in cholangiocarcinoma patients managed with various combinations of chemotherapy and surgical resection with selective liver transplantation. Methods and Materials: From January 1990 to December 1995, 61 patients with histologically confirmed biliary duct adenocarcinoma were seen in the Radiation Oncology Department of the University of Pittsburgh. Median follow-up was 22 months (1 to 91 months). The extent of surgery was complete resection in 23 patients (including 17 with orthotopic liver transplant), partial resection in 4, and biopsy in 34. All patients had radiotherapy; median dose was 49.5 Gy. Thirty patients received chemotherapy: 5-fluorouracil (5-FU)-leucovorin with interferon alpha (IFN#alpha#) in 27, and taxol in 3. Results: The median survival was 20 months (95% CI 15-25 months). The 5-year actuarial survival was 23.8 #+-# 6.8%. The only significant variable in multivariate analysis was achieving a ...
Gastrointestinal lymphomas are almost exclusively of a non Hodgkin's type. The Western form is characterized by a higher incidence of stomach location (50 %), a MALT type (mucosa associated lymphoid tissue) (40 %), a B-cell type (90 %), and a high grade (55 %). Chronic infection with Helicobacter pylori is an important risk factor. Mediterranean lymphomas form a particular clinical and pathological entity with diffuse involvement of the small bowel and are frequently being associated with a chronic malabsorption disorder. Eradication of Helicobacter pylori in early lymphomas, and the use of tetracyclines in early Mediterranean lymphomas, have been shown to induce durable remissions. For more advanced gastric lymphomas, treatment usually consists of anthracycline-based chemotherapy followed by involved field radiotherapy. Surgery is usually reserved for complications such as perforation or bleeding, or in some selected cases for salvage after failure of non-surgical ...
Ewing's sarcoma is the most common malignant bone tumour occurring in children and adolescents and exists in two different clinico pathological entities: osseous Ewing's sarcoma (OES) and extraosseous Ewing's sarcoma (EES). Five cases of primary epidural EES are described, which presented with non-specific symptoms leading to a long diagnostic delay. The median age at diagnosis was 22 years (range 13-36 years). The median diagnostic delay was 3 months. All patients had one or more neurological deficits. All underwent surgical exploration with a laminectomy and partial resection followed by adjuvant radiotherapy to a dose of 46-50 Gy and chemotherapy with VAC (vincristine, adriamycin and cyclophosphamide) alternating with ICE (ifosphamide, cisplatin and etoposide) for at least six cycles. The mean follow-up period is 21.2 months (range 11-32 months). Four of the five patients achieved a complete remission and are disease free at the time of writing this report. Two ...
Bariatric surgical procedures have become important therapeutic options for treatment of morbid obesity in both adults and adolescents co-morbidities of obesity such as glucose intolerance, type 2 diabetes (T2DM), metabolic syndrome, steatohepatitis, hyperlipidemia and cardiovascular disease. These co-morbidities of obesity have significant impacts on the overall quality of life of the individual and our society at large. Roux-en-Y gastric bypass (RYGB) and the relatively newer procedures of gastric banding (GB) and vertical sleeve gastrectomy (VSG) have proven to be efficacious in achieving rapid weight loss and reversing the comorbidities of obesity. Unfortunately, bariatric procedures are not without risks including micronutrient deficiency, failure to maintain lost weight, and mortality. Further, the resolution of T2DM has long been understood to precede weight loss, and this finding provides important clues about the physiologic underpinnings of the ...
The frequency of peripheral pulmonary artery stenosis in patients after surgical repair of tetralogy of Fallot (TOF) ranges from 20 to 40%. This can be either primary or secondary to the surgical intervention. The influence of resulting lung perfusion alterations on the life quality of patients is difficult to predict. The aim of this study was to compare the utility of the diagnostic procedures in this group of patients, with particular focus on lung perfusion scintigraphy. This study comprised 104 patients who underwent repair of TOF at ages from 5 months to 25 years. The patients have been followed up for from 4.2 to 25 years. On the basis of chest X-ray peripheral pulmonary artery stenosis was suspected in 11 patients, in 12 on the basis of echocardiography examination. Lung perfusion scintigraphy has been performed on 87 patients. The disturbances in lung perfusion (mostly in the left lung) were show by means of lung perfusion scintigraphy ...
The epileptogenic and neurodegenerative effects of gamma-dendrotoxin, from Dendroaspis angusticeps, a specific blocker of a non-inactivating, voltage-sensitive K+ channel, were studied after focal injection into one dorsal hippocampus in rats pretreated with CGP040116, a N-methyl-D-aspartate (NMDA) receptor antagonist, and in rats bearing a monolateral surgical lesion of the Schaffer collaterals whose terminals originate from CA3 pyramids and release glutamate in the CA1 hippocampal area. Administration of 35 pmol gamma-dendrotoxin elicited in all of the treated animals (n=8) bilateral EEG discharges and damage to the hippocampal formation. Quantitation of the damage revealed significant bilateral neuronal cell loss in the CA1, CA3 and CA4 pyramidal cell layers. The lowest dose (0.35 pmol; n=4) of the toxin used did not affect EEG activity and failed to cause significant hippocampal cell loss whereas the 3.5 pmol (n=6) dose caused EEG seizures and hippocampal cell ...
Aim: To evaluate magnetic resonance cholangiography (MRC) with high-resolution dynamic gadolinium-enhanced magnetic resonance imaging (MRI) in determining the imaging features of hilar cholangiocarcinoma that relate to tumour extent and influence resectability. Materials and methods: Twenty-six patients that underwent resection were reviewed. Tumour location and extent, lobar atrophy, the degree of portal vein and hepatic artery involvement were recorded. The findings were correlated with surgical and histopathological findings. Results: Biliary assessment was concordant in 14 and discordant in eight of 14 stented and four of 12 non-stented patients. In 63/82 veins and 43/74 arteries results were fully concordant. The mean sensitivity, specificity, positive and negative predictive values (PPV, NPV) in predicting involvement of the main portal vein (MPV) at surgery were 83.3, 100, 100, and 92.5%; of the left main branch of the portal vein (LPV) were 100, 91.6, 93.3, ...
Accurate diagnosis of local invasion of hilar cholangiocarcinomas is challenging due to their small size and the anatomic complexity of the hepatic hilar region. On the other hand, the correct diagnosis of local invasion is essential for assuring the possibility of curative surgery. The purpose of this study was to evaluate the feasibility of four-channel multidetector-row computed tomography (MDCT) in the assessment of vascular and bile duct involvement, by which we could obtain useful information for the surgical management of hilar cholangiocarcinoma. The subjects were 18 patients for whom the extent of tumor invasion was surgically and pathologically confirmed. All patients underwent preoperative multiphasic CT scanning by MDCT. Arterial and portal dominant phases were acquired using a detector configuration of 1.25 mm x 4 mm, and both axial and multiplanar reconstructed images were interpreted. Longitudinal extension was evaluated up to ...
The purpose of the paper is to investigate whether high-resolution CT (HRCT) can detect the subjects with massive emphysematous destruction in a group of patients with severe chronic obstructive pulmonary disease (COPD) and therefor be of help in selecting the candidates to surgical lung volume reduction. Have been examined 40 former smokers with severe COPD (FEV_1#<=#40% of the predicted value, with no major improvement after inhalation of bronchodilators). The emphysema extent score was significantly correlated with the hematocrit value and Tiffeneau index (p<2) in all the 40 patients. The severity of bronchial obstruction was the same in bronchitis and dyspnoeic patients. The subject with chronic bronchitis had milder emphysema (mean extent 35% versus 47% in the dyspnoeic subjects) and a higher frequency of bronchial involvement. A decrease in FEV_1 was significantly correlated with emphysema extent (p<1) in dyspnoeic, but not in bronchitis, patients. ...
The authors investigated the role of Computerized Tomography in guiding fine needle biopsy (FNB) in small (2 2 cm in diameter for CT-guided FNB sensitivity, specificity and diagnostic accuracy. Cytologic specimens were positive for malignancy in 40/52 cases (76.9%) and negative in 12 (23.1%). Clinical-surgical follow-up confirmed all the positive cytologic findings (40 cases), while 2 of the extant 12 cases were false negatives (95.20% sensitivity, 100% specificity and 96.15% diagnostic accuracy). 158 of 195 nodules > 2 cm in diameter and with clinical surgical follow-up (81.3%) were positive for malignancy and 34 were negative (17.43%) (98.75% sensitivity, 97.14% specificity and 98.46% diagnostic accuracy). Pneumothorax occurred in 33 patients (16.5%) with nodules > 2 cm in diameter as a complication of biopsy. Hemoptysis occurred in 15 patients (7.5%). In the whole group of lung lesions, the complications were pneumothorax in 80 ...
January, 1992, to October, 1995, sixty-four patients with advanced head and neck cancer underwent head and neck reconstructive surgery using myocutaneous or revascularized flaps; in the same period, all patients were consecutively examined with CT and MRI. Myocutaneous flaps were used in 26 patients: 12 flaps were tubular and 14 linear. Revascularized flaps were used in 38 patients: to repair a large defect in 26 patients (14 latissimus dorsi flaps and 12 temporal muscle flaps) and to repair an oral damage in 12 patients (5 revascularized radial and 7 jejunal flaps). CT and MR images of myocutaneous flaps showed the flaps as fatty areas, repairing large surgical defects, hypodense at CT and hyperintense at MRI, with no post-contrast enhancement. The appearance of revascularized flaps at CT and MRI depends on the characteristics of the structure used to repair the surgical defect: jejunal and radial flaps appeared as mostly fatty thickened ...
January, 1992, to October, 1995, sixty-four patients with advanced head and neck cancer underwent head and neck reconstructive surgery using myocutaneous or revascularized flaps; in the same period, all patients were consecutively examined with CT and MRI. Myocutaneous flaps were used in 26 patients: 12 flaps were tubular and 14 linear. Revascularized flaps were used in 38 patients: to repair a large defect in 26 patients (14 latissimus dorsi flaps and 12 temporal muscle flaps) and to repair an oral damage in 12 patients (5 revascularized radial and 7 jejunal flaps). CT and MR images of myocutaneous flaps showed the flaps as fatty areas, repairing large surgical defects, hypodense at CT and hyperintense at MRI, with no post-contrast enhancement. The appearance of revascularized flaps at CT and MRI depends on the characteristics of the structure used to repair the surgical defect: jejunal and radial flaps appeared as mostly fatty thickened ...
Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity ...
Intracapsular femoral neck fractures remain unsolved fractures even after improvement in techniques of diagnosis and internal fixation. Individuals who sustain displaced femoral neck fractures are at high risk of developing avascular necrosis and non-union. Although several methods for predicting the viability of femoral head have been reported, they are not effective or widely used because of unreliability, potential complications and technical difficulties. Dynamic MRI was introduced in the recent past as a simple, non-invasive technique to predict the femoral head viability after the femoral neck fractures. In this study role of dynamic MRI was studied in 30 patients with 31 intracapsular femoral neck fractures. Fractures were divided in to three types according to dynamic curve patterns on MRI evaluation and were followed up for 6 months to 2 years to observe the final outcome. Sensitivity, Specificity and the Accuracy of dynamic MRI in predicting vascularity ...
We analyze the average of weak values over statistical ensembles of pre- and post-selected states. The protocol of weak values, proposed by Aharonov et al. [Phys. Rev. Lett. 60 (1988) 1351], is the result of a weak measurement conditional on the outcome of a subsequent strong (projective) measurement. Weak values can be beyond the range of eigenvalues of the measured observable and, in general, can be complex numbers. We show that averaging over ensembles of pre- and post-selected states reduces the weak value within the range of eigenvalues of Formula Not Shown . We further show that the averaged result expressed in terms of pre- and post-selected density matrices, allows us to include the effect of decoherence.
This study reports the outcome of real-time ultrasonographic screening tests of a healthy population. The study group consisted of 33 female teachers who were found to have asymptomatic gallstone disease. All cases were followed up to determine the incidence of biliary colic or complications. After a 38-month period of follow-up, seven subjects (21.2%) developed either biliary colic or complication. Study results revealed that the 38-month cumulative probability of the development of biliary colic or complication was 36%. Data shown that development of biliary colic or complications was positively associated with obesity, but no assocition was found with age, number of activities, or duration of contraceptive pill-taking. Having such a high percentage of subjects who developed biliary colic or complications within a relatively short period of time suggests that the silent gallstone is not innocent. PMID:17372404
Husband AC, Crawford S, McCoy LA, Pacaud D. The effectiveness of glucose, sucrose, and fructose in treating hypoglycemia in children with type 1 diabetes. Objective: There is a lack of evidence regarding the most effective treatment option for managing naturally occurring hypoglycemia in children with type 1 diabetes. The objectives of this study were (i) to determine if sucrose and fructose are equally effective as glucose in the treatment of spontaneous hypoglycemia in children with type 1 diabetes; and (ii) to determine prestudy and poststudy hypoglycemia treatment preferences. Methods: Thirty-three subjects [aged 5.4-15.5 yr and average duration of type 1 diabetes of 3.1 yr (SD = 2.3)] participated in a randomized, crossover design. The main outcome was the effectiveness of treatment a...
Home economics is a dynamic field that imparts knowledge intended to help people adapt to their environment by making effective use of human and material resources. Hence, the profession values global concerns for the environment, human rights, health, and well-being. In Nigeria, home economics teachers must also consider the role they play in programs such as family life education, poverty alleviation, and universal basic education. In particular, home economics is one of the subjects through which core messages of the country's Population and Family Life Education program are to be integrated at the secondary school level. In this article, the author discusses the outcomes of this program and provides recommendations for teachers teaching this subject. (Contains 1 table and 1 resource.)
Purpose To evaluate disease failure patterns and overall survival (OS) of women with triple-negative (TN) breast cancer who underwent breast-conserving therapy (BCT) and to understand the relationship of TN tumors with other prognostic factors. Patients and Methods The Surveillance, Epidemiology, and End Results (SEER) registry identified 562 women diagnosed and/or treated with unilateral invasive breast cancer during 2003?2004 at three Emory hospitals. After medical record review, 193 eligible women, with all tumor types, received BCT. Primary endpoints (local, regional, and distant recurrences) and secondary endpoint (OS) were evaluated using chi-square tests and Cox proportional hazards models. Results Of the 193 women, 33 (17.1%) had TN tumors and 160 (82.9%) had non-TN tumors. Patient...
Two studies (N = 420) were conducted to develop and validate the instructional dissent scale (IDS) for use in the college classroom. Participants in study 1 were 210 students who completed the IDS pilot inventory which was subjected to an exploratory factor analysis yielding three distinct factors of dissent (i.e., expressive, rhetorical, vengeful). Concurrent validity support was provided as perceived teacher misbehaviors were associated positively with students' likelihood of engaging in dissent and students reported fewer learning outcomes when they dissented. Participants in study 2 were from a different sample of 210 students who completed the IDS along with measures of classroom justice and student challenge behavior. A confirmatory factor analysis provided support for the hypothesiz...
Sexual information seeking is an important element within human information behavior. Seeking sexually related information on the Internet takes many forms and channels, including chat rooms discussions, accessing Websites or searching Web search engines for sexual materials. The study of sexual Web queries provides insight into sexually-related information-seeking behavior, of value to Web users and providers alike. We qualitatively analyzed queries from logs of 1,025,910 Alta Vista and AlltheWeb.com Web user queries from 2001. We compared the differences in sexually-related Web searching between Alta Vista and AlltheWeb.com users. Differences were found in session duration, query outcomes, and search term choices. Implications of the findings for sexual information seeking are discussed. PMID:15006171
Deltombe T, Gustin T. Selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients: a 2-year longitudinal follow-up of 30 cases. Objective To assess the long-term efficacy of selective tibial neurotomy in the treatment of spastic equinovarus foot in hemiplegic patients. Design Intervention study (before-after trial) with an observational design and 2-year follow-up. Setting Spasticity group in a university hospital. Participants Hemiplegic patients (N=30) with spastic equinovarus foot. Intervention A selective neurotomy was performed at the level of the motor nerve branches of the tibial nerve. Main Outcome Measures Spasticity (Ashworth scale), muscle strength (Medical Research Council scale), passive ankle dorsiflexion, gait parameters (6 min walking test...
Despite high local control rate in Ewing's sarcoma the exact indication of radiation therapy is still controversial as well as the choice of the target volume and the optimal dose of radiation. The importance of the quality of radiotherapy has been stressed in recently published data and has shown a significant impact on long term local control with adequate radiation therapy. The dramatic improvement of precision allowed by the conformal therapy and three dimensional dosimetry allow to expect a decrease of late effects expected for second malignancies. However, late sequelae and radio-induced osteosarcoma still remain the major side effects after radiotherapy. The authors discuss the results of the main trials on Ewing's sarcoma on the choice of dose and target volume. Surgery is still the preferred choice for small tumors if the foreseen outcome is identical. (authors). 28 refs.
Serious complications due to coronary artery fistulae have been described. Most authors recommend early intervention at the time of diagnosis. We present a case of a fistula originating from a dilated left coronary artery and draining into the right atrium, which was diagnosed prenatally by color Doppler echocardiography. During pregnancy, the echocardiographic findings remained unchanged, and there were no signs of heart failure. After birth, the fistula was confirmed by angiography. Additionally, a persistent left superior vena cava draining into the coronary sinus and a very small ventricular septal defect were detected. The fistula was closed successfully by transcatheter coil embolization. At 17 months old the child was in good clinical condition. Prenatal diagnosis of coronary artery fistulae may be possible and may improve perinatal management and outcome. PMID:12047543
Idiopathic pulmonary fibrosis is the most lethal form of diffuse lung fibrosis, killing approximately half of those affected within 2-3 years of diagnosis. Until recently, no therapies had been shown to have an impact on disease progression. The Clinical Studies Assessing Pirfenidone (Esbriet) in IPF: Research of Efficacy and Safety Outcomes (CAPACITY) program comprised two almost identical double-blind placebo-controlled studies assessing the effects of pirfenidone on change in forced vital capacity, the primary end point, over a 72-week period. One of these studies was positive, matching in magnitude the benefit seen in two previous positive Japanese studies. The other study did not meet its primary end point but positive trends were consistent in this and a number of secondary end point...
ABSTRACT Introduction. Postprostatectomy erectile dysfunction (ED) remains a serious quality-of-life issue. Recent advances in the understanding of the mechanism of postprostatectomy ED have stimulated great attention toward penile rehabilitation. Aim. This review presents and analyzes a contemporary series of the recent medical literature pertaining to penile rehabilitation therapy after radical prostatectomy (RP). Main Outcome Measures. The laboratory and clinical studies related to penile rehabilitation are analyzed. The validity of the methodology and the conclusion of the findings from each study are determined. Methods. The published and presented reports dealing with penile rehabilitation following RP in human and cavernous nerve injury in animal models are reviewed. Results. Exciti...
High-level expression of mitotic arrest defective protein 2 (MAD2), a central component of the spindle assembly checkpoint, has been observed in a variety of human malignancies. Aim of the present study was to observe the expression of MAD2 in human non-small-cell lung cancer (NSCLC) and explore its clinicopathologic significance and evaluate MAD2 expression as a prognostic marker. MAD2 transcript was found to be overexpressed in the great majority of lung cancers by semi-quantitative RT-PCR. A total of 358 NSCLCs were analyzed immunohistochemically on tissue microarrays. High-level MAD2 expression was observed in 26.3% (94 of 358 cases), and correlated with male sex (P=0.0002), tumor progression (pT status) (P=0.0009), visceral or parietal pleural invasion (P=0.0151), non-adenocarcinoma, ...
Introduction: Restrictions in prescribing broad spectrum antimicrobials have been part of a strategy to reduce Clostridium difficile cases in the UK in recent years. However, there has been little work on assessing the safety of alternative antimicrobial agents. Methods: We performed an uncontrolled prospective observational survey over a 1-year period to determine the effectiveness and safety of a new antimicrobial stewardship programme in a district hospital in the UK. Results: In total, 227 Gram-negative bacteraemias (203 episodes) occurred in the study period. Guidelines were adequate in 194 of 203 (95%) episodes and 163 episodes (80.2%) received adequate therapy. Patients in the inadequate therapy group had >2-fold increased likelihood of death [odds ratio (OR) = 2.63, 95% confidence ...
Nowadays, mixing is one of the most powerful tools for the process and products optimization in chemical process industries. The available technology can help in achieving almost any desired outcomes related to the process-side of the systems. This paper presents a practical methodology to improve existing agitation systems in order to overcome the constraints previously identified in the process. Well succeed real cases using this methodology in a petrochemical plant (Nitriflex S.A.) are presented. (author) 13 refs., 1 figs., 2 tabs.
Corneal laser refractive surgery is increasingly being performed on patients with the aim of improving unaided vision. Most candidates for surgery have excellent spectacle- or contact lens-corrected vision. Although microbial keratitis following refractive surgery is a rare complication, and usually has a good visual outcome, it can be sight-threatening. The spectrum of pathogens differs to other causes of microbial keratitis, such as contact lens-associated keratitis, and a different management approach is required. Postoperatively, patients are prescribed topical steroids and broad-spectrum topical antibiotics, typically fluoroquinolones. These do not cover unusual organisms, such as fungi, Nocardia, Acanthamoeba and some atypical mycobacteria. In post-laser-assisted in situ keratomileus...
This study examined the extent to which science, technology, engineering, and math (STEM) students reported having had mentors of their own race and gender and the extent to which they have adopted the idea that matching by race and gender matters. The study also documented the effects of race and gender matching on three academic outcomes, self-reported grade point average, efficacy, and confidence, based on data collected from 1,013 undergraduate and graduate students and postdoctoral scholars actively participating in MentorNet's online community. Analyses indicated that having a mentor of one's own gender or race was felt to be important by many students, especially women and students of Color. Students who had a mentor of their own gender or race reported receiving more help, but matc...
The consequences of exit, voice, loyalty, and neglect behavior were examined using retrospective questionnaires (Study 1) and 2 social interaction diary studies (Study 2). Exit and neglect were generally associated with more negative partner responses and reduced feelings of value and closeness, and were reported to be more harmful to the relationship. Voice was associated with more positive partner responses and greater value and intimacy, and was perceived to be most beneficial to the relationship. In contrast, loyalty was perceived to have the same detrimental consequences as destructive behaviors (Study 1) and did not predict more positive outcomes within daily interactions (Study 2). These results indicate that, despite good intentions, loyal intimates are often left feeling ignored a...
The treatment of acetabular bone defects presents a great challenge in revision total hip arthroplasty (THA). The purpose of this study was to evaluate the clinical and radiological outcome of revision THA using jumbo cups for acetabular reconstruction after applying the bone-grafting technique. We studied 17?patients with acetabular defects ranging from Type 2A to Type 3A according to Paprosky`s classification. According to the AAOS-score twelve patients were classified as Type II and five patients as Type III. Uncemented press-fit cups with an outer diameter larger than 64?mm were used in all cases. Fifteen patients received morselized bone allografts. In eight patients an additional screw fixation was necessary. The mean follow-up period was 82?months (range 33?149). The mean Harris Hip...
Coronary angiography has provided an unrivalled appreciation of coronary anatomy fostering a far greater appreciation of the extent of atherosclerotic disease. However, the subjectivity of coronary angiography at determining the extent of plaque has been exposed with IVUS. Indices of coronary physiology have provided valuable adjunctive information as to the physiological importance of specific lesions. Fractional flow reserve is an established method for evaluating the significance of epicardial stenoses. Fractional flow reserve guided percutaneous coronary intervention is associated with improved outcomes when compared to a conventional angiographic guided strategy, particularly in intermediate lesions. The use of coronary physiology in the cath lab represents a new avenue to guide appro...
Context. Cardiovascular medication overdoses can be difficult to treat. Various treatment modalities are currently recommended. Objective. To describe patient outcomes and adverse events of high-dose insulin therapy in consecutive overdose patients in cardiogenic shock after implementation of a high-dose insulin protocol (1-10 U/kg/h, while avoiding or tapering off vasopressors). Methods. This is an observational consecutive case series of patients identified from a registry. Data were collected by retrospective chart review of patients treated by our toxicology service with this protocol from February 2007 until March 2010. Results. Twelve patients were treated with high-dose insulin. The mean age was 36.5 years (SD 11.7). Seven patients had pre-existing vasopressor therapy, and all were ...
Objective: To reduce mental health symptoms and high-risk behaviors and increase social support and service utilization among street-living youth, the authors conducted a pilot study to assess the feasibility of the social enterprise intervention (SEI) at a homeless youth agency. Method: Convenience sampling was used to recruit 16 street-living youth from the agency. SEI participants received 7 months of vocational and small business training and service referrals. A comparison sample of 12 agency youth was used. Results: Findings from independent sample t tests demonstrate that SEI participants displayed significant improvements at 9 months in life satisfaction, family contact, peer support, and depressive symptoms. Conclusions: Preliminary findings suggest that the SEI was feasible within the agency setting and associated with higher mental health and social outcomes. (Contains 3 figures and 3 tables.)
The two primary objectives of the proposal were (1) to enhance science and technology infrastructure, faculty development, and curriculum by integrating technology throughout science education programs of study, and (2) to increase faculty and students` knowledge of and skills in modern technologies that are designed to enhance the effectiveness of teaching and learning through education, research and communications. These two primary objectives have been accomplished through: Installation and operation of a technology-ready classroom; Upgrading CIS 200 Introduction to Computers; Upgrading all science laboratory courses to include integration of science and technology through installation of computers; Faculty development through attendance at workshops, seminars, or conferences related to technology applicable to sciences; and Undergraduate research internships at the Oak Ridge National Laboratory. The paper briefly discusses the outcome of implementing this ...
Endophytes are microorganisms that live within healthy plant tissues, and include fungi and bacteria. They can be mutualists, comensals or even latent pathogens. Presence of these endosymbionts may affect host physiology, for example by consuming products of photosynthesis (endophytes are heterotrophs) or producing toxic metabolites. In this work two fungicides were used to eliminate fungal endophytes from seedlings of guarea guidonia. light saturated photosynthesis (Amax) was measured in endophytefree plants and compared with control plants. Each fungicide killed different fungal endosymbionts. phomopsis was more susceptible to benomyl while colletotrichum was more susceptible to propiconazole. Although suggestive, values of Amax were not significantly different for each treatment compared with control plants. No prediction can be made at this point about the final outcome of a given plantendophytic fungi interaction
Abstract in english A mathematical model has been developed for describing the dynamic operation of the N-formylmorpholine extractive distillation column and the corresponding solvent recovery column in the benzene extraction plant. The NRTL equation was used to calculate the equilibrium and thermodynamic properties of the mixtures. The validity of the model in terms of temperature, pressure and split fraction was examined using actual plant data at steady-state conditions. Comparison betwee (more) n model results and plant data shows good consistency. In order to improve the control of the process and selection of the optimal control strategy, the model was used to find the optimum values of the constants of the controllers with Nelder-Mead algorithm during unsteady-state operation by minimizing the deviation from steady-state conditions. The outcome of this study could be used by operators and engineers to increase the productivity of the unit.
Summary 1.-Plant-plant interactions fluctuate between competition and facilitation depending upon ecological conditions and species traits. Facilitative interactions are expected to increase in frequency via associational defences with increasing consumer pressure. The ability of species to cope with competition and/or ecological stressors may alter the outcome of plant-plant interactions. 2.-We conducted a transplant experiment to determine if native and non-native grasses and forbs respond similarly to interactions with Juncus effusus L., an unpalatable benefactor species, along a grazing intensity gradient in two contrasting pasture types: intensively managed and semi-natural. We expected competitive taller, erect species (grasses) and non-natives to obtain stronger facilitative effects...
Abstract The fit of patient coping style and psychotherapy focus has been suggested as improving treatment outcome. This article reviews the definitions, measures, and previous research surrounding this hypothesis. An original meta-analysis of 12 carefully selected studies (N = 1,291 patients) resulted in a weighted, mean effect size (d) of .55 in favor of a fit between externalizing patients and symptom-focused treatment or, alternatively, internalizing patients and insight-focused treatment. This medium-size effect indicates that nondiagnostic patient factors, like coping style, are important considerations in the selection of effective therapies. Clinical examples and clinical recommendations are provided. 2010 Wiley Periodicals, Inc. J Clin Psychol: In Session 67:176-183, 2011.
Background For the past 14 years, we have been performing laparoscopic adrenalectomy via the lateral transabdominal as well as the posterior retroperitoneal approach. The aim of this study is to describe patient selection criteria for each approach with comparison of perioperative outcomes. Methods In patients with smaller tumors, low body mass index (BMI), history of previous abdominal operations, appropriate body habitus, and bilateral pathology, we have performed preferentially the posterior approach. Data regarding clinical pathology, tumor size, BMI, estimated blood loss (EBL), operating time (OT), morbidity, mortality, and duration of stay were analyzed retrospectively. Data are expressed as mean +- standard error of the mean (SEM). Results One hundred seventy-two laparoscopic adrena...
The primary goal of this study was to assess the association between the full birth weight distribution and prevalence of specific developmental disabilities and related measures of health and special education services utilization in US children. Using data from the 1997?2005 National Health Interview Survey (NHIS) Sample Child Core, we identified 87,578 children 3?17?years of age with parent-reported information on birth weight. We estimated the prevalences of DDs (attention-deficit/hyperactivity disorder [ADHD], autism, cerebral palsy, hearing impairment, learning disability without mental retardation, mental retardation, seizures, stuttering/stammering, and other developmental delay) and several indicators of health services utilization within a range of birth weight categories. We cal...
Circadian rhythms affect several processes in the body physiology. This commentary revisits the topic of `metabolic basis of diseases' with a view to shed light on how cellular energy requirements feed-forward to a sequential signaling of hormonal response, blood glucose metabolism, antioxidant activities, and pathophysiology. Attempt is made to explain how diseases that may not appear to be closely related, such as bone metabolism and vasculopathy, have an increase in oxidative damage as a common underlying biochemistry. Importantly, this article identifies oxidative damage as an outcome of sleep disturbance and hypothesize that sleep complaint is not merely one of many resulting symptoms of PTSD, but a core feature that arise from trauma and gives rise to the stress biochemistry, which i...
AbstractBACKGROUND: Disparities in treatment and mortality for colorectal cancer (CRC) may reflect differences in access to specialized care or other characteristics of the area where an individual lives. METHODS: Surveillance, Epidemiology and End Results Program-Medicare data for seniors diagnosed with CRC were linked to area measures of the sociodemographic characteristics and the capacity of surgeons, medical oncologists, and radiation oncologists. Outcomes included receipt of stage-appropriate CRC care and mortality. RESULTS: After adjustment, blacks and Hispanics were less likely than whites to undergo surgery (odds ratio [OR] 0.57, 95% confidence interval (CI) 0.52-0.63 and OR 0.82, 95% CI 0.70-0.95, respectively). Individuals who lived in areas with the highest tertile of surgeon c...
In the analysis of power systems security, recently a new concern related to possible malicious attacks caught much attention. Coordination among different transmission system operators (TSO) in an interconnected power system to counteract such attacks has become an important problem. This paper presents a general framework for describing the physical, cyber and decision-making aspects of the problem and their interrelations; within this framework, an analytic tool for the assessment of information impacts in handling on-line security after a malicious attack is proposed and discussed. The model is based on the socially rational multi-agent systems and the equilibrium of a fictitious play is considered to analyze the impacts of various levels of information available to the interconnected system operators on the outcomes of the decision-making process under attack. A 34-buses test system, with 3 systems interconnected by tie-lines, is presented to illustrate the ...
Since the publication by the International Commission on Radiological Protection of revised recommendations which set out some general principles for intervention, some ideas have emerged which address interventions in the case of chronic exposure from contaminated lands. In the past there have been interventions proposed or carried out to rehabilitate land contaminated during the era of atmospheric nuclear weapon testing. Some of these interventions are reviewed in the context of these ideas and it is concluded that, by and large, reasonable outcomes have been achieved. The concept of a 'generic action level' (an effective dose of the order of 10 mSv#centre dot#a"-"1 to representative individuals in the critical group) may be useful in future to aid decision makers in determining whether intervention is appropriate. (author)
Background This study compares the expected 5-year costs for permanent sterilization in women between nonincisional hysteroscopic tubal occlusion with the Essure? system performed in an office setting and laparoscopic bilateral tubal ligation (LBTL). Study Design An economic decision tree is used to predict outcomes and costs to compare these two procedures from a US Medicaid perspective over a 5-year time horizon. Results Expected costs are $2367 for Essure? and $3545 for LBTL (Essure? saves $1178 or 33% of LBTL costs). Sensitivity analyses show Essure? has lower expected costs across all values considered. If the cost for a LBTL procedure were to decrease by 20% and the cost for Essure? to increase by 20%, Essure? would have still have lower expected costs. Conclusion Office-based steril...
In the Advance Coal Liquefaction Concept Proposal (ACLCP) carbon monoxide (CO) and water have been proposed as the primary reagents in the pretreatment process. The main objective of this project is to develop a methodology for pretreating coal under mild conditions based on a combination of existing processes which have shown great promise in liquefaction, extraction and pyrolysis studies. The aim of this pretreatment process is to partially depolymerise the coal, eliminate oxygen and diminish the propensity for retograde reactions during subsequent liquefaction. The desirable outcome of the CO pretreatment step should be: (1) enhanced liquefaction activity and/or selectivity toward products of higher quality due to chemical modification of the coal structure; (2) cleaner downstream products; (3) overall improvement in operability and process economics.
In the Advance Coal Liquefaction Concept Proposal (ACLCP) carbon monoxide (CO) and water have been proposed as the primary reagents in the pretreatment process. The main objective of this project is to develop a methodology for pretreating coal under mild conditions based on a combination of existing processes which have shown great promise in liquefaction, extraction and pyrolysis studies. The aim of this pretreatment process is to partially depolymerise the coal, eliminate oxygen and diminish the propensity for retograde reactions during subsequent liquefaction. The desirable outcome of the CO pretreatment step should be: (1) enhanced liquefaction activity and/or selectivity toward products of higher quality due to chemical modification of the coal structure; (2) cleaner downstream products; (3) overall improvement in operability and process economics.
Background Adrenal incidentaloma remains a diagnostic challenge. Despite well-established management guidelines, the long-term results of following these guidelines are unknown. We sought to determine how accurately these guidelines identify functioning incidentalomas and how often these guidelines result in adrenalectomy for benign tumors. Methods We catalogued adrenal incidentalomas from a retrospective review of 500 consecutive adrenalectomies at a single institution. The outcome measures studied were patient demographics, preoperative biochemical analysis, imaging characteristics, tumor size, type of operation performed, and postoperative histologic diagnosis. Results Eighty-one of the 500 adrenalectomies performed were for incidentalomas. Size was the only significant characteristic t...
We have developed a flexible radioactive polyurethane patch incorporating {beta}-emitting radionuclide (166Ho) to treat malignant skin lesions. We covered the tumor surface (n=133) with the radioactive patch for 33.58 {+-} 5.33 minutes. Radiation dose delivered was 35 Gy for Bowen's disease (n=78), Kaposi sarcoma (n=25), actinic keratosis (n=5), and 50 Gy for BCC (n=17) and squamous carcinoma (n=8). Complete response was observed in 91.7% after the first therapeutic trial, 96.2% after 2nd and 97.7% after 4th trial with excellent cosmetic outcome for 31.15{+-}13.88 months of follow-up. Radioactive patch therapy is effective for superficial skin cancers that are impractical for surgery.
Abstract Aims To determine, in the context of a trial in which counseling did not improve smoking cessation outcomes, whether this was due to a failure of the conceptual theory identifying treatment targets or the action theory specifying interventions. Design Data from a randomized clinical trial of smoking cessation counseling and bupropion SR were submitted to multi level modeling to test whether counseling influenced real time reports of cognitions, emotions and behaviors, and whether these targets predicted abstinence. Setting Center for Tobacco Research and Intervention, Madison, WI. Participants A total of 403 adult, daily smokers without contraindications to bupropion SR use. Participants were assigned randomly to receive individual counseling or no counseling and a 9 week course o...
Starting from the Plebanski formulation of gravity as a constrained BF theory we propose a new spin foam model for 4d Riemmanian quantum gravity that generalises the well-known model of Barrett-Crane and resolves the ultralocality problem that this model is known to possess. It is well known that the BF formulation of 4d gravity possesses two sectors: one corresponding to gravity and the other topological. The model presented here is shown to give a quantisation of the gravitational sector. The present model is dual to the recently proposed spin foam model of Engle et al. which, we show, corresponds to the topological sector of the theory. One important outcome of our approach is that it also allow us to introduce the Immirzi parameter into the framework of spin foam quantisation. We generalize some of our considerations to the Lorentzian setting and obtain a new spin foam model in that context as well.
Summary Background:- Cholinesterase inhibitors form the mainstay of treatment for persons with mild-to-moderate Alzheimer-s disease (AD). The rivastigmine patch may increase compliance and the proportion of patients maintaining an efficacious dose compared with oral cholinesterase inhibitors. Objective:- To investigate the proportion of patients who reached and maintained the target rivastigmine patch dose compared with the target rivastigmine capsule dose reported in clinical trials. Methods:- This was a multicentre, 24-week, open-label study in persons with probable AD and a Mini-Mental State Examination (MMSE) score of --10 and --26. The primary outcome was the proportion of patients (ITT population) treated with 9.5-mg/24-h rivastigmine patch for at least 8-weeks at week 24. Secondary ...