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Sample records for bronchial sparing surgery

  1. Treatment of bronchial ruptures by delayed surgery

    Institute of Scientific and Technical Information of China (English)

    1999-01-01

    Objective:To study the causes that resulted in delayed surgery for bronchial ruptures and the results.Methods:The cases with the bronchial ruptures by the delayed surgery last decade were retrospectively reviewed.The causes and unsatisfactory results were analysed.Results:The severe complications usually occurred after the delayed surgery and the results were not as satisfactory as those by early surgery.Conclusion:The bronchial ruptures ought to be operated in the early stage after being wounded.

  2. Outcomes of Testis Sparing Surgery

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    Muhammet Özcan

    2012-09-01

    Full Text Available Aim: Our aim was to review the indications and results of partial orchidectomy. Material and Method: We retrospectively investigated pathologic and demographic features of patients who underwent partial orchidectomy between February 2005 and December 2011. Results: Partial orchidectomy was performed on 7 patients aged between 2 and 30 years. Partial orchidectomy was performed for testicular tumour/mass on solitary testis, bilateral testicular tumour, trauma on 3,2,1 patients respectively. Pathologic examination of the patient who was undergone partial orchiectomy for testicular trauma revealed a mixed germ cell tumour that was detected incidentally. Discussion: Testis sparing surgery is a treatment option in selected cases with the davantages of fertility preservation and avoiding the need for long-term hormone replacement therapy.

  3. [Organ-sparing surgery in andrology].

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    Song Ning-hong

    2015-12-01

    Penile and testicular tumors, especially those of the malignant nature, usually require radical excision, which alters the organ image, affects sexual and urinary functions, and consequently undermines the self-confidence and quality of life of the patient. Recent studies show that organ-sparing surgery can be an alternative to radical excision for superficial tumors and small masses. Penis-sparing surgery (PSS) has been indicated for superficial penile cancer, such as Tis and T1a lesions, and testis-sparing surgery (TSS) is feasible for benign small bilateral or solitary testicular masses (TIN). Long-term follow-ups after PSS or TSS show that the patients may retain a satisfactory appearance of the organ as well as desirable sexual and reproductive functions.

  4. Problems of sparing surgery for otosclerosis

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    O. N. Sopko

    2013-01-01

    Full Text Available The article deals with optimization of the current technical methods in operations on the osteosclerotic stapes aimed at minimization of any trauma in the inner ear and at maximal possible safety for the sound-conducting structures - the factors that guarantee the functional results of the surgery.

  5. Macula-Sparing rhegmatogenous retinal detachment: Is emergent surgery necessary?

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    Sasan Mahmoudi

    2016-01-01

    Full Text Available The status of the macula is a significant factor in determining final visual outcomes in rhegmatogenous retinal detachment (RRD and should be considered in the timing of surgical repair. Several studies have shown that macula-involving RRDs attain similar visual and anatomic outcomes when surgery is performed within seven days as compared to emergent surgery (within 24 hours. In contrast, surgery prior to macular detachment in macula-sparing RRDs generally yields the best visual outcomes. In the case of macula-sparing RRDs, it is not clear how long the macula may remain attached, therefore, standard practice dictates emergent surgery. Timing of presentation, examination findings, case complexity, co-existing medical conditions, surgeon expertise, and timing and quality of access to operating facilities and staff, however, should all be considered in determining whether a macula-sparing RRD requires immediate intervention or if equivalent visual and possibly better overall outcomes can be achieved with scheduled surgery within an appropriate time frame.

  6. Fertility-Sparing Surgery for Early-Stage Cervical Cancer

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    Adelaide Fernanda Ribeiro Cubal

    2012-01-01

    Full Text Available Nowadays cervical cancer is diagnosed in many women who still want to have children. This led to the need to provide fertility-sparing treatments. The main goal is to maintain reproductive ability without decreasing overall and recurrence-free survival. In this article, we review data on procedures for fertility preservation, namely, vaginal and abdominal trachelectomy, less invasive surgery and neoadjuvant chemotherapy. For each one, oncological and obstetrical outcomes are analyzed. Comparing to traditionally offered radical hysterectomy, the overall oncologic safety is good, with promising obstetrical outcomes.

  7. Nephron-Sparing Surgery for Adenocarcinoma in a Renal Allograft

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    Fernando Vázquez Alonso

    2012-01-01

    Full Text Available The incidence of malignant tumors in recipients of renal allografts is higher than in the general population. Renal cell carcinoma (RCC accounts for 4.6% of the tumors in transplanted patients; of them, only 10% are found in transplanted kidneys. Transplantectomy has always been the usual treatment. However, during the last years, nephron-sparing surgery of the allograft is more frequently done in well-selected cases, and therefore dialysis can be avoided. We report the case of a 37-year-old female patient with renal transplant, diagnosed with a 4.5 cm tumor in the lower pole of the renal allograft. The patient underwent partial nephrectomy successfully. Six years after surgery, there is no evidence of recurrence of the disease and the patient maintains an adequate renal function.

  8. Nephron-Sparing Surgery for Adenocarcinoma in a Renal Allograft

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    Vázquez Alonso, Fernando; Cardozo Rodríguez, Enrique; Puche Sanz, Ignacio; Flores Martin, Jose Francisco; Molina Hernandez, Jose Miguel; Berrio Campos, Raquel; Vicente Prados, Javier; Medina Benitez, Antonio; Cózar Olmo, Jose Manuel

    2012-01-01

    The incidence of malignant tumors in recipients of renal allografts is higher than in the general population. Renal cell carcinoma (RCC) accounts for 4.6% of the tumors in transplanted patients; of them, only 10% are found in transplanted kidneys. Transplantectomy has always been the usual treatment. However, during the last years, nephron-sparing surgery of the allograft is more frequently done in well-selected cases, and therefore dialysis can be avoided. We report the case of a 37-year-old female patient with renal transplant, diagnosed with a 4.5 cm tumor in the lower pole of the renal allograft. The patient underwent partial nephrectomy successfully. Six years after surgery, there is no evidence of recurrence of the disease and the patient maintains an adequate renal function. PMID:22848857

  9. Testicular sparing surgery in small testis masses: A multinstitutional experience

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    Andrea B. Galosi

    2016-12-01

    Full Text Available Introduction: The incidence of benign testicular tumors is increasing in particular in small lesion incidentally found at scrotal ultrasonography. Primary aim of this study was to perform radical surgery in malignant tumor. Secondary aim was to verify the efficacy of the diagnostic-therapeutic pathway recently adopted in management of small masses with testis sparing surgery in benign lesions. Materials and methods: In this multicenter study, we reviewed all patients with single testis lesion less than 15 mm at ultrasound as main diameter. We applied the diagnostic-therapeutic pathway described by Sbrollini et al. (Arch Ital Urol Androl 2014; 86:397 which comprises: 1 testicular tumor markers, 2 repeated scrotal ultrasound at the tertiary center, 3 surgical exploration with inguinal approach, intraoperative ultrasound, and intraoperative pathological examination. Definitive histology was reviewed by a dedicated uro-pathologist. Results: Twenty-eight patients completed this clinical flowchart. The mean lesion size was 9.3 mm (range 2.5-15. Testicular tumor markers were normal except in a case. Intraoperative ultrasound was necessary in 8/28 cases. We treated 11/28 (39.3% with immediate radical orchiectomy and 17/28 (60.7% with testis-sparing surgery. Definitive pathological results were: malignant tumor in 6 cases (seminoma, benign tumor in 10 cases (5 Leydig tumors, 2 Sertoli tumors, 1 epidermoid cyst, 1 adenomatoid tumor, 1 angiofibroma, benign disease in 11 (8 inflammation with haemorragic infiltration, 2 tubular atrophy, 1 fibrosis, and normal parenchyma in 1 case. We observed a good concordance between frozen section examination and definitive histology. Any malignant tumor was treated conservatively. Any delayed orchiectomy was necessary based on definitive histology. Conclusions: The incidence of benign lesions in 60% of small testis lesions with normal tumor markers makes orchiectomy an overtreatment. Testicular sparing surgery of single

  10. Ovarian-Sparing Surgery in Pediatric Benign Ovarian Tumors.

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    Abbas, Paulette I; Dietrich, Jennifer E; Francis, Jessica A; Brandt, Mary L; Cass, Darrell L; Lopez, Monica E

    2016-10-01

    To evaluate outcomes of children after ovarian-sparing surgery (OSS) for non-neoplastic and benign neoplastic ovarian lesions. Retrospective cohort study from January 2003 to January 2012. Single, high-volume, tertiary care hospital. Children 18 years of age and younger. None. Postoperative complications and tumor recurrence after OSS. One hundred nine patients underwent OSS with a median age of 13.3 years (interquartile range [IQR], 11.4-15.1 years). Eighty-two patients were treated laparoscopically with 4 conversions to an open procedure. Postoperative complications included surgical site infections in 7 patients (6%). Pathology most commonly revealed functional ovarian cysts (n = 57) and mature teratomas (n = 37). Ninety-four patients (86%) were followed for a median of 10.4 months (IQR, 0.72-30.8 months). Fifty-five patients (60%) had subsequent imaging surveillance a median of 7.6 months postoperatively (IQR, 3.9-13 months). Ten patients (10%) developed a second ipsilateral lesion within a median time of 11 months (IQR, 7.7-24 months), of whom 5 girls had repeated surgery for mass enlargement or persistent abdominal pain at a median time of 10.5 months (IQR, 8.0-12.65 months). Fifty-eight patients (63%) began or resumed menses at their most recent follow-up. Three girls became pregnant after OSS at a median follow-up of 5 years (range, 2.4-6.7 years). Benign ovarian lesions in children can be treated successfully with OSS with low recurrence and repeat surgery rates. Copyright © 2016 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  11. Simple intratesticular cyst: A rare finding amenable to testis-sparing surgery

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    Jessica N. Jackson

    2016-11-01

    Full Text Available Simple intratesticular cysts (SIC are rare in infancy. There is a paucity of data with regards to management. Concern for malignancy often prompts the pediatric urologist to perform a radical orchiectomy which may impact endocrine function and fertility potential later in life. Recently, there has been a movement towards testis-sparing surgery for SIC. Herein, we describe a case of a 7-month-old infant who presented to pediatric urology clinic with left intraparenchymal SIC that was treated with a testis-sparing approach. In summary, this case report supports the use of testis-sparing surgery for management of preoperatively well-defined SIC.

  12. Laparoscopic ovarian-sparing surgery for a young woman with an exophytic ovarian fibroma.

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    Hasegawa, Akiko; Koga, Kaori; Asada, Kayo; Wada-Hiraike, Osamu; Osuga, Yutaka; Kozuma, Shiro

    2013-12-01

    Ovarian fibroma can occur in young women of reproductive age. Despite its benign feature, most surgical removals are done in open surgery with oophorectomy. However, an ovarian-sparing tumor resection can be an option, especially for an exophytic type of fibroma, which accounts for more than half of ovarian fibromas. Here we report a case of exophytic ovarian fibroma in a young woman treated by laparoscopic ovarian-sparing surgery. A 27-year-old woman presented with a pelvic mass. Magnetic resonance imaging revealed an 11 cm × 8 cm solid mass connected to the normal-appearing left ovary by a pedicle-like structure. A clinical diagnosis of an exophytic ovarian fibroma was made, and laparoscopic ovarian-sparing surgery with an intraoperative pathological examination was planned. The tumor was resected by cutting the pedicle, morcellated in a pouch and removed. All procedures were performed laparoscopically and the affected ovary was completely preserved. Having confirmation of its benign characteristics by the intraoperative examination, no further excision was performed. The patient conceived 3 months after the surgery and no recurrence was reported. We propose that gynecologists should consider laparoscopic ovarian-sparing surgery for exophytic ovarian fibroma in women of reproductive age.

  13. Raman spectroscopic detection of peripheral nerves towards nerve-sparing surgery

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    Minamikawa, Takeo; Harada, Yoshinori; Takamatsu, Tetsuro

    2017-02-01

    The peripheral nervous system plays an important role in motility, sensory, and autonomic functions of the human body. Preservation of peripheral nerves in surgery, namely nerve-sparing surgery, is now promising technique to avoid functional deficits of the limbs and organs following surgery as an aspect of the improvement of quality of life of patients. Detection of peripheral nerves including myelinated and unmyelinated nerves is required for the nerve-sparing surgery; however, conventional nerve identification scheme is sometimes difficult to identify peripheral nerves due to similarity of shape and color to non-nerve tissues or its limited application to only motor peripheral nerves. To overcome these issues, we proposed a label-free detection technique of peripheral nerves by means of Raman spectroscopy. We found several fingerprints of peripheral myelinated and unmyelinated nerves by employing a modified principal component analysis of typical spectra including myelinated nerve, unmyelinated nerve, and adjacent tissues. We finally realized the sensitivity of 94.2% and the selectivity of 92.0% for peripheral nerves including myelinated and unmyelinated nerves against adjacent tissues. Although further development of an intraoperative Raman spectroscopy system is required for clinical use, our proposed approach will serve as a unique and powerful tool for peripheral nerve detection for nerve-sparing surgery in the future.

  14. Extended voice-sparing surgery in selected pyriform sinus carcinoma: Techniques and outcomes

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    Hamoir, Marc; Fievez, Juliette; Schmitz, Sandra; Velasco, Dorris; Lengelé, Benoît

    2013-01-01

    BACKGROUND: Organ-preservation approaches are frequently favored in the treatment of advanced pyriform sinus carcinoma. In selected cases, use of free flaps allows voice-sparing surgery. METHODS:Thirteen patients underwent conservative extended laryngopharyngectomy. In 11 patients, the resection included the supraglottic larynx, whereas the whole hemilarynx was resected in 2. Reconstruction was achieved with a radial forearm free flap with the palmaris longus tendon. In hemilarynx resection, ...

  15. Fertility sparing surgery in gestational trophoblastic neoplasia: A report of 4 cases

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    Hasanzadeh, Malihe; Vahid Roodsari, Ftemeh; Ahmadi, Shahnaz; Gavedan Mehr, Masoumeh; Azadeh, Tabari

    2016-01-01

    Background: Gestational trophoblastic neoplasia (GTN) is a curable disease that involves the development of malignant tumor in the woman after a normal or molar pregnancy. The position of surgery in GTN is not properly specified and is changing due to new chemotherapy protocols. However, the role of surgery is highlighted in chemotherapy-resistant GTN. Other indications of surgery in trophoblastic diseases are drug toxicity and uterine perforation. Based on the fact that most women in certain age tend to preserve fertility, this study reported 4 cases of successful treatment after fertility sparing surgery. Case: A hospital-based case-report study was carried out to investigate the role of surgery in 4 patients with GTN. In this study, acute complications, such as intra-abdominal bleeding and liver dysfunction due to chemotherapy occurred in some patients. Surgery was performed and all cases underwent localized tumor removal while preserving the uterus. No hysterectomy surgery was performed. Conclusion: Surgery is supposed in specific cases of GTN, who desire preserving fertility. PMID:27738663

  16. Rare presentation of a testicular angiofibroma treated with testis sparing surgery

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    Luca Leone

    2016-12-01

    Full Text Available Introduction: Testicular benign tumors are very rare (< 5%. Testicular Angiofibroma (AF is one of those, however the gold standard of treatment and follow-up is still unclear. Case report: A 47 years-old man with only one functioning testis was referred to our clinic for a palpable right testicular mass and atrophic contralateral testis. Patient underwent testis-sparing surgery with inguinal approach and intraoperative frozen sections examination with diagnosis of AF. Final histology confirmed AF. Post-operative follow-up was uneventful. Clinical and ultrasonographic follow-up was negative after 8 months. Conclusion: We report a conservative surgery in a patient with AF of the solitary testis. AF is a benign para-testicular fibrous neoplasm that could be misinterpreted as malignant tumor and treated with orchiectomy. Testis-sparing surgery is recommended in this case with intraoperative pathological examination. The excision of the mass is enough but in front of a possible recurrence a long follow-up is advisable.

  17. Role of intra-operative contrast-enhanced ultrasound (CEUS) in robotic-assisted nephron-sparing surgery.

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    Alenezi, Ahmad N; Karim, Omer

    2015-03-01

    This review examines studies of intra-operative contrast-enhanced ultrasound (CEUS) and its emerging role and advantages in robotic-assisted nephron-sparing surgery. Contrast-enhanced ultrasound is a technology that combines the use of second-generation contrast agents consisting of microbubbles with existent ultrasound techniques. Until now, this novel technology has aided surgeons with procedures involving the liver. However, with recent advances in the CEUS technique and the introduction of robotics in nephron-sparing surgery, CEUS has proven to be efficacious in answering several clinical questions with respect to the kidneys. In addition, the introduction of the microbubble-based contrast agents has increased the image quality and signal uptake by the ultrasound probe. This has led to better, enhanced scanning of the macro and microvasculature of the kidneys, making CEUS a powerful diagnostic modality. This imaging method is capable of further lowering the learning curve and warm ischemia time (WIT) during robotic-assisted nephron-sparing surgery, with its increased level of capillary perfusion and imaging. CEUS has the potential to increase the sensitivity and specificity of intra-operative images, and can significantly improve the outcome of robotic-assisted nephron-sparing surgery by increasing the precision and diagnostic insight of the surgeon. The purpose of this article is to review the practical and potential uses of CEUS as an intra-operative imaging technique during robotic-assisted nephron-sparing surgery.

  18. Managing Renal Cell Carcinoma Associated Paraneoplastic Syndrome with Nephron-sparing Surgery in a Patient with von Hippel-Lindau

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    John M. DiBianco

    2017-07-01

    Full Text Available A patient with germline von Hippel-Lindau (VHL gene alteration and history of multiple tumors present with classical paraneoplastic syndrome (PNS associated with renal cell carcinoma (RCC. She underwent open nephron sparing surgery with resolution of symptoms. She remained without recurrence of RCC for the initial 2 years of her follow-up. To the best of our knowledge, this case represents the first in which PNS was specifically resolved using a partial nephrectomy in a patient with VHL. This case report provides initial evidence for the potential role of nephron sparing surgery in the management of paraneoplastic symptoms associated with hereditary RCC.

  19. Volumetry may predict early renal function after nephron sparing surgery in solitary kidney patients.

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    Kuru, Timur H; Zhu, Jie; Popeneciu, Ionel V; Rudhardt, Nora S; Hadaschik, Boris A; Teber, Dogu; Roethke, Matthias; Hohenfellner, Markus; Zeier, Martin; Pahernik, Sascha A

    2014-01-01

    We investigate the impact of the residual kidney volume measured by tumor volumetry on preoperative imaging in predicting post-operative renal function. Nephron sparing surgery (NSS) in renal cell carcinoma (RCC) is the standard treatment for T1 kidney tumors. Resection of kidney tumors in solidary kidneys needs precise preoperative counseling of patients regarding post-operative renal function. Patients planned for renal tumor surgery who underwent prior nephrectomy on the contralateral side were included. We identified 35 patients in our database that underwent NSS in solitary kidneys and met the inclusion criteria. Tumor volumetry was performed on computer tomography (CT) or magnetic resonance imaging (MRI) with the Medical Imaging Interaction Toolkit (MITK). Clinical and pathological data were assessed. Follow-up data included renal function over 3 years. Mean age was 64 ± 8.1 years. Mean tumor volume on imaging was 27.5 ± 48.6 cc. Mean kidney volume was 195.2 ± 62.8 cc and mean residual kidney volume was 173.4 ± 65.3 cc. We found a correlation between renal function (MDRD) and residual kidney volume on imaging 1-week post-surgery (p = 0.038). Mid- and long-term renal function was not associated with residual kidney volume. In conclusion, renal volumetry may predict early renal function after NSS.

  20. Renal Function Recovery after Nephrectomy or Nephron-Sparing Surgery in Children with Unilateral Renal Tumor.

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    Cozzi, Denis A; Ceccanti, Silvia; Cozzi, Francesco

    2017-02-01

    Introduction Children with unilateral renal tumor (URT) and preoperative renal dysfunction (PRD) may benefit from nephron-sparing surgery (NSS). To test this hypothesis, we studied the outcome of baseline renal function after nephrectomy or NSS among children with URT. Materials and Methods Retrospective records review of children with URT who underwent nephrectomy (25 children) or NSS (11 children) at our institution. We analyzed the estimated glomerular filtration rate (eGFR) changes over time among patients, stratified by both preoperative renal function (with or without PRD) and surgical extent (NSS vs. nephrectomy). The primary end point was evaluation of compensatory recovery of preoperative eGFR after surgery. Only children older than 2 years at surgery were included in the study. Renal dysfunction was defined as an eGFR  100 mL/min/1.73 m(2), respectively, achieved or maintained two-kidney eGFR values (T-KEV) (p = 0.01). After NSS, four adolescent patients with PRD and seven without PRD achieved or maintained T-KEV. Conclusion The majority of children with URT and low baseline eGFR present with an impaired renal function recovery after nephrectomy and may benefit from NSS. Collaborative studies are needed to support present findings. Georg Thieme Verlag KG Stuttgart · New York.

  1. Parenchymal-sparing liver surgery in patients with colorectal carcinoma liver metastases

    Institute of Scientific and Technical Information of China (English)

    Fernando A Alvarez; Rodrigo Sanchez Claria; Sebastian Oggero; Eduardo de Santiba?es

    2016-01-01

    Liver resection is the treatment of choice for patients with colorectal liver metastases(CLM).However,major resections are often required to achieve R0 resection,which are associated with substantial rates of morbidity and mortality.Maximizing the amount of residual liver gained increasing significance in modern liver surgery due to the high incidence of chemotherapyassociated parenchymal injury.This fact,along with the progressive expansion of resectability criteria,has led to the development of a surgical philosophy known as "parenchymal-sparing liver surgery"(PSLS).This philosophy includes a variety of resection strategies,either performed alone or in combination with ablative therapies.A profound knowledge of liver anatomy and expert intraoperative ultrasound skills are required to perform PSLS appropriately and safely.There is a clear trend toward PSLS in hepatobiliary centers worldwide as current evidence indicates that tumor biology is the most important predictor of intrahepatic recurrence and survival,rather than the extent of a negative resection margin.Tumor removal avoiding the unnecessary sacrifice of functional parenchyma has been associated with less surgical stress,fewer postoperative complications,uncompromised cancer-related outcomes and higher feasibility of future resections.The increasing evidence supporting PSLS prompts its consideration as the gold-standard surgical approach for CLM.

  2. Nephron-sparing surgery for bilateral Wilms′ tumours: A single-centre experience with 23 cases

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    Millar AJW

    2011-01-01

    Full Text Available Introduction: The challenge of management with bilateral Wilms′ tumours is the eradication of the neoplasm, while at the same time preserving renal function. Surgical management with a variety of nephron-sparing techniques, combined with chemotherapy and occasionally supplemented by transplantation has evolved over the last 30 years to achieve remarkable success. We document the experience of a single centre in a developing country. Material and Methods: Twenty-three bilateral Wilms′ tumours were seen in our service between 1981 and 2007. Treatment was, in most cases, according to National Wilms′ Tumour Study Group protocols, with initial bilateral biopsy, neoadjuvant chemotherapy, and tumourectomy. Technique of nephrectomy included full mobilization of the tumour-involved kidney, topical cooling with slush ice, vascular exclusion, tumour resection and reconstruction of the remnant kidney. Results: Twelve patients are alive and free of disease one to 15 years after treatment, all with well-preserved renal function (lowest glomerular filtration rate was 65 ml/min per (1.73 m 2 . None of the survivors have hypertension. Eleven have died (two of unrelated disease including six of the seven with spread outside the kidney. All three with unfavourable histology are alive. Four of the five metachronous presentations are alive, as are eight of 12 patients with synchronous bilateral tumours who presented since 2000. Conclusions: Appropriate chemotherapy and nephron-sparing surgery can achieve good results with preservation of adequate renal function in nearly all cases. Unfavourable histology did not have a reduced survival in our series. Metastatic spread outside the kidney had a poor prognosis.

  3. Adrenal sparing surgery compared with total adrenalectomy for aldosterone producing adenoma: A meta–analysis

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    Wei-ren XIAO

    2017-06-01

    Full Text Available Objective To compare the perioperative safety and curative effects of laparoscopic adrenal sparing surgery (ASS with laparoscopic total adrenalectomy (TA for aldosterone producing adenoma (APA. Methods An online systematical retrieval was performed with Pubmed, ScienceDirect, Springerlink, the Cochrane library, CNKI and China Biology Medicine disc for clinical comparative studies published before May 2016, these studies reported the treatment of ASS/partial adrenalectomy (PA versus TA for APA. The selected studies were applied to Revman 5.3 software for meta-analysis. The main contents were perioperative outcomes (operative time, intra-operative blood loss, and length of hospital stay and postoperative efficacy (cure rate, partial response rate, inefficiency rate. Results A total of 9 clinical studies (3 English documents and 6 Chinese documents with 1036 patients were included into the final analysis, among which 544 patients were assigned to ASS group and 492 in TA group. The analyzed results demonstrated no statistical significance between ASS group and TA group on operative time (WMD: –2.09min, 95%CI: –9.86-5.67, P=0.60, length of hospital stay (WMD: –0.10d, 95%CI: –0.32-0.12, P=0.36, intra-operative blood loss (WMD: 1.13ml, 95%CI: –8.86-11.12, P=0.82, cure rate (OR=1.07, 95%CI: 0.73-1.58, P=0.72, partial response rate (OR=0.85, 95%CI: 0.57-1.27, P=0.43 and inefficiency rate (OR=2.15, 95%CI: 0.32-14.34, P=0.43. Conclusion For surgical treatment of APA, ASS is technically safe, can achieve reliable postoperative efficacy and a similar therapeutic effect compared with TA, so deserves further application in clinical practice. DOI: 10.11855/j.issn.0577-7402.2017.05.13

  4. Is testis-sparing surgery safe in small testicular masses? Results of a multicentre study

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    Keske, Murat; Canda, Abdullah Erdem; Yalcin, Serdar; Kilicarslan, Aydan; Kibar, Yusuf; Tuygun, Can; Onder, Evrim; Atmaca, Ali Fuat; Yildirim, Asif; Ozkanli, Sidika Seyma; Kandemir, Olcay; Kargi, Taner; Sar, Mehmet; Tugcu, Volkan; Resorlu, Berkan; Aslan, Yilmaz; Sarikaya, Selcuk; Boylu, Ugur; Cicek, Ali Fuat; Basar, Halil; Tuncel, Altug; Balbay, Mevlana Derya

    2017-01-01

    Introduction Our goal was to evaluate benign and malignant lesions and testicular intraepithelial neoplasia (TIN) in the neighbouring normal-appearing testis tissue in men who underwent radical orchiectomy for testicular mass with a pathologic tumour size of ≤3cm. Methods In this retrospective, multicentre study, data of 252 patients from 11 different institutions were included. Patients were divided into three groups based on tumour size: Group 1 (0–1 cm; n=35), Group 2 (1.1–2cm; n=99), and Group 3 (2.1–3 cm; n=118). Benign lesions and TIN were sought in the neighbouring testicular tissue and compared between groups. Results Mean patient age was 32.3 years. Benign lesions were reported in 54.3%, 33.3%, and 14.4% of Groups 1, 2, and 3, respectively (p0.05 for Groups 2 vs. 3). Multifocality was detected in 8.6%, 4%, and 0% of Groups 1, 2, and 3, respectively (p0.05 for Group 1 vs. Group 2). A tumour cutoff size of 1.5 cm was found to be significant for detecting benign tumour. TIN and multifocality rates were similar in patients with a tumour size of ≤1.5 vs. >1.5 cm (p>0.05). Conclusions Benign lesions and TIN in the neighbouring testis were significantly decreased and multifocality was increased in patients with a tumour mass size of ≤1 cm. Testis-sparing surgery should be performed with caution and a safety rim of normal tissue should also be excised.

  5. Valve sparing surgery in an adult patient with dextrocardia and annuloaortic ectasia.

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    Zeybek, Rahmi; Bacaksiz, Ahmet; Sharifov, Rasul; Sevgili, Emrah; Ay, Yasin

    2016-03-01

    We report the case of a patient with situs inversus totalis, annuloaortic ectasia complicated by aortic insufficiency and mitral regurgitation which induced congestive heart failure. Both valvular lesions were repaired physiologically using aortic root sparing Yacoub 'remodeling' technique and mitral ring annuloplasty. Valve sparing techniques can be used effectively even in patients with complicated clinical scenarios (like dextrocardia and annuloaortic ectasia) to avoid the potential risks related to prosthetic valve implantation and lifelong anticoagulation therapy.

  6. The effects on surgery and preoperative patients with non-small cell lung cancer by preoperative bronchial artery infusion chemotherapy

    Institute of Scientific and Technical Information of China (English)

    Shuhong Tang; Jilai Bian; Mingwu Li

    2008-01-01

    Objective: To study the efficiency, safety and feasibility of preoperative bronchial artery infusion (BAI) chemotherapy on operation in patients with locally advanced (stage Ⅲ) non-small cell lung cancer (NSCLC).Methods: 92 cases with locally advanced NSCLC patients were randomly divided into two groups: (1) BAI chemotherapy group: 39 cases were received BAI chemotherapy for 2 courses and followed surgery; (2) surgery alone group: 51 cases were treated by operation alone.The complete resection rate and preoperative complications were compared between these two groups.Results: In BAI chemotherapy group, the rate of clinical efficiency was 68.3% with slight toxicity.In BAI chemotherapy group the surgery complete resection rate was 89.7%, which was significantly higher than that in surgery alone group (72.5%, P<0.05).No significant differences of blood loss, operative complications and mortality were observed between these two groups.Conclusion: BAI neoadjuvant chemotherapy was safe and effective, which can increase the complete resection rate of the tumor and did not increase the operative complications and mortality.

  7. ORGAN-SPARING SURGERY FOR RECTAL CANCER: EVOLUTION, CURRENT TRENDS, AND PROSPECTS

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    R. I. Tamrazov

    2013-01-01

    Full Text Available The article describes the main stages of the development of sphincter-saving surgery for rectal cancer. An historical look at this issue from the standpoint of research of past years in our country and abroad, as well as analysis of current sphincter-preserving surgery and future directions in this area.

  8. Carcinoid tumours of the lung and the ‘PEPPS’ approach: evaluation of preoperative bronchoscopic tumour debulking as preparation for subsequent parenchyma-sparing surgery

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    Neuberger, Michael; Hapfelmeier, Alexander; Schmidt, Michael; Gesierich, Wolfgang; Reichenberger, Frank; Morresi-Hauf, Alicia; Hatz, Rudolf A; Lindner, Michael

    2015-01-01

    Background Preoperative bronchoscopic tumour ablation has been suggested as a beneficial treatment for bronchopulmonary carcinoid tumours, although data regarding its effects and long-term outcome are lacking. Methods In our case-matched cohort study with 208 patients with bronchopulmonary carcinoid tumours we investigated the role of preoperative bronchoscopic interventions before subsequent surgery and analysed the safety of this Procedure of Endobronchial Preparation for Parenchyma-sparing Surgery (PEPPS) based on metastasis and recurrence rates as well as survival data from 1991 to 2010. The subsequent surgery was classified into parenchyma-sparing procedures and classical lobectomies, bilobectomies and pneumonectomies. Data were obtained from the tumour registry and medical reports. Outcomes were the frequency of parenchyma-sparing surgery after bronchoscopic treatment as well as rates of metastasis, recurrence and survival. Results 132 of 208 carcinoids were located centrally. Among them, 77 patients could be recanalised preoperatively. After bronchoscopic preparation, the rate of subsequent parenchyma-sparing surgery methods was higher (p=0.021). The effect was measured by the number of segments removed. The 10-year survival rate was 89% (typical carcinoids) and 68% (atypical carcinoids), respectively. After applying PEPPS, long-term survival was slightly higher (p=0.23). Metastasis and recurrence rates showed no relevant differences between the bronchoscopically treated or non-treated groups, or between the two types of surgery classes or between the PEPPS and non-PEPPS groups. Conclusions After preoperative bronchoscopic treatment, parenchyma-sparing surgery techniques can be applied more frequently. Furthermore, we detected no negative effects after PEPPS based on metastasis, recurrence and survival rates. PMID:26203359

  9. Use of hypofractionated radiotherapy regimens after organ-sparing surgery for Stages I–IIA breast cancers

    Directory of Open Access Journals (Sweden)

    Yu. V. Efimkina

    2010-01-01

    Full Text Available There have been recent reports on the expediency of applying postoperative hypofractionated accelerated radiotherapy (RT regimens in patients who have undergone breast-sparing surgery. The concept of accelerated hypofractionation (AH includes daily high-dose radiation for a shorter total period of time. In most radiologists’ opinion, the AH RT regimen may be as effective as more conventional treatments that use lower daily radiation doses for a longer period. The appeal of this method is that shorter treatment provides more convenience for patients. By taking into account the fact that the α/β ratio for intact breast tissues is about 3.5 Gy, larger fraction RT regi- mens are likely to be more effective, which will reduce the frequency of recurrences as compared with conventional therapy approaches without increasing the incidence of postradiation intact tissue damage.

  10. Lateral Thoracic Osteoplastic Rib-Sparing Technique Used for Lateral Spine Surgery: Technical Note.

    Science.gov (United States)

    Moisi, Marc; Fisahn, Christian; Tubbs, R Shane; Page, Jeni; Rice, Richard; Paulson, David; Kazemi, Noojan; Hanscom, David; Oskouian, Rod J

    2016-07-05

    Of patients who have undergone lateral approaches to the thoracic spine, surgical site postoperative pain appears to be greater among those who have undergone transection and removal of a rib segment than those who have not. Therefore, techniques that conserve anatomical position and minimize tissue disruption would theoretically result in less pain and a quicker recovery. Herein, we describe a rib-sparing osteoplastic technique used when rib segments need to be displaced in order to create an unobscured corridor to the operative target. Our approach minimizes soft tissue disruption and restores the anatomical function of the rib. Based on our experience, these patients report less pain, mobilize earlier, and are discharged sooner than those who have had rib segments sacrificed as part of a lateral approach to the spine.

  11. [The place of skin-sparing mastectomy in oncoplastic breast surgery].

    Science.gov (United States)

    Mátrai, Zoltán; Gulyás, Gusztáv; Tóth, László; Sávolt, Akos; Kunos, Csaba; Pesthy, Pál; Bartal, Alexandra; Kásler, Miklós

    2011-11-01

    Despite its ever increasing popularity, there is no evidence-based confirmation so far on the results of skin-sparing mastectomy, introduced 20 years ago. However, the results of countless published retrospective, long-term trials seem to underpin the ability of the precisely implemeted procedure in early stage invasive and in situ breast cancers to yield the oncological results of modified radical mastectomy. As a result of the procedure involving special surgical techniques, the skin not affected by cancer can be preserved, which facilitates immediate reconstruction and improves cosmetic outcome. The effect of postmastectomy radiotherapy on the reconstruction needs to be considered at the time of the multidisciplinary design of the surgical procedure. The authors give a detailed description of the surgical techniques, and provide a wide review of the literature, for the first time in Hungarian language.

  12. Lateral Thoracic Osteoplastic Rib-Sparing Technique Used for Lateral Spine Surgery: Technical Note

    Science.gov (United States)

    Fisahn, Christian; Tubbs, R. Shane; Page, Jeni; Rice, Richard; Paulson, David; Kazemi, Noojan; Hanscom, David; Oskouian, Rod J

    2016-01-01

    Of patients who have undergone lateral approaches to the thoracic spine, surgical site postoperative pain appears to be greater among those who have undergone transection and removal of a rib segment than those who have not. Therefore, techniques that conserve anatomical position and minimize tissue disruption would theoretically result in less pain and a quicker recovery. Herein, we describe a rib-sparing osteoplastic technique used when rib segments need to be displaced in order to create an unobscured corridor to the operative target. Our approach minimizes soft tissue disruption and restores the anatomical function of the rib. Based on our experience, these patients report less pain, mobilize earlier, and are discharged sooner than those who have had rib segments sacrificed as part of a lateral approach to the spine. PMID:27551648

  13. Rotationplasty after failed limb-sparing tumor surgery: a report of two cases.

    Science.gov (United States)

    Brigman, Brian E; Kumagai, Steven G; McGuire, Michael H

    2003-10-01

    Rotationplasty was used in two cases of failed limb salvage in adults after tumor resection and reconstruction. Each patient had distal femoral osteosarcoma, one treated with osteoarticular allograft reconstruction, the other with a custom endoprosthetic reconstruction. Both patients had failure attributable to infection, and after multiple surgeries, elected to have rotationplasty. Both had complications associated with the rotationplasty but went on to have functional limbs with Musculoskeletal Tumor Society functional scores of 67% and 87%. One patient died of metastatic disease 29 months after rotationplasty, the other had no problems 50 months after rotationplasty. Although rotationplasty offers a functional improvement over transfemoral amputation in the salvage of failed tumor reconstructions, only 10 such cases have been reported in adults. Rotationplasty should be considered in selected patients for whom an amputation is being considered after failed limb salvage surgery.

  14. PREEMPTIVE PREGABLIN: EFFICACY ON POSTOPERATIVE PAIN RELIEF AND OPIOID SPARING IN LOWER ABDOMINAL SURGERIES

    Directory of Open Access Journals (Sweden)

    Mohamed

    2015-01-01

    Full Text Available OBJECTIVES : We aimed to evaluate the preemptive analgesic properties of pregabalin, an anticonvulsant drug used in clinical practice for the treatment of neuropathic pain. METHOD S : This study was performed on 40 patients from ASA I - II risk group aged 18 - 60 years which underwent lower abdominal surgeries. Group I received 300 mg pregabalin and Group II was given a placebo in oral capsule form. Visual analog scale (VAS scores, morphine consumption and side effects of all patients were recorded at 1, 4, 8, 12 and 24 hour s postoperatively. When Aldrette recovery score reached 9, morphine 0.75mcg/kg was given as rescue analgesia. RESULTS : There was no difference observed in the first analgesic requirement time values between the two groups (p>0.05. A statistically signific ant decrease was observed in the VAS scores of the pregabalin group at 1, 4, 12 and 24 hours after surgery (p0.05. CONCLUSION : Our study demonstrated that a 300 mg pregabalin administered preoperatively is an ef ficient and safe agent for preemptive analgesia. Premedication with pregabalin reduces postoperative pain scores and total analgesic consumption without increasing sedation or other side effects in the postoperative period.

  15. Local control and survival in patients with soft tissue sarcomas treated with limb sparing surgery in combination with interstitial brachytherapy and external radiation

    DEFF Research Database (Denmark)

    Muhic, A.; Hovgaard, D.; Mork, Petersen M.;

    2008-01-01

    PURPOSE: The purpose of this study was to evaluate local control, survival and complication rate after treatment of soft tissue sarcoma (STS) with limb-sparing surgery combined with pulsed-dose rate (PDR) interstitial brachytherapy (BRT) and external beam radiotherapy (EBRT). PATIENTS AND METHODS...... surgery, combined with PDR BRT and EBRT can result in good local control in patients with soft tissue sarcomas. BRT is an effective modality with good cosmetic results and acceptable toxicity Udgivelsesdato: 2008/9......PURPOSE: The purpose of this study was to evaluate local control, survival and complication rate after treatment of soft tissue sarcoma (STS) with limb-sparing surgery combined with pulsed-dose rate (PDR) interstitial brachytherapy (BRT) and external beam radiotherapy (EBRT). PATIENTS AND METHODS......: A retrospective review of 39 adult patients (female/male=25/14, mean age 51(range 21-78) years) with STS who underwent primary limb-sparing surgery combined with PDR BRT (20Gy) and additional post-operative EBRT (50Gy) during the years 1995-2004. RESULTS: Five patients developed local recurrence after a mean...

  16. [Metastatic bronchial carcinoid tumors].

    Science.gov (United States)

    Bouledrak, K; Walter, T; Souquet, P J; Lombard-Bohas, C

    2016-02-01

    Bronchial carcinoids are uncommon pulmonary neoplasms and represent 1 to 2 % of all lung tumors. In early stage of disease, the mainstay and only curative treatment is surgery. Bronchial carcinoids are generally regarded as low-grade carcinomas and metastatic dissemination is unusual. The management of the metastatic stage is not currently standardized due to a lack of relevant studies. As bronchial carcinoids and in particular their metastatic forms are rare, we apply treatment strategies that have been evaluated in gastrointestinal and pancreatic neuroendocrine tumors. However, bronchial carcinoids have their own characteristic. A specific therapeutic feature of these metastatic tumors is that they require a dual approach: both anti-secretory for the carcinoid syndrome, and anti-tumoral.

  17. Nephron-sparing surgery for treatment of reninoma: a rare renin secreting tumor causing secondary hypertension

    Directory of Open Access Journals (Sweden)

    Fabio Cesar Miranda Torricelli

    2015-02-01

    Full Text Available Main findings A 25-year-old hypertensive female patient was referred to our institution. Initial workup exams demonstrated a 2.8 cm cortical lower pole tumor in the right kidney. She underwent laparoscopic partial nephrectomy without complications. Histopathologic examination revealed a rare juxtaglomerular cell tumor known as reninoma. After surgery, she recovered uneventfully and all medications were withdrawn. Case hypothesis Secondary arterial hypertension is a matter of great interest to urologists and nephrologists. Renovascular hypertension, primary hyperadosteronism and pheocromocytoma are potential diagnosis that must not be forgotten and should be excluded. Although rare, chronic pyelonephritis and renal tumors as rennin-producing tumors, nephroblastoma, hypernephroma, and renal cell carcinoma might also induce hypertension and should be in the diagnostic list of clinicians. Promising future implications Approximately 5% of patients with high blood pressure have specific causes and medical investigation may usually identify such patients. Furthermore, these patients can be successfully treated and cured, most times by minimally invasive techniques. This interesting case might expand knowledge of physicians and aid better diagnostic care in future medical practice.

  18. Comparison of the trifecta outcomes of robotic and open nephron-sparing surgeries performed in the robotic era of a single institution

    OpenAIRE

    2015-01-01

    Acar et al. SpringerPlus (2015) 4:472 DOI 10.1186/s40064-015-1274-2 RESEARCH Comparison of the trifecta outcomes of robotic and open nephron‑sparing surgeries performed in the robotic era of a single institution Ömer Acar1*, Esin Öztürk Işık2, Tuna Mut3, Yeşim Sağlıcan4, Aslıhan Onay5, Metin Vural6, Ahmet Musaoğlu3 and Tarık Esen1,3 Abstract Purpose: In this study we aimed to report a comparative analysis between open and robotic nephron sparing sur-geries (NS...

  19. Scoliosis and bronchial obstruction.

    Science.gov (United States)

    Qiabi, Mehdi; Chagnon, Karine; Beaupré, Alain; Hercun, Julian; Rakovich, George

    2015-01-01

    Severe scoliosis may have a significant effect on respiratory function. The effect is most often restrictive due to severe anatomical distortion of the chest, leading to reduced lung volumes, limited diaphragmatic excursion and chest wall muscle inefficiency. Bronchial compression by the deformed spine may also occur but is more unusual. Management options include a conservative approach using bracing and physiotherapy in mild cases, as well as surgical correction of the scoliosis in more severe cases. Bronchial stenting has also been used successfully as an alternative to surgical correction, and in cases in which spinal surgery was either unsuccessful or not feasible. The authors present a case involving a 52-year-old woman who exhibited symptomatic compression of the bronchus intermedius by severe residual scoliosis despite previous corrective surgery. She was treated with an indwelling bronchial stent.

  20. Scoliosis and Bronchial Obstruction

    Directory of Open Access Journals (Sweden)

    Mehdi Qiabi

    2015-01-01

    Full Text Available Severe scoliosis may have a significant effect on respiratory function. The effect is most often restrictive due to severe anatomical distortion of the chest, leading to reduced lung volumes, limited diaphragmatic excursion and chest wall muscle inefficiency. Bronchial compression by the deformed spine may also occur but is more unusual. Management options include a conservative approach using bracing and physiotherapy in mild cases, as well as surgical correction of the scoliosis in more severe cases. Bronchial stenting has also been used successfully as an alternative to surgical correction, and in cases in which spinal surgery was either unsuccessful or not feasible. The authors present a case involving a 52-year-old woman who exhibited symptomatic compression of the bronchus intermedius by severe residual scoliosis despite previous corrective surgery. She was treated with an indwelling bronchial stent.

  1. [Predictors of positive surgical margins after nephron-sparing surgery for renal cell carcinoma: retrospective analysis on 298 consecutive patients].

    Science.gov (United States)

    Schiavina, Riccardo; Borghesi, Marco; Chessa, Francesco; Rizzi, Simona; Martorana, Giuseppe

    2014-01-01

    Aim of our study was to evaluate the predictive factors of positive surgical margins (PSM) in a cohort of patients who underwent partial nephrectomy (PN) for renal cell carcinoma. We retrospectively evaluated our Institutional database of patients treated with open or laparoscopic PN between 200 and 2013. Categorical variables were compared using Pearson's chi-square test and linear-by-linear association. Multivariable Cox analysis was used in order to evaluate independent predictors of PSM. Surgical margins were found to be negative in 274 out of 298 patients (91.9%), and the remaining 24 (8.1%) patients had PSM at the final pathological exam. The median clinical size was significantly lower in patients with PSM than those with negative margins (2.6 vs. 3 cm, p=0.03). At univariable analysis, a shorter operative time (p=0.04), a malignant histotype (p=0.04) and higher Fuhrman grade (p=0.02) were observed in patients with positive surgical margins compared to those without PSM. At multivariable analysis, median tumor dimension (p=0.02), the malignant histotype (p=0.01) and the high Fuhrman grade (3-4) (p=0.01) were found to be independent predictive factors of PSM. The most important goal of any PN is to reach negative surgical margins. In our study, clinical tumor dimensions, malignant tumor histotype and the high Fuhrman grade demonstrated to be independent predictive factors of PSM after nephron sparing surgery for renal cell carcinoma. Other prospective, multi-institutional studies are needed in order to confirm these results.

  2. Fertility sparing surgery in young women affected by endometrial stromal sarcoma: an oncologic dilemma or a reliable option? review of literature starting from a peculiar case

    Directory of Open Access Journals (Sweden)

    Noventa M

    2014-12-01

    Full Text Available Marco Noventa, Salvatore Gizzo, Lorena Conte, Angela Dalla Toffola, Pietro Litta, Carlo Saccardi Department of Woman and Child Health, University of Padua, Padua, Italy Background: Endometrial stromal sarcoma (ESS is a term used to define a rare neoplasm that accounts for approximately 0.2%–1% of all uterine malignancies; it is, however, implicated in an estimated 10%–15% of those malignancies with a mesenchymal component. Recent evidence suggests that while the preservation of the ovaries may be considered appropriate in premenopausal women, hysterectomy and bilateral salpingo-oophorectomy remains the recommended treatment in postmenopausal women. Currently, only a few case series reporting the treatment of ESS in young women with a desire to preserve fertility and thus subjected to a fertility-sparing surgery are available in the literature. Case presentation: We report a peculiar case of early stage ESS treated by laparoscopic fertility-sparing surgery and a strict follow-up program (every 3 months of imaging and clinical evaluation. The patient remained disease free 1 year after primary treatment. Three months after completing oncological follow-up, the patient conceived spontaneously and is, to date, pregnant at 11 weeks of gestation without evidence of recurrent disease or obstetric complications. Conclusion: Based on our case report and in accordance with the data available, we suggest that in young patients affected by early stage ESS who wish to preserve reproductive function, fertility-sparing surgery could represent a valid option, though strict oncological follow-up remains mandatory. Keywords: young women, laparoscopic surgery, pregnancy, neoplasia, surgical management, follow up, disease recurrence

  3. The optimal timing of post-prostate biopsy magnetic resonance imaging to guide nerve-sparing surgery

    Directory of Open Access Journals (Sweden)

    Young Hwii Ko

    2014-04-01

    Full Text Available The goal of our study was to evaluate the impact of the interval between prostate biopsy and magnetic resonance imaging (MRI on the accuracy of simple tumor localization, which is essential information that enables nerve-sparing surgery. We also sought to determine the optimal timing of a post-biopsy MRI. A total of 184 patients who had undergone MRI before radical prostatectomy at an institution without a predetermined schedule for MRI after a prostate biopsy were enrolled. The mean interval from the biopsy to the MRI was 30.8 ± 18.6 days. The accuracy of the MRI for simplifi ed tumor location (right, left, bilateral and none was 44.6%. In the group with discordant pathologic and MRI fi ndings, the most common reason recorded was 'MRI predicted a unilateral lesion, but pathology revealed bilateral lesions' (58.3%, followed by 'MRI predicted no lesion, but pathology revealed the presence of a lesion' (32.0%. Multivariable analysis showed that the discordant group had a shorter interval (25.0 ± 14.3 vs 38.1 ± 20.6 days, P < 0.01 preceding the MRI and a higher rate of hemorrhage as observed by MRI (80.4% vs 54.8%, P < 0.01 in comparison with the accordant group. In receiver operating characteristics analysis, the area under the curve of the MRI interval in accurate prediction of the tumor location was 0.707 (P < 0.001. At the MRI interval's cutoff of 28.5 days, the sensitivity was 73.2% and the specificity was 63.7%. When the MRI was performed within 28 days, the accumulated accuracy was only 26.1% (23/88; however, when it was performed after 28 days, the reversely accumulated accuracy was 61.5% (59/96. These data support a waiting period of at least 4 weeks after a biopsy before performing an MRI for the purposes of surgical refinement.

  4. Do We Need to Clamp the Renal Hilum Liberally during the Initial Phase of the Learning Curve of Robot-Assisted Nephron-Sparing Surgery?

    OpenAIRE

    Ömer Acar; Tarık Esen; Ahmet Musaoğlu; Metin Vural

    2014-01-01

    Research Article Do We Need to Clamp the Renal Hilum Liberally during the Initial Phase of the Learning Curve of Robot-Assisted Nephron-Sparing Surgery? Ömer Acar,1 TarJk Esen,1,2 AhmetMusaoLlu,1 andMetin Vural3 1 Department of Urology, VKF American Hospital, 34365 Istanbul, Turkey 2School ofMedicine, KocUniversity, 34450 Istanbul, Turkey 3Department of Radiology, VKF American Hospital, 34365 Istanbul, Turkey Correspondence should be addressed to ¨ Omer Acar; omer acar...

  5. Robotic-assisted transperitoneal nephron-sparing surgery for small renal masses with associated surgical procedures: surgical technique and preliminary experience.

    Science.gov (United States)

    Ceccarelli, Graziano; Codacci-Pisanelli, Massimo; Patriti, Alberto; Ceribelli, Cecilia; Biancafarina, Alessia; Casciola, Luciano

    2013-09-01

    Small renal masses (T1a) are commonly diagnosed incidentally and can be treated with nephron-sparing surgery, preserving renal function and obtaining the same oncological results as radical surgery. Bigger lesions (T1b) may be treated in particular situations with a conservative approach too. We present our surgical technique based on robotic assistance for nephron-sparing surgery. We retrospectively analysed our series of 32 consecutive patients (two with 2 tumours and one with 4 bilateral tumours), for a total of 37 robotic nephron-sparing surgery (RNSS) performed between June 2008 and July 2012 by a single surgeon (G.C.). The technique differs depending on tumour site and size. The mean tumour size was 3.6 cm; according to the R.E.N.A.L. Nephrometry Score 9 procedures were considered of low, 14 of moderate and 9 of hight complexity with no conversion in open surgery. Vascular clamping was performed in 22 cases with a mean warm ischemia time of 21.5 min and the mean total procedure time was 149.2 min. Mean estimated blood loss was 187.1 ml. Mean hospital stay was 4.4 days. Histopathological evaluation confirmed 19 cases of clear cell carcinoma (all the multiple tumours were of this nature), 3 chromophobe tumours, 1 collecting duct carcinoma, 5 oncocytomas, 1 leiomyoma, 1 cavernous haemangioma and 2 benign cysts. Associated surgical procedures were performed in 10 cases (4 cholecystectomies, 3 important lyses of peritoneal adhesions, 1 adnexectomy, 1 right hemicolectomy, 1 hepatic resection). The mean follow-up time was 28.1 months ± 12.3 (range 6-54). Intraoperative complications were 3 cases of important bleeding not requiring conversion to open or transfusions. Regarding post-operative complications, there were a bowel occlusion, 1 pleural effusion, 2 pararenal hematoma, 3 asymptomatic DVT (deep vein thrombosis) and 1 transient increase in creatinine level. There was no evidence of tumour recurrence in the follow-up. RNSS is a safe and feasible technique

  6. Ipsilateral vascularised ulnar transposition autograft for limb-sparing surgery of the distal radius in 2 dogs with osteosarcoma : clinical communication

    Directory of Open Access Journals (Sweden)

    G.S. Irvine-Smith

    2006-06-01

    Full Text Available Canine osteosarcoma is the most commonly diagnosed primary bone tumour in the dog, affecting mainly large and giant breed dogs with the predilection site being the metaphysis of long bones, specifically the distal radius, proximal humerus, distal femur and proximal tibia and fibula. Treatment options are either palliative or curative intent therapy, the latter limb amputation or limb-sparing surgery together with chemotherapy. This article describes the use of an ipsilateral vascularised ulnar transposition autograft as well as chemotherapy in 2 dogs with osteosarcoma of the distal radius. Both dogs showed minimal complications with the technique and both survived over 381 days following the surgery. Complications seen were loosening of the screws and osteomyelitis. The procedure was well tolerated with excellent limb use. This technique is indicated for use in cases with small tumour size that have not broken through the bone cortex.

  7. Comparative study on early period of recovery between minimally invasive surgery total knee arthroplasty and minimally invasive surgery-quadriceps sparing total knee arthroplasty in Chinese patients

    Institute of Scientific and Technical Information of China (English)

    YU Jia-kuo; YU Chang-long; AO Ying-fang; GONG Xi; WANG Yong-jian; WANG Shu; XING Xie; CHEN Lian-xu; JU Xiao-dong

    2008-01-01

    Background Different kinds of minimally invasive surgery (MIS) procedures have now been used in total knee arthroplasty (TKA). Compared with traditional TKA procedure with a long skin incision, clinical studies showed MIS procedures had some advantages. Quadriceps sparing (QS) procedures are the most minimally invasive MIS procedure until now. This study was aimed to find the insertion types for Chinese patients' vastus medialis and if the QS procedure had some advantages in patients' early recovery.Methods Between February 2006 and May 2007, 120 consecutive patients underwent unilateral primary TKA under general anesthesia, among whom 14 patients were lost to follow-up, the remaining 106 cases were enrolled in this study. Among the 106 cases there were 85 right knees, 21 left knees (15 men and 91 women, with a mean age of 65.1±7.4 years); osteoarthritis in 97 patients (91.5%) and rheumatoid arthritis in 9 patients (8.5%). MIS TKA was performed in 49 cases (MIS TKA group), while MIS-QS TKA in 57 cases (MIS-QS TKA group). During the operation, the type Ⅰ, Ⅱ and Ⅲ insertions of the vastus medialis for all patients were recorded. Each knee was rated post-operatively according to the Hospital of Special Surgery (HSS) scoring system. Clinical follow-up was undertaken at 1 week, 2, 6, 12 and 24 weeks. Operating time and complications were recorded.Results There was no statistically significant difference between the two groups for gender distribution, age, left or right knee incidence, pre-operative diagnosis, incidence of varus or valgus deformity. Of the 106 cases there was 1 (0.9%) case with a type Ⅰ insertion of the vastus medialis, 4 (3.8%) cases with type Ⅱ insertions, 101 (95.3%) cases with type Ⅲ insertions. The HSS scoring was significantly different between the MIS-QS TKA group and MIS TKA group within the first two weeks post operation. From 2 weeks later to 24 weeks, no significant difference was found. The average operating time was (53.3±12

  8. Autofluorescence spectroscopy for nerve-sparing laser surgery of the head and neck-the influence of laser-tissue interaction.

    Science.gov (United States)

    Stelzle, Florian; Rohde, Maximilian; Riemann, Max; Oetter, Nicolai; Adler, Werner; Tangermann-Gerk, Katja; Schmidt, Michael; Knipfer, Christian

    2017-08-01

    The use of remote optical feedback systems represents a promising approach for minimally invasive, nerve-sparing laser surgery. Autofluorescence properties can be exploited for a fast, robust identification of nervous tissue. With regard to the crucial step towards clinical application, the impact of laser ablation on optical properties in the vicinity of structures of the head and neck has not been investigated up to now. We acquired 24,298 autofluorescence spectra from 135 tissue samples (nine ex vivo tissue types from 15 bisected pig heads) both before and after ER:YAG laser ablation. Sensitivities, specificities, and area under curve(AUC) values for each tissue pair as well as the confusion matrix were statistically calculated for pre-ablation and post-ablation autofluorescence spectra using principal component analysis (PCA), quadratic discriminant analysis (QDA), and receiver operating characteristics (ROC). The confusion matrix indicated a highly successful tissue discrimination rate before laser exposure, with an average classification error of 5.2%. The clinically relevant tissue pairs nerve/cancellous bone and nerve/salivary gland yielded an AUC of 100% each. After laser ablation, tissue discrimination was feasible with an average classification accuracy of 92.1% (average classification error 7.9%). The identification of nerve versus cancellous bone and salivary gland performed very well with an AUC of 100 and 99%, respectively. Nerve-sparing laser surgery in the area of the head and neck by means of an autofluorescence-based feedback system is feasible even after ER-YAG laser-tissue interactions. These results represent a crucial step for the development of a clinically applicable feedback tool for laser surgery interventions in the oral and maxillofacial region.

  9. Visualization of bronchial circulation at bronchial anastomotic site using bronchial fluorescein angiography technique.

    Science.gov (United States)

    Iga, Norichika; Miyoshi, Kentaroh; Takata, Katsuyoshi; Hirano, Yutaka; Konishi, Yusuke; Otani, Shinji; Sugimoto, Seiichiro; Yamane, Masaomi; Miyoshi, Shinichiro; Oto, Takahiro

    2016-11-01

    Successful bronchial healing after a bronchoplastic procedure mainly depends on bronchial circulation at the anastomostic site. We developed a bronchial fluorescein angiography (B-FAG) technique for visualizing circulation on the bronchial surface. The technique was evaluated in animals. Fluorescein was used as a contrast agent and an autofluorescence imaging (AFI) bronchoscope as a detector. The left main pulmonary artery (PA) and main bronchus of 10 pigs were isolated. After transection of the left main bronchus and bronchial arteries and re-anastomosis of the bronchus, the pigs were randomly divided into two groups: the PA- group (n = 5), in which the pulmonary artery was transected; and the PA+ group (n = 5), in which the pulmonary artery was preserved. Following intravenous injection of fluorescein, the distal anastomotic site was observed for 30 min with autofluorescence imaging bronchoscopy. Bronchial specimens sampled 2 days after the surgical intervention were histologically evaluated. In the PA- group, there was no fluorescein enhancement in the distal bronchus throughout the observation time. However, enhancement, which turned the bronchial surface from magenta to bright green, was clearly observed in less than 207 ± 102.5 s in the PA+ group. The enhancement status detected by bronchial fluorescein angiography was related to the extent of tissue damage, as was proven histologically in the acute healing stage. Bronchial fluorescein angiography clearly visualized the circulatory status promptly after the anastomosis procedure at the central bronchus. This technique is a potentially practical approach to predict ischaemic airway complications following bronchial anastomosis. © The Author 2016. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  10. Organ-sparing surgery of renal cell carcinoma - operative technique and findings in radiological follow-up; Organerhaltende Chirurgie des Nierenzellkarzinoms - Operationstechniken und Befunde in der radiologischen Nachsorge

    Energy Technology Data Exchange (ETDEWEB)

    Hallscheidt, P.; Hansmann, J.; Schenk, J.P.; Radeleff, B.A.; Kauffmann, G.W. [Abt. Radiodiagnostik der Radiologischen Klinik der Univ. Heidelberg (Germany); Riedasch, G. [Urologische Klinik und Poliklinik der Univ. Heidelberg (Germany)

    2002-04-01

    Nephron-sparing surgery of renal cell carcinoma in the 1970's and 1980's in patients with bilateral renal tumors or reduced renal function (imperative indication) has shown a very low risk of recurrent cancer. Today, nephron-sparing surgery in renal cell carcinoma is considered in an increasing number of patients with expected sufficient renal function after nephrectomy (elective indication). Resection technique, the use of Tabotamp trademark to reduce bleeding, and pseudotumors do complicate the interpretation of the images. It has been not yet defined which diagnostic modality is best suited for follow-up after renal cell carcinoma resection. Follow-up protocols in different institutions show a wide variety. The follow-up of patients after nephron-sparing surgery is performed by annual sonography or MRI every three months. Up to now, CT and ultrasound are the standard methods. MRI with its multiplanar imaging and improved soft tissue contrast seems to have an equal diagnostic value. Additionally, MRI seems to be suited for patients with reduced renal function. The aim of this paper is to give guidelines for the radiologist to understand the different surgical procedures and to evaluate the post-operative findings. Different imaging modalities in the follow-up of patients and special radiological phenomena are discussed. (orig.) [German] Die Nachuntersuchungen der in den 70er und 80er Jahren des vergangenen Jahrhunderts organerhaltend operierten Patienten mit beidseitigen Nierenzellkarzinomen oder eingeschraenkter Nierenfunktion der Gegenseite (imperative Indikation) zeigten eine sehr niedrige Rezidivrate. Heute wird die organerhaltende Operation von Nierentumoren zunehmend auch bei den Patienten in Erwaegung gezogen, deren Nierenfunktion nach der Tumornephrektomie der betroffenen Niere noch ausreichen wuerde (elektive Indikation). Spezielle Operationstechniken wie die Verwendung von Tabotamp trademark zur Blutstillung und die Bildung von Pseudotumoren

  11. Multicystic peritoneal mesothelioma after fertility-sparing surgery for an ovarian tumor of borderline malignancy: A case report

    Directory of Open Access Journals (Sweden)

    Hidetaka Nomura

    2015-02-01

    Full Text Available We report a case of a 19-year-old woman with multicystic peritoneal mesothelioma (MCPM who had previously undergone left adnexectomy due to an ovarian tumor of borderline malignancy at the age of 17 years. Follow-up imaging studies after adnexectomy revealed multiple cystic lesions of increasing size and number, suggesting recurrence of the tumor. Diagnostic laparoscopic surgery was performed, and the cystic lesion was pathologically determined to be MCPM. To our knowledge, this is the first report of MCPM diagnosed and successfully treated by laparoscopic surgery during the course of follow-up for an ovarian tumor. It is important to recognize that MCPM can occur in patients who have previously undergone abdominal surgery, and laparoscopic surgery is recommended for patients of reproductive age, because of the potential risk of infertility associated with extensive pelvic surgery.

  12. Residual disease at the bronchial stump is positively associated with the risk of bronchoplerual fistula in patients undergoing lung cancer surgery: a meta-analysis.

    Science.gov (United States)

    Li, Shuangjiang; Fan, Jun; Zhou, Jian; Ren, Yutao; Shen, Cheng; Che, Guowei

    2016-03-01

    Residual disease at the bronchial stump (RDBS) is regarded as an important factor possibly resulting in bronchopleural fistula (BPF) after lung cancer surgery, but this has not been confirmed. We conducted this meta-analysis to evaluate the effects of RDBS on BPF formation in patients undergoing lung cancer surgery. PubMed and EMBASE databases were searched for full-text articles that met our eligibility criteria. Odds ratios (ORs) with 95% confidence interval (95% CI) served as the summarized outcomes. Q-test and I(2) statistic were used to evaluate the level of heterogeneity, determining the fixed-effect model or random-effect model for quantitative synthesis. Sensitivity analysis was conducted to identify the possible origins of heterogeneity. The publication bias was assessed by Begg's test. A total of eight retrospective observational studies were included in our meta-analysis. In overall analysis, the pooled outcomes indicated that RDBS was significantly associated with BPF formation after lung cancer surgery (OR: 3.12; 95% CI: 1.72-5.64; P analysis, the pooled outcomes revealed a significantly increased risk of post-pneumonectomy BPF in patients with RDBS (OR: 2.78; 95% CI: 1.06-7.28; P = 0.037). The subgroup analysis assessing the effects of RDBS on post-lobectomy BPF was given up due to the scarcity of available data. No heterogeneity was revealed within this meta-analysis. No evidence for publication bias was detected by Begg's test. Our meta-analysis indicates that RDBS is positively associated with the increased risk of BPF in patients undergoing lung cancer surgery. The further analysis also reveals an increased risk of post-pneumonectomy BPF in patients with RDBS. More accurate and comprehensive evidence should be collected and summarized in updated meta-analyses. © The Author 2015. Published by Oxford University Press on behalf of the European Association for Cardio-Thoracic Surgery. All rights reserved.

  13. Combined Limb-Sparing Surgery and Radiation Therapy to Treat Sarcomas of the Hands and Feet: Long-Term Cancer Outcomes and Morbidity

    Energy Technology Data Exchange (ETDEWEB)

    Bishop, Andrew J.; Zagars, Gunar K. [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); Moon, Bryan S.; Lin, Patrick P.; Lewis, Valerae O. [Department of Orthopedic Oncology, MD Anderson Cancer Center, Houston, Texas (United States); Guadagnolo, B. Ashleigh, E-mail: aguadagn@mdanderson.org [Department of Radiation Oncology, MD Anderson Cancer Center, Houston, Texas (United States); Department of Health Services Research, MD Anderson Cancer Center, Houston, Texas (United States)

    2015-08-01

    Purpose: The purpose of this study was to investigate local control, survival outcomes, and complication rates of patients treated with limb-sparing surgery and radiation therapy (RT) for soft tissue sarcomas (STS) of the hands and feet. Methods and Materials: We reviewed the medical records of 85 consecutive patients treated for STS of the hands (n=38, 45%) and feet (n=47, 55%) between 1966 and 2012. The median age was 41 years (range, 10-82 years of age). Sixty-seven patients (79%) received postoperative RT after resection of their tumor (median dose, 60 Gy; range, 45-70 Gy). The remaining 18 patients (21%) were treated with preoperative RT followed by tumor resection (median dose, 50 Gy; range, 50-64 Gy). Results: Median follow-up was 140 months (range, 24-442 months). Five-year local control, overall survival, and disease-specific survival rates were 86%, 89%, and 89%, respectively. Positive or uncertain surgical margin status was the only factor adversely associated with local recurrence (19% vs 6% for negative margins, P=.046) but this lost significance on multivariate analysis when adjusting for RT dose ≥64 Gy. Of the 12 patients who had local relapses, 6 (50%) were salvaged, and only 2 of those required salvage amputation. Five patients had grade ≥3 late RT sequelae, with 2 patients (2%) having moderate limitations of limb function and 3 patients (4%) having severe limitations requiring procedures for skin ulceration. Conclusions: Limb-sparing surgery combined with RT provides excellent local control outcomes for sarcomas arising in the hands or feet. In patients who have local recurrence, salvage without amputation is possible. The excellent cancer control outcomes observed, considering the minimal impact on limb function, support use of combined modality, limb-sparing local therapy for STS arising in the hands or feet.

  14. Fetal brain-sparing after laser surgery for twin-twin transfusion syndrome appears associated with two-year neurodevelopmental outcomes.

    Science.gov (United States)

    Chmait, Ramen H; Chon, Andrew H; Schrager, Sheree M; Llanes, Arlyn; Hamilton, Anita; Vanderbilt, Douglas L

    2016-01-01

    The cerebroplacental ratio (CPR) is a semi-quantitative marker for fetal brain-sparing. Our purpose was to measure the CPR at the time of treatment with selective laser photocoagulation of communicating vessels in gestations with twin-twin transfusion syndrome (TTTS) to test its association with neurological outcomes at approximately 2 years. One-hundred children treated for TTTS with laser surgery underwent neurodevelopmental assessment at age 2 years (within 6 weeks) via the Battelle Developmental Inventory 2nd Edition (BDI-2). The CPR was obtained 24 h before and after laser surgery. An abnormal CPR was categorically defined at <1.0. Multilevel linear regression was used to evaluate associations between CPR and neurodevelopment as assessed by the BDI-2. Ninety-nine children had data available for analysis: 55 (56%) had normal CPR prior to laser surgery, and 62 (63%) had normal CPR following surgery. Post-laser CPR <1.0 was a risk factor for lower BDI-2 scores at age 2 years [98.1 (SD 11.5) vs 103.4 (SD 12.3) vs β = -0.23, p = 0.01]; this relationship remained significant after controlling for pre-surgical CPR and Quintero stage (adjusted β = -0.25, p = 0.01). In this population, an abnormal CPR was associated with poorer 2-year neurodevelopmental outcomes. © 2015 John Wiley & Sons, Ltd. © 2015 John Wiley & Sons, Ltd.

  15. Disseminated typical bronchial carcinoid tumor

    Directory of Open Access Journals (Sweden)

    Novković Dobrivoje

    2013-01-01

    Full Text Available Introduction. Bronchial carcinoids belong to a rare type of lung tumors. If they do not expose outstanding neuroendocrine activity, they develop without clearly visible symptoms. They are often detected during a routine examination. According to their clinical pathological features, they are divided into typical and atypical tumors. Typical bronchial carcinoids metastasize to distant organs very rarely. Localized forms are effectively treated by surgery. The methods of conservative treatment should be applied in other cases. Case report. We presented a 65-year-old patient with carcinoid lung tumor detected by a routine examination. Additional analysis (chest X-ray, computed tomography of the chest, ultrasound of the abdomen, skeletal scintigraphy, bronhoscopy, histopathological analysis of the bioptate of bronchial tumor, as well as bronchial brushing cytology and immunohistochemical staining performed with markers specific for neuroendocrine tumor proved a morphologically typical lung carcinoid with dissemination to the liver and skeletal system, which is very rarely found in typical carcinoids. Conclusion. The presented case with carcinoid used to be showed morphological and pathohistological characteristics of typical bronchial carcinoid. With its metastasis to the liver and skeletal system it demonstrated unusual clinical course that used to be considered as rare phenomenon. Due to its frequent asymptomatic course and varied manifestation, bronchial carcinoid could be considered as a diagnostic challenge requiring a multidisciplinary approach.

  16. Bronchial stents

    Directory of Open Access Journals (Sweden)

    Ibrahim Emad

    2006-01-01

    Full Text Available Bronchial stents are mostly used as a Palliative relief of symptoms often caused by airway obstruction, It is also used for sealing of stump fistulas after pneumonectomy and dehiscence after bronchoplastic operations. Advances in airway prosthetics have provided a variety of silicone stents, expandable metal stents, and pneumatic dilators, enabling the correction of increasingly complex anatomical problems. Several series have been published describing the application and results of these techniques. This manuscript reviews the historical development of stents, types, indication, outcome, and complications. Alternative therapies for tracheobronchial stenting were also reviewed

  17. Quality of life after immediate breast reconstruction and skin-sparing mastectomy - a comparison with patients undergoing breast conserving surgery.

    Science.gov (United States)

    Heneghan, H M; Prichard, R S; Lyons, R; Regan, P J; Kelly, J L; Malone, C; McLaughlin, R; Sweeney, K J; Kerin, M J

    2011-11-01

    Historically breast cancer surgery was associated with significant psychosocial morbidity and suboptimal cosmetic outcome. Recent emphasis on women's quality of life following breast cancer treatment has drawn attention to the importance of aesthetic outcome and potential benefits of immediate breast reconstruction (IBR). Our primary aim was to assess patient's quality of life after IBR, compared to a matched group undergoing breast conservation. We also investigated the oncological safety and morbidity associated with immediate reconstruction. A prospectively collected database of all breast cancer patients who underwent IBR at a tertiary referral breast unit was reviewed. Patients were reviewed clinically, and administered two validated quality of life questionnaires, at least one year after completing their treatment. 255 patients underwent IBR following mastectomy over a 55 month period. Reconstruction with ipsilateral latissimus dorsi flap was most commonly performed (88%). After mean follow-up of 36 months, IBR patients' quality of life was comparable to a group of age-matched women (n = 160) who underwent breast conserving surgery (p = 0.89). No patient experienced local recurrence (0%), distant metastases developed in 4.8% and disease related mortality was 2.2%. Post-operative morbidities included wound infection (11.8%), chronic pain (2.0%), capsular contracture (11%; 36% of whom had radiotherapy) and fat necrosis (14.1%). No patient experienced flap loss. IBR is a highly acceptable form of treatment for women requiring mastectomy. With high rates of patient satisfaction, low associated morbidity, and proven oncological safety, it is an appropriate recommendation for all women requiring mastectomy. Copyright © 2011 Elsevier Ltd. All rights reserved.

  18. Do We Need to Clamp the Renal Hilum Liberally during the Initial Phase of the Learning Curve of Robot-Assisted Nephron-Sparing Surgery?

    Directory of Open Access Journals (Sweden)

    Ömer Acar

    2014-01-01

    Full Text Available Objective. We aimed to compare the results of our initial robot-assisted nephron-sparing surgeries (RANSS performed with or without hilar clamping. Material and Method. Charts of the initial RANSSs (n=44, which were performed by a single surgeon, were retrospectively reviewed. R.E.N.A.L. nephrometry system, modified Clavien classification, and M.D.R.D. equation were used to record tumoral complexity, complications, and estimated glomerular filtration rate (eGFR, respectively. Outcomes of the clamped (group 1, n=14 versus off-clamp (group 2, n=30 RANSSs were compared. Results. The difference between the two groups was insignificant regarding mean patient age, mean tumor size, and mean R.E.N.A.L. nephrometry score. Mean operative time, mean estimated blood loss amount, and mean length of hospitalization were similar between groups. A total of 4 patients in each group suffered 11 Clavien grade ≥2 complications early postoperatively. Open conversion rates were similar. The difference between the 2 groups in terms of the mean postoperative change in eGFR was insignificant. We did not encounter any local recurrence after a mean follow-up of 18.9 months. Conclusions. Creating warm-ischemic conditions during RANSS should not be a liberal decision, even in the initial phases of the learning curve for a highly experienced open surgeon.

  19. Fertility sparing surgery for stage IA type I and G2 endometrial cancer in reproductive-aged patients: evidence-based approach and future perspectives.

    Science.gov (United States)

    Vitale, Salvatore Giovanni; Rossetti, Diego; Tropea, Alessandro; Biondi, Antonio; Laganà, Antonio Simone

    2017-02-10

    Fertility-sparing surgery (FSS) in reproductive-age patients affected by endometrial cancer (EC) gained growing attention in the last decade, although the first reports were already published in 1990-2000s. Nevertheless, only few patients undergoing FSS for stage I, type I EC had been reported in each case series, without a robust multicenter study. In the available literature there are even fewer reported cases of conservative treatment of Stage IA and G2 EC. Considering these important gaps in our current knowledge, the purpose of this review was to summarize the available evidence about conservative treatments for stage IA type I and G2 EC, to improve the pretreatment counseling for reproductive-age patients. According to our overview, women who have low-risk disease (G1 or G2, endometrioid histotype confined to the endometrium) are candidates for progestin therapy. In addition, FSS could be considered a valid option for reproductive-aged patients with stage IA type I and G2 EC. Nevertheless, we solicit new trials to clarify the medium- and long-term outcomes in this kind of patients.

  20. [Bronchial mucoepidermoid carcinoma].

    Science.gov (United States)

    Bregante, J I; Rituerto, B; Font de Mora, F; Alonso, F; Andreu, M J; Figuerola, J; Mulet, J F

    1998-07-01

    We submit the case of a child afflicted with a mucoepidermoid bronchial tumor. The patient is a boy, aged seven, who after undergoing antibiotic treatment for six weeks because of a fever and atelectasia-condensation in the right lower lobe showed no signs of clinical improvement and was sent to our department to undergo further study and treatment. A bronchoscopy performed shows a polypoid mass that partially blocks the main bronchial tube a few milimiters under the access to the right upper lobe. A biopsy is carried out and the anatomopathological test shows there is a low degree epidermoid carcinoma. We decide to perform a lobectomy which for the tumor location and the lung condition has to be medium and lower right. We proceed to remove the adenopaty of hilium not affected by the tumor. The postoperative period develops without incidents. A check-up bronchoscopy performed three months later shows two polypoid masses in the right bronchial tube which, once a biopsy is performed, proved to be granulation tissue. Twelve months after undergoing surgery, the patient's condition is good, there is no evidence of tumor relapse and the breathing capacity is adequate, though there is an obstructive restrictive pattern in the espirometry. Even taking into consideration that lung tumors are extremely unusual, the epidermoid carcinoma is the one which most frequently occurs. The tumor's low malignancy is a sign that points to a good prognosis. Performing conservative surgery by means of bronchoplasty should be taken into account so as to keep the sequelae on the lung condition to a minimum, even though in this case the tumor location made it impossible.

  1. Sexual and Reproductive Outcomes in Early Stage Cervical Cancer Patients after Excisional Cone as a Fertility-sparing Surgery: An Italian Experience

    Science.gov (United States)

    Fanfani, Francesco; Landoni, Fabio; Gagliardi, Maria Lucia; Fagotti, Anna; Preti, Eleonora; Moruzzi, Maria Cristina; Monterossi, Giorgia; Scambia, Giovanni

    2014-01-01

    Background The purpose of this study was to analyze the quality of life in terms of sexual and reproductive outcome in patients suffering from early stage cervical cancer, submitted to an excisional cone as fertility-sparing treatment. Methods A multicenter retrospective analysis about specific dimensions of physical, psychological, reproductive and sexual functions after a cold-knife conization plus pelvic laparoscopic lymphadenectomy was conducted at Division of Gynecologic Oncology, Catholic University of the Sacred Heart, Rome-Italy and at Division of Gynecology, European Institute of Oncology, Milan-Italy. The aim of this study was twofold. It aimed to analyze the quality of life in patients submitted to minimally invasive surgery and to compare these data with radical trachelectomy. Results Twenty-three patients with an average age of 30 years decided to participate in this study. After the treatment, all women (100%) had regular menstruation, 7 (30.4%) had increased not invalidating dysmenorrhea; 1 (4.4%) experienced a cervical stenosis; 6 among 10 patients that tried to conceive (60%) obtained one spontaneous pregnancy; 4 more (40%) underwent in vitro fertilization and embryo transfer and only 1 of them (25%) was successful. About sexual assessment, 1 patient (4.4%) had trouble in lubricating, 3 (13%) had anxiety about performance, 6 (26.1%) complained of dyspareunia which was resolved within 3 subsequent months. All patients (100%) obtained a complete psychological and physical recovery. Conclusion This study demonstrated preliminary encouraging data about sexual and reproductive outcome after excisional conization. A comparison with trachelectomy surely needs longer follow-ups, more cases and prospective analyses. PMID:24696793

  2. Anatomic Tumor Location Influences the Success of Contemporary Limb-Sparing Surgery and Radiation Among Adults With Soft Tissue Sarcomas of the Extremities

    Energy Technology Data Exchange (ETDEWEB)

    Korah, Mariam P., E-mail: mariam.philip@gmail.com [Department of Radiation Oncology, Emory University, Atlanta, GA (United States); Deyrup, Andrea T. [Department of Pathology, Emory University, Atlanta, GA (United States); Monson, David K.; Oskouei, Shervin V. [Department of Orthopedics, Emory University, Atlanta, GA (United States); Weiss, Sharon W. [Department of Pathology, Emory University, Atlanta, GA (United States); Landry, Jerome; Godette, Karen D. [Department of Radiation Oncology, Emory University, Atlanta, GA (United States)

    2012-02-01

    Purpose: To examine the influence of anatomic location in the upper extremity (UE) vs. lower extremity (LE) on the presentation and outcomes of adult soft tissue sarcomas (STS). Methods and Materials: From 2001 to 2008, 118 patients underwent limb-sparing surgery (LSS) and external beam radiotherapy (RT) with curative intent for nonrecurrent extremity STS. RT was delivered preoperatively in 96 and postoperatively in 22 patients. Lesions arose in the UE in 28 and in the LE in 90 patients. Patients with UE lesions had smaller tumors (4.5 vs. 9.0 cm, p < 0.01), were more likely to undergo a prior excision (43 vs. 22%, p = 0.03), to have close or positive margins after resection (71 vs. 49%, p = 0.04), and to undergo postoperative RT (32 vs. 14%, p = 0.04). Results: Five-year actuarial local recurrence-free and distant metastasis-free survival rates for the entire group were 85 and 74%, with no difference observed between the UE and LE cohorts. Five-year actuarial probability of wound reoperation rates were 4 vs. 29% (p < 0.01) in the UE and LE respectively. Thigh lesions accounted for 84% of the required wound reoperations. The distribution of tumors within the anterior, medial, and posterior thigh compartments was 51%, 26%, and 23%. Subset analysis by compartment showed no difference in the probability of wound reoperation between the anterior and medial/posterior compartments (29 vs. 30%, p = 0.68). Neurolysis was performed during resection in (15%, 5%, and 67%, p < 0.01) of tumors in the anterior, medial, and posterior compartments. Conclusions: Tumors in the UE and LE differ significantly with respect to size and management details. The anatomy of the UE poses technical impediments to an R0 resection. Thigh tumors are associated with higher wound reoperation rates. Tumor resection in the posterior thigh compartment is more likely to result in nerve injury. A better understanding of the inherent differences between tumors in various extremity sites will assist in

  3. Morphometric profile of the localised renal tumors managed either by open or robot-assisted nephron-sparing surgery: the impact of scoring systems on the decision making process

    OpenAIRE

    Esen, Tarık; Acar, Ömer; Musaoğlu, Ahmet

    2013-01-01

    RESEARCH ARTICLE Open Access Morphometric profile of the localised renal tumors managed either by open or robot-assisted nephron-sparing surgery: the impact of scoring systems on the decision making process Tarık Esen1,2, Ömer Acar2*, Ahmet Musaoğlu2 and Metin Vural3 Abstract Background: Nephrometric scoring systems aim to improve the manner in which tumoral complexity is measured and reported. Each system provides a way to objectively measure specific tumor features t...

  4. Nipple- and areola-sparing mastectomy for the treatment of breast cancer

    OpenAIRE

    Mota, BS; R. Riera; Ricci, MD; Barrett, JK; de Castria, TB; Atallah, ÁN; Bevilacqua, JLB

    2016-01-01

    $\\textbf{Background}$ The efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of breast cancer are still questionable. It is estimated that the local recurrence rates following nipple-sparing mastectomy are very similar to breast-conserving surgery followed by radiotherapy. $\\textbf{Objectives}$ To assess the efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of ductal carcinoma in situ and ...

  5. Nipple- and areola-sparing mastectomy for the treatment of breast cancer

    OpenAIRE

    Mota, BS; Riera, R.; Ricci, MD; Barrett, Jessica Kate; de Castria, TB; Atallah, ÁN; Bevilacqua, JLB

    2016-01-01

    $\\textbf{Background}$ The efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of breast cancer are still questionable. It is estimated that the local recurrence rates following nipple-sparing mastectomy are very similar to breast-conserving surgery followed by radiotherapy. $\\textbf{Objectives}$ To assess the efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of ductal carcinoma in situ and ...

  6. Benign segmental bronchial obstruction

    Energy Technology Data Exchange (ETDEWEB)

    Loercher, U.

    1988-09-01

    The benigne segmental bronchial obstruction - mostly discovered on routine chest films - can well be diagnosed by CT. The specific findings in CT are the site of the bronchial obstruction, the mucocele and the localized empysema of the involved segment. Furthermore CT allows a better approach to the underlying process.

  7. 保留肾单位手术与肾癌根治术治疗局限性肾癌疗效对比%Comparison of Nephron Sparing Surgery and Open Radical Nephrectomy's Curative Effects on Localized Renal Carcinoma

    Institute of Scientific and Technical Information of China (English)

    马大富

    2012-01-01

    目的:探讨保留肾单位手术与肾癌根治术治疗局限性肾癌的疗效差异.方法:2000年1月至2006年1月诊治的80例局限性肾癌患者分为开放保留肾单位手术组(NSS组)和开放肾癌根治术组(ORN组),比较两组患者在手术疗效和手术前后生存质量的差异.结果:NSS组手术时间、肾蒂阻断时间、术中失血量、住院时间和术后引流时间均显著高于ORN组(P0.05),NSS组术后1个月、1年、2年和3年的血清肌酐均显著低于ORN组(P0.05);术后随访3年提示两组患者在复发、远处转移、复发+转移、肿瘤致死率及3年无瘤生存率方面无明显差异(P>0.05);两组患者手术前的生存质量无明显差异(P>0.05),NSS组患者术后生存质量改善程度显著高于ORN组(P0.05), while it was higher in postoperative quality of life (P<0.05).Conclusion:Nephron sparing surgery and open radical nephrectomy show no differences in complications and recurrences, but nephron sparing surgery could significantly protect residual renal function and promote postoperative quality of life.

  8. Perioperative nursing on robot-assistant laparoscopic nephron-sparing surgery%机器人辅助腹腔镜保留肾单位肾部分切除术的围手术期护理

    Institute of Scientific and Technical Information of China (English)

    周秀彬; 王岩; 张玲; 胡英娜; 付清清

    2011-01-01

    目的 探讨机器人辅助腹腔镜保留肾单位肾部分切除术的围手术期护理措施和效果.方法 对6例行达芬奇机器人(Da Vinci S手术机器人系统)辅助腹腔镜保留肾单位肾部分切除术的患者进行术前心理护理和术前准备,术后心理护理、生命体征监测、引流管护理、并发症的监测、活动训练、饮食护理等围手术期护理.结果 6例手术患者中,1例改开放性保留肾单位肾部分切除术,其余5例手术均成功.全体患者术后恢复顺利,无并发症发生.结论 围手术期系统护理可保证机器人辅助腹腔镜下保留肾单位肾部分切除术的顺利进行,加快患者康复,效果满意.%Objective To analyze and discuss the systemic nursing strategy and effectiveness for robotassistant laparoscopic nephron-sparing surgery. Methods A total of 6 patients had undergone robot-assistant laparoscopic nephron-sparing partial nephrectomy. All the patients were given systemic perioperative nursing which was described as the following: peroperative psychological nursing and preoperative preparation; the postoperative monitoring of patients' vital sign, drainage tube; the postoperative nursing of psychophysiology,food and drink and rehabilitation training; prophylactic nursing of postoperative complications. Results All procedures were successfully completed with one case open conversion. All the patients had successful postoperative recovery without postoperative complications. Conclusions The postoperative systemic nursing strategy was feasible and safe for robot-assistant laparoscopic nephron-sparing surgery.

  9. Port-site metastasis as a primary complication following retroperitoneal laparoscopic radical resection of renal pelvis carcinoma or nephron-sparing surgery: A report of three cases and review of the literature

    Science.gov (United States)

    WANG, NING; WANG, KAI; ZHONG, DACHUAN; LIU, XIA; SUN, JI; LIN, LIANXIANG; GE, LINNA; YANG, BO

    2016-01-01

    The present study reports the clinical data of two patients with renal pelvis carcinoma and one patient with renal carcinoma who developed port-site metastasis following retroperitoneal laparoscopic surgery. The current study aimed to identify the cause and prognosis of the occurrence of port-site metastasis subsequent to laparoscopic radical resection of renal pelvis carcinoma and nephron-sparing surgery. Post-operative pathology confirmed the presence of high-grade urothelial cell carcinoma in two patients and Fuhrman grade 3 renal clear cell carcinoma in one patient. Port-site metastasis was initially detected 1–7 months post-surgery. The two patients with renal pelvis carcinoma succumbed to the disease 2 and 4 months following the identification of the port-site metastasis, respectively, whereas the patient with renal carcinoma survived with no disease progression during the targeted therapy period. The occurrence of port-site metastasis may be attributed to systemic and local factors. Measures to reduce the development of this complication include strict compliance with the operating guidelines for tumor surgery, avoidance of air leakage at the port-site, complete removal of the specimen with an impermeable bag, irrigation of the laparoscopic instruments and incisional wound with povidone-iodine when necessary, and enhancement of the body's immunity. Close post-operative follow-up observation for signs of recurrence or metastasis is essential, and systemic chemotherapy may be required in patients with high-grade renal pelvis carcinoma and renal carcinoma in order to prolong life expectancy. PMID:27313720

  10. Axillary lymph nodes and arm lymphatic drainage pathways are spared during routine complete axillary clearance in majority of women undergoing breast cancer surgery.

    Science.gov (United States)

    Szuba, A; Chachaj, Z; Koba-Wszedybylb, M; Hawro, R; Jasinski, R; Tarkowski, R; Szewczyk, K; Bebenek, M; Forgacz, J; Jodkowska, A; Jedrzejuk, D; Janczak, D; Mrozinska, M; Pilch, U; Wozniewski, M

    2011-09-01

    Alterations in axillary lymph nodes (ALNs) after complete axillary lymph node dissection (ALND) in comparison to the preoperative status were evaluated using lymphoscintigraphy performed preoperatively and 1-6 weeks after surgery in 30 women with a new diagnosis of unilateral, invasive breast carcinoma. Analysis of lymphoscintigrams revealed that ALNs after surgery were present in 26 of 30 examined women. In comparison to preoperative status, they were visualized in the same location (12 women), in the same and additionally in different locations (9 women), or only in different locations (4 women). No lymph nodes were visualized in one woman and lymphocoele were in 4 women. Thus, after ALND, a variable number of axillary lymph nodes remain and were visualized on lymphoscintigraphy in the majority of women. The classical ALND, therefore, does not allow complete dissection and removal of axillary nodes with total disruption of axillary lymphatic pathways, accounting in part for the variable incidence and severity of lymphedema after the procedure.

  11. Laryngeal function-sparing surgery for pyriform sinus cancer:a retrospective analysis of 14 cases%保留喉功能的梨状窝癌手术14例

    Institute of Scientific and Technical Information of China (English)

    钱小飞; 张速勤; 陈建良

    2015-01-01

    目的:探讨保留喉功能的梨状窝癌手术方法和适应证。方法梨状窝癌患者14例,Ⅰ期3例,Ⅱ期5例,Ⅲ期4例,Ⅳ期2例。行保留喉功能的手术治疗,术后放疗40~55 Gy。结果随访5年,14例均恢复发音功能,12例拔管。3年生存率为64.29%,5年生存率为42.86%。结论经严格术前评估,大部分梨状窝癌患者可通过精细手术保留喉正常组织,并通过多种修复方法恢复喉的全部或部分功能。%Objective To explore the approaches and indications of laryngeal function-sparing surgery for pyriform sinus cancer.Methods A total of 14 cases of pyriform sinus cancer were retrospectively reviewed,including stageⅠ(n=3),Ⅱ(n=5),Ⅲ(n=4)andⅣ(n=2).All patients received laryngeal function-sparing surgery,and then 40 to 55 Gy postoperative radiotherapy.Results During the follow-up of 5 years,all cases regained phonate function, and 12 cases’tracheal casings were removed.The 3-year and 5-year survival rate were 64.29% and 42.86%,respec-tively.Conclusion With careful preoperative evaluation,most patients with piriform sinus cancer can have normal laryngeal tissues preserved by delicate operation,and their larynx functions can be partially or completely restored with a variety of repair methods.

  12. Oncologic Outcomes of Kidney-sparing Surgery Versus Radical Nephroureterectomy for Upper Tract Urothelial Carcinoma: A Systematic Review by the EAU Non-muscle Invasive Bladder Cancer Guidelines Panel.

    Science.gov (United States)

    Seisen, Thomas; Peyronnet, Benoit; Dominguez-Escrig, Jose Luis; Bruins, Harman M; Yuan, Cathy Yuhong; Babjuk, Marko; Böhle, Andreas; Burger, Maximilian; Compérat, Eva M; Cowan, Nigel C; Kaasinen, Eero; Palou, Joan; van Rhijn, Bas W G; Sylvester, Richard J; Zigeuner, Richard; Shariat, Shahrokh F; Rouprêt, Morgan

    2016-12-01

    There is uncertainty regarding the oncologic effectiveness of kidney-sparing surgery (KSS) compared with radical nephroureterectomy (RNU) for upper tract urothelial carcinoma (UTUC). To systematically review the current literature comparing oncologic outcomes of KSS versus RNU for UTUC. A computerised bibliographic search of the Medline, Embase, and Cochrane databases was performed for all studies reporting comparative oncologic outcomes of KSS versus RNU. Approaches considered for KSS were segmental ureterectomy (SU) and ureteroscopic (URS) or percutaneous (PC) management. Using the methodology recommended by the Preferred Reporting Items for Systematic Reviews and Meta-analysis guidelines, we identified 22 nonrandomised comparative retrospective studies published between 1999 and 2015 that were eligible for inclusion in this systematic review. A narrative review and risk-of-bias (RoB) assessment were performed using cancer-specific survival (CSS) as the primary end point. Seven studies compared KSS overall (n=547) versus RNU (n=1376). Information on the comparison of SU (n=586) versus RNU (n=3692), URS (n=162) versus RNU (n=367), and PC (n=66) versus RNU (n=114) was available in 10, 5, and 2 studies, respectively. No significant difference was found between SU and RNU in terms of CSS or any other oncologic outcomes. Only patients with low-grade and noninvasive tumours experienced similar CSS after URS or PC when compared with RNU, despite an increased risk of local recurrence following endoscopic management of UTUC. The RoB assessment revealed, however, that the analyses were subject to a selection bias favouring KSS. Our systematic review suggests similar survival after KSS versus RNU only for low-grade and noninvasive UTUC when using URS or PC. However, selected patients with high-grade and invasive UTUC could safely benefit from SU when feasible. These results should be interpreted with caution due to the risk of selection bias. We reviewed the studies that

  13. Olfactory Neuroblastoma Treated by Endoscopic Surgery Followed by Combined External Beam Radiation and Gamma Knife for Optic Nerve and Chiasm Sparing: A Case Report

    Directory of Open Access Journals (Sweden)

    Hansi Z. Jiang

    2011-01-01

    Full Text Available We describe the multimodality treatment regimen of a 53-year-old man diagnosed with olfactory neuroblastoma (Kadish stage C in the right nasal cavity extending into the ethmoid sinus and across the cribriform plate. Endoscopic surgery for tumor resection was followed by a combination of external beam radiotherapy and stereotactic radiosurgery boost with concurrent chemotherapy. The novel combination of dual radiation therapies allowed for the preservation of the nearby optic structures while providing an adequate dosage to a sufficient volume of the afflicted tissue.

  14. Evaluation of nephron sparing surgery for renal tumors: a single institution experience%肾脏肿瘤保留肾单位手术的评价:单一机构的经验

    Institute of Scientific and Technical Information of China (English)

    Hytham Abd-elkareem Ahmed; Abdelhamid Hussein Ezzat; Ismael Mourad

    2011-01-01

    Objective: The aim of the study was to report the experience of National Cancer Institute (NCI), Cairo University, Egypt, in managing various benign and malignant renal tumors with nephron sparing surgery (NSS), and to assess its safety and feasibility. Methods: Reviewing the literature for NSS, and records of patients who underwent NSS in the period from January 2000 to December 2009 at National Cancer Institute, Cairo University regarding the patient and tumor related characteristics, the indication for NSS, operative technique, postoperative complications, full histopathological data, and follow up results. Results: The total number of patients was 17. Mean age at surgery was 30.7 years (range 1.5-65 years). Five patients had bilateral tumors during surgery. The mean tumor size was 4.5 cm (range 1-9 cm). All patients had normal preoperative kidney functions. Seven patients had an absolute indication for NSS, 6 patients had a relative indication, and 4 patients had an elective indication. All the 5 patients with bilateral tumors underwent bilateral simultaneous surgery. Cold ischemia was used in 8 patients, 1 patient was exposed to warm ischemia, manual compression was used in 2 patients, and no vascular control was applied in 6 patients. Complications were encountered in 2 patients, one of them had urinary leakage which needed reoperation, and the other had subcutaneous hematoma which was treated conservatively. Histopathological analysis revealed Wilm's tumor (8 patients), angiomyolipoma (4 patients), renal cell carcinoma (4 patients), and hydatid cyst (1 patient). All patients had negative surgical margin. For patients with Wilm's tumor, the mean follow up was 21.4 months (range 0-94 months), 2 patients had local recurrence, and 1 patient had distant metastasis. For patients with RCC, the mean follow up was 15.3 months (5-33 months), no patients had local recurrence or distant metastasis. All patients had normal kidney functions during postoperative and follow

  15. Bronchial malignant melanoma.

    Science.gov (United States)

    Weshler, Z; Sulkes, A; Kopolovitch, J; Leviatan, A; Shifrin, E

    1980-01-01

    We describe a case of malignant melanoma presenting initially as an endobronchial lesion located in the left main bronchus causing total atelectasis. This resolved with radiation therapy. Widespread metastases developed shortly thereafter. The differential diagnosis of primary and metastatic bronchial malignant melanoma is discussed. Other isolated case reports are reviewed.

  16. Reflexology and bronchial asthma

    DEFF Research Database (Denmark)

    Brygge, T; Heinig, J H; Collins, P

    2001-01-01

    Many asthma patients seek alternative or adjunctive therapies. One such modality is reflexology, whereby finger pressure is applied to certain parts of the body. The aim of the study was to examine the popular claim that reflexology treatment benefits bronchial asthma. Ten weeks of active...

  17. Dynamic Properties of Human Bronchial Airway Tissues

    CERN Document Server

    Wang, Jau-Yi; Pallai, Prathap; Corrigan, Chris J; Lee, Tak H

    2011-01-01

    Young's Modulus and dynamic force moduli were measured on human bronchial airway tissues by compression. A simple and low-cost system for measuring the tensile-strengh of soft bio-materials has been built for this study. The force-distance measurements were undertaken on the dissected bronchial airway walls, cartilages and mucosa from the surgery-removed lungs donated by lung cancer patients with COPD. Young's modulus is estimated from the initial slope of unloading force-displacement curve and the dynamic force moduli (storage and loss) are measured at low frequency (from 3 to 45 Hz). All the samples were preserved in the PBS solution at room temperature and the measurements were perfomed within 4 hours after surgery. Young's modulus of the human bronchial airway walls are fond ranged between 0.17 and 1.65 MPa, ranged between 0.25 to 1.96 MPa for cartilages, and between 0.02 to 0.28 MPa for mucosa. The storage modulus are found varying 0.10 MPa with frequency while the loss modulus are found increasing from ...

  18. Inverted Nipple With Nipple-Sparing Mastectomy.

    Science.gov (United States)

    Yim, Ji Hong; Lee, Taik Jong

    2016-08-01

    The inverted nipple is a relatively common aesthetic problem seen by plastic surgeons. The etiologies of an inverted nipple include insufficiency of supporting tissues, hypoplasia of the lactiferous ducts, and retraction caused by fibrous bands at the base of the nipple. Many different surgical techniques have been described, either individually or in combination, but none represents a landmark strategy. In our present study, we report our experience of spontaneous improvement immediately after nipple-sparing mastectomy with simple buried interrupted sutures to maintain nipple base in inverted nipple patients. We describe our 10 years' experience in using a simple approach to correct inverted nipples after nipple-sparing mastectomy with pedicled transverse rectus abdominis myocutaneous flap reconstruction. Between January 2001 and August 2010, we observed 23 inverted nipples after nipple-sparing mastectomy by using only a buried baseline suture to tighten the base of the nipple. The follow-up period ranged from 3 to 13 years. After nipple-sparing mastectomy with tightening of the base of the nipple, improvements were seen in 18 of the 23 patients. No complications associated with surgery occurred, such as infection, depigmentation, sensory disturbance, or nipple necrosis. The simple method of baseline suturing that only tightens the nipple base with nipple-sparing mastectomy has been used in our center over a 10-year period in patients with breast cancer and an inverted nipple. The retractile duct or fibrous cord was completely cut with nipple-sparing mastectomy, and over 70% of inverted nipples in the patients were improved and maintained with only the tightening of the base of the nipple. Our results show that inverted nipple is caused by tight fibrous band or short duct rather than a lack of subareolar tissue.

  19. Nephron sparing surgery for giant mass in solitary kidney%孤立肾巨大肿瘤保留肾单位的手术治疗

    Institute of Scientific and Technical Information of China (English)

    唐朝朋; 徐振宇; 位志峰; 董杰; 高建平; 徐锋; 程文; 周文泉

    2013-01-01

    目的:探讨孤立肾巨大肿瘤的诊治方法.方法:对2例孤立肾肾肿瘤直径≥8.0 cm的患者,先行腹腔镜手术游离肾脏血管,再行开放手术将肾肿瘤剜除.结果:2例手术均获成功,1例术后发生肾功能不全,1例完全康复,术后随访12个月,肿瘤均无复发或转移.结论:对于孤立肾巨大肿瘤,术前行肾动脉血管检查、肾肿瘤超选择性栓塞,术中运用腹腔镜游离肾血管、开放手术冷缺血阻断肾动脉,使肿瘤与正常肾组织分界清楚、减少出血、加快手术操作、有助于保护患者肾功能,提高患者生活质量.%Objective: To discuss the diagnosis and treatment of giant masses in solitary kidney. Method: We used laparoscopic for dividing renal vascular and then performed open tumor enucleation for two giant masses in solitary kidney (tumor diameter≥8. 0 cm). Result:Both operations were successful ,one presented postoperative renal dysfunction, the other was full recovery, follow-up about 12 months, no recurrence or metastasis of the tumor was seen. Conclusion:For giant masses in solitary kidney ,tumor enucleation is feasible. Preoperative angi-ography of renal artery and highly selective embolization of renal tumors, intraoperative using laparoscopic for dividing renal vascular and then open surgery for cold ischemic, these can make demarcation more clear between tumor and normal tissue , reduce blood loss ,and accelerate the operation , which can protect patient's renal function and to improve the quality of life.

  20. Bronchial Thermoplasty in Asthma

    Directory of Open Access Journals (Sweden)

    Wayne Mitzner

    2006-01-01

    Full Text Available In this review we discuss the potential of a new procedure, termed Bronchial Thermoplasty to prevent serious consequences resulting from excessive airway narrowing. The most important factor in minimizing an asthmatic attack is limiting the degree of smooth muscle shortening. The premise that airway smooth muscle can be either inactivated or obliterated without any long-term alteration of other lung tissues, and that airway function will remain normal, albeit with reduced bronchoconstriction, has now been demonstrated in dogs, a subset of normal subjects, and mild asthmatics. Bronchial Thermoplasty may thus develop into a useful clinical procedure to effectively impair the ability for airway smooth muscle to reach the levels of pathologic narrowing that characterizes an asthma attack. It may also enable more successful treatment of asthma patients who are unresponsive to more conventional therapies. Whether this will remain stable for the lifetime of the patient still remains to be determined, but at the present time, there are no indications that the smooth muscle contractility will return. This successful preliminary experience showing that Bronchial Thermoplasty could be safely performed in patients with asthma has led to an ongoing clinical trial at a number of sites in Europe and North America designed to examine the effectiveness of this procedure in subjects with moderately severe asthma.

  1. [Bronchial morphologic modification in asthma].

    Science.gov (United States)

    Cataldo, D; Louis, R; Godon, A; Munaut, C; Noël, A; Foidart, J M; Bartsch, P

    2000-07-01

    Asthma is an inflammatory disease of the airways clinically characterised by recurrent bronchial obstructions at least partially reversible. Recent epidemiologic data suggest that asthmatics have an increased rate of decrease of their expiratory volumes during life. This irreversible lung function impairment is associated with fundamental structural changes of the bronchial wall in terms of conjunctive tissue and smooth muscle composition. We describe these changes and explore the different mechanisms proposed to explain these structural modifications. We also review their consequences in terms of bronchial physiology and their potential influence on bronchial hyperresponsiveness.

  2. Morgagni’s hernia in a woman with bronchial asthma

    Directory of Open Access Journals (Sweden)

    Gowrinath K

    2014-07-01

    Full Text Available A 59-year-old, other wise asymptomatic lady known to have bronchial asthma was found to have an anterior mediastinal mass on a chest radiograph incidentally obtained as a part of pre-operative work-up for cataract surgery. Computed tomography of the chest confirmed the diagnosis of Morgagni’s hernia.

  3. Nerve-sparing techniques and results in robot-assisted radical prostatectomy

    Science.gov (United States)

    Aytac, Omer; Atug, Fatih

    2016-01-01

    Nerve-sparing techniques in robot-assisted radical prostatectomy (RARP) have advanced with the developments defining the prostate anatomy and robotic surgery in recent years. In this review we discussed the surgical anatomy, current nerve-sparing techniques and results of these operations. It is important to define the right and key anatomic landmarks for nerve-sparing in RARP which can demonstrate individual variations. The patients' risk assessment before the operation and intraoperative anatomic variations may affect the nerve-sparing technique, nerve-sparing degree and the approach. There is lack of randomized control trials for different nerve-sparing techniques and approaches in RARP, therefore accurate preoperative and intraoperative assessment of the patient is crucial. Current data shows that, performing the maximum possible nerve-sparing using athermal techniques have better functional outcomes. PMID:27995221

  4. Isolated bronchial artery involvement by polyarteritis nodosa presenting as hemoptysis: A case report

    Energy Technology Data Exchange (ETDEWEB)

    Park, Su Rin; Kwon, Jae Hyun; Lee, Kwang Hoon [Dongguk University Ilsan Hospital, Goyang (Korea, Republic of)

    2017-03-15

    Polyarteritis nodosa (PAN) is a systemic necrotizing vasculitis that involves medium- and small-sized arteries. PAN may affect any organ, and the presenting symptom of PAN varies depending on the organs affected. However, PAN generally spares the lung; thus, a report of PAN involving the bronchial artery is extremely rare, and hemoptysis has not been reported as the sole presenting symptom. Here, we report the case of a 39-year-old woman with hemoptysis who was diagnosed with PAN involving only the bronchial artery by angiography without involvement of the visceral arteries. Details of this case and a literature review are presented.

  5. Nipple areola complex sparing mastectomy

    Science.gov (United States)

    Mingozzi, Matteo; Curcio, Annalisa; Buggi, Federico; Folli, Secondo

    2015-01-01

    Breast conservative therapy (BCT) is established as a safe option for most women with early breast cancer (BC). The best conservative mastectomy that can be performed, when mastectomy is unavoidable, is nipple-areola-complex sparing mastectomy (NSM), which allows the complete glandular dissection preserving the skin envelope and the nipple areola complex. In the treatment of BC, the cosmetic outcomes have become fundamental goals, as well as oncologic control. NSM is nowadays considered an alternative technique to improve the overall quality of life for women allowing excellent cosmetic results because it provides a natural appearing breast. The breast surgeon must pay attention to details and skin incision must be planned to minimize vascular impairment to the skin and the nipple. Preservation of the blood supply to the nipple is one of the most important concern during NSM because nipple or areolar necrosis is a well-described complication of this surgery. Another issue associated with the nipple preservation and the surgical technique is oncological safety related to nipple-areola-complex (NAC) involvement in patients with invasive BC. The authors present their experience on 252 NSM performed in the Breast Surgery Unit in Forlì. Careful selection of patients for this surgical procedure is imperative and many patients are not ideal candidates for this procedure because of concerns about nipple-areolar viability as women with significant large/ptotic breast, pre-existing breast scars and history of active cigarette smoking. To extend the benefits of nipple preservation to patients who are perceived to be at higher risk for nipple necrosis the authors describe technical modifications of NSM to allow nipple preservation and obtain good cosmetic outcomes. PMID:26645007

  6. Nerve-sparing techniques and results in robot-assisted radical prostatectomy

    OpenAIRE

    Tavukçu, Hasan Hüseyin; Aytac, Omer; Atug, Fatih

    2016-01-01

    Nerve-sparing techniques in robot-assisted radical prostatectomy (RARP) have advanced with the developments defining the prostate anatomy and robotic surgery in recent years. In this review we discussed the surgical anatomy, current nerve-sparing techniques and results of these operations. It is important to define the right and key anatomic landmarks for nerve-sparing in RARP which can demonstrate individual variations. The patients' risk assessment before the operation and intraoperative an...

  7. Retroperitoneal laparoscopic nephron-sparing surgery for renal tumor : report of 15 cases%后腹腔镜保留肾单位肾脏肿瘤切除术(附15例报告)

    Institute of Scientific and Technical Information of China (English)

    梁平; 吴刚; 叶锦; 王鹏; 江军; 靳风烁

    2008-01-01

    目的 探讨后腹腔镜行保留肾单位肾脏肿瘤切除术的手术可行性及疗效.方法 2007年3月至2008年8月,15例肾脏局限性肿瘤患者采用后腹腔镜保留肾单位肾脏肿瘤切除术.术中用bulldog血管钳阻断肾脏血流,用超声刀在距离肿瘤边缘2~10 mm处进行切除,肿瘤床随机切取三处组织送冰冻病理检查.结果 15例手术均顺利完成,无一例中转开放.平均手术时间110 min,术中平均阻断肾血流时间26 min,术中平均出血量200 ml,平均术后住院时间9 d.术中切缘组织病理切片均为阴性.术后随访2~14个月肿瘤无复发.结论 后腹腔镜保留肾单位肾脏肿瘤切除术治疗肾脏肿瘤技术可行,安全有效,其远期疗效尚有待长期随访.%Objective To valuate the clinical effect of retroperitoneal laparoscopic nephron-sparing surgery. Methods From March 2007 to May 2008, 15 patients with local renal tumors underwent retroperitoneal laparoscopic partial nephrectomy by a single surgeon. Hilar control was achieved with bulldog clamps. Hook-cautery is used to circumscribe the tumor for resection by scoring the renal capsule circumferentially with a 2-10 mm margin around the tumor. Specimens are randomly extracted through tumor edges and immediately given to pathological frozen sections. The operative time, blood loss, postoperative stay, complications and the time of complete convalescence were recorded. Results Mean operative time was 110 minutes and mean time of hilar control was 26 minutes. Mean blood loss was 200ml. Mean postoperative stay was 9 days. Final pathological evaluation revealed negative positive margins in these cases. During 2-14 months follow-up there was no local recurrence. Conclusions Retroperitoneal laparoscopic partial nephrectomy for small renal tumors can be performed safely and effectively. Extended follow-up period is required to determine its long-term functional and oncological outcomes.

  8. Condition based spare parts supply

    NARCIS (Netherlands)

    Lin, X.; Basten, Robertus Johannes Ida; Kranenburg, A.A.; van Houtum, Geert-Jan

    2012-01-01

    We consider a spare parts stock point that serves an installed base of machines. Each machine contains the same critical component, whose degradation behavior is described by a Markov process. We consider condition based spare parts supply, and show that an optimal, condition based inventory policy

  9. Surgery of the aortic root: should we go for the valve-sparing root reconstruction or the composite graft-valve replacement is still the first choice of treatment for these patients?

    Directory of Open Access Journals (Sweden)

    Fernando de Azevedo Lamana

    2015-09-01

    Full Text Available AbstractObjective:To compare the results of the root reconstruction with the aortic valve-sparing operation versus composite graftvalve replacement.Methods:From January 2002 to October 2013, 324 patients underwent aortic root reconstruction. They were 263 composite graft-valve replacement and 61 aortic valve-sparing operation (43 reimplantation and 18 remodeling. Twenty-six percent of the patients were NYHA functional class III and IV; 9.6% had Marfan syndrome, and 12% had bicuspid aortic valve. There was a predominance of aneurysms over dissections (81% vs. 19%, with 7% being acute dissections. The complete follow-up of 100% of the patients was performed with median follow-up time of 902 days for patients undergoing composite graft-valve replacement and 1492 for those undergoing aortic valve-sparing operation.Results:In-hospital mortality was 6.7% and 4.9%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns. During the late follow-up period, there was 0% moderate and 15.4% severe aortic regurgitation, and NYHA functional class I and II were 89.4% and 94%, respectively for composite graft-valve replacement and aortic valve-sparing operation (ns. Root reconstruction with aortic valve-sparing operation showed lower late mortality (P=0.001 and lower bleeding complications (P=0.006. There was no difference for thromboembolism, endocarditis, and need of reoperation.Conclusion:The aortic root reconstruction with preservation of the valve should be the operation being performed for presenting lower late mortality and survival free of bleeding events.

  10. Clearance of bronchial secretions after major surgery

    NARCIS (Netherlands)

    Leur, Johannes Peter van de

    2005-01-01

    Minimally invasive airway suctioning is equally effective as routine endotracheal suctioning but results in less suction related adverse events, less recollection of suctioning and less stress. Thus, although it cannot be employed in all situations, minimally invasive airway suctioning should be the

  11. Histopathological study on changes of bronchial epithelium among chromate workers

    Energy Technology Data Exchange (ETDEWEB)

    Mikami, H.

    1982-09-01

    There have been many reports on lung cancer among chromate workers. Chromate compounds are thought to be a carcinogen and lung cancer among chromate workers is considered one of the occupational lung cancers. Recently, it is debated that metaplastic and hyperplastic changes of bronchial epithelium are revealed or not to the development of bronchogenic carcinoma. Histopathological study on changes of bronchial epithelium among chromate workers was performed in order to clarify the effect of chromate compounds to bronchial epithelium. The subjects were 14 cases of lung cancer among chromate workers. As a control, 18 cases of non cancer among chromate workers. Lung tissue which was obtained at necropsy or surgery was fixed by formalin and was produced cross-sections and was stained on Haematoxylin-Eosin. The results were as follows. Of examined 235 cross-sections, basal cell hyperplasia of bronchial epithelium was found in 13 percent. Squamous metaplasia was found in 29 percent, on the contrary, atypical metaplastic changes were observed in 34 percent. Of four cases of carcinoma in situ and two cases of small invasive carcinoma, four cases revealed development from atypical squamous metaplasia to precancerous changes. These cases developed invasive carcinoma from atypical squamous metaplasia for a long period, of which were found by successive exfoliative cytology of sputum. From these findings, it was concluded that inhalation of chromate dust affected bronchial epithelium and caused highly atypical squamous metaplasia which developed to carcinoma in situ and finally to invasive carcinoma.

  12. Histopathological study on changes of bronchial epithelium among chromate workers

    Energy Technology Data Exchange (ETDEWEB)

    Mikami, H.

    1982-09-01

    There have been many reports on lung cancer among chromate workers. Chromate compounds are thought to be a carcinogen and lung cancer among chromate workers is considered one of the occupational lung cancers. Recently, it is debated that metaplastic and hyperplastic changes of bronchial epithelium are revealed or not to the development of bronchogenic carcinoma. Histopathological study on changes of bronchial epithelium among chromate workers was performed in order to clarify the effect of chromate compounds to bronchial epithelium. The subjects were 14 cases of lung cancer among chromate workers. As a control, 18 cases of non cancer among chromate workers. Lung tissue which was obtained at necropsy or surgery was fixed by formalin and was produced cross-sections and was stained on Haematoxylin-Eosin. The results were as follows. 1. Of examined 235 cross-sections, basal cell hyperplasia of bronchial epithelium was found in 13 per cent. Squamous metaplasia was found in 29 per cent, on the contrary, atypical metaplastic changes were observed in 34 per cent. 2. Of four cases of carcinoma in situ and two cases of small invasive carcinoma, four cases revealed development from atypical squamous metaplasia to precancerous changes. 3. These cases developed invasive carcinoma from atypical squamous metaplasia for a long period, of which were found by successive exfoliative cytology of sputum. From these findings, it was concluded that inhalation of chromate dust affected bronchial epithelium and caused highly atypical squamous metaplasia which developed to carcinoma in situ and finally to invasive carcinoma.

  13. Fractura bronquial BRONCHIAL FRACTURE

    Directory of Open Access Journals (Sweden)

    IVÁN CAVIEDES S

    2003-04-01

    Full Text Available El traumatismo torácico es una entidad patológica emergente, relacionada con accidentes automovilísticos. La lesión más frecuente es la fractura costal. Dependiendo de su gravedad, éste puede provocar tórax volante, contusión cardíaca, lesiones vasculares u otras alteraciones. La ruptura bronquial se observa ocasionalmente en traumatismos torácicos cerrados, y por lo general tiene lugar en el tronco principal del árbol tráqueo-bronquial. Su diagnóstico y manejo inicial representan un problema mayor. Los signos clásicos son la persistencia de neumotórax y flujo masivo de aire a través del drenaje torácico; sin embargo también hay casos que no son típicos. Es difícil determinar el momento correcto para iniciar la ventilación mecánica con presión positiva, la que puede aumentar gravemente el flujo de aire a través de la ruptura bronquial y acentuar el neumotórax a tensión. Presentamos el caso de un hombre de 25 años con un traumatismo torácico cerrado, causado por un accidente de automóvil, en quien la broncoscopía demostró una fractura del bronquio lobar medio. Comprobamos en este paciente, que la fibrobroncoscopía es el procedimiento más útil tanto en el diagnóstico, como en el tratamiento inicial y en el seguimiento post operatorio de su fractura bronquiaThoracic trauma is an emerging pathology related to the increase of motor vehicle accidents. Rib fracture is the most frequent injury; depending on the severity of the event it may be associated with flail chest, cardiac contusion, vascular lesions and other injuries. Bronchial rupture is occasionally seen in blunt trauma and it occurs mostly in the main stem of the tracheobronchial tree. It represents a great task in diagnosis and initial management. Persistent pneumothorax and massive airflow by the thoracic drain are the classic signs, however other cases are not so typical. The right moment to begin positive pressure ventilation is challenging, because in

  14. Bronchial artery embolization in hemoptysis

    Institute of Scientific and Technical Information of China (English)

    DAI Hong-xiu; YANG Ding-cai; LIU Wei-hong; TANG He-qing; LIU Ke-yong; ZHAO Xiao-hua; TAN Yi-qing; WANG Jun

    2005-01-01

    Massive hemoptysis is one of the most dreaded of all respiratory emergencies and can have a variety of underlying causes. It is mostly caused by bleeding from bronchial circulation. Bronchial artery embolization is now considered to be the treatment of choice for acute massive hemoptysis. Bronchial artery embolization (BAE) is a safe and effective nonsurgical treatment for patients with massive hemoptysis. However, nonbronchial systemic arteries can be a significant source of massive hemoptysis and a cause of recurrence after successful BAE. So knowledge of the bronchial artery anatomy, together with an understanding of the pathophysiologic features of massive hemoptysis, are essential for planning and performing BAE in affected patients. In addition, interventional radiologists should be familiar with the techniques, results, efficacy, safety and possible complications of BAE and with the characteristics of the various embolic agents. Bronchial arterial catheterisation in human via a percutaneous approach has been practiced for 32 years (1973) in the world and 20 years (1986) in China, initially for direct chemotherapy treatment for bronchial malignancies and then for the embolization of patients with massive haemoptysis. A review of clinical experience to evaluate technique,embolic materials,outcome and complications of BAE is presented.

  15. 保留肾单位手术治疗肾脏小肿瘤三年随访结果分析%Nephron sparing surgery for small renal tumor: complication and 3 years follow-up

    Institute of Scientific and Technical Information of China (English)

    管维; 蓝儒竹; 王志华; 胡志全; 庄乾元; 叶章群

    2010-01-01

    目的 探讨保留肾单位的肾部分切除手术治疗肾脏小肿瘤的安全性和有效性.方法 肾脏小肿瘤患者43例.男27例,女16例.年龄21~79(46.0±13.0)岁.肿瘤直径1.2~4.0(3.1±0.8)cm.行开放保留肾单位手术18例,后腹腔镜下保留肾单位手术25例.评估围手术期及手术前后肾功能、术后并发症及复发情况.结果 43例手术顺利.2组发生术中大出血各1例.开放组和后腹腔镜组平均手术时间分别为69~277(158.0±77.4)和60~226(150.0±69.1)min;热缺血时间分别为20~31(23.2±3.9)和23~35(25.8±4.1)min;术中失血量120~3000(590.8±725.0)和50~1600(468.5±614.0)ml;术前SCr分别为(65.9±22.8)和(68.4±25.0)μmol/L,随访期末分别为(82.2±24.1)和(85.3±25.9)μmol/L;2组间比较差异均无统计学意义(P>0.05).住院日分别为11~47(19.2±8.0)和10~16(12.5±3.8)d(P<0.05);2组术后出现次要并发症14例(33%),其中肾周血肿分别为1例(6%)和3例(12%),2组比较差异有统计学意义(P<0.05).病理报告肾细胞癌25例(T1a),良性肿瘤18例.43例随访25~60(37.4±7.2)个月,1例肾透明细胞癌患者术后20个月出现复发后行肾切除术,术后病理仍为透明细胞癌;1例血管平滑肌脂肪瘤患者术后6个月在远离原病灶处出现新生肿瘤,CT检查提示仍为血管平滑肌脂肪瘤,行动态观察.2组术后3年肿瘤无复发生存率分别为94%及96%,肾癌无复发生存率分别为100%及93%,2组间比较差异均无统计学意义(P>0.05).结果 后腹腔镜下保留肾单位手术治疗肾脏小肿瘤较同期开放保留肾单位手术平均住院日短,但肾周血肿发生率略高,其他并发症发生率无明显差异,2组均未见不可逆肾功能损害,2组肿瘤无复发生存率及肾细胞癌无复发生存率差异无统计学意义.%Objective To evaluate the safety and efficacy of nephron sparing surgery for small renal tumor. Methods A total of 43 patients with small renal tumor underwent

  16. [Rhino-bronchial syndrome].

    Science.gov (United States)

    Gani, F; Vallese, G; Piglia, P; Senna, G; Mezzelani, P; Pozzi, E

    2000-12-01

    A close anatomical and functional relationship between superior and inferior airways is well documented. A typical example is offered by the close relationship between allergic rhinitis and asthma whose close connection is documented by epidemiological and pathological data. The mechanisms which can explain this phenomenon are not fully known but naso-bronchial reflexes, mouth-breathing due to nasal obstruction and aspiration of nasal secretions seem all to be important. Moreover it has been recently proved that the treatment of rhinitis can improve the concomitant asthma thus confirming their relationship. Another less frequent association is between sinusitis and asthma. Such a connection seems to be frequent in patients suffering of atopic rhinitis but also in patients presenting a nasal obstruction of different nature such as deviations of the nasal septum, adenoid hypertrophy etc. Also in this case a correct medical or surgical treatment of sinusitis can improve asthma symptomathology. Finally a classic example of involvement of superior and inferior airways is represented by the syndrome of ASA intolerance. These patients in fact initially complain of rhinitis which afterwards is complicated by the onset of nasal polyposis and asthma which can prove clinically very severe. Nowadays, anyway, there is no evidence that the treatment of rhinitis or polypectomy can improve the clinical course of asthma. In conclusion, diseases of superior and inferior airways must be considered in strict connection and need the same global treatment.

  17. 47 CFR 80.866 - Spare antenna.

    Science.gov (United States)

    2010-10-01

    ... 47 Telecommunication 5 2010-10-01 2010-10-01 false Spare antenna. 80.866 Section 80.866... Spare antenna. A spare transmitting antenna completely assembled for immediate erection must be provided. If the installed transmitting antenna is suspended between supports, this spare antenna must be...

  18. Imaging of hepatic steatosis and fatty sparing

    Energy Technology Data Exchange (ETDEWEB)

    Karcaaltincaba, Musturay [Department of Radiology, Hacettepe University School of Medicine, Ankara 06100 (Turkey)]. E-mail: musturayk@yahoo.com; Akhan, Okan [Department of Radiology, Hacettepe University School of Medicine, Ankara 06100 (Turkey)

    2007-01-15

    Radiology has gained importance in the non-invasive diagnosis of hepatic steatosis. Ultrasonography is usually the first imaging modality for the evaluation of hepatic steatosis. Unenhanced CT with or without dual kVp measurement and MRI with in and out of phase sequence can allow objective evaluation of hepatic steatosis. However, none of the imaging modalities can differentiate non-alcoholic steatohepatitis/fatty liver disease from simple steatosis. Evaluation of hepatic steatosis is important in donor evaluation before orthotopic liver transplantation and hepatic surgery. Recently, one-stop shop evaluation of potential liver donors has become possible by CT and MRI integrating vascular, parenchymal, volume and steatosis evaluation. Moreover hepatic steatosis (diffuse, multinodular, focal, subcortical, perilesional, intralesional, periportal and perivenular), hypersteatosis and sparing (geographic, nodular and perilesional or peritumoral) can cause diagnostic problems as a pseudotumor particularly in the evaluation of oncology patients. Liver MRI is used as a problem-solving tool in these patients. In this review, we discuss the current role of radiology in diagnosing, quantifying hepatic steatosis and solutions for diagnostic problems associated with fatty infiltration and sparing.

  19. Tracheal and bronchial tumors.

    Science.gov (United States)

    Varela, Patricio; Pio, Luca; Brandigi, Elisa; Paraboschi, Irene; Khen-Dunlop, Nazhia; Hervieux, Erik; Muller, Cecile; Mattioli, Girolamo; Sarnacki, Sabine; Torre, Michele

    2016-12-01

    Although primary tracheobronchial tumors are extremely rare in children, recurrent respiratory symptoms resistant to conventional therapy require further investigations to exclude possible malignant obstructive causes. As the matter of fact, early diagnosis may allow minimally invasive surgeries, improving the standard of living and the globally survival rate. The aim of this article is to provide an overview of diagnosis and management of tracheobronchial tumors in the early age, since only few reports are reported in the worldwide literature.

  20. The Use of Extracorporeal Membrane Oxygenation in the Surgical Repair of Bronchial Rupture

    Directory of Open Access Journals (Sweden)

    Ju-Hee Park

    2016-02-01

    Full Text Available Extracorporeal membrane oxygenation (ECMO has been used successfully in critically ill patients with traumatic lung injury and offers an additional treatment modality. ECMO is mainly used as a bridge treatment to delayed surgical management; however, only a few case reports have presented the successful application of ECMO as intraoperative support during the surgical repair of traumatic bronchial injury. A 38-year-old man visited our hospital after a blunt chest trauma. His chest imaging showed hemopneumothorax in the left hemithorax and a finding suspicious for left main bronchus rupture. Bronchoscopy was performed and confirmed a tear in the left main bronchus and a congenital tracheal bronchus. We decided to provide venovenous ECMO support during surgery for bronchial repair. We successfully performed main bronchial repair in this traumatic patient with a congenital tracheal bronchus. We suggest that venovenous ECMO offers a good option for the treatment of bronchial rupture when adequate ventilation is not possible.

  1. Successful Treatment of Bronchial Fistula after Pulmonary Lobectomy by Endobronchial Embolization Using an Endobronchial Watanabe Spigot

    Directory of Open Access Journals (Sweden)

    Yuichiro Machida

    2015-01-01

    Full Text Available A bronchial fistula is one of the most serious complications that can occur following pulmonary lobectomy. We herein report a case of bronchial fistula that was successfully treated by endobronchial embolization using an Endobronchial Watanabe Spigot (EWS. A 72-year-old male underwent right lower lobectomy of the lung with nodal dissection for a pulmonary squamous cell carcinoma. A bronchial fistula developed 53 days after surgery. Tube drainage was performed, and air leakage was apparent. Under endoscopic observation, intrathoracic injection of indigo carmine revealed that a fistula existed at the peripheral site of the B2ai bronchus. After one EWS (small was inserted into the B2a bronchus tightly using a bronchoscope, the air leakage was stopped. Pleurodesis was further carried out, the thoracostomy tube was subsequently removed, and the patient was discharged. Endobronchial embolization using an EWS is an option for the treatment of a bronchial fistula after pulmonary resection.

  2. Physiotherapy and bronchial mucus transport

    NARCIS (Netherlands)

    van der Schans, CP; Postma, DS; Koeter, GH; Rubin, BK

    Cough and expectoration of mucus are the best-known symptoms in patients with pulmonary disease, The most applied intervention for these symptoms is the use of chest physiotherapy to increase bronchial mucus transport and reduce retention of mucus in the airways, Chest physiotherapy interventions

  3. Physiotherapy and bronchial mucus transport

    NARCIS (Netherlands)

    van der Schans, CP; Postma, DS; Koeter, GH; Rubin, BK

    1999-01-01

    Cough and expectoration of mucus are the best-known symptoms in patients with pulmonary disease, The most applied intervention for these symptoms is the use of chest physiotherapy to increase bronchial mucus transport and reduce retention of mucus in the airways, Chest physiotherapy interventions ca

  4. Foveal sparing in stargardt disease

    NARCIS (Netherlands)

    Huet, R.A.C. van; Bax, N.M.; Westeneng-van Haaften, S.C.; Muhamad, M.; Zonneveld-Vrieling, M.N.; Hoefsloot, L.H.; Cremers, F.P.M.; Boon, C.J.F.; Klevering, B.J.; Hoyng, C.B.

    2014-01-01

    PURPOSE: To provide a clinical and genetic description of a patient cohort with Stargardt disease (STGD1) with identifiable foveal sparing. METHODS: Patients with retinal atrophy (defined as an absence of autofluorescence) that surrounded the fovea by at least 180 degrees and did not include the fov

  5. Skin sparing mastectomy: Technique and suggested methods of reconstruction

    Directory of Open Access Journals (Sweden)

    Ahmed M. Farahat

    2014-09-01

    Conclusions: Skin Sparing mastectomy through a circum-areolar incision has proven to be a safe and feasible option for the management of breast cancer in Egyptian women, offering them adequate oncologic control and optimum cosmetic outcome through preservation of the skin envelope of the breast when ever indicated. Our patients can benefit from safe surgery and have good cosmetic outcomeby applying different reconstructive techniques.

  6. The Patient Deficit Model Overturned: a qualitative study of patients' perceptions of invitation to participate in a randomized controlled trial comparing selective bladder preservation against surgery in muscle invasive bladder cancer (SPARE, CRUK/07/011).

    Science.gov (United States)

    Moynihan, Clare; Lewis, Rebecca; Hall, Emma; Jones, Emma; Birtle, Alison; Huddart, Robert

    2012-11-29

    Evidence suggests that poor recruitment into clinical trials rests on a patient 'deficit' model - an inability to comprehend trial processes. Poor communication has also been cited as a possible barrier to recruitment. A qualitative patient interview study was included within the feasibility stage of a phase III non-inferiority Randomized Controlled Trial (RCT) (SPARE, CRUK/07/011) in muscle invasive bladder cancer. The aim was to illuminate problems in the context of randomization. The qualitative study used a 'Framework Analysis' that included 'constant comparison' in which semi-structured interviews are transcribed, analyzed, compared and contrasted both between and within transcripts. Three researchers coded and interpreted data. Twenty-four patients agreed to enter the interview study; 10 decliners of randomization and 14 accepters, of whom 2 subsequently declined their allocated treatment.The main theme applying to the majority of the sample was confusion and ambiguity. There was little indication that confusion directly impacted on decisions to enter the SPARE trial. However, confusion did appear to impact on ethical considerations surrounding 'informed consent', as well as cause a sense of alienation between patients and health personnel.Sub-optimal communication in many guises accounted for the confusion, together with the logistical elements of a trial that involved treatment options delivered in a number of geographical locations. These data highlight the difficulty of providing balanced and clear trial information within the UK health system, despite best intentions. Involvement of multiple professionals can impact on communication processes with patients who are considering participation in RCTs. Our results led us to question the 'deficit' model of patient behavior. It is suggested that health professionals might consider facilitating a context in which patients feel fully included in the trial enterprise and potentially consider alternatives to

  7. The Patient Deficit Model Overturned: a qualitative study of patients' perceptions of invitation to participate in a randomized controlled trial comparing selective bladder preservation against surgery in muscle invasive bladder cancer (SPARE, CRUK/07/011

    Directory of Open Access Journals (Sweden)

    Moynihan Clare

    2012-11-01

    Full Text Available Abstract Background Evidence suggests that poor recruitment into clinical trials rests on a patient ‘deficit’ model – an inability to comprehend trial processes. Poor communication has also been cited as a possible barrier to recruitment. A qualitative patient interview study was included within the feasibility stage of a phase III non-inferiority Randomized Controlled Trial (RCT (SPARE, CRUK/07/011 in muscle invasive bladder cancer. The aim was to illuminate problems in the context of randomization. Methods The qualitative study used a ‘Framework Analysis’ that included ‘constant comparison’ in which semi-structured interviews are transcribed, analyzed, compared and contrasted both between and within transcripts. Three researchers coded and interpreted data. Results Twenty-four patients agreed to enter the interview study; 10 decliners of randomization and 14 accepters, of whom 2 subsequently declined their allocated treatment. The main theme applying to the majority of the sample was confusion and ambiguity. There was little indication that confusion directly impacted on decisions to enter the SPARE trial. However, confusion did appear to impact on ethical considerations surrounding ‘informed consent’, as well as cause a sense of alienation between patients and health personnel. Sub-optimal communication in many guises accounted for the confusion, together with the logistical elements of a trial that involved treatment options delivered in a number of geographical locations. Conclusions These data highlight the difficulty of providing balanced and clear trial information within the UK health system, despite best intentions. Involvement of multiple professionals can impact on communication processes with patients who are considering participation in RCTs. Our results led us to question the ‘deficit’ model of patient behavior. It is suggested that health professionals might consider facilitating a context in which patients

  8. A Review of Selected International Aircraft Spares Pooling Programs: Lessons Learned for F-35 Spares Pooling

    Science.gov (United States)

    2016-01-01

    international military aircraft support program using true spares pooling for which we have any detailed and reliable data, and it is the closest current...for all F77 spares . The remaining non-C-17 unique spares are managed by the Defense Logistics Agency and the Air Force Air Logistics Centers .50...C O R P O R A T I O N Research Report A Review of Selected International Aircraft Spares Pooling Programs Lessons Learned for F-35 Spares Pooling

  9. Lung Sounds in Bronchial Asthma

    Directory of Open Access Journals (Sweden)

    Yukio Nagasaka

    2012-01-01

    In lung sound analysis, the narrower the airways are, the higher the frequency of breathing sounds is, and, if a patient has higher than normal breathing sounds, i.e., bronchial sounds, he or she may have airway narrowing or airway inflammation. It is sometimes difficult to detect subtle changes in lung sounds; therefore, we anticipate that automated analysis of lung sounds will be used to overcome these difficulties in the near future.

  10. Social networks and bronchial asthma.

    Science.gov (United States)

    D'Amato, Gennaro; Cecchi, Lorenzo; Liccardi, Gennaro; D'Amato, Maria; Stanghellini, Giovanni

    2013-02-01

    To focus on both positive and negative aspects of the interaction between asthmatic patients and the social networks, and to highlight the need of a psychological approach in some individuals to integrate pharmacological treatment is the purpose of review. There is evidence that in some asthmatic patients, the excessive use of social networks can induce depression and stress triggering bronchial obstruction, whereas in others their rational use can induce beneficial effects in terms of asthma management. The increasing asthma prevalence in developed countries seen at the end of last century has raised concern for the considerable burden of this disease on society as well as individuals. Bronchial asthma is a disease in which psychological implications play a role in increasing or in reducing the severity of bronchial obstruction. Internet and, in particular, social media are increasingly a part of daily life of both young and adult people, thus allowing virtual relationships with peers sharing similar interests and goals. Although social network users often disclose more about themselves online than they do in person, there might be a risk for adolescents and for sensitive individuals, who can be negatively influenced by an incorrect use. However, although some studies show an increased risk of depression, other observations suggest beneficial effects of social networks by enhancing communication, social connection and self-esteem.

  11. 支气管封堵器用于胸腔镜肺大疱切除术中的有效性和安全性研究%Safety and efficacy of using bronchial occluder in patients undergoing thoracoscopy pulmonary bulla surgery

    Institute of Scientific and Technical Information of China (English)

    陈治富; 康金录

    2016-01-01

    目的 通过与双腔支气管导管对比,研究支气管封堵器(bronchial blockers tube,BB)在胸腔镜肺大疱切除术中应用的有效性和安全性. 方法 肺大疱患者80例,按随机数字表法分为2组(每组40例):双腔支气管导管组(A组)和BB组(B组),A组采用双腔支气管导管,B组采用BB.比较两组患者的一般资料、插管情况,并比较麻醉后即刻(T0)、单腔通气后20min(T1)、单腔通气后60 min(T2)、恢复双腔通气后60 min(T3)时点的血气分析情况及副作用的发生情况. 结果 B组一次插管成功率高于A组,差异有统计学意义(P<0.05).T1、T2时两组患者的动脉血氧分压(arterial blood partial pressure of oxygen,PaO2)低于T0和T3时,且T2时低于T11,差异均有统计学意义(P<0.05);T11T2时B组患者的PaO2高于A组,差异有统计学意义(P<0.05).两组患者各时点的动脉血二氧化碳分压(arterial blood partial pressure of carbon dioxide,PaCO22比较,差异无统计学意义(P>0.05).与T0和T3时比较,两组患者T11T2时气道平台压(airway plateau pressure,Pplat)、气道峰压(peak airway pressure,Ppeak)均升高,且B组患者Ppeak和Pplat低于A组,差异有统计学意义(P<0.05).A组患者术后有11例出现声音嘶哑和咽痛,发生率为27.5%,而B组为3例,发生率为7.5%,两组比较差异有统计学意义(P<0.05). 结论 BB用于胸腔镜肺大疱切除术中是一种安全、有效的方式.%Objective The purpose of this study was to compare the safety and efficacy of using bronchial blockers tube(BB) versus double cavity bronchial catheter in thoracoscopy pulmonary bulla surgery.Methods Eighty patients with pulmonary bulla.were randomly divided into two groups (n=40):group A received a double cavity bronchial tube,group B received the bronchial occluder.The general information,intubation success rate,blood gas analysis at different time points immediately after anesthesia(T0),20 min after one-lung ventilation (T1),60 min

  12. Imaging diagnosis of bronchial asthma and related diseases

    Energy Technology Data Exchange (ETDEWEB)

    Sakai, Fumikazu; Fujimura, Mikihiko; Kimura, Fumiko; Fujimura, Kaori; Hayano, Toshio; Nishii, Noriko; Machida, Haruhiko; Toda, Jo; Saito, Naoko [Tokyo Women' s Medical Coll. (Japan)

    2002-12-01

    We describe imaging features of bronchial asthma and related diseases. The practical roles of imaging diagnosis are the evaluation of severity and complications of bronchial asthma and differential diagnosis of diseases showing asthmatic symptoms other than bronchial asthma. (author)

  13. Is platelet activating factor (PAF an important mediator in bronchial asthma?

    Directory of Open Access Journals (Sweden)

    R. H. Gundel

    1992-01-01

    Full Text Available The development of selective PAF receptor antagonists may provide a novel approach to the treatment of human bronchial asthma. In preclinical animal models of human asthma, PAF receptor antagonists have been found to be efficacious in blocking antigen-induced changes in lung function. However, the majority of these models involve acute inflammatory events and transient changes in lung function and, therefore, their relevance to human asthma is questionable. In a recent study with a primate model of chronic airway inflammation and hyperresponsiveness, we have shown that treatment with a PAF receptor antagonist had no effect on reducing chronic inflammation and hyperresponsiveness. Similarly, recent studies in human asthmatics with PAF receptor antagonists have failed to show efficacy in blocking allergen-induced airway responses or to have any steroid sparing effects in patients with ongoing asthma. Thus, it seems that PAF may not be a key mediator which can be blocked and thereby provide therapy for bronchial asthma.

  14. SURGICAL TREATMENT AND PROGNOSIS OF BRONCHIAL CARCINOID TUMOR

    Institute of Scientific and Technical Information of China (English)

    张志庸; 李单青; 戈烽; 李泽坚; 孙成孚; 徐乐天; 张士农

    1996-01-01

    In order to understand the effect of surgery in the treatment of the bronchial carcinoid tumor and thefactors affecting prognosis, 18 cases of bronchial carcinoid tumor are presented, including 5 cases withCushing's syndiome. There were Iobectoray in 10, lung wedge resection in 3, excision of intraluminal tumor of bronchus in 3, exploratory thoracotomy in 2 cases.No operation death.Pathological examinstion revealed 14 cases were typical carcinoid tumor and 4 cases were atypical carcinoid tumor.By 2-13 years fol-low-up,3,5 and 10 years survival rate were 82%,78% and 70% respectively.Bronchial carcinoid tumor is often confused microscopic and immunohistochemistry studies.Those patients accompanied with ectopicACTH secretion always have Cushing''s syndrome,resection of tumor can produce good result.Proper operation method depnds on the location of the tumor and patient''s extent of cardiac and pulmonary peserve.Atypical carcinoid tumor had high malignancy and poor prognosis.The size of tumor,lymph node involve ment and adjuvant therapy seem no definite effect on the patients'' survival rate.

  15. Clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma

    Institute of Scientific and Technical Information of China (English)

    Jun HU; Li-rong ZHU; Zhi-qing LIANG; Yuan-guang MENG; Hong-yan GUO; Peng-peng QU; Cai-ling MA; Cong-jian XU; Bi-bo YUAN

    2011-01-01

    Objective:To assess the clinical outcomes of fertility-sparing treatments in young patients with epithelial ovarian carcinoma (EOC).Methods:A retrospective study of young EOC inpatients (≤40 years old) was performed during January 1994 and December 2010 in eight institutions.Results:Data were analyzed from 94 patients treated with fertility-sparing surgery with a median follow-up time of 58.7 months.As histologic grade increased,overall survival (OS) and disease-free survival (DFS) of patients receiving fertility-sparing surgery declined.Neither staging surgery nor laparoscopy of early stage EOC with conservative surgery had a significant effect on OS or DFS.Normal menstruation recommenced after chemotherapy in 89% of the fertility-sparing group.Seventeen pregnancies among twelve patients were achieved by the end of the follow-ups.Conclusions:Fertility-sparing treatment for patients with EOC Stage Ⅰ Grade 1 could be cautiously considered for young patients.The surgical procedure and surgical route might not significantly influence the prognosis.Standard chemotherapy is not likely to have an evident impact on ovarian function or fertility in young patients.

  16. [Pharmacotherapeutical management of bronchial asthma].

    Science.gov (United States)

    Leont'ev, S L; Mikhaĭlov, V G; Nevzorova, V P; Sadovnikova, R V; Shabashov, A F; Lugovkina, T K; Leshchenko, I V; Bel'tiukov, E K; Lebedeva, M K

    1998-01-01

    The analysis of the prescriptions for bronchial asthma (BA) patients in outpatient practice was made using data base created at the Regional Fund of Obligatory Health Insurance in the Sverdlovsk region with consideration of GINA principles of BA stepped care. The real structure of prescriptions was compared with the pattern drug official list for asthma care. The cost of each BA care step was calculated on the base of the computer programs. The analysis showed low quality of BA care in outpatient practice. The created computer programs are very useful for the prescriptions structure monitoring, cost-effect analysis and pharmacotherapeutical management of the diseases.

  17. [Epidural emphysema complicating bronchial asthma].

    Science.gov (United States)

    Rouetbi, N; Ben Saad, A; Joobeur, S; Skhiri, N; Cheikh Mhamed, S; Mribah, H; El Kamel, A

    2012-12-01

    Epidural emphysema is an exceptional complication of bronchial asthma, revealed by an incidental finding in chest tomography. We report a case of a 21-year-old man admitted with asthma attack complicated by subcutaneous and mediastinal emphysema. Chest tomography confirmed the mediastinal emphysema and also revealed the epidural emphysema within the vertebral canal. Neurological examination was negative. The patient showed complete recovery 10days after the onset of symptoms. The epidural emphysema is a rare complication during asthma attacks. The benignity of this complication should not require a systematic chest tomography.

  18. [Delayed asthma bronchiale due to epoxy resin].

    Science.gov (United States)

    Authried, Georg; Al-Asadi, Haifaa; Møller, Ulla; Sherson, David Lee

    2013-10-28

    Epoxy resin is a low molecular weight agent, which can cause both acute and delayed allergic reactions. However, it is known causing skin reactions with direct or airborne contact. Rarely it can cause airway reactions like asthma bronchiale. We describe a case of a windmill worker who developed delayed asthma bronchiale due to airborne contact with epoxy resin.

  19. Nipple sparing versus skin sparing mastectomy: a systematic review protocol

    Science.gov (United States)

    Agha, Riaz A; Wellstead, Georgina; Sagoo, Harkiran; Al Omran, Yasser; Barai, Ishani; Rajmohan, Shivanchan; Fowler, Alexander J; Orgill, Dennis P; Rusby, Jennifer E

    2016-01-01

    Introduction Breast cancer has a lifetime incidence of one in eight women. Over the past three decades there has been a move towards breast conservation and a focus on aesthetic outcomes while maintaining oncological safety. For some patients, mastectomy is the preferred option. There is growing interest in the potential use of nipple sparing mastectomy (NSM). However, oncological safety remains unproven, and the benefits and indications have not been clearly identified. The objective of this systematic review will be to determine the safety and efficacy of NSM as compared with skin sparing mastectomy (SSM). Methods and analysis All original comparative studies including; randomised controlled trials, cohort studies and case–control studies involving women undergoing either NSM or SSM for breast cancer will be included. Outcomes are primary—relating to oncological outcomes and secondary—relating to clinical, aesthetic, patient reported and quality of life outcomes. A comprehensive electronic literature search, designed by a search specialist, will be undertaken. Grey literature searches will also be conducted. Eligibility assessment will occur in two stages; title and abstract screening and then full text assessment. Each step will be conducted by two trained teams acting independently. Data will then be extracted and stored in a database with standardised extraction fields to facilitate easy and consistent data entry. Data analysis will be undertaken to explore the relationship between NSM or SSM and preselected outcomes, heterogeneity will be assessed using the Cochrane tests. Ethics and dissemination This systematic review requires no ethical approval. It will be published in a peer-reviewed journal. It will also be presented at national and international conferences. Updates of the review will be conducted to inform and guide healthcare practice and policy. PMID:27207622

  20. Utilização de implante ósseo cortical alógeno conservado em glicerina para preservação de membro torácico: estudo experimental em cães A limb sparing surgery with the use of a cortical allograft preserved in glicerin: an experimental study in dogs

    Directory of Open Access Journals (Sweden)

    Liane Ziliotto

    2003-03-01

    Full Text Available A técnica de preservação de membro é uma alternativa à amputação em cães com osteossarcoma do esqueleto apendicular. OBJETIVO: O desenvolvimento da técnica preservadora aos moldes da original descrita por Straw¹. MÉTODOS: O procedimento cirúrgico foi realizado com modificações, substituindo-se o método de conservação dos implantes pela glicerina e o cimento ósseo utilizado no preenchimento do canal medular do implante pela poliuretana de mamona, e para avaliação da incorporação do implante foram feitos exames clínico, radiográfico e histopatológico em diferentes tempos pós-operatórios. RESULTADOS: Observada a boa função do membro no pós-operatório, a formação de calo ósseo e fechamento das linhas de interfaces com remodelação óssea em avaliação radiográfica e ao exame histopatológico foi notada a reabsorção do implante ósseo com sua substituição por tecido conjuntivo fibroso e tecido ósseo compacto, neovascularização e presença de infiltrado inflamatório plasmocitário. CONCLUSÕES: A poliuretana de mamona mostrou-se uma boa substituta ao cimento originalmente utilizado, aumentando a resistência do implante, sem causar reações do tipo corpo estranho e sem sua osteointegração. O implante ósseo conservado em glicerina apresentou ação osteoindutora e osteocondutora, sem sinais de rejeição; desta forma, a glicerina mostrou ser uma meio alternativo viável. Portanto, a técnica de preservação do membro, com suas modificações, caracterizou-se como alternativa à técnica original e à amputação do membro para cães com osteossarcoma de esqueleto apendicular.A limb-sparing surgery can be an alternative treatment to amputation for dogs with appendicular osteosarcoma. PURPOSE: The purpose of this study was the development of this surgical technique, similar to the original, described by Straw¹, with changes in the procedure of the allografts preservation, and in the bone cement chose to

  1. Laparoscopic cortical sparing adrenalectomy for pediatric bilateral pheochromocytoma: anesthetic management.

    Science.gov (United States)

    Rajappa, Geetha Chamanhalli; Anandaswamy, Tejesh Channasandra

    2014-05-01

    Pheochromocytoma is a catecholamine-secreting tumor, which is seen rarely in children. These tumors predominantly secrete norepinephrine and epinephrine. They might be familial and associated with hereditary tumors such as Von Hippel-Lindau syndrome and multiple endocrine neoplasia type II. The child might present with a spectrum of clinical manifestation including hypertension, headache, visual disturbances, and behavioral problems. A meticulous preoperative preparation is essential for a stable intraoperative and postoperative outcome. We described successful perioperative management of a child who underwent bilateral laparoscopic cortical sparing adrenalectomy and a repeated surgery for the residual tumor removal.

  2. Spare-time Art Education in Shanghai

    Institute of Scientific and Technical Information of China (English)

    2012-01-01

    Tens of thousands of children is Shanghai are receiving art training in their spare time. More than 450 spare-time schools are helping the children in music, dancing, painting and calligraphy. Shanghai Children's Art School, which has 16 branches and over 6,000 pupils, is the biggest of all. Parents send their children to different schools to their different interests.

  3. [Measurement of the Minimum Pressure in the Bronchial Cuff during One-lung Ventilation Using a Capnometer].

    Science.gov (United States)

    Okubo, Haruka; Kawasaki, Takashi; Shibayama, Aiko; Sata, Takeyoshi

    2015-08-01

    It is recommended to avoid overinflation of the bronchial cuff, leading to ischemic pressure damages to the respiratory mucosa and bronchial rupture. We investigated the minimum bronchial cuff pressure of 35 Fr double lumen tubes (DLTs) during one lung ventilation using a capnometer. We studied 50 patients who were scheduled to undergo thoracic surgery. General anesthesia was induced and the patients were intubated with 35 Fr left DLT. With a fiberoptic bronchoscope, the DLT was positioned appropriately. The bronchial cuff was inflated first with air 3-3.5 ml. Lung isolation was confirmed by auscultation. Measurements were performed with the patient in the lateral position. Ventilating one lung isolatedly for 5 minutes, we confirmed non ventilated condition with a capnometer displaying flat line. The bronchial cuff was deflated 0.5-ml steps just before displaying the respiratory pattern by the capnogram. The bronchial cuff pressure and volume were recorded at this point The minimum pressures of bronchial cuff (volume) for one lung ventilation are for male 5.46 ± 0.6 cmH2O (2.33?0.1 ml) and for female 1.5?0.5 cmH20 (1.09 ± 0.3 ml). These values are smaller than the recommended value (< 25 cmH2O). There was no case in which the collapse of the operated lung was insufficient. In this study, the bronchial pressure higher than 12 cmH2O was not necessary for one lung ventilation. If high intracuff pressure is necessary to seal the bronchus, there are possibilities of the incompatibility of the size of DLT and the herniation of the bronchial cuff to the proximal side. The method of confirmation of OLV using a capnometer can display the non ventilated condition on the monitor objectively. We can thus decrease troubles during operations.

  4. Evolutional trends in the management of tracheal and bronchial injuries

    Science.gov (United States)

    2017-01-01

    Tracheal and Bronchial injuries are potentially life threatening complications which require urgent diagnosis and therapeutic intervention. They typically occur in association with blunt and penetrating chest trauma although they are increasingly being encountered in patients following endobronchial intervention and percutaneous tracheostomy insertion. Their precise incidence is unknown. Presenting features include dyspnoea, stridor, respiratory and haemodynamic compromise, haemoptysis, surgical emphysema, pneumothorax and persistent significant airleak. There may be other additional injuries to consider in trauma patients with large airway injury. Familiarity with the diagnosis and management of large airway injuries is important for medical teams engaged in emergency medicine, thoracic surgery and medicine, anaesthesia and intensive care. Although early surgical intervention is the mainstay of treatment, endobronchial manoeuvres to seal defects are receiving increasing attention particularly for patients with medical co-morbidities which may contraindicate formal surgery or transfer or where local surgical expertise is not available. PMID:28203439

  5. Permanent cortical blindness after bronchial artery embolization.

    Science.gov (United States)

    van Doorn, Colette S; De Boo, Diederick W; Weersink, Els J M; van Delden, Otto M; Reekers, Jim A; van Lienden, Krijn P

    2013-12-01

    A 35-year-old female with a known medical history of cystic fibrosis was admitted to our institution for massive hemoptysis. CTA depicted a hypertrophied bronchial artery to the right upper lobe and showed signs of recent bleeding at that location. Bronchial artery embolization (BAE) was performed with gelfoam slurry, because pronounced shunting to the pulmonary artery was present. Immediately after BAE, the patient developed bilateral cortical blindness. Control angiography showed an initially not opacified anastomosis between the embolized bronchial artery and the right subclavian artery, near to the origin of the right vertebral artery. Cessation of outflow in the bronchial circulation reversed the flow through the anastomosis and allowed for spill of embolization material into the posterior circulation. Unfortunately the cortical blindness presented was permanent.

  6. Permanent Cortical Blindness After Bronchial Artery Embolization

    Energy Technology Data Exchange (ETDEWEB)

    Doorn, Colette S. van, E-mail: cvandoorn@gmail.com; De Boo, Diederick W., E-mail: d.w.deboo@amc.uva.nl [Academic Medical Centre, Department of Radiology (Netherlands); Weersink, Els J. M., E-mail: e.j.m.weersink@amc.uva.nl [Academic Medical Centre, Department of Pulmonology (Netherlands); Delden, Otto M. van, E-mail: o.m.vandelden@amc.uva.nl; Reekers, Jim A., E-mail: j.a.reekers@amc.uva.nl; Lienden, Krijn P. van, E-mail: k.p.vanlienden@amc.uva.nl [Academic Medical Centre, Department of Radiology (Netherlands)

    2013-12-15

    A 35-year-old female with a known medical history of cystic fibrosis was admitted to our institution for massive hemoptysis. CTA depicted a hypertrophied bronchial artery to the right upper lobe and showed signs of recent bleeding at that location. Bronchial artery embolization (BAE) was performed with gelfoam slurry, because pronounced shunting to the pulmonary artery was present. Immediately after BAE, the patient developed bilateral cortical blindness. Control angiography showed an initially not opacified anastomosis between the embolized bronchial artery and the right subclavian artery, near to the origin of the right vertebral artery. Cessation of outflow in the bronchial circulation reversed the flow through the anastomosis and allowed for spill of embolization material into the posterior circulation. Unfortunately the cortical blindness presented was permanent.

  7. Bronchial carcinoid tumors: A rare malignant tumor

    African Journals Online (AJOL)

    2015-02-03

    Feb 3, 2015 ... Key words: Bronchial carcinoid tumor, diagnosis, outcome, treatment, West .... They can present with carcinoid syndrome, Cushing's ... 2012 reported BCT as a rare differential of pulmonary ... Management of carcinoid tumors.

  8. Retroperitoneal laparoscopic nephron sparing surgery for the treatment of renal tumors: with a report of 12 cases%腹膜后腹腔镜保留肾单位手术治疗肾肿瘤的临床体会(附12例报告)

    Institute of Scientific and Technical Information of China (English)

    王安; 袁荫田; 刘鹏; 潘爱民; 韩多亮

    2013-01-01

    Objective:To evaluate the methods and clinical efficacy of retroperitoneal laparoscopic nephron sparing surgery for the treatment of renal tumors.Methods:Clinical data of twelve patients with renal tumor received retroperitoneal laparoscopic nephron sparing surgery were analyzed retrospectively.Bulldog clamps were used to clamp the renal artery.Cold scissor was used to resect tumors and Hem-o-lok was used for tightening thread after continuous suture instead of ligature when suturing the kidney parenchyma.The operative time,warm ischemia time,estimated blood loss,intraoperative and postoperative complications and the operative efficacy were recorded.Results:All the operations were successfully performed and no case was converted to open operation.The mean operative tine was (136 ± 28.0) min,mean warm ischemic time was (27 ± 7.9) min,and mean blood loss was (126 ± 83.1) ml.Pathological diagnosis was clear cell carcinoma in 10 cases,and angiomyolipoma in 2.One patient got anemia and low albumin,which was considered to be associated with hepatitis b and diabetes,and the albumin returned to normal after symptomatic treatment.There was no delayed hemorrhage or urinary leakage after surgery.The mean hospital stay was (11 ± 3.8) d.No severe postoperative complications were found,and no recurrence was found in all the patients during the mean follow-up of (12 ± 9.2) months.Conclusions:Retroperitoneal laparoscopic nephron sparing surgery for renal tumors has the advantages of definite effect,minimal invasion,quick recovery,and short hospital stay,surgeons who have skilled laparoscopic operation techniques can perform it as the first choice.%目的:探讨腹膜后腹腔镜保留肾单位手术治疗肾肿瘤的手术方法与临床疗效.方法:回顾分析为12例肾肿瘤患者行腹膜后腹腔镜保留肾单位手术的临床资料,术中用Bulldog夹钳夹肾动脉,冷剪刀剪除肿瘤,连续缝合并用Hem-o-lok收紧缝线,代替打结.观察手术时间、热

  9. 新型左主支气管阻塞器在食管癌术中单肺通气的应用研究%Application of a new type left-bronchial-blocker for one-lung ventilation in esophageal cancer surgery

    Institute of Scientific and Technical Information of China (English)

    赵清军; 杨文锋; 商烁

    2014-01-01

    目的:探讨新型左主支气管阻塞器( NTLBB)在食管癌术中单肺通气的应用价值。方法选择ASAⅠ~Ⅱ级限期手术治疗的食管癌患者30例,在麻醉诱导后,置入NTLBB实现右侧肺通气、左侧肺萎陷,便于手术操作及减轻肺损伤。通过观察导管置入定位一次成功率、单肺通气期间气道峰压( PEAK)和通气量( VT)、呼吸频率( R)、呼气末二氧化碳分压( ETCO2)、经皮血氧饱和度( SpO2)的变化、气道损伤程度、术后咽痛和声音嘶哑发生率,分析其在手术操作及减轻肺损伤中的作用。结果导管置入定位一次成功率为96.7%,侧卧位后经纤维支气管镜检查发现有6例(20%)支气管套囊位置需调整;与双肺通气相比,单肺通气期间PEAK稍升高,VT、R、ETCO2、SpO2变化不明显( P均>0.05);气道损伤程度评分为1.42分;术后咽痛发生率40%,声音嘶哑(伴随咽痛)发生率10%。结论NTLBB用于单肺通气,具有置入定位简单、阻隔效果确切、气道损伤小、术后并发症低等优点,有助于提高食管癌患者的手术及麻醉质量。%Objective To investigate the clinical value of applying a new type left-bronchial-blocker ( NTLBB ) for one-lung ventilation ( OLV) during the esophageal cancer surgery .Methods Thirty patients with esophageal cancer ( ASAⅠ-Ⅱ) were embedded the new type left-bronchial-blocker in order to achieve the right single lung ventilation and the left side collapse after anesthesia induction and thus to operate and reduce the lung injury .By observing the positioning cathe-terization success rate, peak airway pressure (PEAK) during OLV, ventilation (VT), respiratory frequency (R), breath out CO2 partial pressure ( ETCO2 ) , the change of the SpO 2 , damage degree of the airway and the incidence of postoperative sore throat and hoarse , we analyzed the effect of NTLBB during the surgery and reducing

  10. Radiologic management of haemoptysis. Diagnostic and interventional bronchial arterial embolisation

    Energy Technology Data Exchange (ETDEWEB)

    Ittrich, H.; Adam, G. [Univ. Medical Center Hamburg, Hamburg (Germany). Diagnostic and Interventional Radiology Dept. and Clinic; Klose, H. [Univ. Medical Center Hamburg, Hamburg (Germany). Section Pneumology

    2015-04-15

    Hemoptysis can be a life-threatening pulmonary emergency with high mortality, is symptomatic of an underlying severe pulmonary disease and requires immediate diagnosis and treatment. Diagnostically, bronchoscopy, conventional chest x-ray and contrast-enhanced multislice computed tomography (MSCT) with CT angiography (CTA) provide information regarding the underlying pulmonary disease, bleeding site, the vascular anatomy of the bronchial arteries (BA) and extrabronchial branches, as well a basis for planning of endovascular intervention. Therapeutically, bronchial artery embolization (BAE) is a safe and effective technique in the hands of an experienced interventionist with profound knowledge of the BA anatomy and possible pitfalls as well as experience with first-line therapy of recurrent and massive hemoptysis or as an intervention prior to elective surgery. Recurrent episodes of hemoptysis are not uncommon and require a prompt repeat BAE after exclusion of extrabronchial systemic and pulmonary artery bleeding sources. This review article should give an overview of the history, anatomical and pathophysiological basics and the clinical context of hemoptysis and diagnosis, as well as a survey of management, treatment and results of BAE.

  11. [Bronchial asthma pathogenesis and genetic prognosis development].

    Science.gov (United States)

    Balmasova, I P; Sepiashvili, R I; Sepiashvili, Ia R; Malova, E S

    2014-01-01

    The review is dedicated to an actual problem--genetic prognosis of risk of bronchial asthma development that is quite a complex aspect of studies from a methodological viewpoint. Bronchial asthma--heterogeneous disease by both etiology and clinical characteristics. At the same time genetic prognosis is based on the unity of pathogenetic mechanisms of development, though in immunological reactions that are the base of this disease, alternative variants are possible. The aim of this review is carrying out parallels between modern achievements in the field of deciphering trigger mechanisms of bronchial asthma pathogenesis and object of genetic studies based on these mechanisms. Among the examined conceptions--role of epithelial tissue in trigger mechanisms of bronchial asthma, variants of key role of immune system cells, first of all, T-helpers of various types for further development of inflammatory-effector reactions with damage characteristic for this disease. Compliance of contemporary approaches of genetic studies and novel concepts of bronchial asthma pathogenesis is shown.

  12. [Relationship between congenital heart disease and bronchial dysplasia].

    Science.gov (United States)

    Zeng, Shuang-Lin; Li, Ya-Jun; Huang, Ting; Tan, Li-Hua; Mei, Xi-Long; Sun, Jian-Ning

    2011-11-01

    To study the relationship of the incidence of bronchial dysplasia (bronchial anomalous origin and bronchial stenosis) with congenital heart disease. A total of 185 children with congenital heart disease or bronchial dysplasia were enrolled. Bronchial dysplasia was identified by the 64-MSCT conventional scanning or thin slice scanning with three-dimensional reconstruction. Forty-five children (25.3%) had coexisting bronchial dysplasia and congenital heart disease. The incidence rate of bronchial dysplasia in children with congenital heart disease associated with ventricular septal defect was higher than in those without ventricular septal defect (33.7% vs 15.0%; Pdysplasia between the children with congenital heart disease who had a large vascular malformation and who did not. Bronchial dysplasia often occurs in children with congenital heart disease. It is necessary to perform a tracheobronchial CT scanning with three-dimensional reconstruction to identify tracheobronchial dysplasia in children with congenital heart disease, especially associated with ventricular septal defect.

  13. Uterine sparing surgical methods in pelvic organ prolapse

    Science.gov (United States)

    Tola, Esra Nur; Erdemoğlu, Evrim; Erdemoğlu, Ebru

    2015-01-01

    Pelvic organ prolapse (POP) is defined as the protrusion of pelvic organs to the vagen and is an important health problem in patients of older age. Today, most women with POP prefer uterine sparing surgery due to the changes in lifestyle, beliefs, pregnancy desire, and understanding the role of the uterus and cervix in sexual function. Therefore, the need for newer surgical procedures that involve less invasive surgery, reduced intraoperative and postoperative risks, and a faster healing time in POP surgery have gained importance. Vaginal, abdominal, laparoscopic, and robotic methods are defined in uterine preserving surgery but there is not yet a consensus on which of them should be chosen. In choosing the proper technique, the patient’s general status, accompanying disease, correct indication, and the surgeon’s experience are all important. In our practice we prefer laparoscopic mesh sacrohysteropexy in patients who prefer to preserve their uterus because of the lower costs and high success rates compared with abdominal and robotic techniques. PMID:28913063

  14. Robotic nephron-sparing surgery for renal tumors: Current status.

    Science.gov (United States)

    Azhar, Raed A; Gill, Inderbir S; Aron, Monish

    2014-07-01

    There have been a number of advances in robotic partial nephrectomy (RPN) for renal masses. We reviewed these advances with emphasis on the evolution of technique and outcomes as well as the expanding indications for RPN. Literature in the English language was reviewed using the National Library of Medicine database. Relevant articles were extracted, and their citations were utilized to broaden our search. The identified articles were reviewed and summarized with a focus on novel developments. RPN is an evolving procedure and is an emerging viable alternative to laparoscopic partial nephrectomy and open partial nephrectomy with favorable outcomes. The contemporary techniques used for RPN demonstrate excellent perioperative outcomes. The short-term oncologic outcomes are comparable to those of laparoscopic and open surgical approaches. Further studies are needed to assess long-term oncologic control.

  15. Lung-Sparing Surgery May Boost Mesothelioma Survival

    Science.gov (United States)

    ... longer survival times, said study author Dr. Joseph Friedberg. "When you take the [entire] lung out, it's a significant compromise in quality of life," said Friedberg. He's director of the University of Maryland Medical ...

  16. Blood-Sparing Techniques in Head and Neck Surgery.

    Science.gov (United States)

    Rabinowitz, Mindy R; Cognetti, David M; Nyquist, Gurston G

    2016-06-01

    Given the risks and potential complications of allogenic blood transfusion (ABT), as well as the expanding population of patients for whom ABT may not be an option, it is important for the treating physician, anesthesiologist, and surgeon to be well-versed in various alternatives. A good grasp of the concepts discussed in this article will help to customize a treatment plan that is specific to each patient's underlying disease and personal preferences without compromising appropriate medical care.

  17. Upper respiratory tract disease and bronchial asthma

    Institute of Scientific and Technical Information of China (English)

    1993-01-01

    930904 A clinical study on determination ofplasma vasoactive intestinal peptide and its rela-tionship with bronchial responsiveness in asth-matics.LIU Ao(刘翱),et al.Dept Respir Med,Kunming General Hosp,Kunming Command,Kunming,650032.Chin J Intern Med 1993;32(3):165-166.Vasoactive intestinal peptide(VIP),which islocalized in normal human lung,may play an im-portant role in regulating bronchial tone,pul-monary blood flow and mucus secretion.Thelevel of plasma VIP and bronchial responsivenesswere studied in patients with asthma,and chronicbronchitis and in the healthy subjects.The re-sults showed that the level of plasma VIP in

  18. Chronic Pulmonary Aspergillosis Complicating Bronchial Atresia

    Directory of Open Access Journals (Sweden)

    Mazen O. Al-Qadi

    2014-01-01

    Full Text Available Bronchial atresia is a rare pulmonary developmental anomaly characterized by the presence of a focal obliteration of a segmental or lobar bronchial lumen. The lung distal to the atretic bronchus is typically emphysematous along with the presence of mucus filled ectatic bronchi (mucoceles. BA is usually asymptomatic but pulmonary infections can rarely develop in the emphysematous lung distal to the atretic bronchus. We present a unique case of chronic pulmonary aspergillosis (CPA in a patient with BA with no evidence of immune dysfunction. The patient was treated initially with voriconazole and subsequently underwent surgical excision of the involved area. On follow-up, she has done extremely well with no evidence for recurrence. In summary, we describe the first case of chronic pulmonary aspergillosis in an immunocompetent patient with bronchial atresia.

  19. Change of bronchial hyperresponsiveness in asthmatic children

    Directory of Open Access Journals (Sweden)

    Stojković-Anđelković Anđelka

    2011-01-01

    Full Text Available Introduction. Bronchial hyperresponsiveness (BHR is a factor in predicting bronchial asthma independently of inflammation markers. Objective. The aims were to determine the frequency and important predictive facts of BHR and the effect of prophylaxis by Global Initiative for Asthma (GINA and National Asthma Education and Prevention Program (NAEPP on BHR in asthmatic children. Methods. BHR in 106 children was evaluated by the bronchoprovocation test with methacholine. Results. The prevalence rate of symptomatic BHR is 18% for crucial point of PC20=4.1±3.03 mg/ml and PD20=3.22±2.59 μmol methacholine. On average asthmatic children express moderate BHR, which persists even two years after administering prophylaxis. After two years bronchial reactivity is significantly smaller, the change of FEV1 is significantly smaller, the velocity of change of slope dose response curve (sDRC is faster and the provocative concentration of methacholine that causes wheezing is 2-3 times lower. A mild sDRC shows milder bronchoconstriction after two years. The fast change of bronchial reactivity in 41% of asthmatic children is contributed to aero-pollution with sulfur dioxide and/ or, possible insufficient and/or inadequate treatment during two years of administering prophylaxis. A simultaneous effect of allergens from home environment and grass and tree pollens and of excessive aero-pollution on children’s airways is important in the onset of symptomatic BHR. After two years of treatment by GINA and NAEPP children do not show asthma symptoms or show mild asthma symptoms, however bronchial sensitivity remains unchanged. Conclusion. Optimal duration of anti-inflammatory treatment in asthmatic children who show moderate bronchial hyperresponsiveness should be longer than two years.

  20. TCM Diet Therapy for Bronchial Asthma

    Institute of Scientific and Technical Information of China (English)

    DENG Zi

    2009-01-01

    @@ Bronchial asthma is a disease with reversible tracheospasm and tracheostenosis due to excessively increased tracheal-bronchial reactivity induced by sensitinogen or non-sensitinogen. Although its etiology is complicated, the disease is generally caused by internal injury resulting from accumulation of phlegm in the lungs, damage to the spleen by improper diet and impairment of the kidneys by overstrain and excessive coitus;or it can be caused by six exogenous pathogenic factors, with obstruction of the airways by phlegm and upward adverse flow of the lung-qi.

  1. Youth spare time: Typical patterns of behavior

    Directory of Open Access Journals (Sweden)

    Stepanović Ivana

    2009-01-01

    Full Text Available In this research we have tried to identify typical patterns of young people's behavior in their spare time and to use these patterns in order to group our subjects regarding their interests and preferences. Main-component analysis showed that it was possible to find different patterns of secondary school students' behavior in spare time as well as that the identified models could be the criteria for grouping them. Five patterns have been identified describing youth orientations towards their free time: academic orientation, orientation towards sports, orientation towards entertainment, orientation towards spending time going out and orientation towards music and computers.

  2. Bronchial gland duct ectasia in fatal bronchial asthma: association with interstitial emphysema.

    OpenAIRE

    Cluroe, A.; Holloway, L.; Thomson, K.; Purdie, G; Beasley, R.

    1989-01-01

    To determine the incidence of bronchial gland duct ectasia in fatal asthma and its association with interstitial emphysema, the histological features of 72 patients in whom death was considered to be due to asthma, and 72 matched control subjects in whom sudden death was not attributed to asthma, were reviewed. In all cases and controls, sections of two or more blocks of lung tissue stained with haematoxylin and eosin were obtained at necropsy. Bronchial gland duct ectasia was diagnosed if th...

  3. Bronchial hyperresponsiveness and anti-asthmatic therapy

    NARCIS (Netherlands)

    Kraan, Jan

    1990-01-01

    Many asthmatic patients experience shortness of breath or wheezing, when exposed to cold air, or irritants like baking fumes, exhaust gases or cigarette smoke. This clinical phenomenon has been called bronchial hypemsponsiveness (BHR), which is defined as an exaggerated broncho-obstructive response

  4. Clavicular osteoma associated with bronchial osteomas

    Energy Technology Data Exchange (ETDEWEB)

    Saglik, Yener; Yiliz, H. Yusuf; Erakar, Aziz [Department of Orthopaedic Surgery, Ankara University School of Medicine, 06100, Ankara (Turkey); Kendi, Tuba Karaguelle [Integra MR Imaging Center, Ankara (Turkey); CMRR, University of Minnesota, 2021 6th Street SE, MN 55455, Minneapolis (United States); Guengoer, Adem [Department of Chest Surgery, Ankara University School of Medicine, 06100, Ankara (Turkey); Erekul, Selim [Department of Pathology, Ankara University School of Medicine, 06100, Ankara (Turkey)

    2004-04-01

    Osteoma is a rare benign tumor, composed of bony tissues. It predominantly involves the skull but rarely the long bones. In this report we present a case of clavicular osteoma associated with bronchial osteomas. This association has not previously been reported. There was no evidence of Gardner's syndrome. (orig.)

  5. Lung function and bronchial reactivity in farmers.

    Science.gov (United States)

    Iversen, M; Dahl, R; Jensen, E J; Korsgaard, J; Hallas, T

    1989-01-01

    The purpose of this study was to evaluate the prevalence and type of lung function disorders in Danish farmers. Three samples of farmers were drawn from a group of unselected farmers who had participated in an epidemiological study. Group I (47 persons) was a sample of the 8% of all farmers who had reported that they had asthma; group II (63 persons) was a sample of the 28% of farmers who had had wheezing, shortness of breath, or cough without phlegm; and group III (34 persons) a sample of the farmers (64% of the total) who had no asthma and no respiratory symptoms. The farmers with symptoms (groups I and II) had low mean levels of FEV1 and high values for residual volume, whereas the symptomless farmers had normal lung function and no airways obstruction. The proportion of farmers with an FEV1 below the 95% confidence limit for predicted values was 43% in group I and 23% in group II; there were none in group III. Bronchial hyperreactivity to histamine occurred in 96% of asthmatic farmers, 67% of farmers with wheezing or shortness of breath, and 59% of symptomless farmers. A low level of FEV1 was associated with the number of years in pig farming and bronchial hyperreactivity in group II but not group I or III. Most of the bronchial hyperreactivity was explained in the multiple regression analysis by a low FEV1, though this was significant only for farmers in group II. Thus farmers who reported asthma, wheezing, shortness of breath, or a dry cough in general had airways obstruction with an increased residual volume, whereas symptomless farmers had normal lung function. Severe bronchial hyperreactivity was mostly explained by a diagnosis of asthma and poor lung function, though some farmers with normal lung function and no respiratory symptoms had increased bronchial reactivity. PMID:2799744

  6. Second Line of Defense Spares Program

    Energy Technology Data Exchange (ETDEWEB)

    Henderson, Dale L.; Holmes, Aimee E.; Muller, George; Mercier, Theresa M.; Brigantic, Robert T.; Perkins, Casey J.; Cooley, Scott K.; Thorsen, Darlene E.

    2012-11-20

    During Fiscal Year 2012, a team from the Pacific Northwest National Laboratory (PNNL) conducted an assessment and analysis of the Second Line of Defense (SLD) Sustainability spare parts program. Spare parts management touches many aspects of the SLD Sustainability Program including contracting and integration of Local Maintenance Providers (LMP), equipment vendors, analyses and metrics on program performance, system state of health, and maintenance practices. Standardized spares management will provide better data for decisions during site transition phase and will facilitate transition to host country sustainability ownership. The effort was coordinated with related SLD Sustainability Program initiatives, including a configuration items baselining initiative, a metrics initiative, and a maintenance initiative. The spares study has also led to pilot programs for sourcing alternatives that include regional intermediate inventories and partnering agreements that leverage existing supply chains. Many partners from the SLD Sustainability program contributed to and were consulted in the course of the study. This document provides a description of the findings, recommendations, and implemented solutions that have resulted from the study.

  7. Readiness Based Sparing: A Research Summary

    Science.gov (United States)

    2012-07-01

    Halliday of the RAND Corporation. This RAND study dealt with the initial spares provisioning packages (referred to as “push” packages) that... Halliday , J. (2011). Using field data to improve authorized stockage list push packages. Retrieved from Defense Technical Information Center. (ADA554301

  8. Cicatricial Fibromatosis Diagnosis after Suspected Local Recurrence at the Bronchial Stump Following Lobectomy for Lung Cancer.

    Science.gov (United States)

    Hwang, Wan Jin; Lee, Yeiwon; Jung, Soo Young; Yeh, Daewook; Park, Soon Hyo; Yoon, Yoo Sang

    2016-04-01

    A mass excision surrounding the bronchial stump was performed to exclude malignancy in a 42-year-old man who had undergone a right lower lobectomy for lung cancer. The mass was identified as a cicatricial fibroma. Cicatricial fibromatosis, which is desmoid fibromatosis that arises in a surgical scar, is a well-known clinical condition. It consists of histologically benign neoplasms. Their occurrence after thoracic surgery is extremely rare. Biopsy or excision of suspicious lesions is very important for diagnosis. R0 resection remains the principal outcome for intra-thoracic desmoid fibromatosis. We report that a cicatricial fibromatosis in the subcarinal space was removed after suspicion of local recurrence at the bronchial stump follwing lobectomy for lung cancer.

  9. Successful Endobronchial stenting for bronchial compression from a massive thoracic aortic aneurysm

    Directory of Open Access Journals (Sweden)

    David Comer

    2010-06-01

    Full Text Available A case of bronchial occlusion caused by a thoracic aortic aneurysm and the relief of this obstruction by the implantation of expandable metallic stents is described. Stent deployment provided an immediate improvement in lung ventilation and chest radiograph appearances. Stent insertion was uncomplicated, but weaning from mechanical ventilation was unsuccessful and the patient died from a ventilator-associated pneumonia, unrelated to the procedure. Endobronchial stenting should be considered as a non-invasive therapy for the treatment of bronchial obstruction, with respiratory compromise, caused by a thoracic aortic aneurysm when vascular surgery is not an option. The medium to long term survival of this patient group is poor. This can be attributed to complications related to the stent and also to the poor performance status of these patients.

  10. Feasibility of MRI-guided Focused Ultrasound as Organ-Sparing Treatment for Testicular Cancer

    Science.gov (United States)

    Staruch, Robert; Curiel, Laura; Chopra, Rajiv; Hynynen, Kullervo

    2009-04-01

    High cure rates for testicular cancer have prompted interest in organ-sparing surgery for patients with bilateral disease or single testis. Focused ultrasound (FUS) ablation could offer a noninvasive approach to organ-sparing surgery. The objective of this study was to determine the feasibility of using MR thermometry to guide organ-sparing focused ultrasound surgery in the testis. The testes of anesthetized rabbits were sonicated in several discrete locations using a single-element focused transducer operating at 2.787MHz. Focal heating was visualized with MR thermometry, using a measured PRF thermal coefficient of -0.0089±0.0003 ppm/° C. Sonications at 3.5-14 acoustic watts applied for 30 seconds produced maximum temperature elevations of 10-80° C, with coagulation verified by histology. Coagulation of precise volumes in the testicle is feasible with MRI-guided focused ultrasound. Variability in peak temperature for given sonication parameters suggests the need for online temperature feedback control.

  11. Nipple- and areola-sparing mastectomy for the treatment of breast cancer.

    Science.gov (United States)

    Mota, Bruna S; Riera, Rachel; Ricci, Marcos Desidério; Barrett, Jessica; de Castria, Tiago B; Atallah, Álvaro N; Bevilacqua, Jose Luiz B

    2016-11-29

    The efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of breast cancer are still questionable. It is estimated that the local recurrence rates following nipple-sparing mastectomy are very similar to breast-conserving surgery followed by radiotherapy. To assess the efficacy and safety of nipple-sparing mastectomy and areola-sparing mastectomy for the treatment of ductal carcinoma in situ and invasive breast cancer in women. We searched the Cochrane Breast Cancer Group's Specialized Register, the Cochrane Center Register of Controlled Trials (CENTRAL), MEDLINE (via PubMed), Embase (via OVID) and LILACS (via Biblioteca Virtual em Saúde [BVS]) using the search terms "nipple sparing mastectomy" and "areola-sparing mastectomy". Also, we searched the World Health Organization's International Clinical Trials Registry Platform and ClinicalTrials.gov. All searches were conducted on 30th September 2014 and we did not apply any language restrictions. Randomised controlled trials (RCTs) however if there were no RCTs, we expanded our criteria to include non-randomised comparative studies (cohort and case-control studies). Studies evaluated nipple-sparing and areola-sparing mastectomy compared to modified radical mastectomy or skin-sparing mastectomy for the treatment of ductal carcinoma in situ or invasive breast cancer. Two review authors (BS and RR) performed data extraction and resolved disagreements. We performed descriptive analyses and meta-analyses of the data using Review Manager software. We used Cochrane's risk of bias tool to assess studies, and adapted it for non-randomised studies, and we evaluated the quality of the evidence using GRADE criteria. We included 11 cohort studies, evaluating a total of 6502 participants undergoing 7018 procedures: 2529 underwent a nipple-sparing mastectomy (NSM), 818 underwent skin-sparing mastectomy (SSM) and 3671 underwent traditional mastectomy, also known as modified radical

  12. Endoscopic bronchial valve treatment: patient selection and special considerations

    Directory of Open Access Journals (Sweden)

    Eberhardt R

    2015-10-01

    Full Text Available Ralf Eberhardt,1,2 Daniela Gompelmann,1,2 Felix JF Herth,1,2 Maren Schuhmann1 1Pneumology and Critical Care Medicine, Thoraxklinik at the University of Heidelberg, 2Translational Lung Research Center, Member of the German Center for Lung Research, Heidelberg, Germany Abstract: As well as lung volume reduction surgery, different minimally invasive endoscopic techniques are available to achieve lung volume reduction in patients with severe emphysema and significant hyperinflation. Lung function parameters and comorbidities of the patient, as well as the extent and distribution of the emphysema are factors to be considered when choosing the patient and the intervention. Endoscopic bronchial valve placement with complete occlusion of one lobe in patients with heterogeneous emphysema is the preferred technique because of its reversibility. The presence of high interlobar collateral ventilation will hinder successful treatment; therefore, endoscopic coil placement, polymeric lung volume reduction, or bronchoscopic thermal vapor ablation as well as lung volume reduction surgery can be used for treating patients with incomplete fissures. The effect of endoscopic lung volume reduction in patients with a homogeneous distribution of emphysema is still unclear and this subgroup should be treated only in clinical trials. Precise patient selection is necessary for interventions and to improve the outcome and reduce the risk and possible complications. Therefore, the patients should be discussed in a multidisciplinary approach prior to determining the most appropriate treatment for lung volume reduction. Keywords: lung emphysema, valve treatment, collateral ventilation, patient selection, outcome

  13. THEORY OF SPARE PARTS INVENTORY MANAGEMENT FOR PRODUCTION EQUIPMENT

    OpenAIRE

    KATARZYNA GRONDYS

    2013-01-01

    This article presents theoretical basis of spare parts inventory management in manufacturing company. Basis definitions, allocation and differences in spare parts inventory management were compared with other manufacturing inventories. The issue of spare parts inventory management is emphasized in aspect of maintaining continuity of production and generated costs of maintaining inventory.

  14. [Bronchoplasty surgery].

    Science.gov (United States)

    Jaković, R; Malenić, S

    1994-01-01

    Bronchoplastic operations are analysed in 114 patients: 76 (66.67%) with bronchial carcinoma, 33 (28.94%) bronchial adenoma, 4 (3.51%) bronchial rupture or stenosis and bronchial hondroma in one case. Sleeve resection was done in 99 (86.84%) and other kind of bronchoplastic operations in 15 (13.16%). Preoperative diagnostic procedures were focused on: clinical course and symptomatology, exact location of bronchial lesion, type of tumor, mediastinal lymph nodes, bronchial three distal from the lesion and respiratory lung tests. Intraoperatively attention was toward to the evidence of peribronchial growth of tumor, mediastinal lymph nodes and lung tissue. Early postoperative course was without complications in 85 (75.89%), with complications in 26 (23.21%) but two patients died. Incomplete reexpansion or athelectasis of the entire lung or lobe but easily treated, were the commonest complications. There was no evidence of bronchial fistula or bronchial sutura at the level of submucosal growth of tumor. In certain indications bronchoplastic operations are good operative choice for surgical treatment of bronchial tumors and traumatic bronchial rupture or its sequelas-stenosis. For malignant tumors, late results, are, after this kind of operations, equivalent to those achieved after classic resections and they do not depend of the kind of surgical procedures but correlate to the nature of the tumor. For benign and slowly growing malignant tumors late results after these operations are excellent.

  15. Joint sparing correction of cavovarus feet in Charcot-Marie-Tooth disease: what are the limits?

    Science.gov (United States)

    Barton, Tristan; Winson, Ian

    2013-12-01

    Charcot-Marie-Tooth disease is an inherited neuropathy that results in lower limb muscle imbalance and a resultant cavovarus deformity of the foot. With recognized poor outcomes of triple arthrodeses in the young patient, joint sparing surgery is preferred, which takes the form of osteotomies, soft-tissue releases, and tendon transfers to achieve a plantigrade and balanced foot. Due to the variability in muscle involvement and the presence of both mobile and fixed deformities, surgery must be individualized to each patient. Crown Copyright © 2013. Published by Elsevier Inc. All rights reserved.

  16. Bronchiolitis obliterans organising pneumonia simulating bronchial carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Murphy, J.; Flower, C. [Department of Radiology, Addenbrooke`s Hospital, University of Cambridge Teaching Hospital (United Kingdom); Schnyder, P. [Department of Radiology, University Hospital, Lausanne (Switzerland); Herold, C. [Department of Radiology, University Hospital of Vienna (Austria)

    1998-09-01

    Idiopathic bronchiolitis obliterans organising pneumonia (BOOP) is an uncommon but well-recognised condition that usually presents radiologically as bilateral multifocal patchy areas of consolidation on the chest radiograph and on computed tomography (CT). Five cases are described in which the presenting feature was that of a solitary pulmonary nodule. Four of these nodules showed evidence of cavitation and three patients presented with haemoptysis. In all cases the appearances closely resembled bronchial carcinoma. (orig.) With 5 figs., 21 refs.

  17. Oncological considerations of skin-sparing mastectomy

    OpenAIRE

    Cunnick, GH; Mokbel, K

    2006-01-01

    Aim To review evidence concerning the oncological safety of performing skin-sparing mastectomy (SSM) for invasive breast cancer and ductal carcinoma in situ (DCIS). Furthermore, the evidence concerning RT in relation to SSM and the possibility of nipple preservation was considered. Methods Literature review facilitated by Medline and PubMed databases. Findings Despite the lack of randomised controlled trials, SSM has become an accepted procedure in women undergoing mastectomy and immediate re...

  18. Cirurgia conservadora, radioterapia externa e reforço de dose com braquiterapia de alta taxa de dose: uma nova perspectiva no tratamento de sarcomas de partes moles do adulto Limb-sparing surgery, external beam radiotherapy and boost with high-dose rate brachytherapy: a new perspective for the treatment of soft tissue sarcomas in adults

    Directory of Open Access Journals (Sweden)

    Antonio Cássio Assis Pellizzon

    2002-03-01

    Full Text Available OBJETIVO: Avaliar a influência no controle local de pacientes adultos e portadores de sarcoma de partes moles em extremidades e submetidos a cirurgia conservadora do membro, com braquiterapia de alta taxa de dose (BATD como reforço para a radioterapia externa (RT. MATERIAL E MÉTODOS: Foram avaliados 16 pacientes tratados, de 1993 até 1999. A RT foi utilizada com finalidade pré ou pós-operatória (30--55 Gy e BATD com dose de 18--36 Gy (fx 3--6 Gy BID. Com base no modelo linear quadrático calculou-se a dose efetiva biológica ("biological effective dose" - BED para o tumor e comparou-se seu valor a dados da literatura internacional, que utiliza tratamentos com RT e braquiterapia de baixa taxa de dose (BBTD. RESULTADOS: Os valores médios e medianos da BED para os sarcomas de partes moles foram de 78,5 Gy7 e 80 Gy7. A análise univariada mostrou que a BED para o tumor, quando utilizada BATD, era semelhante ao valor de 83 Gy7 quando utilizada BBTD (p = 0,008. As taxas de controle local, sobrevida livre de doença e sobrevida global atuarial em cinco anos foram de 83,2%, 75% e 93,7%, respectivamente. CONCLUSÕES: A BATD, quando utilizada como método complementar no reforço de dose da RT no tratamento conservador dos sarcomas de partes moles, apresenta taxas de controle local equiparáveis às da literatura internacional; no entanto, estudos com número maior de pacientes e período maior de seguimento são ainda necessários para determinar o verdadeiro potencial da BATD em substituir a BBTD.PURPOSE: To evaluate the influence on local control in adult patients with soft tissue sarcomas of the limbs that underwent limb-sparing surgery and high-dose rate brachytherapy (HDRB in association with teletherapy. MATERIAL AND METHODS: Sixteen patients treated from 1993 to 1999 were reviewed. Teletherapy was used pre- or postoperatively (30--55 Gy in association with HDRB in a dose range of 18--36 Gy (fx 3--6 Gy BID. The linear quadratic model was

  19. Audit of bronchial artery embolisation in a specialist respiratory centre.

    OpenAIRE

    1992-01-01

    OBJECTIVE--To audit the use of bronchial arteriography and embolisation for controlling haemoptysis. DESIGN--Retrospective review of radiological and clinical data. SETTING--Brompton and National Heart Hospitals. PATIENTS--35 patients with severe pulmonary disease in whom 58 bronchial arteriograms were obtained between 1 January 1984 and 31 December 1989 with the intention of bronchial artery embolisation for controlling haemoptysis. MAIN MEASURES--Rate of technical success and cessation of h...

  20. Quantitative morphology and water distribution of bronchial biopsy samples.

    OpenAIRE

    Baldwin, D. R.; Wise, R.; Andrews, J. M.; HONEYBOURNE, D

    1992-01-01

    BACKGROUND: An approach to the study of the pharmacokinetics of drugs in the lung is to measure their concentrations in bronchial biopsy specimens. The main criticism of this technique is that bronchial biopsy specimens consist of more than one tissue type and that drugs are often not distributed evenly. The morphology of bronchial biopsy specimens and the distribution of water between the extracellular and the intracellular compartments is therefore important. METHODS: Fifteen subjects under...

  1. [Bronchial hyperresponsiveness and its importance for the clinician].

    Science.gov (United States)

    Mihalache, A; Fitting, J-W

    2014-11-19

    Asthma is a chronic inflammatory airway disease, characterised by bronchial hyperresponsiveness causing bronchoconstriction, and thereby provoking typical symptoms (dyspnoea, cough, wheezing). Bronchial hyperres- ponsiveness indicates a temporary airflow limitation when exposed to a bronchoconstricting stimulus. Its measurement by challenge tests can be a valuable tool for confirming or excluding asthma, as well as for evaluating the efficacy of treatment. However, the origin of bronchial hyperresponsiveness is multifactorial and the different challenge tests are not equivalent. Direct challenge tests, like methacholine, mainly reflect chronic airway remo- delling, whereas indirect tests, like mannitol, better reflect bronchial inflammation.

  2. Right pulmonary artery agenesis and coronary-to-bronchial artery aneurysm.

    Science.gov (United States)

    De Dominicis, Florence; Leborgne, Laurent; Raymond, Alexandre; Berna, Pascal

    2011-03-01

    Isolated unilateral pulmonary artery agenesis is a rare congenital anomaly that may be complicated with hemoptysis, recurrent pulmonary infections or pulmonary hypertension. To our knowledge the occurrence of a coronary syndrome associated with a coronary-to-bronchial artery saccular aneurysmal collateralization has never been described before. A 44-year-old female presented a congenital right pulmonary artery agenesis associated with a hypotrophic and multicystic right lung complicated with recurrent bronchitis. This patient had a coronary syndrome for which the coronary artery imaging showed a coronary-to-bronchial artery collateralization with an aneurysm at this level. It gives rise to a coronary syndrome by coronary steal. Two bronchial collaterals arising from a diaphragmatic artery and the subclavian artery were also found on the computed tomography (CT)-scan. This last collateral also showed another saccular aneurysm. We first performed an embolization of those two aneurysms in order to decrease the risk of hemorrhage and coronary steal, before performing a right pneumonectomy. In this case, the surgery was indicated because of the pathological lung and the risk of postembolization ischaemia. The postoperative course was uneventful and the patient was doing well six months later.

  3. Bronchial carcinoid tumors metastatic to the sella turcica and review of the literature.

    Science.gov (United States)

    Moshkin, Olga; Rotondo, Fabio; Scheithauer, Bernd W; Soares, Mark; Coire, Claire; Smyth, Harley S; Goth, Miklos; Horvath, Eva; Kovacs, Kalman

    2012-06-01

    We review here the literature on neuroendocrine neoplasms metastatic to the pituitary and present an example of the disease. Metastasis of bronchial carcinoid tumors to the sellar region are rare. Herein, we describe the case of a 63-year-old woman who presented with constant cough and headaches. She had previously been operated for carcinoid tumor of the lung. During the preoperative investigation, a CT scan of the head revealed a sellar mass. Six months after a left lower lobectomy, the sellar lesion was removed by transsphenoidal surgery. The two tumors were evaluated by histology, immunohistochemistry and electron microscopy. Both showed identical morphologic features, those of carcinoid tumor. Immunohistochemistry revealed immunoreactivity for the endocrine markers, synaptophysin and chromogranin, as well as CD-56, serotonin, bombesin and vascular endothelial growth factor. The sellar neoplasm showed nuclear immunopositivity for thyroid transcription factor-1, supporting the diagnosis of a metastatic bronchial carcinoid tumor. In conclusion, this is the first report of a serotonin- and bombesin-immunopositive atypical bronchial carcinoid tumor metastatic to the sella.

  4. Nerve plane-sparing radical hysterectomy: a simplified technique of nerve-sparing radical hysterectomy for invasive cervical cancer

    Institute of Scientific and Technical Information of China (English)

    LI Bin; LI Wei; SUN Yang-chun; ZHANG Rong; ZHANG Gong-yi; YU Gao-zhi; WU Ling-ying

    2011-01-01

    Background In order to simplify the complicated procedure of nerve-sparing radical hysterectomy, a novel technique characterized by integral preservation of the autonomic nerve plane has been employed for invasive cervical cancer. The objective of this study was to introduce the nerve plane-sparing radical hysterectomy technique and compare its efficacy and safety with that of nerve-sparing radical hysterectomy.Methods From September 2006 to August 2010, 73 consecutive patients with International Federation of Gynecology and Obstetrics stage IB to IIA cervical cancer underwent radical hysterectomy with two different nerve-sparing approaches. Nerve-sparing radical hysterectomy was performed for the first 16 patients (nerve-sparing radical hysterectomy group). The detailed autonomic nerve structures were identified and separated by meticulous dissection during this procedure. After January 2008, the nerve plane-sparing radical hysterectomy procedure was developed and performed for the next 57 patients (nerve plane-sparing radical hysterectomy group). During this modified procedure, the nerve plane (meso-ureter and its extension) containing most of the autonomic nerve structures was integrally preserved. The patients' clinicopathologic characteristics, surgical parameters, and outcomes of postoperative bladder function were compared between the two groups.Conclusion Nerve plane-sparing radical hysterectomy Is a reproducible and simplified modification of nerve-sparing radical hysterectomy, and may be preferable to nerve-sparing radical hysterectomy for treatment of early-stage invasive cervical cancer.

  5. Spiral (helical) CT of tracheo-bronchial diseases; La tomodensitometrie spiralee (helicoidale) en pathologie tracheobronchique

    Energy Technology Data Exchange (ETDEWEB)

    Remy, J.; Remy-Jardin, M.; Bonnel, F.; Masson, P. [Hopital Calmette, Service de Radiologie, 59 - Lille (France)

    2000-03-01

    The acquisition techniques, including some important dosimetric considerations, and the reconstruction methods reviewing the tomographic, broncho-graphic and endoscopic techniques are first taken into consideration. They are applied to the most usual problems and diseases encountered in the daily activity: pitfalls of interpretation of the tracheobronchial tree; management of hemoptysis; preoperative of proximal bronchial carcinoma; aids and complements to diagnostic and interventional bronchoscopy. The main purpose of this review, which merges the modern technology of spiral (helical) CT with the multislice acquisition in the very near future, consists in delivering, whenever possible, an integrated diagnostic and therapeutic approach of imaging, endoscopy and surgery. (authors)

  6. Symptoms, physical findings and bronchial hypersensitivity in patients with bronchial asthma and normal spirometry

    Directory of Open Access Journals (Sweden)

    Aćimović Slobodan

    2009-01-01

    Full Text Available Background/Aim. The diagnosis of bronchial asthma, a chronic inflammatory disease of the respiratory tract, is made on the basis of anamnesis, pathologic auscultatory findings of the lungs, lung function disturbances, skin tests, as well as the basic indices of immunologic condition in bronchial trunk. The aim of the study was to find out correlation of objective indices of the disease and than relation with the symptoms in the patients with bronchial asthma. Methods. The study included 60 young male non smokers with long lasting symptoms of bronchial asthma including shortness of breath, wheezing, hard breathing, nonproductive or productive cough, weakness and night hard breathing. There were no symptoms of respiratory infection over the past two months and lung radiography and spirometry were normal. Based on the results of nonspecific bronchoprovocative test two groups of the patients were formed, group I (n = 30 with positive histamine test (average value of the inhaled histamine concentration with FEV1 drop by 20% in regard with the initial value (PC20 = 2.99 ± 0.51 mg/ml of histamine and group II (n = 30 with negative histamine test (PC20(a = 14.58 ± 6.34 mg/ml of histamine. Results. The obtained spirometry results revealed a statistically significant difference in values of FEV1 between groups: I group - FEV1 = 93.2%; II group - FEV1 = 101.8%; (p < 0.05, Wilcoxon test, although all the FEV1 values were normal. Regarding the presence of the most common symptoms there was not statistically significant difference between the groups (p > 0. 05, chisquare test. Pathologic auscultatory lung findings were found in 73.4% of the patients in the group I and 27.5% of the patients in the group II. There was statistically significant difference (p < 0.05, chi-squared test. A positive correlation between the degree of hypersensitivity and lung physical findings was confirmed (p < 0.05 Spearman's rho, but there was no correlation with FEV1 values

  7. Intercostal thoracotomy in 20 dogs: muscle-sparing versus traditional techniques

    Science.gov (United States)

    Lee, Suhwon; Jeong, Soon-wuk

    2015-01-01

    The levels of pain, duration of approaching and closure, and surgical exposure associated with intercostal thoracotomy were compared between muscle-sparing and traditional techniques in 20 dogs. Postoperative pain was assessed based on numerical pain scores using behavioral observation, heart rate, respiratory rate, and wound palpation. Time for approaching and closure were measured, and the extent of intrathoracic organ exposure for the surgical procedures was described for each technique. There were significant differences in numerical pain scores at 2 h as well as 1, 2, 3, 4, 5, 6, and 7 days after surgery between the two groups (p intercostal thoracotomy. Additionally, the muscle-sparing technique is as effective as the traditional modality for providing an appropriate time for approaching and closure during intercostal thoracotomy as well as adequate organ exposure for the surgical procedures. PMID:25798045

  8. Tandem intercostal thoracic schwannomas resected using a thoracoscopic nerve-sparing technique: case report.

    Science.gov (United States)

    Gantwerker, Brian R; Dickman, Curtis A

    2011-07-01

    To describe a novel nerve-sparing technique for the resection of intercostal nerve schwannomas. This case demonstrates that intercostal neuralgia can be caused by intercostal schwannomas and that it can be relieved by their removal. A young woman with schwannomatosis had progressively worsening intercostal neuralgia caused by compression of the intercostal nerve against the rib by tandem intercostal schwannomas. After the tumors were removed, her symptoms were completely relieved. A thoracoscopic technique was used to define the involved fascicles and to facilitate removal of the tumors while sparing the uninvolved nerve. The patient's radicular pain was relieved completely by the tumor resection. Thoracoscopic surgery offers a safe and minimally invasive technique for removal of intercostal schwannomas and is a valid alternative to open thoracotomy. Removal of thoracic schwannomas can relieve intercostal neuralgia.

  9. Sparing of number words in oral production

    Directory of Open Access Journals (Sweden)

    Carlo Semenza

    2014-04-01

    In sentences only number words were spared; free standing function words and bound morphemes were as affected as other word categories. Discussion. These findings seem to set cardinal number words apart in the phonological output buffer from other possible building blocks of preassembled phonological units (like function words and bound morphemes. Building blocks constituted by numbers are more cohesive than the blocks constituted by function words and bound morphemes. Bencini et al. (2011 argued that numbers are recursive and consist of basic lexical units which are then combined following syntactic rules. This property would make number words resistant to damage in the phonological buffer.

  10. Stochastic model of forecasting spare parts demand

    Directory of Open Access Journals (Sweden)

    Ivan S. Milojević

    2012-01-01

    hypothesis of the existence of phenomenon change trends, the next step in the methodology of forecasting is the determination of a specific growth curve that describes the regularity of the development in time. These curves of growth are obtained by the analytical representation (expression of dynamic lines. There are two basic stages in the process of expression and they are: - The choice of the type of curve the shape of which corresponds to the character of the dynamic order variation - the determination of the number of values (evaluation of the curve parameters. The most widespread method of forecasting is the trend extrapolation. The basis of the trend extrapolation is the continuing of past trends in the future. The simplicity of the trend extrapolation process, on the one hand, and the absence of other information on the other hand, are the main reasons why the trend extrapolation is used for forecasting. The trend extrapolation is founded on the following assumptions: - The phenomenon development can be presented as an evolutionary trajectory or trend, - General conditions that influenced the trend development in the past will not undergo substantial changes in the future. Spare parts demand forecasting is constantly being done in all warehouses, workshops, and at all levels. Without demand forecasting, neither planning nor decision making can be done. Demand forecasting is the input for determining the level of reserve, size of the order, ordering cycles, etc. The question that arises is the one of the reliability and accuracy of a forecast and its effects. Forecasting 'by feeling' is not to be dismissed if there is nothing better, but in this case, one must be prepared for forecasting failures that cause unnecessary accumulation of certain spare parts, and also a chronic shortage of other spare parts. All this significantly increases costs and does not provide a satisfactory supply of spare parts. The main problem of the application of this model is that each

  11. Upper respiratory tract disease and bronchial asthma

    Institute of Scientific and Technical Information of China (English)

    1995-01-01

    950302 A synthetical evaluation of occupational asth-ma.LIU Jingyu(刘镜愉),et al.Occup Dis Res Cen-ter,3rd Hosp,Beijing Med Univ,Beijing,100083.ChinJ Industr Hyg & Occouat Dis 1994;12(6)322-325.The occupational exposure and medical history,physical examination,allergen bronchial provocationtest(A-BPT),skin test (ST),specific IgE(S-IgE) andIgG4(S-IgG4) were examined in 43 asthmatic patientswho were suspected to be related to their occupationa

  12. Radioaerosol Inhalation Imaging in Bronchial Asthma

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Bum Soo; Park, Young Ha; Park, Jeong Mi; Chung, Myung Hee; Chung, Soo Kyo; Shinn, Kyung Sub; Bahk, Yong Whee [Catholic University College of Medicine, Seoul (Korea, Republic of)

    1991-03-15

    Radioaerosol inhalation imaging (RII) has been used in radionuclide pulmonary studies for the past 20 years. The method is well accepted for assessing regional ventilation because of its usefulness, easy fabrication and simple application system. To evaluate its clinical utility in the study of impaired regional ventilation in bronchial asthma, we obtained and analysed RIIs in 31 patients (16 women and 15 men; age ranging 21-76 years) with typical bronchial asthma at the Department of Radiology, Kangnam St. Mary's Hospital, Catholic University Medical college, from January, 1988 to August, 1989. Scintiscans were obtained with radioaerosol produced by a HARC(Bhabha Atomic Research Center, India) nebulizer with 15 mCi of {sup 99m}Tc-phytate. The scanning was performed in anterior, posterior and lateral projections following 5-minute inhalation of radioaerosol on sitting position. The scans were analysed and correlated with the results of pulmonary function study and the findings of chest radiography. Fifteen patients had concomitant lung perfusion image with {sup 99m}Tc-MAA. Follow-up scans were obtained in 5 patients after bronchodilator therapy. 1 he patients were divided into (1) attack type (4 patients), (2) resistant type (5 patients), (3) remittent type (10 patients) and (4) bronchitic type (12 patients). Chest radiography showed hyperinflation, altered pulmonary vascularity, thickening of the bronchial wall and accentuation of hasal interstitial markings in 26 of the 31 patients. Chest radiographs were normal in the remaining 5 patients. Regardless of type, the findings of RII were basically the same, and characterized by the deposition of radioaerosol in the central parts or in the main respiratory air ways along with mottled nonsegmental ventilation defects in the periphery. Peripheral parenchymal defects were more extensive than that of expected findings from clinical symptoms, pulmonary function test and chest radiograph. Broomstick sign was present

  13. Asthma control during the year after bronchial thermoplasty

    DEFF Research Database (Denmark)

    Cox, Gerard; Thomson, Neil C.; Rubin, Adalberto S.

    2007-01-01

    BACKGROUND: Bronchial thermoplasty is a bronchoscopic procedure to reduce the mass of airway smooth muscle and attenuate bronchoconstriction. We examined the effect of bronchial thermoplasty on the control of moderate or severe persistent asthma. METHODS: We randomly assigned 112 subjects who had...

  14. BRONCHOSCOPIC THERAPY IN PATIENTS WITH INTRALUMINAL TYPICAL BRONCHIAL CARCINOID

    NARCIS (Netherlands)

    SUTEDJA, TG; SCHREURS, AJ; VANDERSCHUEREN, RG; KWA, B; VANDERWERF, TS; POSTMUS, PE

    1995-01-01

    Objective: To study the efficacy of bronchoscopic therapy in patients with intraluminal typical bronchial carcinoid. Design: Retrospective analysis of the data of patients with bronchial carcinoid, treated primarily with bronchoscopic techniques such as Nd-YAG laser in various hospitals in the Nethe

  15. 细支气管肺泡癌的FDG-PET影像特点%FDG-PET in Bronchial Alveolar Carcinoma

    Institute of Scientific and Technical Information of China (English)

    汪涛; 孙玉鹗; 常平; 于长海; 姚树林; 田嘉禾; 尹大一

    2006-01-01

    Objective: The purpose of this study was to assess the features of bronchial alveolar carcinomain fluorine-18 fluorodeoxyglucose (FDG) uptake by Positron emission tomography(PET). Methods: FromDecember 1998 to October 2004, 35 patients with bronchial alveolar carcinoma (BAC) were imaged withFDG-PET before surgery. The PET results were interpreted using visual and semiquantitative assessment.For semiquantitative analysis, standardized uptake value (SUV) was calculated. Results: All tumors of the patients could be detected by FDG-PET and identified by visual method. By semiquantitative analysis, FDG uptake of the tumor (SUVmax and SUVmean) was higher than that of normal lung (SUVlung) (P<0.001), SUVmax, SUVmean of the tumor and SUVlung were 3.14±1.65, 2.40±1.34 and 0.38±0.08respectively. Correlations were found between FDG uptake and tumor size (P<0.05). SUVmean in 21 tumors (21/35, 60.0%) and SUVmax in 15 tumors (15/35, 42.9%) were lower than 2.5. These 21 tumors were all considered as benign by visual method and semiquantitative analysis. Conclusion: (1) FDG uptake was higher in bronchial alveolar carcinoma than that in normal lung tissue. (2) FDG uptake and tumor size appear to be correlated with each other. (3) Bronchial alveolar carcinomas lead to many false negative cases in FDG-PET.

  16. [Increase of nonspecific bronchial reactivity after occupational exposure to vanadium].

    Science.gov (United States)

    Pistelli, R; Pupp, N; Forastiere, F; Agabiti, N; Corbo, G M; Tidei, F; Perucci, C A

    1991-01-01

    A study was conducted to evaluate the level of bronchial responsiveness among workers recently exposed to vanadium pentoxide during periodical removal of ashes and clinker from the boilers of an oil-fired power station. A total of 11 male workers were examined 40-60 hours after the last exposure; male subjects, comparable as to age and smoking habits and not exposed to vanadium, were randomly chosen among the employees of the same power station as a control group. None of the subjects in the two groups had symptoms of bronchial inflammation or significant airways obstruction. However, bronchial responsiveness, investigated using a methacholine challenge test, was significantly higher in the exposed group. It is suggested that exposure to vanadium increases bronchial responsiveness even without clinical appearance of bronchial symptoms. The role of such increased level of airways responsiveness as a risk factor for chronic obstructive lung disease is speculated.

  17. Metastatic urachal carcinoma in bronchial brush cytology

    Directory of Open Access Journals (Sweden)

    Fatima Zahra Aly

    2013-01-01

    Full Text Available Urachal carcinoma is rare comprising less than 1% of all bladder carcinomas. Metastases of urachal carcinoma have been reported to meninges, brain, ovary, lung, and maxilla. Cytologic features of metastatic urachal carcinoma have not been previously reported. We present a case of metastatic urachal adenocarcinoma in bronchial brushings and review the use of immunohistochemistry in its diagnosis. A 47-year-old female was seen initially in 2007 with adenocarcinoma of the bladder dome for which she underwent partial cystectomy. She presented in 2011 with a left lung mass and mediastinal adenopathy. Bronchoscopy showed an endobronchial lesion from which brushings were obtained. These showed numerous groups of columnar cells with medium sized nuclei and abundant cytoplasm. The cells were positive for CK20 and CDX2 and negative for CK7. The cytomorphological findings were similar to those in the previous resection specimen and concurrent biopsy. This is the first case report of bronchial brushings containing metastatic urachal carcinoma. No specific immunohistochemical profile is available for its diagnosis. The consideration of a second primary was a distinct possibility in this case due to the lapse of time from primary resection, absence of local disease, and lack of regional metastases.

  18. Protective effect of endothelial progenitor cells mediated by ischemic preconditioning on renal ischemic injury induced by nephron sparing surgery%缺血预适应介导的内皮祖细胞对保留肾单位手术后肾功能的保护作用

    Institute of Scientific and Technical Information of China (English)

    刘昊; 吴然; 贾瑞鹏; 朱佳庚; 吴剑平

    2013-01-01

    Objective To investigate the role of endothelial progenitor cells (EPCs) mediated by ischemic preconditioning (IPC) in renal ischemic injury in a nephron sparing surgery (NSS) rat model.Methods Ninety male Sprague-Dawley rats were randomly divided into three groups after right-side kidney nephrectomy.In sham-operated rats,lumbotomy without vascular clamping was performed; In NSS rats,renal blood vesses were clamped for 40 min and lower pole partial nephrectomy (PN) was performed; In NSS + IPC rats,besides pre-treatment with 15-min ischemia and 10-min reperfusion,the rest procedures were the same as those in NSS rats.At 1,3,6,12,24 h,and 3 days after reperfusion,the circulating pool and kidneys were harvested.The severity of renal injury,the home of EPCs,proliferation of endothelial cells as well as vascular growth factor expression was examined.Results Pretreated rats exhibited significant improvements in renal function and morphology.The histological score was significantly decreased in IPC group as compared with NSS group [(1.80 ± 0.45) vs.(3.00 ± 0.71),P < 0.05].The number of EPCs in the kidneys was increased at 12 h after reperfusion in IPC group as compared with NSS groups [(5.75 ± 0.71) % vs.(2.92 ± 0.71) %,P < 0.05].Proliferation of EPCs in peritubular capillaries was markedly increased in the kidneys treated with IPC.In addition,the expression of vascular endothelial growth factor,and stromal cell-derived factor-1α in the kidneys of pretreated rats was increased as compared with that in rats subjected to ischemic injury (P < 0.05).Conclusion IPC may attenuate renal ischemic injury induced by NSS; EPCs play an important role in renal protection,which involves promotion of endothelial cell proliferation through release of several angiogenic factors.%目的 探讨缺血预适应(IPC)介导的内皮祖细胞(EPCs)对保留肾单位手术(NSS)后肾功能的保护作用及其机制.方法 90只雄性SD大鼠随机分为对照组(Sham)、保留肾

  19. Electronic spare-parts catalogue, an elementary module of spare-parts supply; Elektronischer Ersatzteilkatalog als elementarer Baustein der Ersatzteilversorgung

    Energy Technology Data Exchange (ETDEWEB)

    Nienhaus, Karl; Bartnitzki, Thomas [RWTH Aachen (Germany). Inst. fuer Maschinentechnik der Rohstoffindustrie; Stoll, Andrea [Bucyrus HEX GmbH, Dortmund (Germany). Abt. Technische Dokumentation

    2011-01-15

    Developments in recent years in the supply of spare parts at Bucyrus HEX GmbH have revealed the increasing importance of quick and error-free ordering of spare parts by means of electronic spare-parts catalogues. The spare-parts catalogue has meanwhile become the central component in order to enter eCommerce with the after sales services. These higher requirements will lead to further optimisation and automation of the publishing process on the manufacturer's side and to quicker acceptance of the new digital media and the linking of the electronic spare-parts catalogues to maintenance planning systems on the customer's side. The authors agree that these are exciting times with regard to electronic spare-parts catalogues. (orig.)

  20. Análise do tratamento cirúrgico da raiz da aorta com o tubo valvulado e com a preservação da valva aórtica Analysis of aortic root surgery with composite mechanical aortic valve conduit and valve-sparing reconstruction

    Directory of Open Access Journals (Sweden)

    Ricardo Ribeiro Dias

    2010-12-01

    Full Text Available OBJETIVO: Análise comparativa dos resultados imediatos e tardios da reconstrução da raiz da aorta com o tubo valvulado e com a preservação da valva aórtica. MÉTODOS: No período de novembro de 2002 a setembro de 2009, 164 pacientes com idade média de 54 ± 15 anos, sendo 115 do sexo masculino, foram submetidos ao tratamento cirúrgico da raiz da aorta. Foram 125 tubos valvulados e 39 reconstruções da raiz da aorta com preservação da valva aórtica. Dezesseis por cento dos pacientes eram portadores de síndrome de Marfan e 4,3% apresentavam valva aórtica bivalvulada. Cento e quarenta e quatro (88% pacientes foram acompanhados durante tempo médio de seguimento de 41,1 ± 20,8 meses. RESULTADOS: A mortalidade hospitalar total foi de 4,9%; sendo 5,6% nas operações com tubo valvulado e 2,6% nas preservações da valva aórtica (POBJECTIVE: Comparative analysis of early and late results of aortic root reconstruction with aortic valve sparing operations and the composite mechanical valve conduit replacement. METHODS: From November 2002 to September 2009, 164 consecutive patients with mean age 54 ± 15 years, 115 male, underwent the aortic root reconstruction (125 mechanical valve conduit replacements and 39 valve sparing operations. Sixteen percent of patients had Marfan syndrome and 4.3% had bicuspid aortic valve. One hundred and forty-four patients (88% were followed for a mean period of 41.1 ± 20.8 months. RESULTS: The hospital mortality was 4.9%, 5.6% in operations with valved conduits and 2.6% in the valve sparing procedures (P <0.05. There was no difference neither in survival (95% CI = 86% - 96%, P= 0.1 nor in reoperation-free survival (95% CI = 85% - 90%, P = 0.29. The survival free of complications such as bleeding, thromboembolism and endocarditis were favorable to the valve sparing operations, respectively (95% CI = 70% - 95%, P = 0.001, (95% CI = 82% - 95% P = 0.03 and (95% CI = 81% - 95%, P = 0.03. Multivariate analysis

  1. Laparoscopic Fertility Sparing Management of Cervical Cancer

    Directory of Open Access Journals (Sweden)

    Chiara Facchini

    2014-03-01

    Full Text Available Fertility can be preserved after conservative cervical surgery. We report on a 29-year-old woman who was obese, para 0, and diagnosed with cervical insufficiency at the first trimester of current pregnancy due to a previous trachelectomy. She underwent laparoscopic transabdominal cervical cerclage (LTCC for cervical cancer. The surgery was successful and she was discharged two days later. The patient underwent a caesarean section at 38 weeks of gestation. Laparoscopic surgery is a minimally invasive approach associated with less pain and faster recovery, feasible even in obese women.

  2. Renal-sparing strategies in cardiac transplantation

    DEFF Research Database (Denmark)

    Gustafsson, Finn; Ross, Heather J

    2009-01-01

    PURPOSE OF REVIEW: Renal dysfunction due to calcineurin inhibitor (CNI) toxicity is a major clinical problem in cardiac transplantation. The aim of the article is to review the efficacy and safety of various renal sparing strategies in cardiac transplantation. RECENT FINDINGS: Small studies have...... documented that late initiation of CNI is safe in patients treated with induction therapy at the time of transplantation. Use of mycophenolate is superior when compared with azathioprine to allow for CNI reduction. More substantial reduction in CNI levels is safe and effective with the introduction...... of sirolimus or everolimus. However, studies that use very early CNI discontinuation have found an increased risk of allograft rejection, and this strategy requires further study before it can be routinely recommended. CNI discontinuation late after cardiac transplantation seems more effective than CNI...

  3. Evolving role of skin sparing mastectomy.

    Science.gov (United States)

    Kasem, Abdul; Mokbel, Kefah

    2014-05-10

    Skin sparing mastectomy (SSM) can facilitate immediate breast reconstruction and is associated with an excellent aesthetic result. The procedure is safe in selected cases; including invasive tumours skin represent contra-indications to SSM due to an unacceptable risk of local recurrence. Prior breast irradiation or the need for post-mastectomy radiotherapy do not preclude SSM, however the aesthetic outcome may be compromised. Preservation of the nipple areola complex is safe for peripherally located node negative tumours. An intraoperative frozen section protocol for the retro-areolar tissue should be considered in these cases. The advent of acellular tissue matrix systems has enhanced the scope of implant-based immediate reconstruction following SSM. Cell-assisted fat transfer is emerging as a promising technique to optimise the aesthetic outcome.

  4. Second Line of Defense Spares Program Assessment

    Energy Technology Data Exchange (ETDEWEB)

    Henderson, Dale L.; Muller, George; Mercier, Theresa M.; Brigantic, Robert T.; Perkins, Casey J.; Cooley, Scott K.

    2012-11-20

    The Office of the Second Line of Defense (SLD) is part of the Department of Energy‘s (DOE) National Nuclear Security Administration (NNSA). The SLD Program accomplishes its critical global security mission by forming cooperative relationships with partner countries to install passive radiation detection systems that augment traditional inspection and law enforcement measures by alerting border officials to the presence of special nuclear or other radiological materials in cross-border traffic. An important tenet of the program is to work collaboratively with these countries to establish the necessary processes, procedures, infrastructure and conditions that will enable them to fully assume the financial and technical responsibilities for operating the equipment. As the number of operational deployments grows, the SLD Program faces an increasingly complex logistics process to promote the timely and efficient supply of spare parts.

  5. APPLICATION OF BUDESONIDE IN BREASTFEEDING MOTHERS WITH BRONCHIAL ASTHMA

    Directory of Open Access Journals (Sweden)

    E.A. Vishneva

    2009-01-01

    Full Text Available Bronchial asthma is a chronic inflammatory disease of respiratory tract. Breastfeeding mothers suffering from bronchial asthma require attention and control over their health status. The results of research described in the article confirm the need for a continued baseline therapy using the inhalant budesonide in the breastfeeding period and allow mothers suffering from bronchial asthma to be sure of safety in application of modern optimal anti-inflammatory disease treatment and not to worry about a possibility of systemic effect of the medication on the baby.Key words: budesonide, inhalant glucocorticosteroids, breast milk.

  6. Endoscopic Management of Obstruction due to an Acquired Bronchial Web

    Directory of Open Access Journals (Sweden)

    Kevin L Kovitz

    2002-01-01

    Full Text Available Bronchial webs are thin, membrane-like diaphragms that may obstruct the airway. Several congenital cases have been reported. Though rare, the true incidence of these lesions is probably underestimated because many of them are unrecognized. The case of a 71-year-old woman with an acquired bronchial web causing right main stem bronchus obstruction that went unrecognized for 47 years post-trauma is reported. The lesion was successfully treated using rigid bronchoscopy with laser therapy, balloon dilation and stent placement. This is the first reported case of an acquired bronchial web formation. It is also the first reported case that was successfully treated with this technique.

  7. Integral optimization of spare parts inventories in systems with redundancies

    NARCIS (Netherlands)

    Sleptchenko, Andrei; van der Heijden, Matthijs C.

    2016-01-01

    In this paper, we analyze spare parts supply for a system with a "k-out-of-N" redundancy structure for key components, different standby policies (cold, warm and hot standby redundancy) and local spare parts inventories for sub-components. We assume multiple part types (sub-components) that fail

  8. Postoperative Radiation Therapy after Nipple-Sparing or Skin-Sparing Mastectomy: A Survey of European, North American, and South American Practices

    NARCIS (Netherlands)

    Marta, G.N.; Poortmans, P.M.P.; Buchholz, T.A.; Hijal, T.

    2017-01-01

    Skin sparing mastectomy, a surgical procedure sparing a large portion of the overlying skin of the breast, and nipple-sparing mastectomy, sparing the whole nipple-areolar complex, are increasingly used, although their oncologic efficacy remains unclear. The aim of this study was to assess the

  9. Valve-sparing aortic root replacement and aortic valve repair in a patient with acromegaly and aortic root dilatation

    Directory of Open Access Journals (Sweden)

    Karel Van Praet

    2015-07-01

    Full Text Available Aortic regurgitation and dilatation of the aortic root and ascending aorta are severe complications of acromegaly. The current trend for management of an aortic root aneurysm is valve-sparing root replacement as well as restoring the diameter of the aortic sinotubular junction (STJ and annulus. Our case report supports the recommendation that in patients with acromegaly, severe aortic root involvement may indicate the need for surgery.

  10. Skin-sparing mastectomy and immediate reconstruction with DIEP flap after breast-conserving therapy

    Science.gov (United States)

    Andree, Christoph; Munder, Beatrix; Seidenstuecker, Katrin; Richrath, Philipp; Behrendt, Philipp; Köppe, Tobias; Hagouan, Mazen; Audretsch, Werner; Nestle-Krämling, Carolin; Witzel, Christian

    2012-01-01

    Summary Background Currently about 70% of women who suffer from breast cancer undergo breast-conserving therapy (BCT) without removing the entire breast. Thus, this surgical approach is the standard therapy for primary breast cancer. If corrections are necessary, the breast surgeon is faced with irritated skin and higher risks of complications in wound healing. After radiation, an implant-based reconstruction is only recommended in selected cases. Correction of a poor BCT outcome is often only solved with an additional extended operation using autologous reconstruction. Material/Methods In our plastic surgery unit, which focuses on breast reconstruction, we offer a skin-sparing or subcutaneous mastectomy, followed by primary breast reconstruction based on free autologous tissue transfer to correct poor BCT outcomes. Between July 2004 and May 2011 we performed 1068 deep inferior epigastric artery perforator (DIEP) flaps for breast reconstruction, including 64 skin-sparing or subcutaneous mastectomies, followed by primary DIEP breast reconstruction procedures after BCT procedures. Results In all free flap-based breast reconstruction procedures, we had a total flap loss in 0.8% (9 cases). Within the group of patients after BCT, we performed 41 DIEP flaps and 23 ms-2 TRAM flaps after skin-sparing or subcutaneous mastectomies to reconstruct the breast. Among this group we had of a total flap loss in 1.6% (1 case). Conclusions In cases of large tumour sizes and/or difficult tumour locations, the initial oncologic breast surgeon should inform the patients of a possibly poor cosmetic result after BCT and radiation. In our opinion a skin-sparing mastectomy with primary breast reconstruction should be discussed as a valid alternative. PMID:23197233

  11. Nipple-Areola Complex Necrosis after Nipple-Sparing Mastectomy with Immediate Autologous Breast Reconstruction

    Directory of Open Access Journals (Sweden)

    Jin-Woo Cho

    2015-09-01

    Full Text Available BackgroundAutologous or implant-based breast reconstruction after nipple-sparing mastectomy is increasingly preferred worldwide as a breast cancer treatment option. However, postoperative nipple-areola complex (NAC necrosis is the most significant complication of nipple-sparing mastectomy. The purpose of our study was to identify the risk factors for NAC necrosis, and to describe the use of our skin-banking technique as a solution.MethodsWe reviewed cases of immediate autologous breast reconstruction after nipple-sparing mastectomy at our institution between June 2005 and January 2014. The patients' data were reviewed and the risk of NAC necrosis was analyzed based on correlations between patient variables and NAC necrosis. Moreover, data pertaining to five high-risk patients who underwent the donor skin-banking procedure were included in the analysis.ResultsEighty-five patients underwent immediate autologous breast reconstruction after nipple-sparing mastectomy during the study period. Partial or total NAC necrosis occurred in 36 patients (43.4%. Univariate analysis and binary regression modeling found that body mass index, smoking history, radiation therapy, and mastectomy volume were significantly associated with NAC necrosis. Of the 36 cases of NAC necrosis, 31 were resolved with dressing changes, debridement, or skin grafting. The other five high-risk patients underwent our prophylactic skin-banking technique during breast reconstruction surgery.ConclusionsNAC necrosis is common in patients with multiple risk factors. The use of the skin-banking technique in immediate autologous breast reconstruction is an attractive option for high-risk patients. Banked skin can be used in such cases without requiring additional donor tissue, with good results in terms of aesthetic and reconstructive outcomes.

  12. Imaging findings of bronchial atresia in fetuses, neonates and infants

    Energy Technology Data Exchange (ETDEWEB)

    Alamo, Leonor; Meuli, Reto [University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Department of Diagnostic and Interventional Radiology, Lausanne (Switzerland); Vial, Yvan [University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Department of Obstetrics and Gynecology, Lausanne (Switzerland); Gengler, Carole [University Hospital of Lausanne (CHUV) and University of Lausanne (UNIL), Department of Pathology, Lausanne (Switzerland)

    2016-03-15

    Congenital lung malformations are increasingly detected before birth. However, bronchial atresia is rarely identified in utero and not always recognized in neonates. There are two types of atresia: (1) proximal, located at the level of the mainstem or the proximal lobar bronchi, which is extremely rare and usually lethal during pregnancy, causing a tremendous volume increase of the distal involved lung with secondary hypoplasia of the normal lung, and (2) peripheral, located at the segmental/subsegmental bronchial level, which may present as an isolated lesion or as part of a complex congenital malformation. Prenatal findings are mostly nonspecific. Postnatal exams show overinflated lung areas and focal bronchial dilations. The typical fluid-filled bronchoceles are not always observed in neonates but develop progressively in the first months of life. This pictorial essay describes the spectrum of imaging findings of bronchial atresia in fetuses, neonates and infants. (orig.)

  13. A Case of Severe Bronchial Asthma Controlled with Tacrolimus

    Directory of Open Access Journals (Sweden)

    Hirokazu Taniguchi

    2011-01-01

    Full Text Available Background. The control of severe bronchial asthma, such as corticosteroid-resistant asthma, is difficult. It is also possible that immunosuppressive agents would be effective for bronchial asthma. Case Summary. A 55-year-old Japanese female presented with severe bronchial asthma controlled with tacrolimus. She had been diagnosed with bronchial asthma during childhood. Her asthma worsened, and a chest radiograph showed atelectasis of the left lung. Bronchoscopy revealed the left main bronchus to be obstructed with viscous sputum consisting of 82% neutrophils and no eosinophils. The atelectasis did not improve with corticosteroid treatment, but was ameliorated by administration of tacrolimus. Discussion. This patient had severe asthma due to neutrophilic inflammation of the airways. Tacrolimus is effective for treating severe asthma, for example, in corticosteroid-resistant cases.

  14. Bronchial Artery Embolization for Massive Hemoptysis: a Retrospective Study

    Directory of Open Access Journals (Sweden)

    Ali Fani

    2013-05-01

    Full Text Available   Introduction: To assess the efficacy and safety of bronchial artery embolization in the treatment of massive hemoptysis.   Materials and Methods: A retrospective study on 46 patients (26 males and 20 females who were referred to the Razavi Hospital from April 2009 to May 2012 with massive hemoptysis and had bronchial artery embolization procedures. General characteristics of the patients including age, gender, etiology, and thorax computed tomograms, findings of bronchial angiographic, results of the embolization, complications related to bronchial artery embolization and clinical outcome during follow-up were reviewed. Results: The etiology included previous pulmonary tuberculosis in 20 cases, previous tuberculosis with bronchiectasis in 16 cases, bronchiectasis in 6 cases, and active pulmonary tuberculosis in one case. No identifiable causes could be detected in three patients. Moreover, massive hemoptysis was successfully and immediately controlled following the embolization procedure in all patients. One patient developed recurrent hemoptysis during one month following the procedure and was treated by re-embolization. No major procedure–related complication such as bronchial infarction was identified However none of the patientsexperienced neurological complications. Conclusion: Bronchial artery embolization is a safe and effective means of controlling massive hemoptysis and should be regarded as the first-line treatment for this condition.

  15. [The measurement of bronchial hyperreactivity for military service fitness].

    Science.gov (United States)

    Ferrante, E; Grasso, S; Corbo, G M; Ciappi, G

    1991-10-01

    The authors discuss the efficacy of methacholine challenge to discriminate fit subjects to military service. We evaluated the relation between bronchial hyperreactivity and clinical symptoms, airways caliber and atopic status in a group of italian conscripts who reported to have bronchial asthma. Five-hundred-four subjects were studied. Bronchial hyperreactivity was measured by methacholine test, and atopic status was assessed by skin-tests. A measurable PC20 FEV1 was detected in 424 subjects. On the basis of the methacholine threshold concentration the overall sample was divided in four categories. The four categories differed as regards onset of disease, lung function and skin reactivity towards Dermatophagoides Pter, whereas no difference was found as regards skin reactivity towards Grass. In the group evaluated in spring, the four categories differed as regards skin reactivity towards Grass. In conclusion we found that bronchial hyperreactivity is related to clinical history, lung function and atopic status; the measurement of bronchial hyperreactivity is important to evaluate conscripts referring bronchial asthma.

  16. EMA- EISENBERGER-MAIOCCO ALGORITHM FOR SPARES PROVISIONING

    Science.gov (United States)

    Eisenberger, I.

    1994-01-01

    The Eisenberger-Maiocco algorithm (EMA) is an efficient Markov sparing algorithm to aid in the provisioning of spare parts. There are two calculations performed by EMA: 1) forecasting the availability of a system with a given spare parts pool, and 2) determining the most cost effective spares package. EMA was used in NASA's Deep Space Network project to calculate the probability that a system would be up and operational with the spares available at each location. The system to be analyzed is defined in terms of modules, which are any pieces of equipment which may fail, be repaired, or be replaced. A module can be in one of three states: working, spare, or failed and waiting for repair. For each module type in the system configuration, there is an actual number in use by the system, and a minimum number for the system to be operational. A module type is considered 'down' when there are fewer than the required minimum number working, and there are no spares in the stockpile. Input to EMA includes module data such as mean time between failure, mean time to repair, number of spares, and cost of the item. EMA determines the overall system availability, or uptime ratio, as the probability the system will be operational during a given time. EMA can also calculate the most cost effective spares package for a given range of uptime ratios. EMA is written in interpreter PC-BASIC and is for interactive execution. It has been implemented on an IBM PC series computer operating under DOS 2.0 with a central memory requirement of approximately 64K of 8 bit bytes. This program was developed in 1978.

  17. Local heat preconditioning in skin sparing mastectomy: a pilot study.

    Science.gov (United States)

    Mehta, Saahil; Rolph, Rachel; Cornelius, Victoria; Harder, Yves; Farhadi, Jian

    2013-12-01

    Experimental data has shown an association with a reduction of flap necrosis after local heat-application to a supraphysiological level resulting from the up-regulation of heat shock proteins, such as HSP-32. The proteins maintained capillary perfusion and increased tissue tolerance to ischaemia. The purpose of this translational study was to evaluate the effect of local heat preconditioning before skin sparing mastectomy and immediate breast reconstruction. A prospective non-randomised trial was performed from July 2009-April 2010. 50 consecutive patients at risk of skin flap necrosis (BMI >30, sternal-to-nipple distance>26 cm or breast size>C-cup) were included. Twenty-five patients were asked to heat-precondition their breast 24-h prior to surgery using a hot water bottle with a water temperature of 43 °C (thermometers provided), in three 30-min cycles interrupted by spontaneous cooling to room temperature. Skin flap necrosis was defined by the need for surgical debridement. LDI images were taken pre- and post-mastectomy to demonstrate an increase in tissue vascularity. 36% of women (n=25) without local heat-treatment developed skin flap necrosis, 12% developed skin flap necrosis in the treatment group, resulting in a 24% difference (n=25; p=0.047 (95%CI 1%-47%)). LDI scanning of the heated breast demonstrated an increase in vascularity compared to the contralateral non-heated breast. Median length of inpatient stay for treatment group was 4 days (95%CI(4, 7)), controls 8 days (95%CI(8, 9) (p=mastectomy. ACTRN12612001197820. II. Copyright © 2013 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  18. Environmental risk factors and allergic bronchial asthma.

    Science.gov (United States)

    D'Amato, G; Liccardi, G; D'Amato, M; Holgate, S

    2005-09-01

    The prevalence of allergic respiratory diseases such as bronchial asthma has increased in recent years, especially in industrialized countries. A change in the genetic predisposition is an unlikely cause of the increase in allergic diseases because genetic changes in a population require several generations. Consequently, this increase may be explained by changes in environmental factors, including indoor and outdoor air pollution. Over the past two decades, there has been increasing interest in studies of air pollution and its effects on human health. Although the role played by outdoor pollutants in allergic sensitization of the airways has yet to be clarified, a body of evidence suggests that urbanization, with its high levels of vehicle emissions, and a westernized lifestyle are linked to the rising frequency of respiratory allergic diseases observed in most industrialized countries, and there is considerable evidence that asthmatic persons are at increased risk of developing asthma exacerbations with exposure to ozone, nitrogen dioxide, sulphur dioxide and inhalable particulate matter. However, it is not easy to evaluate the impact of air pollution on the timing of asthma exacerbations and on the prevalence of asthma in general. As concentrations of airborne allergens and air pollutants are frequently increased contemporaneously, an enhanced IgE-mediated response to aeroallergens and enhanced airway inflammation could account for the increasing frequency of allergic respiratory allergy and bronchial asthma. Pollinosis is frequently used to study the interrelationship between air pollution and respiratory allergy. Climatic factors (temperature, wind speed, humidity, thunderstorms, etc) can affect both components (biological and chemical) of this interaction. By attaching to the surface of pollen grains and of plant-derived particles of paucimicronic size, pollutants could modify not only the morphology of these antigen-carrying agents but also their allergenic

  19. Importance of perforating vessels in nipple-sparing mastectomy: an anatomical description

    Directory of Open Access Journals (Sweden)

    Amanti C

    2015-07-01

    Full Text Available Claudio Amanti,1 Valeria Vitale,1 Augusto Lombardi,1 Stefano Maggi,1 Laura Bersigotti,1 Gianni Lazzarin,1 Emiliano Nuccetelli,1 Camilla Romano,1 Laura Campanella,1 Lara Cristiano,2 Alessandra Bartoloni,2 Giuseppe Argento2 1Breast Surgery Unit, 2Radiology Unit, University of Roma, La Sapienza Sant'Andrea Hospital, Rome, Italy Background: Nipple-sparing mastectomy (NSM, understood as an oncologically valid procedure, is relatively new, and is an evolution of traditional mastectomy, particularly in relation to breast-conserving surgery. The anterior perforating branches are responsible for the cutaneous vascularization of the breast skin, and their preservation is a fundamental step to avoid possible postoperative necrosis. Therefore, evaluating the potential complications of cancer-related reconstructive surgical procedures such as NSM, both the distance of the tumoral lesion from the skin and the surgical incision site should be carefully considered. The preferred site of incision corresponds to the inframammary fold or possibly the periareolar area.Methods: We retrospectively reviewed 113 patients who underwent NSM from January 2005 to October 2012 to evaluate skin complications. The anatomical study was performed by magnetic resonance imaging of the breast.Results: Only one of the 113 women who had undergone a NSM procedure had total necrosis (0.9% and six patients had partial necrosis (5.8% of the nipple-areola complex. Keywords: nipple-sparing mastectomy, breast, magnetic resonance imaging, breast perforating vessels, breast anatomy

  20. Recurrent phyllodes tumor of the breast: defining the role for skin-sparing mastectomy and autologous reconstruction.

    Science.gov (United States)

    Atalla, Mohamed Anwar; Rozen, Warren Matthew; Grinsell, Damien; Hyett, Anthony; Prakash, Saurabh; Cham, Alvin

    2011-05-01

    Phyllodes tumors (PTs) are uncommon fibroepithelial tumors of the breast, noteworthy for their difficult excisions and high recurrence rates. In the setting of recurrence, there is no consensus in the literature as to the extent of excision or the impact on reconstructive options. Breast-conserving surgery and simple mastectomy have each been described with mixed reports. Despite a shift toward the selective use of skin-sparing mastectomy and nipple-areola complex-sparing mastectomy in breast carcinoma, neither the role for these techniques nor the role for breast reconstruction in recurrent PT has been described. A case report is presented demonstrating the utility of skin-sparing mastectomy and autologous breast reconstruction for locally recurrent PT of the breast, with a literature review of management options in this setting presented. The case presented highlights an appropriate setting for autologous microsurgical reconstruction of the breast in recurrent PT. The literature review highlights a lack of any published management consensus, with only the role for mastectomy suggested for recurrent high-grade or malignant lesions. A potential management algorithm is thus presented. Skin-sparing mastectomy, particularly for intermediate-grade lesions, may allow wider resections while enabling aesthetically pleasing reconstructive options without affecting recurrence rates.

  1. Virus Infection-Induced Bronchial Asthma Exacerbation

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    Mutsuo Yamaya

    2012-01-01

    Full Text Available Infection with respiratory viruses, including rhinoviruses, influenza virus, and respiratory syncytial virus, exacerbates asthma, which is associated with processes such as airway inflammation, airway hyperresponsiveness, and mucus hypersecretion. In patients with viral infections and with infection-induced asthma exacerbation, inflammatory mediators and substances, including interleukins (ILs, leukotrienes and histamine, have been identified in the airway secretions, serum, plasma, and urine. Viral infections induce an accumulation of inflammatory cells in the airway mucosa and submucosa, including neutrophils, lymphocytes and eosinophils. Viral infections also enhance the production of inflammatory mediators and substances in airway epithelial cells, mast cells, and other inflammatory cells, such as IL-1, IL-6, IL-8, GM-CSF, RANTES, histamine, and intercellular adhesion molecule-1. Viral infections affect the barrier function of the airway epithelial cells and vascular endothelial cells. Recent reports have demonstrated augmented viral production mediated by an impaired interferon response in the airway epithelial cells of asthma patients. Several drugs used for the treatment of bronchial asthma reduce viral and pro-inflammatory cytokine release from airway epithelial cells infected with viruses. Here, I review the literature on the pathogenesis of the viral infection-induced exacerbation of asthma and on the modulation of viral infection-induced airway inflammation.

  2. Effect of acupuncture on bronchial asthma.

    Science.gov (United States)

    Yu, D Y; Lee, S P

    1976-11-01

    1. Needle acupuncture was performed at three sites in twenty patients in a clinical attack of bronchial asthma. 2. In all patients the symptoms of bronchoconstriction improved during the attacks when the correct site was stimulated, and in five patients wheezing was abolished. 3. Stimulation at the correct site produced a significant increase in the mean FEV1-0 (58%) and FVC (29%) but not in maximal mid-expiratory flow rate (MMFR; 76%), when compared with the findings before acupuncture, along with a significant fall in the Pa,CO2 and an insignificant fall in Pa,O2. A mild tachycardia was also observed. 4. After acupuncture a greater improvement in FEV1-0, FVC and MMFR was produced by inhalation of isoprenaline. 5. No significant changes in FEV1-0, FVC, MMFR, pulse rate or arterial blood gas tensions occurred after acupuncture at control sites. 6. In four of the patients during clinical remission acupuncture was performed before and after histamine aerosol challenge, but there was no effect on either the severity or the duration of the histamine-induced bronchoconstriction. 7. It is concluded that acupunture probably reduced the reflex component of the bronchoconstriction, but failed to influence direct smooth muscle constriction caused by histamine.

  3. Scapholunate Advanced Collapse: Motion-Sparing Reconstructive Options.

    Science.gov (United States)

    Kruse, Kevin; Fowler, John R

    2016-01-01

    Scapholunate advanced collapse (SLAC) is a predictable pattern of degenerative wrist arthritis that develops as a result of scapholunate dissociation. The purpose of this article is to review outcomes for the various motion-sparing surgical treatments for SLAC wrist.

  4. Spare parts inventory risk for decision making in plant maintenance

    Science.gov (United States)

    Sharif, Kamal Imran; Ibrahim, Jafni Azhan; Udin, Zulkifli Mohamed

    2016-08-01

    Equipment breakdown due to unavailability of spare parts is really disastrous in plant maintenance. The failure increase the cost of repair and production downtime. Therefore, it is important to understand the maintenance and inventory function in order to ensure the plant operate accordingly. Moreover, it is necessary for the plant maintenance to balance the issue of shortage and excess of inventory in plant maintenance. In view of this situation, the spare parts become a critical matters and it is good starting point to tackle the issues from looking at the perspective of spare parts inventory risk. This paper describes the development of risk technique for plant maintenance decision making purposes using the Shortage and Excess Impact Table. It also used the Breakdown Probability Table to quantify the risk for the spare part failure.

  5. The Protein-Sparing Modified Fast Diet

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    Marwan Bakhach MD

    2016-01-01

    Full Text Available Objectives: The protein-sparing modified fast (PSMF is a rigorous way of rapidly losing a large amount of weight. Although adult studies have shown the PSMF to be effective, data in adolescents are lacking. The aim of this study was to determine the efficacy and safety of the PSMF in severely obese adolescents. Methods: 12 subjects who were evaluated in the Obesity Management Program at the Cleveland Clinic from 2011 to 2014 were included. The subjects were initiated on the PSMF after failing other conventional methods of weight loss. Once the goal weight was achieved, subjects were transitioned to the refeeding phase for weight maintenance. Results: Follow-up was scheduled at 3-month (11 patients and 6-month (6 patients intervals. At the 6-month follow-up visit, the average weight loss was 11.19 kg (95% confidence interval = -5.4, -27.8, P = .028, with average of 9.8% from baseline. Fifty percent of subjects had >5% weight loss and 20% had >10% weight loss. Four patients were lost to the follow-up (40%. An improvement was noted in total cholesterol and high-density lipoprotein. Due to a small sample size these results were not statistically significant. Side effects reported by subjects were mild dehydration due to nausea (2 patients, decreased energy (1 patient, and transient labile mood (1 patient. No life-threatening side effects were reported. Conclusion: Our results show that the PSMF diet can be used as an effective and safe method in the outpatient setting for rapid weight loss in adolescents with severe obesity.

  6. The predictive value of bronchial histamine challenge in the diagnosis of bronchial asthma

    DEFF Research Database (Denmark)

    Madsen, F; Holstein-Rathlou, N H; Mosbech, H

    1985-01-01

    A prospective survey aiming to study the predictive value of bronchial histamine challenge was performed on 151 patients with a forced expiratory volume1 (FEV1) above 60% of predicted. According to variations in peak expiratory flow rate (PEFR) and medical history the patients were classified...... as asthmatics (n = 97) or non-asthmatics (n = 54). The diagnostic properties of the challenge were calculated using the statement of Baye. Considering PC20 values below 4.00 mg/ml as positive, the predictive value of a positive test was about 0.80 and the predictive value of a negative about 0.76. When PC20...... was below 0.125 mg/ml the predictive value of a positive test was 1.00, but an increase in PC20 in the range from 4.00 to 16 mg/ml did not increase the predictive value of a negative test. In this study the prevalence of asthma was about 0.6. We therefore conclude that bronchial histamine challenge...

  7. Pupil-sparing complete third nerve palsy from cryptogenic midbrain stroke in an otherwise-healthy young adult with patent foramen ovale

    Directory of Open Access Journals (Sweden)

    Arif O Khan

    2012-01-01

    Full Text Available Although pupil-sparing in acute unilateral complete third nerve palsy is often a sign of ischemic nerve injury, it is not specific for injury outside of the midbrain. This report documents acute pupil-sparing complete third nerve palsy in an otherwise healthy young adult with patent foramen ovale and associated atrial dilatation who suffered cryptogenic focal midbrain stroke, presumably from a paradoxical embolism. The patent foramen ovale was surgically closed. Over the next several months neurological recovery was complete except for diplopia and relatively comitant hypotropia, which responded well to conventional strabismus surgery.

  8. Bariatric Surgery

    Science.gov (United States)

    ... Metabolic and Bariatric Surgery MedlinePlus What is bariatric surgery? Bariatric surgery helps people who are very obese to ... What are the endocrine-related benefits of bariatric surgery? Bariatric surgery and the weight loss that results can: ...

  9. Connective Tissue Growth Factor Expression in Human Bronchial Epithelial Cells

    Institute of Scientific and Technical Information of China (English)

    Amrita DOSANJH

    2006-01-01

    Connective tissue growth factor (CTGF) is a cysteine-rich protein that promotes extracellular matrix deposition. CTGF is selectively induced by transforming growth factor β and des-Arg kallidin in lung fibroblasts and increases steady-state mRNA levels of α type I collagen, 5α-integrin and fibronectin in fibroblasts. Bronchial epithelial cells have been proposed to functionally interact with lung fibroblasts. We therefore investigated if bronchial epithelial cells are able to synthesize CTGF. Human bronchial epithelial cells were grown to subconfluence in standard growth media. Proliferating cells grown in small airway growth media were harvested following starvation for up to 24 h. Expression of CTGF transcripts was measured by PCR. Immunocytochemistry was also completed using a commercially available antibody.The cells expressed readily detectable CTGF transcripts. Starvation of these cells resulted in a quantitative decline of CTGF transcripts. Direct sequencing of the PCR product identified human CTGF. Immunocytochemistry confirmed intracellular CTGF in the cells and none in negative control cells. We conclude that bronchial epithelial cells could be a novel source of CTGF. Bronchial epithelial cell-derived CTGF could thus directly influence the deposition of collagen in certain fibrotic lung diseases.

  10. Features of Atopic Reactivity in Schoolchildren with Severe Bronchial Asthma

    Directory of Open Access Journals (Sweden)

    U.I. Marusyk

    2014-12-01

    Full Text Available The study involved 30 students with severe bronchial asthma and 30 children with moderate to severe course. Patients with severe bronchial asthma revealed a clear tendency to increase the relative content of interleukin 4 in peripheral blood, which indirectly indicates the severity of inflammation in the bronchi. Almost every second child suffering from severe bronchial asthma reported an increase in the concentration of immunoglobulin E (more than 545.3 IU/ml, and the odds ratio was 1.9 (95% CI 1.1–3.4. In the group of patients with severe bronchial asthma, cases of increased skin sensitivity to household allergens were significantly more frequent compared to the second group. Thus, the size of hyperemia over 15.0 mm was recorded in 81.5 % of children of the first group and only in 51.9 % of persons (Pϕ < 0.05 in the second one. Clinical and epidemiological risk and diagnostic value of individual indicators of atopic reactivity were determined to verify the phenotype of severe bronchial asthma.

  11. Spare PRELI gene loci: failsafe chromosome insurance?

    Directory of Open Access Journals (Sweden)

    Wenbin Ma

    from spare gene loci appeared ample to surmount Chr 13 PRELI gene deficiency. CONCLUSIONS: These findings suggest that PRELI is a vital LEA B cell protein with failsafe genetics.

  12. A case of bronchial/lung carcinoid cytological, histological and immunohistochemical corroboration

    Directory of Open Access Journals (Sweden)

    Sarita Asotra

    2015-01-01

    Full Text Available Lung carcinoids tumors are uncommon tumors that start in the lung. They tend to grow slower than other types of lung cancers. Carcinoids tumors start from cells of the diffuse neuroendocrine system. It is widely recognized that cytology is superior to small biopsy in diagnosing small cell lung carcinoma since the crush artefacts limiting small biopsy interpretation is minimized in cytology. Similarly, carcinoids can be accurately diagnosed in cytology and small biopsy specimen. A correct preoperative cytological diagnosis helps in planning early and optimal surgery. We received the fine-needle aspiration cytology sample of bronchial mass of 46-year-old patient presenting with cough and hemoptysis for 2 months. Diagnosis of carcinoid tumor was given on cytology that was confirmed on histopathology and immunohistochemistry.

  13. Level IB nodal involvement in oropharyngeal carcinoma: implications for submandibular gland-sparing intensity-modulated radiotherapy.

    Science.gov (United States)

    Yu, Yao; Daly, Megan E; Farwell, D Gregory; Luu, Quang; Gandour-Edwards, Regina; Donald, Paul J; Chen, Allen M

    2015-03-01

    Submandibular gland-sparing intensity-modulated radiotherapy (SMG-sparing IMRT) has been proposed to reduce xerostomia following head and neck irradiation. However, the safety of this practice has been questioned. Data from a large surgical series of oropharyngeal carcinoma patients were extracted to identify clinicopathological correlates for submandibular involvement and to create a risk stratification scheme to guide decision making to refine selection guidelines for SMG-sparing IMRT. Clinicopathologic analysis. The medical records of 153 consecutive patients with squamous cell carcinoma of the oropharynx treated by primary surgery and neck dissection were reviewed. Univariate and multivariate analysis was performed with logistic regression to identify factors predictive of submandibular involvement. Recursive partitioning was used to develop risk stratification schemas based on preoperative data alone and in combination with pathologic data to guide treatment decisions in the definitive and postoperative settings, respectively. Submandibular (level IB) nodal dissection was performed in 119 heminecks (85 ipsilateral and 17 contralateral). The incidence of submandibular involvement was 18%. Young age, T3-4 disease, N2b-3 disease, and perineural invasion were identified as risk factors for submandibular nodal involvement on multivariate analysis (P 60 years and N0-2a disease (low risk, 2%), age ≤60 years and T1-2N2b-3 (intermediate risk, 16%), age ≤60 years and T3-4N2b-3 disease (high risk, 57%). These data provide assurances that SMG-sparing IMRT can reasonably be offered to appropriately selected patients. Risk stratification schemas were successfully developed for SMG-sparing IMRT in both the definitive and adjuvant settings. © 2014 The American Laryngological, Rhinological and Otological Society, Inc.

  14. Recurrent pneumothorax associated with bronchial atresia: report of a case.

    Science.gov (United States)

    Tanaka, Kazuhisa; Suzuki, Hidemi; Nakajima, Takahiro; Tagawa, Tetsuzo; Iwata, Takekazu; Mizobuchi, Teruaki; Yoshida, Shigetoshi; Yoshino, Ichiro

    2015-10-01

    We herein report a case of recurrent pneumothorax associated with congenital bronchial atresia. A 26-year-old male presented with chest pain. Chest roentgenograms showed left pneumothorax, a left apical bulla and an area of hyperlucency in the left upper lung field, and chest computed tomography revealed a discontinuation of the left superior bronchus. Additionally, both ventilation and perfusion scintigraphy showed a defect in the left superior segment. A thoracoscopy-assisted left superior segmentectomy was performed, and a pathological examination indicated left superior segmental bronchial atresia, which might have predisposed the peripheral lung to emphysematous conditions. No relapse was observed 6 months after the operation. Although this entity is rare, congenital bronchial atresia should be considered in the differential diagnosis when a patient has suffered from a recurrent spontaneous pneumothorax.

  15. IMMUNOLOGICAL AND PSYCHOPHYSIOLOGICAL HETEROGENEITY AMONG PATIENTS WITH BRONCHIAL ASTHMA

    Directory of Open Access Journals (Sweden)

    A. V. Smyk

    2008-01-01

    Full Text Available Abstract. Bronchial asthma is a classic psychosomatic disease by immunopathological origin. In present investigation, we studied influence of body-oriented psychotherapeutic methods directed towards clinico-immunological parameters and special psychological features of the patients with bronchial asthma, i.e., decrease in alexithymia, as an important pathogenetic factor of bronchial asthma, and improvement in motor coordination and interhemispheric interactions in motor sphere. We investigated 38 patients (18 men and 20 women, while discriminating those patients who underwent a course of body-oriented psychotherapy, and a group of comparison, who did not undergo similar therapy. When observing conventional standards of randomization according to sex, age, clinical variants, and disease severity, some heterogeneity of these groups was revealed. In general, the people with active life attitude, being ready to work with a psychologist, possessed special features both in psychological and immunological spheres.

  16. Comparison of bronchial washing, brushing and biopsy for diagnosis of pulmonary tuberculosis.

    Science.gov (United States)

    Palenque, E; Amor, E; Bernaldo de Quiros, J C

    1987-04-01

    The diagnostic yields of bronchial washings, bronchial brushings and lung biopsy specimens were compared in 50 patients with positive Mycobacterium tuberculosis cultures. The number of positive results obtained with cultures of bronchial brushings was significantly higher than that with bronchial washings (p less than 0.001). The histological study of biopsy lung material improved the rate of immediate or rapid diagnosis of tuberculosis (p less than 0.001).

  17. Prevention of bronchial hyperreactivity in a rat model of precapillary pulmonary hypertension

    Directory of Open Access Journals (Sweden)

    Beghetti Maurice

    2011-04-01

    Full Text Available Abstract Background The development of bronchial hyperreactivity (BHR subsequent to precapillary pulmonary hypertension (PHT was prevented by acting on the major signalling pathways (endothelin, nitric oxide, vasoactive intestine peptide (VIP and prostacyclin involved in the control of the pulmonary vascular and bronchial tones. Methods Five groups of rats underwent surgery to prepare an aorta-caval shunt (ACS to induce sustained precapillary PHT for 4 weeks. During this period, no treatment was applied in one group (ACS controls, while the other groups were pretreated with VIP, iloprost, tezosentan via an intraperitoneally implemented osmotic pump, or by orally administered sildenafil. An additional group underwent sham surgery. Four weeks later, the lung responsiveness to increasing doses of an intravenous infusion of methacholine (2, 4, 8 12 and 24 μg/kg/min was determined by using the forced oscillation technique to assess the airway resistance (Raw. Results BHR developed in the untreated rats, as reflected by a significant decrease in ED50, the equivalent dose of methacholine required to cause a 50% increase in Raw. All drugs tested prevented the development of BHR, iloprost being the most effective in reducing both the systolic pulmonary arterial pressure (Ppa; 28%, p = 0.035 and BHR (ED50 = 9.9 ± 1.7 vs. 43 ± 11 μg/kg in ACS control and iloprost-treated rats, respectively, p = 0.008. Significant correlations were found between the levels of Ppa and ED50 (R = -0.59, p = 0.016, indicating that mechanical interdependence is primarily responsible for the development of BHR. Conclusions The efficiency of such treatment demonstrates that re-establishment of the balance of constrictor/dilator mediators via various signalling pathways involved in PHT is of potential benefit for the avoidance of the development of BHR.

  18. Empirical description of bronchial and nonbronchial arteries with MDCT

    Energy Technology Data Exchange (ETDEWEB)

    Yu Hong, E-mail: yuhong.2002@hotmail.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Liu Shiyuan, E-mail: cjr.liushiyuan@vip.163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Li Huimin, E-mail: yuhongphd@163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Xiao Xiangsheng, E-mail: cjr.xxsh@vip.163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China); Dong Weihua, E-mail: dongweihua2000@163.co [Department of Imageology, Changzheng hospital, Second Military Medical University, Shanghai 200003 (China)

    2010-08-15

    Purpose: We aimed to retrospectively evaluate bronchial and nonbronchial systemic arteries using multi-detector row helical computed tomographic (MDCT) angiography in patients with pulmonary disorders. Materials and Methods: Thirty-nine patients (24 men, 15 women; mean age, 63.4 years; range, 20-82 years) with congenital and acquired pulmonary disorders of the bronchial and nonbronchial systemic arteries underwent multi-detector row helical computed tomographic angiography of the thorax using a 16-detector row scanner. Each of these patients had experienced an episode of hemoptysis. Computed tomographic angiogram data, which included maximum intensity projections, multiplanar reconstruction, and three-dimensional volume-rendered images, were used to retrospectively analyse the characteristics of the bronchial and nonbronchial systemic arteries. Results: We identified a total of 128 bronchial arteries (76 on the right side and 52 on the left) in 39 patients. We detected 42 nonbronchial systemic artery branches, including 19 internal mammary artery branches, 8 subclavian artery branches, 8 inferior phrenic artery branches, 5 intercostal artery branches, 1 thyrocervical trunk branch, and 1 celiac trunk branch. Thirty-five dilated and tortuous nonbronchial systemic arteries entered into the lung parenchyma and extended down to the lesions. Every case, except the one case of sequestration, was associated with pleural thickening where the vascular structures passed through the extrapleural fat. Conclusions: The variations in both the bronchial artery anatomy and the location and type of the nonbronchial arteries were great. Nonbronchial arteries may be a significant source of hemoptysis. MDCT angiography can be used to detect detailed anatomical information about the origins and courses of bronchial and nonbronchial systemic arteries and their pathophysiologic features.

  19. Bone mineral density changes in protease inhibitor-sparing vs. nucleoside reverse transcriptase inhibitor-sparing highly active antiretroviral therapy: data from a randomized trial

    DEFF Research Database (Denmark)

    Hansen, Ann-Brit Eg; Obel, N; Nielsen, H

    2011-01-01

    The aim of the study was to compare changes in bone mineral density (BMD) over 144 weeks in HIV-infected patients initiating nucleoside reverse transcriptase inhibitor (NRTI)-sparing or protease inhibitor-sparing highly active antiretroviral therapy (HAART).......The aim of the study was to compare changes in bone mineral density (BMD) over 144 weeks in HIV-infected patients initiating nucleoside reverse transcriptase inhibitor (NRTI)-sparing or protease inhibitor-sparing highly active antiretroviral therapy (HAART)....

  20. Bronchial Sparganosis mansoni accompanied by abnormal hyperplasia diagnosed by bronchoscopy

    Institute of Scientific and Technical Information of China (English)

    BAI Jing; HE Zhi-yi; LIU Guang-nan; ZHANG Jian-quan; DENG Jing-min; LI Mei-hua; ZHONG Xiao-ning

    2012-01-01

    Pulmonary sparganosis mansoni is rare in humans and bronchial sparganosis mansoni has not been reported.We reported a patient with a soft-tissue mass in the right hilum area on a chest computed tomography (CT) scan that was suspected of being lung cancer.Bronchoscopy identified sparganum larvae.Bronchial sparganosis mansoni accompanied by abnormal hyperplasia was diagnosed by histopathology.We introduced our experience and reviewed the clinical characteristics of three pulmonary sparganosis mansoni cases and three pleural cavity sparganosis mansoni cases that have been reoorted.

  1. Change in refraction after lens-sparing vitrectomy for rhegmatogenous retinal detachment and epiretinal membrane.

    Science.gov (United States)

    Iwase, Takeshi; Yamamoto, Kentaro; Yanagida, Kosei; Kobayashi, Misato; Ra, Eimei; Murotani, Kenta; Terasaki, Hiroko

    2016-08-01

    The aim of this study was to compare changes in refraction following lens-sparing vitrectomy between patients with rhegmatogenous retinal detachment (RRD) and epiretinal membrane (ERM) and to investigate factors associated with the change in refraction.We reviewed medical records of 49 eyes of 49 patients with RRD (53.6 ± 7.8 years, mean ± standard deviation) and 24 eyes of 24 patients with ERM (50.9 ± 15.7 years) who underwent lens-sparing vitrectomy. Spherical equivalent refractive power was evaluated before and up to 18 months after surgery. The relationship between the change in refraction and several parameters was evaluated.A significant progressive myopic shift in refractive power was observed after vitrectomy in operated RRD and ERM eyes (P refraction values observed at ≥3 and ≥12 months following vitrectomy were significantly different as compared with those observed at baseline in the RRD group (P refraction between the RRD and ERM groups was significant (P = 0.030). The multiple linear regression analysis showed that only age was significantly correlated with the change in refraction in RRD (P = 0.018) and ERM (P refraction was significantly and positively correlated with age in RRD (r = -0.461, P = 0.001) and ERM (r = -0.687, P refraction owing to nuclear sclerosis was observed. Core vitrectomy itself would cause a myopic shift of refraction. The only risk factor associated with cataract progression following lens-sparing vitrectomy is age for both types of patients.

  2. Nipple Sparing Mastectomy in Patients With Prior Breast Scars: Is It Safe?

    Science.gov (United States)

    Olson, Joshua; Anderson, Layla Ann; Ying, Jian; Zhang, Min-Min; Agarwal, Jayant P

    2017-01-01

    Nipple-sparing mastectomy (NSM) preserves the native skin envelope, including the nipple-areolar skin, and has significant benefits including improved aesthetic outcome and psychosocial well-being. Patients with prior breast scars undergoing NSM are thought to be at increased risk for postoperative complications, such as skin and/or nipple necrosis. This study describes our experience performing NSM in patients who have had prior breast surgery and aims to identify potential risk factors in this subset of patients. A retrospective review of all patients undergoing nipple sparing mastectomy at The University of Utah from 2005 to 2011 was performed. Fifty-two patients had prior breast scars, for a total of 65 breasts. Scars were categorized into 4 groups depending on scar location: inframammary fold, outer quadrant, periareolar, and circumareolar. Information regarding patient demographics, social and medical history, treatment intent, and postoperative complications were collected and analyzed. Eight of the 65 breasts (12%) developed a postoperative infection requiring antibiotic treatment. Tobacco use was associated with an increased risk of infection in patients with prior breast scars (odds ratio [OR], 7.95; 95% confidence interval [CI], 1.37-46.00; P = 0.0206). There was a 13.8% rate of combined nipple and skin flap necrosis and receipt of chemotherapy (OR, 5.00; CI, 1.11-22.46; P = 0.0357) and prior BCT (OR, 12.5; CI, 2.2-71.0; P = 0.004) were found to be associated with skin flap or NAC necrosis. Nipple-sparing mastectomy is a safe and viable option for patients with a prior breast scar. Our results are comparable to the published data in patients without a prior scar. Caution should be exercised with patients who have a history of tobacco use or those requiring chemotherapy because these patients are at increased risk for infection and NAC/skin flap necrosis, respectively, when undergoing NSM in the setting of a prior breast scar.

  3. IMMUNOLOGICAL MARKERS OF UNCONTROLLED ATOPIC BRONCHIAL ASTHMA IN CHILDREN

    Directory of Open Access Journals (Sweden)

    M. V. Smolnikova

    2017-01-01

    Full Text Available Bronchial asthma is a prevalent chronic allergic disease of lungs at early ages. A priority  task in allergology  is to search  biological  markers  related  to uncontrolled atopic  bronchial asthma. Cytokines fulfill their distinct function in pathogenesis of atopic  bronchial asthma, participating at the initiation, development and persistence of allergic inflammation in airways, causing different  variations of clinical course of the disease (with  respect  to its acuteness, severity, frequency of exacerbations. The  present  work has studied  indices  of cellular  and  humoral links of immunity, as well as levels of some  pro and  anti-inflammatory cytokines in peripheral blood serum (IL-4, IL-10, IL-2 and TNFα, aiming to determine potential markers of uncontrolled atopic bronchial asthma in children. A group of Caucasian (European children was involved into the research: Cohort 1, moderate atopic  bronchial asthma with controlled course during the last 3 months (n = 59; Cohort 2, severe/moderate-severe atopic bronchial asthma with uncontrolled course of the disease within last 3 months (n = 51,  Cohort 3 – control, practically healthy  children without signs of atopy  (n = 33. All the  children included in the group with atopic  bronchial asthma underwent regular mono/combined basic therapy  at high/ intermediate therapeutic doses.  We performed a comparative analysis  of cell  population indices  reflecting certain cellular  immunity links,  and  determined significantly  lower  levels of CD3+   lymphocytes, as well as decrease in relative  and  absolute  contents of CD4+  and  CD8+  cells in the  cohort with  uncontrolled course of atopic  bronchial asthma, as compared with controlled-course cohort. When  evaluating concentrations  of cytokines in peripheral blood serum of the patients with controlled and uncontrolled atopic  bronchial asthma, we revealed  significantly  higher

  4. To Resect or Not to Resect: The Effects of Rib-Sparing Harvest of the Internal Mammary Vessels in Microsurgical Breast Reconstruction.

    Science.gov (United States)

    Wilson, Stelios; Weichman, Katie; Broer, P Niclas; Ahn, Christina Y; Allen, Robert J; Saadeh, Pierre B; Karp, Nolan S; Choi, Mihye; Levine, Jamie P; Thanik, Vishal D

    2016-02-01

    The internal mammary vessels are the most commonly used recipients for microsurgical breast reconstructions. Often, the costal cartilage is sacrificed to obtain improved vessel exposure. In an effort to reduce adverse effects associated with traditional rib sacrifice, recent studies have described less-invasive, rib-sparing strategies. After obtaining institutional review board's approval, a retrospective review of all patients undergoing microsurgical breast reconstruction at a single institution between November 2007 and December 2013 was conducted. Patients were divided into two cohorts for comparison: rib-sacrificing and rib-sparing internal mammary vessel harvests. A total of 547 reconstructions (344 patients) met inclusion criteria for this study. A total of 64.9% (n = 355) underwent rib-sacrificing internal mammary vessel harvest. Cohorts were similar in baseline patient characteristics, indications for surgery, and cancer therapies. However, patients undergoing rib-sparing reconstructions had significantly shorter operative times (440 vs. 476 minutes; p rib-sparing techniques had greater incidence of fat necrosis requiring excision (12.5 vs. 2.8%; p rib-sacrificing patients. Rib-sparing harvest of internal mammary vessels is a feasible technique in microsurgical breast reconstruction. However, given the significant increase in fat necrosis requiring surgical excision, the trend toward increased postoperative complications, and no significant difference in postoperative revision rates, the purported benefits of this technique may fail to outweigh the possible risks. Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

  5. Occupational allergic airbone contact dermatitis and delayed bronchial asthma from epoxy resin revealed by bronchial provocation test.

    Science.gov (United States)

    Kanerva, L; Estlander, T; Keskinen, H; Jolanki, R

    2000-08-01

    Diglycidyl ether of bisphenol A (DGEBA) epoxy resins belong to the most common causes of occupational allergic contact dermatitis. DGEBA has on rare occasions caused occupational asthma. Here we present a patient who first developed occupational allergic contact dermatitis (ACD) caused by a single accidental exposure to DGEBA. Then, on continued occupational exposure to DGEBA, the patient developed occupational asthma from DGEBA, in addition to ACD. A bronchial provocation test with DGEBA caused a 36% drop in the peak expiratory flow, reflecting a delayed type of occupational asthma. This bronchial provocation test caused a strong dermatitis of the exposed skin of the face, in accordance with airborne ACD from DGEBA.

  6. Additive manufacturing technology in spare parts supply chain

    DEFF Research Database (Denmark)

    Li, Yao; Jia, Guozhu; Yang, Cheng

    2017-01-01

    Additive Manufacturing (AM) technology has the potential to significantly improve supply chain dynamics. The purpose of this paper is to investigate the impact of AM on spare parts supply chain. Three supply chain scenarios are investigated in this paper, namely conventional supply chain......, centralised AM-based supply chain and distributed AM-based supply chain. Based on system dynamics simulations, this paper specifically compares three supply chain scenarios, in terms of total variable cost and carbon emission. The results show the spare part supply chain utilising AM is indeed superior...... to the traditional one in sustainable performance. It is also expected that AM can facilitate the spare parts supply chain to achieve more economic benefits along with its development. To our knowledge, this paper is one of the early studies that explores the impact of AM on supply chain performance...

  7. Additive manufacturing technology in spare parts supply chain

    DEFF Research Database (Denmark)

    Li, Yao; Jia, Guozhu; Yang, Cheng

    2016-01-01

    Additive Manufacturing (AM) technology has the potential to significantly improve supply chain dynamics. The purpose of this paper is to investigate the impact of AM on spare parts supply chain. Three supply chain scenarios are investigated in this paper, namely conventional supply chain......, centralised AM-based supply chain and distributed AM-based supply chain. Based on system dynamics simulations, this paper specifically compares three supply chain scenarios, in terms of total variable cost and carbon emission. The results show the spare part supply chain utilising AM is indeed superior...... to the traditional one in sustainable performance. It is also expected that AM can facilitate the spare parts supply chain to achieve more economic benefits along with its development. To our knowledge, this paper is one of the early studies that explores the impact of AM on supply chain performance...

  8. A hot-spare injector for the APS linac.

    Energy Technology Data Exchange (ETDEWEB)

    Lewellen, J. W.

    1999-04-13

    Last year a second-generation SSRL-type thermionic cathode rf gun was installed in the Advanced Photon Source (APS) linac. This gun (referred to as ''gun2'') has been successfully commissioned and now serves as the main injector for the APS linac, essentially replacing the Koontz-type DC gun. To help ensure injector availability, particularly with the advent of top-up mode operation at the APS, a second thermionic-cathode rf gun will be installed in the APS linac to act as a hot-spare beam source. The hot-spare installation includes several unique design features, including a deep-orbit Panofsky-style alpha magnet. Details of the hot-spare beamline design and projected performance are presented, along with some plans for future performance upgrades.

  9. Comparison of bronchial brushing and sputum in detection of pediatric pulmonary tuberculosis.

    Science.gov (United States)

    Chen, Qiao-Pei; Ren, Shi-Feng; Wang, Xin-Feng; Wang, Mao-Shui

    2016-01-27

    The retrospective study aimed to evaluate the diagnostic value of bronchial brushing and sputum using acid fast bacilli smear, mycobacterial culture and real-time PCR in detection of pediatric pulmonary tuberculosis, sensitivity and specificity of bronchial brushing and sputum examined by the three methods were calculated and compared to each other. Data showed there were no significant difference in sensitivity between bronchial brushing and matched sputum using each method. But the specificity of real-time PCR on bronchial brushing was lower than on sputum. Compared with bronchial brushing, sputum was better specimen in detection of pediatric pulmonary tuberculosis.

  10. [Determination of tumor infiltration of the bronchial wall in lung cancer].

    Science.gov (United States)

    Utkin, V V; Ozols, A Ia; Marga, O Ia

    1975-01-01

    In the article, a new method of diagnosing the extent of the tumor spread in the bronchial wall without involvement of the mucosa (a peripbronchial form of the growth) is described. The method consists of two components - angiography of bronchial arteries with subsequent injection of a staining material in the corresponding bronchial artery and bronchoscopy, by means of which staining of the mucous membrane of the bronchial tree is observed. In case of tumor infiltration of the bronchial wall staining was absent completely or partially. A clinical trial of the method indicated its high efficacy.

  11. Study for comfortable supine for patients with partial nephrectomy by robot-assisted laparoscopic nephron-sparing surgery%机器人辅助腹腔镜肾部分切除患者术后舒适卧位探讨

    Institute of Scientific and Technical Information of China (English)

    胡英娜; 周秀彬

    2014-01-01

    目的:探讨机器人辅助腹腔镜肾部分切除手术后患者最舒适的卧位。方法抽取80例行机器人腹腔镜肾部分切除手术后的患者,随机分为观察组和对照组,观察组患者手术后经医生允许采用早期舒适卧位,即颈部垫软枕、腰部垫20 cm ×20 cm硬枕仰卧位;对照组患者术后按传统方法采用平卧位。术后前2 d进行观察比较,找出患者最舒适卧位。结果观察组患者睡眠、情绪稳定及腰肌酸痛情况明显优于对照组( P<0.05)。结论机器人辅助腹腔镜肾部分切除手术后卧床期间采取颈部垫软枕、腰部垫20 cm ×20 cm硬枕的仰卧位方式,患者最舒适。%Objective To study the most comfortable lying position for post-operative patients with robot assisted laparoscopic partial nephrectomy .Method 80 post-operative patients with robot assisted laparoscopic partial nephrec-tomy surgery were randomly divided into observation group and the control group ,patients observed by doctors after surgery to allow the use of early comfort lying ,that is ,a soft pillow neck cushion ,waist cushion 20 cm × 20 cm hard pillow supine position ,tupatients in control group by traditional methods in supine position ,after 2 days of ob-servation and comparison ,to find the most comfortable lying position .Result The sleep ,comfort and lumbar pain in observation group was obviously better than that of control group (P<0 .05) .Conclusion Robot assisted laparoscop-ic partial nephrectomy surgery took the neck cushion soft pillow ,lumbar pillow pad 20 cm × 20 cm hard way the su-pine position ,the patient feels most comfortable .

  12. Study of Therapeutic Mechanism of Acupuncture in Treating Bronchial Asthma

    Institute of Scientific and Technical Information of China (English)

    LI; Ji

    2001-01-01

    It has been considered by modern medicine that bronchial asthma is a chronic airway allergic inflammation (AAI) which is the major factor that induces reversible airway ventilating disturbance and bronchial hyper-responsiveness (BHR) in asthmatic patients, as well as a correlation between the delayed-phase onset of asthma and AAI is more significant than immediate-phase onset of asthma in its pathogenesis. Anti-inflammatory therapy as a fundamental principle of treatment for bronchial asthma has been brought forward during the interval phase so that a large number of anti-AAI drugs to significantly enhance the curative effect such as inhalant corticoid, disodium cromoglycate, and leukotriene receptors antagonist, etc., has been rapidly developed. Additionally, traditional Chinese medicine (TCM) and integration of TCM and western medicine (WM) therapies, including acupuncture, are gradually taken into account by the medical circle as a characteristic in our country for treatment of bronchial asthma. It is worthy of being pointed out that the curative effect of acupuncture and moxibustion in treating asthma is evident, and that its therapeutic mechanism has to a certain extent, been found along with the recent deep-going acupunctural research.……

  13. Study of Therapeutic Mechanism of Acupuncture in Treating Bronchial Asthma

    Institute of Scientific and Technical Information of China (English)

    2001-01-01

    @@  It has been considered by modern medicine that bronchial asthma is a chronic airway allergic inflammation (AAI) which is the major factor that induces reversible airway ventilating disturbance and bronchial hyper-responsiveness (BHR) in asthmatic patients, as well as a correlation between the delayed-phase onset of asthma and AAI is more significant than immediate-phase onset of asthma in its pathogenesis. Anti-inflammatory therapy as a fundamental principle of treatment for bronchial asthma has been brought forward during the interval phase so that a large number of anti-AAI drugs to significantly enhance the curative effect such as inhalant corticoid, disodium cromoglycate, and leukotriene receptors antagonist, etc., has been rapidly developed. Additionally, traditional Chinese medicine (TCM) and integration of TCM and western medicine (WM) therapies, including acupuncture, are gradually taken into account by the medical circle as a characteristic in our country for treatment of bronchial asthma. It is worthy of being pointed out that the curative effect of acupuncture and moxibustion in treating asthma is evident, and that its therapeutic mechanism has to a certain extent, been found along with the recent deep-going acupunctural research.

  14. Assessment of Serum Vitamin D in Patients with Bronchial Asthma

    Directory of Open Access Journals (Sweden)

    Hisham E. Abd El Aaty

    2015-01-01

    Conclusions: Vitamin D deficiency was highly prevalent in asthmatic patients, there was a strong correlation between asthma severity and 25(OH vitamin D concentrations and there was a direct and a positive significant correlation between vitamin D levels and pulmonary function tests in asthmatic patients, so the measurement of serum vitamin D levels in patients with bronchial asthma is very useful.

  15. Mechanical compression attenuates normal human bronchial epithelial wound healing

    Directory of Open Access Journals (Sweden)

    Malavia Nikita

    2009-02-01

    Full Text Available Abstract Background Airway narrowing associated with chronic asthma results in the transmission of injurious compressive forces to the bronchial epithelium and promotes the release of pro-inflammatory mediators and the denudation of the bronchial epithelium. While the individual effects of compression or denudation are well characterized, there is no data to elucidate how these cells respond to the application of mechanical compression in the presence of a compromised epithelial layer. Methods Accordingly, differentiated normal human bronchial epithelial cells were exposed to one of four conditions: 1 unperturbed control cells, 2 single scrape wound only, 3 static compression (6 hours of 30 cmH2O, and 4 6 hours of static compression after a scrape wound. Following treatment, wound closure rate was recorded, media was assayed for mediator content and the cytoskeletal network was fluorescently labeled. Results We found that mechanical compression and scrape injury increase TGF-β2 and endothelin-1 secretion, while EGF content in the media is attenuated with both injury modes. The application of compression after a pre-existing scrape wound augmented these observations, and also decreased PGE2 media content. Compression stimulated depolymerization of the actin cytoskeleton and significantly attenuated wound healing. Closure rate was partially restored with the addition of exogenous PGE2, but not EGF. Conclusion Our results suggest that mechanical compression reduces the capacity of the bronchial epithelium to close wounds, and is, in part, mediated by PGE2 and a compromised cytoskeleton.

  16. Inhaled Mannitol as a Laryngeal and Bronchial Provocation Test.

    Science.gov (United States)

    Tay, Tunn Ren; Hoy, Ryan; Richards, Amanda L; Paddle, Paul; Hew, Mark

    2017-03-01

    Timely diagnosis of vocal cord dysfunction (VCD), more recently termed "inducible laryngeal obstruction," is important because VCD is often misdiagnosed as asthma, resulting in delayed diagnosis and inappropriate treatment. Visualization of paradoxical vocal cord movement on laryngoscopy is the gold standard for diagnosis, but is limited by poor test sensitivity. Provocation tests may improve the diagnosis of VCD, but the diagnostic performance of current tests is less than ideal. Alternative provocation tests are required. This pilot study demonstrates the feasibility of using inhaled mannitol for concurrent investigation of laryngeal and bronchial hyperresponsiveness. Consecutive patients with suspected VCD seen at our institution's asthma clinic underwent flexible laryngoscopy at baseline and following mannitol challenge. VCD was diagnosed on laryngoscopy based on inspiratory adduction, or >50% expiratory adduction of the vocal cords. Bronchial hyperresponsiveness after mannitol challenge was also assessed. We evaluated the interrater agreement of postmannitol laryngoscopy between respiratory specialists and laryngologists. Fourteen patients with suspected VCD in the context of asthma evaluation were included in the study. Mannitol provocation demonstrated VCD in three of the seven patients with normal baseline laryngoscopy (42.9%). Only two patients had bronchial hyperresponsiveness. There was substantial interrater agreement between respiratory specialists and laryngologists, kappa = 0.696 (95% confidence interval: 0.324-1) (P = 0.006). Inhaled mannitol can be used to induce VCD. It is well tolerated and can evaluate laryngeal and bronchial hyperresponsiveness at the same setting. Copyright © 2017 The Voice Foundation. Published by Elsevier Inc. All rights reserved.

  17. Lung function, bronchial hyperresponsiveness, and atopy among firefighters

    NARCIS (Netherlands)

    Greven, Frans; Krop, Esmeralda; Spithoven, Jack; Rooyackers, Jos; Kerstjens, Huib; Heederik, Dick

    2011-01-01

    Objectives The aim of this study was to determine associations between lung function, bronchial hyperresponsiveness (BHR), and atopy with exposure to fire smoke among firefighters. Methods The study was comprised of 402 firefighters, a randomly chosen subset of a previous survey among firefighters i

  18. Dry powder formulation in the twincertm for bronchial challenge testing

    NARCIS (Netherlands)

    Lexmond, A.J.; Hagedoorn, P.; Frijlink, H.W.; Ten Hacken, N.H.T.; Steckel, H.; De Boer, A.H.

    2013-01-01

    Summary Background: In bronchial challenge testing lung deposition of the stimulus may be poorly controlled due to incorrect use of nebulisers. Furthermore, the need for freshly prepared solutions burdens personnel and budget. In this study we aim to develop a dry powder alternative with higher repr

  19. Thyroid Surgery

    Science.gov (United States)

    ... Fax/Phone Home » Thyroid Surgery Leer en Español Thyroid Surgery GENERAL INFORMATION Your doctor may recommend that ... made in conjunction with your endocrinologist and surgeon. Thyroid Surgery FAQs QUESTIONS AND CONSIDERATIONS When thyroid surgery ...

  20. Plastic Surgery

    Science.gov (United States)

    ... Surgery? A Week of Healthy Breakfasts Shyness Plastic Surgery KidsHealth > For Teens > Plastic Surgery Print A A ... forehead lightened with a laser? What Is Plastic Surgery? Just because the name includes the word "plastic" ...

  1. Inventory Management of a Plant Spare Parts Supply Chain

    Institute of Scientific and Technical Information of China (English)

    ZHANG Ping; ZHOU Zu-de; CHEN You-ping; NI Long-yu

    2007-01-01

    In spare parts industries, firms are dealing with a situation which is more and more uncertain due to the supply chain structure and variable demands. This paper presents a Bayesian approach to forecast demand and subsequently determine the appropriate parameter S of an (S - 1; S) inventory system for controlling plant spare parts. We apply the Bayesian approach in an innovative way to specify the initial prior distributions of the failure rates, using the initial estimates and the failure history of similar items. According to the proposed method, a lower base stock than the one currently used is sufficient to achieve the desired service level.

  2. [Surgery of aortic dissection: for which patient?].

    Science.gov (United States)

    Verhoye, Jean-Philippe; Abouliatim, Issam; Larralde, Antoine; Beneux, Xavier; Heautot, Jean-François

    2011-01-01

    In the acute stage (less than two weeks), surgery is indicated for Stanford type A aortic dissections. With respect to the initial work-up, surgery consists in replacing the ascending aorta, sometimes the aortic arch (with supra aortic vessels reimplantation), and aortic valve replacement (valve replacement, Bentall valved tube or valve sparing Tyron David technique). Ischemic visceral complications must be searched for and treated by endovascular techniques or surgery. Aneurismal evolution of chronic dissections must be treated surgically. Replacement can encompass the entire aorta. Copyright © 2010. Published by Elsevier Masson SAS.

  3. [Skin-sparing mastectomy: an alternative to conventional mastectomy in breast cancer].

    Science.gov (United States)

    Ramos Boyero, Manuel

    2008-10-01

    Women who require or desire mastectomy for breast cancer one option should be immediate breast reconstruction. Skin-sparing mastectomy (SSM) describes the surgery that maximises breast skin and infra- mammary fold preservation, significantly improves the symmetry and natural appearance and a more satisfied patient. In multiple studies, SSM seems to be oncologically safe in patients undergoing mastectomy for invasive T1-T2 tumours, multicentric tumours, ductal carcinoma in situ or risk-reduction. However, the technique should be avoided in patients with inflammatory breast cancer or in those with extensive tumour involvement of the skin. SSM with nipple areola complex preservation appears to be oncologically safe, providing that the tumour is not close to the nipple and the retro-areolar tissue is free of tumour. Though adjuvant radiotherapy is not an absolute contraindication to SSM, it should be used with caution since it decreases the final cosmetic result.

  4. A new method to deliver supraclavicular radiation in breast radiotherapy for lung sparing.

    Science.gov (United States)

    Yang, Bo; Dong, Zhang; Lin, Mu-Han; Ma, C-M

    2011-04-18

    Due to the angulation of the breast board used for tangential breast irradiation, additional normal lung tissues are included in the supraclavicular field. This work investigates a method to reduce the lung volume and dose delivered during supraclavicular irradiation for breast cancer. Ten patients included for this retrospective study received chest wall and supraclavicular irradiation following radical surgery or breast-conserving surgery. Three-dimensional conformal radiation therapy plans were generated using the CMS XiO treatment planning system. The clinical target volume (CTV) of the supraclavicular irradiation is defined as the subcutaneous tissues from 0.5 cm under the anterior skin surface to a 3 cm depth. Only the ipsilateral lung is defined as the organ at risk. In the new method, the couch is rotated 90° and the supraclavicular field is tilted to maintain a normal incident angle to the breast board rather than the couch surface to spare more normal lung tissues. The absolute volume of the ipsilateral lung irradiated, and the volumes of lung tissues receiving 5 Gy and 20 Gy (V5 and V20) are analyzed. The new method can reduce the lung volume irradiated by the supraclavicular field significantly. For the ten patients investigated, only 5.3% of the ipsilateral lung is irradiated with the new method, while 14.9% of the ipsilateral lung is irradiated using the conventional method. Compared with the conventional method, the new method reduces V5 by 53.6% and V20 by 59.0%. Our new method does not alter the patient positioning for breast treatment but rotates the couch to deliver a tilted supraclavicular field to maintain adequate CTV coverage and spare more normal lung tissues. The results of this study demonstrated that our new method is effective, and that the reduction of normal lung tissue volume in the field is significant.

  5. Muscle-Sparing Blepharoplasty: A Prospective Left-Right Comparative Study

    Science.gov (United States)

    Kiang, Lee; Deptula, Peter; Mazhar, Momal; Murariu, Daniel

    2014-01-01

    Background Standard upper blepharoplasty involves removal of both the skin and a portion of the underlying orbicularis oculi muscle. The senior author had observed sluggishness of eyelid closure, lagophthalmos as well as varying degrees of eye irritation in certain patients during the early postoperative period. He postulated that these findings could be due to orbicularis muscle excision. He therefore undertook a prospective study 27 years ago comparing standard blepharoplasty on one eyelid to skin-only excision on the fellow eyelid. Methods A randomized, prospective, single-blinded study was designed using the fellow eye as an internal control. 22 patients undergoing upper blepharoplasty procedure requiring greater than 5 mm of skin resection and with no history of ophthalmologic disease, dry eye, or previous eyelid surgery were selected. Upper blepharoplasty was performed with skin-only removal on one side, and combined skin-muscle removal on the other side. Patients were evaluated until six months after surgery except for two patients who were lost to follow-up after three months. Sluggish eyelid closure, lagophthalmos, dry eye and aesthetic result were outcome measures scored by patient survey, the operating surgeon, and a blinded expert panel. Results There were comparable aesthetic outcomes in both eyelids. The incidence of sluggish eyelid closure, lagophthalmos and dry eye syndrome were significantly higher in eyelids where wide segments of muscle had been resected. Conclusions Muscle-sparing upper blepharoplasty produces similar aesthetic outcomes as conventional blepharoplasty, while significantly reducing the complications of sluggish eyelid closure, lagophthalmos and dry eye disease. The authors therefore recommend muscle-sparing upper blepharoplasty. PMID:25276652

  6. Muscle-Sparing Blepharoplasty: A Prospective Left-Right Comparative Study

    Directory of Open Access Journals (Sweden)

    Lee Kiang

    2014-09-01

    Full Text Available BackgroundStandard upper blepharoplasty involves removal of both the skin and a portion of the underlying orbicularis oculi muscle. The senior author had observed sluggishness of eyelid closure, lagophthalmos as well as varying degrees of eye irritation in certain patients during the early postoperative period. He postulated that these findings could be due to orbicularis muscle excision. He therefore undertook a prospective study 27 years ago comparing standard blepharoplasty on one eyelid to skin-only excision on the fellow eyelid.MethodsA randomized, prospective, single-blinded study was designed using the fellow eye as an internal control. 22 patients undergoing upper blepharoplasty procedure requiring greater than 5 mm of skin resection and with no history of ophthalmologic disease, dry eye, or previous eyelid surgery were selected. Upper blepharoplasty was performed with skin-only removal on one side, and combined skin-muscle removal on the other side. Patients were evaluated until six months after surgery except for two patients who were lost to follow-up after three months. Sluggish eyelid closure, lagophthalmos, dry eye and aesthetic result were outcome measures scored by patient survey, the operating surgeon, and a blinded expert panel.ResultsThere were comparable aesthetic outcomes in both eyelids. The incidence of sluggish eyelid closure, lagophthalmos and dry eye syndrome were significantly higher in eyelids where wide segments of muscle had been resected.ConclusionsMuscle-sparing upper blepharoplasty produces similar aesthetic outcomes as conventional blepharoplasty, while significantly reducing the complications of sluggish eyelid closure, lagophthalmos and dry eye disease. The authors therefore recommend muscle-sparing upper blepharoplasty.

  7. Functional and Radiographic Outcomes Following Growth-Sparing Management of Early-Onset Scoliosis.

    Science.gov (United States)

    Johnston, Charles E; Tran, Dong-Phuong; McClung, Anna

    2017-06-21

    In this study, we sought to evaluate radiographic, functional, and quality-of-life outcomes of patients who have completed growth-sparing management of early-onset scoliosis. This prospective study involved patients with early-onset scoliosis who underwent growth-sparing treatment and either "final" fusion or observation for ≥2 years since the last lengthening procedure. Demographics, radiographic parameters, pulmonary function test (PFT) values, and scores of patient-reported assessments (Early-Onset Scoliosis Questionnaire [EOSQ] and Scoliosis Research Society [SRS]-30) were obtained. At the most recent follow-up, patients performed 2 additional functional outcome tests: step-activity monitoring and a treadmill exercise-tolerance test. Twelve patients were evaluated as "graduates" of growth-sparing management of early-onset scoliosis (mean of 37 months since the most recent surgery). The major scoliosis curve measurement averaged 88° before treatment and 47° at the most recent follow-up. T1-S1 height increased from a mean of 22.3 cm to 34.7 cm and T1-T12 height, from 13.3 to 22.3 cm. At the most recent follow-up, the mean forced expiratory volume in 1 second (FEV1) and forced vital capacity (FVC) as a percentage of the predicted volume were 52.1% and 55.3%, respectively, and were essentially unchanged from the earliest PFT that patients could perform (FEV1 = 53.8% of predicted and FVC = 53.5% of predicted). There was no difference between graduates and controls with respect to activity time or total steps in step-activity monitoring, and in the exercise-tolerance test, graduates walked at the same speed but at a higher heart rate and at a significantly higher (p scoliosis appears to be spine elongation and maintenance of pulmonary function at a level that is no less than the percentage of normal at initial presentation. Functional testing and patient-reported outcomes at a mean of 3 years from the last surgery suggest that activity levels were generally equal

  8. Selective Alexia and Agraphia Sparing Numbers--A Case Study

    Science.gov (United States)

    Starrfelt, Randi

    2007-01-01

    We report a patient (MT) with a highly specific alexia affecting the identification of letters and words but not numbers. He shows a corresponding deficit in writing: his letter writing is impaired while number writing and written calculation is spared. He has no aphasia, no visuo-perceptual or -constructional difficulties, or other cognitive…

  9. Wnt and Extraocular Muscle Sparing in Amyotrophic Lateral Sclerosis

    OpenAIRE

    2014-01-01

    The potential role of Wnt signaling factors in extraocular muscle (EOM) sparing in amyotrophic lateral sclerosis (ALS) was examined. Three of the Wnts were preferentially upregulated in EOM, suggesting that they may be involved in maintenance of neuromuscular junctions in the EOM of ALS patients.

  10. Service differentiation in spare parts supply through dedicated stocks

    NARCIS (Netherlands)

    Alvarez, Elisa; van der Heijden, Matthijs C.; Zijm, Willem H.M.

    2012-01-01

    We investigate keeping dedicated stocks at customer sites in addition to stock kept at some central location as a tool for applying service differentiation in spare parts supply. We study the resulting two-echelon system in a multi-item setting, both under backordering and under emergency shipments

  11. Sparing land for biodiversity at multiple spatial scales

    Directory of Open Access Journals (Sweden)

    Johan eEkroos

    2016-01-01

    Full Text Available A common approach to the conservation of farmland biodiversity and the promotion of multifunctional landscapes, particularly in landscapes containing only small remnants of non-crop habitats, has been to maintain landscape heterogeneity and reduce land-use intensity. In contrast, it has recently been shown that devoting specific areas of non-crop habitats to conservation, segregated from high-yielding farmland (‘land sparing’, can more effectively conserve biodiversity than promoting low-yielding, less intensively managed farmland occupying larger areas (‘land sharing’. In the present paper we suggest that the debate over the relative merits of land sparing or land sharing is partly blurred by the differing spatial scales at which it is suggested that land sparing should be applied. We argue that there is no single correct spatial scale for segregating biodiversity protection and commodity production in multifunctional landscapes. Instead we propose an alternative conceptual construct, which we call ‘multiple-scale land sparing’, targeting biodiversity and ecosystem services in transformed landscapes. We discuss how multiple-scale land sparing may overcome the apparent dichotomy between land sharing and land sparing and help to find acceptable compromises that conserve biodiversity and landscape multifunctionality.

  12. Laryngeal Muscles Are Spared in the Dystrophin Deficient "mdx" Mouse

    Science.gov (United States)

    Thomas, Lisa B.; Joseph, Gayle L.; Adkins, Tracey D.; Andrade, Francisco H.; Stemple, Joseph C.

    2008-01-01

    Purpose: "Duchenne muscular dystrophy (DMD)" is caused by the loss of the cytoskeletal protein, dystrophin. The disease leads to severe and progressive skeletal muscle wasting. Interestingly, the disease spares some muscles. The purpose of the study was to determine the effects of dystrophin deficiency on 2 intrinsic laryngeal muscles, the…

  13. Land sharing not sparing in the “green economy”

    NARCIS (Netherlands)

    Dressler, Wolfram; Koning, de Jessica; Montefrio, Marvin; Firn, Jennifer

    2016-01-01

    In Southeast Asia’s green economy, conservation interventions intensify the production of resources as commodities through land sparing activities and zoning in extensively used landscapes. Such initiatives encounter problems where poor resource users diversify livelihoods in multi-functional landsc

  14. A Combined Forecast-Inventory Control Procedure for Spare Parts

    NARCIS (Netherlands)

    Heuts, R.M.J.; Strijbosch, L.W.G.; van der Schoot, E.H.M.

    1999-01-01

    The interaction between forecast and inventory control has been under-exposed in the literature. This paper introduces a combined forecast-inventory control procedure that is appropriate especially for the lumpy demand character of spare parts. The proposed procedure is succesfully implemented in

  15. Model Development for Auto Spare Parts Inventory Control and ...

    African Journals Online (AJOL)

    2012-12-01

    Dec 1, 2012 ... The management of these parts can only be done with the aid of a computer; hence the spare ... type of costs or consequences as the case ... Supply. Chain Simulation applied to the case study provides useful insights on the decision choices .... (1999) “A combined forecast-inventory control procedure for.

  16. Land sharing not sparing in the “green economy”

    NARCIS (Netherlands)

    Dressler, Wolfram; Koning, de Jessica; Montefrio, Marvin; Firn, Jennifer

    2016-01-01

    In Southeast Asia’s green economy, conservation interventions intensify the production of resources as commodities through land sparing activities and zoning in extensively used landscapes. Such initiatives encounter problems where poor resource users diversify livelihoods in multi-functional landsc

  17. High success rate and considerable adverse events of pelvic prolapse surgery with Prolift: A single center experience

    Directory of Open Access Journals (Sweden)

    Mun-Kun Hong

    2013-09-01

    Conclusions: Prolapse surgery with Prolift yielded a good anatomical outcome and satisfactory symptom improvement at different periods of follow-up, especially in uterus-sparing prolapse surgery. However, adverse events were not uncommon, and patients should be fully informed of all possible adverse events prior to surgery.

  18. Interventional pulmonology for asthma and emphysema: bronchial thermoplasty and bronchoscopic lung volume reduction.

    Science.gov (United States)

    Miller, Russell J; Murgu, Septimiu D

    2014-12-01

    Emphysema and asthma are responsible for economic and social burden. Altering the natural course of these diseases is a field of intense research. The National Emphysema Treatment Trial showed that lung volume reduction surgery (LVRS) could significantly reduce both morbidity and mortality in properly selected patients. LVRS is seldom performed, however, due to the high morbidity associated with the surgery. Numerous bronchoscopic interventions have been introduced with the goal of providing the clinical benefits of LVRS without the surgical complications. Thus far, these modalities have not produced the results once hoped. However, through active modification of both technique and patient selection, the role of minimally invasive modalities in the treatment of emphysema continues to evolve. Bronchial thermoplasty (BT) is a method of delivering controlled heat to airway mucosa with the goal of reducing airway smooth muscle mass and hence bronchoconstriction. In patients suffering from asthma who cannot achieve control with standard medical care, BT has been shown to be safe and improves symptoms, with long lasting benefit. BT does not seem to affect traditional markers of asthma severity such as forced expiratory volume in 1 second and questions remain regarding proper patient selection for this therapy and its true physiologic effects. This article is a review of bronchoscopic modalities for emphysema and asthma.

  19. Efficacy of naturopathy and yoga in bronchial asthma.

    Science.gov (United States)

    Rao, Y Chitharanjan; Kadam, Avinash; Jagannathan, Aarti; Babina, N; Rao, Raghavendra; Nagendra, Hongasandra Ramarao

    2014-01-01

    The aim of the study was to test the efficacy of a one month in-patient naturopathy and yoga programme for patients with asthma. Retrospective data of 159 bronchial asthma patients, undergoing the naturopathy and yoga programme, was analyzed for Forced Vital Capacity, Forced Expiratory Volume at the end of 1 second, Maximum Voluntary Ventilation and Peak Expiratory Flow Rate on admission, 11th day, on discharge and once in three months for three years. The paired sample t test results showed significant increase in the Forced Vital Capacity and Forced Expiratory Volume from the date of admission up to 6th month (P naturopathy and yoga for the management of bronchial asthma.

  20. CYTOKINE RECEPTORS OF BLOOD LYMPHOCYTES IN CHILDREN WITH BRONCHIAL ASTHMA

    Directory of Open Access Journals (Sweden)

    I.A. Gromov

    2006-01-01

    Full Text Available Blood lymphocyte membrane receptors to IFNγ, IL 2, IL 4, IL 5, IL 8 and IL 10 have been investigated to assess cytokine sensitivity variations in children with asthma. Thirty children aged 5–17 with remission of atopic bronchial asthma ranging from mild to moderate persistent formed the study group. Ten children without any atopic disorders formed the group of controls. The flow cytometry with direct reaction of monoclonal antibodies to the mentioned above cytokine receptors has been used. An increased expression of IL 2 (due to high affinity CD122 subunit and IL 5 receptors has been registered in children with asthma, and so a numbers of cells bearing IL 4 and IL 8 receptors that has trended to be higher. At the same time, there has been a decrease of IFNγ receptor expression an a trend to lower expression of IL 10 receptor in these children.Key words: bronchial asthma, children, interferon-γ, interleukins.

  1. Features of Extracranial Hemodynamics in Children with Bronchial Asthma

    Directory of Open Access Journals (Sweden)

    S.M. Nedelska

    2014-11-01

    Full Text Available The paper analyzes the performance of extracranial hemodynamics — volumetric and linear blood flow velocity, the state of peripheral vascular resistance and vascular reactivity at ultrasound Doppler examination of the internal carotid and vertebral arteries of 66 children with bronchial asthma and and 22 healthy children. Development of regional hypoperfusion in vertebrobasilar zone, disorders of the carotid system are proven, but these changes have not led to a decrease in the volumetric blood flow velocity in both internal carotid arteries and the total volume of cerebral blood flow, indicating the compensation of hemodynamic disturbances due to the influence of constant rates in volumetric blood flow in the carotid system. Changes in parameters of extracranial hemodynamics in children with bronchial asthma should be considered as predictor of cerebrovascular complications in this group of patients.

  2. CT findings of the patients with bronchial asthma

    Energy Technology Data Exchange (ETDEWEB)

    Katagiri, Shiro; Ohshima, Kazuki [Chiba-Tokusyukai Hospital, Funabashi (Japan); Ohsawa, Takehiko

    1996-06-01

    CT scans were obtained in 45 patients with bronchial asthma including 23 patients during asthmatic attack. CT findings were as follows. (1) In all cases, thickening of bronchial wall throughout from central to peripheral bronchi and without tapering and/or slight swelling of bronchovascular bundles were observed. (2) Characteristics findings in 23 patients with asthmatic attack, lobular and multilobular high attenuation area were observed in 17 patients (74%) and nonhomogeneous attenuation in lung fields were noticed in 13 patients (57%). (3) Multiple centrilobular sized high attenuation area were observed in 23 patients, but it was difficult to differenciation whether these findings were due to tiny nodules or to small vessels. In conclusion, further studies are needed to know which pathomorphological and/or pathophysiological conditions are underlying these CT findings. (author)

  3. Study on Fuzzy Decision for Purchasing Spare Parts for Machinery Equipment

    Institute of Scientific and Technical Information of China (English)

    YANG Cheng-xian; ZHANG Qi

    2003-01-01

    For purchasing spare parts for machinery products, the general principle, procedure and method are put forward in the paper. Fuzzy theory and method are applied to set up a decisive model for purchasing spare parts. By working out the kinds and quantities of spare parts, the purchase of parts is provided with scientific decision.

  4. Modulation of the Cholinergic Mechanisms in the Bronchial Smooth Muscle.

    Science.gov (United States)

    1984-06-01

    Ginsborg and Hirst, 1q72; Sawynok and Jhamandas, 1976), although theopylline has not shown to be a specific adenosine receptor antagonist in all the tissues... theopylline and other cyclic nucletide phosphodiesterase inhibitors. Acta Pharmacol. Toxicol. 45, 336-344. Fredholm, B.B. and P. Hedqvist, 1980...51 mM) evoked release of [3H]-Ach from cholinergic nerves in the bronchial smooth muscle. The effect of theopylline (I mM) on the response to

  5. Aeroallergen sensitivity among patients suffering from bronchial asthma in Bangalore

    Directory of Open Access Journals (Sweden)

    Giriyanna Gowda

    2013-01-01

    Full Text Available Background: Asthma is a serious public health problem throughout the world and its prevalence has increased in last 2-3 decades. Allergens are one of the many factors which trigger an attack of asthma. Skin prick test is useful in identifying the offending allergen in bronchial asthma. Aim: To identify the possible offending allergens in patients of bronchial asthma. Materials and Methods: The study was a descriptive study conducted at allergy center, Kempegowda Institute of Medical Sciences Hospital and Research Center, Bangalore from January to December 2011. Skin prick test was done in 139 patients suffering from bronchial asthma using 49 allergens extracts. Statistical Analysis: Frequency, proportions, Chi-square test, odds ratio, and 95% confidence interval was used. Results: Out of 139 patients who underwent the skin prick tests, 40% (56 were males and 60% (83 were females. Majority, that is, 60% were in the age group of 21-40 years. Forty-three percent (60 had family history of asthma/atopy, 80% (111 had allergic rhinitis, 24% (34 had chronic urticaria, and 24% (33 had allergic conjunctivitis. Out of 139 patients, 100 (71.94% were sensitive for one or more allergens. The common offending allergens found in the study were dust mites (Dermatophagoides farinae and D. pteronyssinus (DF and DP - 49.28%, dusts - 7.2%, pollens - 6.77%, insects - 6.62%, fungi - 4.53%, and epithelia - 1.92%. Conclusion: The most common allergens in bronchial asthma were dust mites followed by dusts and pollens. Identifying possible allergens in asthma patients help in allergen avoidance and immunotherapy in these patients.

  6. Use motion games in exercise with children with bronchial asthma

    Directory of Open Access Journals (Sweden)

    Viktoriya Polkovnyk-Markova

    2016-02-01

    Full Text Available Purpose: to analyze the possibility of using moving games in the rehabilitation of children with bronchial asthma. Material & Methods: the modern scientific literature on integrated prevention and treatment of children with asthma. Results: A high frequency of morphological and functional deviations at children with asthma. Classification and examples of mobile games, which can be used for this group of children. Conclusions: the results of modern research that show the effectiveness the use of physical rehabilitation, including moving games.

  7. Temperament and stress coping styles in bronchial asthma patients

    Science.gov (United States)

    Kuna, Piotr; Witusik, Andrzej; Wujcik, Radosław; Antczak, Adam; Pietras, Tadeusz

    2016-01-01

    Introduction Temperament, defined as the formal characteristics of behavior, is a personality trait which can influence the clinical presentation and course of bronchial asthma. It determines susceptibility to stress as well as stress coping styles. Aim The aim of the study was to assess whether healthy subjects differ from bronchial asthma patients with regard to temperamental variables and stress coping styles, and whether these factors may also differentiate patients with severe asthma from those with the milder form. The study also assesses whether the results of flow volume curve analysis correlate with temperamental traits and stress coping styles. Material and methods The study was conducted in a group of 65 asthma patients and 62 healthy controls. All underwent flow volume curve examination and psychological tests: Formal Characteristics of Behavior – Temperament Inventory (FCB-TI) and Coping in Stress Situations (CISS) questionnaire. Results Bronchial asthma patients were characterized by a lower level of briskness (“agility”) than healthy subjects (13.35 ±4.48 vs. 14.97 ±3.98, p = 0.031). The remaining temperamental traits and stress coping styles did not differ between the groups. Additionally, the forced expiratory volume in 1 s (FEV1) value was found to correlate negatively with the intensity of the emotion-oriented stress coping style, whereas FEV1 and forced vital capacity (FVC) were found to positively correlate with briskness, emotional reactivity and endurance, while a negative correlation was found with activity. Conclusions Briskness differentiates healthy subjects from bronchial asthma patients. The values obtained in FEV1 and FVC pulmonary function tests were also found to correlate with some temperamental variables. PMID:28035226

  8. Sleeve resection for delayed presentation of traumatic bronchial transection.

    LENUS (Irish Health Repository)

    Mohamed, H Y

    2010-02-01

    Tracheobronchial disruption is uncommon in blunt chest trauma. Many of these patients die before reaching the hospital. In the majority of survivors diagnosis is occasionally delayed resulting in complications like airway stenosis and lung collapse. Thus it is important to have radiological follow up after severe thoracic trauma. Sleeve resection can be an excellent option to conserve lung tissue in delayed presentation of bronchial transection.

  9. Effects of the morphine-lidocaine-ketamine combination on cardiopulmonary function and isoflurane sparing in sheep

    Directory of Open Access Journals (Sweden)

    Suzane Lilian Beier

    2014-10-01

    Full Text Available The aims of this study were to evaluate the isoflurane sparing and clinical effects of a constant rate infusion of morphine – lidocaine – ketamine (MLK in healthy sheep undergoing experimental gastrointestinal surgery. Twelve adult female sheep (Texel breed were used, weighing 36.5 ± 8.1 kg. The sheep were anesthetized for the implantation of duodenal cannulas. The sheep were premedicated with 0.3 mg kg-1 intramuscular (IM morphine and 20 ?g kg-1 intravenous (IV detomidine. After premedication, anesthesia was induced using 5 mg kg-1 ketamine and 0.5 mg kg-1 diazepam IV and maintained using isoflurane in 100% oxygen. After the induction of anesthesia, the animals were allocated into two groups (each n=6; the GMLK (MLK group – 10 mg morphine, 150 mg lidocaine, 30 mg de ketamine were added in 500 mL saline received a 10 mL kg-1h-1 MLK infusion during the maintenance of anesthesia, and GCON (control group received 10 mL kg-1h-1 of 0.9% sodium chloride. The animals were mechanically ventilated. Cardiopulmonary variables and end-tidal isoflurane concentration (FE´Iso were measured at baseline (immediately before the surgery and 15, 30 and 45 minutes after initiation of surgery. In GMLK, there was a decrease in the FE´Iso at 15, 30 and 45 minutes, a reduction of up to 75.6% during the surgery. The HR was lower in GMLK compared with GCON at 30 minutes, and the MAP was at during baseline in GCON compared with GMLK. The standing time was less in GMLK than in GCON. The use of intravenous MLK was demonstrated to offer great efficiency as part of a balanced anesthesia protocol in sheep, with a 75.6% reduction in the need for isoflurane, providing stability of the cardiovascular parameters and blood gases with a shortened recovery period.

  10. Foreign body granulomas in the left main bronchus resulting from the sutures for esophageal cancer surgery: the report of two cases

    Institute of Scientific and Technical Information of China (English)

    JIAO Yang; SHANG Yan; LI Qiang; WANG Yang; WU Ning; WANG Qin; WANG Xiang-qi; XIA Ying

    2012-01-01

    In this report,we present two cases of bronchial foreign body granulomas caused by the suture ties used in bronchial surgery for esophageal cancer.Both of them was hospitalized as “tumor transfer or an invasion”,but pathological examination of the neoplasms indicated an inflammatory granuloma showing reaction to the foreign body,These two cases give us an attention that the neoplasms in tracheal or bronchial was not only the invasion or transfer of the primary tumor,but also the possibility of grenuloma development due to the surgical sutures.

  11. Dermal and bronchial hyperreactivity in urticarial dermographism and urticaria factitia.

    Science.gov (United States)

    Henz, B M; Jeep, S; Ziegert, F S; Niemann, J; Kunkel, G

    1996-03-01

    For investigation of a possible relationship between cutaneous and bronchial hyperreactivity, 74 subjects were grouped according to the presence (n = 33) or absence (n = 41) of urticarial dermographism after application of a standardized shearing pressure with a dermographometer (12.7 x 10(5) Pa). the two groups did not differ in age, sex, smoking habits, presence of urticaria and atopy, or serum IgE levels. Erythema of the dermographic test sites was always significantly greater (P dermographism at 2, 4, and 8 min, and cutaneous reactivity with titrated prick tests was significantly increased in this group with low concentrations of histamine, 0.01% and substance P (0.25 mM) (P dermographism, exhibited bronchial hyperreactivity. However, significantly more subjects with urticarial dermographism had an increase in airway resistance and a decrease in specific airway conductance (P dermographism (urticaria factitia), these differences were even more significant (P < 0.001). These subjects also had larger skin test reactions and significantly higher IgE levels (P < 0.01). Thus, the present data show an association, which may be based on common mechanisms of allergic inflammation, between cutaneous and bronchial hyperreactivity.

  12. Cytotoxic effects of composite dust on human bronchial epithelial cells.

    Science.gov (United States)

    Cokic, Stevan M; Hoet, Peter; Godderis, Lode; Wiemann, Martin; Asbach, Christof; Reichl, Franz X; De Munck, Jan; Van Meerbeek, Bart; Van Landuyt, Kirsten L

    2016-12-01

    Previous research revealed that during routine abrasive procedures like polishing, shaping or removing of composites, high amounts of respirable dust particles (composite dust particles on bronchial epithelium cells. Composite dust of five commercial composites (one nano-composite, two nano-hybrid and two hybrid composites) was generated following a clinically relevant protocol. Polymerized composite samples were cut with a rough diamond bur (grain size 100μm, speed 200,000rpm) and all composite dust was collected in a sterile chamber. Human bronchial epithelial cells (16HBE14o-) were exposed to serially diluted suspensions of composite dust in cell culture medium at concentrations between 1.1 and 3.3mg/ml. After 24h-exposure, cell viability and membrane integrity were assessed by the WST-1 and the LDH leakage assay, respectively. The release of IL-1β and IL-6 was evaluated. The composite dust particles were characterized by transmission electron microscopy and by dynamic and electrophoretic light scattering. Neither membrane damage nor release of IL-1β was detected over the complete concentration range. However, metabolic activity gradually declined for concentrations higher than 660μg/ml and the release of IL-6 was reduced when cells were exposed to the highest concentrations of dust. Composite dust prepared by conventional dental abrasion methods only affected human bronchial epithelial cells in very high concentrations. Copyright © 2016 The Academy of Dental Materials. Published by Elsevier Ltd. All rights reserved.

  13. Benzalkonium Chloride Induced Bronchoconstriction in Patients with Stable Bronchial Asthma

    Science.gov (United States)

    Lee, Byoung Hoon

    2007-01-01

    Background Although benzalkonium chloride (BAC)-induced bronchoconstriction occurs in patients with bronchial asthma, BAC-containing nebulizer solutions are still being used in daily practice in Korea. The aim of this study was to evaluate the effects of inhaled aqueous solutions containing BAC. Methods Thirty subjects with bronchial asthma and 10 normal controls inhaled up to three 600 µg nebulized doses of BAC using a jet nebulizer. FEV1 (forced expiratory volume at one second) was measured 15 minutes after each dose. Inhalations were repeated every 20 minutes until FEV1 decreased by 15% or more (defined as BAC-induced bronchoconstriction) or the 3 doses were administered. Results The percent fall in FEV1 in response to BAC inhalation was significantly higher in asthmatics than in normal subjects (p<0.05). BAC administration in subjects with asthma reached a plateau (maximal effect). BAC-induced bronchoconstriction was found in 6 asthmatics (20%), with two responders after the 2nd inhalation and after the 3rd inhalation. The percent fall in FEV1 in response to the 1st inhalation of BAC was significantly higher in asthmatics with higher bronchial hyperresponsiveness (BHR) than in those with lower BHR. Conclusions This study suggests that the available multi-dose nebulized solution is generally safe. However, significant bronchoconstriction can occur at a relatively low BAC dose in asthmatics with severe airway responsiveness. PMID:18309682

  14. Orbital Cellulitis: A Rare Presentation of Metastatic Bronchial Carcinoma

    Directory of Open Access Journals (Sweden)

    Rohit Kumar

    2011-01-01

    Full Text Available Objective. We report a rare and unusual case of bronchial carcinoma presenting with symptoms of complications of sinonasal disease. Case Report. A 66-year-old lady was referred with a 1-week history of progressive ocular pain, chemosis, and visual disturbance. Computed tomography of the paranasal sinuses revealed frontal and ethmoidal sinus opacification with orbital involvement consistent with a diagnosis of orbital cellulitis secondary to sinusitis. Surgical exploration revealed that the sinuses and right orbit were filled with soft tissue and subsequent histopathological examination of the biopsies indicating metastases from an adenosquamous bronchial carcinoma. Further imaging revealed a large, asymptomatic, bronchial primary with deposits in the brain and liver. The advanced presentation of the disease limited treatment to best supportive care. Conclusion. Orbital cellulitis and sinonasal malignancies have a similar pattern of clinical presentation, posing a potential diagnostic pitfall. There are only two previously reported cases of metastatic lung carcinoma in the frontal sinus with 15 cases of sinonasal tract involvement reported overall. There are no reported cases of adenosquamous carcinoma in the sinonasal tract.

  15. Lung surgery

    Science.gov (United States)

    ... Pneumonectomy; Lobectomy; Lung biopsy; Thoracoscopy; Video-assisted thoracoscopic surgery; VATS ... You will have general anesthesia before surgery. You will be asleep and unable to feel pain. Two common ways to do surgery on your lungs are thoracotomy and video- ...

  16. Turbinate surgery

    Science.gov (United States)

    Turbinectomy; Turbinoplasty; Turbinate reduction; Nasal airway surgery; Nasal obstruction - turbinate surgery ... There are several types of turbinate surgery: Turbinectomy: All or ... This can be done in several different ways, but sometimes a ...

  17. Cataract Surgery

    Science.gov (United States)

    ... and Videos: What Do Cataracts Look Like? Cataract Surgery Written By: Kierstan Boyd Reviewed By: Elena M ... how they work. What to expect with cataract surgery Before surgery: Your ophthalmologist will measure your eye ...

  18. Blood Level of Polymorphonuclear Neutrophil Leukocytes and Bronchial Hyperreactivity in Chronic Obstructive Pulmonary Disease

    OpenAIRE

    Cukic, Vesna

    2015-01-01

    Introduction: Polymorphonuclear neutrophil leukocytes (PMNL) have an important defensive role against various microorganisms and other agents, but by liberating various substances, first of all the superoxide anion (O 2¯), they can damage the bronchial mucosa and influence the development of bronchial inflammation which is the fundamental of bronchial hyperreactivity (BHR). Objective: to show the role of the PMNL for development and level of BHR in patients with chronic obstructive pulmonary ...

  19. PHARMACOECONOMIC ASPECT OF OMALIZUMAB APPLICATION AMONG THE PATIENTS, SUFFERING FROM THE BRONCHIAL ASTHMA

    Directory of Open Access Journals (Sweden)

    A.S. Kolbin

    2008-01-01

    Full Text Available In the given article, the authors discuss the most difficult issue of the pediatrics, which is the treatment of the severe bronchial asthma. Our columnist is professor A.S. Kolbin introduces omalizumab, a new medication from the monoclonal antibodies group, to our readers. It allows practitioners to control the severe persistent bronchial asthma. The article accentuates the clinical effectiveness and pharmacoeconomic aspects of the medication application.Key words: bronchial asthma, severe run, treatment, monoclonal antibodies, children.

  20. Erlotinib-induced rash spares previously irradiated skin

    Energy Technology Data Exchange (ETDEWEB)

    Lips, Irene M.; Vonk, Ernest J.A. [Radiotherapeutisch Instituut Stedendriehoek en Omstreken (RISO), Deventer (Netherlands). Dept. of Radiation Oncology; Koster, Mariska E.Y. [Deventer Hospital (Netherlands). Dept. of Lung Diseases; Houwing, Ronald H. [Deventer Hospital (Netherlands). Dept. of Dermatology

    2011-08-15

    Erlotinib is an epidermal growth factor receptor inhibitor prescribed to patients with locally advanced or metastasized non-small cell lung carcinoma after failure of at least one earlier chemotherapy treatment. Approximately 75% of the patients treated with erlotinib develop acneiform skin rashes. A patient treated with erlotinib 3 months after finishing concomitant treatment with chemotherapy and radiotherapy for non-small cell lung cancer is presented. Unexpectedly, the part of the skin that had been included in his previously radiotherapy field was completely spared from the erlotinib-induced acneiform skin rash. The exact mechanism of erlotinib-induced rash sparing in previously irradiated skin is unclear. The underlying mechanism of this phenomenon needs to be explored further, because the number of patients being treated with a combination of both therapeutic modalities is increasing. The therapeutic effect of erlotinib in the area of the previously irradiated lesion should be assessed. (orig.)

  1. On the syndrome of the "spare limb": one case.

    Science.gov (United States)

    Grossi, Dario; Di Cesare, Gabriela; Tamburro, Rosario Paolo

    2002-04-01

    We describe a case of a brain-damaged patient who had a peculiar bodily illusion which could not be labelled an hallucination but seemed somatognosically and phenomenologically similar to the phantom limb without amputation. The patient, who showed left hemiplegia, felt a third upper limb (without seeing it) which he himself defined as "spare." The spare limb was not deformed; it could be moved and controlled by the patient, and there was no sensation of pain. The patient did not show psychopathological or cognitive disorders. A possible interpretation of the phenomenon is as a "phantom movement" of the paralysed limb: the mental representation of the movement of the limb was dissociated from the bodily representation of his own limb and so was still present in his consciousness despite the paralysis.

  2. Rifampin-induced Pseudomembranous Colitis with Rectosigmoid Sparing.

    Science.gov (United States)

    Yim, Sun Young; Koo, Ja Seol; Kim, Ye Ji; Park, Sang Jung; Kim, Jin Nam; Jung, Sung Woo; Yim, Hyung Joon; Lee, Sang Woo; Choi, Jai Hyun; Kim, Chang Duck

    2011-12-01

    Pseudomembranous colitis (PMC) is known to be associated with antibiotic treatment, but is not commonly related to antitubercular (anti-TB) agent, rifampin. PMC is frequently localized to rectum and sigmoid colon, which can be diagnosed with sigmoidoscopy. We report a case of rifampin-induced PMC with rectosigmoid sparing in a pulmonary tuberculosis patient. An 81-year-old man using anti-TB agents was admitted with a 30-day history of severe diarrhea and general weakness. On colonoscopy, nonspecific findings such as mucosal edema and erosion were found in sigmoid colon, whereas multiple yellowish plaques were confined to cecal mucosa only. Biopsy specimen of the cecum was compatible with PMC. Metronidazole was started orally, and the anti-TB medications excluding rifampin were readministerred. His symptoms remarkably improved within a few days without recurrence. Awareness of rectosigmoid sparing PMC in patients who develop diarrhea during anti-TB treatment should encourage early total colonoscopy.

  3. Hippocampal-Sparing Whole-Brain Radiotherapy for Lung Cancer.

    Science.gov (United States)

    Zhao, Ren; Kong, Wei; Shang, Jun; Zhe, Hong; Wang, Yan-Yang

    2017-03-01

    Brain metastases occur in 20% to 40% of lung cancer patients. Whole-brain radiotherapy (WBRT) has long been considered the treatment of choice for many patients with lung cancer, because of its wide availability, ease of delivery, and effectiveness in prolonging survival. However, WBRT is also associated with several side effects, such as decline in memory and other cognitive functions. There exists significant preclinical and clinical evidence that radiation-induced injury to the hippocampus correlates with neurocognitive decline of patients who receive WBRT. Technological advances in treatment planning and delivery facilitate the use of hippocampal-sparing (HS) WBRT as prophylactic cranial irradiation or the primary treatment modality for lung cancer patients with brain metastases. In this review, we provide a detailed and comprehensive discussion of the safety profile, techniques for hippocampus-sparing, and the clinical evidence of HS-WBRT for lung cancer patients.

  4. Reading strategies in Stargardt's disease with foveal sparing

    OpenAIRE

    Goldschmidt, Mira; Déruaz, Anouk; Lorincz, Erika N; Whatham, Andrew R; Mermoud, Christophe; Safran, Avinoam B

    2010-01-01

    ABSTRACT: BACKGROUND: Subjects with a ring scotoma can use two retinal loci, a foveal and a peripheral, for reading. Our aim was to investigate the relative use of both retinal loci as a function of the spared foveal area size and the spatial resolution at both retinal loci. FINDINGS: Two patients with Stargardt's disease and ring scotomas read through a scanning laser ophthalmoscope a series of letters and words at various character sizes. The number of fixations made using each retinal locu...

  5. Reading strategies in Stargardt's disease with foveal sparing

    OpenAIRE

    Whatham Andrew R; Lorincz Erika N; Déruaz Anouk; Goldschmidt Mira; Mermoud Christophe; Safran Avinoam B

    2010-01-01

    Abstract Background Subjects with a ring scotoma can use two retinal loci, a foveal and a peripheral, for reading. Our aim was to investigate the relative use of both retinal loci as a function of the spared foveal area size and the spatial resolution at both retinal loci. Findings Two patients with Stargardt's disease and ring scotomas read through a scanning laser ophthalmoscope a series of letters and words at various character sizes. The number of fixations made using each retinal locus w...

  6. Initial Spare Parts of the A400M Aircraft

    Science.gov (United States)

    2016-06-14

    Faculty Department of Logistics and Supply Chain Management Graduate School of Engineering and Management Air Force Institute of Technology...Logistics and Supply Chain Management İhsan TOPALOĞLU, BS First Lieutenant, TurAF March 2012 DISTRIBUTION STATEMENT F FURTHER...2010:219). It is obvious that aircraft availability can be limited by lack of spare parts. Supply chain problems can easily cause delays and extend

  7. ERVA - AREVAs Alternative Way for Spare Parts Management

    Energy Technology Data Exchange (ETDEWEB)

    Hoppe, H.

    2014-07-01

    The availability of equipment and systems in power plants throughout the life of the plant is a key challenge for plant operators. Therefore, the management of spare parts during the entire life cycle of a plant is of particular importance. In order to maintain the functionality of the equipment without retrofit or re-design it is important to have original parts available for use or to ensure there is adequate stock available for the future. (Author)

  8. Skin-sparing effects of neutron beam filtering materials.

    Science.gov (United States)

    Otte, V A; Almond, P R; Smathers, J B; Attix, F H

    1987-01-01

    The skin-sparing effects of several filtering materials for fast neutron beams were studied under various conditions. A parallel-plate ionization chamber was used for the measurements. The parameters which were studied included field size, distance from filter to ion chamber, filter material, and filter thickness. On the basis of this work, Teflon (polytetrafluoroethylene) was chosen for fabrication of flattening filters and wedges.

  9. Perioperative dexmedetomidine for acute pain after abdominal surgery in adults

    DEFF Research Database (Denmark)

    Jessen Lundorf, Luise; Korvenius Nedergaard, Helene; Møller, Ann Merete

    2016-01-01

    BACKGROUND: Acute postoperative pain is still an issue in patients undergoing abdominal surgery. Postoperative pain and side effects of analgesic treatment, in particular those of opioids, need to be minimized. Opioid-sparing analgesics, possibly including dexmedetomidine, seem a promising avenue...

  10. Favourable results of Mohs micrographic surgery for basal cell carcinoma

    DEFF Research Database (Denmark)

    Gniadecki, Robert; Glud, Martin; Mortensen, Kia

    2015-01-01

    INTRODUCTION: Basal cell carcinoma (BCC) is the most common malignant neoplasm with an annual incidence approaching 200/100,000 person-years. Mohs micrographic surgery (MMS) is widely used in North America and in Europe for treatment of BCC. This technique ensures radical tumour removal, sparing ...

  11. Robotic nipple-sparing mastectomy for the treatment of breast cancer: Feasibility and safety study.

    Science.gov (United States)

    Toesca, Antonio; Peradze, Nickolas; Manconi, Andrea; Galimberti, Viviana; Intra, Mattia; Colleoni, Marco; Bonanni, Bernardo; Curigliano, Giuseppe; Rietjens, Mario; Viale, Giuseppe; Sacchini, Virgilio; Veronesi, Paolo

    2017-02-01

    We previously devised and reported on an innovative surgical technique of robotic nipple-sparing mastectomy and immediate robotic breast reconstruction. Here we describe the outcome of the first 29 such consecutive procedures performed on breast cancer patients to assess feasibility, reproducibility and safety. The following morbidity factors were tested: operation time, conversion rate to open technique, length of hospitalization, registration of complications for 1 year postoperatively and their characterization as either minor, major, or multiple, depending on clinical severity and treatment required. The total duration of the final robotic surgeries of our series was around 3 h, showing a very rapid learning curve. The conversion rate due to technical problems was 2 of the 29 procedures (6,9%). No major complications, including hematoma, seroma, skin or nipple-areola injury or necrosis or infection were observed for any case. Two patients had a small degree of blistering from internal electrocautery in the breast skin flap, both of which resolved in one week without any specific therapy. No systemic complications were observed. The low conversion rate to open surgery, the rapid learning curve and the low rate of post-operative complications observed in this preliminary series lead us to endorse a prospective study aimed at evaluating patient satisfaction. Copyright © 2016 Elsevier Ltd. All rights reserved.

  12. The role of water-jet dissection in improving erectile function and urinary continence after nerve-sparing prostatectomy.

    Science.gov (United States)

    Glybochko, Peter V; Rapoport, Leonid M; Bezrukov, Eugene A; Sirota, Eugene S; Martirosyan, Gurgen A

    2017-08-01

    The aim of this study was to assess erectile function (EF) and urinary continence (UC) recovery after nerve-sparing retropubic radical prostatectomy (NS-RRPE) and nerve-sparing laparoscopic radical prostatectomy (NS-LRPE) depending on the neurovascular bundle (NVB) dissection technique used. Twenty-four hour pad test was used to assess the degree of postoperative UC 1, 6 and 12 months after the surgery. For the purpose of EF assessment, International Index of Erectile Function-5 (IIEF-5) questionnaire was used. In addition, EF recovery assessment included the time needed to achieve a successful sexual intercourse with or without Inhibitors Phosphodiesterase 5 (IPDE5). A successful sexual intercourse was defined as an ability to achieve a strong erection enough for penetration and maintain erection for a long time, throughout the intercourse. Assessment was performed before the surgery and 8 and 6 months after the surgery. In the patient group with BNS + water jet dissection (WJD), the IIEF-5 score was considerably higher 8 weeks after the surgery (by 2.8 points) (р = 0.02). In 6 months, the difference between the group become more significant and reached 3.5 points (p = 0.01). Three months after urethral catheter removal, majority (95%) of patients in the NS-RPE + WJD group had no urinary incontinence (UI). For standard NS-RPE, that figure was 87%. Mild stress UI was observed in 5% of patients after NS-RPE + WJD and in 13% of patients after NS-RPE. Six months after urethral catheter removal, no significant differences in UC assessment were observed in the two groups. The implementation of WJD of NVB in clinical practice has made it possible to considerably improve the quality of life for postoperative patients due to good outcomes in terms of early UC and EF recovery.

  13. Saphenous Vein Sparing Superficial Inguinal Dissection in Lower Extremity Melanoma

    Directory of Open Access Journals (Sweden)

    Muhammed Beşir Öztürk

    2014-01-01

    Full Text Available Aim. The classic inguinal lymph node dissection is the main step for the regional control of the lower extremity melanoma, but this surgical procedure is associated with significant postoperative morbidity. The permanent lymphedema is the most devastating long-term complication leading to a significant decrease in the patient’s quality of life. In this study we present our experience with modified, saphenous vein sparing, inguinal lymph node dissections for patients with melanoma of the lower extremity. Methods. Twenty one patients (10 women, 11 men who underwent saphenous vein sparing superficial inguinal lymph node dissection for the melanoma of lower extremity were included in this study. The effects of saphenous vein sparing on postoperative complications were evaluated. Results. We have observed the decreased rate of long-term lymphedema in patients undergoing inguinal lymphadenectomy for the lower extremity melanoma. Conclusion. The inguinal lymphadenectomy with saphenous vein preservation in lower extremity melanoma patients seems to be an oncologically safe procedure and it may offer reduced long-term morbidity.

  14. Weight Loss Surgery (Bariatric Surgery) (For Parents)

    Science.gov (United States)

    ... to Be Smart About Social Media Weight Loss Surgery (Bariatric Surgery) KidsHealth > For Parents > Weight Loss Surgery (Bariatric Surgery) ... bariatric surgery might be an option. About Bariatric Surgery Bariatric surgery had its beginnings in the 1960s, ...

  15. Skin and nipple-areola complex sparing mastectomy in breast cancer patients: 15-year experience.

    Science.gov (United States)

    Stanec, Zdenko; Žic, Rado; Budi, Srećko; Stanec, Sanda; Milanović, Rudolf; Vlajčić, Zlatko; Roje, Zeljka; Rudman, Franjo; Martić, Krešimir; Held, Rebeka; Božo, Gorjanc

    2014-11-01

    Skin and nipple-areola complex sparing mastectomy (SNSM) and primary reconstruction have been popular for breast cancer treatment in the last decade. An advantage of the SNSM technique is the removal of all breast tissue as a radical surgical procedure while preserving native breast integrity, nipple-areola complex (NAC), and submammary fold. This retrospective 15-year clinical study analyzes medical records from our breast surgery database collected at our department between 1997 and 2012. A total number of 3757 patients were treated for breast cancer; 411 (10.9%) patients had a skin-sparing mastectomy with the median (range) length follow-up of 63 months. This is the longest follow-up for SNSM in breast cancer patients; 3.7% of patients who underwent SNSM developed disease local recurrence, whereas occult NAC involvement with cancer occurred in 7.7% and local recurrence in the NAC in 1.2%. Partial necrosis of the NAC developed in 9.4% and total necrosis in 0.7% of operated breasts. All disease recurrences occurred in the first 10 years of the follow-up period. Local recurrence developed as first recurrence event has longer median cancer-specific survival time of 70 months than those with only distant metastases with 50 months and locoregional plus distant metastases with 35.5 months. The "Omega" pattern incision combines an oncological radical procedure with a lower incidence of skin flap necrosis. Patients reconstructed with autologous tissue were the group most satisfied. SNSM is an oncological safe procedure for breast cancer treatment with low recurrence in properly selected patients.

  16. Uterine sparing robotic-assisted laparoscopic sacrohysteropexy for pelvic organ prolapse: safety and feasibility.

    Science.gov (United States)

    Lee, Ted; Rosenblum, Nirit; Nitti, Victor; Brucker, Benjamin M

    2013-09-01

    The aim of this study was to describe the surgical technique and report the safety and feasibility of robotic-assisted laparoscopic sacrohysteropexy, a uterine sparing procedure to correct pelvic organ prolapse (POP). Hysterectomy at the time of POP surgery has yet to be proven to improve the durability of repair. Nevertheless, the leading indication for hysterectomy in postmenopausal women is POP. We reviewed the medical records of a consecutive case series of uterine sparing prolapse repair procedures from 2005 to 2011. Fifteen women were identified. Procedures utilized a type I polypropylene mesh securing the posterior uterocervical junction to the sacral promontory. This was later modified to utilize a Y-shaped strip that was inserted through the broad ligaments to include the anterior uterocervical junction. Objective success was defined as Baden Walker grade 0 uterine prolapse and subjective success was defined as no complaint of vaginal bulge or pressure. The mean age of women was 51.8 years (28-64 years). No intraoperative complications were noted. The mean operating time was 159.4 minutes (130-201 minutes) and mean estimated blood loss was 35 mL (0-100 mL). The mean length of stay was 1.6 days (1-4 days) and mean length of follow-up was 10.8 months. Uterine prolapse improved in all 15 patients. Objective success was 93% (14/15) and subjective success was 80% (12/15). Robotic-assisted laparoscopic sacrohysteropexy was found to be a safe and feasible surgical treatment option for POP patients who desire uterine preservation.

  17. Modern technical approaches in resectional hepatic surgery.

    Science.gov (United States)

    Michalski, Christoph W; Billingsley, Kevin G

    2015-01-01

    Techniques in liver surgery have improved considerably during the last decades, allowing for liver resections with low morbidity and mortality. Preoperative patient selection, perioperative management, and intraoperative blood-sparing techniques are the cornerstones of modern liver surgery. Multimodal treatment of colorectal liver metastases has expanded the group of patients who are potential candidates for liver resection. Adjunctive techniques, including preoperative portal vein embolization and staged hepatectomy, have facilitated the safe performance of extensive liver resection. This article provides an overview of indications for liver resection and a systematic description of the technical approach to the most commonly performed resections.

  18. Bone mineral density changes in protease inhibitor-sparing vs. nucleoside reverse transcriptase inhibitor-sparing highly active antiretroviral therapy: data from a randomized trial

    DEFF Research Database (Denmark)

    Hansen, Ab; Obel, N; Nielsen, Henrik Ib

    2011-01-01

    Objective The aim of the study was to compare changes in bone mineral density (BMD) over 144 weeks in HIV-infected patients initiating nucleoside reverse transcriptase inhibitor (NRTI)-sparing or protease inhibitor-sparing highly active antiretroviral therapy (HAART). Methods Sixty-three HAART...

  19. The Role of Eosinophilic Cationic Proteins, Total IgE and Eosinophilia in Children with Bronchial Hyperresponsiveness

    Directory of Open Access Journals (Sweden)

    Ungureanu Adina

    2016-11-01

    Full Text Available Bronchial hyperreactivity (HRB, is defined as an excessive bronchial constriction that acts as an exaggerated bronchoconstrictor of the airways. This occurs as a secondary action of a nonspecific stimuli.

  20. Detection of Bronchial Function of NHBD Lung Following One-h Warm Ischemia by Organ Bath Model

    Institute of Scientific and Technical Information of China (English)

    Yang YANG; Song ZHAO; Qiuming LIAO; Jianjun WANG

    2009-01-01

    laxant abilities of bronchial smooth muscles, and the epithe-lium-dependent adjustment both kept intact. Organ bath model could be a liable and scientific way to evaluate the bronchial function of NHBD lung.

  1. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  2. Dental Implant Surgery

    Science.gov (United States)

    ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, ...

  3. Impact of obesity on bronchial asthma in Indian population.

    Science.gov (United States)

    Ramasamy, Anandha K; Gupta, Nitesh; Kumar, Raj

    2014-04-01

    Obesity and asthma are common inflammatory conditions, having presence of both local and systemic inflammation and this relationship is not well understood. This study was undertaken to compare pulmonary function parameters, inflammatory marker like C-reactive protein (hs-CRP), exhaled nitric oxide (FENO) and atopic profile between non-obese and obese bronchial asthma patients in Indian population. The study aims to elucidate the association between the systemic and local inflammatory response relating to obesity in asthmatics. Sixty bronchial asthma patients were recruited for the study, and were divided equally into obese (BMI>30 kg/m(2)) and non-obese (BMIgroups. These were assessed for pulmonary function parameters, blood hs-CRP levels, exhaled breath analysis of nitric oxide and skin prick testing for atopic profile. The study was approved by institutional ethical committee. The mean body mass index (BMI) for the non-obese and obese group was 21.64 kg/m(2) and 34.1 kg/m(2) respectively (P = 0.001). The functional residual capacity (FRC% predicted) (100.9 ± 4.21 vs 80.40 ± 4.03; P = 0.009) and expiratory reserve volume (ERV% predicted) (95.13 ± 6.71 vs. 67.03 ± 4.54; P = 0.001) both were significantly lower in the obese group. The non-obese and obese group had hs-CRP levels of 3.01 mg/L and 4.07 mg/L, respectively; the difference being statistically insignificant (P = 0.15). Similarly, FENO levels of non-obese and obese group were 63.20 ppb and 63.75 ppb, respectively; difference was not statistically significant (P = 0.95). Atopic profile of both the groups did not differ significantly. Obesity does not appear to increase the local and systemic inflammatory responses in bronchial asthma patients in Indian population.

  4. Increased myoepithelial cells of bronchial submucosal glands in fatal asthma.

    Science.gov (United States)

    Green, F H Y; Williams, D J; James, A; McPhee, L J; Mitchell, I; Mauad, T

    2010-01-01

    Fatal asthma is characterised by enlargement of bronchial mucous glands and tenacious plugs of mucus in the airway lumen. Myoepithelial cells, located within the mucous glands, contain contractile proteins which provide structural support to mucous cells and actively facilitate glandular secretion. To determine if myoepithelial cells are increased in the bronchial submucosal glands of patients with fatal asthma. Autopsied lungs from 12 patients with fatal asthma (FA), 12 patients with asthma dying of non-respiratory causes (NFA) and 12 non-asthma control cases (NAC) were obtained through the Prairie Provinces Asthma Study. Transverse sections of segmental bronchi from three lobes were stained for mucus and smooth muscle actin and the area fractions of mucous plugs, mucous glands and myoepithelial cells determined by point counting. The fine structure of the myoepithelial cells was examined by electron microscopy. FA was characterised by significant increases in mucous gland (p = 0.003), mucous plug (p = 0.004) and myoepithelial cell areas (p = 0.017) compared with NAC. When the ratio of myoepithelial cell area to total gland area was examined, there was a disproportionate and significant increase in FA compared with NAC (p = 0.014). Electron microscopy of FA cases revealed hypertrophy of the myoepithelial cells with increased intracellular myofilaments. The NFA group showed changes in these features that were intermediate between the FA and NAC groups but the differences were not significant. Bronchial mucous glands and mucous gland myoepithelial cell smooth muscle actin are increased in fatal asthma and may contribute to asphyxia due to mucous plugging.

  5. EOTAXIN AND EOTAXIN-2 EXPRESSION IN HUMAN BRONCHIAL EPITHELIAL CELL

    Institute of Scientific and Technical Information of China (English)

    TANG Wei; DENG Wei-wu; Albert CHAN; Stanley CHIK; Adrain WU

    2005-01-01

    Objective To study the role of eotaxin and eotaxin-2 expression by Th2 cytokine and analyze their relationship in normal human bronchial epithelial cell line-BEAS-2B cell. Methods Levels of eotaxin mRNA and protein expression in the bronchial epithelial cell line BEAS-2B cell were determined with RT-PCR and ELISA. We also used RT-PCR to evaluate eotaxin-2 expression under the regulation of Th2 cytokine IL-4 and IL-13 as well as proinflammatory agent-TNFα. Results Eotaxin mRNA expression was the highest at the time point of 12h under the stimulation of TNF-α. While Th2 cytokine IL-4 and IL-13 had the amplification effect on the expression. Eotaxin protein was also elevated with the combination stimulation of proinflammatory agent TNF-α and IL-4 in dose and time dependent manner(P<0.01). These results were also seen when the cells were stimulated by TNF-α and IL-13. Eotaxin-2 mRNA expression was the highest at the time point of 8h. The expression evaluated by semi-quantitative RT-PCR also elevated under the co-stimulation of TNF-α and IL-4 or TNF-α and IL-13 and it should significantly correlate with Eotaxin(P<0.05). Conclusion This study demonstrated that Th2 cytokine like IL-4 and IL-13 enhances eotaxin and eotaxin-2 expression when co-stimulated with proinflammatory agent TNF-α. These results showed that Th2 cytokines existence is the strong evidence for bronchial epithelial cells taking part in the allergic inflammation especially in eosinophils recruitment.

  6. [Research advances in association between pediatric obesity and bronchial asthma].

    Science.gov (United States)

    Zhu, Lian; Xu, Zhi-Liang; Cheng, Yan-Yang

    2016-07-01

    This review article introduces the research advances in the pathophysiological mechanism of obesity in inducing pediatric bronchial asthma, including the role of leptin in obesity and asthma, the association of plasminogen activator inhibitor-1 with obesity and asthma, the association of adiponectin and interleukins with obesity and asthma, and the influence of neurotransmitter on asthma. In particular, this article introduces the latest research on the inhibition of allergic asthma through targeting at the nociceptor of dorsal root ganglion and blocking the signaling pathway of the nociceptor.

  7. Scale dependence of branching in arterial and bronchial trees

    CERN Document Server

    Restrepo, J G; Hunt, B R; Restrepo, Juan G.; Ott, Edward; Hunt, Brian R.

    2005-01-01

    Although models of branching in arterial and bronchial trees often predict a dependence of bifurcation parameters on the scale of the bifurcating vessels, direct verifications of this dependence with data are uncommon. We compare measurements of bifurcation parameters in airways and arterial trees of different mammals as a function of scale to general features predicted by theoretical models. We find that the size dependence is more complex than existing theories based solely on energy minimization explain, and suggest additional factors that may govern the branching at different scales.

  8. Bronchial atresia in a neonate with congenital cytomegalovirus infection

    Directory of Open Access Journals (Sweden)

    Abdullah A Yousef

    2013-01-01

    Full Text Available Bronchial atresia (BA is characterized by a mucus-filled bronchocele in a blind-ending segmental or lobar bronchus with hyperinflation of the obstructed segment of the lung. We describe a neonate who presented on his 9 th day of life with respiratory distress. Chest computed tomography showed a soft tissue density involving the right middle lobe (RML. RML lobectomy confirmed the diagnosis of BA. Cytomegalovirus was detected by polymerase chain reaction in blood, urine, and tracheal aspirates which may provide further insight into the pathogenesis of BA.

  9. Pericardial tamponade as the first manifestation of bronchial adenocarcinoma

    Directory of Open Access Journals (Sweden)

    Dorota Kuzemko

    2016-12-01

    Full Text Available Case report. A 58-year-old woman was admitted to the Department of Internal Diseases due to resting dyspnoea, tachycardia and malaise. Her chest X-ray revealed inflammatory lesions, and empiric antibiotic therapy was initiated. Chest CT was then performed which showed lung tumours. During hospitalization, the patient suddenly developed cardiogenic shock induced by pericardial tamponade. The fluid from pericardium was subsequently collected. An histopathological examination of the fluid showed the presence of atypical cells. The patient then underwent bronchoscopy, the biopsy material of which revealed bronchial adenocarcinoma.

  10. Central bronchial carcinoid: Management of a case and anesthetic perspectives

    Science.gov (United States)

    Goswami, D; Kashyap, L; Batra, RK; Bhagat, C

    2016-01-01

    Obstructing lesions of the central airways present with a variety of symptoms and are often associated with pneumonia or asthma-like states. Anesthesia to these patients often presents challenges right from the preoperative stabilization of underlying lung condition, mask ventilation in the supine position to maintaining oxygenation and ventilation in the intraoperative and postoperative period. We present here a case of a young woman with a central bronchial tumor with significant airway obstruction with potential for major bleeding and subsequent anesthetic management without lung sacrificing measures and cardiopulmonary bypass assistance. PMID:26955320

  11. Central bronchial carcinoid: Management of a case and anesthetic perspectives

    Directory of Open Access Journals (Sweden)

    D Goswami

    2016-01-01

    Full Text Available Obstructing lesions of the central airways present with a variety of symptoms and are often associated with pneumonia or asthma-like states. Anesthesia to these patients often presents challenges right from the preoperative stabilization of underlying lung condition, mask ventilation in the supine position to maintaining oxygenation and ventilation in the intraoperative and postoperative period. We present here a case of a young woman with a central bronchial tumor with significant airway obstruction with potential for major bleeding and subsequent anesthetic management without lung sacrificing measures and cardiopulmonary bypass assistance.

  12. Left Circumflex Coronary Artery Fistula Connected to the Right Bronchial Artery Associated with Bronchiectasis: Multidetector CT and Coronary Angiography Findings

    Energy Technology Data Exchange (ETDEWEB)

    Nam, Kyung Jin; Choo, Ki Seok [Dept. of Radiology, Medical Research Institute, Pusan National University Yangsan Hospital, Pusan National University School of Medicine, Yangsan (Korea, Republic of)

    2013-04-15

    Coronary to bronchial artery fistula is a rare vascular anomaly secondary to enlargement of pre-existing vascular anastomosis between the coronary and bronchial arteries. This occurs when there is a constant disturbance of the pressure equilibrium involving either coronary or broncho-pulmonary disorder. Localized bronchiectasis is the most common related condition in patients with a coronary to bronchial artery fistula. Herein, we report on a case of a large left circumflex coronary artery to right bronchial artery fistula associated with bronchiectasis.

  13. Typhoid fever as a triggering factor in acute and intractable bronchial asthma attack.

    Science.gov (United States)

    Wardhana; Surachmanto, Eko E; Datau, E A

    2013-10-01

    Typhoid fever is an enteric infection caused by Salmonella typhi. In Indonesia, typhoid fever is endemic with high incidence of the disease. In daily practice we frequently have patients with bronchial asthma, and it is becoming worse when these patients get typhoid fever. After oral ingestion, Salmonella typhi invades the the intestine mucosa after conducted by microbial binding to epithelial cells, destroying the microfold cells (M cell) then passed through the lamina propria and detected by dendritic cells (DC) which express a variety of pathogen recognition receptors on the surfaces, including Toll-Like Receptor (TLR). expressed on macrophages and on intestinal epithelial cells inducing degradation of IB, and translocation of NF-B (Nuclear Factor-Kappa Beta). This process initiates the induction of pro-inflammatory gene expression profile adhesion molecules, chemokines, adhesion molecules, and other proteins that induce and perpetuate the inflammation in host cells then will induce acute ant intractable attack of bronchial asthma. The role of typhoid fever in bronchial asthma, especially in persons with acute attack of bronchial asthma, is not well understood. In this article, we will discuss the role of typhoid fever in the bronchial asthma patients which may cause bronchial asthma significantly become more severe even triggering the acute and intractable attack of bronchial asthma. This fact makes an important point, to treat completely the typhoid fever in patients with bronchial asthma.

  14. An increase in bronchial responsiveness is associated with continuing or restarting smoking

    NARCIS (Netherlands)

    Chinn, S; Jarvis, D; Luczynska, CM; Ackermann-Liebrich, U; Anto, JM; Cerveri, [No Value; de Marco, R; Gislason, T; Heinrich, J; Janson, C; Kunzli, N; Leynaert, N; Neukirch, FO; Schouten, JP; Sunyer, J; Svanes, C; Wjst, M; Burney, PG

    2005-01-01

    Rationale: Bronchial responsiveness (BHR) has been found to be associated with smoking, atopy, and lower lung function in cross-sectional studies, but there is little information on determinants of change in adults. Objectives: To analyze change in bronchial responsiveness in an international

  15. BRONCHIAL LAVAGE AND BRONCHOALVEOLAR LAVAGE IN ALLERGEN-INDUCED SINGLE EARLY AND DUAL ASTHMATIC RESPONDERS

    NARCIS (Netherlands)

    AALBERS, R; KAUFFMAN, HF; VRUGT, B; SMITH, M; KOETER, GH; TIMENS, W; DEMONCHY, JGR

    1993-01-01

    The phenotypic cellular profile of bronchial lavage (BL) and bronchoalveolar lavage (BAL) was studied in 7 single early (SR) and 10 dual asthmatic responders (DR). Lavage was performed, after previously having determined bronchial hyperresponsiveness to histamine and the response to house dust mite

  16. Eosinophils in the bronchial mucosa in relation to methacholine dose-response curves in atopic asthma

    NARCIS (Netherlands)

    G.M. Moller (Trude); S.E. Overbeek (Shelley); C.G. van Helden-Meeuwsen; H.C. Hoogsteden (Henk); J.M. Bogaard (Jan)

    1999-01-01

    textabstractAsthma is characterized by both local infiltration of eosinophils in the bronchial mucosa and bronchial hyperreactivity (BHR). A detailed characterization of BHR implies analysis of a histamine or methacholine dose-response curve yielding not only the dose a

  17. BRONCHIAL LAVAGE AND BRONCHOALVEOLAR LAVAGE IN ALLERGEN-INDUCED SINGLE EARLY AND DUAL ASTHMATIC RESPONDERS

    NARCIS (Netherlands)

    AALBERS, R; KAUFFMAN, HF; VRUGT, B; SMITH, M; KOETER, GH; TIMENS, W; DEMONCHY, JGR

    The phenotypic cellular profile of bronchial lavage (BL) and bronchoalveolar lavage (BAL) was studied in 7 single early (SR) and 10 dual asthmatic responders (DR). Lavage was performed, after previously having determined bronchial hyperresponsiveness to histamine and the response to house dust mite

  18. Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report.

    LENUS (Irish Health Repository)

    Martin-Smith, James D

    2009-01-01

    BACKGROUND: The development of a fistula between the tracheobronchial tree and the gastric conduit post esophagectomy is a rare and often fatal complication. CASE PRESENTATION: A 68 year old man underwent radical esophagectomy for esophageal adenocarcinoma. On postoperative day 14 the nasogastric drainage bag dramatically filled with air, without deterioration in respiratory function or progressive sepsis. A fiberoptic bronchoscopy was performed which demonstrated a gastro-bronchial fistula in the posterior aspect of the left main bronchus. He was managed conservatively with antibiotics, enteral nutrition via jejunostomy, and non-invasive respiratory support. A follow- up bronchoscopy 60 days after the diagnostic bronchoscopy, confirmed spontaneous closure of the fistula CONCLUSIONS: This is the first such case where a conservative approach with no surgery or endoprosthesis resulted in a successful outcome, with fistula closure confirmed at subsequent bronchoscopy. Our experience would suggest that in very carefully selected cases where bronchopulmonary contamination from the fistula is minimal or absent, there is no associated inflammation of the tracheobronchial tree and the patient is stable from a respiratory point of view without evidence of sepsis, there may be a role for a trial of conservative management.

  19. Management of gastro-bronchial fistula complicating a subtotal esophagectomy: a case report

    LENUS (Irish Health Repository)

    Martin-Smith, James D

    2009-12-24

    Abstract Background The development of a fistula between the tracheobronchial tree and the gastric conduit post esophagectomy is a rare and often fatal complication. Case presentation A 68 year old man underwent radical esophagectomy for esophageal adenocarcinoma. On postoperative day 14 the nasogastric drainage bag dramatically filled with air, without deterioration in respiratory function or progressive sepsis. A fiberoptic bronchoscopy was performed which demonstrated a gastro-bronchial fistula in the posterior aspect of the left main bronchus. He was managed conservatively with antibiotics, enteral nutrition via jejunostomy, and non-invasive respiratory support. A follow- up bronchoscopy 60 days after the diagnostic bronchoscopy, confirmed spontaneous closure of the fistula Conclusions This is the first such case where a conservative approach with no surgery or endoprosthesis resulted in a successful outcome, with fistula closure confirmed at subsequent bronchoscopy. Our experience would suggest that in very carefully selected cases where bronchopulmonary contamination from the fistula is minimal or absent, there is no associated inflammation of the tracheobronchial tree and the patient is stable from a respiratory point of view without evidence of sepsis, there may be a role for a trial of conservative management.

  20. Spare part management of an electricity distribution network

    Energy Technology Data Exchange (ETDEWEB)

    Lauronen, J.

    1998-07-01

    Electricity distribution companies are required to improve their operational cost effectiveness. The storage systems of the companies have traditionally been based on the 'adequate' number of stores with plenty of different components. Therefore, they are potential objects for cost reduction. The effective operation of spare part management of an electricity distribution network requires that the spare components can be delivered at the fault site quickly in order to avoid excessive outage costs. In a fault situation the stores form a net structure. Currently the rural electricity distribution companies lack suitable methods for designing a spare part storage system. This thesis presents a suitable method for the designing problem. The models assume that faults of a distribution network are stochastic. Therefore, they are best suited for component types installed in large quantities. Improved methods for defining the outage, material and total costs for perpetual order quantity and periodic order-up-to-level storage control systems are described. The method for determining the control parameters of the stores is also presented and ways for finding the necessary initial parameter values are introduced. The developed method is tested in Haemeen Saehko Oy (HSOY). The results of the calculations are given. The key findings are: Small differences in the designing results can increase costs remarkably. For example, in HSOY too low stock levels can result in even eight folds higher outage costs than in the proper design. The best number of stores is not the same for all component types. For example, in HSOY the best number of stores is seven for the 50 kVA transformers and one for the 315 kVA transformers in a summer. If the stock levels are increased the protection against the demand variations is the better the shorter the duration of the review period and/or the replenishment lead time is. (orig.)

  1. Outcome Evaluation after 2023 Nipple-Sparing Mastectomies: Our Experience.

    Science.gov (United States)

    De Vita, Roy; Zoccali, Giovanni; Buccheri, Ernesto Maria; Costantini, Maurizio; Botti, Claudio; Pozzi, Marcello

    2017-02-01

    Although quadrantectomy and lumpectomy help diminish the psychological and physical devastation inflicted, mastectomy is still elected in 20 to 30 percent of breast cancers. Although initially inciting controversy over heightened risk of local recurrences, recent studies maintain that nipple-sparing mastectomy can be used in any patient qualifying for total mastectomy and also improves aesthetic and psychologic outcomes. The manner in which mastectomy influences reconstructive implant outcomes has been documented by several groups. This report details the authors' experience performing nipple-sparing mastectomy with immediate implant-based breast reconstruction, focusing attention on patient characteristics and aspects of surgical mastectomy that influence reconstruction outcomes. The aim of the study was to examine various issues, such as surgical access, mode of tissue dissection, and flap thickness, clearly linked to development of complications and poor results. A retrospective study was conducted, analyzing patients with breast cancer. An external three-surgeon panel served to generate average scores for predefined parameters. Based on total scores, outcomes were designated excellent, good, moderate, or poor. The authors' cohort included 1647 patients. Overall, 2023 nipple-sparing mastectomies were performed, including bilateral procedures in 376 patients. After a minimum follow-up period of 12 months, the authors' cohort was stratified by scored outcomes. Significant impact of body mass index, skin incision, flap thickness, and grade of ptosis has been demonstrated. The authors' data suggest that proper patient selection and well-executed operations are mandatory to limit complications. They also indicate that aesthetic outcome is clearly dependent on surgical proficiency and some patient characteristics. Therapeutic, III.

  2. Left hippocampus sparing whole brain radiotherapy (WBRT): A planning study.

    Science.gov (United States)

    Kazda, Tomas; Vrzal, Miroslav; Prochazka, Tomas; Dvoracek, Petr; Burkon, Petr; Pospisil, Petr; Dziacky, Adam; Nikl, Tomas; Jancalek, Radim; Slampa, Pavel; Lakomy, Radek

    2017-07-20

    Unilateral sparing of the dominant (left) hippocampus during whole brain radiotherapy (WBRT) could mitigate cognitive decline, especially verbal memory, similar to the widely investigated bilateral hippocampus avoidance (HA-WBRT). The aim of this planning study is dosimetrical comparison of HA-WBRT with only left hippocampus sparing (LHA-WBRT) plans. HA-WBRT plans for 10 patients were prepared in accordance with RTOG 0933 trial and served as baseline for comparisons with several LHA-WBRT plans prepared with an effort: 1) to maintain the same left hippocampus dosimetry ("BEST PTV") and 2) to maintain same dosimetry in planning target volume as in HA-WBRT ("BEST LH"). All HA-WBRT plans met RTOG 0933 protocol criteria with a mean Conformity index 1.09 and mean Homogeneity index (HI) 0.21. Mean right and left hippocampal D100 % was 7.8 Gy and 8.5 Gy and mean Dmax 14.0 Gy and 13.8 Gy, respectively. "BEST PTV" plans reduced HI by 31.2 % (P=0.005) which is mirrored by lower PTV_D2% (-0.8 Gy, P=0.005) and higher PTV_D98% (+1.3 Gy, P=0.005) as well as decreased optic pathway's Dmax by 1 Gy. In "BEST LH", mean D100% and Dmax for the left hippocampus were significantly reduced by 11.2 % (P=0.005) and 10.9 % (P=0.005) respectively. LHA-WBRT could improve target coverage and/or further decrease in dose to spared hippocampus. Future clinical trials must confirm whether statistically significant reduction in left hippocampal dose is also clinically significant.

  3. Cytokeratin on frozen sections of sentinel node may spare breast cancer patients secondary axillary surgery

    DEFF Research Database (Denmark)

    Stovgaard, Elisabeth Specht; Tvedskov, Tove Filtenborg; Lænkholm, Anne Vibeke

    2012-01-01

    this method with focus on intraoperative diagnostic values. Material and Methods. Results from 336 patients from the centre using IHC intraoperatively were compared with 343 patients from the center not using IHC on frozen section. Final evaluation on paraffin sections with haematoxylin-eosin (HE) staining...

  4. Adamtsl2 deletion results in bronchial fibrillin microfibril accumulation and bronchial epithelial dysplasia – a novel mouse model providing insights into geleophysic dysplasia

    Directory of Open Access Journals (Sweden)

    Dirk Hubmacher

    2015-05-01

    Full Text Available Mutations in the secreted glycoprotein ADAMTSL2 cause recessive geleophysic dysplasia (GD in humans and Musladin–Lueke syndrome (MLS in dogs. GD is a severe, often lethal, condition presenting with short stature, brachydactyly, stiff skin, joint contractures, tracheal-bronchial stenosis and cardiac valve anomalies, whereas MLS is non-lethal and characterized by short stature and severe skin fibrosis. Although most mutations in fibrillin-1 (FBN1 cause Marfan syndrome (MFS, a microfibril disorder leading to transforming growth factor-β (TGFβ dysregulation, domain-specific FBN1 mutations result in dominant GD. ADAMTSL2 has been previously shown to bind FBN1 and latent TGFβ-binding protein-1 (LTBP1. Here, we investigated mice with targeted Adamtsl2 inactivation as a new model for GD (Adamtsl2−/− mice. An intragenic lacZ reporter in these mice showed that ADAMTSL2 was produced exclusively by bronchial smooth muscle cells during embryonic lung development. Adamtsl2−/− mice, which died at birth, had severe bronchial epithelial dysplasia with abnormal glycogen-rich inclusions in bronchial epithelium resembling the cellular anomalies described previously in GD. An increase in microfibrils in the bronchial wall was associated with increased FBN2 and microfibril-associated glycoprotein-1 (MAGP1 staining, whereas LTBP1 staining was increased in bronchial epithelium. ADAMTSL2 was shown to bind directly to FBN2 with an affinity comparable to FBN1. The observed extracellular matrix (ECM alterations were associated with increased bronchial epithelial TGFβ signaling at 17.5 days of gestation; however, treatment with TGFβ-neutralizing antibody did not correct the epithelial dysplasia. These investigations reveal a new function of ADAMTSL2 in modulating microfibril formation, and a previously unsuspected association with FBN2. Our studies suggest that the bronchial epithelial dysplasia accompanying microfibril dysregulation in Adamtsl2−/− mice

  5. Expression level of TGF-β1, U-Ⅱ in patients with bronchial asthma

    Institute of Scientific and Technical Information of China (English)

    Shang-Sun Cai; Guo-Ping Wu; Yuan-Zheng Yang; Ping Rao; Guang-Yu Wang; Qiong-Lian Huang

    2015-01-01

    Objective: To investigate the expression level in the serum of patients with bronchial asthma in TGF-β1, U-Ⅱ and their correlation. Methods: U-Ⅱ was measured by radioimmunoassay and TGF-β1 was measured by double antibody sandwich ELISA method in 45 patients with acute bronchial asthma, 43 cases of bronchial asthma in remission period and 41 healthy subjects. The correlation between TGF-β1 and U-Ⅱ was also analyzed. Results: There were significant differences in TGF-β1 and U-Ⅱ between healthy subjects and bronchial asthma patients (P<0.01), and the differences between patients at acute stage and remission stage was also significant (P<0.01). TGF-β1 was positively correlated with U-Ⅱ (P<0.05). Conclusions:TGF-β1 and U-Ⅱ are important indicators for treatment of bronchial asthma.

  6. Combined laser phototherapy and growth factor treatment of bronchial obstruction after lung transplantation.

    Science.gov (United States)

    Hertz, M I; Harmon, K R; Knighton, D R; Cahill, B C; Duvall, A J; Shumway, S J; Bolman, R M

    1991-12-01

    Lung transplantation has resulted in dramatic functional improvement in patients with end-stage pulmonary diseases. Among the complications of lung transplantation are dehiscence and stenosis at the site of the bronchial or tracheal anastomosis. In this case report, we describe a single lung transplant recipient in whom partial bronchial dehiscence, followed by exuberant growth of granulation tissue, resulted in obstruction of the bronchial lumen. After mechanical dilation failed to produce lasting relief of bronchial obstruction, a novel approach to this problem was successfully employed: YAG laser phototherapy was used to remove obstructing granulation tissue, followed by application of a preparation derived from autologous blood platelets to promote epithelialization of the bronchial anastomosis. The bronchus remains patent and fully epithelialized six months after therapy.

  7. Remission of bronchial asthma after viral clearance in chronic hepatitis C

    Institute of Scientific and Technical Information of China (English)

    Norihiko Yamamoto; Kazumoto Murata; Takeshi Nakano

    2005-01-01

    A 53-year-old man with a history of blood transfusion at the age of 20 was admitted to our hospital because of liver dysfunction. He had bronchial asthma when he was 18 years old, which naturally resolved within 2 years. However, his bronchial asthma recurred at the age of 45 and was treated with oral theophylline. He was diagnosed as having chronic hepatitis C based on the histological and clinical findings, and then interferon (IFN) therapy was administered. The frequency of bronchial asthma attack was gradually decreasing after IFN therapy with marked improvement of hypereosinophilia. He achieved sustained viral response (SVR) and his bronchial asthma did not worsen even after the cessation of IFN. Hepatitis C virus (HCV) infection and IFN therapy were considered in the remission of asthma in this case. HCV infection could be the cause of bronchial asthma, especially in patients with late appearance of asthma.

  8. Purchase-oriented Classification Model of the Spare Parts of Agricultural Machinery

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    Based on the classification of spare parts and the research results of the demand of spare parts,a three-dimensional classification model of spare parts of agricultural machinery is established,which includes the application axis sorted by technical characteristics,the cost axis classified by ABC method,and the demand axis classified by the demand of the spare parts of agricultural machinery.These dimension axes represent different factors,and the application of factors in purchase is analyzed.Guiding value of each dimension axis is summarized in the field of the spare parts purchase;and corresponding strategy instruction is put forward.Integrated application of these strategies by model makes the purchase have more realistic operational meaning.Application field of the three-dimensional model of spare parts is discussed;and the direction for further research is pointed out.

  9. [Multimodal treatment of pain and nausea in breast cancer surgery

    DEFF Research Database (Denmark)

    Gartner, R.; Kroman, N.; Callesen, T.;

    2008-01-01

    INTRODUCTION: Every year 4000 women in Denmark undergo surgery for breast cancer. According to published literature approximately 50% suffer from post-operative nausea and vomiting (PONV) and moderate pain. No national guidelines are available regarding the treatment or prevention of pain and PONV...... associated with surgery for these patients. MATERIALS AND METHODS: 116 consecutive patients scheduled for breast cancer surgery were prospectively scored according to pain, PONV and sedation after being introduced to a combined evidence-based, empiric multimodal opioid-sparing prevention and treatment regime...... severe PONV and vomiting resistant to treatment. Upon arrival at the recovery 15% of the patients were in a state of moderate to severe sedation. This number was 1.5% 75 minutes later. CONCLUSION: It is possible with a multimodal opioid-sparing prevention and treatment regime for pain and PONV to gain...

  10. Gastro-bronchial fistula after laparoscopic nissen fundoplication.

    Science.gov (United States)

    Faraj, Walid; Khalifeh, Mohamad; Soweid, Asaad; Habli, Nader; Selmo, Francesca; Priest, Oliver; Jamali, Faek R

    2007-10-01

    Gastro-bronchial fistula (GBF) is an unusual complication of Nissen fundoplication, particularly when performed via a transabdominal approach. The mechanism of such fistula is thought to be related to a previously untreated ulcer in the mucosa of the wall of the gastric wrap or to a subclinical injury to the gastric wall during the process of division of the short gastric vessels and gastric mobilization. This process is greatly aided by herniation of the wrap into the chest in the postoperative period, placing the stomach in intimate contact with the bronchial tree. The diagnosis of GBF is often difficult to establish and requires a high index of suspicion. Most investigative studies tend to be unrevealing. Historically, an upper gastrointestinal series was the recommended study of choice in the literature. Newer reports, however, highlight the value and importance of upper endoscopy as a diagnostic tool in this condition. The majority of GBF were reported in the era of transthoracic Nissen fundoplication. The incidence of this complication seems to have markedly decreased after the widespread adoption of the transabdominal approach to the treatment of GERD. We are reporting the second case in the literature of a GBF developing after a laparoscopic Nissen fundoplication in a 28-year-old male patient. This case report should serve to increase awareness of this uncommon complication that should be considered in the differential diagnosis of patients with recurrent pneumonia or refractory hemoptysis after major upper gastrointestinal surgical procedures.

  11. Estradiol increases mucus synthesis in bronchial epithelial cells.

    Directory of Open Access Journals (Sweden)

    Anthony Tam

    Full Text Available Airway epithelial mucus hypersecretion and mucus plugging are prominent pathologic features of chronic inflammatory conditions of the airway (e.g. asthma and cystic fibrosis and in most of these conditions, women have worse prognosis compared with male patients. We thus investigated the effects of estradiol on mucus expression in primary normal human bronchial epithelial cells from female donors grown at an air liquid interface (ALI. Treatment with estradiol in physiological ranges for 2 weeks caused a concentration-dependent increase in the number of PAS-positive cells (confirmed to be goblet cells by MUC5AC immunostaining in ALI cultures, and this action was attenuated by estrogen receptor beta (ER-β antagonist. Protein microarray data showed that nuclear factor of activated T-cell (NFAT in the nuclear fraction of NHBE cells was increased with estradiol treatment. Estradiol increased NFATc1 mRNA and protein in ALI cultures. In a human airway epithelial (1HAE0 cell line, NFATc1 was required for the regulation of MUC5AC mRNA and protein. Estradiol also induced post-translational modification of mucins by increasing total fucose residues and fucosyltransferase (FUT-4, -5, -6 mRNA expression. Together, these data indicate a novel mechanism by which estradiol increases mucus synthesis in the human bronchial epithelium.

  12. Monitoring asthma in childhood: lung function, bronchial responsiveness and inflammation

    Directory of Open Access Journals (Sweden)

    Alexander Moeller

    2015-06-01

    Full Text Available This review focuses on the methods available for measuring reversible airways obstruction, bronchial hyperresponsiveness (BHR and inflammation as hallmarks of asthma, and their role in monitoring children with asthma. Persistent bronchial obstruction may occur in asymptomatic children and is considered a risk factor for severe asthma episodes and is associated with poor asthma outcome. Annual measurement of forced expiratory volume in 1 s using office based spirometry is considered useful. Other lung function measurements including the assessment of BHR may be reserved for children with possible exercise limitations, poor symptom perception and those not responding to their current treatment or with atypical asthma symptoms, and performed on a higher specialty level. To date, for most methods of measuring lung function there are no proper randomised controlled or large longitudinal studies available to establish their role in asthma management in children. Noninvasive biomarkers for monitoring inflammation in children are available, for example the measurement of exhaled nitric oxide fraction, and the assessment of induced sputum cytology or inflammatory mediators in the exhaled breath condensate. However, their role and usefulness in routine clinical practice to monitor and guide therapy remains unclear, and therefore, their use should be reserved for selected cases.

  13. Preoperative Assessment of Different Treatment Modalities in Bronchial Asthma Patients

    Directory of Open Access Journals (Sweden)

    Kawther A. Azzam M.D. and **Sahar S. Khattab MD

    2003-06-01

    Full Text Available This study was performed to assess the effectiveness of acupuncture and medical therapies of bronchial asthma preoperatively. Sixty patients suffered from mild to moderate bronchial asthma and coming for elective operations were chozen from the outpatient clinic of Al-Zahraa University Hospital. Patients were randomly divided into three equal groups (n=20 each. Group I patients (drug group received oral theophylline and Salbutamol (ventolin inhaler according to the needs. Group II patients (drug +ear acupuncture group received same medical treatment as in group I and added ear acupuncture. Group III patients (drug + ear and body acupuncture group received same medical treatment as in group I and II and added ear and body acupuncture. Ventilatory function tests through spirometer and interleukin-13 estimation were performed before treatment and after two weeks of treatment. Improvement of subjective and objective parameters had occurred with significant decrease in the mean serum level of interleukin-13 and decrease in the mean number of using b-agonist puffs after two weeks of treatment in the three groups, with the best results being in group III than in group II and then in group I. Conclusion: Interleukin-13 estimation togheter with ventilatory function tests is a useful parameter for pre-operative assessment and evaluation of asthmatic patients. Also medication was significantly reduced when combined with acupuncture.

  14. Sputum as a source of adipokines in bronchial asthma

    Directory of Open Access Journals (Sweden)

    V. N. Mineev

    2014-01-01

    Full Text Available Forty-four patients with allergic (ABA and non-allergic (NABA variants of bronchial asthma (BA were examined to evaluate levels of key adipokines (leptin, resistin, adiponectin in sputum in different variants of BA. Adipokines in sputum and blood plasma were measured by Enzyme-Linked Immunosorbent Assay (ELISA. The indices that reflect the percentage of adipokines in sputum regarding adipokines in plasma of the same patients were worked out to evaluate the ratio of levels of corresponding adipokines in plasma and sputum in patients with BA. Two regularities are clearly seen in the study: the first - levels of proinflammatory adipokines (leptin, resistin in sputum in ABA correlate directly with indicators of respiratory function but levels of anti-inflammatory adipokines (adiponectin in sputum correlate inversely with indicators of respiratory function; the second -correlation of levels of the studied adipokines with indicators of respiratory function are almost not revealed in NABA. The first regularity reflects the important fact that the content of adipokines in bronchial secretion is to a certain extent one of regulating local mechanisms in target organ controlled system levels of corresponding adipokines in exacerbation of BA.

  15. [Breast reconstruction after skin-sparing mastectomy or nipple-sparing mastectomy for breast cancer].

    Science.gov (United States)

    Chen, Jie; Lü, Qing; Wang, Xiaodong; Li, Hongjiang; Chen, Yujuan; Yang, Xiaoqin; Zeng, Helin

    2013-07-01

    To evaluate the feasibility, oncological safety, and aesthetic result of skin-spring mastectomy (SSM) or nipple-spring mastectomy (NSM) in breast reconstruction of implant (permanent gel or expander) for breast cancer patients who were not fit for the breast conserving surgery (BCS). Between October 2005 and July 2011, 89 women with breast caner underwent SSM or NSM, with an average age of 42.4 years (range, 19-55 years) and an average disease duration of 5.7 months (range, 1-24 months). The pathological examination revealed invasive ductal carcinoma in 55 cases, ductal carcinoma in situ (DCIS) in 15 cases, invasive ductal carcinoma + DCIS in 8 cases, DCIS with infiltration in 10 cases, and occult breast cancer in 1 case. According to tumor staging criterion of American Joint Committee on Cancer (AJCC), 15 cases were rated as stage 0, 51 cases as stage I, 22 cases as stage II, and 1 case as unclear. Finally, 33 patients underwent SSM and 56 patients underwent NSM according to the location and diameter of tumor and the infiltration of tumor to nipple. Secondary breast reconstruction was performed with permanent gel replacement after axillary lymph node dissection in 9 patients with positive sentinel lymph node and 1 patient with occult breast cancer; immediate breast reconstruction was performed with permanent gel in the other patients. All the patients received the chemotherapy or/and radiotherapy according to the National Comprehensive Cancer Network (NCCN) guideline. Complications occurred in 5 patients undergoing breast reconstruction of permanent gel after NSM, including 1 case of haemorrhage, 2 cases of infection, and 2 cases of local skin necrosis. Primary healing of incision was obtained in the others. No nipple necrosis was observed in patients undergoing NSM. All the patients were followed up 14-88 months (median, 40 months). At 10 months after operation, the aesthetic results were excellent in 40 cases, good in 33 cases, fair in 14 cases, and poor in 2

  16. Nose Surgery

    Science.gov (United States)

    ... Patient Health Home Copyright © 2017 American Academy of Otolaryngology–Head and Neck Surgery. Reproduction or republication strictly ... Terms of Use © Copyright 2017. American Academy of Otolaryngology — Head and Neck Surgery 1650 Diagonal Rd Alexandria, ...

  17. After Surgery

    Science.gov (United States)

    ... side effects. There is usually some pain with surgery. There may also be swelling and soreness around ... the first few days, weeks, or months after surgery. Some other questions to ask are How long ...

  18. Construction of a formal methodology to refine a spares suite using TIGER

    OpenAIRE

    Castillo, Steven Anthony

    1989-01-01

    Approved for public release; distribution is unlimited This thesis proposes a method for setting inventory levels for a suite of spares for a ship subsystem. The method extends the one proposed by Judge and Leutjen which uses a computer simulation model called TIGER to modify the levels of shipboard spare parts determinated by a sparing model. By combining TIGER and the Availability Centered Inventory Model (ACIM), one of the coordinated shipboard allowance list (COSAL) models currently us...

  19. Army’s Management of Gray Eagle Spare Parts Needs Improvement (REDACTED)

    Science.gov (United States)

    2016-04-29

    Brief Army’s Management of Gray Eagle Spare Parts Needs Improvement Recommendations (cont’d) located at DoD-fielded locations when forecasting spare...spare parts for Gray Eagle. Review of Internal Controls DoD Instruction 5010.40, “ Managers ’ Internal Control Program Procedures,” May 30, 2013...intended and to evaluate the effectiveness of the controls . We identified internal control weaknesses within the Army’s management of Gray Eagle

  20. Skin-sparing mastectomy in the UK--a review of current practice.

    OpenAIRE

    Sotheran, W. J.; Rainsbury, R. M.

    2004-01-01

    BACKGROUND: Skin-sparing mastectomy (was first described in 1991 and has achieved popularity because it facilitates immediate breast reconstruction, preserving the infra-mammary fold and breast envelope. Little is known about the use of skin-sparing mastectomy in the UK. METHODS: All members of the BASO Breast Specialty Group were contacted in June 2001 with a questionnaire to determine the popularity of skin-sparing mastectomy, techniques used, indications, contra-indications and outcomes. R...

  1. [Progress in immediate breast reconstruction with skin sparing mastectomy].

    Science.gov (United States)

    Garbay, J-R; Saouma, S; Marsiglia, H

    2008-04-01

    Skin sparing mastectomy (SSM) and subcutaneous mastectomy (SCM) are recent techniques. They are always associated with immediate breast reconstruction (IBR). Their safety from an oncologic point of view and indications are of great concern. In early breast cancer, SSM and SCM are associated with the same risk of local recurrence as a modified radical mastectomy, when correctly indicated. This has been validated by numerous studies. In these non-randomised studies, overall survival cannot be evaluated. Such techniques can now be validated in the oncologic setting when correctly indicated and when decision-making is always concerted and multidisciplinary. Skin-sparing techniques are obviously associated with better cosmetic results than secondary reconstructions. Thus SSM with IBR are ideally indicated for ductal carcinoma in situ, pure infiltrating or mixed carcinomas requiring mastectomy without subsequent radiotherapy. The selection criterion of no postoperative radiotherapy allows the right candidates to be chosen for SSM. But often this criterion cannot be obtained preoperatively. In such cases, performing a two-step operation could be a good option. The interval between operations can be used by the patient to obtain more information and to make a mature decision regarding her choice of treatment. It seems essential to be able to offer every patient SSM with IBR which are validated standardised indications. Such is not the case everywhere in France today. The organisation of primary care through professional networks should provide us with an opportunity to fulfil these needs.

  2. Inventory management of spare parts in an energy company

    Energy Technology Data Exchange (ETDEWEB)

    Guajardo, Mario; Roennqvist, Mikael; Halvorsen, Ann Mari; Kallevik, Svein Inge

    2012-06-15

    We address a problem of inventory management of spare parts in the context of a large energy company, producer of oil and gas. Spare parts are critical for assuring operational conditions in offshore platforms. About 200,000 different items are held in several inventory plants. The inventory system implemented at the company corresponds to a min-max system. The control parameters are decided based mainly on the expert judgment of the planners. Also, though the inventory plants can in practice be supplied from each other, the inventory planning is performed separately by the plant planners. This is because of different ownership structures where the studied company has the operative responsibility. The company is pursuing a system in which all planners conform to the same inventory management approach and evaluation, as well as being more cost efficient. Our work focuses on supporting this goal. We apply methods to decide the inventory control parameters for this system under a service level constraint. The methodology we use distinguishes unit-size and lot-size demand cases. We perform computational experiments to find control parameters for a sample of items. After the control parameters are found, we use them to explore the impact of risk pooling among the plants and inaccuracy arising from duplicate item codes.(Author)

  3. Cognitive spare capacity in older adults with hearing loss

    Directory of Open Access Journals (Sweden)

    Sushmit eMishra

    2014-05-01

    Full Text Available Individual differences in working memory capacity are associated with speech recognition in adverse conditions, reflecting the need to maintain and process speech fragments until lexical access can be achieved. When working memory resources are engaged in unlocking the lexicon, there is less Cognitive Spare Capacity (CSC available for higher level processing of speech. CSC is essential for interpreting the linguistic content of speech input and preparing an appropriate response, that is, engaging in conversation. Previously, we showed, using a Cognitive Spare Capacity Test (CSCT that in young adults with normal hearing, CSC was not generally related to working memory capacity (WMC and that when CSC decreased in noise it could be restored by visual cues. In the present study, we investigated CSC in 24 older adults with age-related hearing loss, by administering the CSC Test (CSCT and a battery of cognitive tests. We found generally reduced CSC in older adults with hearing loss compared to the younger group in our previous study, probably because they had poorer cognitive skills and deployed them differently. Importantly, CSC was not reduced in the older group when listening conditions were optimal. Visual cues improved CSC more for this group than for the younger group in our previous study. CSC of older adults with hearing loss was not generally related to WMC but it was consistently related to episodic long term memory, suggesting that the efficiency of this processing bottleneck is important for executive processing of speech in this group.

  4. Elective bladder-sparing treatment for muscle invasive bladder cancer.

    Science.gov (United States)

    Lendínez-Cano, G; Rico-López, J; Moreno, S; Fernández Parra, E; González-Almeida, C; Camacho Martínez, E

    2014-01-01

    Radical cystectomy is the standard treatment for localised muscle invasive bladder cancer (MIBC). We offer a bladder-sparing treatment with TURB +/- Chemotherapy+Radiotherapy to selected patients as an alternative. We analyze, retrospectively, 30 patients diagnosed with MIBC from March 1991 to October 2010. The mean age was 62.7 years (51-74). All patients were candidates for a curative treatment, and underwent strict selection criteria: T2 stage, primary tumor, solitary lesion smaller than 5cm with a macroscopic disease-free status after TURB, negative random biopsy without hydronephrosis. Staging CT evaluation was normal. Restaging TURB or tumor bed biopsy showed a disease-free status or microscopic muscle invasion. 14 patients underwent TURB alone, 13 TURB+Chemotherapy and 3 TURB+Chemotherapy+Radiotherapy. The mean follow up was 88.7 months (19-220). 14 patients remained disease free (46.6%), 10 had recurrent non-muscle invasive bladder cancer (33%). 81.3% complete clinical response. 71% bladder preserved at 5-years. Overall, 5-years survival rate was 79% and 85% cancer-specific survival rate. Although radical cystectomy is the standard treatment for localised MIBC, in strictly selected cases, bladder-sparing treatment offers an alternative with good long term results. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  5. Deterministic and heuristic models of forecasting spare parts demand

    Directory of Open Access Journals (Sweden)

    Ivan S. Milojević

    2012-04-01

    Full Text Available Knowing the demand of spare parts is the basis for successful spare parts inventory management. Inventory management has two aspects. The first one is operational management: acting according to certain models and making decisions in specific situations which could not have been foreseen or have not been encompassed by models. The second aspect is optimization of the model parameters by means of inventory management. Supply items demand (asset demand is the expression of customers' needs in units in the desired time and it is one of the most important parameters in the inventory management. The basic task of the supply system is demand fulfillment. In practice, demand is expressed through requisition or request. Given the conditions in which inventory management is considered, demand can be: - deterministic or stochastic, - stationary or nonstationary, - continuous or discrete, - satisfied or unsatisfied. The application of the maintenance concept is determined by the technological level of development of the assets being maintained. For example, it is hard to imagine that the concept of self-maintenance can be applied to assets developed and put into use 50 or 60 years ago. Even less complex concepts cannot be applied to those vehicles that only have indicators of engine temperature - those that react only when the engine is overheated. This means that the maintenance concepts that can be applied are the traditional preventive maintenance and the corrective maintenance. In order to be applied in a real system, modeling and simulation methods require a completely regulated system and that is not the case with this spare parts supply system. Therefore, this method, which also enables the model development, cannot be applied. Deterministic models of forecasting are almost exclusively related to the concept of preventive maintenance. Maintenance procedures are planned in advance, in accordance with exploitation and time resources. Since the timing

  6. Tissue engineering and biotechnology in general thoracic surgery.

    Science.gov (United States)

    Molnar, Tamas F; Pongracz, Judit E

    2010-06-01

    Public interest in the recent progress of tissue engineering, a special line of biotechnology, makes the current review on thoracic surgery highly relevant. In this article, techniques, materials and cellular processes are discussed alongside their potential applications in tissue repair. Different applications of tissue engineering in tracheo-bronchial replacement, lung tissue cultures and chest-wall reconstruction are also summarised in the article. Potential tissue engineering-based solutions for destructive, chronic lung-injury-related conditions and replacement of tubular structures in the central airways are also examined. Copyright 2010 European Association for Cardio-Thoracic Surgery. Published by Elsevier B.V. All rights reserved.

  7. Contribution of spinal glia activation to mechanical hyperalgesia induced by spared nerve injury in rats

    Institute of Scientific and Technical Information of China (English)

    FENG Si-zhe; WEI Xue-zhong; ZHANG Xiang

    2004-01-01

    Objective: To investigate the role of spinal glial cells activation in neuropathic pain in a recently developed spared nerve injury (SNI) animal model by Decosterd and Woolf. Methods: A lesion was made to two of the three terminal branches of the sciatic nerve of rats (tibial and common peroneal nerves) leaving the sural nerve intact. Continuous intrathecai administration of propentofyliine, a glial modulating agent, 1 d before and 5 d after operation, was performed to disrupt spinal cord glia function. The vehicle was intrathecally administrated as control. The paw withdrawal threshold to mechanical stimulation (paw withdrawal mechaical threshold PWMT), body mass and motor function were determined pre- and post-surgery. Results: It produced a prolonged mechanical allodynia in the medial and lateral part of the ipsilateral hind paw in SNL models. The treatment with propentofylline significantly prevented the development of mechanical allodynia located in either medial or lateral plantar surface. Rats in two groups showed normal motor function and body weight increase. Conclusion:SNI model can be applied as a useful method with little variance in searching the mechanism of neuropathic pain. These study suggest that spinal glia activation may contribute to mechanical allodynia induced by SNI.

  8. Prediction of margin involvement and local recurrence after skin-sparing and simple mastectomy.

    Science.gov (United States)

    Al-Himdani, S; Timbrell, S; Tan, K T; Morris, J; Bundred, N J

    2016-07-01

    Skin-sparing mastectomy (SSM) facilitates immediate breast reconstruction. We investigated locoregional recurrence rates after SSM compared with simple mastectomy and the factors predicting oncological failure. Patients with early breast cancer that underwent mastectomy between 2000 and 2005 at a single institution were studied to ascertain local and systemic recurrence rates between groups. Kaplan-Meier curves and log-rank test were used to evaluate disease-free survival. Patients (n = 577) underwent simple mastectomy (80%) or SSM (20%). Median follow up was 80 months. Patients undergoing SSM were of younger average age, less often had involved lymph nodes (22% vs 44%, p mastectomy respectively (p = 0.35). Predictors of locoregional recurrence were lymph node involvement (HR 8.0, for >4 nodes, p mastectomy radiotherapy. Re-excision of involved margins is essential to prevent local recurrence after mastectomy. Copyright © 2016 Elsevier Ltd, BASO ~ the Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.

  9. Selective ultrasound guided pectoral nerve targeting in breast augmentation: How to spare the brachial plexus cords?

    Science.gov (United States)

    Desroches, Jean; Grabs, Ursula; Grabs, Detlev

    2013-01-01

    Subpectoral breast augmentation surgery under regional anesthesia requires the selective neural blockade of the medial and lateral pectoral nerves to diminish postoperative pain syndromes. The purpose of this cadaver study is to demonstrate a reliable ultrasound guided approach to selectively target the pectoral nerves and their branches while sparing the brachial plexus cords. After evaluating the position and appearance of the pectoral nerves in 25 cadavers (50 sides), a portable ultrasound machine was used to guide the injection of 10 ml of 0.2% aqueous methylene blue solution in the pectoral region on both sides of three Thiel's embalmed cadavers using a single entry point-triple injection technique. This technique uses a medial to lateral approach with the entry point just medial to the pectoral minor muscle and three subsequent infiltrations: (1) deep lateral part of the pectoralis minor muscle, (2) between the pectoralis minor and major muscles, and (3) between the pectoralis major muscle and its posterior fascia under ultrasound visualization. Dissection demonstrates that the medial and lateral pectoral nerves were well stained while leaving the brachial plexus cords unstained. We show that 10 ml of an injected solution is sufficient to stain all the medial and lateral pectoral nerve branches without a proximal extension to the cords of the brachial plexus. Copyright © 2012 Wiley-Liss, Inc.

  10. Middle-Preserving Pancreatectomy: An Interesting Procedure for Pancreas-Sparing Resection

    Directory of Open Access Journals (Sweden)

    Cosimo Sperti

    2010-05-01

    Full Text Available Context Total pancreatectomy is the treatment of choice for multicentric diseases involving the head and the body-tail of the pancreas. Middle-preserving pancreatectomy is a recently reported alternative procedure when the pancreatic body is spared from disease. We report on the successful preservation of the pancreatic body in a patient harboring a multicentric intraductal papillary mucinous neoplasia (IPMN. Case report A multicentric IPMN was diagnosed in a 59-year-old man. A standard pylorus preserving pancreaticoduodenectomy was performed, followed by a spleen-preserving distal pancreatectomy. The splenic vessels were carefully preserved. The residual 5 cm of the pancreatic body were anastomosed to the jejunum after verifying that the resection line on both sides was negative at frozen section examination. The postoperative course was complicated by transient peritoneal bleeding managed with angiographic embolization of the splenic artery. A borderline mixed type IPMN of the head and chronic pancreatitis of the tail were found at pathological examination. Eleven months after surgery, the patient is well and disease free; glycemic control is achieved by diet. Conclusion A middle-preserving pancreatectomy can be performed safely for multicentric IPMNs involving the head and the body-tail of the gland. It can prevent problems with the glycemic control that usually follows total pancreatectomy.

  11. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws and ... Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, surgery, and is best performed by ...

  12. Breast operative technique for single-stage reconstruction after conservative skin sparing and nipple sparing mastectomies: a preliminary study

    Directory of Open Access Journals (Sweden)

    Egidio Riggio

    2012-02-01

    Full Text Available The Authors present a novel technique of immediate breast reconstruction with definite implants after mastectomy conserving the nipple- areola complex and, less frequently, in skin-sparing mastectomy. The increase of indications for both oncologic and prophylactic nipple-sparing mastectomy has induced the research for a single-stage technique that could replace the two-stage reconstruction with expanders and/or autogenous reconstructions with flaps. The new techniques introduce modifications of the pocket coverage for the implants occurring in two ways: i autologous adaptation of muscle-fascia-fat-skin layers, ii application of alloplastic materials as the meshes. A series of 124 immediate reconstructions were performed from 2008 to 2011 using a continuous composite pocket made of pectoralis maior and serratus anterior muscle above, and skin-fat flap below. The innovation is represented by an extended electrosurgical scoring of the lower pole of the mammary pocket at two levels. The first is the deep-fascia and muscle layer; the second is the superfiacial fascial system. This operative technique represents an advancement of a prior procedure described by the Authors in 1998. This preliminary study would primarily describe the technique step by step. Discussion debates about alternative techniques in terms of either surgical details of technique or cosmetic results are still to be reached.

  13. Applications of Metal Additive Manufacturing in Veterinary Orthopedic Surgery

    Science.gov (United States)

    Harrysson, Ola L. A.; Marcellin-Little, Denis J.; Horn, Timothy J.

    2015-03-01

    Veterinary medicine has undergone a rapid increase in specialization over the last three decades. Veterinarians now routinely perform joint replacement, neurosurgery, limb-sparing surgery, interventional radiology, radiation therapy, and other complex medical procedures. Many procedures involve advanced imaging and surgical planning. Evidence-based medicine has also become part of the modus operandi of veterinary clinicians. Modeling and additive manufacturing can provide individualized or customized therapeutic solutions to support the management of companion animals with complex medical problems. The use of metal additive manufacturing is increasing in veterinary orthopedic surgery. This review describes and discusses current and potential applications of metal additive manufacturing in veterinary orthopedic surgery.

  14. Rotational flaps in oncologic breast surgery. Anatomical and technical considerations.

    Science.gov (United States)

    Acea Nebril, Benigno; Builes Ramírez, Sergio; García Novoa, Alejandra; Varela Lamas, Cristina

    2016-01-01

    Local flaps are a group of surgical procedures that can solve the thoracic closure of large defects after breast cancer surgery with low morbidity. Its use in skin necrosis complications after conservative surgery or skin sparing mastectomies facilitates the initiation of adjuvant treatments and reduces delays in this patient group. This article describes the anatomical basis for the planning of thoracic and abdominal local flaps. Also, the application of these local flaps for closing large defects in the chest and selective flaps for skin coverage by necrosis in breast conserving surgery.

  15. Eosinophil cationic protein mRNA expression in children with bronchial asthma.

    Science.gov (United States)

    Yu, H Y; Li, X Y; Cai, Z F; Li, L; Shi, X Z; Song, H X; Liu, X J

    2015-11-13

    Studies have shown that eosinophils are closely related to pathogenesis of bronchial asthma. Eosinophils release eosinophil cationic protein (ECP), which plays an important role in infection and allergic reactions. Serum ECP mRNA expression in children with bronchial asthma has not been adequately investigated. We analyzed serum ECP mRNA expression in 63 children with bronchial asthma and 21 healthy children by using reverse-transcriptase polymerase chain reaction to understand the role of ECP in children with bronchial asthma. The children with bronchial asthma were segregated into acute-phase and stable-phase groups, based on the severity of the illness. Serum ECP mRNA expression in children with bronchial asthma (0.375 ± 0.04) was significantly higher than that in healthy controls (0.20 ± 0.02; P children in the acute-phase group showed higher ECP mRNA expression level (0.44 ± 0.06) than those in the stable-phase (0.31 ± 0.03) and healthy control groups (0.20 ± 0.02; P children with bronchial asthma.

  16. [Response mechanisms of the airway smooth muscle tissue in experimental bronchial spasm].

    Science.gov (United States)

    Zashikhin, A L; Agafonov, Iu V; Barmina, A O

    2009-01-01

    This investigation was aimed at the complex evaluation of the reactivity mechanisms of bronchial smooth muscle tissue (SMT) in experimental bronchial spasm. Morphometric, cytospectrophotometric and electron microscopical analysis demonstrated the presence of three types of smooth muscle cells (SMC) within the bronchial SMT (small, medium, large), that differed in their linear and metabolic parameters. The findings of this study indicate that under the conditions of experimental bronchial spasm development, the ratios of SMC in bronchial SMT are changed with the increase in proportion of small SMC and the elimination of large SMC. In the dynamics of experimental bronchial spasm development, the activation of cytoplasmic synthesis as well as of DNA synthesis was detected mainly in group of small SMC. The reactive-dystrophic changes were marked at the subcellular level, that were most often identified in large SMC resulting in their elimination from population in the dynamics of an experiment. The data obtained suggest that one of the important mechanisms of airway SMT adaptation to the bronchial spasm development is a dynamic reorganization of SMC population.

  17. [Coexistence of bronchial asthma and diabetes mellitus type 2--retrospective analysis].

    Science.gov (United States)

    Glück, J; Rogala, B

    1999-01-01

    Bronchial asthma and diabetes mellitus type 2 are often found among adult patients. However, coincidence of these two diseases is very rare. The aim of the study was the retrospective analysis of all patients with bronchial asthma and diabetes mellitus type 2 hospitalised in Department and Clinic of Internal Diseases and Allergology in Zabrze, Silesian School of Medicine in Katowice in 1988-1997. Diabetes mellitus type 2 was diagnosed according to WHO criteria of 1985 and bronchial asthma was diagnosed with the use of American Thoracic Society criteria. Bronchial asthma and diabetes mellitus type 2 occurring together were found in 18 patients (0.3% of all hospitalized patients). In most patients the symptoms of bronchial asthma preceded the diagnosis of diabetes mellitus by a few years. All these cases were heterogeneous in terms of the duration of the diseases, clinical picture, and therapeutical approaches. In patients with bronchial asthma the existence of diabetes mellitus type 2 was not related to use of glikocorticosteroids. Patients in whom the coexistence of bronchial asthma and diabetes mellitus type 2 was found should be subjects of further studies to extend our knowledge of patomechanism of these diseases.

  18. Bronchial morphometry in smokers: comparison with healthy subjects by using 3D CT

    Energy Technology Data Exchange (ETDEWEB)

    Montaudon, Michel [Unite d' Imagerie Thoracique, CHU de Bordeaux, Pessac (France); Universite Bordeaux 2, Laboratoire de Physiologie Cellulaire Respiratoire, Bordeaux (France); INSERM, Bordeaux (France); Hopital Cardiologique, Unite d' Imagerie Thoracique, Pessac (France); Berger, Patrick; Marthan, Roger [Universite Bordeaux 2, Laboratoire de Physiologie Cellulaire Respiratoire, Bordeaux (France); INSERM, Bordeaux (France); Service d' Exploration Fonctionnelle Respiratoire, CHU de Bordeaux, Pessac (France); Lederlin, Mathieu [Unite d' Imagerie Thoracique, CHU de Bordeaux, Pessac (France); Tunon-de-Lara, Jose Manuel [Universite Bordeaux 2, Laboratoire de Physiologie Cellulaire Respiratoire, Bordeaux (France); INSERM, Bordeaux (France); Service des Maladies Respiratoires, CHU de Bordeaux, Pessac (France); Laurent, Francois [Unite d' Imagerie Thoracique, CHU de Bordeaux, Pessac (France); Universite Bordeaux 2, Laboratoire de Physiologie Cellulaire Respiratoire, Bordeaux (France); INSERM, Bordeaux (France)

    2009-06-15

    The assessment of airway dimensions in patients with airway disease by using computed tomography (CT) has been limited by the obliquity of bronchi, the ability to identify the bronchial generation, and the limited number of bronchial measurements. The aims of the present study were (i) to analyze cross-sectional bronchial dimensions after automatic orthogonal reconstruction of all visible bronchi on CT images, and (ii) to compare bronchial morphometry between smokers and nonsmokers. CT and pulmonary function tests were performed in 18 males separated into two groups: 9 nonsmokers and 9 smokers. Bronchial wall area (WA) and lumen area (LA) were assessed using dedicated 3D software able to provide accurate cross-sectional measurements of all visible bronchi on CT. WA/LA and WA/(WA+LA) ratios were computed and all parameters were compared between both groups. Smokers demonstrated greater WA, smaller LA, and consequently greater LA/WA and LA/(WA+LA) ratios than nonsmokers. These differences occurred downward starting at the fourth bronchial generation. 3D quantitative CT method is able to demonstrate significant changes in bronchial morphometry related to tobacco consumption. (orig.)

  19. The developments and achievements of endoscopic surgery, robotic surgery and function-preserving surgery.

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    Yoshida, Masashi; Furukawa, Toshiharu; Morikawa, Yasuhide; Kitagawa, Yuko; Kitajima, Masaki

    2010-09-01

    The breakthrough in laparoscopic surgery has been the development of a charge-coupled device camera system and Mouret performing cholecystectomy in 1987. The short-term benefits of laparoscopic surgery are widely accepted and the long-term benefit of less incidence of bowel obstruction can be expected. The important developments have been the articulating instrumentation via new laparoscopic access ports. Since 2007, single-incision laparoscopic surgery has spread all over the world. Not only single-scar but also no-scar operation is a current topic. In 2004, Kalloo reported the flexible transgastric peritoneoscopy as a novel approach to therapeutic interventions. In 2007, Marescaux reported transvaginal cholecystectomy in a patient. The breakthrough in robotic surgery was the development of the da Vinci Surgical System. It was introduced to Keio University Hospital in March 2000. Precision in the surgery will reach a higher level with the use of robotics. In collaboration with the faculty of technology and science, Keio University, the combined master-slave manipulator has been developed. The haptic forceps, which measure the elasticity of organs, have also been developed. The first possible sites of lymphatic metastasis are known as sentinel nodes. Otani reported vagus-sparing segmental gastrectomy under sentinel node navigation. This kind of function-preserving surgery will be performed frequently if the results of the multicenter prospective trial of the dual tracer method are favorable. Indocyanine green fluorescence-guided method using the HyperEye charge-coupled device camera system can be a highly sensitive method without using the radioactive colloid. 'Minimally invasive, function-preserving and precise surgery under sentinel node navigation in community hospital' may be a goal for us.

  20. Impact of obesity on bronchial asthma in Indian population

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    Anandha K Ramasamy

    2014-01-01

    Full Text Available Background and Objective: Obesity and asthma are common inflammatory conditions, having presence of both local and systemic inflammation and this relationship is not well understood. This study was undertaken to compare pulmonary function parameters, inflammatory marker like C-reactive protein (hs-CRP, exhaled nitric oxide (FE NO and atopic profile between non-obese and obese bronchial asthma patients in Indian population. The study aims to elucidate the association between the systemic and local inflammatory response relating to obesity in asthmatics. Materials and Methods: Sixty bronchial asthma patients were recruited for the study, and were divided equally into obese (BMI>30 kg/m 2 and non-obese (BMI<25 kg/m 2 groups. These were assessed for pulmonary function parameters, blood hs-CRP levels, exhaled breath analysis of nitric oxide and skin prick testing for atopic profile. The study was approved by institutional ethical committee. Results: The mean body mass index (BMI for the non-obese and obese group was 21.64 kg/m 2 and 34.1 kg/m 2 respectively (P = 0.001. The functional residual capacity (FRC% predicted (100.9 ± 4.21 vs 80.40 ± 4.03; P = 0.009 and expiratory reserve volume (ERV% predicted (95.13 ± 6.71 vs. 67.03 ± 4.54; P = 0.001 both were significantly lower in the obese group. The non-obese and obese group had hs-CRP levels of 3.01 mg/L and 4.07 mg/L, respectively; the difference being statistically insignificant (P = 0.15. Similarly, FE NO levels of non-obese and obese group were 63.20 ppb and 63.75 ppb, respectively; difference was not statistically significant (P = 0.95. Atopic profile of both the groups did not differ significantly. Conclusion : Obesity does not appear to increase the local and systemic inflammatory responses in bronchial asthma patients in Indian population.

  1. Hyaluronidases and hyaluronan synthases expression is inversely correlated with malignancy in lung/bronchial pre-neoplastic and neoplastic lesions, affecting prognosis

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    V.K. de Sá

    2015-11-01

    Full Text Available We collected a series of 136 lung/bronchial and 56 matched lung parenchyma tissue samples from patients who underwent lung/bronchial biopsies and presented invasive carcinoma after lung surgery. The lung/bronchial samples included basal cell hyperplasia, squamous metaplasia, moderate dysplasia, adenomatous hyperplasia, severe dysplasia, squamous cell carcinoma and adenocarcinoma. Matched lung parenchyma tissue samples included 25 squamous cell carcinomas and 31 adenocarcinomas. Immunohistochemistry was performed to analyze for the distribution of hyaluronidase (Hyal-1 and −3, and hyaluronan synthases (HAS-1, −2, and −3. Hyal-1 showed significantly higher expression in basal cell hyperplasia than in moderate dysplasia (P=0.01, atypical adenomatous hyperplasia (P=0.0001, or severe dysplasia (P=0.03. Lower expression of Hyal-3 was found in atypical adenomatous hyperplasia than in basal cell hyperplasia (P=0.01 or moderate dysplasia (P=0.02. HAS-2 was significantly higher in severe dysplasia (P=0.002 and in squamous metaplasia (P=0.04 compared with basal cell hyperplasia. HAS-3 was significantly expressed in basal cell hyperplasia compared with atypical adenomatous hyperplasia (P=0.05 and severe dysplasia (P=0.02. Lower expression of HAS-3 was found in severe dysplasia compared with squamous metaplasia (P=0.01 and moderate dysplasia (P=0.01. Epithelial Hyal-1 and −3 and HAS-1, −2, and −3 expressions were significantly higher in pre-neoplastic lesions than in neoplastic lesions. Comparative Cox multivariate analysis controlled by N stage and histologic tumor type showed that patients with high HAS-3 expression in pre-neoplastic cells obtained by lung/bronchial biopsy presented a significantly higher risk of death (HR=1.19; P=0.04. We concluded that localization of Hyal and HAS in lung/bronchial pre-neoplastic and neoplastic lesions was inversely related to malignancy, which implied that visualizing these factors could be a useful

  2. Spare parts management for nuclear power generation facilities

    Science.gov (United States)

    Scala, Natalie Michele

    With deregulation, utilities in the power sector face a much more urgent imperative to emphasize cost efficiencies as compared to the days of regulation. One major opportunity for cost savings is through reductions in spare parts inventories. Most utilities are accustomed to carrying large volumes of expensive, relatively slow-moving parts because of a high degree of risk-averseness. This attitude towards risk is rooted in the days of regulation. Under regulation, companies recovered capital inventory costs by incorporating them into the base rate charged to their customers. In a deregulated environment, cost recovery is no longer guaranteed. Companies must therefore reexamine their risk profile and develop policies for spare parts inventory that are appropriate for a competitive business environment. This research studies the spare parts inventory management problem in the context of electric utilities, with a focus on nuclear power. It addresses three issues related to this problem: criticality, risk, and policy. With respect to criticality and risk, a methodology is presented that incorporates the use of influence diagrams and the Analytic Hierarchy Process (AHP). A new method is developed for group aggregation in the AHP when Saaty and Vargas' (2007) dispersion test fails and decision makers are unwilling or unable to revise their judgments. With respect to policy, a quantitative model that ranks the importance of keeping a part in inventory and recommends a corresponding stocking policy through the use of numerical simulation is developed. This methodology and its corresponding models will enable utilities that have transitioned from a regulated to a deregulated environment become more competitive in their operations while maintaining safety and reliability standards. Furthermore, the methodology developed is general enough so that other utility plants, especially those in the nuclear sector, will be able to use this approach. In addition to regulated

  3. Cortical blindness and ataxia complicating bronchial artery embolization for severe hemoptysis.

    Science.gov (United States)

    Peng, Guoping; Liang, Hui; Ruan, Lingxiang; Luo, Benyan

    2010-01-01

    Complications of bronchial artery embolization (BAE) are uncommon. A 37-year-old patient with pulmonary tuberculosis received bronchial artery embolization because of severe hemoptysis. The bilateral bronchial arteries and left internal mammary artery were embolized using a gelatin sponge, and the patient exhibited occipital blindness and ataxia after the second BAE. The dissolvable gelatin sponge possibly entered the posterior circulation, resulting in the multiple infarctions in the bilateral occipital lobes and cerebellum. Because of the bad prognosis and the difficulty for curability, this kind of complication should be recognized in a timely manner and carefully avoided by the interventional radiologists carrying out the BAE.

  4. APPLICATION OPPORTUNITIES FOR THE NONMEDICAMENTOUS PREVENTION AND TREATMENT METHODS OF BRONCHIAL ASTHMA IN CHILDREN

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    D.A. Bezrukova

    2007-01-01

    Full Text Available In the article, the authors justify the necessity to apply non medicamentous treatment methods to the children with bronchial asthma. The scientists familiarize us with a new me dication, whose effect is based on the noninvasive impact of the electromagnetic radiation of the knowingly non thermal intensity. It is for normalization of the disturbed function of the respiratory system. The researchers showed the efficiency of the above said innovative medication, while treating bronchial asthma among children with no side effects whatsoever.Key words: bronchial asthma, nonmedicamentous treatment methods, children.

  5. NERVE SPARING VENTRAL CLITOROPLASTY : A NEW TREATMENT FOR CLITOROMEGALY

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    Immadi Chandra

    2015-04-01

    Full Text Available BACKGROUND: Ambiguous genitalia are the most common presentation with which the child is brought to the clinician in congenital adrenal hyperplasia ( CAH . Several enzymes necessary for cortisol biosynthesis may be affected . Deficiency of 21 - hydroxylase is responsible for 90 - 95% of all cases of CAH . CAH presents with spectrum of symptoms . Females present with genital virilisation . 3 case studies of congenital adrenal hyperplasia presenting to us with complaints of ambiguous genitalia are discussed here which were diagnosed as CAH . All of them are treated with T . Hydrocortisone and Fludrocortisone and later nerve sparing ventral clitoroplasty was done where nerves to clitoris are preserved . This is a new treatment which does not compromise her future sexual satisfaction .

  6. Allotment of aircraft spare parts using genetic alorithms

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    Batchoun Pascale

    2003-01-01

    Full Text Available In this paper we attempt to determine the optimal allocation of aircraft parts used as spares for replacement of defective parts on-board of a departing flight. In order to minimize the cost of delay caused by unexpected failure, Genetic algorithms (GAs are used to allocate the initial quantity of parts among the airports. GAs are a class of adaptive search procedures, that distinguish themselves from other optimization techniques by the use of concepts from population genetics to guide the search. Problem-specific knowledge is incorporated into the problem and efficient parameters are identified and tested for the task of optimizing the allocation of parts. The approach is illustrated by numerical results.

  7. Open Maximal Mucosa-Sparing Functional Total Laryngectomy

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    Pavel Dulguerov

    2017-10-01

    Full Text Available BackgroundTotal laryngectomy after (chemoradiotherapy is associated with a high incidence of fistula and therefore flaps are advocated. The description of a transoral robotic total laryngectomy prompted us to develop similar minimally invasive open approaches for functional total laryngectomy.MethodsA retrospective study of consecutive unselected patients with a dysfunctional larynx after (chemoradiation that underwent open maximal mucosal-sparing functional total laryngectomy (MMSTL between 2014 and 2016 is presented. The surgical technique is described, and the complications and functional outcome are reviewed.ResultsThe cohorts included 10 patients who underwent open MMSTL. No pedicled flap was used. Only one postoperative fistula was noted (10%. All patients resumed oral diet and experienced a functional tracheo-esophageal voice.ConclusionMMSTL could be used to perform functional total laryngectomy without a robot and with minimal incidence of complications.

  8. Relatively spared central multifocal electroretinogram responses in acute quinine toxicity

    Science.gov (United States)

    Saeed, Muhammad Usman; Noonan, Carmel; Hagan, Richard; Brown, Malcolm

    2011-01-01

    A 71-year-old man was investigated with electrodiagnostic testing 4 months after a deliberate quinine overdose. Initially he was admitted to intensive care unit with visual acuity (VA) of perception of light in both eyes. VA recovered to 6/6 right eye and 6/12 left eye, though severely constricted fields were noted. Slow stimulus (base period of 83 ms) multifocal electroretinogram (ERG) showed electronegative responses outside the inner 5 degrees, with a reduced but electropositive response seen in this central area. It appears that in this case of bilaterally negative ERGs that the macula/fovea (which has a vascular supply through the choroid) is relatively spared as is seen in bilateral vascular electronegative ERGs. This may indicate that quinine toxicity to the retina may be secondary to effects similar to vascular occlusion or severe ischemia during the acute phase of quinine poisoning. PMID:22693278

  9. Design of inventory pools in spare part support operation systems

    Science.gov (United States)

    Mo, Daniel Y.; Tseng, Mitchell M.; Cheung, Raymond K.

    2014-06-01

    The objective of a spare part support operation is to fulfill the part request order with different service contracts in the agreed response time. With this objective to achieve different service targets for multiple service contracts and the considerations of inventory investment, it is not only important to determine the inventory policy but also to design the structure of inventory pools and the order fulfilment strategies. In this research, we focused on two types of inventory pools: multiple inventory pool (MIP) and consolidated inventory pool (CIP). The idea of MIP is to maintain separated inventory pools based on the types of service contract, while CIP solely maintains a single inventory pool regardless of service contract. Our research aims to design the inventory pool analytically and propose reserve strategies to manage the order fulfilment risks in CIP. Mathematical models and simulation experiments would be applied for analysis and evaluation.

  10. Low power laser therapy in treatment of bronchial asthma

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    Milojević Momir

    2003-01-01

    Full Text Available Introduction Modern concept of acupuncture is based on the fact there are designated locations on the surface of human body, which are related to integrative systems of an organism by means of sensory nerves, correlating and synchronizing organ functioning, depending on external and internal conditions, by means of nervous and neurohumoral regulation of metabolic and regenerative processes, including also mobilization of immunological, protective and antistress reactions. Apart from standard needle acupuncture, other methods of stimulating acupuncture points are also applied. Due to invention of low power lasers, irradiation laser acupuncture has been introduced into routine medical practice, characterized by painless and aseptic technique and outstanding clinical results. Material and methods The investigation was aimed at defining therapeutic effects of low power laser irradiation by stimulating acupuncture points or local treatment of asthma. A prospective analysis included 50 patients treated at the Institute of Pulmonary Diseases in Sremska Kamenica during 2000, 2001 and 2002. Together with conservative treatment of present disease, these patients were treated with laser stimulation of acupuncture points in duration of ten days. During treatment changes of functional respiratory parameters were recorded. Results were compared with those in the control group. The control group consisted of the same number of patients and differed from the examination group only by not using laser stimulation. Results Patients with bronchial asthma presented with significant improvement (p<0,0005 of all estimated lung function parameters just 30 minutes after laser stimulation. Improvements achieved on the third and the tenth day of treatment were significantly higher (p<0,001 to p<0,00005 in the examination group in comparison with the control group. Further investigation confirmed that improvement of measured lung function parameters was significantly

  11. Role of human mast cells and basophils in bronchial asthma.

    Science.gov (United States)

    Marone, Gianni; Triggiani, Massimo; Genovese, Arturo; De Paulis, Amato

    2005-01-01

    Mast cells and basophils are the only cells expressing the tetrameric (alphabetagamma2) structure of the high affinity receptor for IgE (FcepsilonRI) and synthesizing histamine in humans. Human FcepsilonRI+ cells are conventionally considered primary effector cells of bronchial asthma. There is now compelling evidence that these cells differ immunologically, biochemically, and pharmacologically, which suggests that they might play distinct roles in the appearance and fluctuation of the asthma phenotype. Recent data have revealed the complexity of the involvement of human mast cells and basophils in asthma and have shed light on the control of recruitment and activation of these cells in different lung compartments. Preliminary evidence suggests that these cells might not always be detrimental in asthma but, under some circumstances, they might exert a protective effect by modulating certain aspects of innate and acquired immunity and allergic inflammation.

  12. Bronchial hypersecretion, chronic airflow limitation, and peptic ulcer.

    Science.gov (United States)

    Kauffmann, F; Brille, D

    1981-11-01

    Men with and men without a history of peptic ulcers were compared using respiratory symptoms and spirographic measurements taken from data recorded in an epidemiologic study. Among the 1,049 men examined, 7% reported a history of peptic ulcer. A clear relationship appeared between bronchial hypersecretion and peptic ulcers. It persisted after adjustment for age, smoking habits, social class, and country of origin. Men with ulcers inhaled tobacco smoke more often. Ulcers, smoking, and chronic phlegm were independently related to a lower body build index. It seems that the relationship between smoking and ulcers was greater among men with chronic phlegm, and it is postulated that peptic ulcers and "chronic bronchitis" might be related to a "common secretory disorder." After adjustment for age, men with a history of peptic ulcers had, not a lower FEV1, but a higher vital capacity. A slightly lower FEV1/VC ratio cannot in such cases be considered as an index of chronic airflow limitation.

  13. Randomized controlled study of CBT in bronchial asthma

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    Grover Naveen

    2007-01-01

    Full Text Available The aim of the present study was to find out efficacy of cognitive behavior therapy, as an adjunct to standard pharmacotherapy, in bronchial asthma. In a random-ized two-group design with pre-and post assessments, forty asthma patients were randomly allotted to two groups: self management group and cognitive behavior therapy group. Both groups were exposed to 6-8 weeks of intervention, asthma self management program and cognitive behavior therapy. Assessment measures used were-Semi structured interview schedule, Asthma Symptom Checklist, Asthma di-ary, Asthma Bother Profile, Hospital Anxiety & Depression Scale, AQLQ and Peak Expiratory Flow Rate. Within group comparison showed significant improvement in both groups at the post assessment. Between group comparisons showed that CBT group reported significantly greater change than that of SM group. Cognitive behavior therapy helps in improving the managment of asthma.

  14. Contribution of CT for the diagnosis of bronchial carcinoids

    Energy Technology Data Exchange (ETDEWEB)

    Koenig, R.; Kaick, G. van; Toomes, H.

    1984-03-01

    The CT findings in 10 patients with carcinoid tumors of the lung are reported. The tumors were located in the hilar region, in the perihilar region and in the periphery of the lung. Dystelectasis and atelectasis of the lung with poststenotic inflammation were found in 4 patients. Infiltrating tumor growth with lymph node metastases were detected only once. This tumor was not able to be differentiated from other malignant space occupying lesions. There were no reliable CT criteria for bronchial carcinoids. Compared to conventional radiography the CT examination has the following advantages: better demonstration of size and location of the tumor, and the exlusion of infiltrating tumor growth, enlarged lymph nodes and calcified lung nodules.

  15. [Efficiency of kinesi- and hydrokinesitherapy in children with bronchial asthma].

    Science.gov (United States)

    Surovenko, T N; Iashchuk, A V; Iansons, T Ia; Ezhov, S N

    2003-01-01

    The authors review efficiency of various programs of kinesi and hydrokinesitherapy of children with atopic bronchial asthma (BA). Efficiency of the treatment was assessed by quality of life using the questionnaire by A. West, D. French "Childhood asthma questionnaire" (adapted for Russia by V. I. Petrov et al). Monitoring of the activity of allergic inflammation of the upper respiratory tracts was performed by examination of the nasal lavage fluid for nitric oxide metabolites, of the lower respiratory tracts--by the metabolites in the condensate of the expired air. It is shown that hydrokinesitherapy raises BA children's quality of life and declines inflammation activity leading to reduction of the number of BA exacerbations and hospitalizations. The above criteria of the treatment efficacy proved sensitive.

  16. Assessment of quality of life in bronchial asthma patients

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    N Nalina

    2015-01-01

    Full Text Available Introduction: Asthma is a common chronic disease that affects persons of all ages. People with asthma report impact on the physical, psychological and social domains of quality of life. Health-related quality of life (HRQoL measures have been developed to complement traditional health measures such as prevalence, mortality and hospitalization as indicators of the impact of disease. Objective and Study Design: The objective of this study was to assess HRQoL in Bronchial asthma patients and to relate the severity of asthma with their quality of life. About 85 asthma patients were evaluated for HRQoL and their pulmonary function tests values were correlated with HRQoL scores. Results and Conclusion: It was found that asthma patients had poor quality of life. There was greater impairment in quality of life in females, obese and middle age patients indicating that sex, body mass index and age are determinants of HRQoL in asthma patients.

  17. Hippocampus sparing in whole-brain radiotherapy. A review

    Energy Technology Data Exchange (ETDEWEB)

    Oskan, F. [University of Munich, Department of Radiation Oncology and CCC Neuro-Oncology, Munich (Germany); Saarland University Medical Center, Department of Radiation Oncology, Homburg/Saar (Germany); Ganswindt, U.; Schwarz, S.B.; Manapov, F.; Belka, C.; Niyazi, M. [University of Munich, Department of Radiation Oncology and CCC Neuro-Oncology, Munich (Germany)

    2014-04-15

    Radiation treatment techniques for whole-brain radiation therapy (WBRT) have not changed significantly since development of the procedure. However, the recent development of novel techniques such as intensity-modulated radiation therapy (IMRT), volumetric-modulated arc therapy (VMAT) and helical tomotherapy, as well as an increasing body of evidence concerning neural stem cells (NSCs) have altered the conventional WBRT treatment paradigm. In this regard, hippocampus-sparing WBRT is a novel technique that aims to spare critical hippocampus regions without compromising tumour control. Published data on this new technique are limited to planning and feasibility studies; data on patient outcome are still lacking. However, several prospective trials to analyse the feasibility of this technique and to document clinical outcome in terms of reduced neurotoxicity are ongoing. (orig.) [German] Die Technik der Ganzhirnbestrahlung (''whole-brain radiation therapy'', WBRT) hat sich seit der Entwicklung nicht wesentlich veraendert. Allerdings stellten die Neuentwicklung von Techniken wie die intensitaetsmodulierte Strahlentherapie (IMRT), die volumenmodulierte Arc-Therapie (VMAT) oder die helikale Tomotherapie sowie immer groesseres Wissen ueber das neurale Stammzellkompartiment (NSCs) das herkoemmliche Ganzhirn-Paradigma in Frage. Die hippocampusschonende Ganzhirnbestrahlung ist eine neuartige Technik, welche die kritische Region des Hippocampus schont, ohne die Tumorkontrolle zu gefaehrden. Ueber diese Technik gibt es bisher nur eine begrenzte Datenlage im Sinne von Planungs- und Machbarkeitsstudien. Klinische Daten bzgl. der Behandlungsergebnisse fehlen nach wie vor, aber einige prospektive Studien sind im Gange, um nicht nur die Machbarkeit zu belegen, sondern auch das klinische Outcome im Sinne einer verringerten Neurotoxizitaet nachzuweisen. (orig.)

  18. [Effects and significance of methacholine bronchial provocation tests and salbutamol bronchial dilation test on measurements of fractional exhaled nitric oxide in patients with asthma].

    Science.gov (United States)

    Liu, Jielu; Yu, Huapeng; Tan, Xiaomei; Wu, Shuhan; Zhang, Pan; Fang, Zekui; Wang, Cuilan; He, Xi

    2016-03-01

    To study the effects and significance of methacholine (Mch) bronchial provocation tests and salbutamol bronchial dilation test on measurements of fractional exhaled nitric oxide (FeNO) in patients with asthma. This was a prospective study conducted between November 2014 and August 2015. A total of 135 patients with asthma visiting the respiratory clinic of Zhujiang Hospital were enrolled. The patients received either Mch bronchial provocation test or salbutamol bronchial dilation test based on their FEV1/FVC values and cooperative degree. Mch bronchial provocation test was performed by using Astograph Jupiter-21 (Astograh group) or APS-Pro airway reaction testing apparatus (APS group), and salbutamol bronchial dilation test was performed by using Jaeger spirometer (Dilation group). We compared the differences between FeNO values measured before examinations (Pre-FeNO) and 5 min after completion of these examinations (Post-FeNO). The geometric mean of Pre-FeNO and Post-FeNO was 28.07 ppb and 24.08 ppb respectively in the Astograh group, with a significant decrease of the FeNO value after the examination (Z=-3.093, P=0.002). A significant difference between Pre-FeNO and Post-FeNO was found in patients who had positive provocation results in the Astograh group (Z=-2.787, P=0.005), but not in the patients with negative results (Z=-1.355, P=0.176). The geometric mean of FeNO in the APS group decreased significantly from 27.95 ppb to 23.15 ppb after the examination was completed (Z=-5.170, P=0.000); both in patients with positive saline or Mch provocation results and in patients with negative provocation results, the differences between Pre-FeNO and Post-FeNO in the APS group being significant (Z=-2.705, -3.709, -2.371, P=0.002, 0.000, 0.018). No difference of FeNO change(ΔFeNO) was observed between the 2 Mch bronchial provocation test groups (Uppb and that of Post-FeNO was 34.79 ppb in the Dilation group; the difference being not significant (Z=-1.281, P=0.200). Our

  19. Bronchial thermoplasty: reappraising the evidence (or lack thereof).

    Science.gov (United States)

    Iyer, Vivek N; Lim, Kaiser G

    2014-07-01

    Bronchial thermoplasty (BT) involves the application of radiofrequency energy to visible proximal airways to selectively ablate airway smooth muscle. BT is the first nonpharmacologic interventional therapy approved by the US Food and Drug Administration (FDA) for severe asthma. This approval was based on the results of the pivotal Asthma Intervention Research (AIR)-2 trial, which is the only randomized, double-blind, sham-controlled trial of BT. The primary end point of the AIR-2 trial was improvement in the Asthma Quality of Life Questionnaire (AQLQ). The results of the AIR-2 trial have generated enormous interest, controversy, and confusion regarding the true efficacy of BT for severe asthma. Current marketing of BT highlights its use for patients with "severe" asthma, which is interpreted by most practicing clinicians as meaning oral corticosteroid dependence, frequent exacerbations, or a significantly reduced FEV1 with a poor quality of life. Did the AIR-2 trial include patients with a low FEV1, oral steroid dependence, or frequent exacerbations? Did the trial show efficacy for any of the primary or secondary end points? The FDA approved the device based on the reduction in severe asthma exacerbations. However, were the rates of asthma exacerbations, ED visits, or hospitalizations truly different between the two groups, and was this type of analysis even justified given the original study design? This commentary is designed to specifically answer these questions and help the practicing clinician navigate the thermoplasty literature with confidence and clarity. We carefully dissect the design, conduct, and results of the AIR-2 trial and raise serious questions about the efficacy of bronchial thermoplasty.

  20. Functional Metagenomics of the Bronchial Microbiome in COPD.

    Directory of Open Access Journals (Sweden)

    Laura Millares

    Full Text Available The course of chronic obstructive pulmonary disease (COPD is frequently aggravated by exacerbations, and changes in the composition and activity of the microbiome may be implicated in their appearance. The aim of this study was to analyse the composition and the gene content of the microbial community in bronchial secretions of COPD patients in both stability and exacerbation. Taxonomic data were obtained by 16S rRNA gene amplification and pyrosequencing, and metabolic information through shotgun metagenomics, using the Metagenomics RAST server (MG-RAST, and the PICRUSt (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States programme, which predict metagenomes from 16S data. Eight severe COPD patients provided good quality sputum samples, and no significant differences in the relative abundance of any phyla and genera were found between stability and exacerbation. Bacterial biodiversity (Chao1 and Shannon indexes did not show statistical differences and beta-diversity analysis (Bray-Curtis dissimilarity index showed a similar microbial composition in the two clinical situations. Four functional categories showed statistically significant differences with MG-RAST at KEGG level 2: in exacerbation, Cell growth and Death and Transport and Catabolism decreased in abundance [1.6 (0.2-2.3 vs 3.6 (3.3-6.9, p = 0.012; and 1.8 (0-3.3 vs 3.6 (1.8-5.1, p = 0.025 respectively], while Cancer and Carbohydrate Metabolism increased [0.8 (0-1.5 vs 0 (0-0.5, p = 0.043; and 7 (6.4-9 vs 5.9 (6.3-6.1, p = 0.012 respectively]. In conclusion, the bronchial microbiome as a whole is not significantly modified when exacerbation symptoms appear in severe COPD patients, but its functional metabolic capabilities show significant changes in several pathways.

  1. Pranlukast hydrate in the treatment of pediatric bronchial asthma

    Directory of Open Access Journals (Sweden)

    Yoshihara S

    2013-07-01

    Full Text Available Shigemi Yoshihara Department of Pediatrics, Dokkyo Medical University, Tochigi, Japan Abstract: Pranlukast hydrate is a potent, selective, orally active, cysteinyl leukotriene antagonist that binds at the type 1 receptor. It is used as a 10% dry syrup to treat asthma and allergic rhinitis in pediatric patients. In a 4-week, dose-finding study, a dose-dependent improvement in lung function was observed in pediatric patients with asthma at an optimal dose of 5.1–10 mg/kg/day. In a comparative, randomized, double-blind, 4-week multicenter trial, pranlukast dry syrup 7 mg/kg/day achieved significantly better final overall improvement (71.4% versus oxatomide 1 mg/kg/day (37.2% in pediatric patients older than one year with asthma. In two 12-week, open-label trials and in a long-term open-label trial of treatment for up to 24 months, pranlukast dry syrup improved asthma control over baseline values. In a prospective post-marketing surveillance study and a long-term follow-up study, the safety and efficacy of pranlukast dry syrup was confirmed in infants younger than one year with bronchial asthma. In a 4-week, open-label trial, pranlukast dry syrup improved overall health-related quality of life and physical and emotional domain scores over baseline in pediatric patients with asthma. In a randomized, multicenter, double-blind, placebo-controlled, two-period crossover trial, pranlukast dry syrup significantly inhibited exercise-induced bronchospasm in children with asthma compared with placebo. In a modified Childhood Asthma Control Test, pranlukast dry syrup was significantly more effective in controlling asthma in patients younger than 4 years with the common cold. These findings show that pranlukast is useful and beneficial for treating pediatric patients with bronchial asthma. Keywords: pranlukast, leukotriene receptor antagonist, pediatric asthma

  2. Functional Metagenomics of the Bronchial Microbiome in COPD.

    Science.gov (United States)

    Millares, Laura; Pérez-Brocal, Vicente; Ferrari, Rafaela; Gallego, Miguel; Pomares, Xavier; García-Núñez, Marian; Montón, Concepción; Capilla, Silvia; Monsó, Eduard; Moya, Andrés

    2015-01-01

    The course of chronic obstructive pulmonary disease (COPD) is frequently aggravated by exacerbations, and changes in the composition and activity of the microbiome may be implicated in their appearance. The aim of this study was to analyse the composition and the gene content of the microbial community in bronchial secretions of COPD patients in both stability and exacerbation. Taxonomic data were obtained by 16S rRNA gene amplification and pyrosequencing, and metabolic information through shotgun metagenomics, using the Metagenomics RAST server (MG-RAST), and the PICRUSt (Phylogenetic Investigation of Communities by Reconstruction of Unobserved States) programme, which predict metagenomes from 16S data. Eight severe COPD patients provided good quality sputum samples, and no significant differences in the relative abundance of any phyla and genera were found between stability and exacerbation. Bacterial biodiversity (Chao1 and Shannon indexes) did not show statistical differences and beta-diversity analysis (Bray-Curtis dissimilarity index) showed a similar microbial composition in the two clinical situations. Four functional categories showed statistically significant differences with MG-RAST at KEGG level 2: in exacerbation, Cell growth and Death and Transport and Catabolism decreased in abundance [1.6 (0.2-2.3) vs 3.6 (3.3-6.9), p = 0.012; and 1.8 (0-3.3) vs 3.6 (1.8-5.1), p = 0.025 respectively], while Cancer and Carbohydrate Metabolism increased [0.8 (0-1.5) vs 0 (0-0.5), p = 0.043; and 7 (6.4-9) vs 5.9 (6.3-6.1), p = 0.012 respectively]. In conclusion, the bronchial microbiome as a whole is not significantly modified when exacerbation symptoms appear in severe COPD patients, but its functional metabolic capabilities show significant changes in several pathways.

  3. [6 years' personal experience with duodenum-sparing procedures in chronic pancreatitis].

    Science.gov (United States)

    Sváb, J; Fried, M; Bortlík, M; Lukás, M; Horejs, J

    2000-06-01

    The First Surgical Clinic of the First Medical Faculty Charles University and General Faculty Hospital Prague made operations of the pancreas ever since 1971. In the work sooner or later all approaches to surgical treatment of pancreatitis were reflected. The authors present a brief review of results and their own experience since 1994 when duodenum sparing operations were introduced. Indications for surgical treatment were based on the diagnosis by US, CT and ERCP, in exceptional cases MR, after evaluation by a pancreatologist, roentgenologist and surgeon. The group of patients with chronic pancreatitis was extended by 15 patients from a group operated because of preoperative suspicion of a malignant pancreatic tumour not confirmed during and after surgery. In those Whipple's operation was performed. The same operation was performed in three patients with chronic pancreatitis with serious changes in the area of the head of the pancreas. In 111 patients a drainage and duodenum sparing operation was performed. Of these in 46x according to Neger, 9x according to Frey, 10x modification of these operations, 37x Partington-Rochelle's procedure. The authors did not record postoperative complications after the classical Beger operation and the hospital stay was on average by five days shorter as compared with the classical method of Whipple. When evaluating postoperative complaints and problems (pain, malnutrition, physical constitution and social position) the authors recorded equally favourable results as after non-complicated duodenopancreatectomy. They varied, depending on the patient s co-operation round 87% while after longitudinal drainage of the duct a satisfactory result was recorded in 78% of the operated patients. The authors consider Beger's operation logical because of the removal of the main tissue mass of the head of the pancreas, responsible for pain, complications caused by fibrosis in the area round the bile duct and duodenum, responsible for the

  4. Configuration model of partial repairable spares under batch ordering policy based on inventory state

    Institute of Scientific and Technical Information of China (English)

    Ruan Minzhi; Luo Yi; Li Hua

    2014-01-01

    Rational planning of spares configuration project is an effective approach to improve equipment availability as well as reduce life cycle cost (LCC). With an analysis of various impacts on support system, the spares demand rate forecast model is constructed. According to systemic analysis method, spares support effectiveness evaluation indicators system is built, and then, initial spares configuration and optimization method is researched. To the issue of discarding and con-sumption for incomplete repairable items, its expected backorders function is approximated by Laplace demand distribution. Combining the (s-1, s) and (R, Q) inventory policy, the spares resup-ply model is established under the batch ordering policy based on inventory state, and the optimi-zation analysis flow for spares configuration is proposed. Through application on shipborne equipment spares configuration, the given scenarios are analyzed under two constraint targets:one is the support effectiveness, and the other is the spares cost. Analysis reveals that the result is consistent with practical regulation;therefore, the model’s correctness, method’s validity as well as optimization project’s rationality are proved to a certain extent.

  5. Psoriasis sparing the polio-affected limb: Is it merely the koebner phenomenon?

    Directory of Open Access Journals (Sweden)

    B C Ravikumar

    2014-01-01

    Full Text Available Psoriasis being a common skin condition, atypical forms and unusual localizations of this disease are quite frequently seen. However, psoriasis sparing a polio-affected limb is extremely rare. We report a case of an adult male, who presented with psoriasis distributed all over the body but with almost complete sparing of the polio-affected left lower limb.

  6. Military Logistics. Buying Army Spares Too Soon Creates Excess Stocks and Increases Costs

    Science.gov (United States)

    1989-08-01

    Department of Defense (DoD) response to the General Accounting Office (GAO) draft report, " MILITARY LOGISTICS : Buying Army Spares Too Soon Creates Excessive...DATED MAY 30, 1989 (GAO CODE 393294) OSD CASE 8011 " MILITARY LOGISTICS : BUYING ARM SPARES TOO SOON CREATES EXCESSIVE STOCKS AND INCREASES COSTS

  7. Joint optimization of level of repair analysis and spare parts stocks.

    NARCIS (Netherlands)

    Basten, Robertus Johannes Ida; van der Heijden, Matthijs C.; Schutten, Johannes M.J.

    2011-01-01

    In the field of service logistics for capital goods, generally, metric type methods are used to decide where to stock spare parts in a multi-echelon repair network such that a target availability of the capital goods is achieved. These methods generate a trade-off curve of spares investment costs

  8. Joint optimization of level of repair analysis and spare parts stocks

    NARCIS (Netherlands)

    Basten, R.J.I.; Heijden, van der M.C.; Schutten, J.M.J.

    2011-01-01

    In the field of service logistics for capital goods, generally, metric type methods are used to decide where to stock spare parts in a multi-echelon repair network such that a target availability of the capital goods is achieved. These methods generate a trade-off curve of spares investment costs ve

  9. Joint optimization of level of repair analysis and spare parts stocks

    NARCIS (Netherlands)

    Basten, R.J.I.; Heijden, van der M.C.; Schutten, J.M.J.

    2012-01-01

    In the field of after sales service logistics for capital goods, generally, METRIC type methods are used to decide where to stock spare parts in a multi-echelon repair network such that a target availability of the capital goods is achieved. These methods generate a trade-off curve of spares investm

  10. Object Recognition with Severe Spatial Deficits in Williams Syndrome: Sparing and Breakdown

    Science.gov (United States)

    Landau, Barbara; Hoffman, James E.; Kurz, Nicole

    2006-01-01

    Williams syndrome (WS) is a rare genetic disorder that results in severe visual-spatial cognitive deficits coupled with relative sparing in language, face recognition, and certain aspects of motion processing. Here, we look for evidence for sparing or impairment in another cognitive system--object recognition. Children with WS, normal mental-age…

  11. Configuration model of partial repairable spares under batch ordering policy based on inventory state

    Directory of Open Access Journals (Sweden)

    Ruan Minzhi

    2014-06-01

    Full Text Available Rational planning of spares configuration project is an effective approach to improve equipment availability as well as reduce life cycle cost (LCC. With an analysis of various impacts on support system, the spares demand rate forecast model is constructed. According to systemic analysis method, spares support effectiveness evaluation indicators system is built, and then, initial spares configuration and optimization method is researched. To the issue of discarding and consumption for incomplete repairable items, its expected backorders function is approximated by Laplace demand distribution. Combining the (s−1, s and (R, Q inventory policy, the spares resupply model is established under the batch ordering policy based on inventory state, and the optimization analysis flow for spares configuration is proposed. Through application on shipborne equipment spares configuration, the given scenarios are analyzed under two constraint targets: one is the support effectiveness, and the other is the spares cost. Analysis reveals that the result is consistent with practical regulation; therefore, the model’s correctness, method’s validity as well as optimization project’s rationality are proved to a certain extent.

  12. Mixed transcortical aphasia. On relative sparing of phonological short-term store in a case.

    Science.gov (United States)

    Trojano, L; Fragassi, N A; Postiglione, A; Grossi, D

    1988-01-01

    A case of Mixed Transcortical Aphasia is reported. The patient showed completely impaired verbal comprehension and speech production, with preservation of automatic speaking and singing; repetition was relatively spared. A detailed study of word and nonword repetition is reported, in order to demonstrate that the patient's residual repetition ability is based on relative sparing of short-term phonological store.

  13. Optimal provisioning strategies for slow moving spare parts with small lead times

    NARCIS (Netherlands)

    Teunter, R.H.; Klein Haneveld, W.K.

    1997-01-01

    When an expensive piece of equipment is bought, spare parts can often be bought at a reduced price. A decision must be made about the initial provisioning of spare parts. Furthermore, if at a certain time the stock drops to zero, because a number of failures have occurred, a decision must be made ab

  14. Land Sparing and Land Sharing Policies in Developing Countries - Drivers and Linkages to Scientific Debates

    DEFF Research Database (Denmark)

    Mertz, Ole; Mertens, Charlotte Filt

    2017-01-01

    The need for developing land sparing or land sharing policies for protecting the environment has been a polarized debate in the scientific literature. Some studies show that "spared" landscapes with clearly separated intensive agriculture and pristine forest are better for biodiversity and other...

  15. Retzus-sparing robotic-assisted laparoscopic radical prostatectomy: a step–by-step technique description of this first brazilian experience

    Directory of Open Access Journals (Sweden)

    Marcos Tobias-Machado

    Full Text Available Abstract Introduction: Retzus-sparing robotic-assisted radical prostatectomy(RARP is a newly approach that preserve the Retzus structures and provide better recovery of continence and erectile function. In Brazil, this approach has not yet been previously reported. Objective: Our goal is to describe Step-by-Step the Retzus-sparing RARP surgical technique and report our first Brazilian experience. Methods: We present a case of a 60-year-old white man with low risk prostate cancer. Surgical materials were four arms Da Vinci robotic platform system, six transperitoneal portals, two prolene wires and Polymer Clips. This surgical technique was step-by-step described according to Galfano et al. One additional step was added as a modification of Galfano et al. Primary technique description: The closure of the Denovellier fascia. Results: We have operated one patient with this technique. The operative time was 180minutes, console time was135 min, the blood loss was 150ml, none perioperative or postoperative complications was found, hospital stay of 01 day. The anatomopathological classification revealed a pT2aN0M0 specimen with free surgical margins. The patient achieved continence immediately after bladder stent retrieval. Full erection reported after 30 days of surgery. Conclusion: Retzus-sparing RARP approach is feasible and reproducible. However, further comparative studies are necessary to demonstrate potential benefits in continence and sexual outcomes over the standard approaches.

  16. Fertility sparing therapy on gestational trophoblastic neoplasms%妊娠滋养细胞肿瘤保留生育功能的治疗

    Institute of Scientific and Technical Information of China (English)

    赵峻; 向阳

    2012-01-01

    妊娠滋养细胞肿瘤(gestational trophoblastic neoplasms,GTN)包括侵蚀性葡萄胎、绒毛膜癌、胎盘部位滋养细胞肿瘤和上皮样滋养细胞肿瘤.由于GTN多发生于育龄妇女,治疗的同时保留患者的生育功能显得尤为重要.本文详细阐述了保留生育功能治疗GTN的方法,如化疗、栓塞治疗、保守性手术、放疗等,并总结了治疗后的妊娠结局.%ence to.- XIANG Yang E-mail: xiangyang65&gmail. com [Abstract] Gestational trophoblastic neoplasm includes invasive mole, choriocarcinoma, placental site trophoblastic tumor and epithelial trophoblastic tumor. Fertility sparing therapy for these patients is especially important because these diseases often involve reproductive aged women. This article expounds fertility sparing therapy for GTN including chemotherapy, embolotherapy, conservative surgery, and radiotherapy. The outcome of future pregnancies after fertility sparing therapy is reviewed as well.

  17. SOME SIMPLE APPROACHES TO PLANNING THE INVENTORY OF SPARE COMPONENTS OF AN INDUSTRIAL SYSTEM

    Directory of Open Access Journals (Sweden)

    Alenka Brezavšek

    2016-02-01

    Full Text Available Two variants of a simple stochastic model for planning the inventory of spare components supporting maintenance of an industrial system are developed. In both variants, the aim is to determine how many spare components are needed at the beginning of a planning interval to fulfil demand for corrective replacements during this interval. Under the first variant, the acceptable probability of spare shortage during the planning interval is chosen as a decision variable while in the second variant, the adequate spare inventory level is assessed taking into account the expected number of component failures within the planning interval. Calculation of the number of spare components needed depends on the form of the probability density function of component failure times. Different statistical density functions that are useful to describe this function are presented. Advantages and disadvantages of using a particular density function in our model are discussed. The applicability of the model is given through illustrative numerical examples.

  18. REPAIRABLE SYSTEM AVAILABILITY MODEL WITH RESPECT TO LIFE DISTRIBUTION OF SPARE PARTS

    Institute of Scientific and Technical Information of China (English)

    WU Yueming

    2008-01-01

    The failed components of repairable systems are replaced with spare parts that may have different failure distributions from those of the components that have failed. The spare parts may be either the same as new, better than new, or worse than new. This is the reality in maintenance engineering. Repair with better spare parts is defined as "super repair". The failure distributions of the spare parts affect the availability of the components and their systems. A novel model is proposed to describe the availability of repairable systems across their operating time, at the level of their components, on the assumption that the failed components are immediately replaced. The model functions with arbitrary failure distributions of spare parts. It can be used to compute the availability of components and systems not only under perfect and imperfect repair but also under super repair.

  19. Endodontic surgery.

    Science.gov (United States)

    Chong, B S; Rhodes, J S

    2014-03-01

    A better understanding of endodontic disease and the causes of treatment failure has refined the role of surgery in endodontics. The advent of newer materials, advances in surgical armamentarium and techniques have also led to an improved endodontic surgical outcome. The aim of this article is to provide a contemporary and up-to-date overview of endodontic surgery. It will focus primarily on the procedures most commonly performed in endodontic surgery.

  20. Influence of the tobacco smoking on the bronchial asthma in teenagers

    Directory of Open Access Journals (Sweden)

    B. Ts. Batozhargalova

    2012-01-01

    Full Text Available Comparative epidemiological research on studying prevalence tobacco smoking and respiratory symptoms among rural teenagers with bronchial asthma. Control group have made non-smoking (n = 59, and skilled — smoking teenagers (n = 72. Prevalence of smoking among adolescents with bronchial asthma has made 55% against 44,3% on the average at adolescents (p < 0.05. At smokers sick of a bronchial asthma the presence of respiratory complaints, level of СO in exhaled air and urinary cotinine has been raised. Authentic communication of smoking with a series of symptoms bronchial asthma and chronic bronchitis in teenagers, shown is taped by a high and average parity of chances.

  1. [Treatment of patients with bronchial asthma associated with obesity in a health resort "Okeanskiy"].

    Science.gov (United States)

    Tsureva, U V; Demeev, Ya A; Skachkov, O A; Sheverdina, E A

    2015-06-01

    In this paper we assess the efficiency of sanatorium treatment of patients with bronchial asthma of two different weigh groups: with normal body weight and obesity. According to the results of clinical examination it was found that in patients with bronchial asthma and obesity of I-II degree efficiency of sanatorium treatment is lower in comparison with patients with bronchial asthma and normal body weight. The use of a standard set of procedures is not enough to correct the symptoms of asthma in obese patients. Comparative analysis of clinical symptoms in patients with bronchial asthma with normal body weight and obesity were differences of up to 50%. The conclusion about the need to develop a set of techniques to optimize the effectiveness of rehabilitation is given.

  2. Current practice in assessment and treatment of bronchial asthma in young males in Italy.

    Science.gov (United States)

    Ferrante, E; Pantaleo, C; Quatela, M; Fuso, L; Basso, S; Pistelli, R

    2000-10-01

    The aim of the study was to evaluate, in a sample of young asthmatics in Italy, the current practice in assessment and treatment of asthma after the publication of guidelines. Young soldiers who declared bronchial asthma at the beginning of the compulsory military service were evaluated. One-hundred and thirty-eight subjects with confirmed asthma were selected. Sixty-seven subjects (48.5%) had had at last one spirometry, and only one subject had underwent peak flow monitoring at home; most of the subjects (96.8%) had had prick tests. More of the 50% of the subjects with bronchial obstruction or with severe bronchial hyperresponsiveness, with clinical moderate or severe asthma, had used only bronchodilators or no therapy at all in the preceding year. In this sample of young asthmatics, the lung function tests were still underutilized for the diagnosis and follow-up of bronchial asthma; moreover, the inhaled anti-inflammatory drugs were still underutilized.

  3. RATIONALE FOR A SPECIFIC THERAPY OF CYTOMEGALOVIRUS INFECTION IN CHILDREN WITH BRONCHIAL ASTHMA

    Directory of Open Access Journals (Sweden)

    E. N. Suprun

    2013-01-01

    Full Text Available Abstract. We propose a protocol of treatment in cases of bronchial asthma with cytomegalovirus (CMV persistence. This basic therapy is administered depending on the disease severity, according to the National Programme 2009. The treatment includes administration of human immunoglobulin, with dosage according on CMV antibodies titers. The study has revealed that such regimen of antibody administration based on the content of anti-CMV antibodies in bronchial asthma treatment stops active CMV replication in bronchial mucous membrane, alleviates clinical course of the disease, diminishes changes of immune system typical to children suffering from bronchial asthma and CMV reactivation, thus allowing to reduce the volume of basic therapy, along with maintaining control of asthma control.

  4. Peak expiratory flow variability, bronchial responsiveness, and susceptibility to ambient air pollution in adults

    NARCIS (Netherlands)

    Boezen, M; Schouten, Jan; Rijcken, B; Vonk, J; Gerritsen, J; Hoek, G; Brunekreef, B; Postma, D

    1998-01-01

    Bronchial hyperresponsiveness (BHR) and peak expiratory flow (PEF) variability are associated expressions of airway lability, yet probably reflect different underlying pathophysiologic mechanisms. We investigated whether both measures can be used interchangeably to identify subjects who are suscepti

  5. HYPOXIHYPOBAROTHERAPY IN REGULATION OF NEUROHUMORAL AND CYTOKINE RESPONSE IN REHABILITATION OF CHILDREN WITH BRONCHIAL ASTHMA

    Directory of Open Access Journals (Sweden)

    G.D. Alemanova

    2009-01-01

    Full Text Available The effect of hypoxihypobarotherapy in children with bronchial asthma at the rehabilitation stage on the clinicals and dynamics of immunity response to the disease has been studied. Clinical efficacy of hypoxihypobarotherapy was 63,3% in moderate asthma. Positive dynamics of immunological indicators and neuropeptides have manifested in reduced of IL 4, IL 5, IL 18 and substance P serum levels. Use of hypoxihypobarotherapy in children with bronchial asthma has resulted in favourable clinical and immune dynamics and positive alteration of neurohumoral regulation mechanisms and reduced intensity of neurogenic inflammation. Determining immunological indicators, including neuropeptides, may serve as an additional criterion for assessing the efficacy of this treatment in children with bronchial asthma at the rehabilitation stage.Key words: children, bronchial asthma, pneumotherapy, hypoxihypobarotherapy, neuropeptides, cytokines.

  6. ALLERGEN-INDUCED CHANGES IN ADENOSINE 5'-MONOPHOSPHATE BRONCHIAL RESPONSIVENESS - EFFECT OF NEDOCROMIL SODIUM

    NARCIS (Netherlands)

    AALBERS, R; KAUFMAN, HF; GROEN, H; KOETER, GH; DEMONCHY, JGR

    1992-01-01

    Bronchial hyperresponsiveness to adenosine 5'-monophosphate (AMP) was studied after allergen challenge in allergic asthmatic patients. Measurements were made with and without nedocromil sodium pretreatment. Nedocromil sodium inhibited both the early and late asthmatic reactions (P <.01). After aller

  7. Long-term (5 year) safety of bronchial thermoplasty: Asthma Intervention Research (AIR) trial

    DEFF Research Database (Denmark)

    Thomson, Neil C; Rubin, Adalberto S; Niven, Robert M

    2011-01-01

    Bronchial thermoplasty (BT) is a bronchoscopic procedure that improves asthma control by reducing excess airway smooth muscle. Treated patients have been followed out to 5 years to evaluate long-term safety of this procedure....

  8. Lung sound analysis can be an index of the control of bronchial asthma

    Directory of Open Access Journals (Sweden)

    Terufumi Shimoda

    2017-01-01

    Conclusions: The E/I LF measurement obtained by LSA is useful as an indicator of changes in airway obstruction and inflammation and can be used for monitoring the therapeutic course of bronchial asthma patients.

  9. Spectral Karyotyping Detects Chromosome Damage in Bronchial Cells of Smokers and Patients with Cancer

    OpenAIRE

    Varella-Garcia, Marileila; Chen, Lin; Powell, Roger L.; Hirsch, Fred R.; Kennedy, Timothy C.; Keith, Robert; Miller, York E.; Mitchell, John D; Franklin, Wilbur A.

    2007-01-01

    Rationale: Lung cancer is a multistep process that is preceded and often accompanied by molecular cytogenetic lesions in benign bronchial epithelium, the precise character, extent and timing of which are not well defined.

  10. Features of application of medical physical culture for the children of patients by bronchial asthma.

    Directory of Open Access Journals (Sweden)

    Aleshina A.I.

    2012-07-01

    Full Text Available The purpose of work consists in generalization of scientific recommendations of scientists in relation to application of medical physical culture for children with bronchial asthma. The problem of bronchial asthma is analysed, as an enough widespread disease in the world, the basic tendencies of his prevalence, range of measures instrumental in diagnostics and treatment, are certain. It is presented statistical information about prevalence of bronchial asthma on Ukraine among children. Principal reasons of origin of disease and role of physical exercises in the process of rehabilitation of patients with bronchial asthma are certain. The features of the use and influencing of respiratory gymnastics on the method of Buteyko, Strel'nikovoy, drainage exercises, sound gymnastics, exercises of aerobic character are analysed. The necessity of application of medical physical culture at this disease is grounded.

  11. [Incidentally detected bronchial artery aneurysm with combined operation for mitral regurgitation;report of a case].

    Science.gov (United States)

    Sato, Hisashi; Oteki, Hitoshi; Naito, Kozo; Yunoki, Junji

    2015-02-01

    A 77-year-old woman was admitted to the hospital for heart failure with orthopnea. Echocardiography revealed massive mitral regurgitation. During preoperative cardiac catheterization, an aneurysm was indentified incidentally just below the tracheal carina. Three dimensional computed tomography showed three bronchial artery aneurysms behind the pulmonary artery and the left atrium. The proximal aneurysm was the largest and was 22 mm in diameter. It was resected by retracting the ascending aorta to the left, the superior vana cava to the right and right pulmonary artery cranially under cardiopulmonary bypass, and mitral valve plasty was performed. We believed that resection of the proximal aneurysm would cause thrombotic occlusion of the other 2 aneurysms. Bronchial artery aneurysm is a rare entity that is observed in fewer than 1% of those who undergo selective bronchial arteriography. In addition, because bronchial artery aneurysm is a potentially life-threatening lesion, it should be treated promptly when diagnosed.

  12. ALLERGEN-INDUCED CHANGES IN ADENOSINE 5'-MONOPHOSPHATE BRONCHIAL RESPONSIVENESS - EFFECT OF NEDOCROMIL SODIUM

    NARCIS (Netherlands)

    AALBERS, R; KAUFMAN, HF; GROEN, H; KOETER, GH; DEMONCHY, JGR

    1992-01-01

    Bronchial hyperresponsiveness to adenosine 5'-monophosphate (AMP) was studied after allergen challenge in allergic asthmatic patients. Measurements were made with and without nedocromil sodium pretreatment. Nedocromil sodium inhibited both the early and late asthmatic reactions (P <.01). After

  13. Main bronchial diverticula in the subcarinal region: Their relation to airflow limitations

    Energy Technology Data Exchange (ETDEWEB)

    Higuchi, Takeshi; Takahashi, Naoya; Shiotani, Motoi; Sato, Suguru; Ohta, Atsushi; Maeda, Haruo; Nakajima, Haruhiko; Itoh, Kazuhiko; Tsukada, Hiroki (Department of Radiology, Respiratory Medicine, Niigata City General Hospital, Niigata-city, Niigata-ken (Japan)), Email: higuchi@hosp.niigata.niigata.jp

    2012-02-15

    Background. To date, bronchial diverticula have generally been treated as a pathological condition associated with chronic obstructive pulmonary disease (COPD), although only a limited amount of published information is available on the relationship between bronchial diverticula as depicted by multidetector computed tomography (MDCT) and airflow limitations. Purpose. To evaluate the relationship between airflow limitations and main bronchial diverticula in the subcarinal region using spirometry and thin-section MDCT. Material and Methods. A total of 189 consecutive adult patients were retrospectively evaluated based on spirometry and thin-section MDCT of the chest. All examinations were performed at our institution between June and October 2008. The study group included 70 women and 119 men with a mean age of 65 years (range 19-86 years). The relationship between the FEV1% and bronchial diverticula in the subcarinal region was analyzed (Student's t-test). Results. The indications for conducting the examinations were pulmonary diseases (82 patients), cardiovascular diseases (22), extrapulmonary malignancies (74), and other conditions (11). A total of 84/189 (44.4%) patients showed bronchial diverticula, and the FEV{sub 1}% of 70/84 (83.3%) patients was above 70. The FEV{sub 1}% of patients with lesions ranged from 26.0 to 97.8 (mean 76.8), whereas the range was 28.1-94.4 (mean 73.7) in those without lesions. There was no significant association between the FEV{sub 1}% and the presence of subcarinal bronchial diverticula (P > 0.05). Conclusion. Our data demonstrate that thin-section chest CT commonly demonstrates main bronchial diverticula in the subcarinal region in patients without airflow limitations. We propose that the presence of a small number of tiny bronchial diverticula under the carina may not be a criterion for the diagnosis of COPD

  14. Clinical and Immunological Features of Bronchial Asthma in Children on the Background of Persistent Intracellular Infections

    Directory of Open Access Journals (Sweden)

    O.Ye. Chernyshova

    2015-03-01

    Full Text Available The article presents information on the impact of persistent intracellular infections on the course of the di­sease and the state of immune system in children with bronchial asthma. Clinical features of bronchial asthma, the degree of sensitization, level of proinflammatory (IL-1, IL-2, IL-6, ­IL-8, IFN-α and IFN-γ, TNF-α and antiinflammatory (IL-4, ­IL-10 cytokines in the blood serum are described.

  15. The function and significance of SELENBP1 downregulation in human bronchial epithelial carcinogenic process.

    Directory of Open Access Journals (Sweden)

    Gu-Qing Zeng

    Full Text Available BACKGROUND: Our quantitative proteomic study showed that selenium-binding protein 1 (SELENBP1 was progressively decreased in human bronchial epithelial carcinogenic process. However, there is little information on expression and function of SELENBP1 during human lung squamous cell cancer (LSCC carcinogenesis. METHODS: iTRAQ-tagging combined with 2D LC-MS/MS analysis was used to identify differentially expressed proteins in the human bronchial epithelial carcinogenic process. SELENBP1, member of selenoproteins family and progressively downregulated in this process, was selected to further study. Both Western blotting and immunohistochemistry were performed to detect SELENBP1 expression in independent sets of tissues of bronchial epithelial carcinogenesis, and ability of SELENBP1 for discriminating NBE (normal bronchial epithelium from preneoplastic lesions from invasive LSCC was evaluated. The effects of SELENBP1 downregulation on the susceptibility of benzo(apyrene (B[a]P-induced human bronchial epithelial cell transformation were determined. RESULTS: 102 differentially expressed proteins were identified by quantitative proteomics, and SELENBP1 was found and confirmed being progressively decreased in the human bronchial epithelial carcinogenic process. The sensitivity and specificity of SELENBP1 were 80% and 79% in discriminating NBE from preneoplastic lesions, 79% and 82% in discriminating NBE from invasive LSCC, and 77% and 71% in discriminating preneoplastic lesions from invasive LSCC, respectively. Furthermore, knockdown of SELENBP1 in immortalized human bronchial epithelial cell line 16HBE cells significantly increased the efficiency of B[a]P-induced cell transformation. CONCLUSIONS: The present data shows for the first time that decreased SELENBP1 is an early event in LSCC, increases B[a]P-induced human bronchial epithelial cell transformation, and might serve as a novel potential biomarker for early detection of LSCC.

  16. Disorders of cardiac hemodynamic in attack period of bronchial asthma in children.

    OpenAIRE

    Kondratiev V.А.; Reznyk А.V.

    2016-01-01

    By dopplerechocardiography method there was studied functional state of cardiac ventricles and character of hemodynamic disorders in 48 patients aged 5-17 years in attack period of moderately-severe and severe bronchial asthma. Group of comparison included 40 healthy peers. Disorders of central and peripheral hemodynamic in attack period of bronchial asthma in children were accompanied both by systolic and diastolic dysfunction of the left and right heart ventricles, herewith right ventricle ...

  17. Leukocyte peroxidase and leptin: an associated link of glycemic tolerance and bronchial asthma?

    OpenAIRE

    2010-01-01

    Sergio ParcoImmunopathology Unit, Laboratory of the Department of Medicine, Children’s Hospital, IRCCS Burlo Garofolo, Trieste, ItalyAbstract: Recent observations suggest the presence of an interaction between leptin and the inflammatory system during bronchial asthma. Although there is evidence of a positive association between asthma and obesity in adults and children, little is yet known about the role of serum leptin, as a potential mediator for bronchial epithelial homeostasis,...

  18. Evaluation of serum l-carnitine level in children with acute bronchial asthma

    Directory of Open Access Journals (Sweden)

    Eman Ramadan

    2014-07-01

    Conclusion: According to our study, it could be concluded that l-carnitine decrease is linked to the occurrence of attack of bronchial asthma. Accordingly, it is recommended to make further studies to find out if there is a beneficial role of carnitine intake in the prophylaxis & treatment of attacks of bronchial asthma. The recommended studies should search for the most suitable dose & side effects of carnitine as a potential pharmaceutical agent.

  19. Single-Cell RNA Sequencing of the Bronchial Epithelium in Smokers With Lung Cancer

    Science.gov (United States)

    2015-07-01

    bronchoscopy for the suspicion of lung cancer. A protocol has been developed to isolate single cells from these bronchial brushings using fluorescence ...bronchial brushings using fluorescence - activated cell sorting (FACS). Next, we have implemented an adapted version of the CEL-Seq RNA library preparation...report.   Journal publications.   Nothing to report.     Books or other non-periodical, one-time publications.   Nothing to report

  20. “Peripheral Neuropathy Crippling Bronchial Asthma”: Two Rare Case Reports of Churg-Strauss Syndrome

    Directory of Open Access Journals (Sweden)

    Kamal Kishore Pandita

    2014-01-01

    Full Text Available Churg-Strauss syndrome (CSS is a rare cause of vasculitic neuropathy. Although rare and potentially fatal, Churg-Strauss syndrome (CSS is easily diagnosable and treatable. The presence of bronchial asthma with peripheral neuropathy in a patient alerts a physician to this diagnosis. This is vividly illustrated by the presented two cases who had neuropathy associated with bronchial asthma, eosinophilia, sinusitis, and positive perinuclear antineutrophil cytoplasmic antibodies (p-ANCA test, which improved with administration of steroids.

  1. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Dental Implant Surgery Dental implant surgery is, of course, surgery, and is best performed by a trained ... Dental Implant Surgery Dental implant surgery is, of course, surgery, and is best performed by a trained ...

  2. [Bronchial carcinoid tumor and scintigraphy of somatostatin receptors: detection of bone metastasis].

    Science.gov (United States)

    Banzo, J; Abós, M D; Prats, E; García, F; Freile, E; Razola, P; Escalera, T

    2001-10-01

    Surgery is the treatment of choice for bronchial carcinoid tumor (BCT), whenever the staging is adequate. There is little information about the capability of the somatostatin receptor scintigraphy (SRS) to detect bone metastases in the carcinoid tumor. This work has aimed to evaluate retrospectively the diagnostic accuracy of the SRS in the detection of bone metastases in BCT. Based on their clinical indication, the patients were classified into two different groups: Group A (n = 4), staging of a known BCT; and Group B (n = 6), treatment control. The SRS results could be correlated with the CT results in all 4 patients from the group A, and in one patient from the group B, and the SRS results were compared with the clinical follow up during at least one year in the other 5 patients. The SRS scan detected the 4 BCT from the group A; in 2 of them the patient staging was superior when the SRS was used than with the CT, whereas the scan overestimated the tumor stage (BCT + sarcoidosis) in another patient. During the clinical course, one of these patients developed bone and liver metastases. The SRS was normal in 5 asymptomatic patients from group B, whereas the scan showed disseminated metastatic disease (liver, bone, spleen and lymph nodes) in another patient. In the 2 patients with bone metastases, the total number of bone metastases detected by the bone scan was 12, and by the SRS 8. The four lesions that were not detected by SRS were located in the ribs (n = 3) and 12-D (n = 1). The capability of the SRS to detect bone metastases makes it more useful in BCT staging. Over the next few years, the role of the bone scan and SRS in the detection of bone metastases in carcinoid tumors needs to be established.

  3. Bronchial thermoplasty: implementing best practice in the era of cost containment

    Directory of Open Access Journals (Sweden)

    Tan LD

    2017-07-01

    Full Text Available Laren D Tan,1 Nicholas Kenyon,2 Ken Y Yoneda,2 Samuel Louie2 1Division of Pulmonary, Critical Care, Hyperbaric and Sleep Medicine, Department of Internal Medicine, School of Medicine, Loma Linda University, Loma Linda, CA, USA; 2Division of Pulmonary, Critical Care and Sleep Medicine, Department of Internal Medicine, School of Medicine, University of California, Davis, Sacramento, USA Abstract: Increasing dependence on advanced technologies in the 21st century has created a dilemma between the practice and business of medicine. From information technology to robotic surgery, new technologies have expanded treatment possibilities and have potentially improved patient outcomes and safety. Simultaneously, their escalating costs limit access for certain patients and health care facilities. Nevertheless, medical decisions should not simply be based on cost. Input from physicians and other health care specialists as well as adherence to best practice position statements, are vital to implementing truly cost-effective strategies in medicine. Bronchial thermoplasty (BT, a US Food and Drug Administration approved bronchoscopy procedure in difficult-to-control persistent asthma, is a prime example of a new technology facing cost and implementation challenges. We discuss the specific indications and contraindications for BT and review recent real-world experiences that can provide the foundation for building a comprehensive asthma program that provides BT for difficult-to-control asthma patients who fail national guideline treatment recommendations after an adequate clinical trial of one. We also offer insight into the barriers to implementing a successful BT program and strategies for overcoming them. Keywords: asthma, severe asthma, severe refractory asthma, biologic resistant asthma, BT

  4. Effect of TRPV1 gene mutation on bronchial asthma in children before and after treatment.

    Science.gov (United States)

    Chen, Chuan-Liang; Li, Hong; Xing, Xiao-Hong; Guan, Hai-Shan; Zhang, Jian-Hua; Zhao, Jun-Wu

    2015-01-01

    Bronchial asthma is a worldwide disease with high incidence. It not only harms children's physical and mental health, but it also brings a heavy burden to their families as well as the society. However, the trigger and pathogenesis of the disease remain unclear. This study aimed to analyze TRPV1 gene mutation and expression of cytokines in children with acute bronchial asthma before and after treatment, thus providing theoretical guidance for the diagnosis and treatment of bronchial asthma in children. Real-time quantitative polymerase chain reaction was adopted to detect TRPV1 mRNA expression level and enzyme-linked immuno sorbent assay was used to detect the serum total IgE level, eosinophil (EOS) number, IL-4, IL-5, and interferon (IFN) gamma levels in peripheral venous blood of children in the healthy control group and asthma group before and after treatment. Logistic regression analysis was applied to analyze the most essential factor inducing bronchial asthma in children. TRPV1 mRNA level of peripheral blood in the asthma group was higher than that in the control group before treatment (p asthma in children. TRPV1 gene mutation was closely related to bronchial asthma in children, which provided a theoretical basis for the treatment and prognosis of children with bronchial asthma.

  5. Stimulation of mucin secretion from human bronchial epithelial cells by mast cell chymase

    Institute of Scientific and Technical Information of China (English)

    Shao-heng HE; Jian ZHENG

    2004-01-01

    AIM: To investigate the effect ofchymase on the mucin secretion from human bronchial epithelial cells. METHODS:Primarily-cultured human bronchial epithelial (PCHBE) cells and normal human bronchial epithelial (NHBE) cells were cultured with chymase or other stimulus in a mixture of bronchial epithelial growth medium (BEGM) and Dulbecco's modified Eagle's medium (DMEM), and the quantities of stimulatory mucin release were recorded.MUC5AC mucin was measured with an ELISA and dolichos biflorus agglutinin (DBA) mucin was determined with an enzyme linked DBA assay. RESULTS: A dose-dependent secretion of DBA mucin from PCHBE cells was observed with chymase with a maximum secretion of 98 % above baseline being achieved following 3 h incubation.The action of chymase started from 1 h, peaked at 3 h and dramatically decreased at 20 h following incubation.Chymase was able to also stimulate approximately 38 % increase in MUC5AC mucin release from PCHBE cells, and about 121% increase in DBA mucin release from NHBE cells. A chymase inhibitor soybean trypsin inhibitor (SBTI)was able to inhibit up to 85 % chymase induced mucin release, indicating that the enzymatic activity was essential for the actions of chymase on bronchial epithelial cells. CONCLUSION: Chymase is a potent stimulus of mucin secretion from human bronchial epithelial cells. It can contribute to mucus hypersecretion process in the patients with chronic obstructive pulmonary disease or asthma.

  6. Thyroid Surgery

    Science.gov (United States)

    ... etc.). Surgery is also an option for the treatment of hyperthyroidism (Grave’s disease or a “toxic nodule” (see Hyperthyroidism brochure ), for large and multinodular goiters and for any goiter that may be causing ... MEANS OF TREATMENT? Surgery is definitely indicated to remove nodules suspicious ...

  7. Choosing surgery

    DEFF Research Database (Denmark)

    Thorstensson, Carina; Lohmander, L; Frobell, Richard

    2009-01-01

    ABSTRACT: BACKGROUND: The objective was to understand patients' views of treatment after acute anterior cruciate ligament (ACL) injury, and their reasons for deciding to request surgery despite consenting to participate in a randomised controlled trial (to 'cross-over'). METHODS: Thirty-four in......-depth qualitative interviews were conducted with young (aged 18-35), physically active individuals with ACL rupture who were participating in a RCT comparing training and surgical reconstruction with training only. 22/34 were randomised to training only but crossed over to surgery. Of these, 11 were interviewed...... before surgery, and 11 were interviewed at least 6 months after surgery. To provide additional information, 12 patients were interviewed before randomisation. Interviews were audio-recorded, transcribed and analysed using the Framework approach. RESULTS: Strong preference for surgery was commonplace...

  8. Reliability Based Spare Parts Management Using Genetic Algorithm

    Directory of Open Access Journals (Sweden)

    Rahul Upadhyay

    2015-08-01

    Full Text Available Effective and efficient inventory management is the key to the economic sustainability of capital intensive modern industries. Inventory grows exponentially with complexity and size of the equipment fleet. Substantial amount of capital is required for maintaining an inventory and therefore its optimization is beneficial for smooth operation of the project at minimum cost of inventory. The size and hence the cost of the inventory is influenced by a large no of factors. This makes the optimization problem complex. This work presents a model to solve the problem of optimization of spare parts inventory. The novelty of this study lies with the fact that the developed method could tackle not only the artificial test case but also a real-world industrial problem. Various investigators developed several methods and semi-analytical tools for obtaining optimum solutions for this problem. In this study non-traditional optimization tool namely genetic algorithms GA are utilized. Apart from this Coxs regression analysis is also used to incorporate the effect of some environmental factors on the demand of spares. It shows the efficacy of the applicability of non-traditional optimization tool like GA to solve these problems. This research illustrates the proposed model with the analysis of data taken from a fleet of dumper operated in a large surface coal mine. The optimum time schedules so suggested by this GA-based model are found to be cost effective. A sensitivity analysis is also conducted for this industrial problem. Objective function is developed and the factors like the effect of season and production pressure overloading towards financial year-ending is included in the equations. Statistical analysis of the collected operational and performance data were carried out with the help of Easy-Fit Ver-5.5.The analysis gives the shape and scale parameter of theoretical Weibull distribution. The Coxs regression coefficient corresponding to excessive loading

  9. On the value of certain genotypic properties for forming exercise-induced bronchial asthma in children

    Directory of Open Access Journals (Sweden)

    Лорина Алімівна Іванова

    2015-10-01

    Full Text Available Introduction. Exercise-induced bronchial asthma is a separate phenotype of bronchial asthma (BA that defines an exercise-associated transitory obstruction of bronchial tubes, especially decrease of the forced expiration volume for 1 sec. (FEV1 by 10 % and more of an output quantity after the relevant bronchial provocation test. At the same time there is not sufficient elucidation of the role of genetic component especially GSTT1 і GSTM1 gene deletions and\\or mutational polymorphism of еNOS gene in development of exercise-induced bronchial asthma in children.Aim. To study the value of deletion (GSTT1 and GSTM1 genes and mutational (еNOS gene polymorphism in formation of bronchial tubes lability in children with exercise-induced bronchial asthma to optimize individual medioprophylactic recommendations.Materials and methods. During the study there were examined 102 school-aged children with BA in pulmo-allergology department of RSCH in Chernovtsy. To verify the exercise-induced bronchial asthma (EIBA there was studied an exercise tolerance of patients and their bronchial tubes lability in the response to the dosed run and bronchomotor test with inhalation with 200 mkg of salbutamol. And the received results were represented as a bronchial tubes lability indicator (BTLI, % and its components – bronchospasm index (BSI, % and bronchodilation index (BDI, %. 2 clinical groups were formed in examination of children. The first (I, main included 50 schoolchildren with EIBA and the comparative one (II group – 52 children with BA without the signs of exercise-induced bronchospasm (EIBS. Results of research. There was established that the “null” genotype of aforesaid genes is three times more often (10,0 % against 3,85 %, P<0,05in children with exercise-induced bronchial asthma and mutations of еNOS gene ( GT, ТТ genotype take place in every second children. There was detected that the highest bronchospasm indicators are in patients with GSTT1

  10. The impact of central sparing on the word-length effect in hemianopia.

    Science.gov (United States)

    Rubino, Cristina; Yeung, Shanna C; Barton, Jason J S

    Studies suggest that a word-length effect of up to 160 ms/letter distinguishes hemianopic dyslexia from pure alexia. However, partial preservation of central vision is common in right hemianopia, but its effects on single-word reading are unknown. Eighteen healthy subjects read single words with a gaze-contingent right hemianopia simulation that varied the degree of central sparing. Mean reading onset time declined with small degrees of central sparing, but the word-length effect did not decrease until sparing exceeded 3.15°. We next evaluated the effects of font size. Effects of central sparing were constant when expressed in number of letters, with a decline in word-length effect beginning as sparing approached 4 letters. We conclude that the effects of central sparing on mean reading onset time and the word-length effect are distinct. We provide diagnostic word-length criteria for discriminating between pure alexia and hemianopic dyslexia with various degrees of central sparing.

  11. Tracheal and bronchial involvement in colitis ulcerosa – a colo-bronchitic syndrome? A case report and some additional considerations

    Directory of Open Access Journals (Sweden)

    von Wichert, Peter

    2015-03-01

    Full Text Available Systemic involvement is well known in patients with inflammatory bowel diseases (IBD, but there are only few data looking to Crohn’s disease (CD and ulcerative colitis (UC separately instead of lumping together both entities to IBD. The frequency of bronchial involvement in UC is not yet exactly analysed but reported to be rare. We asked 100 patients with UC for bronchial complaints, and found in 13 patients a bronchial affection. From reports in the literature it is known that sometimes a bronchial involvement in patients with UC can affect the whole bronchial tree including small bronchi. The involvement of bronchial system in UC is obviously more prominent than previously thought and may fulfil the criteria for a separate syndrome. These relations may have consequences for pathogenetic understanding of UC as well as bronchitis and also consequences for treatment regimes.

  12. Prevention of Antigen-Induced Bronchial Hyperreactivity and Airway Inflammation in Sensitized Guinea-Pigs by Tacrolimus

    Directory of Open Access Journals (Sweden)

    J. R. Lapa e Silva

    1999-01-01

    Full Text Available We examined the effect of the immunosuppressive agent, tacrolimus (FK506, on antigen-induced bronchial hyperreactivity to acetylcholine and leukocyte infiltration into the airways of ovalbumin-challenged guinea-pigs. Subcutaneous injection of 0.5 mg/kg of FK506, 1 h before and 5 h after intra-nasal antigen challenge prevented bronchial hyperreactivity to aerosolized acetylcholine, eosinophilia in bronchoalveolar lavage (BAL fluid and bronchial tissue and the invasion of the bronchial wall by CD4+ T-lymphocytes. FK506 also suppressed ovalbumininduced increase in the number of leukocytes adhering to the pulmonary vascular endothelium and expressing α4-integrins. Inhibition by FK506 of antigen-induced bronchial hyperreactivity in sensitized guinea-pigs may thus relate to its ability to prevent the emergence of important inflammatory components of airway inflammation, such as eosinophil accumulation, as well as CD4+ T-lymphocyte infiltration into the bronchial tissue.

  13. Tracheal and bronchial involvement in colitis ulcerosa – a colo-bronchitic syndrome? A case report and some additional considerations

    Science.gov (United States)

    von Wichert, Peter; Barth, Peter; von Wichert, Goetz

    2015-01-01

    Systemic involvement is well known in patients with inflammatory bowel diseases (IBD), but there are only few data looking to Crohn’s disease (CD) and ulcerative colitis (UC) separately instead of lumping together both entities to IBD. The frequency of bronchial involvement in UC is not yet exactly analysed but reported to be rare. We asked 100 patients with UC for bronchial complaints, and found in 13 patients a bronchial affection. From reports in the literature it is known that sometimes a bronchial involvement in patients with UC can affect the whole bronchial tree including small bronchi. The involvement of bronchial system in UC is obviously more prominent than previously thought and may fulfil the criteria for a separate syndrome. These relations may have consequences for pathogenetic understanding of UC as well as bronchitis and also consequences for treatment regimes. PMID:25834480

  14. Tracheal and bronchial involvement in colitis ulcerosa - a colo-bronchitic syndrome? A case report and some additional considerations.

    Science.gov (United States)

    von Wichert, Peter; Barth, Peter; von Wichert, Goetz

    2015-01-01

    Systemic involvement is well known in patients with inflammatory bowel diseases (IBD), but there are only few data looking to Crohn's disease (CD) and ulcerative colitis (UC) separately instead of lumping together both entities to IBD. The frequency of bronchial involvement in UC is not yet exactly analysed but reported to be rare. We asked 100 patients with UC for bronchial complaints, and found in 13 patients a bronchial affection. From reports in the literature it is known that sometimes a bronchial involvement in patients with UC can affect the whole bronchial tree including small bronchi. The involvement of bronchial system in UC is obviously more prominent than previously thought and may fulfil the criteria for a separate syndrome. These relations may have consequences for pathogenetic understanding of UC as well as bronchitis and also consequences for treatment regimes.

  15. Perioperative pain management strategies among women having reproductive surgeries.

    Science.gov (United States)

    Prabhu, Malavika; Bortoletto, Pietro; Bateman, Brian T

    2017-08-01

    This review presents opioid-sparing strategies for perioperative pain management among women undergoing reproductive surgeries and procedures. Recommendations are provided regarding the use of nonsteroidal anti-inflammatory drugs, acetaminophen, other adjunctive medications, and regional anesthetic blocks. Additional considerations for chronic opioid users or patients using opioid replacement or antagonist therapy are discussed. Copyright © 2017 American Society for Reproductive Medicine. Published by Elsevier Inc. All rights reserved.

  16. Diagnostic challenges and management of a patient with acromegaly due to ectopic growth hormone-releasing hormone secretion from a bronchial carcinoid tumour

    Directory of Open Access Journals (Sweden)

    Nikolaos Kyriakakis

    2017-01-01

    Full Text Available A male patient presented at the age of 30 with classic clinical features of acromegaly and was found to have elevated growth hormone levels, not suppressing during an oral glucose tolerance test. His acromegaly was originally considered to be of pituitary origin, based on a CT scan, which was interpreted as showing a pituitary macroadenoma. Despite two trans-sphenoidal surgeries, cranial radiotherapy and periods of treatment with bromocriptine and octreotide, his acromegaly remained active clinically and biochemically. A lung mass was discovered incidentally on a chest X-ray performed as part of a routine pre-assessment for spinal surgery 5 years following the initial presentation. This was confirmed to be a bronchial carcinoid tumour, which was strongly positive for growth hormone-releasing hormone (GHRH and somatostatin receptor type 2 by immunohistochemistry. The re-examination of the pituitary specimens asserted the diagnosis of pituitary GH hyperplasia. Complete resolution of the patient’s acromegaly was achieved following right lower and middle lobectomy. Seventeen years following the successful resection of the bronchial carcinoid tumour the patient remains under annual endocrine follow-up for monitoring of the hypopituitarism he developed after the original interventions to his pituitary gland, while there has been no evidence of active acromegaly or recurrence of the carcinoid tumour. Ectopic acromegaly is extremely rare, accounting for <1% of all cases of acromegaly. Our case highlights the diagnostic challenges differentiating between ectopic acromegaly and acromegaly of pituitary origin and emphasises the importance of avoiding unnecessary pituitary surgery and radiotherapy. The role of laboratory investigations, imaging and histology as diagnostic tools is discussed.

  17. Profiles of impaired, spared, and recovered neuropsychologic processes in alcoholism.

    Science.gov (United States)

    Oscar-Berman, Marlene; Valmas, Mary M; Sawyer, Kayle S; Ruiz, Susan Mosher; Luhar, Riya B; Gravitz, Zoe R

    2014-01-01

    Long-term chronic alcoholism is associated with disparate and widespread residual consequences for brain functioning and behavior, and alcoholics suffer a variety of cognitive deficiencies and emotional abnormalities. Alcoholism has heterogeneous origins and outcomes, depending upon factors such as family history, age, gender, and mental or physical health. Consequently, the neuropsychologic profiles associated with alcoholism are not uniform among individuals. Moreover, within and across research studies, variability among subjects is substantial and contributes to characteristics associated with differential treatment outcomes after detoxification. In order to refine our understanding of alcoholism-related impaired, spared, and recovered abilities, we focus on five specific functional domains: (1) memory; (2) executive functions; (3) emotion and psychosocial skills; (4) visuospatial cognition; and (5) psychomotor abilities. Although the entire brain might be vulnerable in uncomplicated alcoholism, the brain systems that are considered to be most at risk are the frontocerebellar and mesocorticolimbic circuitries. Over time, with abstinence from alcohol, the brain appears to become reorganized to provide compensation for structural and behavioral deficits. By relying on a combination of clinical and scientific approaches, future research will help to refine the compensatory roles of healthy brain systems, the degree to which abstinence and treatment facilitate the reversal of brain atrophy and dysfunction, and the importance of individual differences to outcome. © 2014 Elsevier B.V. All rights reserved.

  18. Using Spare Logic Resources To Create Dynamic Test Points

    Science.gov (United States)

    Katz, Richard; Kleyner, Igor

    2011-01-01

    A technique has been devised to enable creation of a dynamic set of test points in an embedded digital electronic system. As a result, electronics contained in an application specific circuit [e.g., gate array, field programmable gate array (FPGA)] can be internally probed, even when contained in a closed housing during all phases of test. In the present technique, the test points are not fixed and limited to a small number; the number of test points can vastly exceed the number of buffers or pins, resulting in a compact footprint. Test points are selected by means of spare logic resources within the ASIC(s) and/or FPGA(s). A register is programmed with a command, which is used to select the signals that are sent off-chip and out of the housing for monitoring by test engineers and external test equipment. The register can be commanded by any suitable means: for example, it could be commanded through a command port that would normally be used in the operation of the system. In the original application of the technique, commanding of the register is performed via a MIL-STD-1553B communication subsystem.

  19. Reading strategies in Stargardt's disease with foveal sparing

    Directory of Open Access Journals (Sweden)

    Whatham Andrew R

    2010-01-01

    Full Text Available Abstract Background Subjects with a ring scotoma can use two retinal loci, a foveal and a peripheral, for reading. Our aim was to investigate the relative use of both retinal loci as a function of the spared foveal area size and the spatial resolution at both retinal loci. Findings Two patients with Stargardt's disease and ring scotomas read through a scanning laser ophthalmoscope a series of letters and words at various character sizes. The number of fixations made using each retinal locus was quantified. The relative use of each retinal locus depended on character size of the stimulus. Both patients used exclusively the eccentric retinal locus to read words of large character sizes. At small character sizes, the central retinal locus was predominantly used. For reading letters or words, once foveal fixation was used, patients did not shift back to the eccentric retinal locus. When spatial resolution allowed deciphering at both the eccentric and the central areas, patients consistently fixated with the eccentric retinal locus. Conclusions Spatial resolution at the eccentric locus appears as a determinant factor to select the retinal area for reading. Reading strategies in patients with Stargardt's disease and a ring scotoma demonstrate a pattern of coordination of both eccentric and central retinal loci, reflecting a high degree of adaptation.

  20. Skin-sparing mastectomy and radiotherapy: an update.

    Science.gov (United States)

    Mokbel, Ramia; Mokbel, Kefah

    2006-10-17

    Despite the lack of randomised controlled trials and paucity of the published data, the current evidence suggests that the post-mastectomy radiation therapy (PMRT) does not represent a contraindication to skin-sparing mastectomy (SSM) and immediate breast reconstruction (IBR) in the multidisciplinary setting. Although PMRT is associated with a higher incidence of complications, a satisfactory cosmetic outcome can be achieved in most patients. Radiation has a deleterious effect on autologous flap reconstruction that relies on fat for volume replacement such as the deep inferior epi-gastric perforator (DIEP) flap reconstruction and this method of reconstruction should be delayed until RT is completed. Until better methods of RT delivery are developed to minimise complications, women at high risk of requiring PMRT, can be safely offered SSM and IBR with a sub-pectoral saline-filled tissue expander and this can be replaced with a permanent prosthesis or converted into an autologous flap reconstruction after the completion of RT. Any capsule formation can be surgically treated at this stage. This new concept, known as immediate-delayed reconstruction, can avoid the cosmetic and RT delivery problems that can occur after IBR.Furthermore, prior RT does not represent a contra-indication to SSM and IBR, however it increases the incidence of complications.

  1. [Skin-sparing mastectomies: how to avoid skin necrosis?].

    Science.gov (United States)

    Delbaere, M; Delaporte, T; Toussoun, G; Delay, E

    2008-04-01

    Skin-sparing mastectomy (SSM) has emerged as the surgical technique best adapted to the treatment of early breast cancers or breast cancer recurrences after conservative treatment; the technique is particularly appreciated by the patients who had been expecting the development of immediate, high-quality breast reconstruction for over 15 years. SSM preserves anatomical landmarks on the skin surface (notably the under-breast fold and the conical shape of the breast). The procedure must be performed by a skilled surgical team in order to maximize the quality of breast resection and reconstruction, particularly to avoid postoperative complications, notably damage to blood vessels within the skin flap and prosthesis infection. These complications generally affect the cosmetic outcome of the reconstruction, with serious short-term and long-term consequences for the acceptability of the surgical procedure, and may sometimes compromise the delivery of adjuvant treatments (either chemo- or radiotherapy). Based on our previous experience (1000 new cases since 1992), we will compare the advantages and drawbacks of the procedure, discuss its indications, describe the clinical situations encountered and the various specific interventions available, as well as the methods to reduce the risks of tissue damage and skin necrosis.

  2. Functional sparing of intrafusal muscle fibers in muscular dystrophies.

    Science.gov (United States)

    Aimonetti, Jean-Marc; Ribot-Ciscar, Edith; Rossi-Durand, Christiane; Attarian, Shahram; Pouget, Jean; Roll, Jean-Pierre

    2005-07-01

    In a previous study, we showed that patients with muscular dystrophies (MDs) perceive passive movements, experience sensations of illusory movement induced by muscle tendon vibration, and have proprioceptive-regulated sways in response to vibratory stimulation applied to the neck and ankle muscle tendons. These findings argue for preserved proprioceptive functions of muscle spindles. However, it is unclear whether the function of intrafusal muscle fibers is spared, i.e., whether they retain their ability to contract when submitted to a fusimotor drive. To answer this question, we analyzed the effects of reinforcement maneuvers (mental computation and the Jendrassik maneuver) that are known to increase muscle spindle sensitivity via fusimotor drive in healthy subjects. Nine patients with different MDs participated in the study. Reinforcement maneuvers increased both the mean amplitude of the Achilles tendon reflex (187 +/- 52.9% of the mean control amplitude) and the sensitivity of muscle spindle afferents to imposed movements of the ankle. The same reinforcement maneuvers failed to alter the amplitude of the Hoffmann reflex in the triceps surae muscle. These results suggest that the intrafusal muscle fibers preserve their contractile abilities in slowly progressive MDs. The reasons for a differential impairment of intrafusal and extrafusal muscle fibers and the clinical implications of the present results are discussed.

  3. Governance, agricultural intensification, and land sparing in tropical South America.

    Science.gov (United States)

    Ceddia, Michele Graziano; Bardsley, Nicholas Oliver; Gomez-y-Paloma, Sergio; Sedlacek, Sabine

    2014-05-20

    In this paper we address two topical questions: How do the quality of governance and agricultural intensification impact on spatial expansion of agriculture? Which aspects of governance are more likely to ensure that agricultural intensification allows sparing land for nature? Using data from the Food and Agriculture Organization, the World Bank, the World Database on Protected Areas, and the Yale Center for Environmental Law and Policy, we estimate a panel data model for six South American countries and quantify the effects of major determinants of agricultural land expansion, including various dimensions of governance, over the period 1970-2006. The results indicate that the effect of agricultural intensification on agricultural expansion is conditional on the quality and type of governance. When considering conventional aspects of governance, agricultural intensification leads to an expansion of agricultural area when governance scores are high. When looking specifically at environmental aspects of governance, intensification leads to a spatial contraction of agriculture when governance scores are high, signaling a sustainable intensification process.

  4. A prospective study comparing the functional impact of SIEA, DIEP, and muscle-sparing free TRAM flaps on the abdominal wall: part I. unilateral reconstruction.

    Science.gov (United States)

    Selber, Jesse C; Nelson, Jonas; Fosnot, Joshua; Goldstein, Jesse; Bergey, Meredith; Sonnad, Seema S; Serletti, Joseph M

    2010-10-01

    The purpose of this two-part study was to demonstrate the impact of free flap breast reconstruction on the abdominal wall. In Part I, the authors present the results for unilateral techniques. A blinded, prospective, cohort study was performed involving 234 free flap breast reconstruction patients. Patients were evaluated preoperatively, and followed for 1 year. At each encounter, patients underwent abdominal strength testing using the Upper and Lower Rectus Abdominis Manual Muscle Function Test, the Functional Independence Measure, and psychometric testing using the 36-Item Short-Form Health Survey. Patients also completed a satisfaction questionnaire specific to breast reconstruction. Statistical analysis included the Kruskal-Wallis, Mann-Whitney, Friedman, and Wilcoxon signed rank tests. Two-hundred thirty-four patients were enrolled. Of these, 157 underwent reconstruction (75 of which were unilateral), completed follow-up, and were included in the analysis. There was a significantly greater decline in upper abdominal strength in patients undergoing muscle-sparing free transverse rectus abdominis musculocutaneous (TRAM) flap surgery compared with deep inferior epigastric perforator (DIEP) flap surgery at early (p = 0.01) and late follow-up (p = 0.02). Unilateral superficial inferior epigastric artery flap procedures (n = 3) were too few for a meaningful conclusion to be reached. Lower abdominal and Functional Independence Measure scores showed no significant differences. Psychometric testing showed that there was a significant decline in physical health within the free TRAM flap group. No significant difference among groups was appreciable. In unilateral cases, the impact of the muscle-sparing free TRAM flap versus the DIEP flap follows theoretical predictions based on the degree of muscle sacrifice: the muscle-sparing free TRAM flap demonstrated a greater decline than the DIEP flap in certain measurable parameters.

  5. Use of multiparametric MR with neurovascular bundle evaluation to optimize the oncological and functional management of patients considered for nerve-sparing radical prostatectomy.

    Science.gov (United States)

    Panebianco, Valeria; Salciccia, Stefano; Cattarino, Susanna; Minisola, Francesco; Gentilucci, Alessandro; Alfarone, Andrea; Ricciuti, Gian Piero; Marcantonio, Andrea; Lisi, Danilo; Gentile, Vincenzo; Passariello, Roberto; Sciarra, Alessandro

    2012-08-01

    To obtain the best results with radical prostatectomy, either from an oncological or a functional point of view, a correct selection of cases and planning of surgery are crucial. Multiparametric magnetic resonance imaging (MRI) promises to make it a successful imaging tool for improving many aspects of prostate cancer management. The aim of this study is to evaluate whether a modern multiparametric MRI can help either to better select prostate cancer cases for a nerve-sparing radical prostatectomy or to improve the functional evaluation related to neurovascular bundles preservation. The effect of preoperative MRI on neurovascular bundle management was examined for the frequency and the appropriateness of changes of the surgical plane on the basis of MRI indications. In a prospective study, 125 consecutive patients with biopsy proven prostate cancer who were scheduled to undergo bilateral nerve-sparing surgery. All patients included into the study were submitted to a preoperative multiparametric MRI. On the basis of MRI evaluation, patients were divided into two groups. Patients in group A were then submitted to a bilateral nerve-sparing (NS) radical prostatectomy (RP), whereas patients in group B were submitted to unilateral NS or non-NS RP. In group A, the confirmation from the MRI study to perform a bilateral NS procedure was appropriate in 70 of 73 cases (95.9%), whereas in group B, the surgical plan was appropriate in 28 of 32 cases (87.5%). On the contrary, MRI findings suggested a change in the initial surgical plan (group B) for 32 of 105 cases (30.5%). Of these 32 cases in group B, MRI suggested to perform a unilateral NS procedure in 21 of 32 cases (65.6%) and a non-NS procedure in 11 of 32 cases (34.4%). Multiparametric MRI analysis can significantly improve the standard selection and management of prostate carcinoma cases considered for an NS RP. © 2012 International Society for Sexual Medicine.

  6. Comparison of Glucocorticoid (Budesonide) and Antileukotriene (Montelukast) Effect in Patients with Bronchial Asthma Determined with Body Plethysmography

    OpenAIRE

    Lajqi, Njomza; Ilazi, Ali; Kastrati, Bashkim; Islami, Hilmi

    2015-01-01

    Objective: Effect of glucocorticoids-budesonide and antileukotriene–montelukast in patients with bronchial asthma and bronchial increased reactivity was studied in this work. Methods: Parameters of the lung function are determined with Body plethysmography. Raw and ITGV were registered and specific resistance (SRaw) was also calculated. Results: Results of this research, in patients with bronchial asthma, indicate that glucocorticoids – budesonide (Pulmicort; 2 × 2 mg inh) has significant act...

  7. Duodenal-bronchial fistula: an unusual cause of shortness of breath and a productive cough

    Directory of Open Access Journals (Sweden)

    Cynthia Wong, BMBS

    2016-09-01

    Full Text Available Duodenal-bronchial fistulas are very uncommon, even among the already rare subgroup of abdominal-bronchial fistulas. We describe a case of a woman with Crohn's disease who presented with shortness of breath and a productive cough who was found to have a duodeanl bronchial fistula on computed tomography scan. We demonstrate with this case how these rare cases can lead to chronic lung aspirations and require multidisciplinary involvement.

  8. Pathogenesis and management of virus infection-induced exacerbation of senile bronchial asthma and chronic pulmonary emphysema.

    Science.gov (United States)

    Yamaya, Metstuo

    2002-06-01

    The number of senile patients with therapy resistant bronchial asthma, chronic pulmonary emphysema increases due to the habit of smoking and increased number of older people, and these inflammatory pulmonary diseases are the leading causes of death worldwide. Rhinoviruses cause the majority of common colds, and provoke exacerbations of bronchial asthma and chronic pulmonary emphysema. Here, I review the pathogenesis and management of rhinovirus infection-induced exacerbation of senile bronchial asthma and chronic pulmonary emphysema.

  9. Phosphorylation of p65 Is Required for Zinc Oxide Nanoparticle–Induced Interleukin 8 Expression in Human Bronchial Epithelial Cells

    OpenAIRE

    Wu, Weidong; Samet, James M.; Peden, David B.; Bromberg, Philip A.

    2010-01-01

    Background Exposure to zinc oxide (ZnO) in environmental and occupational settings causes acute pulmonary responses through the induction of proinflammatory mediators such as interleukin-8 (IL-8). Objective We investigated the effect of ZnO nanoparticles on IL-8 expression and the underlying mechanisms in human bronchial epithelial cells. Methods We determined IL-8 mRNA and protein expression in primary human bronchial epithelial cells and the BEAS-2B human bronchial epithelial cell line usin...

  10. Spare parts sharing with joint optimization of maintenance and inventory policies

    DEFF Research Database (Denmark)

    Larsen, Christian; Wong, Hartanto Wijaya; Nielsen, Lars Relund

    inventory policies for both a single- and a multi-company problem. The cost savings obtained as a result of sharing are evaluated. A number of cost allocation schemes, making all the companies involved being better off by sharing the spare parts rather than acting independently, are developed.......We consider a collaborative arrangement where a number of companies are willing to share expensive spare parts, required for both failure replacement and preventive maintenance purposes. We develop a discrete-time Markov decision model for the joint optimization of maintenance and spare parts...

  11. Rotator cuff-sparing approaches for glenohumeral joint access: an anatomic feasibility study.

    Science.gov (United States)

    Amirthanayagam, Tressa D; Amis, Andrew A; Reilly, Peter; Emery, Roger J H

    2017-03-01

    The deltopectoral approach for total shoulder arthroplasty can result in subscapularis dysfunction. In addition, glenoid wear is more prevalent posteriorly, a region difficult to access with this approach. We propose a posterior approach for access in total shoulder arthroplasty that uses the internervous interval between the infraspinatus and teres minor. This study compares this internervous posterior approach with other rotator cuff-sparing techniques, namely, the subscapularis-splitting and rotator interval approaches. The 3 approaches were performed on 12 fresh frozen cadavers. The degree of circumferential access to the glenohumeral joint, the force exerted on the rotator cuff, the proximity of neurovascular structures, and the depth of the incisions were measured, and digital photographs of the approaches in different arm positions were analyzed. The posterior approach permits direct linear access to 60% of the humeral and 59% of the glenoid joint circumference compared with 39% and 42% for the subscapularis-splitting approach and 37% and 28% for the rotator interval approach. The mean force of retraction on the rotator cuff was 2.76 (standard deviation [SD], 1.10) N with the posterior approach, 2.72 (SD, 1.22) N with the rotator interval, and 4.75 (SD, 2.56) N with the subscapularis-splitting approach. From the digital photographs and depth measurements, the estimated volumetric access available for instrumentation during surgery was comparable for the 3 approaches. The internervous posterior approach provides greater access to the shoulder joint while minimizing damage to the rotator cuff. Copyright © 2017. Published by Elsevier Inc.

  12. Radiation-sparing managements for cervical cancer: a developing countries perspective

    Directory of Open Access Journals (Sweden)

    de la Garza Jaime

    2006-11-01

    Full Text Available Abstract Cervical cancer is the seventh most frequent cancer worldwide but more than 80% of cases occur in developing countries. Till date, radiation therapy with external beam and brachytherapy remains as the core treatment for most stages of cervical cancer. However, radiation treatment protocols and equipment modelled on the best developed countries can be seldom applied directly to developing countries owing to financial constraints and lack of qualified personnel, thus, a substantial proportion of patients do not have access to even palliative radiation therapy. Treatment options when the standard therapy is either not available or difficult to reproduce in particular settings is highly desirable with the potential to save lives that otherwise could be lost by the lack of adequate treatment. These options of treatment ideally had to have show, 1 that these are not inferior to the "standard" in terms of either survival or quality of life; 2 that these can be delivered in settings were the "standard" is not available or if available its quality is poor; and 3 that the treatment option be accepted by the population to be treated. Based on these considerations, it is obvious that cervical cancer patients, particularly those who live in countries with limited resources and therefore may not have sufficient radiation therapy resources are in need of newer therapeutical options. There is now a considerable amount of information emanating from clinical studies where surgery has a major role in treating this disease. These forms of "radiation-sparing" treatments include total mesometrial resection that could make unnecessary the use of adjuvant radiation; neoadjuvant chemotherapy that could avoid the use of adjuvant radiation in around 85% of patients and preoperative chemoradiation that could make brachytherapy dispensable. The feasibility and therapeutical value of these potential forms of management need to be prospectively evaluated.

  13. Early oral feeding after elective abdominal surgery--what are the issues?

    DEFF Research Database (Denmark)

    Bisgaard, Thue; Kehlet, Henrik

    2002-01-01

    procedures. It appears that several factors may promote postoperative oral feeding such as thoracic epidural analgesia, multimodal anti-emetic treatment, opioid-sparing analgesia, selective peripheral opioid antagonists, and enforced oral nutrition. Recent data from multimodal fast-track rehabilitation...... surgical programs in abdominal surgery provide a rational basis for future studies to investigate and facilitate enforced oral feeding after major abdominal procedures....

  14. The minimally invasive, orbicularis-sparing, lower eyelid recession for mild to moderate lower eyelid retraction with reduced orbicularis strength.

    Science.gov (United States)

    Yoo, Donald B; Griffin, Garrett R; Azizzadeh, Babak; Massry, Guy G

    2014-01-01

    IMPORTANCE Identifying a procedure to address lower eyelid retraction (LER) in the presence of an orbicularis deficit is a useful tool for aesthetic and reconstructive eyelid surgery. OBJECTIVE To describe and evaluate a surgical technique consisting of a closed canthal suspension and true lower eyelid retractor recession to address LER in the setting of orbicularis weakness. DESIGN, SETTING, AND PARTICIPANTS A retrospective medical record review of patients who underwent the minimally invasive, orbicularis-sparing, lower eyelid recession from January 1, 2010, to October 1, 2012, by one of us (G.G.M.) in an ophthalmic plastic surgical practice. We included 29 patients with reduced orbicularis strength and LER resulting from eyelid paresis related to facial nerve disease, surgical trauma (after blepharoplasty), involutional change, or idiopathic causes. INTERVENTIONS Surgical intervention consisting of closed canthal suspension and lower eyelid retractor recession. MAIN OUTCOMES AND MEASURES Surgical results, complications, and patient satisfaction. RESULTS The 29 patients included 18 women and 11 men. The mean patient age was 52 (range, 6-72) years; mean follow-up, 11 (range, 6-21) months; and mean preoperative orbicularis strength, 2.7 (on a scale of 0-4, where 0 indicates no function and 4, normal function). The causes of orbicularis weakness included eyelid paresis related to facial nerve disease (11 patients), surgical trauma (13 patients), involutional change (4 patients), and an isolated idiopathic finding (1 patient). In 12 patients, the eyelid retraction was unilateral; in 17, bilateral. A small tarsorrhaphy was added to the surgery in 6 patients with facial nerve disease. The mean eyelid elevation after surgery was 1.80 mm, with only minor complications. Patient and surgeon satisfaction were high. CONCLUSIONS AND RELEVANCE Recent publications have demonstrated the utility of closed canthal suspension and true lower eyelid retractor recession as separate

  15. Novel Bioreactors to Study Forces on Bronchial Epithelial Cultures

    Science.gov (United States)

    Carpenter, Jerome; Millard, Mike; Cozon, Matthew; Superfine, Richard

    2008-10-01

    Studying cells in a physiologically relevant environment is an important tool in understanding cell signaling and gene expression. Human bronchial epithelial cells (HBECs) are responsible for mucociliary clearance, which removes pathogens from the air we breathe. Recreating the in vivo conditions of HBECs is difficult; they are polarized and undergo a variety of forces. Polarization is required for organ-specific systems such as cilia motility and mucus regulation. We achieve polarization by growing cells on an electrospun nanoporous scaffold which we attach to a silastic annulus. Using this geometry we apply vacuum to the annulus and stretch the cells. This bioreactor allows us to study polarized HBECs as they experience cyclic strain similar to breathing. We've grown polarized cultures on the scaffold and are evaluating the scaffold's mechanical properties. In a second bioreactor, we place the scaffold into a microfluidics channel to study the affect of shear stress on polarized cells. We also reproduce the branching structure found in the lungs to investigate the regulation of mucus as it ascends the airway tree.

  16. A locus regulating bronchial hyperresponsiveness maps to chromosome 5q

    Energy Technology Data Exchange (ETDEWEB)

    Levitt, R.C.; Meyers, D.A. [Johns Hopkins Medical Institutions, Baltimore, MD (United States); Bleecker, E.R. [Univ. of Maryland, Baltimore, MD (United States)] [and others

    1994-09-01

    Bronchial hyperresponsiveness (BHR) is one of the hallmarks of asthma. BHR correlates well with asthmatic symptoms and the response to treatment. Moreover, BHR appears to be closely related to airways inflammation. Numerous studies have demonstrated a familial aggregation; however, this phenotype is not likely inherited as a simple Mendelian trait. BHR is also closely associated with total serum IgE levels, as are allergy and asthma. We studied 92 families from Northern Holland ascertained through a parent with asthma who were originally studied between 1962-1970. Since there are a number of candidate genes on chromosome 5q potentially important in producing BHR, families were genotyped for markers in this region. These genes regulate IgE production and the cellular elements that are likely involved in inflammation associated with BHR, allergy and asthma. They include IL-4, IL-3, IL-5, IL-9, IL-12, IL-13 and GM-CSF. Linkage of BHR with markers on 5q was tested using a model free sib-pair method. The data suggest a locus for BHR maps near the cytokine gene cluster on 5q. This region appears critical in producing susceptibility to BHR and possibly to asthma.

  17. Detection of trisomy 7 in bronchial cells from uranium miners

    Energy Technology Data Exchange (ETDEWEB)

    Lechner, J.F.; Neft, R.E.; Belinsky, S.A. [and others

    1995-12-01

    New Mexico was the largest producer of uranium in the western world during 1960s and 1970s. Investigators at the University of New Mexico School of Medicine`s Epidemiology and Cancer Control Program have been conducting epidemiological studies on uranium miners over the past 2 decades. Currently, this cohort includes more than 3600 men who had completed at least 1 y of underground work experience in New Mexico by December 31, 1976. These miners, who are now in their 5th through 7th decades, the age when lung cancer incidence is highest, are at high risk for developing this disease because they were exposed to high levels of radon progeny in the mines, and they also smoked tobacco. However, not all people comparably exposed develop lung cancer; in fact, the lifetime risk of lung cancer for the smoking uranium miners has been projected by epidemiological analyses to be no higher than 50%. Therefore, the identification of gene alterations in bronchial epithelium would be a valuable tool to ascertain which miners are at greatest risk for lung cancer. The underlying significance of the current effort confirms the hypothesis that chronic exposure to high concentrations of {alpha}-particles and tobacco smoke produces genetically altered lung epithelial cells throughout the respiratory tract of some susceptible individuals before they develop clinical disease.

  18. [Efficacy of combined relaxation exercises for children with bronchial asthma].

    Science.gov (United States)

    Gröller, B

    1991-05-01

    In the framework of a pilot study, 15 children having bronchial asthma (4 female, 11 male; age 5-11;6) participated, over a period of 8 weeks, in two weekly sessions of combined relaxation, respiratory and sports exercises. The present article in particular focuses on the relaxation exercises, made up of Progressive Muscle Relaxation and Autogenic Training elements as well as of phantasy travels, mantras, and periodic music. Ongoing observation of the children during training, the findings of subsequent semi-structured interviews with them, topical instances of coping with impending asthma attacks by using the techniques learned, as well as the results of a catamnestic inquiry some three years later--all indicate a positive impact of the relaxation exercises. Statistical analysis of the data at hand revealed significant improvements in a number of pulmonary function parameters (airway resistance, forced expiratory volume for 1 s, forced vital capacity, peak expiratory flow rate). Interpretation of these findings must however take into account the entirety of the training provided.

  19. [Effectiveness of combined relaxation exercises for children with bronchial asthma].

    Science.gov (United States)

    Gröller, B

    1992-02-01

    In the framework of a pilot study, 15 children having bronchial asthma (4 female, 11 male; age 5-11; 6) participated, over a period of 8 weeks, in two weekly sessions of combined relaxation, respiratory and sports exercises. The present article in particular focuses on the relaxation exercises, made up of Progressive Muscle Relaxation and Autogenic Training elements as well as of phantasy travels, mantras, and periodic music. Ongoing observation of the children during training, the findings of subsequent semi-structured interviews with them, topical instances of coping with impending asthma attacks by using the techniques learnt, as well as the result of a catamnestic inquiry some three years later--all indicate a positive impact of the relaxation exercises. Statistical analysis of the data at hand revealed significant improvements in a number of pulmonary function parameters (airway resistance, forced expiratory volume for 1 s, forced vital capacity, peak expiratory flow rate). Interpretation of these findings must however take into account the entirety of the training provided.

  20. Tungsten-induced carcinogenesis in human bronchial epithelial cells

    Science.gov (United States)

    Laulicht, Freda; Brocato, Jason; Cartularo, Laura; Vaughan, Joshua; Wu, Feng; Kluz, Thomas; Sun, Hong; Oksuz, Betul Akgol; Shen, Steven; Paena, Massimilano; Medici, Serenella; Zoroddu, Maria Antonietta; Costa, Max

    2015-01-01

    Metals such as arsenic, cadmium, beryllium, and nickel are known human carcinogens; however, other transition metals, such as tungsten (W), remain relatively uninvestigated with regard to their potential carcinogenic activity. Tungsten production for industrial and military applications has almost doubled over the past decade and continues to increase. Here, for the first time, we demonstrate tungsten’s ability to induce carcinogenic related endpoints including cell transformation, increased migration, xenograft growth in nude mice, and the activation of multiple cancer related pathways in transformed clones as determined by RNA seq. Human bronchial epithelial cell line (Beas-2B) exposed to tungsten developed carcinogenic properties. In a soft agar assay, tungsten-treated cells formed more colonies than controls and the tungsten-transformed clones formed tumors in nude mice. RNA-sequencing data revealed that the tungsten-transformed clones altered the expression of many cancer-associated genes when compared to control clones. Genes involved in lung cancer, leukemia, and general cancer genes were deregulated by tungsten. Taken together, our data shows the carcinogenic potential of tungsten. Further tests are needed, including in vivo and human studies, in order to validate tungsten as a carcinogen to humans. PMID:26164860

  1. Asbestos exposure increases human bronchial epithelial cell fibrinolytic activity.

    Science.gov (United States)

    Gross, T J; Cobb, S M; Gruenert, D C; Peterson, M W

    1993-03-01

    Chronic exposure to asbestos fibers results in fibrotic lung disease. The distal pulmonary epithelium is an early target of asbestos-mediated injury. Local plasmin activity may be important in modulating endoluminal inflammatory responses in the lung. We studied the effects of asbestos exposure on cell-mediated plasma clot lysis as a marker of pericellular plasminogen activation. Exposing human bronchial epithelial (HBE) cells to 100 micrograms/ml of asbestos fibers for 24 h resulted in increased plasma clot lysis. Fibrinolytic activity was augmented in a dose-dependent fashion, was not due to secreted protease, and occurred only when there was direct contact between the plasma clot and the epithelial monolayer. Further analysis showed that asbestos exposure increased HBE cell-associated urokinase-type plasminogen activator (uPA) activity in a time-dependent manner. The increased cell-associated PA activity could be removed by acid washing. The increase in PA activity following asbestos exposure required new protein synthesis because it was abrogated by treatment with either cycloheximide or actinomycin D. Therefore, asbestos exposure increases epithelial-mediated fibrinolysis by augmenting expression of uPA activity at the cell surface by mechanisms that require new RNA and protein synthesis. These observations suggest a novel mechanism whereby exposure of the distal epithelium to inhaled particulates may result in a chronic inflammatory response that culminates in the development of fibrotic lung disease.

  2. Peptide receptor radionuclide therapy: focus on bronchial neuroendocrine tumors.

    Science.gov (United States)

    Lo Russo, Giuseppe; Pusceddu, Sara; Prinzi, Natalie; Imbimbo, Martina; Proto, Claudia; Signorelli, Diego; Vitali, Milena; Ganzinelli, Monica; Maccauro, Marco; Buzzoni, Roberto; Seregni, Ettore; de Braud, Filippo; Garassino, Marina Chiara

    2016-10-01

    Well-differentiated bronchial neuroendocrine tumors (B-NETs) are rare. They represent 1-5 % of all lung cancers. The incidence of these neoplasms has risen over the past 30 years and, especially for advanced or metastatic disease, management is complex and requires a multidisciplinary approach. Treatment with somatostatin analogs (SSAs) is the most important first-line therapy, in particular in well-differentiated NETs with high somatostatin type receptor (SSTR) expression. In these tumors, the role of mammalian target of rapamycin (m-TOR) inhibitors and the potential utility of other target therapies remain unclear while chemotherapy represents the gold standard treatment only for aggressive forms with low SSTR expression. Peptide receptor radionuclide therapy (PRRT) is an emerging treatment modality for advanced NETs. There are many cumulative evidences about the effectiveness and tolerability of this therapeutic approach, especially in gastro-entero-pancreatic (GEP)-NETs. For B-NETs, scientific research is moving more slowly. Here, we performed a review in order to evaluate the efficacy and toxicity of PRRT with a focus on patients with inoperable or metastatic well-differentiated B-NETs.

  3. Medical image of the week: bronchial artery embolization

    Directory of Open Access Journals (Sweden)

    Jarrett BJ

    2016-07-01

    Full Text Available No abstract available. Article truncated after 150 words. A 25-year-old woman with a past medical history significant for pulmonary coccidioidomycosis and poorly controlled type I diabetes mellitus presented to the emergency department with a chief complaint of 4 days of progressively worsening shortness of breath and 3-4 days of intermittent hemoptysis. Initial CT scan demonstrated progressive tree-in-bud and ground glass opacities in the right upper and lower lung lobes suggesting worsening of her ongoing coccidiomycosis (Figure 1. On hospital day 3 she began to have worsening hypoxemia and hemoptysis requiring transfer to the intensive care unit. Interventional radiology was consulted who performed an emergent right sided bronchial artery embolization with the ethylene vinyl alcohol polymer, Onyxtm. After embolization her chest radiographs demonstrated evidence of the embolization material in the pulmonary vasculature (Figure 2. Ethylene vinyl alcohol polymer, Onyxtm is a liquid embolic substance which solidifies after contact with ionic materials (1. This results in a rapid, irreversible and ...

  4. Effect of 4% lidocaine inhalation in bronchial asthma.

    Science.gov (United States)

    Prakash, G S; Sharma, S K; Pande, J N

    1990-01-01

    The effect of 4% lidocaine inhalation was studied in a single-blind fashion in 18 patients with chronic stable asthma. Inhalation of normal saline solution was used as placebo. None of the parameters except flow rate at 50% of vital capacity (V50) showed any statistically significant change from baseline values. V50 at 15 min was significantly lower (p less than 0.05) after 4% lidocaine inhalation. Considering more than 10% change from the baseline value as significant, 8 of 15 patients showed decrease in airway resistance (Raw) and 7 of the 15 patients showed an increase in specific airway conductance (SGaw) after 15 min of inhalation. However, V50 (8/18 patients), flow rate at 25% vital capacity [V25 (6/15 patients], and forced expiratory flow rate at 25-75% of the vital capacity (FEF25-75) (5/15 patients) showed a decrease after 15 min of 4% lidocaine inhalation. No change in pulmonary function was noted after 30 min of lidocaine inhalation. It is concluded from this study that lidocaine produces a small bronchodilatory effect on the large airways and a bronchoconstrictor effect on the small airways after 15 min of inhalation, but this effect is not statistically significant. It can be safely used as topical agent for bronchoscopy in patients with bronchial asthma.

  5. Indications for the use of bronchial thermoplasty in severe asthma.

    Science.gov (United States)

    Dheda, Keertan; Koegelenberg, Coenraad F N; Esmail, Aliasgar; Irusen, Elvis; Wechsler, Michael E; Niven, Rob M; Chung, Kian Fan; Bateman, Eric D

    2015-09-18

    Approximately 5% of the ~3 million asthmatics in South Africa have severe asthma that is associated with substantial morbidity, cost, absenteeism, preventable mortality, and the requirement for costly chronic medication that may be associated with significant adverse events. There is an unmet need for alternative safer and more effective interventions for severe asthma. A recently introduced option, bronchial thermoplasty (BT), imparts radiofrequency-generated heat energy to the airways to cause regression of airway smooth muscle. The effectiveness of this technique has been confirmed in randomised control trials and is now endorsed by several international guidelines, including the Global Initiative for Asthma (GINA) guideline, the British Asthma Guideline, and the UK National Institute of Clinical Excellence (NICE) guideline. We recommend BT as a potential therapeutic intervention for severe uncontrolled asthma, provided that it is performed by an experienced pulmonologist at an accredited centre and done within the broader context of appropriate management of the disease by doctors experienced in treating difficult-to-control asthma.

  6. Prognostic factors in bronchial arterial embolization for hemoptysis

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Eui Jong; Yoon, Yup; Oh, Joo Hyeong; Lim, Joo Won; Sung, Dong Wook [Kyung Hee University Hospital, Seoul (Korea, Republic of)

    1994-07-15

    To find the rebleeding factors in bronchial arterial embolization for treatment of hemoptysis, a retrospective study was performed. Medical records, angiographic findings and embolic materials of 35 patients who had undertaken arterial embolization for control of hemoptysis were reviewed. The period of follow-up for rebleeding was from 3 to 32 months after arterial embolization. We investigated the angiographic findings of extravasation, neovascularity, intervascular shunt, aneurysm and periarterial diffusion. Neovascularity was classified as mild(numerable neovascularity) and severe(innumerable). Rebleeding occurred in 15(43%) among 35 cases. Only two of 11 cases with no past episode of hemoptysis showed recurrence, while 9 of 15 cases who had more than three episodes did. Severe neovascularity were seen in 11 of 15 recurred cases, but seven of 20 non- recurred cases showed severe neovascularity. More than three angiographic findings representing hemoptysis were seen on 11(73%) among recurred 15 cases and seven(35%) among non- recurred 20 cases. The lesion was supplied by more than two different arteries on 8(54%) of the recurred cases, but only three(15%) of the non- recurred cases. Six of seven cases persistent neovascularity after arterial embolization were recurred. The history of repeated hemoptysis, severe neovascularity, variable angiographic findings, and post-embolization persistency of neovascularity were the factors related with the rebleeding after arterial embolization for hemoptysis. Careful and active arterial embolization are required on these conditions.

  7. Diagnostic challenges and management of a patient with acromegaly due to ectopic growth hormone-releasing hormone secretion from a bronchial carcinoid tumour

    Science.gov (United States)

    Kyriakakis, Nikolaos; Trouillas, Jacqueline; Dang, Mary N; Lynch, Julie; Belchetz, Paul; Korbonits, Márta

    2017-01-01

    Summary A male patient presented at the age of 30 with classic clinical features of acromegaly and was found to have elevated growth hormone levels, not suppressing during an oral glucose tolerance test. His acromegaly was originally considered to be of pituitary origin, based on a CT scan, which was interpreted as showing a pituitary macroadenoma. Despite two trans-sphenoidal surgeries, cranial radiotherapy and periods of treatment with bromocriptine and octreotide, his acromegaly remained active clinically and biochemically. A lung mass was discovered incidentally on a chest X-ray performed as part of a routine pre-assessment for spinal surgery 5 years following the initial presentation. This was confirmed to be a bronchial carcinoid tumour, which was strongly positive for growth hormone-releasing hormone (GHRH) and somatostatin receptor type 2 by immunohistochemistry. The re-examination of the pituitary specimens asserted the diagnosis of pituitary GH hyperplasia. Complete resolution of the patient’s acromegaly was achieved following right lower and middle lobectomy. Seventeen years following the successful resection of the bronchial carcinoid tumour the patient remains under annual endocrine follow-up for monitoring of the hypopituitarism he developed after the original interventions to his pituitary gland, while there has been no evidence of active acromegaly or recurrence of the carcinoid tumour. Ectopic acromegaly is extremely rare, accounting for <1% of all cases of acromegaly. Our case highlights the diagnostic challenges differentiating between ectopic acromegaly and acromegaly of pituitary origin and emphasises the importance of avoiding unnecessary pituitary surgery and radiotherapy. The role of laboratory investigations, imaging and histology as diagnostic tools is discussed. Learning points: Ectopic acromegaly is rare, accounting for less than 1% of all cases of acromegaly. Ectopic acromegaly is almost always due to extra-pituitary GHRH secretion

  8. Diagnostic challenges and management of a patient with acromegaly due to ectopic growth hormone-releasing hormone secretion from a bronchial carcinoid tumour.

    Science.gov (United States)

    Kyriakakis, Nikolaos; Trouillas, Jacqueline; Dang, Mary N; Lynch, Julie; Belchetz, Paul; Korbonits, Márta; Murray, Robert D

    2017-01-01

    A male patient presented at the age of 30 with classic clinical features of acromegaly and was found to have elevated growth hormone levels, not suppressing during an oral glucose tolerance test. His acromegaly was originally considered to be of pituitary origin, based on a CT scan, which was interpreted as showing a pituitary macroadenoma. Despite two trans-sphenoidal surgeries, cranial radiotherapy and periods of treatment with bromocriptine and octreotide, his acromegaly remained active clinically and biochemically. A lung mass was discovered incidentally on a chest X-ray performed as part of a routine pre-assessment for spinal surgery 5 years following the initial presentation. This was confirmed to be a bronchial carcinoid tumour, which was strongly positive for growth hormone-releasing hormone (GHRH) and somatostatin receptor type 2 by immunohistochemistry. The re-examination of the pituitary specimens asserted the diagnosis of pituitary GH hyperplasia. Complete resolution of the patient's acromegaly was achieved following right lower and middle lobectomy. Seventeen years following the successful resection of the bronchial carcinoid tumour the patient remains under annual endocrine follow-up for monitoring of the hypopituitarism he developed after the original interventions to his pituitary gland, while there has been no evidence of active acromegaly or recurrence of the carcinoid tumour. Ectopic acromegaly is extremely rare, accounting for ectopic acromegaly and acromegaly of pituitary origin and emphasises the importance of avoiding unnecessary pituitary surgery and radiotherapy. The role of laboratory investigations, imaging and histology as diagnostic tools is discussed. Ectopic acromegaly is rare, accounting for less than 1% of all cases of acromegaly.Ectopic acromegaly is almost always due to extra-pituitary GHRH secretion, mainly from neuroendocrine tumours of pancreatic or bronchial origin.Differentiating between acromegaly of pituitary origin and

  9. Patient satisfaction with nipple-sparing mastectomy: A prospective study of patient reported outcomes using the BREAST-Q.

    Science.gov (United States)

    Howard, Michael A; Sisco, Mark; Yao, Katharine; Winchester, David J; Barrera, Ermilo; Warner, Jeremy; Jaffe, Jennifer; Hulick, Peter; Kuchta, Kristine; Pusic, Andrea L; Sener, Stephen F

    2016-09-01

    The authors sought to study patient-reported outcomes following nipple-sparing mastectomy (NSM). From 2008 to 2011, the BREAST-Q was administered to women undergoing NSM surgery for cancer treatment or risk-reduction prior to surgery and at 2 years after completion of reconstruction. The change in score over time and the impact of surgical indication, complication occurrence, and laterality on scores were analyzed. The BREAST-Q was prospectively administered to 39 women undergoing NSM for cancer treatment (n = 17) or risk-reduction (RR) (n = 22). At 2 years after operation, median overall satisfaction with breasts was 75 (IQR = 67,100). There were significant postoperative increases in scores for overall satisfaction with breasts (+8, P = 0.021) and psychosocial well-being (+14, P = 0.003). Postoperatively, RR patients had significantly higher scores for psychosocial wellness, physical impact (chest), and overall satisfaction with outcome compared to cancer treatment patients (P quality of life as measured by BREAST-Q. Satisfaction level increased 2 years following operation. J. Surg. Oncol. 2016;114:416-422. © 2016 Wiley Periodicals, Inc. © 2016 Wiley Periodicals, Inc.

  10. Prognosis of R1-resection at the bronchial stump in patients with non-small cell lung cancer

    Institute of Scientific and Technical Information of China (English)

    Lyu Jima; Hao Xuezhi; Hui Zhouguang; Liang Jun; Zhou Zongmei; Feng Qinfu; Xiao Zefen

    2014-01-01

    Background The prognosis of R1-resection at the bronchial stump in patients with non-small cell lung cancer (NSCLC) remains unclear.This study intends to identify the prognostic factors and to optimize treatments for these patients under update conditions.Methods The data of 124 NSCLC patients who underwent R1-resection at the bronchial stump was reviewed.There were 41 patients in the surgery group (S),21 in the postoperative radiotherapy (PORT) group (S+R),30 in the postoperative chemotherapy (POCT) group (S+C),and 32 in the PORT plus POCT group (S+R+C).The constitute proportion in different groups was tested using the X2 method,univariate analysis was performed using the Kaplan-Meier and log-rank method,and multivariate analysis was done using the Cox hazard regression with entry factors including age,sex,pathological type and stage,classification of the residual disease,and treatment procedure.The process was performed stepwise backward with a maximum iteration of 20 and an entry possibility of 0.05 as well as an excluded possibility of 0.10 at each step.Results In univariate analysis,survival was more favorable for patients with squamous cell carcinoma,early pathological T or N stage,and chemotherapy or radiotherapy.There was no significant difference in the survival for patients with different types of the residual disease,except for the difference between patients with carcinoma in situ and lymphangiosis carcinomatosa (P=0.030).The survival for patients receiving chemoradiotherapy was superior to that for those undergoing surgery alone (P=0.016).In multivariate analysis,the pathological type (HR 2.51,95% CI 1.59 to 3.96,P=0.000),pathological T (HR 1.29,95% CI 1.04 to 1.60,P=-0.021) or N stage (HR 2.04,95% CI 1.40 to 2.98,P=0.000),and chemotherapy (HR 0.24,95% CI 0.13 to 0.43,P=0.000) were independent prognostic factors.Conclusion Patients with squamous cell carcinoma,early pathological T or N stage,or receiving chemotherapy had a more favorable

  11. Intestinal ischemia/reperfusion induces bronchial hyperreactivity and increases serum TNF-alpha in rats

    Directory of Open Access Journals (Sweden)

    Arruda Marcio Jose Cristiano de

    2006-01-01

    Full Text Available INTRODUCTION: Intestinal or hepatic ischemia/reperfusion induces acute lung injury in animal models of multiple organ failure. Tumor necrosis factor (TNF- alpha is involved in the underlying inflammatory mechanism of acute respiratory distress syndrome. Although the inflammatory cascade leading to acute respiratory distress syndrome has been extensively investigated, the mechanical components of acute respiratory distress syndrome are not fully understood. Our hypothesis is that splanchnic ischemia/reperfusion increases airway reactivity and serum TNF-alpha levels. OBJECTIVE: To assess bronchial smooth muscle reactivity under methacholine stimulation, and to measure serum TNF-alpha levels following intestinal and/or hepatic ischemia/reperfusion in rats. METHOD: Rats were subjected to 45 minutes of intestinal ischemia, or 20 minutes of hepatic ischemia, or to both (double ischemia, or sham procedures (control, followed by 120 minutes of reperfusion. The animals were then sacrificed, and the bronchial response to increasing methacholine molar concentrations (10-7 to 3 x 10-4 was evaluated in an ex-vivo bronchial muscle preparation. Serum TNF-alpha was determined by the L929-cell bioassay. RESULTS: Bronchial response (g/100 mg tissue showed increased reactivity to increasing methacholine concentrations in the intestinal ischemia and double ischemia groups, but not in the hepatic ischemia group. Similarly, serum TNF-alpha (pg/mL concentration was increased in the intestinal ischemia and double ischemia groups, but not in the hepatic ischemia group. CONCLUSION: Intestinal ischemia, either isolated or associated with hepatic ischemia, increased bronchial smooth muscle reactivity, suggesting a possible role for bronchial constriction in respiratory dysfunction following splanchnic ischemia/reperfusion. This increase occurred in concomitance with serum TNF-alpha increase, but whether the increase in TNF-alpha caused this bronchial contractility remains

  12. CARDIOTHORACIC SURGERY

    African Journals Online (AJOL)

    lbadan, Nigeria. Reprint requests to: Dr. V. O. Adegboye, Department Of Surgery, University College Hospital, Iberian,. Nigeria. ... been shown to be related to the rate of bleeding. .... patients after an interval of conservative/medical treatment.

  13. General Surgery

    African Journals Online (AJOL)

    bbshehu

    underwent major colonic restorative resection between July 1997 and September 199 in order to ... factors, the level of anastomosis and the experience of the surgeon are perhaps the ... indications for surgery and cancer stage were similar.

  14. Brain surgery

    Science.gov (United States)

    Craniotomy; Surgery - brain; Neurosurgery; Craniectomy; Stereotactic craniotomy; Stereotactic brain biopsy; Endoscopic craniotomy ... cut depends on where the problem in the brain is located. The surgeon creates a hole in ...

  15. Hemorrhoid surgery

    Science.gov (United States)

    ... and hemorrhoidectomy. In: Delaney CP, ed. Netter's Surgical Anatomy and Approaches . Philadelphia, PA: Elsevier Saunders; 2014:chap 26. Review Date 4/5/2015 Updated by: Debra G. Wechter, MD, FACS, general surgery practice specializing in breast cancer, Virginia Mason ...

  16. GENERAL SURGERY

    African Journals Online (AJOL)

    The traditional operative approach is an open surgical one to drain the cysts and ... early outcomes of laparoscopic treatment of liver hydatid cysts at our institution. .... O. Radical vs. conservative surgery for hydatid liver cysts: Experience from ...

  17. Outpatient Surgery

    Science.gov (United States)

    ... thirds of all operations are performed in outpatient facilities, according to the Centers for Disease Control and Prevention. Outpatient surgery provides patients with the convenience of recovering at home, and can cost less. ...

  18. Laparoscopic Surgery

    Science.gov (United States)

    ... surgeon’s perspective, laparoscopic surgery may allow for easier dissection of abdominal scar tissue (adhesions), less surgical trauma, ... on Facebook About ACG ACG Store ACG Patient Education & Resource Center Home GI Health and Disease Recursos ...

  19. Emergency surgery

    DEFF Research Database (Denmark)

    Stoneham, M; Murray, D; Foss, N

    2014-01-01

    National reports recommended that peri-operative care should be improved for elderly patients undergoing emergency surgery. Postoperative mortality and morbidity rates remain high, and indicate that emergency ruptured aneurysm repair, laparotomy and hip fracture fixation are high-risk procedures...... undertaken on elderly patients with limited physiological reserve. National audits have reported variations in care quality, data that are increasingly being used to drive quality improvement through professional guidance. Given that the number of elderly patients presenting for emergency surgery is likely...

  20. [Robotic surgery].

    Science.gov (United States)

    Moreno-Portillo, Mucio; Valenzuela-Salazar, Carlos; Quiroz-Guadarrama, César David; Pachecho-Gahbler, Carlos; Rojano-Rodríguez, Martín

    2014-12-01

    Medicine has experienced greater scientific and technological advances in the last 50 years than in the rest of human history. The article describes relevant events, revises concepts and advantages and clinical applications, summarizes published clinical results, and presents some personal reflections without giving dogmatic conclusions about robotic surgery. The Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) defines robotic surgery as a surgical procedure using technology to aid the interaction between surgeon and patient. The objective of the surgical robot is to correct human deficiencies and improve surgical skills. The capacity of repeating tasks with precision and reproducibility has been the base of the robot´s success. Robotic technology offers objective and measurable advantages: - Improving maneuverability and physical capacity during surgery. - Correcting bad postural habits and tremor. - Allowing depth perception (3D images). - Magnifying strength and movement limits. - Offering a platform for sensors, cameras, and instruments. Endoscopic surgery transformed conceptually the way of practicing surgery. Nevertheless in the last decade, robotic assisted surgery has become the next paradigm of our era.

  1. [Aesthetic surgery].

    Science.gov (United States)

    Bruck, Johannes C

    2006-01-01

    The WHO describes health as physical, mental and social well being. Ever since the establishment of plastic surgery aesthetic surgery has been an integral part of this medical specialty. It aims at reconstructing subjective well-being by employing plastic surgical procedures as described in the educational code and regulations for specialists of plastic surgery. This code confirms that plastic surgery comprises cosmetic procedures for the entire body that have to be applied in respect of psychological exploration and selection criteria. A wide variety of opinions resulting from very different motivations shows how difficult it is to differentiate aesthetic surgery as a therapeutic procedure from beauty surgery as a primarily economic service. Jurisdiction, guidelines for professional conduct and ethical codes have tried to solve this question. Regardless of the intention and ability of the health insurances, it has currently been established that the moral and legal evaluation of advertisements for medical procedures depends on their purpose: advertising with the intent of luring patients into cosmetic procedures that do not aim to reconstruct a subjective physical disorder does not comply with a medical indication. If, however, the initiative originates with the patient requesting the amelioration of a subjective disorder of his body, a medical indication can be assumed.

  2. Treatment of brain metastases of renal cell cancer with combined hypofractionated stereotactic radiotherapy and whole brain radiotherapy with hippocampal sparing.

    Science.gov (United States)

    Vrána, David; Študentová, Hana; Matzenauer, Marcel; Vlachová, Zuzana; Cwiertka, Karel; Gremlica, David; Kalita, Ondřej

    2016-06-01

    Renal cell cancer patients with brain metastatic disease generally have poor prognosis. Treatment options include surgery, radiotherapy, targeted therapy or best supportive care with respect to disease burden, patient preference and performance status. In the present case report the radiotherapy technique combining whole brain radiotherapy with hippocampal sparing (hippocampal avoidance whole brain radiotherapy HA-WBRT) and hypofractionated stereotactic radiotherapy (SRT) of the brain metastases is performed in a patient with metastatic renal cell carcinoma. HA-WBRT was administered to 30 Gy in 10 fractions with sparing of the hippocampal structures and SRT of 21 Gy in 3 fractions to brain metastases which has preceded the HA-WBRT. Two single arc volumetric modulated arc radiotherapy (VMAT) plans were prepared using Monaco planning software. The HA-WBRT treatment plan achieved the following results: D2=33.91 Gy, D98=25.20 Gy, D100=14.18 Gy, D50=31.26 Gy. The homogeneity index was calculated as a deduction of the minimum dose in 2% and 98% of the planning target volume (PTV), divided by the minimum dose in 50% of the PTV. The maximum dose to the hippocampus was 17.50 Gy and mean dose was 11.59 Gy. The following doses to organs at risk (OAR) were achieved: Right opticus Dmax, 31.96 Gy; left opticus Dmax, 30.96 Gy; chiasma D max, 32,76 Gy. The volume of PTV for stereotactic radiotherapy was 3,736 cm3, with coverage D100=20.95 Gy and with only 0.11% of the PTV being irradiated to dose below the prescribed dose. HA-WBRT with SRT represents a feasible technique for radiotherapy of brain metastatic disease, however this technique is considerably demanding on departmental equipment and staff time/experience.

  3. 电子支气管镜下冷冻治疗支气管结核102例分析%Bronchial Tuberculosis by Cryotherapy under Electronic Bronchoscope:Analysis of 102 Cases

    Institute of Scientific and Technical Information of China (English)

    刘福升; 徐建华; 蔡秀敏; 曹艳红

    2014-01-01

    目的:探讨电子支气管镜下冷冻治疗支气管结核的疗效。方法2010年2月~2013年7月,对102例支气管结核在常规抗结核化疗基础上,在支气管镜介入下冷冻治疗2~6次,每次间隔2~3周。冷冻术后,用抗结核药物雾化吸入治疗。结果90例溃疡坏死型及肉芽增殖型治疗后,支气管黏膜光滑、管腔通畅;7例支气管腔内遗留少量瘢痕组织,轻度管腔狭窄,不影响通气功能;5例瘢痕型经多次冷冻治疗后,支气管腔狭窄程度无明显改变。治愈率88.2%(90/102),改善率6.8%(7/102),总有效率95.1%(97/102)。结论电子支气管镜下冷冻治疗支气管结核,创伤小,无明显并发症,安全有效。%Objective To observe the cryotherapy ’ s efficacy for bronchial tuberculosis under electronic bronchoscope. Methods A total of 102 cases of bronchial tuberculosis received cryotherapy under bronchoscope on the basis of conventional antituberculosis chemotherapy, ranging from 2 -6 times per case with an interval of 2 -3 weeks.After frozen surgery, inhalation therapy with anti-TB drugs was used. Results For 90 cases with necrotizing ulceration and granulation proliferative lesions, patients’ bronchial mucosa appeared smooth and the lumen became unimpeded.A small amount of scar tissue with mild stenosis was found in 7 patients’ bronchial lumen, but the ventilatory function was unaffected.Five cases of scar-type patients’ bronchial stenosis showed no significant change after repeated cryotherapy.Totally 88.2%(90/102) of the 102 cases were cured, 6.8%(7/102) improved, and the total efficiency was 95.1%(97/102). Conclusion Cryotherapy under electronic bronchoscope for bronchial tuberculosis is a safe and effective method without significant complications.

  4. A comparison of the disconnection technique with continuous bronchial suction for lung deflation when using the Arndt endobronchial blocker during video-assisted thoracoscopy: A randomised trial.

    Science.gov (United States)

    El-Tahan, Mohamed R

    2015-06-01

    The use of the Arndt endobronchial blocker has not gained widespread acceptance during video-assisted thoracoscopic surgery (VATS) because of its high cost and longer time to operative lung collapse especially in patients with chronic obstructive pulmonary disease (COPD). The use of a ventilator disconnection technique has been shown to produce a comparable degree of lung collapse when used with either a double-lumen tube or an Arndt endobronchial blocker. We hypothesised that the use of bronchial suction through the suction port of the endobronchial blocker would be associated with a comparable time to achieve optimum lung collapse as the disconnection technique. A randomised, double-blind study. Single university hospital. Fifty-eight patients with spontaneous pneumothorax scheduled for elective VATS using the Arndt endobronchial blocker for one-lung ventilation (OLV). Patients were randomly assigned to one of two groups (n = 29 per group) to deflate the operative lung with either disconnection of the endotracheal tube from the ventilator for 60 s prior to inflation of the endobronchial blocker or connection of a suction pressure of -30 cmH2O to the suction port of the endobronchial blocker through the barrel of a 1 ml syringe. The primary outcome was the time to total lung collapse. Secondary outcomes included surgeon rating of lung collapse, overall surgeon satisfaction, need for further fibreoptic bronchial suction manoeuvres and intraoperative hypoxaemia. The bronchial suction technique was associated with a significantly shorter time to total lung collapse than the disconnection method [93 (95% confidence interval, 95% CI 81.3 to 103.7) vs. 197 (95% CI 157.4 to 237) s respectively; P suction groups had a comparable surgical rating of excellent lung collapse 40 min after the start of OLV (65.5 vs. 79.3%, respectively; P = 0.24), overall surgeon satisfaction [median (interquartile range, IQR) 9 (8 to 10) vs. 9 (8 to 10) respectively; P = 0.90] and

  5. Computer system design description for the spare pump mini-dacs data acquisition and control system

    Energy Technology Data Exchange (ETDEWEB)

    Vargo, G.F. Jr.

    1994-09-29

    The attached document outlines the computer software design for the mini data acquisition and control system (DACS), that supports the testing of the spare pump for Tank 241-SY-101, at the maintenance and storage facility (MASF).

  6. Self-Restoration Properties of VWP Networks by Spare Wavelength Optimization

    Institute of Scientific and Technical Information of China (English)

    Yu; Sasaki; Kiyoshi; Nakagawa; Katsumi; Takano; Kazuhiro; Kondo

    2003-01-01

    The self-restoration properties in VWP networks are investigated with optimization about spare wavelength by simulations. Rapid restoration can be achieved by selection of rerouting path with long delay and no delay-limitation for new routes.

  7. Revisiting the spread of sparing in the attentional blink.

    Science.gov (United States)

    Chen, Xi; Zhou, Xiaolin

    2015-07-01

    The attentional blink (AB) refers to a deficit in reporting the second of two targets (T2) in a rapid serial visual presentation (RSVP) stream when this target is presented less than 500 ms after the onset of the first target (T1). It is under debate whether the AB originates from a limitation of cognitive resources or from an attentional suppression process triggered by a distractor or by target discontinuity. In this study, we placed a distractor (D(inter)) or an extra target (T(inter)) between T1 and T2 while at the same time manipulating the time interval between D(inter) (or T(inter)) and T2 (0, 200, or 500 ms). The level of attentional enhancement induced by the detection of T1 was also manipulated by adding external noise to T1. The results showed that, as compared to the dual-target condition, T2 performance was better in the consecutive-target condition, when T2 was close in time to T(inter) (i.e., the spread of sparing), but was worse with a longer interval between T2 and the preceding item. Adding external noise to T1 improved T2 performance when T2 was close in time to the preceding item, irrespective of whether this item was D(inter) or T(inter). These findings present difficulties for the existing models of the AB, although the overall pattern observed is generally more consistent with the episodic simultaneous-type, serial-token (eSTST) model than with conventional resource accounts or distractor-based attentional selection accounts of the AB.

  8. Hippocampal-sparing whole-brain radiotherapy using Elekta equipment.

    Science.gov (United States)

    Nevelsky, Alexander; Ieumwananonthachai, Nantakan; Kaidar-Person, Orit; Bar-Deroma, Raquel; Nasrallah, Haitam; Ben-Yosef, Rahamim; Kuten, Abraham

    2013-05-06

    The purpose of this study was to evaluate the feasibility of hippocampal-sparing whole-brain radiotherapy (HS WBRT) using the Elekta Infinity linear accelerator and Monaco treatment planning system (TPS). Ten treatment plans were created for HS-WBRT to a dose of 30 Gy (10 fractions). RTOG 0933 recommendations were applied for treatment planning. Intensity-modulated radiotherapy (IMRT) plans for the Elekta Infinity linear accelerator were created using Monaco 3.1 TPS-based on a nine-field arrangement and step-and-shoot delivery method. Plan evaluation was performed using D2% and D98% for the whole-brain PTV (defined as whole brain excluding hippocampus avoidance region), D100% and maximum dose to the hippocampus, and maximum dose to optic nerves and chiasm. Homogeneity index (HI) defined as (D2%-D98%)/Dmedian was used to quantify dose homogeneity in the PTV. The whole-brain PTV D2% mean value was 37.28 Gy (range 36.95-37.49Gy), and D98% mean value was 25.37 Gy (range 25.40-25.89 Gy). The hippocampus D100% mean value was 8.37 Gy (range 7.48-8.97 Gy) and the hippocampus maximum dose mean value was 14.35 Gy (range 13.48-15.40 Gy). The maximum dose to optic nerves and optic chiasm for all patients did not exceed 37.50 Gy. HI mean value was 0.36 (range 0.34-0.37). Mean number of segments was 105 (range 88-122) and mean number of monitor units was 1724 (range 1622-1914). Gamma evaluation showed that all plans passed 3%, 3 mm criteria with more than 99% of the measured points. These results indicate that Elekta equipment (Elekta Infinity linac and Monaco TPS) can be used for HS WBRT planning according to compliance criteria defined by the RTOG 0933 protocol.

  9. Cognitive Spare Capacity: Evaluation data and its association with comprehension of dynamic conversations

    Directory of Open Access Journals (Sweden)

    Gitte eKeidser

    2015-05-01

    Full Text Available It is well established that communication involves the working memory system, which becomes increasingly engaged in understanding speech as the input signal degrades. The more resources allocated to recovering a degraded input signal, the fewer resources, referred to as cognitive spare capacity, remain for higher-level processing of speech. Using simulated natural listening environments, the aims of this paper were to (1 evaluate an English version of a recently introduced auditory test to measure cognitive spare capacity that targets the updating process of the executive function, (2 investigate if the test predicts speech comprehension better than the reading span test commonly used to measure working memory capacity, and (3 determine if the test is sensitive to increasing the number of attended locations during listening. In experiment I, the cognitive spare capacity test was presented using a male and a female talker, in quiet and in spatially separated babble- and cafeteria-noises, in an audio-only and in an audio-visual mode. Data collected on 21 listeners with normal and impaired hearing confirmed that the English version of the cognitive spare capacity test is sensitive to population group, noise condition, and clarity of speech, but not presentation modality. In experiment II, performance by 27 normal-hearing listeners on a novel speech comprehension test presented in noise was significantly associated with working memory capacity, but not with cognitive spare capacity. Moreover, this group showed no significant difference in cognitive spare capacity as the number of talker locations in the test increased. There was no consistent association between the cognitive spare capacity test and the reading span test. It is recommended that future studies investigate the psychometric properties of the cognitive spare capacity test, and examine its sensitivity to the complexity of the listening environment in participants with both normal and

  10. Army Contracting Officials Could Have Purchased Husky Mounted Detection System Spare Parts at Lower Prices (Redacted)

    Science.gov (United States)

    2016-03-31

    1500 March 31, 2016 MEMORANDUM FOR AUDITOR GENERAL , DEPARTMENT OF THE ARMY SUBJECT: Army Contracting Officials Could Have Purchased Husky Mounted... Report No. DODIG-2015-153, “Defense Logistics Agency Aviation Generally Purchased Sole-Source Spare Parts From the General Electric Company at Fair...DoD Office of Inspector General Spare-Parts Pricing Audits: Additional Guidance is Needed,” March 31, 2015 Report No. DODIG-2015-053, “Naval Supply

  11. Anterior urethra sparing cystoprostatectomy for bladder cancer: a 10-year, single center experience

    OpenAIRE

    Hayakawa, Nozomi; Kikuno, Nobuyuki; Ishihara, Hiroki; Ryoji, Osamu; Tanabe, Kazunari

    2015-01-01

    Purpose Decision making regarding the urethra before and after radical cystectomy due to urothelial carcinoma has always been controversial. To determine whether anterior urethra sparing cystoprostatectomy for bladder cancer is an oncologically-safe procedure, we evaluated the long-term oncologic clinical outcome. Patients and methods A total of 51 male patients with cTa-4N0-2M0 bladder cancer were treated with anterior urethra sparing cystoprostatectomy and simultaneous urinary diversion bet...

  12. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... find out more. Dental and Soft Tissue Surgery Dental and Soft Tissue Surgery Oral and facial surgeons ... here to find out more. Dental Implant Surgery Dental Implant Surgery Dental implant surgery is, of course, ...

  13. Tennis elbow surgery

    Science.gov (United States)

    Lateral epicondylitis - surgery; Lateral tendinosis - surgery; Lateral tennis elbow - surgery ... Surgery to repair tennis elbow is usually an outpatient surgery. This means you will not stay in the hospital overnight. You will be given ...

  14. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...

  15. Mohs micrographic surgery

    Science.gov (United States)

    Skin cancer - Mohs surgery; Basal cell skin cancer - Mohs surgery; Squamous cell skin cancer - Mohs surgery ... Mohs surgery usually takes place in the doctor's office. The surgery is started early in the morning and is ...

  16. Corrective Jaw Surgery

    Science.gov (United States)

    ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...

  17. Linking the spare parts management with the total costs of ownership: An agenda for future research

    Directory of Open Access Journals (Sweden)

    Orlando Duran

    2016-12-01

    Full Text Available Purpose: This manuscript explores the link between Spare Parts Management and Total Costs of Ownership or Life Cycle Costs (LCC. Design/methodology/approach: First, this work enumerates the different managerial decisions instances in spare parts management that are present during the life cycle of a physical asset. Second, we analyse how those decision instances could affect the TCO of a physical asset (from the economic point of view. Finally, we propose a conceptual framework for incorporating the spare parts management into a TCO model. Findings: The recent literature lacks discussions on the integration of spare parts management with the Total Costs of Ownership (TCO. Based in an extensive literature revision we can declare that the computation of costs related to spare parts management has been neglected by TCO models. Originality/value: The contribution of this paper is twofold. First, a literature review and identification of a series of spare parts management decision instances and its relationship with TCOs is presented in this paper. Second, a conceptual framework is suggested for linking those decisions instances to a total cost of ownership perspective. Some research questions and future research challenges are presented at the end of this work.

  18. The Sparing Phenomenon. A case series of the inverse Koebner and related phenomena

    Directory of Open Access Journals (Sweden)

    Ajith P. Kannangara

    2013-01-01

    Full Text Available Introduction: The sparing of the involvement of a cutaneous disease in a site that has been previously subjected to a skin disease, congenital nevus or physical insult has been reported in literature by various names, including the inverse Koebner phenomenon.Objectives: To review cases that we have seen and to document the reported cases and unify them with a single term, the “Sparing phenomenon”. Materials and Methods: We report four new examples of this phenomenon and performed a PubMed literature search on related search terms and summarized the reported cases.Results: We report four new cases of this phenomenon. An additional 16 reported cases of the sparing phenomenon were identified. Herpes zoster was the most reported inflammatory disease site followed by; skin irradiation was the commonly documented physical insult. Drug reactions and psoriasis were the most common diseases that spare these sites. The time gap between first and second insult was highly variable.Conclusions: We proposed the term “Sparing phenomenon” to describe the skin disease sparing on an area which was previously subjected to skin disease or physical insult. By introducing this new term to the dermatology glossary, it would be easy to collect and analysis to understand the immuno-pathophsiology of this skin reaction described in various names.

  19. Protective effect of sodium cromoglycate on lipopolysaccharide-induced bronchial obstruction in asthmatics.

    Science.gov (United States)

    Michel, O; Ginanni, R; Sergysels, R

    1995-11-01

    Lipopolysaccharides (LPS, the major part of endotoxins) are bacterial proinflammatory substances which can induce in asthmatic patients after inhalation a bronchial obstruction with an increase in both histamine bronchial hyperresponsiveness and blood inflammatory markers. The aim of the present study was to evaluate whether an acute inhalation of sodium cromoglycate, an anti-inflammatory and membrane-stabilizating agent, can block the LPS-induced lung function response. Using a double-blind placebo-controlled crossover method, 7 asthmatic subjects were submitted, at 4 days' interval, to a bronchial challenge test with either solvent solution or LPS (20 micrograms) preceded by inhalation of sodium cromoglycate (10 mg) or placebo. Compared to the solvent reaction, LPS induced a significant bronchial obstruction [measured by both the forced expiratory volume in 1 s (FEV1) and the airway resistances] beginning at the 60th minute and lasting more than 300 min (p sodium cromoglycate significantly inhibited the LPS-induced bronchial obstruction. The total lung capacity did not change significantly after LPS inhalation. Thus, this study showed that in asthmatics the LPS-induced FEV1 response is blocked by acute treatment with sodium cromoglycate. Sodium cromoglycate could be an active treatment in asthmatics exposed to house dust containing endotoxin.

  20. HIV Infects Bronchial Epithelium and Suppresses Components of the Mucociliary Clearance Apparatus

    Science.gov (United States)

    Chinnapaiyan, S.; Parira, T.; Dutta, R.; Agudelo, M.; Morris, A.; Nair, M.; Unwalla, H. J.

    2017-01-01

    Recurrent lung infections and pneumonia are emerging as significant comorbidities in the HIV-infected population in the era of combination antiretroviral therapy (cART). HIV infection has been reported to suppress nasal mucociliary clearance (MCC). Since the primary components driving nasal MCC and bronchial MCC are identical, it is possible that bronchial MCC is affected as well. Effective MCC requires optimal ciliary beating which depends on the maintenance of the airway surface liquid (ASL), a function of cystic fibrosis transmembrane conductance regulator (CFTR) activity and the integrity of the signaling mechanism that regulates ciliary beating and fluid secretion. Impairment of either component of the MCC apparatus can compromise its efficacy and promote microbial colonization. We demonstrate that primary bronchial epithelium expresses HIV receptor CD4 and co-receptors CCR5 and CXCR4 and can be infected by both R5 and X4 tropic strains of HIV. We show that HIV Tat suppresses CFTR biogenesis and function in primary bronchial epithelial cells by a pathway involving TGF-β signaling. HIV infection also interferes with bronchial epithelial cell differentiation and suppresses ciliogenesis. These findings suggest that HIV infection suppresses tracheobronchial mucociliary clearance and this may predispose HIV-infected patients to recurrent lung infections, pneumonia and chronic bronchitis. PMID:28060951