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Sample records for center mskcc experience

  1. Treatment of Advanced or Recurrent Endometrial Carcinoma with Doxorubicin in Patients Progressing after Paclitaxel/Carboplatin: Memorial Sloan-Kettering Cancer Center (MSKCC) Experience from 1995-2009

    Science.gov (United States)

    Makker, Vicky; Hensley, Martee L.; Zhou, Qin; Iasonos, Alexia; Aghajanian, Carol. A.

    2013-01-01

    Objective Long-term survival for patients with advanced endometrial carcinoma is poor, and limited options exist for the management of recurrent disease. Our goal was to investigate the activity of doxorubicin in the second-line setting in patients who progressed after paclitaxel/carboplatin adjuvant treatment. Methods We conducted a retrospective analysis of patients with recurrent endometrial carcinoma who were treated at Memorial Sloan-Kettering Cancer Center from 1995-2009, and who received paclitaxel/carboplatin adjuvant chemotherapy followed by second-line doxorubicin therapy at time of recurrence. The median PFS and OS times following paclitaxel/carboplatin and following second-line doxorubicin therapy were estimated using the Kaplan-Meier method. Toxicity was assessed by the treating physician at each visit and graded using version 4.0 of Common Terminology Criteria for Adverse Events (CTCAE). Patient presentation, treatment, patterns of recurrence, and patient outcomes were summarized. Results Seventeen patients were included in study analyses. The median PFS from completion of paclitaxel/carboplatin was 8.0 months (95% CI: 4.5-13.6 months). At the time of recurrence, all 17 patients were treated with doxorubicin as second-line therapy. No patient achieved objective response of stable disease. The median PFS of this cohort following doxorubicin treatment was 2.1 months (95% CI: 0.95-2.7) months. Median OS was 5.8 months (95% CI: 1.0-15.0 months). There is only one patient still alive; her median follow-up time is 49.4 months. Predominant doxorubicin-related grade 2 toxicities included nausea/vomiting (18.8%), fatigue (18.8%), and neutropenia (12.5%). No grade 3 or 4 toxicities occurred. Conclusions Among patients with advanced endometrial carcinoma who had received adjuvant paclitaxel/carboplatin, treatment with doxorubicin at time of disease recurrence failed to achieve any objective responses and was associated with a very short (2 months) time to

  2. Contemporary management of penile cancer: greater than 15 year MSKCC experience.

    Science.gov (United States)

    Moses, Kelvin A; Winer, Andrew; Sfakianos, John P; Poon, Stephen A; Kent, Matthew; Bernstein, Melanie; Russo, Paul; Dalbagni, Guido

    2014-04-01

    Penile cancer is a rare malignancy, and few guidelines are available to define treatment paradigms. For greater understanding of the natural history of surgically treated penile cancer, we analyzed the experience at our institution. Using an institutional database, we identified 127 patients treated for squamous cell carcinoma of the penis from 1995-2011. Cancer-specific survival (CSS) was calculated using the Kaplan-Meier method. Survival data were compared using the log-rank test. The difference in risk of cancer-specific death by lymph node status and histological grade was determined by univariate Cox regression analysis. Five year CSS for pTis, pT1, pT2, and pT3/4 was 100%, 84% (95% CI 58%-95%), 54% (95% CI 33%-71%), and 54% (95% CI 25%-76%), respectively (p ≤ .005). Three year CSS for patients with N0, N+, and Nx disease was 90% (95% CI 47%-99%), 65% (95% CI 47%-79%), and 86% (95% CI 73%-93%), respectively (p = .03). The receipt of neoadjuvant chemotherapy did not change per 5 year period over the 16 years of our study. Median follow up was 2.8 years. Penile cancer patients with advanced disease had poor survival. Tumor stage and nodal status were significant predictors of CSS. Penis-sparing approaches may be considered for most patients; however, pathological stage and grade dictate the management and ultimate outcome. Further studies are necessary to clarify the benefits of chemotherapy in this disease.

  3. 美國著名癌症機構ASCO、ECOG和MSKCC簡介%Introduction for ASCO,ECOG,MSKCC in USA

    Institute of Scientific and Technical Information of China (English)

    吳懷申

    2004-01-01

    @@ 中國抗癌協會臨床腫瘤學協作中心(Chinese Societyof Clinical Oncology,CSCO)應美國臨床腫瘤學會(American Society of Clinical Oncology, ASCO)邀請,在吳孟超院士、孫燕院士和儲大同教授的共同率領下,CSCO高層代表團一行10人於2003年12月7日-14日專程赴美國,對ASCO、美國東部腫瘤協作組(Eastern Cooperative Oncologv Group,ECOG)和紐約斯隆-凱特林紀念癌症中心(Memorial Sloan-KetteringCancer Center,MSKCC)進行了友好訪問.

  4. Medico-economic impact of MSKCC non-sentinel node prediction nomogram for ER-positive HER2-negative breast cancers

    Science.gov (United States)

    Guillot, Eugénie; Feron, Jean-Guillaume; Fourchotte, Virginie; Alran, Séverine; Pierga, Jean-Yves; Cottu, Paul; Lerebours, Florence; Stevens, Denise; Vincent-Salomon, Anne; Sigal-Zafrani, Brigitte; Campana, François; Rouzier, Roman; Reyal, Fabien

    2017-01-01

    Background Avoiding axillary lymph node dissection (ALND) for invasive breast cancers with isolated tumor cells or micrometastatic sentinel node biopsy (SNB) could decrease morbidity with minimal clinical significance. Purpose The aim of this study is to simulate the medico-economic impact of the routine use of the MSKCC non-sentinel node (NSN) prediction nomogram for ER+ HER2- breast cancer patients. Methods We studied 1036 ER+ HER2- breast cancer patients with a metastatic SNB. All had a complementary ALND. For each patient, we calculated the probability of the NSN positivity using the MSKCC nomogram. After validation of this nomogram in the population, we described how the patients’ characteristics spread as the threshold value changed. Then, we performed an economic simulation study to estimate the total cost of caring for patients treated according to the MSKCC predictive nomogram results. Results A 0.3 threshold discriminate the type of sentinel node (SN) metastases: 98.8% of patients with pN0(i+) and 91.6% of patients with pN1(mic) had a MSKCC score under 0.3 (false negative rate = 6.4%). If we use the 0.3 threshold for economic simulation, 43% of ALND could be avoided, reducing the costs of caring by 1 051 980 EUROS among the 1036 patients. Conclusion We demonstrated the cost-effectiveness of using the MSKCC NSN prediction nomogram by avoiding ALND for the pN0(i+) or pN1(mic) ER+ HER2- breast cancer patients with a MSKCC score of less than or equal to 0.3. PMID:28241044

  5. Validation of the memorial Sloan-Kettering Cancer Center nomogram to predict disease-specific survival after R0 resection in a Chinese gastric cancer population.

    Directory of Open Access Journals (Sweden)

    Donglai Chen

    Full Text Available BACKGROUND: Prediction of disease-specific survival (DSS for individual patient with gastric cancer after R0 resection remains a clinical concern. Since the clinicopathologic characteristics of gastric cancer vary widely between China and western countries, this study is to evaluate a nomogram from Memorial Sloan-Kettering Cancer Center (MSKCC for predicting the probability of DSS in patients with gastric cancer from a Chinese cohort. METHODS: From 1998 to 2007, clinical data of 979 patients with gastric cancer who underwent R0 resection were retrospectively collected from Peking University Cancer Hospital & Institute and used for external validation. The performance of the MSKCC nomogram in our population was assessed using concordance index (C-index and calibration plot. RESULTS: The C-index for the MSKCC predictive nomogram was 0.74 in the Chinese cohort, compared with 0.69 for American Joint Committee on Cancer (AJCC staging system (P<0.0001. This suggests that the discriminating value of MSKCC nomogram is superior to AJCC staging system for prognostic prediction in the Chinese population. Calibration plots showed that the actual survival of Chinese patients corresponded closely to the MSKCC nonogram-predicted survival probabilities. Moreover, MSKCC nomogram predictions demonstrated the heterogeneity of survival in stage IIA/IIB/IIIA/IIIB disease of the Chinese patients. CONCLUSION: In this study, we externally validated MSKCC nomogram for predicting the probability of 5- and 9-year DSS after R0 resection for gastric cancer in a Chinese population. The MSKCC nomogram performed well with good discrimination and calibration. The MSKCC nomogram improved individualized predictions of survival, and may assist Chinese clinicians and patients in individual follow-up scheduling, and decision making with regard to various treatment options.

  6. The Deep Impact Network Experiment Operations Center

    Science.gov (United States)

    Torgerson, J. Leigh; Clare, Loren; Wang, Shin-Ywan

    2009-01-01

    Delay/Disruption Tolerant Networking (DTN) promises solutions in solving space communications challenges arising from disconnections as orbiters lose line-of-sight with landers, long propagation delays over interplanetary links, and other phenomena. DTN has been identified as the basis for the future NASA space communications network backbone, and international standardization is progressing through both the Consultative Committee for Space Data Systems (CCSDS) and the Internet Engineering Task Force (IETF). JPL has developed an implementation of the DTN architecture, called the Interplanetary Overlay Network (ION). ION is specifically implemented for space use, including design for use in a real-time operating system environment and high processing efficiency. In order to raise the Technology Readiness Level of ION, the first deep space flight demonstration of DTN is underway, using the Deep Impact (DI) spacecraft. Called the Deep Impact Network (DINET), operations are planned for Fall 2008. An essential component of the DINET project is the Experiment Operations Center (EOC), which will generate and receive the test communications traffic as well as "out-of-DTN band" command and control of the DTN experiment, store DTN flight test information in a database, provide display systems for monitoring DTN operations status and statistics (e.g., bundle throughput), and support query and analyses of the data collected. This paper describes the DINET EOC and its value in the DTN flight experiment and potential for further DTN testing.

  7. Pediatric renal transplantation: a single center experience

    Directory of Open Access Journals (Sweden)

    João Nascimento

    2015-12-01

    Full Text Available Introduction: End-stage renal disease in children is associated with numerous comorbidities and with age-specific mortality rates approximately 30 times higher than in healthy children. The first kidney transplantation in children was performed successfully in 1954. Surgical advances and new immunosuppressive medications have greatly improved patient’s and graft’s survival in the last years. Aim: Report Centro Hospitalar do Porto experience in pediatric renal transplantation in the last 30 years. Methods: Epidemiological and clinical data of all patients younger than 18 years, transplanted between January 1984 and August 2013, were collected from our database. In order to analyze the transplantation outcome in our center we compare graft survival between decades (1984-89 / 1990-99 / 2000-09 / 2010-13. We also compare graft survival between two age groups of patients (0-10 years ; 11-17 years at the time of surgery. Results: One hundred thirty-nine patients (58.3% male underwent 147 renal transplants (6.8% live donors. Congenital anomalies of the kidney and urinary tract (56.5% and glomerulonephritis (18.4% were the major causes of renal disease. Uncensored graft survivals rates at 5, 10, 15 and 20 years were 84.7%, 71.1%, 60.0% and 51.0%, while patient survivals were 97.9%, 95.9%, 94.7% and 94.7% respectively. Graft survival improved over time and the difference between the decades was statistically significant (p=0.004. Despite the better survival in the group of patients older than 11 years, graft’s survival difference between the two age groups was not statistically significant (p=0.697. Conclusion: The results of our hospital are comparable to other international centers. Significant improvement in survival was observed over the time. It seems that an accurate follow-up of our patients helps to minimize the negative impact of adolescence on graft survival rates.

  8. Single Center Experience With Hyperthermic Intraperitoneal Chemotherapy

    Science.gov (United States)

    Kim, Woo Ram; Hur, Hyuk; Min, Byung Soh; Baik, Seung Hyuk; Lee, Kang Young

    2017-01-01

    Purpose Cytoreductive surgery (CRS) and hyperthermic intraperitoneal chemotherapy (HIPEC) have been proposed for controlling peritoneal seeding metastasis in some kinds of cancers, including those of colorectal origin, but their safety and oncological benefits are subjects of debate. We present our early experience with those procedures. Methods Data were retrospectively collected from all patients with peritoneal carcinomatosis (PC) and pseudomyxoma peritonei (PMP) treated using CRS and HIPEC at Yonsei Cancer Center between July 2014 and July 2015. Short-term outcomes and risk factors for postoperative complications were analyzed. Results Twenty-three patients with PC (n = 18) and PMP (n = 5) underwent CRS and HIPEC. Median follow-up and age were 2 months and 54 years, respectively. The median peritoneal carcinomatosis index score was 15, and CC0-1 was achieved in 78.3% of all patients. The median operation time and bleeding loss were 590 minutes and 570 mL, respectively. Grade-IIIa/grade-IIIb complications occurred in 4.3% (n = 1)/26.1% (n = 6) of the patients within 30 days postoperatively, and no 30-day mortalities were reported. Factors related to postoperative complications with CRS and HIPEC were number of organ resection (P = 0.013), longer operation time (P patients treated with cetuximab for recurred colorectal cancer had grade-III postoperative complication. Conclusion Our initial experience with CRS and HIPEC presented about 30% grade-III postoperative complications. Therefore, expert surgeons need to perform those procedures with great caution in selected patients who might benefit from it.

  9. The Renewal Center Time, Experience, Memory

    OpenAIRE

    Tennant, Mark

    2005-01-01

    Time, Experience, Memory Through experience we are conscious of time. Through time, our experiences become memories, influencing both conscious and unconscious thought. It is through our five senses; touch, sight, hearing, smell and taste, that these experiences are gathered. Humans are also born with inherent knowledge that our species has collected from generation to generation. This inherent knowledge, also called the collective unconscious, has a direct effect on the way we perce...

  10. Experience-Centered Design Designers, Users, and Communities in Dialogue

    CERN Document Server

    Wright, Peter

    2010-01-01

    Experience-centered design, experience-based design, experience design, designing for experience, user experience design. All of these terms have emerged and gained acceptance in the Human-Computer Interaction (HCI) and Interaction Design relatively recently. In this book, we set out our understanding of experience-centered design as a humanistic approach to designing digital technologies and media that enhance lived experience. The book is divided into three sections. In Section 1, we outline the historical origins and basic concepts that led into and flow out from our understanding of experi

  11. Increasing Counseling Center Utilization: Yeshiva University's Experience

    Science.gov (United States)

    Schwartz, Victor; Nissel, Chaim; Eisenberg, Daniel; Kay, Jerald; Brown, Joshua T.

    2012-01-01

    Yeshiva University established a counseling center during the 2004-2005 academic year. As a religiously based institution, the administration recognized that there would likely be significant impediments to utilization of on-campus mental health services as a result of negative attitudes about mental illness and its treatment--stigma. To combat…

  12. Increasing Counseling Center Utilization: Yeshiva University's Experience

    Science.gov (United States)

    Schwartz, Victor; Nissel, Chaim; Eisenberg, Daniel; Kay, Jerald; Brown, Joshua T.

    2012-01-01

    Yeshiva University established a counseling center during the 2004-2005 academic year. As a religiously based institution, the administration recognized that there would likely be significant impediments to utilization of on-campus mental health services as a result of negative attitudes about mental illness and its treatment--stigma. To combat…

  13. Transplant nephrectomy - A single-center experience

    Directory of Open Access Journals (Sweden)

    Arun Ariyarathenam

    2015-01-01

    Full Text Available Transplant nephrectomy (TN is associated with significant morbidity and mortality and influences the outcome of subsequent renal transplantation. The aim of this study was to identify the reasons for TN in a single transplant center in the United Kingdom and to determine the complication rate, effect on relisting and re-transplantation. We studied all the TNs in our center from January 2000 to December 2011. Detailed information including cause of allograft failure and reason for TN were analyzed. Of 602 renal transplants performed at our center during the period of the study, 42 TNs were performed on 38 (6% patients (24 men and 14 women. The median age of the patients at the time of transplantation who subsequently underwent TN was 56 years (range: 28-73 years and 71% of the allografts were donated after circulatory death. The mean human leucocyte antigen mismatch for these patients was 2.3. The most commonly used immunosuppression was a combination of prednisolone, mycophenolate and tacrolimus, which was used in 50% of the patients. Twenty-five (60% of the TNs in this series were for allografts failing during the first month of transplantation. The most common indication for the TN was graft thrombosis (50%, with an overall in-hospital mortality rate of 9.5% and a morbidity rate of 31%. Seven of 19 patients listed underwent successful re-transplantation. Although TN is associated with a risk of significant morbidity and mortality, it does not preclude from listing for re-transplantation. The difficulty of access to complete information about transplant failures and TN highlights the need for a national registry.

  14. Pregnancy during Hemodialysis: A Single Center Experience

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    Bahadi Abdelali

    2010-01-01

    Full Text Available Successful pregnancy outcome is an uncommon occurrence in women requiring chronic dialysis treatment. We reviewed the course and outcome of 9 pregnancies occurred in women on chronic hemodialysis in our center from 1999-2007; 5 of them ended with delivery of alive newborns, 2 with fetal deaths in-utero, and 2 with abortions. The average age of patients was 34 years. The etiology of the original kidney disease was unknown in 44.4% of the cases, and only 22.2% of the patients maintained diuresis. Dialysis started in 8 cases before the diagnosis of pregnancy. The average gestational age at diagnosis was 14 weeks. We modified the prescription of dialysis in 4 patients by increasing the frequency of the dialysis sessions to 6 per week and in 3 by increasing the duration of each session to 6 hours. Anemia was present in all the cases; 3 patients received erythropoietin and 4 patients required transfusion. The pregnancy was com-plicated in 44% of the cases by a polyhydramnios. The average time at delivery was 33 weeks and it was achieved in 80% of pregnancies through vaginal route. The average weight of newborns was to 2380 g. We conclude that pregnancy in women on hemodialysis is possible. The success of pregnancy may be influenced by the residual diuresis and early diagnosis to improve the quality of dialysis by increasing the dialysis dose.

  15. Ambulatory laparoscopic cholecystectomy: A single center experience

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    Cagri Tiryaki

    2016-01-01

    Full Text Available Aim: To evaluate the demographic and clinical parameters affecting the outcomes of ambulatory laparoscopic cholecystectomy (ALC in terms of pain, nausea, anxiety level, and satisfaction of patients in a tertiary health center. Materials and Methods: ALC was offered to 60 patients who met the inclusion criteria. Follow-up (questioning for postoperative pain or discomfort, nausea or vomiting, overall satisfaction was done by telephone contact on the same day at 22:00 p.m. and the first day after surgery at 8: 00 a.m. and by clinical examination one week after operation. STAI I and II data were used for proceeding to the level of anxiety of patients before and/or after the operation. Results: Sixty consecutive patients, with a mean age of 40.6 ± 8.1 years underwent ALC. Fifty-five (92% patients could be sent to their homes on the same day but five patients could not be sent due to anxiety, pain, or social indications. Nausea was reported in four (6.7% cases and not associated with any demographic or clinical features of patients. On the other hand, pain has been reported in 28 (46.7% cases, and obesity and shorter duration of gallbladder disease were associated with the increased pain perception (P = 0.009 and 0.004, respectively. Preopereative anxiety level was significantly higher among patients who could not complete the ALC procedure (P = 0.018. Conclusion: Correct management of these possible adverse effects results in the increased satisfaction of patients and may encourage this more cost-effective and safe method of laparoscopic cholecystectomy.

  16. Prior Experiences Shaping Family Science Conversations at a Nature Center

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    McClain, Lucy R.; Zimmerman, Heather Toomey

    2014-01-01

    Using families as the analytical focus, this study informs the field of informal science education with a focus on the role of prior experiences in family science conversations during nature walks at an outdoor-based nature center. Through video-based research, the team analyzed 16 families during walks at a nature center. Each family's prior…

  17. Ultraviolet A1 phototherapy: One center's experience

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    Sasi Kiran Attili

    2017-01-01

    Full Text Available Background: Ultraviolet A1(UVA1 phototherapy is increasingly being used in the treatment of morphea, atopic dermatitis, lupus and some other recalcitrant dermatoses. We present a retrospective review of our experience with this modality. Aim: To evaluate the treatment response rates for various dermatoses and adverse effects of UVA1 phototherapy. Methods: We reviewed phototherapy notes along with electronic and/or paper case records for all patients treated with UVA1 phototherapy from October 1996 to December 2008. Results: A total of 269 patients (outcomes available for 247 had 361 treatment courses (treatment data available for 317 courses over this period. We found phototherapy to be beneficial in 28 (53% of 53 patients with atopic dermatitis and 19 (51% of 37 patients with morphea. A beneficial outcome was recorded in all six (100% cases of urticaria and six (85.7% of seven patients treated for a polymorphic light eruption. Benefit was also recorded in systemic lupus erythematosus (8 (44.4% of 18, lichen sclerosus (6 (42.9% of 14, mastocytosis (2 (33.3% of 6, necrobiosis lipoidica (4 (30.8% of 13, granuloma annulare (2 (25% of 8, scleroderma (2 (22.2% of 9 and keloids (1 (7.7% of 13. Overall, treatment was well tolerated with no patients having to stop treatment due to adverse effects. Limitations: This is a retrospective study with no control group. Subjective/recall bias is quite possible as a number of patients were followed up over the phone. Conclusions: Our data suggest that ultraviolet A1 can be considered for the treatment of selected dermatoses. However, long-term malignancy risk is as yet unknown.

  18. Johnson Space Center Flight Medicine Clinic Experience

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    Landry, Trela

    2006-01-01

    Being a member of the Flight Medicine Clinic (FMC) Staff is a great experience. I joined the FMC staff 2 years ago when I became part of the Kelsey-Seybold team. The FMC staff consists of Flight Surgeons, Family Clinic Physician, Nursing staff, Wellness Coordinator and Support staff. We serve as the Primary Care Physicians for the astronauts and their families and provide annual physicals for the retired astronauts. We have approximately 800 patients in the FMC. As the Family Clinic Physician, I care for the astronaut spouses and children and provide annual physicals for the retired astronauts. Since we have a small patient population, we have the opportunity to spend increased personal time with our patients, which I enjoy. We have a pretty healthy patient population, who are very interested in their overall health and preventive care. In preparation for a shuttle launch, our nursing staff assists the flight surgeons with the astronaut physical exams, which occur 10 days prior to launch and again 3 days after their return. We also provide Primary Contact physicals for the families and guests, who will be in close contact with shuttle crew members. During these physicals, we provide education, emphasizing the importance of preventing the spread of communicable diseases to shuttle crew members. Being a part of the Space Medicine Program is an honor. To know that you contribute in some way to our nation s Space Program is very special. (This article was prepared by Dr. Trela Landry, M.D. for inclusion in a Kelsey-Seybold newsletter on 25 OCT 2006.)

  19. WIDE Research Center as an Incubator for Graduate Student Experience

    Science.gov (United States)

    Turner, Heather Noel; Nguyen, Minh-Tam; Keller, Beth; Sackey, Donnie Johnson; Ridolfo, Jim; Pigg, Stacey; Lauren, Benjamin; Potts, Liza; Hart-Davidson, Bill; Grabill, Jeff

    2017-01-01

    This article describes graduate mentorship experiences at the Writing, Information, and Digital Experience (WIDE) research center at Michigan State University and offers a stance on graduate student mentorship. It describes WIDE's mentorship model as feminist and inclusive and as a means to invite researchers with different backgrounds to engage…

  20. AMS experiment takes off for Kennedy Space Center August 2010

    CERN Multimedia

    CERN Video Productions

    2010-01-01

    Geneva, 18 August 2010. The Alpha Magnetic Spectrometer (AMS), an experiment that will search for antimatter and dark matter in space, leaves CERN next Tuesday on the next leg of its journey to the International Space Station. The AMS detector is being transported from CERN to Geneva International Airport in preparation for its planned departure from Switzerland on 26 August, when it will be flown to the Kennedy Space Center in Florida on board a US Air Force Galaxy transport aircraft.

  1. Experience with Server Self Service Center (S3C)

    CERN Document Server

    Sucik, J; CERN. Geneva. IT Department

    2010-01-01

    CERN has a successful experience with running Server Self Service Center (S3C) for virtual server provisioning which is based on Microsoft® Virtual Server 2005. With the introduction of Windows Server 2008 and its built-in hypervisor based virtualization (Hyper-V) there are new possibilities for the expansion of the current service. This paper describes the architecture of the redesigned virtual Server Self Service based on Hyper-V which provides dynamically scalable virtualized resources on demand as needed and outlines the possible implications on the future use of virtual machines at CERN.

  2. Experience with Server Self Service Center (S3C)

    CERN Multimedia

    Sucik, J

    2009-01-01

    CERN has a successful experience with running Server Self Service Center (S3C) for virtual server provisioning which is based on Microsoft® Virtual Server 2005. With the introduction of Windows Server 2008 and its built-in hypervisor based virtualization (Hyper-V) there are new possibilities for the expansion of the current service. This paper describes the architecture of the redesigned virtual Server Self Service based on Hyper-V which provides dynamically scalable virtualized resources on demand as needed and outlines the possible implications on the future use of virtual machines at CERN.

  3. Joint Langley Research Center/Jet Propulsion Laboratory CSI experiment

    Science.gov (United States)

    Neat, Gregory W.; O'Brien, John F.; Lurie, Boris J.; Garnica, Angel; Belvin, W. K.; Sulla, Jeff; Won, John

    1992-01-01

    This paper describes a joint Control Structure Interaction (CSI) experiment in which Jet Propulsion Laboratory (JPL) damping devices were incorporated into the Langley Research Center (LaRC) Phase 0 Testbed. The goals of the effort were twofold: (1) test the effectiveness of the JPL structural damping methods in a new structure and (2) assess the feasibility of combining JPL local control methods with the LaRC multiple input multiple output global control methods. Six dampers (2 piezoelectric active members, 4 viscous dampers), placed in three different regions of the structure, produced up to 26 dB attenuation in target modes. The combined control strategy in which the JPL damping methods contributed local control action and the LaRC control scheme provided global control action, produced and overall control scheme with increased stability margins and improved performance. This paper presents an overview of the technologies contributed from the two centers, the strategies used to combine them, and results demonstrating the success of the damping and cooperative control efforts.

  4. CCSDS telemetry systems experience at the Goddard Space Flight Center

    Science.gov (United States)

    Carper, Richard D.; Stallings, William H., III

    1990-09-01

    NASA Goddard Space Flight Center (GSFC) designs, builds, manages, and operates science and applications spacecraft in near-earth orbit, and provides data capture, data processing, and flight control services for these spacecraft. In addition, GSFC has the responsibility of providing space-ground and ground-ground communications for near-earth orbiting spacecraft, including those of the manned spaceflight programs. The goal of reducing both the developmental and operating costs of the end-to-end information system has led the GSFC to support and participate in the standardization activities of the Consultative Committee for Space Data Systems (CCSDS), including those for packet telemetry. The environment in which such systems function is described, and the GSFC experience with CCSDS packet telemetry in the context of the Gamma-Ray Observatory project is discussed.

  5. SINGLE-CENTER EXPERIENCE OF ABO-INCOMPATIBLE LIVER TRANSPLANTATION

    Directory of Open Access Journals (Sweden)

    S. V. Gautier

    2011-01-01

    Full Text Available Since 2008 up to 2010 eight ABO-incompatible liver transplantations have been performed in our center: one of them was urgent liver transplantation to adult patient from deceased donor, other seven were transplantations of left lateral segment to children from living relative donors. Own experience, as well as world one, proves, that barrier of ABO-incompatibility can be overcome more successfully in liver transplantation, particularly in pediatric population, that in other solid organs transplantation. Good results can be achieved even with less ag- gressive immunosuppressive therapy. Recipient conditioning before operation can significantly improve results of ABO-incompatible liver transplantation, but as own experience has shown, often there’s no need to hold some special preparation of children, because their anti-ABO antibodies are very low or absent before transplantation and do not increase after it. Thereby ABO-incompatible liver transplantation is reasonable in urgent cases and in pediatric population because of the limited pull of living relative donors for children. 

  6. Mycophenolate mofetil in pediatric renal transplantation: A single center experience.

    LENUS (Irish Health Repository)

    Raheem, Omer A

    2011-05-01

    Raheem OA, Kamel MH, Daly PJ, Mohan P, Little DM, Awan A, Hickey DP. Mycophenolate mofetil in pediatric renal transplantation: A single center experience. Pediatr Transplantation 2011: 15:240-244. © 2009 John Wiley & Sons A\\/S. Abstract:  We assessed our long-term experience with regards to the safety and efficacy of MMF in our pediatric renal transplant population and compared it retrospectively to our previous non-MMF immunosuppressive regimen. Forty-seven pediatric renal transplants received MMF as part of their immunosuppressive protocol in the period from January 1997 till October 2006 (MMF group). A previously reported non-MMF group of 59 pediatric renal transplants was included for comparative analysis (non-MMF group). The MMF group comprised 29 boys and 18 girls, whereas the non-MMF group comprised 34 boys and 25 girls. Mean age was 11.7 and 12 yr in the MMF and non-MMF groups, respectively. The incidence of acute rejection episodes was 11 (23.4%) and 14 (24%) in the MMF and non-MMF group, respectively. Two (3.3%) grafts were lost in the non-MMF group compared with one (2.1%) in the MMF group. Twenty-one (44.68%) patients in the MMF group developed post-transplant infections compared with 12 (20.33%) in the non-MMF group (p < 0.0001). In conclusion, the use of MMF in pediatric renal transplantation was not associated with a lower rejection rate or immunological graft loss. It did, however, result in a significantly higher rate of viral infections.

  7. Establishing an Adult Epilepsy Diet Center: Experience, efficacy and challenges.

    Science.gov (United States)

    Cervenka, Mackenzie C; Henry, Bobbie J; Felton, Elizabeth A; Patton, Katlyn; Kossoff, Eric H

    2016-05-01

    Over 250 medical centers worldwide offer ketogenic diets to children with epilepsy; however, access to these therapies has been extremely limited for adults until recent years. We examine our 5-year experience creating and implementing a dedicated Adult Epilepsy Diet Center designed to provide adults with epilepsy access to ketogenic diets. Outpatients seen at the Johns Hopkins Adult Epilepsy Diet Center from August 2010 thru September 2015 age 18years and older were enrolled in a prospective open-label observational study. Patients that also enrolled in ongoing clinical diet trials were excluded from this study. Participant demographics, diet type, urine and/or serum ketones, laboratory studies, seizure frequency, diet duration, reason for discontinuing diet therapy, and side effects were recorded. A subgroup analysis of participants that met International League Against Epilepsy (ILAE) criteria for drug-resistant epilepsy (DRE) and were treated de novo with a Modified Atkins Diet (MAD) was performed to compare outcomes with the current literature regarding efficacy of other antiseizure treatments for DRE. Two hundred and twenty-nine adults attended the Adult Epilepsy Diet Center, and 168 met inclusion criteria. Two-thirds (n=113, 67%) were women with an age range of 18-86years at the initial visit. Thirty-five participants (21%, n=133) were already on a therapeutic diet while 79% (n=133) were naïve to diet therapy at the time of the initial visit. Diet-naïve participants were typically prescribed MAD (n=130, 98%), unless unable to intake adequate oral nutrition, in which case they were prescribed KD (n=1) or a combination of oral MAD and ketogenic formula (n=2). Twenty-nine of 130 (22%) participants prescribed MAD elected not to start or were lost to follow-up, and 101 (78%) began MAD. A subgroup analysis was performed on one hundred and six participants naïve to diet therapy that met International League Against Epilepsy criteria for DRE, were able to

  8. [Minimally Invasive Surgery in Pediatric Oncology. Tertiary center experience].

    Science.gov (United States)

    Gómez-Chacón Villalba, J; Rodríguez Caraballo, L; Marco Macián, A; Segarra Llido, V; Vila Carbó, J J

    2015-07-20

    To describe our experience using Minimally Invasive Surgery (MIS) techniques in tertiary center with specific oncological pediatric surgery unit. Retrospective review of patients undergoing MIS techniques in pediatric oncology surgery unit between January 2011 and December 2014. MIS procedures were considered made by both techniques such as laparoscopy and thoracoscopy with both diagnostic and therapeutic intent. 4 procedures were diagnostic and the rest were therapeutic: During the study, 56 procedures were performed by MIS. By type of technique, 13 were thoracoscopic (7 metastasectomies, 6 thoracic masses) and 43 laparoscopic (3 hepatic masses, 3 pancreatic masses 7 abdominal masses, 2 ovarian masses, 2 typhlitis 1 splenic mass and 25 oophorectomy for ovarian cryopreservation). In 5 cases (2 thoracic masses 1 pancreatic mass abdominal masses) conversion to open surgery to complete the procedure (2 for caution in the absence of vascular control bleeding 1 and 2 for lack of space) was necessary. In all cases safety principles of oncological surgery were respected. Providing an adecuate selection of patiens, MIS techniques are safe, reproducible and fulfill the objectives of quality of cancer surgery.

  9. LIVER TRANSPLANTATION. A SINGLE CENTER EXPERIENCE OF 100 CASES

    Directory of Open Access Journals (Sweden)

    A. M. Granov

    2012-01-01

    Full Text Available A single center experience of first 100 liver transplantations (LTs is summarized. Analysis of trends in cadaver donor population and waiting list status changes, and also of early and late postoperative complications are presented. 100 LTs were performed for 95 patients (pts, retransplantation – 4 pts; one patient received 3 liver transplants (female – 55 pts, male – 40 pts, mean age – 39.9 ± 12.1 years. Cumulative 1-year survival rate of pts by Kaplan–Meyer was 91%, 3-year – 83%. Biliary complications were revealed in 9% of pts during 2–9 months after LT. 77 pts have been regularly observed in outpatient clinic, mean age – 44 ± 9.2 years, male – 35, fema- le – 42, follow-up period – 1 months up to 13 years after LT. 3.9% remained invalid with limitation of ability to work, 61.8% have been working, 22.3% were capable to work, retirees were 10.5%. Development of preoperati- ve planning, adequate organ selection will allow to improve the results of LT. Study of hematopoietic stem cells role will expand tools of prognosis of posttransplant complications. 

  10. Penile lichen sclerosus: An urologist's nightmare! - A single center experience

    Science.gov (United States)

    Singh, Jitendra Pratap; Priyadarshi, Vinod; Goel, Hemant Kumar; Vijay, Mukesh Kumar; Pal, Dilip Kumar; Chakraborty, Sudip; Kundu, Anup Kumar

    2015-01-01

    Purpose: Penile lichen sclerosus (LS) is a nagging condition and its progression result in devastating urinary and sexual problems and reduction in the quality-of-life. This study has been carried out to present our experience about this disease with simultaneous review of the available literature. Materials and Methods: This retrospective study has been done at a tertiary care center of eastern India. The data of 306 patients affected with LS were analyzed for clinical presentation, physical examination, investigations, and treatment offered. Results: Presenting symptoms were non-specific. The prepuce was most commonly involved location followed by glans and meatus. Urethral involvement was not isolated as the primary site. Circumcision was done in 237 patients, while 63 patients underwent meatotomy. Thirty-six of 39 cases of LS induced stricture were treated with buccal mucosal graft (BMG) either in one stage or in two stages. Conclusion: LS varies from being a highly aggressive disease of the penis and anterior urethra to a burnt out condition affecting just the meatus and surrounding glans. Early diagnosis and treatment are required to prevent its complication and associated morbidity. Management depends on the anatomical location of lesion, extent of involvement, rapidity of progression and its severity. Use of BMG in LS induced urethral stricture has shown encouraging results. PMID:26229314

  11. Sports hernias: experience in a sports medicine center.

    Science.gov (United States)

    Santilli, O L; Nardelli, N; Santilli, H A; Tripoloni, D E

    2016-02-01

    Chronic pain of the inguino-crural region or "pubalgia" explains the 0.5-6.2% of the consultations by athletes. Recently, areas of weakness in the posterior wall called "sports hernias," have been identified in some of these patients, capable of producing long-standing pain. Several authors use different image methods (CT, MRI, ultrasound) to identify the lesion and various techniques of repair, by open or laparoscopic approaches, have been proposed but there is no evidence about the superiority of one over others due to the difficulty for randomizing these patients. In our experience, diagnosis was based on clinical and ultrasound findings followed by laparoscopic exploration to confirm and repair the injury. The present study aims to assess the performance of our diagnostic and therapeutic management in a series of athletes affected by "pubalgia". 1450 athletes coming from the orthopedic office of a sport medicine center were evaluated. In 590 of them (414 amateur and 176 professionals) sports hernias were diagnosed through physical examination and ultrasound. We performed laparoscopic "TAPP" repair and, thirty days after, an assessment was performed to determine the evolution of pain and the degree of physical activity as a sign of the functional outcome. We used the U Mann-Whitney test for continuous scale variables and the chi-square test for dichotomous variables with p hernias. We found 84 "sport hernias" in 769 patients with previous diagnosis of adductor muscle strain (10.92%); on the other hand, in 127 (21.52%) of our patients with "sport hernias" US detected concomitant injuries of the adductor longus tendon, 7 of which merited additional surgical maneuvers (partial tenotomy). Compared with the findings of laparoscopy, ultrasound had a sensitivity of 95.42% and a specificity of 100%; the positive and negative predictive values were 100 and 99.4% respectively. No postoperative complications were reported. Only seven patients suffered recurrence of pain

  12. An Exploration of Hispanic Mothers' Culturally Sustaining Experiences at an Informal Science Center

    Science.gov (United States)

    Weiland, Ingrid

    2015-01-01

    Science education reform focuses on learner-centered instruction within contexts that support learners' sociocultural experiences. The purpose of this study was to explore Hispanic mothers' experiences as accompanying adults at an informal science center within the context of culturally sustaining experiences, which include the fluidity…

  13. Encapsulating peritoneal sclerosis: experience of a tertiary referral center.

    LENUS (Irish Health Repository)

    Phelan, P J

    2010-05-01

    Encapsulating peritoneal sclerosis (EPS) is arguably the most serious complication of chronic peritoneal dialysis (PD) therapy with extremely high mortality rates. We aimed to establish the rates of EPS and factors associated with its development in a single center.

  14. Vocabulary and Experiences to Develop a Center of Mass Model

    Science.gov (United States)

    Kaar, Taylor; Pollack, Linda B.; Lerner, Michael E.; Engels, Robert J.

    2017-10-01

    The use of systems in many introductory courses is limited and often implicit. Modeling two or more objects as a system and tracking the center of mass of that system is usually not included. Thinking in terms of the center of mass facilitates problem solving while exposing the importance of using conservation laws. We present below three laboratory activities that build this systems thinking for introductory physics students.

  15. User-Centered Design in Practice: The Brown University Experience

    Science.gov (United States)

    Bordac, Sarah; Rainwater, Jean

    2008-01-01

    This article presents a case study in user-centered design that explores the needs and preferences of undergraduate users. An analysis of LibQual+ and other user surveys, interviews with public service staff, and a formal American with Disabilities Act accessibility review served as the basis for planning a redesign of the Brown University…

  16. Spin-torch experiment on reaction centers of Rhodobacter sphaeroides

    NARCIS (Netherlands)

    Sai Sankar Gupta, Karthick Babu

    2011-01-01

    Photosynthesis is the physico-chemical process by which plants, algae and photosynthetic bacteria use light energy to drive the synthesis of organic compounds. Light-induced electron transfer in photosynthetic reaction centers (RCs) is highly efficient, having a quantum yield close to unity. In RCs

  17. Early experiences with big data at an academic medical center.

    Science.gov (United States)

    Halamka, John D

    2014-07-01

    Beth Israel Deaconess Medical Center (BIDMC), an academic health care institution affiliated with Harvard University, has been an early adopter of electronic applications since the 1970s. Various departments of the medical center and the physician practice groups affiliated with it have implemented electronic health records, filmless imaging, and networked medical devices to such an extent that data storage at BIDMC now amounts to three petabytes and continues to grow at a rate of 25 percent a year. Initially, the greatest technical challenge was the cost and complexity of data storage. However, today the major focus is on transforming raw data into information, knowledge, and wisdom. This article discusses the data growth, increasing importance of analytics, and changing user requirements that have shaped the management of big data at BIDMC.

  18. Clinical spectrum of hypopituitarism in India: A single center experience

    Directory of Open Access Journals (Sweden)

    Abhay Gundgurthi

    2012-01-01

    Full Text Available Objectives: There is paucity of information regarding clinical profile of hypopituitarism from India. We report the clinical profile of hypopituitarism from a tertiary center in North India. Materials and Methods: This study was carried out in patients attending our endocrine center between January 2010 and December 2011. All new patients were studied prospectively and those registered before January 2010 retrospectively. Relevant clinical, hormonal, and imaging data were collected. Dynamic testing for pituitary functions was carried out as necessary. Hormonal deficiencies were defined as per prevailing recommendations. Results: This study included 113 subjects. The mean age was 38.6 ± 17.8 years (range, 4 - 76 years. There were 78 (69% males and 35 females (31%. There were 22 subjects aged ≤18 years (childhood and adolescence and 91 adults (>18 years. Visual disturbances were the most common presenting complaint (33%, though headache was the most common symptom (81%. Fifteen percent presented with pituitary apoplexy. Tumors comprised of 84% of cases. Hypogonadism (97% was the most common abnormality seen followed by hypothyroidism (83.2%, hypoadrenalism (79.6%, growth hormone deficiency (88.1% of the 42 patients tested, and diabetes insipidus (13.3%. Panhypopituitarism was seen in 104 (92% patients. There were no cases of hypopituitarism secondary to traumatic brain injury, subarachnoid hemorrhage, central nervous system infections, or cranial irradiation to extrasellar tumors. Conclusion: The most common cause of hypopituitarism at tertiary care center is pituitary tumors and the commonest presenting complaint is visual symptoms. Panhypopituitarism is present in 92% cases.

  19. Tennessee Valley Authority validation experience with substation reliability centered maintenance

    Energy Technology Data Exchange (ETDEWEB)

    Bolton, S.M.; Graziano, J.A. [Tennessee Valley Authority, Chattanooga, TN (United States)

    1996-08-01

    This paper discusses the approach the Tennessee Valley Authority (TVA) used in the application of the Reliability Centered Maintenance (RCM) process during the evaluation of a Delle air blast circuit breaker. It discusses the selection of a system, establishing system boundaries, and the problems encountered in reviewing test data and personnel interviews. This paper also shows the functional failure analysis process, critical failure mode causes and resulting tasks. From the failure mode causes a task comparison is developed. The results from the RCM evaluation are shown as a cost savings. Finally, from this evaluation a list of conclusions and recommendations concerning the RCM validation process is provided.

  20. Location-based solutions in the experience center

    DEFF Research Database (Denmark)

    Witzner Hansen, Dan; Alapetite, Alexandre; Holdgaard, Nanna

    2009-01-01

    In this paper we present a prototype system for location-based guiding. A user survey has been conducted and the observations are used to support design choices. The prototype allows for both indoor and outdoor navigation at and in the vicinity of the NaturBornholm [1] experience centre in Denmark...

  1. Docker experience at INFN-Pisa Grid Data Center

    Science.gov (United States)

    Mazzoni, E.; Arezzini, S.; Boccali, T.; Ciampa, A.; Coscetti, S.; Bonacorsi, D.

    2015-12-01

    Clouds and virtualization offer typical answers to the needs of large-scale computing centers to satisfy diverse sets of user communities in terms of architecture, OS, etc. On the other hand, solutions like Docker seems to emerge as a way to rely on Linux kernel capabilities to package only the applications and the development environment needed by the users, thus solving several resource management issues related to cloud-like solutions. In this paper, we present an exploratory (though well advanced) test done at a major Italian Tier2, at INFN-Pisa, where a considerable fraction of the resources and services has been moved to Docker. The results obtained are definitely encouraging, and Pisa is transitioning all of its Worker Nodes and services to Docker containers. Work is currently being expanded into the preparation of suitable images for a completely virtualized Tier2, with no dependency on local configurations.

  2. Cardiac channelopathies in pediatric patients - 7-years single center experience.

    Science.gov (United States)

    Illikova, V; Hlivak, P; Hatala, R

    2015-01-01

    Channelopathies are associated with mutations of genes encoding proteins creating or interacting with the specialized ion channels in myocardial cell membranes, thus forming arrhythmogenic substrate predisposing the patient to sudden cardiac death. The study focuses the clinical and ECG presentation and management of children with channelopathies in Slovakia. Twenty-two children with suspected channelopathy were admitted to Children's Cardiac Center Bratislava in the years 2007-2014. Genetic testing was made in 19 patients. Fourteen patients were symptomatic. Long QT syndrome was genetically proven in eight and catecholaminergic polymorphic ventricular tachycardia in five patients. Twenty children are treated with beta-blockers, five in combination with mexiletine or flecainide. Nine patients received implantable cardiac defibrillator and one underwent left cardiac sympathetic denervation. Both clinical presentation and genetic testing must be considered in the diagnostic and therapeutic process of channelopathies. Early diagnosis allows for adequate treatment and lifestyle modification. Copyright © 2015 Elsevier Inc. All rights reserved.

  3. DISTRIBUTION OF CONGENITAL HEART DISEASES AT TERTIARY CARE CENTER: SINGLE CENTER EXPERIENCE

    Directory of Open Access Journals (Sweden)

    Vaishali

    2016-02-01

    Full Text Available BACKGROUND The current study was undertaken at a tertiary care center, Bhopal, MP, India, with the objective of establishing frequency of occurrence of congenital heart diseases by echocardiography. MATERIALS AND METHOD 10,000 consecutive cases undergoing Echo Color Doppler in the Cardiology Department Hamidia Hospital, Bhopal, between 1st Jan 2009 and July 2011 were analysed. Echo CD was performed by consultant cardiologist using Acuson Aspen Color Doppler machine following the ASE guidelines. RESULTS AND CONCLUSIONS In the present study out of 10,000consecutive cases undergoing echo 648 were identified to having congenital heart diseases. Isolated VSD (30.5%, isolated ASD (23.6% PDA (9% and TOF (8.3% were commonest defect observed. Most common congenital heart disease found in the present study is VSD and is most prevalent in males and is highest among 0-5 yrs.

  4. Occupational toxicant inhalation injury: the World Trade Center (WTC) experience.

    Science.gov (United States)

    de la Hoz, Rafael E; Shohet, Michael R; Chasan, Rachel; Bienenfeld, Laura A; Afilaka, Aboaba A; Levin, Stephen M; Herbert, Robin

    2008-02-01

    Clinical descriptive data is presented on a group of 554 former workers and volunteers (with more than 90 different occupations) at the World Trade Center (WTC) disaster site. A subsample of 168 workers (30% of the group) was selected to examine lower airway disease risk in relation to smoking and WTC exposure variables. Five diagnostic categories clearly predominate: upper airway disease (78.5%), gastroesophageal reflux disease (57.6%), lower airway disease (48.9%), psychological (41.9%) and chronic musculoskeletal illnesses (17.8%). The most frequent pattern of presentation was a combination of the first three of those categories (29.8%). Associations were found between arrival at the WTC site within the first 48 h of the terrorist attack and lower airway and gastroesophageal reflux disease, and between past or present cigarette smoking and lower airway disease. Occupational exposures at the WTC remain consistently associated with a disease profile, which includes five major diagnostic categories. These conditions often coexist in different combinations, which (as expected) mutually enhances their clinical expression, complicates medical management, and slows recovery. Cigarette smoking and early arrival at the WTC site appear to be risk factors for lower airway disease diagnosis.

  5. Ten-year experience of phototherapy in Yonsei Medical Center.

    Science.gov (United States)

    Park, S H; Hann, S K; Park, Y K

    1996-12-01

    Phototherapy with PUVA or UVB has been used to treat a wide variety of diseases such as psoriasis, vitiligo, atopic dermatitis and mycosis fungoides, etc. The present study was performed to investigate the pattern of phototherapy in the phototherapy clinic of Yonsei Medical Center. One thousand six hundred ninety two patients who received PUVA or UVB phototherapy were included in this study. We analyzed the protocols for phototherapy between 1985 and 1994. The number of phototherapy per year increased sharply until 1991 and thereafter it has remained relatively constant. The most common age group at the start of phototherapy was the third decade. The most common indications for PUVA and UVB phototherapy were vitiligo and psoriasis, respectively. Most patients had received less than 50 treatments of PUVA and less than 200 J/cm2 of cumulative UVA. Most patients had received less than 50 treatments with UVB and cumulative UVB doses were variable. We had not found any malignancy in the skin. Since the maximum safe cumulative doses of UVA or UVB have not yet been established, it is difficult to decide when phototherapy should be discontinued. The data presented in this study needs to be further analyzed in correlation with photoaging and cancer development for the safe usage of phototherapy.

  6. Multidisciplinary approach to transvenous lead extraction: a single center's experience.

    Science.gov (United States)

    Maus, Timothy M; Shurter, Jesse; Nguyen, Liem; Birgersdotter-Green, Ulrika; Pretorius, Victor

    2015-04-01

    To evaluate the success and complication rates of a single center's multidisciplinary approach to transvenous lead extraction. One university hospital. One hundred ninety-five patients scheduled for transvenous lead extraction. A multidisciplinary approach to transvenous lead extraction involving cardiac surgery, electrophysiology, perfusion, and cardiac anesthesiology. A case series of 351 lead extractions performed in 195 patients over a 42-month period. Indications, success rates, and complication rates were tracked and retrospectively evaluated and reported. Indications for lead extraction included 53.3% because of lead malfunction, 36.9% because of infection, with the remaining 9.7% from other categories such as venous stenosis. The lead extraction rate was 99.7%, with complete removal in 97.7%. The overall major complication rate was 3.08%. After an initial 1-year period of performing lead extractions, the overall major complication rate reduced to 1.23%. Transvenous lead extraction generally is a safe procedure, but not without complications. A multidisciplinary approach involving cardiac surgery, electrophysiology, and cardiac anesthesiology allows for successful management and the ability to rapidly manage major complications. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Postpercutaneous Nephrolithotomy Nephrostogram: Is It Mandatory? A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Abdul Rouf Khawaja

    2014-01-01

    Full Text Available Aims and Objective. “Postpercutaneous nephrolithotomy nephrostogram” (PPNN is routinely performed in most of the centers. No published series could be found in the literature without post percutaneous nephrolithotomy nephrostogram. Hence, the aim of our study is to highlight that post percutaneous nephrolithotomy nephrostogram is not mandatory and it only adds to cost and morbidity without adding any information in the management of such patients. Methods. It was a prospective study from 2005 to 2012, conducted in our institute. It included 119 patients of renal stones who underwent percutaneous nephrolithotomy performed under the guidance of a single surgeon. Postoperative nephrostogram was not done in any of the patients. Results. Complete stone clearance was achieved in 97.5% of patients and 2.5% of patients needed two to three sessions of ESWL later on. None of the patients needed second look percutaneous nephrolithotomy or nephrostogram. Conclusion. Postpercutaneous nephrolithotomy nephrostogram increases chances of infection, inconvenience, contrast related complications, and cost, with no added advantage over plain X-ray KUB, and it should not be done as a routine investigation prior to the removal of PCN tube in patients with complete stone clearance.

  8. Improving the life science (biology) laboratory education experience: From an instructor-centered to a learner-centered educational environment

    Science.gov (United States)

    Stevens, Marcella Liffick

    The component parts of the educational experience in a freshman biology laboratory course could be improved if the knowledge, skills, and personality of the students could be integrated with the instructor's. Lack of integration of instruction with learning often results in students unwilling or unable to learn content and to transfer it to future courses. This research examined the component parts of instruction and learning for a freshman biology laboratory class and provided an alternative approach to the traditional experience in this lab. Outcome assessment revealed that students experiencing a learner-centered lab responded differently to instruction than students in the traditional lab did and expressed more of a learning orientation and awareness. Not all methods used were successful but course evaluations demonstrated an increased awareness of the learning process among students in the learner-centered lab. The alternative group indicated differences specifically directed toward learning, more often than the traditional group did.

  9. A Qualitative Examination of Connections between Learner-Centered Teaching and Past Significant Learning Experiences

    Science.gov (United States)

    Brackenbury, Tim

    2012-01-01

    Learner-centered teaching is a collection of instructional practices that shift the emphasis of courses from the instructors' goals and methods of delivery to the knowledge and skills that the students develop. This study examined potential commonalities between features of learner-centered teaching and the past significant learning experiences of…

  10. Managing disorder of sexual development surgically: A single center experience

    Directory of Open Access Journals (Sweden)

    Jatinder Kumar

    2012-01-01

    Full Text Available Introduction: Ambiguous genitalia are a major cause of parental anxiety and create psychological and social problems to patient, if not managed properly. Here we present our experience in managing patients with ambiguous genitalia. Material and Methods: We retrospectively reviewed clinical records of all patients with ambiguous genitalia managed surgically at out institute between December 1989 and January 2011. Relevant history, clinical examination , investigations and surgical procedures performed were analyzed and results were evaluated in terms of anatomical, functional and psychosexual outcomes. Results: Female pseudohermaphroditism was the most common cause of genital ambiguity in our patients. Male and female genitoplasty was done according to gender of rearing, genital anatomy and parental choice. Twenty six patients (86.6% reported satisfactory cosmetic outcome and 22 (73.3% satisfactory functional outcome on long term follow-up. Among the 24 patients diagnosed as male pseudohermaphroditism 14 (82.3% patient have reported satisfactory cosmetic outcome and 13 (76.4% have reported satisfactory functional outcome. In patients with mixed gonadal dysgenesis and true hermaphroditism satisfactory cosmetic and functional outcome was seen in 70% patient. Conclusion: Managing patients of genital ambiguity according to gender of rearing, genital anatomy and parental choice carries good prognosis in terms of anatomical, functional and psychosexual outcome.

  11. Mycophenolate mofetil in pediatric renal transplantation: a single center experience.

    LENUS (Irish Health Repository)

    Raheem, Omer A

    2012-02-01

    We assessed our long-term experience with regards to the safety and efficacy of MMF in our pediatric renal transplant population and compared it retrospectively to our previous non-MMF immunosuppressive regimen. Forty-seven pediatric renal transplants received MMF as part of their immunosuppressive protocol in the period from January 1997 till October 2006 (MMF group). A previously reported non-MMF group of 59 pediatric renal transplants was included for comparative analysis (non-MMF group). The MMF group comprised 29 boys and 18 girls, whereas the non-MMF group comprised 34 boys and 25 girls. Mean age was 11.7 and 12 yr in the MMF and non-MMF groups, respectively. The incidence of acute rejection episodes was 11 (23.4%) and 14 (24%) in the MMF and non-MMF group, respectively. Two (3.3%) grafts were lost in the non-MMF group compared with one (2.1%) in the MMF group. Twenty-one (44.68%) patients in the MMF group developed post-transplant infections compared with 12 (20.33%) in the non-MMF group (p < 0.0001). In conclusion, the use of MMF in pediatric renal transplantation was not associated with a lower rejection rate or immunological graft loss. It did, however, result in a significantly higher rate of viral infections.

  12. Five years' experience with capsule endoscopy in a single Center

    Institute of Scientific and Technical Information of China (English)

    Taylan Kav; Yusuf Bayraktar

    2009-01-01

    Capsule endoscopy (CE) is a novel technology that facilitates highly effective and noninvasive imaging of the small bowel. Although its efficacy in the evaluation of obscure gastrointestinal bleeding (OGIB) has been proven in several trials, data on uses of CE in different small bowel diseases are rapidly accumulating in the literature, and it has been found to be superior to alternative diagnostic tools in a range of such diseases.Based on literature evidence, CE is recommended as a first-line investigation for OGIB after negative bidirectional endoscopy. CE has gained an important role in the diagnosis and follow-up of Crohn's disease and celiac disease and in the surveillance of small bowel tumors and polyps in selected patients. Capsule retention is the major complication, with a frequency of 1%-2%. The purpose of this review was to discuss the procedure, indications, contraindications and adverse effects associated with CE. We also review and share our five-year experience with CE in various small bowel diseases. The recently developed balloon-assisted enteroscopies have both diagnostic and therapeutic capability. At the present time, CE and balloon-assisted enteroscopies are complementary techniques in the diagnosis and management of small bowel diseases.

  13. Interventional Treatment of Pulmonary Valve Stenosis: A Single Center Experience

    Directory of Open Access Journals (Sweden)

    Shpend Idrizi

    2015-08-01

    Full Text Available BACKGROUND: Percutaneous pulmonary valvuloplasty is well established treatment of choice in pulmonary valve stenosis. AIM: The aim of our study was to present our experience with the interventional technique, its immediate and mid-term effectiveness as well as its complication rate. MATERIAL AND METHODS: The study included 43 patients, where 33 (74% of them were children between the age of 1 month and 15 years. RESULTS: The procedure was successful in 38 patients or 90%. Mean peak to peak transvalvular gradient was reduced from 91.2 mmHg (55-150 mmHg to 39.1 mmHg (20-80 mmHg. Follow- up of patients was between 2 and 13 years and included echocardiographic evaluation of pulmonary valve gradient, right heart dimensions and function as well as assessment of pulmonary regurgitation. We experienced one major complication pericardial effusion in a 5 months old child that required pericardiocenthesis. Six patients (13.9% required a second intervention. During the follow up period there was significant improvement of right heart function and echocardiography parameters. Mild pulmonary regurgitation was noted in 24 (55% patients, and four (9% patients developed moderate regurgitation, without affecting the function of the right ventricle. CONCLUSIONS: Percutaneous pulmonary valvuloplasty is an effective procedure in treatment of pulmonary stenosis with good short and mid-term results.

  14. Transcatheter Closure of Patent Foramen Ovale: A Single Center Experience

    Science.gov (United States)

    Milev, Ivan; Zafirovska, Planinka; Zimbakov, Zan; Idrizi, Shpend; Ampova-Sokolov, Vilma; Gorgieva, Emilija; Ilievska, Liljana; Tosheski, Goce; Hristov, Nikola; Georgievska-Ismail, Ljubica; Anguseva, Tanja; Mitrev, Zan

    2016-01-01

    BACKGROUND: Percutaneous transcatheter closure (PTC) of patent foramen ovale (PFO) is implicated in cryptogenic stroke, transitional ischemic attack (TIA) and treatment of a migraine. AIM: Our goal was to present our experience in the interventional treatment of PFO, as well as to evaluate the short and mid-term results in patients with closed PFO. MATERIAL AND METHODS: Transcatheter closure of PFO was performed in 52 patients (67.3% women, mean age 40.7 ± 11.7 years). Patients were interviewed for subjective grading of the intensity of headaches before and after the PFO closure. RESULTS: During 2 years of follow-up, there was no incidence of new stroke, TIA and/or syncope. Follow-up TCD performed in 35 patients showed complete PFO closure in 20 patients (57.1%). Out of 35 patients, 22 (62.9%) reported having a migraine before the procedure with an intensity of headaches at 8.1 ± 1.9 on a scale from 1 to 10. During 2 years of follow-up, symptoms of a migraine disappeared in 4 (18.2%) and the remaining 18 patients reported the significant decrease in intensity 4.8 ± 2.04 (p = 0.0001). In addition, following PFO closure the incidence of the headaches decreased significantly (p = 0.0001). CONCLUSIONS: Percutaneous transcatheter closure of PFO is a safe and effective procedure showing mid-term relief of neurological symptoms in patients as well as significant reduction of migraine symptoms. PMID:28028400

  15. Experience with Evans syndrome in an academic referral center

    Directory of Open Access Journals (Sweden)

    José Carlos Jaime-Pérez

    2015-08-01

    Full Text Available OBJECTIVE: To document the experience of one referral service with patients diagnosed with Evans syndrome, the treatment and response and to briefly review current treatment strategies and results.METHODS: Patients enrolled in this study fulfilled criteria for Evans syndrome. Data were retrieved from the clinical files and electronic databases of the Department of Hematology, Hospital Universitario "Dr. José Eleuterio González". Treatment modalities and response and the use of additional therapies were evaluated. The literature was reviewed in the context of the clinical course of the studied patients.RESULTS: Six patients were diagnosed with Evans syndrome in the study period. Patient 1 was treated with steroids, relapsed twice and was again treated with steroids. Patient 2 treated initially with steroids plus intravenous immunoglobulin was subsequently lost to follow-up. A good response was achieved in Patients 3 and 4, who were treated with steroids plus rituximab; patient 4 also received danazol as a second-line therapy. However both relapsed and subsequently underwent splenectomy at ten and nine months, respectively. One patient, number 5, treated with steroids, danazol and rituximab did not relapse within four years of follow-up and Patient 6, who received steroids plus danazol did not relapse within three years of follow-up.CONCLUSION: Evans syndrome is an uncommon hematologic condition rarely diagnosed and not widely studied. Clinicians must have it in mind when evaluating a patient with a positive direct antiglobulin test, anemia and thrombocytopenia, since prognosis depends on its early recognition and opportune therapy, but even this leads to variable results.

  16. Valve replacement in pediatric patients:a single center experience

    Institute of Scientific and Technical Information of China (English)

    YU Jian-hua; GUO Hong-wei; ZHANG Gong; WU Shu-ming; SONG Guang-min; SUN Wen-yu

    2011-01-01

    Background Reconstructive surgery is the primary goal in pediatric patients with valve disease.However,in cases with irreparable valve lesions,valve replacement is the only option.This study aimed to retrospectively analyze the clinical experience of heart valve prosthesis replacement in children.Methods Between January 1990 and July 2009,35 pediatric patients (16 boys,19 girls) underwent mechanical valve replacement in Shandong University Qilu Hospital.The ages ranged from 2.5 to 14 years (mean,(8.8±3.8) years) and body weight varied from 11 to 37 kg (mean,(22.1±5.2) kg).Mechanical valve replacement was performed because of congenital heart disease in 23 patients,rheumatic disease in ten patients and infective endocarditis in two patients.St.Jude bileaflet mechanical valves were implanted in all the 35 patients including mitral valve replacement (MVR) in 18,aortic valve replacement (AVR) in 12,tricuspid valve replacement (TVR) in two,AVR and MVR in two and MVR and TVR in one.The size of the prostheses ranged between 19 and 27 mm.All patients received long-term anticoagulation treatment with sodium warfarin,aiming to maintain an international normalized ratio between 1.5 to 2.0.Follow-up was performed in all the patients with a total follow-up of 119.4 patient-years.Results The operative mortality was 8.57% (3/35).One patient,who underwent cardiac debridement and AVR,died 2 hours after being admitted to the intensive care unit because of severe low cardiac output syndrome and ventricular fibrillation.Two patients died of cardiogenic shock and renal failure during initial hospitalization after the operation.One patient who received replacement of a tricuspid valve developed complete heart block requiring temporary pacing and recovered sinus rhythm 4 days later.Thirty-two patients survived and their cardiac function was in New York Heart Association (NYHA) class Ⅰ to class Ⅱ when discharged.Late events included hemorrhage and endocarditis.Two patients required

  17. Nasal metastases from renal cell carcinoma are associated with Memorial Sloan-Kettering Cancer Center poor-prognosis classification

    Institute of Scientific and Technical Information of China (English)

    Caroline Victoria Choong; Tiffany Tang; Wen Yee Chay; Christopher Goh; Miah Hiang Tay; Nor Azhari Mohd Zam; Puay Hoon Tan; Min-Han Tan

    2011-01-01

    Unusual sites of metastases are recognized in patients with renai cell carcinoma (RCC). However, the prognostic implications of these sites are not well understood. We used the Memorial Sloan-Kettering Cancer Center (MSKCC) risk classification for metastatic RCC to evaluate 912 consecutive patients with RCC managed at the Singapore General Hospital between 1990 and 2009. Among these patients, 301 had metastases either at diagnosis or during the course of illness. Nasal metastases, all arising from clear cell RCC, were identified histologically in 4 patients (1.3% of those with metastasis). All 4 patients were classified as MSKCC poor prognosis by current risk criteria. Nasal metastases were significantly associated with lung and bone metastases. The frequency of nasal metastases in patients with metastatic RCC is about 1%, occurring predominantly in patients with clear cell RCC. Nasal metastases are associated with poor prognosis as estimated by the MSKCC risk classification, with attendant implications for selection of targeted therapy, and are usually associated with multi-organ dissemination, including concurrent lung and bone involvement.

  18. Ecology-Centered Experiences among Children and Adolescents: A Qualitative and Quantitative Analysis

    Science.gov (United States)

    Orton, Judy

    2013-01-01

    The present research involved two studies that considered "ecology-centered experiences" (i.e., experiences with living things) as a factor in children's environmental attitudes and behaviors and adolescents' ecological understanding. The first study (Study 1) examined how a community garden provides children in an urban setting the…

  19. Ecology-Centered Experiences among Children and Adolescents: A Qualitative and Quantitative Analysis

    Science.gov (United States)

    Orton, Judy

    2013-01-01

    The present research involved two studies that considered "ecology-centered experiences" (i.e., experiences with living things) as a factor in children's environmental attitudes and behaviors and adolescents' ecological understanding. The first study (Study 1) examined how a community garden provides children in an urban setting the…

  20. Parents' Experiences with Childhood Deafness: Implications for Family-Centered Services

    Science.gov (United States)

    Jackson, Carla Wood; Traub, Randi J.; Turnbull, Ann P.

    2008-01-01

    In response to the need for family-centered follow-up, this study examined parents' experiences with deafness after early identification. Qualitative inquiry methods were used to explore and describe the perceptions and experiences of nine parents of children identified with severe to profound deafness. Parents participated in face-to-face…

  1. The experience of Latino parents of hospitalized children during family-centered rounds.

    Science.gov (United States)

    Walker-Vischer, Lisa; Hill, Constance; Mendez, Suzanne S

    2015-03-01

    The aim of this study is to describe the experience of Latino parents of hospitalized children during family-centered rounds (FCRs). Family-centered rounds provide a mechanism to exchange information and facilitate shared decision making. Latino parents may have a suboptimal experience during FCRs. Understanding this experience helps nurse leaders improve patient satisfaction. Using a convenience sample, written surveys in Spanish were given to 20 parents who had attended at least 2 FCRs. The surveys were translated into English for data analysis. The narrative data were analyzed for common themes using content analysis. Four themes were identified: valued perception, inclusion and care, facilitated communication, and meeting expectations. Parents in this study felt that their participation and input were valued and that these positively impacted care. Family-centered rounds helped them understand the plan and facilitated communication when done in Spanish. Nurse leaders play a key role in improving satisfaction and increasing access to translation services or bilingual staff.

  2. An Exploration of Student Experiences with Learner-Centered Instructional Strategies

    Science.gov (United States)

    Stefaniak, Jill E.; Tracey, Monica W.

    2015-01-01

    In this exploratory study, we examined how undergraduate students experience learning in a learner-centered teaching environment and their perceptions of motivation towards learning material in an introductory public speaking communications course. Six faculty members participated in a semester-long study where their teaching strategies were…

  3. Design experience of a base-isolation system applied to a computer center building

    Energy Technology Data Exchange (ETDEWEB)

    Hasebe, Akiyoshi; Kojima, Hideo; Tamura, Kazuo (Tohoku Electric Power Co., Sendai (Japan))

    1991-06-01

    Design experience of the base-isolated new computer center of the Tohoku Electric Power Co. is described. This building after completion will be the largest isolated building in Japan with a total floor space of {proportional to} 10,000 m{sup 2}. High-damping laminated rubber bearings are used as base-isolation devices. (orig.).

  4. Individual Differences and the Conundrums of User-Centered Design: Two Experiments.

    Science.gov (United States)

    Allen, Bryce

    2000-01-01

    Discusses individual differences between users of information systems that can influence search performance, and describes two experiments that addressed user-centered design of information systems. Highlights include interaction between cognitive abilities and design features; compensation and capitalization perspectives; recall and precision;…

  5. CENTER DIRECTOR RICHARD SMITH AND OTHER PERSONNEL OBSERVE SPACELAB 1 MODULE AND EXPERIMENT PALLET HO

    Science.gov (United States)

    1983-01-01

    CENTER DIRECTOR RICHARD SMITH AND OTHER PERSONNEL OBSERVE SPACELAB 1 MODULE AND EXPERIMENT PALLET HO KSC-383C-2860.02 P-16225,ARCHIVE-03951 Spacelab 1 module and its attached pallet are hoisted out of the payload canister, over the work stands and into the cargo bay of the Columbia.

  6. Parent Perspectives on How a Child-Centered Preschool Experience Shapes Children's Navigation of Kindergarten

    Science.gov (United States)

    Recchia, Susan; Bentley, Dana Frantz

    2013-01-01

    The authors used qualitative case study methodology to explore parents' perceptions of their children's readiness for kindergarten. The authors interviewed parents, focusing on their children's experiences during their transition from a child-centered, play-based preschool setting guided by an emergent curriculum into a range of diverse…

  7. Single center experience and technical nuances in the treatment of distal anterior cerebral artery aneurysms

    Directory of Open Access Journals (Sweden)

    Gherasim Dorin Nicolae

    2017-03-01

    Full Text Available Objective: This study presents the experience of one neurosurgical center in the treatment of 18 consecutive patients with distal anterior cerebral artery (DACA aneurysms during a 10 years period. Our aim was to compare treatment outcomes of these lesions with intracranial aneurysms in general, and to present technical nuances in surgical treatment.

  8. A Qualitative Study of Information Technology Managers' Experiences and Perceptions Regarding Outsourced Data Centers

    Science.gov (United States)

    Reid, Eric Justin

    2015-01-01

    This qualitative study explored the perceptions and experiences of IT Managers in publicly traded companies within the San Antonio, Texas area about outsourced data centers. Narrative data was collected using open-ended questions and face-to-face interviews within semi-structured environments. The research questions guided the study: (1)…

  9. Leaders' Experiences with High School-College Writing Center Collaborations: A Qualitative Multiple-Case Study

    Science.gov (United States)

    Story, Julie A.

    2014-01-01

    The purpose of this qualitative multiple-case study was to explore academic leaders' experiences with the organizational elements of their own high school-college writing center collaborations. Conjoining theories framed this study: collaborative leadership theory, Kenneth Bruffee's notion of social constructionism and collaborative learning…

  10. Implementing a Veteran-Centered Community Health Clinical Experience in a Baccalaureate Nursing Program.

    Science.gov (United States)

    Champlin, Barbara E; Kunkel, Dorcas Elisabeth

    2017-03-01

    In a baccalaureate nursing curriculum, students focused on the unique health care needs of veterans and their families. The learning experiences aimed to equip them with the knowledge, skills, and attitudes (KSAs) to provide holistic relation-centered care to veterans and their families. The clinical course integrated the findings of several veteran-centered publications and the American Association of Colleges of Nursing veteran-centered resources. Formative and summative anecdotal information was gathered in the learning experience during weekly postclinical discussions, course assignments, and a seminar after completion of the experience. Three noteworthy themes stand out: Increased Descriptions of Resources and Services Available to Veterans and Their Families, Increased Expressions of the Complex Health Care Needs of Veterans, and Increasing Recognition of the Autonomous Nature of the Community Health Nursing Role. Early indicators are that this community health field work experience will be sustainable into the future. The academic institution and clinical partner remain committed to working together to provide meaningful learning opportunities to students. Students completed the experience with increased KSAs and a beginning orientation to the Veterans Affairs Health Care System. [J Nurs Educ. 2017;56(3):186-190.]. Copyright 2017, SLACK Incorporated.

  11. Arterial pseudoaneurysms following hepato-pancreato-biliary surgery: a single center experience.

    Science.gov (United States)

    Ielpo, Benedetto; Caruso, Riccardo; Prestera, Antonio; De Luca, Giuseppe Massimiano; Duran, Hipolito; Diaz, Eduardo; Fabra, Isabel; Olivares, Sergio; Quijano, Yolanda; Vicente, Emilio

    2015-01-31

    Arterial pseudoaneurysm is an uncommon lethal complication following hepato-pancreato-biliary surgery. Aim of this study is to present and discuss the experience of a high volume oncological center. Since 2007 all major surgeries performed at Sanchinarro Oncological Center have been included in a prospective database looking for postoperative arterial pseudonaurysm. Until June 2014, among 559 hepato-pancreato-biliary procedures, a total of 14 arterial pseudoaneurysms have been identified (2.5%). Sentinel bleeding was in 57% of cases. Failed arterial embolization occurred in 2 cases. Overall mortality rate was 28.5%. We also identified 3 asymptomatic pseudoaneurysms, one of them managed without embolization, developing a sudden bleeding and died after surgery. According to our experience, pseudoaneurysm incidence is higher than reported in current literature and it can be successfully managed through arterial embolization. Furthermore, we found 3 asymptomatic pseudoaneurysms, whose management is still controversial.

  12. Causes and outcomes of revisional bariatric surgery: initial experience at a single center

    OpenAIRE

    2014-01-01

    Purpose Bariatric surgery has become more prevalent owing to the worldwide obesity epidemic. With the growing number of bariatric procedures performed annually, the requirement for revisional and secondary operations is increasing accordingly. This study aimed to evaluate the initial experience of revisional bariatric surgery at a single specialized center. Methods A retrospective review of the prospectively established database identified all patients who underwent revisional bariatric surge...

  13. Partial Cystectomy after Neoadjuvant Chemotherapy: Memorial Sloan Kettering Cancer Center Contemporary Experience

    OpenAIRE

    Bazzi, Wassim M.; Kopp, Ryan P.; Donahue, Timothy F.; Bernstein, Melanie; Russo, Paul; Bochner, Bernard H.; Donat, Sherri M.; Dalbagni, Guido; Herr, Harry W.

    2014-01-01

    Objective. To report our contemporary experience with partial cystectomy after neoadjuvant chemotherapy. Patients and Methods. Retrospective review of patients who underwent neoadjuvant chemotherapy and partial cystectomy for urothelial cell carcinoma of the bladder at Memorial Sloan Kettering Cancer Center from 1995 to 2013. Log-rank test and Cox regression models were used to analyze variables possibly associated with recurrence-free, advanced recurrence-free (free from recurrence beyond sa...

  14. Evaluation of mode equivalence of the MSKCC Bowel Function Instrument, LASA Quality of Life, and Subjective Significance Questionnaire items administered by Web, interactive voice response system (IVRS), and paper.

    Science.gov (United States)

    Bennett, Antonia V; Keenoy, Kathleen; Shouery, Marwan; Basch, Ethan; Temple, Larissa K

    2016-05-01

    To assess the equivalence of patient-reported outcome (PRO) survey responses across Web, interactive voice response system (IVRS), and paper modes of administration. Postoperative colorectal cancer patients with home Web/e-mail and phone were randomly assigned to one of the eight study groups: Groups 1-6 completed the survey via Web, IVRS, and paper, in one of the six possible orders; Groups 7-8 completed the survey twice, either by Web or by IVRS. The 20-item survey, including the MSKCC Bowel Function Instrument (BFI), the LASA Quality of Life (QOL) scale, and the Subjective Significance Questionnaire (SSQ) adapted to bowel function, was completed from home on consecutive days. Mode equivalence was assessed by comparison of mean scores across modes and intraclass correlation coefficients (ICCs) and was compared to the test-retest reliability of Web and IVRS. Of 170 patients, 157 completed at least one survey and were included in analysis. Patients had mean age 56 (SD = 11), 53% were male, 81% white, 53% colon, and 47% rectal cancer; 78% completed all assigned surveys. Mean scores for BFI total score, BFI subscale scores, LASA QOL, and adapted SSQ varied by mode by less than one-third of a score point. ICCs across mode were: BFI total score (Web-paper = 0.96, Web-IVRS = 0.97, paper-IVRS = 0.97); BFI subscales (range = 0.88-0.98); LASA QOL (Web-paper = 0.98, Web-IVRS = 0.78, paper-IVRS = 0.80); and SSQ (Web-paper = 0.92, Web-IVRS = 0.86, paper-IVRS = 0.79). Mode equivalence was demonstrated for the BFI total score, BFI subscales, LASA QOL, and adapted SSQ, supporting the use of multiple modes of PRO data capture in clinical trials.

  15. NASA Glenn Research Center's Materials International Space Station Experiments (MISSE 1-7)

    Science.gov (United States)

    deGroh, Kim K.; Banks, Bruce a.; Dever, Joyce A.; Jaworske, Donald A.; Miller, Sharon K.; Sechkar, Edward A.; Panko, Scott R.

    2008-01-01

    NASA Glenn Research Center (Glenn) has 39 individual materials flight experiments (>540 samples) flown as part of the Materials International Space Station Experiment (MISSE) to address long duration environmental durability of spacecraft materials in low Earth orbit (LEO). MISSE is a series of materials flight experiments consisting of trays, called Passive Experiment Carriers (PECs) that are exposed to the space environment on the exterior of the International Space Station (ISS). MISSE 1-5 have been successfully flown and retrieved and were exposed to the space environment from one to four years. MISSE 6A & 6B were deployed during the STS-123 shuttle mission in March 2008, and MISSE 7A & 7B are being prepared for launch in 2009. The Glenn MISSE experiments address atomic oxygen (AO) effects such as erosion and undercutting of polymers, AO scattering, stress effects on AO erosion, and in-situ AO fluence monitoring. Experiments also address solar radiation effects such as radiation induced polymer shrinkage, stress effects on radiation degradation of polymers, and radiation degradation of indium tin oxide (ITO) coatings and spacesuit fabrics. Additional experiments address combined AO and solar radiation effects on thermal control films, paints and cermet coatings. Experiments with Orion Crew Exploration Vehicle (CEV) seals and UltraFlex solar array materials are also being flown. Several experiments were designed to provide ground-facility to in-space calibration data thus enabling more accurate in-space performance predictions based on ground-laboratory testing. This paper provides an overview of Glenn s MISSE 1-7 flight experiments along with a summary of results from Glenn s MISSE 1 & 2 experiments.

  16. Experience with interstitial implantation of iodine 125 in the treatment of prostatic carcinoma.

    Science.gov (United States)

    Sogani, P C; Whitmore, W F; Hilaris, B S; Batata, M A

    1980-01-01

    Between February 1970 and April 1977 300 patients with localized prostatic carcinoma were treated with I-125 implantation and bilateral pelvic lymphadenectomy at Memorial Sloan-Kettering Cancer Center (MSKCC). 68% had clinical Stage B (T-1 and T-2) and 32% had Stage C (T-3) neoplasms. Pelvic lymph nodes were histologically positive in 38% of the patients. Five-year survival for all patients was 73%. Five-year survival for Stage B disease was 100% and Stage C 65%. Lymph node metastases implied a poor prognosis. While 92% of patients with negative nodes survived five years, only 46% of the patients with positive nodes did so. Supplemental external radiation to pelvic and periaortic region in 28 patients with positive nodes did not improve survival or disease free interval or reduce distal or local recurrence but rather increased the incidence of radiation morbidity. The complications and morbidity as a consequence of I-125 implantation are minimal. The ultimate role of I-125 implantation in the management of localized prostatic cancer is yet to be determined. The early experience with this technique, however, suggests that it may be as effective as alternative modalities for comparable stages in terms of patient survival and may prove superior in terms of the quality of survival.

  17. Pediatric Vascular Surgery Review with a 30-Year-Experience in a Tertiary Referral Center

    Science.gov (United States)

    Min, Seung-Kee; Cho, Sungsin; Kim, Hyun-Young; Kim, Sang Joon

    2017-01-01

    Pediatric vascular disease is rare, and remains a big challenge to vascular surgeons. In contrast to adults, surgery for pediatric vascular disease is complicated by issues related to small size, future growth, and availability of suitable vascular conduit. During the last 30 years, 131 major vascular operations were performed in a tertiary referral center, Seoul National University Hospital, including aortoiliac aneurysm, acute or chronic arterial occlusion, renovascular hypertension, portal venous hypertension, trauma, tumor invasion to major abdominal vessels, and others. Herein we review on the important pediatric vascular diseases and share our clinical experiences on these rare diseases. PMID:28690995

  18. Health professionals’ experiences of person-centered collaboration in mental health care

    Directory of Open Access Journals (Sweden)

    Rita Sommerseth

    2008-10-01

    Full Text Available Rita Sommerseth, Elin DysvikUniversity of Stavanger, Faculty of Social Sciences, Department of Health Studies, Stavanger, NorwayObjective: The basic aim in this paper is to discuss health care professionals’ experiences of person-centered collaboration and involvement in mental health rehabilitation and suggest ways of improving this perspective. Furthermore, the paper explains the supportive systems that are at work throughout the process of rehabilitation.Method: The study design is a qualitative approach using three focus group interviews with a total of 17 informants with different professional backgrounds such as nurses, social workers, and social pedagogies. In addition, one nurse and one social worker participated in a semistructured in-depth interview to judge validity.Results: Our results may demonstrate deficits concerning mental health care on several levels. This understanding suggests firstly, that a person-centered perspective and involvement still are uncommon. Secondly, multidisciplinary work seems uncommon and only sporadically follows recommendations. Thirdly, family support is seldom involved. Lastly, firm leadership and knowledge about laws and regulations seems not to be systematically integrated in daily care.Conclusion: Taking these matters together, the improvement of a person-centered perspective implies cooperation between different services and levels in mental health care. In order to bring about improvement the health care workers must critically consider their own culture, coordination of competence must be increased, and leadership at an institutional and organizational level must be improved so that scarce rehabilitation resources are used to the optimal benefit of people with a mental illness.Keywords: multidisciplinary teams, person-centered collaboration, supportive systems, rehabilitation

  19. Group Violence and Migration Experience among Latin American Youths in Justice Enforcement Centers (Madrid, Spain).

    Science.gov (United States)

    Martínez García, José Manuel; Martín López, María Jesús

    2015-10-30

    Group violence among Latin American immigrant youth has led to ongoing debates in political, legal, and media circles, yet none of those many perspectives has arrived at a solid, empirically supported definition for the phenomenon. This study aims to explore the relationship between the immigrant experience and violent group behavior in youths from Latin America serving prison sentences in Justice Enforcement Centers in the Community of Madrid. Semi-structured interviews were conducted with 19 juveniles, and content analysis was applied to the resulting transcripts, employing Grounded Theory to create an axial codification of intra- and inter-categorical contents, and Delphi panels for quality control. The research team delved into 62 topics, addressing participants' perceptions of the immigrant experience and its effects on five socialization settings (neighborhood, school, family, peer group, and significant other), and each one's relationship to violent behavior. The results led us to believe the young people's immigration experiences had been systematically examined. Their personal and social development was influenced by negative socioeconomic conditions, ineffective parental supervision, maladjustment and conflict at school, and experiences of marginalization and xenophobia. All those conditions favored affiliation with violent groups that provided them instrumental (economic and material), expressive, or affective support.

  20. Atmospheric monitoring of a perfluorocarbon tracer at the 2009 ZERT Center experiment

    Science.gov (United States)

    Pekney, Natalie; Wells, Arthur; Rodney Diehl, J.; McNeil, Matthew; Lesko, Natalie; Armstrong, James; Ference, Robert

    2012-02-01

    Field experiments at Montana State University are conducted for the U.S. Department of Energy as part of the Zero Emissions Research and Technology Center (ZERT) to test and verify monitoring techniques for carbon capture and storage (CCS). A controlled release of CO 2 with an added perfluorocarbon tracer was conducted in July 2009 in a multi-laboratory study of atmospheric transport and detection technologies. Tracer plume dispersion was measured with various meteorological conditions using a tethered balloon system with Multi-Tube Remote Samplers (MTRS) at elevations of 10 m, 20 m, and 40 m above ground level (AGL), as well as a ground-based portable tower with monitors containing sorbent material to collect the tracer at 1 m, 2 m, 3 m, and 4 m AGL. Researchers designed a horizontal grid of sampling locations centered at the tracer plume source, with the tower positioned at 10 m and 30 m in both upwind and downwind directions, and the MTRS spaced at 50 m and 90 m downwind and 90 m upwind. Tracer was consistently detected at elevated concentrations at downwind sampling locations. With very few exceptions, higher tracer concentrations correlated with lower elevations. Researchers observed no statistical difference between sampling at 50 m and 90 m downwind at the same elevation. The US EPA AERMOD model applied using site-specific information predicted transport and dispersion of the tracer. Model results are compared to experimental data from the 2009 ZERT experiment. Successful characterization of the tracer plume simulated by the ZERT experiment is considered a step toward demonstrating the feasibility of remote sampling with unmanned aerial systems (UAS's) at future sequestration sites.

  1. The Manuel Lujan Jr. Neutron Scattering Center (LANSCE) experiment reports 1993 run cycle. Progress report

    Energy Technology Data Exchange (ETDEWEB)

    Farrer, R.; Longshore, A. [comps.

    1995-06-01

    This year the Manuel Lujan Jr. Neutron Scattering Center (LANSCE) ran an informal user program because the US Department of Energy planned to close LANSCE in FY1994. As a result, an advisory committee recommended that LANSCE scientists and their collaborators complete work in progress. At LANSCE, neutrons are produced by spallation when a pulsed, 800-MeV proton beam impinges on a tungsten target. The proton pulses are provided by the Clinton P. Anderson Meson Physics Facility (LAMPF) accelerator and a associated Proton Storage Ring (PSR), which can Iter the intensity, time structure, and repetition rate of the pulses. The LAMPF protons of Line D are shared between the LANSCE target and the Weapons Neutron Research (WNR) facility, which results in LANSCE spectrometers being available to external users for unclassified research about 80% of each annual LAMPF run cycle. Measurements of interest to the Los Alamos National Laboratory (LANL) may also be performed and may occupy up to an additional 20% of the available beam time. These experiments are reviewed by an internal program advisory committee. This year, a total of 127 proposals were submitted. The proposed experiments involved 229 scientists, 57 of whom visited LANSCE to participate in measurements. In addition, 3 (nuclear physics) participating research teams, comprising 44 scientists, carried out experiments at LANSCE. Instrument beam time was again oversubscribed, with 552 total days requested an 473 available for allocation.

  2. Training for life science experiments in space at the NASA Ames Research Center

    Science.gov (United States)

    Rodrigues, Annette T.; Maese, A. Christopher

    1993-01-01

    As this country prepares for exploration to other planets, the need to understand the affects of long duration exposure to microgravity is evident. The National Aeronautics and Space Administration (NASA) Ames Research Center's Space Life Sciences Payloads Office is responsible for a number of non-human life sciences payloads on NASA's Space Shuttle's Spacelab. Included in this responsibility is the training of those individuals who will be conducting the experiments during flight, the astronauts. Preparing a crew to conduct such experiments requires training protocols that build on simple tasks. Once a defined degree of performance proficiency is met for each task, these tasks are combined to increase the complexity of the activities. As tasks are combined into in-flight operations, they are subjected to time constraints and the crew enhances their skills through repetition. The science objectives must be completely understood by the crew and are critical to the overall training program. Completion of the in-flight activities is proof of success. Because the crew is exposed to the background of early research and plans for post-flight analyses, they have a vested interest in the flight activities. The salient features of this training approach is that it allows for flexibility in implementation, consideration of individual differences, and a greater ability to retain experiment information. This training approach offers another effective alternative training tool to existing methodologies.

  3. Prognostic Factors and Treatment Outcomes of Parotid Gland Cancer: A 10-Year Single-Center Experience.

    Science.gov (United States)

    Chang, Jae Won; Hong, Hyun Jun; Ban, Myung Jin; Shin, Yoo Seob; Kim, Won Shik; Koh, Yoon Woo; Choi, Eun Chang

    2015-12-01

    To investigate the treatment outcomes of parotid gland cancer at a single center over a 10-year period and to evaluate the prognostic significance of maximum standardized uptake value. Retrospective case series with chart review. Academic care center. Ninety-eight patients with primary parotid gland cancer who were surgically treated at Yonsei University Head & Neck Cancer Clinic between January 1999 and December 2008 were analyzed. Patient data were collected retrospectively from medical charts. The investigators analyzed the association of clinicopathological factors and maximum standardized uptake value on (18)F-fluorodeoxyglucose positron emission tomography-computed tomography scan with disease-specific survival. Mean patient age was 49.7 years. Mean follow-up was 48.8 months. Thirty-three, 40, 30, and 23 patients had stage I, II, III, and IVA disease, respectively. Mucoepidermoid carcinoma was the most common histologic type (34.7%), followed by acinic cell carcinoma (27.6%). Eighteen patients (18.4%) experienced recurrences (mean recurrence gap, 20.6 months; range, 2-87 months). Five- and 10-year disease-specific survival rates were 93.6% and 81.8%, respectively. In the univariate analysis, pathologic T stage, pathologic lymph node status, resection margin, external parenchymal extension, and maximum standardized uptake value were significantly associated with disease-specific survival. Pathologic lymph node status and maximum standardized uptake value were independent prognostic factors in the multivariate analysis. Our single-center experience with parotid gland cancer treatment is consistent with the literature. Cervical lymph node metastasis and high maximum standardized uptake value are associated with poor survival in parotid gland cancer. © American Academy of Otolaryngology—Head and Neck Surgery Foundation 2015.

  4. Computed tomography-guided core-needle biopsy of lung lesions: an oncology center experience

    Energy Technology Data Exchange (ETDEWEB)

    Guimaraes, Marcos Duarte; Fonte, Alexandre Calabria da; Chojniak, Rubens, E-mail: marcosduarte@yahoo.com.b [Hospital A.C. Camargo, Sao Paulo, SP (Brazil). Dept. of Radiology and Imaging Diagnosis; Andrade, Marcony Queiroz de [Hospital Alianca, Salvador, BA (Brazil); Gross, Jefferson Luiz [Hospital A.C. Camargo, Sao Paulo, SP (Brazil). Dept. of Chest Surgery

    2011-03-15

    Objective: The present study is aimed at describing the experience of an oncology center with computed tomography guided core-needle biopsy of pulmonary lesions. Materials and Methods: Retrospective analysis of 97 computed tomography-guided core-needle biopsy of pulmonary lesions performed in the period between 1996 and 2004 in a Brazilian reference oncology center (Hospital do Cancer - A.C. Camargo). Information regarding material appropriateness and the specific diagnoses were collected and analyzed. Results: Among 97 lung biopsies, 94 (96.9%) supplied appropriate specimens for histological analyses, with 71 (73.2%) cases being diagnosed as malignant lesions and 23 (23.7%) diagnosed as benign lesions. Specimens were inappropriate for analysis in three cases. The frequency of specific diagnosis was 83 (85.6%) cases, with high rates for both malignant lesions with 63 (88.7%) cases and benign lesions with 20 (86.7%). As regards complications, a total of 12 cases were observed as follows: 7 (7.2%) cases of hematoma, 3 (3.1%) cases of pneumothorax and 2 (2.1%) cases of hemoptysis. Conclusion: Computed tomography-guided core needle biopsy of lung lesions demonstrated high rates of material appropriateness and diagnostic specificity, and low rates of complications in the present study. (author)

  5. Patient-Centered Care Transition for Patients Admitted through the ED: Improving Patient and Employee Experience

    Directory of Open Access Journals (Sweden)

    Andrea Algauer BSN, RN

    2015-05-01

    Full Text Available With increasing wait times in emergency departments (ED across America, there is a need to streamline the inpatient admission process in order to decrease wait times and more important, to increase patient and employee satisfaction. One inpatient unit at New York-Presbyterian Weill Cornell Medical Center initiated a program to help expedite the inpatient admission process from the ED. The goal of the ED Bridge program is to ease the patient's transition from the ED to an inpatient unit by visiting the patient in the ED and introducing and setting expectations for the inpatient environment (i.e. telemetry alarms, roommates, hourly comfort rounds. Along with improving the patient experience, this program intends to improve the collaboration between ED nurses and inpatient nurses. With the continued support of our nurse management, hospital administrators and most important, our staff, this concept is aimed to increase patient satisfaction scores and subsequently employee satisfaction.

  6. Experiments and contexts in the interactive exhibitions of centers and museums of science

    Directory of Open Access Journals (Sweden)

    Maura Ventura Chinelli

    2009-12-01

    Full Text Available Here is described a research that meant to indentify, through analysis of experiments and contexts in interactive expositions held by centers and museums of science, the necessary conditions for grasping the scientific culture in the post-positivist conception. The project was developed with the participation of students in training courses for teachers on a proposal based on the principles and methods of action research, in order to form skills that lead to interferences in the professional future. The results show that the samples of interactive exhibits are organized according to the classic paradigm: they offer opportunities for experimentation that produce observational data supposedly neutral and maintain separate nature and human being. In conclusion, we have those exhibits contribute to bringing the visitors closer to the positivistic science, not contributing to bring them closer to the concept of science based on the contemporary paradigm of complexity.

  7. [Lung and heart-lung transplantation in Rabin medical center: early experience with 70 cases].

    Science.gov (United States)

    Kramer, Mordechai R; Saute, Milton; Eidelman, Leonid; Aravot, Dan; Fink, Gershon; Shitrit, David; Izbicky, Gabriel; Izvicky, Gavriel; Dayan, Daniel Ben; Bakal, Ilana; Kogan, Alex; Gendel, Boris; Vidne, Bernardo; Sahar, Gideon

    2004-01-01

    Lung transplantation is a relatively new field in solid organ transplantation. We present our early experience with the first 70 cases at the Rabin Medical Center during the years 1997-2003. Forty seven patients underwent single lung, eight double lung and eight heart-lung transplantations. The patients treated included 49 men and 21 women aged 5-66 years. There were 26 cases with emphysema COPD. 30 patients with pulmonary fibrosis. 5 patients with pulmonary hypertension/Eisenmenger and 9 patients with cystic fibrosis and bronchiectasis. Although early results (1997-1999) showed 1 and 3 year survival of only 50%, in the last 3 years (2000-2003), survival reached 84% and 82% at 1 and 3 years respectively. Improvement in the success rate is due to better patient selection, new immunosuppressive regimen and, most importantly, excellent teamwork. We conclude that lung transplantation is a viable option for selected patients with end-stage lung disease.

  8. Technology Transfer from University-Based Research Centers: The University of New Mexico Experience.

    Science.gov (United States)

    Rogers, Everett M.; Hall, Brad; Hashimoto, Michio; Steffensen, Morten; Speakman, Kristen L.; Timko, Molly K.

    1999-01-01

    A study of 55 research centers at the University of New Mexico investigated the nature of the typical center, why funding has risen during the 1990s, reasons for founding the centers, the director's role, how university-based research centers transfer technology to private companies and other organizations, and what determines program…

  9. Crack-Detection Experiments on Simulated Turbine Engine Disks in NASA Glenn Research Center's Rotordynamics Laboratory

    Science.gov (United States)

    Woike, Mark R.; Abdul-Aziz, Ali

    2010-01-01

    The development of new health-monitoring techniques requires the use of theoretical and experimental tools to allow new concepts to be demonstrated and validated prior to use on more complicated and expensive engine hardware. In order to meet this need, significant upgrades were made to NASA Glenn Research Center s Rotordynamics Laboratory and a series of tests were conducted on simulated turbine engine disks as a means of demonstrating potential crack-detection techniques. The Rotordynamics Laboratory consists of a high-precision spin rig that can rotate subscale engine disks at speeds up to 12,000 rpm. The crack-detection experiment involved introducing a notch on a subscale engine disk and measuring its vibration response using externally mounted blade-tip-clearance sensors as the disk was operated at speeds up to 12 000 rpm. Testing was accomplished on both a clean baseline disk and a disk with an artificial crack: a 50.8-mm- (2-in.-) long introduced notch. The disk s vibration responses were compared and evaluated against theoretical models to investigate how successful the technique was in detecting cracks. This paper presents the capabilities of the Rotordynamics Laboratory, the baseline theory and experimental setup for the crack-detection experiments, and the associated results from the latest test campaign.

  10. Assessing exploitation experiences of girls and boys seen at a Child Advocacy Center.

    Science.gov (United States)

    Edinburgh, Laurel; Pape-Blabolil, Julie; Harpin, Scott B; Saewyc, Elizabeth

    2015-08-01

    The primary aim of this study was to describe the abuse experiences of sexually exploited runaway adolescents seen at a Child Advocacy Center (N=62). We also sought to identify risk behaviors, attributes of resiliency, laboratory results for sexually transmitted infection (STI) screens, and genital injuries from colposcopic exams. We used retrospective mixed-methods with in-depth forensic interviews, together with self-report survey responses, physical exams and chart data. Forensic interviews were analyzed using interpretive description analytical methods along domains of experience and meaning of sexual exploitation events. Univariate descriptive statistics characterized trauma responses and health risks. The first sexual exploitation events for many victims occurred as part of seemingly random encounters with procurers. Older adolescent or adult women recruited some youth working for a pimp. However, half the youth did not report a trafficker involved in setting up their exchange of sex for money, substances, or other types of consideration. 78% scored positive on the UCLA PTSD tool; 57% reported DSM IV criteria for problem substance use; 71% reported cutting behaviors, 75% suicidal ideation, and 50% had attempted suicide. Contrary to common depictions, youth may be solicited relatively quickly as runaways, yet exploitation is not always linked to having a pimp. Avoidant coping does not appear effective, as most patients exhibited significant symptoms of trauma. Awareness of variations in youth's sexual exploitation experiences may help researchers and clinicians understand potential differences in sequelae, design effective treatment plans, and develop community prevention programs. Copyright © 2015 The Authors. Published by Elsevier Ltd.. All rights reserved.

  11. Experience with multimodality telepathology at the University of Pittsburgh Medical Center

    Directory of Open Access Journals (Sweden)

    Liron Pantanowitz

    2012-01-01

    Full Text Available Several modes of telepathology exist including static (store-and-forward, dynamic (live video streaming or robotic microscopy, and hybrid technology involving whole slide imaging (WSI. Telepathology has been employed at the University of Pittsburgh Medical Center (UPMC for over a decade at local, national, and international sites. All modes of telepathology have been successfully utilized to exploit our institutions subspecialty expertise and to compete for pathology services. This article discusses the experience garnered at UPMC with each of these teleconsultation methods. Static and WSI telepathology systems have been utilized for many years in transplant pathology using a private network and client-server architecture. Only minor clinically significant differences of opinion were documented. In hematopathology, the CellaVision® system is used to transmit, via email, static images of blood cells in peripheral blood smears for remote interpretation. While live video streaming has remained the mode of choice for providing immediate adequacy assessment of cytology specimens by telecytology, other methods such as robotic microscopy have been validated and shown to be effective. Robotic telepathology has been extensively used to remotely interpret intra-operative neuropathology consultations (frozen sections. Adoption of newer technology and increased pathologist experience has improved accuracy and deferral rates in teleneuropathology. A digital pathology consultation portal (https://pathconsult.upmc.com/ was recently created at our institution to facilitate digital pathology second opinion consults, especially for WSI. The success of this web-based tool is the ability to handle vendor agnostic, large image files of digitized slides, and ongoing user-friendly customization for clients and teleconsultants. It is evident that the practice of telepathology at our institution has evolved in concert with advances in technology and user experience

  12. Experience with multimodality telepathology at the University of Pittsburgh Medical Center.

    Science.gov (United States)

    Pantanowitz, Liron; Wiley, Clayton A; Demetris, Anthony; Lesniak, Andrew; Ahmed, Ishtiaque; Cable, William; Contis, Lydia; Parwani, Anil V

    2012-01-01

    Several modes of telepathology exist including static (store-and-forward), dynamic (live video streaming or robotic microscopy), and hybrid technology involving whole slide imaging (WSI). Telepathology has been employed at the University of Pittsburgh Medical Center (UPMC) for over a decade at local, national, and international sites. All modes of telepathology have been successfully utilized to exploit our institutions subspecialty expertise and to compete for pathology services. This article discusses the experience garnered at UPMC with each of these teleconsultation methods. Static and WSI telepathology systems have been utilized for many years in transplant pathology using a private network and client-server architecture. Only minor clinically significant differences of opinion were documented. In hematopathology, the CellaVision(®) system is used to transmit, via email, static images of blood cells in peripheral blood smears for remote interpretation. While live video streaming has remained the mode of choice for providing immediate adequacy assessment of cytology specimens by telecytology, other methods such as robotic microscopy have been validated and shown to be effective. Robotic telepathology has been extensively used to remotely interpret intra-operative neuropathology consultations (frozen sections). Adoption of newer technology and increased pathologist experience has improved accuracy and deferral rates in teleneuropathology. A digital pathology consultation portal (https://pathconsult.upmc.com/) was recently created at our institution to facilitate digital pathology second opinion consults, especially for WSI. The success of this web-based tool is the ability to handle vendor agnostic, large image files of digitized slides, and ongoing user-friendly customization for clients and teleconsultants. It is evident that the practice of telepathology at our institution has evolved in concert with advances in technology and user experience. Early and

  13. Heidelberg Ion Therapy Center (HIT): Initial clinical experience in the first 80 patients

    Energy Technology Data Exchange (ETDEWEB)

    Combs, Stephanie E. (Univ. Hospital of Heidelberg, Dept. of Radiation Oncology, Heidelberg (Germany)), E-mail: Stephanie.Combs@med.uni-heidelberg.de; Ellerbrock, Malte; Haberer, Thomas (Heidelberger Ionenstrahl Therapiezentrum (HIT), Im Neuenheimer Feld 450, 69120 Heidelberg (Germany)) (and others)

    2010-10-15

    The Heidelberg Ion Therapy Center (HIT) started clinical operation in November 2009. In this report we present the first 80 patients treated with proton and carbon ion radiotherapy and describe patient selection, treatment planning and daily treatment for different indications. Patients and methods. Between November 15, 2009 and April 15, 2010, 80 patients were treated at the Heidelberg Ion Therapy Center (HIT) with carbon ion and proton radiotherapy. Main treated indications consisted of skull base chordoma (n = 9) and chondrosarcoma (n = 18), malignant salivary gland tumors (n=29), chordomas of the sacrum (n = 5), low grade glioma (n=3), primary and recurrent malignant astrocytoma and glioblastoma (n=7) and well as osteosarcoma (n = 3). Of these patients, four pediatric patients aged under 18 years were treated. Results. All patients were treated using the intensity-modulated rasterscanning technique. Seventy-six patients were treated with carbon ions (95%), and four patients were treated with protons. In all patients x-ray imaging was performed prior to each fraction. Treatment concepts were based on the initial experiences with carbon ion therapy at the Gesellschaft fuer Schwerionenforschung (GSI) including carbon-only treatments and carbon-boost treatments with photon-IMRT. The average time per fraction in the treatment room per patient was 29 minutes; for irradiation only, the mean time including all patients was 16 minutes. Position verification was performed prior to every treatment fraction with orthogonal x-ray imaging. Conclusion. Particle therapy could be included successfully into the clinical routine at the Dept. of Radiation Oncology in Heidelberg. Numerous clinical trials will subsequently be initiated to precisely define the role of proton and carbon ion radiotherapy in radiation oncology.

  14. The Fetus with Ectopia Cordis: Experience and Expectations from Two Centers.

    Science.gov (United States)

    Escobar-Diaz, Maria C; Sunderji, Sherzana; Tworetzky, Wayne; Moon-Grady, Anita J

    2016-12-19

    Ectopia cordis (EC) is a rare congenital anomaly often associated with congenital heart disease (CHD). There is a lack of contemporary information on EC diagnosed prenatally. We sought to combine the experiences of two regional referral centers in order to evaluate current outcomes for EC. Clinical, echocardiographic features and perinatal outcomes of fetuses with EC managed at two large cardiac centers from 1995 to 2014 were retrospectively reviewed. Seventeen fetuses with EC were diagnosed at a median gestational age of 23 weeks (range 17-36). There were 6 thoracic EC and 11 thoracoabdominal. Fifteen had associated CHD: 10 conotruncal defects, 2 tricuspid atresia, 1 aortic stenosis, 1 atrial septal defect, and 1 atrioventricular septal defect. There were 2 terminations of pregnancy, 2 fetal deaths, 2 lost to follow-up, and 11 live born. Mean gestational age at birth was 36.4 weeks (range 26-39). Three patients died shortly after birth with comfort care, and 8 were actively managed. Six patients underwent postnatal cardiac intervention and are currently alive with a mean follow-up of 7.3 years (range 1.4-11.4), 2 of them with chronic dependency on ventilatory support. Two patients without CHD died after attempted chest closure. When diagnosed in utero, a high proportion of pregnancy termination or fetal demise is expected. In our cohort, conotruncal anomalies were the most common associated CHD. Though mortality in actively managed patients was not as high as previously reported, and cardiac surgical intervention may be achieved, EC is still associated with high mortality and significant long-term morbidity.

  15. One center's experiences of 101 cases of kidney transplants from cardiac death donors.

    Science.gov (United States)

    Yuan, Xiao-peng; Han, Ming; Wang, Xiao-ping; Zhou, Jian; Chen, Chuan-bao; He, Xiao-shun

    2014-08-01

    In 2011, a pilot program of organ donation after cardiac death was begun at the First Affiliated Hospital of Sun Yat-sen University, Guangzhou, China, where we hosted one of the largest donation after cardiac death organ transplant programs in the country. We report our initial single-center experiences of kidney transplant from donation after cardiac deaths. From January 2011 to July 2013 at our center, 101 kidney transplants from donation after cardiac death donors were performed. The results of kidney transplants from donation after cardiac death donors were compared with those of 50 kidney transplants from donation after brain death performed during the same time. Delayed graft function occurred more frequently in donation after cardiac death than donation after brain death kidneys (16.8% vs 4.0%; P = .035). There was no difference in the incidence of acute rejection between donation after cardiac death and donation after brain death kidneys (10.9% vs 6.0%). Actual 1-year graft survival rate was similar (donation after cardiac death 94.4% vs donation after brain death 96.2%). Estimated glomerular filtration rate at 12 months was similar between donation after cardiac death and donation after brain death kidneys (73.8 ± 20.0 vs 77.8 ± 22.7 mL/min/1.73 m2). Kidney transplants from donation after cardiac death donors have comparable short-term outcomes to kidney transplants from donation after brain death donors. Donation after cardiac death can play a crucial role in overcoming the organ shortage in China.

  16. Outcomes of adult-to-adult living donor liver transplantation:a single center experience

    Institute of Scientific and Technical Information of China (English)

    FENG Xi; YUAN Ding; WEI Yong-gang; LI Fu-qiang; WEN Tian-fu; ZENG Yong; ZHAO Ji-chun; WANG Wen-tao; XU Ming-qing; YANG Jia-yin; MA Yu-kui; CHEN Zhe-yu; YE Hui; YAN Lü-nan; LI Bo

    2009-01-01

    Background Since January 2002,adult-to-adult living donor liver transplantation (AALDLT) has gained increasing popularity in China in response to the shortage of cadaveric donor livers.This study presents a detailed analysis of the outcomes of AALDLT in a single center.Methods A total of 70 patients underwent AALDLT at our center between January 2002 and January 2007.Among these,67 patients received a right lobe graft without the middle hepatic vein and 3 patients received dual grafts.Three-dimensional volumetric computed tomography,magnetic resonance imaging with angiography and cholangiography were performed preoperatively.Recipient operation time,intraoperative transfusion requirement,length of intensive care unit stay,length of hospital stay,liver function tests,coagulation tests and surgical outcomes were routinely investigated throughout this study.Results All donors survived the procedure with an overall complication rate of 15.3%.Overall recipient 1-year survival and complication rates were 87.1% and 34.2%,respectively.Among the 70 cases,average graft recipient weight ratio was 0.94% (0.72%-1.43%) and average graft volume/standard liver volume ratio was 46.42% (31.74%-71.68%).All residual liver volumes exceeded 35%.Liver function and coagulation recovered rapidly within the first 7 days after transplantation.Conclusions AALDLT is a safe procedure for the donors and an effective therapy for patients with end-stage liver disease.Patient selection and timely decision-making for transplantation are essential in achieving good outcomes.With accumulation of experience in surgery and clinical management,timely feedback and proper modification,we foresee better outcomes in the future.

  17. Toward quality assurance for metaphase FISH: A multi-center experience

    Energy Technology Data Exchange (ETDEWEB)

    Dewald, G. [Mayo Clinic, Rochester, NY (United States); Higgins, R. [Abbott Northwestern Hospital, Minneapolis, MN (United States); Hirsch, B. [Univ. Minnesota Hospitals and Clinics, Minneapolis, MN (United States)] [and others

    1996-09-06

    Although fluorescent in situ hybridization (FISH) is rapidly becoming a part of clinical cytogenetics, no organization sponsors multi-center determinations of the efficacy of probes. We report on 23 laboratories that volunteered to provide slides and to use a probe for SNRPN and a control locus. Experiences with FISH for these laboratories during 1994 ranged from 0 to 645 utilizations (median = 84) involving blood, amniotic fluid and bone marrow. In an initial study of hybridization efficiency, the median percentage of metaphases from normal individuals showing two SNRPN and 2 control signals for slides prepared at each site was 97.0 (range = 74-100); for slides prepared by a central laboratory, it was 97.8 (range = 81.6-100). In a subsequent blind study, each laboratory attempted to score 5 metaphases from each of 23 specimens [8 with del(15)(q11.2{r_arrow}q12) and 15 with normal 15 chromosomes]. Of 529 challenges, the correct SNRPN pattern was found in 5 of 5 metaphases in 457 (86%) and in 4 of 5 in 33 (6%). Ambiguous, incomplete or no results were reported for 32 (6%) challenges. Seven (1%) diagnostic errors were made including 6 false positives and 1 false negative: 1 laboratory made 3 errors, 1 made 2, and 2 made 1 each. Most errors and inconsistencies seemed due to inexperience with FISH. The working time to process and analyze slides singly averaged 49.5 minutes; slides processed in batches of 4 and analyzed singly required 36.9 minutes. We conclude that proficiency testing for FISH using an extensive array of challenges is possible and that multiple centers can collaborate to test probes and to evaluate costs. 10 refs., 1 fig., 4 tabs.

  18. Congenital duodenal obstruction in neonates:a decade's experience from one center

    Institute of Scientific and Technical Information of China (English)

    Qing-Jiang Chen; Zhi-Gang Gao; Jin-Fa Tou; Yun-Zhong Qian; Min-Ju Li; Qi-Xing Xiong; Qiang Shu

    2014-01-01

    Background: Congenital duodenal obstruction (CDO) is one of the most common anomalies in newborns, and accounting for nearly half of all cases of neonatal intestinal obstruction. This study aimed to review our single-center experience in managing congenital duodenal obstruction while evaluate the outcomes. Methods: We conducted a retrospective analysis of the records of all neonates dianogsed with congenital duodenal obstruction admitted to our center between January 2003 and December 2012. We analyzed demographic criteria, clinical manifestations, associated anomalies, radiologic findings, surgical methods, postoperative complications, and fi nal outcomes. Results: The study comprised 287 newborns (193 boys and 94 girls). Birth weight ranged from 950 g to 4850 g. Fifty-three patients were born prematurely between 28 and 36 weeks' gestation. Malrotation was diagnosed in 174 patients, annular pancreas in 66, duodenal web in 55, duodenal atresia or stenosis in 9, preduodenal portal vein in 2, and congenital band compression in 1. Twenty patients had various combinations of these conditions. Presenting symptoms included bilious vomiting, dehydration, and weight loss. X-rays of the upper abdomen demonstrated the presence of a typical doublebubble sign or air-fl uid levels in 68.64% of patients, and confi rmatory upper and/or lower gastrointestinal contrast studies were obtained in 64.11%. Multiple associated abnormalities were observed in 50.52% of the patients. Various surgical approaches were used, including Ladd's procedure, duodenoplasty, duodenoduodenostomy, duodenojejunostomy, or a combination of these. Seventeen patients died postoperatively and 14 required re-operation. Conclusions: Congenital duodenal obstruction is a complex entity with various etiologies and often includes multiple concomitant disorders. Timely diagnosis and aggressive surgery are key to improving prognosis. Care should be taken to address all of the causes of duodenal obstruction and

  19. Minimally invasive esophagectomy for cancer: Single center experience after 44 consecutive cases

    Directory of Open Access Journals (Sweden)

    Bjelović Miloš

    2015-01-01

    Full Text Available Introduction. At the Department of Minimally Invasive Upper Digestive Surgery of the Hospital for Digestive Surgery in Belgrade, hybrid minimally invasive esophagectomy (hMIE has been a standard of care for patients with resectable esophageal cancer since 2009. As a next and final step in the change management, from January 2015 we utilized total minimally invasive esophagectomy (tMIE as a standard of care. Objective. The aim of the study was to report initial experiences in hMIE (laparoscopic approach for cancer and analyze surgical technique, major morbidity and 30-day mortality. Methods. A retrospective cohort study included 44 patients who underwent elective hMIE for esophageal cancer at the Department for Minimally Invasive Upper Digestive Surgery, Hospital for Digestive Surgery, Clinical Center of Serbia in Belgrade from April 2009 to December 2014. Results. There were 16 (36% middle thoracic esophagus tumors and 28 (64% tumors of distal thoracic esophagus. Mean duration of the operation was 319 minutes (approximately five hours and 20 minutes. The average blood loss was 173.6 ml. A total of 12 (27% of patients had postoperative complications and mean intensive care unit stay was 2.8 days. Mean hospital stay after surgery was 16 days. The average number of harvested lymph nodes during surgery was 31.9. The overall 30-day mortality rate within 30 days after surgery was 2%. Conclusion. As long as MIE is an oncological equivalent to open esophagectomy (OE, better relation between cost savings and potentially increased effectiveness will make MIE the preferred approach in high-volume esophageal centers that are experienced in minimally invasive procedures.

  20. Nuclear Energy Experiments to the Center for Global Security and Cooperation.

    Energy Technology Data Exchange (ETDEWEB)

    Osborn, Douglas M. [Sandia National Lab. (SNL-NM), Albuquerque, NM (United States)

    2015-06-01

    This is to serve as verification that the Center 6200 experimental pieces supplied to the Technology Training and Demonstration Area within the Center of Global Security and Cooperation are indeed unclassified unlimited released for viewing.

  1. Hepatobilio-pancreatic robotic surgery: initial experience from a single center institute.

    Science.gov (United States)

    Quijano, Yolanda; Vicente, Emilio; Ielpo, Benedetto; Duran, Hipolito; Diaz, Eduardo; Fabra, Isabel; Malave, Luis; Ferri, Valentina; Plaza, Carlos; Lindemann, Jan Lammel; D'Andrea, Vito; Caruso, Riccardo

    2016-12-30

    The use of robotic surgery in the hepatobilio-pancreatic (HBP) field is still limited. Our aim is to present our early experience of robotic liver resection. A retrospective review of robotic pancreatic and liver resection was performed at Sanchinarro University hospital from October 2010 to April 2016. Since the beginning of the robotic program in our center, 22 hepatic procedures and 45 pancreatic robotic procedures have been performed. Of the 21 patients subjected to liver resection, 13 (65%) were for malignancy. There were two left hepatectomies, one right hepatectomy, one associated liver partition and portal vein ligation staged procedure (both steps by robotic approach), three bisegmentectomies and three segmentectomies, eight wedge resections, and three pericystectomies. The mean operating time was 282 min. The overall conversion rate and postoperative complication rate were 4.7 and 19%, respectively. The mean length of hospital stay was 13.4 days (range 4-64 days). Of the 45 patients subjected to pancreatic resection, 22 were male and 23 female. The average age of all patients was 62 years (range 31-82 years). The mean operating room (OR) time was 370 min (120-780 min). Among the procedures performed were 15 pancreatico-duodenectomies, 19 distal pancreatectomies, and 11 enucleations. All procedures in the HBP area were R0. Our early experience shows that robotic surgery is a safe and feasible procedure in the HBP area. The complication and mortality rates are comparable to those of open surgery, but with the advantages of minimally invasive surgery.

  2. Mental health and solidarity economy: the experience of users and workers of a Psychosocial Care Center

    Directory of Open Access Journals (Sweden)

    Ioneide de Oliveira Campos

    2015-07-01

    Full Text Available This work is within the context of discussions on mental health and solidarity economy. It is an account of the experience lived at the Tabatinga II Psychosocial Care Center (CAPS in the Federal District, Brazil, where projects designed to generate employment and income in the mental health area reaffirm their ability, as tools for social inclusion, to incorporate the principles and values of solidarity economy aiming at the empowerment and autonomy of citizens in mental distress. This work intended to support and encourage reflections on the possibilities for social inclusion arising from the generation of jobs and income through collective and cooperative actions developed and elaborated with the participation of users, family members, and workers of this service. Emphasis on participatory methodology guided the development of the experience, and the proposition of triggering actions on mental health and solidarity economy at different times, under the coordination of the performing team, afforded, concurrently, the realization of two actions/interventions: a group activity designed to service users and their relatives who gathered to learn and reflect on collective work and supportive venture; and three monthly training sessions, from August to December 2013, on cooperativism, solidarity economy, and mental health addressed to the professionals of that CAPS. At the end of these interventions, it was possible to observe that the involvement of people under mental distress in these projects contributes to overcome their current state of subordination and weakness. It is worth mentioning that, in general, the development of these actions favored reflections on the world of collective work and aggregated methodological knowledge on solidarity ventures.

  3. An excellent navigation system and experience in craniomaxillofacial navigation surgery: a double-center study.

    Science.gov (United States)

    Dai, Jiewen; Wu, Jinyang; Wang, Xudong; Yang, Xudong; Wu, Yunong; Xu, Bing; Shi, Jun; Yu, Hongbo; Cai, Min; Zhang, Wenbin; Zhang, Lei; Sun, Hao; Shen, Guofang; Zhang, Shilei

    2016-06-16

    Numerous problems regarding craniomaxillofacial navigation surgery are not well understood. In this study, we performed a double-center clinical study to quantitatively evaluate the characteristics of our navigation system and experience in craniomaxillofacial navigation surgery. Fifty-six patients with craniomaxillofacial disease were included and randomly divided into experimental (using our AccuNavi-A system) and control (using Strker system) groups to compare the surgical effects. The results revealed that the average pre-operative planning time was 32.32 mins vs 29.74 mins between the experimental and control group, respectively (p > 0.05). The average operative time was 295.61 mins vs 233.56 mins (p > 0.05). The point registration orientation accuracy was 0.83 mm vs 0.92 mm. The maximal average preoperative navigation orientation accuracy was 1.03 mm vs 1.17 mm. The maximal average persistent navigation orientation accuracy was 1.15 mm vs 0.09 mm. The maximal average navigation orientation accuracy after registration recovery was 1.15 mm vs 1.39 mm between the experimental and control group. All patients healed, and their function and profile improved. These findings demonstrate that although surgeons should consider the patients' time and monetary costs, our qualified navigation surgery system and experience could offer an accurate guide during a variety of craniomaxillofacial surgeries.

  4. Introducing sexual orientation and gender identity into the electronic health record: one academic health center's experience.

    Science.gov (United States)

    Callahan, Edward J; Sitkin, Nicole; Ton, Hendry; Eidson-Ton, W Suzanne; Weckstein, Julie; Latimore, Darin

    2015-02-01

    Many U.S. populations experience significant health disparities. Increasing health care providers' awareness of and education about sexual orientation (SO) and gender identity (GI) diversity could help reduce health disparities among lesbian, gay, bisexual, and transgender (LGBT) patients. The authors share the University of California, Davis, Health System's (UCDHS's) experience as it became the first U.S. academic health center to formally introduce patient SO/GI demographic data into its electronic health record (EHR) as a step toward reducing LGBT health disparities. Adding these data to the EHR initially met with resistance. The authors, members of the UCDHS Task Force for Inclusion of SO/GI in the EHR, viewed this resistance as an invitation to educate leaders, providers, and staff about LGBT health disparities and to expose providers to techniques for discussing SO/GI with patients. They describe the strategies they employed to effect institutional culture change, including involvement of senior leadership, key informant interviews, educational outreach via grand rounds and resident workshops, and creation of a patient safety net through inviting providers to self-identify as welcoming LGBT patients. The ongoing cultural change process has inspired spin-off projects contributing to an improved climate for LGBT individuals at UCDHS, including an employee organization supporting SO/GI diversity, support for and among LGBT medical learners through events and listservs, development and implementation of an LGBT health curriculum, and creation of peer navigator programs for LGBT patients with cancer. The authors reflect on lessons learned and on institutional pride in and commitment to providing quality care for LGBT patients.

  5. Turner syndrome: review of clinical, neuropsychiatric, and EEG status: an experience of tertiary center.

    Science.gov (United States)

    Saad, Khaled; Abdelrahman, Ahmed A; Abdel-Raheem, Yasser F; Othman, Essam R; Badry, Reda; Othman, Hisham A K; Sobhy, Karema M

    2014-03-01

    We reviewed the clinical, neuropsychiatric, and EEG status of 53 turner syndrome (TS) females, aged 3-16 years, in Assiut university hospitals, Upper Egypt. The diagnosis and care of patients with TS in Egypt is still in the developing stage. Hence this study was undertaken to review the details of patients with TS with respect to the pattern of cognitive, psychiatric, and motor dysfunction. We aimed to provide a comprehensive data about the experience of our center comparable to previous studies, which have been published in this field. This will contribute to a better definition of the neuropsychiatric features that may be specific to TS that allows early and better detection and management of these cases. We found FSIQ and verbal IQ that seem to be at a nearly normal level and a decreased performance IQ. ADHD and autistic symptoms were found in 20.70 and 3.77 % of our cohort, respectively. The motor performance in TS was disturbed, with some neurological deficits present in 17 % (reduced muscle tone and reduced muscle power). In addition, females with TS in our study exhibit social and emotional problems, including anxiety (5.66 %) and depression (11.30 %). The EEG results revealed abnormalities in seven patients (13.20 %). One patient presenting with generalized tonic-clonic seizures showed generalized epileptiform activity, and six patients presenting with intellectual disabilities showed abnormal EEG background activity.

  6. Hyperhemolysis in Patients With Hemoglobinopathies: A Single-Center Experience and Review of the Literature.

    Science.gov (United States)

    Danaee, Anicee; Inusa, Baba; Howard, Jo; Robinson, Susan

    2015-10-01

    Hyperhemolysis is a severe and potentially life-threatening complication of transfusion described in numerous case reports and gaining recognition since 2009 via the UK Serious Hazards of Transfusion scheme. Although it is predominantly seen in patients with sickle cell disease, there are several reports of this complication in patients with other hemoglobinopathies as well as patients with a range of other hematologic diagnoses who have blood transfusions as part of their management. Our understanding of the underlying pathophysiology of this subtype of delayed transfusion reaction has increased over the last few years; however, there are still questions, which remain unanswered. In our center alone, we have encountered 9 cases in the last 5 years both in the adult and pediatric population. Here we discuss our experience in the diagnosis and management of this complication, and review other cases reported in the literature and the various existing theories behind the pathophysiology of this process. We also discuss the role of genotyping and using DNA technology to aid selection of the most appropriate blood for this patient group. With an increased awareness of hyperhemolysis, it would be advantageous to finally develop international registries to determine the true incidence of hyperhemolysis, better understand the pathophysiology, identify markers to predict which patients are at risk, and inform management guidelines.

  7. [Balloon pulmonary valvuloplasty, 15-year experience at the Siglo XXI IMSS National Medical Center].

    Science.gov (United States)

    Juárez Rodríguez, Mariano; Alva Espinosa, Carlos; Ledesma Velasco, Mariano; Lázala Rodríguez, Gustavo; Jiménez Arteaga, Santiago; Sánchez Soberanes, Agustín; Ortegón Cardeña, José; David Gómez, Felipe; Hernández González, Martha; Magaña Serrano, José

    2003-01-01

    To evaluate 15 years of experience with balloon pulmonary valvuloplasty in a single third level health care center. Hundred-fifty patients underwent the procedure, 73 (48%) men and 77 (52%) women, mean age 10.5 +/- 11.3 years. The initial systolic gradient decreased from 86 +/- 35 to 21.67 +/- 12.20 mm Hg, p < 0.001, whereas the initial right ventricular systolic pressure decreased from 106 +/- 34.8 to 53 +/- 27 mm Hg, p < 0.0001. At the end of the follow-up, 48 +/- 44 months, the systolic gradient was 13.43 +/- 8.73 mm Hg, p < 0.001. Major complications occurred in 9 (6.4%) patients. Immediate technical success was achieved in 111 (74%) patients and failure in 39 (26%). At the end of the follow-up period, successful outcomes were achieved in 104 (89.6%); in contrast, failures were present in 12 (10.4%) patients, p < 0.001. Death occurred in 2 (1.33%) patients. The predictors for failure were age < 1.5 +/- 1-33 years (p < 0.004), dysplastic valve (p < 0.001), high initial systolic gradient (p < 0.002), and high initial systolic right ventricular pressure (p < 0.0001). Balloon pulmonary valvuloplasty is an effective, safe, and first choice treatment for congenital pulmonary valve stenosis.

  8. OCCUPATIONAL THERAPY EXPERIENCES IN THE FAMILY HEALTH SUPPORT CENTERS (NASF IN THE DISTRITO FEDERAL

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    Kelly Ranyelle Alves Araujo

    2013-09-01

    Full Text Available To support and expand the care attention and the health management in primary care, in particular the Family Health Strategy, it was created the Family Health Support Centers (NASF. The NASF accounts with several professionals, including occupational therapists, who develop different activities, including health promotion, holistic care and psychosocial rehabilitation. The aim of this article is to discuss from practical experience in a NASF in the metropolitan region of Brasilia how students and practitioners of occupational therapy falls within that service, identifying the main limitations and the work that advances the health care setting. Results: The students and occupational therapist service sought to develop an integrated and intersectoral. Actions were part of the home visits, group approaches with different community groups, active search for users and partnerships in the community. Thus, the work is still very limited assistance and connected to the matricial point of view, as recommended. We conclude that, despite the NASF be a new field of labor for occupational therapists, the actions of social inclusion, empowerment and citizenship developed can encourage healthy habits, but practices need to be revised to follow the proposal of this device.

  9. Transanal surgery for obstructed defecation syndrome: Literature review and a single-center experience

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    Liu, Wei-Cheng; Wan, Song-Lin; Yaseen, SM; Ren, Xiang-Hai; Tian, Cui-Ping; Ding, Zhao; Zheng, Ken-Yan; Wu, Yun-Hua; Jiang, Cong-Qing; Qian, Qun

    2016-01-01

    Obstructed defecation syndrome (ODS) is a functional disorder commonly encountered by colorectal surgeons and gastroenterologists, and greatly affects the quality of life of patients from both societal and psychological aspects. The underlying anatomical and pathophysiological changes of ODS are complex. However, intra-rectal intussusception and rectocele are frequently found in patients with ODS and both are thought to play an important role in the pathogenesis of ODS. With the development of evaluation methods in anorectal physiology laboratories and radiology studies, a great variety of new operative procedures, especially transanal procedures, have been invented to treat ODS. However, no procedure has been proved to be superior to others at present. Each operation has its own merits and defects. Thus, choosing appropriate transanal surgical procedures for the treatment of ODS remains a challenge for all surgeons. This review provides an introduction of the current problems and options for treatment of ODS and a detailed summary of the essential assessments needed for patient evaluation before carrying out transanal surgery. Besides, an overview of the benefits and problems of current transanal surgical procedures for treatment of ODS is summarized in this review. A report of clinical experience of some transanal surgical techniques used in the authors’ center is also presented. PMID:27672293

  10. Infections caused by Fusobacterium in children: a 14-year single-center experience.

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    Shamriz, Oded; Engelhard, Dan; Temper, Violeta; Revel-Vilk, Shoshana; Benenson, Shmuel; Brooks, Rebecca; Tenenbaum, Ariel; Stepensky, Polina; Koplewitz, Benjamin; Kaufmann, Michal; Averbuch, Diana

    2015-12-01

    This study aimed at reviewing our experience with infections caused by Fusobacterium in children. A retrospective analysis of medical records of children admitted to Hadassah-Hebrew University Medical Center from 2000 to 2013, in whom Fusobacterium spp. was identified in any specimen. A total of 22 patients (males = 12) at a mean ± SE age of 5 ± 1 (range 1-17) years, were identified. The most common complication was abscess formation (n = 11, 50 %). Eight children (36.4 %) had intracranial complications, including brain abscess (n = 4), meningitis (n = 4) and cerebral sinus vein thrombosis (CSVT, n = 5). Seventeen children (77 %) had bacteremia. Primary site of infection was otogenic (n = 9), oropharyngeal (n = 7), respiratory (n = 2), sinuses (n = 2), intra-abdominal (n = 1) and mucositis (n = 1). Fourteen cases were caused by Fusobacterium necrophorum, including four cases with CSVT, 7/8 cases of mastoiditis, four of them with subperiosteal abscess formation; all four cases with meningitis and two brain abscesses. Fifteen (68 %) patients required surgical intervention and 3 (14 %) received anti-coagulation therapy. Excluding one patient with overwhelming sepsis with fatal outcome, all patients recovered. Fusobacterium infections in children can cause a diverse spectrum of disease and is associated with high rates of abscess formation and intracranial complications. Although Fusobacterium nucleatum is abundant in the oral cavity, F. necrophorum is the main pathogen that causes severe infections in healthy children.

  11. Retroperitoneal Laparoscopic Nephroureterectomy for Tuberculous Nonfunctioning Kidneys: a single-center experience

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    Xiquan Tian

    2015-04-01

    Full Text Available Purpose To present our surgical techniques and experiences of retroperitoneal laparoscopic nephroureterectomy for the treatment of tuberculous nonfunctioning kidneys. Materials and Methods From March 2005 to March 2013, a total of 51 patients with tuberculous nonfunctioning kidney underwent retroperitoneal laparoscopic nephroureterectomy at our medical center. The techniques included early control of renal vessels and dissection of the diseased kidney along the underlying layer outside the Gerato’s fascia. The distal ureter was dissected through a Gibson incision and the entire specimen was removed en bloc from the incision. Patient demographics, perioperative characteristics and laboratory parameters as well as postoperative outcome were retrospectively reviewed. Results Retroperitoneal laparoscopic nephroureterectomy was successfully performed in 50 patients, whereas one case required conversion to open surgery due to non-progression of dissection. The mean operating time was 123.0 minutes (107-160 minutes and the mean estimated blood loss was 134 mL (80-650 mL.The mean postoperative hospital stay was 3.6 days (3-5days and the mean return to normal activity was 11.6 days (10-14days. Most intra-operative and post-operative complications were minor complications and can be managed conservatively. After 68 months (12-96 months follow-up, the outcome was satisfactory, and ureteral stump syndrome did not occur. Conclusions Retroperitoneal laparoscopic nephroureterectomy as a minimally invasive treatment option is feasible for treatment of tuberculous nonfunctioning kidneys.

  12. Endovascular Aortic Aneurysm Repair for Abdominal Aortic Aneurysm: Single Center Experience in 122 Patients

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    Lee, Yun Young; Song, Jang Hyeon; Kim, Yong Tae; Yim, Nam Yeol; Kim, Jae Kyu; Lee, Ho Kyun; Choi, Soo Jin Na; Chung, Sang Young [Dept. of Radiology, Chonnam National University Hospital, Chonnam National University School of Medicine, Gwangju (Korea, Republic of); Kim, Soo Hyun; Chang, Nam Kyu [Dept. of Radiology, Chonnam National University Hwasun Hospital, Chonnam National University School of Medicine, Hwasun (Korea, Republic of)

    2013-02-15

    To analyze a single center experience of endovascular aneurysm repair (EVAR) for abdominal aortic aneurysms. Results of 122 patients who underwent EVAR were analyzed, retrospectively. Sex, age, aneurysmal morphology, hostile neck anatomy, preprocedural and postprocedural sac-diameter, technical and clinical success, postprocedural complication and need of additional procedure were analyzed. A total of 111 male and 11 female patients were included. Morphology of the aneurysms was as follows: fusiform (n = 108), saccular (n = 3) and ruptured type (n = 11). Sixty-four patients had hostile neck anatomy. The preprocedural mean sac-diameter was 52.4 mm. Postprocedural sac-diameter was decreased or stable in 110 patients (90.2%) and increased in 8 patients (6.6%). Technical success rate was 100% and clinical success rate was 86.1%. Fifty-one patients showed endoleak (41.8%) and 15 patients (12.3%) underwent secondary intervention due to type I endoleak (n = 4), type II endoleak (n = 4) and stent-graft thrombosis (n = 7). EVAR is a safe and effective therapy for abdominal aortic aneurysm, and it has high technical success and clinical success rate, and low complication rate.

  13. Early liver retransplantation versus late liver retransplantation:analysis of a single-center experience

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    CHEN Gui-hua; ZHANG Jun-feng; ZHANG Tong; WANG Guo-ying; FU Bin-sheng; YANG Yang; CAI Chang-jie; LU Min-qiang; LI Hua; WANG Gen-shu; YI Shu-hong; XU Chi

    2008-01-01

    Background Orthotopic liver retransplantation (re-OLT) is the only effective therapy for irreversible failure of a liver graft. Early and late graft failure gives way to two different clinical conditions that should be discussed separately. This study was designed to compare early and late re-OLT for patients with poor graft function after primary transplantation at our center and sum up our clinical experience in re-OLT.Methods The clinical data of 31 re-OLTs at our center from January 2004 to February 2007 were analyzed retrospectively, consisting of the first group with 14 cases of early re-OLT and the second group with 17 cases of late re-OLT.Results Biliary tract complications were the main indications for early re-OLT (57.1%) and late re-OLT (52.9%). Other common indications were vascular complications in early re-OLT and recurrence of primary diseases in late re-OLT. No significant differences were found between the groups with regard to the volume of bleeding during operation, cold ischemia time, operative duration, and perioperative mortality; except for the model of end-stage liver disease (MELD) score. Outcome was fatal for 7 patients in early re-OLT and 9 patients in late re-OLT. Two deaths were due to multiple organ failure with 3 deaths due to severe sepsis-related disease in early re-OLT, and 4 deaths were due to severe sepsis-related disease with 3 deaths due to recurrence of hepatocellular carcinoma (HCC) in late re-OLT. One and 2-year actuarial survival rates after re-OLT were 55.2% and 36.9%, respectively, for patients in early re-OLT, and 65.1% and 52% respectively, for patients in late re-OLT. No significant differences were found regarding survival rates between the two groups.Conclusions Similar clinical results can be achieved in early and late re-OLT. Proper indications and optimal operation timing, adequate preoperative preparation, experienced surgical procedures, and effective perioperative anti-infection strategy contribute to the

  14. Validation of the Memorial Sloan Kettering Cancer Center nomogram for predicting non-sentinel lymph node metastasis in sentinel lymph node-positive breast-cancer patients

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    Bi X

    2015-02-01

    Full Text Available Xiang Bi,1,* Yongsheng Wang,2 Minmin Li,1,* Peng Chen,2 Zhengbo Zhou,2 Yanbing Liu,2 Tong Zhao,2 Zhaopeng Zhang,2 Chunjian Wang,2 Xiao Sun,2 Pengfei Qiu2 1School of Medicine and Life Sciences, University of Jinan-Shandong Academy of Medical Sciences, Shandong Cancer Hospital, 2Breast Cancer Center, Shandong Cancer Hospital, Jinan, People’s Republic of China *These authors contributed equally to this study Background: The main purpose of the study reported here was to validate the clinical value of the Memorial Sloan Kettering Cancer Center (MSKCC nomogram that predicts non-sentinel lymph node (SLN metastasis in SLN-positive patients with breast cancer. Methods: Data on 1,576 patients who received sentinel lymph node biopsy (SLNB at the Shandong Cancer Hospital from December 2001 to March 2014 were collected in this study, and data on 509 patients with positive SLN were analyzed to evaluate the risk factors for non-SLN metastasis. The MSKCC nomogram was used to estimate the probability of non-SLN metastasis and was compared with actual probability after grouping into deciles. A receiver-operating characteristic (ROC curve was drawn and predictive accuracy was assessed by calculating the area under the ROC curve. Results: Tumor size, histological grade, lymphovascular invasion, multifocality, number of positive SLNs, and number of negative SLNs were correlated with non-SLN metastasis (P<0.05 by univariate analysis. However, multivariate analysis showed that tumor size (P=0.039, histological grade (P=0.043, lymphovascular invasion (P=0.001, number of positive SLNs (P=0.001, and number of negative SLNs (P=0.000 were identified as independent predictors for non-SLN metastasis. The trend of actual probability in various decile groups was comparable to the predicted probability. The area under the ROC curve was 0.722. Patients with predictive values lower than 10% (97/492, 19.7% had a frequency of non-SLN metastasis of 17.5% (17/97. Conclusion: The

  15. Advancing user experience research to facilitate and enable patient-centered research: current state and future directions.

    Science.gov (United States)

    Payne, Philip R O

    2013-01-01

    Human-computer interaction and related areas of user experience (UX) research, such as human factors, workflow evaluation, and data visualization, are thus essential to presenting data in ways that can further the analysis of complex data sets such as those used in patient-centered research. However, a review of available data on the state of UX research as it relates to patient-centered research demonstrates a significant underinvestment and consequently a large gap in knowledge generation. In response, this report explores trends in funding and research productivity focused on UX and patient-centered research and then presents a set of recommendations to advance innovation at this important intersection point. Ultimately, the aim is to catalyze a community-wide dialogue concerning future directions for research and innovation in UX as it applies to patient-centered research.

  16. Second-Line Immunosuppressive Treatment of Childhood Nephrotic Syndrome: A Single-Center Experience

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    J. Kim

    2014-01-01

    Full Text Available Objective: Most cases of idiopathic nephrotic syndrome in childhood are responsive to corticosteroids. However, there is a small group of children that demonstrate steroid resistance (steroid-resistant nephrotic syndrome; SRNS, steroid dependence, or that frequently relapse (frequent-relapse steroid-sensitive nephrotic syndrome; FR-SSNS which are more clinically difficult to treat. Therefore, second-line immunosuppressants, such as alkylating agents, calcineurin inhibitors, antimetabolites and, more recently, rituximab, have been used with varying success. The objective was to evaluate the response rates of various second-line therapies in the treatment of childhood nephrotic syndrome. Study Design: A retrospective chart review of pediatric subjects with idiopathic nephrotic syndrome was conducted at a single tertiary care center (2007-2012. Drug responses were classified as complete response, partial response, and no response. Results: Of the 188 charts reviewed, 121 children were classified as SSNS and 67 children as SRNS; 58% were classified as FR-SSNS. Sixty-five subjects were diagnosed with focal segmental glomerulosclerosis via biopsy. Follow-up ranged from 6 months to 21 years. The combined rate of complete and partial response for mycophenolate mofetil (MMF was 65% (33/51 in SSNS and 67% (6/9 in SRNS. For tacrolimus, the response rate was 96% (22/23 for SSNS and 77% (17/22 for SRNS. Eighty-three percent (5/6 of SSNS subjects treated with rituximab went into complete remission; 60% relapsed after B-cell repletion. Eight refractory subjects were treated with combined MMF/tacrolimus/corticosteroid therapy with a 75% response rate. Conclusion: Our experience demonstrates that older medications can be replaced with newer ones such as MMF, tacrolimus, and rituximab with good outcomes and better side effect profiles. The treatment of refractory cases with combination therapy is promising.

  17. Outcome of deceased donor renal transplantation - A single-center experience from developing country

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    Himanshu V Patel

    2013-01-01

    Full Text Available Renal transplantation (RTx is considered as the best therapeutic modality for patient suffering from end-stage renal disease (ESRD. Dearth of donor kidneys is a major problem everywhere, and deceased donor renal transplantation (DDRTx is seen as at least a partial solution. Even so, DDRTx accounts for only less than 4% of RTx in India. We report our 6-year single-center experience on DDRTx vis-à-vis patient/graft survival, graft function in terms of serum creatinine (SCr, rejection episodes, and delayed graft function (DGF. Between January 2005 and March 2011, 236 DDRTx were performed. Majority of the donors were those with brain death due to road traffic/cerebrovascular accidents. The commonest recipient diseases leading to ESRD were chronic glomerulonephritis (42.8%, diabetes (12.7%, and hypertension (10.6%. Mean recipient age was 36.2 ± 14.2 years; 162 were males and 74 were females. Mean donor age was 45.3 ± 17.13 years; 144 were males and 92 were females. Mean dialysis duration pre-transplantation was 18.5 ± 2.5 months. All recipients received single-dose rabbit-anti-thymocyte globulin induction and steroids, calcinueurin inhibitor, and mycophenolate mofetil/azathioprine for maintenance immunosuppression. Delayed graft function was observed in 29.6% patients and 22% had biopsy-proven acute rejection. Over the mean follow-up of 2.18 ± 1.75 years, patient and graft survival rates were 74.57% and 86.8%, respectively, with mean SCr of 1.42 ± 0.66 mg%. DDRTx achieves acceptable graft function with patient/graft survival, encouraging the use of this approach in view of organ shortage.

  18. Thirty-day outcome of carotid artery stenting in Chinese patients: a single-center experience

    Institute of Scientific and Technical Information of China (English)

    JIAO Li-qun; SONG Gang; LI Shen-mao; MIAO Zhong-rong; ZHU Feng-shui; JI Xun-ming; YIN Guo-yang

    2013-01-01

    Background Carotid artery stenting (CAS) as a competing treatment modality has had to adhere to limits to gain widespread acceptance in some studies.This study analyzed the clinical data of 1700 consecutive patients after CAS to retrospectively evaluate the 30-day outcome of CAS for internal carotid artery stenosis in a Chinese population.Methods Medical records of 1700 patients who underwent CAS at Xuanwu Hospital affiliated to Capital Medical University between January 2001 and August 2012 were reviewed.Postoperative 30-day complication rates were analyzed and compared with those of other studies.Univariate and multivariate Logistic regression analyses were used to identify factors associated with perioperation myocardial infarction (MI),stroke,and death.Results The overall 30-day rate of MI,stroke,and death after CAS was 2.53%.In univariate analysis,patients who were symptomatic,had a neurological deficit (modified Rankin score (mRS) ≥3; P=0.001),and who were not taking statins experienced a significantly increased rate of MI,stroke,and death (P=-0.017).In multivariate Logistic regression analysis,the presence of symptoms (odds ratio (OR)=2.485; 95% confidence interval (CI)=1.267-4.876; P=0.008) and a neurological deficit (mRS ≥3) (OR=3.025; 95% CI=1.353-6.763; P=0.007) were independent risk factors for perioperative MI,stroke,and death.Conclusions According to this single-center experience,CAS may effectively prevent and treat carotid artery stenosis that would otherwise lead to stroke.Being symptomatic and having a neurological deficit (mRS ≥3) increased the risk of perioperative MI,stroke,and death.

  19. Multiple clinical presentations of lymphoproliferative disorders in pediatric liver transplant recipients: a single-center experience.

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    Pinho-Apezzato, M L; Tannuri, U; Tannuri, A C A; Mello, E S; Lima, F; Gibelli, N E; Santos, M M; Ayoub, A A; Maksoud-Filho, J G; Velhote, M C; Silva, M M; Andrade, W C; Miyatani, H T

    2010-06-01

    Posttransplantation lymphoproliferative disorder (PTLD) is a serious complication following solid organ transplantation that has been linked to Epstein-Barr virus (EBV) infection. The aim of this article was to describe a single-center experience with the multiplicity of clinical presentations of PTLD. Among 350 liver transplantations performed in 303 children, 13 survivor children displayed a histological diagnosis of PTLD (13/242 survivors; 5.4%). The age at diagnosis ranged from 12 to 258 months (median, 47), and the time from transplantation ranged from 1 to 84 months (median, 13). Ten of these children (76.9%) were EBV-naïve prior to transplantation. Fever was present in all cases. The clinical signs at presentation were anemia (92.3%), diarrhea and vomiting (69.2%), recurrent upper airway infections (38.4%), Waldeyer ring lymphoid tissue hypertrophy (23.0%), abdominal mass lesions (30.7%), massive cervical and mediastinal adenopathy (15.3%), or gastrointestinal and respiratory symptoms (30.7%). One child developed fulminant hepatic allograft failure secondary to graft involvement by PTLD. Polymorphic PTLD was diagnosed in 6 patients; 7 had the diagnosis of lymphoma. Treatment consisted of stopping immunosuppression as well as starting intravenous gancyclovir and anti-CD20 monoclonal antibody therapy. The mortality rate was 53.8%. The clinical presentation of PTLD varied from fever of unknown origin to fulminant hepatic failure. The other symptoms that may be linked to the diagnosis of PTLD are pancytopenia, tonsil and adenoid hypertrophy, cervical or mediastinal lymph node enlargement, as well as abdominal masses. Despite numerous advances, the optimal treatment approach for PTLD is not completely known and the mortality rate is still high.

  20. Congenital bronchopulmonary malformations: A single-center experience and a review of literature

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    Kumar Basant

    2008-01-01

    Full Text Available Purpose: To present a single-center experience with 25 cases of bronchopulmonary malformations and the review the literature. Materials and Methods: We conducted a retrospective analysis of the medical records of patients with congenital bronchopulmonary malformations who were operated between July 1997 and July 2007 in our institute; we examined the modes of presentations, management, and outcome. Outcome of all patients was assessed over a short follow-up period (average 1.8 months. Results: Out of 25 patients, 18 (72% were male and 7 (28% were female. Age of patients ranged from 1 day to 11 years. The histopathological diagnosis was congenital cystic adenomatoid malformations [CCAM; n = 14 (56%], congenital lobar emphysema [CLE; n = 5 (20%], pulmonary sequestrations [PS; n = 3 (12%], and bronchogenic cysts [BC; n = 3 (12%]. Antenatal diagnosis was available in only 2 (8% patients. The common presenting symptoms were respiratory distress and chest infections. Lobectomy was the procedure of choice . Mortality was 16% (n = 4; M: F = 3: 1. Two patients died because of overwhelming sepsis, one from compromised cardiac function, and one from aspiration which might possibly have been prevented. Conclusion: Patients with progressive respiratory distress due to these anomalies may require urgent surgical intervention regardless of age. The surgical outcome is favorable, with manageable complications. Plain x-ray chest and CT of thorax are usually sufficient for diagnosis and planning of treatment. Pathological diagnosis may differ from the imaging diagnosis. Mortality is found to be more in neonates. Apart from initial stabilization, resection of lesion and careful postoperative care is necessary to reduce mortality and morbidity.

  1. Critical care issues in solid organ injury: Review and experience in a tertiary trauma center

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    Chhavi Sawhney

    2014-01-01

    Full Text Available Background and Aim: Solid organ (spleen and liver injuries are dreaded by both surgeons and anesthesiologists because of associated high morbidity and mortality. The purpose of this review is to describe our experience of critical care concerns in solid organ injury, which otherwise has been poorly addressed in the literature. Materials and Methods: Retrospective cohort of solid organ injury (spleen and liver patients was done from January 2010 to December 2011 in tertiary level trauma Center. Results: Out of 624 abdominal trauma patients, a total of 212 patients (70% were admitted in intensive care unit (ICU. Their ages ranged from 6 to 74 years (median 24 years. Nearly 89% patients in liver trauma and 84% patients in splenic trauma were male. Mechanism of injury was blunt abdominal trauma in 96% patients and the most common associated injury was chest trauma. Average injury severity score, sequential organ failure assessment, lactate on admission was 16.84, 4.34 and 3.42 mmol/L and that of dying patient were 29.70, 7.73 and 5.09 mmol/L, respectively. Overall mortality of ICU admitted solid organ injury was 15.55%. Major issues of concern in splenic injury were hemorrhagic shock, overwhelming post-splenectomy infection and post-splenectomy vaccination. Issues raised in liver injury are damage control surgery, deadly triad, thromboelastography guided transfusion protocols and hemostatic agents. Conclusions: A protocol-based and multidisciplinary approach in high dependency unit can significantly reduce morbidity and mortality in patients with solid organ injury.

  2. Critical care issues in solid organ injury: Review and experience in a tertiary trauma center

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    Sawhney, Chhavi; Kaur, Manpreet; Gupta, Babita; Singh, P. M.; Gupta, Amit; Kumar, Subodh; Misra, M. C.

    2014-01-01

    Background and Aim: Solid organ (spleen and liver) injuries are dreaded by both surgeons and anesthesiologists because of associated high morbidity and mortality. The purpose of this review is to describe our experience of critical care concerns in solid organ injury, which otherwise has been poorly addressed in the literature. Materials and Methods: Retrospective cohort of solid organ injury (spleen and liver) patients was done from January 2010 to December 2011 in tertiary level trauma Center. Results: Out of 624 abdominal trauma patients, a total of 212 patients (70%) were admitted in intensive care unit (ICU). Their ages ranged from 6 to 74 years (median 24 years). Nearly 89% patients in liver trauma and 84% patients in splenic trauma were male. Mechanism of injury was blunt abdominal trauma in 96% patients and the most common associated injury was chest trauma. Average injury severity score, sequential organ failure assessment, lactate on admission was 16.84, 4.34 and 3.42 mmol/L and that of dying patient were 29.70, 7.73 and 5.09 mmol/L, respectively. Overall mortality of ICU admitted solid organ injury was 15.55%. Major issues of concern in splenic injury were hemorrhagic shock, overwhelming post-splenectomy infection and post-splenectomy vaccination. Issues raised in liver injury are damage control surgery, deadly triad, thromboelastography guided transfusion protocols and hemostatic agents. Conclusions: A protocol-based and multidisciplinary approach in high dependency unit can significantly reduce morbidity and mortality in patients with solid organ injury. PMID:25538517

  3. Fertility preservation in female cancer patients:a single center experience

    Institute of Scientific and Technical Information of China (English)

    Cristina Sigismondi; Enrico Papaleo; Paola Viganò; Simona Vailati; Massimo Candiani; Jessica Ottolina; Valentina E. Di Mattei; Giorgia Mangili

    2015-01-01

    Advances in cancer treatment allow women to be cured and live longer. However, the necessary chemotherapy and radiotherapy regimens have a negative impact on future fertility. Oncofertility has emerged as a new interdisciplinary field to address the issue of gonadotoxicity associated with cancer treatment and to facilitate fertility preservation, including oocyte and ovarian tissue cryopreservation. These fertility issues are often inadequately addressed, and referral rates to oncofertility centers are low. The aim of this study was to report the 3-year experience of the San Raffaele Oncofertility Unit. A total of 96 patients were referred to the Oncofertility Unit for evaluation after the diagnosis of cancer and before gonadotoxic treatment between April 2011 and June 2014. Of the 96 patients, 30 (31.2%) were affected by breast cancers, 20 (20.8%) by sarcomas, 28 (29.2%) by hematologic malignancies, 13 (13.5%) by central nervous system cancers, 3 (3.1%) by bowel tumors, 1 (1.0%) by Wilms’ tumor, and 1 (1.0%) by a thyroid tumor; 47 (49.0%) were referred for oocyte cryopreservation before starting chemotherapy, 20 (20.8%) were referred for ovarian tissue cryopreservation, and 29 (30.2%) were not recruited. The mean time between the patients’ counseling and oocyte retrieval was 15 days (range, 2–37 days). The mean time between the laparoscopic surgery and the beginning of treatment was 4 days (range, 2–10 days). The number of patients who were referred increased over time, whereas the rate of patients who were not recruited decreased, showing an improvement in referrals to the Oncofertility Unit and in the patients’ counseling and understanding. Our results indicate that an effective multidisciplinary oncofertility team is necessary for prompt referrals and treatment.

  4. CryoPlasty therapy of the superficial femoral and popliteal arteries: a single center experience.

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    Samson, Russell H; Showalter, David P; Lepore, Michael R; Ames, Scott

    Long-term patency remains a significant hurdle in the minimally invasive treatment of arteriosclerosis in the superficial femoral and popliteal arteries. New technologies designed to address the sources of restenosis have recently been introduced. CryoPlasty therapy (Boston Scientific, Natick, Mass) is a new approach designed to significantly reduce injury, elastic recoil, stent implantation, neointimal hyperplasia, and constrictive remodeling. The technique combines the dilatation forces of percutaneous transluminal angioplasty with cold thermal energy applied to the plaque and vessel wall. The cumulative effect of limiting the sources of restenosis with CryoPlasty therapy was shown to demonstrate longer term patency in a prospective, multicenter, Investigational Device Exemption study of the PolarCath Peripheral Dilatation System. The CryoPlasty therapy experience of 1 center is reported, in which 47 lesions in 32 consecutive patients (34 procedures, 33 limbs) were treated. The technical success rate was 96%. There were no type 3 flow-limiting dissections, and only 4 (8.5%) lesions were stented. There were no unanticipated adverse events, specifically no thrombus, acute occlusions, distal embolizations, aneurysms, or groin complications. With an average follow-up of 12 months, only 5 lesions have recurred, 4 requiring re-intervention. The 12-month freedom from restenosis for lesions and limbs treated was 82.2% and 84.4%, respectively. These results are similar to the findings of the Investigational Device Exemption study and are encouraging. CryoPlasty therapy appears to be a viable endovascular therapeutic option to achieve longer term patency without compromising options for future interventions. The lack of early occlusions may be due to a low rate of spiral dissection that may be a particular benefit of this form of angioplasty.

  5. Living Related Donor Kidney Transplantation in Libya: A Single Center Experience

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    Elusta Ahmed

    2008-01-01

    Full Text Available The aim of this study is to report the experience from a single center in Libya, on the prevailing live-related kidney transplantation program. The results of three years work on kidney transplantation at the Tripoli Central Hospital (National Organ Transplant Program in Libya were evaluated. The transplant program was launched on 17 th August, 2004 and 135 patients have been transplanted since then till 17 th August, 2007. All donors and recipients were screened thoroughly prior to transplant and monitored closely in the post-transplant period. Our immuno-suppressive protocol was cyclosporine-based. Among the 135 accepted pairs, donors and reci-pients were genetically-related in 133 cases (98.5% and emotionally-related in two others. The mean donor age was 37 ± 9.5 years (range 18-56 years and recipient age 37 ± 13.6 years (range 7-67 years. There were 95 males (70.4% and 40 females (29.6% among the recipients while among the donors, there were 102 males (75.6% and 33 females (24.4%. Delayed graft function was seen in three patients (2.2%, acute rejection in six (4.4%, post-transplant urinary tract infection in six (4.4%, pneumonia in three (2.2%, ureteric kink in two (1.5% and urine leak in four (3.0%. Graft survival at 36 months was 93.3% while patient survival at the same period was 96.3%. This report indicates that the results of our transplant program are good and comparable with other international programs.

  6. Management of traumatic popliteal vascular injuries in a level I trauma center: A 6-year experience.

    Science.gov (United States)

    Sciarretta, Jason D; Macedo, Francisco Igor B; Otero, Christian A; Figueroa, Jose N; Pizano, Louis R; Namias, Nicholas

    2015-06-01

    Popliteal vascular trauma remains a challenging entity, and carries the greatest risk of limb loss among the lower extremity vascular injuries. Operative management of traumatic popliteal vascular injuries continues to evolve. We aim at describing our experience with such complex injuries, with associated patterns of injury, diagnostic and therapeutic challenges, and outcomes. From January 2006 to September 2011, 191 adult trauma patients presented to an urban level I trauma center in Miami, Florida with traumatic lower extremity vascular injuries. Variables collected included age, gender, mechanism of injury, and clinical status at presentation. Surgical data included vessel injury, technical aspects of repair, associated complications and outcomes. Forty-seven (24.6%) patients were diagnosed with traumatic popliteal vascular injuries. Mean age was 38.1 ± 16.1 years, and the majority of patients were males (43 patients, 91.4%). There were 21 (44.7%) penetrating injuries, and 26 (55.3%) blunt injuries. Vascular repair with saphenous venous interposition graft and PTFE (polytetrafluoroethylene) grafting were performed in 36 (70.7%) and 2 (3.9%) patients, respectively. Blunt popliteal injuries were significantly more associated with major tissue loss, and length of hospital and intensive care unit (ICU) stays. The risk for amputation is increased with longer ICU stays and the use of PTFE grafting for vascular repair. The overall mortality rate in this series was 8.5%. Blunt popliteal vascular injuries are associated with increased morbidity compared to penetrating trauma. Early restoration of blood perfusion, frequent use of interposition grafts with autogenous saphenous vein, and liberal use of fasciotomies play important role to achieve acceptable outcomes. Copyright © 2015 IJS Publishing Group Limited. Published by Elsevier Ltd. All rights reserved.

  7. 47. A cardiac center experience with Brugada syndrome who survived sudden cardiac death

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    I. Suliman

    2016-07-01

    Full Text Available Brugada syndrome is a heritable arrhythmia syndrome that is characterized by an electrocardiographic pattern consisting of coved-type ST-segment elevation (2 mm followed by a negative T wave in the right precordial leads, V1 through V3 (often referred to as type 1 Brugada electrocardiographic pattern, here we describe 3 cases of Brugada who survived sudden cardiac death (SCD cardiac center experience with survived Brugada syndrome patients – case series. First Case: The Father 45 years old male, presented in 2005 after involvement in unprovoked motor vehicle accident, the patient was the driver who lost consciousness and rushed to the hospital. On arrival to our ER and putting the patient on the bed, the ER doctor observed a brief episode of VF on the monitor. The patient was taken to the catheterization Lab , his coronaries were normal. The diagnosis of Brugada was established and the patient received a defibrillator. At That Time all family members were screened and were negative. Second Case: The Son of the first patient 5 years later his 23 years old male rushed to our ER after he lost consciousness, he was passenger in the car of his friend. Third Case: The pilot A military pilot aged a male 35 years old was in very good health when he lost consciousness and brought to the hospital after resuscitation in 2005. He had full invasive cardiac evaluation, subsequently he received a defibrillator in the same admission period, till 2015 he is doing fine. Brugada syndrome is associated with high tendency for sudden cardiac death. In our three cases the first clinical presentation was survived sudden cardiac death (SCD and all three male patients survived. We did not encounter a female patient who survived sudden cardiac death.

  8. Meningitis and Meningoencephalitis among Israel Defense Force Soldiers: 20 Years Experience at the Hadassah Medical Centers.

    Science.gov (United States)

    Pikkel, Yoav Y; Ben-Hur, Tamir; Eliahou, Ruth; Honig, Asaf

    2015-11-01

    Meningitis and meningoencephalitis pose major risks of morbidity and mortality. To describe 20 years of experience treating infections of the central nervous system in Israel Defense Force (IDF) soldiers, including the common presentations, pathogens and sequelae, and to identify risk groups among soldiers. All soldiers who were admitted to the Hadassah University Medical Center (both campuses: Ein Kerem and Mt. Scopus) due to meningitis and meningoencephalitis from January 1993 to January 2014 were included in this retrospective study. Clinical, laboratory and radiologic data were reviewed from their hospital and army medical corps files. Attention was given to patients' military job description, i.e., combat vs. non-combat soldier, soldiers in training, and medical personnel. We identified 97 cases of suspected meningitis or meningoencephalitis. Six were mistakenly filed and these patients were found to have other disorders. Four soldiers were diagnosed with epidural abscess and five with meningitis due to non-infectious in flammatory diseases. Eighty-two soldiers in active and reserve duty had infectious meningitis or meningoencephalitis. Of these, 46 (56.1%) were combat soldiers and 31 (37.8%) non-combat; 20 (29.2%) were soldiers in training, 10 (12.2%) were training staff and 8 (9.8%) were medical staff. The main pathogens were enteroviruses, Epstein-Barr virus an d Neisseria meningitidis. In our series, soldiers in training, combat soldiers and medical personnel had meningitis and meningoencephalitis more than other soldiers. Enteroviruses are highly infectious pathogens and can cause outbreaks. N. meningitidis among IDF soldiers is still a concern. Early and aggressive treatment with steroids should be considered especially in robust meningoencephalitis cases.

  9. New insights into folliculotropic mycosis fungoides (FMF): A single-center experience.

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    Hodak, Emmilia; Amitay-Laish, Iris; Atzmony, Lihi; Prag-Naveh, Hadas; Yanichkin, Natalia; Barzilai, Aviv; Kershenovich, Ruben; Feinmesser, Meora

    2016-08-01

    It is generally accepted that folliculotropic mycosis fungoides (FMF) is usually typified by indurated plaques and tumors mainly on the head/neck and an aggressive course. However, its clinical manifestations have long been recognized to be quite variable, and some studies indicate a better prognosis for certain presentations. We sought to summarize our experience with the clinicopathological presentations of FMF and impact on prognosis. Data were collected retrospectively for adults with FMF followed up prospectively at a tertiary medical center in 1995 through 2014. In all, 34 patients presented with follicle-based patch/flat plaques, keratosis pilaris-like lesions, and/or acneiform lesions, defined clinically as early stage (IA, IB), and 15 presented with follicle-based infiltrated plaques and/or tumors, defined as advanced stage (IIB). The head/neck was involved in all tumor-stage cases, whereas early-stage lesions involved mainly the trunk/limbs. The tumor stage was characterized by more pruritus, heavier perifollicular infiltrates, greater vertical depth, and more frequent presence of eosinophils. On multivariate analysis, infiltrate density was the only significant histopathological discriminator between the stages. Estimated 5-year survival was 0.94 in the early-stage group and 0.69 in the tumor-stage group. Lack of long-term follow-up and relatively small sample are limitations. FMF presents with 2 distinct patterns of clinicopathologic features, early stage and advanced stage, each with different prognostic implications. Copyright © 2016 American Academy of Dermatology, Inc. Published by Elsevier Inc. All rights reserved.

  10. Image-guided chemoport insertion by interventional radiologists: A single-center experience on periprocedural complications

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    Yazmin Yaacob

    2013-01-01

    Full Text Available Purpose: To report our early experience in image-guided chemoport insertions by interventional radiologists. Materials and Methods: This was a cross-sectional study conducted in a tertiary center with 161 chemoport insertions done from June 2008 to June 2010. The chemoports were inserted either at the angiography suite or at the mobile operation theater unit. Ninety percent of the chemoports had right internal jugular vein (IJV as the entry site. Other entry sites included the left IJV, subclavian veins and the inferior vena cava. Immediate and early complications were recorded. All insertions were performed under image guidance with the aid of ultrasound and fluoroscopy. Results: The technical success rate was 99.4%. In terms of immediate complications, there were only two cases of arterial puncture that resolved with local compression. No pneumothorax or air embolism was documented. Twenty-six early complications were recorded. The most common early complication was catheter blockage (12/161; 7.4%, followed by catheter-related infection (9/161; 5.6%. Other complications were catheter malposition, venous thrombosis and catheter dislodgement or leak. A total of 11 (6.8% chemoports had to be removed within 30 days; most of them were due to infections that failed to respond to systemic antibiotic therapy. In terms of place of procedure, there were no significant differences in complication rates between the angiography suite and the mobile operation theater unit. Conclusion: Image-guided chemoport insertion by interventional radiologist gives low periprocedural complication rates. Using right IJV as the entry site, the image guidance gives good success rate with least complication.

  11. Laparoscopic splenectomy: a single center experience. Unusual cases and expanded inclusion criteria for laparoscopic approach.

    Science.gov (United States)

    Marte, Gianpaolo; Scuderi, Vincenzo; Rocca, Aldo; Surfaro, Giuseppe; Migliaccio, Carla; Ceriello, Antonio

    2013-06-01

    Laparoscopic splenectomy (LS) is nowadays considered as the gold standard for most hematological diseases where splenectomy is necessary, but many questions still remain. The aim of this study was to analyze our 5-years experiences consisting of 48 consecutive LS cases in order to assess the optimal approach and the feasibility of the procedure also in malignant diseases and unusual cases such as a primary spleen lymphoma, a big splenic artery aneurism, or a spleen infarct due to a huge pancreatic pseudo-cyst. Forty-eight consecutive patients underwent LS from January 2006 to January 2011 with at least 1-year follow-up. Clinical data and immediate outcome were retrospectively recorded; age, diagnosis, operation time, perioperative transfusion requirement, conversion rate, accessory incision, hospital stay, and complications were analyzed. We had 14 cases of malignant splenic disease, the most frequent malignant diagnosis was non-Hodgkin's lymphoma (12/14, 85.7 %). Splenomegaly (interpole diameter (ID) >20 cm) was observed in 12 cases (25 %) and massive splenomegaly (ID >25 cm) in 3 cases (6.25 %). Conversion to laparotomy occurred in two patients (4.16 %), both associated to uncontrollable bleeding in patients with splenomegaly. Mean operative time was 138 ± 22 min. Mean hospital stay was 4.5 days. Postoperative morbidity rate was 8.8 % for the benign group and 35.7 % in the malignant group. Mortality occurred in 1/48 patients (2.08 %), as a result of overwhelming post-splenectomy infection (OPSI). LS can be performed safely for malignant splenic disease and splenomegaly without any statistically significant increase of morbidity and mortality rate. Conversion rate is increased for massive splenomegaly. LS should be considered as the preferential approach even in patients with malignant disease, splenomegaly, or unusual cases. Massive splenomegaly should be considered as relative contraindication to LS even at experienced centers.

  12. Outcomes of endoscopic dacryocystorhinostomy: Experience of a fellowship trainee at a tertiary care center

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    Saurabh Kamal

    2016-01-01

    Full Text Available Aim: The study aims to report a single trainee's experience of learning and performing endoscopic endonasal dacryocystorhinostomy (En-DCR. Settings and Design: This study was a retrospective, interventional case series. Subjects and Methods: Fifty-four eyes of fifty patients presenting at a tertiary eye care center over 1 year were included in the study. All cases underwent endoscopic DCR with mitomycin-C and silicone intubation. The parameters studied included demographics, clinical features, intraoperative details, and postoperative ostium evaluation. Stent removal and nasal endoscopy were performed at 6 weeks and a further ostium evaluation at 3 and 6 months following surgery. Anatomical success rate was defined as patent irrigation, and functional success rate was defined as positive functional endoscopic dye test and absence of epiphora. Results: Fifty-four eyes of fifty patients were operated, and three cases were lost to follow-up after surgery. The mean age at presentation was 34 (4–75 years. Clinical diagnosis included primary acquired nasolacrimal duct (NLD obstruction in 72% (39/54, acute dacryocystitis in 15% (8/54, failed DCR in 7% (4/54, and persistent congenital NLD obstruction in 5% (3/54. The first five cases needed intervention by the mentor for superior osteotomy. Common variations in anatomical landmarks were posterior location of sac, large ethmoidal bulla, high internal common opening, and thick maxillary bone. Surgical time taken in the last 27 eyes was significantly lesser compared to the surgical duration taken in the initial 27 cases (P < 0.05. Anatomical and functional success rate was 94% (48/51 at 6 months follow-up period. Conclusions: Endoscopic En-DCR has a good success rate when performed by oculoplastic surgery trainees. Nasal anatomical variations, instrument handling, and adaptation to monocular view of endoscope are few of the challenges for beginners. Structured skill transfer can help trainees to learn

  13. Percutaneous closure of secundum atrial septal defects: Experience of a tertiary referral center

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    Ali Hikmet Kırdök

    2012-03-01

    Full Text Available Objectives: This study was aimed to evaluate our clinical experiences and investigate results of percutaneous closure of secundum atrial septal defects (ASD in our clinic.Results: We retrospectively included 70 patients (19 male, 51 female undergoing percutaneous ASD closure procedure with mean age of 36±14.8 (17-75 in our clinic between March 2008 and January 2010. Defect diameter measured by transesophageal echocardiography was 19.7±6.3 mm (6-32 mm. Device size used for percutaneous closure of ASD was 23.7±6.2 (12-36. Devices used for percutaneous closure were nitinol-based devices including Amplatzer (64.7%, Cardiofix (26.7% and biodegredable BioStar (8.6%. The percutaneous closure procedure was successful at 68 of 70 (97% patients. In 2 patients procedure failed. Failure reason was device embolization in one patient and device strut fracture in other; so these 2 patients referred to surgery. During follow up 2 more patients also referred to surgery because of device embolization in first day control. In 3 patients (4.2% supraventricular arrythmias that are converted to sinus by cardioversion are observed. Mean follow up interval was 18.6±9.6 months (1-44 and during this period peripheral vascular complications, cerebrovascular accidents, thrombus on devices, device erosion or death is not observed.Conclusion: Percutaneous closure of secundum ASD which started to replace surgical treatment of ASD in last decades is safe and effective method in short to mid-term period. However because of potentially serious complication risks it should be performed in special centers by operators who are experienced in treating structural heart diseases.

  14. Endovascular treatment of ruptured proximal pica aneurysms: A single-center 5-years experience

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    Vivek Gupta

    2014-01-01

    Full Text Available Background and Purpose: Posterior inferior cerebellar artery (PICA like other intracranial arteries is prone to aneurysm formation. Aneurysms usually arise from the vertebral artery (VA - PICA junction and the proximal segment of the PICA. The use of endovascular treatment as an alternative treatment to surgery has been increasing. We present our last 5 years experience in treating the ruptured proximal PICA aneurysms. Materials and Methods: Retrospective analysis of records of all patients with ruptured VA-PICA junction aneurysms treated at our referral center between July 2008 and July 2013 was performed. Over the last 5 years, we came across 17 patients who had aneurysms of proximal PICA or VA-PICA junction out of which 13 patients underwent endovascular treatment for ruptured saccular VA-PICA junction aneurysms and were the focus of this research. Follow-up studies ranged from 6 months to 3 years. Results: All the patients presented with an acute intracranial hemorrhage on NCCT. All the aneurysms were at VA-PICA junction with partial or complete incorporation of PICA origin in the sac. Endovascular treatment of all the 13 aneurysm was successful in the first attempt. Aneurysms were treated with balloon assisted coiling either by placing the balloon across the VA-PICA junction (n = 3 or in the vertebral artery proper (n = 9. Stent assisted coiling VA-PICA was performed in one aneurysm (n = 1. There was no intra-procedural rupture of the aneurysms. Conclusion: Endovascular therapy of ruptured proximal PICA aneurysms is possible and safe with the use of adjuvant devices and should be considered as first line treatment.

  15. The Brave New World of GEC Evaluation: The Experience of the Rhode Island Geriatric Education Center

    Science.gov (United States)

    Filinson, Rachel; Clark, Phillip G.; Evans, Joann; Padula, Cynthia; Willey, Cynthia

    2012-01-01

    In 2007, the Health Resources Services Administration introduced new mandates that raised the standards on program evaluation for Geriatric Education Centers. Described in this article are the primary and secondary evaluation efforts undertaken for one program within the Rhode Island Geriatric Education Center (RIGEC), the findings from these…

  16. Staff's experiences of a person-centered health education group intervention for people with a persistent mental illness.

    Science.gov (United States)

    Jormfeldt, Henrika; Brunt, David Arthur; Rask, Mikael; Bengtsson, Agneta; Svedberg, Petra

    2013-07-01

    Patient education in mental health care is a conventional intervention to increase patients' knowledge about their illness and treatment. A provider-centered focus in patient education may put patients in a passive role, which can counteract their processes of recovery. There is an increasing emphasis on recovery-oriented practice, an approach that is aligned with the service user perspective, but little is known about health care staff's perspectives on person-centered mental health care. A qualitative approach was used to describe staff's experiences of being group leaders in a person-centered health education intervention in municipal services for persons with a persistent mental illness. The analysis of staff experiences revealed three core categories: (1) implications of the division of responsibility among local authorities, (2) awareness of facilitating factors of growth, and (3) the meaning of dialogue. These formed the theme Preconditions for Person-Centered Care. Further research is required to explore larger economic, political, and social structures as backdrops to person-centered mental health care, from the perspective of service users, families, health professionals, and the community at large.

  17. Evaluating trauma center structural performance: The experience of a Canadian provincial trauma system

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    Lynne Moore

    2013-01-01

    Full Text Available Background: Indicators of structure, process, and outcome are required to evaluate the performance of trauma centers to improve the quality and efficiency of care. While periodic external accreditation visits are part of most trauma systems, a quantitative indicator of structural performance has yet to be proposed. The objective of this study was to develop and validate a trauma center structural performance indicator using accreditation report data. Materials and Methods: Analyses were based on accreditation reports completed during on-site visits in the Quebec trauma system (1994-2005. Qualitative report data was retrospectively transposed onto an evaluation grid and the weighted average of grid items was used to quantify performance. The indicator of structural performance was evaluated in terms of test-retest reliability (kappa statistic, discrimination between centers (coefficient of variation, content validity (correlation with accreditation decision, designation level, and patient volume and forecasting (correlation between visits performed in 1994-1999 and 1998-2005. Results: Kappa statistics were >0.8 for 66 of the 73 (90% grid items. Mean structural performance score over 59 trauma centers was 47.4 (95% CI: 43.6-51.1. Two centers were flagged as outliers and the coefficient of variation was 31.2% (95% CI: 25.5% to 37.6%, showing good discrimination. Correlation coefficients of associations with accreditation decision, designation level, and volume were all statistically significant (r = 0.61, -0.40, and 0.24, respectively. No correlation was observed over time (r = 0.03. Conclusion: This study demonstrates the feasibility of quantifying trauma center structural performance using accreditation reports. The proposed performance indicator shows good test-retest reliability, between-center discrimination, and construct validity. The observed variability in structural performance across centers and over-time underlines the importance of

  18. Axial lumbar interbody fusion: a 6-year single-center experience

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    Zeilstra DJ

    2013-08-01

    Full Text Available Dick J Zeilstra,1 Larry E Miller,2,3 Jon E Block3 1Bergman Clinics, Naarden and NedSpine, Ede, The Netherlands; 2Miller Scientific Consulting, Inc, Arden, NC, USA; 3The Jon Block Group, San Francisco, CA, USA Introduction: The aim of this study is to report our 6-year single-center experience with L5–S1 axial lumbar interbody fusion (AxiaLIF. Methods: A total of 131 patients with symptomatic degenerative disc disease refractory to nonsurgical treatment were treated with AxiaLIF at L5–S1, and were followed for a minimum of 1 year (mean: 21 months. Main outcomes included back and leg pain severity, Oswestry Disability Index score, working status, analgesic medication use, patient satisfaction, and complications. Computed tomography was used to determine postoperative fusion status. Results: No intraoperative complications, including vascular, neural, urologic, or bowel injuries, were reported. Back and leg pain severity decreased by 51% and 42%, respectively, during the follow-up period (both P < 0.001. Back function scores improved 50% compared to baseline. Clinical success, defined as improvement ≥30%, was 67% for back pain severity, 65% for leg pain severity, and 71% for back function. The employment rate increased from 47% before surgery to 64% at final follow-up (P < 0.001. Less than one in four patients regularly used analgesic medications postsurgery. Patient satisfaction with the AxiaLIF procedure was 83%. The fusion rate was 87.8% at final follow-up. During follow-up, 17 (13.0% patients underwent 18 reoperations on the lumbar spine, including pedicle screw fixation (n = 10, total disc replacement of an uninvolved level (n = 3, facet screw fixation (n = 3, facet screw removal (n = 1, and interbody fusion at L4–L5 (n = 1. Eight (6.1% reoperations were at the index level. Conclusion: Single-level AxiaLIF is a safe and effective means to achieve lumbosacral fusion in patients with symptomatic degenerative disc disease. Keywords: Axia

  19. ECTOPIC CUSHING SYNDROME: A 10-YEAR EXPERIENCE FROM A TERTIARY CARE CENTER IN SOUTHERN INDIA.

    Science.gov (United States)

    Sathyakumar, Samantha; Paul, Thomas Vizhalil; Asha, Hesargatta Shyamsunder; Gnanamuthu, Birla Roy; Paul, M J; Abraham, Deepak Thomas; Rajaratnam, Simon; Thomas, Nihal

    2017-08-01

    Ectopic adrenocorticotropic hormone (ACTH) secretion is a less common cause of Cushing syndrome and is seen in 5 to 10% of cases with endogenous hypercortisolemia. We hereby describe our experience of patients with ectopic ACTH syndrome, who have been managed over the past 10 years at a tertiary care center in Southern India. The inpatient and outpatient records of patients from 2006 to 2015 were retrospectively reviewed. The clinical features, clinical history, biochemical values, imaging features, including radiologic findings and positron emission tomography scans, management, details of follow-up, and outcomes, were documented. We compared the biochemical findings in these patients with 20 consecutive patients with Cushing disease (Cushing syndrome of pituitary origin). A total of 21 patients were studied. The median age at presentation was 34 years (range, 19 to 55 years). Seven patients had thymic carcinoid, 7 had bronchial carcinoid, 3 had lung malignancies, 2 had medullary carcinoma thyroid, 1 patient had a pancreatic neuroendocrine tumor, and 1 patient had an occult source of ACTH. The most common clinical features at presentation were muscle weakness (95%), hyperpigmentation (90%), facial puffiness (76%), easy bruising (61%), edema (57%), and striae (52%). Extensive acne was seen in a large number of patients (43%). Only 3 patients (14%) had central obesity. The median 8 am cortisol was 55.5 μg/dL (range, 3.8 to 131 μg/dL), median 8 am ACTH was 207 pg/mL (range, 31.1 to 703 pg/mL), and the median 24-hour urinary free cortisol was 2,484 μg (range, 248 to 25,438 μg). Basal cortisol and ACTH, as well as midnight cortisol and ACTH level, were markedly higher in patients with ectopic Cushing syndrome as compared to patients with Cushing disease. Twelve of 21 patients had developed life-threatening infections by follow-up. Nine patients had undergone surgical intervention to address the primary tumor. However, only 1 patient exhibited a complete cure on

  20. Retinoblastoma: experience of a referral center in the North Region of Portugal

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    Rocha-Bastos R

    2014-05-01

    Full Text Available RA da Rocha-Bastos,1 JR Araújo,1 RS Silva,2 MJ Gil-da-Costa,2 E Brandão,1 NJ Farinha,2,3 F Falcão-Reis,1,4 T Dinah-Bragança1 1Department of Ophthalmology, Hospital São João, 2Hematology and Oncology Unit, Pediatric Hospital, Hospital São João, 3Pediatrics Department, Faculty of Medicine, University of Porto, 4Department of Sense Organs, Faculty of Medicine, University of Porto, Porto, Portugal Purpose: To describe the experience of the Ophthalmology Department of Hospital São João (HSJ, a tertiary health care center in North Region, Portugal, in terms of the diagnosis, treatment, and follow-up of retinoblastoma. Methods: This was a retrospective study of patients diagnosed with retinoblastoma in Hospital São João, between 1978 and 2012. Results: Fifty patients with retinoblastoma were evaluated in our institution between 1978 and 2012. Four patients were excluded due to loss of follow-up. Among the 46 retinoblastoma cases, 33 (71.7% were unilateral and 13 (28.3% bilateral, with a mean age at diagnosis of 22.19 months and 6.92 months, respectively (P<0.001. Leukocoria was the most common presenting sign (36.9%, followed by strabismus (19.6%, a combination of leukocoria and strabismus (8.7%, and buphthalmia (2.2%. Between 1978 and 1992, nine retinoblastoma cases were referred to our hospital, all of them unilateral, and, in each case, enucleation was performed, with or without salvage therapy. Between 1993 and 2012, 18 eyes with retinoblastoma were successfully managed with conservative treatment. Conclusion: Demographic results were generally coincident with previous reports. It is crucial to screen leukocoria in pediatric practice, even in asymptomatic children. The outcome of retinoblastoma treatment in our hospital is similar to other series in developed countries. Keywords: retinoblastoma, leukocoria, strabismus, enucleation, pediatric cancer

  1. Alternative funding for academic medicine: experience at a Canadian Health Sciences Center.

    Science.gov (United States)

    Rosenbaum, Paul; Shortt, S E D; Walker, D M C

    2004-03-01

    In 1994 the School of Medicine of Queen's University in Kingston, Ontario, its clinical teachers, and the three principal teaching hospitals initiated a new approach to funding, the Alternative Funding Plan, a pragmatic response to the inability of fee-for-service billing by clinical faculty to subsidize the academic mission of the health sciences center. The center was funded to provide a package of service and academic deliverables (outputs), rather than on the basis of payment for physician clinical activity (inputs). The new plan required a new governance structure representing stakeholders and raised a number of important issues: how to reconcile the preservation of physician professional autonomy with corporate responsibilities; how to gather requisite information so as to equitably allocate resources; and how to report to the Ontario Ministry of Health and Long-term Care in order to demonstrate accountability. In subsequent iterations of the agreement it was necessary to address issues of flexibility resulting from locked-in funding levels and to devise meaningful performance measures for departments and the center as a whole. The authors conclude that the Alternative Funding Plan represents a successful innovation in funding for an academic health sciences center in that it has created financial stability, as well as modest positive effects for education and research. The Ontario government hopes to replicate the model at the province's other four health sciences centers, and it may have applicability in any jurisdiction in which the costs of medical education outstrip the capacity of faculty clinical earnings.

  2. Measuring User Experience of the Student-Centered e-Learning Environment

    Science.gov (United States)

    Santoso, Harry B.; Schrepp, Martin; Isal, R. Yugo Kartono; Utomo, Andika Yudha; Priyogi, Bilih

    2016-01-01

    The aim of the current study is to develop an adapted version of User Experience Questionnaire (UEQ) and evaluate a learning management system. Although there is a growing interest on User Experience, there are still limited resources (i.e. measurement tools or questionnaires) available to measure user experience of any products, especially…

  3. Report on Ten Years' Experience of Premarital Hemoglobinopathy Screening at a Center in Antalya, Southern Turkey.

    Science.gov (United States)

    Canatan, Duran; Delibas, Serpil

    2016-08-01

    Thalassemia and hemoglobinopathies are a major public health problem in Turkey. Hemoglobinopathy prevention programs (HPPs) were started in 33 provinces situated in Thrace, Marmara, Aegean, Mediterranean and South Eastern regions of Turkey in 2003. A premarital hemoglobinopathy test is mandatory and free of charge in this program. According to the Ministry of Health reports, 46 first level hemoglobinopathy diagnostic centers were established for premarital tests. Within the last 10 years, approximately 79.0% of married individuals per year were screened by the centers. While the percentage of premarital screening tests was 30.0% of all couples in 2003, it reached 86.0% in 2013. The number of newborn with thalassemia and hemoglobinopathies were 272 in 2002 and dropped to 25 in 2013. There has been a 90.0% reduction in affected births. Our hemoglobinopathy diagnostic center was established in 2003 and licensed by the Ministry of Health in 2004. We studied a total of 89,981 blood samples from premarital tests for 10 years and the incidence of β- and α-thalassemia (β- and α-thal) trait was found to be 6.57 and 3.56%, respectively. The distribution of the most common abnormal hemoglobins (Hbs) was: Hb S (HBB: c.20A > T) (0.31%), Hb D-Los Angeles (HBB: c.364G > C) (0.15%), Hb G-Coushatta (HBB: c.68A > C) (0.06%) and Hb E (HBB: c.79G > A) (0.02%). A total of 60 couples, both carrying β-thal trait, were directed to the prenatal diagnosis (PND) center in 10 years. The premarital hemoglobinopathy screening program is running successfully at our center and other centers in Turkey.

  4. Trends in cancer survivors' experience of patient-centered communication: results from the Health Information National Trends Survey (HINTS).

    Science.gov (United States)

    Blanch-Hartigan, Danielle; Chawla, Neetu; Moser, Richard P; Finney Rutten, Lila J; Hesse, Bradford W; Arora, Neeraj K

    2016-12-01

    Two Institute of Medicine reports almost a decade apart suggest that cancer survivors often feel "lost in transition" and experience suboptimal quality of care. The six core functions of patient-centered communication: managing uncertainty, responding to emotions, making decisions, fostering healing relationships, enabling self-management, and exchanging information, represent a central aspect of survivors' care experience that has not been systematically investigated. Nationally representative data from four administrations of the Health Information National Trends Survey (HINTS) was merged with combined replicate weights using the jackknife replication method. Linear and logistic regression models were used to assess (1) characteristics of cancer survivors (N = 1794) who report suboptimal patient-centered communication and (2) whether survivors' patient-centered communication experience changed from 2007 to 2013. One third to one half of survivors report suboptimal patient-centered communication, particularly on core functions of providers helping manage uncertainty (48 %) and responding to emotions (49 %). In a fully adjusted linear regression model, survivors with more education (Wald F = 2.84, p = .04), without a usual source of care (Wald F = 11.59, p trend = .04), this trend did not remain significant in fully adjusted models. Despite increased attention to survivorship, many survivors continue to report suboptimal communication with their health care providers. Survivorship communication should include managing uncertainty about future risk and address survivors' emotional needs. Efforts to improve patient-centered communication should focus on survivors without a usual source of care and in poorer health.

  5. Experiences of CFD simulations at Foster Wheeler Energia Oy`s Karhula R and D center

    Energy Technology Data Exchange (ETDEWEB)

    Hyppaenen, T. [Foster Wheeler Energia Oy, Karhula (Finland). Karhula R and D Center

    1996-12-31

    Karhula R and D Center is specialized in the research of solid fuel combustion based on circulating fluidized bed technology. Since the 1970`s, numerical models have been utilized in process development to enhance fundamental understanding of the technology. Both own and commercial computer models have been used. Until now, a special problem in circulating fluidized beds has been the modeling of dense phase multiphase flow, especially for industrial solid-fuel boilers. This has prevented the Karhula R and D Center from using commercial codes, and as a consequence, own modeling approaches have been necessary. This presentation describes some main points of the modeling activities in circulating fluidized bed boilers. (author)

  6. Further Analyses of the NASA Glenn Research Center Solar Cell and Photovoltaic Materials Experiment Onboard the International Space Station

    Science.gov (United States)

    Myers, Matthew G.; Prokop, Norman F.; Krasowski, Michael J.; Piszczor, Michael F.; McNatt, Jeremiah S.

    2016-01-01

    Accurate air mass zero (AM0) measurement is essential for the evaluation of new photovoltaic (PV) technology for space solar cells. The NASA Glenn Research Center (GRC) has flown an experiment designed to measure the electrical performance of several solar cells onboard NASA Goddard Space Flight Center's (GSFC) Robotic Refueling Mission's (RRM) Task Board 4 (TB4) on the exterior of the International Space Station (ISS). Four industry and government partners provided advanced PV devices for measurement and orbital environment testing. The experiment was positioned on the exterior of the station for approximately eight months, and was completely self-contained, providing its own power and internal data storage. Several new cell technologies including four-junction (4J) Inverted Metamorphic Multi-Junction (IMM) cells were evaluated and the results will be compared to ground-based measurement methods.

  7. [Management of motor disability in rural Sahelian environment. Experience of the center for rehabilitation and devices in Bogande, Burkina Faso].

    Science.gov (United States)

    Condamine, J L; Artigues, S; Catherine, V; Diagnougou, N; Ouoba, T

    1998-01-01

    The center for rehabilitation and fitting of the disabled in Bogande, Burkina Faso has been in operation since 1992. It was created by a non-governmental organization named Actions de Solidarité Internationale (ASI). The primary goal of the center is to provide support devices to restore upright position and mobility and allow social reinsertion especially for disabled persons between the ages of 0 and 20 years. Approximately one hundred people are treated annually. Treatment is delivered either directly in villages or in dispensaries if the disabled person can be brought in with the assistance of family members or health care workers. This policy has enhanced the quality of information, training, and prevention. Patients with severe disabilities beyond the scope of treatment at the center are contraindicated. The activities of the center have been organized with a view to covering costs. A welding shop has been set up to produce aid devices and provide revenues to pay for some services. The major lessons of this experience involve the need for active recruitment in villages, for contraindicating patients with severe untreatable disability, for developing economically sustainable programs, for training management staff, and for good financial planning. In 4 years of operation, the rehabilitation and fitting center has demonstrated its ability to meet the needs of the disabled in Bogande.

  8. Acute Renal Replacement Therapy in Children with Diarrhea-Associated Hemolytic Uremic Syndrome: A Single Center 16 Years of Experience

    OpenAIRE

    Silviu Grisaru; Morgunov, Melissa A.; Samuel, Susan M.; Julian P Midgley; Wade, Andrew W; Tee, James B.; Hamiwka, Lorraine A.

    2011-01-01

    Acute kidney injury (AKI) is becoming more prevalent among hospitalized children, its etiologies are shifting, and new treatment modalities are evolving; however, diarrhea-associated hemolytic uremic syndrome (D+HUS) remains the most common primary disease causing AKI in young children. Little has been published about acute renal replacement therapy (ARRT) and its challenges in this population. We describe our single center's experience managing 134 pediatric patients with D+HUS out of whom 5...

  9. Earth resources programs at the Langley Research Center. Part 1: Advanced Applications Flight Experiments (AAFE) and microwave remote sensing program

    Science.gov (United States)

    Parker, R. N.

    1972-01-01

    The earth resources activity is comprised of two basic programs as follows: advanced applications flight experiments, and microwave remote sensing. The two programs are in various stages of implementation, extending from experimental investigations within both the AAFE program and the microwave remote sensing program, to multidisciplinary studies and planning. The purpose of this paper is simply to identify the main thrust of the Langley Research Center activity in earth resources.

  10. The Structure and Functioning of a Low-Budget Center for Applied Linguistics: The Brazilian Experience.

    Science.gov (United States)

    Gomes de Matos, Francisco

    1980-01-01

    Describes the structure and functioning of the "Centro de Linguistica Aplicada do Instituto de Idiomas Yazigi" of Sao Paulo and comments on its role in promoting applied linguistics studies in Latin America. Also outlines the Center's historical background and its educational services, particularly those related to the teaching of English. (MES)

  11. Understanding and Engagement in Places of Science Experience: Science Museums, Science Centers, Zoos, and Aquariums

    Science.gov (United States)

    Schwan, Stephan; Grajal, Alejandro; Lewalter, Doris

    2014-01-01

    Science museums, science centers, zoos, and aquariums (MCZAs) constitute major settings of science learning with unique characteristics of informal science education. Emphasis will be given to the analysis of four specific characteristics of MCZAs that seem relevant for educational research and practice, namely, conditions of mixed motives and…

  12. The Structure and Functioning of a Low-Budget Center for Applied Linguistics: The Brazilian Experience.

    Science.gov (United States)

    Gomes de Matos, Francisco

    1980-01-01

    Describes the structure and functioning of the "Centro de Linguistica Aplicada do Instituto de Idiomas Yazigi" of Sao Paulo and comments on its role in promoting applied linguistics studies in Latin America. Also outlines the Center's historical background and its educational services, particularly those related to the teaching of…

  13. Treatment Outcome of Pulmonary Tuberculosis in Eastern Taiwan—Experience at a Medical Center

    Directory of Open Access Journals (Sweden)

    Jen-Jyh Lee

    2007-01-01

    Conclusion: The unsatisfactory outcome of pulmonary tuberculosis treatment in this medical center in eastern Taiwan highlights the importance of implementing directly observed treatment short course strategy. Improvement in the quality of data reported by the National Tuberculosis Program is urgently needed. [J Formos Med Assoc 2007;106(1:25-30

  14. Social and Architectural Aspects of Revitalization of Historic Urban Centers: Foreign Experience

    Directory of Open Access Journals (Sweden)

    Indrė Gražulevičiutė-Vileniškė

    2011-03-01

    Full Text Available The structure and architecture of many European cities has started their development during the Middle Ages or even earlier. The historic cores gradually had become centers of contemporary cities and are constantly evolving. They are affected by the tendencies of destruction, initiatives and movements of preservation are also taking place there. The comprehensive works of rehabilitation of Lithuanian historic urban centers were carried out during the period of soviet occupation. The insularity of the Soviet empire, ideological reasons and the absence of the private property has determined certain architectural expressions and solutions for the social problems. After the restoration of the country‘s independence the problems and tendencies typical to Western city centers, such as commercialization and gentrification, started to appear in Lithuanian historic urban cores. This justifies the aim of the article which is to analyze the tendencies of revitalization of historic city centers in Western countries with the main attention to the social and architectural aspects.Article in Lithuanian

  15. Intergenerational Learning at a Nature Center: Families Using Prior Experiences and Participation Frameworks to Understand Raptors

    Science.gov (United States)

    Zimmerman, Heather Toomey; McClain, Lucy Richardson

    2014-01-01

    Using a sociocultural framework to approach intergenerational learning, this inquiry examines learning processes used by families during visits to one nature center. Data were collected from videotaped observations of families participating in an environmental education program and a follow-up task to draw the habitat of raptors. Based on a…

  16. The Structure and Functioning of a Low-Budget Center for Applied Linguistics: The Brazilian Experience.

    Science.gov (United States)

    Gomes de Matos, Francisco

    1980-01-01

    Describes the structure and functioning of the "Centro de Linguistica Aplicada do Instituto de Idiomas Yazigi" of Sao Paulo and comments on its role in promoting applied linguistics studies in Latin America. Also outlines the Center's historical background and its educational services, particularly those related to the teaching of…

  17. Sentinel node biopsy for early-stage oral cavity cancer: the VU University Medical Center experience

    NARCIS (Netherlands)

    Den Toom, I.J.; Heuveling, D.A.; Flach, G.B.; van Weert, S.; Karagozoglu, K.H.; van Schie, A.; Bloemena, E.; Leemans, C.R.; de Bree, R.

    2015-01-01

    Background Sentinel node biopsy (SNB) in head and neck cancer is recently introduced as the staging technique of oral squamous cell carcinoma. We report the results of SNB in patients diagnosed with a T1-T2 oral squamous cell carcinoma and clinically negative (N0) neck in a single center. Methods A

  18. Toxicological consultation data management system based on experience of Pomeranian Center of Toxicology

    Directory of Open Access Journals (Sweden)

    Piotr Maciej Kabata

    2015-10-01

    Full Text Available Background: In this paper the structure of poisonings is described, based on the material collected from tele-toxicology consults by the Pomeranian Center of Toxicology in Gdańsk and harvested from its Electronic Poison Information Management System. In addition, we analyzed conclusions drawn from a 27-month operation of the system. Material and Methods: Data were harvested from the Electronic Poison Information Management System developed in 2012 and used by the Pomeranian Center of Toxicology since then. The research was based on 2550 tele-toxicology consults between January 1 and December 31, 2014. Subsequently the data were electronically cleaned and presented using R programming language. Results: The Pomeranian voivodeship was the prevalent localisation of calls (N = 1879; 73.7%. Most of the calls came from emergency rooms (N = 1495; 58.63%. In the case of 1396 (54.7% patients the time-lag between intoxication and the consult was less than 6 h. There were no differences in the age distribution between genders. Mean age was 26.3 years. Young people predominated among intoxicated individuals. The majority of intoxications were incidental (N = 888; 34.8% or suicidal (N = 814; 31.9% and the most of them took place in the patient’s home. Conclusions: Information about Poison Control Center consultations access should be better spread among medical service providers. The extent of poison information collected by Polish Poison Control Centers should be limited and unified. This should contribute to the increased percentage of properly documented consultations. Additional duties stemming from the need of digital archiving of consults provided, require the involvement of additional staff, leading to the increased operation costs incurred by Poison Control Centers. Med Pr 2015;66(5:635–644

  19. Information Retrieval eXperience (IRX): Towards a Human-Centered Personalized Model of Relevance

    NARCIS (Netherlands)

    Sluis, van der Frans; Broek, van den Egon L.; Dijk, van Betsy; Hoeber, O.; Li, Y.; Huang, X.J.

    2010-01-01

    We approach Information Retrieval (IR) from a User eXperience (UX) perspective. Through introducing a model for Information Retrieval eXperience (IRX), this paper operationalizes a perspective on IR that reaches beyond topicality. Based on a document's topicality, complexity, and emotional value, a

  20. Volume of Cataract Surgery and Surgeon Gender: The Florida Ambulatory Surgery Center Experience 2005 Through 2012.

    Science.gov (United States)

    French, Dustin D; Margo, Curtis E; Campbell, Robert R; Greenberg, Paul B

    2016-01-01

    Cataract is the most common surgically reversible cause of vision loss and the most common major surgical procedure performed in the United States. To understand how gender composition might affect differences in health services, we examined the surgeon gender-specific rates of routine cataract surgery performed in ambulatory surgical centers in Florida. Routine cataract surgeries were identified through the Florida Agency for Health Care Administration (AHCA) ambulatory surgery center dataset. The background of individual surgeons was determined by linking license numbers in the dataset to physician profiles publicly available from AHCA. From 2005 through 2012, women ophthalmologists in Florida performed roughly half the annual rate of cataract surgery as their male counterparts. This difference is not explained by greater time in clinical practice for men. Further investigation into the causes of this gender-volume disparity is warranted to determine what roles choice and barriers may play.

  1. A Proposed Experiment to Study Relaxation Formation of a Spherical Tokamak with a Plasma Center Column

    CERN Document Server

    Hsu, S C

    2006-01-01

    A spherical tokamak (ST) with a plasma center column (PCC) can be formed via driven magnetic relaxation of a screw pinch plasma. An ST-PCC could in principle eliminate many problems associated with a material center column, a key weakness of the ST reactor concept. This work summarizes the design space for an ST-PCC in terms of flux amplification, aspect ratio, and elongation, based on the zero-beta Taylor-relaxed analysis of Tang & Boozer [Phys. Plasmas 13, 042514 (2006)]. The paper will discuss (1) equilibrium and stability properties of the ST-PCC, (2) issues for an engineering design, and (3) key differences between the proposed ST-PCC and the ongoing Proto-Sphera effort in Italy.

  2. Proposed Experiment to Study Relaxation Formation of a Spherical Tokamak with a Plasma Center Column

    Science.gov (United States)

    Hsu, S. C.; Tang, X. Z.

    2007-06-01

    A spherical tokamak (ST) with a plasma center column (PCC) can be formed via driven magnetic relaxation of a screw pinch plasma. An ST-PCC could in principle eliminate many problems associated with a material center column, a key weakness of the ST reactor concept. This work summarizes the design space for an ST-PCC in terms of flux amplification, aspect ratio, and elongation, based on the zero-β Taylor-relaxed analysis of Tang & Boozer [Phys. Plasmas 13, 042514 (2006)]. The paper will discuss (1) equilibrium and stability properties of the ST-PCC, (2) issues for an engineering design, and (3) key differences between the proposed ST-PCC and the ongoing Proto-Sphera effort in Italy.

  3. Male victims of sexual assault; 10 years' experience from a Danish Assault Center

    DEFF Research Database (Denmark)

    Larsen, Mie-Louise; Hilden, Malene

    2016-01-01

    . Of the 62% of male victims who gave information on sexual orientation, 36% reported themselves as heterosexuals. A total of 45.5% had an alcohol intake of more than 5 units in the hours before the assault. Forty two percent reported the assault to the police. The male victims differed from female victims......This study aims to provide descriptive data regarding male victims of sexual assault seen at the Centre for Victims of Sexual Assault in Copenhagen, Denmark. All 55 male victims attending the center in the time period of March 2001 until December 2010 underwent a standardized data collection. Data...... included information on the victim and the sexual assault. Male victims accounted for less than 2% of the total number of visits to the center in this time period. Fifty three percent were between 15 and 24 years. In all cases the perpetrator was male, and 25% were assaulted by more than one perpetrator...

  4. Researching children's health experiences: The place for participatory, child-centered, arts-based approaches.

    Science.gov (United States)

    Carter, Bernie; Ford, Karen

    2013-02-01

    A central concern when conducting qualitative health research with children is eliciting data that genuinely reflect their perspectives. Invariably, this involves being child-centered and participatory. Drawing and photography increasingly accompany dialogic methods to facilitate children's communication through arts-based and verbal modes of expression. However, little literature is available on how arts-based tools shape data. We suggest that researchers need to be attentive to how such tools can liberate, constrain and frame data generated by children, drawing attention to the promises of such approaches as well as the conundrums that can arise from their use. We explore the place for participatory, child-centered, arts-based approaches using examples of the use of drawing and photography in our own studies.

  5. Cytomegalovirus Reactivation in Adult Recipients of Autologous Stem Cell Transplantation: a Single Center Experience

    OpenAIRE

    Al-Rawi, Omar; Abdel-Rahman, Fawzi; Al-Najjar, Rula; Abu-Jazar, Husam; Salam, Mourad; Saad, Mustafa

    2015-01-01

    Introduction Cytomegalovirus (CMV) reactivation and infection are well-recognized complications after allogeneic stem cell transplantation (SCT). Only a few studies have addressed CMV reactivation after autologous SCT (ASCT). Methods We retrospectively reviewed medical records of 210 adult patients who underwent ASCT for lymphoma or multiple myeloma (MM) at a single center from January 1st, 2007 until December 31st, 2012. All patients were monitored weekly with CMV antigenemia test till day 4...

  6. Natalizumab treatment in multiple sclerosis: the experience from two Brazilian MS centers

    OpenAIRE

    Enedina Maria Lobato Oliveira; Renata Faria Simm; Gorana Dasic; Marília Mamprim de Morais; Samira Luiza dos Apostolos Perreira; Dagoberto Callegaro

    2015-01-01

    Objective Analyze the demographics, clinical characteristics, efficacy and safety of natalizumab treatment in Brazilian patients with multiple sclerosis (MS) followed up for at least 12 months, in two tertiary MS care centers in São Paulo.Method We evaluated the effect of natalizumab treatment on annualized relapse rate and disability progression in 75 patients with MS treated with natalizumab for at least 12 months. A subgroup analysis was performed to evaluate efficacy of natalizumab treatm...

  7. OPERATIONAL EXPERIENCE OF THE MUCOVISCIDOSIS CENTER IN THE REPUBLIC OF BASHKORTOSTAN

    Directory of Open Access Journals (Sweden)

    E.N. Akhmadeeva

    2008-01-01

    Full Text Available The article highlights the results of the long term observations over the children, residing in the republic of Bashkortostan and suffering from cystic fibrosis. They particularly dwells on the arrangement of the comprehensive diagnostics, first results of the neonatal screening, peculiar properties of the clinical presentation, issues of the medicated support and social rehabilitation at the republican center of cystic fibrosis.Key words: cystic fibrosis, treatment, social rehabilitation, children, teenagers.

  8. Causes of amenorrhea in Korea: Experience of a single large center

    OpenAIRE

    2014-01-01

    Objective To investigate the causes of amenorrhea in Korean women. Methods Medical records from 1,212 women with amenorrhea who visited the Department of Obstetrics and Gynecology, Asan Medical Center, between January 1989 and December 2011 were retrospectively reviewed. Amenorrhea was categorized as either primary or secondary. Results Primary amenorrhea was identified in 132 of the patients (10.9%) and secondary amenorrhea in 1,080 (89.1%). The most frequent causes of primary amenorrhea wer...

  9. Chromogranin A as serum marker for gastroenteropancreatic neuroendocrine tumors: a single center experience and literature review.

    OpenAIRE

    Christoph J Auernhammer; Christine Spitzweg; Burkhard Göke; Hoffmann, Johannes N.; Herrmann, Karin A.; Alexander Haug; Michael Vogeser; Axel Kuttner; Michael Lauseker; Svenja Nölting

    2012-01-01

    The aim of this study was to assess the clinical sensitivities of the tumor markers chromogranin A (CgA), urinary 5-hydroxyindoleacetic acid (5-HIAA) and alkaline phosphatase (AP) in neuroendocrine tumors (NETs) of the GastroEnteroPancreatic-(GEP-) system depending on tumor primary location and metastatic spread. In a retrospective single-center series, sensitivities were evaluated in serum samples from 110 patients with midgut (n = 62) and pancreatic (n = 48) NETs. CgA levels were analyzed b...

  10. Epidemiological profile of nonmelanoma skin cancer in renal transplant recipients: experience of a referral center

    OpenAIRE

    Ferreira, Flávia Regina; Ogawa, Marilia Marufuji; Nascimento, Luiz Fernando Costa; Tomimori, Jane

    2014-01-01

    BACKGROUND: Nonmelanoma skin cancer is the most common form of cancer in humans and also the malignant disease that is increasingly common among kidney transplant recipients. OBJECTIVE: To determine the epidemiological characteristics of renal transplant recipients with nonmelanoma skin cancer seen at a referral transplantation center. METHODS: Cross-sectional descriptive study with renal transplant recipients presenting nonmelanoma skin cancer, treated at a transplantation referral cente...

  11. Cost analysis of awake versus asleep deep brain stimulation: a single academic health center experience.

    Science.gov (United States)

    Jacob, R Lorie; Geddes, Jonah; McCartney, Shirley; Burchiel, Kim J

    2016-05-01

    OBJECT The objective of this study was to compare the cost of deep brain stimulation (DBS) performed awake versus asleep at a single US academic health center and to compare costs across the University HealthSystem Consortium (UHC) Clinical Database. METHODS Inpatient and outpatient demographic and hospital financial data for patients receiving a neurostimulator lead implant (from the first quarter of 2009 to the second quarter of 2014) were collected and analyzed. Inpatient charges included those associated with International Classification of Diseases, Ninth Revision (ICD-9) procedure code 0293 (implantation or replacement of intracranial neurostimulator lead). Outpatient charges included all preoperative charges ≤ 30 days prior to implant and all postoperative charges ≤ 30 days after implant. The cost of care based on reported charges and a cost-to-charge ratio was estimated. The UHC database was queried (January 2011 to March 2014) with the same ICD-9 code. Procedure cost data across like hospitals (27 UHC hospitals) conducting similar DBS procedures were compared. RESULTS Two hundred eleven DBS procedures (53 awake and 158 asleep) were performed at a single US academic health center during the study period. The average patient age ( ± SD) was 65 ± 9 years old and 39% of patients were female. The most common primary diagnosis was Parkinson's disease (61.1%) followed by essential and other forms of tremor (36%). Overall average DBS procedure cost was $39,152 ± $5340. Asleep DBS cost $38,850 ± $4830, which was not significantly different than the awake DBS cost of $40,052 ± $6604. The standard deviation for asleep DBS was significantly lower (p ≤ 0.05). In 2013, the median cost for a neurostimulator implant lead was $34,052 at UHC-affiliated hospitals that performed at least 5 procedures a year. At Oregon Health & Science University, the median cost was $17,150 and the observed single academic health center cost for a neurostimulator lead implant was

  12. Neuro-Oncology Branch patient experience and expertise | Center for Cancer Research

    Science.gov (United States)

    Experience and Expertise We have more than 20 years of experience working with patients and their physicians to offer a comprehensive approach to patient care. Patients travel from all over the world to be evaluated and treated by our clinical team. The Brain Tumor Clinic sees hundreds of new patients and 2,000–3,000 follow-up patients each year. 

  13. 64-row multi-dector computed tomography coronary image from a center with early experience: first illustration of learning curve

    Institute of Scientific and Technical Information of China (English)

    Sze Piaw CHIN; Tiong Kiam ONG; Wei Ling CHAN; Chee Khoon LIEW; M.Tobias Seyfarth; Fong Yean Yip ALAN; Houng Bang LIEW; Kui Hian SIM

    2006-01-01

    Background and objectives The recent joint ACCF/AHA clinical competence statement on cardiac imaging with multi-detector computed tomography recommended a minimum of 6 months training and 300 contrast examinations, of which the candidate must be directly involved in at least 100 studies. Whether this is adequate to become proficient in interpretation of coronary computed tomogsignificant coronary stenosis in a center with 1 year's experience using a 64-row scanner. Methods A total of 778 patients underwent contrast-enhanced CTA between January and December 2005. Out of these patients, 301 patients also underwent contrast-enhanced conventional coronary angiography (CCA). These patients were divided into 4 groups according to the time the examination was underwent. Group Q1: first quarter of the year (n=20), Group Q2: second quarter (n=128), Group Q3: third quarter (n=134), and Group Results The sensitivity, specificity, positive, and negative predictive values were Q1 - 64%, 89%, 49% and 94%, respectively; Q2 -79%, 96%, 74% and 97%, respectively; Q3 - 78%, 96%, 74%, 97%, respectively, and Q4 - 100% for all. Conclusions In a center with formal training and high caseload, our accuracy in CTA analysis reached a plateau after 6 months experience. Test-bolus protocols produce better image quality and can improve accuracy. New centers embarking on CTA will need to overcome an initial 6-month learning curve depending upon the caseload during which time they should consider correlation with CCA.

  14. Environmental center for integrated waste management: an experience in the Amazon

    Energy Technology Data Exchange (ETDEWEB)

    Jaramillo V, Jairo; Banalcazar, Fernando L.; Noboa Garcia, Gabriel [EnCanEcuador S.A., Houston, TX (United States)

    2004-07-01

    The creation of a large amount of both solid and liquid waste within the petroleum industry should be the reason for providing a facility that makes it possible to apply proper treatment to the waste matter, depending on the degree of complexity, especially if these operations are taking place within or in the area of influence of a national park or a biosphere reserve. EnCanEcuador has invested $1 200,000 in the construction of facilities and equipment for an integrated environmental management center, which will allow us to create in-house resources for the management of waste control. Organic waste is grinded, homogenized with sawdust and placed in a dynamic sanitary fill to form fertilizer. The leachates material will be used as foliage fertilizer. Inorganic waste is classified, grinded, compacted, packed and sent to different recycling companies or in some cases incinerated in a low emission incinerator. Drilling waste: Drilling mud water based potassium nitrate is treated through a de-nitrification process using bioremediation methods. Liquid waste: from well completion, washing vehicles, drains from production stations, is passed through an API separator system into two physical-chemical treatment pits for its later re-injection. Contaminated soil: that may be caused by petroleum activity is treated in a pit where the greatest possible amount of hydrocarbon is recovered by means of hot hydro-washing and is then treated with native bacteria in two land farming centers. Dangerous solid waste is transported to a secure fill for its confinement. Laboratory and Meteorological Station: For the control and monitoring of petroleum activities and to determine climatic variations. Plant nursery: it will have a capacity to produce 300,000 plants a year. Community Cooperatives will manage the center, enforcing our Social responsibility in our daily activities. (author)

  15. Dealing with drug-seeking patients: the Tripler Army Medical Center experience.

    Science.gov (United States)

    Lewis, P; Gaule, D

    1999-12-01

    Patients who exhibit drug-seeking behavior are a chronic problem in most health care delivery settings. In June 1996, Tripler Army Medical Center, a tertiary care hospital serving approximately 300,000 beneficiaries, implemented a sole provider program to identify and help such patients. A multidisciplinary sole provider team assigns a sole provider to identified drug seekers. Twice a year, the team scans a printout of all prescriptions for controlled substances to identify suspicious drug usage patterns. The team also accepts referrals from health care providers. This article describes the program and reports on results, problems encountered, and steps taken to improve its efficacy.

  16. Surgery for gastrointestinal malignant melanoma:Experience from surgical training center

    Institute of Scientific and Technical Information of China (English)

    Thawatchai; Akaraviputh; Satida; Arunakul; Varut; Lohsiriwat; Cherdsak; Iramaneerat; Atthaphorn; Trakarnsanga

    2010-01-01

    AIM:To characterize clinical features,surgery,outcome,and survival of malignant melanoma(MM) of the gastrointestinal(GI) tract in a surgical training center in Bangkok,Thailand. METHODS:A retrospective review was performed for all patients with MM of the GI tract treated at our institution between 1997 and 2007. RESULTS:Fourteen patients had GI involvement either in a metastatic form or as a primary melanoma. Thirteen patients with sufficient data were reviewed. The median age of the patients was 66 years(r...

  17. The experience of a Power Nap Center in the largest city of Brazil

    Directory of Open Access Journals (Sweden)

    Rogerio Santos-Silva

    2016-07-01

    Full Text Available We evaluated the frequency of naps and features of nappers who took a nap in a Power Nap Center located in downtown area of São Paulo. Company database was retrospectively analyzed and 4.625 naps were evaluated (January–December 2014. Most naps (57% lasted 30 min. 33% of subjects took a nap more than once a week (73% male. Progressive growth in the number of naps across the months was observed (January=110 to December=505. Results suggest that the society is sleep deprived and taking a nap during the day could be an important strategy to improve quality of life and increase productivity.

  18. Communication for heath behavior change: experiences lived at the Center for Communication Programs at Johns Hopkins University.

    Directory of Open Access Journals (Sweden)

    Ana Carolina de Oliveira Monteiro dos SANTOS

    2016-01-01

    Full Text Available Sharing experiences is the best way to learn and contribute to the construction of knowledge. It is with this intention that arises this article, a result of the lived experience of the author in workshop taught by the Center for Communication Programs - CCP (Communication Programs Center at Johns Hopkins University in Baltimore, USA, in June 2014. In this workshop intensive of 20 days, with daily classes full-time, the author had the opportunity to study and share experiences with great thinkers and professionals from Johns Hopkins. This promoted contact with the philosophy of the institution and the methodologies they developed and implemented in countries around the world, in order to promote improvements in the health status of populations through strategic planning focused on behavior change communication. This was an experience not just in study and planning communication, but a leadership training experience, withmore aware, engaged and complete professionals and, above all, of self-knowledge and personal growth. An article would not be enough to describe all this experience, so we chose to focus on issues about the institution’s vision on health, the practice of health communication, behavior change and an overview of the essential aspects the methodology developed and used by them, called P process. In this article, the reader will come across a breach of academic theoretical reflections promoted by further technical discussions practices, managerial characteristics. This ends up reflecting the logic implemented by the CCP, which develops the practice based on a broad theoretical framework. And in the same way that the institution does not close in their theories and allows to reinvent itself, this article will also feature the author’s own reflections about some of the issues presented.

  19. Acute nonvariceal upper gastrointestinal bleeding--experience of a tertiary care center in southern India.

    Science.gov (United States)

    Simon, Ebby George; Chacko, Ashok; Dutta, Amit Kumar; Joseph, A J; George, Biju

    2013-07-01

    Over the last few decades, epidemiologic studies from the West have shown changing trends in etiology and clinical outcomes in patients with nonvariceal upper gastrointestinal bleed (NVUGIB). There are limited data from India on the current status of NVUGIB. The aim of this study therefore was to assess the etiological profile and outcomes of patients with NVUGIB at our center. We prospectively studied all patients (≥15 years) who presented with NVUGIB over a period of 1 year. The clinical and laboratory data, details of endoscopy, and course in hospital were systematically recorded. Outcome measures assessed were rebleeding rate, surgery, and mortality. Two hundred and fourteen patients (age, ≥15 years) presented to us with NVUGIB during the study period. The mean age was 49.9 ± 16.8 years and 73.8 % were males. Peptic ulcer was the commonest cause (32.2 %) of NVUGIB. About one third of patients required endoscopic therapy. Rebleeding occurred in 8.9 % patients, surgery was required in 3.7 %, and mortality rate was 5.1 %. Rebleeding and mortality were significantly higher among inpatients developing acute NVUGIB compared to those presenting directly to the emergency room. Peptic ulcer was the most common cause of NVUGIB. Outcomes (rebleed, surgery, and mortality) at our center appear similar to those currently being reported from the West.

  20. De novo cancers following liver transplantation: a single center experience in China.

    Science.gov (United States)

    Yu, Songfeng; Gao, Feng; Yu, Jun; Yan, Sheng; Wu, Jian; Zhang, Min; Wang, Weilin; Zheng, Shusen

    2014-01-01

    De novo cancers are a growing problem that has become one of the leading causes of late mortality after liver transplantation. The incidences and risk factors varied among literatures and fewer concerned the Eastern population. The aim of this study was to examine the incidence and clinical features of de novo cancers after liver transplantation in a single Chinese center. 569 patients who received liver transplantation and survived for more than 3 months in a single Chinese center were retrospectively reviewed. A total of 18 de novo cancers were diagnosed in 17 recipients (13 male and 4 female) after a mean of 41 ± 26 months, with an overall incidence of 3.2%, which was lower than that in Western people. Of these, 8 (3.32%) cases were from 241 recipients with malignant liver diseases before transplant, while 10 (3.05%) cases were from 328 recipients with benign diseases. The incidence rates were comparable, p = 0.86. Furthermore, 2 cases developed in 1 year, 5 cases in 3 years and 11 cases over 3 years. The most frequent cancers developed after liver transplantation were similar to those in the general Chinese population but had much higher incidence rates. Liver transplant recipients were at increased risk for developing de novo cancers. The incidence rates and pattern of de novo cancers in Chinese population are different from Western people due to racial and social factors. Pre-transplant malignant condition had no relationship to de novo cancer. Exact risk factors need further studies.

  1. Clinicopathologic spectrum of Waldenström′s macroglobulinemia: A single center experience

    Directory of Open Access Journals (Sweden)

    Sajid Raihan

    2010-07-01

    Full Text Available Waldenström′s Macroglobulinemia (WM is a B cell neoplasm characterized by infiltration of the bone marrow by a lymphoplasmacytic infiltrate and an IgM monoclonal gammopathy. We report a 15-year review of patients diagnosed with WM at our center. A total of 18 patients were diagnosed and treated at our center during the study period. Neurological symptoms were seen in almost 95% while B symptoms were present in almost 80% of patients. More than two-thirds of patients were anemic at the time of presentation and more than 90% showed bone marrow infiltration with lymphoplasmacytoid cells. Anemia, B symptoms, splenomegaly and neurological symptoms were the primary reasons in the majority of patients to initiate treatment. Chlorambucil was the primary treatment in more than half the patients followed by CVP. The median overall survival in all patients was 29 months (range 22-81 months. WM is a rare disorder and novel therapeutic modalities need to be identified to improve survival in these patients.

  2. Rapid steroid discontinuation for pediatric renal transplantation: a single center experience.

    Science.gov (United States)

    Lau, Keith K; Haddad, Maha N; Berg, Gerre M; Perez, Richard V; Butani, Lavjay

    2007-08-01

    To determine the outcomes of pediatric renal transplant recipients who received immunosuppression consisting of early withdrawal of corticosteroids at a single Northern California center. Protocols using minimal steroid exposure have been recently reported in adult transplant recipients with successful results. We examined the outcomes of pediatric renal transplant recipients who were managed at our center using a protocol with very early discontinuation of steroids after renal transplantation. We retrospectively studied the medical records of all renal transplant recipients followed at the Children's Hospital at the University of California, Davis Medical Center from 01/2004 to 12/2005. All patients were less than 18 yr of age at the time of transplantation. The immunosuppressive protocol included three tapering daily doses of methylprednisolone, together with five doses of thymoglobulin followed by maintenance therapy with tacrolimus and MMF. Eight patients with equal numbers of males and females were transplanted during this time period. There were equal numbers of Caucasians, African-Americans, Hispanics, and Asians. A total of 37.5% (3/8) of the subjects received preemptive transplantation, 25% (2/8) received peritoneal, and 37.5% (3/8) received hemodialysis before transplantation. The median (range) age at transplantation was 12.3 (3.1-16.0) year with a follow-up of 1.7 (0.9-2.8) year. At one yr post-transplantation, 57% (4/7) of patients still required anti-hypertensives. Three children required erythropoietin supplementation after transplantation. The mean delta height standard deviation score at 12 months was 0.20 +/- 0.56. There were no episodes of clinical acute rejection. One patient switched from tacrolimus to sirolimus due to biopsy-proven CAN. No patient became diabetic or required hypoglycemic agents. Surveillance biopsies showed no subclinical acute rejection in any patient. Steroid-free immunosuppression is safe in children after renal

  3. Charcot Neuropathic Arthropathy of the Foot: A Literature Review and Single-Center Experience

    Science.gov (United States)

    Shaikh, Haroun Hassan

    2016-01-01

    Charcot neuropathic osteoarthropathy of the foot is a relatively common complication of diabetic neuropathy. Incorrect diagnosis and improper treatment often result in the extremity having to be amputated. This paper summarises the current view on the etiology, diagnostics, and treatment of diabetic Charcot neuropathic osteoarthropathy, with particular focus on preserving the extremity through surgical intervention from our own experiences. PMID:27656656

  4. Charcot Neuropathic Arthropathy of the Foot: A Literature Review and Single-Center Experience

    OpenAIRE

    Tomas Kucera; Haroun Hassan Shaikh; Pavel Sponer

    2016-01-01

    Charcot neuropathic osteoarthropathy of the foot is a relatively common complication of diabetic neuropathy. Incorrect diagnosis and improper treatment often result in the extremity having to be amputated. This paper summarises the current view on the etiology, diagnostics, and treatment of diabetic Charcot neuropathic osteoarthropathy, with particular focus on preserving the extremity through surgical intervention from our own experiences.

  5. Charcot Neuropathic Arthropathy of the Foot: A Literature Review and Single-Center Experience

    Directory of Open Access Journals (Sweden)

    Tomas Kucera

    2016-01-01

    Full Text Available Charcot neuropathic osteoarthropathy of the foot is a relatively common complication of diabetic neuropathy. Incorrect diagnosis and improper treatment often result in the extremity having to be amputated. This paper summarises the current view on the etiology, diagnostics, and treatment of diabetic Charcot neuropathic osteoarthropathy, with particular focus on preserving the extremity through surgical intervention from our own experiences.

  6. The Manuel Lujan, Jr. Neutron Scattering Center LANSCE experiment reports 1989 run cycle

    Energy Technology Data Exchange (ETDEWEB)

    Hyer, D.K.; DiStravolo, M.A. (comps.)

    1990-10-01

    This report contains a listing and description of experiments carried on at the LANSCE neutron scattering facility in the following areas: High Density Powder Diffraction; Neutron Powder Diffractometer, (NPD); Single Crystal Diffractometer, (SCD); Low-Q Diffractometer, (LQD); Surface Profile Analysis Reflectometer, (SPEAR); Filter Difference Spectrometer, (FDS); and Constant-Q Spectrometer.

  7. Evaluating the experiences with an Information and Referral Center (IRC) following a large air crash disaster.

    NARCIS (Netherlands)

    Brake, H. te; Duckers, M.L.; Drogendijk, A.N.

    2017-01-01

    Study/Objective: To evaluate the use of, and experiences with a ‘one-stop-shop’ website for information and referral for bereaved people following an air crash disaster. Background: On July 17, 2014 the disaster of Flight MH17 (Malaysia Airlines) took place above Eastern Ukraine. None of the 298

  8. Online Digital Archives Technology That Supports Rich, Student-Centered Learning Experiences

    Science.gov (United States)

    Hofer, Mark

    2004-01-01

    Today's students watch the newest movie trailers on the Web, share music files, play video games with other players over the Internet, and swap digital pictures of the latest teen idols. Donald Tapscott points out in his book Growing Up Digital that as this rich multimedia experience becomes more a part of students' lives outside of school, they…

  9. Managing Disaster Recovery Centers on Campus: The Experience of Southeastern Louisiana University

    Science.gov (United States)

    Lawrence, Heather; Shafer, Duane

    2007-01-01

    When Hurricane Katrina hit the Gulf Coast in August 2005, Southeastern Louisiana University was spared the brunt of the storm and was fortunate that most structures on campus remained intact. However, the storm still affected the campus for weeks. This article reflects on the experiences of university leaders and facility managers as they provided…

  10. Extracorporeal Membrane Oxygenation Support in Neonates: A Single Medical Center Experience in Taiwan

    Directory of Open Access Journals (Sweden)

    Chi-Man Kuok

    2017-08-01

    Conclusion: This is the first report for ECMO in neonatal disease in Taiwan. We achieved an overall survival rate of 59.2% with good neurological outcomes in this 10-year experience. ECMO could be a useful transportation tool for critical neonates who have a poor response to ventilator support.

  11. Renal angiomyolipoma in Indian population - a single center experience and review of literature

    Directory of Open Access Journals (Sweden)

    Sanjay Gogoi

    2001-01-01

    Conclusion: Our experience validates the presently accepted recommendation of conservative management in renal AML less than 4 cm in size with regard to probability of complications. However we found a poor correlation between tumor size and severity of symptoms and early intervention may be judiciously offered for relief of symptoms.

  12. Experience Transitioning Models and Data at the NOAA Space Weather Prediction Center

    Science.gov (United States)

    Berger, Thomas

    2016-07-01

    The NOAA Space Weather Prediction Center has a long history of transitioning research data and models into operations and with the validation activities required. The first stage in this process involves demonstrating that the capability has sufficient value to customers to justify the cost needed to transition it and to run it continuously and reliably in operations. Once the overall value is demonstrated, a substantial effort is then required to develop the operational software from the research codes. The next stage is to implement and test the software and product generation on the operational computers. Finally, effort must be devoted to establishing long-term measures of performance, maintaining the software, and working with forecasters, customers, and researchers to improve over time the operational capabilities. This multi-stage process of identifying, transitioning, and improving operational space weather capabilities will be discussed using recent examples. Plans for future activities will also be described.

  13. Metastases of esophageal carcinoma to skeletal muscle:Single center experience

    Institute of Scientific and Technical Information of China (English)

    Jan Cincibuch; Miroslav Myslive(c)ek; Bohuslav Melichar; (C)estmír Neoral; Iva Metelková; Michaela Zezulová; Hana Procházková-(S)tudentová

    2012-01-01

    Metastases of esophageal carcinoma to the skeletal muscle are rare,but the incidence may be increasing because of better diagnosis resulting from widespread use of positron emission tomography/computed tomography (PET/CT).A cohort of 205 patients with esophageal carcinoma treated at our center who had PET/CT between 2006 and 2010 was retrospectively evaluated for the presence of skeletal muscle metastases.Four patients had skeletal muscle metastases of esophageal carcinoma,including two patients with squamous cell carcinoma.In another patient with squamous cell carcinoma of the esophagus and synchronous skeletal muscle metastases,muscle metastases were subsequently shown to be related to second primary pancreatic adenocarcinoma.In all cases,skeletal muscle metastases were the first manifestation of systemic disease.In three patients palliation was obtained with the combination of external beam radiation therapy,systemic chemotherapy or surgical resection.Skeletal muscle metastases are a rare complication of esophageal carcinoma.

  14. Using the accreditation journey to achieve global impact: UHN's experience at the Kuwait Cancer Control Center.

    Science.gov (United States)

    Ladha-Waljee, Nafeesa; McAteer, Stephen; Nickerson, Veronica; Khalfan, Adil

    2014-01-01

    On January 1, 2011, Princess Margaret Cancer Centre (PM) - University Health Network (UHN) began a five-year partnership agreement with the Kuwait Ministry of Health's Kuwait Cancer Control Center (KCCC) to enhance cancer care services. Over the course of the partnership, opportunities for improvement were identified by UHN experts in order to accelerate KCCC's development toward subspecialty cancer care. Many of these opportunities involved building a robust infrastructure to support foundational hospital operation processes and procedures. Harnessing UHN's own successes in accreditation, the partnership took advantage of the national accreditation mandate in Kuwait to initiate a quality program and drive clinical improvement at KCCC. This resulted in improved staff engagement, better awareness and alignment of administration with clinical management and a stronger patient safety culture. This article discusses the successes and lessons learned at KCCC that may provide insight to healthcare providers implementing Accreditation Canada International's accreditation framework in other countries and cultures.

  15. Outcome science in practice: an overview and initial experience at the Vanderbilt Spine Center.

    Science.gov (United States)

    McGirt, Matthew J; Speroff, Theodore; Godil, Saniya Siraj; Cheng, Joseph S; Selden, Nathan R; Asher, Anthony L

    2013-01-01

    In terms of policy, research, quality improvement, and practice-based learning, there are essential principles--namely, quality, effectiveness, and value of care--needed to navigate changes in the current and future US health care environment. Patient-centered outcome measurement lies at the core of all 3 principles. Multiple measures of disease-specific disability, generic health-related quality of life, and preference-based health state have been introduced to quantify disease impact and define effectiveness of care. This paper reviews the basic principles of patient outcome measurement and commonly used outcome instruments. The authors provide examples of how utilization of outcome measurement tools in everyday neurosurgical practice can facilitate practice-based learning, quality improvement, and real-world comparative effectiveness research, as well as promote the value of neurosurgical care.

  16. Neonatal screening of hearing function by otoacustic emissions: A single center experience

    Directory of Open Access Journals (Sweden)

    Živić Ljubica

    2012-01-01

    Full Text Available Background/Aim. Nowadays development of techniques enables detection of hearing impairment in a very short time, immediately after birth by using otoacoustic emissions. They are low-pitched sounds produced in physiologically clear cochlea and can be recorded in cochlear outer meatus. By this method, complete data are found on a whole presynaptic auditory nervous system functioning that has mostly been affected by pathological changes making it a perfect screening test. Reliability and sensibility of this method is up to 98%. The aim of this study was to present the first results of systematic neonatal screening of hearing function by otoacoustic emissions in the Clinical Center Kragujevac (Kragujevac, Serbia. Methods. This prospective study of neonatal hearing screening function, initiated systematically by the 2008 at the Clinical Center Kragujevac, included full-term newborns and premature born ones, within the first 24 h after birth, using a DPOAEs interacoustics otoread-screener. Retesting was done after a month. Results. From January 1st, 2009 to December 1st, 2010, a total number of examined infants by this method was 1,994 out of which 1,778 were full-term and 216 were premature born. The test passing was higher in the group of full-term babies (92.5% than in the preterm ones (55.1%. No bilateral answers were recorded in premature born children compared to the full-term ones, of whom a larger number was with missing lateral responses. The results of re-examination test in the group of full-term born and premature newborns were 83.7%, and 61%, respectively. Conclusion. Deliberately provoked transient otoacoustic emission is an efficient method in testing hearing function in newborns, since it is non-invasive, rapid and objective. Its correlation with audibly evoked potentials is very high, which confirms its reliability.

  17. Blood blister-like aneurysms: single center experience and systematic literature review.

    Science.gov (United States)

    Gonzalez, Ana Marcos; Narata, Ana Paula; Yilmaz, Hasan; Bijlenga, Philippe; Radovanovic, Ivan; Schaller, Karl; Lovblad, Karl-Olof; Pereira, Vitor Mendes

    2014-01-01

    Blood blister-like aneurysms (BBAs) are a controversial entity. They arise from non-branching sites on the supraclinoid internal carotid artery (ICA) and are suspected to originate from a dissection. Our aim is to describe the BBA cases seen in our center and to present a systematic review of the literature on BBAs. We analyzed the eleven cases of BBA admitted to our center from 2003 to 2012. We assessed the medical history, treatment modality (endovascular and/or surgery), complications and clinical outcome. The cohort included 8 women and 4 men with a mean age of 53.16 years. Treatment of the BBA consisted of stenting and coiling in 5 patients, stenting only in 4 patients, coiling and clipping in 1 patient, clipping only in 1 patient, and conservative treatment in 1 patient. A good outcome was found in 10 patients, as defined by a modified Rankin Scale (mRS) less than or equal to two at three months. A systematic review of the literature was performed, and 314 reported patients were found: 221 patients were treated with a primarily surgical approach, and 87 patients were treated with a primarily endovascular approach. A rescue or second treatment was required in 46 patients (21%). The overall estimated treatment morbidity rate was 17%, and the mortality rate was 15%. BBAs exhibit more aggressive behavior compared to saccular aneurysms, and more intra-operative complications occur with BBAs, independent of the treatment type offered. They are also significantly more likely to relapse and rebleed after treatment. Endovascular treatment offers a lower morbidity-mortality compared with surgical approaches. Multilayer flow-diverting stents appear to be a promising strategy. Copyright © 2013 The Authors. Published by Elsevier Ireland Ltd.. All rights reserved.

  18. De novo cancers following liver transplantation: a single center experience in China.

    Directory of Open Access Journals (Sweden)

    Songfeng Yu

    Full Text Available BACKGROUND: De novo cancers are a growing problem that has become one of the leading causes of late mortality after liver transplantation. The incidences and risk factors varied among literatures and fewer concerned the Eastern population. AIMS: The aim of this study was to examine the incidence and clinical features of de novo cancers after liver transplantation in a single Chinese center. METHODS: 569 patients who received liver transplantation and survived for more than 3 months in a single Chinese center were retrospectively reviewed. RESULTS: A total of 18 de novo cancers were diagnosed in 17 recipients (13 male and 4 female after a mean of 41 ± 26 months, with an overall incidence of 3.2%, which was lower than that in Western people. Of these, 8 (3.32% cases were from 241 recipients with malignant liver diseases before transplant, while 10 (3.05% cases were from 328 recipients with benign diseases. The incidence rates were comparable, p = 0.86. Furthermore, 2 cases developed in 1 year, 5 cases in 3 years and 11 cases over 3 years. The most frequent cancers developed after liver transplantation were similar to those in the general Chinese population but had much higher incidence rates. CONCLUSIONS: Liver transplant recipients were at increased risk for developing de novo cancers. The incidence rates and pattern of de novo cancers in Chinese population are different from Western people due to racial and social factors. Pre-transplant malignant condition had no relationship to de novo cancer. Exact risk factors need further studies.

  19. Treatment outcome of patients with carcinoma of vulva: Experience from a tertiary cancer center of India

    Directory of Open Access Journals (Sweden)

    Sharma Daya

    2010-01-01

    Full Text Available Purpose: The aim of our retrospective study was to analyze and report the clinical outcome of patients with vulvar carcinoma (VC treated at our center. Materials and Methods: We retrieved the information regarding patients′ clinical details, treatment given, survival and complications from the case records of all VC patients who were treated at our center during the year 1998-2005. Overall survival (OS was determined with respect to age, histopathological grade, stage of disease, treatment group, pathological lymph node status, etc. Results: A total of 60 case records were retrieved for this retrospective analysis. Age ranged from 24 to 92 years (median 63 years. International Federation of Gynecology and Obstetrics (FIGO stage distribution was as follows: stage I: 2 patients; stage II: 17 patients; stage III: 31 patients; stage IV: 9 patients; and unknown stage: 1 patient. Thirty-three patients underwent surgery (wide local excision 3, radical vulvectomy 30. Eleven patients received postoperative radiation therapy (PORT, 12 received palliative radiation therapy (RT and 15 underwent definitive RT (5 of them received concurrent chemotherapy. Median follow-up period was 23 months (range 2-144 months. The 5-year OS for all stages was 41%. FIGO stage and pathological node positivity were found to be statistically significant prognostic factors for survival. Conclusion: Despite the majority of patients presenting in advanced stage, the 5-year OS of 41% in our series reflects a decent therapeutic outcome. The results have shown FIGO stage and pathological node positivity to be significant prognostic factors for survival. The use of preoperative chemotherapy/RT needs to be studied in our setup.

  20. Blood blister-like aneurysms: Single center experience and systematic literature review

    Energy Technology Data Exchange (ETDEWEB)

    Gonzalez, Ana Marcos; Narata, Ana Paula; Yilmaz, Hasan [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland); Bijlenga, Philippe; Radovanovic, Ivan; Schaller, Karl [Service of Neurosurgery, University Hospital of Geneva (Switzerland); Lovblad, Karl-Olof [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland); Pereira, Vitor Mendes, E-mail: vitormpbr@hotmail.com [Interventional Neuroradiology Unit, Service of Neuroradiology, University Hospital of Geneva (Switzerland)

    2014-01-15

    Blood blister-like aneurysms (BBAs) are a controversial entity. They arise from non-branching sites on the supraclinoid internal carotid artery (ICA) and are suspected to originate from a dissection. Our aim is to describe the BBA cases seen in our center and to present a systematic review of the literature on BBAs. We analyzed the eleven cases of BBA admitted to our center from 2003 to 2012. We assessed the medical history, treatment modality (endovascular and/or surgery), complications and clinical outcome. The cohort included 8 women and 4 men with a mean age of 53.16 years. Treatment of the BBA consisted of stenting and coiling in 5 patients, stenting only in 4 patients, coiling and clipping in 1 patient, clipping only in 1 patient, and conservative treatment in 1 patient. A good outcome was found in 10 patients, as defined by a modified Rankin Scale (mRS) less than or equal to two at three months. A systematic review of the literature was performed, and 314 reported patients were found: 221 patients were treated with a primarily surgical approach, and 87 patients were treated with a primarily endovascular approach. A rescue or second treatment was required in 46 patients (21%). The overall estimated treatment morbidity rate was 17%, and the mortality rate was 15%. BBAs exhibit more aggressive behavior compared to saccular aneurysms, and more intra-operative complications occur with BBAs, independent of the treatment type offered. They are also significantly more likely to relapse and rebleed after treatment. Endovascular treatment offers a lower morbidity–mortality compared with surgical approaches. Multilayer flow-diverting stents appear to be a promising strategy.

  1. Clinical Characteristics of Pediatric Esophagitis in Southern Iran; A Single-Center Experience

    Directory of Open Access Journals (Sweden)

    Mozhgan Zahmatkeshan

    2013-06-01

    Full Text Available Background: We sought to determine the clinical characteristics of pediatric esophagitis in southern Iran. Methods: This cross-sectional study was conducted over a 4-year period, from 2005 to 2009, in Nemazee Hospital, a tertiary healthcare center in Shiraz, southern Iran. We consecutively included all pediatric patients (<18 years who underwent endoscopy in our center and had pathology-confirmed diagnosis of esophagitis. Data regarding the patients’ demographic characteristics, comorbidities, and clinical findings were recorded using a questionnaire. All the patients underwent upper gastrointestinal endoscopy and biopsy of the esophagus, and the findings were recorded in the questionnaire. Results: We studied 125 children, comprising 61 (48.8% girls and 64 (51.2% boys at a mean age of 6.6±5.5 years. Repeated vomiting was the prominent symptom in our series, with it being reported by 75 (60% patients, followed by fever in 35 (28%. Erythema (33.6%, esophageal ulcer (11.2%, and whitish patch (8.0% were the most common endoscopic findings, while reflux esophagitis (32.8%, chronic (6.4% and acute esophagitis (5.6%, and candida esophagitis (5.6% were the most common histological diagnoses. Only one (0.8% patient was diagnosed as having eosinophilic esophagitis, aspergillosis, and graft-versus-host disease. Conclusion: Reflux was the most common cause of esophagitis in the pediatric population of southern Iran. Contrary to previous reports, the prevalence of eosinophilic esophagitis was far less than that estimated, while the prevalence of opportunistic infections was higher secondary to post-liver transplantation immunosuppression.

  2. The 10-year Trend of Periprocedural Complication Following Carotid Artery Stenting; Single Center Experience

    Energy Technology Data Exchange (ETDEWEB)

    Hong, Jeong-Ho [Keimyung University Dongsan Medical Center, Department of Neurology (Korea, Republic of); Kang, Jihoon; Yeo, Min-Ju; Kim, Beom Joon; Jang, Min Uk; Bae, Hee-Joon [Seoul National University College of Medicine, Department of Neurology, Stroke Center, Seoul National University Bundang Hospital (Korea, Republic of); Kwon, O-Ki; Hwang, Gyo Jun; Oh, Chang Wan [Seoul National University Bundang Hospital, Department of Neurosurgery (Korea, Republic of); Jung, Cheolkyu [Seoul National University Bundang Hospital, Department of Radiology (Korea, Republic of); Lee, Ji Sung [Soonchunhyang University Medical Center, Biostatistical Consulting Unit (Korea, Republic of); Han, Moon-Ku, E-mail: mkhan@snu.ac.kr [Seoul National University College of Medicine, Department of Neurology, Stroke Center, Seoul National University Bundang Hospital (Korea, Republic of)

    2015-04-15

    PurposeCarotid endarterectomy and stenting are used to treat carotid stenosis, with the volume of carotid artery procedures increasing over the past decade. We investigated the 10-year trend of periprocedural complications with an increasing procedure volume of carotid stenting at a single tertiary hospital.MethodsWe collected 416 consecutive cases (384 patients) of carotid artery stenting performed for either symptomatic (231 cases, 55.5 %) or asymptomatic (185 cases, 44.5 %) internal carotid artery stenosis at a single center. Periprocedural complication was defined as any stroke, myocardial infarction, or death. Procedure-related outcome included any dissection, hemodynamic event, or periprocedural complication.ResultsThe mean age was 68.8 years (82.8 % males; range of 20–89 years); 23.9 % were older than 75 years. Before the procedure, 99.3 and 56.0 % of patients received antiplatelet and lipid-lowering medication, respectively. The overall periprocedural complication rate was 3.6 % (1.6 and 5.2 % in the asymptomatic and symptomatic group, respectively). The composite outcome of any stroke or death was 3.4 %. Periprocedural complication and procedure-related outcome showed a decremental trend with increasing procedure volume, and this trend remained after adjusting for confounders.ConclusionsOur study suggests that carotid stenting at an experienced center might reduce the periprocedural complications. Our periprocedural complication rate of carotid artery stenting may be comparable to, or somewhat lower than, that reported in other clinical trials.

  3. Implementing PDA technology in a medical library: experiences in a hospital library and an academic medical center library.

    Science.gov (United States)

    Morgen, Evelyn Breck

    2003-01-01

    Personal digital assistants (PDAs) have grown from being a novelty in the late 1990s to an essential tool for healthcare professionals in the 2000s. This paper describes the experiences of a librarian who implemented PDA technology first in a hospital library, and then at an academic medical center library. It focuses on the role of the library in supporting PDA technology and resources. Included are programmatic issues such as training for library staff and clinicians, and technical issues such as Palm and Windows operating systems. This model could be used in either a hospital or academic health sciences library.

  4. A single-center experience with abiraterone as treatment for metastatic castration-resistant prostate cancer

    DEFF Research Database (Denmark)

    Thortzen, Anita; Thim, Stine; Røder, Martin Andreas;

    2016-01-01

    BACKGROUND: Continuous stimulation of the androgen receptor (AR) axis is a prerequisite for growth in castration-resistant prostate cancer (CRPC). Abiraterone acetate (AA) is a potent inhibitor of extracellular and intracellular androgen synthesis by inhibition of the CYP-17 enzyme system, which...... has been shown to be up-regulated in CRPC. AA was recently introduced in the management of patients with metastatic CRPC (mCRPC) both before and after taxane-based chemotherapy. The purpose of this study is to report the initial clinical experience obtained from mCRPC patients managed on AA......% of the patients. Time to biochemical and radiological progression was 3.5 and 4.9 months, respectively. Overall survival was 13.2 months (95% CI: 9.0-17.4). CONCLUSION: Our initial experience with AA in the routine management of patients with mCRPC demonstrates an efficacy-effectiveness gap compared with clinical...

  5. The Manuel Lujan, Jr. Neutron Scattering Center, LANSCE experiment reports: 1990 Run Cycle

    Energy Technology Data Exchange (ETDEWEB)

    DiStravolo, M.A. (comp.)

    1991-10-01

    This year was the third in which LANSCE ran a formal user program. A call for proposals was issued before the scheduled run cycles, and experiment proposals were submitted by scientists from universities, industry, and other research facilities around the world. An external program advisory committee, which LANSCE shares with the Intense Pulsed Neutron Source (IPNS), Argonne National Laboratory examined the proposals and made recommendations. At LANSCE, neutrons are produced by spallation when a pulsed, 800-MeV proton beam impinges on a tungsten target. The proton pulses are provided by the Clinton P. Anderson Meson Physics Facility (LAMPF) accelerator and an associated Proton Storage Ring (PSR), which can alter the intensity, time structure, and repetition rate of the pulses. The LAMPF protons of Line D are shared between the LANSCE target and the Weapons Neutron Research facility, which results in LANSCE spectrometers being available to external users for unclassified research about 80% of each six-month LAMPF run cycle. Measurements of interest to the Los Alamos National Laboratory may also be performed and may occupy up to an additional 20% of the available beam time. These experiments are reviewed by an internal program advisory committee. One hundred thirty-four proposals were submitted for unclassified research and twelve proposals for research of a programmatic nature to the Laboratory. Our definition of beam availability is when the proton current from the PSR exceeds 50% of the planned value. The PSR ran at 65{mu}A current (average) at 20 Hz for most of 1990. All of the scheduled experiments were performed and experiments in support of the LANSCE research program were accomplished during the discretionary periods.

  6. Modeling Approach of Regression Orthogonal Experiment Design for Thermal Error Compensation of CNC Turning Center

    Institute of Scientific and Technical Information of China (English)

    2002-01-01

    The thermal induced errors can account for as much as 70% of the dimensional errors on a workpiece. Accurate modeling of errors is an essential part of error compensation. Base on analyzing the existing approaches of the thermal error modeling for machine tools, a new approach of regression orthogonal design is proposed, which combines the statistic theory with machine structures, surrounding condition, engineering judgements, and experience in modeling. A whole computation and analysis procedure is given. ...

  7. [Diagnosis and treatment of pediatric subglottic stenosis: experience in a tertiary care center].

    Science.gov (United States)

    Botto, Hugo Alberto; Pérez, Cinthia Giselle; Cocciaglia, Alejandro; Nieto, Mary; Rodríguez, Hugo Aníbal

    2015-08-01

    Subglottic stenosis is among the most common causes of airway obstruction in children, 90% of which resulting from endotracheal intubation. The diagnosis is based on the patient's clinical, radiologic evaluation, flexible laryngoscopy and rigid airway endoscopy under general anesthesia. It must be suspected in children with respiratory distress after extubation. The therapeutic approach depends on the severity of the subglottic stenosis and the patient's symptoms. We describe our experience with the subglottic stenosis etiologies, diagnosis, treatment and outcome of patients with this condition.

  8. The ontology supported intelligent system for experiment search in the scientific Research center

    Directory of Open Access Journals (Sweden)

    Cvjetković Vladimir

    2014-01-01

    Full Text Available Ontologies and corresponding knowledge bases can be quite successfully used for many tasks that rely on domain knowledge and semantic structures, which should be available for machine processing and sharing. Using SPARQL queries for retrieval of required elements from ontologies and knowledge bases, can significantly simplify modeling of arbitrary structures of concepts and data, and implementation of required functionalities. This paper describes developed ontology for support of Research Centre for testing of active substances that conducts scientific experiments. According to created ontology corresponding knowledge base was made and populated with real experimental data. Developed ontology and knowledge base are directly used for an intelligent system of experiment search which is based on many criteria from ontology. Proposed system gets the desired search result, which is actually an experiment in the form of a written report. Presented solution and implementation are very flexible and adaptable, and can be used as kind of a template by similar information system dealing with biological or similar complex system.

  9. A 5-year retrospective analysis of Necrotizing fasciitis: A single center experiences

    Directory of Open Access Journals (Sweden)

    Kiralj Aleksandar I

    2015-01-01

    Full Text Available Background/Aim. Necrotizing fasciitis (NF is usually an acute infection of superficial fascia with rapid progression in around soft tissue. If not promptly recognized and aggressively treated NF usualy leads to sepsis and multiorgan failure with fatal outcome, thus early diagnosis and prompt surgical treatment are crucial for healing of these patients. The aim of this article was to evaluate the clinical presentation of all patients with acute NF diagnosed and treated in surgical clinics of Clinical Center of Vojvodina, Novi Sad, Serbia. Methods. The medical records of patients treated for acute NF localized on a different parts of the body in Clinical Center of Vojvodina, Novi Sad, Serbia, during a 5- year period (from January 2008 to December 2012 were retrospectively evaluated. This study enrolled patients admitted via Emergency Center of Vojvodina with the diagnosis of acute NF either as the primary diagnosis or with the diagnosis at discharge after surgical treatment. Results. During a 5-year period there were 216 patients with final diagnosis of acute NF. Most of our patients (140 - 64.81% were admitted with the initial diagnosis of cellulitis, abscesses, phlegmons or sepsis. Unfortunately, the clinical symptoms of acute NF were atypical at time of initial examination. Pain and swelling of the affected localization were the most presented bias of symptoms (183 - 84.72%. The majority of our patients were male (164 - 75.92%. Among the 216 patients, the most common pre-existing single factor was drug abuse (39 - 18.05%, followed by obesity (38 - 17.59% and diabetes mellitus (31 - 14.35%. Trauma was most common etiological factor (22 - 10.8% in infected wounds, followed by abdominal (15 - 6.94% and orthopedic (11 - 5.09% surgical intervention. In the present study idiopathic acute NF was diagnosed in 22 (10.18% patients and more than one etiological factor were diagnosed in 20 (9.25% patients. The majority of our patients had type I acute NF

  10. Cochlear implant surgery at the Clinical Center of Vojvodina - ten-year experience

    Directory of Open Access Journals (Sweden)

    Dankuc Dragan

    2014-01-01

    Full Text Available Introduction. The first cochlear implant surgery was performed at the Center for Cochlear Implantation of the Department of Ear, Nose and Throat Diseases, Clinical Center of Vojvodina in 2002 after long preparations and that was the first successful cochlear implantation in Serbia. Material and Methods. Over the period from November 2002 to November 2013, 99 patients underwent surgical procedures and 100 cochlear implants were placed. Results. The analysis encompassed 99 patients, the youngest and the oldest one being 1 year and 61 years old, respectively. Prelingual and postlingual deafness developed in 84 (84.9% and in 15 (15.1%, respectively. Postlingual deafness was observed in all 11 adult patients. The prelingual deafness was diagnosed in 84 (95.4% children, whereas in four (4.6% children it occurred after the development of speech between 6 and 8 years of age. Progressive hearing loss was observed in 11 patients - seven adults and four children. The majority of our patients, i.e. 74 (74.75% manifested idiopathic deafness of unknown cause. A range of usually reported hearing loss etiologies included ototoxic medications in seven (7.07%, hereditary factor in six (6.06%, and bacterial meningitis in four (4.04% patients. Somewhat less common causes were perinatal hypoxia in three (3.03%, premature birth in three (3.03%, Down syndrome in one (1.01%, and chronic otitis media in one (1.01% patient. Conclusion. Both intraoperative and postoperative complications were analyzed in the investigated patient population. The complications developed in 11 patients, i.e. in 10.5% of 105 surgical procedures. The majority of procedures (89.5% were not accompanied by any post-surgical complications. Unsuccessful implantation in a single-step procedure and transient facial nerve paralysis can be considered most frequent among our patients, whereas cochlear ossification and transient ataxia occurred more rarely. Stimulation of facial nerve, intraoperative

  11. Marginal living donor in kidney transplantation: experience in a Chinese single center

    Institute of Scientific and Technical Information of China (English)

    LI Gang; WANG Yun-peng; MA Lu-lin; ZHANG Jing; ZHANG Hong-xian; HUANG Yi; HOU Xiao-fei

    2013-01-01

    Background Living donor kidney transplantation is becoming popular in China,whereas,in clinical situations,some kidney donors may be sub-optimal,namely marginal living donor.The present study aimed to evaluate the safety and efficacy of marginal living donor kidney transplantation in a Chinese single center.Methods Between January 2001 and December 2009,888 kidney transplantations were performed in our center; 149were living donor kidney transplantations.The living donors and recipients were followed up regularly after the operation.Of the living donors,30 donors were marginal,who were older than 60 years or suffered from kidney anomaly or some benign diseases.Among the non-marginal living kidney transplantations,58 donors and recipients had complete perioperative and follow-up data.We compared the marginal and non-marginal living donor kidney transplantations with regard to donor age,follow-up period,donor's serum creatinine at the last follow-up,recipient's serum creatinine at the last follow-up,and graft survival at the last follow-up.Results The mean age of donors in the marginal and non-marginal living donors were (55±9) (37-66) and (43±12) (30-59) years.The mean follow-up times of the marginal and non-marginal groups were (26.4±13.4) months and (28.8±14.8)months.The donor and recipient serum creatinine levels at the last follow-up were (1.16±0.20) mg/dl and (1.30±0.24) mg/dl in the marginal group,and (1.12±0.32) mg/dl and (1.34±0.32) mg/dl in the non-marginal group.Three recipients in the marginal group and five recipients in the non-marginal group had acute rejection episodes during the first year.Actuarial 3-year graft survival was 96.7% in the marginal group and 100% in the non-marginal group.No significant differences were detected between the two groups with regard to these data.Conclusion Utilization of highly selective marginal living donors can be a safe,feasible,and effective way for the treatment of patients with end stage renal disease.

  12. Epidemiological profile of nonmelanoma skin cancer in renal transplant recipients: experience of a referral center*

    Science.gov (United States)

    Ferreira, Flávia Regina; Ogawa, Marilia Marufuji; Nascimento, Luiz Fernando Costa; Tomimori, Jane

    2014-01-01

    BACKGROUND Nonmelanoma skin cancer is the most common form of cancer in humans and also the malignant disease that is increasingly common among kidney transplant recipients. OBJECTIVE To determine the epidemiological characteristics of renal transplant recipients with nonmelanoma skin cancer seen at a referral transplantation center. METHODS Cross-sectional descriptive study with renal transplant recipients presenting nonmelanoma skin cancer, treated at a transplantation referral center between 08/01/2004 and 08/31/2009. Analyzed variables were: gender, age, skin phototype, occupational and recreational sun exposure, use of photoprotection, personal and family history of non-melanoma skin cancer, clinical type and location, time between transplantation and the appearance of the first nonmelanoma skin cancer, occurrence of viral warts, timing of transplantation, type of donor, cause of kidney failure, previous transplants, comorbidities, pre-transplant dialysis, type and duration of dialysis. RESULTS 64 subjects were included. Males - 71.9%; low skin phototypes (up to Fitzpatrick III) - 89%; mean age - 57.0 years - and mean age at transplant - 47.3 years; sun exposure - 67.2% occupational - and 64.1% recreational; photoprotection - 78.2% (although only 34.4% in a regular manner); squamous cell carcinoma - 67.2%; squamous cell carcinoma/basal cell carcinoma ratio - 2:1; personal history of nonmelanoma skin cancer - 25% - and family history - 10.9%; location at photoexposed area - 98.4%; average latency time between transplantation and first nonmelanoma skin cancer appearance - 78.3 months; viral warts (HPV) after transplant - 53.1%; average timing of transplantation - 115.5 months; living donor - 64.1%; triple regimen (antirejection) - 73.2%; comorbidities - 92.2%; pre-transplant dialysis - 98.4%; hemodialysis - 71.7%; average duration of dialysis - 39.1 months; previous transplants - 3.1%; hypertension as cause of renal failure - 46.9%. CONCLUSION This study allowed

  13. Clinical and experimental studies of multiple sclerosis in Russia: experience of the leading national research centers

    Directory of Open Access Journals (Sweden)

    Zavalishin IA

    2015-08-01

    Full Text Available Igor A Zavalishin,1 Alexey A Belogurov Jr,2–4 Yakov A Lomakin,2 Natalia A Ponomarenko,2 Sofia N Morozova,1 Zinaida A Suslina,1,† Michael A Piradov,1 Sergey N Illarioshkin,1 Alexander G Gabibov2–5 1Research Center of Neurology, 2Institute of Bioorganic Chemistry, Russian Academy of Sciences, Moscow, 3Institute of Fundamental Medicine and Biology, Kazan Federal University, Kazan, Republic of Tatarstan, 4Institute of Gene Biology, RAS, 5Chemistry Department, Moscow State University, Moscow, Russia †Dr Zinaida A Suslina passed away on June 22, 2014 Abstract: Mechanisms of axonal damage and adaptive capacity in multiple sclerosis (MS, including cortical reorganization, have been actively studied in recent years. The lack of regenerative capabilities and the irreversibility of neurodegeneration in MS are critical factors for the optimization of MS treatment. In this study, we present the results of clinical and basic studies in the field of MS by two leading Russian centers. Clinical and neuroimaging correlations show that spinal damage in MS is accompanied by functional reorganization of the cerebral cortex, which is determined not only by the efferent component but also by the afferent component. Comparative analysis of MS treatment with both interferon β1b (IFN-β1b and IFN-β1a at a dosage of 22 µg for 3 years through subcutaneous administration and glatiramer acetate showed equally high efficiency in reducing the number of exacerbations in relapsing-remitting MS and secondary-progressive MS. We demonstrate a reduced risk of disability in relapsing-remitting MS and secondary-progressive MS patients in all groups treated with IFN-β1 and glatiramer acetate. MS appears to be a disease that would greatly benefit from the development of personalized therapy; thus, adequate molecular predictors of myelin degradation are greatly needed. Therefore, novel ideas related to the viral hypothesis of the etiology of MS and new targets for

  14. Contrast ultrasound in hepatocellular carcinoma at a tertiary liver center: First Indian experience.

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    Laroia, Shalini Thapar; Bawa, Simranjeet Singh; Jain, Deepak; Mukund, Amar; Sarin, Shiv

    2013-06-28

    To assess the role of contrast enhanced ultrasonography in evaluation of hepatocellular carcinoma (HCC) at the first Indian tertiary liver center. Retrospective analysis of contrast enhanced ultrasound (CEUS) examinations over 24 mo for diagnosis, surveillance, characterization and follow up of 50 patients in the context of HCC was performed. The source and indication of referrals, change in referral rate, accuracy and usefulness of CEUS in a tertiary liver center equipped with a 64 slice dual energy computer tomography (CT) and 3 tesla magnetic resonance imaging (MRI) were studied. Sonovue (BR1, Bracco, Italy, a second generation contrast agent) was used for contrast US studies. Contrast enhanced CT/MRI or both were performed in all patients. The findings were taken as a baseline reference and correlation was done with respect to contrast US. Contrast enhanced MRI was performed using hepatocyte specific gadobenate dimeglumine (Gd-BOPTA). Iomeron (400 mg; w/v) was used for dynamic CT examinations. About 20 (40%) of the examinations were referred from clinicians for characterization of a mass from previous imaging. About 15 (30%) were performed for surveillance in chronic liver disease; 5 (10%) examinations were performed for monitoring lesions after radiofrequency ablation (RFA); 3 (6%) were post trans-arterial chemo-embolization (TACE) assessments and 3 (6%) were patients with h/o iodinated contrast allergy. About 2 (4%) were performed on hemodynamically unstable patients in the intensive care with raised alpha fetoprotein and 2 (4%) patients were claustrophobic. The number of patients referred from clinicians steadily increased from 12 in the first 12 mo of the study to 38 in the last 12 mo. CEUS was able to diagnose 88% of positive cases of HCC as per reference standards. In the surveillance group, specificity was 53.3% vs 100% by CT/MRI. Post RFA and TACE specificity of lesion characterization by CEUS was 100% in single/large mass assessment, similar to CT

  15. Efficacy of liver transplantation for acute hepatic failure:a single-center experience

    Institute of Scientific and Technical Information of China (English)

    Xian-Jie Shi; Hong-Bin Xu; Wen-Bin Ji; Yu-Rong Liang; Wei-Dong Duan; Lei He; Ming-Jun Wang; Zhi-Ming Zhao

    2011-01-01

    BACKGROUND: Acute hepatic failure (AHF) is a devastating clinical syndrome with a high mortality rate. The outcome of AHF varies with etiology, but liver transplantation (LT) can significantly improve the prognosis and survival rate of such patients. This study aimed to detect the role of LT and artificial liver support systems (ALSS) for AHF patients and to analyze the etiology and outcome of patients with this disease. METHODS: A retrospective analysis was made of 48 consecutive patients with AHF who fulfilled the Kings College Criteria for LT at our center. We analyzed and compared the etiology, outcome, prognosis, and survival rates of patients between the transplantation (LT) group and the non-transplantation (N-LT) group. RESULTS: AHF was due to viral hepatitis in 25 patients (52.1%; hepatitis B virus in 22), drug or toxic reactions in 14 (29.2%; acetaminophen in 6), Wilson disease in 4 (8.3%), unknown reasons in 3 (6.3%), and miscellaneous conditions in 2 (4.2%). In the LT group, 36 patients (7 underwent living donor LT, and 29 cadaveric LT) had an average model for end-stage liver disease score (MELD) of 35.7. Twenty-eight patients survived with good graft function after a follow-up of 27.3± 4.5 months. During the waiting time, 6 patients were treated with ALSS and 2 of them died during hospitalization. The 30-day, 12-month, and 18-month survival rates were 77.8%, 72.2%, and 66.7%, respectively. In the N-LT group, 12 patients had an average MELD score of 34.5. Four patients were treated with ALSS and all died during hospitalization. The 90-day and 1-year survival rates were only 16.7% and 8.3%, respectively. CONCLUSIONS: Hepatitis is the most prominent cause of AHF at our center. Most patients with AHF, who fulfill the Kings College Criteria for LT, did not survive longer without LT. ALSS did not improve the prognosis of AHF patients, but may extend the waiting time for a donor. Currently, LT is still the most effective way to improve the prognosis

  16. Circumcision with Glubran® 2 in children: experience of Italian Center

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    Cerchia, Elisa; Molinaro, Francesco; Bulotta, Anna Lavinia; Ferrara, Francesco; Bindi, Edoardo; Messina, Mario

    2016-01-01

    Background Circumcision is one of the most common surgical procedures in the world. Despite it is known its wide prevalence for religious and medical reasons in children, it remains a controversial practice in paediatric age. To date, there is no described the gold standard technique to circumcise paediatric patients. We started to use glue for circumcision about 2 years ago. We designed this prospective study with the aim to compare two surgical techniques, which were used in our hospital to perform circumcision in children. The implication for practice was the understanding if there were differences between these approaches related to patient’s and parents benefits to manage this condition and benefits for surgeon and hospital in term of saving money and time. Methods This is a randomized, single-blind one-center study. It was conducted at the Department of Paediatric Surgery of Siena. Data were collected between March 2011 and December 2012. Study’s population involved all patients who required circumcision. Two randomizes groups: group one which involved patients who underwent circumcision using sutures and group two, which involved patients who underwent circumcision using surgical glue (Glubran® 2). Two exclusion criteria were used: the redo-circumcision and the allergy or hyper-sensibility to cyanoacrylate (main component of glue). Results We report 99 patients who underwent circumcision with Glubran® 2 in comparison with a group of children circumcised with sutures (vycril rapide). We measured three outcomes (operating time, postoperative pain and assessment of cosmetic), which, even if not all statistically significant, allowed us to draw any conclusions about the use of glue in circumcision. Conclusions Traditional circumcision is performed using a standard sleeve technique with sutures for the approximation of the skin edges. However, since some years a tissue adhesive as N-butyl-2-cyanoacrylate (NBCA) (Glubran® 2) is used in many centers to

  17. Analysis of patterns of palliative radiotherapy in north west India: A regional cancer center experience

    Directory of Open Access Journals (Sweden)

    Akhil Kapoor

    2015-01-01

    Full Text Available Background: Palliative radiotherapy (PRT is the eventual requirement in 30-50% of all cancer patients. PRT is primarily aimed to relieve pain and prevent/treat collapse or fracture in case of bone metastasis, to reduce edema in patients with cranial metastasis, and to control distressing symptoms of rapid primary growth. An audit of PRT planned in a busy cancer center can help in the characterization of the requirements of the patients and the formulation of institutional policies. Materials and Methods: In total, 516 patients who received PRT in our regional cancer center from January 2012 to December 2012 and whose complete records were available for analysis were selected for this retrospective study. Medical records and radiotherapy files were analyzed to obtain data such as sociodemographic parameters, prescription of PRT, and follow up. Descriptive statistics were evaluated in terms of frequencies and percentages to allow comparisons. Results: Of the 516 patients, 73% patients were male; the median age of the patients receiving PRT was 62 years (range 13-83 years. About 48% ( n = 248 patients received PRT at the primary site while rest (52% were given PRT at the metastatic site. The most common indication of PRT was pain (56.8% cases, followed by cytostatic PRT (19.8% and raised ICT (12.4%. The median dose prescribed was 30 Gy (range 8-36 Gy delivered in 1-12 fractions over the duration of 1-18 days. The overall response rate was about 43% at 2 weeks of completion of PRT; the median follow-up of the patients was 154 days (range 9-256 days. The long-term symptom relief at median follow up was 8%. Conclusions: Good clinical judgment and expertise is required in prescribing correct fractionation schedule to achieve effective symptom palliation with lowest possible cost and inconvenience to the patients and relatives. Hypofractionated radiotherapy is a feasible treatment option in patients with advanced incurable disease to achieve effective

  18. [Work experience of a stroke center in the Western region of Kazakhstan].

    Science.gov (United States)

    Kabdrakhmanova, G B; Ermagambetova, A P; Suleĭmanova, S Iu; Khamidulla, A A; Darin, D B

    2014-01-01

    Objectives. To analyze results of the work of a regional stroke center in Aktobe city opened in Kazakhstan according to a state program of Health Care development for 2011-2015 years "Healthy Kazakhstan". Material and methods. In total 1177 stroke patients were hospitalized, including 721 patients (61.2%) with ischemic stroke, 268 (22.8%) patients with hemorrhagic stroke, 108 (9.2%) with transitory disturbances of cerebral blood circulation, 26 (2.2%) with subarachnoid hemorrhage and 54 (4.6%) with unspecified stroke. Results. The use of thrombolytic therapy (TLT), a highly specialized method of treatment of ischemic stroke, was analyzed. Other aspects of the work, including the measures of early and continued rehabilitation, are presented. During the first day after TLT, a significant reduction in neurological disorders was observed in 22 patients (84.6%). The partial recovery was seen in 3 patients (11.5%). One patient (3.8%) had hemorrhagic transformation. Conclusions. The use of TLT in the acute stage of ischemic stroke allows to achieve the complete recovery of neurological functions so patients can return to work and full life.

  19. Kratom abuse in Ramathibodi Poison Center, Thailand: a five-year experience.

    Science.gov (United States)

    Trakulsrichai, Satariya; Tongpo, Achara; Sriapha, Charuwan; Wongvisawakorn, Sunun; Rittilert, Panee; Kaojarern, Sming; Wananukul, Winai

    2013-01-01

    Kratom (Mitragyna speciosa Korth), a native tree in Southeast Asia, is misused as an abuse drug and becomes legally widespread to several countries. Currently, it is available through the online market or by some shops. The clinical manifestations of Kratom's effects are not well-defined and the clinical studies are limited. This study was designed to identify the characteristics of Kratom poisoning and withdrawal cases from Kratom exposure cases in Ramathibodi Poison Center (RPC), Thailand, during a five-year period. We used a retrospective review of Kratom exposure cases from the RPC toxic surveillance system. A total of 52 Kratom exposure cases were identified. The trend of case consultations has been increasing. There were Kratom poisoning cases (76.9%) and withdrawal cases (23.1%). Common presenting symptoms in the poisoning group were palpitation (22.5%), followed by seizure (17.5%). For the withdrawal group, the common presenting symptoms were myalgia (33.3%), insomnia (16.67%), fatigue (16.67%), and chest discomfort (16.67%). There was a baby with withdrawal symptoms who was delivered from a chronic Kratom-abusing mother, suggesting possible exposure via the transplacental route. There were no deaths in either group. Kratom abuse can cause either poisoning or withdrawal. Most cases in both groups had good prognostic outcome.

  20. Abdominal inflammatory masses mimicking neoplasia in children-experience of two centers.

    Science.gov (United States)

    Czauderna, Piotr; Schaarschmidt, Klaus; Komasara, Leszek; Harms, Dieter; Lempe, Michael; Vorpahl, Klaus; Szumera, Malgorzata; Balanda, Alicja

    2005-05-01

    Despite progress in modern imaging, some inflammatory masses are difficult to distinguish clinically from neoplastic processes. In such cases the pathology report has a great distinctive value, but even then the final diagnosis may be difficult to reach. Eight patients with abdominal tumors of inflammatory origin were treated in two institutions, the Department of Pediatric Surgery of the Medical University of Gdansk, Poland, and Helios Center of Pediatric Surgery in Berlin, Germany, during the last 10 years. Four tumors were located in the pelvis, two in the liver, and two in the colonic mesentery. Five of them were inflammatory pseudotumors (two subclassified as inflammatory fibrosarcoma), one had nonspecific inflammatory changes, one was diagnosed as idiopathic retroperitoneal fibrosis, and one was diagnosed as bacillary angiomatosis. All patients underwent surgical tumor biopsy, excisional in four and incisional in four. All but two children underwent macroscopically complete tumor excision (four primarily, two secondarily). In one case the tumor resolved with antibiotherapy. Surgery in retroperitoneal masses was often extensive and associated with significant complications because of invasive tumor growth. In conclusion, intraabdominal inflammatory lesions may closely mimic neoplasia in children. Clinical doubts result in repeated biopsies, and for this reason excisional biopsy should be preferred. In some cases, when excisional biopsy is not feasible due to invasive growth of the tumor, delayed complete mass excision should follow, despite occasional significant morbidity. The etiology and exact nature of inflammatory pseudotumors are still obscure, and it is unknown whether they represent inflammatory lesions or true neoplasia.

  1. High-fat diets and seizure control in myoclonic-astatic epilepsy: a single center's experience.

    Science.gov (United States)

    Simard-Tremblay, Elisabeth; Berry, Patricia; Owens, Aaron; Cook, William Byron; Sittner, Haley R; Mazzanti, Marta; Huber, Jennifer; Warner, Molly; Shurtleff, Hillary; Saneto, Russell P

    2015-02-01

    To determine the efficacy of the Modified Atkins Diet (MAD) and Ketogenic Diet (KD) in seizure control within a population of myoclonic-astatic epilepsy (MAE) patients. This was a retrospective, single center study evaluating the seizure control by high fat diets. Seizure diaries kept by the parents performed seizure counts. All patients met the clinical criteria for MAE. Nine patients met the clinical criteria. We found that both the MAD and KD were efficacious in complete seizure control and allowed other medications to be stopped in seven patients. Two patients had greater than 90% seizure control without medications, one on the KD and the other on the MAD. Seizure freedom has ranged from 13 to 36 months, and during this time four patients have been fully weaned off of diet management. One patient was found to have a mutation in SLC2A1. Our results suggest that strictly defined MAE patients respond to the MAD with prolonged seizure control. Some patients may require the KD for seizure freedom, suggesting a common pathway of increased requirement for fats. Once controlled, those fully responsive to the Diet(s) could be weaned off traditional seizure medications and in many, subsequently off the MAD or KD. Copyright © 2014 British Epilepsy Association. Published by Elsevier Ltd. All rights reserved.

  2. Has the prevalence of cholesterol gallstones increased in Korea? A preliminary single-center experience.

    Science.gov (United States)

    Kim, Ju Wan; Oh, Hyoung-Chul; Do, Jae Hyuk; Choi, Yoo-Shin; Lee, Seung Eun

    2013-10-01

    We aimed to determine the prevalence of cholesterol gallstones, the compositional changes of gallstones and its predisposing factors in Korea with this single-center study. Data of 365 patients who underwent cholecystectomy for cholecystolithiasis from July 2008 to September 2011 were reviewed. Based on the compositional analysis of the gallstones, patients were assigned to either cholesterol gallstone group or pigment gallstone group. The characteristics of the patients and the gallstones were summarized and compared. After eight patients with mixed gallstones were excluded, 357 patients were enrolled in the study, including cholesterol gallstones in 175 (49.0%) and pigment gallstones in 182 (51.0%). The number of patients with cholecystolithiasis increased but the prevalence of cholesterol gallstone decreased with age. Compared with the pigment gallstone group, the cholesterol gallstone group was associated with young age (gallstones in Korea has been stationary so far, but may change in the future since cholesterol gallstones are increasingly prevalent in the young generation. © 2013 Wiley Publishing Asia Pty Ltd and Chinese Medical Association Shanghai Branch, Chinese Society of Gastroenterology, Renji Hospital Affiliated to Shanghai Jiaotong University School of Medicine.

  3. Thoracic outlet syndrome: a 50-year experience at Baylor University Medical Center

    Science.gov (United States)

    Kourlis, Harry

    2007-01-01

    During the past 5 decades, the recognition and management of thoracic outlet syndrome (TOS) have evolved. This article elucidates these changes and improvements in the diagnosis and management of TOS at Baylor University Medical Center. The most remarkable change over the past 50 years is the use of nerve conduction velocity to diagnose and monitor patients with nerve compression. Recognition that procedures such as breast implantation and median sternotomy may produce TOS has been revealing. Prompt thrombolysis followed by surgical venous decompression for Paget-Schroetter syndrome has markedly improved results compared with the conservative anticoagulation approach; thrombolysis and prompt first rib resection is the optimal treatment for most patients with Paget-Schroetter syndrome. Complete first rib extirpation at the initial procedure markedly reduces the incidence of recurrent neurologic symptoms or the need for a second procedure. Chest pain or pseudoangina can be caused by TOS. Dorsal sympathectomy is helpful for patients with sympathetic maintained pain syndrome or causalgia and patients with recurrent TOS symptoms who need a second procedure. PMID:17431445

  4. Post-transplant lymphoproliferative disease after allogeneic hematopoietic stem cell transplantation: a single-center experience.

    Science.gov (United States)

    Luo, Lan; Zhang, Lin; Cai, Bo; Li, Honghua; Huang, Wenrong; Jing, Yu; Zhu, Haiyan; Zhao, Yu; Bo, Jian; Wang, Quanshun; Han, Xiaoping; Yu, Li; Gao, Chunji

    2014-01-08

    Post-transplant lymphoproliferative disease (PTLD) is a rare and serious complication after allogeneic hematopoietic stem cell transplantation (allo-HSCT) or solid organ transplantation. We conducted a retrospective analysis of the occurrence of post-transplant lymphoproliferative disease in allo-HSCT recipients over 12 years in a single center in China. A total of 343 patients received allo-HSCT. The conditioning therapy consisted of a busulfan/cyclophosphamide-based regimen, a fludarabine/cyclophosphamide-based regimen, or total-body irradiation and cyclophosphamide. In transplantations from unrelated donors and haplo-identical donors, patients also received antithymocyte globulin (ATG) or thymoglobulin as part of the conditioning. Five of the 343 patients (1.46%) were diagnosed with PTLD and all 5 were given ATG as part of conditioning. Among these 5 patients, 4 had lymphoid neoplasm before transplantation. EBV-positivity was confirmed in 4 patients. All 5 PTLD patients received reduction of immunosuppression (RI) as fundamental therapy. At follow-up on April 1, 2013, 1 patient had survived for 2 years and 1 had survived for 9 years. The correlation of PTLD with ATG and underlying diseases were examined by statistical analysis using the chi-squared test or Fisher's exact test (P=0.011 and 0.025, respectively). Although only 1.46% of patients progressed to PTLD associated with ATG and underlying diseases, the mortality was still high. Moreover, RI can be an effective therapy for PTLD patients, but other approaches should be further explored.

  5. Liver transplantation using organs from deceased organ donors: a single organ transplant center experience.

    Science.gov (United States)

    Han, Ming; Guo, Zhi-Yong; Zhao, Qiang; Wang, Xiao-Ping; Yuan, Xiao-Peng; Jiao, Xing-Yuan; Yang, Chun-Hua; Wang, Dong-Ping; Ju, Wei-Qiang; Wu, Lin-Wei; Hu, An-Bin; Tai, Qiang; Ma, Yi; Zhu, Xiao-Feng; He, Xiao-Shun

    2014-08-01

    In 2011, a pilot program for deceased organ donation was initiated in China. We describe the first successful series of liver transplants in the pilot program. From July 2011 to August 2012, our center performed 26 liver transplants from a pool of 29 deceased donors. All organ donation and allograft procurement were conducted according to the national protocol. The clinical data of donors and recipients were collected and summarized retrospectively. Among the 29 donors, 24 were China Category II donors (organ donation after cardiac death), and five were China Category III donors (organ donation after brain death followed by cardiac death). The recipients were mainly the patients with hepatocellular carcinoma. The one-year patient survival rate was 80.8% with a median follow-up of 422 (2-696) days. Among the five mortalities during the follow-up, three died of tumor recurrence. In terms of post-transplant complications, 9 recipients (34.6%) experienced early allograft dysfunction, 1 (3.8%) had non-anastomotic biliary stricture, and 1 (3.8%) was complicated with hepatic arterial thrombosis. None of these complications resulted in patient death. Notably, primary non-function was not observed in any of the grafts. With careful donor selection, liver transplant from deceased donors can be performed safely and plays a critical role in overcoming the extreme organ shortage in China.

  6. Clinical staging and survival in refractory celiac disease: a single center experience.

    Science.gov (United States)

    Rubio-Tapia, Alberto; Kelly, Darlene G; Lahr, Brian D; Dogan, Ahmet; Wu, Tsung-Teh; Murray, Joseph A

    2009-01-01

    Refractory celiac disease (RCD) occurs when both symptoms and intestinal damage persist or recur despite strict adherence to a gluten-free diet. In RCD, the immunophenotype of intraepithelial lymphocytes may be normal and polyclonal (RCD I) or abnormal and monoclonal (RCD II). The aim is to describe the clinical characteristics, treatment, and long-term outcome in a large single-center cohort of patients with RCD. We compared the clinical characteristics and outcome in 57 patients with RCD: 42 with RCD I and 15 with RCD II. Fifteen of 57 patients died during follow-up (n=8 with RCD I and n=7 with RCD II), each within the first 2 years after RCD diagnosis. The overall 5-year cumulative survival is 70%, 80%, and 45% for the entire cohort, RCD I, and RCD II, respectively. The refractory state itself and enteropathy-associated T-cell lymphoma (EATL) were the most common causes of death, respectively. A new staging system is proposed based on the cumulative effect of 5 prognostic factors investigated at the time of the refractory state diagnosis: for patients in stages I, II, and III, the 5-year cumulative survival rate was 96%, 71%, and 19%, respectively (PRCD is associated with high mortality with RCD II having an especially poor prognosis because of the development of EATL. A new staging model is proposed that may improve the precision of prognosis in patients with RCD.

  7. Sports hernia: the experience of Baylor University Medical Center at Dallas.

    Science.gov (United States)

    Preskitt, John T

    2011-04-01

    Groin injuries in high-performance athletes are common, occurring in 5% to 28% of athletes. Athletic pubalgia syndrome, or so-called sports hernia, is one such injury that can be debilitating and sport ending in some athletes. It is a clinical diagnosis of chronic, painful musculotendinous injury to the medial inguinal floor occurring with athletic activity. Over the past 12 years, we have operated on >100 patients with this injury at Baylor University Medical Center at Dallas. These patients have included professional athletes, collegiate athletes, competitive recreational athletes, and the occasional "weekend warrior." The repair used is an open technique using a lightweight polypropylene mesh. Patient selection is important, as is collaboration with other experienced and engaged sports health care professionals, including team trainers, physical therapists, team physicians, and sports medicine and orthopedic surgeons. Of the athletes who underwent surgery, 98% have returned to competition. After a minimum of 6 weeks for recovery and rehabilitation, they have usually returned to competition within 3 months.

  8. Tracheostomy in children: a ten-year experience from a tertiary center in southern Brazil.

    Science.gov (United States)

    Schweiger, Cláudia; Manica, Denise; Becker, Carolina Fischer; Abreu, Larissa Santos Perez; Manzini, Michelle; Sekine, Leo; Kuhl, Gabriel

    2016-08-24

    Children may require tracheostomy due to many different health conditions. Over the last 40 years, indications of tracheostomy have endorsed substantial modifications. To evaluate pediatric patients warranted tracheostomy at our Hospital, in regard to their indications, associated comorbidities, complications and decannulation rates. Retrospective study concerning patients under 18 years of age undergoing tracheostomy in a tertiary health care center, from January 2006 to November 2015. One hundred and twenty-three children required a tracheostomy after ENT evaluation during the study period. A proportion of 63% was male, and 56% was under one year of age. Glossoptosis was the most common indication (30%), followed by subglottic stenosis (16%) and pharyngomalacia (11%). The mortality rate was 31%. By the end of this review, 35 children (28.4%) had been decannulated, and the fewer the number of comorbidities, the greater the decannulation rate (0.77±0.84 vs. 1.7±1.00 comorbidities; p<0.001). Tracheostomy in children is a relatively frequent procedure at our hospital. The most common indications are glossoptosis and subglottic stenosis. A high mortality rate was found, potentially substantiated by the high number of critical care patients with chronic neurological conditions in this cohort. Our decannulation rate is slightly below other series, probably because of the greater amount of patients with comorbidities. Copyright © 2016 Associação Brasileira de Otorrinolaringologia e Cirurgia Cérvico-Facial. Published by Elsevier Editora Ltda. All rights reserved.

  9. Neurological complications of dengue fever: Experience from a tertiary center of north India.

    Science.gov (United States)

    Verma, Rajesh; Sharma, Pawan; Garg, Ravindra Kumar; Atam, Veerendra; Singh, Maneesh Kumar; Mehrotra, Hardeep Singh

    2011-10-01

    Dengue, an acute viral disease transmitted by Aedes mosquitoes, is highly endemic in many tropical and subtropical areas of the world. Neurological complications of dengue infection have been observed more frequently in the recent past and some studies highlighted varied neurological complications arising in the course of dengue illness. In this retrospective study, we report various neurological complications observed during the last 2 years in patients of dengue fever. The patients presenting with neurological complications with positive serology (IgM antibody) for dengue infection were consecutively recruited from the Department of Neurology/Medicine from a tertiary center of Lucknow, India. These patients were subjected to a detailed clinical evaluation, laboratory assessment including blood count, hematocrit, coagulation parameters, biochemical assays, serology for dengue fever, enzyme-linked immunosorbent assay for human immunodeficiency virus and other relevant investigations. Twenty-six patients with neurological complications associated with confirmed dengue infection were observed during the last 2 years. Eighteen of these patients were male. Of the 26 patients, 10 patients were suffering from brachial neuritis, four patients had encephalopathy, three patients were consistent with the diagnosis of Guillain Barre syndrome, three patients had hypokalemic paralysis associated with dengue fever and two patients had acute viral myositis. Opsoclonus-myoclonus syndrome was diagnosed in two patients, myelitis in one patient and acute disseminated encephalo-myelitis also in one patient. Dengue fever was associated with widespread neurological complications. Brachial neuritis and opsoclonus-myoclonus syndrome were observed for the first time in this study.

  10. Patterns of Early Rejection in Renal Retransplantation: A Single-Center Experience

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    Lan Zhu

    2016-01-01

    Full Text Available It has been reported that kidney retransplant patients had high rates of early acute rejection due to previous sensitization. In addition to the acute antibody-mediated rejection (ABMR that has received widespread attention, the early acute T-cell-mediated rejection (TCMR may be another important issue in renal retransplantation. In the current single-center retrospective study, we included 33 retransplant patients and 90 first transplant patients with similar protocols of induction and maintenance therapy. Analysis focused particularly on the incidence and patterns of early acute rejection episodes, as well as one-year graft and patient survival. Excellent short-term clinical outcomes were obtained in both groups, with one-year graft and patient survival rates of 93.9%/100% in the retransplant group and 92.2%/95.6% in the first transplant group. Impressively, with our strict immunological selection and desensitization criteria, the retransplant patients had a very low incidence of early acute ABMR (6.1%, which was similar to that in the first transplant patients (4.4%. However, a much higher rate of early acute TCMR was observed in the retransplant group than in the first transplant group (30.3% versus 5.6%, P<0.001. Acute TCMR that develops early after retransplantation should be monitored in order to obtain better transplant outcomes.

  11. The pregnancy rate and live birth rate after kidney transplantation: a single-center experience.

    Science.gov (United States)

    Fontana, I; Santori, G; Fazio, F; Valente, U

    2012-09-01

    Kidney transplantation is the treatment of choice for end-stage renal disease (ESRD). Kidney transplantation recipients live longer and have better quality of life than patients on dialysis. Hypothalamic gonadal dysfunction in females who have ESRD may be reversed within the first few months after kidney transplantation, such as the ability to have children. Despite thousands of successful pregnancies in transplantation recipients, there is limited information about it. In this study, we evaluated the pregnancy rates and live birth rates in women (n = 133) who underwent kidney transplantation in our center from 1983 to 2010. Recipients of a second kidney transplantation and recipients of multiorgan transplantations were excluded. We observed 33 pregnancies with 11 live births (33.3%), 12 spontaneous abortions (36.36%), and 10 therapeutic abortions (30.3%). The pregnancy rate was 18%. The live birth rate was 33.3%. Therapeutic abortions were 36.3%, and the pregnancies resulting in fetal loss were 30.3%. The pregnancies were identified in 32 women. The majority of women (n = 32; 96.9%) had a single pregnancy, whereas 1 woman (3.1%) had two pregnancies. In our series, the pregnancy rates for kidney transplantation recipients were markedly lower and decreased more rapidly than those reported in the general population.

  12. Laparoscopic vs open donor nephrectomy: Lessons learnt from single academic center experience

    Science.gov (United States)

    Tsoulfas, Georgios; Agorastou, Polyxeni; Ko, Dicken S C; Hertl, Martin; Elias, Nahel; Cosimi, AB; Kawai, Tatsuo

    2017-01-01

    AIM To compare laparoscopic and open living donor nephrectomy, based on the results from a single center during a decade. METHODS This is a retrospective review of all living donor nephrectomies performed at the Massachusetts General Hospital, Harvard Medical School, Boston, between 1/1998 - 12/2009. Overall there were 490 living donors, with 279 undergoing laparoscopic living donor nephrectomy (LLDN) and 211 undergoing open donor nephrectomy (OLDN). Demographic data, operating room time, the effect of the learning curve, the number of conversions from laparoscopic to open surgery, donor preoperative glomerular filtration rate and creatinine (Cr), donor and recipient postoperative Cr, delayed graft function and donor complications were analyzed. Statistical analysis was performed. RESULTS Overall there was no statistically significant difference between the LLDN and the OLDN groups regarding operating time, donor preoperative renal function, donor and recipient postoperative kidney function, delayed graft function or the incidence of major complications. When the last 100 laparoscopic cases were analyzed, there was a statistically significant difference regarding operating time in favor of the LLDN, pointing out the importance of the learning curve. Furthermore, another significant difference between the two groups was the decreased length of stay for the LLDN (2.87 d for LLDN vs 3.6 d for OLDN). CONCLUSION Recognizing the importance of the learning curve, this paper provides evidence that LLDN has a safety profile comparable to OLDN and decreased length of stay for the donor. PMID:28101451

  13. Aggressive Treatment of Patients with Metastatic Colorectal Cancer Increases Survival: A Scandinavian Single-Center Experience

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    Kristoffer Watten Brudvik

    2013-01-01

    Full Text Available Background. We examined overall and disease-free survivals in a cohort of patients subjected to resection of liver metastasis from colorectal cancer (CRLM in a 10-year period when new treatment strategies were implemented. Methods. Data from 239 consecutive patients selected for liver resection of CRLM during the period from 2002 to 2011 at a single center were used to estimate overall and disease-free survival. The results were assessed against new treatment strategies and established risk factors. Results. The 5-year cumulative overall and disease-free survivals were 46 and 24%. The overall survival was the same after reresection, independently of the number of prior resections and irrespectively of the location of the recurrent disease. The time intervals between each recurrence were similar (11 ± 1 months. Patients with high tumor load given neoadjuvant chemotherapy had comparable survival to those with less extensive disease without neoadjuvant chemotherapy. Positive resection margin or resectable extrahepatic disease did not affect overall survival. Conclusion. Our data support that one still, and perhaps to an even greater extent, should seek an aggressive therapeutic strategy to achieve resectable status for recurrent hepatic and extrahepatic metastases. The data should be viewed in the context of recent advances in the understanding of cancer biology and the metastatic process.

  14. Magnetic resonance imaging appearance of soft-tissue metastases: our experience at an orthopedic oncology center

    Energy Technology Data Exchange (ETDEWEB)

    Sammon, Jennifer; Jain, Abhishek; Bleakney, Robert; Mohankumar, Rakesh [Mount Sinai Hospital and University of Toronto, Division of Musculoskeletal Imaging, Joint Department of Medical Imaging, Toronto, Ontario (Canada)

    2017-04-15

    To assess the prevalence and magnetic resonance imaging appearance of metastasis presenting as a soft-tissue mass. A retrospective chart review was performed on 51 patients who presented to an orthopedic oncology center with soft-tissue masses, with a histology-proven diagnosis of soft-tissue metastasis, over a 14-year period. Their magnetic resonance imaging, primary origin, and follow-up have been assessed. Soft-tissue metastasis was identified in patients ranging from 18 to 85 years old. Most (80%) of the masses were located deep to the deep fascia. In our cohort of patients, melanoma was the most common primary malignancy contributing to soft-tissue metastasis (21.8%). Among soft-tissue metastasis from solid organs, breast and lung were the most frequent (9.1% each). Five patients had soft-tissue metastases from an unknown primary. Imaging diagnosis of soft-tissue metastases is challenging as it can demonstrate imaging appearances similar to primary soft-tissue sarcoma. The presence of a known malignancy may not be evident in everyone, and even if available, histopathology will be necessary for diagnosis if this is the only site of recurrence/metastasis to differentiate from a primary soft-tissue sarcoma. Moreover, soft-tissue metastasis may be the initial presentation of a malignancy. Primary malignancies with soft-tissue metastasis carry a poor prognosis; hence, prompt diagnosis and management in essential. (orig.)

  15. Family Centered Approach in Primary Health Care: Experience from an Urban Area of Mangalore, India

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    Siddharudha Shivalli

    2015-01-01

    Full Text Available Introduction. “Health for All” still eludes public health experts despite many approaches to prevent disease and promote health among urban poor. Several key illness factors lie beyond the conventional healthcare boundaries. Objective. To examine the effectiveness of family centered approach (FCA in addressing health and related issues in an urban area of Mangalore, India. Method. A longitudinal study was conducted in Bengre, an outreach centre of Mangalore from June 2011 to November 2013. Family folders were created with pertinent details. Demand generation and health education activities were conducted through two female community health link workers. An FCA package was implemented by medical and nursing interns, under supervision, to address the priority issues. Effect was assessed by comparing their practices and service utilization before and after the study. Results. About 809 families participated in this study. Social, cultural, and religious factors were responsible for viciousness of malaria and maternal and child health issues. FCA improved their perceptions and practices towards health and related issues. Significant (P<0.05 and sustained hike in service utilization was evident. Conclusion. FCA exposes key illness factors beyond the conventional care, eases need based healthcare implementation, and provides feasible and enduring solutions. Community involvement makes it more practicable.

  16. Outcome analysis of management of liver trauma: A 10-year experience at a trauma center

    Institute of Scientific and Technical Information of China (English)

    Wong; Hoi; She; Tan; To; Cheung; Wing; Chiu; Dai; Simon; HY; Tsang; Albert; CY; Chan; Daniel; KH; Tong; Gilberto; KK; Leung; Chung; Mau; Lo

    2016-01-01

    AIM: To review the outcomes of liver trauma in patients with hepatic injuries only and in patients with associated injuries outside the liver.METHODS: Data of liver trauma patients presented to our center from January 2003 to October 2013 were reviewed. The patients were divided into two groups. Group 1 consisted of patients who had hepatic injuries only. Group 2 consisted of patients who also had associated injuries outside the liver.RESULTS: Seven(30.4%) patients in group 1 and 10(28.6%) patients in group 2 received non-operative management; the rest underwent operation. Blunt trauma occurred in 82.8%(48/58) of the patients and penetrative trauma in 17.2%(10/58). A higher injury severity score(ISS) was observed in group 2(median 45 vs 25, P < 0.0001). More patients in group 1 were hemodynamically stable(65.2% vs 37.1%, P = 0.036). Other parameters were comparable between groups. Group 1 had better 30-d survival(91.3% vs 71.4%, P = 0.045). On multivariate analysis using the logistic regression model, ISS was found to be associated with mortality(P = 0.004, hazard ratio = 1.035, 95%CI:CONCLUSION: Liver trauma patients with multiple injuries are relatively unstable on presentation. Despite a higher ISS in group 2, non-operative management was possible for selected patients. Associated injuries outside the liver usually account for morbidity and mortality.

  17. The Manuel Lujan, Jr. Neutron Scattering Center (LANSCE) experiment reports 1992 run cycle. Progress report

    Energy Technology Data Exchange (ETDEWEB)

    DiStravolo, M.A. [comp.

    1993-09-01

    This year was the fifth in which LANSCE ran a formal user program. A call for proposals was issued before the scheduled run cycles, and experiment proposals were submitted by scientists from universities, industry, and other research facilities around the world. An external program advisory committee, which LANSCE shares with the Intense Pulsed Neutron Source (IPNS), Argonne National Laboratory, examined the proposals and made recommendations. At LANSCE, neutrons are produced by spallation when a pulsed, 800-MeV proton beam impinges on a tungsten target. The proton pulses are provided by the Clinton P. Anderson Meson Physics Facility (LAMPF) accelerator and an associated Proton Storage Ring (PSR), which can alter the intensity, time structure, and repetition rate of the pulses. The LAMPF protons of Line D are shared between the LANSCE target and the Weapons Neutron Research (WNR) facility, which results in LANSCE spectrometers being available to external users for unclassified research about 80% of each annual LAMPF run cycle. Measurements of interest to the Los Alamos National Laboratory may also be performed and may occupy up to an additional 20% of the available beam time. These experiments are reviewed by an internal program advisory committee. One hundred sixty-seven proposals were submitted for unclassified research and twelve proposals for research of a programmatic interest to the Laboratory; six experiments in support of the LANSCE research program were accomplished during the discretionary periods. Oversubscription for instrument beam time by a factor of three was evident with 839 total days requested and only 371 available for allocation.

  18. Simultaneous liver and kidney transplantation:analysis of a single-center experience

    Institute of Scientific and Technical Information of China (English)

    MA Yi; WANG Guo-dong; HE Xiao-shun; LI Qiang; LI Jun-liang; ZHU Xiao-feng; WANG Chang-xi

    2010-01-01

    Background Simultaneous liver and kidney transplantation (SLKT) has been proven to be a favorable treatment for combined renal and hepatic end-stage disease.However, recipients receiving SLKT have a long medical history, poor general condition that is often accompanied by anemia, hypoalbuminemia, coagulopathy, water-electrolyte imbalance and acid-base disorders.This study aimed to explore the indications, surgical techniques, therapeutic experience,prevention and treatment of postoperative complications of SLKT.Methods The clinical data of 22 SLKTs cases performed at the First Affiliated Hospital of Sun Yat-sen University from January 2001 to December 2008 were retrospectively studied.Indications for SLKT, surgical techniques, perioperative fluid management, immunosuppressive regimen and experience in prevention and treatment of postoperative complications were analyzed.Results All operations were successfully performed.Postoperative complications occurred in 13 cases (59.1%), including pleural effusions (7), intra-abdominal bleeding (2), biliary complications (2), repeated upper gastrointestinal bleeding (1), and acute liver graft rejection (1).All complications were treated conservatively.In this study, there were five deaths during follow-up, in which three perioperative deaths occurred due to serious conditions.Mortality at 3 months was 13.6%.The one and three year patient survival rate was 81.3% and 73.9% respectively.Conclusions SLKT is an effective therapy for end-stage liver disease with chronic renal failure or severe damage to renal function.It is a complex surgical procedure, causing a large disturbance of circulation and fluid balance, and more postoperative complications.The SLKT surgical techniques selected are based on the experience of surgeons, the anatomy of the recipient and primary diseases.It is essential to use the correct perioperative fluid management, reasonable immunosuppressive regimen, and prevention and treatment of postoperative

  19. REPEATED LIVER TRANSPLANTATION: EXPERIENCE OF RUSSIAN SCIENTIFIC CENTER OF RADIOLOGY AND SURGICAL TECHNOLOGY (RSCRST

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    D. A. Granov

    2011-01-01

    Full Text Available The article gives the report about the experience in repeated liver transplantation (LT. Totally 99 LT including 6 repeated operation at five patients performed between june 1999 and june 2011. In 3 of 6 cases bile ducts necroses was the indication to repeated LT. Retransplantations were connected with difficulties, enlargement of duration and replacement therapy volume, also explained high number of complication after operation. It is demonstrated that chronic biliary infection and bad condition of patients are the main reasons of complication and poor prognosis after repeated liver transplantation. 

  20. Reconstructive surgery for male stress urinary incontinence: Experiences using the ATOMS system at a single center

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    Krause, Jens

    2014-12-01

    Full Text Available Objective: To propose possible success-driven solutions for problem and complication rates encountered with the ATOMS sling system, based on first-hand experience; and to provide possible actual alternative scenarios for the treatment of male . Patients and methods: During the defined period (between 4/2010 and 04/2014, 36 patients received ATOMS system implants at our clinic. We collected pre- and post-operative evaluation data using the International Consultation on Incontinence Questionnaire Short Form (ICIQ SF. As an expansion of the questionnaire, we added questions about post-operative perineal pain, the general satisfaction with the results of the intervention and willingness to recommend the operation to a best friend. Results: Our data shows a relatively high explantation rate, but a surprisingly high patient satisfaction rate. Explantation was required mainly due to late onset infections or other symptomatic factors. Compared to other studies early onset infections were rare. Conclusion: A non-invasive, uncomplicated adjustable system to alleviate male stress urinary incontinence remains a challenge. Although there are various systems available for the treatment of male stress urinary incontinence, it seems that despite the advantages of the ATOMS system, an artificial sphincter system may pose more advantages based on our experience, understanding and knowledge of its well-documented long-term solutions and problems.

  1. Abdominal aorta aneurysms in children: single-center experience of six patients.

    Science.gov (United States)

    Ye, Caisheng; Yin, Henghui; Lin, Ying; Zhou, Li; Ye, Runyi; Li, Xiaoxi; Han, Anjia; Wang, Shenming

    2012-01-01

    Abdominal aortic aneurysms (AAA) are rare in children and are associated with significant morbidity and mortality as in adults. We summarize our experience in the diagnosis and management of AAAs in 6 children at a single institution. The clinical data of 6 pediatric patients with AAAs treated at our hospital from November 2005 to November 2008 were retrospectively analyzed. There were 4 males and 2 females with a mean age at diagnosis of 8 years (range, 17 months to 18 years). All patients presented with pulsatile abdominal masses. Color Doppler ultrasonography and computed tomography angiography were the primary diagnostic tools. One patient has a history of tuberous sclerosis, and 1 had Takayasu's arteritis; no risk factors or identifiable causes were found in the other patients. All of the AAAs identified were infrarenal. Surgical reconstruction with aneurysm resection and prosthetic graft placement was performed successfully in all 6 cases. No intraoperative or postoperative complications occurred. Mean follow-up has been 48 months (range, 32 to 69). In 1 patient, recurrence was noted at 3 years postoperatively. The patient's family declined further surgery, and the patient died, likely of rupture of the aneurysm at 41 months postoperatively. All other patients are currently alive and well. Our experience indicates that good outcomes can be obtained in children with AAAs with prompt and accurate diagnosis and surgical management with artificial grafts. Copyright © 2012 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  2. Chronic Thromboembolic Pulmonary Hypertension: Experience from a Single Center in Mexico.

    Science.gov (United States)

    Al-Naamani, Nadine; Espitia H, Gaudalupe; Velazquez-Moreno, Hugo; Macuil-Chazaro, Benjamin; Serrano-Lopez, Arturo; Vega-Barrientos, Ricardo S; Hill, Nicholas S; Preston, Ioana R

    2016-04-01

    Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by precapillary pulmonary hypertension secondary to vaso-occlusive pulmonary vasculopathy and is classified as Pulmonary Hypertension Group 4. The aim of this study is to report the clinical experience of CTEPH in Mexico. Consecutive patients diagnosed with CTEPH were identified from the Registro de Pacientes con Hipertension Pulmonar del Instituto de Seguridad y Servicio Social de los Trabajadores del Estado (REPHPISSSTE) registry between January 2009 and February 2014. Right heart catheterization was not routinely performed prior to August 2010 in the work-up of CTEPH. We identified 50 patients with CTEPH; their median age was 63 years and 58 % were female. Patients had multiple associated co-morbidities and moderate hemodynamic impairment. All patients were treated with anticoagulation. Despite surgical evaluation for pulmonary endarterectomy (PEA), only one patient underwent PEA given the lack of infrastructure for post-operative care and lack of insurance for this procedure. Most of the patients were treated with sildenafil, bosentan, or both, with increasing use of rivaroxaban and sildenafil in recent years. The overall survival of the cohort was similar to that reported in other international registries, despite the limitations of care imposed by drug availability and surgical feasibility. This is the first report on the CTEPH experience in Mexico. It highlights the similarity of patients in the REPHPISSSTE registry to those in international registries as well as the challenges that clinicians face in a resource-limited setting.

  3. A Ventral Visual Stream Reading Center Independent of Sensory Modality and Visual Experience

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    Lior Reich

    2011-10-01

    Full Text Available The Visual Word Form Area (VWFA is a ventral-temporal-visual area that develops expertise for visual reading. It encodes letter-strings irrespective of case, font, or location in the visual-field, with striking anatomical reproducibility across individuals. In the blind, reading can be achieved using Braille, with a comparable level-of-expertise to that of sighted readers. We investigated which area plays the role of the VWFA in the blind. One would expect it to be at either parietal or bilateral occipital cortex, reflecting the tactile nature of the task and crossmodal plasticity, respectively. However, according to the notion that brain areas are task specific rather than sensory-modality specific, we predicted recruitment of the left-hemispheric VWFA, identically to the sighted and independent of visual experience. Using fMRI we showed that activation during Braille reading in congenitally blind individuals peaked in the VWFA, with striking anatomical consistency within and between blind and sighted. The VWFA was reading-selective when contrasted to high-level language and low-level sensory controls. Further preliminary results show that the VWFA is selectively activated also when people learn to read in a new language or using a different modality. Thus, the VWFA is a mutlisensory area specialized for reading regardless of visual experience.

  4. Lung transplantation in a Chinese single center:7 years of experience

    Institute of Scientific and Technical Information of China (English)

    HE Wen-xin; ZHANG Peng; LIU Ming; JIANG Ge-ning; DING Jia-an; GAO Wen; ZHU Yu-ming; ZHOU Xiao; CHEN Chang; WANG Hao; FAN Jiang

    2011-01-01

    Background Lung transplantation (LT) is a viable option for patients with end-stage lung diseases,but in China,the supply is limited,and the experience with LT is rare too. This study aimed to evaluate the survival and postoperative complications of recipients undergone LT.Methods From January 2003 to May 2010,all patients who underwent LT were included. The clinical data of recipients were analyzed retrospectively,including demographic characteristics,survival rate,and the occurrences of postoperative complications,acute rejection and bronchiolitis obliterans syndrome. Results In total,37 patients underwent LT. The early mortality (<30 days) was 14% (5/37). Cumulative survival rate was 78%,70%,70% and 42% at 1,3,5 and 6 years,respectively. In 37 patients,5 (14%) developed fungal infections,9 (24%)pulmonary bacterial infections,and 6 (16%) had bronchial anastomosis complications after LT. At three months posttransplantation,a significant improvement was observed in lung function (P <0.05). Fifteen recipients (41%) developed acute rejection within the first year. Freedom from bronchiolitis obliterans syndrome was 89%,85% and 80% at 1,2 and 3years after transplantation.Conclusions Despite the limited number of cases,the survival and occurrences of complications after LT were comparable to the international experience. Single LT may be a reasonable option for some patients with end-stage pulmonary diseases.

  5. Chronic Thromboembolic Pulmonary Hypertension: Experience from a Single Center in Mexico

    Science.gov (United States)

    Al-Naamani, Nadine; Espitia H, Gaudalupe; Velazquez-Moreno, Hugo; Macuil-Chazaro, Benjamin; Serrano-Lopez, Arturo; Vega-Barrientos, Ricardo S.; Hill, Nicholas S.

    2017-01-01

    Introduction Chronic thromboembolic pulmonary hypertension (CTEPH) is characterized by precapillary pulmonary hypertension secondary to vaso-occlusive pulmonary vasculopathy and is classified as Pulmonary Hypertension Group 4. The aim of this study is to report the clinical experience of CTEPH in Mexico. Methods Consecutive patients diagnosed with CTEPH were identified from the Registro de Pacientes con Hipertension Pulmonar del Instituto de Seguridad y Servicio Social de los Trabajadores del Estado (REPHPISSSTE) registry between January 2009 and February 2014. Right heart catheterization was not routinely performed prior to August 2010 in the work-up of CTEPH. Results We identified 50 patients with CTEPH; their median age was 63 years and 58 % were female. Patients had multiple associated co-morbidities and moderate hemodynamic impairment. All patients were treated with anticoagulation. Despite surgical evaluation for pulmonary endarterectomy (PEA), only one patient underwent PEA given the lack of infrastructure for post-operative care and lack of insurance for this procedure. Most of the patients were treated with sildenafil, bosentan, or both, with increasing use of rivaroxaban and sildenafil in recent years. The overall survival of the cohort was similar to that reported in other international registries, despite the limitations of care imposed by drug availability and surgical feasibility. Conclusion This is the first report on the CTEPH experience in Mexico. It highlights the similarity of patients in the REPHPISSSTE registry to those in international registries as well as the challenges that clinicians face in a resource-limited setting. PMID:26748498

  6. Robot-assisted cardiac surgery using the da vinci surgical system: a single center experience.

    Science.gov (United States)

    Kim, Eung Re; Lim, Cheong; Kim, Dong Jin; Kim, Jun Sung; Park, Kay Hyun

    2015-04-01

    We report our initial experiences of robot-assisted cardiac surgery using the da Vinci Surgical System. Between February 2010 and March 2014, 50 consecutive patients underwent minimally invasive robot-assisted cardiac surgery. Robot-assisted cardiac surgery was employed in two cases of minimally invasive direct coronary artery bypass, 17 cases of mitral valve repair, 10 cases of cardiac myxoma removal, 20 cases of atrial septal defect repair, and one isolated CryoMaze procedure. Average cardiopulmonary bypass time and average aorta cross-clamping time were 194.8±48.6 minutes and 126.1±22.6 minutes in mitral valve repair operations and 132.0±32.0 minutes and 76.1±23.1 minutes in myxoma removal operations, respectively. During atrial septal defect closure operations, the average cardiopulmonary bypass time was 128.3±43.1 minutes. The median length of stay was between five and seven days. The only complication was that one patient needed reoperation to address bleeding. There were no hospital mortalities. Robot-assisted cardiac surgery is safe and effective for mitral valve repair, atrial septal defect closure, and cardiac myxoma removal surgery. Reducing operative time depends heavily on the experience of the entire robotic surgical team.

  7. Chromogranin A as Serum Marker for Gastroenteropancreatic Neuroendocrine Tumors: A Single Center Experience and Literature Review

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    Christoph J. Auernhammer

    2012-02-01

    Full Text Available The aim of this study was to assess the clinical sensitivities of the tumor markers chromogranin A (CgA, urinary 5-hydroxyindoleacetic acid (5-HIAA and alkaline phosphatase (AP in neuroendocrine tumors (NETs of the GastroEnteroPancreatic-(GEP- system depending on tumor primary location and metastatic spread. In a retrospective single-center series, sensitivities were evaluated in serum samples from 110 patients with midgut (n = 62 and pancreatic (n = 48 NETs. CgA levels were analyzed by a commercially-available immunoradiometric assay (CIS-bio during routine follow-up in the years 2000–2009. CgA showed a higher sensitivity for midgut (68% than pancreatic (54% NETs. A higher CgA sensitivity and significantly higher median CgA values were found in patients with liver metastases than in those without, and in patients with hepatic and additionally extra-hepatic metastases than in those with hepatic and nodal metastases alone, respectively. We found an overall sensitivity for elevated 5HIAA excretion of 69% for midgut NETs and a significant correlation between median CgA and 5-HIAA values. The sensitivity of AP and the correlations of AP/CgA-data-pairs were low in both midgut and pancreatic NETs, although highest for metastatic pancreatic NETs. The sensitivity of CgA measurement depends on the NET primary location and spread of disease. 5-HIAA and CgA showed comparable sensitivity in midgut NETs, while AP does not seem to be useful as a tumor marker in GEP-NETs.

  8. Mycetoma: experience of 482 cases in a single center in Mexico.

    Science.gov (United States)

    Bonifaz, Alexandro; Tirado-Sánchez, Andrés; Calderón, Luz; Saúl, Amado; Araiza, Javier; Hernández, Marco; González, Gloria M; Ponce, Rosa María

    2014-08-01

    Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013). A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11%) were actinomycetomas and 38 cases (7.88%) were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3:1. The mean age was 34.5 years old (most ranged from 21 to 40 years). The main affected localization was lower and upper limbs (70.74% and 14.52% respectively). Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported). The main clinical presentation was as tumor-like soft tissue swelling with draining sinuses (97.1%). Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21%) and Actinomadura madurae (8.7%); meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii) were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico.

  9. Mycetoma: experience of 482 cases in a single center in Mexico.

    Directory of Open Access Journals (Sweden)

    Alexandro Bonifaz

    2014-08-01

    Full Text Available Mycetoma is a chronic granulomatous disease. It is classified into eumycetoma caused by fungi and actinomycetoma due to filamentous actinomycetes. Mycetoma can be found in geographic areas in close proximity to the Tropic of Cancer. Mexico is one of the countries in which this disease is highly endemic. In this retrospective study we report epidemiologic, clinical and microbiologic data of mycetoma observed in the General Hospital of Mexico in a 33 year-period (1980 to 2013. A total of 482 cases were included which were clinical and microbiology confirmed. Four hundred and forty four cases (92.11% were actinomycetomas and 38 cases (7.88% were eumycetomas. Most patients were agricultural workers; there was a male predominance with a sex ratio of 3:1. The mean age was 34.5 years old (most ranged from 21 to 40 years. The main affected localization was lower and upper limbs (70.74% and 14.52% respectively. Most of the patients came from humid tropical areas (Morelos, Guerrero and Hidalgo were the regions commonly reported. The main clinical presentation was as tumor-like soft tissue swelling with draining sinuses (97.1%. Grains were observed in all the cases. The principal causative agents for actinomycetoma were: Nocardia brasiliensis (78.21% and Actinomadura madurae (8.7%; meanwhile, for eumycetomas: Madurella mycetomatis and Scedosporium boydii (synonym: Pseudallescheria boydii were identified. This is a single-center, with long-follow up, cross-sectional study that allows determining the prevalence and characteristics of mycetoma in different regions of Mexico.

  10. "Awake Veno-arterial Extracorporeal Membrane Oxygenation" in Pediatric Cardiogenic Shock: A Single-Center Experience.

    Science.gov (United States)

    Schmidt, F; Jack, T; Sasse, M; Kaussen, T; Bertram, H; Horke, A; Seidemann, K; Beerbaum, P; Koeditz, H

    2015-12-01

    In pediatric patients with acute refractory cardiogenic shock (CS), extracorporeal membrane oxygenation (ECMO) remains an established procedure to maintain adequate organ perfusion. In this context, ECMO can be used as a bridging procedure to recovery, VAD or transplantation. While being supported by ECMO, most centers tend to keep their patients well sedated and supported by invasive ventilation. This may be associated with an increased risk of therapy-related morbidity and mortality. In order to optimize clinical management in pediatric patients with ECMO therapy, we report our strategy of veno-arterial ECMO (VA-ECMO) in extubated awake and conscious patients. We therefore present data of six of our patients with CS, who were treated by ECMO being awake without continuous analgosedation and invasive ventilation. Of these six patients, four were 14 years of age. Median time on ECMO was 17.4 days (range 6.9-94.2 days). Median time extubated, while receiving ECMO support was 9.5 days. Mean time extubated was 78 % of the total time on ECMO. Three patients reached full recovery of cardiac function on "Awake-VA-ECMO," whereas the other three were successfully bridged to destination therapy (VAD, heart transplantation, withdrawal). Four out of our six patients are still alive. Complications related to ECMO therapy (i.e., severe bleeding, site infection or dislocation of cannulas) were not observed. We conclude that "Awake-VA-ECMO" in extubated, spontaneously breathing conscious pediatric patients is feasible and safe for the treatment of acute CS and can be used as a "bridging therapy" to recovery, VAD implantation or transplantation.

  11. Relationship between renal function and extracorporeal membrane oxygenation use: a single-center experience.

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    Gupta, Punkaj; Carlson, Jacob; Wells, Dennis; Selakovich, Patrick; Robertson, Michael J; Gossett, Jeffrey M; Fontenot, Eudice E; Steiner, Matthew B

    2015-04-01

    The effects of extracorporeal membrane oxygenation (ECMO) support on renal function in children with critical illness are unknown. The objective of this study was to investigate the impact of ECMO on renal function among children in different age groups. We performed a single-center retrospective observational study in critically ill children ≤ 18 years supported on ECMO for refractory cardiac or pulmonary failure (2006-2012). The patient population was divided into four age groups for the purpose of comparisons. The Acute Kidney Injury Network's (AKIN's) validated, three-tiered staging system for acute kidney injury was used to categorize the degree of worsening renal function. Data on patient demographics, baseline characteristics, renal function parameters, dialysis, ultrafiltration, duration of mechanical cardiac support, and mortality were collected. Comparisons of baseline characteristics, duration of mechanical cardiac support, and renal function were made between the four age groups. During the study period, 311 patients qualified for inclusion, of whom 289 patients (94%) received venoarterial (VA) ECMO, 12 (4%) received venovenous (VV) ECMO, and 8 (3%) received both VV and VA ECMO. A total of 109 patients (36%) received ultrafiltration on ECMO, 58 (19%) received hemodialysis, and 51 (16%) received peritoneal dialysis. There was a steady and sustained improvement in renal function in all age groups during the ECMO run, with the maximum and longest-sustained improvement occurring in the oldest age group. Proportions of patients in different AKIN stages remained similar in the first 7 days after ECMO initiation. We demonstrate that renal dysfunction improves early after ECMO support. Irrespective of the underlying disease process or patient age, renal function improves in children with pulmonary or cardiac failure who are placed on ECMO.

  12. Safety and retention rate of rufinamide in 300 patients: a single pediatric epilepsy center experience.

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    Thome-Souza, Sigride; Kadish, Navah E; Ramgopal, Sriram; Sánchez Fernández, Iván; Bergin, Ann M; Bolton, Jeffrey; Harini, Chellamani; Libenson, Mark; Olson, Heather; Peters, Jurriaan; Poduri, Annapurna; Rotenberg, Alexander; Takeoka, Masanori; Kothare, Sanjeev V; Kapur, Kush; Bourgeois, Blaise F D; Loddenkemper, Tobias

    2014-08-01

    Reports of studies evaluating rufinamide as an add-on therapy in children and adolescents with refractory epilepsy are restricted to a few publications. Prospective multicenter studies including children and adults have yielded important information about several types of epilepsies and syndromes. We evaluated the use of rufinamide in a single pediatric center with a large cohort and long-term follow-up period. We retrospectively included patients taking rufinamide from November 2008 to March 2013. Response was defined by a seizure reduction of ≥50% compared to baseline. Three hundred patients with a median age of 9.1 years (range 0.4-29.6 years) were reviewed. Median follow-up was 9 months (range 1-37 months). Epilepsy etiology was classified as genetic (23.7%), structural/metabolic (41%), and unknown cause (35.3%). Overall, rufinamide treatment led to a median seizure frequency reduction of 59.2% from responders to baseline. Seizure reduction was greater in patients with genetic etiology compared to structural/metabolic (66.2% vs. 45.5% responders, p = 0.005). Rufinamide was discontinued in 110 (36.7%) of 300 patients: 63 (21%) due to unsatisfactory response, 47 (15.7%) due to side effects, and in 18 (6%) of those due to both. Most common adverse effects were sleepiness, vomiting, mood changes, nausea, and loss of appetite. Median time to loss of efficacy was 11.6 months (range 3-28 months). Rufinamide provides satisfactory seizure reduction as an adjunctive treatment in refractory epilepsy. Results need to be interpreted in the setting of data acquisition, including inherent biases of retrospective studies. Patients with a known genetic etiology may have better responses than patients with structural/metabolic etiology. Wiley Periodicals, Inc. © 2014 International League Against Epilepsy.

  13. Pregnancy Outcomes in HIV-Infected Women: Experience from a Tertiary Care Center in India.

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    Dadhwal, Vatsla; Sharma, Aparna; Khoiwal, Kavita; Deka, Dipika; Sarkar, Plaboni; Vanamail, P

    2017-01-01

    There is conflicting data on the effect of HIV infection as well as antiretroviral therapy (ART) on pregnancy outcome. The objectives of this study were to compare pregnancy outcomes in women with and without HIV infection, and to evaluate the effect of HAART on pregnancy in HIV-infected women. This is a prospective case record analysis of 212 HIV-infected women delivering between 2002 and 2015, in a tertiary health care center in India. The pregnancy outcome in HIV-infected women was compared to 238 HIV-uninfected controls. Women received ART for prevention of mother to child transmission as per protocol which varied during the period of study. Effect of use of ART on preterm birth (PTB) and intrauterine growth restriction (IUGR) was analyzed. HIV-infected women were more likely to have PTB, IUGR, and anemia (9.4%, 9.9%, 5.2%) compared to uninfected women (7.6%, 5%, 3.8%), this did not reach statistical significance (P-value = >0.05). The incidence of PIH, diabetes mellitus and intrahepatic cholestasis of pregnancy was similar in both groups. Mean birth weight was significantly lower in neonates of HIV-infected women (2593.60±499g) than HIV-uninfected women (2919±459g) [P-value=0.001]. neonatal intensive care unit admissions were also significantly higher in infants born to HIV-infected women (P-value=0.002). HIV-infected women on ART had decreased incidence of PTB and IUGR. Good antenatal care and multidisciplinary team approach can optimize pregnancy outcomes in HIV-infected women.

  14. Transcatheter Atrial Septal Defect Closure Using Occlutech Figulla Device: A Two-Center Experience

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    Hojat Mortezaeian

    2015-10-01

    Full Text Available Background: Despite several reports regarding the use of the Occlutech Figulla® Flex septal occluder (OFFSO in adults, there are few reports on its use in children. We sought to study the result of the transcatheter closure of atrial septal defect (ASD using the OFFSO in children ≤ 12 years.Methods: We enrolled 45 consecutive patients, ranging from 2.5 to 12 years of age, in two large pediatric cardiovascular centers. All the children underwent complete echocardiographic examination before the procedure. Defect/device ratio and device/weight ratio were measured. The device diameter to the cardiac diameter ratio (DD/CD ratio in anteroposterior projection after device release and the DD/CD index were calculated by dividing the DD/CD ratio by the body surface area. Results: Of the 45 enrolled patients, 25 (55% were female. The range and mean ± standard deviation (SD of age were2.5 to 12 years and 6.8 ± 2.5 years, respectively. The range and mean ± SD weight were 8.5 to 37.0 kg and 19.7 ± 7.2 kg, respectively. Successful implantation was performed in all the patients. No major complications occurred in any of the subjects. We encountered one cobra head deformity in one patient. Neither residual shunt nor conduction abnormality was observed in any of the cases.Conclusion: Transcatheter ASD closure using the OFFSO was effective in our pediatric patients. Although this device needs relatively larger delivery sheaths, its use is safe while closing even large defects in children.

  15. Cryptococcal meningitis in HIV infected: Experience from a North Indian tertiary center

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    Kumar Susheel

    2008-01-01

    Full Text Available Background: Cryptococcal meningitis is a common opportunistic infection in Human Immunodeficiency Virus (HIV-infected individuals. There is little information specifically addressing cryptococcal meningitis in HIV-infected patients from North India. Aims: To determine clinical presentation, hospital course, response to treatment, complications developed, in-hospital mortality, any recurrence of cryptococcal meningitis and reasons of recurrence during follow-up. Settings and Design: A retrospective observational study undertaken in a large tertiary care center. Materials and Methods: Patient′s demographic data, presenting clinical symptomatology, physical findings, laboratory parameters, cerebrospinal fluid (CSF examination findings, side-effects of treatment, development of any complications and hospital outcome were analyzed. During follow-up any recurrence of cryptococcal meningitis, possible reasons of recurrence, type of treatment received, complications developed and outcome was recorded as well. Results: Forty patients diagnosed to have cryptococcal meningitis were analyzed. Twenty-two (55% patients had acute/ subacute presentation. Thirty-six (90% patients presented with headache and 18 (45% had altered sensorium. Twenty (50% patients had no cells in the CSF. Hypoglycorrhchia was seen in 30 (75% patients. Cryptococcal meningitis was the first acquired immune deficiency syndrome (AIDS-defining illness in 30 (75% patients. Thirty-five patients developed some adverse effects to amphotericin-B. Thirty-three patients improved with treatment while three patients died. Four patients had recurrence of cryptococcal meningitis within six months of first episode. Non-compliance of fluconazole therapy was the reason for recurrence in all of these patients. Conclusions: Cryptococcal meningitis is a common initial AIDS-defining illness. Acute and/or subacute presentation of cryptococcal meningitis is not uncommon in HIV-infected individuals. An early

  16. Predisposing Factors of Ischemic Colitis: Data from 14 Years of Experience in a Single Center

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    Hyun Il Seo

    2017-01-01

    Full Text Available Background and Aims. While several case reports on ischemic colitis (IC suggest the presence of predisposing causative factors, a few studies have investigated the predisposing factors in IC. This study aimed to identify the characteristics of patients with IC, particularly focusing on the predisposing factors. Methods. We conducted a single-center, retrospective analysis of 159 patients with IC. Clinical characteristics, laboratory data, endoscopic findings, and medical records were reviewed. Data were compared between groups of patients defined according to the predisposing factors. The predisposing factors are defined as temporary states or episodic events occurring within a week before the development of IC such as colonoscopy, enema, use of laxatives, heavy drinking, pancreatitis, shock, and burn. Results. Compared to the group of patients without predisposing factors of IC, the group of patients with predisposing factors was characterized by a relatively higher prevalence of male sex (56.9% versus 33.3%, p=0.005, younger age (60.9 ± 15.4 versus 67.2 ± 13.4 years, p=0.010, lower incidence of hypertension (43.1% versus 60.2%, p=0.044, and fewer risk factors (1.24 ± 1.18 versus 1.82 ± 1.22, p=0.005. Conclusions. Among men with predisposing factors, IC may develop even at a relatively younger age and in the absence of multiple risk factors, suggesting that predisposing factors may be involved in the pathogenesis of IC.

  17. Central nervous system involvement in T-cell lymphoma: A single center experience.

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    Gurion, Ronit; Mehta, Neha; Migliacci, Jocelyn C; Zelenetz, Andrew; Moskowitz, Alison; Lunning, Matthew; Moskowitz, Craig; Hamlin, Paul; Horwitz, Steven

    2016-05-01

    Background We characterized the incidence of central nervous system (CNS) involvement, risk factors and outcome in a large single institution dataset of peripheral T-cell lymphoma (PTCL). Methods Retrospective review of the PTCL database at Memorial Sloan Kettering Cancer Center. We identified 231 patients with any subtype of PTCL between 1994-2011 with a minimum six months of follow-up or an event defined as relapse or death. Results Histologies included peripheral T-cell lymphoma-not otherwise specified (PTCL-NOS) (31.6%), angioimmunoblastic (16.9%), anaplastic large cell lymphoma (ALCL), ALK- (12.1%), ALCL, ALK + (6.1%), extranodal NK/T-cell lymphoma (7.4%), adult T-cell leukemia/lymphoma (ATLL) (7.4%), and transformed mycosis fungoides (8.7%). Seventeen patients had CNS disease (7%). Fifteen had CNS involvement with PTCL and two had diffuse large B-cell lymphoma and glioblastoma. Median time to CNS involvement was 3.44 months (0.16-103.1). CNS prophylaxis was given to 24 patients (primarily intrathecal methotrexate). Rates of CNS involvement were not different in patients who received prophylaxis. Univariate analysis identified stage III-IV, bone marrow involvement, >1 extranodal site and ATLL as risk factors for CNS disease. On multivariate analysis, >1 extranodal site and international prognostic index (IPI) ≥ 3 were predictive for CNS involvement. The median survival of patients with CNS involvement was 2.63 months (0.10-75). Conclusions Despite high relapse rates, PTCL, except ATLL, carries a low risk of CNS involvement. Prognosis with CNS involvement is poor and risk factors include: >1 extra nodal site and IPI ≥3.

  18. Percutaneous CT-guided radiofrequency ablation of solitary small renal masses. A single center experience

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    Pieper, C.C.; Fischer, S.; Strunk, H.; Meyer, C.; Thomas, D.; Willinek, W.A.; Schild, H. [Univ. Bonn (Germany). Dept. of Radiology; Hauser, S. [Univ. Bonn (Germany). Dept. of Urology; Nadal, J. [Univ. Bonn (Germany). Inst. for Medical Biometry; Wilhelm, K. [Johanniter Hospital Bonn (Germany). Dept. of Radiology

    2015-07-15

    To analyze the outcome of patients undergoing percutaneous CT-guided radiofrequency ablation (RFA) of small renal masses (SRM) at a single center during a ten-year time period. Patient records of renal RFAs (07/2003 - 11/2013) were reviewed. Indications were SRM suspicious of malignancy on imaging and one of the following: severe comorbidity; old age; solitary kidney; impaired renal function; patient wish. Biopsy was performed at the time of RFA. Patients were excluded if no follow-up was available. Patient and procedural characteristics were recorded. Survival rates were calculated using the Kaplan-Meier's method and compared with log-rank or cox tests. 38 patients (16 females, mean age 70.0 years [range 52 - 87]) presenting with a solitary SRM were included in the study. Biopsy showed malignancy in 29 patients; 9 had benign tumors. 26 patients suffered from cardiovascular, respiratory or hepatic comorbidities. Technical success (complete ablation on first follow-up) was achieved in 95 % of cases. Two major complications (bowel perforation; hematothorax) occurred. The 3- and 7-year overall survival (OS) [any cause] rates were 73.4 ± 0.8 % and 50.3 ± 1.0 %, respectively (mean follow-up 54.6 months, range 1 - 127). 4 recurrences and 2 metastases were observed. The presence of comorbidities was the only independent predictor of OS. There was no difference in survival between patients with benign and malignant tumors. RFA of SRM is successful in a large percentage of cases with a low complication rate and durable local control. As RFA is typically performed in multimorbid patients, overall survival seems to depend primarily on comorbidities rather than cancer progression.

  19. Is Antibiotic Usage Necessary after Donor Nephrectomy? A Single Center Experience

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    Zomorrodi Afshar

    2008-01-01

    Full Text Available Proper management of living kidney donors is a very important aspect of all renal transplants. To date, approximately 60,000 living donor nephrectomies have been performed worldwide and about 20 deaths directly related to the operation have been reported. The most common cause of death has been pulmonary embolism. Wound infection following surgery is the third most common nosocomial infection, and is dependent on the surgeon and his/her team, the operating room, number and virulence of contaminated bacteria, patient characteristics (immunity and defense, as well as time and duration of administration of antibiotics. Approach to the prophylaxis of wound infection in kidney donors varies in different transplant centers. This study was conducted at the Emam Hospital, Tabriz, Iran in order to delineate the protocol regarding antibiotic usage after donor nephrectomy. One hundred kidney donors were enrolled in the study. They were classified randomly in two groups: Group-1, comprising 50 donors, who received antibiotics immediately following surgery and for at least seven days thereafter. Group-2, comprised of 50 donors, in whom one gram of cephazoline was injected intravenously before anesthesia and continued for 24 hours after surgery. The patients were followed-up for one month with particular emphasis on occurrence of wound infection. One patient in Group-1, and two in Group-2 had wound infection; the difference was not statistically significant (p = > 0.5. Our study suggests that antibiotic prophylaxis started before incision and continued for 24 hours after donor nephrectomy is safe and effective in preventing wound infection.

  20. Treatment of hepatitis C in patients with haemophilia - the Israeli National Hemophilia Center experience.

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    Maor, Y; Schapiro, J M; Bashari, D; Lurie, Y; Safadi, R; Segol, O; Paritsky, M; Rachlis, Z; Avidan, B; Bar-Meir, S; Martinowitz, U

    2008-03-01

    Treatment with pegylated interferon (Peg-IFN) and ribavirin, now the standard of care, has been shown to achieve sustained viral response (SVR) in up to 60% of patients with hepatitis C (HCV). Studies of response to this combination in HCV-infected haemophilia patients are scarce. The aim of the study was to report the results and safety of interferon/ribavirin treatment in HCV and HCV-/HIV-infected patients at the Israeli National Hemophilia Center. A retrospective observational cohort study was conducted on haemophilia patients infected with HCV or HCV/HIV. Patients received combination of Peg-IFN and ribavirin. Few were still treated with standard interferon. The primary end-point was sustained viral response (SVR). The secondary end-point was safety, with emphasis on increased bleeding episodes. Some 18/43 (42%) HCV mono-infected haemophilia patients achieved SVR. Relapse occurred in 14 (33%), while 11 patients (25%) were non-responders. SVR was achieved among 17/37 (46%) naïve patients receiving Peg-IFN and ribavirin. Among patients with genotype-1, SVR was achieved in 12/36 (33%) and 11/30 (37%) in the whole group and Peg-IFN treated naïve patients, respectively. In HCV/HIV co-infected patients only 1 patient achieved SVR. Severe anaemia occurred in 14/50 (28%) patients, four received erythropoietin. None maintained stable haemoglobin levels. Two patients had significant bleeding episodes. In our cohort of haemophilia patients, SVR was achieved in a lower than expected rates. A relatively high relapse rate in the HCV mono-infected patients and a very high non-response rate in the HCV/HIV co-infected patients were observed as anticipated. Anaemia was a major side effect and the use of growth factors seemed unrevealing.

  1. Outcome results in children with IgA nephropathy: a single center experience

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    Bulut, Ipek Kaplan; Mir, Sevgi; Sozeri, Betul; Bulut, Mustafa Orhan; Sen, Sait; Dincel, Nida

    2012-01-01

    Background Immunoglobulin A nephropathy (IgAN) is the most common primary glomerulonephritis. Patients manifest variable clinical symptoms (eg, microhematuria) with preserved or progressive deterioration of renal function resulting in end-stage renal disease. The aim of this study was to evaluate patients from a single center to describe the clinical features, treatments, and follow-up results of those with the disease. Methods This is a retrospective data study of all children with IgAN. Patients who had a histopathologically proven diagnosis of IgAN and were followed up for at least 5 years were included in the study. Renal biopsy, graded as Hass classification, was performed on all patients. A total of 39 patients were included in the study. Results The mean follow-up time (± standard deviation) was 10.4 ± 3.51 (range 5–16) years. Twenty-nine patients (74.4%) were male and ten (25.6%) were female. Nineteen (48.7%) patients presented with recurrent macroscopic hematuria, ten (25.6%) with microscopic hematuria ± proteinuria, six (15.4%) with nephritic syndrome, and four (10.3%) with nephrotic syndrome. All patients underwent a renal biopsy, which was graded according to the Hass classification. At the end of follow-up time, 18 (46.1%) patients were normal, 15 (38.5%) had minor urinary abnormalities, three (7.7%) had active renal disease, and three (7.7%) developed renal failure. Conclusion The results of the present study are better than those from most other series. The majority of children with IgAN in this study were admitted with recurrent macroscopic hematuria and found to have a good prognosis. We suggest that children with IgAN have a good prognosis in the first 5-year follow-up period. PMID:22334797

  2. Premarital screening for hemoglobinopathies: experience of a single center in Kurdistan, Iraq.

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    Al-Allawi, Nasir A S; Al-Doski, Adnan A S; Markous, Raji S D; Mohamad Amin, Khyria A K; Eissa, Adil A Z; Badi, Ameer I A; Asmaro, Rafal R H; Hamamy, Hanan

    2015-01-01

    A program for the prevention of major hemoglobinopathies was initiated in 2008 in the Kurdistan region of Iraq. This study reports on the achievements and challenges of the program. A total of 102,554 individuals (51,277 couples) visiting a premarital center between 2008 and 2012 were screened for carrier status of hemoglobinopathies, and at-risk couples were counseled. A total of 223 (4.3/1,000) couples were identified and counseled as high-risk couples. Available data on 198 high-risk couples indicated that 90.4% proceeded with their marriage plans, and 15% of these married couples decided to have prenatal diagnosis (PND) in subsequent pregnancies with the identification of 8 affected fetuses; all were terminated as chosen by the parents. Thirty affected births were recorded among the high-risk couples. The premarital program managed to reduce the affected birth rate of major hemoglobinopathies by 21.1%. Of the 136 affected babies born during the study period, 77.9% were born to couples married prior to the start of the program, while 22.1% were born to couples identified as having a high risk. The main reason for not taking the option of PND was unaffordable costs. Financial support would have increased opting for PND by high-risk couples. Further reduction in affected birth rates could be achieved by including parallel antenatal screening programs to cover those married before the initiation of the premarital program and improving the public health education and counseling programs. © 2015 S. Karger AG, Basel.

  3. Clinical profile of primary hyperparathyroidism from western India: A single center experience

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    Gopal R

    2010-01-01

    Full Text Available Background: Primary hyperparathyroidism (PHPT has a variable clinical presentation and symptomatic PHPT is still the predominant form of the disease in India. Data from western India is lacking. Aim : To present the clinical profile of PHPT from western India. Settings and Design : This retrospective study was conducted at a tertiary care referral center. Materials and Methods : We analyzed the clinical presentation, biochemical, radiological features, and operative findings in adult patients with PHPT (1986-2008 and compared with our published data of children and adolescent patients with PHPT. Statistical Analysis : was done with SPSS 16 software. Results : Seventy-nine patients (F: M-2:1 with age ranging from 21 to 55 years (mean 33.5±8.82 were analyzed. Skeletal manifestations (75.5%, renal calculi (40.5% and proximal muscle weakness (45.5% were the most common symptoms of presentation with mean duration of symptoms being 33.70 (median: 24, range 1-120 months. Biochemical features included hypercalcemia (total corrected calcium 12.55±1.77 mg/dl, low inorganic phosphorus (1.81±0.682 mg/dl, elevated total alkaline phosphatase (mean: 762.2; median: 559; range: 50-4930IU/L and high parathyroid hormone (PTH (mean±SD: 866.61±799.15; median: 639.5; range: 52-3820 pg/ml. Preoperative localization was achieved in 74 patients and single adenoma was found during surgery in 72 patients. Hungry bone disease was seen in 30.3% and transient hypoparathyroidism developed in 62% patients. In comparison to PHPT in children there were no significant differences with regard to clinical, laboratory and radiological features. Conclusions : PHPT in western India is symptomatic disorder with skeletal and renal mani-festations at a much younger age. Clinical profile of PHPT in children is similar to that of adults.

  4. Predictors of pathologic complete response after preoperative concurrent chemoradiotherapy of rectal cancer: A single center experience

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    Choi, Eun Cheol [Proton Therapy Center, National Cancer Center, Goyang (Korea, Republic of); Kim, Jin Hee; Kim, Ok Bae; Kim, Mi Young; Oh, Young Ki; Baek, Sung Gyu [Dongsan Medical Center, Keimyung University School of Medicine, Daegu (Korea, Republic of)

    2016-06-15

    To identify possible predictors of pathologic complete response (pCR) of rectal cancer after preoperative concurrent chemoradiotherapy (CCRT). We conducted a retrospective review of 53 patients with rectal cancer who underwent preoperative CCRT followed by radical surgery at a single center between January 2007 and December 2012. The median radiotherapy dose to the pelvis was 54.0 Gy (range, 45.0 to 63.0 Gy). Five-fluorouracil-based chemotherapy was administered via continuous infusion with leucovorin. The pCR rate was 20.8%. The downstaging rate was 66%. In univariate analyses, poor and undifferentiated tumors (p = 0.020) and an interval of ≥7 weeks from finishing CCRT to surgery (p = 0.040) were significantly associated with pCR, while female gender (p = 0.070), initial carcinoembryonic antigen concentration of <5.0 ng/dL (p = 0.100), and clinical stage T2 (p = 0.100) were marginally significant factors. In multivariate analysis, an interval of ≥7 weeks from finishing CCRT to surgery (odds ratio, 0.139; 95% confidence interval, 0.022 to 0.877; p = 0.036) was significantly associated with pCR, while stage T2 (odds ratio, 5.363; 95% confidence interval, 0.963 to 29.877; p = 0.055) was a marginally significant risk factor. We suggest that the interval from finishing CCRT to surgery is a predictor of pCR after preoperative CCRT in patients with rectal cancer. Stage T2 cancer may also be an important predictive factor. We hope to perform a robust study by collecting data during treatment to obtain more advanced results.

  5. Five years renal transplantation data: Single-center experience from Iraq

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    Ala A Ali

    2016-01-01

    Full Text Available Renal transplantation is the treatment of choice for patients with end-stage renal disease. In Iraq, renal transplantation started in 1973 and has continued until now with live donor transplantation, since deceased donor transplant program is not approved as yet. Long-term transplant data are still scarce. The aim of our study is to present data on transplantation and medical follow-up at one year and, survival analysis at one, three and five years. A total of 250 renal transplantations were performed at the Nephrology and Renal Transplantation Center, Baghdad between January 2009 and January 2014. It is a living donor, blood group compatible donor program. All patients received triple immunosuppression (calcineurine inhibitor, mycophenolate mofetil or mycophenolic acid, and steroid. The Kaplan-Meier method was used to determine the survival rate. There were 92 live related donors, 143 unrelated donors, and 15 spouse donors. The mean age was 34.07 ± 12.2 years. The one-year graft survival for related and unrelated donor transplants was 98.9% and 91.8%, respectively. Graft survival was lower (82.9% in recipients with acute rejection episodes. The patient survival at one-year was 94%. The three-year graft and patient survival was 91% and 90%, respectively, and five-year survival for grafts and patients was 87.1% and 88%, respectively. The outcome of the renal transplantation in Iraq is improving. Long-term patient follow-up needs more meticulous attention. The development of renal transplant registry is critical for future planning. Moreover, renal transplantation practice in Iraq needs more social, religious, and governmental support.

  6. Perinatal Outcomes in Women with Preeclampsia: Experience of a Tertiary Referral Center

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    Semra Eroglu

    2015-11-01

    , pregestational medical evaluation and regular antenatal follow-up visits especially for high-risk women should be emphasized. Whenever possible, women diagnosed with severe preeclampsia or HELLP syndrome should be transferred to a tertiary medical center with adequate capabilities for maternal and neonatal intensive care in order to decrease perinatal morbidities.

  7. Management of autoimmune hemolytic anemia in children and adolescents: A single center experience

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    Nazan Sarper

    2011-09-01

    Full Text Available Objective: To present and discuss the treatment of autoimmune hemolytic anemia (AIHA. Materials and Methods: The medical records of all patients (n=19 diagnosed in a tertiary hematology center between 1999 and 2010 were retrospectively reviewed.Results: Median age at diagnosis of AIHA was 5 years (range: 4 months-17 years. In all, 13 patients had primary (idiopathic AIHA, whereas 2 had primary Evans Syndrome (ES, 2 had autoimmune lymphoproliferative syndrome (ALPS+ES, and 1 had Wiskott-Aldrich syndrome (WAS+AIHA. Among the 13 primary idiopathic AIHA patients, 9 recovered following a 4-8-week course of prednisolone treatment without relapses, whereas 3 patients required a longer course of prednisolone. One AIHA patient that was very resistant to prednisolone recovered after cyclosporine A was added to the treatment. All patients with primary idiopathic AIHA were in remission for a median of 3 years (range: 4 months-10 years at the time this manuscript was written. Among the patients with primary ES, 2 had relapses similar to the ALPS patients. Splenectomy was performed in 1 primary ES patient, who at the time this report was written was also in remission. One ALPS patient required the addition of mycophenolate mofetil due to prednisolone resistance. The WAS patient was treatment resistant and died due to septicemia.Conclusions: Primary AIHA in pediatric patients generally has an acute onset and good response to corticosteroids. Primary or secondary ES has a chronic or relapsing course, and treatment may require other immunosuppressive agents in addition to corticosteroids. Complications of splenectomy must not be underestimated in patients with underlying immunodeficiency. AIHA often causes considerable morbidity and mortality in WAS.

  8. Management and outcomes of intramedullary spinal cord tumors: A single center experience from a developing country

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    Bakhshi, Saqib K.; Waqas, Muhammad; Shakaib, Baila; Enam, Syed A.

    2016-01-01

    Background: Intraoperative neurophysiology, high magnification microscopes, and ultrasonic aspirators are considered essential aid for the safe resection of intramedullary spinal cord tumors (IMSCTs). Most centers in developing countries such as Pakistan still lack these facilities. The purpose of this study was to review the management of IMSCTs at our hospital and to determine factors associated with the outcomes of surgery. Methods: This was a retrospective review of medical records of adult patients undergoing surgery for IMSCT over 12 years. The institutional ethical review committee approved this study. Data were collected regarding demographics, clinical and radiological features, and surgical details. Modified McCormick Scale was used to grade patients’ neurological status at admission, discharge, and follow-up. Statistical analysis was performed using the Statistical Package for Social Sciences version 22. Results: Forty three cases were reviewed. Mean age was 33.8 ± 15.1 years whereas median follow-up was 5 months (range: 0.25–96 months). Most patients had ependymoma (n = 16; 73%). Cervical region was the most commonly involved (n = 15; 34.9%). Gross total resection (GTR) was achieved in 30 cases (69.8%). The preoperative McCormick grade was significantly associated with follow-up McCormick grade (P value = 0.002). Eight patients (18.6%) underwent intraoperative electrophysiological monitoring, out of which GTR was achieved in all cases, and none had disease progression or recurrence. Ten patients received postoperative radiotherapy. Thirty five patients (81.4%) had progression free survival at last follow-up. Conclusions: We achieved a GTR rate of 68.9% for IMSCTs with limited resources. In few cases, where intraoperative electrophysiology was used, the rate of GTR was 100%. Preoperative neurological status was associated with better postoperative McCormick score. PMID:27656322

  9. Analysis of periinterventional complications of intracranial angioplasty and stenting: A single center experience

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    Silber, Toni; Ziemann, Ulf [Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen (Germany); Ernemann, Ulrike [Department of Diagnostic and Interventional Neuroradiology, University of Tübingen (Germany); Bischof, Felix, E-mail: felix.bischof@uni-tuebingen.de [Center of Neurology, Hertie-Institute for Clinical Brain Research, University of Tübingen (Germany)

    2014-12-15

    Highlights: • Periinterventional complications in 7.5% of patients with intracranial artery stenting. • 2.5% of periinterventional complications were perforator strokes. • 3.8% of patients developed a hemorrhagic stroke due to reperfusion injury. • Complications could be reduced by individualized measures to prevent perforator stroke or reperfusion injury. - Abstract: Background and purpose: Treatment of symptomatic intracranial atherosclerotic disease by angioplasty and stenting (PTAS) is limited by a high rate of periinterventional strokes. We performed a detailed analysis of these strokes at our center in order to identify strategies to reduce the risk of periinterventional complications. Methods: Case records and imaging data of 80 patients with a symptomatic 70–99% stenosis of a major intracranial artery treated with PTAS between July 2007 and December 2013 were reviewed. All patients had a sufficient response to aspirin and clopidogrel. Periinterventional strokes were categorized as either ischemic (perforator territory, distal embolic or delayed stent thrombosis) or hemorrhagic (intraparenchymal, subarachnoid). Results: Periinterventional complications occurred in 6/80 (7.5%) patients, consisting of 2 ischemic strokes (2.5%, both perforator territory), 3 hemorrhagic strokes (3.8%, 2 intraparenchymal due to reperfusion injury, 1 subarachnoid due to vessel rupture) and one death (1.3%) unrelated to stroke. All strokes occurred within 24 h after PTAS. Conclusion: Our retrospective data analysis suggests that the risk of periinterventional stroke after PTAS of symptomatic intracranial atherosclerotic disease might be reduced by sufficient antiplatelet therapy and optimized management of patients with high risk for reperfusion injury or perforator strokes, including selection of a stenting device adapted to individual vessel morphology.

  10. Initial clinical experience with scanned proton beams at the Italian National Center for Hadrontherapy (CNAO).

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    Tuan, J; Vischioni, B; Fossati, P; Srivastava, A; Vitolo, V; Iannalfi, A; Fiore, M R; Krengli, M; Mizoe, J E; Orecchia, R

    2013-07-01

    We report the initial toxicity data with scanned proton beams at the Italian National Center for Hadrontherapy (CNAO). In September 2011, CNAO commenced patient treatment with scanned proton beams within two prospective Phase II protocols approved by the Italian Health Ministry. Patients with chondrosarcoma or chordoma of the skull base or spine were eligible. By October 2012, 21 patients had completed treatment. Immobilization was performed using rigid non-perforated thermoplastic-masks and customized headrests or body-pillows as indicated. Non-contrast CT scans with immobilization devices in place and MRI scans in supine position were performed for treatment-planning. For chordoma, the prescribed doses were 74 cobalt grey equivalent (CGE) and 54 CGE to planning target volume 1 (PTV1) and PTV2, respectively. For chondrosarcoma, the prescribed doses were 70 CGE and 54 CGE to PTV1 and PTV2, respectively. Treatment was delivered five days a week in 35-37 fractions. Prior to treatment, the patients' positions were verified using an optical tracking system and orthogonal X-ray images. Proton beams were delivered using fixed-horizontal portals on a robotic couch. Weekly MRI incorporating diffusion-weighted-imaging was performed during the course of proton therapy. Patients were reviewed once weekly and acute toxicities were graded with the Common Terminology Criteria for Adverse Events (CTCAE). Median age of patients = 50 years (range, 21-74). All 21 patients completed the proton therapy without major toxicities and without treatment interruption. Median dose delivered was 74 CGE (range, 70-74). The maximum toxicity recorded was CTCAE Grade 2 in four patients. Our preliminary data demonstrates the clinical feasibility of scanned proton beams in Italy.

  11. Acute pancreatitis induced by transarterial chemoembolization:a single-center experience of over 1500 cases

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    Wong Hoi She; Albert CY Chan; Tan To Cheung; Kenneth SH Chok; See Ching Chan; Ronnie TP Poon; Chung Mau Lo

    2016-01-01

    BACKGROUND: Acute pancreatitis is a relatively rare but po-tentially lethal complication after transarterial chemotherapy. This study aimed to review the complications such as acute pancreatitis after transarterial chemotherapy with or without embolization for hepatocellular carcinoma. METHODS: A total of 1632 patients with hepatocellular car-cinoma who had undergone transarterial chemoembolization from January 2000 to February 2014 in a single-center were reviewed retrospectively. We investigated the potential com-plications of transarterial chemoembolization, such as acute pancreatitis and acute pancreatitis-related complications. RESULTS: Of the 1632 patients with hepatocellular carcinoma who had undergone 5434 transarterial chemoembolizations, 1328 were male and 304 female. The median age of these pa-tients was 61 years. Most (79.6%) of the patients suffered from HBV-related hepatocellular carcinoma. The median tumor size was 5.2 cm. Of the 1632 patients, 145 patients underwent transarterial chemoembolization with doxorubicin elut-ing bead, making up a total of 538 episodes. The remaining patients underwent transarterial chemoembolization with cisplatin. Seven (0.4%) patients suffered from acute pancre-atitis post-chemoembolization. Six patients had chemoembo-lization with doxorubicin and one had chemoembolization with cisplatin. Patients who received doxorubicin eluting bead had a higher risk of acute pancreatitis [6/145 (4.1%) vs 1/1487 (0.1%), P CONCLUSIONS: Acute pancreatitis after transarterial chemo-embolization could result in serious complications, especially after treatment with doxorubicin eluting bead. Continuation of current treatment with transarterial chemoembolization after acute pancreatitis is feasible providing the initial attack is completely resolved.

  12. Neurological complications of dengue fever: Experience from a tertiary center of north India

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    Rajesh Verma

    2011-01-01

    Full Text Available Introduction: Dengue, an acute viral disease transmitted by Aedes mosquitoes, is highly endemic in many tropical and subtropical areas of the world. Neurological complications of dengue infection have been observed more frequently in the recent past and some studies highlighted varied neurological complications arising in the course of dengue illness. In this retrospective study, we report various neurological complications observed during the last 2 years in patients of dengue fever. Materials and Methods: The patients presenting with neurological complications with positive serology (IgM antibody for dengue infection were consecutively recruited from the Department of Neurology/Medicine from a tertiary center of Lucknow, India. These patients were subjected to a detailed clinical evaluation, laboratory assessment including blood count, hematocrit, coagulation parameters, biochemical assays, serology for dengue fever, enzyme-linked immunosorbent assay for human immunodeficiency virus and other relevant investigations. Results: Twenty-six patients with neurological complications associated with confirmed dengue infection were observed during the last 2 years. Eighteen of these patients were male. Of the 26 patients, 10 patients were suffering from brachial neuritis, four patients had encephalopathy, three patients were consistent with the diagnosis of Guillain Barre syndrome, three patients had hypokalemic paralysis associated with dengue fever and two patients had acute viral myositis. Opsoclonus-myoclonus syndrome was diagnosed in two patients, myelitis in one patient and acute disseminated encephalo-myelitis also in one patient. Conclusion: Dengue fever was associated with widespread neurological complications. Brachial neuritis and opsoclonus-myoclonus syndrome were observed for the first time in this study.

  13. Acute kidney injury and mortality in hematopoietic stem cell transplantation: A single-center experience

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    B Sehgal

    2017-01-01

    Full Text Available Hematopoietic stem cell transplant (HSCT is a life-saving procedure for patients with several malignant and nonmalignant hematological disorders. Acute kidney injury (AKI is a common complication after HSCT. The aim of the study was to identify the incidence and outcomes of AKI associated with HSCT in our center. Sixty-six HSCT recipients from October 2008 to March 2014 at Christian Medical College, Ludhiana, were followed up till July 31, 2014. RIFLE criteria utilizing serum creatinine was used to diagnose and stage AKI. Mortality and AKI were the primary outcomes studied. The risk of AKI in relation to conditioning regimen, type of HSCT (allogeneic and autologous, co-morbidities, graft versus host disease, drug toxicity, and veno-occlusive disease were analyzed. Sixty-five patients were included in the study. Male: Female ratio was 3.6:1 with a median age of 17 years (1.5–62. Forty-nine (75.4% patients had AKI over 3 months, R 17 (26.2%, I 19 (29.2%, and F 13 (20%. AKI occurred at a mean of 19.4 ± 29.2 days after the HSCT. AKI was more commonly observed in patients undergoing allogeneic versus autologous HSCT (85.2% in allogeneic vs. 27.8% in autologous, P = 0.005. Mortality was seen in 20 patients (30.8% in 3 months. AKI in the first 2 weeks (P < 0.016 was a significant risk factor for mortality. Incidence of AKI in HSCT is high and accounts for significant mortality and morbidity. RIFLE classification of AKI has prognostic significance among HSCT patients with an incremental trend in mortality.

  14. Cinacalcet in pediatric and adolescent chronic kidney disease: a single-center experience.

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    Alharthi, Abdulla A; Kamal, Naglaa M; Abukhatwah, Mohamed W; Sherief, Laila M

    2015-01-01

    Cinacalcet, a calcimimetic drug, has been shown to be efficacious in adult chronic kidney disease (CKD) patients; however, it was not fully studied in pediatric CKD patients. We aimed at assessing the effect of cinacalcet on intact parathyroid hormone (iPTH) secretion in children with CKD-4/5 with iPTH consistently ≥ 300 pg/mL refractory to conventional treatment. This is a prospective cohort analysis of 28 children with uncontrolled hyper-parathyroidism secondary to stage 4 and 5 CKD admitted to a tertiary center during the period from April 2012 to April 2014. Twenty-eight patients with CKD-4/5 were assessed prospectively regarding bone biochemistry, renal ultrasonography, serum iPTH level, and medications. Patients were classified into 3 groups: group 1, 6 patients with CKD-4 on supplemental and supportive therapy; group 2, 6 patients with CKD-5 on hemodialysis and; group 3, 16 patients with CKD-5 on automated peritoneal dialysis. Patients were between the ages of 9 months and 18 years on commencing cinacalcet at doses of 0.5 to 1.5 mg/kg. All patients showed at least a 60% reduction in iPTH (60%-97%). Highly significant reduction in iPTH and serum alkaline phosphatase levels was detected post-cinacalcet. The serum calcium (Ca), phosphate (P), and Ca × P product were unaffected. Treatment was well tolerated with no hypophosphatemia, hypocalcemia, or other adverse effects almost in all patients. Cinacalcet use was proven safe for all pediatric and adolescent patients with CKD-4/5 during the study period, and at the same time most of the patients reached the suggested iPTH target values.

  15. Gamma Knife Radiosurgery in Sphenopetroclival Meningiomas: Preliminary Experience at the Iran Gamma Knife Center.

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    Azar, Maziar; Kazemi, Farid; Chanideh, Iran; Amirjamshidi, Abbas; Amini, Elahe; Ghanavati, Pedram

    2016-09-01

    The aims of this study were to characterize the epidemiologic, histologic, and radiologic aspects of sphenopetroclival meningiomas (SpPCMs) and to evaluate the outcome of Gamma Knife radiosurgery (GKRS) either as an adjunct to microsurgery or as a primary SpPCM treatment modality. In this retrospective study, medical records of patients with SpPCM who underwent GKRS at the Iran Gamma Knife Center between April 2003 and March 2012 were analyzed. We assessed 122 patients with SpPCMs, including 101 women and 21 men, aged 24-94 years. The mean tumor volume was 12.24 ± 9.30 mL. Patients received 22.32 ± 3.29 Gy and 13.18 ± 1.02 Gy maximal and average marginal dose of GKRS, respectively. The most common complaint was visual impairment, followed by facial sensory impairment and headache. The most frequently involved cranial nerves were III, IV, and VI in 72.1% of patients, followed by II in 52.9%, and V in 35.5%. After radiosurgery, headaches improved in 90.0%, diplopia in 75.0%, and ptosis in 63.0% of patients. On magnetic resonance imaging, tumor size was reduced, unchanged, or increased in 77, 44, and 1 patient, respectively. Progression-free survival at the 5-year follow-up was 56.6%. Younger age (hazard ratio = 0.972, P = 0.011) and lower tumor volume (hazard ratio = 0.959, P = 0.009) were the main prognostic factors for progression-free survival. GKRS can be an effective alternative treatment for controlling the progression of SpPCM tumors, producing appropriate clinical outcomes and few complications. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Extremity compartment syndrome following blunt trauma: a level I trauma center's 5-year experience.

    Science.gov (United States)

    Zuchelli, Daniel; Divaris, Nicholas; McCormack, Jane E; Huang, Emily C; Chaudhary, Neeta D; Vosswinkel, James A; Jawa, Randeep S

    2017-05-10

    Extremity compartment syndrome is a recognized complication of trauma. We evaluated its prevalence and outcomes at a suburban level 1 trauma center. The trauma registry was reviewed for all blunt trauma patients aged ≥18 years, admitted between 2010 and 2014. Chart review of patients with extremity compartment syndrome was performed. Of 6180 adult blunt trauma admissions, 83 patients developed 86 extremity compartment syndromes; two patients had compartment syndromes on multiple locations. Their (n = 83) median age was 44 years (interquartile range: 31.5-55.5). The most common mechanism of injury was motor vehicle/motor cycle accident (45.8%) followed by a fall (21.7%). The median injury severity score was 9 (interquartile range: 5-17); 65.1% had extremity abbreviate injury score ≥3. Notably, 15 compartment syndromes did not have an underlying fracture. Among patients with fractures, the most commonly injured bone was the tibia, with tibial plateau followed by tibial diaphyseal fractures being the most frequent locations. Fasciotomies were performed, in order of frequency, in the leg (n = 53), forearm (n = 15), thigh (n = 9), foot (n = 5), followed by multiple or other locations. Extremity compartment syndrome was a relatively uncommon finding. It occurred in all extremity locations, with or without an associated underlying fracture, and from a variety of mechanisms. Vigilance is warranted in evaluating the compartments of patients with extremity injuries following blunt trauma. Copyright © 2017 Elsevier Inc. All rights reserved.

  17. Minimally invasive transxiphoid approach for management of pediatric cardiac tamponade – one center's experience

    Science.gov (United States)

    Haponiuk, Ireneusz; Kwasniak, Ewelina; Chojnicki, Maciej; Steffens, Mariusz; Sendrowska, Aneta; Gierat-Haponiuk, Katarzyna; Leszczyńska, Katarzyna; Paczkowski, Konrad; Zielinski, Jacek

    2015-01-01

    Introduction Cardiac tamponade is excessive collection of fluid in the pericardial sac surrounding the heart that leads to restriction of cardiac function and causes critical cardiogenic shock and rapid circulatory depression. Despite the potential variety of different etiologies in the face of a dangerous decrease of cardiac output, the emergency life-saving procedure is surgical pericardial fluid evacuation. Aim To perform a retrospective analysis of clinical data and the results of minimally invasive transxiphoid pediatric cardiac tamponade evacuation procedures performed in a cardiac surgery center. Material and methods We performed a retrospective analysis of all consecutive patients referred for treatment in our department in a period of 6 years (15 patients) who underwent emergency pericardial drainage after an echocardiographically proven diagnosis. The procedure of choice was minimally invasive transxiphoid fluid evacuation with routine pericardial drainage. Retrospective operative data analysis was performed: clinical symptoms, pre-admission and initial emergency diagnostics and interventions, the morphology and total amount of drained pericardial fluid, length of stay, final results, and overall survival rate. We introduced an original pediatric tamponade index (PTI). The PTI was analyzed according to catecholamine support before the drainage and the length of hospital stay after the procedure. Results All patients survived the procedure. No early complications of the presented minimally invasive subxiphoid approach were noted. Mean PTI in patients with intensive catecholamine support before the operation was significantly higher than in patients without it. Conclusions Minimally invasive surgical transxiphoid interventions appear to be a safe and effective method to provide life-saving support with retrieval of the fluid for further laboratory investigations. PMID:25960801

  18. [Complications with peripherally inserted central catheters - observations and nursing experiences at one medical center in Chengdu].

    Science.gov (United States)

    Yue, Zhi-Ying; Li, Jun-Ying; Yu, Chun-Hua; Zhao, Shu-Zhen; Fu, Yan

    2010-06-01

    Its peripheral vein puncture point, safe insertion procedure and high rate of success have made the peripherally inserted central catheter (PICC) a particularly suitable medical device for cancer patients who require long-term intravenous chemotherapy. PICC can help avoid the pain of repeat punctures as well as reduce incidence of cytotoxic drug extravasation-induced phlebitis and tissue necrosis. With PICC, patient activity is not limited, which improves quality of life. This paper reported on complications and subsequent nursing care provided to 400 cancer patients who received PICC in our center between September 2007 and October 2008. A total of 395 cases had successful PICC insertion on the first attempt and 5 cases achieved success immediately following the second insertion attempt (overall success rate: 98.8%). The average catheter dwell-in time was 122 days (range 2-350 days), during which time no patient required repeat puncture. During the insertion process, arrhythmia occurred in 1.5% (6/400), difficult catheter propelling in 3.75% (15/400), and excessive oozing of blood in 0.3% (1/400) of subjects. During the catheter dwell-in period, sensitizing dermatitis occurred in 8% (38/400), mechanical phlebitis in 7.5% (30/400), catheter occlusion in 9.5% (38/400) (including 2% [8/400] complete and 7.5% [30/400] partial occlusions), catheter associated hematogenous infection in 3% (12/400) and venous thrombosis in 2% (8/400) of subjects. All complications were well controlled with active and effective management. In conclusion, the safety of PICC can be maximized and complications reduced when nurses fully evaluate patients prior to their operation, strictly adhere to PICC operating guidelines, detect complications early, and manage problems promptly.

  19. Febrile neutropenia in children with acute lymphoblastic leukemia: single center experience

    Science.gov (United States)

    Özdemir, Nihal; Tüysüz, Gülen; Çelik, Nigar; Yantri, Leman; Erginöz, Ethem; Apak, Hilmi; Özkan, Alp; Yıldız, İnci; Celkan, Tiraje

    2016-01-01

    Aim: An important life-threatening complication of intensive chemotherapy administered in children with leukemia is febrile neutropenia. The objective of this study was to evaluate the clinical features and consequences of febrile neutropenia attacks in children who were treated for acute lymphoblastic leukemia. Material and Methods: Nighty-six children who received chemotherapy for acute lymphoblastic leukemia in our center between January 1995 and December 2010 were included in the study. The data related to demographic characteristics, treatment features, relapse and febrile neutropenia incidences, risk factors, culture results and prognosis were retrospectively evaluated from the patients’ files. Results: A total of two hundred-ninety nine febrile neutropenia attacks observed in the patients during initial treatment and relapse treatment were evaluated. When the incidence of febrile neutropenia was evaluated by years, it was observed that the patients treated after year 2000 had statistically significantly more febrile neutopenia attacks compared to the patients treated before year 2000. When the incidences of febrile neutropenia during initial treatment and during relapse treatment were compared, it was observed that more febrile neutropenia attacks occured during relapse treatment. Fifty-nine percent of all febrile neutropenia attacks were fever of unknown origin. Eighty microorganisms grew in cultures during febrile neutropenia throughout treatment in 75 patients; 86% were bacterial infections (50% gram positive and 50% gram negative), 8% were viral infections and 6% were fungal infections. Coagulase negative staphylococcus (n=17) was the most frequent gram positive pathogen; E. Coli (n=17) was the most commonly grown gram negative pathogen. Conclusions: In this study, it was found that an increase in the incidence of febrile neutropenia occured in years. Increments in treatment intensities increase the incidence of febrile neutropenia while improving

  20. Incidental pulmonary embolism in cancer patients: clinical characteristics and outcome – a comprehensive cancer center experience

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    Abdel-Razeq H

    2011-03-01

    Full Text Available Hikmat N Abdel-Razeq1, Asem H Mansour2, Yousef M Ismael11Department of Internal Medicine, 2Department of Radiology, King Hussein Cancer Center, Amman, JordanBackground and objectives: Cancer patients undergo routine imaging studies much more than others. The widespread use of the recently introduced multi-detector CT scanners has resulted in an increasing number of incidentally diagnosed pulmonary embolism (PE in asymptomatic cancer patients. The significance and clinical outcome of such incidental PE is described.Methods: Both radiology department and hospital databases were searched for all cancer patients with a diagnosis of incidental PE. CT scans were performed using a 64-slice scanner with a 5.0 mm slice thickness.Results: During the study period, 34 patients with incidental PE were identified. The mean age (±SD was 57.7 (±12.4 years. All patients had active cancer, gastric, lung, colorectal, and lymphomas being the most frequent. Most patients had advanced-stage disease at the time of PE diagnosis; 26 (77% patients had stage IV, whereas only 3 patients had stages I or II disease. Twenty-seven (79% patients had their PE while undergoing active treatment with chemotherapy (68% or radiotherapy (12%; none, however, were on hormonal therapy. Most (74% patients had their PE diagnosed without history of recent hospital admission. Except for 5 (15%, all other patients were anticoagulated. With follow-up, 2 patients developed recurrent PE, 2 others had clinical and echocardiographic evidence of pulmonary hypertension, and 9 (26% died suddenly within 30 days of the diagnosis of incidental PE; 2 of these where among the 5 patients who were not anticoagulated.Conclusion: Incidental PE in cancer patients is increasingly encountered. Similar to symptomatic PE, many were diagnosed in patients with advanced stage disease and while undergoing active anti-cancer therapy. A significant percentage of patients had recurrent emboli, pulmonary hypertension

  1. Demographic and Clinical Characteristics of Type 1 Diabetes Mellitus in Omani Children - Single Center Experience

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    Saif Al-Yaarubi

    2014-03-01

    Full Text Available Objectives: To describe the demographic characteristics and clinical presentation of Omani children with type 1 diabetes mellitus at Sultan Qaboos University Hospital, Muscat, Oman. Methods: A retrospective analysis of all children with type 1 diabetes mellitus attending the Pediatric Endocrine Unit at Sultan Qaboos University Hospital, Oman from June 2006 to May 2013. Results: One hundred and forty-four patients were included in the study. The mean±SD of age at diagnosis was 6.7 ± 3.7 years. The median duration of symptoms was 10 days (IQR; 5-14. The most commonly reported presenting symptoms were polyuria (94%, polydipsia (82%, and weight loss (59%. Diabetic ketoacidosis at initial presentation was diagnosed in 31% of the patients. Different insulin regimens were prescribed: multiple daily injections in 109 (76% patients, twice daily insulin regimen in 23 (16% patients, and insulin pump therapy in 12 (8% patients. Family history of type 1 diabetes mellitus was present in 31 (22% patients. There were no significant differences in presenting complaints (polyuria, p=0.182; polydipsia, p=0.848, duration of symptoms (p=0.331, reported weight loss (p=0.753, or diabetic ketoacidosis at presentation (p=0.608 between patients with and without family history of type 1 diabetes mellitus. Conclusion: Polyuria, polydipsia and weight loss are the most common presenting symptoms. Family history of type 1 diabetes mellitus is highly prevalent among the studied patients. Diabetic ketoacidosis was found to be less common in Oman compared to other diabetes centers in the Middle East.

  2. Applications of neuronavigation system in cranial surgery: experience of a single center

    Science.gov (United States)

    Nouri, Mohsen; Pahlavani, Mehrdad; Amirjamshidi, Abbas; Shirani-Bidabadi, Mohammad; Ketabchi, Ebrahim; Karimi-Yarandi, Kourosh

    2012-01-01

    Abstract: Background: Since the advent of navigational systems in neurosurgery, various implications have been introduced for them in spine and brain practices. Although, the range of surgeries in which these systems are being used is getting wider over time, their application is becoming more specific in certain situations. Methods: This means that defining specific indications for their usage is not as easy as it was previously thought. Brief reviewing of the available literature showed various navigation systems proposed and used in neurosurgery. Results: In this study, we review case selection criteria, techniques, and the results of neuronavigation applications in the patients underwent neurosurgical operations in the Sina hospital (Tehran, Iran) during 2011. Conclusions: The findings of our survey and experiences prove the efficacy and advantages of this technique that reduces the risk of neurovascular damage, neural tissue manipulation, operation time, and bleeding. Keywords: Neuronavigation, Cranial surgery, Navigational system

  3. Interactive data analysis for astronomy Shuttle experiments at Goddard Space Flight Center

    Science.gov (United States)

    Klinglesmith, D. A., III

    1981-01-01

    The eye as an efficient selection device for determining what is important in astronomical imagery can be greatly aided by the computer. A suitable facility, called the Interactive Astronomical Data Analysis Facility (IADAF), has been developed for the display and analysis of astronomical imagery by the Laboratory for Astronomy and Solar Physics. The Laboratory for Astronomy and Solar Physics currently has approval to fly two experiments on Spacelab. The Solar Extreme Ultraviolet Telescope (SEUTS) is to be used for the study of several fundamental problems of solar physics. The Ultraviolet Image Telescope for Astronomical Investigations (UIT) is to provide direct imagery of selected fields of view throughout the sky. A description is given of IADAF, taking into account its 16-bit computer and the COMTAL image processing display system. The use of IADAF by SEUTS and UIT is discussed.

  4. BRAIN METASTASES OF GERM CELL TUMORS. THE RUSSIAN CANCER RESEARCH CENTER'S EXPERIENCE

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    A. A. Tryakin

    2014-07-01

    Full Text Available This paper analyzes the experience in treating 20 patients with nonseminomatous germ cell tumors metastasizing to the brain. It presents brain metastasis-associated factors: multiple lung metastases; IGCCCG poor prognosis; and a baseline human chorionic gonadotropin level of > 50000 mIU/ml. The authors have identified a group to be screened for brain metastasis, which includes patients with intermediate/poor prognosis and multiple lung metastases. Long-term survival was achieved in 45 % of patients with baseline brain damage and in 22 % of those with metastases revealed after first-line chemotherapy. The positive prognostic factors associated with long-term survival were a single brain lesion, no neurological symptoms, and achievement of clinical complete personse in the brain.

  5. Hypertensive crisis in children: an experience in a single tertiary care center in Korea.

    Science.gov (United States)

    Lee, Geum Hwa; Lee, I Re; Park, Se Jin; Kim, Ji Hong; Oh, Ji Young; Shin, Jae Il

    2015-01-01

    Hypertensive crisis is a medical emergency that can cause acute damage to multiple end-organs. However, relatively little is known on the etiology, treatment, and outcomes of hypertensive crisis in Korean children. The aim of this study was to determine the etiologies and efficacy of drugs for hypertensive crisis in children during the past 5 years at a single center in Korea. We analyzed data from 51 children with hypertensive crisis during the period between January 1, 2010 and April 1, 2014. The patients were divided into two groups: those diagnosed with a hypertensive emergency (hypertension with organ injury, n = 31) and those diagnosed with a hypertensive urgency (hypertension without organ injury, n = 20). Baseline etiologies and risk factors were compared between the two groups. In addition, systolic and diastolic blood pressures were evaluated at 1, 2, 4, and 5 hours after the administration of intravenous antihypertensive drugs. Kidney injury and cancer were the common causes in patients with hypertensive crisis. Cardiovascular complications (cardiac hypertrophy) (p = 0.002), central nervous system complications (p = 0.004), and retinopathy (p = 0.034) were more frequently observed in children with hypertensive emergency than those with hypertensive urgency. However, the proportion of renal complications was similar in both groups. Hydralazine was most commonly used in both groups to control acute increasing blood pressure at first. However, it was often ineffective for controlling abrupt elevated blood pressure. Therefore, intravenous antihypertensive drugs were changed from hydralazine to nicardipine, labetalol, or nitroprusside to control the high blood pressure in 45.1 % of the patients. Particularly, in patients with hypertensive crisis, there was no significant difference in reduction of systolic and diastolic blood pressure and in improvement of clinical outcomes between nicardipine and labetalol administration. Close blood

  6. Clinical Characteristics of Bowel Obstruction in Southern Iran; Results of a Single Center Experience

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    Majid Akrami

    2015-01-01

    Full Text Available Objective: To determine the epidemiological, clinical, laboratory characteristics as well as outcome of 411 patients with bowel obstruction in Southern Iran. Methods: This was a cross-sectional study being performed in Shahid Faghihi hospital of Shiraz between 2006 and 2012. We reviewed the medical charts of the 411 patients with initial diagnosis of bowel obstruction who were admitted to our center during the study period. The patients’ demographic, clinical and laboratory findings as well as their management and outcome was recorded in data gathering forms. The data were then analyzed according to the outcome and clinical characteristics. Results: Among the 411 patients with initial diagnosis of bowel obstruction, 253 (61.5% were men and 158 (38.5% were women. The mean age of the patients was 48.2±19.7 years. Besides, 73.6% were observed and 26.4% were operated. Those who were operated had those who underwent operation had significantly lower frequency of obstipation (28.1% vs. 71.9%; p=0.045 and abdominal distention (32.3% vs. 67.7%; p=0.007. Intraoperative findings included adhesion band formation in 50 (48.1%, mass 18 (17.3%, and hernia 7 (6.7%. We found that the frequency of malignancy was significantly higher in those who were managed conservatively compared to those undergoing operation (64.3% vs. 35.7%; p=0.042. The mean hospital stay was significantly higher in those who underwent operation (8.1±7.5 vs. 2.6±2.2 days; p=0.035. Conclusion: The results of this study demonstrates although some signs and symptoms, such as abdominal pain, vomiting, abdominal tenderness, abdominal distention, and obstipation, were more common among the patients with bowel obstruction, they were not sensitive and specific enough for definite diagnosis. Due to the lack of positive predictive value of clinical signs and symptoms in diagnosis of bowel obstruction, a reasonable and logical modality is needed for bowel obstruction diagnosis with better

  7. Impact of hepatitis C infection on renal transplant patients: A single-center experience in Libya

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    Abdel-Naser Y Elzouki

    2014-01-01

    Full Text Available The objective of this study was to assess the effect of hepatitis C virus (HCV infection on graft and patient survival in a cohort of Libyan renal transplant recipients. Medical records of 241 renal transplant (RT patients who have been followed-up at the Benghazi Nephrology Center up to February 2010 were reviewed. Based on the presence or absence of anti-HCV antibodies and HCV-RNA in the serum, patients were divided into two groups: HCV-positives and HCV-negatives. Anti-HCV antibodies were detected by the enzyme-linked immunosorbent assay technique and HCV-RNA by the polymerase chain reaction. Of the 241 RT patients, 162 were male and 79 were female. One hundred and ten patients (45.6% were HCV-positives and 131 (54.4% were HCV-negatives. Acute graft rejection was significantly higher among HCV-negative than HCV-positive patients (42 patients versus 28 patients, respectively; P < 0.001. Conversely, chronic graft rejection was higher among HCV-positives than that among HCV-negative patients (35 patients versus 24 patients, respectively; P <0.05, and this difference became more significant after a 12-month period of transplantation (P <0.01. Seventeen patients died during the follow-up: Seven HCV-positives (6.3% and 10 HCV-negatives (7.6%, and there was no significant difference in the death rate following RT between the two groups (P = 0.08. Among the seven deaths of HCV-positives, liver disease-related complications were the main cause of death in three (42.8% HCV-positive patients compared with none in the HCV-negative patients. The presence of HCV infection influenced chronic graft survival in RT patients and a higher proportion of HCV-infected patients had hepatic dysfunctions after RT. An increase in fatal liver complications was noted in HCV-positive patients with RT. In addition to pre-RT-specific therapy of HCV infection, all measures should be taken to prevent HCV infection pre- and post-RT. HCV-infected RT recipients need close

  8. DEB TACE for Intermediate and advanced HCC - Initial Experience in a Brazilian Cancer Center.

    Science.gov (United States)

    Luz, Jose Hugo Mendes; Luz, Paula M; Martin, Henrique S; Gouveia, Hugo R; Levigard, Raphal Braz; Nogueira, Felipe Diniz; Rodrigues, Bernardo Caetano; de Miranda, Tiago Nepomuceno; Mamede, Marcelo Henrique

    2017-02-06

    According to Barcelona Clinic Liver Cancer classification transarterial chemoembolization is indicated in patients with Hepatocellular Carcinoma in the intermediate stage. Drug-eluting microspheres can absorb and release the chemotherapeutic agent slowly for 14 days after its intra-arterial administration. This type of transarterial chemoembolization approach appears to provide at least equivalent effectiveness with less toxicity. This is a prospective, single-center study, which evaluated 21 patients with intermediate and advanced hepatocellular carcinoma who underwent transarterial chemoembolization with drug-eluting microspheres. The follow up period was 2 years. Inclusion criteria was Child-Pugh A or B liver disease patients, intermediate or advanced hepatocellular carcinoma and performance status equal or below 2. Transarterial chemoembolization with drug-eluting microspheres was performed at 2-month intervals during the first two sessions. The third and subsequent sessions were performed according to the image findings on follow-up, on a "demand schedule". Tumor response and time to progression were evaluated along the two-year follow up period. Of the 21 patients 90% presented with liver cirrhosis, 62% had Barcelona Clinic Liver Cancer stage B and 38% had Barcelona Clinic Liver Cancer stage C hepatocellular carcinoma. Average tumor size was 6.9 cm. The average number of Transarterial chemoembolization with drug-eluting microspheres procedures was 3 with a total of 64 sessions. The predominant toxicity was mild. Liver function was not significantly affected in most patients. Two deaths occurred within 90 days after Transarterial chemoembolization with drug-eluting microspheres (ischemic hepatitis and hydropic decompensation). Technical success was achieved in 63 of 64 procedures. The mean hospital stay was 1.5 days. The progression free and overall survival at 1 and 2 years were 73.0% and 37.1%, 73.7% and 41.6%, respectively. Transarterial

  9. Spectrum of intradialytic complications during hemodialysis and its management: A single-center experience

    Directory of Open Access Journals (Sweden)

    Prabhakar

    2015-01-01

    Full Text Available Hemodialysis (HD is one of the important modalities of renal replacement therapy in acute renal failure (ARF as well as chronic renal failure (CRF. This study was performed to evaluate the various intradialytic complications that occur during HD and their management. This is a retrospective study performed in patients who underwent conventional HD during the period of 1 January 2000 to 31 December 2011 at our center. Clinical details, various complications faced and their management were retrieved from dialysis case sheets. A total of 2325 patients of renal failure (790 ARF and 1535 CRF patients were assessed for the intradialytic complications of HD. During the study period, there were 12,785 bicarbonate dialyses performed on these patients. In the ARF patients, the common intradialytic complications were: Hypotension, seen in 1296 sessions (30.4%, nausea and vomiting seen in 1125 sessions (26.4%, fever and chills seen in 818 sessions (19.2%, headache seen in 665 sessions (15.6%, cramps seen in 85 sessions (2.0%, chest pain and back pain seen in 82 sessions (1.92%, hypoglycemia seen in 77 sessions (1.8%, first-use syndrome seen in 72 sessions (1.7% and femoral hematoma seen in 31 sessions (0.73%. In the CRF group, common complications were hypotension in 2230 sessions (26.1%, nausea and vomiting in 1211 sessions (14.2%, fever and chills in 1228 sessions (14.4%, chest pain and back pain in 1108 cases (13.0%, hypertension in 886 sessions (10.4%, headache in 886 sessions (10.4%, cramps in 256 sessions (3.0%, hematoma in 55 sessions (0.64%, intracerebral hemorrhage in three sessions (0.03% and catheter tip migration in three sessions (0.03%. There is a need for special attention for the diagnosis and management of intradialytic complications of HD because such complications could be managed successfully without the need for termination of the dialysis procedure.

  10. Impact of hepatitis C infection on renal transplant patients: a single-center experience in Libya.

    Science.gov (United States)

    Elzouki, Abdel-Naser Y; Gargoum, Huda M; Habas, Elmukhtar M; Rayani, Amnna A; Othman, Muftah

    2014-11-01

    The objective of this study was to assess the effect of hepatitis C virus (HCV) infection on graft and patient survival in a cohort of Libyan renal transplant recipients. Medical records of 241 renal transplant (RT) patients who have been followed-up at the Benghazi Nephrology Center up to February 2010 were reviewed. Based on the presence or absence of anti-HCV antibodies and HCV-RNA in the serum, patients were divided into two groups: HCV-positives and HCV-negatives. Anti-HCV antibodies were detected by the enzyme-linked immunosorbent assay technique and HCV-RNA by the polymerase chain reaction. Of the 241 RT patients, 162 were male and 79 were female. One hundred and ten patients (45.6%) were HCV-positives and 131 (54.4%) were HCV-negatives. Acute graft rejection was significantly higher among HCV-negative than HCV-positive patients (42 patients versus 28 patients, respectively; P<0.001). Conversely, chronic graft rejection was higher among HCV-positives than that among HCV-negative patients (35 patients versus 24 patients, respectively; P<0.05), and this difference became more significant after a 12-month period of transplantation (P<0.01). Seventeen patients died during the follow-up: Seven HCV-positives (6.3%) and 10 HCV-negatives (7.6%), and there was no significant difference in the death rate following RT between the two groups (P=0.08). Among the seven deaths of HCV-positives, liver disease-related complications were the main cause of death in three (42.8%) HCV-positive patients compared with none in the HCV-negative patients. The presence of HCV infection influenced chronic graft survival in RT patients and a higher proportion of HCV-infected patients had hepatic dysfunctions after RT. An increase in fatal liver complications was noted in HCV-positive patients with RT. In addition to pre-RT-specific therapy of HCV infection, all measures should be taken to prevent HCV infection pre- and post-RT. HCV-infected RT recipients need close monitoring for graft

  11. Congenital heart anomaly in newborns with congenital diaphragmatic hernia: a single-center experience.

    Science.gov (United States)

    Ruano, R; Javadian, P; Kailin, J A; Maskatia, S A; Shamshirsaz, A A; Cass, D L; Zamora, I J; Sangi-Haghpeykar, H; Lee, T C; Ayres, N A; Mehollin-Ray, A; Cassady, C I; Fernandes, C; Welty, S; Belfort, M A; Olutoye, O O

    2015-06-01

    To evaluate the impact of the presence of a congenital heart anomaly (CHA) and its potential contribution to morbidity and mortality in infants with congenital diaphragmatic hernia (CDH). In this retrospective cohort study, prenatal and postnatal data of all newborns diagnosed with CDH between January 2004 and December 2012 in a single center were reviewed. Cases were classified into two groups: those with 'isolated' CDH and those with both CDH and CHA. Patients with CHA were further subclassified into those with a major or minor CHA based on the Risk Adjustment for Congenital Heart Surgery-1 (RACHS-1), and the Society of Thoracic Surgeons-European Association for Cardiothoracic Surgery (STS-EACTS) scoring systems. Patients with associated non-cardiac anomalies, including 'syndromic cases', were excluded from the analysis. Primary and secondary outcomes were survival up to 1 year of age and a need for extracorporeal membrane oxygenation (ECMO), respectively. Of the 180 infants with CDH, 41 were excluded because of the presence of non-cardiac associated anomalies, 118 had isolated CDH and 21 had CDH with CHA (16 with minor and five with major CHA). Receiver-operating characteristics curve analysis demonstrated that the best cut-off for survival was when the score for CHA was ≤ 2 for both RACHS-1 (area under the curve (AUC), 0.74 (P = 0.04); sensitivity, 80.0%; specificity, 87.5%) and STS-EACTS (AUC, 0.83 (P = 0.03); sensitivity, 100%; specificity, 87.5%). Survival rate at 1 year was significantly lower in those with CHD and a major CHA (40.0%; P = 0.04) than in those with isolated CDH (77.1%) and those with CDH and a minor CHA (81.3%). We found no significant differences among the groups with regard to the need for ECMO. In general, a milder form of CHA does not appear to have a negative impact on the survival of infants with CDH. However, mortality appears to be significantly higher in infants with CDH and a major form of CHA. The scoring systems

  12. Performance characteristics of retrograde single-balloon endoscopy: A single center experience

    Institute of Scientific and Technical Information of China (English)

    Kaci E Christian; Karan Kapoor; Eric M Goldberg

    2016-01-01

    AIM: To evaluate the technical success, diagnostic yield(DY) and therapeutic potential of retrograde single balloon enteroscopy(rS BE). METHODS: A retrospective review of 136 rS BE procedures performed at a tertiary academic referral center from January 2006 and September 2013 was completed. Patient characteristics including age, gender and inpatient status were collected. The indication for the procedure was categorized into one of three groups: Obscure gastrointestinal bleeding(GIB), evaluation for Crohn’s disease and abnormal imaging. Procedural characteristics including insertion depth(ID), procedure time, concordance with pre-procedural imaging and complications were also recorded. Lastly, DY, defined as the percentage of cases producing either a definitive diagnosis or findings that could explain clinical symptoms and therapeutic yield(TY), defined as the percentage of cases in which a definitive intervention was performed, were determined. Mucosal tattooing and biopsy alone were not included in the TY. RESULTS: A total of 136 rS BE procedures were identified. Mean patient age was 57.5(± 16.2) years, 67(49.2%) were male, and 110(80.9%) procedures were performed on an outpatient basis. Indications for rS BE included GIB in 55(40.4%), evaluation of inflammatory bowel disease(IBD) in 29(21.3%), and imaging suggestive of pathology other than GIB or IBD in 43(31.6%). Nine(6.6%) rS BEs were performed for other indications. Mean ID was 68.3(± 39.3) cm proximal to the ileocecal valve and mean time to completion was 41.7(± 15.5) min. Overall, 73(53.7%) cases were diagnostic and 25(18.4%) cases were therapeutic in which interventions(argon plasma coagulation, stricture dilatation, polypectomy, etc.) were performed. Pre-procedural imaging was performed in 88(64.7%) patients. Endoscopic concordance of positive imaging findings was seen in 31(35.2%) cases. Follow up data was available in 93(68.4%) patients; 2(2.2%) reported post-procedural abdominal pain within 30 d

  13. Fifteen-year experience with the Bicarbon heart valve prosthesis in a single center.

    Science.gov (United States)

    Misawa, Yoshio; Muraoka, Arata; Ohki, Shin-ichi; Aizawa, Kei; Kawahito, Koji; Saito, Tsutomu; Sato, Hirotaka; Takazawa, Ippei; Kurumisawa, Soki; Akutsu, Hirohiko; Sugaya, Akira

    2015-06-28

    The purpose of this study was to evaluate retrospectively the clinical performance of the Bicarbon valve (Sorin Biomedica Cardio, Saluggia, Italy) implanted at our center in Japan. Between January 1997 and December 2011, 415 patients in our institution were implanted with the Bicarbon valve. Nine of these recipients were excluded from the study because they had already undergone valve implantation and received a Bicarbon valve in a different position. The remaining patients were analyzed for evaluation of the postoperative clinical outcomes. Of the 406 patients (mean age 60.2 ± 11.7 years), 179 underwent aortic valve replacement (AVR), 149 mitral valve replacement (MVR), and 78 both aortic and mitral valve replacement (DVR). There were 10 early deaths (2.5 %: 4 in the AVR group and 6 in the MVR group). Three hundred eighty-nine patients were followed up (95.8 % completeness of follow-up) with a mean follow-up of 6.6 ± 4.2 years overall (AVR 6.8 ± 4.2, MVR, 6.7 ± 4.4, and DVR 5.7 ± 3.4 years) and a cumulative follow-up of 2661 patient-years (1214, 1001, and 446 patient-years for AVR, MVR, and DVR, respectively). Ninety-nine patients died (3.7 % per patient-year: 22 valve-related and 77 valve-unrelated deaths). Survival at 10 years was 74.1 ± 4.0 % in the AVR group, 73.7 ± 4.2 % in the MVR group, and 61.0 ± 7.9 % in the DVR group. The linearized incidence of thromboembolic complications, bleeding complications, prosthetic valve endocarditis, paravalvular leaks, and sudden death in all patients was 0.5 %, 0.5 %, 0.2 %, 0.2 %, and 0.4 % per patient-year, respectively. The incidence of valve-related complications and reoperation was 1.6 % and 0.4 %, respectively. No other valve-related complications were observed. The Bicarbon prosthetic heart valve has shown excellent clinical results and is associated with a low incidence of valve-related complications.

  14. Conversion from temporary to tunneled catheters by nephrologists: report of a single-center experience

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    Silva BC

    2016-04-01

    Full Text Available Bruno C Silva, Camila E Rodrigues, Regina CRM Abdulkader, Rosilene M Elias Nephrology Division, Hospital das Clínicas, University of São Paulo, São Paulo, Brazil Background: Nephrologists have increasingly participated in the conversion from temporary catheters (TC to tunneled-cuffed catheters (TCCs for hemodialysis. Objective: To prospectively analyze the outcomes associated with TCC placement by nephrologists with expertise in such procedure, in different time periods at the same center. The impact of vancomycin or cefazolin as prophylactic antibiotics on the infection outcomes was also tested. Patients and methods: Hemodialysis patients who presented to such procedure were divided into two cohorts: A (from 2004 to 2008 and B (from 2013 to 2015. Time from TC to TCC conversion, prophylactic antibiotics, and reasons for TCC removal were evaluated. Results: One hundred and thirty patients were included in cohort A and 228 in cohort B. Sex, age, and follow-up time were similar between cohorts. Median time from TC to TCC conversion was longer in cohort A than in cohort B (14 [3; 30] vs 4 [1; 8] days, respectively; P<0.0001. Infection leading to catheter removal occurred in 26.4% vs 18.9% of procedures in cohorts A and B, respectively, and infection rate was 0.93 vs 0.73 infections per 1,000 catheter-days, respectively (P=0.092. Infection within 30 days from the procedure occurred in 1.4% of overall cohort. No differences were observed when comparing vancomycin and cefazolin as prophylactic antibiotics on 90-day infection-free TCC survival in a Kaplan–Meier model (log-rank = 0.188. TCC removal for low blood flow occurred in 8.9% of procedures. Conclusion: Conversion of TC to TCC by nephrologists had overall infection, catheter patency, and complications similar to data reported in the literature. Vancomycin was not superior to cefazolin as a prophylactic antibiotic. Keywords: renal dialysis, tunneled catheters, interventional nephrology

  15. The patient experience of patient-centered communication with nurses in the hospital setting: a qualitative systematic review protocol.

    Science.gov (United States)

    Newell, Stephanie; Jordan, Zoe

    2015-01-01

    The objective of this systematic review is to synthesize the eligible evidence of patients' experience of engaging and interacting with nurses, in the medical-surgical ward setting.This review will consider the following questions: Communication is a way in which humans make sense of the world around them. Communication takes place as an interactive two-way process or interaction, involving two or more people and can occur by nonverbal, verbal, face-to-face or non-face-to-face methods. Effective communication is described to occur when the sender of a message sends their message in a way that conveys the intent of their message and then is understood by the receiver of the message. As a result of the communication from both the sender and the receiver of the message a shared meaning is created between both parties.Communication can therefore be viewed as a reciprocal process. In the health care literature the terms communication and interaction are used interchangeably.Communication failures between clinicians are the most common primary cause of errors and adverse events in health care. Communication is a significant factor in patient satisfaction and complaints about care. Communication plays an integral role in service quality in all service professions including health care professions.Within healthcare, quality care has been defined by the Institute of Medicine as 'care that is safe, effective, timely, efficient, equitable and patient-centred'. Patient-centered care is defined as 'care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient's values guide all clinical decisions. Patient centered-care encompasses the 'individual experiences of a patient, the clinical service, the organizational and the regulatory levels of health care'. At the individual patient level, patient-centered care is care that is 'provided in a respectful manner, assures open and ongoing sharing of useful information in an

  16. High-pressure balloon dilation for male anterior urethral stricture:single-center experience

    Institute of Scientific and Technical Information of China (English)

    Shi-cheng YU; Hai-yang WU; Wei WANG; Li-wei XU; Guo-qing DING; Zhi-gen ZHANG; Gong-hui LI‡

    2016-01-01

    题目:高压球囊扩张治疗男性前尿道狭窄:单中心的临床经验  目的:评估高压球囊扩张治疗男性前尿道狭窄的有效性和安全性。  创新点:既往高压球囊扩张技术已成熟应用于输尿管狭窄的临床治疗,我们将这一技术拓宽应用于男性前尿道狭窄的治疗,并证明高压球囊扩张治疗前尿道狭窄同样安全、有效。  方法:采用回顾性病例对照研究,收集并分析了31例接受高压球囊扩张和25例接受直视下尿道内切开术治疗的前尿道患者的病例资料,比较两组患者的手术时间、手术难易程度、术后并发症(出血和感染)、术后1年狭窄复发率和术后3年狭窄复发率等相关指标。  结论:高压球囊扩张组的手术时间和术后并发症发生率要优于直视下尿道内切开术组,两组患者的远期尿道狭窄复发率无统计学差异,但高压球囊扩张组的术后1年狭窄复发率明显低于直视下尿道内切开术组。高压球囊扩张治疗男性前尿道狭窄是安全、有效的,且近期疗效要优于传统腔内治疗方式。%Objectives: We retrospectively reviewed the urethral stricture cases treated in our tertiary center, and assessed the safety and feasibility of the high-pressure baloon dilation (HPBD) technique for anterior urethral stricture. Methods: From January 2009 to December 2012, a total of 31 patients with anterior urethral strictures underwent HPBD at our center, while another 25 cases were treated by direct vision internal urethrotomy (DVIU). Patient de-mographics, stricture characteristics, surgical techniques, and operative outcomes were assessed and compared between the two groups. The Kaplan-Meier survival analysis was applied to evaluate the stricture-free rate for the two surgical techniques. Results: The operation time was much shorter for the HPBD procedure than for the DVIU ((13.19±2.68) min vs. (18.44±3.29) min,P<0

  17. Empowering patients of a mental rehabilitation center in a low-resource context: a Moroccan experience as a case study.

    Science.gov (United States)

    Khabbache, Hicham; Jebbar, Abdelhak; Rania, Nadia; Doucet, Marie-Chantal; Watfa, Ali Assad; Candau, Joël; Martini, Mariano; Siri, Anna; Brigo, Francesco; Bragazzi, Nicola Luigi

    2017-01-01

    Mental, neurological and substance use (MNS) disorders represent a major source of disability and premature mortality worldwide. However, in developing countries patients with MNS disorders are often poorly managed and treated, particularly in marginalized, impoverished areas where the mental health gap and the treatment gap can reach 90%. Efforts should be made in promoting help by making mental health care more accessible. In this article, we address the challenges that psychological and psychiatric services have to face in a low-resource context, taking our experience at a Moroccan rehabilitation center as a case study. A sample of 60 patients were interviewed using a semi-structured questionnaire during the period of 2014-2015. The questionnaire investigated the reactions and feelings of the patients to the rehabilitation program, and their perceived psychological status and mental improvement, if any. Interviews were then transcribed and processed using ATLAS.ti V.7.0 qualitative analysis software. Frequencies and co-occurrence analyses were carried out. Despite approximately 30 million inhabitants within the working age group, Morocco suffers from a shortage of specialized health workers. Our ethnographic observations show that psychiatric treatment can be ensured, notwithstanding these hurdles, if a public health perspective is assumed. In resource-limited settings, working in the field of mental health means putting oneself on the line, exposing oneself to new experiences, and reorganizing one's own skills and expertise. In the present article, we have used our clinical experience at a rehabilitation center in Fes as a case study and we have shown how to use peer therapy to overcome the drawbacks that we are encountered daily in a setting of limited resources.

  18. Characteristics predicting laparoscopic skill in medical students: nine years' experience in a single center.

    Science.gov (United States)

    Nomura, Tsutomu; Matsutani, Takeshi; Hagiwara, Nobutoshi; Fujita, Itsuo; Nakamura, Yoshiharu; Kanazawa, Yoshikazu; Makino, Hiroshi; Mamada, Yasuhiro; Fujikura, Terumichi; Miyashita, Masao; Uchida, Eiji

    2017-06-21

    We introduced laparoscopic simulator training for medical students in 2007. This study was designed to identify factors that predict the laparoscopic skill of medical students, to identify intergenerational differences in abilities, and to estimate the variability of results in each training group. Our ultimate goal was to determine the optimal educational program for teaching laparoscopic surgery to medical students. Between 2007 and 2015, a total of 270 fifth-year medical students were enrolled in this observational study. Before training, the participants were asked questions about their interest in laparoscopic surgery, experience with playing video games, confidence about driving, and manual dexterity. After the training, aspects of their competence (execution time, instrument path length, and economy of instrument movement) were assessed. Multiple regression analysis identified significant effects of manual dexterity, gender, and confidence about driving on the results of the training. The training results have significantly improved over recent years. The variability among the results in each training group was relatively small. We identified the characteristics of medical students with excellent laparoscopic skills. We observed educational benefits from interactions between medical students within each training group. Our study suggests that selection and grouping are important to the success of modern programs designed to train medical students in laparoscopic surgery.

  19. Adult Living Donor Liver Transplantation with ABO-Incompatible Grafts: A German Single Center Experience

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    Armin D. Goralczyk

    2009-01-01

    Full Text Available Adult living donor liver transplantations (ALDLTs across the ABO blood group barrier have been reported in Asia, North Americas, and Europe, but not yet in Germany. Several strategies have been established to overcome the detrimental effects that are attached with such a disparity between donor and host, but no gold standard has yet emerged. Here, we present the first experiences with three ABO-incompatible adult living donor liver transplantations in Germany applying different immunosuppressive strategies. Four patient-donor couples were considered for ABO-incompatible ALDLT. In these patients, resident ABO blood group antibodies (isoagglutinins were depleted by plasmapheresis or immunoadsorption and replenishment was inhibited by splenectomy and/or B-cell-targeted immunosuppression. Despite different treatments ALDLT could safely be performed in three patients and all patients had good initial graft function without signs for antibody-mediated rejection (AMR. Two patients had long-term graft survival with stable graft function. We thus propose the feasibility of ABO-incompatible ALDLT with these protocols and advocate further expansion of ABO incompatible ALDLT in multicenter trials to improve efficacy and safety.

  20. Results of candidemia treatment in children with hematologic malignancies: single center experience

    Directory of Open Access Journals (Sweden)

    I. I. Kalinina

    2014-07-01

    Full Text Available Candidemia is one of the most serious infectious complications in children with hematological malignancies and has a high morta lity rate.Seven-year experience of candidemia diagnosis and therapy in patients with various hematologic malignancies w as analyzed. Candidemia registered in 37 patients (AML and MDS — 14, ALL — 10, solid tumors — 5, histocytic syndromes — 4, AA — 3, other non-malignancy diseases— 2. C. non-albicans (36 isolates from 32 patients was common cause of, while C. albicans isolated in 5 patients (8 strains. Antifungal prophylactic therapy was applied to 31 patients. 22 patients at the time of candidemia have neutropenia (< 0.5 × 10 9/l. Main clinical manifestations were febrile fever (100 % cases and pneumonia (21.6 % cases. Less frequent multiorgan failure (8.1 %, septic shoc k (5.4 %, chronic disseminated candidiasis (5.4 % and meningitis (2.7 % were registered. All patients received antifungal therapy (monotherapy — 17, combination therapy — 20. Central venous catheter removed in 21 patients. In 14 patients hematopoietic recovery w as registered, none of these patients died, while from group of patients without hematopoietic recovery 6 patients died (p = 0.0001. Recurrent candidemia episodes were seen in 4 patients. Overall survival was 0.37 ± 0.09.

  1. Atypical presentation of Merkel cell carcinoma positive to polyomavirus DNA detection: Experience from a single center

    Directory of Open Access Journals (Sweden)

    Iovino F

    2014-07-01

    Full Text Available Merkel cell carcinoma (MCC is a rare malignant tumor of the skin with tendency to rapid local progression and frequent spread to regional lymph nodes. In this paper we retrospectively describe the atypical presentation of 5 cases of Merkel cell carcinoma observed in our surgical department in the last ten years. Four patients had buttock localization whilst one patient had primary nodal presentation. Since integration of Merkel cell polyomavirus (MCPyV DNA into the tumor genome is frequently recorded in this type of cancer, we analyzed formalin-fixed paraffin embedded MCC tissue samples from our five patients for the presence of MCPyV DNA by means of polymerase chain reaction (PCR. MCPyV DNA was present in all five carcinomas. All patients were treated with wide surgical excision of the tumor and sentinel node biopsy. One patient had stage I disease, three patients had stage II disease, and one patient had stage III disease. Adjuvant radiotherapy was administered in all cases for local control. Chemotherapy was administered to the patient with primary nodal presentation and in stage III disease. Median time of follow-up was 84 months. None of the patients relapsed. Despite the low number of patients examined, our experience suggests that surgery is a necessary step whereas implementation of adjuvant therapy, radiotherapy and chemotherapy depends on individual risk assessment. Treatment outcome was very good, probably due to early detection of MCC.

  2. Successful Renal Transplantation with Desensitization in Highly Sensitized Patients: A Single Center Experience

    Science.gov (United States)

    Yoon, Hye Eun; Hyoung, Bok Jin; Hwang, Hyeon Seok; Lee, So Young; Jeon, Youn Joo; Song, Joon Chang; Oh, Eun-Jee; Park, Sun Cheol; Choi, Bum Soon; Moon, In Sung; Kim, Yong Soo

    2009-01-01

    Intravenous immunoglobulin (IVIG) and/or plasmapheresis (PP) are effective in preventing antibody-mediated rejection (AMR) of kidney allografts, but AMR is still a problem. This study reports our experience in living donor renal transplantation in highly sensitized patients. Ten patients with positive crossmatch tests or high levels of panel-reactive antibody (PRA) were included. Eight patients were desensitized with pretransplant PP and low dose IVIG, and two were additionally treated with rituximab. Allograft function, number of acute rejection (AR) episodes, protocol biopsy findings, and the presence of donor-specific antibody (DSA) were evaluated. With PP/IVIG, six out of eight patients showed good graft function without AR episodes. Protocol biopsies revealed no evidence of tissue injury or C4d deposits. Of two patients with AR, one was successfully treated with PP/IVIG, but the other lost graft function due to de novo production of DSA. Thereafter, rituximab was added to PP/IVIG in two cases. Rituximab gradually decreased PRA levels and the percentage of peripheral CD20+ cells. DSA was undetectable and protocol biopsy showed no C4d deposits. The graft function was stable and there were no AR episodes. Conclusively, desensitization using PP/IVIG with or without rituximab increases the likelihood of successful living donor renal transplantation in sensitized recipients. PMID:19194545

  3. Phenylketonuria. Experience at one center in the first year of screening in California.

    Science.gov (United States)

    Peterson, R M; Koch, R; Schaeffler, G E; Wohlers, A; Acosta, P B; Boyle, D

    1968-05-01

    One year's experience with phenylketonuria during the calendar year 1966, the first year for compulsory newborn screening in California, was reviewed. The over-all prevalence rate from reported cases in California during this period was one case per 19,500 persons tested. Fifty-seven persons suspected of having pku were evaluated, and 25 of them were determined to be phenylketonuric. Eleven of the 25 were infants in whom the abnormality was detected through the newborn screening program or because it was detected in a sibling through a screening program. All the newborn phenylketonuric patients were developing normally at the time of last report (although the follow-up periods were short). In nine of the other children, pku was detected because they were retarded. Five retarded children who were diagnosed as phenylketonuric at another clinic were given dietary assistance. Five additional infants had elevated serum phenylalanines but did not have the classic biochemical findings of pku and are being evaluated further. Nine infants with positive screening tests exhibited biochemical and clinical findings consistent with transient tyrosinemia. Eighteen other children were evaluated and found to have no metabolic abnormality. The newborn screening program for pku is of decided benefit in early identification of a group of infants who have a high rate of potentially serious metabolic disease. Early identification permits treatment soon enough to prevent mental retardation. Newly identified patients should be evaluated in a medical setting capable of careful pediatric, biochemical and nutritional surveillance.

  4. Phenylketonuria—Experience at One Center in the First Year of Screening in California

    Science.gov (United States)

    Peterson, Raymond M.; Koch, Richard; Schaeffler, Graciela E.; Wohlers, Audrey; Acosta, Phyllis B.; Boyle, David

    1968-01-01

    One year's experience with phenylketonuria during the calendar year 1966, the first year for compulsory newborn screening in California, was reviewed. The over-all prevalence rate from reported cases in California during this period was one case per 19,500 persons tested. Fifty-seven persons suspected of having pku were evaluated, and 25 of them were determined to be phenylketonuric. Eleven of the 25 were infants in whom the abnormality was detected through the newborn screening program or because it was detected in a sibling through a screening program. All the newborn phenylketonuric patients were developing normally at the time of last report (although the follow-up periods were short). In nine of the other children, pku was detected because they were retarded. Five retarded children who were diagnosed as phenylketonuric at another clinic were given dietary assistance. Five additional infants had elevated serum phenylalanines but did not have the classic biochemical findings of pku and are being evaluated further. Nine infants with positive screening tests exhibited biochemical and clinical findings consistent with transient tyrosinemia. Eighteen other children were evaluated and found to have no metabolic abnormality. The newborn screening program for pku is of decided benefit in early identification of a group of infants who have a high rate of potentially serious metabolic disease. Early identification permits treatment soon enough to prevent mental retardation. Newly identified patients should be evaluated in a medical setting capable of careful pediatric, biochemical and nutritional surveillance. PMID:5652755

  5. Hematopoietic Stem-Cell Transplantation in the Developing World: Experience from a Center in Western India

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    Chirag A. Shah

    2015-01-01

    Full Text Available We describe our experience of first 50 consecutive hematopoietic stem-cell transplants (HSCT done between 2007 and 2012 at the Apollo Hospital, Gandhinagar, 35 autologous HSCT and 15 allogeneic HSCT. Indications for autologous transplant were multiple myeloma, non-Hodgkin lymphoma, Hodgkin lymphoma, and acute myeloid leukemia, and indications for allogeneic transplants were thalassemia major, aplastic anaemia, chronic myeloid leukemia, and acute lymphoblastic and myeloid leukaemia. The median age of autologous and allogeneic patient’s cohort was 50 years and 21 years, respectively. Median follow-up period for all patients was 39 months. Major early complications were infections, mucositis, acute graft versus host disease, and venoocclusive disease. All of our allogeneic and autologous transplant patients survived during the first month of transplant. Transplant related mortality (TRM was 20% (N = 3 in our allogeneic and 3% (N = 1 in autologous patients. Causes of these deaths were disease relapse, sepsis, hemorrhagic complications, and GVHD. 46% of our autologous and 47% of our allogeneic patients are in complete remission phase after a median follow-up of 39 months. 34% of our autologous patients and 13% of our allogeneic patients had disease relapse. Overall survival rate in our autologous and allogeneic patients is 65.7% and 57.1%, respectively. Our results are comparable to many national and international published reports.

  6. Prevalence of Ectopic Breast Tissue and Tumor: A 20-Year Single Center Experience.

    Science.gov (United States)

    Famá, Fausto; Cicciú, Marco; Sindoni, Alessandro; Scarfó, Paola; Pollicino, Andrea; Giacobbe, Giuseppa; Buccheri, Giancarlo; Taranto, Filippo; Palella, Jessica; Gioffré-Florio, Maria

    2016-08-01

    Ectopic breast tissue, which includes both supernumerary breast and aberrant breast tissue, is the most common congenital breast abnormality. Ectopic breast cancers are rare neoplasms that occur in 0.3% to 0.6% of all cases of breast cancer. We retrospectively report, using a large series of breast abnormalities diagnosed and treated, our clinical experience on the management of the ectopic breast cancer. In 2 decades, we observed 327 (2.7%) patients with ectopic breast tissue out of a total of 12,177 subjects undergoing a breast visit for lesions. All patients were classified into 8 classes, according to the classification of Kajava, and assessed by a physician examination, ultrasounds, and, when appropriate, further studies with fine needle aspiration cytology and mammography. All specimens were submitted to the anatomo-pathologist. The most frequent benign histological diagnosis was fibrocystic disease. A rare granulosa cell tumor was also found in the right anterior thoracic wall of 1 patient. Four malignancies were also diagnosed in 4 women: an infiltrating lobular cancer in 1 patient with a lesion classified as class I, and an infiltrating apocrine carcinoma, an infiltrating ductal cancer, and an infiltrating ductal cancer with tubular pattern, occurring in 3 patients with lesions classified as class IV. Only 1 recurrence was observed. We recommend an earlier surgical approach for patients with lesions from class I to IV. Copyright © 2016 Elsevier Inc. All rights reserved.

  7. Domino heart transplantation: long-term outcome of recipients and their living donors: single center experience.

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    Raffa, G M; Pellegrini, C; Viganò, M

    2010-11-01

    "Domino" cardiac procedure is an effective option to increase the donor pool when heart-lung transplantation (HLT) is the only treatment for patients with terminal cardiopneumopathy. We reviewed the long-term outcomes of domino cardiac donors and recipients at our institution. Ten of 35 patients who underwent HLT from 1991 onward served as domino cardiac donors. They included eight female and two male subjects of overall mean age of 33 years and mean weight of 55 kg. Their diagnoses were primary pulmonary hypertension (n = 6) as well as cystic fibrosis, bronchiectasis, Eisenmenger's syndrome, and bronchiolitis obliterans (n = 1 each). The domino cardiac recipients included six males and four females of overall mean age of 47 years and mean weight of 61 kg. They were affected by ischemic heart disease (n = 5), cardiomyopathy (n = 4), and valvular heart disease (n = 1). Mean pulmonary vascular resistance was 3 Wood units. The heart was used either in the orthotopic (n = 8) or in the heterotopic position (n = 2). The 1-, 5-, and 10-year survivals for the domino cardiac donors versus their recipients were 60%, 40%, 30% versus 90%, 70%, 60%, respectively. Five domino donors developed bronchiolitis obliterans syndrome. Among the domino recipients group, cardiac allograft vasculopathy was rare (n = 1). Common causes of late death were in the domino recipients infections in the domino donors (n = 2) and malignancies. Our experience suggested good long-term results of the domino procedure. Copyright © 2010 Elsevier Inc. All rights reserved.

  8. Outcomes of arteriovenous fistula for hemodialysis in Sudanese patients: Single-center experience

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    Gamal Mustafa Ahmed

    2012-01-01

    Full Text Available A well-functioning arteriovenous fistula (AVF is essential for the maintenance of hemodialysis (HD in patients with chronic renal failure. Our aim is to review our experience of creating AVF and to asses its success rate and common complication. A prospective, hospital-based study was conducted on 73 patients (48 males and 25 females on chronic HD in Gezira Hospital for Renal Diseases and Surgery, from January to July 2007. Their mean age was 43.9 years (range from 18 to 72 years. Seventy-one (97.3% of the study subjects had been dialyzed before creation of the AVF, 67 (91.8% of them having undergone HD with temporary access. All patients (n=73 had a native AVF as the permanent vascular access (VA. A primary radiocephalic AVF was created in 78.1% of the patients, cubital fossa in 20.5% and one case had left snuff box AVF (1.4%. Percentage of AVF maturation was reported in 67.1% of the cases within the first six weeks and in 9.6% of the cases AVF never matured. Failure of AVF function occurred in 26% of the cases, due to thrombosis in 20.5% (n=15 and aneurysm in 5.5% of the cases. We conclude that an optimum outcome is likely when there is a multidisciplinary team approach, and early referral to vascular surgery is paramount.

  9. COMBREX-DB: an experiment centered database of protein function: knowledge, predictions and knowledge gaps.

    Science.gov (United States)

    Chang, Yi-Chien; Hu, Zhenjun; Rachlin, John; Anton, Brian P; Kasif, Simon; Roberts, Richard J; Steffen, Martin

    2016-01-01

    The COMBREX database (COMBREX-DB; combrex.bu.edu) is an online repository of information related to (i) experimentally determined protein function, (ii) predicted protein function, (iii) relationships among proteins of unknown function and various types of experimental data, including molecular function, protein structure, and associated phenotypes. The database was created as part of the novel COMBREX (COMputational BRidges to EXperiments) effort aimed at accelerating the rate of gene function validation. It currently holds information on ∼ 3.3 million known and predicted proteins from over 1000 completely sequenced bacterial and archaeal genomes. The database also contains a prototype recommendation system for helping users identify those proteins whose experimental determination of function would be most informative for predicting function for other proteins within protein families. The emphasis on documenting experimental evidence for function predictions, and the prioritization of uncharacterized proteins for experimental testing distinguish COMBREX from other publicly available microbial genomics resources. This article describes updates to COMBREX-DB since an initial description in the 2011 NAR Database Issue.

  10. Ureteroscopy and Laser Lithotripsy for Treatment of Ureteral Stones in Pregnants: Single Center Experience

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    Mustafa Okan İstanbulluoğlu

    2016-03-01

    Full Text Available Objective: To report our ureteroscopic laser lithotrip­sy experiences in the treatment of symptomatic ureter stones in pregnants which do not respond to conservative treatment Methods: A total of 6 pregnants aged between 22-33 years in second or third trimester were studied. Holmium-YAG laser lithotripsy was performed with 6.5 F semirigid uretroscope. Results: The diagnosis of ureter stone was made with ab­dominal ultrasonography in 5 patients and with magnetic resonance in one patient. Adequate stone fragmentation was performed in 2 mid-ureter and 4 distal-ureter stones. J stent was applied in one patient after the fragmenta­tion process. The mean operation time was 24.8 ± 10.0 minutes after the entry of bladder with ureteroscope un­der spinal anesthesia. No urologic, anesthetic or obstetric complication was seen and all patients gave healthy birth at term. Conclusion: Fine calibrated ureteroscopes for the treat­ment of ureter stones in pregnants are fast and effective treatment modalities which decrease the operation time and remove difficulties in entering the ureter.

  11. Results of candidemia treatment in children with hematologic malignancies: single center experience

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    I. I. Kalinina

    2011-01-01

    Full Text Available Candidemia is one of the most serious infectious complications in children with hematological malignancies and has a high morta lity rate.Seven-year experience of candidemia diagnosis and therapy in patients with various hematologic malignancies w as analyzed. Candidemia registered in 37 patients (AML and MDS — 14, ALL — 10, solid tumors — 5, histocytic syndromes — 4, AA — 3, other non-malignancy diseases— 2. C. non-albicans (36 isolates from 32 patients was common cause of, while C. albicans isolated in 5 patients (8 strains. Antifungal prophylactic therapy was applied to 31 patients. 22 patients at the time of candidemia have neutropenia (< 0.5 × 10 9/l. Main clinical manifestations were febrile fever (100 % cases and pneumonia (21.6 % cases. Less frequent multiorgan failure (8.1 %, septic shoc k (5.4 %, chronic disseminated candidiasis (5.4 % and meningitis (2.7 % were registered. All patients received antifungal therapy (monotherapy — 17, combination therapy — 20. Central venous catheter removed in 21 patients. In 14 patients hematopoietic recovery w as registered, none of these patients died, while from group of patients without hematopoietic recovery 6 patients died (p = 0.0001. Recurrent candidemia episodes were seen in 4 patients. Overall survival was 0.37 ± 0.09.

  12. Evaluation of treatment outcomes of early-stage endometrial cancer radiotherapy: a single center experience.

    Science.gov (United States)

    Demiral, S; Beyzadeoglu, M; Sager, O; Dincoglan, F; Uysal, B; Gamsiz, H; Akin, M; Turker, T; Dirican, B

    2014-01-01

    Postoperative adjuvant radiotherapy (RT) in the management of early stage endometrial cancer (EC) is still controversial. Here we report our institutional experience with patients who received postoperative RT for stage I-II EC over a period of 35 years and assess potential predictors of local recurrence (LR), distant metastasis (DM), and overall survival (OS). A total of 188 patients undergoing postoperative RT for stage IA-II EC between 1977 and 2012 were evaluated. Some 96 received median 46 Gy whole pelvic radiotherapy (WPRT) (range: 40-60 Gy), 37 were given WPRT with vaginal cuff therapy (VCT), and 55 received only VCT either with brachytherapy (BT) or stereotactic body radiotherapy (SBRT). Chemotherapy was given to 5 patients with uterine papillary serous carcinoma (UPSC). Logistic regression analysis was used to assess the effect of clinicopathological factors on LR, DM, and OS. Median follow-up time was 11 years (range: 1-35 years). At the time of analysis, 34 patients were not alive. Of the 15 patients with LR, 7 (46.7%) recurred in the vaginal stump, 5 (33.3%) in the pelvic region, and 3 (20%) in the paraaortic nodal region, while 12 had distant metastasis. UPSC histology (p=0.027), sole VCT (p=0.041), high histologic grade (p=0.034), and age≥71 (p=0.04) were poor prognostic factors on univariate analysis. In our patients receiving radiotherapy for early-stage EC, grade III disease and age≥71 were associated with shorter OS whereas UPSC histology was an independent predictor for both LR and DM.

  13. Surgical analysis of pediatric and adolescent sporadic pheochromocytoma: single center experience.

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    Osman, Yasser; Hussein, Naser; Sarhan, Osama; Shorrab, Ahmed A; Dawaba, Mohamed; Ghoneim, Mohamed A

    2011-12-01

    The aim of this study is to review our experience with sporadic pheochromocytoma in pediatrics and adolescents focusing upon surgical approach, incidence of malignancy, and recurrence rate. Between 1990 and 2007, 8 pediatric patients were diagnosed with sporadic pheochromocytoma. Demographic data, clinical and radiological findings, laboratory profile, preoperative preparation, surgical approach, operative findings, postoperative course as well as pathologic diagnosis of the removed specimen were reviewed. Mean age of presentation was 13.1 ± 4.7 years. Five patients had right-sided masses, 1 harbored left-sided mass, and bilaterality was observed in 2 with mean size of 5.7 ± 1.3 cm. Computed tomography showed no evidence of local infiltration, regional lymphadenopathy or distant metastasis in all patients but two. Six masses were excised through thoraco-abdominal approach, 3 were removed laparoscopically, while percutaneous alcohol ablation was adopted for the last. We had one postoperative death (12.5%:1/8), and the remaining 7 patients were followed for a mean of 8.6 ± 3 years. Five patients never had recurrence. Bilateral recurrence developed in 2 patients, where they were safely excised in one patient and was a part of disseminated disease in the other. Malignant nature of the disease was proved in 2 patients and showed poor survival. Under adequate anesthetic control, pediatric pheochromocytoma could be safely managed through both the open and laparoscopic approaches. Advanced radiological stage would suggest the malignant nature of the disease with dismal outcome. Long-term follow-up is warranted for possibility of delayed curable recurrence.

  14. Successful Splenectomy for Hypersplenism in Wilson’s Disease: A Single Center Experience from China

    Science.gov (United States)

    Chen, Huai-Zhen; Wu, Yun-Hu; Fang, Xiang; Zhang, Jing; Wang, Zhen; Han, Yong-Sheng; Wang, Yu

    2015-01-01

    Splenomegaly and pancytopenia are common in Wilson’s disease (WD) and splenectomy is one of the conventional treatments for splenomegaly and the associated pancytopenia. However, splenectomy remained controversial for hypersplenism in WD as it was reported that splenectomy leaded to serious emotional and neurological deterioration in WD patients with hypersplenism. In the current study, we present our experiences in 70 WD patients with hypersplenism who had undergone splenectomy, outlining the safety and efficacy of splenectomy in WD. The clinical database of 70 WD patients with hypersplenism who had undergone splenectomy in our hospital between 2009 and 2013 were reviewed and followed-up regularly. Before splenectomy, all the patients accepted a short period of anti-copper treatment with intravenous sodium 2, 3-dimercapto-1-propane sulfonate (DMPS). All the patients demonstrated a marked improvement in platelet and leucocyte counts after splenectomy. No severe postoperative complication was observed. In particular, none of the 37 patients with mixed neurologic and hepatic presentations experienced neurological deterioration after splenectomy, and none of the patients with only hepatic presentations newly developed neurological symptoms. During the one year follow-up period, no patient presented hepatic failure or hepatic encephalopathy, no hepatic patient newly developed neurological presentations, and only 3 patients with mixed neurologic and hepatic presentations suffered neurological deterioration and these 3 patients had poor compliance of anti-copper treatment. Quantative analysis of the neurological symptoms in the 37 patients using the Unified Wilson’s Disease Rating Scale (UWDRS) showed that the neurological symptoms were not changed in a short-term of one week after splenectomy but significantly improved in a long-term of one year after splenectomy. Additionally, compared to that before splenectomy, the esophageal gastric varices in most patients

  15. Successful Splenectomy for Hypersplenism in Wilson's Disease: A Single Center Experience from China.

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    Liang-Yong Li

    Full Text Available Splenomegaly and pancytopenia are common in Wilson's disease (WD and splenectomy is one of the conventional treatments for splenomegaly and the associated pancytopenia. However, splenectomy remained controversial for hypersplenism in WD as it was reported that splenectomy leaded to serious emotional and neurological deterioration in WD patients with hypersplenism. In the current study, we present our experiences in 70 WD patients with hypersplenism who had undergone splenectomy, outlining the safety and efficacy of splenectomy in WD. The clinical database of 70 WD patients with hypersplenism who had undergone splenectomy in our hospital between 2009 and 2013 were reviewed and followed-up regularly. Before splenectomy, all the patients accepted a short period of anti-copper treatment with intravenous sodium 2, 3-dimercapto-1-propane sulfonate (DMPS. All the patients demonstrated a marked improvement in platelet and leucocyte counts after splenectomy. No severe postoperative complication was observed. In particular, none of the 37 patients with mixed neurologic and hepatic presentations experienced neurological deterioration after splenectomy, and none of the patients with only hepatic presentations newly developed neurological symptoms. During the one year follow-up period, no patient presented hepatic failure or hepatic encephalopathy, no hepatic patient newly developed neurological presentations, and only 3 patients with mixed neurologic and hepatic presentations suffered neurological deterioration and these 3 patients had poor compliance of anti-copper treatment. Quantative analysis of the neurological symptoms in the 37 patients using the Unified Wilson's Disease Rating Scale (UWDRS showed that the neurological symptoms were not changed in a short-term of one week after splenectomy but significantly improved in a long-term of one year after splenectomy. Additionally, compared to that before splenectomy, the esophageal gastric varices in most

  16. Pregnancy after renal transplantation: ten-year single-center experience.

    Science.gov (United States)

    Ghafari, A; Sanadgol, H

    2008-01-01

    There has been an increase in the number of pregnancies among renal transplant recipients. Our experience included 61 pregnancies in 53 patients from January 1997 to April 2007, with 6 patients having multiple pregnancies. Patients were studied for clinical, obstetrical, and perinatal outcomes. The mean patient age was 24.5 years (range, 19-38). They all received living donor kidneys. The mean transplantation-pregnancy interval was 2.7 years (range, 1.7-5.3 years). Immunosuppressive drugs consisted of cyclosporine (CsA), mycophenolate mofetil (MMF), and prednisolone (pred) in 38 patients (72%); CsA, azathioprine (AZA), plus pred were used in 15 patients (28%). Pregnancy complications were chronic hypertension in 21 patients (40%), anemia in 28 (52.6%), and urinary tract infection in 18 (34%). Twelve patients (22.6%) received blood transfusions. Pre-eclampsia was diagnosed in 14 cases (26.4%) and renal dysfunction in 11 (20.7%) with pre-eclampsia assumed to be the main cause. Three patients (5.6%) had graft losses as a result of hemorrhagic shock, sepsis, and eclampsia. Premature rupture of membranes occurred in 6 cases (11.3%), and preterm delivery occurred in 14 cases (26.4%). Eleven (20.7%) newborns were small for gestational age. One club foot and one large facial hemangioma occurred in 2 infants, respectively. One case of neonatal death was registered as a result of excessive prematurity. One mother died due to sepsis. Cesarean section was performed in 24 patients (45.2%), the main indications being related to hypertension and fetal distress. There were no significant differences between MMF-treated and AZA-treated patients with respect to clinical, obstetrical, and perinatal outcomes. This group of patients was characterized by a wide range of antenatal and perinatal problems that must be managed in specialized tertiary units to achieve the best results. MMF may be as safe as AZA in pregnancy.

  17. Liver transplantation in children with hyper-reduced grafts - a single-center experience.

    Science.gov (United States)

    Thomas, Naveen; Thomas, Gordon; Verran, Deborah; Stormon, Michael; O'Loughlin, Edward; Shun, Albert

    2010-05-01

    In small infants and babies who receive split or living-related adult left lateral segmental liver grafts, further reduction (hyper-reduction) of the graft may be necessary to optimize the size of the graft for the child. We report our experience with hyper-reduction of adult left lateral segment grafts in nine children. A retrospective review of the medical records of children who received hyper-reduced grafts at the Children's Hospital at Westmead, Australia was performed. Of 215 liver transplants performed on 186 children between 1986 and May 2009, 147 were reduced grafts. Nine grafts were further reduced (hyper-reduced) after an on-table assessment of graft size relative to the available abdominal space was made. Mean graft size reduction was by 30%. The pledgetted technique of resection was used in four patients. All required delayed closure of the abdomen, and in three patients, fascial closure was not possible and a Surgisis patch (Cook Surgical International, West Lafayette, IN, USA) was placed to augment the abdominal capacity. Two children had hepatic artery thrombosis. One was successfully thrombectomized. In the other, technical problems with the donor liver contributed to death 10 days post-transplant. Two bile leaks, one from the cut surface and the other at the anastomotic site, were oversewn at the time of abdominal closure. On follow-up (median 33 months), two developed biliary strictures requiring dilatation. Hyper-reduction of segmental grafts can be safely performed when needed. In view of its versatility, it may be preferable to hyper-reduce a graft rather than use a monosegment graft. Comparable long-term results are possible. The pledgetted technique of resection is easy, quick, and safe. The fact that it can be performed after revascularization with minimal blood loss adds great flexibility to this technically challenging procedure.

  18. Endoscopic Submucosal Dissection for Early Colorectal Neoplasms: Clinical Experience in a Tertiary Medical Center in Taiwan

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    Mei-Yu Tseng

    2013-01-01

    Full Text Available Objectives. Endoscopic submucosal dissection (ESD is a promising technique to treat early colorectal neoplasms by facilitating en bloc resection without size limitations. Although ESD for early gastrointestinal epithelial neoplasms has been popular in Japan, clinical experience with colorectal ESD has been rarely reported in Taiwan. Methods. From March 2006 to December 2011, 92 consecutive patients with early colorectal neoplasms resected by ESD at Tri-Service General Hospital were included. ESD was performed for colorectal epithelial neoplasms with a noninvasive pit pattern which had the following criteria: (1 lesions difficult to remove en bloc with a snare, such as laterally spreading tumors-nongranular type (LST-NG ≧20 mm and laterally spreading tumors-granular type (LST-G ≧30 mm; (2 lesions with fibrosis or which had recurred after endoscopic mucosal resection with a nonlifting sign. Results. The mean age of the patients was 66.3±12.9 years, and the male-female ratio was 1.8 : 1. The mean tumor size was 37.2±17.9 mm. The en bloc resection rate was 90.2% and the R0 resection rate was 89.1%. Perforations during ESD occurred in 11 patients (12.0% and all of them were effectively treated by endoscopic closure with hemoclips. No delayed perforation or postoperative bleeding was recorded. There were no procedure-related morbidities or mortalities. Conclusion. ESD is an effective method for en bloc resection of large early colorectal neoplasms and those with a nonlifting sign. An endoscopic technique to close perforations is essential for colorectal ESD.

  19. Single center experience in endovascular aortic repair: review of technical and clinical aspects

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    Sinan Demirtaş

    2014-09-01

    Full Text Available Objective: The aim of this study is sharing of our endovascular aortic repair experiments in patients with high risk for surgery and contributing to literature with comparing previous report according to mortality complicationsand additional operations. Methods:Patients with endovascular aortic repair application were evaluated retrospectively. Perioperative one month mortality, additional applications during procedure, occurred complications, endoleak types, approaching anesthetical technique, diagnosis of disease, comorbid factors and demographical data registered. Results were compared with data in the literature Results: Abdominal endovascular aortic repair (EVAR applicated into 19 patients. Thoracic endovascular aor tic repair (TEVAR applicated into 11 patients. EVAR patients were operated with diagnosis of abdominal aortic aneurysm. Nine of these patients were emergely operated due to rupture. TEVAR applicated 8 patients were operated due to Type 3 Aortic Dissection and 1 patient was operated due to transsection. One month mortality of all patients were found as 10% (three atients. Endoleaks were occurred 6 patients: Three of them were Type 1a, two of them were Type1b and one of them was Type2. Balloon angioplasty applicated in two patients due to Type 1a endoleak and, in one patient due to Type 1b endoleak. Chronic renal failure was developed in one patient (3.3% due to contrast nephropathy. Reexploration was applicated in two patients (6.7% due to hematoma. Conclusion: Endovascular techniques are become frequently preferred treatment modality with the developing technology. We believed that endovascular approaches are safely preferable alternative in patients with high surgical risk as our series.

  20. Twenty-year single-center experience with the medtronic open pivot mechanical heart valve.

    Science.gov (United States)

    Van Nooten, Guido J; Bové, Thierry; Van Belleghem, Yves; François, Katrien; Caes, Frank; Vandenplas, Guy; De Pauw, Michel; Taeymans, Yves

    2014-04-01

    Since May 1992 the Medtronic Open Pivot mechanical heart valve has been implanted routinely at the authors' institution. The study aim was to analyze, retrospectively, the 20-year clinical results of the valve. Between May 1992 and December 2011 a total of 1,520 valves was inserted into 1,382 consecutive patients (1,012 aortic, 473 mitral, 26 tricuspid, 9 pulmonary). The mean age of the patients was 61±13.2 years. Preoperatively, 65% of the patients were in New York Heart Association (NYHA) class III or greater. Frequent comorbidities included atrial fibrillation (n=419), coronary disease (n=357), and diabetes (n=255). The 99% complete follow-up totaled 10,527 patient-years (range 12 to 244 months). Ninety-day mortality was 5.2% (n=73, 8 valve related). Of the 550 total deaths, 240 were cardiac and 56 valve related. Multivariate analysis selected age, NYHA III or greater, concomitant coronary revascularization, and respiratory insufficiency as risk factors for death. Renal failure was considered a risk factor in the aortic and atrial fibrillation in the mitral subgroup. Erratic international normalized ratio (INR), NYHA class III or greater, and non-sinus rhythm were risk factors for thromboembolism; likewise redo operations in the aortic subgroup. Erratic INR and age were risk factors for bleeding as were over-coagulation and coronary revascularization in the aortic subgroup and redo operations and renal failure in mitral patients. This 20-year experience demonstrated excellent clinical outcomes with no structural valve failure. Odds ratio defined aortic patients as the lowest risk for adverse events. By contrast atrial fibrillation and elderly age, in combination with instable anticoagulation, yielded the worst long-term results. Copyright © 2014 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  1. Living-Donor Liver Transplant Follow-Up: A SingleCenter Experience.

    Science.gov (United States)

    Laeeq, Syed Mudassir; Hanif, Farina M; Luck, Nasir Hassan; Mandhwani, Rajesh Kumar; Iqbal, Jawed; Mehdi, Syed Haider

    2017-02-01

    Liver transplant is a definite treatment of decompensated liver disease. Because of the shortage of livers from deceased donors, living-donor liver transplant is becoming more common. Here, we analyzed our clinical experience in the follow-up care of these patients. Liver transplant recipients seen at the Sindh Institute of Urology and Transplantation (Karachi, Pakistan) were included in this analysis. Baseline characteristics and follow-up events were recorded. Our study population included 76 liver transplant patients registered at our clinic. Median age was 42 years, with 62 patients (81.6%) being males. The most common indication of transplant was hepatitis C virus-related cirrhosis (42 patients; 55%), followed by hepatitis B-hepatitis D virus coinfection (8 patients; 10.5%). Anastomotic biliary stricture developed in 16 patients (21.1%),which required biliary stenting. Biliary leak developed in 5 patients (6.6%), and renal cell carcinoma developed in 1 patient. Two recipients died due to hepatitis C virus-related fibrosing cholestasis hepatitis and pulmonary com plications. Posttransplant diabetes mellitus developed in 36 (47.1%), hypertension in 17 (38.6%), and dyslipidemia in 19 patients (25%). Of 42 patients with hepatitis C virus infection, 26 were treated with pegylated interferon and ribavirin, of which 65.3% achieved sustained virologic response at 24 weeks. The other 16 patients received sofosbuvir com - bined with ribavirin for 24 weeks. A sustained virologic response at 12 weeks was achieved in 5 patients, with not yet determined results in the remaining patients. Seven patients were lost to follow-up. Hepatitis C-related cirrhosis was the most common indication for liver transplant, and infection recurrence was observed in our patients. Biliary anastomotic stricture formation was the most prevalent complication after transplant. As liver transplants are becoming more widely available for Pakistani patients at home and abroad, gastroenterologists and

  2. Single-center experience on endovascular reconstruction of traumatic internal carotid artery dissections.

    Science.gov (United States)

    Cohen, José E; Gomori, John M; Itshayek, Eyal; Spektor, Sergey; Shoshan, Yigal; Rosenthal, Guy; Moscovici, Samuel

    2012-01-01

    Traumatic internal carotid artery dissection (CAD) has a potentially grave outcome. Anticoagulant therapy may be ineffective or contraindicated; surgery impractical. We present our experience with endovascular stenting in CAD patients. From 2004 to 2011, 23 patients with angiographically proven traumatic CAD underwent endovascular stent-assisted arterial reconstruction based on clinical and radiographic criteria: contraindication or failure of anticoagulation, evidence of impending ischemic stroke, or need for urgent intracranial revascularization. Dissections were graded based on degree of stenosis and extent of injury. Seventeen patients (73.9%) presented with stroke or transient ischemic attack. Carotid revascularization was achieved with one (11 patients, 48%) or multiple stents (12 patients, 52%); distal protection was used rarely (three patients, 13%). No complications were directly attributed to stenting. Mean dissection-related stenosis improved from 72% ± 28.87% to 4% ± 8.29%. At a mean clinical follow-up of 28.7 months ± 31.9 months, 16 patients (69.6%) improved, six (26.1%) remained stable, and one (4.3%) had died secondary to multiple traumatic injuries. At long-term follow-up, no patient had a transient ischemic attack or stroke or presented evidence of de novo in-stent stenosis or stent thrombosis. There were no neurologic sequelae after partial or total discontinuation of antiplatelet therapy in seven patients undergoing trauma-related surgeries. Selected cases of traumatic CAD can be safely managed by endovascular stent-assisted angioplasty. Procedural complications are infrequent; the need for postprocedure antiplatelet therapy is a concern. Early detection is essential to avoid stroke. Stenting restores the integrity of the vessel lumen immediately, efficiently prevents the occurrence or recurrence of ischemic events, and avoids the need of long-term anticoagulation.

  3. Polyetheretherketone implants for the repair of large cranial defects: a 3-center experience.

    Science.gov (United States)

    Rosenthal, Guy; Ng, Ivan; Moscovici, Samuel; Lee, Kah K; Lay, Twyila; Martin, Christine; Manley, Geoffrey T

    2014-11-01

    Calvarial reconstruction of large cranial defects following decompressive surgery is challenging. Autologous bone cannot always be used due to infection, fragmentation, bone resorption, and other causes. Polyetheretherketone (PEEK) is a synthetic material that has many advantages in cranial-repair surgery, including strength, stiffness, durability, and inertness. To describe our experience with custom-made PEEK implants for the repair of large cranial defects in 3 institutions: San Francisco General Hospital, Hadassah-Hebrew University Hospital, and the National Neuroscience Institute, Singapore. A preoperative high-resolution computed tomography scan was obtained for each patient for design of the PEEK implant. Cranioplasty was performed via standard technique with the use of self-tapping titanium screws and miniplates. Between 2006 and 2012, 66 cranioplasties with PEEK implants were performed in 65 patients (46 men, 19 women, mean age 35 ± 14 years) for repair of large cranial defects. There were 5 infections of implants and 1 wound breakdown requiring removal of the implant (infection and surgical removal rates of 7.6% and 9.1%, respectively). Two patients required drainage of postoperative hematoma (overall surgical complication rate, 12.7%). Nonsurgical complications in 5 patients included seizures, nonoperative collection, and cerebrospinal fluid rhinorrhea that resolved spontaneously. Overall median patient or family satisfaction with the cranioplasty and aesthetic result was good, 4 on a scale of 5. Temporal wasting was the main aesthetic concern. Custom-designed PEEK implants are a good option for patients with large cranial defects. The rate of complications is comparable to other implants or autologous bone. Given the large size of these defects, the aesthetic results are good.

  4. The efficacy of topiramate in adult refractory status epilepticus: experience of a tertiary care center.

    Science.gov (United States)

    Synowiec, Andrea S; Yandora, Kristin A; Yenugadhati, Vamsi; Valeriano, James P; Schramke, Carol J; Kelly, Kevin M

    2012-02-01

    Refractory status epilepticus (RSE) occurs in patients with SE when they fail to respond to traditional medical therapy. Because there are very few case reports of topiramate (TPM) treatment of RSE in adult patients, we examined our experience with TPM with regard to its safety and efficacy in seizure termination in RSE in an adult patient population. We report a retrospective review of 35 adult patients with RSE who were treated with TPM in addition to other antiepileptic drugs (AEDs) between 2003 and 2010. After failure of initial treatments of benzodiazepines and weight-based intravenous loading doses of standard AEDs, TPM tablets were crushed and administered via nasogastric tube. Data were collected on age, gender, history of epilepsy, etiology of RSE, daily dose of TPM, co-therapeutic agents, treatment response, and disposition. Following initiation of TPM use and discontinuation of continuous intravenous anesthetics with no additional AEDs administered, cumulative cessation of RSE in patients was 4/35 (11%) at one day, 10/35 (29%) at two days, and 14/35 (40%) at three days. However, when including all patients and comparing the two patient groups in which RSE was or was not terminated within three days of initiating TPM as the last or not last AED given, there was no significant difference. Time to TPM response was not associated with the type of seizures, etiology of SE, or whether there was a history of epilepsy. There were no documented side effects or complications of therapy with TPM. This study provides support for the use of TPM as an adjunctive agent in the treatment of RSE.

  5. Long term outcome of acquired food allergy in pediatric liver recipients: a single center experience

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    Antigoni Mavroudi

    2012-01-01

    Full Text Available Food induced sensitization has been reported in pediatric liver recipients. However long term follow up has not been established so far. We report here our experience regarding 3 pediatric patients who developed acquired food allergy after liver transplantation. The first patient suffered from persistent diarrhea and eczema. The second one presented with abdominal pain with no signs of rejection, abdominal discomfort, vomiting when ingesting milk proteins and responded well to the elimination diet. The third patient presented with facial angioedema and hoarseness of voice. She had multiple food allergies and reacted to milk, egg and sesame. All the patients had elevated total Immunoglobulin E (IgE and elevated specific IgE antibodies to the implicated food allergens. The first patient presented clinical manifestations of allergy when she was 19 months old. The second patient became allergic at the age of 16 and the third patient at the age of 3. The symptoms of food allergy persisted for 8 years in the first case and for 2 years in the other two cases. Low levels of specific IgE antibodies to the implicated food allergens and an enhanced T-helper 1 cell immune response toward interferon-gamma production were markers of tolerance acquisition. The long term prognosis in our cases was excellent. Food allergy resolved in all the patients. The long term prognosis of acquired food allergy after liver transplantation is currently obscure. More studies would be needed including greater number of patients to determine whether acquired food allergy is transient in pediatric liver recipients.

  6. Strengthening the role of universities in addressing sustainability challenges: the Mitchell Center for Sustainability Solutions as an institutional experiment

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    David D. Hart

    2015-06-01

    Full Text Available As the magnitude, complexity, and urgency of many sustainability problems increase, there is a growing need for universities to contribute more effectively to problem solving. Drawing upon prior research on social-ecological systems, knowledge-action connections, and organizational innovation, we developed an integrated conceptual framework for strengthening the capacity of universities to help society understand and respond to a wide range of sustainability challenges. Based on experiences gained in creating the Senator George J. Mitchell Center for Sustainability Solutions (Mitchell Center, we tested this framework by evaluating the experiences of interdisciplinary research teams involved in place-based, solutions-oriented research projects at the scale of a single region (i.e., the state of Maine, USA. We employed a multiple-case-study approach examining the experiences of three interdisciplinary research teams working on tidal energy development, adaptation to climate change, and forest vulnerability to an invasive insect. Drawing upon documents, observations, interviews, and other data sources, three common patterns emerged across these cases that were associated with more effective problem-solving strategies. First, an emphasis on local places and short-term dynamics in social-ecological systems research provides more frequent opportunities for learning while doing. Second, iterative stakeholder engagement and inclusive forms of knowledge co-production can generate substantial returns on investment, especially when researchers are dedicated to a shared process of problem identification and they avoid framing solutions too narrowly. Although these practices are time consuming, they can be accelerated by leveraging existing stakeholder relationships. Third, efforts to mobilize interdisciplinary expertise and link knowledge with action are facilitated by an organizational culture that emphasizes mutual respect, adaptability, and solutions

  7. Extracorporeal membrane oxygenation during double-lung transplantation: single center experience

    Institute of Scientific and Technical Information of China (English)

    XU Ling-feng; LI Xin; GUO Zhen; XU Mei-yin; GAO Cheng-xin; ZHU Jin-hong; JI Bing-yang

    2010-01-01

    Background For patients with end-stage lung diseases, lung transplantation is the final therapeutic option. Sequential double-lung transplantation is recognized as an established procedure to avoid cardiopulmonary bypass (CPB). But some of the sequential double-lung transplantations require CPB support during the surgical procedure for various reasons. However, conventional CPB may increase the risk of bleeding and early allograft dysfunction. Extracorporeal membrane oxygenation (ECMO) is more advantageous than conventional CPB during the perioperative period of transplantation. Replacing traditional CPB with ECMO is promising for those patients needing cardiopulmonary support during a sequential double-lung transplantation procedure. This study aimed to summarize the preliminary experience of ECMO practice in lung transplantation.Methods Between November 2002 and October 2008, twelve patients with end-stage lung diseases undergoing sequential double-lung transplantation were subjected to ECMO during the surgical procedure. Eleven patients were prepared were prepared for the procedure via transverse thoracostomy (clamshell) and cannulated through the ascending aorta and right atrium for ECMO. The first patient who underwent bilateral thoracotomy for bilateral sequential lung transplantation required emergency ECMO via the femoral artery and vein during the second lung implantation. The Medtronic centrifugal pump and ECMO package (CB1V97R1, Medtronic, Inc., USA) were used for all of the patients.Results During ECMO,the blood flow rate was set between 1.88-2.0 L·m~(-2)·min~(-1) to keep hemodynamic and oxyhgen saturation stable; colloid oncotic pressure was maintained at more than 18 mmHg with albumin and hematocrit (HCT) kept at 28% or more. Two patients died early in this series and the other 10 patients were weaned from ECMO successfully. The duration of ECMO was 1.38-67.00 hours, and postoperative intubation was 10.5-67.0 hours.Conclusions As an established

  8. Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience

    Science.gov (United States)

    Chen, Qiuming; Gao, Huawei; Hua, Zhongdong; Yang, Keming; Yan, Jun; Zhang, Hao; Ma, Kai; Zhang, Sen; Qi, Lei; Li, Shoujun

    2016-01-01

    Objective This study aimed to report our experiences with surgical repair in patients of all ages with persistent truncus arteriosus. Methods From July 2004 to July 2014, 50 consecutive patients with persistent truncus arteriosus who underwent anatomical repair were included in the retrospective review. Median follow-up time was 3.4 years (range, 3 months to 10 years). Results Fifty patients underwent anatomical repair at a median age of 19.6 months (range, 20 days to 19.1 years). Thirty patients (60%) were older than one year. The preoperative pulmonary vascular resistance and mean pulmonary artery pressure were 4.1±2.1 (range, 0.1 to 8.9) units.m2 and 64.3±17.9 (range, 38 to 101) mmHg, respectively. Significant truncal valve regurgitation was presented in 14 (28%) patients. Hospital death occurred in 3 patients, two due to pulmonary hypertensive crisis and the other due to pneumonia. Three late deaths occurred at 3, 4 and 11 months after surgery. The actuarial survival rates were 87.7% and 87.7% at 1 year and 5 years, respectively. Multivariate analysis identified significant preoperative truncal valve regurgitation was a risk factor for overall mortality (odds ratio, 7.584; 95%CI: 1.335–43.092; p = 0.022). Two patients required reoperation of truncal valve replacement. One patient underwent reintervention for conduit replacement. Freedom from reoperation at 5 years was 92.9%. At latest examination, there was one patient with moderate-to-severe truncal valve regurgitation and four with moderate. Three patients had residual pulmonary artery hypertension. All survivors were in New York Heart Association class I-II. Conclusions Complete repair of persistent truncus arteriosus can be achieved with a relatively low mortality and acceptable early- and mid-term results, even in cases with late presentation. Significant preoperative truncal valve regurgitation remains a risk factor for overall mortality. The long-term outcomes warrant further follow-up. PMID:26752522

  9. [Post-transplant lymphoproliferative disease in liver transplant recipients--Merkur University Hospital single center experience].

    Science.gov (United States)

    Filipec-Kanizaj, Tajana; Budimir, Jelena; Colić-Cvrlje, Vesna; Kardum-Skelin, Ika; Sustercić, Dunja; Naumovski-Mihalić, Slavica; Mrzljak, Anna; Kolonić, Slobodanka Ostojić; Sobocan, Nikola; Bradić, Tihomir; Dolić, Zrinka Misetić; Kocman, Branislav; Katicić, Miroslava; Zidovec-Lepej, Snjezana; Vince, Adriana

    2011-09-01

    favoring the diagnosis. The management of PTLD poses a major therapeutic challenge and although there is reasonable agreement about the overall principles of treatment, there is still considerable controversy about the optimal treatment of individual patients. EBV-related PTLDs are a significant cause of mortality in patients undergoing orthotopic liver transplantation with the observed mortality rate of up to 50%. This paper presents the experience acquired at Merkur University Hospital in the diagnosis and treatment of patients with liver transplantation and PTLD.

  10. Familial Mediterranean fever in Russia: Experience of the Federal Rheumatology Center

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    E. S. Fedorov

    2017-01-01

    Full Text Available The paper gives the experience of the V.A. Nasonova Research Institute of Rheumatology in identifying and managing patients with familial Mediterranean fever (FMF. Objective: to describe the features of the disease in patients with FMF in Russia and to compare them with the data obtained in the study of Turkish and Armenian populations with a high incidence of this disease. Patients and methods. The investigation enrolled 23 patients with a documented diagnosis of FMF who met the Turkish pediatric criteria (F. Yalcinkaya et al. and/or the criteria described by A. Livnech et al. and had two identical mutations (homozygosity or two different mutations (compound heterozygosity in the MEFV gene. Among the patients there were 9 men and 14 women. The age of the patients at the time of treatment was 4.5 to 36 years. Their age at onset of FMF was 2 months to 15 years (mean age, 3.2±2.3 years. Results. The examination established that 18 (78.3% patients were Armenians, 3 were representatives of the North Caucasus peoples (a Darghin woman, an Avar man, and an Ingush/Kabardian man, a man from mixed (Greek/Georgian marriage, and a Russian woman whose ancestors were Armenian and Jewish. The most common manifestation of FMF were recurrent episodes of fever (22; 95.7%; abdominal pain with fever ranked second (19; 82.6%, followed by chest pain (11; 47.8%, locomotor apparatus lesion (16; 69.6%, and skin lesions (7; 30.4%. The episodes were accompanied by increased levels of acutephase markers in 100% of the patients. There were a high proportion of patients, in whom FMF was concurrent with other rheumatic and autoinflammatory diseases (juvenile chronic arthritis, chronic recurrent multifocal osteomyelitis, and acute rheumatic fever (7; 30.4%. Twenty-two (95.6% patients received colchicine; the tumor necrosis factor inhibitor etanercept was prescribed in 2 (8.7% patients with comorbidity; there was a pronounced therapeutic effect. Conclusion. Although the

  11. Early Correction of Common Atrioventricular Septal Defects: A Single-Center 20-Year Experience.

    Science.gov (United States)

    Vida, Vladimiro L; Tessari, Chiara; Castaldi, Biagio; Padalino, Massimo A; Milanesi, Ornella; Gregori, Dario; Stellin, Giovanni

    2016-12-01

    Over the past 20 years our policy has been to electively repair common atrioventricular canal defects (CAVCD) in patients between 8 and 12 weeks of age. We sought to evaluate the results of our past 20-year experience. From January 1992 to April 2014, 159 consecutive patients underwent CAVCD repair (133 patients had complete CAVCD and 26 patients had a transitional form of CAVCD). Surgical repair was accomplished with a double-patch (n = 137 [86%]) or a modified single patch (n = 22 [14%]) technique. Median age at operation was 96 days (interquartile range [IQR], 73-128 days); 90 patients were younger than 3 months of age. There were 3 operative (1.9%) and 12 late (7.7%) deaths. Median follow-up time after repair was 8.2 years (IQR, 3.6-15 years). Twenty patients (13%) required reoperation-16 (10%) for left atrioventricular valve (LAVV) regurgitation. Reoperation on the LAVV was more frequent in patients with a dysplastic LAVV preoperatively (p = 0.01; odds ratio [OR], 4.2; 95% confidence interval [CI], 1.33-13.5) and in patients who underwent closure for an absent/incomplete cleft at the time of repair (p = 0.01; OR, 5.4; 95% CI, 1.4-21). Late LAVV performance (regurgitation greater than or equal to moderate or the need for reoperation), including late deaths and patients who underwent reoperation, was significantly worse in patients older than 3 months at repair (10 of 83 patients [12%] versus 20 of 73 patients [27%]; hazard ratio [HR], 2.71; 95% CI, 1.19-6.19) and in patients with LAVV dysplasia (19 of 68 patients [28%] versus 11 of 88 patients [12%]; HR, 3; 95% CI, 1.53-8.51). Individualized early repair of CAVCD is safe and beneficial, with good early and long-term results. Copyright © 2016 The Society of Thoracic Surgeons. Published by Elsevier Inc. All rights reserved.

  12. Outcomes of Surgical Repair for Persistent Truncus Arteriosus from Neonates to Adults: A Single Center's Experience.

    Directory of Open Access Journals (Sweden)

    Qiuming Chen

    Full Text Available This study aimed to report our experiences with surgical repair in patients of all ages with persistent truncus arteriosus.From July 2004 to July 2014, 50 consecutive patients with persistent truncus arteriosus who underwent anatomical repair were included in the retrospective review. Median follow-up time was 3.4 years (range, 3 months to 10 years.Fifty patients underwent anatomical repair at a median age of 19.6 months (range, 20 days to 19.1 years. Thirty patients (60% were older than one year. The preoperative pulmonary vascular resistance and mean pulmonary artery pressure were 4.1±2.1 (range, 0.1 to 8.9 units.m2 and 64.3±17.9 (range, 38 to 101 mmHg, respectively. Significant truncal valve regurgitation was presented in 14 (28% patients. Hospital death occurred in 3 patients, two due to pulmonary hypertensive crisis and the other due to pneumonia. Three late deaths occurred at 3, 4 and 11 months after surgery. The actuarial survival rates were 87.7% and 87.7% at 1 year and 5 years, respectively. Multivariate analysis identified significant preoperative truncal valve regurgitation was a risk factor for overall mortality (odds ratio, 7.584; 95%CI: 1.335-43.092; p = 0.022. Two patients required reoperation of truncal valve replacement. One patient underwent reintervention for conduit replacement. Freedom from reoperation at 5 years was 92.9%. At latest examination, there was one patient with moderate-to-severe truncal valve regurgitation and four with moderate. Three patients had residual pulmonary artery hypertension. All survivors were in New York Heart Association class I-II.Complete repair of persistent truncus arteriosus can be achieved with a relatively low mortality and acceptable early- and mid-term results, even in cases with late presentation. Significant preoperative truncal valve regurgitation remains a risk factor for overall mortality. The long-term outcomes warrant further follow-up.

  13. Perioperative outcome of initial 190 cases of robot-assisted laparoscopic radical prostatectomy - A single-center experience

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    P N Dogra

    2012-01-01

    Full Text Available Objective: To analyze the perioperative outcome of the first 190 cases of robot-assisted laparoscopic radical prostatectomy performed at our center from July 2006 to December 2010. Materials and Methods: Operative and recovery data for men with localized prostate cancer undergoing robot-assisted radical prostatectomy at our center were reviewed. All surgeries were performed using the 4-arm da Vinci-S surgical robot. Preoperative data included age, body mass index (BMI, prostate specific antigen (PSA level, prostate weight, biopsy Gleason score and TNM staging, while operative and recovery data included total operative time, estimated blood loss, complications, hospital stay and catheter time. These parameters were evaluated for the safety and efficacy of this procedure in our center. Results: The mean age of our patients was 65 ± 1.2 years. The mean BMI was 25.20 ± 2.88 and the median PSA was 14.8 ng/ml. Majority of our patients belonged to clinical stage T2 (51.58%. The mean total operative time was 166.44 ± 11.5 min. Six patients required conversion to open procedure and there was one rectal injury. The median estimated blood loss was 302 ± 14.45 ml and the median duration of hospital stay was 4 days. The overall margin positivity rate was 12.63%. Conclusion: Despite our limited robotic surgery experience, our perioperative outcome and complication rate is comparable to most contemporary series. Robot-assisted laparoscopic prostatectomy (RALP is easy to learn and provides the patient with the benefits of minimally invasive surgery with minimal perioperative morbidity.

  14. Challenges in treatment and diagnosis of forgotten/encrusted double-J ureteral stents: the largest single-center experience.

    Science.gov (United States)

    Adanur, Senol; Ozkaya, Fatih

    2016-07-01

    We aimed to evaluate the effectiveness of the endourologic management of forgotten and/or encrusted ureteral stents together with our single-center experience. Fifty-four patients with forgotten double-J ureteral stents were treated in our center between January 2008 and March 2014. Encrustation and the related stone burdens were estimated by using computerized tomography and kidney-ureter-bladder radiography. The management method was chosen based on the stone burden or clinical and radiological findings. Fifty-four patients, 39 males and 15 females, were included in the study. The average age of the patients was 38.2 ± 25.06 (2-86) years. The average indwelling time of the ureteral stents was 22.6 ± 30.3 (6-144) months. Six of the patients with forgotten stents had solitary kidneys. The double-J stent (DJS) was fragmented in four (7.4%) patients. A urinary system infection was present in 15 (27.7%) of the patients. The ureteral stents and related stones were successfully removed without any complications by combined endourologic techniques to achieve a stone-free state in all patients except for patient with 110 months of forgotten stent time in whom nephrectomy was performed for a nonfunctioning kidney related to the forgotten stent. Forgotten/encrusted DJS may lead to complications in a range of urinary system infections, up to a loss of renal function. They can be safely and successfully removed, and the renal function can be preserved by endourologic techniques, starting with the least invasive procedures in centers highly experienced.

  15. Foetoscopic endotracheal occlusion (FETO) for severe isolated left-sided congenital diaphragmatic hernia: single center Polish experience.

    Science.gov (United States)

    Kosinski, Przemyslaw; Wielgos, Miroslaw

    2017-07-04

    To present early experience with foetoscopic endotracheal occlusion (FETO) for congenital diaphragmatic hernia (CDH) in a new center in Poland. This was a prospective study in singleton pregnancies with CDH treated by FETO between 2014 and 2016 in the Medical University of Warsaw, Poland. FETO was carried out at 25.6-30.1 (median 27.7) weeks' gestation in 28 consecutive cases of isolated left-sided CDH with observed over expected lung area to head circumference ratio (o/e LHR) of 20.7-22.6 (median 18.9). Neonatal survival rate was 46.4% (13/28) at the time of discharge. The median o/e LHR the day before balloon removal was 33.4 (19.7-57.5) and median gestational age at delivery was 34.7 (29.0-38.1) weeks. Comparison of the survivors and perinatal deaths showed no significant differences in median gestational age at FETO or median o/e LHR before FETO, but higher median gestational age at delivery (35.9, range 32.7-38.1 weeks vs. 33.2, range 29.0-37.7 weeks; p = .007) and o/e LHR before balloon removal (33.7, range 28.3-57.5 vs. 30.9, range 19.7-37.5; p = .017). FETO was implemented successfully in Poland and the survival rate (46.4%) is similar to that reported in other centers. Important determinants of survival were gestational age at delivery and pulmonary response to FETO. The rate of preterm prelabor rupture of membranes (PPROM) in our series is similar to the larger series treated with FETO in the pioneering centers of this technique.

  16. Management of traumatic vascular injuries to the neck: a 7-year experience at a Level I trauma center.

    Science.gov (United States)

    Simmons, Jon D; Ahmed, Naveed; Donnellan, Kimberly A; Schmieg, Robert E; Porter, John M; Mitchell, Marc E

    2012-03-01

    Injury to the carotid artery results in significant mortality and morbidity. The general consensus is to repair all injuries to the common and internal carotid arteries. Ligation is usually reserved for neurologic or hemodynamic instability. We report our experience at a Level I trauma center with vascular injuries to the neck. Retrospective chart review of all patients with vascular injuries in the neck resulting from either blunt or penetrating trauma treated at a Level I trauma center between January 2000 and February 2007. Demographics and outcomes were collected from a chart review. Twenty-five patients with vascular injuries to the neck were identified. There were 13 carotid artery injuries (CAI), five internal jugular vein (IJV) injuries, and 13 external jugular vein (EJV) injuries. Of the carotid artery injuries, six (50%) underwent operative repair (4 primary repairs and 2 bypasses), five (38%) were managed nonoperatively, and one was treated using endovascular techniques. No patient had a postoperative decrease in Glasgow Coma Scale score. There were five isolated IJV injuries (3 primary repair and 2 ligations). Four of the venous injuries (all internal jugular veins) were repaired and the remaining 13 were ligated. Vascular injuries to the neck have significant mortality and morbidity. Treatment of these injuries must be individualized. All CAI in noncomatose patients should be repaired if hemodynamically stable. All IJV injuries should be repaired but may be ligated if hemodynamically unstable. All EJV injuries can be ligated without reservation regardless of neurological status.

  17. EXPERIENCE TUTORIALS IN THE GRADUATE FROM THE CENTER OF UPDATE OF THE MAGISTERIUM IN THE STATE OF DURANGO

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    Diana María Espinosa Sánchez

    2013-09-01

    Full Text Available Following the experiences we have had in the Teacher Upgrading Center in tutorials graduate programs in the State of Durango we could detect the strengths and weaknesses, enabling us to make the diagnosis in order to reduce them and develop strengths. The biggest problem that humanity is to educate its members and society as it enters the twenty-first century requires changes and improvements to the educational systems, it is clear the need of teaching and learning for the continued existence of society, higher education institutions should strive to achieve development in man and woman, tutoring in higher education, is a complementary action to develop ethical behavior, intellectual skills and teaching skills. The study is predominantly qualitative and case study method.

  18. Use of CAHPS® patient experience survey data as part of a patient-centered medical home quality improvement initiative

    Directory of Open Access Journals (Sweden)

    Quigley DD

    2015-07-01

    Full Text Available Denise D Quigley,1 Peter J Mendel,1 Zachary S Predmore,2 Alex Y Chen,3 Ron D Hays41RAND Corporation, Santa Monica, CA, 2RAND Corporation, Boston, MA, 3AltaMed Health Services Corporation, 4Division of General Internal Medicine and Health Services Research, UCLA, Los Angeles, CA, USAObjective: To describe how practice leaders used Consumer Assessment of Healthcare Providers and Systems (CAHPS® Clinician and Group (CG-CAHPS data in transitioning toward a patient-centered medical home (PCMH.Study design: Interviews conducted at 14 primary care practices within a large urban Federally Qualified Health Center in California.Participants: Thirty-eight interviews were conducted with lead physicians (n=13, site clinic administrators (n=13, nurse supervisors (n=10, and executive leadership (n=2.Results: Seven themes were identified on how practice leaders used CG-CAHPS data for PCMH transformation. CAHPS® was used: 1 for quality improvement (QI and focusing changes for PCMH transformation; 2 to maintain focus on patient experience; 3 alongside other data; 4 for monitoring site-level trends and changes; 5 to identify, analyze, and monitor areas for improvement; 6 for provider-level performance monitoring and individual coaching within a transparent environment of accountability; and 7 for PCMH transformation, but changes to instrument length, reading level, and the wording of specific items were suggested.Conclusion: Practice leaders used CG-CAHPS data to implement QI, develop a shared vision, and coach providers and staff on performance. They described how CAHPS® helped to improve the patient experience in the PCMH model, including access to routine and urgent care, wait times, provider spending enough time and listening carefully, and courteousness of staff. Regular reporting, reviewing, and discussing of patient-experience data alongside other clinical quality and productivity measures at multilevels of the organization was critical in maximizing the

  19. Preliminary Single-Center Canadian Experience of Human Normothermic Ex Vivo Liver Perfusion: Results of a Clinical Trial.

    Science.gov (United States)

    Bral, M; Gala-Lopez, B; Bigam, D; Kneteman, N; Malcolm, A; Livingstone, S; Andres, A; Emamaullee, J; Russell, L; Coussios, C; West, L J; Friend, P J; Shapiro, A M J

    2017-04-01

    After extensive experimentation, outcomes of a first clinical normothermic machine perfusion (NMP) liver trial in the United Kingdom demonstrated feasibility and clear safety, with improved liver function compared with standard static cold storage (SCS). We present a preliminary single-center North American experience using identical NMP technology. Ten donor liver grafts were procured, four (40%) from donation after circulatory death (DCD), of which nine were transplanted. One liver did not proceed because of a technical failure with portal cannulation and was discarded. Transplanted NMP grafts were matched 1:3 with transplanted SCS livers. Median NMP was 11.5 h (range 3.3-22.5 h) with one DCD liver perfused for 22.5 h. All transplanted livers functioned, and serum transaminases, bilirubin, international normalized ratio, and lactate levels corrected in NMP recipients similarly to controls. Graft survival at 30 days (primary outcome) was not statistically different between groups on an intent-to-treat basis (p = 0.25). Intensive care and hospital stays were significantly more prolonged in the NMP group. This preliminary experience demonstrates feasibility as well as potential technical risks of NMP in a North American setting and highlights a need for larger, randomized studies. © 2016 The American Society of Transplantation and the American Society of Transplant Surgeons.

  20. The National Criticality Experiments Research Center at the Device Assembly Facility, Nevada National Security Site: Status and Capabilities, Summary Report

    Energy Technology Data Exchange (ETDEWEB)

    S. Bragg-Sitton; J. Bess; J. Werner

    2011-09-01

    The National Criticality Experiments Research Center (NCERC) was officially opened on August 29, 2011. Located within the Device Assembly Facility (DAF) at the Nevada National Security Site (NNSS), the NCERC has become a consolidation facility within the United States for critical configuration testing, particularly those involving highly enriched uranium (HEU). The DAF is a Department of Energy (DOE) owned facility that is operated by the National Nuclear Security Agency/Nevada Site Office (NNSA/NSO). User laboratories include the Lawrence Livermore National Laboratory (LLNL) and Los Alamos National Laboratory (LANL). Personnel bring their home lab qualifications and procedures with them to the DAF, such that non-site specific training need not be repeated to conduct work at DAF. The NNSS Management and Operating contractor is National Security Technologies, LLC (NSTec) and the NNSS Safeguards and Security contractor is Wackenhut Services. The complete report provides an overview and status of the available laboratories and test bays at NCERC, available test materials and test support configurations, and test requirements and limitations for performing sub-critical and critical tests. The current summary provides a brief summary of the facility status and the method by which experiments may be introduced to NCERC.

  1. Distance to the Center of the Milky Way Galaxy: An Experiment for Intermediate-Level Students Using Research Data and Professional Analysis Tools

    Science.gov (United States)

    Fitzgerald, M. T.; Feteris, S. M.; Gillessen, S.; Eisenhauer, F.

    2008-01-01

    The most recent data on stars orbiting Sagittarius A*, the black hole at the center of the Milky Way galaxy, have been used in an experiment undertaken by second-year university students to determine the distance R[theta] to the center of the galaxy. Students applied each of Kepler's 17th-century laws, in turn, to 21st-century data. The…

  2. Nurturing 21st century physician knowledge, skills and attitudes with medical home innovations: the Wright Center for Graduate Medical Education teaching health center curriculum experience

    Directory of Open Access Journals (Sweden)

    Linda Thomas-Hemak

    2015-02-01

    Full Text Available Purpose. The effect of patient centered medical home (PCMH curriculum interventions on residents’ self-reported and demonstrated knowledge, skills and attitudes in PCMH competency arenas (KSA is lacking in the literature. This study aimed to assess the impact of PCMH curricular innovations on the KSA of Internal Medicine residents.Methods. Twenty four (24 Internal Medicine residents—12 Traditional (TR track residents and 12 Teaching Health Center (THC track residents—began training in Academic Year (AY 2011 at the Wright Center for Graduate Medical Education (WCGME. They were followed through AY2013, covering three years of training. PCMH curricular innovations were focally applied July 2011 until May 2012 to THC residents. These curricular innovations were spread program-wide in May 2012. Semi-annual, validated PCMH Clinician Assessments assessing KSA were started in AY2011 and were completed by all residents.Results. Mean KSA scores of TR residents were similar to those of THC residents at baseline for all PCMH competencies. In May 2012, mean scores of THC residents were significantly higher than TR residents for most KSA. After program-wide implementation of PCMH innovations, mean scores of TR residents for all KSA improved and most became equalized to those of THC residents. Globally improved KSA scores of THC and TR residents were maintained through May 2014, with the majority of improvements above baseline and reaching statistical significance.Conclusions. PCMH curricular innovations inspired by Health Resources and Services Administration (HRSA’s Teaching Health Center funded residency program expansion quickly and consistently improved the KSA of Internal Medicine residents.

  3. Acute Renal Replacement Therapy in Children with Diarrhea-Associated Hemolytic Uremic Syndrome: A Single Center 16 Years of Experience

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    Silviu Grisaru

    2011-01-01

    Full Text Available Acute kidney injury (AKI is becoming more prevalent among hospitalized children, its etiologies are shifting, and new treatment modalities are evolving; however, diarrhea-associated hemolytic uremic syndrome (D+HUS remains the most common primary disease causing AKI in young children. Little has been published about acute renal replacement therapy (ARRT and its challenges in this population. We describe our single center's experience managing 134 pediatric patients with D+HUS out of whom 58 (43% required ARRT over the past 16 years. In our cohort, all but one patient were started on peritoneal dialysis (PD. Most patients, 47 (81%, received acute PD on a pediatric inpatient ward. The most common recorded complications in our cohort were peritoneal fluid leaks 13 (22%, peritonitis 11 (20%, and catheter malfunction 5 (9%. Nine patients (16% needed surgical revision of their PD catheters. There were no bleeding events related to PD despite a mean platelets count of 40.9 (±23.5 × 103/mm3 and rare use of platelets infusions. Despite its methodological limitations, this paper adds to the limited body of evidence supporting the use of acute PD as the primary ARRT modality in children with D+HUS.

  4. Laparoscopic versus open approach in the management of appendicitis complicated exclusively with peritonitis: a single center experience.

    Science.gov (United States)

    Quezada, Felipe; Quezada, Nicolas; Mejia, Ricardo; Brañes, Alejandro; Padilla, Oslando; Jarufe, Nicolas; Pimentel, Fernando

    2015-01-01

    Controversial evidence exists regarding the laparoscopic approach in patients with acute appendicitis complicated with peritonitis due to a higher rate of surgical complications. The aim of this study was to compare post-operatory outcomes in patients with acute appendicitis complicated exclusively with peritonitis approached by laparoscopy versus open surgery. Single center retrospective analysis of clinical records of patients with appendicitis complicated with peritonitis operated from January 2003 until October 2013. Demographic data, intra-operative variables, length of stay, surgical complications, mortality, readmissions and reoperations were retrieved. 227 patients were identified, 43% males, mean age 39±17 years (range: 12-85 years). Ninety-seven patients (43%) underwent laparoscopic appendectomy, 13 of them were converted to open surgery (13%). Ninety-four patients presented with diffuse peritonitis (41.4%). Laparoscopic appendectomy showed longer operative time but shorter hospital stay (pperitonitis. In our experience, laparoscopic appendectomy is a safe approach in cases of appendicitis complicated exclusively with peritonitis. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  5. CMS Software Distribution and Installation Systems:Concepts,Practical Solutions and Experience at Fermilab as a CMS Tier 1 Center

    Institute of Scientific and Technical Information of China (English)

    NataliaM.Ratnikova; GregoryE.Graham

    2001-01-01

    The CMS Collaboration of 2000 scientists involves 150 institutions from 31 nations spread all over the world.CMS software system integration and release management is performed at CERN.Code management is based on CVS,with read or write access to the repository via a CVS server,Software configuration,release management tools(SCRAM) are being developed at CERN.Software releases are then distributed to regional centers,where the software is used by a local community for a wide variety of tasks,such as software development detector simulation and reconstruction and physics analysis.Depending on specific application,the system environment and local hardware requirements,different approaches and tools are used for the CMS software installation at different places.This presentation describes concepts and reactial solutions for a variety of ways of software distribution,with an emphasis on the CMS experience at Fermilab,Installation and usage of different models used for the production farm,for code development and for physics analysis are described.

  6. Multimodal treatment of craniofacial osteosarcoma with high-grade histology. A single-center experience over 35 years.

    Science.gov (United States)

    König, Marton; Osnes, Terje A; Lobmaier, Ingvild; Bjerkehagen, Bodil; Bruland, Øyvind S; Sundby Hall, Kirsten; Meling, Torstein R

    2017-07-01

    High-grade craniofacial osteosarcoma (CFOS) is an aggressive malignancy with a poor prognosis. Our goals were to evaluate treatment outcomes in those treated at a single referral institution over 35 years and to compare our results to the available literature. A retrospective analysis of all 42 patients treated between 1980 and 2015 at Oslo University Hospital, Norway, identified in a prospectively collected database, was conducted. Mean follow-up was 79.6 months. Overall survival at 2 and 5 years was 70.5 and 44.7%, respectively. The corresponding disease-specific survival rates were 73.0 and 49.8%. Treatment was surgery only in eight cases. Additional therapy was administered in 34 patients: chemotherapy in nine, radiotherapy in seven, and a combination of these in 18 cases. Stratified analysis by resection margins demonstrated significantly better survival at 2 and 5 years after radical surgical treatment. Neoadjuvant chemotherapy and subsequent adequate surgery resulted in better survival than surgery alone. Half of the patients either had a primary or familial cancer predisposition. This is the largest single-center study conducted on high-grade CFOS to date. Our experience indicates that neoadjuvant chemotherapy with complete surgical resection significantly improved survival, compared to surgery alone.

  7. Efficacy of neoadjuvant therapy and surgical rescue for locally advanced hepatoblastomas: 10 year single-center experience and literature review

    Science.gov (United States)

    Ayllon Teran, Dolores; Gómez Beltran, Oscar; Ciria Bru, Rubén; Mateos González, Elena; Peña Rosa, María José; Luque Molina, Antonio; López Cillero, Pedro; Briceño Delgado, Javier

    2014-01-01

    AIM: To report our experience with long-term outcomes after multimodal management therapy. METHODS: An observational retrospective study was performed containing seven patients with hepatoblastoma (Hbl) treated in our institution, a tertiary referral center, from 2003 to 2011. Demographic, preoperative, surgical, and outcome variables were collected. A survival analysis and a review of the current literature related to combination neoadjuvant chemotherapy and surgical resection on Hbl were performed. RESULTS: The median age at surgery was 14.4 mo, with a male to female ratio of 4:3. Pretext staging at diagnosis was as follows: stage I, 4 cases; stage II, 2 patients; and stage III, 1 case. Mean pretreatment tumor volume was 735 cm3. Five out of seven patients received neoadjuvant chemotherapy according to SIOPEL-3 or SIOPEL-6 protocols. Tumor volume and alpha-fetoprotein levels significantly dropped after neoadjuvant therapy. Surgical procedures performed included hemihepatectomies, segmentectomies and atypical resection. All patients received chemotherapy after surgery. Median postoperative hospital stay was 8 d. All patients were alive and disease-free after a median follow-up period of 23 mo. With regards to the literature review, seventeen articles were found that were related to our search. CONCLUSION: Our series shows how multimodal management of Hbl, exhaustive control and a meticulous surgical approach leads to almost 100% complete resection with optimal postoperative results. PMID:25110441

  8. Experiences at Langley Research Center in the application of optimization techniques to helicopter airframes for vibration reduction

    Science.gov (United States)

    Murthy, T. Sreekanta; Kvaternik, Raymond G.

    1991-01-01

    A NASA/industry rotorcraft structural dynamics program known as Design Analysis Methods for VIBrationS (DAMVIBS) was initiated at Langley Research Center in 1984 with the objective of establishing the technology base needed by the industry for developing an advanced finite-element-based vibrations design analysis capability for airframe structures. As a part of the in-house activities contributing to that program, a study was undertaken to investigate the use of formal, nonlinear programming-based, numerical optimization techniques for airframe vibrations design work. Considerable progress has been made in connection with that study since its inception in 1985. This paper presents a unified summary of the experiences and results of that study. The formulation and solution of airframe optimization problems are discussed. Particular attention is given to describing the implementation of a new computational procedure based on MSC/NASTRAN and CONstrained function MINimization (CONMIN) in a computer program system called DYNOPT for the optimization of airframes subject to strength, frequency, dynamic response, and fatigue constraints. The results from the application of the DYNOPT program to the Bell AH-1G helicopter are presented and discussed.

  9. Recent Experiences of the NASA Engineering and Safety Center (NESC) GN and C Technical Discipline Team (TDT)

    Science.gov (United States)

    Dennehy, Cornelius J.

    2010-01-01

    The NASA Engineering and Safety Center (NESC), initially formed in 2003, is an independently funded NASA Program whose dedicated team of technical experts provides objective engineering and safety assessments of critical, high risk projects. The GN&C Technical Discipline Team (TDT) is one of fifteen such discipline-focused teams within the NESC organization. The TDT membership is composed of GN&C specialists from across NASA and its partner organizations in other government agencies, industry, national laboratories, and universities. This paper will briefly define the vision, mission, and purpose of the NESC organization. The role of the GN&C TDT will then be described in detail along with an overview of how this team operates and engages in its objective engineering and safety assessments of critical NASA projects. This paper will then describe selected recent experiences, over the period 2007 to present, of the GN&C TDT in which they directly performed or supported a wide variety of NESC assessments and consultations.

  10. Bovine pericardium for portal vein reconstruction in abdominal surgery: a surgical guide and first experiences in a single center.

    Science.gov (United States)

    Jara, Maximilian; Malinowski, Maciej; Bahra, Marcus; Stockmannn, Martin; Schulz, Antje; Pratschke, Johann; Puhl, Gero

    2015-01-01

    Resection and reconstruction of infiltrated vessels achieve resectability of extended pancreatic tumors. The aim of the present study was to assess the feasibility of bovine pericardium as graft material for the individualised portal vein reconstruction and demonstrate a surgical technique for abdominal vein repair. We performed a MEDLINE search to review the methods for complex abdominal vein reconstruction in the course of extended pancreatectomy. Moreover, clinical data of patients receiving portal vein reconstruction using a bovine pericardial patch at our institution were retrospectively analyzed. Based on the results of a review of the literature, autologous venous grafts using the internal jugular vein represent the most popular option for segmental portal vein reconstruction in case of impossible direct suture. At our center, segmental portal vein reconstruction with bovine pericardial patch in course of pancreatic surgery was performed in 4 patients. No case of vascular complications such as occlusion, segmental stenosis or thrombosis occurred. Our experience suggests a surgical procedure for an individual size-matched portal vein reconstruction using bovine pericardium. Although first results appear promising, prospective studies are required to objectively assess the patency of bovine pericardium compared with autologous and synthetic interposition grafts for portal vein reconstruction. © 2015 S. Karger AG, Basel.

  11. Therapeutic rigid bronchoscopy at a tertiary care center in North India: Initial experience and systematic review of Indian literature

    Directory of Open Access Journals (Sweden)

    Karan Madan

    2014-01-01

    Full Text Available Background and Aim: Rigid bronchoscopy is often an indispensable procedure in the therapeutic management of a wide variety of tracheobronchial disorders. However, it is performed at only a few centers in adult patients in India. Herein, we report our initial 1-year experience with this procedure. Materials and Methods: A prospective observational study on the indications, outcomes, and safety of various rigid bronchoscopy procedures performed between November 2009 and October 2010. Improvement in dyspnea, cough, and the overall quality of life was recorded on a visual analog scale from 0 to 100 mm. A systematic review of PubMed was performed to identify studies reporting the use of rigid bronchoscopy from India. Results: Thirty-eight rigid bronchoscopies (50 procedures were performed in 19 patients during the study period. The commonest indication was benign tracheal stenosis followed by central airway tumor, and the procedures performed were rigid bronchoplasty, tumor debulking, and stent placement. The median procedure duration was 45 (range, 30-65 min. There was significant improvement in quality of life associated with therapeutic rigid bronchoscopy. Minor procedural complications were encountered in 18 bronchoscopies, and there was no procedural mortality. The systematic review identified 15 studies, all on the role of rigid bronchoscopy in foreign body removal. Conclusions: Rigid bronchoscopy is a safe and effective modality for treatment of a variety of tracheobronchial disorders. There is a dire need of rigid bronchoscopy training at teaching hospitals in India.

  12. Does imatinib turn recurrent and/or metastasized gastrointestinal stromal tumors into a chronic disease? - single center experience.

    Science.gov (United States)

    Armbrust, Thomas; Sobotta, Michael; Gunawan, Bastian; Füzesi, Laszlo; Langer, Claus; Cameron, Silke; Ramadori, Giuliano

    2009-07-01

    Gastrointestinal stromal tumors (GIST) are mesenchymal tumors of the gastrointestinal tract supposed to arise from the cells of Cajal because of gain-of-function mutations of the tyrosine receptor kinases c-kit or platelet-derived growth factor receptor A. Imatinib selectively inhibits the kinase activity of both receptors. Despite this breakthrough in the treatment of GIST, resistance against imatinib has been reported to be as high as 50% after the first 2 years of treatment. Outcome of 13 consecutive patients with relapsed or metastasized GIST who were treated with imatinib was analyzed. Mean duration of treatment was 53.5 months. Four patients developed progressive disease and died after a mean treatment time of 31 months in spite of increase of imatinib dosages to 800 mg daily. Two patients (23%) developed a progressive disease after 46 months or 52 months of treatment. Two patients had a stable disease and five had a partial response. The overall progression rate was 46%, the mean survival time since primary diagnosis was 85.8 months. From our experience, frequency of resistance development to imatinib may be below that given in the literature (50% after 2 years). Individual treatment in specialized centers may improve compliance.

  13. Matched unrelated donor HSCT for thalassemia major using treosulphan based conditioning protocol for children: A single center experience from India

    Directory of Open Access Journals (Sweden)

    Khushnuma Mullanfiroze

    2017-03-01

    Full Text Available Hematopoietic stem cell transplantation (HSCT is the only potentially curative treatment for patients with thalassemia major. However, only 30-35% of patients have a suitable HLA-matched family donor (MFD. We report herewith our experience with matched unrelated donor (MUD HSCT using a treosulfan based conditioning protocol, from a tertiary center in India. The cohort consisted of 25 children (18 boys and 7 girls with transfusion-dependent thalassemia major who were transplanted using matched or minimally mismatched unrelated donors over four years with a median follow-up of 12 months (range 2–36 months. The median age of the cohort at HSCT was five years. None of the children transplanted had graft rejection. Reactivation of cytomegaloviral infection occurred in 32% of children. Grade II-IV acute graft versus host disease (aGvHD occurred in 60% of the children. Of these, two (8%, succumbed to aGvHD. Chronic extensive GvHD was not observed in any of the children until the last follow-up. The probability of survival at a mean of 34.3 months (CI 31.2–37.4 months for those who underwent a fully HLA-matched unrelated donor HSCT was 95%. This data shows that if the donor selection is based on strict compatibility criteria, MUD-HSCT can offer a cure to children with thalassemia major, with outcomes similar to the MFD-HSCT.

  14. Technical and clinical success of infrarenal endovascular abdominal aortic aneurysm repair: A 10-year single-center experience

    Energy Technology Data Exchange (ETDEWEB)

    Steingruber, I.E. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria)]. E-mail: iris.steingruber@uibk.ac.at; Neuhauser, B. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Seiler, R. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Greiner, A. [Department of Vascular Surgery, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Chemelli, A. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Kopf, H. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Walch, C. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Waldenberger, P. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Jaschke, W. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria); Czermak, B. [Department of Radiology, University Hospital Innsbruck, Anichstr. 35, A-6020 Innsbruck (Austria)

    2006-09-15

    Objective: The aim of our retrospective study was to review our single-center experience with aortic abdominal aneurysm (AAA) repair retrospectively. Material and methods: From 1995 to 2005, 70 consecutive patients affected by AAA were treated by endovascular stent-graft repair. Mean follow-up was 23.9 months. Follow-up investigations were performed at 6 and 12 months and yearly thereafter. Five different stent-graft designs were compared to each other. Primary technical success (PTS), assisted primary technical success (APTS), primary clinical success (PCS) and secondary clinical success (SCS) were evaluated. Results: All over PTS was achieved in 94.3%, APTS in 97.1%, PCS in 61.4%, APCS in 64.3% and SCS in 70%. There were 3 type I endoleaks, 25 type II endoleaks, 4 type III endoleaks, 8 limb problems, 5 conversions to open surgery, 10 aneurysm sac expansions and 14 device migrations. Patients with newer generation devices showed better results than patients with first generation prosthesis. In addition results were better for grafts with suprarenal fixation (versus infrarenal fixation) and grafts with barbs and hooks (versus grafts without barbs and hooks). Patients with bad anatomic preconditions showed a higher complication rate. Conclusion: Contrary to first generation products, new stent-graft designs show acceptable technical and clinical results in endovascular AAA aneurysm repair. However, this therapy still should be reserved only for patients with significant comorbities and suitable anatomic conditions.

  15. Empowering patients of a mental rehabilitation center in a low-resource context: a Moroccan experience as a case study

    Directory of Open Access Journals (Sweden)

    Khabbache H

    2017-04-01

    Full Text Available Hicham Khabbache,1 Abdelhak Jebbar,2,* Nadia Rania,3,* Marie-Chantal Doucet,4 Ali Assad Watfa,5 Joël Candau,6 Mariano Martini,7 Anna Siri,8,* Francesco Brigo,9,10,* Nicola Luigi Bragazzi1,2,4–8,11,* 1Faculty of Literature and Humanistic Studies, Sais, Sidi Mohamed Ben Abdellah University, Fez, 2Faculty of Art and Humanities, Sultan Moulay Slimane University, Beni-Mellal, Morocco; 3School of Social Sciences, Department of Education Sciences, University of Genoa, Genova, Italy; 4Faculty of Human Sciences, School of Social Work, University of Québec-Montréal, Montreal, QC, Canada; 5Faculty of Education, Kuwait University, Kuwait City, Kuwait; 6Laboratory of Anthropology and Cognitive and Social Psychology, University of Nice Sophia Antipolis, Nice, France; 7Department of Health Sciences (DISSAL, Section of Bioethics, University of Genoa, 8UNESCO Chair “Health Anthropology, Biosphere and Healing Systems”, Genova, 9Department of Neurology, Franz Tappeiner Hospital, Merano, 10Department of Neurological, Biomedical, and Movement Sciences, University of Verona, Verona, 11School of Public Health, Department of Health Sciences (DISSAL, University of Genoa, Genova, Italy *These authors contributed equally to this work Abstract: Mental, neurological and substance use (MNS disorders represent a major source of disability and premature mortality worldwide. However, in developing countries patients with MNS disorders are often poorly managed and treated, particularly in marginalized, impoverished areas where the mental health gap and the treatment gap can reach 90%. Efforts should be made in promoting help by making mental health care more accessible. In this article, we address the challenges that psychological and psychiatric services have to face in a low-resource context, taking our experience at a Moroccan rehabilitation center as a case study. A sample of 60 patients were interviewed using a semi-structured questionnaire during the period of

  16. Integration of the clinical engineering specialist at a high complexity children's hospital. Our professional experience at a surgical center

    Energy Technology Data Exchange (ETDEWEB)

    Vargas Enriquez, M J; Chazarreta, B; Emilio, D G; Fernandez Sarda, E [Surgical Center-Neurophysiology Division of Medical Tecnology Department, Garrahan Children' s Hospital, Combate de los Pozos 1881, Buenos Aires (Argentina)

    2007-11-15

    This document aims to find relating points between the current and future Clinical Engineer professional in order to discuss about the hospital environment, its characteristics and its realities which lead to our professional development. The main aim is to depict our experience through a retrospective analysis based on the underwriting experience and consequently to arrive at conclusions that will support the inclusion and active interaction of the Clinic Engineer Specialist as part of a Hospital's Surgical Center.

  17. A single German center experience with intermittent inotropes for patients on the high-urgent heart transplant waiting list.

    Science.gov (United States)

    Hübner, T; Nickel, T; Steinbeck, G; Massberg, S; Schramm, R; Reichart, B; Hagl, C; Kiwi, A; Weis, Michael

    2015-11-01

    Currently, more than 900 patients with end-stage heart failure are listed for heart transplantation in Germany. All patients on the Eurotransplant high-urgent status (HU) have to be treated in intensive care units and have to be relisted every 8 weeks. Long-term continuous inotropes are associated with tachyphylaxia, arrhythmias and even increased mortality. In this retrospective analysis, we report our single center experience with HU patients treated with intermittent inotropes as a bridging therapy. 117 consecutive adult HU candidates were treated at our intensive care heart failure unit between 2008 and 2013, of whom 14 patients (12 %) were stabilized and delisted during follow-up. In the remaining 103 patients (age 42 ± 15 years), different inotropes (dobutamine, milrinone, adrenaline, noradrenaline, levosimendan) were administered based on the patient's specific characteristics. After initial recompensation, patients were weaned from inotropes as soon as possible. Thereafter, intermittent inotropes (over 3-4 days) were given as a predefined weekly (until 2011) or 8 weekly regimen (from 2011 to 2013). In 57 % of these patients, additional regimen-independent inotropic support was necessary due to hemodynamic instabilities. Fourteen patients (14 %) needed a left- or biventricular assist device; 14 patients (14 %) died while waiting and 87 (84 %) received heart transplants after 87 ± 91 days. Cumulative 3 and 12 months survival of all 103 patients was 75 and 67 %, respectively. Intermittent inotropes in HU patients are an adequate strategy as a bridge to transplant; the necessity for assist devices was low. These data provide the basis for a prospective multicenter trial of intermittent inotropes in patients on the HU waiting list.

  18. The impact of interventional nephrologists on the growth of a peritoneal dialysis program: Long-term, single-center experience.

    Science.gov (United States)

    Ros-Ruiz, Silvia; Alonso-Esteve, Ángela; Gutiérrez-Vílchez, Elena; Rudas-Bermúdez, Edisson; Hernández, Domingo

    2016-01-01

    Peritoneal dialysis (PD) is an underutilized form of renal replacement therapy. Although a variety of factors have been deemed responsible, timely insertion of a PD catheter may also be a contributory factor. Furthermore, a good catheter implantation technique is important to allow for effective peritoneal access function and long-term technique survival. Studies regarding results obtained by nephrologists in comparison with surgeons have been limited to small single-center experiences. Thus, the objective of this study was to explore the impact of the peritoneal dialysis (PD) catheter insertion by nephrologists compared to surgeons on early catheter complications and on technique survival. We also examine whether PD catheter insertion by nephrologists has a positive impact on the growth in the number of patients using PD. We performed 313 consecutive procedures: 192 catheter insertions and 121 catheter removal from January 1, 2006 to December 31, 2013. The main reasons for catheter removal were: renal transplantation, 52 (43%) follow of transfer to HD, 48 (40%) and catheter malfunction, 16 (13%). The patients were mostly male (63.4%) with the mean age of 50.8±15.1 years and 23.8 were diabetics. We only observed seven (2.5%) early complications (<4 weeks) associated to peritoneal catheter surgery (3 peritonitis episodes, 2 hemoperitoneum episodes, one complicated hernia and one omental entrapment). There were not significant differences in surgery-related complications in both periods. The penetration ratio of PD after 2006 was 117% higher compared with procedures performing before this date. In conclusions, we have demonstrated a positive impact on the growth of the PD population when catheter insertion is performed by nephrologists with a minimal incidence of complications associated.

  19. Image-guided cryoablation for the treatment of painful musculoskeletal metastatic disease: a single-center experience

    Energy Technology Data Exchange (ETDEWEB)

    Prologo, J.D. [Emory University Hospital, Department of Radiology and Imaging Sciences, Division of Interventional Radiology and Image-Guided Medicine, Atlanta, GA (United States); Passalacqua, Matthew; Patel, Indravadan; Bohnert, Nathan [University Hospitals Case Medical Center, Department of Radiology, Cleveland, OH (United States); Corn, David J. [University Hospitals Case Medical Center, Departments of Radiology and Biomedical Engineering, Cleveland, OH (United States)

    2014-11-15

    The role of image-guided thermal ablation techniques for the nonoperative local management of painful osseous metastatic disease has expanded during recent years, and several advantages of cryoablation in this setting have emerged. The purpose of this study is to retrospectively evaluate and report a single-center experience of CT-guided percutaneous cryoablation in the setting of painful musculoskeletal metastatic disease. This study was approved by the institutional review board and is compliant with the Health Insurance Portability and Accountability Act. Electronic medical records of all patients who underwent percutaneous image-guided palliative cryoablation at our institution were reviewed (n = 61). An intent-to-treat analysis was performed. Records were reviewed for demographic data and anatomical data, primary tumor type, procedure details, and outcome - including change in analgesic requirements (expressed as morphine equivalent dosages), pain scores (utilizing the clinically implemented visual analog scale), subsequent therapies (including radiation and/or surgery), and complications during the 24 h following the procedure and at 3 months. Patients were excluded (n = 7) if data were not retrospectively identifiable at the defined time points. Fifty-four tumors were ablated in 50 patients. There were statistically significant decreases in the median VAS score and narcotic usage at both 24 h and 3 months (p < 0.000). Six patients (11 %) incurred complications related to their therapy. Two patients had no relief at 24 h, of which both reported worsened pain at 3 months. One patient had initial relief but symptom recurrence at 3 months. Four patients went on to have radiation therapy of the ablation site at some point following the procedure. CT-guided cryoablation is a safe, effective, reproducible procedural option for the nonoperative local treatment of painful musculoskeletal metastatic disease. (orig.)

  20. Robotic surgical telepathology between the Iron Mountain and Milwaukee Department of Veterans Affairs Medical Centers: a 12-year experience.

    Science.gov (United States)

    Dunn, Bruce E; Choi, Hongyung; Recla, Daniel L; Kerr, Sarah E; Wagenman, Benjamin L

    2009-08-01

    Since mid-1996, we have operated a diagnostic robotic telepathology (TP) system at the Iron Mountain, MI, Department of Veterans Affairs Medical Center (VAMC) from the Milwaukee, WI, VAMC, located some 220 miles away. No on-site pathologist is present in Iron Mountain. Instead, an experienced, well-trained pathologist assistant, under direction of pathologists located in Milwaukee, is responsible for tissue grossing and sectioning. The pathologist assistant places slides onto the stage of the robotic microscope, which is then controlled by pathologists in Milwaukee. Each case read by TP is subsequently read by light microscopy (LM) by the same pathologist. Three distinct phases of TP have been recognized. Our experience during phase I (mid-1996 to early 1999) has been published previously. During phase II (early 1999 to mid-2004), 1 of the 2 senior telepathologists in phase I retired, and 3 junior pathologists were hired. During phase III (mid-2004 to June 2008), 2 new junior pathologists were hired, and ASAP Imaging (Apollo Telemedicine, Inc., Falls Church, VA) was implemented. The number of TP case opportunities in phases I, II, and III was 2200, 5841, and 3512, respectively, resulting in a total of 11 553. A total of 1834 cases were deferred to LM for a variety of reasons. The number of TP diagnoses rendered in phases I, II, and III was 2144, 4636, and 2939, respectively, resulting in a total of 9719. The major discordance rates in phases I, II, and III were 0.33%, 0.45%, and 0.20%, respectively, with an overall rate of 0.35%. Pathologist-specific discordance rates were not significantly different and ranged from a low of 0.12% to a high of 0.77%, whereas case deferral rates were significantly different (P Iron Mountain clinicians have expressed great satisfaction with the services provided by their off-site pathologist colleagues.

  1. Robotic surgical telepathology between the Iron Mountain and Milwaukee Department of Veterans Affairs Medical Centers: a twelve year experience.

    Science.gov (United States)

    Dunn, Bruce E; Choi, Hongyung; Recla, Daniel L; Kerr, Sarah E; Wagenman, Benjamin L

    2009-11-01

    Since mid-1996 we have operated a diagnostic robotic telepathology (TP) system at the Iron Mountain, Michigan, Department of Veterans Affairs Medical Center (VAMC) from the Milwaukee, Wisconsin VAMC, located some 220 miles away. No on-site pathologist is present in Iron Mountain. Instead, an experienced, well-trained pathologist assistant, under direction of pathologists located in Milwaukee, is responsible for tissue grossing and sectioning. The pathologist assistant places slides onto the stage of the robotic microscope, which is then controlled by pathologists in Milwaukee. Each case read by TP is subsequently read by light microscopy (LM) by the same pathologist. Three distinct phases of TP have been recognized. Our experience during Phase I (mid-1996 through early 1999) has been published previously. During Phase II (early 1999 through mid-2004), one of the two senior telepathologists in Phase I retired and three junior pathologists were hired. During Phase III (mid-2004 though June 2008), two new junior pathologists were hired and ASAP Imaging (Apollo Telemedicine, Inc., Falls Church, VA) was implemented. The number of TP case opportunities in Phases I, II and III was 2,200; 5,841 and 3,512; respectively resulting in a total of 11,553. A total of 1,834 cases were deferred to LM for a variety of reasons. The number of TP diagnoses rendered in Phases I, II and III was 2,144; 4,636 and 2,939; respectively, for a total of 9,719. The major discordance rates in Phases I, II and III were 0.33%, 0.45% and 0.20%, respectively with an overall rate of 0.35%. Pathologist-specific discordance rates were not significantly different and ranged from a low of 0.12% to a high of 0.77%, while case deferral rates were significantly different (P Iron Mountain clinicians have expressed great satisfaction with the services provided by their off-site pathologist colleagues.

  2. Sofosbuvir and Simeprevir Combination Therapy for HCV Genotype 1 Infection: Results of a Single-Center VA Experience.

    Science.gov (United States)

    Sclair, Seth N; Hernandez, Maria Del Pilar; Vance, Evan; Gilinski, Dani; Youtseff, Helen; Toro, Maribel; Antoine, Marie; Jeffers, Lennox J; Peyton, Adam

    2016-08-01

    Treatment of chronic hepatitis C virus (HCV) infection remains a priority in the veterans affairs (VA) health care system nationwide, as there is a high burden of liver disease due to HCV infection among US veterans. The combination of sofosbuvir and simeprevir was the first all-oral antiviral regimen used in clinical practice to treat veterans with HCV infection. In this study, we report a single-center experience showing both the feasibility and effectiveness of this all-oral combination to treat HCV genotype 1 infection. One hundred patients with HCV genotype 1 infection were treated between December 2013 and June 2014. Eighty-six patients were treated with sofosbuvir and simeprevir, with or without ribavirin, for 12 weeks; 12 patients were treated with sofosbuvir, pegylated interferon, and ribavirin for 12 weeks; and 2 patients were treated with sofosbuvir and ribavirin for 24 weeks. Overall, treatment was well tolerated and feasible, with compliance rates over 95% in patients treated with all-oral therapy. The sustained virologic response (SVR) rate for sofosbuvir and simeprevir (88.4%) was superior to the rate for sofosbuvir, pegylated interferon, and ribavirin (50.0%). Subgroup analysis showed diminished SVR rates in cirrhotic patients vs noncirrhotic patients. There were no significant differences in SVR when comparing treatment with or without ribavirin or among genotype subtypes. In conclusion, this study demonstrated excellent completion rates for all-oral treatment of veterans with chronic HCV infection. Additionally, treatment was highly effective, nearing a 90% cure rate. Thus, we recommend that the VA health care system continue to incorporate new HCV medications into its formulary so as to expand HCV treatment for US veterans.

  3. Demystifying the Chemistry Literature: Building Information Literacy in First-Year Chemistry Students through Student-Centered Learning and Experiment Design

    Science.gov (United States)

    Bruehl, Margaret; Pan, Denise; Ferrer-Vinent, Ignacio J.

    2015-01-01

    This paper describes curriculum modules developed for first-year general chemistry laboratory courses that use scientific literature and creative experiment design to build information literacy in a student-centered learning environment. Two curriculum units are discussed: Exploring Scientific Literature and Design Your Own General Chemistry…

  4. Pedagogies, Perspectives, and Practices: Mobile Learning through the Experiences of Faculty Developers and Instructional Designers in Centers for Teaching and Learning

    Science.gov (United States)

    Hosler, Kim A.

    2013-01-01

    The purpose of this qualitative case study was to explore the experiences, perceptions, and pedagogy of nine self-identified faculty developers and instructional designers who work in centers for teaching and learning supporting faculty members requesting assistance with mobile learning. With the ever-increasing use of mobile devices across…

  5. The impact of center experience on results of reduced intensity : allogeneic hematopoietic SCT for AML. An analysis from the Acute Leukemia Working Party of the EBMT

    NARCIS (Netherlands)

    Giebel, S.; Labopin, M.; Mohty, M.; Mufti, G. J.; Niederwieser, D.; Cornelissen, J. J.; Janssen, J. J. W. M.; Milpied, N.; Vindelov, L.; Petersen, E.; Arnold, R.; Bacigalupo, A.; Blaise, D.; Craddock, C.; Nagler, A.; Frassoni, F.; Sadus-Wojciechowska, M.; Rocha, V.

    2013-01-01

    Allogeneic hematopoietic SCT with reduced-intensity conditioning (RIC-HSCT) is increasingly adopted for the treatment of older adults with AML. Our goal was to verify for the first time, if center experience influences outcome of RIC-HSCT. Results of 1413 transplantations from HLA-matched related or

  6. The impact of center experience on results of reduced intensity:allogeneic hematopoietic SCT for AML. An analysis from the Acute Leukemia Working Party of the EBMT

    DEFF Research Database (Denmark)

    Giebel, S; Labopin, M; Mohty, M

    2013-01-01

    Allogeneic hematopoietic SCT with reduced-intensity conditioning (RIC-HSCT) is increasingly adopted for the treatment of older adults with AML. Our goal was to verify for the first time, if center experience influences outcome of RIC-HSCT. Results of 1413 transplantations from HLA-matched related...

  7. Promoting patient-centered care: a qualitative study of facilitators and barriers in healthcare organizations with a reputation for improving the patient experience.

    Science.gov (United States)

    Luxford, Karen; Safran, Dana Gelb; Delbanco, Tom

    2011-10-01

    To investigate organizational facilitators and barriers to patient-centered care in US health care institutions renowned for improving the patient care experience. A qualitative study involving interviews of senior staff and patient representatives. Semi-structured interviews focused on organizational processes, senior leadership, work environment, measurement and feedback mechanisms, patient engagement and information technology and access. Eight health care organizations across the USA with a reputation for successfully promoting patient-centered care. Forty individuals, including chief executives, quality directors, chief medical officers, administrative directors and patient committee representatives. Interviewees reported that several organizational attributes and processes are key facilitators for making care more patient-centered: (i) strong, committed senior leadership, (ii) clear communication of strategic vision, (iii) active engagement of patient and families throughout the institution, (iv) sustained focus on staff satisfaction, (v) active measurement and feedback reporting of patient experiences, (vi) adequate resourcing of care delivery redesign, (vii) staff capacity building, (viii) accountability and incentives and (ix) a culture strongly supportive of change and learning. Interviewees reported that changing the organizational culture from a 'provider-focus' to a 'patient-focus' and the length of time it took to transition toward such a focus were the principal barriers against transforming delivery for patient-centered care. Organizations that have succeeded in fostering patient-centered care have gone beyond mainstream frameworks for quality improvement based on clinical measurement and audit and have adopted a strategic organizational approach to patient focus.

  8. O doador marginal: experiência de um centro de transplante de fígado The marginal donor: a single-center experience in orthotopic liver transplantation

    Directory of Open Access Journals (Sweden)

    Olival Cirilo Lucena da Fonseca-Neto

    2008-03-01

    Full Text Available RACIONAL: Desde que o uso de enxertos marginais é solução aceita para escassez de órgãos para transplante, ele tornou-se muito comum em todo mundo e a literatura vem mostrando efetividade desses enxertos no transplante de fígado. OBJETIVO: Apresentar a experiência do Serviço de Transplante Hepático do Hospital Universitário Oswaldo Cruz, em transplante de fígado com o uso de doadores marginais. MÉTODOS: Estudo retrospectivo em 137 transplantes ortotópicos de fígado, usando enxertos marginais entre 1999 e 2006, com acompanhamento mínimo de 180 dias. Os receptores foram classificados de acordo com a função inicial do enxerto no pós-operatório como normal (FN e disfunção primária (DP. RESULTADOS: Não foi observada diferença estatisticamente significante entre os grupos FN e DP com os seguintes parâmetros dos doadores: idade, sódio sérico, tempo de protrombina, esteatose hepática, transaminases sérica, pressão sanguínea, drogas vasoativas, índice de massa corpórea, parada cardíaca antes da doação de órgão, doador em assistolia e tempo de isquemia quente. Análise da curva de sobrevida (Kaplan-Meier de pacientes e de enxertos de fígado de pacientes que receberam fígado de doadores ideais versus doadores marginais não mostrou diferença com significância estatística. CONCLUSÃO: Pode ser recomendado o uso de enxertos marginais para transplantes hepáticos, inclusive os provenientes de doadores com o coração parado.BACKGROUND: Since marginal grafts are a solution to deal with the shortage of organ donors, its use became more common worldwide, and the literature had shown its effectiveness in the liver transplantation (LT outcomes. AIM: To present a single center experience, at the Liver Transplantation Unit of Oswaldo Cruz University Hospital, with orthotopic LT using marginal organ donors. METHODS: Retrospectivety review of 137 orthotopic LT using marginal grafts between 1999 and 2006, with a minimum 180

  9. Intermediate photovoltaic system application experiment operational-performance report for Lovington Square Shopping Center, Lovington, New Mexico

    Energy Technology Data Exchange (ETDEWEB)

    1982-09-01

    Presented are the data accumulated during June at the intermediate photovoltaic project at Lovington Square Shopping Center, Lovington, New Mexico. Generated energy and environmental (weather) data are presented graphically. Explanations of irregularities not attributable to weather are provided.

  10. Intermediate photovoltaic system application experiment operational performance report. Lovington Square Shopping Center, Lovington, New Mexico for November 1982. Volume 17

    Energy Technology Data Exchange (ETDEWEB)

    1983-01-01

    The data accumulated during November 1982 at the intermediate photovoltaic project at Lovington Square Shopping Center, Lovington, New Mexico, are presented. Generated energy and environmental (weather) data are presented graphically. Explanations of irregularities not attributable to weather are provided.

  11. Intermediate photovoltaic system application experiment operational performance report for Lovington Square Shopping Center, Lovington, New Mexico for December 1982

    Energy Technology Data Exchange (ETDEWEB)

    1983-03-01

    Presented are the data accumulated during December 1982 at the intermediate photovoltaic project at Lovington Square Shopping Center, Lovington, New Mexico. Generated energy and environmental (weather) data are presented graphically. Explanations of irregularities not attributable to weather are provided.

  12. Intermediate photovoltaic system application experiment operational performance report for Lovington Square Shopping Center, Lovington, New Mexico for January 1983

    Energy Technology Data Exchange (ETDEWEB)

    Harrison, T.D.

    1983-06-01

    This report presents the data accumulated during January 1983 at the intermediate photovoltaic project at Lovington Square Shopping Center, Lovington, New Mexico. Generated energy and environmental (weather) data are presented graphically. Explanations of irregularities not attributable to weather are provided.

  13. 9/11-Related Experiences and Tasks of Landfill and Barge Workers: Qualitative Analysis from the World Trade Center Health Registry

    Directory of Open Access Journals (Sweden)

    Cone James E

    2011-05-01

    Full Text Available Abstract Background Few studies have documented the experiences of individuals who participated in the recovery and cleanup efforts at the World Trade Center Recovery Operation at Fresh Kills Landfill, on debris loading piers, and on transport barges after the September 11, 2001 terrorist attack. Methods Semi-structured telephone interviews were conducted with a purposive sample of workers and volunteers from the World Trade Center Health Registry. Qualitative methods were used to analyze the narratives. Results Twenty workers and volunteers were interviewed. They described the transport of debris to the Landfill via barges, the tasks and responsibilities associated with their post-9/11 work at the Landfill, and their reflections on their post-9/11 experiences. Tasks included sorting through debris, recovering human remains, searching for evidence from the terrorist attacks, and providing food and counseling services. Exposures mentioned included dust, fumes, and odors. Eight years after the World Trade Center disaster, workers expressed frustration about poor risk communication during recovery and cleanup work. Though proud of their contributions in the months after 9/11, some participants were concerned about long-term health outcomes. Conclusions This qualitative study provided unique insight into the experiences, exposures, and concerns of understudied groups of 9/11 recovery and cleanup workers. The findings are being used to inform the development of subsequent World Trade Center Health Registry exposure and health assessments.

  14. GLOBE Observer and the Association of Science & Technology Centers: Leveraging Citizen Science and Partnerships for an International Science Experiment to Build Climate Literacy

    Science.gov (United States)

    Riebeek Kohl, H.; Chambers, L. H.; Murphy, T.

    2016-12-01

    For more that 20 years, the Global Learning and Observations to Benefit the Environment (GLOBE) Program has sought to increase environment literacy in students by involving them in the process of data collection and scientific research. In 2016, the program expanded to accept observations from citizen scientists of all ages through a relatively simple app. Called GLOBE Observer, the new program aims to help participants feel connected to a global community focused on advancing the scientific understanding of Earth system science while building climate literacy among participants and increasing valuable environmental data points to expand both student and scientific research. In October 2016, GLOBE Observer partnered with the Association of Science & Technology Centers (ASTC) in an international science experiment in which museums and patrons around the world collected cloud observations through GLOBE Observer to create a global cloud map in support of NASA satellite science. The experiment was an element of the International Science Center and Science Museum Day, an event planned in partnership with UNESCO and ASTC. Museums and science centers provided the climate context for the observations, while GLOBE Observer offered a uniform experience and a digital platform to build a connected global community. This talk will introduce GLOBE Observer and will present the results of the experiment, including evaluation feedback on gains in climate literacy through the event.

  15. [Congenital bilateral absence of vas deferens: From diagnosis to assisted reproductive techniques - the experience of three centers].

    Science.gov (United States)

    Beauvillard, D; Perrin, A; Drapier, H; Ravel, C; Fréour, T; Férec, C; De Braekeleer, M; Amice, V

    2015-05-01

    To review the management with assisted reproductive technologies (ART) of men with congenital bilateral absence of vas deferens (CBAVD), associated with cystic fibrosis or not, after surgical retrieval [epididymal aspiration (MESA) or testicular biopsy (TESE)]. Multicenter retrospective study made of 2 groups: CBAVD and cystic fibrosis (CF) or CBAVD only (CF-RD). Two centers performed MESA (Brest and Nantes) and one TESE (Rennes). Sperm numeration, motility, vitality, morphology and nuclear maturity were measured in both centers performing MESA. Fertilization rate (TF) and cumulated progressive pregnancy rate by retrieved oocyte (TGC) were compared between centers following ART. Ninety patients underwent surgical retrieval between January 1996 and March 2013, 30 in the CF group and 60 in the CF-RD group. Semen parameters were comparable between groups and centers. Fifty-eight (22 in the CF group and 36 in the CF-RD group) patients received ART between April 1996 and October 2014. TF was 50% and 52% and TGC 26% and 32% in the CF group and CF-RD groups, respectively. The results did not differ between groups but TGC was higher in Rennes than in the other two centers. Both semen parameters and ART results are comparable and similar to those reported in the literature. As shown by the results obtained in Rennes, TESE seems to be more effective. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  16. The identification, characterization and optimization of small molecule probes of cysteine proteases: experiences of the Penn Center for Molecular Discovery with cathepsin B and cathepsin L.

    Science.gov (United States)

    Huryn, Donna M; Smith, Amos B

    2009-01-01

    During the pilot phase of the NIH Molecular Library Screening Network, the Penn Center for Molecular Discovery focused on a series of projects aimed at high throughput screening and the development of probes of a variety of protease targets. This review provides our medicinal chemistry experience with two such targets--cathepsin B and cathepsin L. We describe our approach for hit validation, characterization and triage that led to a critical understanding of the nature of hits from the cathepsin B project. In addition, we detail our experience at hit identification and optimization that led to the development of a novel thiocarbazate probe of cathepsin L.

  17. Research experiments planned for the Integrated Solar Energy Heating/Cooling System for the proposed new Physical Science Education Center in Richmond, Virginia

    Energy Technology Data Exchange (ETDEWEB)

    Iachetta, F.A.

    1976-06-01

    A review of the Integrated Solar Energy Heating and Cooling system for the New Physical Science Education Center in Richmond is provided and several potential experiments were developed for possible inclusion in the design. The evaluation of the system performance includes instrumentation for the (A) collector subsystem, (B) heating mode, (C) cooling mode (adsorption chiller, centrifugal chiller), and (D) the storage system. Research experiments dealing with experimental collectors, stratification in thermal storage tanks, insolation/material life studies, and corrosion studies are included. Separate abstracts were prepared for three papers in this report.

  18. Outpatient management of intra-corporeal left ventricular assist device system in children: a multi-center experience.

    Science.gov (United States)

    Schweiger, M; Vanderpluym, C; Jeewa, A; Canter, C E; Jansz, P; Parrino, P E; Miera, O; Schmitto, J; Mehegan, M; Adachi, I; Hübler, M; Zimpfer, D

    2015-02-01

    Little is known about the outcomes of children supported on intracorporeal left ventricular assist device (HVAD), and the feasibility of outpatient management. All centers with pediatric patients discharged from the hospital on the device were identified using company database. A total of 14 centers were contacted, with 9 centers, contributing data retrospectively. From 2011 to 2013, 12 pediatric patients (7 females), mean aged 11.9 ± 2.3 years (range 8-15), mean weight 43 ± 19 kg (range 18-81), mean body surface area 1.3 ± 0.3 m(2) (range 0.76-1.96) were identified. Diagnosis included: dilated cardiomyopathy (CMP) (n = 5), noncompaction CMP (n = 4), toxic CMP (n = 2) and viral CMP (n = 1). Indications for support were permanent support (n = 1), bridge to recovery (n = 1) and bridge to transplantation (n = 10). Prior to HVAD implantation, all patients received intravenous inotropes and two patients were on temporary mechanical support. Overall mortality was 0%. Mean duration of inpatient and outpatient support were 56 (range: 19-95 days) and 290 days (range: 42-790), respectively. Mean readmission rate was 0.02 per patient month (2.1 per patient). No adverse events involving emergency department occurred. Eight children resumed local schooling. Home discharge of children supported on HVAD is feasible and safe. School integration can be achieved. There is wide center variability to discharge practice for children.

  19. An analysis of clinical process measures for acute healthcare delivery in Appalachia: The Roane Medical Center experience

    OpenAIRE

    Sills Eric; Hancock John S; Pope Karla

    2006-01-01

    Abstract Objective To survey management of selected emergency healthcare needs in a Tennessee community hospital. Materials and methods In this descriptive report, discharges and associated standard process measures were retrospectively studied for Roane Medical Center (RMC) in Harriman, Tennessee (pop. 6,757). Hospital data were extracted from a nationwide database of short-term acute care hospitals to measure 16 quality performance measures in myocardial infarction (MI), heart failure, and ...

  20. Reducing health disparities through a culturally centered mentorship program for minority faculty: the Southwest Addictions Research Group (SARG) experience.

    Science.gov (United States)

    Viets, Vanessa Lopez; Baca, Catherine; Verney, Steven P; Venner, Kamilla; Parker, Tassy; Wallerstein, Nina

    2009-08-01

    Ethnic minority faculty members are vastly underrepresented in academia. Yet, the presence of these individuals in academic institutions is crucial, particularly because their professional endeavors often target issues of health disparities. One promising way to attract and retain ethnic minority faculty is to provide them with formal mentorship. This report describes a culturally centered mentorship program, the Southwest Addictions Research Group (SARG, 2003-2007), at the University of New Mexico (UNM) that trained a cadre of minority researchers dedicated to reducing health disparities associated with substance abuse. The SARG was based at UNM's School of Medicine's Institute for Public Health, in partnership with the UNM's Center on Alcoholism, Substance Abuse, and Addictions. The program consisted of regular research meetings, collaboration with the Community Advisory Board, monthly symposia with renowned professionals, pilot projects, and conference support. The authors collected data on mentee research productivity as outcomes and conducted separate mentee and mentor focus-group interviews to assess the strengths and weaknesses of the SARG program. The SARG yielded positive outcomes as evidenced by mentee increase in grant submissions, publications, and professional presentations. Focus-group qualitative data highlighted program and institutional barriers as well as successes that surfaced during the program. Based on this evaluation, a Culturally Centered Mentorship Model (CCMM) emerged. The CCMM can help counter institutional challenges by valuing culture, community service, and community-based participatory research to support the recruitment and advancement of ethnic minority faculty members in academia.

  1. The grand experiment, a historical account of a museum/school partnership: The Alexander Science Center School of Los Angeles

    Science.gov (United States)

    Heughins, Andrew R.

    This study tells the history of The Alexander Science Center School, a museum/school partnership between the Los Angeles Unified School District and the California Science Center created with the goal of becoming a national model in elementary science education. To provide a background to the development of the school, this study explores the definition of what constitutes a museum school, including the existence of a formal partnership between a school district and a museum and systemic change in the partner institutions leading to a marriage of formal and informal learning styles. In addition, the literature review explores the unique models of museum/school partnerships developed in the United States. The history of the Alexander Science Center School is told in a narrative style using documentation from the schools development and through interviews with individuals who played key roles, from the schools inception through its opening. The study covers the initiation of concept, architectural design, formation of the partnership, and development of the curriculum. The study also identifies the roadblocks encountered in the schools development and makes recommendations for school districts and institutions seeking to create future museum school projects. In addition, a comparison is made other recently studied museum schools to provide a context for the school's historical and programmatic development.

  2. Clinicopathological correlates of primary central nervous system lymphoma: Experience from a tertiary care center in South India

    Directory of Open Access Journals (Sweden)

    Bimal Patel

    2015-01-01

    Full Text Available Background: Primary central nervous system lymphomas (PCNSL constitute a rare group of extranodal non-Hodgkin′s lymphomas (NHLs. Aim: To study the clinical and immunophenotypic profile of patients with a PCNSL who presented between the years 2000 and 2013 in a tertiary care center in South India. Materials and Methods: This was a retrospective study. Demographic and clinical data were obtained from the clinical case records. Inclusion criteria: Cases of PCNSL involving brain. Exclusion criteria: Cases of PCNSL involving the spinal cord, meninges and orbit as well as intravascular large B-cell lymphoma, lymphomas with evidence of systemic disease or secondary lymphomas. Archived slides and tissue blocks were retrieved. All cases had hematoxylin and eosin stained sections and immunohistochemistry for CD20, CD3, and MIB-1. Additional immunohistochemistry was performed for CD10, BCL6, and MUM1 on paraffin blocks with sufficient tissue. Results: There were a total of 73 cases with the mean age of presentation being 45.9 years (range 8-71 years and with a male predominance (male: female (M:F = 2.3:1. Headache was the commonest presenting complaint. The mean duration of symptoms was 10.6 weeks. All patients were immunocompetent. Most tumors were supratentorial in location. Out of 73 cases, 70 presented with a diffuse large B-cell lymphoma (DLBCL, two with a Burkitt′s lymphoma, and one with a lymphomatoid granulomatosis. Only 51 of the DLBCL cases had sufficient tissue for additional studies. Non-germinal center was the most common phenotype seen in 65.7% (33/51 of cases. Germinal center B-cell (GCB phenotype was seen in 18/51 cases (34.3%. Conclusion: DLBCL constituted the majority of PCNSLs and although non-germinal center was the predominant phenotype, more than a third of the cases were of the GCB phenotype. As the germinal center phenotype is known to have a better prognosis, further studies to explore its relevance in the Asian population are

  3. Patient Experience Assessment is a Requisite for Quality Evaluation: A Discussion of the In-Center Hemodialysis Consumer Assessment of Health Care Providers and Systems (ICH CAHPS) Survey.

    Science.gov (United States)

    Cavanaugh, Kerri L

    2016-01-01

    Patient experience surveys provide a critical and unique perspective on the quality of patient-centered healthcare delivery. These surveys provide a mechanism to systematically express patients' voice on topics valued by patients to make decisions about choices in care. They also provide an assessment to healthcare organizations about their service that cannot be obtained from any other source. Regulatory agencies have mandated the assessment of patients' experience as part of healthcare value based purchasing programs and weighted the results to account for up to 30% of the total scoring. This is a testimony to the accepted importance of this metric as a fundamental assessment of quality. After more than a decade of rigorous research, there is a significant body of growing evidence supporting specifically the validity and use of the Consumer Assessment of Healthcare Providers and Systems (CAHPS) surveys, including a version specific to in-center hemodialysis (ICH CAHPS). This review will focus on the ICH CAHPS survey including a review of its development, content, administration, and also a discussion of common criticisms. Although it is suggested that the survey assesses activities and experiences that are not modifiable by the healthcare organization (or the dialysis facility in our case) emerging evidence suggests otherwise. Dialysis providers have an exclusive opportunity to lead the advancement of understanding the implications and serviceability of the evaluation of the patient experience in health care. © 2016 Wiley Periodicals, Inc.

  4. National Rehabilitation Information Center

    Science.gov (United States)

    ... including News and Notes) Welcome to the National Rehabilitation Information Center! We are conducting improvements to the ... experience. We apologize for any inconvenience The National Rehabilitation Information Center ( NARIC ) is the library of the ...

  5. Role of water quality assessments in hospital infection control: Experience from a new oncology center in eastern India

    Directory of Open Access Journals (Sweden)

    Ramkrishna Bhalchandra

    2014-01-01

    Full Text Available Water quality assessment and timely intervention are essential for health. Microbiology, total dissolved solids (TDS and free residual chlorine were measured for water quality maintenance in an oncology center in India. Impact of these interventions over a period of 22 months has been demonstrated with four cardinal events. Pseudomonas in hospital water was controlled by adequate chlorination, whereas high TDS in the central sterile supply department water was corrected by the installation of electro-deionization plant. Contaminated bottled water was replaced using quality controlled hospital supply. Timely detection and correction of water-related issues, including reverse osmosis plant was possible through multi-faceted approach to water quality.

  6. [The practical experience of quality control organization in the laboratory of Municipal consultative diagnostic center 1 of St. Petersburg].

    Science.gov (United States)

    Ostroumova, M N; Mnuskina, M M

    2011-10-01

    The article specifies the functioning of quality control system in the laboratory of Municipal consultative diagnostic center i 1 of St. Petersburg. Initially, on the basis of interpretations of biological variations of every analyte, the requirements to analytical quality are developed. Subsequently, the actually attainable reproducibility of measurements and their bias is examined. The real analytical characteristics of 27 biochemical analytes are presented. The aggregate laboratory ratings are quoted based on the results of involvement in three EQAS programs since 2005, concerning biochemistry, immunochemistry and hematology. The important quality of laboratory research on its analytical stage is maintained by the interaction between inter-laboratory and regular external control.

  7. [New perspective in liaison psychiatry. Experience at the Pediatric Hospital of the National Medical Center Siglo XXI].

    Science.gov (United States)

    Sauceda García, J M; Maldonado Durán, J M; Angel Montoya Cabrera, M

    1994-01-01

    In hospitalized and chronically ill children, the prevalence of psychopathology is very high. It is necessary that in its prevention, diagnosis and treatment not only professionals of the mental health disciplines intervene but also that the pediatricians, nurses and the family of the patient himself participate actively. Consultation Liaison Child Psychiatry activities at the Pediatric Hospital of the National Medical Center "Siglo XXI" are described. Its goal is to incorporate the mental health professional to the team of hospital care and promote that pediatricians gain a greater conscience of psychological and social factors that are crucial for the sick child.

  8. The McGill Pain Questionnaire in Amharic: Zwai Health Center patients' reports on the experience of pain.

    Science.gov (United States)

    Aboud, Frances E; Hiwot, Mismay G; Arega, Adefris; Molla, Mesfin; Samson, S; Seyoum, Nebyou; Ressom, Shewangizaw; Worku, Solomon; Mulatu, Mesfin; Egale, Tewedros

    2003-01-01

    This paper presents for the first time an Amharic translation of the McGill Pain Questionnaire developed by Melzack and used in many countries around the world. It allows for a quantitative and qualitative assessment of the intensity, location, and nature of experienced pain, as well as conditions that relieve pain. Data collected from one hundred patients attending the Zwai Health Center indicated that 81% reported pain at the time, one-quarter of whom were in severe pain. The most commonly chosen descriptors were: burning, stabbing, sore, gnawing, aching, and cramping. Descriptors were often associated with certain diagnoses: burning with gastrointestinal problems, stabbing with respiratory diseases, and gnawing or aching with myalgia/neuralgia. Approximately 40% of those in pain had previously sought relief from a clinic or pharmacy and were attending the center because the pain persisted. Analgesics were more likely to be prescribed for those in mild pain, while other medication without analgesics were prescribed for those in severe pain. The McGill Pain Questionnaire--Amharic (MPQ-Am) could be a useful tool for future studies of illness-specific pain, and of the effectiveness of pharmaceutical and non-pharmaceutical strategies for pain management.

  9. Epidemiology of post-transplant malignancy in Chinese renal transplant recipients: a single-center experience and literature review.

    Science.gov (United States)

    Zhang, Jian; Ma, Linlin; Xie, Zelin; Guo, Yuwen; Sun, Wen; Zhang, Lei; Lin, Jun; Xiao, Jing; Zhu, Yichen; Tian, Ye

    2014-07-01

    This study investigated the incidence and types of post-transplant malignancy in Chinese renal transplant recipients and the risk factors associated with malignancy. Data from 3,462 patients who underwent renal transplantation at Beijing Friendship Hospital were combined with data from 26 previous reports describing malignancy rates in 27,170 Chinese renal transplant recipients. Between 1974 and 2014, 179/3,462 (5.17 %) patients who underwent renal transplantation at our center developed malignancy. The most common site of malignancy was the urinary system, and the most common type was urothelial transitional cell carcinoma. Combined data from our center and previous reports showed malignancy in 671 (2.19 %) Chinese renal transplant recipients. The ten most common malignancies were urothelial transitional cell carcinoma (n = 283), hepatocellular carcinoma (n = 68), gastrointestinal cancer (n = 63), renal cell carcinoma (n = 42), lymphoma (n = 42), lung cancer (n = 28), breast cancer (n = 19), skin cancer (n = 18), Kaposi's sarcoma (n = 12), and cervical cancer (n = 10). The incidence of post-transplant malignancy in renal transplant recipients was lower in China than the reported rates in other countries, and the most common sites of malignancy were the urinary and digestive system. The relative frequency of malignancy sites differed between northern and southern China. Renal transplant recipients on long-term immunosuppressive therapy should receive careful follow-up, including annual or biannual screening for malignancy in high-risk individuals.

  10. Newborn screening for methylmalonic aciduria by tandem mass spectrometry: 7 years' experience from two centers in Taiwan.

    Science.gov (United States)

    Cheng, Kang-Hsiang; Liu, Mei-Ying; Kao, Chuan-Hong; Chen, Yann-Jang; Hsiao, Kwang-Jen; Liu, Tze-Tze; Lin, Hsiang-Yu; Huang, Cheng-Hung; Chiang, Chuan-Chi; Ho, Huey-Jane; Lin, Shuan-Pei; Lee, Ni-Chung; Hwu, Wuh-Liang; Lin, Ju-Li; Hung, Ping-Yao; Niu, Dau-Ming

    2010-06-01

    The clinical course of methylmalonic aciduria (MMA) is fulminant in neonates and emergency management is necessary to save lives. It is therefore very important to differentiate affected from unaffected neonates immediately when there are abnormal results regarding MMA in newborn screening. Between January 2002 and December 2008, 598,522 newborns were screened for MMA by 2 neonatal screening centers: the Chinese Foundation of Health and the Taipei Institute of Pathology. A total of 22 newborns were referred to confirmatory medical centers, and 7 were confirmed as having MMA. The initial propionylcarnitine (C3) level, C3/acetylcarnitine (C2) ratio, plasma ammonia, liver function tests, blood pH and bicarbonate were compared between the true-positive and false-positive groups. The C3/C2 ratio and plasma ammonia were markedly higher in the true-positive MMA group (p 0.4 or ammonia levels > 200 mg/dL should be highly suspected of having MMA. Copyright (c) 2010 Elsevier. Published by Elsevier B.V. All rights reserved.

  11. Establishing a regional network of academic centers to support decision making for new vaccine introduction in Latin America and the Caribbean: the ProVac experience.

    Science.gov (United States)

    Toscano, C M; Jauregui, B; Janusz, C B; Sinha, A; Clark, A D; Sanderson, C; Resch, S; Ruiz Matus, C; Andrus, J K

    2013-07-02

    The Pan American Health Organization's ProVac Initiative, designed to strengthen national decision making regarding the introduction of new vaccines, was initiated in 2004. Central to realizing ProVac's vision of regional capacity building, the ProVac Network of Centers of Excellence (CoEs) was established in 2010 to provide research support to the ProVac Initiative, leveraging existing capacity at Latin American and Caribbean (LAC) universities. We describe the process of establishing the ProVac Network of CoEs and its initial outcomes and challenges. A survey was sent to academic, not-for-profit institutions in LAC that had recently published work in the areas of clinical decision sciences and health economic analysis. Centers invited to join the Network were selected by an international committee on the basis of the survey results. Selection criteria included academic productivity in immunization-related work, team size and expertise, successful collaboration with governmental agencies and international organizations, and experience in training and education. The Network currently includes five academic institutions across LAC. Through open dialog and negotiation, specific projects were assigned to centers according to their areas of expertise. Collaboration among centers was highly encouraged. Faculty from ProVac's technical partners were assigned as focal points for each project. The resulting work led to the development and piloting of tools, methodological guides, and training materials that support countries in assessing existing evidence and generating new evidence on vaccine introduction. The evidence generated is shared with country-level decision makers and the scientific community. As the ProVac Initiative expands to other regions of the world with support from immunization and public health partners, the establishment of other regional and global networks of CoEs will be critical. The experience of LAC in creating the current network could benefit the

  12. Low-cost semirigid ureteroscopy is effective for ureteral stones: Experience of a single high volume center

    Directory of Open Access Journals (Sweden)

    Roberto Giulianelli

    2014-06-01

    Full Text Available Aim of the study: To demonstrate how, in a center with a large number of patients, as our center is, it is possible to perform ureterolithotripsy using a limited set of instruments. Methods: We evaluated medical charts of our center related to semirigid ureteral ureteroscopy (URS with ureterolithotripsy using Holmium laser performed from July 2004 to July 2011. Overall, 658 URS for ureteral stones were performed in 601 patients, of which 204 in proximal ureter (31%, 86 in the mid (13.06% and 368 (57.76% in the distal ureter. In 504 patients (76.5% ureterohydronephrosis (Grade II-III was observed. In 57 patients (8.6%, we performed a bilateral approach at the same time, but most patients had a solitary distal ureteral stone. 106 patients (16.1% had more than one stone in their distal ureter and 96 (14.8% had a proximal ureteral stone treated in the same surgery as well. Results: The overall stone-free rate for ureteral stones was 86.1% (567/658. Success rates for proximal, medial and distal ureteral stones were 68.13% (139/204 patients, 84.8% (73/86 patients and 96.4% (355/368 patients, respectively. One hundred and twenty patients (18.3% required additional surgical treatment for their stones beyond the initial URS, including a second URS in 97 patients (14.74% and URS plus Retrograde Intra-Renal Surgery (RIRS in 23 patients (3.54%. The overall stonefree rate after the second treatment was 99.3%. Intra-operative complications accounted for 5.92% and consisted of ureteral perforations in 16 pts (2.4%, erosions of urothelium leading to significant bleeding in 15 pts (2.27%, severe pain in 4 pts (0.6%, fever in 3 pts (0.45% and one case of ureteral avulsion (0.15%. Conclusions: This study demonstrates that the use of Holmium laser lithotripsy is a safe and effective means of treating ureteral stones regardless of sex, age, stone location, or stone size. The instrumentation we used was extremely limited, in order to reduce costs related to the

  13. Training Consumer Educators: A Curriculum and Program Handbook. A Report on the Experience of the Consumer Law Training Center.

    Science.gov (United States)

    New York Law School, NY. Consumer Law Training Center.

    Information is presented on the administration of consumer education programs to train teachers and community group leaders who will be teaching consumer education in their own communities. Suggestions and examples are based on experience in creating and teaching such a program in consumer law in New York City. The first three chapters give…

  14. Training Consumer Educators: A Curriculum and Program Handbook. A Report on the Experience of the Consumer Law Training Center.

    Science.gov (United States)

    New York Law School, NY. Consumer Law Training Center.

    Information is presented on the administration of consumer education programs to train teachers and community group leaders who will be teaching consumer education in their own communities. Suggestions and examples are based on experience in creating and teaching such a program in consumer law in New York City. The first three chapters give…

  15. The War on Poverty’s Experiment in Public Medicine: Community Health Centers and the Mortality of Older Americans†

    Science.gov (United States)

    Bailey, Martha J.; Goodman-Bacon, Andrew

    2015-01-01

    This paper uses the rollout of the first Community Health Centers (CHCs) to study the longer-term health effects of increasing access to primary care. Within ten years, CHCs are associated with a reduction in age-adjusted mortality rates of 2 percent among those 50 and older. The implied 7 to 13 percent decrease in one-year mortality risk among beneficiaries amounts to 20 to 40 percent of the 1966 poor/non-poor mortality gap for this age group. Large effects for those 65 and older suggest that increased access to primary care has longer-term benefits, even for populations with near universal health insurance. (JEL H75, I12, I13, I18, I32, I38, J14) PMID:25999599

  16. Transcatheter Closure of Congenital Coronary Artery Fistulas with a Giant Coronary Artery Aneurysm in Children: Experiences from a Single Center

    Science.gov (United States)

    Li, Yi-Fan; Zhang, Zhi-Wei; Wang, Shu-Shui; Xie, Zhao-Feng; Zhang, Xu; Li, Yu-Fen

    2017-01-01

    Background: Transcatheter closure of congenital coronary artery fistulas (CCAFs) is an alternative therapy to surgery; however, data regarding transcatheter closure for CCAF with a giant coronary artery aneurysm (CAA) in pediatric patients are still limited due to the rarity of the disease. We aimed to evaluate the efficacy and safety of transcatheter closure for CCAF with a giant CAA in a pediatric population at a single center. Methods: Medical records of pediatric patients (aneurysm dilation after the second intervention. One patient experienced thrombus formation within the CAA after the procedure. Among those with closure at the entry point of the CAA, a mild-to-moderate residual shunt was detected in three patients. Conclusions: Transcatheter closure appears to be a safe and effective alternative therapy for CCAF with a giant CAA in the pediatric population. Closure at the entry point of the CAA, and closure at both the entry and exit points when feasible, may reduce the risk of postinterventional complications. PMID:28776543

  17. Total-skin electron irradiation for cutaneous T-cell lymphoma: The Northern Israel Oncology Center experience

    Energy Technology Data Exchange (ETDEWEB)

    Kuten, A.; Stein, M.; Mandelzweig, Y.; Tatcher, M.; Yaacov, G.; Epelbaum, R.; Rosenblatt, E. (Northern Israel Oncology Center, Haifa (Israel). Radiotherapy Unit)

    1991-07-01

    Total skin electron irradiation (TSEI) is effective and frequently used in the treatment of cutaneous T-cell lymphoma. A treatment technique has been developed at our center, using the Philips SL 75/10 linear accelerator. In our method, the patient is irradiated in a recumbent position by five pairs of uncollimated electron beams at a source to skin distance of 150 cm. This method provides a practical solution to clinical requirements with respect to uniformity of electron dose and low X-ray contamination. Its implementation does not require special equipment or modification of the linear accelerator. 19 of 23 patients (83%) with mycosis fungoides, treated by this method, achieved complete regression of their cutaneous lesions. (orig.).

  18. Association of interatrial septal abnormalities with cardiac impulse conduction disorders in adult patients: experience from a tertiary center in Kosovo.

    Directory of Open Access Journals (Sweden)

    Zaim Gashi

    2011-06-01

    Full Text Available Interatrial septal disorders, which include: atrial septal defect, patent foramen ovale and atrial septal aneurysm, are frequent congenital anomalies found in adult patients. Early detection of these anomalies is important to prevent their hemodynamic and/or thromboembolic consequences. The aims of this study were: to assess the association between impulse conduction disorders and anomalies of interatrial septum; to determine the prevalence of different types of interatrial septum abnormalities; to assess anatomic, hemodynamic, and clinical consequences of interatrial septal pathologies. Fifty-three adult patients with impulse conduction disorders and patients without ECG changes but with signs of interatrial septal abnormalities, who were referred to our center for echocardiography, were included in a prospective transesophageal echocardiography study. Intera trial septal anomalies were detected in around 85% of the examined patients.

  19. Intermediate photovoltaic system application experiment operational performance report. Volume 5 for Lovington Square Shopping Center, Lovington, NM

    Energy Technology Data Exchange (ETDEWEB)

    1981-12-01

    For the months of September and October, 1981, operational performance data are presented for a photovoltaic power system at a New Mexico shopping center. The electrical energy yield, incident solar energy, and efficiency of the solar cell array are given, including daily and monthly energy yield and insolation and efficiency, and energy yield as a function of power level, voltage, cell temperature, and hour of the day. Data are presented for two power conditioning units, including power conditioner input, output, and efficiency. The total photovoltaic system efficiency and capacity factor are given as well as daily availability data. Meteorological data include monthly insolation data, heating and cooling degree days, average monthly ambient temperature, monthly average wind speed and distribution of wind directions. Also included are plots of cell temperature, ambient temperature, wind speed, and insolation versus the hour of the day. Also included is a brief narrative description of the system operation and data. (LEW)

  20. Transdisciplinary cardiovascular and cancer health disparities training: experiences of the centers for population health and health disparities.

    Science.gov (United States)

    Golden, Sherita Hill; Ferketich, Amy; Boyington, Josephine; Dugan, Sheila; Garroutte, Eva; Kaufmann, Peter G; Krok, Jessica; Kuo, Alice; Ortega, Alexander N; Purnell, Tanjala; Srinivasan, Shobha

    2015-07-01

    The Centers for Population Health and Health Disparities program promotes multilevel and multifactorial health equity research and the building of research teams that are transdisciplinary. We summarized 5 areas of scientific training for empowering the next generation of health disparities investigators with research methods and skills that are needed to solve disparities and inequalities in cancer and cardiovascular disease. These areas include social epidemiology, multilevel modeling, health care systems or health care delivery, community-based participatory research, and implementation science. We reviewed the acquisition of the skill sets described in the training components; these skill sets will position trainees to become leaders capable of effecting significant change because they provide tools that can be used to address the complexities of issues that promote health disparities.

  1. [Psychiatric reform and substitutive mental health practices: an institutional reading of an experience at a psychosocial care center].

    Science.gov (United States)

    Koda, Mirna Yamazato; Fernandes, Maria Inês Assumpção

    2007-06-01

    This article discusses the development of mental health care services based on the Anti-Asylum Movement. Drawing on contributions from psychoanalysis and social psychology, the study analyzes the conflicts and dilemmas arising in a Psychosocial Care Center (NAPS) in Santos, São Paulo, Brazil. This study is part of Master's degree research at the Social and Occupational Psychology Department, Institute of Psychology, University of São Paulo. Semi-structured interviews were used with workers at the NAPS. According to the interviews, the transformation of the mental health care model mobilizes psychological issues among the workers. Various conflicts and anxieties were observed in relation to changes in the institutional support provided by the NAPS over time. The article analyzes difficulties in dealing with differences in the team or feelings of abandonment resulting from changes in the local administration in the interface between subjects and the institution.

  2. Moving Toward Patient-Centered Care in Africa: A Discrete Choice Experiment of Preferences for Delivery Care among 3,003 Tanzanian Women.

    Directory of Open Access Journals (Sweden)

    Elysia Larson

    Full Text Available In order to develop patient-centered care we need to know what patients want and how changing socio-demographic factors shape their preferences.We fielded a structured questionnaire that included a discrete choice experiment to investigate women's preferences for place of delivery care in four rural districts of Pwani Region, Tanzania. The discrete choice experiment consisted of six attributes: kind treatment by the health worker, health worker medical knowledge, modern equipment and medicines, facility privacy, facility cleanliness, and cost of visit. Each woman received eight choice questions. The influence of potential supply- and demand- side factors on patient preferences was evaluated using mixed logit models.3,003 women participated in the discrete choice experiment (93% response rate completing 23,947 choice tasks. The greatest predictor of health facility preference was kind treatment by doctor (β = 1.13, p<0.001, followed by having a doctor with excellent medical knowledge (β = 0.89 p<0.001 and modern medical equipment and drugs (β = 0.66 p<0.001. Preferences for all attributes except kindness and cost were changed with changes to education, primiparity, media exposure and distance to nearest hospital.Care quality, both technical and interpersonal, was more important than clinic inputs such as equipment and cleanliness. These results suggest that while basic clinic infrastructure is necessary, it is not sufficient for provision of high quality, patient-centered care. There is an urgent need to build an adequate, competent, and kind health workforce to raise facility delivery and promote patient-centered care.

  3. Review of Experience of a Statewide Poison Control Center With Pediatric Exposures to Oral Antineoplastic Drugs in the Nonmedical Setting.

    Science.gov (United States)

    Thornton, Stephen L; Liu, Jehnan; Soleymani, Kamyar; Romasco, Rebecca L; Farid, Hanieh; Clark, Richard F; Cantrell, F Lee

    2016-01-01

    The use of oral antineoplastic agents in nonmedical settings continues to increase. There are limited data available on pediatric exposures to these agents. We sought to identify characteristics of such exposures. We performed a retrospective review of database of a statewide poison system from 2000 to 2009 for all cases of pediatric exposures to oral antineoplastic agents, which took place in a nonmedical setting. Data collected include gender, age, agent of exposure, dose, drug concentration, reason for exposure, symptoms, outcomes, interventions, and length of hospital stay. There were a total of 328 patients. The mean average age was 4.1 years. Eighty-nine percentage (n = 293) was unintentional. Exposures to 21 different antineoplastic agents were identified. Methotrexate (n = 91) and 6-mercaptopurine (n = 47) were the most common agents encountered. Two hundred ninety-nine (91%) cases had no symptoms reported. When reported, gastrointestinal symptoms (n = 17) and central nervous system sedation (n = 6) were most common. One case of pancytopenia was reported. No deaths were reported in this series. Sixty-seven percent (n = 220) were managed at home, whereas 19 (6%) were admitted to a health care facility. Cases were followed by the poison control center for 0.34 days (SD = 1.40). In this study, exposures to oral antineoplastics were primarily unintentional, asymptomatic, and managed at home. Study limitations include possible reporting bias, inability to objectively confirm exposures, and limited duration of monitoring by the poison control center. In this retrospective review, no significant morbidity or mortality was reported from pediatric exposures to oral antineoplastic drugs in the nonmedical setting.

  4. Technical Failure of MR Elastography Examinations of the Liver: Experience from a Large Single-Center Study.

    Science.gov (United States)

    Wagner, Mathilde; Corcuera-Solano, Idoia; Lo, Grace; Esses, Steven; Liao, Joseph; Besa, Cecilia; Chen, Nelson; Abraham, Ginu; Fung, Maggie; Babb, James S; Ehman, Richard L; Taouli, Bachir

    2017-01-03

    Purpose To assess the determinants of technical failure of magnetic resonance (MR) elastography of the liver in a large single-center study. Materials and Methods This retrospective study was approved by the institutional review board. Seven hundred eighty-one MR elastography examinations performed in 691 consecutive patients (mean age, 58 years; male patients, 434 [62.8%]) in a single center between June 2013 and August 2014 were retrospectively evaluated. MR elastography was performed at 3.0 T (n = 443) or 1.5 T (n = 338) by using a gradient-recalled-echo pulse sequence. MR elastography and anatomic image analysis were performed by two observers. Additional observers measured liver T2* and fat fraction. Technical failure was defined as no pixel value with a confidence index higher than 95% and/or no apparent shear waves imaged. Logistic regression analysis was performed to assess potential predictive factors of technical failure of MR elastography. Results The technical failure rate of MR elastography at 1.5 T was 3.5% (12 of 338), while it was higher, 15.3% (68 of 443), at 3.0 T. On the basis of univariate analysis, body mass index, liver iron deposition, massive ascites, use of 3.0 T, presence of cirrhosis, and alcoholic liver disease were all significantly associated with failure of MR elastography (P technical failure rate of MR elastography with a gradient-recalled-echo pulse sequence was low at 1.5 T but substantially higher at 3.0 T. Massive ascites, iron deposition, and high body mass index were additional independent factors associated with failure of MR elastography of the liver with a two-dimensional gradient-recalled-echo pulse sequence. (©) RSNA, 2017.

  5. Patients' and procedural characteristics of AV-block during slow pathway modulation for AVNRT-single center 10year experience.

    Science.gov (United States)

    Wasmer, Kristina; Dechering, Dirk G; Köbe, Julia; Leitz, Patrick; Frommeyer, Gerrit; Lange, Phillip S; Kochhäuser, Simon; Reinke, Florian; Pott, Christian; Mönnig, Gerold; Breithardt, Günter; Eckardt, Lars

    2017-10-01

    Permanent AV-block is a recognized and feared complication of slow pathway modulation for AVNRT. We aimed to assess incidence of transient and permanent AV-block as well as consequences of transient AV-block in a large contemporary AVNRT ablation cohort. We searched our single center prospective ablation database for occurrence of transient and permanent AV-block during slow pathway modulation between January 2004 and October 2015. We analyzed patients' and procedural characteristics as well as outcome of patients in whom transient or permanent AV-block occurred. Of 9170 patients who underwent a catheter ablation at our institution between January 2004 and October 2015, 2101 patients (64% women, mean age 50±18years) underwent slow pathway modulation. In three patients, permanent AV-block occurred during RF application. Additional two patients had transient AV-block that recovered (after a few minutes and 25min), but recurred within two days of the procedure. All five patients underwent dual chamber pacemaker implantation (0.2%). Transient AV-block related to RF delivery occurred in 44 patients (2%). Transient mechanical AV-block occurred in additional 17 patients (0.8%). In 12 patients, ablation was continued despite transient AV-block. One of these patients developed permanent AV-block. Permanent AV-block following slow pathway modulation is a rare event, occurring in 0.2% of patients in a large contemporary single center cohort. Transient AV-block is more frequent (2%). Copyright © 2017 Elsevier B.V. All rights reserved.

  6. Lessons Learned from Delayed Versus Immediate Microsurgical Reconstruction of Complex Maxillectomy and Midfacial Defects: Experience in a Tertiary Center in Mexico.

    Science.gov (United States)

    Santamaria, Eric; de la Concha, Erika

    2016-10-01

    Microsurgical reconstruction of complex midfacial and maxillectomy defects is among the most challenging procedures in plastic surgery, and it often requires composite flaps to improve functional and aesthetic results. Various factors have been identified as having influence in the outcome of microsurgical reconstruction. In this article, the authors present their experience with immediate and delayed reconstruction of complex maxillectomy defects in a tertiary center in Mexico. The authors present a total of 37 patients with microsurgical reconstruction of a complex maxillectomy defect; 13 patients had immediate and 24 had delayed reconstructions. The authors recommend doing immediate reconstruction when feasible.

  7. Comparison of optimal cardiovascular risk factor management in patients with Type 2 diabetes who attended urban medical health center with those attended a tertiary care center: Experiences from Tehran, Iran

    Directory of Open Access Journals (Sweden)

    Sedighe Moradi

    2016-01-01

    Conclusions: Both centers have failure in target achievement in some risk factors; however, the inability of the primary care center in controlling hyperlipidemia in comparison with the tertiary center is a serious warning to provide training about managing dyslipidemia in these centers.

  8. Centers for permanent healthcare education: an analysis on the experience of social players in the north of the state of Paraná¹

    Directory of Open Access Journals (Sweden)

    Sônia Cristina Stefano Nicoletto

    2010-01-01

    Full Text Available The policy of continuing healthcare education (CHE aims to develop healthcare workers. With the objective of analyzing the process of implementing and developing the policy in Paraná, a qualitative study involving the six regions of this state is being concluded. This paper relates to the results from the northern region, focusing on the "experiencing CHE" category. In December 2006, two focus groups were conducted involving representatives from management, training, attendance and participation. The data underwent thematic content analysis. The first CHE encounters aroused feelings of mistrust and resistance, and the center was understood as a means of enabling courses and funding sources. There was a diversity of interests and little negotiating capacity. During the process, the study participants began to talk, reflect and participate. Their teamwork was a positive experience. This experience allowed them to recognize the power of CHE for linking and mobilizing different players.

  9. Comparison of peritonitis rates and patient survival in automated and continuous ambulatory peritoneal dialysis: a 10-year single center experience.

    Science.gov (United States)

    El-Reshaid, Wael; Al-Disawy, Hanan; Nassef, Hossameldeen; Alhelaly, Usama

    2016-09-01

    Peritonitis is a common complication in patients undergoing continuous ambulatory peritoneal dialysis (CAPD) and automated peritoneal dialysis (APD). In this retrospective study, peritonitis rates and patient survival of 180 patients on CAPD and 128 patients on APD were compared in the period from January 2005 to December 2014 at Al-Nafisi Center in Kuwait. All patients had prophylactic topical mupirocin at catheter exit site. Patients on CAPD had twin bag system with Y transfer set. The peritonitis rates were 1 in 29 months in CAPD and 1 in 38 months in APD (p peritonitis free patients over 10-year period in CAPD and APD were 49 and 60%, respectively (p peritonitis was 10.25 ± 3.1 months in CAPD compared to 16.1 ± 4 months in APD (p peritonitis was 13.1 ± 1 and 14 ± 1.4 months respectively (p = 0.3) whereas in peritonitis free patients it was 15 ± 1.4 months in CAPD and 23 ± 3.1 months in APD (p = 0.025). APD had lower incidence rate of peritonitis than CAPD. Patient survival was better in APD than CAPD in peritonitis free patients but was similar in patients who had peritonitis.

  10. Preparation of cell blocks for lung cancer diagnosis and prediction: protocol and experience of a high-volume center.

    Science.gov (United States)

    Kossakowski, Claudia A; Morresi-Hauf, Alicia; Schnabel, Philipp A; Eberhardt, Ralf; Herth, Felix J F; Warth, Arne

    2014-01-01

    Minimally invasive diagnostic techniques are increasingly being used to obtain specimens for pathological diagnosis and prediction. Referring to lung cancer, both endobronchial and endoesophageal ultrasound are used worldwide as diagnostic routine methods. Consequently, an increasing number of pathological samples are cytological and fewer are histological. On the other hand, the requirements for specific and sensitive tumor subtyping complemented by predictive analyses are steadily increasing and are an essential basis for evidence-based treatment decisions. In this article we focus on the cell block method as a helpful tool for diagnostic and predictive analyses in lung cancer and point out its advantages and disadvantages in comparison to conventional cytological and biopsy specimens. Furthermore, we retrospectively analyze the diagnostic results of the cell block method in a high-volume center over 5 years. The main advantages of cell blocks are the availability of established and validated protocols, archiving and the opportunity to have serial sections from the same specimens to provide or repeat molecular analyses. Actually, in case of tumor progression, even additional biomarkers can be tested using the original cell block when re-biopsies are not feasible. The cell block method should be considered as a reliable, complimentary approach to conventional cytological or biopsy procedures, which is helpful to fulfill the increasing requirements of high-quality diagnostics and prediction.

  11. Short-term follow-up results of percutaneous mitral balloon valvuloplasty: A single-center experience

    Directory of Open Access Journals (Sweden)

    Abdulkadir Yıldız

    2014-12-01

    Full Text Available Objective: We sought to analyze short-term clinical, echocardiographic, and hemodynamic consequences of percutaneous mitral balloon valvuloplasty (PMBV in the treatment of rheumatic mitral stenosis (MS in our clinic. Methods: We retrospectively reviewed 53 patients (49 females, 5 males; mean age 38±11 years who underwent PMBV for moderate or severe MS between January 2010 and October 2014. Procedural success was defined as the reaching a mitral valve area (MVA >1.5 cm2 and absence of grade 3 mitral regurgitation. Results: We were able to perform PMBV in 48 of 53 patients (91% and all the procedures that were completed were successful. PMBV couldn’t be performed in 3 patients due to inability to pass the mitral valve, 1 patient due to membranous obstructive vena cava and 1 patient due inability to perform septostomi. Two patients who underwent successful PMBV became symptomatic after an average of 14 months follow-up and mitral valve replacement was performed due to moderate-to-severe MS. Patients were followed for an average of 13 ± 8 months and atrial fibrillation development or embolic complications were not observed. Conclusion: Percutaneous mitral balloon valvuloplasty procedure is a safe and effective treatment approach with high success and low complication rates in experienced centers.

  12. Role of endoscopic ultrasonography in evaluation of metastatic lesions to the pancreas: a tertiary cancer center experience.

    Science.gov (United States)

    Atiq, Muslim; Bhutani, Manoop S; Ross, William A; Raju, Gottumukkala S; Gong, Yun; Tamm, Eric P; Javle, Milind; Wang, Xuemei; Lee, Jeffrey H

    2013-04-01

    Metastatic lesions to the pancreas pose diagnostic challenges with regards to their differentiation from primary pancreatic cancer. Data on the yield of endoscopic ultrasonography (EUS)-guided fine-needle aspiration in detection of these lesions are limited. This is a retrospective review of 23 patients referred to a tertiary referral center for further evaluation of suspected pancreatic metastases. Main outcome measures were diagnostic yield of endoscopic ultrasonography-guided fine-needle aspiration in evaluation of metastatic lesions to the pancreas. Of 644 patients, 23 (3.6%) undergoing EUS of the pancreas were diagnosed to have metastatic disease to the pancreas based on clinical, radiological, and cytological results. Mean (SD) age was 64.3 (11.7) years. Of the 23 patients, 18 (78.3%) were asymptomatic. Mean (SD) size of lesion on EUS was 39.1 (19.9) mm. A diagnosis of malignant lesion was made in 21 of 23 cases, with a diagnostic accuracy of 91.3%. Metastatic lesions to the pancreas present as incidental, solitary mass lesions on staging or surveillance imaging. Endoscopic ultrasonography-guided fine-needle aspiration is an important tool in the characterization and further differentiation of metastatic lesions to the pancreas from primary pancreatic cancer.

  13. Kidneys from Older Living Donors Provide Excellent Short and Intermediate Outcomes--A Single China Center's Experience.

    Science.gov (United States)

    Song, Turun; Fu, Lei; Rao, Zhengsheng; Zeng, Dongyang; Huang, Zhongli; Wang, Xianding; Chen, Mianzhi; Wei, Qiang; Lin, Tao

    2015-08-01

    Transplantation with kidneys from older living donors is on the rise, yet controversy still exists over whether the outcomes are as satisfactory as with kidneys from younger donors. We retrospectively analyzed 1009 living donor kidney transplants performed at our center between 2006 and 2013. Graft and patient outcomes were compared between transplants with kidneys from old living donors (OLD, 55-65 years) (n = 264) and from young living donors (YLD, transplantation was also similar for patients receiving YLD kidneys (98.5%, 97.1%, and 96.7%) and for patients receiving OLD kidneys (99.6%, 99.6%, and 96.8%; P = 0.110). The OLD kidneys were not associated with increased risk of death-censored graft failure (hazard ratio, 2.5; 95% confidence interval, 0.57 to 11.11) and patient death (hazard ratio, 1.67; 95% confidence interval, 0.75 to 3.73). In addition, there is no increased graft loss or patient death for each 10-year increase in donor age. Transplantation with OLD kidneys was not associated with reduced patient or graft outcomes in the short term (≤ 12 months) or medium term (>1 year). Graft and patient outcomes after living-donor kidney transplantation are similar in the short-term and medium-term for donors aged 55 to 65 years and for younger donors. Therefore, the use of OLD kidneys should be encouraged in China.

  14. Renal Transplantation Using Stone-bearing Deceased Donor Kidneys-Experience of a Transplant Center in China.

    Science.gov (United States)

    Chen, Chuan-Bao; Zhao, Liang; Han, Ming; Wang, Xiao-Ping; Zhou, Jian; Yuan, Xiao-Peng; Wang, Chang-Xi

    2017-09-01

    To evaluate the outcomes of transplantation of deceased donor stone-bearing kidneys. A total of 32 patients who received renal transplantation at our center from July 2011 to June 2016 were included. Eight recipients received kidneys with incidental renal stone(s) (stone group). Twenty-four recipients received kidneys without renal stones (non-stone group). The transplantation outcomes of the 2 groups were compared. There was 1 case of postoperative urinary tract infection in the stone group, and 2 cases in the non-stone group. No ureteral obstruction or hydronephrosis occurred in either group. No significant difference was found in the incidence of complications, serum creatinine level, and estimated glomerular filtration rate between the groups (all, P >.05). No deaths occurred in either group during the follow-up period. One recipient had postoperative calculi recurrence, and 4 recipients had residual calculi before transplantation. However, these patients had no symptomatic nephrolithiasis or obstruction, and their renal functions were normal. Transplantation of deceased donor stone-bearing kidneys can achieve comparable outcomes of deceased donor non-stone-bearing kidneys. Copyright © 2017 Elsevier Inc. All rights reserved.

  15. Percutaneous closure of atrial septal defects without balloon sizing in adults: Experience of a tertiary referral center

    Directory of Open Access Journals (Sweden)

    Hasan Kaya

    2013-03-01

    Full Text Available Objective: We aimed to evaluate our clinical experienceand short-term results of percutaneous closure of secundumtype atrial septal defects (ASD in adults.Methods: We studied 71 patients (49 female, 22 male,mean age 35±14 years undergoing percutaneous closureof ASD between January 2010-October 2012 in ourclinic. All procedures were performed under sedoanalgesiawithout balloon sizing. Clinical characteristics of patients,properties of percutaneous closure intervention,complications and short-term results are evaluated.Results: Defect diameter measured by transesophagealechocardiographic examination was 19.8±6.4 mm. Devicesize used for percutaneous closure was 24.7±6.7mm. Procedure was successfully performed in 67 patients(94%. Four patients were referred for surgery because ofprocedural failure. During procedure, a patient developedtransient 2nd degree AV block, and another developeddevice thrombosis. Residual shunt was detected in threepatients at first day control echocardiographic examination.In the follow-up of 13±8 months, no residual shunt,embolic or arrhythmic complications were observed.Conclusion: Percutaneous closure of secundum ASD isa safe and effective method with high success and lowcomplication rates in experienced centers. J Clin Exp Invest2013; 4 (1: 67-72Key words: Secundum atrial septal defect, percutaneousclosure, sedoanalgesia, transesophageal echocardiography

  16. Ten-year single-center experience of the ketogenic diet: factors influencing efficacy, tolerability, and compliance.

    Science.gov (United States)

    Wibisono, Cinthya; Rowe, Natalie; Beavis, Erin; Kepreotes, Helen; Mackie, Fiona E; Lawson, John A; Cardamone, Michael

    2015-04-01

    To evaluate the efficacy, tolerability, and compliance of 3 ketogenic diets, the classical ketogenic diet, medium-chain triglyceride (MCT), and modified Atkins diet. A single-center, retrospective study of 48 children with intractable epilepsy receiving ketogenic diets from 2003 to 2012. Patient demographics, epilepsy history, nutritional management, and side effects were collated. Compliance and tolerability were assessed by recording reasons for diet modification and cessation. The value of potassium citrate supplementation for preventing nephrolithiasis was reviewed. Median age at ketogenic diet initiation was 3.8 years (IQR: 2.3-7 years). The majority had intractable epilepsy, and 33 of the 48 children (69%) had epileptic encephalopathies. Three (6%) patients became seizure free, 35 (73%) reported Diet duration or ketogenic diet type did not predict reduction in seizures (P = .381; P = .272). Constipation (n = 31, 65%) was very common. Food refusal (n = 3, 6%) and poor parental compliance (n = 5, 10%) were common reasons cited for cessation. There were lower rates of side effects for modified Atkins diet. Diet cessation was greatest for MCT; however, 3 patients on MCT ceased therapy because adequate seizure control was achieved. Nephrolithiasis was reported in 1 patient before potassium citrate was used and 2 patients noncompliant with potassium citrate supplementation developed hypercalciuria. The 3 ketogenic diets were comparably effective in seizure control and generally well-tolerated. Potassium citrate supplementation is an effective prophylactic supplement for the prevention of nephrolithiasis. Crown Copyright © 2015. Published by Elsevier Inc. All rights reserved.

  17. Liquid Metal Processing and Casting Experiences at the U.S. Department of Energy's Albany Research Center

    Energy Technology Data Exchange (ETDEWEB)

    Jablonski, Paul D.; Turner, Paul C.

    2005-09-01

    In this paper we will discuss some of the early pioneering work as well as some of our more recent research. The Albany Research Center (ARC) has been involved with the melting and processing of metals since it was established in 1942. In the early days, hardly anything was known about melting refractory or reactive metals and as such, virtually everything had to be developed in-house. Besides the more common induction heated air-melt furnaces, ARC has built and/or utilized a wide variety of furnaces including vacuum arc remelt ingot and casting furnaces, cold wall induction furnaces, electric arc furnaces, cupola furnaces and reverberatory furnaces. The melt size of these furnaces range from several grams to a ton or more. We have used these furnaces to formulate custom alloys for wrought applications as well as for such casting techniques as spin casting, investment casting and lost foam casting among many. Two early spin-off industrializations were Wah Chang (wrought zirconium alloys for military and commercial nuclear applications) and Oremet (both wrought and cast Ti). Both of these companies are now part of the ATI Allegheny Ludlum Corporation.

  18. Five years' experience of preimplantation genetic diagnosis in the Parisian Center: outcome of the first 441 started cycles.

    Science.gov (United States)

    Feyereisen, Estelle; Steffann, Julie; Romana, Serge; Lelorc'h, Marc; Ray, Pierre; Kerbrat, Violaine; Tachdjian, Gérard; Frydman, René; Frydman, Nelly

    2007-01-01

    To investigate the evolution of techniques and strategies and to evaluate the results of preimplantation genetic diagnosis (PGD) from January 2000 to December 2004 in chromosomal, monogenic and mitochondrial DNA disorders treated at our institution. Retrospective study. Single French Parisian PGD center. Patients at risk of transmitting a serious genetic disorder to their offspring. 171 couples enrolled in the program undergoing stimulated and frozen embryo replacement cycles with PGD. Results of the 441 first PGD cycles performed for various genetic conditions. During 5 years, 416 stimulation and 25 frozen embryo replacement cycles were started, among which 52 clinical and 47 ongoing pregnancies occurred. In stimulation cycles, the overall ongoing pregnancy rate was 24% per embryo transfer, 11% per started cycle, and 27% per couple. The implantation rate was 16%. These encouraging results demonstrate that PGD might be considered as a valid alternative to prenatal diagnosis. Nevertheless, couples referred for PGD must be selected and counseled appropriately, considering the complexity of the treatment and the relatively low take-home baby rate.

  19. Etiology of Hypopituitarism in Adult Patients: The Experience of a Single Center Database in the Serbian Population

    Directory of Open Access Journals (Sweden)

    M. Doknić

    2017-01-01

    Full Text Available There are only a few published studies related to the population-based etiology of hypopituitarism. New risks for developing hypopituitarism have been recognized in the last 10 years. Aim. To present data regarding the etiology of hypopituitarism collected in a tertiary center over the last decade. This is a cross-sectional database study. Patients and Methods. We included 512 patients (pts with hypopituitarism, with a mean age of 45.9 ± 1.7 yrs (range: 18–82; male: 57.9%. Results. Nonfunctional pituitary adenomas were presented in 205 pts (40.5%, congenital causes in 74 pts (14.6%, while acromegaly and prolactinomas were presented in 37 (7.2% and 36 (7.0% patients, respectively. Craniopharyngiomas were detected in 30 pts (5.9%, and head trauma due to trauma brain injury-TBI and subarachnoid hemorrhage-SAH in 27 pts (5.4%. Survivors of hemorrhagic fever with renal syndrome (HFRS and those with previous cranial irradiation were presented in the same frequency (18 pts, 3.5% each. Conclusion. The most common causes of hypopituitarism in our database are pituitary adenomas. Increased awareness of the other causes of pituitary dysfunction, such as congenital, head trauma, extrapituitary cranial irradiation, and infections, is the reason for a higher frequency of these etiologies of hypopituitarism in the presented database.

  20. Bridging basic and clinical science with policy studies: The Partners with Transdisciplinary Tobacco Use Research Centers experience.

    Science.gov (United States)

    Kobus, Kimberly; Mermelstein, Robin

    2009-05-01

    The Partners with Transdisciplinary Tobacco Use Research Centers (TTURCs) initiative was a transdisciplinary team-building program, funded by the Robert Wood Johnson Foundation, to expand the policy research capacity of the TTURCs. EXPANSION INTO POLICY RESEARCh: Policy research activities at the TTURCs fell into four broad domains: (a) health services research, (b) examination of the business case for cessation treatment and funding, (c) collaborative teams with key stakeholders, and (d) direct assessment of smoking-related policies. Examples of each domain are presented. Goals of the initiative included efforts to foster collaborative, transdisciplinary research, to bring new investigators into the field, to develop programs of policy research, to answer next-step translational questions, and to enhance awareness of policy relevance. Success at meeting each of these goals is discussed. We offer recommendations for incorporating programs of policy research into full-spectrum transdisciplinary research initiatives, including the roles of research teams, senior researchers, infrastructure, stakeholders, and communications activities. The TTURC Partners initiative represented a first-generation effort to fill the gap between scientific discovery and research translation through expansion into policy studies. While all aspects of the effort were not equally successful, the effort demonstrated that it is possible to develop successful collaborations that extend more basic and applied research into studies that examine their policy and practice implications.

  1. Determinants of graft survival in pediatric and adolescent live donor kidney transplant recipients: a single center experience.

    Science.gov (United States)

    El-Husseini, Amr A; Foda, Mohamed A; Shokeir, Ahmed A; Shehab El-Din, Ahmed B; Sobh, Mohamed A; Ghoneim, Mohamed A

    2005-12-01

    To study the independent determinants of graft survival among pediatric and adolescent live donor kidney transplant recipients. Between March 1976 and March 2004, 1600 live donor kidney transplants were carried out in our center. Of them 284 were 20 yr old or younger (mean age 13.1 yr, ranging from 5 to 20 yr). Evaluation of the possible variables that may affect graft survival were carried out using univariate and multivariate analyses. Studied factors included age, gender, relation between donor and recipient, original kidney disease, ABO blood group, pretransplant blood transfusion, human leukocyte antigen (HLA) matching, pretransplant dialysis, height standard deviation score (SDS), pretransplant hypertension, cold ischemia time, number of renal arteries, ureteral anastomosis, time to diuresis, time of transplantation, occurrence of acute tubular necrosis (ATN), primary and secondary immunosuppression, total dose of steroids in the first 3 months, development of acute rejection and post-transplant hypertension. Using univariate analysis, the significant predictors for graft survival were HLA matching, type of primary urinary recontinuity, time to diuresis, ATN, acute rejection and post-transplant hypertension. The multivariate analysis restricted the significance to acute rejection and post-transplant hypertension. The independent determinants of graft survival in live-donor pediatric and adolescent renal transplant recipients are acute rejection and post-transplant hypertension.

  2. Contributing Factors for Complications and Outcomes in Patients With Snakebite: Experience in a Medical Center in Southern Taiwan.

    Science.gov (United States)

    Hsieh, Yu-Hsuan; Hsueh, Jung-Hua; Liu, Wen-Chung; Yang, Kuo-Chung; Hsu, Kuei-Chang; Lin, Cheng-Ta; Ho, Yen-Yi; Chen, Lee-Wei

    2017-03-01

    Snakebite usually results in various complications, such as significant soft tissue damage, infection, hematological, and neurological deficit. Surgical intervention, usually, is indicated in patients with tissue necrosis, infection, and compartment syndrome. To identify the contributing factors for complications and outcomes in different patients with snakebite so that outcomes can be evaluated and treatment of such patients can be initiated at the earliest. Information was collected regarding age, sex, underlying disease, species of snake, and the course of treatment of the victims of snakebite who visited the emergency department of a medical center in southern Taiwan between 2004 and 2014. The data obtained were analyzed using SPSS 20.0. The bites from Taiwan cobra (Naja naja atra) significantly resulted in more complications than those from other snakes and required surgical intervention. The use of antivenin and antibiotics, immediate presentation to the hospital, and the location of the bite also were significant contributing factors. Taiwan cobra significantly results in higher possibility of prolonged hospitalization, operation, tissue necrosis, infection, and necrotizing fasciitis. Location of the bite, immediate presentation to the hospital, and use of antivenin and antibiotics affect the outcome of snakebite. Knowledge of these factors will help in a better management of patients with snakebite.

  3. Donor safety in adult living donor liver transplantation using the right lobe:Single center experience in China

    Institute of Scientific and Technical Information of China (English)

    Fu-Gui Li; Lu-Nan Yan; Yong Zeng; Jia-Yin Yang; Qi-Yuan Lin; Xiao-Zhong Jiang; Bin Liu

    2007-01-01

    AIM: To evaluate the safety of donors in adult living donor liver transplantation (LDLT) using the right lobe in a single liver transplantation center in China.METHODS: We investigated retrospectively 52 living donor liver resections performed from October 2003 to July 2006. All patients were evaluated by blood tests and abdominal CT. The mean donor age was 28.2±7.4years. Residual liver volume was 42.1%±4.7%. Mean operative time was 420±76.2 min; mean ICU stay, less than 36 h; mean hospital stay, 16.4±8.6 d; and mean follow-up period, 6 mo.RESULTS: There was no mortality. The overall complication rate was 40% (21 donors). Major complications included biliary leak in two, and pneumonia in 2 donors. Minor complications included mild pleural effusion in 12 donors, transient ascites in 6, mild depression in 4, intra-abdominal collections in 2,and wound infections in 1 donor. Residual liver volume did not affect the complication rate. None required reoperation. Return to pre-donation activity occurred within 5-8 wk.CONCLUSION: Right hemi-hepatectomy can be performed safely with minimal risk in cases of careful donor selection. Major complications occurred in only 7.7% of our series.

  4. Achievement of Therapeutic Goals with Low-Dose Imiglucerase in Gaucher Disease: A Single-Center Experience

    Directory of Open Access Journals (Sweden)

    Irina Tukan

    2013-01-01

    Full Text Available Gaucher disease, a lysosomal storage disorder, is a multisystem disorder with variable and unpredictable onset and severity. Disease-specific enzyme replacement therapy (ERT has been shown to reverse or ameliorate disease-specific hepatosplenomegaly and anemia and thrombocytopenia. ERT also impacts bone manifestations, including bone crises, bone pain, and appearance of new osteonecrosis, and improves bone mineral density to varying degrees. The objective of this study was to assess achievement of predefined therapeutic goals based on international registry outcomes for Israeli patients with Gaucher disease receiving imiglucerase for four consecutive years on a low-dose regimen followed in a single center. All data were taken from patient files. The therapeutic goals were taken from standards published in the literature for disease-specific clinical parameters. Among 164 patients at baseline, values for spleen and liver volumes, hemoglobin and platelet counts, and Z-scores for lumbar spine and femoral were significantly different from the goal. After four years ERT, there was a significant improvement ( in each of the therapeutic goal parameters from baseline. 15.2% of these patients achieved all hematology-visceral goals. In children, there was achievement of linear growth and puberty. This survey highlights the good overall response in symptomatic patients receiving low-dose ERT with imiglucerase in Israel.

  5. Incidence of primary skin cancer after organ transplantation: An 18-year single-center experience in Korea.

    Science.gov (United States)

    Park, Gyeong-Hun; Chang, Sung Eun; Won, Chong Hyun; Lee, Mi Woo; Choi, Jee Ho; Moon, Kee Chan; Han, Duck Jong; Park, Su Kil; Kim, Jae-Joong; Lee, Jae Won; Lee, Sung-Gyu

    2014-03-01

    Skin cancer is the most common malignancy to arise after organ transplantation in Caucasians, but limited data are available on its incidence in Asian transplant recipients. We sought to assess the incidence of skin cancer after organ transplantation in a Korean cohort. A cohort study was conducted to determine the incidence and risk factors for skin cancers among kidney, liver, heart, or pancreas transplant recipients, treated at the Asan Medical Center in Seoul, Korea. The cumulative incidences of skin cancer were 0.70% at 5 years, 1.66% at 10 years, and 2.31% at 15 years. For all skin cancers, squamous cell carcinoma, basal cell carcinoma, and Kaposi sarcoma, the standardized incidence ratios between the recipients and the Korean general population were 30.9 (95% confidence interval, 12.4-63.6), 61.9 (12.8-180.8), 11.9 (0.3-66.1), and 565.2 (68.4-2041.6) after the end of the fifth posttransplantation year, respectively. We cannot exclude the possibility of both the underestimation because of potential missing cases and the overestimation because of the ascertainment bias. The incidence of posttransplantation skin cancer is very low in Korean patients. However, the risk of skin cancer in organ transplant recipients may be considerably higher than that in the Korean general population. Copyright © 2013 American Academy of Dermatology, Inc. Published by Mosby, Inc. All rights reserved.

  6. Outcomes of acute upper gastrointestinal bleeding in relation to timing of endoscopy and the experience of endoscopist: a tertiary center experience

    Science.gov (United States)

    Mohammed, Noor; Rehman, Amer; Swinscoe, Mark Thomas; Mundre, Pradeep; Rembacken, Bjorn

    2016-01-01

    Introduction: Patients with gastrointestinal bleeding admitted out of hours or at the weekends may have an excess mortality rate. The literature reports around this are conflicting. Aims and methods: We aimed to analyze the outcomes of emergency endoscopies performed out of hours and over the weekends in our center. We retrospectively analyzed data from April 2008 to June 2012. Results: A total of 507 ‘high risk’ emergency gastroscopies were carried out over the study period for various indications. Patients who died within 30 days of the index procedure [22 % (114 /510)] had a significantly higher Rockall score (7.6 vs. 6.0, P < 0.0001), a higher American Society of Anesthesiologists (ASA) status (3.5 vs. 2.7, P < 0.001), and a lower systolic blood pressure (BP) at the time of the examination (94.8 vs 103, P = 0.025). These patients were significantly older (77.7 vs. 67.5 years, P = 0.006), and required more blood transfusion (5.9 versus 3.8 units). Emergency out-of-hours endoscopy was not associated with an increased risk of death [relative risk (RR) 1.09, 95 % confidence interval (CI) 1.12 – 1.95]. Whether the examination was carried out by a senior specialist registrar (senior trainee) or a consultant made no difference to the survival of the patient (RR 0.98, CI 0.77 – 1.32). Conclusion: Higher pre-endoscopy Rockall score and ASA status contributed significantly to the 30-day mortality following upper gastrointestinal bleeding, whereas lower BP tended towards significance. Outcomes did not vary with the time of the endoscopy nor was there any difference between a consultant and a senior specialist registrar led service. PMID:27004244

  7. 电工电子实验教学示范中心建设探索%Exploration of Establishing Electrical and Electronic Experiment Center

    Institute of Scientific and Technical Information of China (English)

    郗艳华; 张辉; 王西明

    2013-01-01

    Students' practical ability and innovation ability can be promoted, the integration of resources sharing can be got, and school-running level and teaching quality can be enhanced by the construction of experimental teaching demonstration center. To improve power of professional applied talents training quality, exploration of the construction of electrical and electronic ex-perimental teaching demonstration center of ideas is provided by constructing the hierarchical experimental teaching system, opti-mizing experiment content, riching teaching methods and means, strengthening the construction of teaching staff and the experi-mental teaching platform construction.%实验教学示范中心建设能推动学生实践能力和创新能力培养,促进资源整合共享,提高学校办学水平和教学质量。该文提出了从构建实验教学平台,改革实验教学体系,优化实验教学方法和手段以及加强师资队伍建设等方面探索电工电子实验教学示范中心建设的思路,为提高电类专业应用型人才培养质量进行探讨。

  8. Three Experiments Examining the Use of Electroencephalogram,Event-Related Potentials, and Heart-Rate Variability for Real-Time Human-Centered Adaptive Automation Design

    Science.gov (United States)

    Prinzel, Lawrence J., III; Parasuraman, Raja; Freeman, Frederick G.; Scerbo, Mark W.; Mikulka, Peter J.; Pope, Alan T.

    2003-01-01

    Adaptive automation represents an advanced form of human-centered automation design. The approach to automation provides for real-time and model-based assessments of human-automation interaction, determines whether the human has entered into a hazardous state of awareness and then modulates the task environment to keep the operator in-the-loop , while maintaining an optimal state of task engagement and mental alertness. Because adaptive automation has not matured, numerous challenges remain, including what the criteria are, for determining when adaptive aiding and adaptive function allocation should take place. Human factors experts in the area have suggested a number of measures including the use of psychophysiology. This NASA Technical Paper reports on three experiments that examined the psychophysiological measures of event-related potentials, electroencephalogram, and heart-rate variability for real-time adaptive automation. The results of the experiments confirm the efficacy of these measures for use in both a developmental and operational role for adaptive automation design. The implications of these results and future directions for psychophysiology and human-centered automation design are discussed.

  9. Experiences in Bridging the Gap between Science and Decision Making at NASA's GSFC Earth Science Data and Information Services Center (GES DISC)

    Science.gov (United States)

    Kempler, Steven; Teng, Bill; Friedl, Lawrence; Lynnes, Chris; Leptoukh, Gregory

    2008-01-01

    Recognizing the significance of NASA remote sensing Earth science data in monitoring and better understanding our planet s natural environment, NASA has implemented the Decision Support Through Earth Science Research Results program (NASA ROSES solicitations). a) This successful program has yielded several monitoring, surveillance, and decision support systems through collaborations with benefiting organizations. b) The Goddard Space Flight Center (GSFC) Earth Sciences Data and Information Services Center (GES DISC) has participated in this program on two projects (one complete, one ongoing), and has had opportune ad hoc collaborations gaining much experience in the formulation, management, development, and implementation of decision support systems utilizing NASA Earth science data. c) In addition, GES DISC s understanding of Earth science missions and resulting data and information, including data structures, data usability and interpretation, data interoperability, and information management systems, enables the GES DISC to identify challenges that come with bringing science data to decision makers. d) The purpose of this presentation is to share GES DISC decision support system project experiences in regards to system sustainability, required data quality (versus timeliness), data provider understanding of how decisions are made, and the data receivers willingness to use new types of information to make decisions, as well as other topics. In addition, defining metrics that really evaluate success will be exemplified.

  10. The learning curve effect on embolization of cerebral dural arteriovenous fistula single-center experience in 48 consecutive patients.

    Science.gov (United States)

    Le Foll, D; Raoult, H; Ferré, J C; Naudet, F; Trystram, D; Gauvrit, J Y

    2017-02-01

    Cerebral dural arteriovenous fistulas (DAVFs) are rare intracranial vascular lesions but can cause significant morbidity and mortality. To analyze the effect of the center's experience on DAVF embolization efficacy and safety. From May 2008 to October 2014, 57 embolization procedures were attempted on 48 patients (37 men and 11 women; median age: 63.9 years) for DAVF in a single center. DAVF presented with cortical venous reflux in 44/48 cases (91.7%) and hemorrhagic manifestation in 21/48 cases (43.75%). Angiographic occlusion quality, whether complete or incomplete (efficacy), and neurological complications (safety) were recorded. The patient population was divided into four consecutive quartiles during the inclusion period to assess the progress profile. Efficacy and safety outcomes were compared with Fisher's test. A logistic regression was performed to explore a learning curve phenomenon, showing a significant association between the chronological rank in the cohort and embolization efficacy (P=0.007). Significant differences were found between first and last quarter (P=0.036). The endovascular technique involved an arterial injection of Onyx(®) in 36/48 cases (75%), administered via the middle meningeal artery in 25/36 cases (69.5%). The complete occlusion rate improved significantly from 33.3% for the first quartile of the population, to 75.0% for the 2nd and 3rd quartiles and 83.3% for the last quartile. Neurological complications were found in 7/48 patients (14.6%), the rate decreased by 41.7% to 16.7%, without statistically difference. The efficacy and safety of DAVF embolization improved with the experience gained at the center, suggesting the existence of a learning curve. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  11. Endoscopic submucosal dissection of early gastric neoplasia with a water jet-assisted knife: a Western, single-center experience.

    Science.gov (United States)

    Schumacher, Brigitte; Charton, Jean-Pierre; Nordmann, Thomas; Vieth, Michael; Enderle, Markus; Neuhaus, Horst

    2012-06-01

    Endoscopic submucosal dissection (ESD) of early gastric neoplasia has not yet been established in Western countries because of a lack of data and the difficult, time-consuming, and hazardous nature of the method. Some of the technical limitations may be overcome by use of a water jet-assisted knife, which allows a combination of a high-pressure water jet and electrosurgical interventions. To evaluate the efficacy and safety of water jet-assisted ESD (WESD) with a water jet-assisted knife in selected patients with early gastric neoplasia. Single-center, prospective study. This study involved 29 consecutive patients (13 female; median age 61 years; age range 35-93 years) with early gastric neoplasia that met the expanded criteria of the Japanese Gastric Cancer Association. Histology of biopsies had shown gastric adenocarcinoma in 21 cases, adenoma in 8 case, and suspicion of a GI stromal tumor in 1 case. The median maximal diameter of the lesions was 20 mm (range 10-40 mm). All procedures were done with patients under sedation with propofol. The water jet-assisted knife was used for setting coagulation markers around the neoplastic lesions, then for circumferential incision and dissection in combination with repeated submucosal injection of saline solution with a water jet system. Bleeding was treated with diathermia by use of the water jet-assisted knife or hemostatic forceps in case of failure or larger vessels. Clips were used for closure of perforations. Complete resection of neoplasia, procedure time, complication and recurrence rates. According to endoscopic criteria, complete resection of the targeted area could be achieved in all cases, with an en bloc resection rate of 90%. The median procedure duration was 74 minutes (range 15-402 minutes). Exchange of the device was needed in only 10 cases because of severe bleeding from larger vessels, which could be managed by use of hemostatic forceps. The 30-day morbidity rate was 4 of 30 (13.8%) because of

  12. Risk Factors of Road Traffic Accidents Associated Mortality in Northern Iran; A Single Center Experience Utilizing Oaxaca Blinder Decomposition.

    Science.gov (United States)

    Sherafati, Faranak; Homaie-Rad, Enayatollah; Afkar, Abolhassan; Gholampoor-Sigaroodi, Ramin; Sirusbakht, Soheil

    2017-04-01

    To investigate the differences in death after receiving emergency services in traffic accidents between urban and rural regions, and decompose factors of the gap in Langerood, Northern Iran. This cross-sectional study was conducted in Langrood, Northern Iran during a 1-year period from 2013 to 2014. The hospital data of traffic crashes were used. Data contained those patients who survived at the scene of accident. Injury severity score, time to admission, age, gender, season of crash and type of collision were variables used in this study. Oaxaca decomposition technique was used to show the amount of inequity. In addition, three regression models were used to show the reason of inequity. Overall 1520 patients with road traffic accidents were admitted to our center during the study period. The mean age of the patients was 35.45 ± 17.9 years, and there were 1158 (76.1 %) men among the victims. Motorbike accidents accounted for 869 (57.1%) injuries and 833 (54.8 %) accidents occurred in rural regions. The in-hospital mortality rate was 60 (3.9%). The results of this study showed that 95% of inequity came from factors used in this study and 2.04% disadvantages were for rural crashes. Severity of crash and time to admission had relationship with death, while the effects of time to admission was higher in rural region and severity of the accident had more effect on mortality in urban regions in comparison with rural ones. The high rate of fatal accidents could be decreased by deleting the gap of access to health care services between urban and rural regions. This study suggested that more efforts of health system are needed to reduce the gap.

  13. Association of interatrial septal abnormalities with cardiac impulse conduction disorders in adult patients: experience from a tertiary center in Kosovo

    Science.gov (United States)

    Bakalli, Aurora; Pllana, Ejup; Koçinaj, Dardan; Bekteshi, Tefik; Dragusha, Gani; Gashi, Masar; Musliu, Nebih; Gashi, Zaim

    2011-01-01

    Interatrial septal disorders, which include: atrial septal defect, patent foramen ovale and atrial septal aneurysm, are frequent congenital anomalies found in adult patients. Early detection of these anomalies is important to prevent their hemodynamic and/or thromboembolic consequences. The aims of this study were: to assess the association between impulse conduction disorders and anomalies of interatrial septum; to determine the prevalence of different types of interatrial septum abnormalities; to assess anatomic, hemodynamic, and clinical consequences of interatrial septal pathologies. Fifty-three adult patients with impulse conduction disorders and patients without ECG changes but with signs of interatrial septal abnormalities, who were referred to our center for echocardiography, were included in a prospective transesophageal echocardiography study. Interatrial septal anomalies were detected in around 85% of the examined patients. Patent foramen ovale was encountered in 32% of the patients, and in combination with atrial septal aneurysm in an additional 11.3% of cases. Atrial septal aneurysm and atrial septal defect were diagnosed with equal frequency in 20.7% of our study population. Impulse conduction disorders were significantly more suggestive of interatrial septal anomalies than clinical signs and symptoms observed in our patients (84.91% vs 30.19%, P=0.002). Right bundle branch block was the most frequent impulse conduction disorder, found in 41 (77.36%) cases. We conclude that interatrial septal anomalies are highly associated with impulse conduction disorders, particularly with right bundle branch block. Impulse conduction disorders are more indicative of interatrial septal abnormalities in earlier stages than can be understood from the patient’s clinical condition. PMID:21977304

  14. Clinical characteristics of non-perianal fistulating Crohn's disease in China: a single-center experience of 184 cases

    Institute of Scientific and Technical Information of China (English)

    WANG Ge-fei; REN Jian-an; LIU Song; CHEN Jun; GU Guo-sheng; WANG Xin-bo; FAN Chao-gang; LI Jie-shou

    2012-01-01

    Background There is little information of non-perianal fistulating Crohn's disease in the consensus published by the European Crohn's and Colitis Organization in 2006 and 2010.This study was designed to demonstrate the clinical characteristics of non-perianal fistulating Crohn's disease among homogenous Chinese population.Methods One-hundred-and-eighty-four patients were retrospectively collected.All of these patients were diagnosed of Crohn's disease between February 2001 and April 2011.Results The male-to-female ratio was 2.7:1.The most common symptoms at onset were abdominal pain (88.0%),diarrhea (34.7%),and fever (28.3%).The most common disease location and behavior at diagnosis were small bowel (56.0%) and penetrating (51.6%).Among 324 non-perianal fistulae,the most common types were ileocolonic anastomotic (30.9%),terminal ileocutaneous (19.7%),and enteroenteric anastomotic (11.4%).One-hundred-and-thirty-eight (75.0%) patients received antibiotics,and β-lactam (85.5%) and metronidazole (67.4%) are most frequently used.One-hundred-and-seventy-eight (96.7%) patients suffered 514 surgical operations,and the cumulative surgical rates after 1,3,and 5 years were 38.0%,52.2%,and 58.7% respectively.Nine patients died during the follow-up period,and the cumulative survival rates after 1,3,and 5 years were 97.8%,96.7%,and 96.2% respectively.Conclusions This study displayed the clinical characteristics of non-perianal fistulating Crohn's disease in our center.Large population-based studies are required for further investigation in China.

  15. An analysis of clinical process measures for acute healthcare delivery in Appalachia: The Roane Medical Center experience

    Directory of Open Access Journals (Sweden)

    Sills Eric

    2006-03-01

    Full Text Available Abstract Objective To survey management of selected emergency healthcare needs in a Tennessee community hospital. Materials and methods In this descriptive report, discharges and associated standard process measures were retrospectively studied for Roane Medical Center (RMC in Harriman, Tennessee (pop. 6,757. Hospital data were extracted from a nationwide database of short-term acute care hospitals to measure 16 quality performance measures in myocardial infarction (MI, heart failure, and pneumonia during the 14 month interval ending March 2005. The data also permitted comparisons with state and national reference groups. Results Of RMC patients with myocardial infarction (MI, 94% received aspirin on arrival, a figure higher than both state (85% and national (91% averages. Assessment of left ventricular dysfunction among heart failure patients was also higher at RMC (98% than the state (74% or national (79% average. For RMC pneumonia patients, 79% received antibiotics within 4 h of admission, which compared favorably with State (76% and national (75% average. RMC scored higher on 13 of 16 clinical process measures (p95% CI compared to state and national averages. Discussion Although acute health care needs are often met with limited resources in medically underserved regions, RMC performed above state and national average for most process measures assessed in this review. Our data were derived from one facility and the associated findings may not be applicable in other healthcare settings. Further studies are planned to track other parameters and specific clinical outcomes at RMC, as well as to identify specific institutional policies that facilitate attainment of target quality measures.

  16. The Role of Wrist Magnetic Resonance Arthrography in Diagnosing Triangular Fibrocartilage Complex Tears; Experience at King Hussein Medical Center, Jordan

    Directory of Open Access Journals (Sweden)

    Asem A. Al-Hiari

    2013-05-01

    Full Text Available Objectives: The aims of the study were to evaluate the role of magnetic resonance arthrography (MRA of the wrist in detecting full-thickness tears of the triangular fibrocartilage complex (TFCC and to compare the results of the magnetic resonance arthrography (MRA with the gold standard arthroscopic findings. Methods:The study was performed at King Hussein Medical Center, Amman, Jordan, between January 2008 and December 2011. A total of 42 patients (35 males and 7 females who had ulnar-sided wrist pain and clinical suspicions of TFCC tears were included in the study. All patients underwent wrist magnetic resonance arthrography (MRA and then a wrist arthroscopy. The results of MRA were compared with the arthroscopic findings. Results: After comparison with the arthroscopic findings, the MRA had three false-negative results (sensitivity = 93% and no false-positive results. A total of 39 patients were able to return to work. Satisfaction was high in 38 of the patients and 33 had satisfactorypain relief. The sensitivity of the wrist MRA in detecting TFCC full-thickness tears was 93% (39, and specificity was 80% (16/20. The overall accuracy of wrist arthroscopy in detecting a full-thickness tear of the TFCC in our study was 85% (29/34. Conclusion: These results illustrate the role of wrist MRA in assessing the TFCC pathology and suggest its use as the first imaging technique, following a plain X-ray, in evaluating patients with chronic ulnar side wrist pain with suspected TFCC injuries.

  17. Outcomes for primary kidney transplantation from donation after Citizens' death in China: a single center experience of 367 cases.

    Science.gov (United States)

    Xue, Wujun; Tian, Puxun; Xiang, Heli; Ding, Xiaoming; Pan, Xiaoming; Yan, Hang; Hou, Jun; Feng, Xinshun; Liu, Linjuan; Ding, Chenguang; Tian, Xiaohui; Li, Yang; Zheng, Jin

    2017-04-04

    The cases of donation after brain death followed by circulatory death (DBCD) and donation after cardiac death (DCD) have been increased year by year in China. Further research is needed to understand in the outcomes and risk factors of delayed graft function (DGF) in order to minimize the risk of DGF and ameliorate its potential impact on long-term outcomes. This study was to explore the differences in outcomes between DBCD and DCD transplant and the main risk factors for DGF in DBCD. Retrospective analysis of the clinical data of 367donations after citizens' death kidney transplant procedures (donors and recipients) between July 2012 and August 2015 at our center. During the study period, the donation success rate was 25.3%. 164 cases of DBCD and 35 cases of DCD had been implemented and 367 kidneys were transplanted. The incidence of DGF in DBCD group were significantly lower than that of DCD group (12.0% vs. 27.0%, p = 0.002). The 1-year percent freedom from acute rejection (AR) was significantly higher in DBCD group compared with it of DCD group (94% vs. 82%, p = 0.036). Multivariate logistic regression analysis of the kidney transplants revealed that the high risk factors for DGF after renal transplantation in DBCD were history of hypertension (Odds Ratio [OR] = 5.88, 95% CI: 1.90 to 18.2, p = 0.002), low blood pressure (BP transplants are donors with a history of hypertension, low blood pressure, and serum creatinine of donor before donation.

  18. Treatment and outcome of intestinal perforation after liver transplant surgery in adults: a single-center experience

    Directory of Open Access Journals (Sweden)

    Lin J

    2017-05-01

    Full Text Available Jianyu Lin,1,* Jing Wang,2,* Peng Yue,3 Xingmao Zhang,4 Ren Lang,4 Yuan Wang,4 Chen Cui,4 Qiang He4 1Integrated Department, 2Patient Service Center, The Affiliated Hospital to Capital Medical University, Beijing Chaoyang Hospital, 3School of Nursing, Department of Basic Nursing, Capital Medical University, 4Department of Hepatobiliary Surgery, The Affiliated Hospital to Capital Medical University, Beijing Chaoyang Hospital, Beijing, People’s Republic of China *These authors contributed equally to this work Objective: Intestinal perforation is a rare complication after liver transplantation. This study was designed to calculate the incidence and investigate the outcomes of intestinal perforation in adult liver transplant patients.Materials and methods: The clinical records of liver transplant recipients between January 2014 and June 2016 were obtained. The incidence of intestinal perforation was calculated, and high risk factors were analyzed.Results: The mean operative time was 8.5 h (range: 6–11 h. The mean portal vein occlusion time was 66.5 min (range: 58–72 min, and the mean cold ischemia time was 7.9 h (range: 6.5–9.5 h. Four (2.7% patients developed intestinal perforation from 9 to 14 days postliver transplant. All perforations were single and repaired by interrupted silk sutures. Two patients uneventfully recovered, but intestinal perforation recurred in two other patients. Simple repair was undertaken in one patient, and terminal ileum resection and ileostomy were performed in the other patient. There were no perioperative deaths.Conclusion: The incidence of intestinal perforation after liver transplantation is low. Prompt diagnosis and treatment should be carried out to reduce comorbidities and mortality. Keywords: liver transplant, intestinal perforation, incidence, treatment, nursing

  19. MR-guided vacuum-assisted breast biopsy of MRI-only lesions: a single center experience

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    Spick, Claudio; Schernthaner, Melanie; Pinker, Katja; Kapetas, Panagiotis; Bernathova, Maria; Polanec, Stephan H.; Bickel, Hubert; Wengert, Georg J.; Helbich, Thomas H.; Baltzer, Pascal A. [Medical University of Vienna (AKH), Department of Biomedical Imaging and Image-guided Therapy, Division of Molecular and Gender Imaging, Wien (Austria); Rudas, Margaretha [Medical University of Vienna (AKH), Clinical Institute of Pathology, Wien (Austria)

    2016-11-15

    The purpose of this study was to compare three different biopsy devices on false-negative and underestimation rates in MR-guided, vacuum-assisted breast biopsy (VABB) of MRI-only lesions. This retrospective, single-center study was IRB-approved. Informed consent was waived. 467 consecutive patients underwent 487 MR-guided VABB using three different 8-10-gauge-VABB devices (Atec-9-gauge,A; Mammotome-8-gauge,M; Vacora-10-gauge,V). VABB data (lesion-type, size, biopsy device, histopathology) were compared to final diagnosis (surgery, n = 210 and follow-up, n = 277). Chi-square, and Kruskal-Wallis tests were applied. P values < 0.05 were considered significant. Final diagnosis was malignant in 104 (21.4 %), high risk in 64 (13.1 %) and benign in 319 (65.5 %) cases. Eleven of 328 (3.4 %) benign-rated lesions were false-negative (1/95, 1.1 %, A; 2/73, 2.7 %, M; 8/160 5.0 % V; P = 0.095). Eleven high-risk (11/77, 14.3 %) lesions proved to be malignant (3/26, 11.5 % A; 4/12, 33.3 % M; 4/39, 10.3 % V; P = 0.228). Five of 34 (14.7 %) DCIS were upgraded to invasive cancer (2/15, 13.3 %, A; 1/6, 16.6 % M; 2/13, 15.3 %, V; P = 0.977). Lesion size (P = 0.05) and type (mass vs. non-mass, P = 0.107) did not differ significantly. MR-guided VABB is an accurate method for diagnosis of MRI-only lesions. No significant differences on false-negative and underestimation rates were observed between three different biopsy devices. (orig.)

  20. Etiology and clinical characteristics of fever of unknown origin in children: a 15-year experience in a single center.

    Science.gov (United States)

    Kim, Yi-Seul; Kim, Kyung-Ran; Kang, Ji-Man; Kim, Jong-Min; Kim, Yae-Jean

    2017-03-01

    Fever is one of the most common symptoms in children. In previous studies, infectious disease was the most common cause of pediatric fever of unknown origin (FUO). The aim of this study is to investigate the etiology, clinical characteristics and prognosis of pediatric FUO in 21 century with more diagnostics available and to analyze the factors for certain disease categories. Among the children under 18 years old who were hospitalized at Samsung Medical Center from January 2000 to December 2014, the patients who met the criteria including fever of ≥38.0℃ for longer than ≥14 days and failure to reach a diagnosis after one week of investigations were included. Total 100 patients were identified. Confirmed diagnosis was achieved in 57 patients (57%). Among them, infectious diseases (n=19, 19%) were most common, followed by connective tissue diseases (n=15, 15%), necrotizing lymphadenitis (n=8, 8%), and malignancies (n=7, 7%). Children with fever duration over 28 days had a trend for higher frequency of connective tissue diseases (28.3%) except undiagnosed etiology. The symptoms such as arthritis, lymph node enlargement and only fever without other symptoms were significantly related with connective tissue diseases, necrotizing lymphadenitis and undiagnosed respectively (P<0.001). Ninety-two patients have become afebrile at discharge and 1 patient died (1%). Almost half of our patients were left without diagnosis. Although it has been known that infectious disease was most common cause of pediatric FUO in the past, undiagnosed portion of FUO have now increased due to development of diagnostic techniques for infectious diseases.

  1. Spinal Epidural Abscess in Adults: A 10-Year Clinical Experience at a Tertiary Care Academic Medical Center.

    Science.gov (United States)

    Artenstein, Andrew W; Friderici, Jennifer; Holers, Adam; Lewis, Deirdre; Fitzgerald, Jan; Visintainer, Paul

    2016-10-01

    Background.  Delayed recognition of spinal epidural abscess (SEA) contributes to poor outcomes from this highly morbid and potentially lethal infection. We performed a case-control study in a regional, high-volume, tertiary care, academic medical center over the years 2005-2015 to assess the potential changing epidemiology, clinical and laboratory manifestations, and course of this disorder and to identify factors that might lead to early identification of SEA. Methods.  Diagnostic billing codes consistent with SEA were used to identify inpatient admissions for abstraction. Subjects were categorized as cases or controls based on the results of spinal imaging studies. Characteristics were compared using Fisher's exact or Kruskal-Wallis tests. All P values were 2-sided with a critical threshold of <.05. Results.  We identified 162 cases and 88 controls during the study period. The incidence of SEA increased from 2.5 to 8.0 per 10 000 admissions, a 3.3-fold change from 2005 to 2015 (P < .001 for the linear trend). Compared with controls, cases were significantly more likely to have experienced at least 1 previous healthcare visit or received antimicrobials within 30 days of admission; to have comorbidities of injection drug use, alcohol abuse, or obesity; and to manifest fever or rigors. Cases were also more likely to harbor coinfection at a noncontiguous site. When available, inflammatory markers were noted to be markedly elevated in cases. Focal neurologic deficits were seen with similar frequencies in both groups. Conclusions.  Based on our analysis, it appears that selected factors noted at the time of clinical presentation may facilitate early recognition of SEA.

  2. Radiological imaging features and clinicopathological correlation of hemosiderotic fibrolipomatous tumor: experience in a single tertiary cancer center

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    O' Driscoll, Dearbhail; Athanasian, Edward; Hameed, Meera; Hwang, Sinchun [Memorial Sloan Kettering Cancer Center, New York, NY (United States)

    2015-05-01

    To determine the imaging features of hemosiderotic fibrolipomatous tumor (HFLT), which has a propensity towards local recurrence and the potential to transform into myxoinflammatory fibroblastic sarcoma (MIFS). The study included 8 patients with a diagnosis of HFLT and imaging at a tertiary cancer center. Imaging studies included radiographs (n = 2), ultrasound (n = 3), and MRI (n = 16). Imaging features were evaluated including location, calcification, sonographic echogenicity, vascular flow, size, border, signal characteristics, contrast enhancement, and blooming on MRI. The HFLT was located in the ankle/foot in 4 out of 8 and was subcutaneous in 8 out of 8, ranging in size from 2 to 18 cm. Histology at initial diagnosis was HFLT in 5 out of 8 and HFLT with MIFS in 3 out of 8. None was calcified on radiography. On ultrasound 2 out of 3 were heterogeneously echogenic with ≥10 foci of vascular flow. Two out of 8 patients had MRI only at local recurrence. The tumor border was infiltrative in 4 out of 6 at initial diagnosis and in 2 patients with MRI at recurrence only. Fat and septae were present in 7 out of 8 at initial diagnosis and at recurrence. Signal intensity was iso-/hypointense to muscle on T1-weighted sequences in more than two thirds of the tumor in 4 out of 7 and hyperintense to muscle in at least one third of the tumor on fluid-sensitive sequences in 6 out of 8. Contrast enhancement was heterogeneous in 7 out of 7; blooming in two thirds of the tumor on gradient-echo sequence MRI indicated hemorrhage. The HFLT commonly presents as a mass with an infiltrative border, interspersed fat and septations at initial diagnosis and local recurrence on MRI regardless of histology of HFLT alone or with MIFS. Hemosiderin deposits may be detected as blooming on gradient-echo sequences. (orig.)

  3. Clinical utility of panfungal polymerase chain reaction for the diagnosis of invasive fungal disease: a single center experience.

    Science.gov (United States)

    Trubiano, J A; Dennison, A M; Morrissey, C O; Chua, K Y; Halliday, C L; Chen, S C-A; Spelman, D

    2016-02-01

    The role of panfungal polymerase chain reaction (PCR) assays for diagnosis of invasive fungal disease (IFD) is inadequately defined. We describe the use of an internal transcribed spacer 1 (ITS-1) region-directed panfungal PCR in this context at a tertiary referral transplant center. A retrospective review of patients at Alfred Health, Melbourne, Australia (2009-2014) who had clinical samples referred for panfungal PCR testing was conducted. Baseline patient characteristics, antifungal drug history, fungal culture/histopathology, and radiology results were recorded. For bronchoalveolar lavage (BAL) fluid samples, identification of a fungus other than a Candida spp. was defined as a potential pathogen.Of 138 panfungal PCR tests (108 patients), 41 (30%) were positive for a fungal product. Ninety-seven percent (134/138) of specimens were from immunocompromised hosts. Thirteen percent (19/138) of panfungal PCR positive results were for potential pathogens and potential pathogens were detected more frequently in tissue as compared with BAL (12/13 vs. 6/26; P = .0001). No positive panfungal PCR results were obtained from CSF specimens. If histopathology examination was negative, panfungal PCR identified a potential pathogen in only 12% (11/94) of specimens. For the 20 culture negative/histopathology positive specimens, diagnosis of IFD to causative species level by panfungal PCR occurred in 35% (6/20).Sterile site specimens, in particular tissue, were more frequently panfungal PCR positive for potential pathogens than BAL. The utility of panfungal PCR appears greatest in tissue specimens, as an adjunct to histopathology to improve diagnostic sensitivity and specificity. Based on the results of this study we are now only testing tissue specimens by panfungal PCR.

  4. Clinical Impact and Cost-Effectiveness of Whole Exome Sequencing as a Diagnostic Tool: A Pediatric Center's Experience.

    Science.gov (United States)

    Valencia, C Alexander; Husami, Ammar; Holle, Jennifer; Johnson, Judith A; Qian, Yaping; Mathur, Abhinav; Wei, Chao; Indugula, Subba Rao; Zou, Fanggeng; Meng, Haiying; Wang, Lijun; Li, Xia; Fisher, Rachel; Tan, Tony; Hogart Begtrup, Amber; Collins, Kathleen; Wusik, Katie A; Neilson, Derek; Burrow, Thomas; Schorry, Elizabeth; Hopkin, Robert; Keddache, Mehdi; Harley, John Barker; Kaufman, Kenneth M; Zhang, Kejian

    2015-01-01

    There are limited reports of the use of whole exome sequencing (WES) as a clinical diagnostic tool. Moreover, there are no reports addressing the cost burden associated with genetic tests performed prior to WES. We demonstrate the performance characteristics of WES in a pediatric setting by describing our patient cohort, calculating the diagnostic yield, and detailing the patients for whom clinical management was altered. Moreover, we examined the potential cost-effectiveness of WES by examining the cost burden of diagnostic workups. To determine the clinical utility of our hospital's clinical WES, we performed a retrospective review of the first 40 cases. We utilized dual bioinformatics analyses pipelines based on commercially available software and in-house tools. Of the first 40 clinical cases, we identified genetic defects in 12 (30%) patients, of which 47% of the mutations were previously unreported in the literature. Among the 12 patients with positive findings, seven have autosomal dominant disease and five have autosomal recessive disease. Ninety percent of the cohort opted to receive secondary findings and of those, secondary medical actionable results were returned in three cases. Among these positive cases, there are a number of novel mutations that are being reported here. The diagnostic workup included a significant number of genetic tests with microarray and single-gene sequencing being the most popular tests. Significantly, genetic diagnosis from WES led to altered patient medical management in positive cases. We demonstrate the clinical utility of WES by establishing the clinical diagnostic rate and its impact on medical management in a large pediatric center. The cost-effectiveness of WES was demonstrated by ending the diagnostic odyssey in positive cases. Also, in some cases it may be most cost-effective to directly perform WES. WES provides a unique glimpse into the complexity of genetic disorders.

  5. Pelvic Inflammatory Disease in Virgin Women With Tubo-ovarian Abscess: A Single-Center Experience and Literature Review.

    Science.gov (United States)

    Cho, Hyun-Woong; Koo, Yu-Jin; Min, Kyung-Jin; Hong, Jin-Hwa; Lee, Jae-Kwan

    2017-04-01

    To evaluate the incidence of pelvic inflammatory disease (PID) in virgin women and investigate the clinical characteristics of the patients. Retrospective chart review and literature review. Tertiary academic center. Virgin women who were confirmed to have PID via surgery from 2002 to 2014. None. The evaluation of medicosurgical history, clinical progress, surgical record, and pathologic reports. Of 122 patients diagnosed with PID via surgery, 5 women were virgins (4.1%). The median age was 21 years (range, 14-24 years), and all patients presented with abdominal pain. The median diameter of the pelvic abscess pocket on preoperative imaging was 4.5 cm (range, 2.6-15 cm). Only 1 case was preoperatively diagnosed as a tubo-ovarian abscess; the others were expected to be benign ovarian tumors, such as endometrioma and dermoid cysts. No possible source of infection was identified for any patient, except 1 who had a history of an appendectomy because of a ruptured appendix. The results of the histopathological analysis of the excisional biopsy performed during surgery in 4 cases were consistent with acute suppurative inflammation. After postoperative antibiotic use, the conditions of all patients stabilized, and they were discharged from the hospital on median postoperative day 9. PID in virgin women is rare, but it should be considered in all women with abdominal pain, regardless of sexual history. Copyright © 2017 North American Society for Pediatric and Adolescent Gynecology. Published by Elsevier Inc. All rights reserved.

  6. Vaginal birth after cesarean section: 10 years of experience in a tertiary medical center in Taiwan.

    Science.gov (United States)

    Li, Wai-Hou; Yang, Ming-Jie; Wang, Peng-Hui; Juang, Chi-Mou; Chang, Yi-Wen; Wang, Hsing-I; Chen, Chih-Yao; Yen, Ming-Shyen

    2016-06-01

    Because of the increased risk of uterine rupture and other morbidities, instances of trial of labor after cesarean (TOLAC) have decreased in number each year. Nevertheless, under careful assessment and advanced medical care, TOLAC is still a safe option for delivery. The objective of this study is to find the factors that impact the success rate for TOLAC and to compare the results with Taiwan national registry data. A longitudinal cohort study that includes a total of 254 cases of women receiving TOLAC in a tertiary medical center over a period of 10 years. A total of 254 participants who underwent TOLAC, which accounts for 1.67% of total labor instances (254/15,166), were enrolled for analysis. The success rate of TOLAC was found to be 80.70% (205/254), including 146 (57.5%) normal deliveries, 45 (17.7%) vacuum-assisted deliveries, and 14 (5.5%) forceps-assisted deliveries. The conversion rate to cesarean section was 19.3%. There were no uterine rupture cases in our study, and there were only two suspected cases, which turned out to have no actual rupture. When analyzing the factors affecting the results of TOLAC, we found that a successfully spontaneously delivered baby had a lower birth weight than the failed TOLAC cases that were converted to cesarean delivery (mean, 2989 g vs. 3379 g; p cesarean section, the most common reason was dysfunctional labor (79.6%), followed by fetal distress (14.3%). Under intensive care and observation, TOLAC section may still be a feasible choice. Nevertheless, the body weight of the baby has been shown to be a factor that can influence the success rate. Copyright © 2016. Published by Elsevier B.V.

  7. Hematopoietic Stem Cell Transplantations for Primary Immune Deficiencies: 3 Decades of Experience From a Tertiary Medical Center.

    Science.gov (United States)

    Rousso, Sharon Z; Shamriz, Oded; Zilkha, Amir; Braun, Jacques; Averbuch, Diana; Or, Reuven; Weintraub, Michael; Revel-Vilk, Shoshana; Stepensky, Polina

    2015-07-01

    Hematopoietic stem cell transplantation (HSCT) remains the leading treatment for the majority of severe primary immune deficiency (PID). This study aims to analyze changes in outcome over time. We conducted a retrospective analysis of HSCT in children with PID in a tertiary medical center over the period of 1983 to 2012. We identified 93 children with PID with a median follow-up of 3.6 years (range, 29 d to 21.2 y) after HSCT. The 2-year survival rates after HSCT for children with severe combined immune deficiency, hemophagocytic lymphohistiocytosis/lymphoproliferative disease, Wiskott-Aldrich syndrome, granulocyte defect, and undefined PID were 65.7%±6.8%, 80%±10.3%, 83.3%±15.2%, 75%±12.5%, and 25%±21.7%, respectively. Survival was associated with year of HSCT and matching. The hazard ratio (HR) (95% CI) for HSCT done in 1983 to 1999 compared with 2000 to 2012 and for matched (related and unrelated) compared with mismatched donor were 2.14 (0.99 to 4.653) and 3.07 (1.46 to 6.4), respectively. Survival was not associated with age, sex of the recipient, underlying PID, conditioning regimen, and presence of acute graft-versus-host disease. After adjustment to the underlying PID, donor and use of fludarabine-based conditioning, the HR (95% CI) for HSCT from the year 2000 was 4.69 (range, 1.4 to 15.45). Advances in HSCT over time have improved the survival of children with PID.

  8. Prenatal diagnosis and outcome of absent pulmonary valve syndrome: contemporary single-center experience and review of the literature.

    Science.gov (United States)

    Wertaschnigg, D; Jaeggi, M; Chitayat, D; Shannon, P; Ryan, G; Thompson, M; Yoo, S J; Jaeggi, E

    2013-02-01

    To review the anomaly spectrum of prenatally detected absent pulmonary valve syndrome (APVS) and the outcome after diagnosis. Previous fetal studies reported survival rates of ≤ 25% for patients with intended postnatal care. Clinical data and echocardiograms of 12 cases with a fetal diagnosis of APVS between 2000 and 2010 were analyzed in this retrospective single-center study. Collected parameters included: gestational age at referral, associated fetal abnormalities, cardiothoracic ratio, maximum diameters of pulmonary annulus and main and branch pulmonary arteries, ventricular dimensions and function as well as ventricular Doppler flows. Karyotyping included fluorescence in-situ hybridization (FISH) analysis for microdeletion 22q11.2. Median gestational age at diagnosis was 24 weeks. Three subtypes of APVS were observed: (1) with tetralogy of Fallot (TOF) and no arterial duct (n = 10; 83%); (2) isolated, with a large arterial duct (n = 1; 8%); and (3) with tricuspid atresia, right ventricular dysplasia and a restricted duct (n = 1; 8%). The cardiothoracic ratio and pulmonary artery dimensions were increased in all cases. The karyotype was abnormal in 70% of fetuses with TOF and their mortality rate was significantly higher due to pregnancy termination (n = 3) or perinatal demise (n = 2) (hazard ratio, 5; 95% CI, 0.87-28.9; P = 0.015). Of seven live births with active postnatal care, six children (86%) were alive without residual respiratory symptoms at a median follow-up of 4.7 (range, 2.1-10.6) years. Outcome after fetal diagnosis of APVS was significantly better in this study compared with those of previous fetal series, with a low mortality rate for actively managed patients. Copyright © 2012 ISUOG. Published by John Wiley & Sons, Ltd.

  9. Quality Improvement in the National Cancer Institute Community Cancer Centers Program: The Quality Oncology Practice Initiative Experience

    Science.gov (United States)

    Siegel, Robert D.; Castro, Kathleen M.; Eisenstein, Jana; Stallings, Holley; Hegedus, Patricia D.; Bryant, Donna M.; Kadlubek, Pam J.; Clauser, Steven B.

    2015-01-01

    Purpose: The National Cancer Institute (NCI) Community Cancer Centers Program (NCCCP) began in 2007; it is a network of community-based hospitals funded by the NCI. Quality of care is an NCCCP priority, with participation in the American Society of Clinical Oncology Quality Oncology Practice Initiative (QOPI) playing a fundamental role in quality assessment and quality improvement (QI) projects. Using QOPI methodology, performance on quality measures was analyzed two times per year over a 3-year period to enhance our implementation of quality standards at NCCCP hospitals. Methods: A data-sharing agreement allowed individual-practice QOPI data to be electronically sent to the NCI. Aggregated data with the other NCCCP QOPI participants were presented to the network via Webinars. The NCCCP Quality of Care Subcommittee selected areas in which to focus subsequent QI efforts, and high-performing practices shared voluntarily their QI best practices with the network. Results: QOPI results were compiled semiannually between fall 2010 and fall 2013. The network concentrated on measures with a quality score of ≤ 0.75 and planned voluntary group-wide QI interventions. We identified 13 measures in which the NCCCP fell at or below the designated quality score in fall 2010. After implementing a variety of QI initiatives, the network registered improvements in all parameters except one (use of treatment summaries). Conclusion: Using the NCCCP as a paradigm, QOPI metrics provide a useful platform for group-wide measurement of quality performance. In addition, these measurements can be used to assess the effectiveness of QI initiatives. PMID:25538082

  10. The 17-year single-center experience with the use of azathioprine to maintain remission in ulcerative colitis.

    Science.gov (United States)

    Actis, Giovanni C; Fadda, Maurizio; Pellicano, Rinaldo; David, Ezio; Rizzetto, Mario; Sapino, Anna

    2009-06-01

    Despite the accumulation of positive data, the role of azathioprine (AZA) in the maintenance of remission of ulcerative colitis is still controversial. We looked at the follow-up of the ulcerative colitis patients who, after responding to either steroids or cyclosporin (CsA), received AZA at our referral center for over a decade. The 39 patients (29 m/10f) were treated between 1991 and 2007. Twenty-five of them had responded to CsA, the remaining 14 to corticosteroids. AZA was usually overlapped with either of the two agents at the initial dose of 2mg/kg/day. The definitions of remission, relapse, and AZA toxicity followed commonly agreed criteria. The median duration of the AZA treatment was 14 months (<1-201). Fifty-two percent and 14%, respectively, of the CsA and the steroid responders needed surgery (overall rate=38%). The figures were 32 and 15 at the first year. The majority of the patients had 1-2 relapses often in connection with withdrawal of AZA; only 3 of these relapsers needed hospitalization. AZA caused toxicity in 16/39 (41%) patients, requiring withdrawal in 23% of the cases; leukopenia (17%) and hepatitis/cholestasis (10%) ranked first and second for frequency. All of the patients in whom AZA was stopped (or reduced) relapsed. In conclusion, the 1-year colectomy rates compare favorably with the figures reported by the literature. By contrast, the toxicity rates were higher than expected. Failure to genotype or to use escalating AZA doses can only be hypothesized as causes.

  11. Initial CT-guided needle biopsy of extremity skeletal lesions: Diagnostic performance and experience of a tertiary musculoskeletal center

    Energy Technology Data Exchange (ETDEWEB)

    Nouh, Mohamed Ragab, E-mail: mragab73@yahoo.com [Department of Radiology, Faculty of Medicine, Alexandria University (Egypt); Department of Radiology, Al-Razi Hospital, Sulibikhate 13001 (Kuwait); Abu Shady, Hamdy Mohamed, E-mail: hamdi_abushadi@yahoo.com [Department of Radiology, Al-Razi Hospital, Sulibikhate 13001 (Kuwait)

    2014-02-15

    Introduction: Appendicular long bones are the target for a wide spectrum of bony lesions with variable clinical presentations. Biopsy procedures are needed for subsequent proper patient's management. Most of the available literature globally assessed musculoskeletal biopsies with inclusion of repeat biopsy results. We thought to retrospectively assess the diagnostic performance of initial CT-guided percutaneous core needle biopsy (PCNB) of extremity long bone lesions in a tertiary musculoskeletal referral center. Patients and methods: We retrospectively analyzed the outcome of initial CT-guided PCNB of 49 patients who presented with extremity long bone lesions which were biopsied in our hospital during a 36 months’ time period. The diagnostic performance was assessed in terms of diagnostic yield and accuracy. Results: There were 34 males and 15 females with a mean age of 33.69 years (range from 4 to 77 years). The overall diagnostic yield of initial biopsies was 87.75% with a diagnostic accuracy of 82.85% derived from the surgically proven cases. The higher diagnostic yield was recorded with malignancy, presence of extra-osseous soft-tissue component as well as mixed and sclerotic lesions. The pathologies of the non-diagnostic biopsies included large-cell lymphoma, giant-cell tumor, langerhans cell histiocytosis, osteoid osteoma and a non-ossifying fibroma. Conclusion: Initial CT-guided PCNB in extremities’ long bones lesions showed high diagnostic performance in malignant, mixed and/or sclerotic lesions as well as lesions with extra-osseous exophytic tissue growth. Lack of extra-osseous components, benign and lytic lesions all had worse diagnostic performance.

  12. The treatment of neuroendocrine tumors with long-acting somatostatin analogs: a single center experience with lanreotide autogel.

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    Bianchi, A; De Marinis, L; Fusco, A; Lugli, F; Tartaglione, L; Milardi, D; Mormando, M; Lassandro, A P; Paragliola, R; Rota, C A; Della Casa, S; Corsello, S M; Brizi, M G; Pontecorvi, A

    2011-10-01

    The aim of this retrospective study was to evaluate the efficacy, safety, and tolerability of lanreotide autogel given to metastatic well-differentiated (WD) neuroendocrine tumors (NET) patients observed in our Institute between 2005 and 2008. Patients with metastatic NET referred to our tertiary referral center were given lanreotide autogel 120 mg/month by deep sc injection for a period of at least 24 months. The efficacy was evaluated by the relief of disease symptoms, behavior of tumor markers and response rate in terms of time to tumor progression. Safety and tolerability were evaluated by assessing the onset of adverse events and treatment feasibility. Twenty-three patients (13 males), median age 62 yr (range 32-87) were considered for the study. All patients were affected by WD metastatic NET and had tumor progression in the last 6 months before the enrolment in the study. Median duration of response was 28 months (range 6-50 months). Fourteen patients (60.9%) showed flushing and diarrhea which improved by 85.7% and 55.6%, respectively, bronchoconstrinction and abdominal pain also ameliorated. A complete, partial or no-changed response in the tumor markers behavior was observed, respectively, in 42.9%, 22.9%, and 17.1% of cases. According to RECIST (Response Evaluation Criteria In Solid Tumors) criteria (version 1.1), there were 2 partial regression (8.7%) and 15 stable disease (65.3%); 6 patients (26.0%) progressed. No patient complained from any severe adverse reaction. The results of our study suggest that lanreotide autogel is effective in the symptoms, biochemical markers, and tumor progression control of WD metastatic NET and confirm that the treatment is well tolerated.

  13. Implantable cardioverter defibrillator therapy in pediatric and congenital heart disease patients: a single tertiary center experience in Korea

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    Bo Kyung Jin

    2013-03-01

    Full Text Available Purpose: The use of implantable cardioverter defibrillators (ICDs to prevent sudden cardiac death is increasing in children and adolescents. This study investigated the use of ICDs in children with congenital heart disease. Methods: This retrospective study was conducted on the clinical characteristics and effectiveness of ICD implantation at the department of pediatrics of a single tertiary center between 2007 and 2011. Results: Fifteen patients underwent ICD implantation. Their mean age at the time of implantation was 14.5±5.4 years (range, 2 to 22 years. The follow-up duration was 28.9±20.4 months. The cause of ICD implantation was cardiac arrest in 7, sustained ventricular tachycardia in 6, and syncope in 2 patients. The underlying disorders were as follows: ionic channelopathy in 6 patients (long QT type 3 in 4, catecholaminergic polymorphic ventricular tachycardia [CPVT] in 1, and J wave syndrome in 1, cardiomyopathy in 5 patients, and postoperative congenital heart disease in 4 patients. ICD coils were implanted in the pericardial space in 2 children (ages 2 and 6 years. Five patients received appropriate ICD shock therapy, and 2 patients received inappropriate shocks due to supraventricular tachycardia.During follow-up, 2 patients required lead dysfunction-related revision. One patient with CPVT suffered from an ICD storm that was resolved using sympathetic denervation surgery. Conclusion: The overall ICD outcome was acceptable in most pediatric patients. Early diagnosis and timely ICD implantation are recommended for preventing sudden death in high-risk children and patients with congenital heart disease.

  14. Presentation, Management, and Outcome of Thyroglossal Duct Cysts in Adult and Pediatric Populations: A 14-Year Single Center Experience

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    Hassan Al-Thani

    2016-07-01

    Full Text Available Objectives: A thyroglossal duct cyst (TDC is a frequent congenital midline anomaly of the neck that usually manifests during the first decade of life. We aimed to describe the presentation, management, and outcome of TDC in pediatric and adult cases. Methods: A retrospective observational analysis was conducted for all patients diagnosed and treated for TDC between 2000 and 2014 in a single center in Qatar. Data included patients’ demographics, presentations, preoperative investigations, anesthesia type, histopathological findings, surgical management, recurrences, and complications. Results: We identified 102 patients, of which 57% were males. The mean age of patients was 20.2±15.6 years. A bimodal distribution of TDC has been observed, which peaked between the ages of 6–13 years and at ≥19 years. The preoperative evaluation mainly includes ultrasonography (66%, thyroid function test (44%, and fine-needle aspiration cytology (10%. The median size of the cyst was 25 (2–60 mm. Patients mainly presented with an asymptomatic midline neck mass at or below the hyoid bone (82%, followed by fistula (9%, infection (2%, and dysphagia (2%. Eighty-nine cases were identified preoperatively as TDC. The histopathological findings confirmed TDC with hyoid bone in 61 cases, and TDC alone in 38 cases. Eighty patients underwent the Sistrunk procedure while excision of TDC alone was observed in 18 cases. Five cases of recurrent disease were also treated. Adults had a greater median cyst size (30 (9–60 vs. 22 (2–55 mm; p = 0.005 and required prolonged operation time (69 (1–169 vs. 32.5 (1–140 mins; p = 0.004 compared to the pediatric group. Conclusion: The occurrence of TDC shows a bimodal age distribution. Preoperative evaluation and time for surgery vary whereas clinical presentations, surgical management, and postoperative outcomes are comparable among adult and pediatric groups. Ultrasonography is the preferred diagnostic modality, and the

  15. Severe combined immunodeficiency in Serbia and Montenegro between years 1986 and 2010: a single-center experience.

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    Pasic, Srdjan; Vujic, Dragana; Veljković, Dobrila; Slavkovic, Bojana; Mostarica-Stojkovic, Marija; Minic, Predrag; Minic, Aleksandra; Ristic, Goran; Giliani, Silvia; Villa, Anna; Sobacchi, Cristina; Lilić, Desa; Abinun, Mario

    2014-04-01

    Severe combined immunodeficiency (SCID), including the 'variant' Omenn syndrome (OS), represent a heterogeneous group of monogenic disorders characterized by defect in differentiation of T- and/or B lymphocytes and susceptibility to infections since birth. In the period of 25 years, between January 1986 and December 2010, a total of 21 patients (15 SCID, 6 OS) were diagnosed in Mother & Child Health Institute of Serbia, a tertiary-care teaching University hospital and a national referral center for patients affected with primary immunodeficiency (PID). The diagnoses were based on anamnestic data, clinical findings, and immunological and genetic analysis. The median age at the onset of the first infection was the 2nd month of life. Seven (33 %) patients had positive family history for SCID. Out of five male infants with T-B+NK- SCID phenotype, mutation analysis revealed interleukin-2 (common) gamma-chain receptor (IL2RG) mutations in 3 with positive X-linked family history, and Janus-kinase (JAK)-3 gene defects in the other two. Six patients had T-B-NK+ SCID phenotype and further 6 features of OS, 11 of which had recombinase-activating gene (RAG1or RAG2) and 1 Artemis gene mutations. One child with T+B+NK+ SCID phenotype as well had proven RAG mutation. One child each with T-B+NK+ SCID phenotype, CD8 lymphopenia and unknown phenotype remained without known underlying genetic defect. Of the eight patients who underwent hematopoetic stem cell transplant (HSCT) 5 survived, the other 13 died between 2 days and 12 months after diagnosis was made. Early diagnosis of SCID, before onset of severe infections, offers possibility for HSCT and cure. Education of primary-care pediatricians, in particular including awareness of the risk of using live vaccines and non-irradiated blood products, should improve prognosis of SCID in our setting.

  16. Extranodal diffuse large B-cell lymphoma: Experience from a tertiary care oncology center in South India

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    K. C. Lakshmaiah

    2014-01-01

    Full Text Available Aims: Diffuse large B-cell lymphoma (DLBCL is the most common non-Hodgkin′s lymphoma (NHL with frequent extra nodal (EN presentation. The overall occurrence of lymphomas has been increasing; however, those of EN-NHL have been increasing much more rapidly. There is limited data found on EN-DLBCL in the Indian population and hence we carried out this retrospective observational study of primary EN-DLBCL at our center in Southern India. Materials and Methods: A total of 90 consecutive cases diagnosed as EN-DLBCL (according to the standard criteria by tissue biopsy confirmed by immunohistochemistry between 2007 and 2011 were included. Staging workup including computed tomography of neck, thorax and abdomen and pelvis, bone marrow aspiration and biopsy was done and International Prognostic Index (IPI calculated. Staging was according to Cotswold′s modification of Ann Arbor. The actuarial survival analysis was performed by Kaplan-Meier. Data were analyzed using the SPSS (version 16 statistical software. Results: The median age in this study was 49 years (18-88 with results showing EN-DLBCL to be 1.36 times more common in males. Advanced stages were seen in 15 subjects (16.6% and bulky disease in 13 subjects (14.4%. CD20 was positive in 89 (98.8% while 32 had high serum lactate dehydrogenase. According to the IPI most were low-risk-56 (66.6%. Overall response rate for the various combination chemotherapies was 85.7% with complete response in 62.3%. The overall survival range spanned from 2 to 123 months. Univariate analysis showed only bulky disease was associated with inferior survival. Conclusions: EN-DLBCL was present at an early age compared to nodal DLBCL, present more often in early stage and low IPI score. Chemoimmunotherapy with radiotherapy to the EN or bulky site is the standard treatment at present.

  17. A User-Centered Framework for Deriving A Conceptual Design From User Experiences: Leveraging Personas and Patterns to Create Usable Designs

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    Javahery, Homa; Deichman, Alexander; Seffah, Ahmed; Taleb, Mohamed

    Patterns are a design tool to capture best practices, tackling problems that occur in different contexts. A user interface (UI) design pattern spans several levels of design abstraction ranging from high-level navigation to low-level idioms detailing a screen layout. One challenge is to combine a set of patterns to create a conceptual design that reflects user experiences. In this chapter, we detail a user-centered design (UCD) framework that exploits the novel idea of using personas and patterns together. Personas are used initially to collect and model user experiences. UI patterns are selected based on personas pecifications; these patterns are then used as building blocks for constructing conceptual designs. Through the use of a case study, we illustrate how personas and patterns can act as complementary techniques in narrowing the gap between two major steps in UCD: capturing users and their experiences, and building an early design based on that information. As a result of lessons learned from the study and by refining our framework, we define a more systematic process called UX-P (User Experiences to Pattern), with a supporting tool. The process introduces intermediate analytical steps and supports designers in creating usable designs.

  18. Selective intraarterial radionuclide therapy with yttrium-90 (Y-90 microspheres for hepatic neuroendocrine metastases: Initial experience at a single center

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    Arslan Nuri

    2011-01-01

    Full Text Available Background/Aim. Selective intraarterial radionuclide therapy (SIRT with Yttrium-90 (Y-90 microspheres is also known as radioembolization and delivers high doses of radiation to hepatic tumors with minimum healthy liver exposure. The aim of this study was to present our preliminary experience in the role of liver directed radiotherapy with Y-90 microspheres for the treatment of unresectable hepatic metastases from neuroendocrine tumors (NET. Methods. The results of SIRT in 10 patients (5 males, 5 females; mean age 48.7 years; age range 24-73 years with metastatic liver disease from NETs during the period from April 2008 through August 2010 were reviewed. All patients had meticulous pre- and post-imaging studies as a part of their work-up procedure, as well as serologic tests of liver function to determine the extent of liver function damage. The patients who were eligible for SIRT had pretreatment visceral angiography to define and occlude non-target arteries. Results. The mean ± SD administered SIR-Spheres® activity was 1.49 ± 0.42 GBq (range 0.72-2.21 GBq in all the patients. These treatments delivered a dose of 99.73 ± 66.36 Gy (range 49- 420.8 Gy to the target tumors. The estimated dose to the lungs and normal liver was 4.45 ± 1.95 Gy (range 2.4-8.5 Gy and 26.73 ± 14.19 Gy (range 5-58.9 Gy, respectively. Overall response rate of 90% and patient tolerance was satisfactory for most patients. Conclusion. From our limited experience, we can conclude that SIRT with Y-90 microspheres is a safe and efficacious treatment option for patients with liver metastasis of NET without any serious side effects.

  19. Diffuse large B-cell lymphoma in elderly: Experience from a tertiary care oncology center in South India

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    K N Lokesh

    2017-01-01

    Full Text Available Introduction: Diffuse large B-cell lymphoma (DLBCL is the most frequent non-Hodgkins lymphoma in the elderly. With the rising proportion of older persons in India, it is important to study current patterns and management of this disease, given that data in this regard are scarce in Indian settings. The aim of this study was to document the clinical features of DLBCL among elderly patients and their outcome over 7 years at a tertiary care oncology center. Materials and Methods: This was a retrospective records review of 119 DLBCL cases between January 2007 and January 2015 aged 60 years and above done at Kidwai Memorial Institute of Oncology, Bengaluru, Karnataka, India. Clinical staging was done according to Ann Arbor staging as modified by Cotswold's and International Prognostic Index (IPI calculated. Results: The mean age was 69.54 years (±5.44 with male: female ratio of 1.52:1. B symptoms were seen in 33% of patients. Thirty-six percent of the patients had stage II disease. The advanced stage was seen in 12% and bulky disease in 9.5%. Bone marrow was involved in 12%. The most common extranodal site was the head and neck region. The distribution according to the IPI was as follows: Low risk 38 (31.93%, low-intermediate risk 53 (44.54%, high-intermediate risk 20 (16.80%, and high risk 8 (6.72%. Among 119 patients, 98 (64.7% received treatment with either combination of rituximab, cyclophosphamide, adriamycin, vincristine, epirubicin, and prednisolone. Overall response rate was 63.26% with a complete response rate of 38.77%. The overall survival ranged from 2 to 123 months with the median being 9.5 months. Conclusion: In elderly, DLBCL is common in seventh decade and most of them present in an early stage and low IPI. The incorporation of rituximab to anthracycline based chemotherapy shows a significant improvement in survival in elderly DLBCL.

  20. Predictors of caregivers’ burden of Parkinson’s disease in India: experience of a tertiary care center in India

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    Agrawal V

    2012-11-01

    Full Text Available Vikas Agrawal,1 Vinay Goyal,2 Garima Shukla,2 Madhuri Behari21Department of Neurology, Yashoda Hospital, Secunderabad, Andhra Pradesh, India; 2Department of Neurology, All India Institute of Medical Sciences, New Delhi, IndiaIntroduction: Parkinson’s disease (PD is a progressive neurodegenerative disorder characterized by increasing dependence on caregivers for activities of daily living that imposes a major burden upon the patients’ caregiver. Caregiver burden (CB refers to the physical, mental, and socioeconomic problems experienced by the caregivers of chronic patients.Patients and methods: This is a onetime cross-sectional observational study carried out in the movement disorder clinic of a tertiary referral center in India. Persons with PD were interviewed and information was collected regarding demographic and clinical details, treatment taken, and presence of non-motor features such as dementia, psychosis, depression, etc, on a pre-tested format and their caregivers were interviewed for self-perceived burden using Zerit’s caregivers’ burden inventory.Results: We interviewed 91 persons with PD (71 [78%] men, 20 [22%] women with their primary caregivers. The age of the patients ranged from 25 to 75 years (mean 56.66 ± 11.83 years. After regression analysis, depression in patients (beta = 0.352, 95% confidence interval [CI]: 0.275 to 0.790, high UPDRS-motor scores (beta = 0.255, 95% CI: 0.108 to 0.532, and presence of sleep disturbances in the atient (beta = 0.206, 95% CI: 0.817 to 11.823 were associated with increased caregiver burden and the presence of multiple caregivers was associated with lower caregiver burden (beta = −0.311, 95% CI: −10.155 to −3.436.Conclusion: The total number of caregivers was found to be an important predictor for reducing CB. Multiple caregivers is a phenomenon which has not been studied till now. Other factors which were found to have adverse predictive effect on caregiver burden are presence of

  1. Identification of factors associated with sedation tolerance in 5000 patients undergoing outpatient colonoscopy: Canadian tertiary center experience

    Science.gov (United States)

    Shingina, Alexandra; Ou, George; Takach, Oliver; Svarta, Sigrid; Kwok, Ricky; Tong, Jessica; Donaldson, Kieran; Lam, Eric; Enns, Robert

    2016-01-01

    /benzodiazepines. Age and gender adjusted analysis yielded similar results. These patients are more likely to need a longer recovery periods post-endoscopy, which could result in additional time and personnel requirements. The final predictive model has good predictive ability for Fentanyl ≥ 100 mcg and Midazolam ≥ 3 mg and fair predictive ability for Fentanyl ≥ 50 mcg and Midazolam ≥ 2 mg. The external validity of this model is planned to be tested in another center. PMID:28042391

  2. Prevalence and risk factors for type 2 diabetes mellitus with Prader-Willi syndrome: a single center experience.

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    Yang, Aram; Kim, Jinsup; Cho, Sung Yoon; Jin, Dong-Kyu

    2017-08-30

    Prader-Willi syndrome (PWS) is often related to severe obesity and type-2 diabetes mellitus (T2DM). However, few studies, and none in Korea, have examined prevalence of T2DM and other variables in PWS. The aim of this study was to identify the prevalence and associated risk factors for T2DM in Korean patients with PWS. We performed a retrospective cohort study of the 84 PWS patients aged 10 or over (10.3-35.8 years of age) diagnosed with PWS at Samsung Medical Center from 1994 to 2016. We estimated occurrence of T2DM according to age (10-18 years versus >18 years), body mass index (BMI), genotype, history of growth hormone therapy, homeostasis model of assessment-insulin resistance (HOMA-IR), and the presence of dyslipidemia, hypogonadism, or central precocious puberty. Additionally, we investigated cutoff values of risk factors for development of T2DM. Twenty-nine of a total 211 patients, diagnosed with PWS over the study period, were diagnosed as having T2DM (13.7%, mean age 15.9 ± 3.6 years). In the >18 years group, obesity, HOMA-IR, and presence of dyslipidemia, hypogonadism, or central precocious puberty were associated with the occurrence of T2DM in univariate analysis. In multivariate logistic regression analysis, only obesity (p = 0.001) and HOMA-IR (p 2.7 and >28.49 kg/m(2), respectively. Of the 29 patients, seven had ≥1 microvascular complication, with non-proliferative diabetic retinopathy in 6 of 7 cases. Advanced age and HOMA-IR were positively correlated with diabetic microvascular complications (p < 0.05, Spearman correlation coefficient 0.393 and 0.434, respectively). The prevalence of diabetes in Korean PWS was similar to that in previous results. BMI and HOMA-IR were strong predictive factors for the development of T2DM in PWS. We specifically suggest the regular monitoring of glucose homeostasis parameters through a detailed settlement of ethnically specific cutoff values for BMI and HOMA-IR in PWS to prevent progression of T2DM

  3. Allogeneic Stem Cell Transplantation in Congenital Hemoglobinopathies Using a Tailored Busulfan-Based Conditioning Regimen: Single-Center Experience.

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    Zaidman, Irina; Rowe, Jacob M; Khalil, Abdalla; Ben-Arush, Myriam; Elhasid, Ronit

    2016-06-01

    Hematopoietic stem cell transplantation (HSCT) is the only proven curative option for patients with hemoglobinopathies, both thalassemia and sickle cell anemia (SCA). A busulfan-based myeloablative conditioning regimen is the standard of care for HSCT in these patients, although increased treatment-related morbidity, including veno-occlusive disease (VOD), has been demonstrated. Thirty-eight pediatric patients, median age 8 years (range, 6 months to 22 years), suffering from hemoglobinopathy were treated at Rambam Medical Center in Haifa, Israel, between 1998 and 2011. Thirty-four patients had thalassemia major and 4 had SCA. The 38 patients underwent 40 HSCTs, 34 of which were first transplants and 6 second transplants. Most transplants (32/40) were from matched sibling donors. Sources of stem cells were peripheral blood in 30 transplants, bone marrow in 7 transplants, and cord blood in 3 transplants. All received different customized busulfan-based conditioning regimens tailored by pharmacokinetic analysis of busulfan levels. Primary engraftment occurred in 37 of 40 transplants. Neutrophil engraftment (>.5 × 10(9)/L) occurred at a median of 15.3 days post-transplantation (range, 10 to 45). Platelet transfusion independence (>20 × 10(9)/L) occurred at a median of 22.3 days (range, 11 to 60). The rate of 5-year overall survival for thalassemia patients after first transplantation was 90.5% ± 5.3%. The rate of 5-year thalassemia-free survival was 81.7% ± 6.8%. Cumulative incidence of acute graft-versus-host disease (GVHD) was 17.6%. Rate of grades III to IV GVHD was 8.8%. Cumulative incidence of chronic GVHD was 23.5%, with 11.8% incidence of extensive chronic GVHD. One patient developed VOD. Full donor chimerism occurred in 36.4% of patients with class 1 + 2 thalassemia, compared with 78.6% in class 3 thalassemia (P = .049). Overall survival above 90% in patients undergoing their first transplant was demonstrated using busulfan

  4. Lower Respiratory Tract Diseases Caused by Common Respiratory Viruses among Stem Cell Transplantation Recipients: A Single Center Experience in Korea

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    Hong, Kyung-Wook; Choi, Su-Mi; Cho, Sung-Yeon; Lee, Hyo-Jin; Choi, Jae-Ki; Kim, Si-Hyun; Park, Sun Hee; Choi, Jung-Hyun; Yoo, Jin-Hong; Lee, Jong-Wook

    2017-01-01

    Purpose To describe the incidence, clinical courses, and risk factors for mortality of lower respiratory tract diseases (LRDs) caused by common respiratory viruses (CRVs) in stem cell transplantation (SCT) recipients. Materials and Methods We retrospectively reviewed the medical records of 1038 patients who received SCT between January 2007 and August 2011 at a single center in Korea. Results Seventy-one CRV-LRDs were identified in 67 (6.5%) patients. The human parainfluenza virus (HPIV) was the most common causative pathogen of CRV-LRDs at 100 days [cumulative incidence estimate, 23.5%; 95% confidence interval (CI), 3.3–43.7] and 1 year (cumulative incidence estimate, 69.2%; 95% CI, 45.9–92.5) following SCT. The 30-day overall mortality rates due to influenza-LRDs, respiratory syncytial virus-LRDs, HPIV-LRDs, and human rhinovirus-LRDs were 35.7, 25.8, 31.6, and 42.8%, respectively. Co-pathogens in respiratory specimens were detected in 23 (33.8%) patients. The overall mortality at day 30 after CRV-LRD diagnosis was 32.8% (22/67). High-dose steroid usage (p=0.025), a severe state of immunodeficiency (p=0.033), and lymphopenia (p=0.006) were significantly associated with death within 30 days following CRV-LRD diagnosis in a univariate analysis. Multivariate logistic regression analysis revealed that high-dose steroid usage [odds ratio (OR), 4.05; 95% CI, 1.12–14.61; p=0.033] and lymphopenia (OR, 6.57; 95% CI, 1.80–24.03; p=0.004) were independent risk factors for mortality within 30 days of CRV-LRDs. Conclusion CRV-LRDs among SCT recipients showed substantially high morbidity and mortality rates. Therefore, the implement of an active diagnostic approaches for CRV infections is required for SCT recipients with respiratory symptoms, especially those receiving high-dose steroids or with lymphopenia. PMID:28120567

  5. A single center kidney transplant experience among ten Caucasian females with end-stage renal disease due to scleroderma
.

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    Saxena, Nishkarsh; Djamali, Arjang; Astor, Brad C; Mohamed, Maha; Mandelbrot, Didier; Parajuli, Sandesh

    2017-07-01

    There is limited information on kidney transplant recipients with end-stage renal disease (ESRD) due to scleroderma. We conducted an observational study on kidney transplant recipients with ESRD due to scleroderma who received kidney transplant at our center between 01/1994 and 06/2013. During the study period, there were 10 kidney transplant recipients, all of whom were Caucasian females. Seven of them were living-donor kidney transplant recipients, and the mean age at time of transplant was 56.6 ± 11.99 years. The mean post-transplant follow-up was 76.75 ± 56.18 months; the mean dialysis vintage was 46.4 ± 80.35 months, ranging from 8 to 272 months; and the mean serum creatinine (Cr) levels at 3, 6, and 12 months were 1.31 ± 0.47 mg/dL, 1.35 ± 0.51 mg/dL, and 1.34 ± 0.49 mg/dL, respectively. There were 5 graft failures with median graft survival of 101 months. None had recurrence of scleroderma renal crisis. In those without graft failure, the mean serum Cr at last follow-up was 0.96 ± 0.39 mg/dL. Six patients were on angiotensin converting enzyme inhibitors (ACE-I) after transplant. In univariate analysis, none of the factors including, age at time of transplant, dialysis vintage, use of ACE-I, living-donor transplant, cytomegalovirus infection, and serum Cr at 1 year were predictive of graft failure. In our study, we hoped to find outcomes and various factors associated with graft failure in these patients. We found a wide variation in outcomes after kidney transplantation. More studies are needed to assess the factors that may influence the graft survival in this rare disease.
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  6. Taquiarritmias supraventriculares no feto. Experiência de uma unidade de referência em cardiologia fetal Fetal supraventricular tachyarrhythmias. Experience of a fetal cardiology reference center

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    Paulo Zielinsky

    1998-05-01

    Full Text Available OBJETIVO: Avaliar a forma de apresentação, diagnóstico e tratamento das taquiarritmias supraventriculares fetais, através do relato de uma série de casos acompanhados em um centro terciário de cardiologia fetal. MÉTODOS: São descritos 25 casos de taquiarritmia supraventricular diagnosticados intra-útero, no período de janeiro/89 a outubro/97, em uma população compreendendo 3117 gestantes. RESULTADOS: Foram diagnosticados 17 casos de taquiarritmia supraventricular e 8 casos de flutter atrial fe