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Sample records for correct surgical indications

  1. Surgical correction of postoperative astigmatism

    Directory of Open Access Journals (Sweden)

    Lindstrom Richard

    1990-01-01

    Full Text Available The photokeratoscope has increased the understanding of the aspheric nature of the cornea as well as a better understanding of normal corneal topography. This has significantly affected the development of newer and more predictable models of surgical astigmatic correction. Relaxing incisions effectively flatten the steeper meridian an equivalent amount as they steepen the flatter meridian. The net change in spherical equivalent is, therefore, negligible. Poor predictability is the major limitation of relaxing incisions. Wedge resection can correct large degrees of postkeratoplasty astigmatism, Resection of 0.10 mm of tissue results in approximately 2 diopters of astigmatic correction. Prolonged postoperative rehabilitation and induced irregular astigmatism are limitations of the procedure. Transverse incisions flatten the steeper meridian an equivalent amount as they steepen the flatter meridian. Semiradial incisions result in two times the amount of flattening in the meridian of the incision compared to the meridian 90 degrees away. Combination of transverse incisions with semiradial incisions describes the trapezoidal astigmatic keratotomy. This procedure may correct from 5.5 to 11.0 diopters dependent upon the age of the patient. The use of the surgical keratometer is helpful in assessing a proper endpoint during surgical correction of astigmatism.

  2. [Surgical correction of cleft palate].

    Science.gov (United States)

    Kimura, F T; Pavia Noble, A; Soriano Padilla, F; Soto Miranda, A; Medellín Rodríguez, A

    1990-04-01

    This study presents a statistical review of corrective surgery for cleft palate, based on cases treated at the maxillo-facial surgery units of the Pediatrics Hospital of the Centro Médico Nacional and at Centro Médico La Raza of the National Institute of Social Security of Mexico, over a five-year period. Interdisciplinary management as performed at the Cleft-Palate Clinic, in an integrated approach involving specialists in maxillo-facial surgery, maxillar orthopedics, genetics, social work and mental hygiene, pursuing to reestablish the stomatological and psychological functions of children afflicted by cleft palate, is amply described. The frequency and classification of the various techniques practiced in that service are described, as well as surgical statistics for 188 patients, which include a total of 256 palate surgeries performed from March 1984 to March 1989, applying three different techniques and proposing a combination of them in a single surgical time, in order to avoid complementary surgery.

  3. Patient Satisfaction with Surgical Outcome after Hypospadias Correction

    NARCIS (Netherlands)

    Dokter, E.M.J.; Moues, C.M.; Rooij, I.A.L.M. van; Biezen, J.J. van der

    2017-01-01

    Background: Hypospadias is a congenital malformation in which surgical correction is indicated in most cases. Postoperative patient satisfaction is important because of its influence on the child's psychological development. Objective: To evaluate patient satisfaction with surgical outcome after

  4. Histologic examination of hepatic biopsy samples as a prognostic indicator in dogs undergoing surgical correction of congenital portosystemic shunts: 64 cases (1997-2005).

    Science.gov (United States)

    Parker, Jacquelyn S; Monnet, Eric; Powers, Barbara E; Twedt, David C

    2008-05-15

    To determine whether results of histologic examination of hepatic biopsy samples could be used as an indicator of survival time in dogs that underwent surgical correction of a congenital portosystemic shunt (PSS). Retrospective case series. 64 dogs that underwent exploratory laparotomy for an extrahepatic (n = 39) or intrahepatic (25) congenital PSS. All H&E-stained histologic slides of hepatic biopsy samples obtained at the time of surgery were reviewed by a single individual, and severity of histologic abnormalities (ie, arteriolar hyperplasia, biliary hyperplasia, fibrosis, cell swelling, lipidosis, lymphoplasmacytic cholangiohepatitis, suppurative cholangiohepatitis, lipid granulomas, and dilated sinusoids) was graded. A Cox proportional hazards regression model was used to determine whether each histologic feature was associated with survival time. Median follow-up time was 35.7 months, and median survival time was 50.6 months. Thirty-eight dogs were alive at the time of final follow-up; 15 had died of causes associated with the PSS, including 4 that died immediately after surgery; 3 had died of unrelated causes; and 8 were lost to follow-up. None of the histologic features examined were significantly associated with survival time. Findings suggested that results of histologic examination of hepatic biopsy samples obtained at the time of surgery cannot be used to predict long-term outcome in dogs undergoing surgical correction of a PSS.

  5. Surgical correction of the snout suffocation syndrome.

    Science.gov (United States)

    Keipper, V L; Chikes, P G

    1990-04-01

    Two nursing home patients with difficulty breathing because of occlusion of the mouth and nares by an involuntary snout reflex-like mannerism have previously been described. In both cases advanced dementia, edentia, and a downward-angled nasal base were present. Life-threatening hypoxia occurred intermittently in one case, and after becoming severe, was corrected by the surgical procedure described.

  6. Surgical results of strabismus correction in patients with myelomeningocele

    Directory of Open Access Journals (Sweden)

    Dayane Cristine Issaho

    2015-02-01

    Full Text Available Purpose: Myelomeningocele is one of the most common birth defects. It is associated with severe neurological deficiencies, and ocular changes, such as strabismus, are very common. The purpose of this study was to describe indications for strabismus surgery in patients with myelomeningocele and to evaluate the results achieved with surgical correction. Methods: We retrospectively reviewed records of all patients with myelomeningocele who underwent surgery for strabismus correction in a 5-year period in an institution for disabled children. Results: The main indications for strabismus surgery were esotropia and A-pattern anisotropia. Excellent surgical results were achieved in 60.9% of patients, satisfactory in 12.2%, and unsatisfactory in 26.9%. Conclusion: Patients with myelomeningocele and strabismus had a high incidence of esotropia and A-pattern anisotropia. Strabismus surgery in these patients had an elevated percentage of excellent and satisfactory results, not only for the ocular deviation, but also for improvement of head posture.

  7. Surgical correction of gynecomastia in thin patients.

    Science.gov (United States)

    Cigna, Emanuele; Tarallo, Mauro; Fino, Pasquale; De Santo, Liliana; Scuderi, Nicolò

    2011-08-01

    Gynecomastia refers to a benign enlargement of the male breast. This article describes the authors' method of using power-assisted liposuction and gland removal through a subareolar incision for thin patients. Power-assisted liposuction is performed for removal of fatty breast tissue in the chest area to allow skin retraction. The subareolar incision is used to remove glandular tissue from a male subject considered to be within a normal weight range but who has bilateral grade 1 or 2 gynecomastia. Gynecomastia correction was successfully performed for all the patients. The average volume of aspirated fat breast was 100-200 ml on each side. Each breast had 5-80 g of breast tissue removed. At the 3-month, 6-month, and 1-year follow-up assessments, all the treated patients were satisfied with their aesthetic results. Liposuction has the advantages of reducing the fat tissue where necessary to allow skin retraction and of reducing the traces left by surgery. The combination of surgical excision and power-assisted lipoplasty also is a valid choice for the treatment of thin patients.

  8. Trends in the Surgical Correction of Gynecomastia

    OpenAIRE

    Brown, Rodger H.; Chang, Daniel K.; Siy, Richard; Friedman, Jeffrey

    2015-01-01

    Gynecomastia refers to the enlargement of the male breast due to a proliferation of ductal, stromal, and/or fatty tissue. Although it is a common condition affecting up to 65% of men, not all cases require surgical intervention. Contemporary surgical techniques in the treatment of gynecomastia have become increasingly less invasive with the advent of liposuction and its variants, including power-assisted and ultrasound-assisted liposuction. These techniques, however, have been largely limited...

  9. Early surgical correction of buried penis

    African Journals Online (AJOL)

    2018-11-05

    Nov 5, 2018 ... Downloaded from https://journals.lww.com/aps by ... The mean follow-up was 8 months, ranging from 6 to. 22 months ... 2012 and January 2015. ..... 14 Ferro F, Spagnoli A, Spyridakis I, Atzori P, Martini L, Borsellino A. Surgical.

  10. Trends in the Surgical Correction of Gynecomastia

    Science.gov (United States)

    Brown, Rodger H.; Chang, Daniel K.; Siy, Richard; Friedman, Jeffrey

    2015-01-01

    Gynecomastia refers to the enlargement of the male breast due to a proliferation of ductal, stromal, and/or fatty tissue. Although it is a common condition affecting up to 65% of men, not all cases require surgical intervention. Contemporary surgical techniques in the treatment of gynecomastia have become increasingly less invasive with the advent of liposuction and its variants, including power-assisted and ultrasound-assisted liposuction. These techniques, however, have been largely limited in their inability to address significant skin excess and ptosis. For mild to moderate gynecomastia, newer techniques using arthroscopic morcellation and endoscopic techniques promise to address the fibrous component, while minimizing scar burden by utilizing liposuction incisions. Nevertheless, direct excision through periareolar incisions remains a mainstay in treatment algorithms for its simplicity and avoidance of additional instrumentation. This is particularly true for more severe cases of gynecomastia requiring skin resection. In the most severe cases with significant skin redundancy and ptosis, breast amputation with free nipple grafting remains an effective option. Surgical treatment should be individualized to each patient, combining techniques to provide adequate resection and optimize aesthetic results. PMID:26528088

  11. Trends in the Surgical Correction of Gynecomastia.

    Science.gov (United States)

    Brown, Rodger H; Chang, Daniel K; Siy, Richard; Friedman, Jeffrey

    2015-05-01

    Gynecomastia refers to the enlargement of the male breast due to a proliferation of ductal, stromal, and/or fatty tissue. Although it is a common condition affecting up to 65% of men, not all cases require surgical intervention. Contemporary surgical techniques in the treatment of gynecomastia have become increasingly less invasive with the advent of liposuction and its variants, including power-assisted and ultrasound-assisted liposuction. These techniques, however, have been largely limited in their inability to address significant skin excess and ptosis. For mild to moderate gynecomastia, newer techniques using arthroscopic morcellation and endoscopic techniques promise to address the fibrous component, while minimizing scar burden by utilizing liposuction incisions. Nevertheless, direct excision through periareolar incisions remains a mainstay in treatment algorithms for its simplicity and avoidance of additional instrumentation. This is particularly true for more severe cases of gynecomastia requiring skin resection. In the most severe cases with significant skin redundancy and ptosis, breast amputation with free nipple grafting remains an effective option. Surgical treatment should be individualized to each patient, combining techniques to provide adequate resection and optimize aesthetic results.

  12. The surgical correction of buried penis: a new technique

    NARCIS (Netherlands)

    Boemers, T. M.; de Jong, T. P.

    1995-01-01

    We report a new surgical technique for the correction of buried penis. The study comprised 10 boys with buried penis. The technique consisted of resection of abnormal dartos attachments, unfurling of the prepuce and correction of the deficient shaft skin by reapproximation of the preputial skin

  13. Finger replantation: surgical technique and indications.

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    Barbary, S; Dap, F; Dautel, G

    2013-12-01

    In this article, we discuss the surgical technique of finger replantation in detail, distinguishing particularities of technique in cases of thumb amputation, children fingertip replantation, ring finger avulsion, and very distal replantations. We emphasize the principles of bone shortening, the spare part concept, the special importance of nerve sutures and the use of vein graft in case of avulsion or crushing. However, even if finger replantation is now a routine procedure, a clear distinction should be made between revascularization and functional success. The indications for finger replantation are then detailed in the second part of this paper. The absolute indications for replantation are thumb, multiple fingers, transmetacarpal or hand, and any upper extremity amputation in a child whatever the level. Fingertip amputations distal to the insertion of the Flexor digitorum superficialis (FDS) are also a good indication. Other cases are more controversial because of the poor functional outcome, especially for the index finger, which is often functionally excluded. Copyright © 2013. Published by Elsevier SAS.

  14. [Palliative surgical correction of respiratory insufficiency in diffusive pulmonary emphysema].

    Science.gov (United States)

    Gorbunkov, S D; Varlamov, V V; Cherny, S M; Lukina, O V; Kiryukhina, L D; Romanikhin, A I; Zinchenko, A V; Akopov, A L

    To analyze early postoperative period in patients with diffuse pulmonary emphysema after palliative surgical correction of respiratory failure. The study included 196 patients who underwent bullectomy (n=111) and surgical reduction of pulmonary volume (n=85). Overall morbidity and mortality were 40.8% and 12.2% respectively. Among patients older than 60 years these values were significantly higher (58.0% and 22.6% respectively). It was shown that age over 60 years is associated with high risk of complications and mortality after excision of large and giant bulls. In patients pulmonary volume. Selection of patients for palliative surgical correction of respiratory failure is generally corresponded to that for lung transplantation. However, these methods should be considered complementary rather competing.

  15. Surgical correction of joint deformities and hyaline cartilage regeneration

    Directory of Open Access Journals (Sweden)

    Vyacheslav Alexandrovich Vinokurov

    2015-12-01

    Full Text Available Aim. To determine a method of extra-articular osteochondral fragment formation for the improvement of surgical correction results of joint deformities and optimization of regenerative conditions for hyaline cartilage. Materials and Methods. The method of formation of an articular osteochondral fragment without penetration into the joint cavity was devised experimentally. More than 30 patients with joint deformities underwent the surgery. Results. During the experiments, we postulated that there may potentially be a complete recovery of joint defects because of hyaline cartilage regeneration. By destructing the osteochondral fragment and reforming it extra-articularally, joint defects were recovered in all patients. The results were evaluated as excellent and good in majority of the patients. Conclusion. These findings indicate a novel method in which the complete recovery of joint defects due to dysplastic genesis or osteochondral defects as a result of injuries can be obtained. The devised method can be used in future experiments for objectification and regenerative potential of hyaline cartilage (e.g., rate and volume of the reformed joints that regenerate, detection of cartilage elements, and the regeneration process.

  16. Correction: An Indicator of Media Credibility

    Directory of Open Access Journals (Sweden)

    Gordana Vilović

    2010-12-01

    Full Text Available The regularity of publishing corrections, clarifi cations, and letters to the editor, entail a high level of respect among the media for their audiences as they signify accountability and media credibility.This study began on the general assumption that the Croatian media is reluctant to publish corrections regularly, projecting an image that errors simply do not occur. Certainly errorless reporting is impossible due to fact that journalism is a profession prone to human error. Therefore, this study has enacted a content analysis methodology to follow the four primary Croatian daily newspapers, Jutarnji list, Večernji list, 24 sata and Vjesnik, for the period between May 6 and 30, 2010. The primary conclusion is that Croatian newspaper editors are hesitant to publish corrections if they are not under pressure from the Media Law.

  17. [Interlamellar sectoral keratoplasty in the surgical correction of astigmatism].

    Science.gov (United States)

    Frolov, M A; Beliaev, V S; Dushin, N V; Kravchinina, V V; Barashkov, V I; Gonchar, P A

    1996-01-01

    A new original method of interlamellar sectorial keratoplasty is proposed for surgical correction of astigmatism. Eleven operations were carried out in 8 patients (11 eyes) with astigmatism of 4 to 7.0 diopters. Vision acuity without correction was 0.6 to 1.0 in 5 patients (7 eyes, 63.6%). In 2 patients (2 eyes, 18.2%) vision acuity without correction was 0.3 to 0.5 diopters, and in 2 more patients (2 eyes, 18.2%) it was from 0.1 to 0.3 diopters, that is, equal to the maximal vision acuity with the optimal correction. The refraction effect stabilized in 3-4 months. The highest refraction effect attained was 7.0 diopters. The patients were followed up for 3 months to 4 years. Clinical analysis of the operations confirmed the efficacy and reliability of the method and stability of refraction. Interlamellar sectorial keratoplasty is recommended for surgical correction of astigmatism.

  18. Surgical correction of the webbed neck: an alternative lateral approach

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    Mehri Turki, Imen

    2017-03-01

    Full Text Available Objective: The webbed neck deformity or pterygium colli is the number one symptom of the Turner syndrome that leads the patient to consult a doctor. Various but rare surgical approaches have been described to correct this deformity. We reviewed our experience with the surgical correction of the pterygium colli.Methods: Through five clinical cases, we describe the surgical technique with a lateral approach which provides a better control of the operative site, allows for the excision of the underlying trapezial fascial web, thus preventing recurrence seen in the posterior approach, and restores a normal hairline. Results: No postoperative wound infection occurred. No recurrence was observed through 24 months. Three patients developed hypertrophic scars.Conclusion: The lateral approach associated with an advanced flap and a Z-plasty is an effective technique for correction of this neck deformity. The presence of a multidisciplinary team, formed with maxillofacial and plastic surgeons, endocrinologists and psychologists, is required to treat these patients allowing reintegration into society and family.

  19. Real time noninvasive assessment of external trunk geometry during surgical correction of adolescent idiopathic scoliosis

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    Mac-Thiong Jean-Marc

    2009-02-01

    Full Text Available Abstract Background The correction of trunk deformity is crucial in scoliosis surgery, especially for the patient's self-image. However, direct visualization of external scoliotic trunk deformity during surgical correction is difficult due to the covering draping sheets. Methods An optoelectronic camera system with 10 passive markers is used to track the trunk geometry of 5 scoliotic patients during corrective surgery. The position of 10 anatomical landmarks and 5 trunk indices computed from the position of the passive markers are compared during and after instrumentation of the spine. Results Internal validation of the accuracy of tracking was evaluated at 0.41 +/- 0.05 mm RMS. Intra operative tracking during surgical maneuvers shows improvement of the shoulder balance during and after correction of the spine. Improvement of the overall patient balance is observed. At last, a minor increase of the spinal length can be noticed. Conclusion Tracking of the external geometry of the trunk during surgical correction is useful to monitor changes occurring under the sterile draping sheets. Moreover, this technique can used be used to reach the optimal configuration on the operating frame before proceeding to surgery. The current tracking technique was able to detect significant changes in trunk geometry caused by posterior instrumentation of the spine despite significant correction of the spinal curvature. It could therefore become relevant for computer-assisted guidance of surgical maneuvers when performing posterior instrumentation of the scoliotic spine, provide important insights during positioning of patients.

  20. Surgical correction of severe enophthalmos caused by bullet injury

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    S M Balaji

    2016-01-01

    Full Text Available Ballistic injuries of oral and maxillofacial region are usually fatal due to close propinquity with the vital structures. The severity of injury depends on the caliber of the weapon used and distance from which the patient is shot. The preliminary care of facial ballistic wounds strictly adheres to the basics of trauma resuscitation. Early and appropriate surgical management has proved to be influential on the final outcome and esthetic result. Treatment of facial gunshot wounds should be planned and carried out carefully to avoid esthetic complications. It takes even multiple-staged corrections to achieve the targeted functional and esthetic treatment plan. Prevention and control of infection is one of the most important goals to achieve the success of the treatment. Herewith, we present a case of facial gunshot injury with fractures in the orbital floor, medial wall maxillary sinus, and buttress of the zygomatic bone causing deficit, which was successfully managed by surgical reconstruction.

  1. Aesthetic acceptance equals to nature's compensation plus surgical correction.

    Science.gov (United States)

    Vadgaonkar, Vaishali; Gangurde, Parag; Karandikar, Anita; Mahajan, Nikhil

    2013-07-25

    Orthognathic surgery has become an acceptable treatment plan for patients with various maxillofacial deformities. The rehabilitation of severe class III adult patients requires a complex interdisciplinary orthodontic and orthognathic approach. This presentation aims to show a case of combination of camouflage and bilateral sagittal split osteotomy (BSSO).Camouflage in maxillary arch was accepted after analysing visual treatment objective (VTO) and pleasing soft tissue compensation which gave us the clue to go ahead for surgical correction of excess mandibular length to achieve best aesthetic outcome while maintaining nature's compensation in upper arch.

  2. [Intestinal stomas--indications, stoma types, surgical technique].

    Science.gov (United States)

    Renzulli, P; Candinas, D

    2007-09-01

    The formation of an intestinal stoma is one of the most frequent operations in visceral surgery. Despite new operative techniques and a more restrictive use of the stoma, the stoma formation remains an often necessary surgical procedure, which results to a dramatic change in the patients' life. The stoma formation and its later closure are associated with a high morbidity. Many complications, such as stoma necrosis, stoma retraction or stoma prolapse, are related to surgical mistakes made during stoma formation. These complications are therefore largely avoidable. The stoma formation needs careful planning together with a professional stoma nursing team. Moreover, it is mandatory that the stoma formation is made with great care and that it meticulously follows the well established surgical principles. A perfectly placed, technically correctly fashioned and easy to care for stoma is essential for a good patients'quality of life.

  3. [Indications and surgical approach for lamellar macular holes and pseudoholes].

    Science.gov (United States)

    Haritoglou, C; Schumann, R G

    2017-12-01

    This article presents a discussion on the indications for surgical interventions of lamellar macular holes and pseudoholes. What are the criteria for deciding on the surgical intervention for lamellar macular holes and pseudoholes? The article is based on a literature search in PubMed RESULTS: Lamellar macular holes and pseudoholes are subdivided into degenerative and tractive alterations. Both entities are associated with relatively specific morphological and functional criteria, which correlate with the expected functional and morphological results of the surgical intervention. Patients with pseudoholes therefore profit more from a surgical intervention because alterations to the outer retina are less pronounced in these cases. The indications for surgery of lamellar macular holes and pseudoholes are established by the type of lamellar defect and the morphological and functional alterations associated with this condition.

  4. Surgical Indications for Eye Removal in Enugu, South Eastern Nigeria

    African Journals Online (AJOL)

    Objective: To determine the surgical indications for removal of the eye in Enugu in south eastern Nigeria. Method: Retrospective case series review. Results: At the University of Nigeria Teaching Hospital Enugu, between 1st January 1994 and 31st December 2003, 106 eyes of 106 patients, comprising 71 (67.0%) males ...

  5. Surgical Approaches to Chronic Pancreatitis: Indications and Techniques.

    Science.gov (United States)

    Dua, Monica M; Visser, Brendan C

    2017-07-01

    There are a number of surgical strategies for the treatment of chronic pancreatitis. The optimal intervention should provide effective pain relief, improve/maintain quality of life, preserve exocrine and endocrine function, and manage local complications. Pancreaticoduodenectomy was once the standard operation for patients with chronic pancreatitis; however, other procedures such as the duodenum-preserving pancreatic head resections and its variants have been introduced with good long-term results. Pancreatic duct drainage via a lateral pancreaticojejunostomy continues to be effective in ameliorating symptoms and expediting return to normal lifestyle in many patients. This review summarizes operative indications and gives an overview of the different surgical strategies in treating chronic pancreatitis.

  6. Surgical correction of pectus carinatum improves perceived body image, mental health and self-esteem.

    Science.gov (United States)

    Knudsen, Marie Veje; Grosen, Kasper; Pilegaard, Hans K; Laustsen, Sussie

    2015-09-01

    The purpose of this study was to assess the effects of surgical correction of pectus carinatum on health-related quality of life and self-esteem. Between May 2012 and May 2013, a prospective observational single-center cohort study was conducted on consecutive patients undergoing surgical correction of pectus carinatum at our institution. Patients filled in questionnaires on health-related quality of life and self-esteem before and six months after surgery. Disease-specific health-related quality of life was improved by 33% (95% CI: 23; 44%) according to responses to the Nuss Questionnaire modified for Adults. The improvement for generic mental health-related quality of life was 7% (95% CI: 3; 12%) in responses to the Short Form-36 Questionnaire. The improvement in self-esteem was 9% (95% CI: 2; 17%) as assessed with the Rosenberg Self-Esteem Scale. A Single Step Questionnaire supported the improvements in health-related quality of life and self-esteem six months postsurgery. This study confirms positive effects of surgical correction of pectus carinatum on health-related quality of life and self-esteem. Patients were to a greater extent self-satisfied about chest appearance following surgery, indicating this to be a step in the right direction toward improved body image, mental health and self-esteem. Copyright © 2015 Elsevier Inc. All rights reserved.

  7. Correction of Hemodynamic Disorders in the Complex Surgical Correction of Acquired Cardiac Valvular Defects

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    A. I. Lenkin

    2011-01-01

    Full Text Available Objective: to compare the efficiency of using the values of transpulmonary (PiCCO and prepulmonary (Swan-Ganz catheter thermodilution as guides to targeted therapy for hemodynamic disorders in the surgical correction of mixed cardiac valvular defects. Subjects and methods. The study enrolled 40 patients operated on for acquired cardiac diseases who were randomized to two matched groups. Hemodynamics was monitored by means of a Swan-Ganz catheter in Group 1 and by transpulmonary thermodilution in Group 2. Anesthesia was maintained with propofol and fentanyl. Infusion therapy was performed using crystalloid and colloid solutions. Continuous intravenous infusion of inotropic agents was used when heart failure was developed. Hemodynamic, clinical, and laboratory parameters were estimated intraoperatively and within 24 hours postoperatively. Results. The groups did not differ in the degree of baseline heart failure, the duration of an operation and myocardial ischemia, and the length of extracorporeal circulation. In the PiCCO group, postoperative infusion volume was 33% higher than that in the Swan-Ganz group, which ensured increases in stroke volume and oxygen delivery in the early postoperative period (p<0.05. Respiratory support was 26% shorter in the PiCCO group (p<0.04. Conclusion. After surgical interventions for mixed cardiac defects, the targeted therapy algorithm based on transpulmonary thermodilution provided more steady-state values of hemodynamics and oxygen transport, which was followed by the increased scope of infusion therapy and the shorter length of postoperative mechanical ventilation than that based on hemodynamics being corrected from the values of prepul-monary thermodilution. Key words: transpulmonary thermodilution, targeted therapy, prepulmonary ther-modilution, acquired heart disease.

  8. British Military surgical key performance indicators: time for an update?

    Science.gov (United States)

    Marsden, Max Er; Sharrock, A E; Hansen, C L; Newton, N J; Bowley, D M; Midwinter, M

    2016-10-01

    Key performance indicators (KPIs) are metrics that compare actual care against an ideal structure, process or outcome standard. KPIs designed to assess performance in deployed military surgical facilities have previously been published. This study aimed to review the overall performance of surgical trauma care for casualties treated at Role 3 Camp Bastion, Medical Treatment Facility, Afghanistan, in light of the existing Defence Medical Services (DMS) KPIs. The secondary aims were to assess the utility of the surgical KPIs and make recommendations for future surgical trauma care review. Data on 22 surgical parameters were prospectively collected for 150 injured patients who had primary surgery at Camp Bastion between 1 May 2013 and 20 August 2013. Additional information for these patients was obtained using the Joint Theatre Trauma Register. The authors assessed data recording, applicability and compliance with the KPIs. Median data recording was 100% (IQR 98%-100%), median applicability was 56% (IQR 10%-99%) and median compliance was 78% (IQR 58%-93%). One KPI was not applicable to any patient in our population. Eleven KPIs achieved >80% compliance, five KPIs had 80%-60% compliance and five KPIs had performance of the surgical aspect of military trauma care in 2013. The KPIs highlight areas for improvement in service delivery. Individual KPI development should be driven by evidence and reflect advances in practice and knowledge. A method of stakeholder consultation, and sequential refinement following evidence review, may be the right process to develop the future set of DMS KPIs. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

  9. [Evaluation of several immunologic indices in suppurative surgical infections].

    Science.gov (United States)

    Barashkov, V G; Shemerovskaia, T G; Iusupov, Iu N; Vinogradov, O T

    1984-02-01

    The clinical course of the disease was correlated with the indices characterizing the activity of different components of the immune system in 47 patients with a purulent surgical infection. The investigation has shown the clinical value of immunological tests studied to be not identical. The determination of the concentration of the circulating immune complexes and the migration activity of macrophages is proposed for the prognostic assessment of the course of the disease.

  10. Determination of surgical variables for a brain shift correction pipeline using an Android application

    Science.gov (United States)

    Vijayan, Rohan; Conley, Rebekah H.; Thompson, Reid C.; Clements, Logan W.; Miga, Michael I.

    2016-03-01

    Brain shift describes the deformation that the brain undergoes from mechanical and physiological effects typically during a neurosurgical or neurointerventional procedure. With respect to image guidance techniques, brain shift has been shown to compromise the fidelity of these approaches. In recent work, a computational pipeline has been developed to predict "brain shift" based on preoperatively determined surgical variables (such as head orientation), and subsequently correct preoperative images to more closely match the intraoperative state of the brain. However, a clinical workflow difficulty in the execution of this pipeline has been acquiring the surgical variables by the neurosurgeon prior to surgery. In order to simplify and expedite this process, an Android, Java-based application designed for tablets was developed to provide the neurosurgeon with the ability to orient 3D computer graphic models of the patient's head, determine expected location and size of the craniotomy, and provide the trajectory into the tumor. These variables are exported for use as inputs for the biomechanical models of the preoperative computing phase for the brain shift correction pipeline. The accuracy of the application's exported data was determined by comparing it to data acquired from the physical execution of the surgeon's plan on a phantom head. Results indicated good overlap of craniotomy predictions, craniotomy centroid locations, and estimates of patient's head orientation with respect to gravity. However, improvements in the app interface and mock surgical setup are needed to minimize error.

  11. The status of oral hygiene in cleft lip, palate patients after surgical correction

    Directory of Open Access Journals (Sweden)

    Pandey S

    2005-01-01

    Full Text Available The cleft lip and palate patients usually present a number of problems viz. altered oral anatomy leading to changes in oral physiology diminishing the self-cleansing ability of individual. The handicapped children are unable to maintain their oral hygiene properly. The present study was formulated with the aim that does normalization of oral anatomy have its effect on improvement of oral hygiene? An assessment of oral hygiene index-simplified was performed between preoperative and postoperative values in the same patient at KGMU and KGDU. A total of 50 cases were recorded in two groups of 25 each: (i < 6 years old and (ii > 6 years. The observations are statistically analyzed by paired ′t′ test to get the significance of results. Results: The data analyzed showed the significant decrease in oral hygiene indices observed in both groups. A relative significance in oral hygiene status following surgery was observed. Both groups expressed greater significance when compared pre and postoperatively which is indicative of considerable improvement of oral hygiene after surgical correction. The study concludes that oral hygiene improves more in older cleft lip-palate cases following reconstruction of palatal vault, premaxilla and anterior lip seal by secondary bone grafting method when compared with oral hygiene indices results in primary periosteoplasty cases. The surgical correction of cleft lip palate enhances self-cleaning ability and better compliance to maintain oral hygiene in children as the age advances.

  12. Surgical-orthodontic correction of a Class III dentofacial deformity.

    Science.gov (United States)

    Devanna, Raghu; Kakkirala, Neelima

    2010-04-01

    This case report describes the surgical-orthodontic treatment of a 26-year-old post-pubertal male patient with a Class III dentofacial deformity. In the pre-surgical orthodontic phase of treatment, a reverse overjet of 5.5 mm was created and arch compatibility was obtained. A mandibualr set back with BSSO was performed during surgery to restore ideal overjet, overbite, occlusion and optimal esthetics. After 1 year of treatment, the results remained stable.

  13. Surgical-orthodontic correction of a Class III dentofacial deformity

    Directory of Open Access Journals (Sweden)

    Raghu Devanna

    2010-01-01

    Full Text Available This case report describes the surgical-orthodontic treatment of a 26-year-old post-pubertal male patient with a Class III dentofacial deformity. In the pre-surgical orthodontic phase of treatment, a reverse overjet of 5.5 mm was created and arch compatibility was obtained. A mandibualr set back with BSSO was performed during surgery to restore ideal overjet, overbite, occlusion and optimal esthetics. After 1 year of treatment, the results remained stable.

  14. Surgical management of bronchiectasis. The indications and outcomes

    International Nuclear Information System (INIS)

    Gursoy, S.; Ozturk, A.A.; Ucvet, A.; Erbaycu, A.E.

    2010-01-01

    Social limitations in addition to treatment failure, despite preventive precautions and aggressive medical treatment, are the main indications for surgery in patients with bronchiectasis. The aim of this study was to evaluate all aspects of treatment outcomes in surgically treated patients with bronchiectasis. Ninety-two patients with bronchiectasis treated by a surgical resection between January 2002 and June 2007 were included in the study. Age, sex, symptoms, etiologic factors, radiological findings, surgical procedures, postoperative morbidity and mortality, and hospital stay were analyzed. Fifty-four patients were female and 38 were male, with an average age of 38.7 (range, 10-67) years, and 84.8% were symptomatic. The etiologic factors included frequent infections (37%), childhood infections (22%), tuberculosis (12%), foreign bodies (3%), and unknown causes (26%). Ten pneumonectomies, 36 lobectomies, 2 bilobectomies, 32 lobectomies and segmentectomies, and 12 segmentectomies were performed. The morbidity was 16%, the mortality was 1%, and the mean follow-up duration was 15.3 months. Follow-up data were obtained in 75 patients of whom 63 (84%) were asymptomatic, 8 (10.7%) were symptomatic with clinical improvement, and 4 (5.3%) had had no clinical improvement. Despite the advances in preventive precautions, medical treatment, and follow-up, surgery, with its low mortality and morbidity rates, remains a good alternative in selected patients in the treatment of bronchiectasis, and fulfills the clinical and social improvement expectations of patients. (author)

  15. Arm rotated medially with supination – the ARMS variant: description of its surgical correction

    Directory of Open Access Journals (Sweden)

    Melcher Sonya E

    2009-03-01

    Full Text Available Abstract Background Patients who have suffered obstetric brachial plexus injury (OBPI have a high incidence of musculoskeletal complications stemming from the initial nerve injury. The presence of muscle imbalances and contractures leads to typical bony changes affecting the shoulder, including the SHEAR (Scapular Hypoplasia, Elevation and Rotation deformity. The SHEAR deformity commonly occurs in conjunction with Medial Rotation Contracture (MRC of the arm. OBPI also causes muscle imbalances at the level of the forearm, that lead to a fixed supination deformity (SD in a small number of patients. Both MRC and SD will cause severe functional limitations without surgical intervention. Methods Fourteen OBPI patients were diagnosed with MRC of the shoulder and SD of the forearm along with SHEAR deformity during a 16 month study period, with eight patients available to long-term follow-up (age range 2.2 – 18 years. Surgical correction of the MRC was performed as a triangle tilt or humeral osteotomy depending on the age of the child, after which, the patients were treated with a radial osteotomy to correct the fixed supination deformity. Function was assessed using the modified Mallet scale, examination of apparent supination and appearance of the extremity at rest. Results Significant functional improvements were observed in patients with surgical reconstruction. Mallet score increased by an average of 5.2 (p Conclusion The simultaneous presence of two opposing deformities in the same limb will visually offset each other at the level of the wrist and hand, giving the false impression of neutral positioning of the limb. In reality, the neutral-appearing position of the hand indicates a fixed supination posture of the forearm in the face of a medial rotation contracture of the shoulder. Both of these deformities require surgical attention, and the presence of concurrent MRC and SD should be monitored for in OBPI patients.

  16. Surgical approaches to chronic pancreatitis: indications and imaging findings.

    Science.gov (United States)

    Hafezi-Nejad, Nima; Singh, Vikesh K; Johnson, Stephen I; Makary, Martin A; Hirose, Kenzo; Fishman, Elliot K; Zaheer, Atif

    2016-10-01

    Chronic pancreatitis (CP) is an irreversible, inflammatory process characterized by progressive fibrosis of the pancreas that can result in abdominal pain, exocrine insufficiency, and diabetes. Inadequate pain relief using medical and/or endoscopic therapies is an indication for surgery. The surgical management of CP is centered around three main operations including pancreaticoduodenectomy (PD), duodenum-preserving pancreatic head resection (DPPHR) and drainage procedures, and total pancreatectomy with islet autotransplantation (TPIAT). PD is the method of choice when there is a high suspicion for malignancy. Combined drainage and resection procedures are associated with pain relief, higher quality of life, and superior short-term and long-term survival in comparison with the PD. TPIAT is a reemerging treatment that may be promising in subjects with intractable pain and impaired quality of life. Imaging examinations have an extensive role in pre-operative and post-operative evaluation of CP patients. Pre-operative advanced imaging examinations including CT and MRI can detect hallmarks of CP such as calcifications, pancreatic duct dilatation, chronic pseudocysts, focal pancreatic enlargement, and biliary ductal dilatation. Post-operative findings may include periportal hepatic edema, pneumobilia, perivascular cuffing and mild pancreatic duct dilation. Imaging can also be useful in the detection of post-operative complications including obstructions, anastomotic leaks, and vascular lesions. Imaging helps identify unique post-operative findings associated with TPIAT and may aid in predicting viability and function of the transplanted islet cells. In this review, we explore surgical indications as well as pre-operative and post-operative imaging findings associated with surgical options that are typically performed for CP patients.

  17. Scheuermann kyphosis: the importance of tight hamstrings in the surgical correction.

    NARCIS (Netherlands)

    Hosman, A.J.F.; Kleuver, M. de; Anderson, P.G.; Limbeek, J. van; Langeloo, D.D.; Veth, R.P.H.; Slot, G.H.

    2003-01-01

    STUDY DESIGN: A historic cohort study of the sagittal alignment in 33 consecutive patients with surgically corrected thoracic Scheuermann kyphosis. OBJECTIVES: To determine if postsurgical imbalance, sagittal malalignment, and decreased lumbar-pelvic range of motion in patients with thoracic

  18. TVT versus TVT-O for minimally invasive surgical correction of stress urinary incontinence

    OpenAIRE

    Sola, Vicente; Pardo, Jack; Ricci, Paolo; Guiloff, Enrique; Chiang, Humberto

    2007-01-01

    OBJECTIVE: The present work describes our experience in surgical correction of stress urinary incontinence, comparing both the TVT and the TVT-O techniques. METHOD: Between October 2001 and March 2004, 76 patients underwent the TVT procedure. Between January 2004 and January 2005, 98 surgical corrections of urinary incontinence were carried out using the TVT-O technique. RESULTS: Median operative time was 28 minutes for TVT and 7 minutes for TVT-O. Intraoperative complications for TVT occurre...

  19. Results in a consecutive series of 83 surgical corrections of symptomatic stenotic kinking of the internal carotid artery.

    Science.gov (United States)

    Illuminati, Giulio; Ricco, Jean-Baptiste; Caliò, Francesco G; D'Urso, Antonio; Ceccanei, Gianluca; Vietri, Francesco

    2008-01-01

    Although there is a growing body of evidence to document the safety and efficacy of operative treatment of carotid stenosis, surgical indications for elongation and kinking of the internal carotid artery remain controversial. The goal of this study was to evaluate the efficacy of surgical correction of internal carotid artery kinking in patients with persistent hemispheric symptoms despite antiplatelet therapy. A consecutive series of 81 patients (mean age, 64 years) underwent 83 surgical procedures to correct kinking of the internal carotid artery either by shortening and reimplanting the vessel on the common carotid artery, inserting a bypass graft, or transposing the vessel onto the external carotid artery. Mean follow-up was 56 months (range, 15-135 months). Study endpoints were 30-day mortality and any stroke occurring during follow-up. No postoperative death was observed. The postoperative stroke rate was 1%. Primary patency, freedom from neurologic symptoms, and late survival at 5 years (x +/- standard deviation) were 89 +/- 4.1%, 92 +/- 4%, and 71 +/- 6%, respectively. The findings of this study indicate that surgical correction for symptomatic stenotic kinking of the internal carotid artery is safe and effective in relieving symptoms and preventing stroke. Operative correction should be considered as the standard treatment for patients with symptomatic carotid kinking that does not respond to antiplatelet therapy.

  20. Functional recovery and surgical indication in putaminal hemorrhage

    International Nuclear Information System (INIS)

    Fujitsu, Kazuhiko

    1983-01-01

    Forty-one cases of varied sized putaminal hemorrhage were classified into 4 types according to the precise localization on CT (Fig. 1). All cases with large-sized hemorrhage (more than 4-5 cm in the actual diameter) were treated surgically regardless of their types in CT classification. ADL was assessed 6 months after the onset in all 41 cases, and in 17 of these Standard Language Test of Aphasia (SLTA) was also given 1 to 3 months after the dominant hemispheric hemorrhage. Type I hemorrhage usually showed excellent ADL independently of the size of the hemorrhage (Table 3). In type II hemorrhage, the ADL is determined by the extent of the lesion and tended to deteriorate as the size of the hemorrhage increased (Table 4). Type III hemorrhage resumed less favorable ADL than the type II did (Table 5), and there was scarcely any functional recovery in Type IV hemorrhage (Table 6). On SLTA, impairment of the speaking ability was the prominant feature when the hemorrhage was primarily located in the anterior portion of the insula, while the hearing ability was more markedly impaired in the posteriorly located lesion. These location-dependent specific patterns of impairment on SLTA are schematically presented in Fig. 12. From these results described above, the author's CT classification is considered to be very useful not only in forecasting the prospects of functional recovery, but in determining the surgical indication in putaminal hemorrhage. (author)

  1. The floating knee: epidemiology, prognostic indicators & outcome following surgical management.

    Science.gov (United States)

    Rethnam, Ulfin; Yesupalan, Rajam S; Nair, Rajagopalan

    2007-11-26

    Floating Knee injuries are complex injuries. The type of fractures, soft tissue and associated injuries make this a challenging problem to manage. We present the outcome of these injuries after surgical management. 29 patients with floating knee injuries were managed over a 3 year period. This was a prospective study were both fractures of the floating knee injury were surgically fixed using different modalities. The associated injuries were managed appropriately. Assessment of the end result was done by the Karlstrom criteria after bony union. The mechanism of injury was road traffic accident in 27/29 patients. There were 38 associated injuries. 20/29 patients had intramedullary nailing for both fractures. The complications were knee stiffness, foot drop, delayed union of tibia and superficial infection. The bony union time ranged from 15 - 22.5 weeks for femur fractures and 17 - 28 weeks for the tibia. According to the Karlstrom criteria the end results were Excellent - 15, Good - 11, Acceptable - 1 and Poor - 3. The associated injuries and the type of fracture (open, intra-articular, comminution) are prognostic indicators in the Floating knee. Appropriate management of the associated injuries, intramedullary nailing of both the fractures and post operative rehabilitation are necessary for good final outcome.

  2. [Remote results of high myopia surgical correction by tunnel keratoplasty ].

    Science.gov (United States)

    Dushin, N V; Beliaev, V S; Gonchar, P A; Barashkov, V I; Kravchinina, V V; Frolov, M A

    2000-01-01

    Remote results evidence high refraction efficiency of tunnel keratoplasty, stable results being observed for up to 15 years. A total of 104 operations (58 patients) were analyzed for a period of observation of more than 10 years. The patients' ages varied from 17 to 52 years, there were 34 women and 24 men. The main advantage of interlamellar refraction meridional keratoplasty is easiness of operation. At present it is the operation of choice for dosed reduction of eye refraction aimed at correction of high myopia and astigmatism. The possibility of correcting residual myopia after keratotomy and repair of refraction abnormalities resultant from perforating keratoplasty is particularly interesting. The possibility of regulating the corrective effect in remote periods by replacing the implants also deserves attention. Hence, low traumatism, high efficiency, and stability of the refraction effect once more confirm our recommendation to use tunnel keratoplasty in clinical practice.

  3. Indications for surgical resection of benign pancreatic tumors

    International Nuclear Information System (INIS)

    Isenmann, R.; Henne-Bruns, D.

    2008-01-01

    Benign pancreatic tumors should undergo surgical resection when they are symptomatic or - in the case of incidental discovery - bear malignant potential. This is the case for the majority of benign pancreatic tumors, especially for intraductal papillary mucinous neoplasms or mucinous cystic adenomas. In addition, resection is indicated for all tumors where preoperative diagnostic fails to provide an exact classification. Several different operative techniques are available. The treatment of choice depends on the localization of the tumor, its size and on whether there is evidence of malignant transformation. Partial duodenopancreatectomy is the oncological treatment of choice for tumors of the pancreatic head whereas for tumors of the pancreatic tail a left-sided pancreatectomy is appropriate. Middle pancreatectomy or duodenum-preserving resection of the pancreatic head is not a radical oncologic procedure. They should only be performed in cases of tumors without malignant potential. (orig.) [de

  4. Indications for Surgical Management of Hyperparathyroidism: A Review.

    Science.gov (United States)

    Stephen, Antonia E; Mannstadt, Michael; Hodin, Richard A

    2017-09-01

    Primary hyperparathyroidism (pHPT) is a common clinical entity, with approximately 100 000 new cases diagnosed each year in the United States. Most patients with pHPT have a relatively mild form of the disease and present with few if any overt signs or symptoms. This has led to a dilemma regarding which patients should be considered for parathyroid surgery. In this article, we review the established literature on the indications for surgery in asymptomatic pHPT and discuss the most recent consensus conference guidelines. The reviewed literature suggests that there were improved outcomes among patients with asymptomatic pHPT who underwent curative surgery. Most patients with pHPT should be considered for parathyroidectomy. More randomized clinical trials are needed to strongly support a surgical recommendation for all asymptomatic patients with pHPT.

  5. Surgical Management of the Giant Pannus: Indications, Strategies, and Outcomes.

    Science.gov (United States)

    Michaels, Joseph; Coon, Devin; Calotta, Nicholas A; Peter Rubin, J

    2018-04-01

    The obesity pandemic continues to produce an inexorable increase in the number of patients requiring surgical treatment of obesity and obesity-related complications. Along with this growing number of patients, there is a concomitant increase in the complexity of management. One particular example is the treatment of patients with an exceptionally large and morbid pannus. In this report, we detail the management of seven patients suffering from a giant pannus. Medical and surgical variables were assessed. A quality of life questionnaire was administered pre- and postoperatively. All seven patients suffered some obesity-related medical morbidity and six of seven (86%) had local complications of the giant pannus. Each patient underwent giant panniculectomy [resection weight > 13. 6 kg (30 lb)]. The mean resection weight was 20.0 kg. Four of seven (57%) patients experienced postoperative complications, with two (29%) requiring re-operation and blood transfusion. Six patients were available for long-term follow-up; 100% of participants indicated an increased quality of life while five (83%) reported additional postoperative weight loss, increase in exercise frequency and walking ability, and improved ability to work. Our results indicate that giant panniculectomy is a challenging and risky procedure, but careful patient selection and intraoperative scrutiny can ameliorate these risks and afford patients a dramatically improved quality of life. Level of Evidence IV This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  6. SURGICAL TREATMENT OF MALUNITED COLLES’ FRACTURE BY CORRECTIVE OSTEOTOMY

    Directory of Open Access Journals (Sweden)

    Gopinath

    2015-12-01

    Full Text Available BACKGROUND Malunion occurs more often after Colles fracture than any other and can result in considerable disability. Multiple techniques for corrective osteotomy have been developed in recent years with objective of restoring the normal anatomy of distal end of radius and also to evaluate the results with respect to pain, restoration of function of wrist and forearm. MATERIALS AND METHODS A prospective randomized controlled study was conducted in 20 cases of malunited Colles fracture who underwent Corrective osteotomy with a Dorsal Ellis T plate and bone graft. Post operatively all patients were immobilized on a Sugar-Tong splint and followed up at 4, 6 and 12 weeks. RESULTS All measurements of Pain, final range of motion and grip strength significantly improved compared with preoperative measurements. Based on Fernandez et al scoring system we obtained Excellent results in 8 cases, Good in 7 cases, Fair in 3 cases and Poor in 2 cases which was attributed to infection in 1 case and RSD in the other case. Radiologically a mean radial length of 6.14mm (N:10mm, Radial Angle of 21.25⁰ (N:22⁰ and Volar angle of -3.4⁰ (N: +4⁰ was achieved. CONCLUSION Corrective Osteotomy with Bone graft is a preferred and an Ideal procedure if performed after Proper selection of patients i.e in young adults and extra articular malunions with good range of movements.

  7. Review article: Surgical approaches for correction of post-tubercular kyphosis.

    Science.gov (United States)

    Panchmatia, Jaykar R; Lenke, Lawrence G; Molloy, Sean; Cheung, Kenneth M C; Kebaish, Khaled M

    2015-12-01

    This study reviewed the literature regarding the pros and cons of various surgical approaches (anterior, anterolateral, combined, and posterior) for correction of post-tubercular kyphosis. The anterior and anterolateral approaches are effective in improving neurological deficit but not in correcting kyphosis. The combined anterior and posterior approach and the posterior approach combined with 3-column osteotomy achieve good neurological improvement and kyphosis correction. The latter is superior when expertise and facilities are available.

  8. Analysis of radiographic bone parameters throughout the surgical lengthening and deformity correction of extremities.

    Science.gov (United States)

    Atanasov, Nenad; Poposka, Anastasika; Samardziski, Milan; Kamnar, Viktor

    2014-01-01

    Radiographic examination of extremities in surgical lengthening and/or correction of deformities is of crucial importance for the assessment of new bone formation. The purpose of this study is to confirm the diagnostic value of radiography in precise detection of bone parameters in various lengthening or correction stages in patients treated by limb-lengthening and deformity correction. 50 patients were treated by the Ilizarov method of limb lengthening or deformity correction at the University Orthopaedic Surgery Clinic in Skopje, and analysed over the period from 2006 to 2012. The patients were divided into two groups. The first group consisted of 27 patients with limb-lengthening because of congenital shortening. The second group consisted of 23 patients treated for acquired limb deformities. The results in both groups were received in three stages of new bone formation and were based on the appearance of 3 radiographic parameters at the distraction/compression site. The differences between the presence of all radiographic bone parameters in different stages of new bone formation were statistically signficant in both groups, especially the presence of the cortical margin in the first group (Cochran Q=34.43, df=2, p=0.00000). The comparative analysis between the two groups showed a statistically significant difference in the presence of initial bone elements and cystic formations only in the first stage. Almost no statistical significance in the differences between both groups of patients with regard to 3 radiographic parameters in 3 stages of new bone formation, indicates a minor influence of the etiopathogenetic background on the new bone formation in patients treated by gradual lengthening or correction of limb deformities.

  9. Availability of cardiac surgical care in surgical correction of acquired heart defects in patients of older age group

    Directory of Open Access Journals (Sweden)

    Kubatbek S. Urmanbetov

    2018-02-01

    Full Text Available Objective: A study of accessibility of surgical care to elderly patients (aged 60 and above with valvular heart disease has been conducted at the BSCCS "Bakulev Scientific Center of Cardiovascular Surgery» of the Ministry of Health of the Russian Federation. Methods: A retrospective analysis of structure of hospitalizations of 1726 patients, that were hospitalized between 2009 and 2010 at the BSCCS for surgical correction of valvular heart disease was performed. Results: Our study demonstrated that age, on one hand, is not the most significant barrier in the geographical accessibility of cardiac surgical care. On the other hand, it can influence the availability in general, taking into account other factors (urban / rural areas, the presence of cardiac surgical clinics, and clinical status. Provision of cardiac surgical care for patients with heart defects at the BSCCS per 1 million population varies considerably in the context of federal districts and is 0.4 for the Siberian Federal District 30 for the Central Federal District (the highest is 42 for the Moscow Region. Conclusion: Thus, our study demonstrated accessibility of surgical care for elderly patients is the highest for the urban areas with specialized cardiac surgery centers, where patients referred from rural regions

  10. [Surgical aspects of indications and techniques for adenomatous polyposis variants].

    Science.gov (United States)

    Möslein, Gabriela

    2016-08-01

    Due to the advances in molecular genetic diagnostics of adenomatous polyposis variants, identification of patients with a genetic predisposition and their at risk relatives is becoming increasingly important in clinical practice. Precise knowledge of the specific risk profile is gaining significance especially for surgeons and requires a clinically differentiated approach in order to correctly identify the indications for prophylactic surgery. In this article reference will be made to the technical details of the pouch operation rather than the decision-making process per se, since this has become common knowledge for specialized colorectal surgeons. Besides the more commonly known polyposis syndromes, such as familial adenomatous polyposis (FAP), surgeons should nowadays at least be able to clinically distinguish between attenuated and classical variants of FAP, be aware of MUTYH-associated polyposis (MAP) and also the new polyposis syndrome polymerase proofreading-associated polyposis (PPAP). Surgeons should be familiar with the specific indications and extent of surgery for prophylactic organ removal in the lower gastrointestinal tract in order to be able to competently advise patients.

  11. Indications to radical surgical interventions in chondrosarcomas of the limbs

    International Nuclear Information System (INIS)

    Korolev, V.I.

    1988-01-01

    On the basis of analysis carried out in treatment of 229 patients suffering from chondrosarcomas of the limbs it is established that radical surgical intervention in bulk of amputation or exarticulation is the choice of the treatment method at the 3d clinical stage of disease. Sex does not influence the chondrosarcomas prognosis. 20-years age patients have the shortest life-time after operation. Radiotherapy and chemotherapy does not improve the results of surgical treatment

  12. The floating knee: epidemiology, prognostic indicators & outcome following surgical management

    OpenAIRE

    Yesupalan Rajam S; Rethnam Ulfin; Nair Rajagopalan

    2007-01-01

    Abstract Background Floating Knee injuries are complex injuries. The type of fractures, soft tissue and associated injuries make this a challenging problem to manage. We present the outcome of these injuries after surgical management. Methods 29 patients with floating knee injuries were managed over a 3 year period. This was a prospective study were both fractures of the floating knee injury were surgically fixed using different modalities. The associated injuries were managed appropriately. ...

  13. [Endoscopic calcaneoplasty (ECP) in Haglund's syndrome. Indication, surgical technique, surgical findings and results].

    Science.gov (United States)

    Jerosch, J; Sokkar, S; Dücker, M; Donner, A

    2012-06-01

    Posterior calcaneal exostosis treatment modalities have given rise to many controversial opinions. After failure of the conservative treatment, surgical bursectomy and resection of the calcaneal exostosis are indicated by many authors. But clinical studies also show a high rate of unsatisfactory results with a relative high incidence of complications. The minimally invasive surgical technique by an endoscopic calcaneoplasty (ECP) could be an option to overcome some of these problems. Between 1999 und 2010 we operated 164 patients with an age range between 16 and 67 years, 81 males and 83 females. The radiological examination prior to surgery documented in all cases a posterior superior calcaneal exostosis that showed friction to the Achilles tendon. All patients included in the study had no clinical varus of the hind foot, nor cavus deformities. All patients had undergone a trial of conservative treatment for at least 6 months and did not show a positive response. The average follow-up was 46.3 (range: 8-120) months. According to the Ogilvie-Harris score 71 patients presented good and 84 patients excellent results, while 5 patients showed fair results, and 4 patients only poor results. All the post-operative radiographs showed sufficient resection of the calcaneal spur. In 61 patients the preoperative MRI showed a partial rupture of the Achilles tendon close to the insertion side. In no case could we observe a complete tear at the time of follow-up. Only minor postoperative complications were observed. In many patients we could observe a chondral layer at the posterior aspect of the calcaneus. Close to the intersion the Achilles tendon showed also in many patients a chondroide metaplasia. ECP is an effective and minimally invasive procedure for the treatment of patients with calcaneal exostosis. After a short learning curve the endoscopic exposure is superior to the open technique, has less morbidity, less operating time, and nearly no complications. Moreover, the

  14. The kleeblattschädel anomaly in Apert syndrome: intracranial anatomy, surgical correction, and subsequent cranial vault development.

    Science.gov (United States)

    Gosain, A K; Moore, F O; Hemmy, D C

    1997-12-01

    We present a case of Apert syndrome in which intracranial anomalies of the cranial base were localized to the lesser wings of the sphenoid and sphenoid ridge. The lesser wings of the sphenoid were displaced superiorly to follow the fused coronal sutures bilaterally, where they met at a single point on the skull vertex. Careful preoperative study of the intracranial anatomy in the kleeblattschädel anomaly led to a surgical plan for early correction of the anomaly. The present report indicates that an aggressive approach to the correction of the kleeblattschädel anomaly beginning early in infancy can result in normalization of the trilobar skull configuration. Although this approach can correct the kleeblattschädel anomaly, 3.5-year follow-up in this patient with Apert syndrome demonstrates progressive turricephaly despite repeated cranial vault remodeling. Although the trilobar skull configuration can be corrected through early surgical intervention, the long-term correction of progressive turricephaly in patients with Apert syndrome remains an unsolved problem.

  15. A novel surgical correction and innovative splint for swan neck deformity in hypermobility syndrome

    Directory of Open Access Journals (Sweden)

    Karthik Vishwanathan

    2018-01-01

    Full Text Available Splinting is a great domain of occupational therapy profession. Making a splint for the patient would depend on the need or requirement of the problems and deformities. Swan neck deformity is an uncommon condition, and it can be seen in rheumatoid arthritis, cerebral palsy, and after trauma. Conservative treatment of the swan neck deformity is available by different static splints only. There are very few reports of surgical correction of swan-neck deformity in benign hypermobility syndrome. This case report describes the result of novel surgical intervention and an innovative hand splint in a 20-year-old female with a history of cardiovascular stroke with no residual neurological deficit. She presented with correctable swan neck deformity and failed to improve with static ring splints to correct the deformity. She underwent volar plate plication of the proximal interphalangeal joint of the left ring finger along with hemitenodesis of ulnar slip of flexor digitorum superficialis (FDS tendon whereby, the ulnar slip of FDS was passed through a small surgically created rent in A2 pulley and sutured back to itself. Postoperatively, the patient was referred to occupational therapy for splinting with the instruction that the splint would work sometimes for as static and some time as dynamic for positional and correction of the finger. After occupational therapy intervention and splinting, the patient had a full correction of the swan-neck deformity with near full flexion of the operated finger and can work independently.

  16. Sexual and Overall Quality of Life Improvements After Surgical Correction of "Buried Penis".

    Science.gov (United States)

    Hughes, Duncan B; Perez, Edgar; Garcia, Ryan M; Aragón, Oriana R; Erdmann, Detlev

    2016-05-01

    "Buried penis" is an increasing burden in our population with many possible etiologies. Although surgical correction of buried penis can be rewarding and successful for the surgeon, the psychological and functional impact of buried penis on the patient is less understood. The study's aim was to evaluate the sexual satisfaction and overall quality of life before and after buried penis surgery in a single-surgeon's patient population using a validated questionnaire (Changes in Sexual Functioning Questionnaire short-form). Using Likert scales generated from the questionnaire and 1-tailed paired t test analysis, we found that there was significantly improved sexual function after correction of a buried penis. Variables individually showed that there was significant improvement with sexual pleasure, urinating, and with genital hygiene postoperatively. There were no significant differences concerning frequency of pain with orgasms. Surgical correction of buried penis significantly improves the functional, sexual, and psychological aspects of patient's lives.

  17. Autologous fat graft as treatment of post short stature surgical correction scars.

    Science.gov (United States)

    Maione, Luca; Memeo, Antonio; Pedretti, Leopoldo; Verdoni, Fabio; Lisa, Andrea; Bandi, Valeria; Giannasi, Silvia; Vinci, Valeriano; Mambretti, Andrea; Klinger, Marco

    2014-12-01

    Surgical limb lengthening is undertaken to correct pathological short stature. Among the possible complications related to this procedure, painful and retractile scars are a cause for both functional and cosmetic concern. Our team has already shown the efficacy of autologous fat grafting in the treatment of scars with varying aetiology, so we decided to apply this technique to scars related to surgical correction of dwarfism. A prospective study was conducted to evaluate the efficacy of autologous fat grafting in the treatment of post-surgical scars in patients with short-limb dwarfism using durometer measurements and a modified patient and observer scar assessment scale (POSAS), to which was added a parameter to evaluate movement impairment. Between January 2009 and September 2012, 36 children (28 female and 8 male) who presented retractile and painful post-surgical scars came to our unit and were treated with autologous fat grafting. Preoperative and postoperative mean durometer measurements were analysed using the analysis of variance (ANOVA) test and POSAS parameters were studied using the Wilcoxon rank sum test. There was a statistically significant reduction in all durometer measurements (p-value treatment with autologous fat grafting. Surgical procedures to camouflage scars on lower limbs are not often used as a first approach and non-surgical treatments often lead to unsatisfactory results. In contrast, our autologous fat grafting technique in the treatment of post-surgical scars has been shown to be a valuable option in patients with short-limb dwarfism. There was a reduction of skin hardness and a clinical improvement of all POSAS parameters in all patients treated. Moreover, the newly introduced POSAS parameter appears to be reliable and we recommend that it is included to give a more complete evaluation of patient perception. Copyright © 2014 Elsevier Ltd. All rights reserved.

  18. Surgical correction of pectus carinatum improves perceived body image, mental health and self-esteem

    DEFF Research Database (Denmark)

    Knudsen, Marie Veje; Grosen, Kasper; Pilegaard, Hans K.

    2014-01-01

    to the Nuss Questionnaire modified for Adults. The improvement for generic mental health-related quality of life was 7% (95% CI: 3; 12%) in responses to the Short Form-36 Questionnaire. The improvement in self-esteem was 9% (95% CI: 2; 17%) as assessed with the Rosenberg Self-Esteem Scale. A Single Step......PURPOSE: The purpose of this study was to assess the effects of surgical correction of pectus carinatum on health- related quality of life and self-esteem. METHODS: Between May 2012 and May 2013, a prospective observational single-center cohort study was conduct- ed on consecutive patients...... undergoing surgical correction of pectus carinatum at our institution. Patients filled in questionnaires on health-related quality of life and self-esteem before and six months after surgery. RESULTS: Disease-specific health-related quality of life was improved by 33% (95% CI: 23; 44%) according to responses...

  19. Surgical correction of scoliosis in children with spastic quadriplegia: benefits, adverse effects, and patient selection.

    Science.gov (United States)

    Legg, Julian; Davies, Evan; Raich, Annie L; Dettori, Joseph R; Sherry, Ned

    2014-04-01

    Cerebral palsy (CP) is a group of nonprogressive syndromes of posture and motor impairment associated with lesions of the immature brain. Spastic quadriplegia is the most severe form with a high incidence of scoliosis, back pain, respiratory compromise, pelvic obliquity, and poor sitting balance. Surgical stabilization of the spine is an effective technique for correcting deformity and restoring sitting posture. The decision to operate in this group of patients is challenging. The aim of this study is to determine the benefits of surgical correction of scoliosis in children with spastic quadriplegia, the adverse effects of this treatment, and what preoperative factors affect patient outcome after surgical correction. A systematic review was undertaken to identify studies describing benefits and adverse effects of surgery in spastic quadriplegia. Factors affecting patient outcome following surgical correction of scoliosis were assessed. Studies involving adults and nonspastic quadriplegia were excluded. A total of 10 case series and 1 prospective and 3 retrospective cohort studies met inclusion criteria. There was significant variation in the overall risk of complications (range, 10.9-70.9%), mortality (range, 2.8-19%), respiratory/pulmonary complications (range, 26.9-57.1%), and infection (range, 2.5-56.8%). Factors associated with a worse outcome were a significant degree of thoracic kyphosis, days in the intensive care unit, and poor nutritional status. Caregivers report a high degree of satisfaction with scoliosis surgery for children with spastic quadriplegia. There is limited evidence of preoperative factors that can predict patient outcome after scoliosis. There is a need for well-designed prospective studies of scoliosis surgery in spastic quadriplegia.

  20. Optimization of surgical correction of genital prolapse with subsequent tubal sterilization

    OpenAIRE

    NASIMOVA NIGINA RUSTAMOVNA

    2015-01-01

    Currently, pelvic organ prolapse is the most common pathology among women of reproductive age. For these patients it is relevant not only the correction of pelvic organ prolapse but also the search for the most effective contraceptive methods. Treatment of prolapse with simultaneous contraception for these patients is an actual problem of modern gynecology. This paper proposes a method of transvaginal voluntary surgical contraception, produced in conjunction with surgery descent and prolapse ...

  1. Surgical Options for the Refractive Correction of Keratoconus: Myth or Reality

    Directory of Open Access Journals (Sweden)

    L. Fernández-Vega-Cueto

    2017-01-01

    Full Text Available Keratoconus provides a decrease of quality of life to the patients who suffer from it. The treatment used as well as the method to correct the refractive error of these patients may influence on the impact of the disease on their quality of life. The purpose of this review is to describe the evidence about the conservative surgical treatment for keratoconus aiming to therapeutic and refractive effect. The visual rehabilitation for keratoconic corneas requires addressing three concerns: halting the ectatic process, improving corneal shape, and minimizing the residual refractive error. Cross-linking can halt the disease progression, intrastromal corneal ring segments can improve the corneal shape and hence the visual quality and reduce the refractive error, PRK can correct mild-moderate refractive error, and intraocular lenses can correct from low to high refractive error associated with keratoconus. Any of these surgical options can be performed alone or combined with the other techniques depending on what the case requires. Although it could be considered that the surgical option for the refracto-therapeutic treatment of the keratoconus is a reality, controlled, randomized studies with larger cohorts and longer follow-up periods are needed to determine which refractive procedure and/or sequence are most suitable for each case.

  2. Factors related to stability following the surgical correction of skeletal open bite.

    Science.gov (United States)

    Ito, Goshi; Koh, Myongsun; Fujita, Tadashi; Shirakura, Maya; Ueda, Hiroshi; Tanne, Kazuo

    2014-05-01

    If a skeletal anterior open bite malocclusion is treated by orthognathic surgery directed only at the mandible, the lower jaw is repositioned upward in a counter-clockwise rotation. However, this procedure has a high risk of relapse. In the present study, the key factors associated with post-surgical stability of corrected skeletal anterior open bite malocclusions were investigated. Eighteen orthognathic patients were subjected to cephalometric analysis to assess the dental and skeletal changes following mandibular surgery for the correction of an anterior open bite. The patients were divided into two groups, determined by an increase or decrease in nasion-menton (N-Me) distance as a consequence of surgery. Changes in overbite, the displacements of molars and positional changes in Menton were evaluated immediately before and after surgery and after a minimum of one year post-operatively. The group with a decreased N-Me distance exhibited a significantly greater backward positioning of the mandible. The group with an increased N-Me distance experienced significantly greater dentoalveolar extrusion of the lower molars. A sufficient mandibular backward repositioning is an effective technique in the prevention of open bite relapse. In addition, it is important not to induce molar extrusion during post-surgical orthodontic treatment to preserve stability of the surgical open bite correction.

  3. Retropupillary iris-claw intraocular lens for the surgical correction of aphakia in cases with microspherophakia

    Directory of Open Access Journals (Sweden)

    Sameh Mosaad Fouda

    2016-01-01

    Full Text Available Purpose: This study aimed to evaluate the safety and efficacy of retropupillary fixation of an iris-claw intraocular lens (IOL; Verisyse polymethyl methacrylate IOL, Abbott Medical Optics [AMO], Netherlands for the surgical correction of aphakia in microspherophakic eyes without sufficient capsular support. Design: This was a prospective, interventional, noncomparative case series. Methods: This interventional case series comprised 17 eyes of 9 microspherophakic patients. Retropupillary fixation of the Verisyse iris-claw IOL (AMO was performed in all cases. The surgical time was measured. Corrected distance visual acuity, astigmatism, intraocular pressure (IOP, tissue reaction, pigment dispersion, and stability of the IOL were studied 1 day, 3 days, 1 week, 2 weeks, 1 month, and 6 months postoperatively. Results: Eight patients had familial microspherophakia and one patient had Marfan's syndrome. Eighty-two percent of the cases achieved a visual acuity of 0.3 or better. There was no significant postoperative inflammatory reaction. Transient elevation of IOP was recorded in two cases in the 1st week only. One IOL developed disengagement of one of the haptics from the iris and was successfully re-engaged. All the other IOLs were well centered and stable. The mean surgical time was 18.0 ± 4.5 min. Conclusions: Retropupillary fixation of an iris-claw IOL is a safe and effective procedure that provides early visual recovery. It is also a time-saving method for correcting aphakia in microspherophakic eyes without sufficient capsular support.

  4. Predictors of emotional functioning in youth after surgical correction of idiopathic scoliosis.

    Science.gov (United States)

    Zebracki, Kathy; Thawrani, Dinesh; Oswald, Timothy S; Anadio, Jennifer M; Sturm, Peter F

    2013-09-01

    Patients with idiopathic scoliosis, although otherwise healthy, often have significant concerns about their self-image and appearance. In a group of juveniles and adolescents, this can impact adjustment in school, functioning in peer groups, and general sense of well-being. There are limited data to help physicians reliably and precisely identify those who are at higher risk of poor emotional adjustment even after spine deformity correction. The purpose of this study was to determine the predictors of emotional maladjustment in juvenile and adolescent patients after surgical correction of idiopathic scoliosis. A total of 233 juveniles, mean age 11.26 ± 1.02 (range, 8 to 12) years and 909 adolescents, mean age 14.91 ± 1.61 (range, 13 to 21) years, who underwent surgical correction for idiopathic scoliosis and who were participating in a prospective longitudinal multicenter database, were enrolled in the study. Participants completed the Scoliosis Research Society-22 (SRS-22) questionnaire before surgery and 2 years postoperatively. Radiographs were used to measure Cobb angle and surface measurements were used to determine decompensation and trunk shift. Adolescents reported poorer mental health preoperatively (Pself-image (Pself-image (Padolescent group, mental health 2 years postoperatively was predicted by preoperative mental health (Pself-image 2 years postoperatively was predicted by preoperative mental health (Pself-image (PSelf-image and mental health are significantly improved after spine deformity correction in juveniles and adolescents with idiopathic scoliosis. However, consistent with normative development, adolescents are at higher risk for emotional maladjustment than juveniles. Surgical decision making in scoliosis correction should take the emotional status of the patient into consideration.

  5. Autologous fat injection into the pectoralis major as an adjunct to surgical correction of gynecomastia.

    Science.gov (United States)

    Pilanci, Ozgur; Basaran, Karaca; Aydin, Hasan Utkan; Cortuk, Oguz; Kuvat, Samet Vasfi

    2015-03-01

    Correction of gynecomastia in males is a frequently performed aesthetic procedure. Various surgical options involving the removal of excess skin, fat, or glandular tissue have been described. However, poor aesthetic outcomes, including a flat or depressed pectoral area, limit the success of these techniques. The authors sought to determine patient satisfaction with the results of upper chest augmentation by direct intrapectoral fat injection in conjunction with surgical correction of gynecomastia. In this prospective study, 26 patients underwent liposuction and glandular excision, glandular excision alone, or Benelli-type skin excision. All patients received intramuscular fat injections in predetermined zones of the pectoralis major (PM). The mean volume of fat injected was 160 mL (range, 80-220 mL per breast) bilaterally. Patients were monitored for an average of 16 months (range, 8-24 months). Hematoma formation and consequent infraareolar depression was noted in 1 patient and was corrected by secondary lipografting. Mean patient satisfaction was rated as 8.4 on a scale of 1 (unsatisfactory) to 10 (highly satisfactory). Autologous intrapectoral fat injection performed simultaneously with gynecomastia correction can produce a masculine appearance. The long-term viability of fat cells injected into the PM needs to be determined. 4 Therapeutic. © 2015 The American Society for Aesthetic Plastic Surgery, Inc. Reprints and permission: journals.permissions@oup.com.

  6. TVT versus TVT-O for minimally invasive surgical correction of stress urinary incontinence

    Directory of Open Access Journals (Sweden)

    Vicente Sola

    2007-04-01

    Full Text Available OBJECTIVE: The present work describes our experience in surgical correction of stress urinary incontinence, comparing both the TVT and the TVT-O techniques. METHOD: Between October 2001 and March 2004, 76 patients underwent the TVT procedure. Between January 2004 and January 2005, 98 surgical corrections of urinary incontinence were carried out using the TVT-O technique. RESULTS: Median operative time was 28 minutes for TVT and 7 minutes for TVT-O. Intraoperative complications for TVT occurred in 4 patients (6.6%: urinary bladder perforation in 3 patients (5%, p = 0.0228 and parietal peritoneum perforation in 1 case (1.6%. No intraoperative complications took place during TVT-O. Immediate postoperative complications: transient urinary retention in TVT, 2 cases (2.6% and overcorrection in TVT-O (1% which was readjusted within 24 hours. There were no late complications after TVT. There were 2 cases (2.04% with late complications in TVT-O. TVT and TVT-O resulted in correction of incontinence in 100% of the patients. CONCLUSION: TVT and TVT-O are two effective techniques for the correction of stress urinary incontinence. TVT-O would seem to be a technique much easier to perform resulting in less intraoperative complications.

  7. Prognostic indicators for surgical peri-implantitis treatment

    NARCIS (Netherlands)

    de Waal, Yvonne C M; Raghoebar, Gerry M; Meijer, Henny J A; Winkel, Edwin G; van Winkelhoff, Arie Jan

    2016-01-01

    Objectives: Objective of this study was to identify prognostic indicators for the outcome of resective peri-implantitis treatment, by an analysis of the pooled data of two previously conducted randomized controlled trials. Material and methods: Data of 74 patients with peri-implantitis (187

  8. Problem in the surgical correction of long-face with vertical open bite

    Directory of Open Access Journals (Sweden)

    Coen Pramono D

    2005-12-01

    Full Text Available Long-face cases usually need both treatment of orthodontic and surgery. The problem appearing in the correction of long-face might be able to be related with some difficult factors such as the crowded teeth and excessive vertical height. A class III malocclusion and excessive open bite can be also followed in long face. This situation might worsen the facial aesthetic condition and increase the difficulty in orthodontic treatment. The orthodontic approach is oriented toward positioning the teeth pre-surgically to facilitate the surgical plan. The form of mandible which has grown in the downward direction in the area of mandible angle makes an extreme vertical open bite. The maxilla is usually presented with a maxillary hypolasia. Double-jaw surgery was done as the correction of the lower jaw alone would produce a flattened face appearance and difficulty in repositioning the mandible to achieve a good facial performance. Several cephalometric points were measured to observe the facial situation progress after surgery. Two cases of longface are reported, and the same surgical treatments were performed and showed different results.

  9. Surgical Indications and Clinical Results of Patients with Exchanged Intraocular Lenses in a Tertiary Eye Hospital.

    Science.gov (United States)

    Kavuncu, Sevim; Omay, Aslıhan Esra; Tırhış, Mehmet Hakan; Yılmazbaş, Pelin

    2016-08-01

    To evaluate the demographics, surgical indications and clinical results of patients with repositioned or explanted intraocular lens (IOL) in a tertiary referral eye hospital. Forty-eight eyes of 48 patients that underwent surgery to exchange or reposition the IOL at Ulucanlar Eye Training and Research Hospital between 2009 and 2013 were included in the study. Medical records of patients were evaluated for surgical indications, time elapsed since initial operation, preoperative and postoperative best corrected distance visual acuity and the presence of ocular disease. The mean age of the 31 male and 17 female patients was 64.91±14.26 years. Median time between the initial and final operations was 36.0 months. Pseudoexfoliation syndrome (PEX) was present in 25% of the patients. There was history of previous vitreoretinal surgery in 18.8% of patients, ocular trauma in 6.3%, high myopia and refractive surgery in 4% of patients. In the first operation the IOL was implanted in the sulcus in 50%, in the bag in 27.1%, and in the anterior chamber in 20.8%; following the final surgery the IOL was in the sulcus in 27.1%, in the anterior chamber in 22.9%, and fixated to the sclera in 10.4% of the patients, while the remaining 29.1% remained aphakic. Indication for the secondary surgery was IOL dislocation in 58%, corneal decompensation in 20.8% and IOL degeneration in 6.3%. In the final surgery, IOL was exchanged in 54.2% of the cases, removed in 31.3% of cases, and repositioned in 14.6%. Visual acuity improved by 1-3 lines in 52.3% and remained stable in 13.6% of the patients postoperatively. IOL exchange may be necessary at any time following cataract surgery due to surgical complications, IOL dislocation, biometric measurement errors and corneal decompensation. Factors such as vitreoretinal surgery and the existence of PEX increase the risk of IOL exchange surgery.

  10. Surgical Indications and Clinical Results of Patients with Exchanged Intraocular Lenses in a Tertiary Eye Hospital

    Directory of Open Access Journals (Sweden)

    Sevim Kavuncu

    2016-08-01

    Full Text Available Objectives: To evaluate the demographics, surgical indications and clinical results of patients with repositioned or explanted intraocular lens (IOL in a tertiary referral eye hospital. Materials and Methods: Forty-eight eyes of 48 patients that underwent surgery to exchange or reposition the IOL at Ulucanlar Eye Training and Research Hospital between 2009 and 2013 were included in the study. Medical records of patients were evaluated for surgical indications, time elapsed since initial operation, preoperative and postoperative best corrected distance visual acuity and the presence of ocular disease. Results: The mean age of the 31 male and 17 female patients was 64.91±14.26 years. Median time between the initial and final operations was 36.0 months. Pseudoexfoliation syndrome (PEX was present in 25% of the patients. There was history of previous vitreoretinal surgery in 18.8% of patients, ocular trauma in 6.3%, high myopia and refractive surgery in 4% of patients. In the first operation the IOL was implanted in the sulcus in 50%, in the bag in 27.1%, and in the anterior chamber in 20.8%; following the final surgery the IOL was in the sulcus in 27.1%, in the anterior chamber in 22.9%, and fixated to the sclera in 10.4% of the patients, while the remaining 29.1% remained aphakic. Indication for the secondary surgery was IOL dislocation in 58%, corneal decompensation in 20.8% and IOL degeneration in 6.3%. In the final surgery, IOL was exchanged in 54.2% of the cases, removed in 31.3% of cases, and repositioned in 14.6%. Visual acuity improved by 1-3 lines in 52.3% and remained stable in 13.6% of the patients postoperatively. Conclusion: IOL exchange may be necessary at any time following cataract surgery due to surgical complications, IOL dislocation, biometric measurement errors and corneal decompensation. Factors such as vitreoretinal surgery and the existence of PEX increase the risk of IOL exchange surgery.

  11. Aesthetic acceptance equals to nature’s compensation plus surgical correction

    Science.gov (United States)

    Vadgaonkar, Vaishali; Gangurde, Parag; Karandikar, Anita; Mahajan, Nikhil

    2013-01-01

    Orthognathic surgery has become an acceptable treatment plan for patients with various maxillofacial deformities. The rehabilitation of severe class III adult patients requires a complex interdisciplinary orthodontic and orthognathic approach. This presentation aims to show a case of combination of camouflage and bilateral sagittal split osteotomy (BSSO).Camouflage in maxillary arch was accepted after analysing visual treatment objective (VTO) and pleasing soft tissue compensation which gave us the clue to go ahead for surgical correction of excess mandibular length to achieve best aesthetic outcome while maintaining nature’s compensation in upper arch. PMID:23887991

  12. A uniquely shaped rod improves curve correction in surgical treatment of adolescent idiopathic scoliosis

    DEFF Research Database (Denmark)

    Gehrchen, Poul Martin; Ohrt-Nissen, Søren; Hallager, Dennis Winge

    2016-01-01

    . Posterior fusion using all pedicle screw instrumentation has become the standard for the surgical treatment of AIS. Traditionally, the rod is circular in the cross-sectional plane. Recent biomechanical studies suggest that a beam-like structure of the rod may enhance the stiffness of the construct...... correction, sagittal balance, or coronal balance (P>0.058). A postoperative decrease in thoracic kyphosis was seen with no significant difference between groups. Median T5-T12 change was -7° versus -3° for BR and CR, respectively (P=0.051).  Conclusion. A BR design results in a significantly better curve...

  13. Virtual Reality Simulation as a Tool to Monitor Surgical Performance Indicators: VIRESI Observational Study.

    Science.gov (United States)

    Muralha, Nuno; Oliveira, Manuel; Ferreira, Maria Amélia; Costa-Maia, José

    2017-05-31

    Virtual reality simulation is a topic of discussion as a complementary tool to traditional laparoscopic surgical training in the operating room. However, it is unclear whether virtual reality training can have an impact on the surgical performance of advanced laparoscopic procedures. Our objective was to assess the ability of the virtual reality simulator LAP Mentor to identify and quantify changes in surgical performance indicators, after LAP Mentor training for digestive anastomosis. Twelve surgeons from Centro Hospitalar de São João in Porto (Portugal) performed two sessions of advanced task 5: anastomosis in LAP Mentor, before and after completing the tutorial, and were evaluated on 34 surgical performance indicators. The results show that six surgical performance indicators significantly changed after LAP Mentor training. The surgeons performed the task significantly faster as the median 'total time' significantly reduced (p virtual reality training simulation as a benchmark tool to assess the surgical performance of Portuguese surgeons. LAP Mentor is able to identify variations in surgical performance indicators of digestive anastomosis.

  14. Surgical indication in Schistosomiasis mansoni portal hypertension: follow-up from 1985 to 2001

    Directory of Open Access Journals (Sweden)

    Maria José Conceição

    2002-10-01

    Full Text Available The study had the objective to evaluate the benefits of surgical indication for portal hypertension in schistosomiasis patients followed from 1985 to 2001. Schistosoma mansoni eggs were confirmed by at least six stool examinations or rectal biopsy. Clinical examination, abdominal ultrasonography, and digestive endoscopy confirmed the diagnosis of esophageal varices. A hundred and two patients, 61.3% male (14-53 years old were studied. Digestive hemorrhage, hypersplenism, left hypochondrial pain, abdominal discomfort, and hypogonadism were, in a decreasing order, the major signs and symptoms determining surgical indication. Among the surgical techniques employed, either splenectomy associated to splenorenal anastomosis or azigoportal desvascularization, esophageal gastric descompression and esophageal sclerosis were used. Follow-up of patients revealed that, independent on the technique utilized, a 9.9% of death occurred, caused mainly by digestive hemorrhage due to the persistence of post-treatment varices. The authors emphasize the benefits of elective surgical indication allowing a normal active life.

  15. Professionals' and laypersons' appreciation of various options for Class III surgical correction.

    Science.gov (United States)

    Fabré, M; Mossaz, C; Christou, P; Kiliaridis, S

    2010-08-01

    The objectives of this study were to evaluate the assessments of maxillofacial surgeons, orthodontists, and laypersons on the predicted aesthetic outcome of various surgical options in Class III correction and the associations between certain initial cephalometric values and the judges' preferred option. Pre-surgical lateral headfilms and coloured profile photographs of 18 skeletal Class III Caucasian adult patients (10 males and 8 females) with a mean age of 24.5 years were used. The headfilms were hand traced and digitized. Conventional cephalometric analysis was performed. Computerized predictions of three surgical options, mandibular setback, Le Fort I advancement, and bimaxillary surgery, were made. For each case, the pre-surgical profile photograph with the three predictions was presented on a printed page. The questionnaire was sent to 51 maxillofacial surgeons (response rate 45.1 per cent), 78 orthodontists (response rate 71.8 per cent), and 61 laypersons (response rate 100 per cent) to aesthetically evaluate the pre-surgical photographs and the surgical predictions by placing a mark along a 10-graded visual analogue scale (VAS) using a standard profile for calibration. Confidence interval was calculated for each patient. An independent samples t-test was used to detect initial cephalometric values associated with the judges' preferred option and analysis of variance/Tukey's honestly significant differences to evaluate differences between judges. Intra-observer reliability was assessed with a paired t-test. All treatment predictions led to improved scoring of facial aesthetics with the exception of the setback option for three patients. For 14 patients, general agreement for the preferred option existed between the three groups of judges. Laypersons tended to give lower improvement scores than professionals. Overjet, nasofacial, and nasomental angles were important in decision making between the mandibular setback and Le Fort I options (the more negative

  16. [Is local bone graft sufficient to maintain the surgical correction in adolescent idiopathic scoliosis curves?].

    Science.gov (United States)

    Mardomingo, A; Sánchez-Mariscal, F; Alvarez, P; Pizones, J; Zúñica, L; Izquierdo, E

    2013-01-01

    The purpose of this study was to compare postoperative clinical and radiological results in adolescent idiopathic scoliosis curves treated by posterior arthrodesis using autogenous bone graft from iliac crest (CI) versus only local autograft bone (HL). A retrospective matched cohort study was conducted on 73 patients (CI n=37 and HL n=36) diagnosed with adolescent idiopathic scoliosis and treated surgically by posterior arthrodesis. The mean post-operative follow-up was 126 months in the CI group vs. 66 months in the HL group. The radiographic data collected consisted of preoperative, postoperative, and final follow-up antero-posterior and lateral full-length radiographs. Loss of correction and quality of arthrodesis were evaluated by comparing the scores obtained from the Spanish version of the SRS-22 questionnaire. There were significant differences in the post-operative results as regards the correction of the Cobb angle of the main curve (HL 61 ± 15% vs. CI 51 ± 14%, P<.004), however a greater loss of correction was found in the local bone group (CI 4.5 ± 7.3° vs. HL 8.5 ± 6.3°, P=.02). There were no significant differences as regards the correction of the Cobb angle of the main curve at the end of follow-up. There were no clinical differences between the two groups in the SRS-22 scores. At 5 years of follow-up, there was a statistically significant greater loss of radiographic correction at the end of final follow-up in the local bone graft group. However clinical differences were not observed as regards the SRS-22 scores. Copyright © 2013 SECOT. Published by Elsevier Espana. All rights reserved.

  17. Immediate postoperative outcome of orthognathic surgical planning, and prediction of positional changes in hard and soft tissue, independently of the extent and direction of the surgical corrections required

    DEFF Research Database (Denmark)

    Donatsky, Ole; Bjørn-Jørgensen, Jens; Hermund, Niels Ulrich

    2011-01-01

    orthognathic correction using the computerised, cephalometric, orthognathic, surgical planning system (TIOPS). Preoperative cephalograms were analysed and treatment plans and prediction tracings produced by computerised interactive simulation. The planned changes were transferred to models and finally...... with the presently included soft tissue algorithms, the current study shows relatively high mean predictability of the immediately postoperative hard and soft tissue outcome, independent of the extent and direction of required orthognathic correction. Because of the relatively high individual variability, caution...

  18. Improvement of gastroesophageal reflux disease in Japanese patients with spinal kyphotic deformity who underwent surgical spinal correction.

    Science.gov (United States)

    Sugimoto, Mitsushige; Hasegawa, Tomohiko; Nishino, Masafumi; Sahara, Shu; Uotani, Takahiro; Ichikawa, Hitomi; Kagami, Takuma; Sugimoto, Ken; Yamato, Yu; Togawa, Daisuke; Kobayashi, Sho; Hoshino, Hironobu; Matsuyama, Yukihiro; Furuta, Takahisa

    2016-01-01

    Spinal kyphotic deformity occasionally results in gastroesophageal reflux disease (GERD). The effects of acid reflux on the esophagus in kyphotic patients are unclear, however, and it is unknown whether acid reflux, endoscopic GERD, and reflux-related symptoms improve following surgical spinal correction in these patients. Herein, we investigated the characteristics of GERD in kyphotic patients and the improvement in GERD following surgical correction. In 48 patients with severe kyphotic deformity scheduled for surgical spinal correction, we conducted esophagogastroduodenoscopy, 24-h pH monitoring and three questionnaire surveys, including the frequency scale for the symptoms of GERD (FSSG). We repeated these measurements after surgical correction and compared pre- and post-surgery values. Of 48 patients, 70.8% [95% CI: 55.9-83.0%, 34/48] had endoscopically evaluated esophageal mucosal injury. Regarding pH before surgery, 64.9% (CI: 47.5-79.8%, 24/37) had abnormal acid reflux (intraesophageal pH reflux decreased from 66.7% (95% CI: 41.0-86.7%) to 33.3% (95% CI: 13.3-59.0%) (P = 0.045). Surgical spinal correction in kyphosis patients improves not only kyphotic deformity-related disorders but also esophageal mucosal injury, abnormal acid reflux, and reflux-related symptoms. © 2015 Japan Gastroenterological Endoscopy Society.

  19. What is a Good Looking Penis? How Women Rate the Penile Appearance of Men with Surgically Corrected Hypospadias.

    Science.gov (United States)

    Ruppen-Greeff, Norma Katharina; Weber, Daniel M; Gobet, Rita; Landolt, Markus A

    2015-08-01

    Some men with corrected hypospadias perceive their penile appearance to be abnormal, although health professionals consider these results satisfactory. The aim of this study was to investigate how relevant women consider single aspects of penile appearance to be. Moreover, we studied whether women perceive hypospadias-affected surgically repaired genitals (HASRGs) to be as normal-looking as circumcised genitals and identified the most relevant predictors that influence whether a penis is perceived as normal. In this cross-sectional study, 105 women in different age groups (age range: 16-20, 25-30, and 40-45 years) completed a standardized questionnaire. Participants had to rate the importance of eight penile aspects and to indicate how normal they found the appearance of standardized photos of 10 HASRGs and of 10 circumcised genitals. Furthermore, they were asked about demographic characteristics and their sexuality. Results showed that women considered the position and shape of the meatus as the least important penile aspect. Furthermore, results showed that HASRGs with distal hypospadias were perceived to be as normal-looking as circumcised genitals, whereas genitals with more proximal hypospadias were perceived as significantly less normal. However, the difference need not be considered clinically relevant, as the effect size was small. Observer-related predictors of a more positive perception of HASRGs were higher age, higher sexual interest, and perceiving the general cosmetic penile appearance as more important and penile length as less important. Overall, women were found to consider the "position and shape of the meatus" as the least important penile aspect. These findings may stimulate reflections regarding the relevance of surgical correction of the meatus in minor forms of hypospadias. In addition, this study indicates that women perceived genitals of men with distal operated hypospadias (which represents the majority of hypospadias) to be as normal as

  20. Use of 3D Printed Bone Plate in Novel Technique to Surgically Correct Hallux Valgus Deformities

    Science.gov (United States)

    Smith, Kathryn E.; Dupont, Kenneth M.; Safranski, David L.; Blair, Jeremy; Buratti, Dawn; Zeetser, Vladimir; Callahan, Ryan; Lin, Jason; Gall, Ken

    2016-01-01

    Three-dimensional (3-D) printing offers many potential advantages in designing and manufacturing plating systems for foot and ankle procedures that involve small, geometrically complex bony anatomy. Here, we describe the design and clinical use of a Ti-6Al-4V ELI bone plate (FastForward™ Bone Tether Plate, MedShape, Inc., Atlanta, GA) manufactured through 3-D printing processes. The plate protects the second metatarsal when tethering suture tape between the first and second metatarsals and is a part of a new procedure that corrects hallux valgus (bunion) deformities without relying on doing an osteotomy or fusion procedure. The surgical technique and two clinical cases describing the use of this procedure with the 3-D printed bone plate are presented within. PMID:28337049

  1. Surgical correction of congenital esotropia alternating and subsequent abnormal correspondence retinal: a case report

    Directory of Open Access Journals (Sweden)

    Luigi Mazzeo

    2015-10-01

    Full Text Available Introduction: Accomodative esotropia is secondary to inappropriate convergence during accomodative effort in an uncorrected hyperope and is often familial. Case presentation: we report the case of 20 year old Caucasian patient with congenital esotropia alternating, of 30 prism diopters distance (5 m and 40 prism diopters of esotropia at near, in both eyes. Measures: Was performed strabismus, in peribulbar anesthesia, the right medial rectus was cashed 3.0mm, the left medial rectus was collected 3.5 mm. Results: Immediately after surgery, the patient complained of intermittent diplopia, resolved with orthotic exercise which stimulated binocular vision, Conclusion: This case report suggests that the surgical correction strabismus, should be considered with due caution in the treatment of congenital esotropia alternating and branches, and in some clinical scenarios selected to avoid the complication of postoperative diplopia, that in the case report resolved so benign. After three months surgical treatmen, remains a small angle strabismus aesthetically acceptable, has not given double vision and remains abnormal retinal correspondence with orthotic exercise.

  2. Regional cerebral perfusion for surgical correction of neonatal aortic arch obstruction.

    Science.gov (United States)

    Zhang, Hui; Cheng, Pei; Hou, Jia; Li, Lei; Liu, Hu; Liu, Ruifang; Ji, Bingyang; Luo, Yi

    2009-05-01

    One-stage repair of aortic arch obstruction and associated cardiac anomalies is a surgical challenge in infants.The purpose of the present study is to review the current outcome using regional cerebral perfusion (RCP) during a procedure correcting interrupted aortic arch (IAA) and also isolated aortic coarctation (CoA) and CoA combined with hypoplastic aortic arch (CoA-HyAA) in our center. Between January 2007 and July 2008, 24 infant patients with interrupted aortic arch (IAA) (n=3), isolated aortic coarctation (iCoA) (n=9) and aortic coarctation with hypoplastic aortic arch (CoA-HyAA) (n=12) underwent one-stage surgical correction in our hospital. End-to-end anastomosis was employed in 12 infants (IAA n=3 and iCoA n=9); for the other 12 patients with CoA-HyAA, an end-to-end extended anastomosis was used in 8 cases, end-to-side anastomosis in 2 cases, and composite heterologous pericardial patch in 2 cases. RCP with 40 mL/kg/min through the innominate artery during aortic arch reconstruction was employed for all pediatric patients. One single-dose histidine-ketoglutarate-tryptophan (HTK) solution was used for myocardial protection during CPB. Cardiopulmonary bypass time and aortic cross-clamp time were 165.6+/-32.4 min and 81.7+/-30.0 min, respectively. The mean regional cerebral perfusion time was 31.0+/-10.6 min; lowest nasopharyngeal temperature was 19.1+/-1.1 degrees C. Operative mortality rate in both groups was 8.3%. Mean follow-up was 10.5+/-4.8 months. There was no late mortality or postoperative neurologic, renal or hepatic complications. All patients are asymptomatic and are developing normally. One-stage total arch repair using the RCP technique is an excellent method that may minimize neurologic and renal complications. Our surgical strategy for arch anomaly has a low rate of residual and recurrent coarctation when performed in these infants.

  3. Indications for surgical removal of the eye in adults: a five-year review

    African Journals Online (AJOL)

    Background: To determine the indications and procedures used for removing the eye in adults in our environment. Method: A retrospective study of destructive ocular surgeries carried out between January 1999 and December 2003. Theatre and case records of adult patients that underwent surgical removal of the eye over ...

  4. Outcome and complications of retropubic and transobturator midurethral slings translated into surgical therapeutic indices

    NARCIS (Netherlands)

    Houwert, R. Marijn; Roovers, Jan Paul W. R.; Venema, Pieter L.; Bruinse, Hein W.; Dijkgraaf, Marcel G. W.; Vervest, Harry A. M.

    2010-01-01

    OBJECTIVE: We sought to determine and compare surgical therapeutic indices (STIs) of the retropubic tension-free vaginal tape (TVT) and 2 kinds of transobturator tape (TOT), Monarc (American Medical Systems, Minneapolis, MN), and tension-free vaginal tape obturator. STUDY DESIGN: This was a

  5. Risk factors for adjacent segment degeneration after surgical correction of degenerative lumbar scoliosis

    Directory of Open Access Journals (Sweden)

    Kee-yong Ha

    2013-01-01

    Full Text Available Background: Degenerative lumbar scoliosis surgery can lead to development of adjacent segment degeneration (ASD after lumbar or thoracolumbar fusion. Its incidence, risk factors, morbidity and correlation between radiological and clinical symptoms of ASD have no consensus. We evaluated the correlation between the occurrence of radiologic adjacent segment disease and certain imperative parameters. Materials and Methods: 98 patients who had undergone surgical correction and lumbar/thoracolumbar fusion with pedicle screw instrumentation for degenerative lumbar scoliosis with a minimum 5 year followup were included in the study. We evaluated the correlation between the occurrence of radiologic adjacent segment disease and imperative patient parameters like age at operation, sex, body mass index (BMI, medical comorbidities and bone mineral density (BMD. The radiological parameters taken into consideration were Cobb′s angle, angle type, lumbar lordosis, pelvic incidence, intercristal line, preoperative existence of an ASD on plain radiograph and magnetic resonance imaging (MRI and surgical parameters were number of the fusion level, decompression level, floating OP (interlumbar fusion excluding L5-S1 level and posterolateral lumbar interbody fusion (PLIF. Clinical outcomes were assessed with the Visual Analogue Score (VAS and Oswestry Disability Index (ODI. Results: ASD was present in 44 (44.9% patients at an average period of 48.0 months (range 6-98 months. Factors related to occurrence of ASD were preoperative existence of disc degeneration (as revealed by MRI and age at operation ( P = 0.0001, 0.0364. There were no statistically significant differences between radiological adjacent segment degeneration and clinical results (VAS, P = 0.446; ODI, P = 0.531. Conclusions: Patients over the age of 65 years and with preoperative disc degeneration (as revealed by plain radiograph and MRI were at a higher risk of developing ASD.

  6. Bone and bone marrow function of reconstructed chest wall after surgical correction of pectus excavatum

    International Nuclear Information System (INIS)

    Watanabe, Yoh; Magara, Tatsuo; Kobayashi, Hiroaki; Ichihashi, Takumi; Hikishima, Hiroshi

    1984-01-01

    Bone and Bone marrow functions of the reconstructed chest wall after surgical correction of the funnel chest deformities were evaluated by scanning method. In our series, three kinds of operative procedures were employed; strut method for adult cases, sternal turnover method with and without muscle pedicle for infant cases. Bone function was scanned by sup(99m)Tc-methylene-diphosphonate and bone marrow function was evaluated by sup(99m)Tc-sulfur-colloid. For the cases undergone each surgical procedure, bone and bone marrow scan were done at short term after surgery (within 30 days), at intermediate stage (one month to 12 months), and at long term stage (beyond one year). The results were as follows: By the evaluation at the long term stage of the cases undergoing strut method, bone as well as bone marrow scan visualized normal view of the reconstructed sternum. Regarding the cases undergone sternal turnover method without muscle pedicle, or free graft implantation of the plastron, the bone scan at the long term follow-up stage showed abnormal finding, i.e. hypo-, or defect-visualization of the inverted sternum, in 11.5% of the cases. Furthermore, bone marrow scan showed abnormality in 33.3% of the cases. On the other hand, the cases undergone sternal turnover method with muscle pedicle, in which blood supply to the plastron were preserved by the connection from superior epigastric artery to internal mammary artery, showed no abnormality as far as at the long term follow-up study neither in bone scan nor bone marrow scan. However, in the evaluation at short term after surgery, 50% of the cases undergoing bone scan showed abnormality. In addition, in this stage 85.7% of the bone marrow scan showed abnormal finding. These abnormality, however, normalized within 6 months for bone scan and 12 months for bone marrow scan, in contrast to the results of the cases undergone sternal turnover without pedicle. (J.P.N.)

  7. Bias correction for the estimation of sensitivity indices based on random balance designs

    International Nuclear Information System (INIS)

    Tissot, Jean-Yves; Prieur, Clémentine

    2012-01-01

    This paper deals with the random balance design method (RBD) and its hybrid approach, RBD-FAST. Both these global sensitivity analysis methods originate from Fourier amplitude sensitivity test (FAST) and consequently face the main problems inherent to discrete harmonic analysis. We present here a general way to correct a bias which occurs when estimating sensitivity indices (SIs) of any order – except total SI of single factor or group of factors – by the random balance design method (RBD) and its hybrid version, RBD-FAST. In the RBD case, this positive bias has been recently identified in a paper by Xu and Gertner [1]. Following their work, we propose a bias correction method for first-order SIs estimates in RBD. We then extend the correction method to the SIs of any order in RBD-FAST. At last, we suggest an efficient strategy to estimate all the first- and second-order SIs using RBD-FAST. - Highlights: ► We provide a bias correction method for the global sensitivity analysis methods: RBD and RBD-FAST. ► In RBD, first-order sensitivity estimates are corrected. ► In RBD-FAST, sensitivity indices of any order and closed sensitivity indices are corrected. ► We propose an efficient strategy to estimate all the first- and second-order indices of a model.

  8. Acute-onset of superior mesenteric artery syndrome following surgical correction of scoliosis: Case report and review of literature

    Directory of Open Access Journals (Sweden)

    Christian Ovalle-Chao

    2017-04-01

    Full Text Available Superior mesenteric artery (SMA syndrome is a rare condition caused by compression of the third portion of duodenum by the angle between the superior mesenteric artery against the aorta. A rare presentation of SMA syndrome is following scoliosis repair and spinal fusion with a low incidence and most of these patients present with symptoms within one to two weeks or even more after the surgical repair. A high suspicion index after surgical correction of scoliosis with well-known risk factors (low BMI, low percentile of weight for height, and a high degree of change in the Cobb's angles can anticipate the postoperative diagnosis. Management has been described for postsurgical scoliosis repair with a late onset presentation of SMA syndrome with nutritional support with good success rates, but there is no data for best treatment management for acute onset especially when the surgical correction of the spine causes complete duodenal obstruction and a surgical intervention might be warranted. Here in, we present a 14 year-old boy with an acute 24-h postoperative SMA syndrome following surgical correction of scoliosis.

  9. Psychosocial functioning of young adults after surgical correction for congenital heart disease in childhood: a follow-up study

    NARCIS (Netherlands)

    Utens, E. M.; Verhulst, F. C.; Erdman, R. A.; Meijboom, F. J.; Duivenvoorden, H. J.; Bos, E.; Roelandt, J. R.; Hess, J.

    1994-01-01

    To investigate the long-term psychosocial outcome of congenital heart disease, the emotional, intellectual and social functioning of 288 (young) adult patients was assessed with standardized assessment procedures 9-23 years (mean follow-up interval: 16 years) after surgical correction for congenital

  10. Free-flap surgical correction of facial deformity after anteromedial maxillectomy.

    Science.gov (United States)

    Sarukawa, Shunji; Kamochi, Hideaki; Noguchi, Tadahide; Sunaga, Ataru; Uda, Hirokazu; Mori, Yoshiyuki; Nishino, Hiroshi; Yoshimura, Kotaro

    2017-09-01

    Anteromedial maxillectomy is typically performed in conjunction with low-dose radiotherapy and intraarterial chemotherapy. In doing so, the extent of surgical defects is reduced. However, nasal deviation and oral incompetence may ensue, due to cicatricial contracture of wounds, and may be distressing to these patients. Herein, we report a series of eight free perforator flap procedures (anterolateral thigh [ALT] flap, 6; thoracodorsal artery perforator [TAP] flap, 2) used to correct such deformities. The TAP flap was combined with scapular tip [ST] osseous flap in patients with added zygomatic prominence defects. Three adipocutaneous parts developed from each perforator flap were applied as follows: two to reconstruct nasal lining and oral vestibule, and one to augment cheek volume. All aesthetic results proved satisfactory, although orbital dystopia and contracture of mimic muscles were not resolved completely. These secondary interventions are suitable for sequelae of simple anteromedial maxillectomy. Immediate reconstruction should be considered if orbital floor and mimic muscles are involved. Copyright © 2017 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  11. Retrospective Analysis of the Effect of Hering's Law on Outcomes of Surgical Correction of Ptosis.

    Science.gov (United States)

    Pan, Er; Yu, Jiangang; Zhang, Shengchang; Nie, Yunfei; Li, Qin

    2018-03-01

    Several factors may influence aesthetic outcomes of ptosis surgery, especially in patients with asymmetrical ptosis. We retrospectively assessed the effect of Hering's law on surgical outcomes of patients with asymmetrical ptosis. Patients with mild to moderate asymmetrical ptosis (N = 300) who underwent advancement or plication of upper eyelid aponeurosis between January 2014 and July 2016 were enrolled. Fifty patients (group A) underwent surgery without taking into consideration the impact of Hering's law. Of these, 35 patients with unilateral ptosis (subgroup A1) underwent standard surgery on the contralateral side, whereas 15 patients with bilateral ptosis (subgroup A2) were first operated on the milder side followed by the more severely affected side.In 250 patients (group B), surgery was performed taking cognizance of the implications of Hering's law. These included 100 patients with unilateral ptosis (B1) and 150 with bilateral ptosis (B2). Difference in bilateral palpebral fissure symmetry by less than 0.5 mm was considered as satisfactory outcome. Duration of postoperative follow-up ranged from 3 to 24 months. Satisfactory outcomes were achieved over 60% of patients in group A (A1, 60.6%; A2, 66.67%) and in 96% of patients in group B (B1, 95%; B2, 96.67%). Patients with unsatisfactory outcomes underwent repair according to Hering's law after 3 months and obtained good results. Application of Hering's law may improve outcomes of corrective surgery in patients with asymmetric ptosis.

  12. Patient-perceived surgical indication influences patient expectations of surgery for degenerative spinal disease.

    Science.gov (United States)

    Wilson, Thomas J; Franz, Eric; Vollmer, Carolyn F; Chang, Kate W-C; Upadhyaya, Cheerag; Park, Paul; Yang, Lynda J-S

    2017-06-01

    Patients frequently have misconceptions regarding diagnosis, surgical indication, and expected outcome following spinal surgery for degenerative spinal disease. In this study, we sought to understand the relationship between patient-perceived surgical indications and patient expectations. We hypothesized that patients reporting appendicular symptoms as a primary surgical indication would report a higher rate of having expectations met by surgery compared to those patients reporting axial symptoms as a primary indication. Questionnaires were administered to patients who had undergone surgery for degenerative spinal disease at 2 tertiary care institutions. Questions assessed perception of the primary indication for undergoing surgery (radicular versus axial), whether the primary symptom improved after surgery, and whether patient expectations were met with surgery. Outcomes of interest included patient-reported symptomatic improvement following surgery and expectations met by surgery. Various factors were assessed for their relationship to these outcomes of interest. There were 151 unique survey respondents. Respondents were nearly split between having a patient-perceived indication for surgery as appendicular symptoms (55.6%) and axial symptoms (44.4%). Patient-perceived surgical indication being appendicular symptoms was the only factor predictive of patient-reported symptomatic improvement in our logistic regression model (OR 2.614; 95% CI 1.218-5.611). Patient-perceived surgical indication being appendicular symptoms (OR 3.300; 95% CI 1.575-6.944) and patient-reported symptomatic improvement (OR 33.297; 95% CI 12.186-90.979) were predictive of patients reporting their expectations met with surgery in both univariate and multivariate logistic regression modeling. We found that patient-reported appendicular symptoms as the primary indication for surgery were associated with a higher rate of both subjective improvement following surgery and having expectations met

  13. Correction

    DEFF Research Database (Denmark)

    Pinkevych, Mykola; Cromer, Deborah; Tolstrup, Martin

    2016-01-01

    [This corrects the article DOI: 10.1371/journal.ppat.1005000.][This corrects the article DOI: 10.1371/journal.ppat.1005740.][This corrects the article DOI: 10.1371/journal.ppat.1005679.].......[This corrects the article DOI: 10.1371/journal.ppat.1005000.][This corrects the article DOI: 10.1371/journal.ppat.1005740.][This corrects the article DOI: 10.1371/journal.ppat.1005679.]....

  14. Improvement in Creatinine Clearance after Open Heart Surgery in Infants as an Early Indicator of Surgical Success.

    Science.gov (United States)

    Dagan, Amit; Dagan, Ovadia

    2016-12-01

    Early surgical correction of congenital heart malformations in neonates and small infants may be complicated by acute kidney injury (AKI), which is associated with higher morbidity and mortality rates, especially in patients who require dialysis. Glomerular filtration rate (GFR) is considered the best measurement of renal function which, in neonates and infants, is highly dependent on heart function. To determine whether measurements of creatinine clearance after open heart surgery in neonates and young infants can serve as an early indicator of surgical success or AKI. We conducted a prospective observational study in 19 neonates and small infants (body weight creatinine clearance and albumin excretion was performed before and during surgery and four times during 48 hours after surgery. Mean creatinine clearance was lowest during surgery (25.2 ± 4. ml/min/1.73 m2) and increased significantly in the first 16 hours post-surgery (45.7 ± 6.3 ml/min/1.73 m2). A similar pattern was noted for urine albumin which was highest during surgery (203 ± 31 µg/min) and lowest (93 ± 20 µg/min) 48 hours post-surgery. AKI occurred in four patients, and two patients even required dialysis. All six showed a decline in creatinine clearance and an increase in urine albumin between 8 and 16 hours post-surgery. In neonates and small infants undergoing open heart surgery, a significant improvement in creatinine clearance in the first 16 hours postoperatively is indicative of a good surgical outcome. This finding has important implications for the early evaluation and treatment of patients in the intensive care unit on the first day post-surgery.

  15. Computer-aided design and computer-aided modeling (CAD/CAM) generated surgical splints, cutting guides and custom-made implants: Which indications in orthognathic surgery?

    Science.gov (United States)

    Scolozzi, P

    2015-12-01

    The purpose of the present report was to describe our indications, results and complications of computer-aided design and computer-aided modeling CAD/CAM surgical splints, cutting guides and custom-made implants in orthognathic surgery. We analyzed the clinical and radiological data of ten consecutive patients with dentofacial deformities treated using a CAD/CAM technique. Four patients had surgical splints and cutting guides for correction of maxillomandibular asymmetries, three had surgical cutting guides and customized internal distractors for correction of severe maxillary deficiencies and three had custom-made implants for additional chin contouring and/or mandibular defects following bimaxillary osteotomies and sliding genioplasty. We recorded age, gender, dentofacial deformity, surgical procedure and intra- and postoperative complications. All of the patients had stable cosmetic results with a high rate of patient satisfaction at the 1-year follow-up examination. No intra- and/or postoperative complications were encountered during any of the different steps of the procedure. This study demonstrated that the application of CAD/CAM patient-specific surgical splints, cutting guides and custom-made implants in orthognathic surgery allows for a successful outcome in the ten patients presented in this series. Copyright © 2015 Elsevier Masson SAS. All rights reserved.

  16. Renal impairment as a surgical indication in primary hyperparathyroidism: do the data support this recommendation?

    Science.gov (United States)

    Hendrickson, Chase D; Castro Pereira, Daniel J; Comi, Richard J

    2014-08-01

    Management of primary hyperparathyroidism has evolved over the past two decades, yet impaired renal function has consistently been a surgical indication. This recommendation has been based upon the historical association between primary hyperparathyroidism and renal impairment, and a review of the literature is needed to determine whether such a recommendation is warranted. PubMed was utilized to identify English-language articles published between January 1990 and February 2014 using keywords related to hyperparathyroidism and renal function. The keywords were "primary hyperparathyroidism," "surgery," "parathyroidectomy," "kidney," "renal," "glomerular filtration rate," and "creatinine." Of the 1926 articles obtained with this search, all articles germane to the topic that quantified the relationship between primary hyperparathyroidism and renal function were included. All references within these articles were investigated for inclusion. When helpful, data tables were constructed to summarize the results succinctly. A secondary elevation of PTH levels has not been consistently shown to occur at the threshold currently indicated for surgical intervention. While renal impairment is seen with more significant disease, mild asymptomatic primary hyperparathyroidism has not been conclusively associated with renal impairment. Furthermore, there is no evidence to suggest that surgically curing primary hyperparathyroidism via a parathyroidectomy has any impact upon renal function.

  17. The Indication of Surgical Treatment and Visual Rehabilitation in the Congenital Cataracts

    Directory of Open Access Journals (Sweden)

    Uğur Keklikçi

    2005-01-01

    Full Text Available Congenital cataracts constitute an important part of blindness in childhood. It’s a curable disease which is one of the most common causes of blindness in childhood. Main treatment is surgical operation. Timing of surgery, appropriate and rapid post sur- gery visual rehabilitation have a major effect on prognosis. Surgery should be perfor-med as soon as possible after the diagnosis in order to prevent amblyopia.Visual rehabi- litation of congenital cataract includes optical correction and amblyopia treatment. The most effective treatment of amblyopia is occlusion therapy. In this article congenital cataracts were evaluated in the light of recent literature and the importance of the timing of surgery and visual rehabilitation were attempted to be emphasized.

  18. Surgical Navigation: A Systematic Review of Indications, Treatments, and Outcomes in Oral and Maxillofacial Surgery.

    Science.gov (United States)

    Azarmehr, Iman; Stokbro, Kasper; Bell, R Bryan; Thygesen, Torben

    2017-09-01

    This systematic review investigates the most common indications, treatments, and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years, and therapeutic indications are discussed. A systematic search in relevant electronic databases, journals, and bibliographies of the included articles was carried out. Clinical studies with 5 or more patients published between 2010 and 2015 were included. Traumatology, orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign body removal were the areas of interests. The search generated 13 articles dealing with traumatology; 5, 6, 2, and 0 studies were found that dealt with the topics of orthognathic surgery, cancer and reconstruction surgery, skull-base surgery, and foreign body removal, respectively. The average technical system accuracy and intraoperative precision reported were less than 1 mm and 1 to 2 mm, respectively. In general, SN is reported to be a useful tool for surgical planning, execution, evaluation, and research. The largest numbers of studies and patients were identified in the field of traumatology. Treatment of complex orbital fractures was considerably improved by the use of SN compared with traditionally treated control groups. SN seems to be a very promising addition to the surgical toolkit. Planning details of the surgical procedure in a 3-dimensional virtual environment and execution with real-time guidance can significantly improve precision. Among factors to be considered are the financial investments necessary and the learning curve. Copyright © 2017 American Association of Oral and Maxillofacial Surgeons. All rights reserved.

  19. Analysis of corrective action data from trial program on programmatic performance indicators

    International Nuclear Information System (INIS)

    Mays, G.T.; Poore, W.P.

    1989-01-01

    The Nuclear Regulatory Commission (NRC) is considering the use of cause codes as performance indicators (PIs) to monitor licensee performance. In conjunction with the cause codes, corrective action codes are also under consideration to describe licensee corrective actions for problems as represented by the cause codes. The set of cause codes and corrective actions employed in a trial program to assess their usefulness included: (1) administrative error -- training; (2) design/installation -- procedure modification; (3) fabrication error -- discipline; (4) random equipment failure -- management change; (5) licensed operator error -- design modification; and (6) other personal error -- equipment replacement/adjustment. These causes were selected to represent a broad range of licensee programs, hence the designation of programmatic PIs, that could be monitored in a systematic manner to identify trends in performance. They should establish a basis and focus for further investigation of a particular programmatic area if undesirable trends are evidence. 2 figs

  20. Influence of Structural Corrective and Respiratory Exercises on Cardiorespiratory Indices of Male Children Afflicted with Kyphosis

    Directory of Open Access Journals (Sweden)

    Hasan Meamari

    2017-06-01

    Conclusion According to our findings, it can be concluded that there is an improvement in cardiopulmonary function indices following respiratory exercises. Keeping in mind the ease with which they can be performed and the fact they do not require special devices, it can be firmly stated that respiratory muscle exercises are more efficient than other corrective exercises during a brief intervention period (six weeks. With regard to the approved influence of structural corrective exercise in kyphosis in previous studies and its relatively inadequate influence in the present study, it seems that corrective exercises need a comparatively longer duration (probably 12 weeks to prove effective. A limitation of this study was the lack of controlling false habits in daily physical activities and postures that could have had an influence on kyphosis. Its evaluation is recommended for future studies.

  1. Three-dimensional dental arch changes of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusion

    OpenAIRE

    Peixoto,Adriano Porto; Pinto,Ary dos Santos; Garib,Daniela Gamba; Gonçalves,João Roberto

    2014-01-01

    INTRODUCTION: This study assessed the three-dimensional changes in the dental arch of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusions at three different periods. METHODS: Landmarks previously identified on upper and lower dental casts were digitized on a three-dimensional digitizer MicroScribe-3DX and stored in Excel worksheets in order to assess the width, length and depth of patient's dental arches. RESULTS: During orthodontic preparation, the m...

  2. Supportive psychotherapy or client education alongside surgical procedures to correct complications of female genital mutilation: A systematic review.

    Science.gov (United States)

    Abayomi, Olukayode; Chibuzor, Moriam T; Okusanya, Babasola O; Esu, Ekpereonne; Odey, Edward; Meremikwu, Martin M

    2017-02-01

    Supportive psychotherapy, in individual or group settings, may help improve surgical outcomes for women and girls living with female genital mutilation (FGM). To assess whether supportive psychotherapy given alongside surgical procedures to correct complications of FGM improves clinical outcomes. We searched major databases including CENTRAL, Medline, African Index Medicus, SCOPUS, PsycINFO, and others. There were no language restrictions. We checked the reference lists of retrieved studies for additional reports of relevant studies. We included studies of girls and women living with any type of FGM who received supportive psychotherapy or client education sessions alongside any surgical procedure to correct health complications from FGM. Two team members independently screened studies for eligibility. There were no eligible studies identified. There is no direct evidence for the benefits or harms of supportive psychotherapy alongside surgical procedures for women and girls living with FGM. Research evidence is urgently needed to guide clinical practice. 42015024639. © 2017 International Federation of Gynecology and Obstetrics. The World Health Organization retains copyright and all other rights in the manuscript of this article as submitted for publication.

  3. Surgical indication for functional tricuspid regurgitation at initial operation: judging from long term outcomes.

    Science.gov (United States)

    Pozzoli, Alberto; Lapenna, Elisabetta; Vicentini, Luca; Alfieri, Ottavio; De Bonis, Michele

    2016-09-01

    The assessment and management of tricuspid valve disease have evolved substantially during the past several years. Whereas tricuspid stenosis is uncommon, tricuspid regurgitation is frequently encountered and it is most often secondary due to annular dilatation and leaflet tethering from right ventricular remodelling. The indications for tricuspid valve surgery to treat tricuspid regurgitation are several and mainly related to the underlying disease, to the severity of insufficiency and to the right ventricular function. Surgical tricuspid repair has been avoided for years, because of the misleading concept that tricuspid regurgitation should disappear once the primary left-sided problem has been eliminated. Instead, during the last decade, many investigators have reported evidence in favor of a more aggressive surgical approach to functional tricuspid regurgitation, recognising the risk of progressive tricuspid insufficiency in patients with moderate or lesser degrees of tricuspid regurgitation and tricuspid annular dilatation. This concept, along with the long-term outcomes of principal surgical repair techniques are reported and discussed. Last, novel transcatheter therapies have begun to emerge for the treatment of severe tricuspid regurgitation in high-risk patients. Hence, very preliminary pre-clinical and clinical experiences are illustrated. The scope of this review is to explore the anatomic basis, the pathophysiology, the outcomes and the new insights in the management of functional tricuspid regurgitation.

  4. [Integrate the surgical hand disinfection as a quality indicator in an operating room of urology].

    Science.gov (United States)

    Francois, M; Girard, R; Mauranne, C C; Ruffion, A; Terrier, J E

    2017-12-01

    The surgical hand disinfection by friction (SDF) helps to reduce the risk of surgical site infections. For this purpose and in order to promote good compliance to quality care, the urology service of Centre Hospitalier Lyon Sud achieved a continuous internal audit to improve the quality of the SDF. An internal audit executed by the medical students of urology was established in 2013. The study population was all operators, instrumentalists and operating aids of urology operating room (OR). Each student realized 5-10 random observations, of all types of professionals. The criteria measured by the audit were criteria for friction. The evolution of indicators was positive. Particularly, the increasing duration of the first and second friction was statistically significant during follow-up (P=0.001). The total duration of friction shows a similar trend for all professionals. The surgical hand disinfection by friction in the urology OR of the Centre Hospitalier Lyon Sud has gradually improved over the iterative audits. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  5. Computer-aided surgical planner for a new bone deformity correction device using axis-angle representation.

    Science.gov (United States)

    Wu, Ying Ying; Plakseychuk, Anton; Shimada, Kenji

    2014-11-01

    Current external fixators for distraction osteogenesis (DO) are unable to correct all types of deformities in the lower limb and are difficult to use because of the lack of a pre-surgical planning system. We propose a DO system that consists of a surgical planner and a new, easy-to-setup unilateral fixator that not only corrects all lower limb deformity, but also generates the contralateral/predefined bone shape. Conventionally, bulky constructs with six or more joints (six degrees of freedom, 6DOF) are needed to correct a 3D deformity. By applying the axis-angle representation, we can achieve that with a compact construct with only two joints (2DOF). The proposed system makes use of computer-aided design software and computational methods to plan and simulate the planned procedure. Results of our stress analysis suggest that the stiffness of our proposed fixator is comparable to that of the Orthofix unilateral external fixator. We tested the surgical system on a model of an adult deformed tibia and the resulting bone trajectory deviates from the target bone trajectory by 1.8mm, which is below our defined threshold error of 2mm. We also extracted the transformation matrix that defines the deformity from the bone model and simulated the planned procedure. Copyright © 2014 IPEM. Published by Elsevier Ltd. All rights reserved.

  6. Surgical anatomy and histology of the levator palpebrae superioris muscle for blepharoptosis correction

    Directory of Open Access Journals (Sweden)

    Đorđević Boban

    2013-01-01

    Full Text Available Background/Aim. The detailed knowledge of the architecture of the upper eyelid is very important in numerous upper eyelid corrective surgeries. The article deals with the detailed anatomy of the major components of the upper lid, which are commonly seen in surgical practice. Methods. This study was conducted on 19 human cadavers (12 adults and 7 infants without pathologic changes in the orbital region and eyelids. Anatomic microdissection of the contents of the orbita was performed bilaterally on 12 orbits from 6 unfixed cadavers (3 male and 3 female. Micromorphologic investigations of the orbital tissue were performed on 8 en bloc excised and formalin-fixed orbits of infant cadavers. Specimens were fixed according to the Duvernoy method. An intra-arterial injection of 5% mixture of melt formalin and black ink was administered into the carotid arterial system. Using routine fixation, decalcination, dehydration, illumination, impregnation and molding procedures in paraplast, specimens were prepared for cross-sections. Results. The measurement of the muscle length and diameter in situ in 6 nonfixed cadavers (12 orbits showed an average length of the levator palpbrae superioris (LPS muscle body of the 42.0 ± 1.41 mm on the right, and 40.3 ± 1.63 mm on the left side. In all the cases, the LPS had blood supply from 4 different arterial systems: the lacrimal, supratrochlear, and supraorbital artery and muscle branches of the ophthalmic artery. The LPS muscle in all the specimens was supplied by the superior medial branch of the oculomotor nerve. The connective tissue associated with the LPS muscle contains two transverse ligaments: the superior (Whitnall’s and intermuscular transverse ligaments (ITL. The orbital septum in all the specimens originated from the arcus marginalis of the frontal bone, and consisted of two layers - the superficial and the inner layer. In addition, a detailed histological analysis revealed that the upper eyelid

  7. Surgical anatomy and histology of the levator palpebrae superioris muscle for blepharoptosis correction.

    Science.gov (United States)

    Djordjević, Boban; Novaković, Marijan; Milisavljević, Milan; Milićević, Sasa; Maliković, Aleksandar

    2013-12-01

    The detailed knowledge of the architecture of the upper eyelid is very important in numerous upper eyelid corrective surgeries. The article deals with the detailed anatomy of the major components of the upper lid, which are commonly seen in surgical practice. This study was conducted on 19 human cadavers (12 adults and 7 infants) without pathologic changes in the orbital region and eyelids. Anatomic microdissection of the contents of the orbita was performed bilaterally on 12 orbits from 6 unfixed cadavers (3 male and 3 female). Micromorphologic investigations of the orbital tissue were performed on 8 en bloc excised and formalin-fixed orbits of infant cadavers. Specimens were fixed according to the Duvernoy method. An intra-arterial injection of 5% mixture of melt formalin and black ink was administered into the carotid arterial system. Using routine fixation, decalcination, dehydration, illumination, impregnation and molding procedures in paraplast, specimens were prepared for cross-sections. The measurement of the muscle length and diameter in situ in 6 nonfixed cadavers (12 orbits) showed an average length of the levator palpbrae superioris (LPS) muscle body of the 42.0 +/- 1.41 mm on the right, and 40.3 +/- 1.63 mm on the left side. In all the cases, the LPS had blood supply from 4 different arterial systems: the lacrimal, supratrochlear, and supraorbital artery and muscle branches of the ophthalmic artery. The LPS muscle in all the specimens was supplied by the superior medial branch of the oculomotor nerve. The connective tissue associated with the LPS muscle contains two transverse ligaments: the superior (Whitnall's) and intermuscular transverse ligaments (ITL). The orbital septum in all the specimens originated from the arcus marginalis of the frontal bone, and consisted of two layers--the superficial and the inner layer. In addition, a detailed histological analysis revealed that the upper eyelid's crease was formed by the conjoined fascia including the

  8. [Corrective effect of aromatherapy on indices of heart rate variability in students under exam stress conditions].

    Science.gov (United States)

    Abrahamyan, H T; Minasyan, S M

    2016-01-01

    There were investigated changes in indices of the activity of regulatory mechanisms of heart rhythm in student under exam stress conditions and the possibility of their correction with aid of aromatherapy. The examination stress was established to be accompanied by pronounced shifts of integral and spectral indices of heart rhythm in students, indicating to the activation of the sympathetic circuit of Autonomic Nervous System in conditions of examination stress. A positive, relaxation impact of the essential oil of orange on the investigated indices was also recorded. The latter is expressed by weakly pronounced changes or lack of them in data of integral and spectral heart rate indices in students from the experimental group, that indicates to the stabilizing effect of used ethereal oil on the psycho-physiological state of students in conditions of exam stress

  9. Use of digital computers for correction of gamma method and neutron-gamma method indications

    International Nuclear Information System (INIS)

    Lakhnyuk, V.M.

    1978-01-01

    The program for the NAIRI-S computer is described which is intended for accounting and elimination of the effect of by-processes when interpreting gamma and neutron-gamma logging indications. By means of slight corrections it is possible to use the program as a mathematical basis for logging diagram standardization by the method of multidimensional regressive analysis and estimation of rock reservoir properties

  10. Key performance indicators in an acute surgical unit: have we made an impact?

    Science.gov (United States)

    Hsee, Li; Devaud, Marcelo; Civil, Ian

    2012-10-01

    Timely access to acute surgery is a worldwide issue and New Zealand is similarly affected. Auckland City Hospital is one of the largest metropolitan public hospitals in New Zealand where more than 60 % of surgical admissions fit into the acute category. In January 2009, an Acute Surgical Unit (ASU) was set up to improve acute surgical flow. Key performance indicators (KPIs) were identified as valuable tools in evaluating ASU service performance. Our goals were to describe the current acute patient pathway, present the early trend of KPIs for the ASU and determine whether an impact has been made on acute surgical patients. A retrospective review of patients admitted with acute general surgical conditions from January 2008 (pre-ASU) to October 2010 was performed. Patient data were identified through hospital electronic records. KPIs assessed included: (1) time to assess referred patients from the emergency department (ED) and from GPs [where patient assessment occurs in the assessment and planning unit (APU)]; (2) preoperative length of stay (LOS[PO]); (3) length of stay of nonadmitted patients (LOS[NA]); (4) case volume "in h" (0730-1730) versus "after h"; and (5) readmission rate. Statistical analysis was performed with one-way ANOVA, regression, and χ(2) tests. Results show a reduction of mean time from referral to assessment from 2.28 to 1.6 h in the ED (p ≤ 0.001). Patients are seen in APU after GP referral sooner as well as the time from referral to assessment reducing from 2 to 1.76 h (p < 0.001). The LOS[PO] has not changed significantly overall (34.58 vs. 34.88 h, p = not significant [NS]). However, there are encouraging signs in high-volume procedures, such as appendicectomy. The mean LOS[PO] for appendicectomy was 7.81 h but is now 6.53 h (p ≤ 0.005). The LOS[NA] has decreased from 15.23 to 9.48 h (p < 0.005). Since the development of the ASU, the number of cases operated on "in hours" is increasing with a corresponding decrease in "after hours

  11. Posterior-only surgical correction of adolescent idiopathic scoliosis: an Egyptian experience

    Directory of Open Access Journals (Sweden)

    Elnady Belal

    2017-01-01

    Conclusion: This is a prospective study of at least 80% metal density pedicle screws technique and intra-operative wake-up test in Egyptian patients with AIS. It proved to be an effective and safe technique in correction of radiological parameters, with no neurological or implant related complications. It allowed excellent scoliotic and kyphotic curves correction with minimal loss of correction. On the whole it led to better quality of life.

  12. Correction of sampling bias in a cross-sectional study of post-surgical complications.

    Science.gov (United States)

    Fluss, Ronen; Mandel, Micha; Freedman, Laurence S; Weiss, Inbal Salz; Zohar, Anat Ekka; Haklai, Ziona; Gordon, Ethel-Sherry; Simchen, Elisheva

    2013-06-30

    Cross-sectional designs are often used to monitor the proportion of infections and other post-surgical complications acquired in hospitals. However, conventional methods for estimating incidence proportions when applied to cross-sectional data may provide estimators that are highly biased, as cross-sectional designs tend to include a high proportion of patients with prolonged hospitalization. One common solution is to use sampling weights in the analysis, which adjust for the sampling bias inherent in a cross-sectional design. The current paper describes in detail a method to build weights for a national survey of post-surgical complications conducted in Israel. We use the weights to estimate the probability of surgical site infections following colon resection, and validate the results of the weighted analysis by comparing them with those obtained from a parallel study with a historically prospective design. Copyright © 2012 John Wiley & Sons, Ltd.

  13. Duty hour restrictions and surgical complications for head and neck key indicator procedures.

    Science.gov (United States)

    Smith, Aaron; Jain, Nikhita; Wan, Jim; Wang, Lei; Sebelik, Merry

    2017-08-01

    Graduate medical education has traditionally required long work hours, allowing trainees little time for adequate rest. Based on concerns over performance deterioration with sleep deprivation and its effect on patient outcomes, duty hour restrictions have been mandated. We sought to characterize complications from otolaryngology key indicator procedures performed before and after duty hour reform. Retrospective cross-sectional analysis of National Inpatient Sample (NIS). The NIS was queried for procedure codes associated with head and neck key indicator groupings for the years 2000-2002 (45,363 procedures) and 2006-2008 (51,144 procedures). Hospitals were divided into three groups: nonteaching hospitals (NTH), teaching hospitals without otolaryngology programs (TH), and teaching hospitals with otolaryngology programs (TH-OTO). Surgical complication rates, length of stay, and mortality rates were analyzed using logistic and linear regression. The number of procedures increased (12.7%), with TH-OTO contributing more in postrestriction years (21% to 30%). Overall complication rates between the two periods revealed no difference, regardless of hospital setting. Subset analysis showed some variation within each complication within each grouping. Length of stay increased at TH-OTO (2.75 to 2.78 days) and decreased at NTH (2.28 to 2.24 days) and TH (2.39 to 2.36 days). Mortality did not increase among the three hospital types (NTH, P key indicator procedures. Moreover, concerns about reduced surgical case numbers appear unfounded, especially for otolaryngology programs. 2c Laryngoscope, 127:1797-1803, 2017. © 2016 The American Laryngological, Rhinological and Otological Society, Inc.

  14. A preliminary investigation of shape memory alloys in the surgical correction of scoliosis.

    Science.gov (United States)

    Sanders, J O; Sanders, A E; More, R; Ashman, R B

    1993-09-15

    Nitinol, a shape memory alloy, is flexible at low temperatures but retains its original shape when heated. This offers interesting possibilities for scoliosis correction. Of the shape memory alloys, nitinol is the most promising medically because of biocompatibility and the ability to control transition temperature. In vivo: Six goats with experimental scoliosis were instrumented with 6-mm nitinol rods. The rods were transformed, and the scoliosis corrected, in the awakened goats by 450-kHz radio frequency induction heating. The curves averaged 41 degrees before instrumentation, 33 degrees after instrumentation, and 11 degrees after rod transformation. The animals tolerated the heating without discomfort, neurologic injury, or evidence of thermal injury to the tissues or the spinal cord. In vitro: Nitinol rods were tested under both constant deflection and constant loading conditions and plotted temperature versus either force or displacement. The 6-mm rod generated forces of 200 N. The 9-mm rod generated up to 500 N. We safely coupled shape memory alloy transformation to the spine and corrected an experimental spinal deformity in awake animals. The forces generated can be estimated by the rod's curvature and temperature. The use of shape memory alloys allows continuous neurologic monitoring during awake correction, true rotational correction by rod torsion, and the potential option of periodic correction to take advantage of spinal viscoelasticity and the potential of true rotational correction by rod torsion.

  15. Performance indicators for quality in surgical and laboratory services at Muhimbili National Hospital (MNH) in Tanzania.

    Science.gov (United States)

    Mbembati, Naboth A; Mwangu, Mugwira; Muhondwa, Eustace P Y; Leshabari, Melkizedek M

    2008-04-01

    Muhimbili National Hospital (MNH), a teaching and national referral hospital, is undergoing major reforms to improve the quality of health care. We performed a retrospective descriptive study using a set of performance indicators for the surgical and laboratory services of MNH in years 2001 and 2002, to help monitor and evaluate the impact of reforms on the quality of health care during and after the reform process. Hospital records were reviewed and information recorded for planned and postponed operations, laboratory equipment, reagents, laboratory tests and quality assurance programmes. In the year 2001 a total of 4332 non-emergency operations were planned, 3313 operations were performed and 1019 (23.5%) operations were postponed. In the year 2002, 4301 non-emergency operations were planned, 3046 were performed and 1255 (29%) were postponed. The most common reasons for operation postponement were "time-barred", interference by emergency operations, no show of patients and inoperable anaesthetic machines. Equipment problems and supply and staff shortages together accounted for one quarter of postponements. In the laboratory, a lack of equipment prevented some tests, but quality assurance was performed for most tests. Current surgical services at MNH are inadequate; operating theatres require modern, functioning equipment and adequate supplies of consumables to provide satisfactory care.

  16. Surgical correction of class II skeletal malocclusion in an adult patient

    Directory of Open Access Journals (Sweden)

    Ramakrishnan Balachander

    2014-01-01

    Full Text Available Correction of skeletal deformities in adult patients with orthodontics is limited. Orthognathic surgery is the best option for cases when camouflage treatment is questionable and growth modulation is not possible. This case report illustrates the benefit of the team approach in correcting vertical maxillary excess along with class II skeletal deformity. A cosmetic correction was achieved by superior repositioning of maxilla with LeFort I osteotomy and augmentation genioplasty, along with orthodontic treatment. The patient′s facial appearance was markedly improved along with functional and stable occlusion

  17. The trans-caval approach for surgical correction of sinus venosus ...

    African Journals Online (AJOL)

    Mohamed Nassar

    2011-11-23

    Nov 23, 2011 ... Abstract Background: Many techniques have been developed to address the partial anomalous pulmonary venous drainage into the superior vena cava. The morphology of this anomaly is respon- sible for the possible surgical complications including sinus node dysfunction, systemic and/or pul-.

  18. Simultaneous surgical correction of atrial fibrillation and aortic valve replacement: immediate results after surgery

    Directory of Open Access Journals (Sweden)

    Leo A. Bockeria

    2016-12-01

    Conclusions ― There are few data demonstrating experience in performing of such complex surgical cases due to the severity of patients and small number of institutions having such experience. In our series of hospital mortality observations correlated with the calculated and accounted for 4.4%, which is an acceptable result in this group of patients.

  19. Surgical correction of mitral valve prolapse : a cure for recurrent ventricular tachycardia in Marfan syndrome?

    Science.gov (United States)

    Beroukhim, Rebecca S; Reed, John H; Schaffer, Michael S; Yetman, Anji T

    2006-01-01

    We describe the case of a 3-year-old child with neonatal Marfan syndrome complicated by mitral valve prolapse with regurgitation, marked aortic root dilatation, and ventricular tachycardia. The patient had resolution of ventricular tachycardia following surgical intervention consisting of a valve-sparing aortic root replacement and mitral valve annuloplasty.

  20. The trans-caval approach for surgical correction of sinus venosus ...

    African Journals Online (AJOL)

    Background: Many techniques have been developed to address the partial anomalous pulmonary venous drainage into the superior vena cava. The morphology of this anomaly is responsible for the possible surgical complications including sinus node dysfunction, systemic and/or pulmonary venous channels obstruction.

  1. h-index, h-type Indices, and the Role of Corrected Quality Ratio

    Directory of Open Access Journals (Sweden)

    Tahira, Muzammil

    2014-12-01

    Full Text Available This study examines the foremost concerns related to most noted research performance index. The most popular and widely acceptable h-index underestimates the highly visible scientist, the middle order group, due to citation distribution issues. The study addresses this issue and uses 'Corrected Quality Ratio' (CQ to check the implicit underpinnings as evident in h-index. CQ helps to incorporate the aspects of a good research performance indicator. This simple revision performs more intimately and logically to gauge the broader research impact for all groups and highly visible scientists with less statistical error.

  2. Early rehabilitation treatment combined with equinovarus foot deformity surgical correction in stroke patients: safety and changes in gait parameters.

    Science.gov (United States)

    Giannotti, Erika; Merlo, Andrea; Zerbinati, Paolo; Longhi, Maria; Prati, Paolo; Masiero, Stefano; Mazzoli, Davide

    2016-06-01

    Equinovarus foot deformity (EVFD) compromises several prerequisites of walking and increases the risk of falling. Guidelines on rehabilitation following EVFD surgery are missing in current literature. The aim of this study was to analyze safety and adherence to an early rehabilitation treatment characterized by immediate weight bearing with an ankle-foot orthosis (AFO) in hemiplegic patients after EVFD surgery and to describe gait changes after EVFD surgical correction combined with early rehabilitation treatment. Retrospective observational cohort study. Inpatient rehabilitation clinic. Forty-seven adult patients with hemiplegia consequent to ischemic or haemorrhagic stroke (L/R 20/27, age 56±15 years, time from lesion 6±5 years). A specific rehabilitation protocol with a non-articulated AFO, used to allow for immediate gait training, started one day after EVFD surgery. Gait analysis (GA) data before and one month after surgery were analyzed. The presence of differences in GA space-time parameters, in ankle dorsiflexion (DF) values and peaks at initial contact (DF at IC), during stance (DF at St) and swing (DF at Sw) were assessed by the Wilcoxon Test while the presence of correlations between pre- and post-operative values by Spearman's correlation coefficient. All patients completed the rehabilitation protocol and no clinical complications occurred in the sample. Ankle DF increased one month after surgery at all investigated gait phases (Wilcoxon Test, Prehabilitation associated with surgical procedure is safe and may be suitable to correct EVFD by restoring both the neutral heel foot-ground contact and the ankle DF peaks during stance and swing at one month from surgery. The proposed protocol is a safe and potentially useful rehabilitative approach after EVFD surgical correction in stroke patients.

  3. Surgical indications for unilateral neonatal hydronephrosis in considering ureteropelvic junction obstruction

    Directory of Open Access Journals (Sweden)

    Hong-Lin Cheng

    2014-09-01

    Full Text Available Prenatal hydronephrosis is one of the most common urological congenital abnormalities detected by ultrasound. The incidence ranges from 0.59% to 0.69%. Approximately 50% of these fetuses do not have hydronephrosis on postnatal examination, whereas 25–33% of the rest have persistent hydronephrosis leading to the diagnosis of ureteropelvic junction (UPJ obstruction. Renal ultrasonography and renal radionuclide scanning are the major modalities used for assessment and follow-up. Three main criteria used to determine the presence of obstruction are: (1 the magnitude of hydronephrosis present on ultrasound, (2 the relative renal function (RRF measured by renography, and (3 the response of radionuclide washout with furosemide. Unfortunately, it is not always easy to determine obstruction; different types of management have been developed. Without depending on the severity of renal pelvis dilation, percentage of RRF, and response of radionuclide washout in the initial presentation, early surgery to preserve renal function and aggressive observation to prevent unnecessary surgery are two extremes on the spectrum of management for neonatal UPJ obstruction. Relying on renal function in renography, <35–40% or 5–10% of a decrease in the percentage of RRF or on the enlarging of hydronephrosis, respectively, and parenchymal thinning on ultrasonography are the indications for the surgical management to recover renal function in time. In addition to renal function change and imaging progression, the follow-up protocol and family compliance are the other considerations in prevention of impaired renal function. Through more than 40 years of development in the field of UPJ obstruction in infants, there have been several advances in management but controversies remain to be resolved. In this review, we focus on the surgical indications for the UPJ obstruction in this cohort.

  4. [Pre-surgical orthodontic treatment of skeletal class II patients with gingival smile corrected by anterior maxillary segmental osteotomy].

    Science.gov (United States)

    Li, Xiaobing; Xiao, Liwei; Chen, Song; Chen, Yangxi

    2002-11-01

    To discuss the pre-surgical orthodontic treatment of skeletal class II patients with gingiva smile corrected by AMSO. We analyzed the clinical features of 20 skeletal class II patients treated by AMSO combined with Orthodontic treatment and evaluated the effects of AMSO by means of cephalometric analysis. After the AMSO treatment, ANB angle, the height of anterior maxilla, the protrusion of the upper anterior teeth, and the of A point had reduced significantly (P orthodontically to make arch relationship. Extract the upper bicuspid half a year before the surgery was recommended. When necessary, genioplasty could be performed.

  5. Surgical correction of severe spinal deformities using a staged protocol of external and internal techniques.

    Science.gov (United States)

    Prudnikova, Oksana G; Shchurova, Elena N

    2018-02-01

    There is high risk of neurologic complications in one-stage management of severe rigid spinal deformities in adolescents. Therefore, gradual spine stretching variants are applied. One of them is the use of external transpedicular fixation. Our aim was to retrospectively study the outcomes of gradual correction with an apparatus for external transpedicular fixation followed by internal fixation used for high-grade kyphoscoliosis in adolescents. Twenty five patients were reviewed (mean age, 15.1 ± 0.4 years). Correction was performed in two stages: 1) gradual controlled correction with the apparatus for external transpedicular fixation; and 2) internal posterior transpedicular fixation. Rigid deformities in eight patients required discapophysectomy. Clinical and radiographic study of the outcomes was conducted immediately after treatment and at a mean long-term period of 3.8 ± 0.4 years. Pain was evaluated using the visual analogue scale (VAS, 10 points). The Oswestry questionnaire (ODI scale) was used for functional assessment. Deformity correction with the external apparatus was 64.2 ± 4.6% in the main curve and 60.7 ± 3.7% in the compensatory one. It was 72.8 ± 4.1% and 66.2 ± 5.3% immediately after treatment and 70.8 ± 4.6% and 64.3 ± 4.2% at long term, respectively. Pain relieved by 33.2 ± 4.2% (p external transpedicular fixation provides gradual controlled correction for high-grade kyphoscoliosis in adolescents. Transition to internal fixation preserves the correction achieved, and correction is maintained at long term.

  6. Spontaneous Improvement of Compensatory Knee Flexion After Surgical Correction of Mismatch Between Pelvic Incidence and Lumbar Lordosis.

    Science.gov (United States)

    Cheng, Xiaofei; Zhang, Feng; Wu, Jigong; Zhu, Zhenan; Dai, Kerong; Zhao, Jie

    2016-08-15

    A retrospective study. The aim of this study was to investigate the correlation between pelvic incidence (PI) and lumbar lordosis (LL) mismatch and knee flexion during standing in patients with lumbar degenerative diseases and to examine the effects of surgical correction of the PI-LL mismatch on knee flexion. Only several studies focused on knee flexion as a compensatory mechanism of the PI-LL mismatch. Little information is currently available on the effects of lumbar correction on knee flexion in patients with the PI-LL mismatch. A group of patients with lumbar degenerative diseases were divided into PI-LL match group (PI-LL ≤ 10°) and PI-LL mismatch group (PI-LL > 10°). A series of radiographic parameters and knee flexion angle (KFA) were compared between the two groups. The PI-LL mismatch group was further subdivided into operative and nonoperative group. The changes in KFA with PI-LL were examined. The PI-LL mismatch group exhibited significantly greater sagittal vertical axis (SVA), pelvic tilt (PT) and KFA, and smaller LL, thoracic kyphosis (TK), and sacral slope than the PI-LL match group. PI-LL, LL, PI, SVA, and PT were significantly correlated with KFA in the PI-LL mismatch group. From baseline to 6-month follow-up, all variables were significantly different in the operative group with the exception of PI, although there was no significant difference in any variable in the nonoperative group. The magnitude of surgical correction in the PI-LL mismatch was significantly correlated with the degree of spontaneous changes in KFA, PT, and TK. The PI-LL mismatch would contribute to compensatory knee flexion during standing in patients with lumbar degenerative disease. Surgical correction of the PI-LL mismatch could lead to a spontaneous improvement of compensatory knee flexion. The degree of improvement in knee flexion depends in part on the amount of correction in the PI-LL mismatch. 3.

  7. Comparative Analysis of Different Types of Analgesia in Patients after Surgical Correction of Scoliotic Spinal Deformity

    Directory of Open Access Journals (Sweden)

    M.A. Georgiyants

    2013-03-01

    Full Text Available A comparative study of epidural analgesia and anesthesia using opiates after surgical interventions for spinal scoliosis in children has beem carried out. Patients were divided into 2 groups. In the first one postoperative analgesia was carried out by intramuscular injection of promedol, in second one epidural analgesia was used with the constant introduction of ropivacaine. The authors studied the effect of these techniques on hemodynamics, the analysis of the subjective perception of pain by patients.

  8. Virtual Surgical Planning for Correction of Delayed Presentation Scaphocephaly Using a Modified Melbourne Technique.

    Science.gov (United States)

    Macmillan, Alexandra; Lopez, Joseph; Mundinger, Gerhard S; Major, Melanie; Medina, Miguel A; Dorafshar, Amir H

    2018-02-23

    Late treatment of scaphocephaly presents challenges including need for more complex surgery to achieve desired head shape. Virtual surgical planning for total vault reconstruction may mitigate some of these challenges, but has not been studied in this unique and complex clinical setting. A retrospective chart review was conducted for patients with scaphocephaly who presented to our institution between 2000 and 2014. Patients presenting aged 12 months or older who underwent virtual surgical planning-assisted cranial vault reconstruction were included. Patient demographic, intraoperative data, and postoperative outcomes were recorded. Pre- and postoperative anthropometric measurements were obtained to document the fronto-occipital (FO) and biparietal (BP) distance and calculate cephalic index (CI). Virtual surgical planning predicted, and actual postoperative anthropometric measurements were compared. Five patients were identified who fulfilled inclusion criteria. The mean age was 50.6 months. One patient demonstrated signs of elevated intracranial pressure preoperatively. Postoperatively, all but one needed no revisional surgery (Whitaker score of 1). No patient demonstrated postoperative evidence of bony defects, bossing, or suture restenosis. The mean preoperative, simulated, and actual postoperative FO length was 190.3, 182, and 184.3 mm, respectively. The mean preoperative, simulated, and actual postoperative BP length was 129, 130.7, and 131 mm, respectively. The mean preoperative, simulated, and actual postoperative CI was 66, 72, and 71.3, respectively. Based on our early experience, virtual surgical planning using a modified Melbourne technique for total vault remodeling achieves good results in the management of late presenting scaphocephaly.

  9. Late versus early surgical correction for congenital diaphragmatic hernia in newborn infants.

    Science.gov (United States)

    Moyer, V; Moya, F; Tibboel, R; Losty, P; Nagaya, M; Lally, K P

    2002-01-01

    Congenital diaphragmatic hernia, although rare (1 per 2-4,000 births), is associated with high mortality and cost. Opinion regarding the timing of surgical repair has gradually shifted from emergent repair to a policy of stabilization using a variety of ventilatory strategies prior to operation. Whether delayed surgery is beneficial remains controversial. To summarize the available data regarding whether surgical repair in the first 24 hours after birth rather than later than 24 hours of age improves survival to hospital discharge in infants with congenital diaphragmatic hernia who are symptomatic at or immediately after birth. Search of MEDLINE (1966-2002), EMBASE (1978-2002) and the Cochrane databases using the terms "congenital diaphragmatic hernia" and "surg*"; citations search, and contact with experts in the field to locate other published and unpublished studies. Studies were eligible for inclusion if they were randomized or quasi-randomized trials that addressed infants with CDH who were symptomatic at or shortly after birth, comparing early (24 hours) surgical intervention, and evaluated mortality as the primary outcome. Data were collected regarding study methods and outcomes including mortality, need for ECMO and duration of ventilation, both from the study reports and from personal communication with investigators. Analysis was performed in accordance with the standards of the Cochrane Neonatal Review Group. Two trials met the pre-specified inclusion criteria for this review. Both were small trials (total n<90) and neither showed any significant difference between groups in mortality. Meta-analysis was not performed because of significant clinical heterogeneity between the trials. There is no clear evidence which favors delayed (when stabilized) as compared with immediate (within 24 hours of birth) timing of surgical repair of congenital diaphragmatic hernia, but a substantial advantage to either one cannot be ruled out. A large, multicenter randomized

  10. Choice of approaches for surgical correction of tricuspid pathology in patients with rheumatic multi-valvular heart disease

    Directory of Open Access Journals (Sweden)

    Hamidullah A. Abdumadzhidov

    2017-04-01

    Full Text Available Objective: To analyze the results of surgical correction of patients with tricuspid pathology in rheumatic multi-valvular heart disease. Methods: We retrospectively analyzed outcomes of surgical correction of tricuspid valve disease in 292 patients with rheumatic multi-valvular heart defects, who underwent surgery in our clinic. Results: The age of our patients ranged from 12 to 74 years (mean age 36.7 (9.4 years, among them 197 (67.4% women and 95 (32.6% - men. According to the degree of circulatory disorders, 21 (7.2% patients were in NYHA class III and 271 (92.8% patients - class IV. Of them 235 (80.5% patients were operated by the method of De Vega using plastic fibrous ring. After tricuspid valve (TV and fibrous ring repair in 26.9% - tricuspid regurgitation disappeared, in 62.8% - regurgitation decreased to the 1st degree, and the remaining 10.3% of patients had 2nd (moderate degree tricuspid regurgitation. In 7 (2.38% cases of infective endocarditis, the "open heart surgery" correction – replacement of TV with biological prosthesis was made. Creation of the bicuspid tricuspid valve techniques was used in 13.4% of cases. Conclusion: Our study demonstrated that correction of tricuspid valve disease in our cohort of patients, including valve repair and replacement and reconstructive surgery of fibrous ring alone or in combination with mitral or aortic valve replacement/ repair is accompanied by reduction of tricuspid regurgitation and reduction of cardiac chamber size and right ventricular pressure. No complications intrinsic to operative technique of tricuspid valve reconstructive surgery as advanced atrioventricular block or myocardial ischemia and infarction were recorded.

  11. Combined orthodontic and surgical correction of adult skeletal class II with hyperdivergent jaws.

    Science.gov (United States)

    Abraham, Jiku; Bagchi, Paulami; Gupta, Swati; Gupta, Hemant; Autar, Ram

    2012-01-01

    A case of severe Class II skeletal malocclusion with anterior open bite having vertical growth pattern and matching soft tissue profile is presented. Considering age of the patient and the severity of the malocclusion, it was decided to combine orthodontic treatment with surgery. A 0.022 Roth Pre-adjusted Edgewise Appliance was chosen for the orthodontic correction and Le-Fort 1 differential vertical impaction of maxilla with mandibular autorotation and augmentation genioplasty was considered as the treatment plan. The main aim was to reduce the gummy smile and correct the class II profile.

  12. Surgically induced astigmatism after phacoemulsification with and without correction for posture-related ocular cyclotorsion: randomized controlled study.

    LENUS (Irish Health Repository)

    Dooley, Ian

    2012-02-01

    PURPOSE: To report the impact of posture-related ocular cyclotorsion on one surgeon\\'s surgically induced astigmatism (SIA) results and the variance in SIA. SETTING: Institute of Eye Surgery, Whitfield Clinic, Waterford, Ireland. METHODS: This prospective randomized controlled study included eyes that had phacoemulsification with intraocular lens implantation. Eyes were randomly assigned to have (intervention group) or not have (control group) correction for posture-related ocular cyclotorsion. In the intervention group, the clear corneal incision was placed precisely at the 120-degree meridian with instruments designed to correct posture-related ocular cyclotorsion. In the control group, the surgeon endeavored to place the incision at the 120-degree meridian, but without markings. RESULTS: The intervention group comprised 41 eyes and the control group, 61 eyes. The mean absolute SIA was 0.74 diopters (D) in the intervention group and 0.78 D in the control group; the difference between groups was not statistically significant (P>.5, unpaired 2-tailed Student t test). The variance in SIA was 0.29 D(2) and 0.31 D(2), respectively; the difference between groups was not statistically significant (P>.5, unpaired F test). CONCLUSIONS: Attempts to correct for posture-related ocular cyclotorsion did not influence SIA or its variance in a single-surgeon series. These results should be interpreted with full appreciation of the limitations of currently available techniques to correct for posture-related ocular cyclotorsion in the clinical setting.

  13. Direct surgical repair of spondylolysis in athletes: indications, techniques, and outcomes.

    Science.gov (United States)

    Drazin, Doniel; Shirzadi, Ali; Jeswani, Sunil; Ching, Harry; Rosner, Jack; Rasouli, Alexandre; Kim, Terrence; Pashman, Robert; Johnson, J Patrick

    2011-11-01

    Athletes present with back pain as a common symptom. Various sports involve repetitive hyperextension of the spine along with axial loading and appear to predispose athletes to the spinal pathology spondylolysis. Many athletes with acute back pain require nonsurgical treatment methods; however, persistent recurrent back pain may indicate degenerative disc disease or spondylolysis. Young athletes have a greater incidence of spondylolysis. Surgical solutions are many, and yet there are relatively few data in the literature on both the techniques and outcomes of spondylolytic repair in athletes. In this study, the authors undertook a review of the surgical techniques and outcomes in the treatment of symptomatic spondylolysis in athletes. A systematic review of the MEDLINE and PubMed databases was performed using the following key words to identify articles published between 1950 and 2011: "spondylolysis," "pars fracture," "repair," "athlete," and/or "sport." Papers on both athletes and nonathletes were included in the review. Articles were read for data on methodology (retrospective vs prospective), type of treatment, number of patients, mean patient age, and mean follow-up. Eighteen articles were included in the review. Eighty-four athletes and 279 nonathletes with a mean age of 20 and 21 years, respectively, composed the population under review. Most of the fractures occurred at L-5 in both patient groups, specifically 96% and 92%, respectively. The average follow-up period was 26 months for athletes and 86 months for nonathletes. According to the modified Henderson criteria, 84% (71 of 84) of the athletes returned to their sports activities. The time intervals until their return ranged from 5 to 12 months. For a young athlete with a symptomatic pars defect, any of the described techniques of repair would probably produce acceptable results. An appropriate preoperative workup is important. The ideal candidate is younger than 20 years with minimal or no listhesis and

  14. Surgical Correction of Posttraumatic Scapulothoracic Bursitis, Rhomboid Major Muscle Injury, Ipsilateral Glenohumeral Instability, and Headaches Resulting from Circus Acrobatic Maneuvers

    Directory of Open Access Journals (Sweden)

    John G. Skedros

    2015-01-01

    Full Text Available We report the case of a 28-year-old transgender (male-to-female patient that had a partial tear of the rhomboid major tendon, scapulothoracic bursitis, and glenohumeral instability on the same side. These conditions resulted from traumatic events during circus acrobatic maneuvers. Additional aspects of this case that make it unique include (1 the main traumatic event occurred during a flagpole exercise, where the patient’s trunk was suspended horizontally while a vertical pole was grasped with both hands, (2 headaches were associated with the periscapular injury and they improved after scapulothoracic bursectomy and rhomboid tendon repair, (3 surgical correction was done during the same operation with an open anterior capsular-labral reconstruction, open scapulothoracic bursectomy without bone resection, and rhomboid tendon repair, (4 a postoperative complication of tearing of the serratus anterior and rhomboid muscle attachments with recurrent scapulothoracic pain occurred from patient noncompliance, and (5 the postoperative complication was surgically corrected and ultimately resulted in an excellent outcome at the one-year final follow-up.

  15. Radiofrequency for the Treatment of Lumbar Radicular Pain: Impact on Surgical Indications.

    Science.gov (United States)

    Trinidad, José Manuel; Carnota, Ana Isabel; Failde, Inmaculada; Torres, Luis Miguel

    2015-01-01

    Study Design. Quasiexperimental study. Objective. To investigate whether radiofrequency treatment can preclude the need for spinal surgery in both the short term and long term. Background. Radiofrequency is commonly used to treat lumbosacral radicular pain. Only few studies have evaluated its effects on surgical indications. Methods. We conducted a quasiexperimental study of 43 patients who had been scheduled for spinal surgery. Radiofrequency was indicated for 25 patients. The primary endpoint was the decision of the patient to reject spinal surgery 1 month and 1 year after treatment (pulsed radiofrequency of dorsal root ganglion, 76%; conventional radiofrequency of the medial branch, 12%; combined technique, 12%). The primary endpoint was the decision of the patient to reject spinal surgery 1 month and 1 year after treatment. In addition, we also evaluated adverse effects, ODI, NRS. Results. We observed after treatment with radiofrequency 80% of patients rejected spinal surgery in the short term and 76% in the long term. We conclude that radiofrequency is a useful treatment strategy that can achieve very similar outcomes to spinal surgery. Patients also reported a very high level of satisfaction (84% satisfied/very satisfied). We also found that optimization of the electrical parameters of the radiofrequency improved the outcome of this technique.

  16. Radiofrequency for the Treatment of Lumbar Radicular Pain: Impact on Surgical Indications

    Directory of Open Access Journals (Sweden)

    José Manuel Trinidad

    2015-01-01

    Full Text Available Study Design. Quasiexperimental study. Objective. To investigate whether radiofrequency treatment can preclude the need for spinal surgery in both the short term and long term. Background. Radiofrequency is commonly used to treat lumbosacral radicular pain. Only few studies have evaluated its effects on surgical indications. Methods. We conducted a quasiexperimental study of 43 patients who had been scheduled for spinal surgery. Radiofrequency was indicated for 25 patients. The primary endpoint was the decision of the patient to reject spinal surgery 1 month and 1 year after treatment (pulsed radiofrequency of dorsal root ganglion, 76%; conventional radiofrequency of the medial branch, 12%; combined technique, 12%. The primary endpoint was the decision of the patient to reject spinal surgery 1 month and 1 year after treatment. In addition, we also evaluated adverse effects, ODI, NRS. Results. We observed after treatment with radiofrequency 80% of patients rejected spinal surgery in the short term and 76% in the long term. We conclude that radiofrequency is a useful treatment strategy that can achieve very similar outcomes to spinal surgery. Patients also reported a very high level of satisfaction (84% satisfied/very satisfied. We also found that optimization of the electrical parameters of the radiofrequency improved the outcome of this technique.

  17. Usefulness of 67Ga scintigraphy in deciding surgical indication in secondary hyperparathyroidism

    International Nuclear Information System (INIS)

    Otsuka, Nobuaki; Mimura, Hiroaki; Sone, Teruki; Tamada, Tsutomu; Yanagimoto, Shinichi; Tomomitsu, Tatsushi; Fukunaga, Masao; Katagiri, Makoto

    1999-01-01

    In order to evaluate the usefulness in deciding surgical indication in secondary hyperparathyroidism (SHP), 67 Ga scintigraphy was performed in 37 patients of SHP before parathyroidectomy (PTx). The radionuclide accumulation in skull and submandible was classified into 4 patterns (skull-submandibular pattern, skull pattern, submandibular pattern and normal pattern). Serum alkaline phosphatase levels were significantly elevated in patients of skull-submandibular pattern (13 cases) compared with skull pattern (6 cases), submandibular pattern (6 cases) and normal pattern (12 cases). Serum intact parathyroid hormone levels were significantly elevated in patients of skull-submandibular and skull patterns compared with normal pattern. No significant difference was observed among the weight of resected parathyroid glands. In 4 of 6 patients of normal pattern on 67 Ga scintigram, bone scintigraphy showed a characteristic pattern of SHP including an increased accumulation in the skull and submandible. Bone mineral density (BMD) in the distal radius was increased within six to twelve months after PTx in 10 of 11 patients of skull-submandibular pattern on 67 Ga scintigram, whereas only one patient showed an increase in BMD in 9 patients of normal pattern. In summary, it was concluded that 67 Ga scintigraphy could provide a useful information in deciding the indication for PTx in secondary hyperparathyroidism. (author)

  18. Drug correction of intestinal motility disorders in intensive care in the postoperative period in surgical patients

    Directory of Open Access Journals (Sweden)

    Novitskaya-Usenko L.V.

    2015-03-01

    Full Text Available Aim: improving the results of the complex treatment of patients with surgical pathology of abdominal organs by improving prevention and treatment of motor-evacuation disorders of the gastrointestinal tract in the postoperative period. Results: the article presents data on the use of metoclopramide, L- ar¬ginine, simethicone for the prevention of postoperative dysmotility development. It is proved that L-arginine use reduces the effects of peripheral vasospasm by improving microcirculation of the intestinal wall and this leads to a more rapid recovery of motor-evacuation function of the gastrointestinal tract.

  19. The Megameatus, Intact Prepuce Variant of Hypospadias: Use of the Inframeatal Vascularized Flap for Surgical Correction

    Directory of Open Access Journals (Sweden)

    Marc Cendron

    2018-03-01

    Full Text Available IntroductionThe megameatus intact prepuce (MIP variant of hypospadias is a rare variant of hypospadias that is diagnosed either early at the time of circumcision or later as the foreskin is retracted. The true incidence of the anomaly is difficult to determine precisely as some patient never come to medical attention but is felt to under 5% of all cases of hypospadias. The purposes of this study are to review the embryology and clinical findings of MIP and then, in light of a personal experience, present a series of patients evaluated for MIP who were treated with a modification of the Mathieu technique.Materials and methodsA PubMed search of all articles in the MIP variant of hypospadias was carried out followed by an exhaustive review of the literature. The charts of all patients evaluated and treated at Boston Children’s Hospital by MC between 2007 and 2017 were reviewed retrospectively. The patients were divided into two groups: those who underwent the standard procedure and those who underwent a repair using a modification of the Mathieu procedure using an inframeatal flap.ResultsThe embryologic explanation of the MIP variant is not clear but failure of the distal, glanular portion of the urethra to tubularize results in spectrum of abnormality characterized by a deep glanular groove and an abnormal opening of the urethra anywhere from the mid-glans to a subcoronal location. Surgical repair is complicated by a wide distal urethra which may be injured if not properly identified. Overall good outcomes were noted with one patient experiencing a urethra cutaneous fistula in the first group and one patient having a mild glans dehiscence in the second.ConclusionThe MIP variant of hypospadias is a rare variant of hypospadias that presents as a spectrum of urethral anomaly. Surgical repair may not always be necessary but if surgical repair is carried out, the Mathieu technique modification may offer better anatomic delineation of the urethra and

  20. The Megameatus, Intact Prepuce Variant of Hypospadias: Use of the Inframeatal Vascularized Flap for Surgical Correction.

    Science.gov (United States)

    Cendron, Marc

    2018-01-01

    The megameatus intact prepuce (MIP) variant of hypospadias is a rare variant of hypospadias that is diagnosed either early at the time of circumcision or later as the foreskin is retracted. The true incidence of the anomaly is difficult to determine precisely as some patient never come to medical attention but is felt to under 5% of all cases of hypospadias. The purposes of this study are to review the embryology and clinical findings of MIP and then, in light of a personal experience, present a series of patients evaluated for MIP who were treated with a modification of the Mathieu technique. A PubMed search of all articles in the MIP variant of hypospadias was carried out followed by an exhaustive review of the literature. The charts of all patients evaluated and treated at Boston Children's Hospital by MC between 2007 and 2017 were reviewed retrospectively. The patients were divided into two groups: those who underwent the standard procedure and those who underwent a repair using a modification of the Mathieu procedure using an inframeatal flap. The embryologic explanation of the MIP variant is not clear but failure of the distal, glanular portion of the urethra to tubularize results in spectrum of abnormality characterized by a deep glanular groove and an abnormal opening of the urethra anywhere from the mid-glans to a subcoronal location. Surgical repair is complicated by a wide distal urethra which may be injured if not properly identified. Overall good outcomes were noted with one patient experiencing a urethra cutaneous fistula in the first group and one patient having a mild glans dehiscence in the second. The MIP variant of hypospadias is a rare variant of hypospadias that presents as a spectrum of urethral anomaly. Surgical repair may not always be necessary but if surgical repair is carried out, the Mathieu technique modification may offer better anatomic delineation of the urethra and will provide an extra layer of tissue to cover the reconstructed

  1. Indicators of surgical treatment of patent ductus arteriosus in preterm neonates in the first week of life

    OpenAIRE

    Braulio, Renato; Gelape, Cláudio Léo; Araújo, Fátima Derlene da Rocha; Brandão, Kelly Nascimento; Abreu, Luciana Drummond Guimarães; Costa, Paulo Henrique Nogueira; Capanema, Flávio Diniz

    2013-01-01

    OBJECTIVE: To identify clinical and echocardiographic indicators of the necessity for early surgical closure of patent ductus arteriosus in preterm neonates. METHODS: The prospective study was conducted at the Neonatal Unit of Hospital Municipal Odilon Behrens between 2006 and 2010. The study population comprised 115 preterm neonates diagnosed with patent ductus arteriosus in the first week after birth, of whom 55 (group S) were submitted to clinical and or surgical closure and 60 (group NS) ...

  2. Surgical treatment of the concomitant pathology in corrected transposition of great arteries

    Directory of Open Access Journals (Sweden)

    O.Ye. Repin

    2016-03-01

    Full Text Available The aim – to analyze our experience in the treatment of patients with congenitally corrected transposition of great arteries (CCTGA. Materials and methods. Thirty-nine patients with CCTGA (0.7 %, age from 4 months to 48 years, were observed since 1995 to 2014. Insufficiency of the tricuspid valve was diagnosed in 7 patients, ventricular septal defect (VSD – in 12, III degree AV blockade – in 5 patients (in 4 cases – primary AV blockade and in one case – after VSD repair, insufficiency of mitral valve – in 3 cases (in one of them as a result of bacterial endocarditis after implantation of the endocardial electrode, pulmonary stenosis – in 5. Rezults. Totally 24 surgeries were performed: correction of systemic valve insufficiency – in 6 patients (plastics – in 4 of them and prosthesis in 2 patients, VSD plastics – 9, pacemaker implantation – 4, mitral valve plastics – 2, pulmonary artery banding – 2, bidirectional Glenn – 1. Surgeries were performed without lethal outcomes. Patients were observed from 8 months till 14 years. Adequate correction of all associated pathology was achieved in all patients. Concerning the progressing of tricuspid valve insufficiency, replacement of it was done in 3 cases. Medical treatment of the progressive heart failure was prescribed to 48 years-old patient. Conclusion. The submitted material confirms the data regarding high risk of the development of AV blockade, tricuspid valve insufficiency, as well as right ventricular failure during 4–5th decade of life. Early revealing and adequate correction of accompanying defects and developing complications allows to achieve satisfactory immediate and long-term results.

  3. THE CORRECTION OF HALLUX VARUS DEFORMITY IN CONSEQUENCE OF SURGICAL TREATMENT FOR HALLUX VALGUS

    Directory of Open Access Journals (Sweden)

    V. M. Mashkov

    2010-01-01

    Full Text Available The analysis of treatment of 21 patients (24 feet with postoperative hallux varus deformity which have arisen after operations apropos hallux valgus is carried out. For correction of vicious position of the first finger we successfully carried out the Brandes procedure, sometimes in a combination to operations on sinews of muscles of the first finger - an adductor hallucis tendotomy and/or lengthening of the extensor hallucis longus tendon.

  4. Surgical correction of hallux valgus complicated with adult-type pes plano-valgus.

    Science.gov (United States)

    Choi, Jun Young; Yoon, Hyeong Hwa; Suh, Yu Min; Suh, Jin Soo

    2017-01-01

    To investigate the efficiency of simultaneous correction of moderate to severe hallux valgus deformity and adult-type pes planus. Twenty cases of moderate to severe hallux valgus complicated with adult-type pes planus in 19 consecutive patients (15 (79%) women, 4 (11%) men; mean age: 44.50 ± 17.13 years, mean follow-up duration: 31.30 ± 17.02 months) were included. Medial calcaneal sliding osteotomy was performed to correct hindfoot valgus, whereas treatments of hallux valgus were case dependent. The mean postoperative hallux valgus angle, intermetatarsal angle, hindfoot alignment angle, and hindfoot alignment ratio were 8.40 ± 5.29°, 4.20 ± 2.54°, 3.09 ± 2.92º and 0.41 ± 0.17, respectively. Although a hallux varus deformity occurred as a postoperative complication in one case (5%), there were no cases of postoperative recurrence. Simultaneous correction of hallux valgus and pes plano-valgus using medial calcaneal sliding osteotomy is an effective technique that reduces recurrence of hallux valgus and increases satisfaction in patients with moderate to severe hallux valgus deformity complicated with adult-type pes planus accompanying hindfoot valgus.

  5. What are the appropriate indicators of surgical difficulty during laparoscopic cholecystectomy? Results from a Japan-Korea-Taiwan multinational survey.

    Science.gov (United States)

    Iwashita, Yukio; Ohyama, Tetsuji; Honda, Goro; Hibi, Taizo; Yoshida, Masahiro; Miura, Fumihiko; Takada, Tadahiro; Han, Ho-Seong; Hwang, Tsann-Long; Shinya, Satoshi; Suzuki, Kenji; Umezawa, Akiko; Yoon, Yoo-Seok; Choi, In-Seok; Huang, Wayne Shih-Wei; Chen, Kuo-Hsin; Watanabe, Manabu; Abe, Yuta; Misawa, Takeyuki; Nagakawa, Yuichi; Yoon, Dong-Sup; Jang, Jin-Young; Yu, Hee Chul; Ahn, Keun Soo; Kim, Song Cheol; Song, In Sang; Kim, Ji Hoon; Yun, Sung Su; Choi, Seong Ho; Jan, Yi-Yin; Sheen-Chen, Shyr-Ming; Shan, Yan-Shen; Ker, Chen-Guo; Chan, De-Chuan; Lee, King-Teh; Toyota, Naoyuki; Higuchi, Ryota; Nakamura, Yoshiharu; Mizuguchi, Yoshiaki; Takeda, Yutaka; Ito, Masahiro; Norimizu, Shinji; Yamada, Shigetoshi; Matsumura, Naoki; Shindoh, Junichi; Sunagawa, Hiroki; Hasegawa, Hiroshi; Rikiyama, Toshiki; Sata, Naohiro; Kano, Nobuyasu; Kitano, Seigo; Tokumura, Hiromi; Yamashita, Yuichi; Watanabe, Goro; Nakagawa, Kunitoshi; Kimura, Taizo; Yamakawa, Tatsuo; Wakabayashi, Go; Endo, Itaru; Miyazaki, Masaru; Yamamoto, Masakazu

    2016-09-01

    Serious complications continue to occur in laparoscopic cholecystectomy (LC). The commonly used indicators of surgical difficulty such as the duration of surgery are insufficient because they are surgeon and institution dependent. We aimed to identify appropriate indicators of surgical difficulty during LC. A total of 26 Japanese expert LC surgeons discussed using the nominal group technique (NGT) to generate a list of intraoperative findings that contribute to surgical difficulty. Thereafter, a survey was circulated to 61 experts in Japan, Korea, and Taiwan. The questionnaire addressed LC experience, surgical strategy, and perceptions of 30 intraoperative findings listed by the NGT. The response rate of the survey was 100%. There was a statistically significant difference among nations regarding the duration of surgery and adoption rate of safety measures and recognition of landmarks. The criteria for conversion to an open or subtotal cholecystectomy were at the discretion of each surgeon. In contrast, perceptions of the impact of 30 intraoperative findings on surgical difficulty (categorized by factors related to inflammation and additional findings of the gallbladder and other intra-abdominal factors) were consistent among surgeons. Intraoperative findings are objective and considered to be appropriate indicators of surgical difficulty during LC. © 2016 Japanese Society of Hepato-Biliary-Pancreatic Surgery.

  6. Development of a Detailed Volumetric Finite Element Model of the Spine to Simulate Surgical Correction of Spinal Deformities

    Directory of Open Access Journals (Sweden)

    Mark Driscoll

    2013-01-01

    Full Text Available A large spectrum of medical devices exists; it aims to correct deformities associated with spinal disorders. The development of a detailed volumetric finite element model of the osteoligamentous spine would serve as a valuable tool to assess, compare, and optimize spinal devices. Thus the purpose of the study was to develop and initiate validation of a detailed osteoligamentous finite element model of the spine with simulated correction from spinal instrumentation. A finite element of the spine from T1 to L5 was developed using properties and geometry from the published literature and patient data. Spinal instrumentation, consisting of segmental translation of a scoliotic spine, was emulated. Postoperative patient and relevant published data of intervertebral disc stress, screw/vertebra pullout forces, and spinal profiles was used to evaluate the models validity. Intervertebral disc and vertebral reaction stresses respected published in vivo, ex vivo, and in silico values. Screw/vertebra reaction forces agreed with accepted pullout threshold values. Cobb angle measurements of spinal deformity following simulated surgical instrumentation corroborated with patient data. This computational biomechanical analysis validated a detailed volumetric spine model. Future studies seek to exploit the model to explore the performance of corrective spinal devices.

  7. Perceived changes by peer group of social impact associated with combined orthodontic-surgical correction of class III malocclusion.

    Science.gov (United States)

    Jesani, Aliza; DiBiase, Andrew T; Cobourne, Martyn T; Newton, Timothy

    2014-09-01

    Whereas the psychosocial benefits of orthognathic treatment for the individual patient are established, there is little data relating to social perceptions in relation to changes in facial appearance as a result of combined orthodontic and orthognathic treatment. This study aimed to investigate the social impact of combined orthodontic-orthognathic surgical correction for class III malocclusion in Caucasian subjects. This cross-sectional study compared perceptions of facial appearance prior to and after orthognathic correction of class III malocclusion. Eighty undergraduate students were shown photographs of four Caucasian subjects (2 male and 2 female) pre- and post-orthognathic class III correction. Observers were asked to rate these subjects in relation to four different outcomes: (i) social competence (SC); (ii) intellectual ability (IA); (iii) psychological adjustment (PA); (iv) attractiveness. A mixed-model analysis of variance (ANOVA) was calculated to determine the effect of each variable. Statistically significant differences were found in ratings of the same face before and after treatment. After treatment, faces were rated as more psychologically adjusted, more sociable, more likely to be successful and more attractive; with the mean psychological adjustment rating being associated with the most change (before treatment=8.06 [SD 2.30]; after treatment=6.64 [SD 2.03], t=2.04, pclass III malocclusion in Caucasians, individuals are rated by young adults as being better adjusted both psychologically and socially, more likely to be successful and more attractive. Copyright © 2014 Elsevier Ltd. All rights reserved.

  8. Effects of ventilation modalities on near-infrared spectroscopy in surgically corrected CDH infants.

    Science.gov (United States)

    Conforti, Andrea; Giliberti, Paola; Landolfo, Francesca; Valfrè, Laura; Columbo, Claudia; Mondi, Vito; Capolupo, Irma; Dotta, Andrea; Bagolan, Pietro

    2016-03-01

    Near-infrared spectroscopy (NIRS) is a noninvasive technique for monitoring tissue oxygenation and perfusion. The aim of this study was to evaluate cerebral and splanchnic NIRS changes in CDH operated infants enrolled into the VICI trial and therefore randomized for ventilatory modalities. CDH newborns enrolled into the VICI trial (Netherlands Trial Register, NTR 1310) were randomized at birth for high-frequency oscillatory ventilation (HFOV) or conventional mechanical ventilation (CMV) according to the trial. Cerebral oxygenation (rSO2C) and splanchnic oxygenation (rSO2S) were obtained by NIRS (INVOS 5100; Somanetics, Troy, MI) before and after surgery. Variations in rSO2C and rSO2S were evaluated. Mann-Whitney test and one-way ANOVA were used as appropriate. p<0.05 was considered significant. Thirteen VICI trial patients underwent surgical repair between March 2011 and December 2012, and were enrolled in the study. Seven patients were assigned to HFOV and six to CMV group respectively. During surgery, a significant reduction in rSO2C (p=0.0001) and rSO2S (p=0.005) were observed. HFOV patients experienced prolonged reduction in rSO2C value (p=0.003) while rSO2S did not vary between HFOV and CMV (p=0.94). Surgical CDH repair was associated with decrease of cerebral and splanchnic oxygenation, regardless of ventilation. Patients ventilated by HFOV need a longer time interval to recovery normal rSO2C values, than those ventilated by CMV. This may be owing to a different impact of HFOV on patients' hemodynamic status with a higher impairment on total venous return and its negative consequences on cardiac output. Copyright © 2016 Elsevier Inc. All rights reserved.

  9. Correction

    CERN Multimedia

    2002-01-01

    Tile Calorimeter modules stored at CERN. The larger modules belong to the Barrel, whereas the smaller ones are for the two Extended Barrels. (The article was about the completion of the 64 modules for one of the latter.) The photo on the first page of the Bulletin n°26/2002, from 24 July 2002, illustrating the article «The ATLAS Tile Calorimeter gets into shape» was published with a wrong caption. We would like to apologise for this mistake and so publish it again with the correct caption.

  10. Surgical Reimplantation for the Correction of Vesicoureteral Reflux following Failed Endoscopic Injection

    Directory of Open Access Journals (Sweden)

    Boris Chertin

    2011-01-01

    Full Text Available Purpose. In recent years, endoscopic injection became the procedure of choice for the correction of vesicoureteral reflux in the majority of the centers. Unfortunately, endoscopic treatment is not always successful and sometimes requires more than one trial to achieve similar results to that of an open reimplantation surgery. Our aim of this study is to evaluate the feasibility and success rate of open ureteral reimplantation following failed endoscopic procedure. Patients and Methods. During 2004–2010, we evaluated 16 patients with persistent vesicoureteral reflux (grades II–IV following failed endoscopic treatment. All patients underwent open ureteral reimplantation. All patients were followed with an ultrasound 6 weeks following surgery and every 6 months thereafter for an average of 22 months. Voiding cystography was performed at 3 months after surgery. Results. During unilateral open ureteral reimplantation, the implanted deposit from previous procedures was either excised, drained, or incorporated into the neotunnel with the ureter. Vesicoureteral reflux was resolved in all patients with 100% success rate. No new hydronephrosis or signs of obstruction developed in any of the patients. qDMSA renal scan was available in 8 patients showing improvement of function in 5 and stable function in 3, and no new scars were identified. Conclusions. Open ureteral reimplantation is an excellent choice for the correction of failed endoscopic treatment in children with vesicoureteral reflux.

  11. [Management of patients with chronic renal failure during surgical correction of cardiovascular disease].

    Science.gov (United States)

    Iarustovskiĭ, M B; Stupchenko, O S; Abramian, M V; Nazarova, E I; Popok, Z V

    2010-01-01

    End-stage of chronic renal failure (CRF) is frequently associated with cardiac and vascular comorbidities requiring cardiosurgical interventions. Over 9 years, from 2000 to 2009, the A. N. Bakulev Research Center of Cardiovascular Surgery, Russian Academy of Medical Sciences, delivered cardiosurgical care to 16 patients aged 20 to 74 years with end-stage CRF. The duration of programmed hemodialysis was 1 to 102 months. The preoperative patient preparation protocol comprised correction of anemia, hypoproteinemia, hypertension, and water-electrolyte and acid-base balances. Five patients underwent endovascular myocardial revascularization; open heart surgery was performed in one patient. Interventions under extracorporeal circulation were made in 10 other patients. Ultrafiltration was intraoperatively carried out. On-line hemodiafiltration was performed following coronary artery stenting. After open operations, renal replacement therapy (first hemodiafiltration, then hemodialysis) as daily sessions was initiated on day 2 and, when the patients were transferred to intensive care units, it was performed by the programmed hemodialysis protocol. There were no fatal outcomes at the follow-up. The key aspects of treatment success achievement and improved quality of life in patients on programmed hemodialysis are the detection of cardiovascular diseases requiring surgery, the timely referral of the patients to a cardiosurgical hospital, the meticulous pre- and perioperative management (correction of anemia, hypoproteinemia, water-electrolyte balance, use of ultrafiltration and the adequate rate of perfusion at the stage of extracorporeal circulation, and daily renal replacement therapy in the postoperative period), and continuity in the work of all specialists.

  12. Predicting erectile dysfunction following surgical correction of Peyronie's disease without inflatable penile prosthesis placement: vascular assessment and preoperative risk factors.

    Science.gov (United States)

    Taylor, Frederick L; Abern, Michael R; Levine, Laurence A

    2012-01-01

    Surgical therapy remains the gold standard treatment for Peyronie's Disease (PD). Surgical options include plication, grafting, and placement of inflatable penile prosthesis (IPP). Postoperative erectile dysfunction (ED) is a potential complication for PD surgery without IPP. We present our large series follow-up to evaluate preoperative risk factors for postoperative ED. The aim of this study is to evaluate preoperative risk factors for the development of ED following surgical correction of PD taking into account the degree of curvature, graft size, surgical approach, hypertension, hyperlipidemia, diabetes, smoking history, preoperative use of phosphodiesterase 5 inhibitors (PDE5), and preoperative duplex ultrasound findings including peak systolic and end diastolic velocities and resistive index. We identified 218 men undergoing either tunica albuginea plication (TAP) or partial plaque excision with pericardial grafting for PD following a previously published algorithm between November 1992 and April 2007. Preoperative and postoperative erectile function, curvature characteristics, presence of vascular risk factors, and duplex ultrasound findings were available on 109 patients. Our primary outcome measure is the development of ED after surgery for PD. Ten percent of TAP and 21% of plaque excision with grafting patients developed postoperative ED. Neither curve direction (P = 0.76), graft area (P = 0.78), surgical approach (P = 0.12), chronic hypertension (P = 0.51), hyperlipidemia (P = 0.87), diabetes (P = 0.69), nor smoking history (P = 0.99) were significant predictors of postoperative ED. No combination of risk factors was found to be predictive of postoperative ED. Preoperative use of PDE5 was not a significant predictor of postoperative ED (P = 0.33). Neither peak systolic, end diastolic, nor resistive index were significant predictors of ED (P = 0.28, 0.28, and 0.25, respectively). This long-term follow-up of a large published series suggests that neither

  13. Correction

    Directory of Open Access Journals (Sweden)

    2012-01-01

    Full Text Available Regarding Gorelik, G., & Shackelford, T.K. (2011. Human sexual conflict from molecules to culture. Evolutionary Psychology, 9, 564–587: The authors wish to correct an omission in citation to the existing literature. In the final paragraph on p. 570, we neglected to cite Burch and Gallup (2006 [Burch, R. L., & Gallup, G. G., Jr. (2006. The psychobiology of human semen. In S. M. Platek & T. K. Shackelford (Eds., Female infidelity and paternal uncertainty (pp. 141–172. New York: Cambridge University Press.]. Burch and Gallup (2006 reviewed the relevant literature on FSH and LH discussed in this paragraph, and should have been cited accordingly. In addition, Burch and Gallup (2006 should have been cited as the originators of the hypothesis regarding the role of FSH and LH in the semen of rapists. The authors apologize for this oversight.

  14. Correction

    CERN Multimedia

    2002-01-01

    The photo on the second page of the Bulletin n°48/2002, from 25 November 2002, illustrating the article «Spanish Visit to CERN» was published with a wrong caption. We would like to apologise for this mistake and so publish it again with the correct caption.   The Spanish delegation, accompanied by Spanish scientists at CERN, also visited the LHC superconducting magnet test hall (photo). From left to right: Felix Rodriguez Mateos of CERN LHC Division, Josep Piqué i Camps, Spanish Minister of Science and Technology, César Dopazo, Director-General of CIEMAT (Spanish Research Centre for Energy, Environment and Technology), Juan Antonio Rubio, ETT Division Leader at CERN, Manuel Aguilar-Benitez, Spanish Delegate to Council, Manuel Delfino, IT Division Leader at CERN, and Gonzalo León, Secretary-General of Scientific Policy to the Minister.

  15. Indications for surgical resection of benign pancreatic tumors; Indikationen zur chirurgischen Therapie benigner Pankreastumoren

    Energy Technology Data Exchange (ETDEWEB)

    Isenmann, R.; Henne-Bruns, D. [Chirurgische Universitaetsklinik, Klinik fuer Allgemein-, Viszeral- und Transplantationschirurgie, Ulm (Germany)

    2008-08-15

    Benign pancreatic tumors should undergo surgical resection when they are symptomatic or - in the case of incidental discovery - bear malignant potential. This is the case for the majority of benign pancreatic tumors, especially for intraductal papillary mucinous neoplasms or mucinous cystic adenomas. In addition, resection is indicated for all tumors where preoperative diagnostic fails to provide an exact classification. Several different operative techniques are available. The treatment of choice depends on the localization of the tumor, its size and on whether there is evidence of malignant transformation. Partial duodenopancreatectomy is the oncological treatment of choice for tumors of the pancreatic head whereas for tumors of the pancreatic tail a left-sided pancreatectomy is appropriate. Middle pancreatectomy or duodenum-preserving resection of the pancreatic head is not a radical oncologic procedure. They should only be performed in cases of tumors without malignant potential. (orig.) [German] Die Indikationsstellung zur Resektion benigner Pankreastumoren ist gegeben, wenn es sich um einen symptomatischen Tumor handelt oder - bei einem Zufallsbefund - um einen Tumor mit Potenzial zur malignen Entartung. Dies besteht bei der Mehrzahl der benignen Pankreastumoren, insbesondere bei der intraduktalen papillaeren muzinoesen Neoplasie (IPMN) oder muzinoesen Zystadenomen. Operativer Abklaerung beduerfen auch Tumoren, die unter Ausschoepfung aller diagnostischer Moeglichkeiten nicht eindeutig klassifizierbar sind. An chirurgischen Therapieverfahren stehen verschiedene Techniken zur Verfuegung. Die Wahl des Verfahren haengt von der Groesse und Lokalisation des Tumors ab und von der Frage, ob eine maligne Entartung bereits stattgefunden hat. Das onkologisch korrekte Standardresektionsverfahren bei Tumoren des Pankreaskopfes ist die partielle Duodenopankreatektomie, bei Tumoren des Pankreasschwanzes die Pankreaslinksresektion. Eine segmentale Resektion des

  16. [The sural medial perforator flap: Anatomical bases, surgical technique and indications in head and neck reconstruction].

    Science.gov (United States)

    Struk, S; Schaff, J-B; Qassemyar, Q

    2018-04-01

    The medial sural artery perforator (MSAP) flap is defined as a thin cutaneo-adipose perforator flap harvested on the medial aspect of the leg. The aims of this study were to describe the anatomical basis as well as the surgical technique and discuss the indications in head and neck reconstructive surgery. We harvested 10 MSAP flap on 5 fresh cadavers. For each case, the number and the location of the perforators were recorded. For each flap, the length of pedicle, the diameter of source vessels and the thickness of the flap were studied. Finally, we performed a clinical application of a MSAP flap. A total of 23 perforators with a diameter superior than 1mm were dissected on 10 legs. The medial sural artery provided between 1 and 4 musculocutaneous perforators. Perforators were located in average at 10.3cm±2cm from the popliteal fossa and at 3.6cm±1cm from the median line of the calf. The mean pedicle length was 12.1cm±2.5cm. At its origin, the source artery diameter was 1.8mm±0.25mm and source veins diameters were 2.45mm±0.9mm in average. There was no complication in our clinical application. This study confirms the reliability of previous anatomical descriptions of the medial sural artery perforator flap. This flap was reported as thin and particularly adapted for oral cavity reconstruction and for facial or limb resurfacing. Sequelae might be reduced as compared to those of the radial forearm flap with comparable results. Copyright © 2017 Elsevier Masson SAS. All rights reserved.

  17. Correction

    Directory of Open Access Journals (Sweden)

    2014-01-01

    Full Text Available Regarding Tagler, M. J., and Jeffers, H. M. (2013. Sex differences in attitudes toward partner infidelity. Evolutionary Psychology, 11, 821–832: The authors wish to correct values in the originally published manuscript. Specifically, incorrect 95% confidence intervals around the Cohen's d values were reported on page 826 of the manuscript where we reported the within-sex simple effects for the significant Participant Sex × Infidelity Type interaction (first paragraph, and for attitudes toward partner infidelity (second paragraph. Corrected values are presented in bold below. The authors would like to thank Dr. Bernard Beins at Ithaca College for bringing these errors to our attention. Men rated sexual infidelity significantly more distressing (M = 4.69, SD = 0.74 than they rated emotional infidelity (M = 4.32, SD = 0.92, F(1, 322 = 23.96, p < .001, d = 0.44, 95% CI [0.23, 0.65], but there was little difference between women's ratings of sexual (M = 4.80, SD = 0.48 and emotional infidelity (M = 4.76, SD = 0.57, F(1, 322 = 0.48, p = .29, d = 0.08, 95% CI [−0.10, 0.26]. As expected, men rated sexual infidelity (M = 1.44, SD = 0.70 more negatively than they rated emotional infidelity (M = 2.66, SD = 1.37, F(1, 322 = 120.00, p < .001, d = 1.12, 95% CI [0.85, 1.39]. Although women also rated sexual infidelity (M = 1.40, SD = 0.62 more negatively than they rated emotional infidelity (M = 2.09, SD = 1.10, this difference was not as large and thus in the evolutionary theory supportive direction, F(1, 322 = 72.03, p < .001, d = 0.77, 95% CI [0.60, 0.94].

  18. Technique of Antireflux Procedure without Creating Submucosal Tunnel for Surgical Correction of Vesicoureteric Reflux during Bladder Closure in Exstrophy.

    Science.gov (United States)

    Sunil, Kanoujia; Gupta, Archika; Chaubey, Digamber; Pandey, Anand; Kureel, Shiv Narain; Verma, Ajay Kumar

    2018-01-01

    To report the clinical application of the new surgical technique of antireflux procedure without creating submucosal tunnel for surgical correction of vesicoureteric reflux during bladder closure in exstrophy. Based on the report of published experimental technique, the procedure was clinically executed in seven patients of classic exstrophy bladder with small bladder plate with polyps, where the creation of submucosal tunnel was not possible, in last 18 months. Ureters were mobilized. A rectangular patch of bladder mucosa at trigone was removed exposing the detrusor. Mobilized urteres were advanced, crossed and anchored to exposed detrusor parallel to each other. Reconstruction included bladder and epispadias repair with abdominal wall closure. The outcome was measured with the assessment of complications, abolition of reflux on cystogram and upper tract status. At 3-month follow-up cystogram, reflux was absent in all. Follow-up ultrasound revealed mild dilatation of pelvis and ureter in one. The technique of extra-mucosal ureteric reimplantation without the creation of submucosal tunnel is simple to execute without risk and complications and effectively provides an antireflux mechanism for the preservation of upper tract in bladder exstrophy. With the use of this technique, reflux can be prevented since the very beginning of exstrophy reconstruction.

  19. Clinical And Morphological Androgenic Status Characteristics At Children Suffering From Hypospadias And Its Influence On Results Of Surgical Correction

    Directory of Open Access Journals (Sweden)

    F.K. Napolnikov

    2009-09-01

    Full Text Available The goal of this article is to estimate the androgenic status and analyze its influence on the surgical treatment of hypospadias. From 2000 till 2008 there were 209 children under treatment, whose age varied from 8 months till 15 years old (average age — 4,5+ 1,5. 49 patients were subjected to clinical, humoral and morphological study. Preoperational preparation was carried out by testosterone medications. The comparison group consisted of 10 boys with cicatricial phimosis. The patients with the medium and back forms of hypospadias suffered from the androgenic deficit characterized by proximal level of meatus ectopia, diminution of penis length and prostate volume, decrease of blood vessels in deep layers of penis skin. The testosterone pre-operational medication of patients makes possible to improve the results of surgical correction due to blood supply of plastic material. On the basis of recieved data logistically regressive model has been worked out and the prognosis of results has been estimated

  20. Three-dimensional dental arch changes of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusion

    Directory of Open Access Journals (Sweden)

    Adriano Porto Peixoto

    2014-08-01

    Full Text Available INTRODUCTION: This study assessed the three-dimensional changes in the dental arch of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusions at three different periods. METHODS: Landmarks previously identified on upper and lower dental casts were digitized on a three-dimensional digitizer MicroScribe-3DX and stored in Excel worksheets in order to assess the width, length and depth of patient's dental arches. RESULTS: During orthodontic preparation, the maxillary and mandibular transverse dimensions measured at the premolar regions were increased and maintained throughout the follow-up period. Intercanine width was increased only in the upper arch during orthodontic preparation. Maxillary arch length was reduced during orthodontic finalization, only. Upper and lower arch depths were stable in the study periods. Differences between centroid and gingival changes suggested that upper and lower arch premolars buccaly proclined during the pre-surgical period. CONCLUSIONS: Maxillary and mandibular dental arches presented transverse expansion at premolar regions during preoperative orthodontic preparation, with a tendency towards buccal tipping. The transverse dimensions were not altered after surgery. No sagittal or vertical changes were observed during the follow-up periods.

  1. Three-dimensional dental arch changes of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusion.

    Science.gov (United States)

    Peixoto, Adriano Porto; dos Santos Pinto, Ary; Garib, Daniela Gamba; Gonçalves, João Roberto

    2014-01-01

    This study assessed the three-dimensional changes in the dental arch of patients submitted to orthodontic-surgical treatment for correction of Class II malocclusions at three different periods. Landmarks previously identified on upper and lower dental casts were digitized on a three-dimensional digitizer MicroScribe-3DX and stored in Excel worksheets in order to assess the width, length and depth of patient's dental arches. During orthodontic preparation, the maxillary and mandibular transverse dimensions measured at the premolar regions were increased and maintained throughout the follow-up period. Intercanine width was increased only in the upper arch during orthodontic preparation. Maxillary arch length was reduced during orthodontic finalization, only. Upper and lower arch depths were stable in the study periods. Differences between changes in centroid and gingival points suggested that upper and lower premolars buccaly proclined during the pre-surgical period. Maxillary and mandibular dental arches presented transverse expansion at premolar regions during preoperative orthodontic preparation, with a tendency towards buccal tipping. The transverse dimensions were not altered after surgery. No sagittal or vertical changes were observed during the follow-up periods.

  2. Surgical correction of ectopic penis and scrotum associated with bilateral orchidopexy.

    Science.gov (United States)

    Sobral, Daniel Santos Rocha; Silva, Helder Damásio da; Damázio, Eulálio

    2017-01-01

    Ectopic penis is usually associated with penoscrotal transposition, and it is rarely observed in isolation. We report a surgical approach for an extremely rare case. A 10-year-old male patient with bilateral cryptorchidism and ectopic penis and scrotum in perineal area, with no penoscrotal transposition, representing an association not yet described in literature. A previous orchiopexy failed due to ectopic scrotum. By means of an inverted Y incision, the penis was mobilized and a perineal skin flap in form of a testicular sac was prepared. Finally orchiopexy was performed. The surgery was essential to treat cryptorchidism and to improve the self-image of the patient. RESUMO O pênis ectópico geralmente ocorre associado à transposição peno-escrotal, sendo raro isoladamente. Relatamos uma abordagem cirúrgica para um caso extremamente raro. Tratava-se de paciente do sexo masculino, 10 anos, com criptorquidia bilateral e pênis e escroto ectópicos, na região perineal, sem transposição peno-escrotal, representando uma associação ainda não descrita na literatura. Orquidopexia prévia sem sucesso, devido à ectopia do escroto. Por meio de uma incisão em Y invertido, mobilizou-se o pênis e preparou-se um retalho da pele perineal em forma de bolsa testicular. Por fim, realizou-se a orquidopexia. A cirurgia foi fundamental para tratar a criptorquidia e promover ganho na autoimagem do paciente.

  3. MRI findings in patients with defecatory dysfunction after surgical correction of anorectal malformation

    International Nuclear Information System (INIS)

    Cui, Yong; Shao, Guang-rui; Wang, Ruo-yi; Zhang, Yuan; Zhang, Shu-hui

    2013-01-01

    Postoperative anorectal malformation patients frequently have defecatory dysfunction. MRI may be useful in the management of these patients. To analyze static and dynamic MRI findings in patients with defecatory dysfunction after correction of anorectal malformation (ARM), and compare differences between patients with constipation and fecal incontinence. Pelvic MRI studies of 20 constipated and 32 incontinent postoperative ARM patients were analyzed retrospectively to determine the location and morphology of the neorectum, presence of peritoneal fat herniation, presence of scarring, development of the striated muscle complex (SMC) and any other abnormalities. The two groups were then compared using χ 2 -test. Eighteen patients also underwent MRI defecography to evaluate pelvic floor function and abnormalities are reported. The children with incontinence were more likely to have abnormal location of the neorectum (P = 0.031), increased anorectal angle (ARA) (P = 0.031) and peritoneal fat herniation (P = 0.032), and less likely to have dilation of the neorectum (P = 0.027), than the children with constipation. There were no significant differences between the two groups in incidence of focal stenosis of the neorectum (P = 0.797), presence of extensive scarring (P = 0.591) and developmental agenesis of the SMC (P > 0.05). MRI defecography showed 6 anterior rectoceles, 6 cystoceles and 18 pelvic floor descents. MRI is a helpful imaging modality in postoperative ARM patients with defecatory dysfunction, and it shows distinct differences between the children with constipation and incontinence and provides individualized information to guide further treatment. (orig.)

  4. MRI findings in patients with defecatory dysfunction after surgical correction of anorectal malformation

    Energy Technology Data Exchange (ETDEWEB)

    Cui, Yong; Shao, Guang-rui [Second Hospital of Shandong University, Department of Radiology, Jinan (China); Wang, Ruo-yi [Second Hospital of Shandong University, Department of Pediatric Surgery, Jinan (China); Zhang, Yuan [Second Hospital of Shandong University, Evidence-based Medical Center, Jinan (China); Zhang, Shu-hui [Second Hospital of Shandong University, Department of Laboratory, Jinan (China)

    2013-08-15

    Postoperative anorectal malformation patients frequently have defecatory dysfunction. MRI may be useful in the management of these patients. To analyze static and dynamic MRI findings in patients with defecatory dysfunction after correction of anorectal malformation (ARM), and compare differences between patients with constipation and fecal incontinence. Pelvic MRI studies of 20 constipated and 32 incontinent postoperative ARM patients were analyzed retrospectively to determine the location and morphology of the neorectum, presence of peritoneal fat herniation, presence of scarring, development of the striated muscle complex (SMC) and any other abnormalities. The two groups were then compared using {chi} {sup 2}-test. Eighteen patients also underwent MRI defecography to evaluate pelvic floor function and abnormalities are reported. The children with incontinence were more likely to have abnormal location of the neorectum (P = 0.031), increased anorectal angle (ARA) (P = 0.031) and peritoneal fat herniation (P = 0.032), and less likely to have dilation of the neorectum (P = 0.027), than the children with constipation. There were no significant differences between the two groups in incidence of focal stenosis of the neorectum (P = 0.797), presence of extensive scarring (P = 0.591) and developmental agenesis of the SMC (P > 0.05). MRI defecography showed 6 anterior rectoceles, 6 cystoceles and 18 pelvic floor descents. MRI is a helpful imaging modality in postoperative ARM patients with defecatory dysfunction, and it shows distinct differences between the children with constipation and incontinence and provides individualized information to guide further treatment. (orig.)

  5. Surgical treatment of delayed radiation effects in the skin and its indication

    International Nuclear Information System (INIS)

    Tilkorn, H.; Drepper, H.

    1987-01-01

    Since 1960 a total of 1200 patients with skin disease as delayed radiation effects were treated at the Hornheide special clinic, 40% of whom received plastic surgery. This requires knowledge of the type of radiation applied and when it was applied, additional harmful influences, exposure, differentiation in cases of ulcers between primary, cumulative, and combination effect, early radiation effects, and late radiation effects. Secondary factors leading possibly to necrosis may be: recidivation of the primary tumours, benign or malignant neoplasms, traumatic injuries such as injections, sampling, tight clothing, chemical factors like therapeuticals for local application, allergies, infections of the skin with bacteria or fungi, osteomyelitis, non-infections skin disease, and internal disease. A precondition for successful dermatological and surgical treatment are a careful review of the previous case history and exact diagnosis. Some clinical cases serve to illustrate the theoretical explanations and point out possibilities for surgical treatment. (TRV) [de

  6. Risk factors for indications of intraoperative blood transfusion among patients undergoing surgical treatment for colorectal adenocarcinoma.

    Science.gov (United States)

    Gonçalves, Iara; Linhares, Marcelo; Bordin, Jose; Matos, Delcio

    2009-01-01

    Identification of risk factors for requiring transfusions during surgery for colorectal cancer may lead to preventive actions or alternative measures, towards decreasing the use of blood components in these procedures, and also rationalization of resources use in hemotherapy services. This was a retrospective case-control study using data from 383 patients who were treated surgically for colorectal adenocarcinoma at 'Fundação Pio XII', in Barretos-SP, Brazil, between 1999 and 2003. To recognize significant risk factors for requiring intraoperative blood transfusion in colorectal cancer surgical procedures. Univariate analyses were performed using Fisher's exact test or the chi-squared test for dichotomous variables and Student's t test for continuous variables, followed by multivariate analysis using multiple logistic regression. In the univariate analyses, height (P = 0.06), glycemia (P = 0.05), previous abdominal or pelvic surgery (P = 0.031), abdominoperineal surgery (Pblood transfusion.

  7. Posterior Segment Intraocular Foreign Body: Extraction Surgical Techniques, Timing, and Indications for Vitrectomy

    Directory of Open Access Journals (Sweden)

    Dante A. Guevara-Villarreal

    2016-01-01

    Full Text Available Ocular penetrating injury with Intraocular Foreign Body (IOFB is a common form of ocular injury. Several techniques to remove IOFB have been reported by different authors. The aim of this publication is to review different timing and surgical techniques related to the extraction of IOFB. Material and Methods. A PubMed search on “Extraction of Intraocular Foreign Body,” “Timing for Surgery Intraocular Foreign Body,” and “Surgical Technique Intraocular Foreign Body” was made. Results. Potential advantages of immediate and delayed IOFB removal have been reported with different results. Several techniques to remove IOFB have been reported by different authors with good results. Conclusion. The most important factor at the time to perform IOFB extraction is the experience of the surgeon.

  8. The Argentine Guide of Recommendations for the Correct Indications of Diagnostic Imaging Examinations

    International Nuclear Information System (INIS)

    Buzzi, Alfredo; Rojas, Roberto; Touzet, Rodolfo E.

    2008-01-01

    of the Guide (developing stage); the fourth is the evaluation of the results and presentation of a report to the health authorities justifying its mandatory use; and the fifth is to obtain the emission by the competent authorities of requirements that assure the extended use of the Guide. The initial goal was the development of the 'Guide of Recommendations for the Correct Indications of Diagnostic Imaging Examinations' by Argentine professionals. The intention of this Guide is to improve the clinical practice supporting the task of the prescriptor physician. The Guide PR/118 (from the European Community, based on a first British initiative) and the equivalent Guide prepared by the French Society of Radiology were used as a model. To adapt the European model to Argentina, the Argentine Society of Radiology summoned 12 commissions of experts in 12 areas (Head and Neck, Spine and Locomotive, Circulatory, Thorax, Digestive, Adrenal and Urinary, Gynaecology and Obstetrics, Breast, Trauma, Cancer, Paediatrics, and Nuclear Medicine), organised by a General Coordinator. The Guide was presented at the 2007 Argentine Congress of Radiology, during the 3 rd . Meeting of Patient Radiological Protection. (author)

  9. Introduction of an acute surgical unit: comparison of performance indicators and outcomes for operative management of acute appendicitis.

    Science.gov (United States)

    Lancashire, John F; Steele, M; Parker, D; Puhalla, H

    2014-08-01

    The Acute Surgical Unit (ASU) is a recent change in management of acute general surgical patients in hospitals worldwide. In contrast to traditional management of acute surgical presentations by a rotating on-call system, ASUs are shown to deliver improved efficiency and patient outcomes. This study investigated the impact of an ASU on operative management of appendicitis, the most common acute surgical presentation, by comparing performance indicators and patient outcomes prior to and after introduction of an ASU at the Gold Coast Hospital, Queensland, Australia. A retrospective study of patients admitted from the Emergency Department (ED) and who underwent emergency appendectomy from February 2010 to January 2011 (pre-ASU) and after introduction of the ASU from February 2011 to January 2012 (post-ASU). A total of 548 patients underwent appendectomy between February 2010 and January 2012, comprising 247 pre-ASU and 301 post-ASU patients. Significant improvements were demonstrated: reduced time to surgical review, fewer complications arising from operations commencing during ASU in-hours, and more appendectomies performed during the daytime attended by the consultant. There was no significant difference in total cost of admission or total admission length of stay. This study demonstrated that ASUs have potential to significantly improve the outcomes for operative management of acute appendicitis compared to the traditional on-call model. The impact of the ASU was limited by access to theaters and restricted ASU operation hours. Further investigation of site-specific determinants could be beneficial to optimize this new model of acute surgical care.

  10. Evolution of ventricular outpouching through the fetal and postnatal periods: Unabating dilemma of serial observation or surgical correction

    Directory of Open Access Journals (Sweden)

    Niraj Kumar Dipak

    2017-07-01

    Full Text Available Ventricular outpouching is a rare finding in prenatal sonography and the main differential diagnoses are diverticulum, aneurysm, and pseudoaneurysm in addition to congenital cysts and clefts. The various modes of fetal presentation of congenital ventricular outpouching include an abnormal four-chamber view on fetal two-dimensional echocardiogram, fetal arrhythmia, fetal hydrops, and pericardial effusion. Left ventricular aneurysm (LVA/nonapical diverticula are usually isolated defects. Apical diverticula are always associated with midline thoracoabdominal defects (epigastric pulsating diverticulum or large omphalocele and other structural malformations of the heart. Most patients with LVA/congenital ventricular diverticulum remain clinically asymptomatic but they can potentially give rise to complications such as ventricular tachyarrhythmias, systemic embolism, sudden death, spontaneous rupture, and severe valvular regurgitation. The treatment of asymptomatic LVA and isolated congenital ventricular diverticulum is still undefined. In this review, our aim is to outline a systematic approach to a fetus detected with ventricular outpouching. Starting with prevalence and its types, issues in fetal management, natural course and evolution postbirth, and finally the perpetual dilemma of serial observation or surgical correction is discussed.

  11. Risk factors for venous thromboembolic events in pediatric surgical patients: Defining indications for prophylaxis.

    Science.gov (United States)

    Cairo, Sarah B; Lautz, Timothy B; Schaefer, Beverly A; Yu, Guan; Naseem, Hibbut-Ur-Rauf; Rothstein, David H

    2017-12-27

    Venous thromboembolism (VTE) in pediatric surgical patients is a rare event. The risk factors for VTE in pediatric general surgery patients undergoing abdominopelvic procedures are unknown. The American College of Surgeon's National Surgical Quality Improvement Program-Pediatric (NSQIP-P) database (2012-2015) was queried for patients with VTE after abdominopelvic general surgery procedures. Patient and operative variables were assessed to identify risk factors associated with VTE and develop a pediatric risk score. From 2012-2015, 68 of 34,813 (0.20%) patients who underwent abdominopelvic general surgery procedures were diagnosed with VTE. On multivariate analysis, there was no increased risk of VTE based on concomitant malignancy, chemotherapy, inflammatory bowel disease, or laparoscopic surgical approach, while a higher rate of VTE was identified among female patients. The odds of experiencing VTE were increased on stepwise regression for patients older than 15 years and those with preexisting renal failure or a diagnosis of septic shock, patients with American Society of Anesthesia (ASA) classification ≥ 2, and for anesthesia time longer than 2 h. The combination of age > 15 years, ASA classification ≥ 2, anesthesia time > 2 h, renal failure, and septic shock was included in a model for predicting risk of VTE (AUC = 0.907, sensitivity 84.4%, specificity 88.2%). VTE is rare in pediatric patients, but prediction modeling may help identify those patients at heightened risk. Additional studies are needed to validate the factors identified in this study in a risk assessment model as well as to assess the efficacy and cost-effectiveness of prophylaxis methods. Level III, retrospective comparative study. Copyright © 2018. Published by Elsevier Inc.

  12. Surgical-site infection following lymph node excision indicates susceptibility for lymphedema

    DEFF Research Database (Denmark)

    Jørgensen, Mads Gustaf; Toyserkani, Navid Mohamadpour; Thomsen, Jørn Bo

    2018-01-01

    BACKGROUND AND OBJECTIVES: Cancer-related lymphedema is a common complication following lymph node excision. Prevention of lymphedema is essential, as treatment options are limited. Known risk factors are firmly anchored to the cancer treatment itself; however potentially preventable factors...... such as seroma and surgical-site infection (SSI) have yet to be asserted. METHODS: All malignant melanoma patients treated with sentinel lymph node biopsy (SNB) and/or complete lymph node dissection (CLND) in the axilla or groin between January 2008 and December 2014 were retrospectively identified. Identified...

  13. Indicators of surgical treatment of patent ductus arteriosus in preterm neonates in the first week of life

    Directory of Open Access Journals (Sweden)

    Renato Braulio

    2013-12-01

    Full Text Available OBJECTIVE: To identify clinical and echocardiographic indicators of the necessity for early surgical closure of patent ductus arteriosus in preterm neonates. METHODS: The prospective study was conducted at the Neonatal Unit of Hospital Municipal Odilon Behrens between 2006 and 2010. The study population comprised 115 preterm neonates diagnosed with patent ductus arteriosus in the first week after birth, of whom 55 (group S were submitted to clinical and or surgical closure and 60 (group NS received non-surgical treatment. The parameters analyzed were birth weight, diameter of the ductus arteriosus (DAD, left atrial-to-aortic root diameter ratio (LA:Ao, the quotient of DAD² and birth weight (mm²/kg, and ductal shunting. RESULTS: The study population comprised 58 males and 57 females. The average birth weight of group S (924 ± 224.3 g was significantly (P=0.049 lower than that of group NS (1012.3 ± 242.8 g. The probability of the preterm neonates being submitted to surgical closure was 62.1% (P=0.006 when the DAD2/birth weight index was > 5 mm²/kg, 72.2% (P=0.001 when the LA:Ao ratio was > 1.5, and 61.2% when ductal shunting was high (P=0.025. CONCLUSION: The parameters DAD²/birth weight index > 5 mm²/kg, LA:Ao ratio > 1.5 and high ductal shunting were statistically significant indicators (P 1.5 was associated with the occurrence of shock, the probability of surgical closure increased to 78.4%.

  14. Surgical clips for position verification and correction of non-rigid breast tissue in simultaneously integrated boost (SIB) treatments

    International Nuclear Information System (INIS)

    Penninkhof, Joan; Quint, Sandra; Boer, Hans de; Mens, Jan Willem; Heijmen, Ben; Dirkx, Maarten

    2009-01-01

    be further reduced to about 1 mm by using an eNAL protocol instead. Conclusions: The relative positions of implanted surgical clips in the lumpectomy cavity after breast-conserving surgery remain stable during the course of radiotherapy treatment. Application of a NAL or eNAL set-up correction protocol based on surgical clips allows for adequate treatment of both the tumour bed and the whole breast with tight CTV-PTV margins

  15. Surgical management of peptic ulcer disease today--indication, technique and outcome.

    Science.gov (United States)

    Zittel, T T; Jehle, E C; Becker, H D

    2000-03-01

    The current surgical management of peptic ulcer disease and its outcome have been reviewed. Today, surgery for peptic ulcer disease is largely restricted to the treatment of complications. In peptic ulcer perforation, a conservative treatment trial can be given in selected cases. If laparotomy is necessary, simple closure is sufficient in the large majority of cases, and definitive ulcer surgery to reduce gastric acid secretion is no longer justified in these patients. Laparoscopic surgery for perforated peptic ulcer has failed to prove to be a significant advantage over open surgery. In bleeding peptic ulcers, definitive hemostasis can be achieved by endoscopic treatment in more than 90% of cases. In 1-2% of cases, immediate emergency surgery is necessary. Some ulcers have a high risk of re-bleeding, and early elective surgery might be advisable. Surgical bleeding control can be achieved by direct suture and extraluminal ligation of the gastroduodenal artery or by gastric resection. Benign gastric outlet obstruction can be controlled by endoscopic balloon dilatation in 70% of cases, but gastrojejunostomy or gastric resection are necessary in about 30% of cases. Elective surgery for peptic ulcer disease has been largely abandoned, and bleeding or obstructing ulcers can be managed safely by endoscopic treatment in most cases. However, surgeons will continue to encounter patients with peptic ulcer disease for emergency surgery. Currently, laparoscopic surgery has no proven advantage in peptic ulcer surgery.

  16. [Management of spinal metastasis by minimal invasive surgery technique: Surgical principles, indications: A literature review].

    Science.gov (United States)

    Toquart, A; Graillon, T; Mansouri, N; Adetchessi, T; Blondel, B; Fuentes, S

    2016-06-01

    Spinal metastasis are getting more frequent. This raises the question of pain and neurological complications, which worsen the functional and survival prognosis of this oncological population patients. The surgical treatment must be the most complete as possible: to decompress and stabilize without delaying the management of the oncological disease. Minimal invasive surgery techniques are by definition, less harmful on musculocutaneous plan than opened ones, with a comparable efficiency demonstrated in degenerative and traumatic surgery. So they seem to be applicable and appropriate to this patient population. We detailed different minimal invasive techniques proposed in the management of spinal metastasis. For this, we used our experience developed in degenerative and traumatic pathologies, and we also referred to many authors, establishing a literature review thanks to Pubmed, Embase. Thirty eight articles were selected and allowed us to describe different techniques: percutaneous methods such as vertebro-/kyphoplasty and osteosynthesis, as well as mini-opened surgery, through a posterior or anterior way. We propose a surgical approach using these minimal invasive techniques, first according to the predominant symptom (pain or neurologic failure), then characteristics of the lesions (number, topography, type…) and the deformity degree. Whatever the technique, the main goal is to stabilize and decompress, in order to maintain a good quality of life for these fragile patients, without delaying the medical management of the oncological disease. Copyright © 2016 Elsevier Masson SAS. All rights reserved.

  17. Evaluation of efficacy and indications of surgical fixation for multiple rib fractures: a propensity-score matched analysis.

    Science.gov (United States)

    Uchida, K; Nishimura, T; Takesada, H; Morioka, T; Hagawa, N; Yamamoto, T; Kaga, S; Terada, T; Shinyama, N; Yamamoto, H; Mizobata, Y

    2017-08-01

    The purpose of this study was to assess the effects of recent surgical rib fixation and establish its indications not only for flail chest but also for multiple rib fractures. Between 2007 and 2015, 187 patients were diagnosed as having multiple rib fractures in our institution. After the propensity score matching was performed, ten patients who had performed surgical rib fixation and ten patients who had treated with non-operative management were included. Categorical variables were analyzed with Fischer's exact test and non-parametric numerical data were compared using the Mann-Whitney U test. Wilcoxon signed-rank test was performed for comparison of pre- and postoperative variables. All statistical data are presented as median (25-75 % interquartile range [IQR]) or number. The surgically treated patients extubated significantly earlier than non-operative management patients (5.5 [1-8] vs 9 [7-12] days: p = 0.019). The duration of continuous intravenous narcotic agents infusion days (4.5 [3-6] vs 12 [9-14] days: p = 0.002) and the duration of intensive care unit stay (6.5 [3-9] vs 12 [8-14] days: p = 0.008) were also significantly shorter in surgically treated patients. Under the same ventilating conditions, the postoperative values of tidal volume and respiratory rate improved significantly compared to those values measured just before the surgery. The incidence of pneumonia as a complication was significantly higher in non-operative management group (p = 0.05). From the viewpoints of early respiratory stabilization and intensive care unit disposition without any complications, surgical rib fixation is a sufficiently acceptable procedure not only for flail chest but also for repair of severe multiple rib fractures.

  18. The importance of determining surgical indications in cases of lung cancer and interstitial pneumonia with multiple intrapulmonary lymph nodes

    Directory of Open Access Journals (Sweden)

    Yuki Nakajima

    2016-01-01

    Discussion and conclusions: The greatest problem in treating pulmonary cancer complicated with interstitial pneumonia is acute exacerbation, wherein, in the absence of any surgical indications, alternative treatment is limited. Thus, contra-indicating surgery for a patient due to a diagnosis of metastasis within the lungs, based only on nodule images, should be avoided. If nodules are noted in the area of the pleura, the possibility exists that these could be intrapulmonary lymph nodes, along with metastasis within the lung, and thoracoscopic surgery should be implemented proactively while keeping these in mind.

  19. IATROGENIC HALLUX VARUS: CAUSES OF DEFORMITY AND POSSIBILITIES OF PERCUTANEOUS SURGICAL CORRECTION (RETROSPECTIVE ANALYSIS OF CASE REPORTS

    Directory of Open Access Journals (Sweden)

    S. Yu. Berezhnoy

    2017-01-01

    Full Text Available Introduction. Hallux varus is a relatively rare foot deformity. Commonly, hallux varus is a complication after the hallux valgus surgery and typically is the result of the first metatarsal medial eminence over resection, first and second metatarsal excessive convergence, over release of the lateral soft tissues, overtightening of the medial soft tissues and soft tissue imbalance of the first metatarsophalangeal joint.The purpose of this study was to clarify the causes and timing of the iatrogenic hallux varus formation and to evaluate the possibility and efficiency of percutaneous techniques in its surgical treatment.Material and methods. Thirty-one feet (31 females suffering from iatrogenic hallux varus were examined clinically and radiologically, including 14 patients who underwent surgery. The average age of the whole group was 57 years (range, 39 to 74, the subgroup of operated patients — 60 years (range from 53 to 68. The time after primary interventions before the examination varied from 2 to 44 years. The mean follow-up after surgery was 6 months (range from 1.5 to 54.Results. No infection or wound-healing issues were observed. Overall, the patients were completely satisfied with the outcomes of 12 surgeries and satisfied with reservation in 2 cases.Conclusions. The visual manifestations of hallux varus are determined not only by the hallux varus angle, but also by the value of the first intermetatarsal angle. In addition to well-known factors, hallux varus formation is determined by first metatarsal bone elongation and first metatarsophalangeal joint instability. In rare cases, only one of the factors leads to the hallux varus; as a rule, we see a combination of factors with their mutual reinforcement. Despite the demonstration of usage possibility and the efficiency of percutaneous techniques in hallux varus correcting, a small number of observations in the study does not yet allow giving recommendations on the use of specific

  20. Metabolic profiles of prokaryotic and eukaryotic communities in deep-sea sponge Neamphius huxleyi [corrected]. indicated by metagenomics.

    Science.gov (United States)

    Li, Zhi-Yong; Wang, Yue-Zhu; He, Li-Ming; Zheng, Hua-Jun

    2014-01-27

    The whole metabolism of a sponge holobiont and the respective contributions of prokaryotic and eukaryotic symbionts and their associations with the sponge host remain largely unclear. Meanwhile, compared with shallow water sponges, deep-sea sponges are rarely understood. Here we report the metagenomic exploration of deep-sea sponge Neamphius huxleyi [corrected] . at the whole community level. Metagenomic data showed phylogenetically diverse prokaryotes and eukaryotes in Neamphius huxleyi [corrected]. MEGAN and gene enrichment analyses indicated different metabolic potentials of prokaryotic symbionts from eukaryotic symbionts, especially in nitrogen and carbon metabolisms, and their molecular interactions with the sponge host. These results supported the hypothesis that prokaryotic and eukaryotic symbionts have different ecological roles and relationships with sponge host. Moreover, vigorous denitrification, and CO2 fixation by chemoautotrophic prokaryotes were suggested for this deep-sea sponge. The study provided novel insights into the respective potentials of prokaryotic and eukaryotic symbionts and their associations with deep-sea sponge Neamphius huxleyi [corrected].

  1. Sciatic nerve compression by neurogenic heterotopic ossification: use of CT to determine surgical indications

    International Nuclear Information System (INIS)

    Salga, Marjorie; Jourdan, Claire; Durand, Marie-Christine; Hangard, Chloe; Carlier, Robert-Yves; Denormandie, Philippe; Genet, Francois

    2015-01-01

    To describe the characteristics of neurogenic heterotopic ossification (NHO) based on clinical tests, electroneuromyography (ENMG) and CT in a database of patients with lesions of the central nervous system who required sciatic nerve neurolysis along with posterior hip NHO resection, and to determine the respective roles of ENMG and CT in the management of posterior hip NHOs in patients who are unable to communicate or express pain. The consistency of the ENMG results with clinical findings, CT results and macroscopic signs of lesions was retrospectively assessed after sciatic nerve neurolysis and ablation of 55 posterior hip NHOs. Sciatic nerve neurolysis was necessary in 55 cases (47.4 %; 55 out of 116). CT showed contact of the NHO with the nerve in all cases: 5 in contact with no deflection, 3 in contact with deflection, 21 moulded into a gutter and 26 entrapped in the NHO. There were clinical signs of sciatic nerve lesion in 21.8 % of cases (12 out of 55). ENMG showed signs of sciatic nerve lesions in only 55.6 % (10 out of 18), only 4 of whom presented with clinical signs of a nerve lesion. No significant relationship was found between clinical symptoms and ENMG findings of sciatic nerve compression (n = 13, p = 0.77). Nerve compression by NHO is likely an underdiagnosed condition, particularly in patients who are unable to communicate. Diagnosis of sciatic compression by NHO should be based on regular clinical examinations and CT. ENMG is not sufficiently sensitive to be used alone for surgical decision-making. (orig.)

  2. Sciatic nerve compression by neurogenic heterotopic ossification: use of CT to determine surgical indications

    Energy Technology Data Exchange (ETDEWEB)

    Salga, Marjorie [Hopital Raymond Poincare, APHP, CIC-IT 805, Department of Physical Medicine and Rehabilitation, Garches (France); Jourdan, Claire [Hopital Raymond Poincare, APHP, CIC-IT 805, Department of Physical Medicine and Rehabilitation, Garches (France); Universite de Versailles Saint Quentin en Yvelines, Handi-Resp, (EA4047), Versailles (France); Durand, Marie-Christine [Hopital Raymond Poincare, APHP, CIC-IT 805, Department of Neurophysiology, Garches (France); Universite de Versailles Saint Quentin en Yvelines, Groupement de Recherche Clinique et Technologique sur le Handicap (GRCTH, EA 4497), Versailles (France); Hangard, Chloe; Carlier, Robert-Yves [Hopital Raymond Poincare, APHP, CIC-IT 805, Department of Medical Imaging, Garches (France); Denormandie, Philippe [Universite de Versailles Saint Quentin en Yvelines, Groupement de Recherche Clinique et Technologique sur le Handicap (GRCTH, EA 4497), Versailles (France); Hopital Raymond Poincare, APHP, CIC-IT 805, Department of Orthopaedic Surgery, Garches (France); Genet, Francois [Hopital Raymond Poincare, APHP, CIC-IT 805, Department of Physical Medicine and Rehabilitation, Garches (France); Universite de Versailles Saint Quentin en Yvelines, Groupement de Recherche Clinique et Technologique sur le Handicap (GRCTH, EA 4497), Versailles (France); Military Medical Service, Hopital d' Instruction des Armees Percy, Department of Physical Medicine and Rehabilitation, Clamart (France)

    2014-09-14

    To describe the characteristics of neurogenic heterotopic ossification (NHO) based on clinical tests, electroneuromyography (ENMG) and CT in a database of patients with lesions of the central nervous system who required sciatic nerve neurolysis along with posterior hip NHO resection, and to determine the respective roles of ENMG and CT in the management of posterior hip NHOs in patients who are unable to communicate or express pain. The consistency of the ENMG results with clinical findings, CT results and macroscopic signs of lesions was retrospectively assessed after sciatic nerve neurolysis and ablation of 55 posterior hip NHOs. Sciatic nerve neurolysis was necessary in 55 cases (47.4 %; 55 out of 116). CT showed contact of the NHO with the nerve in all cases: 5 in contact with no deflection, 3 in contact with deflection, 21 moulded into a gutter and 26 entrapped in the NHO. There were clinical signs of sciatic nerve lesion in 21.8 % of cases (12 out of 55). ENMG showed signs of sciatic nerve lesions in only 55.6 % (10 out of 18), only 4 of whom presented with clinical signs of a nerve lesion. No significant relationship was found between clinical symptoms and ENMG findings of sciatic nerve compression (n = 13, p = 0.77). Nerve compression by NHO is likely an underdiagnosed condition, particularly in patients who are unable to communicate. Diagnosis of sciatic compression by NHO should be based on regular clinical examinations and CT. ENMG is not sufficiently sensitive to be used alone for surgical decision-making. (orig.)

  3. Feasibility and safety of on table extubation after corrective surgical repair of tetralogy of Fallot in a developing country: A case series

    Directory of Open Access Journals (Sweden)

    Mohammad Irfan Akhtar

    2015-01-01

    Full Text Available Fast-track extubation is an established safe practice in pediatric congenital heart disease (CHD surgical patients. On table extubation (OTE in acyanotic CHD surgical patients is well established with validated safety profile. This practice is not yet reported in tetralogy of Fallot (TOF cardiac surgical repair patients in developing countries. Evidence suggests that TOF total correction patients should be extubated early, as positive pressure ventilation has a negative impact on right ventricular function and the overall increase in post-TOF repair complications such as low cardiac output state and arrhythmias. The objective of the case series was to determine the safety and feasibility of OTE in elective TOF total correction cardiac surgical patients with an integrated team approach. To the best of our knowledge, this is the first reported case series. A total of 8 elective male and female TOF patients were included. Standard anesthetic, surgical and perfusion techniques were used in these procedures. All patients were extubated in the operating room safely without any complications with the exception of one patient who continued to bleed for 3 h of postextubation at 2-3 ml/kg/h which was managed with transfusion of fresh frozen plasma at 15 mL/kg, packed red blood cells 10 mL/kg and bolus of transamine at 20 mg/kg. Apart from better surgical and bypass techniques, the most important factor leading to successful OTE was an excellent analgesia. On the basis of the case series, it is suggested to extubate selected TOF cardiac surgery repair patients on table safely with integrated multidisciplinary approach.

  4. Measuring party nationalisation: A new Gini-based indicator that corrects for the number of units

    DEFF Research Database (Denmark)

    Bochsler, Daniel

    2010-01-01

    The study of the territorial distribution of votes in elections has become an important field of the political party research in recent years. Quantitative studies on the homogeneity of votes and turnout employ different indicators of territorial variance, but despite important progresses...... in measurement, many of them are sensitive to size and number of political parties or electoral districts. This article proposes a new 'standardised party nationalisation score', which is based on the Gini coefficient of inequalities in distribution. Different from previous indicators, the standardised party...

  5. R1 correction in amide proton transfer imaging: indication of the influence of transcytolemmal water exchange on CEST measurements.

    Science.gov (United States)

    Li, Hua; Li, Ke; Zhang, Xiao-Yong; Jiang, Xiaoyu; Zu, Zhongliang; Zaiss, Moritz; Gochberg, Daniel F; Gore, John C; Xu, Junzhong

    2015-12-01

    Amide proton transfer (APT) imaging may potentially detect mobile proteins/peptides non-invasively in vivo, but its specificity may be reduced by contamination from other confounding effects such as asymmetry of non-specific magnetization transfer (MT) effects and spin-lattice relaxation with rate R1 (=1/T1). Previously reported spillover, MT and R1 correction methods were based on a two-pool model, in which the existence of multiple water compartments with heterogeneous relaxation properties in real tissues was ignored. Such simple models may not adequately represent real tissues, and thus such corrections may be unreliable. The current study investigated the effectiveness and accuracy of correcting for R1 in APT imaging via simulations and in vivo experiments using tumor-bearing rats subjected to serial injections of Gd-DTPA that produced different tissue R1 values in regions of blood-brain-barrier breakdown. The results suggest that conventional measurements of APT contrast (such as APT* and MTRasym ) may be significantly contaminated by R1 variations, while the R1 -corrected metric AREX* was found to be relatively unaffected by R1 changes over a broad range (0.4-1 Hz). Our results confirm the importance of correcting for spin-lattice relaxation effects in quantitative APT imaging, and demonstrate the reliability of using the observed tissue R1 for corrections to obtain more specific and accurate measurements of APT contrast in vivo. The results also indicate that, due to relatively fast transcytolemmal water exchange, the influence of intra- and extracellular water compartments on CEST measurements with seconds long saturation time may be ignored in tumors. Copyright © 2015 John Wiley & Sons, Ltd.

  6. Indication for the operative methods in surgical treatment of cervical spondylotic myelopathy

    International Nuclear Information System (INIS)

    Kobayashi, Akira; Inoue, Shunichi; Watabe, Tsuneo; Nagase, Joji; Harada, Yoshitada

    1984-01-01

    Indication for the operative methods for cervical spondylotic myelopathy was examined in 16 patients undergoing CT-myelography before and after operation. There was a highly significant correlation between the anteroposterior (A-P) diameter of the spinal cord and clinical symptoms. Patients with shorter A-P diameter of the spinal cord tended to have severer preoperative clinical symptoms. Clinical symptoms improved as the post operative A-P diameter of the spinal cord increased. Fixation with decompression of the anterior spinal cord should be indicated when constriction of 5 mm or less of the spinal cord is seen segmentally at the level of the intervertebral disc. Dilation of the spinal cavity should be indicated when the constriction of the spinal cord is 5 mm or less at all levels of the cervical spinal cord. In performing fixation with anterior decompression, 15 mm is considered to be the most suitable width for complete and safe decompression of the flattened spinal cord with a wide transverse diameter. (Namekawa, K)

  7. Advantages, Disadvantages, Indications, Contraindications and Surgical Technique of Laryngeal Airway Mask.

    Science.gov (United States)

    Jannu, Anubhav; Shekar, Ashim; Balakrishna, Ramdas; Sudarshan, H; Veena, G C; Bhuvaneshwari, S

    2017-12-01

    The beauty of the laryngeal mask is that it forms an air tight seal enclosing the larynx rather than plugging the pharynx, and avoid airway obstruction in the oropharynx. The goal of its development was to create an intermediate form of airway management face mask and endotracheal tube. Indication for its use includes any procedure that would normally involve the use of a face mask. The laryngeal mask airway was designed as a new concept in airway management and has been gaining a firm position in anesthetic practice. Despite wide spread use the definitive role of the laryngeal mask airway is yet to be established. In some situations, such as after failed tracheal intubation or in oral surgery its use is controversial. There are several unresolved issues, for example the effect of the laryngeal mask on regurgitation and whether or not cricoids pressure prevents placement of mask. We review the techniques of insertion, details of misplacement, and complications associated with use of the laryngeal mask. We then attempt to clarify the role of laryngeal mask in air way management during anesthesia, discussing the advantages and disadvantages as well as indications and contraindications of its use in oral and maxillofacial surgery.

  8. [Hysterectomies at the Conakry university hospitals: social, demographic, and clinical characteristics, types, indications, surgical approaches, and prognosis].

    Science.gov (United States)

    Baldé, I S; Sy, T; Diallo, B S; Diallo, Y; Mamy, M N; Diallo, M H; Bah, E M; Diallo, T S; Keita, N

    2014-01-01

    The objectives of this study were to calculate the frequency of hysterectomies at the Conakry university hospitals (Donka Hospital and Ignace Deen Hospital), describe the women's social, demographic, and clinical characteristics, and identify the key indications, the surgical techniques used, and the prognosis. This was a 2-year descriptive study, retrospective for the first year (May 2011-April 2012) and prospective for the second (May 2012-April 2013), of 333 consecutive hysterectomies performed in the obstetrics and gynecology departments of these two hospitals. Hysterectomy is one of the surgical procedures most commonly performed in these departments (following cesarean deliveries), with frequency of 4.4% interventions. The profile of the women undergoing this surgery was that of a woman aged younger than 49 years (61%), married (75.7%), multiparous (33%), of childbearing age (61%), and with no history of abdominal or pelvic surgery (79.6%). Nearly all hysterectomies were total (95%, compared with 5% subtotal; the approach was abdominal in 82.25% of procedures and vaginal in 17.75%. The most common indication for surgery was uterine fibroids (39.6%), followed by genital prolapse (22.2%), and obstetric emergencies (17.8%). The average duration of surgery was 96 minutes for abdominal and 55 minutes for vaginal hysterectomies. The principal intraoperative complication was hemorrhage (12.31%), and the main postoperative complication parietal suppuration (21.02%). The average length of hospital stay was 10.3 days for abdominal hysterectomies and 7.15 days for vaginal procedures. We recorded 14 deaths for a lethality rate of 4.2%; most of these deaths were associated with hemorrhagic shock during or after an obstetric hysterectomy (93%). Hysterectomy remains a common intervention in developing countries. Its indications are common during the pregnancy and postpartum period, with high morbidity and mortality rates. Improving obstetric coverage could reduce its

  9. Effective cataract surgical coverage: An indicator for measuring quality-of-care in the context of Universal Health Coverage.

    Directory of Open Access Journals (Sweden)

    Jacqueline Ramke

    Full Text Available To define and demonstrate effective cataract surgical coverage (eCSC, a candidate UHC indicator that combines a coverage measure (cataract surgical coverage, CSC with quality (post-operative visual outcome.All Rapid Assessment of Avoidable Blindness (RAAB surveys with datasets on the online RAAB Repository on April 1 2016 were downloaded. The most recent study from each country was included. By country, cataract surgical outcome (CSOGood, 6/18 or better; CSOPoor, worse than 6/60, CSC (operated cataract as a proportion of operable plus operated cataract and eCSC (operated cataract and a good outcome as a proportion of operable plus operated cataract were calculated. The association between CSC and CSO was assessed by linear regression. Gender inequality in CSC and eCSC was calculated.Datasets from 20 countries were included (2005-2013; 67,337 participants; 5,474 cataract surgeries. Median CSC was 53.7% (inter-quartile range[IQR] 46.1-66.6%, CSOGood was 58.9% (IQR 53.7-67.6% and CSOPoor was 17.7% (IQR 11.3-21.1%. Coverage and quality of cataract surgery were moderately associated-every 1% CSC increase was associated with a 0.46% CSOGood increase and 0.28% CSOPoor decrease. Median eCSC was 36.7% (IQR 30.2-50.6%, approximately one-third lower than the median CSC. Women tended to fare worse than men, and gender inequality was slightly higher for eCSC (4.6% IQR 0.5-7.1% than for CSC (median 2.3% IQR -1.5-11.6%.eCSC allows monitoring of quality in conjunction with coverage of cataract surgery. In the surveys analysed, on average 36.7% of people who could benefit from cataract surgery had undergone surgery and obtained a good visual outcome.

  10. Intraductal papillary mucinous neoplasm of the pancreas (IPMN: clinico-pathological correlations and surgical indications

    Directory of Open Access Journals (Sweden)

    Cantù Massimiliano

    2010-04-01

    Full Text Available Abstract Background Intraductal papillary mucinous neoplasms (IPMNs are increasingly recognized entities, whose management remains sometimes controversial, due to the high rate of benign lesions and on the other side to the good survival after resection of malignant ones. Methods Retrospective analysis of a prospectively collected Western series of IPMN. Results Forty cases of IPMN were analysed (1992-2007. Most patients were symptomatic (72.5%; cholangio-MRI had the best diagnostic accuracy both for the tumour nature (83.3% and for the presence of malignancy (57.1%. ERCP was done in 8 cases (20%, and the results were poor. Thirteen patients were treated by pancreatic resection and 27 were maintained in follow-up. Total pancreatectomy was performed in 46% of the cases; in situ and invasive carcinoma were recognized in 15.4% and 38.4% of the cases, respectively. The mean follow-up was 42 months (range 12-72. One only patients with nodal metastases died 16 months after the operation for disease progression, while 91.6% of the operated patients are disease free. Out of the 27 not resected patients, 2 out of 4 presenting a lesion at high risk for malignancy died, while the remaining are in good conditions and disease free, with a mean follow-up of 31 months. Conclusion Therapeutic indication for IPMNs is mainly based upon radiological evaluation of the risk of malignancy. While the main duct tumours should be resected, preserving whenever possible a portion of the gland, the secondary ducts tumours may be maintained under observation, in absence of radiological elements of suspicion such as size larger than 3 cm, or a wall greater than 3 mm or nodules or papillae in the context of the cyst.

  11. Association between surgical indications, operative risk, and clinical outcome in infective endocarditis: a prospective study from the International Collaboration on Endocarditis.

    Science.gov (United States)

    Chu, Vivian H; Park, Lawrence P; Athan, Eugene; Delahaye, Francois; Freiberger, Tomas; Lamas, Cristiane; Miro, Jose M; Mudrick, Daniel W; Strahilevitz, Jacob; Tribouilloy, Christophe; Durante-Mangoni, Emanuele; Pericas, Juan M; Fernández-Hidalgo, Nuria; Nacinovich, Francisco; Rizk, Hussien; Krajinovic, Vladimir; Giannitsioti, Efthymia; Hurley, John P; Hannan, Margaret M; Wang, Andrew

    2015-01-13

    Use of surgery for the treatment of infective endocarditis (IE) as related to surgical indications and operative risk for mortality has not been well defined. The International Collaboration on Endocarditis-PLUS (ICE-PLUS) is a prospective cohort of consecutively enrolled patients with definite IE from 29 centers in 16 countries. We included patients from ICE-PLUS with definite left-sided, non-cardiac device-related IE who were enrolled between September 1, 2008, and December 31, 2012. A total of 1296 patients with left-sided IE were included. Surgical treatment was performed in 57% of the overall cohort and in 76% of patients with a surgical indication. Reasons for nonsurgical treatment included poor prognosis (33.7%), hemodynamic instability (19.8%), death before surgery (23.3%), stroke (22.7%), and sepsis (21%). Among patients with a surgical indication, surgical treatment was independently associated with the presence of severe aortic regurgitation, abscess, embolization before surgical treatment, and transfer from an outside hospital. Variables associated with nonsurgical treatment were a history of moderate/severe liver disease, stroke before surgical decision, and Staphyloccus aureus etiology. The integration of surgical indication, Society of Thoracic Surgeons IE score, and use of surgery was associated with 6-month survival in IE. Surgical decision making in IE is largely consistent with established guidelines, although nearly one quarter of patients with surgical indications do not undergo surgery. Operative risk assessment by Society of Thoracic Surgeons IE score provides prognostic information for survival beyond the operative period. S aureus IE was significantly associated with nonsurgical management. © 2014 American Heart Association, Inc.

  12. [Kirschner wire transfixation of unstable ankle fractures: indication, surgical technique and outcomes].

    Science.gov (United States)

    Marvan, J; Džupa, V; Bartoška, R; Kachlík, D; Krbec, M; Báča, V

    2015-01-01

    transfixation, no radiographic evidence of ankle osteoarthritis was recorded in 25 (42%) patients. While tibiofibular synostosis was recorded in only few patients (9%) of the group with one-stage osteosynthesis, it showed a high occurrence in the group with temporary transfixation (35%). The patients with one-stage osteosynthesis (188/68%) had a higher proportion of excellent outcomes measured on the Olerund-Molander ankle scoring scale than the other two groups (temporary transfixation, 47%; definitive transfixation,10%); in both cases the difference was significant (p ankle fractures were assessed. The patients with one-stage osteosynthesis were compared with those treated by temporary or definitive transfixation. The majority of patients undergoing temporary transfixation had a fractured posterior margin of the tibia and major ankle joint dislocation, which suggested serious injuries to bone and ligament structures. Generally, the use of only two K-wires inserted through the calcaneus and talus into the distal tibia is recommended. Patients with K-wire transfixation usually require a longer hospital stay because of the serious nature of their injuries. CONCLUSIONS The therapy of choice for unstable ankle fractures is one-stage osteosynthesis. Temporary transfixation is an effective method of primary management when an unstable fracture cannot be treated by definitive osteosynthesis at the early stage due to local or general health conditions of the patient. The temporary transfixation provides good alignment of the ankle joint necessary for successful healing of soft tissues. A higher occurrence of post-traumatic ankle osteoarthritis, ossification and distal tibiotalar synostosis found in the patients treated by temporary transfixation is more related to serious types of ankle fractures the patient had suffered than to the method itself. Key words: unstable ankle fracture, soft tissue condition, indications for transfixation, treatment outcome.

  13. Violation of specific indicators pigment and lipid metabolism in experimental pneumonia in an immobilization stress and correction of corvitin

    OpenAIRE

    Ferenc, N. M.

    2015-01-01

    Ferenc N. M. Violation of specific indicators pigment and lipid metabolism in experimental pneumonia in an immobilization stress and correction of corvitin. Journal of Education, Health and Sport. 2015;5(9):709-713. ISSN 2391-8306. DOI http://dx.doi.org/10.5281/zenodo.32430 http://ojs.ukw.edu.pl/index.php/johs/article/view/2015%3B5%289%29%3A709-713 https://pbn.nauka.gov.pl/works/658656 Formerly Journal of Health Sciences. ISSN 1429-9623 / 2300-665X. Archives 2011–2014 http://journ...

  14. Practical Use of the Extended No Action Level (eNAL) Correction Protocol for Breast Cancer Patients With Implanted Surgical Clips

    International Nuclear Information System (INIS)

    Penninkhof, Joan; Quint, Sandra; Baaijens, Margreet; Heijmen, Ben; Dirkx, Maarten

    2012-01-01

    Purpose: To describe the practical use of the extended No Action Level (eNAL) setup correction protocol for breast cancer patients with surgical clips and evaluate its impact on the setup accuracy of both tumor bed and whole breast during simultaneously integrated boost treatments. Methods and Materials: For 80 patients, two orthogonal planar kilovoltage images and one megavoltage image (for the mediolateral beam) were acquired per fraction throughout the radiotherapy course. For setup correction, the eNAL protocol was applied, based on registration of surgical clips in the lumpectomy cavity. Differences with respect to application of a No Action Level (NAL) protocol or no protocol were quantified for tumor bed and whole breast. The correlation between clip migration during the fractionated treatment and either the method of surgery or the time elapsed from last surgery was investigated. Results: The distance of the clips to their center of mass (COM), averaged over all clips and patients, was reduced by 0.9 ± 1.2 mm (mean ± 1 SD). Clip migration was similar between the group of patients starting treatment within 100 days after surgery (median, 53 days) and the group starting afterward (median, 163 days) (p = 0.20). Clip migration after conventional breast surgery (closing the breast superficially) or after lumpectomy with partial breast reconstructive techniques (sutured cavity). was not significantly different either (p = 0.22). Application of eNAL on clips resulted in residual systematic errors for the clips’ COM of less than 1 mm in each direction, whereas the setup of the breast was within about 2 mm of accuracy. Conclusions: Surgical clips can be safely used for high-accuracy position verification and correction. Given compensation for time trends in the clips’ COM throughout the treatment course, eNAL resulted in better setup accuracies for both tumor bed and whole breast than NAL.

  15. [Study on concomitant surgical correction of pelvic organ prolapse and TVT-O for treatment of stress urinary incontinence].

    Science.gov (United States)

    Wang, Su-mei; Zhang, Zhen-yu; Liu, Chong-dong; Wang, Shu-zhen

    2013-07-01

    To investigate the necessity, safety and efficacy of transobturator tension-free vaginal tape (TVT-O) for treatment of stress urinary incontinence (SUI) during transvaginal corrective operation of pelvic organ prolapse (POP). From Jan. 2005 to Dec. 2010, 92 patients undergoing transvaginal pelvic reconstruction surgery for correction of POP concomitant TVT-O for treatment of SUI in Department of Obstetrics and Gynecology affiliated to Beijing Chaoyang Hospital as concomitant surgery group were enrolled in this retrospective study matched with 90 patients with mild SUI without SUI surgery as non-concomitant surgery group and 120 patients without SUI as control group.Variable clinical index, clinical efficacy and complications were compared among those three groups. Compared with those in the other two groups, the mean age [(62 ± 11) years] was lower (P = 0.007,0.038), the operation time only slightly increased (12.8 min and 12.9 min respectively) significantly in concomitant TVT-O group. The bleeding loss and the length of staying hospital after operation all exhibited no significant differences within three groups (P > 0.05). The effective rate for SUI was 96.7% (89/92) in concomitant TVT-O group, corrective operation of POP was ineffective for 74.4% (67/90) SUI, 9.2% (11/120) patients presented new SUI in the patients without SUI preoperatively. TVT-O is a simple, safe and effective method in the treatment of SUI, which is more suitable for performing simultaneously during the corrective operation of POP.Efficacy of SUI correction was limited in those patients undergoing only pelvic reconstructive surgery. However, a preventive anti-incontinence procedure is not recommended because of the lower incidence in POP patients without SUI preoperatively.

  16. Violation of specific indicators pigment and lipid metabolism in experimental pneumonia in an immobilization stress and correction of corvitin

    Directory of Open Access Journals (Sweden)

    N. M. Ferenc

    2015-09-01

      Abstract   The aim of study was to investigate the features change cholesterol and bilirubin in the blood serum of guinea pigs (males with experimental pneumonia (EP under conditions of immobilization stress (IS and prove the feasibility of Corvitin. The study was conducted on 48 guinea pigs (males were divided into 6 groups. The research results make it possible to detect liver damage in terms of IS EP and in violation of its functional state. Application domestic preparation Corvitin led to a significant reduction in the changed parameters bilirubin and cholesterol under conditions of formation of EP and IP, which indicates its positive corrective effect.   Keywords: experimental pneumonia, stress, liver, cholesterol, bilirubin.

  17. [ The new 2010 Ghent criteria for the indication to surgical treatment of patients affected by Marfan syndrome. Experience of a single cardiac surgery center].

    Science.gov (United States)

    Grego, Susanna; Nardi, Paolo; Gislao, Valentina; Nicolò, Francesca; D'Annolfo, Antonella; Marcucci, Rosaria; Bovio, Emanuele; Versaci, Francesco; Chiariello, Luigi

    2013-01-01

    The diagnosis and surgical treatment of patients with Marfan syndrome remain controversial. It is of utmost importance to identify patients at risk for acute aortic events to establish the correct surgical timing and the appropriate surgical treatment. From May 2008 to December 2012, 500 patients were screened at the Marfan Presidium of the Tor Vergata University Hospital of Rome (Italy). Patients were evaluated by a cardiac surgeon, including echocardiographic, orthopedic, ophthalmologic and dental examinations. All patients received genetic counseling, and genetic sampling was performed if appropriate. The diagnosis of Marfan syndrome was confirmed in 146 patients (29.2%). Fifty-four patients (37%) underwent cardiac surgery on the aortic root, 4 patients had surgery on the mitral valve, 13 patients had combined surgery; 11 cases were emergent surgery for acute aortic dissection. Twenty-eight patients (52%) were operated on at our Division: 13 underwent valve-sparing aortic root replacement (David procedure), 1 underwent Yacoub remodeling procedure and 14 underwent Bentall procedure. Following the establishment of the Marfan Center, the David aortic valve-sparing operation was the most frequently performed procedure compared to the previous period of surgical activity (63 vs 22%, psyndromes. Early surgical treatment is recommended in these patients to achieve optimal results of valve-sparing procedures and life-saving management, especially for patients who live far away from a cardiac surgery center.

  18. [Liver transplantation--indications, surgical technique, results--the analysis of a clinical series of 200 cases].

    Science.gov (United States)

    Popescu, I; Ionescu, M; Braşoveanu, V; Hrehoreţ, D; Matei, E; Dorobantu, B; Zamfir, R; Alexandrescu, S; Grigorie, M; Tulbure, D; Popa, L; Ungureanu, M; Tomescu, D; Droc, G; Popescu, H; Cristea, A; Gheorghe, L; Iacob, S; Gheorghe, C; Boroş, M; Lupescu, I; Vlad, L; Herlea, V; Croitoru, M; Platon, P; Alloub, A

    2010-01-01

    Initially considered experimental, liver transplantation (LT) has become the treatment of choice for the patients with end-stage liver diseases. Between April 2000 and October 2009, 200 LTs (10 reLTs) were performed in 190 patients, this study being retrospective. There were transplanted 110 men and 80 women, 159 adults and 31 children with the age between 1 and 64 years old (mean age--39.9). The main indication in the adult group was represented by viral cirrhosis, while the pediatric series the etiology was mainly glycogenosis and biliary atresia. There were performed 143 whole graft LTs, 46 living donor LTs, 6 split LTs, 4 reduced LTs and one domino LT RESULTS: The postoperative survival was 90% (170 patients). The patient and graft one-year and five-year survivals were 76.9%, 73.6% and 71%, 68.2%, respectively. The early complications occurred in 127 patients (67%). The late complications were recorded in 71 patients (37.3%). The intraoperative and early postoperative mortality rate was 9.5% (18 patients). The Romanian liver transplantation program from Fundeni includes all types of current surgical techniques and the results are comparable with those from other international centers.

  19. Successful correction of tibial bone deformity through multiple surgical procedures, liquid nitrogen-pretreated bone tumor autograft, three-dimensional external fixation, and internal fixation in a patient with primary osteosarcoma: a case report.

    Science.gov (United States)

    Takeuchi, Akihiko; Yamamoto, Norio; Shirai, Toshiharu; Nishida, Hideji; Hayashi, Katsuhiro; Watanabe, Koji; Miwa, Shinji; Tsuchiya, Hiroyuki

    2015-12-07

    In a previous report, we described a method of reconstruction using tumor-bearing autograft treated by liquid nitrogen for malignant bone tumor. Here we present the first case of bone deformity correction following a tumor-bearing frozen autograft via three-dimensional computerized reconstruction after multiple surgeries. A 16-year-old female student presented with pain in the left lower leg and was diagnosed with a low-grade central tibial osteosarcoma. Surgical bone reconstruction was performed using a tumor-bearing frozen autograft. Bone union was achieved at 7 months after the first surgical procedure. However, local tumor recurrence and lung metastases occurred 2 years later, at which time a second surgical procedure was performed. Five years later, the patient developed a 19° varus deformity and underwent a third surgical procedure, during which an osteotomy was performed using the Taylor Spatial Frame three-dimensional external fixation technique. A fourth corrective surgical procedure was performed in which internal fixation was achieved with a locking plate. Two years later, and 10 years after the initial diagnosis of tibial osteosarcoma, the bone deformity was completely corrected, and the patient's limb function was good. We present the first report in which a bone deformity due to a primary osteosarcoma was corrected using a tumor-bearing frozen autograft, followed by multiple corrective surgical procedures that included osteotomy, three-dimensional external fixation, and internal fixation.

  20. Comparison of Srs-24 And Srs-22 Scores in Thirty Eight Adolescent Idiopathic Scoliosis Patients Who Had Undergone Surgical Correction

    OpenAIRE

    CYW Chan; LB Saw; MK Kwan

    2009-01-01

    Adolescent idiopathic scoliosis is a spinal deformity that affects patients’ self image and confidence. Surgery is offered when the curvature is greater than 50 degrees based on the likelihood of curvature progression. Outcome measures for scoliosis correction can be described in terms of radiological improvement or improvement of health related quality of life scores. The Scoliosis Research Society 22 (SRS-22) and Scoliosis Research Society 24 (SRS-24) questionnaires are widely accepted and ...

  1. The role of cardiovascular magnetic resonance in assessment of patients after radical surgical correction of tetralogy of Fallot

    International Nuclear Information System (INIS)

    Genova, K.; Dasheva, A.

    2014-01-01

    Surgical management of tetralogy of Fallot (TOF) results in residual anatomic and functional abnormalities in majority of patients. Primarily considered as a benign pulmonary regurgitation with the time results in right ventricular overload, loses the compensatory mechanisms and irreversible right ventricular dilatation and dysfunction. Cardiovascular magnetic resonance (CMR) has evolved during the last two decades as the reference standard imaging modality to assess the anatomic and functional changes in patients with repaired TOF. This article reviews the role of CMR to assess the right ventricular function and to evaluate the degree of pulmonary regurgitation and comments some technical aspects, based to our experience. Key words: Tetralogy of Fallot. Cardiovascular Magnetic Resonance. Pulmonary regurgitation. Right ventricular assessment

  2. Application of hyperbaric oxygen therapy in the rehabilitation of patients after surgical correction of the penile urethral strictures

    Directory of Open Access Journals (Sweden)

    Kotenko К.V.

    2013-12-01

    Full Text Available The aim of the article is to examine the impact and justify the use of hyperbaric oxygenation in the complex rehabilitation of patients after surgery for penile urethral strictures. Material and Methods. A group of 37 patients were examined who underwent various reconstructive operations on the urethra, 16 of which in the postoperative period in addition to conventional therapy conducted hyperbaric oxygenation. Results. It is shown that the use of hyperbaric oxygenation in the early postoperative period in patients undergoing replacement plastic of urethra can reduce the incidence of postoperative complications, and reduced the time of urethral drainage. Conclusion. An integrated approach with the use of hyperbaric oxygen therapy in the rehabilitation of patients undergoing extended replacement plastic of penile urethral strictures, reduces the amount of potential effect-dependent postoperative complications, which generally leads to shorter hospital stay after surgical treatment.

  3. SURGICAL CORRECTION OF HALLUX VALGUS IN PATIENTS WITH TRANSVERSE FLATFOOT AND DEFORMING ARTHROSIS OF THE FIRST METATARSOPHALANGEAL JOINT

    Directory of Open Access Journals (Sweden)

    V. M. Mashkov

    2013-01-01

    Full Text Available Objective: to determine the opportunity of usage of Schede-Brandes procedure in the treatment of patients with hallux valgus. Material and methods. The results of Shede-Brandeis operation were studied in 119 patients (198 feet. The study included patients who were followed up long-term results of treatment for up to 10 years. The results of the surgical treatment were assessed by the AOFAS scale and total criteria proposed I.A. Pakhomov. According to these scales the following results were obtained: the good - in 59,59% of patients, satisfactory - in 22,73%, poor - in 17,68%. Conclusion. These results allow to recommend Schede-Brandes procedure for use in elderly patients with osteoporosis, concomitant vascular diseases of lower extremities and with rheumatoid arthritis.

  4. Risk management: correct patient and specimen identification in a surgical pathology laboratory. The experience of Infermi Hospital, Rimini, Italy.

    Science.gov (United States)

    Fabbretti, G

    2010-06-01

    Because of its complex nature, surgical pathology practice is prone to error. In this report, we describe our methods for reducing error as much as possible during the pre-analytical and analytical phases. This was achieved by revising procedures, and by using computer technology and automation. Most mistakes are the result of human error in the identification and matching of patient and samples. To avoid faulty data interpretation, we employed a new comprehensive computer system that acquires all patient ID information directly from the hospital's database with a remote order entry; it also provides label and request forms via-Web where clinical information is required before sending the sample. Both patient and sample are identified directly and immediately at the site where the surgical procedures are performed. Barcode technology is used to input information at every step and automation is used for sample blocks and slides to avoid errors that occur when information is recorded or transferred by hand. Quality control checks occur at every step of the process to ensure that none of the steps are left to chance and that no phase is dependent on a single operator. The system also provides statistical analysis of errors so that new strategies can be implemented to avoid repetition. In addition, the staff receives frequent training on avoiding errors and new developments. The results have been shown promising results with a very low error rate (0.27%). None of these compromised patient health and all errors were detected before the release of the diagnosis report.

  5. Radionuclide evaluation of volemia and its correction in surgical and combined treatment of patients with gastric cancer

    International Nuclear Information System (INIS)

    Vapnyar, V.V.

    1984-01-01

    The materials of observation of 48 patients with gastric cancer were used to show, that preoperative radiotherapy doesn't effect considerably on redistribution of volume blood indexes. Combined treatment of patients with gastric cancer results in pronounced hypoprotnemia and hypohemoglobinemia, which are beyond the sufficient correction. The sufficient decrease of volemic values, especially in red blood indexes, is noted on the 3d day after gastrectomy or stomach resection. The complex infusion-transfusion therapy, conducted in yearly postoperative period corregates adequately liquid losses, enables to compansate in time energy consumption of organism

  6. Shaft-Condylar Angle for surgical correction in neglected and displaced lateral humeral condyle fracture in children.

    Science.gov (United States)

    Mulpruek, Pornchai; Angsanuntsukh, Chanika; Woratanarat, Patarawan; Sa-Ngasoongsong, Paphon; Tawonsawatruk, Tulyapruek; Chanplakorn, Pongsthorn

    2015-09-01

    To assess the outcome after using the Shaft-Condylar angle (SCA) as intraoperative reference for sagittal plane correction in displaced lateral humeral condyle fractures in children presented 3-weeks after injury. Ten children, with delayed presentation of a displaced lateral humeral condyle fracture and undergoing surgery during 1999-2011, were reviewed. The goal was to obtain a smooth articular surface with an intraoperative SCA of nearly 40° and nearest-anatomical carrying angle. They were allocated into two groups according to the postoperative SCA [Good-reduction group (SCA=30-50°), and Bad-reduction group (SCA50°)] and the final outcomes were then compared. All fractures united without avascular necrosis. The Good-reduction group (n=7) showed a significant improvement in final range of motion and functional outcome compared to the Bad-reduction group (n=3) (p=0.02). However, there was no significant difference in pain, carrying angle and overall outcome between both groups. SCA is a possible intraoperative reference for sagittal alignment correction in late presented displaced lateral humeral condyle fractures.

  7. Nasal Duplication Combined with Cleft Lip and Palate: Surgical Correction and Long-Term Follow-Up.

    Science.gov (United States)

    Long, Kanharith; Yamaguchi, Kazuaki; Lonic, Daniel; Long, Vanna; Chhoeurn, Vuthy; Lo, Lun-Jou

    2017-10-01

    Diprosopus dirrhinus, or nasal duplication, is a rare entity of partial craniofacial duplication. The case we present is the first report of diprosopus dirrhinus associated with complete cleft lip and palate. The baby was born in Cambodia at full term by normal vaginal delivery with no significant perinatal and family history. Physical examination revealed significant facial deformity due to the duplicated nose and the left complete cleft lip/palate on the right subset. There were 4 nostrils; both medial apertures including the cleft site were found to be 10-15 mm deep cul-de-sac structures without communication to the nasopharynx. The upper third of the face was notable for hypertelorism with a duplication of the soft-tissue nasion and glabella. Between the 2 nasal dorsums, there was a small cutaneous depression with a lacrimal fistula in the midline. Surgical treatment included the first stage of primary lip and nose repair and the second stage of palatoplasty. The patient was followed up at the age of 10 years showing satisfactory results for both aesthetic and functional aspects. Further management in the future will be required for the hypertelorism and nasal deformity.

  8. Comparison of Srs-24 And Srs-22 Scores in Thirty Eight Adolescent Idiopathic Scoliosis Patients Who Had Undergone Surgical Correction

    Directory of Open Access Journals (Sweden)

    CYW Chan

    2009-05-01

    Full Text Available Adolescent idiopathic scoliosis is a spinal deformity that affects patients’ self image and confidence. Surgery is offered when the curvature is greater than 50 degrees based on the likelihood of curvature progression. Outcome measures for scoliosis correction can be described in terms of radiological improvement or improvement of health related quality of life scores. The Scoliosis Research Society 22 (SRS-22 and Scoliosis Research Society 24 (SRS-24 questionnaires are widely accepted and used to characterize clinical results. Therefore, this prospective study of 38 patients aims to investigate how the SRS-24 and SRS-22 questionnaires compare to each other in terms of scoring when the same group of patients is evaluated. The SRS-22 questionnaire tends to give an inflated value in the overall score, pain and self image domain compared to the SRS-24 questionnaire.

  9. Analysis of stress-strain state of a human eye by the method of elastotonometry after the surgical correction of hyperopia

    Science.gov (United States)

    Bauer, S. M.; Venatovskaya, L. A.

    2018-05-01

    The mathematical model of measuring of the intraocular pressure (IOP) by Maklakoff tonometer in the software package ANSYS, Inc. is presented. The dependence of the tonometric pressure on the weight of the tonometer before and after LASIK and Femto LASIK surgical corrections of hyperopia is analized. Cornea-scleral eye shell is modeled as two thin transversely isotropic joint spherical shells with different radii of curvature and biomechanical properties. To analyze the biomechanical state of the corneoscleral shell of the eye after the surgery the elastotonometry method is used. Firstly sequential measurements of intraocular pressure by Maklakoff tonometers weighting 5; 7.5; 10 and 15 g is carried out, then the dependence curve of tonometric IOP vs. tonometer weight is plotted and analyzed. The results of the calculations are compared with the clinical data.

  10. Indicaciones quirúrgicas de la epilepsia en la niñez Surgical indications in pediatric epilepsy

    Directory of Open Access Journals (Sweden)

    María Isabel Bragatti Winckler

    2007-01-01

    Full Text Available Con el objetivo de presentar el seguimiento de los pacientes ambulatorios de la clínica de epilepsia refractaria del Hospital de Clínicas de Porto Alegre (HCPA, Brasil, se hizo una revisión de la literatura de las epilepsias y síndromes epilépticos del niño y del adolescente, las indicaciones quirúrgicas y los métodos de evaluación. Los casos de epilepsia recomendados por la Subcomisión de Cirugía de la Epilepsia Pediátrica de la Liga Internacional Contra las Epilepsias para evaluación quirúrgica son: displasia cortical, esclerosis tuberosa, polimicrogiria, hamartoma hipotalámico, síndromes hemisféricos, síndromes de Sturge-Weber, Síndrome de Rasmussen, Síndrome de Landau-Kleffner y otras situaciones como tumores o alteraciones vasculares. Se recomienda la formación de centros de referencia que cuenten con métodos de evaluación funcional y de neuroimagen, así como equipo multidisciplinario formado por neurólogos, neurocirujanos, neurofisiólogos, neuropediatras, neuropsicólogos, patólogos, neurorradiólogos y técnicos en electroneurofisiología que mantengan los estándares impuestos de forma estricta. La formación de estos centros en países en desarrollo parece viable, con la cooperación de las regiones con mayores recursos. Numerosos estudios han demostrado una mejoría de la calidad de vida con reducción en la frecuencia de crisis diarias. En el HCPA se desarrolla un estudio de seguimiento ambulatorio de casos de epilepsias refractarias todavía en investigación y tratamiento clínico. La cirugía de la epilepsia es potencialmente curativa y es posible utilizarla en la población infantil.With the goal of presenting follow-up data from patients seen at the Refractory Epilepsy out-patient clinic of the Hospital de Clínicas de Porto Alegre (HCPA, Brazil, we reviewed the literature on childhood and adolescent epilepsy and epileptic syndromes with indication for surgical treatment. The International League

  11. Surgical correction of Peyronie's disease via tunica albuginea plication or partial plaque excision with pericardial graft: long-term follow up.

    Science.gov (United States)

    Taylor, Frederick L; Levine, Laurence A

    2008-09-01

    Limited publications exist regarding long-term outcomes of surgical correction for Peyronie's Disease (PD). To report on long-term postoperative parameters including rigidity, curvature, length, sensation, function, and patient satisfaction in men with PD treated surgically via Tunica Albuginea Plication (TAP) or Partial Plaque Excision with Tutoplast Human Pericardial Grafting (PEG). Objective and subjective data regarding patients who underwent either TAP or PEG. We report on 142 patients (61 TAP and 81 PEG) with both objective data and subjective patient reports on their postoperative experience. Patients underwent either TAP or PEG following our previously published algorithm. Data was collected via chart review and an internally generated survey, in which patients were asked about their rigidity, straightness, penile length, sensation, sexual function and satisfaction. Average follow up for TAP patients was 72 months (range 8-147) and 58 months (range 6-185) for PEG patients. At survey time, 93% of TAP and 91% of PEG patients reported curvatures of less than 30o. Rigidity was reportedly as good as or better than preoperative in 81% of TAP and 68% of PEG patients, and was adequate for coitus in 90% of TAP and 79% of PEG patients with or without the use of PDE5i. Objective flaccid stretched penile length measurements obtained pre and postoperatively show an average overall length gain of 0.6 cm (range -3.5-3.5) for TAP and 0.2 cm (range -1.5-2.0) for PEG patients. Sensation was reportedly as good as or better than preoperative in 69% of both TAP and PEG patients; 98% of TAP patients and 90% of PEG are able to achieve orgasm. 82% of TAP patients and 75% of PEG patients were either very satisfied or satisfied. Our long-term results support both TAP and PEG as durable surgical therapy for men with clinically significant PD.

  12. Concomitant surgical correction of severe stress urinary incontinence and anterior vaginal wall prolapse by anterior vaginal wall wrap: 18 months outcomes

    Science.gov (United States)

    Zargham, Mahtab; Alizadeh, Farshid; Tadayyon, Farhad; Khorrami, Mohammad-Hatef; Nouri-Mahdavi, Kia; Gharaati, Mohammad Reza; Izadpanahi, Mohammad Hossein; Yazdani, Mohammad; Mazdak, Hamid

    2013-01-01

    Background: The aim of this study is to evaluate the outcome of an innovative, minimally invasive sling technique with autologous tissue in women with concomitant incontinence and anterior vaginal wall prolapse (AVWP). Materials and Methods: Fifty-six women with stress urinary incontinence (SUI) or mixed urinary incontinence and AVWP were randomly assigned into two groups: In Group A (26 patients), anterior colporrhaphy (Kelly placation) and sling placement using a strip of anterior vaginal wall were performed, and in Group B (30 patients), transvaginal mesh correction of AVWP and tension-free vaginal tape (TVT) insertion (retropubic – craniocaudal route) using polypropylene mesh were carried out. The patients were followed-up for over 18 months and were assessed objectively using a 48 h frequency-volume chart, a 48 h pad test and a standardized stress test. Related surgical complications and outcomes were recorded and compared. Results: Surgical cure rates for Group A and Group B at the first (3 days) and last (18 months) post-operative visits were 62% and 84%; and 54%, and 72%, respectively (P = 0.09 and 0.31). Complications occurred in 9 patients (44%) of Group B, but only 3 patients (12%) in Group A. Conclusion: Vaginal sling surgery using an anterior vaginal wall strip can improve SUI and in comparison with propylene mesh is associated with lower complication rates. Although, the surgical success rate of this technique is lower than T-Sling, larger studies with selected patients will help assess the suitable patients for this pelvic reconstructive surgery. PMID:24516492

  13. Concomitant surgical correction of severe stress urinary incontinence and anterior vaginal wall prolapse by anterior vaginal wall wrap: 18 months outcomes

    Directory of Open Access Journals (Sweden)

    Mahtab Zargham

    2013-01-01

    Full Text Available Background: The aim of this study is to evaluate the outcome of an innovative, minimally invasive sling technique with autologous tissue in women with concomitant incontinence and anterior vaginal wall prolapse (AVWP. Materials and Methods : Fifty-six women with stress urinary incontinence (SUI or mixed urinary incontinence and AVWP were randomly assigned into two groups: In Group A (26 patients, anterior colporrhaphy (Kelly placation and sling placement using a strip of anterior vaginal wall were performed, and in Group B (30 patients, transvaginal mesh correction of AVWP and tension-free vaginal tape (TVT insertion (retropubic - craniocaudal route using polypropylene mesh were carried out. The patients were followed-up for over 18 months and were assessed objectively using a 48 h frequency-volume chart, a 48 h pad test and a standardized stress test. Related surgical complications and outcomes were recorded and compared. Results: Surgical cure rates for Group A and Group B at the first (3 days and last (18 months post-operative visits were 62% and 84%; and 54%, and 72%, respectively (P = 0.09 and 0.31. Complications occurred in 9 patients (44% of Group B, but only 3 patients (12% in Group A. Conclusion: Vaginal sling surgery using an anterior vaginal wall strip can improve SUI and in comparison with propylene mesh is associated with lower complication rates. Although, the surgical success rate of this technique is lower than T-Sling, larger studies with selected patients will help assess the suitable patients for this pelvic reconstructive surgery.

  14. CLINICAL AND FUNCTIONAL ASSESSMENT OF THE BIOLOGICAL PROSTHESIS “ASPIRE” FOR SURGICAL CORRECTION OF MITRAL VALVE DISEASE

    Directory of Open Access Journals (Sweden)

    S. G. Esin

    2015-01-01

    Full Text Available Aim: To assess clinical and functional efficacy of implanted biological prosthesis “ASPIRE” (manufactured by Vascutek for correction of mitral valve disease.Materials and methods: From October 2008 to December 2013, biological prostheses “ASPIRE” (Vascutek were implanted to 34 patients with mitral valve disease (mean age 63.59 ± 4.96 years, 79.4% female. From these, 24 patients had mitral stenosis and 10 patients had mitral insufficiency. 73.5% of all patients had heart failure Strazhesko-Vasilenko IIA grade and 85.3% of patients had chronic heart failure NYHA III. Isolated mitral valve replacement was performed only in 8 (23.5% of patients. In 22 (64.7% of cases mitral valve replacement was combined with tricuspid valvuloplasty in various modifications. Duration of cardiopulmonary bypass and of aortic clamping was 88.09 ± 25.95 and 65.68 ± 25.51 minutes, respectively. Before and after surgery all patients underwent echocardiographic assessment and clinical assessment of their general status.Results: In-hospital mortality was 5.88% (n = 2 and was related to multiorgan failure in the early postoperative period. All 32 (94.12% surviving patients improved with decrease or complete disappearance of heart failure. Postoperative complications were typical for cardiac surgery. There were no episodes of embolism, structural dysfunction, thrombosis of the prosthesis and endocarditis of the prosthesis in the early postoperative period. Pressure gradients across prosthetic valves were not high and corresponded to good clinical and hemodynamic results in the early postoperative period.Conclusion: Taking into account good immediate results of mitral valve replacement, as well as no need in lifelong anticoagulation in patients with multiple concomitant disorders, implantation of the biological prosthesis “ASPIRE” (Vascutek could become a procedure of choice for correction of valve abnormalities in patients above 65 years. For more comprehensive

  15. Resolution of persistent pneumothorax by use of blood pleurodesis in a dog after surgical correction of a diaphragmatic hernia.

    Science.gov (United States)

    Merbl, Yael; Kelmer, Efrat; Shipov, Anna; Golani, Yael; Segev, Gilad; Yudelevitch, Sigal; Klainbart, Sigal

    2010-08-01

    A 15-kg (33-lb) pregnant female mixed-breed dog of unknown age was referred because of a 10-day history of difficulty breathing. Physical examination findings were dyspnea, tachypnea, decreased bronchovesicular sounds (bilateral), muffled heart sounds, and abdominal distention with palpable fetuses. Hematologic abnormalities included anemia, leukocytosis, and thrombocytosis. Abnormalities detected during serum biochemical analysis included decreases in concentrations of albumin, sodium, triglycerides, and total calcium and increases in activities of alkaline phosphatase, alanine aminotransferase, gamma-glutamyltransferase, aspartate aminotransferase, lactate dehydrogenase, and creatine kinase. Thoracic radiography revealed a diaphragmatic hernia with fetuses and a soft tissue or fluid opacity within the thoracic cavity. Exploratory celiotomy, ovariohysterectomy, partial sternotomy, placement of a right-sided thoracostomy tube, and herniorrhaphy were performed. After surgery, pneumothorax developed, and the thoracostomy tube was used to remove pleural effusion and free air. The pneumothorax did not resolve after continuous drainage of the thoracic cavity for 4 days. Autologous blood pleurodesis was performed by infusion of 80 mL (6 mL/kg [2.73 mL/lb]) of whole blood. The pneumothorax resolved immediately after injection of the blood. Blood pleurodesis was used for resolution of pneumothorax in a dog after correction of a diaphragmatic hernia. Blood pleurodesis may provide a simple, safe, and inexpensive medical treatment for resolution of persistent (duration>5 days) pneumothorax when surgery is not an option.

  16. Results of the surgical correction of urinary stress incontinence according to the type of transobturator tape utilized

    Directory of Open Access Journals (Sweden)

    Bárbara Padilla-Fernández

    2013-09-01

    Full Text Available Objectives: To analyze the short and long term results of tapes of different materials used to treat stress urinary incontinence (SUI. A secondary objective was to evaluate the ability to adjust the tape after implantation. Materials and methods: Retrospective chart review of 355 patients with SUI operated between March 2003 and October 2011. Eight different types of transobturator tapes were used: Gynecare TVT-O®, Monarc®, SAFYRE®, Contasure KIM®, I-Stop®, DynaMesh®, Aris® Bandellete and Swing-band®. Results and complications were recorded. Results: The mean age at operation was 61 years. Correction of SUI was achieved in 87.88% of cases. The best results were obtained with Contasure KIM® (98.26 % continence. The tape was well tolerated and was elastic enough to be able to be adjusted 48-72 hours after implantation without deformation. Slings with macropores and over lock stiches on the superior and inferior borders presented the lower rates of postoperative urinary retention, pain, perior postoperative bleeding and urinary tract infections. Conclusions: Transobturator tension free tapes require a short operation time and have a low complication rate. The possibility of adjustment in the early postoperative period increases the success rate and reduces complications. Knotless meshes with macropores and over lock stiches appear to be better balanced, are quite resistant to stretching and deformation when readjusted after implantation and present a low infection rate.

  17. Size of pneumothorax can be a new indication for surgical treatment in primary spontaneous pneumothorax: a prospective study.

    Science.gov (United States)

    Sayar, Adnan; Kök, Abdulaziz; Citak, Necati; Metin, Muzaffer; Büyükkale, Songül; Gürses, Atilla

    2014-01-01

    Surgical treatment of primary spontaneous pneumothorax (PSP) is usually performed in cases of prolonged air leak (PAL) or recurrence. We investigated the effect of the size of pneumothorax in surgically treated PSP cases. Between 2007 and 2008, 181 patients hospitalized with the diagnosis of PSP were prospectively recorded. The size of pneumothorax was calculated in percentages by the method defined by Kircher and Swartzel. Patients were divided into two groups, according to pneumothorax size: Group A (large pneumothorax, ≥50%), and Group B (small or moderate pneumothorax, <50%). The mean size of pneumothorax was 80.5 ± 10.4% in Group A (n = 54, 29%) and 39.5 ± 6.5% in Group B (n = 127, 71%). History of smoking and smoking index were significantly higher in Group A patients (p = 0.02, p <0.001, respectively). Fifty-five patients (29.3%) required surgery because of PAL or ipsilateral recurrence. The rate of patients requiring surgical operation was significantly higher in Group A (51.9%) than in Group B (n = 25; p <0.001). Rates of PAL and recurrence were higher in Group A than in Group B (p = 0.007, p = 0.004, respectively). The size of pneumothorax is larger in those with a smoking history and a higher smoking index. Surgical therapy can be considered in cases with a pneumothorax size ≥50% after the first episode immediately.

  18. Vaginal vault suspension during hysterectomy for benign indications: a prospective register study of agreement on terminology and surgical procedure.

    Science.gov (United States)

    Bonde, Lisbeth; Noer, Mette Calundann; Møller, Lars Alling; Ottesen, Bent; Gimbel, Helga

    2017-07-01

    Several suspension methods are used to try to prevent pelvic organ prolapse (POP) after hysterectomy. We aimed to evaluate agreement on terminology and surgical procedure of these methods. We randomly chose 532 medical records of women with a history of hysterectomy from the Danish Hysterectomy and Hysteroscopy Database (DHHD). Additionally, we video-recorded 36 randomly chosen hysterectomies. The hysterectomies were registered in the DHHD. The material was categorized according to predefined suspension methods. Agreement compared suspension codes in DHHD (gynecologists' registrations) with medical records (gynecologists' descriptions) and with videos (reviewers' categorizations) respectively. Whether the vaginal vault was suspended (pooled suspension) or not (no suspension method + not described) was analyzed, in addition to each suspension method. Regarding medical records, agreement on terminology was good among patients undergoing pooled suspension in cases of hysterectomy via the abdominal and vaginal route (agreement 78.7, 92.3%). Regarding videos, agreement on surgical procedure was good among pooled suspension patients in cases of hysterectomy via the abdominal, laparoscopic, and vaginal routes (agreement 88.9, 97.8, 100%). Agreement on individual suspension methods differed regarding both medical records (agreement 0-90.1%) and videos (agreement 0-100%). Agreement on terminology and surgical procedure regarding suspension method was good in respect of pooled suspension. However, disagreement was observed when individual suspension methods and operative details were scrutinized. Better consensus of terminology and surgical procedure is warranted to enable further research aimed at preventing POP among women undergoing hysterectomy.

  19. Effects of dexamethasone-21-isonicotinate on peripheral insulin action in dairy cows 5 days after surgical correction of abomasal displacement.

    Science.gov (United States)

    Kusenda, M; Kaske, M; Piechotta, M; Locher, L; Starke, A; Huber, K; Rehage, J

    2013-01-01

    Dexamethasone frequently is used for treatment of ketosis in dairy cows, but its effects are not fully understood. Dexamethasone treatment affects whole body insulin sensitivity. Twelve German Holstein cows, 2-4 weeks postpartum, 5 days after omentopexy to correct left abomasal displacement. Randomized, blinded, case-control study. Treatment with dexamethasone-21-isonicotinate (DG; 40 μg/kg IM; n = 6) or saline (control group [CG], 15 mL IM, n = 6) on day 0 (d0). Blood samples were obtained before (d0) and after treatment (d1 and d2), and analyzed for glucose, insulin, and nonesterified fatty acid (NEFA) concentrations. Hepatic triglycerides (TAG) were measured in liver samples taken on d0 and d2. Five consecutive hyperinsulinemic-euglycemic clamps (HEC-I-V; insulin dosages: 0.1, 0.5, 2, 5, 10 mU/kg/min, respectively) were performed on d1 and steady state glucose infusion rate (SSGIR), insulin concentration (SSIC), insulin sensitivity index (ISI = SSGIR/SSIC), and plasma NEFA concentration (SSNEFA) were assessed. Compared with CG-cows, DG-cows on d1 had higher plasma glucose (P = .004) and insulin (P insulin-stimulated decrease in SSNEFA (HEC-II, P = .006; HEC-III, P = .01; HEC-IV, P = .003; HEC-V, P = .011). Decrease in hepatic TAG content in DG-cows was higher compared with CG-cows (P insulin sensitivity and affects glucose and lipid metabolism in early lactating dairy cows. Copyright © 2012 by the American College of Veterinary Internal Medicine.

  20. Uso da rede neural artificial no planejamento cirúrgico da correção do estrabismo Neural network approach for planning surgical correction of strabismus

    Directory of Open Access Journals (Sweden)

    Murilo Barreto Souza

    2004-06-01

    ínicas of the University of São Paulo. The neural network was designed containing 3 layers. Sixty-eight patients were used in the training and validation set, and 27 in the test set. RESULTS: In the 68 patients used in the training and validation set, 37 had exotropia, and 31 esotropia. The backpropagation approach was used for training the neural network. A learning rate of 0.6, and a tolerance error of 0.05 were used. In the 27 patients used in the test set, 18 had exotropia, and 9 had esotropia. The efficacy of the neural network was analyzed using the average of the difference between the indication supplied by the network and the original indication. In patients with exotropia, the average error was 0.4 mm (±0.4, for recession of the lateral rectus muscle, and 0.3 mm (±0.3, for the resection of the medial rectus muscle. In the esotropia group, the average error was 0.2 mm (±0.2 for the recession of the medial rectus muscle, and 0.5 mm (±0.3 for resection of the lateral rectus muscle. CONCLUSION: As the artificial neural network can simulate a biological central nervous system, and is able to carry out cognitive tasks, it can be a viable option to help the surgical planning for strabismus correction.

  1. Development of a questionnaire encompassing indicators of distress: a tool for use with women in surgical continuity of care for breast cancer.

    Science.gov (United States)

    Jørgensen, L; Garne, J P; Søgaard, M; Laursen, B S

    2015-04-01

    Women with breast cancer often experience significant distress. Currently, there are no questionnaires aimed at identifying women's unique and possible changing indicators for distress in surgical continuity of care for breast cancer. We developed and tested three questionnaires specifically for this use. We first searched PubMed, CINAHL and PsycINFO to retrieve information on previously described indicators. Next, we conducted a focus group interview with 6 specialised nurses, who have extensive experience about consequences of breast cancer for women in surgical continuity of care. The questionnaire was tested on 18 women scheduled for breast cancer surgery. Subsequently, the women were debriefed to gain knowledge about comprehensibility, readability and relevance of items, and the time needed to complete the questionnaire. After adjustment, the questionnaires were field-tested concomitantly with a clinical study, which both consisted of a survey and an interview study. Three multi-item questionnaires were developed specific to different time points in surgical continuity of care. The questionnaires share a core of statements divided into seven sub-scales: emotional and physical situation, social condition, sexuality, body image, religion and organisational factors. Besides the core of statements, each questionnaire has different statements depending on the time point of surgical continuity of care when it was to be responded to. The questionnaires contain comprehensive items that can identify indicators for distress in individual women taking part in surgical continuity of care. The items were understandable and the time used for filling in the questionnaires was reasonable. Copyright © 2014 Elsevier Ltd. All rights reserved.

  2. Deformidade de Sprengel: tratamento cirúrgico pela técnica de green modificada Sprengel's deformity: surgical correction by a modified green procedure

    Directory of Open Access Journals (Sweden)

    Sandro da Silva Reginaldo

    2009-06-01

    Full Text Available OBJETIVO: Demonstrar os resultados estéticos e funcionais de pacientes submetidos à correção cirúrgica de escápula alta congênita - deformidade de Sprengel - por uma modificação da técnica de Green, bem como avaliar o grau de satisfação dos pacientes e as complicações da técnica utilizada. MÉTODOS: Foram avaliados nove pacientes operados pela técnica de Green modificada, no período de setembro de 1993 a abril de 2008. Como modificação da técnica original foram realizados descolamento muscular subperiosteal, ressecção apenas da porção súpero-medial da escápula e, em vez da utilização de tração esquelética, optou-se pela fixação com fio de aço subcutâneo da porção medial da espinha da escápula à crista ilíaca posterior contralateral. A idade média dos pacientes foi de sete anos e três meses. O seguimento pós-operatório médio foi de três anos e sete meses. RESULTADOS: Houve incremento médio na elevação de cerca de 39º (variando de 0º a 80º . Segundo a classificação de Cavendish, obteve-se a melhora estética de dois graus em oito casos e de três graus em um. Todos os pacientes ficaram satisfeitos com o resultado. CONCLUSÕES: Os pacientes com deformidade de Sprengel submetidos a tratamento cirúrgico por meio de uma modificação da técnica de Green, com fixação da escápula na crista ilíaca posterior contralateral em vez de se utilizar tração esquelética, apresentaram melhora tanto funcional como estética; todos os pacientes e/ou familiares ficaram satisfeitos e as complicações relacionadas com a técnica cirúrgica não interferiram no resultado final.OBJECTIVE: To evaluate the cosmetic and functional results of patients submitted to surgical correction of Congenital High Scapula (Sprengel's Deformity using modified Green's Procedure, as well as patients' satisfaction and complications. METHODS: Nine patients submitted to surgical treatment from September 1993 to April 2008 have

  3. Detour technique, Dipping technique, or IIeal bladder flap technique for surgical correction of uretero-ileal anastomotic stricture in orthotopic ileal neobladder

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    Mohamed Wishahi

    2015-08-01

    Full Text Available ABSTRACTBackground:Uretero-ileal anastomotic stricture (UIAS is a urological complication after ileal neobladder, the initial management being endourological intervention. If this fails or stricture recurs, surgical intervention will be indicated.Design and Participants:From 1994 to 2013, 129 patients were treated for UIAS after unsuccessful endourological intervention. Unilateral UIAS was present in 101 patients, and bilateral in 28 patients; total procedures were 157. The previous ileal neobladder techniques were Hautmann neobladder, detubularized U shape, or spherical shape neobladder.Surgical procedures:Dipping technique was performed in 74 UIAS. Detour technique was done in 60 renal units. Ileal Bladder flap was indicated in 23 renal units. Each procedure ended with insertion of double J, abdominal drain, and indwelling catheter.Results:Follow-up was done for 12 to 36 months. Patency of the anastomosis was found in 91.7 % of cases. Thirteen patients (8.3% underwent antegrade dilatation and insertion of double J.Conclusion:After endourological treatment for uretero-ileal anastomotic failure, basically three techniques may be indicated: dipping technique, detour technique, and ileal bladder flap. The indications are dependent on the length of the stenotic/dilated ureteral segment. Better results for long length of stenotic ureter are obtained with detour technique; for short length stenotic ureter dipping technique; when the stenotic segment is 5 cm or more with a short ureter, the ileal tube flap is indicated. The use of double J stent is mandatory in the majority of cases. Early intervention is the rule for protecting renal units from progressive loss of function.

  4. Total pancreatectomy and islet autotransplantation in children for chronic pancreatitis: indication, surgical techniques, postoperative management, and long-term outcomes.

    Science.gov (United States)

    Chinnakotla, Srinath; Bellin, Melena D; Schwarzenberg, Sarah J; Radosevich, David M; Cook, Marie; Dunn, Ty B; Beilman, Gregory J; Freeman, Martin L; Balamurugan, A N; Wilhelm, Josh; Bland, Barbara; Jimenez-Vega, Jose M; Hering, Bernhard J; Vickers, Selwyn M; Pruett, Timothy L; Sutherland, David E R

    2014-07-01

    Describe the surgical technique, complications, and long-term outcomes of total pancreatectomy and islet autotransplantation (TP-IAT) in a large series of pediatric patients. Surgical management of childhood pancreatitis is not clear; partial resection or drainage procedures often provide transient pain relief, but long-term recurrence is common due to the diffuse involvement of the pancreas. Total pancreatectomy (TP) removes the source of the pain, whereas islet autotransplantation (IAT) potentially can prevent or minimize TP-related diabetes. Retrospective review of 75 children undergoing TP-IAT for chronic pancreatitis who had failed medical, endoscopic, or surgical treatment between 1989 and 2012. Pancreatitis pain and the severity of pain statistically improved in 90% of patients after TP-IAT (P Puestow procedure (P = 0.018), lower body surface area (P = 0.048), higher islet equivalents (IEQ) per kilogram body weight (P = 0.001), and total IEQ (100,000) (P = 0.004) were associated with insulin independence. By multivariate analysis, 3 factors were associated with insulin independence after TP-IAT: (1) male sex, (2) lower body surface area, and (3) higher total IEQ per kilogram body weight. Total IEQ (100,000) was the single factor most strongly associated with insulin independence (odds ratio = 2.62; P < 0.001). Total pancreatectomy and islet autotransplantation provides sustained pain relief and improved quality of life. The β-cell function is dependent on islet yield. Total pancreatectomy and islet autotransplantation is an effective therapy for children with painful pancreatitis that failed medical and/or endoscopic management.

  5. Detecting adverse events in surgery: comparing events detected by the Veterans Health Administration Surgical Quality Improvement Program and the Patient Safety Indicators.

    Science.gov (United States)

    Mull, Hillary J; Borzecki, Ann M; Loveland, Susan; Hickson, Kathleen; Chen, Qi; MacDonald, Sally; Shin, Marlena H; Cevasco, Marisa; Itani, Kamal M F; Rosen, Amy K

    2014-04-01

    The Patient Safety Indicators (PSIs) use administrative data to screen for select adverse events (AEs). In this study, VA Surgical Quality Improvement Program (VASQIP) chart review data were used as the gold standard to measure the criterion validity of 5 surgical PSIs. Independent chart review was also used to determine reasons for PSI errors. The sensitivity, specificity, and positive predictive value of PSI software version 4.1a were calculated among Veterans Health Administration hospitalizations (2003-2007) reviewed by VASQIP (n = 268,771). Nurses re-reviewed a sample of hospitalizations for which PSI and VASQIP AE detection disagreed. Sensitivities ranged from 31% to 68%, specificities from 99.1% to 99.8%, and positive predictive values from 31% to 72%. Reviewers found that coding errors accounted for some PSI-VASQIP disagreement; some disagreement was also the result of differences in AE definitions. These results suggest that the PSIs have moderate criterion validity; however, some surgical PSIs detect different AEs than VASQIP. Future research should explore using both methods to evaluate surgical quality. Published by Elsevier Inc.

  6. Changes in individual indicators of protein metabolism in experimental pnevmonia in a imobilizatsiynoho stress and correction corvitin

    Directory of Open Access Journals (Sweden)

    Nataliya M. Ferents

    2015-02-01

    Lviv National Medical University Daniel Galician               Реферат             Изучение сдвигов отдельных показателей белкового обмена, в частности белка, альбуминов, глобулиновых фракций при экспериментальной пневмонии в условиях иммобилизацийного стресса, и их коррекция с помощью корвитина, даёт основание утверждать, что этот антиоксидант оказывает положительное влияние, которое особенно хорошо видно по повышением содержания в плазме крови альбуминов и снижение уровня глобулинов в условиях его применения. Ключевые слова: белковый обмен, пневмония, иммобилизационный стресс, Корвитин.                 Abstract             Study of changes of selected indicators of protein metabolism, including protein, albumin, globulin fractions in experimental pneumonia in aimobilizatsiynoho stress, and their correction using Corvitin gives reason to believe that this antioxidant reveals positive effect, which is particularly well illustrated by the increasing of plasma blood albumin and globulin by reducing conditions of use. Keywords: protein metabolism, pneumonia, immobilization stress, Corvitin.

  7. Establishing Key Performance Indicators [KPIs] and Their Importance for the Surgical Management of Inflammatory Bowel Disease-Results From a Pan-European, Delphi Consensus Study.

    Science.gov (United States)

    Morar, Pritesh S; Hollingshead, James; Bemelman, Willem; Sevdalis, Nick; Pinkney, Thomas; Wilson, Graeme; Dunlop, Malcolm; Davies, R Justin; Guy, Richard; Fearnhead, Nicola; Brown, Steven; Warusavitarne, Janindra; Edwards, Cathryn; Faiz, Omar

    2017-10-27

    Key performance indicators [KPIs] exist across a range of areas in medicine. They help to monitor outcomes, reduce variation, and drive up standards across services. KPIs exist for inflammatory bowel disease [IBD] care, but none specifically cover inflammatory bowel disease [IBD] surgical service provision. This was a consensus-based study using a panel of expert IBD clinicians from across Europe. Items were developed and fed through a Delphi process to achieve consensus. Items were ranked on a Likert scale from 1 [not important] to 5 [very important]. Consensus was defined when the inter quartile range was ≤ 1, and items with a median score > 3 were considered for inclusion. A panel of 21 experts [14 surgeons and 7 gastroenterologists] was recruited. Consensus was achieved on procedure-specific KPIs for ileocaecal and perianal surgery for Crohn's disease, [N = 10] with themes relating to morbidity [N = 7], multidisciplinary input [N = 2], and quality of life [N = 1]; and for subtotal colectomy, proctocolectomy and ileoanal pouch surgery for ulcerative colitis [N = 11], with themes relating to mortality [N = 2], morbidity [N = 8], and service provision [N = 1]. Consensus was also achieved for measures of the quality of IBD surgical service provision and quality assurance in IBD surgery. This study has provided measurable KPIs for the provision of surgical services in IBD. These indicators cover IBD surgery in general, the governance and structures of the surgical services, and separate indicators for specific subareas of surgery. Monitoring of IBD services with these KPIs may reduce variation across services and improve quality. Copyright © 2017 European Crohn’s and Colitis Organisation (ECCO). Published by Oxford University Press. All rights reserved. For permissions, please email: journals.permissions@oup.com

  8. Surgical orthodontics.

    Science.gov (United States)

    Strohl, Alexis M; Vitkus, Lauren

    2017-08-01

    The article reviews some commonly used orthodontic treatments as well as new strategies to assist in the correction of malocclusion. Many techniques are used in conjunction with surgical intervention and are a necessary compliment to orthognathic surgery. Basic knowledge of these practices will aid in the surgeon's ability to adequately treat the patient. Many orthodontists and surgeons are eliminating presurgical orthodontics to adopt a strategy of 'surgery first' orthodontics in orthognathic surgery. This has the benefit of immediate improvement in facial aesthetics and shorter treatment times. The advent of virtual surgical planning has helped facilitate the development of this new paradigm by making surgical planning faster and easier. Furthermore, using intraoperative surgical navigation is improving overall precision and outcomes. A variety of surgical and nonsurgical treatments may be employed in the treatment of malocclusion. It is important to be familiar with all options available and tailor the patient's treatment plan accordingly. Surgery-first orthodontics, intraoperative surgical navigation, virtual surgical planning, and 3D printing are evolving new techniques that are producing shorter treatment times and subsequently improving patient satisfaction without sacrificing long-term stability.

  9. Single center outcomes after reconstructive surgical correction of adult acquired buried penis: measurements of erectile function, depression, and quality of life.

    Science.gov (United States)

    Rybak, James; Larsen, Stephen; Yu, Michelle; Levine, Laurence A

    2014-04-01

    Management of adult acquired buried penis is a troublesome situation for both patient and surgeon. The buried penis has been associated with significant erectile and voiding dysfunction, depression, and overall poor quality of life (QOL). To identify outcomes following reconstructive surgery with release of buried penis, escutcheonectomy, and circumcision with or without skin grafting. We retrospectively identified 11 patients treated by a single surgeon between 2007 and 2011, patient ages were 44-69; complete data review was available on all 11. Validated European Organisation for Research and Treatment of Cancer 15 QOL, Center for Epidemiologic Studies Depression Scale (CES-D), and International Index of Erectile Function (IIEF) surveys assessed patient QOL, depression, and erectile function pre- and postoperatively. Mean body mass index (BMI) was 48.8 (42.4-64.6). Mean operative time was 191 minutes (139-272). Mean length of stay was 2.1 days. Ten of 11 patients required phallic skin grafting. There was one perioperative complication resulting in respiratory failure and overnight stay in the intensive care unit. Wound complications were seen in 2/11 patients, and 1 needed surgical debridement for superficial wound infection. Skin graft take was seen in 100% of the patients. Ninety-one percent of patients noted significant improvement in voiding postoperatively. Ninety-one percent of patients reported significant erectile dysfunction preoperatively. Subsequently, IIEF scores improved post surgery by an average of 7.7 points. Clinical depression was noted to be present in 7/11 patients preoperatively and 2/11 postoperatively based on CES-D surveys. QOL improved significantly in 10/11 compared with preoperative baseline; however, many patients noted significant difficulties based on their weight and other comorbidities. Management of adult acquired buried penis is a challenging, yet correctable problem. In our series it appears that by using established surgical

  10. Indicaciones médicas y quirúrgicas de los potenciales evocados Medical and surgical indications of evoked potentials

    Directory of Open Access Journals (Sweden)

    Oscar Papazian

    2007-01-01

    Full Text Available Los potenciales evocados (PE son procedimientos neurofisiológicos más sensibles que específicos, objetivos, fidedignos, reproducibles y seguros que se emplean para evaluar la integridad de las vías sensoriales y motoras periféricas y centrales. La integridad de estas vías se determina midiendo la latencia de los eventos eléctricos producidos por estímulos adecuados y registrados después de ser promediados digitalmente. Las indicaciones médicas y quirúrgicas incluyen condiciones en las cuales el diagnóstico, la determinación del riesgo de secuelas neurológicas en pacientes comatosos y anestesiados y la determinación del curso de la enfermedad y respuesta al tratamiento no se pueden definir con el examen neurológico y otras pruebas neurodiagnósticas.Evoked potentials (EP are more sensitive than specific, safe, objective and reproducible neurophysiologic techniques to assess integrity of peripheral and central sensory and motor pathways. The integrity of pathways are determined by measurement the latency of the recorded and digitally averaged electrical events elicited after adequate stimulation. EP are medically and surgically recommended in conditions in which the diagnoses, determination of neurological outcome in comatose and under anesthesia patients, and determination of the course and evaluation of treatment are uncertain with neurologic examination and other neurodiagnostic studies.

  11. Geometrical modified nesbit corporoplasty to correct different types of penile curvature: description of the surgical procedure based on geometrical principles and long-term results.

    Science.gov (United States)

    Vicini, P; Di Nicola, S; Antonini, G; De Berardinis, E; Gentile, V; De Marco, F

    2016-11-01

    We present the use of a modified corporoplasty, based on geometrical principles, to determine the exact site for the incision in the tunica or plaque and the exact amount of albuginea for overlaying to correct with extreme precision the different types of congenital or acquired penile curvature due to Peyronie's disease. To describe our experience with a new surgical procedure for the enhancement of penile curvature avoiding any overcorrection or undercorrection. Between March 2004 and April 2013, a total of 74 patients underwent the geometrical modified corporoplasty. All patients had congenital curvature until 90° or acquired stable penile curvature 'less' than 60°, that made sexual intercourse very difficult or impossible, normal erectile function, absence of hourglass or hinge effect. Preoperative testing included a physical examination, 3 photographs (frontal, dorsal and lateral) of penis during erection, a 10 mcg PGE1-induced erection and Doppler ultrasound, administration of the International Index of Erectile Function (IIEF-15) questionnaire. A follow-up with postoperative evaluation at 12 weeks, 12 and 24 months, included the same preoperative testing. Satisfaction rates were better assessed with the use of validated questionnaire such as the International Erectile Dysfunction Inventory of the Treatment Satisfaction (EDITS). Statistical analysis with Student's t-test was performed using commercially available, personal computer software. A total of 25 patients had congenital penile curvature with a mean deviation of 46.8° (range 40-90), another 49 patients had Peyronie's disease with a mean deviation of 58.4 (range 45-60). No major complications were reported. Postoperative correction of the curvature was achieved in all patients (100%). Neither undercorrection nor overcorrection were recorded. No significant relapse (curvature>15°) occurred in our patients. Shortening of the penis was reported by 74% but did not influence the high overall

  12. Impact of surgical correction of tetralogy of fallot on short-term right and left ventricular function as determined by 2-dimensional speckle tracking echocardiography

    Science.gov (United States)

    Li, Yuman; Wang, Xinfang; Lv, Qing; Wang, Jing; Yang, YaLi; He, Lin; Yuan, Li; Zhang, Li; Xie, Mingxing

    2016-01-01

    Abstract Right ventricular (RV) and left ventricular (LV) dysfunction is an important determinant of poor clinical status in repaired patients with tetralogy of Fallot (TOF). The purpose of our study is to assess the impact of surgical repair on short-term RV and LV function by 2-dimensional speckle tracking echocardiography (STE). Sixty-seven patients (median age 12 months) with TOF before and 6 months after repair and 35 healthy subjects were studied. The patients were divided into the younger (age at surgery ≤12 months) and older (age at surgery >12 months) subgroups. RV and LV global longitudinal systolic strain and strain rate (SR), and LV global circumferential and radial systolic strain and SR were measured by STE. After repair, RV longitudinal strain and SR increased in the younger patients, whereas RV longitudinal SR was decreased in the older patients. LV deformation parameters were unchanged in all patients. In the multivariate analysis, patients with better RV and LV deformation parameters preoperatively were identified to have better RV and LV strain and SR postoperatively (P < 0.05 for all). The surgical approach of the pulmonary valve ring was predictive of RV and LV systolic function postoperatively (P < 0.05 for all). After TOF repair, short-term RV function improvement is identified in the younger but not in the older patients, whereas LV function is unchanged in all patients. The preoperative RV and LV deformational indices are the determinant of postoperative biventricular function improvement. STE appears to be a valuable tool for assessment of biventricular function after congenital heart disease surgery. PMID:27495064

  13. Conduction-corrected modified effective temperature as the indices of combined and separate effect of environmental factors on sensational temperature

    Energy Technology Data Exchange (ETDEWEB)

    Kurazumi, Yoshihito [School of Life Studies, Sugiyama Jogakuen University, 17-3 Hoshigaoka-motomachi, Chikusa-ku, Nagoya, Aichi 464-8662 (Japan); Tsuchikawa, Tadahiro [School of Human Science and Environment, University of Hyogo, 1-1-12 Hon-cho, Shinzaike, Himeji, Hyogo 670-0092 (Japan); Kondo, Emi [Graduate School Nagoya Institute of Technology, Gokiso-cyo, Showa-ku, Nagoya, Aichi 468555 (Japan); Horikoshi, Tetsumi [Department of Techno-Business Administration, Graduate School of Nagoya Institute of Technology, Gokiso-cho, Showa-ku, Nagoya, Aichi 468555 (Japan); Matsubara, Naoki [Division of Environmental Sciences, Graduate School of Kyoto Prefectural University, Nakaragi-cho, Shimogamo, Sakyo-ku, Kyoto 608522 (Japan)

    2010-04-15

    In living spaces, people sit or lie on the floor and adopt a posture in which much of the surface of the body is in contact with the floor. When the temperature of the spatial structure or the surface temperature of an object in contact with the human body is not equivalent to the air temperature, these effects are non-negligible. Most research examining the physiological and psychological responses of the human body has involved subjects sitting in chairs. Research that takes into account body heat balance and assessments of thermal conduction into the environment is uncommon. Thus, in this study, conduction-corrected modified effective temperature (ETF), which is a new thermal environmental index incorporating heat conduction, is defined in order to make possible the evaluation of thermal environments that take into account different postures. This sensational temperature index converts the effects of the following parameters into a temperature equivalent: air velocity, thermal radiation, contact material surface temperature and humidity. This index has the features of a summation formula. Through the use of these parameters, it is possible to represent and quantify their composite influence on bodily sensation and the effects of discrete meteorological elements through an evaluation on an identical axis. (author)

  14. Improvement in remote sensing of low vegetation cover in arid regions by correcting vegetation indices for soil ''noise''

    International Nuclear Information System (INIS)

    Escadafal, R.; Huete, A.

    1991-01-01

    The variations of near-infrared red reflectance ratios of ten aridic soil samples were correlated with a ''redness index'' computed from red and green spectral bands. These variations have been shown to limit the performances of vegetation indices (NDVI and SAVI) in discriminating low vegetation covers. The redness index is used to adjust for this ''soil noise''. Dala simulated for vegetation densities of 5 to 15% cover showed that the sensitivity of the corrected vegetation indices was significantly improved. Specifically, the ''noise-corrected'' SAVI was able to assess vegetation amounts with an error four times smaller than the uncorrected NDVI. These promising results should lead to a significant improvement in assessing biomass in arid lands from remotely sensed data. (author) [fr

  15. Preoperative evaluation of the depth of anal canal invasion in very low rectal cancer by magnetic resonance imaging and surgical indications for intersphincteric resection

    International Nuclear Information System (INIS)

    Bamba, Yoshiko; Itabashi, Michio; Kameoka, Shingo

    2012-01-01

    The present study was performed to evaluate the depth of anal canal invasion (DACI), and determine whether magnetic resonance imaging (MRI) assessment of the conjoined longitudinal muscle (CLM) can be used to identify the surgical indication for intersphincteric resection. Sixty-six patients with T1 (n=2), T2 (n=20), T3 (n=39), and T4 (n=5) lower rectal cancer were included. Depth of anal canal invasion was defined as extension of the tumor to the anal canal. The outline of the CLM on MRI was assessed as clear, unclear, or absent (indicating invasion). A comparison of overall T-stage and DACI of 22 pT1-pT2 tumors revealed that none had a higher T-stage within the anal canal, and 16 of 39 pT3 tumors had only pT0-pT2 invasion within the anal canal. The CLM was clear in 30 cases of T0-T2 DACI, unclear in 5 cases of T0-T2 DACI, and 3 cases of T3-T4 DACI, and showed invasion in 3 cases of T2 DACI and 25 cases of T3-T4 DACI. The sensitivity, specificity, positive predictive value, and negative predictive value of using a clear CLM outline for determining T0-T2 DACI was 78.9, 91.9, 100, and 77.8%, respectively. Preoperative evaluation of DACI was compatible with the surgical indications. A clear CLM accurately indicates T0-T2 DACI. (author)

  16. Scattering of light passing through a statistically rough interface between media with different refractive indices after laser correction of vision

    Energy Technology Data Exchange (ETDEWEB)

    Semchishen, A V; Seminogov, V N; Semchishen, V A [Institute of Laser and Information Technologies, Russian Academy of Sciences, Troitsk, Moscow Region (Russian Federation)

    2012-04-30

    Forward scattering of light passing through large-scale irregularities of the interface between two media having different refractive indices is considered. An analytical expression for the ratio of intensities of directional and diffusion components of scattered light in the far-field zone is derived. It is theoretically shown that the critical depth of possible interface relief irregularities, starting from which the intensity of the diffuse component in the passing light flow becomes comparable with the directional light component, responsible for the image formation on the eye retina, is 3 - 4 {mu}m, with the increase in the refractive index in the postoperational zone taken into account. These profile depth values agree with the experimentally measured ones and may affect the contrast sensitivity of vision.

  17. Scattering of light passing through a statistically rough interface between media with different refractive indices after laser correction of vision

    International Nuclear Information System (INIS)

    Semchishen, A V; Seminogov, V N; Semchishen, V A

    2012-01-01

    Forward scattering of light passing through large-scale irregularities of the interface between two media having different refractive indices is considered. An analytical expression for the ratio of intensities of directional and diffusion components of scattered light in the far-field zone is derived. It is theoretically shown that the critical depth of possible interface relief irregularities, starting from which the intensity of the diffuse component in the passing light flow becomes comparable with the directional light component, responsible for the image formation on the eye retina, is 3 - 4 μm, with the increase in the refractive index in the postoperational zone taken into account. These profile depth values agree with the experimentally measured ones and may affect the contrast sensitivity of vision.

  18. Post operative infections of the spine: technique, indications and results of the surgical treatment - A retrospective study of 90 cases.

    Science.gov (United States)

    Lazennec, J Y; Laville, C; Konel, B; Roy-Camille, R; Saillant, G; Poloujadoff, M P

    1996-05-01

    Post operative infection in spine surgery is a well known complication. The authors studied a series of 90 patients in accordance with an homogenous strategy based on the excision of necrotic and infected tissues, associated with appropriate antibiotics.The results are analyzed according to the degree of infection (which is based on the type of germs and their associations), and type of patients, the delay in diagnosis and the anatomical extension of the infected lesions.Making a difference between superficial and deep infection is of no therapeutic value and may lead to wrong and inadequate treatment.One must separate the common infections (which are due to germs as staphylococcus aureus or others from the urinary or digestive tract), and severe infections (which are either due to a per operative massive and deep contamination, or associated with patient's poor general condition).This series is mainly about posterior approaches to the spine, with or without osteosynthesis. Technical problems for treatment depend on the site of infection, particularly at the thoracic kyphosis level, or at the lumbar level where the muscle necrosis can be extensive. At the cervical level, the infection of an anterior approach mandates a check on the respiratory and digestive tracts.Removing the osteosynthesis is not mandatory in post operative spinal infections, as it may induce severe mechanical destabilization. An anterior approach is not necessarily required in the case of a posterior infection, except with massive contamination of an anterior graft. In some cases, posterior lumbar interbody fusion can lead to the indication for anterior cage removal.Pseudarthrosis of an infected spine, initially treated to obtain fusion, is still the worst complication. In case of previous posterior infection, even a severe one, fusion can still be obtained through a secondary anterior or posterior approach for grafting, with or without osteosynthesis.In this series, there was no neurological

  19. Combined use of rapid-prototyping model and surgical guide in correction of mandibular asymmetry malformation patients with normal occlusal relationship.

    Science.gov (United States)

    Xu, Haisong; Zhang, Ce; Shim, Yoong Hoon; Li, Hongliang; Cao, Dejun

    2015-03-01

    The aim of this study is to discuss the application of rapid-prototyping model and surgical guide in the treatment of mandibular asymmetry malformation with normal occlusal relationship. Twenty-four mandibular asymmetry malformation patients with relatively normal occlusal relationship were included in this study. Surgical 3-dimensional rapid-prototyping mandibular models were made for all patients from the computed tomography (CT) DICOM data. The presurgical plan was designed on the model, and the surgical guiders for the osteotomy lines were manufactured. Genioplasty and/or mandibular osteotomy based on the presurgical plan were performed on these patients with the combined use of the rapid-prototyping model and surgical guides. All patients underwent postoperative CT scan and had at least 3-month follow-up. All patients were satisfied with the final results. According to the postoperative CT images and 3-month follow-up, all patients' mandibular asymmetry malformation was significantly improved, and the operation time was distinctly shortened relative to the conventional method. Rapid-prototyping model and surgical guide are viable auxiliary devices for the treatment of mandibular asymmetry malformation with relatively normal occlusal relationship. Combined use of them can make precise preoperative design, improve effects of operation, and shorten operating time.

  20. Correção cirúrgica da esotropia em portadores de fixação excêntrica Surgical correction of esotropia in eccentric fixation patients

    Directory of Open Access Journals (Sweden)

    Andréa Alejandra González Martinez

    2005-10-01

    Full Text Available OBJETIVO: Avaliar o resultado da correção cirúrgica da esotropia em pacientes com fixação excêntrica e compará-lo com o de pacientes esotrópicos operados que não possuíam essa alteração sensorial. MÉTODOS: Estudo retrospectivo do resultado da correção cirúrgica da esotropia essencial de 19 pacientes com fixação excêntrica do Serviço de Motilidade Ocular Extrínsica da Santa Casa de São Paulo. Como grupo-controle, foram estudados 17 pacientes esotrópicos com ambliopia estrábica e fixação central e 16 pacientes esotrópicos sem ambliopia. O teste estatístico utilizado foi aplicação de variância para proporções (ANOVA. RESULTADOS: Nos 3 grupos estudados prevaleceu a subcorreção, 12 (63,2% casos no grupo I, 13 (76,5% casos no grupo II e 13 (81,3% pacientes no grupo III. O sucesso cirúrgico (desvios ABSTRACT PURPOSE: To evaluate the result of the surgical correction of esotropic patients with eccentric fixation and to compare it with operated on esotropic patients who did not have this sensorial disorder. METHODS: A retrospective study of the result of the surgical correction of essential esotropia in 19 patients with eccentric fixation of the "Santa Casa de São Paulo". As group controls, 17 esotropic patients with strabismic amblyopia and central fixation and 16 esotropic patients without amblyopia who had been operated on. The statistical test was application of variance for proportions (ANOVA. RESULTS: In the 3 studied groups undercorrection prevailed, 12 (63,2% cases in group I, 13(76,5% cases in group II and 13 (81,3% patients in group III. The surgical success occurred in 7 (36,8% patients of the group with eccentric fixation, of whom 4 cases were overcorrected and 3 of orthotropia. In group II, of the 7 cases of surgical success, 3 (17,6% had orthotropia and 1 (5,9% case presented with overcorrection. In group III, we had 5 (31,3% cases of surgical success, 1 (6,3% of them with orthotropia. Among the 36

  1. Thermostable adenylate kinase technology: a new process indicator and its use as a validation tool for the reprocessing of surgical instruments.

    Science.gov (United States)

    Hesp, J R; Poolman, T M; Budge, C; Batten, L; Alexander, F; McLuckie, G; O'Brien, S; Wells, P; Raven, N D H; Sutton, J M

    2010-02-01

    Adenylate kinase (tAK), a thermostable enzyme, was assessed as a possible means of providing a quantitative measure of cleaning efficacy suitable for validating the performance of an automated washer disinfector (AWD) during routine use. Two indicator formulations were developed using either a commercially available washer disinfector soil or a protein-based soil. Each indicator consisted of 100 microg (in test soil) of tAK dried on to a steel or plastic surface. These indicators were placed in each basket of a washer disinfector and processed alongside soiled surgical instruments during a standard day's operation. After processing, remaining tAK activity was detected using a rapid enzyme assay (2 min detection time) in a handheld hygiene monitor. The amount of tAK remaining on each indictor after a full AWD cycle was found to range from 0.1 to 0.4 ng, which represented a mean log(10) removal of 5.8+/-0.3. There was no statistical difference in the residual tAK activity between individual runs or the position of the indicator in the machine. The tAK indicator was also used to analyse the protein removal within each component of the wash cycle. These results demonstrated that all phases of the wash process contributed to the removal of the protein load, with the main wash alone being responsible for 3.6-4.0 log(10) reductions in protein activity. We propose that a quantitative cleaning index using such rapid readout indicator devices would provide a valuable addition to the methodologies for validating cleaning processes.

  2. Micro-surgical endodontics.

    Science.gov (United States)

    Eliyas, S; Vere, J; Ali, Z; Harris, I

    2014-02-01

    Non-surgical endodontic retreatment is the treatment of choice for endodontically treated teeth with recurrent or residual disease in the majority of cases. In some cases, surgical endodontic treatment is indicated. Successful micro-surgical endodontic treatment depends on the accuracy of diagnosis, appropriate case selection, the quality of the surgical skills, and the application of the most appropriate haemostatic agents and biomaterials. This article describes the armamentarium and technical procedures involved in performing micro-surgical endodontics to a high standard.

  3. Surgical Navigation

    DEFF Research Database (Denmark)

    Azarmehr, Iman; Stokbro, Kasper; Bell, R. Bryan

    2017-01-01

    Purpose: This systematic review investigates the most common indications, treatments, and outcomes of surgical navigation (SN) published from 2010 to 2015. The evolution of SN and its application in oral and maxillofacial surgery have rapidly developed over recent years, and therapeutic indicatio...

  4. Development of a Unifying Target and Consensus Indicators for Global Surgical Systems Strengthening: Proposed by the Global Alliance for Surgery, Obstetric, Trauma, and Anaesthesia Care (The G4 Alliance).

    Science.gov (United States)

    Haider, Adil; Scott, John W; Gause, Colin D; Meheš, Mira; Hsiung, Grace; Prelvukaj, Albulena; Yanocha, Dana; Baumann, Lauren M; Ahmed, Faheem; Ahmed, Na'eem; Anderson, Sara; Angate, Herve; Arfaa, Lisa; Asbun, Horacio; Ashengo, Tigistu; Asuman, Kisembo; Ayala, Ruben; Bickler, Stephen; Billingsley, Saul; Bird, Peter; Botman, Matthijs; Butler, Marilyn; Buyske, Jo; Capozzi, Angelo; Casey, Kathleen; Clayton, Charles; Cobey, James; Cotton, Michael; Deckelbaum, Dan; Derbew, Miliard; deVries, Catherine; Dillner, Jeanne; Downham, Max; Draisin, Natalie; Echinard, David; Elneil, Sohier; ElSayed, Ahmed; Estelle, Abigail; Finley, Allen; Frenkel, Erica; Frykman, Philip K; Gheorghe, Florin; Gore-Booth, Julian; Henker, Richard; Henry, Jaymie; Henry, Orion; Hoemeke, Laura; Hoffman, David; Ibanga, Iko; Jackson, Eric V; Jani, Pankaj; Johnson, Walter; Jones, Andrew; Kassem, Zeina; Kisembo, Asuman; Kocan, Abbey; Krishnaswami, Sanjay; Lane, Robert; Latif, Asad; Levy, Barbara; Linos, Dimitrios; Linz, Peter; Listwa, Louis A; Magee, Declan; Makasa, Emmanuel; Marin, Michael L; Martin, Claude; McQueen, Kelly; Morgan, Jamie; Moser, Richard; Neighbor, Robert; Novick, William M; Ogendo, Stephen; Omigbodun, Akinyinka; Onajin-Obembe, Bisola; Parsan, Neil; Philip, Beverly K; Price, Raymond; Rasheed, Shahnawaz; Ratel, Marjorie; Reynolds, Cheri; Roser, Steven M; Rowles, Jackie; Samad, Lubna; Sampson, John; Sanghvi, Harshadkumar; Sellers, Marchelle L; Sigalet, David; Steffes, Bruce C; Stieber, Erin; Swaroop, Mamta; Tarpley, John; Varghese, Asha; Varughese, Julie; Wagner, Richard; Warf, Benjamin; Wetzig, Neil; Williamson, Susan; Wood, Joshua; Zeidan, Anne; Zirkle, Lewis; Allen, Brendan; Abdullah, Fizan

    2017-10-01

    After decades on the margins of primary health care, surgical and anaesthesia care is gaining increasing priority within the global development arena. The 2015 publications of the Disease Control Priorities third edition on Essential Surgery and the Lancet Commission on Global Surgery created a compelling evidenced-based argument for the fundamental role of surgery and anaesthesia within cost-effective health systems strengthening global strategy. The launch of the Global Alliance for Surgical, Obstetric, Trauma, and Anaesthesia Care in 2015 has further coordinated efforts to build priority for surgical care and anaesthesia. These combined efforts culminated in the approval of a World Health Assembly resolution recognizing the role of surgical care and anaesthesia as part of universal health coverage. Momentum gained from these milestones highlights the need to identify consensus goals, targets and indicators to guide policy implementation and track progress at the national level. Through an open consultative process that incorporated input from stakeholders from around the globe, a global target calling for safe surgical and anaesthesia care for 80% of the world by 2030 was proposed. In order to achieve this target, we also propose 15 consensus indicators that build on existing surgical systems metrics and expand the ability to prioritize surgical systems strengthening around the world.

  5. Diagnostic efficiency of demographically corrected Wechsler Adult Intelligence Scale-III and Wechsler Memory Scale-III indices in moderate to severe traumatic brain injury and lower education levels.

    Science.gov (United States)

    Walker, Alexandra J; Batchelor, Jennifer; Shores, E Arthur; Jones, Mike

    2009-11-01

    Despite the sensitivity of neuropsychological tests to educational level, improved diagnostic accuracy for demographically corrected scores has yet to be established. Diagnostic efficiency statistics of Wechsler Adult Intelligence Scale-III (WAIS-III) and Wechsler Memory Scale-III (WMS-III) indices that were corrected for education, sex, and age (demographically corrected) were compared with age corrected indices in individuals aged 16 to 75 years with moderate to severe traumatic brain injury (TBI) and 12 years or less education. TBI participants (n = 100) were consecutive referrals to an outpatient rehabilitation service and met careful selection criteria. Controls (n = 100) were obtained from the WAIS-III/WMS-III standardization sample. Demographically corrected indices did not provide higher diagnostic efficiency than age corrected indices and this result was supported by reanalysis of the TBI group against a larger and unmatched control group. Processing Speed Index provided comparable diagnostic accuracy to that of combined indices. Demographically corrected indices were associated with higher cut-scores to maximize overall classification, reflecting the upward adjustment of those scores in a lower education sample. This suggests that, in clinical practice, the test results of individuals with limited education may be more accurately interpreted with the application of demographic corrections. Diagnostic efficiency statistics are presented, and future research directions are discussed.

  6. Safety, Efficacy, Predictability and Stability Indices of Photorefractive Keratectomy for Correction of Myopic Astigmatism with Plano-Scan and Tissue-Saving Algorithms

    Directory of Open Access Journals (Sweden)

    Mehrdad Mohammadpour

    2013-10-01

    Full Text Available Purpose: To assess the safety, efficacy and predictability of photorefractive keratectomy (PRK [Tissue-saving (TS versus Plano-scan (PS ablation algorithms] of Technolas 217z excimer laser for correction of myopic astigmatismMethods: In this retrospective study one hundred and seventy eyes of 85 patients (107 eyes (62.9% with PS and 63 eyes (37.1% with TS algorithm were included. TS algorithm was applied for those with central corneal thickness less than 500 µm or estimated residual stromal thickness less than 420 µm. Mitomycin C (MMC was applied for 120 eyes (70.6%; in case of an ablation depth more than 60 μm and/or astigmatic correction more than one diopter (D. Mean sphere, cylinder, spherical equivalent (SE refraction, uncorrected visual acuity (UCVA, best corrected visual acuity (BCVA were measured preoperatively, and 4 weeks,12 weeks and 24 weeks postoperatively.Results: One, three and six months postoperatively, 60%, 92.9%, 97.5% of eyes had UCVA of 20/20 or better, respectively. Mean preoperative and 1, 3, 6 months postoperative SE were -3.48±1.28 D (-1.00 to -8.75, -0.08±0.62D, -0.02±0.57 and -0.004± 0.29, respectively. And also, 87.6%, 94.1% and 100% were within ±1.0 D of emmetropia and 68.2, 75.3, 95% were within ±0.5 of emmetropia. The safety and efficacy indices were 0.99 and 0.99 at 12 weeks and 1.009 and 0.99 at 24 weeks, respectively. There was no clinically or statistically significant difference between the outcomes of PS or TS algorithms or between those with or without MMC in either group in terms of safety, efficacy, predictability or stability. Dividing the eyes with subjective SE≤4 D and SE≥4 D postoperatively, there was no significant difference between the predictability of the two groups. There was no intra- or postoperative complication.Conclusion: Outcomes of PRK for correction of myopic astigmatism showed great promise with both PS and TS algorithms.

  7. Combined Orthodontic and Surgical Approach in the Correction of a Class III Skeletal Malocclusion with Mandibular Prognathism and Vertical Maxillary Excess Using Bimaxillary Osteotomy

    OpenAIRE

    George Jose Cherackal; Eapen Thomas; Akhilesh Prathap

    2013-01-01

    For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment. Surgery is not a substitute for orthodontics in these patients. Instead, it must be properly coordinated with orthodontics and other dental treatments to achieve good overall results. Dramatic progress in recent years has made it possible for combined surgical orthodontic treatm...

  8. Surgical Assisting

    Science.gov (United States)

    ... instruction, including: Microbiology Pathophysiology Pharmacology Anatomy and physiology Medical terminology Curriculum . Course content includes: Advanced surgical anatomy Surgical microbiology Surgical pharmacology Anesthesia methods and agents Bioscience Ethical ...

  9. The role of surgical expertise with regard to chronic postoperative inguinal pain (CPIP) after Lichtenstein correction of inguinal hernia: a systematic review.

    Science.gov (United States)

    Lange, J F M; Meyer, V M; Voropai, D A; Keus, E; Wijsmuller, A R; Ploeg, R J; Pierie, J P E N

    2016-06-01

    The aim of this study was to evaluate whether a relation exists between surgical expertise and incidence of chronic postoperative inguinal pain (CPIP) after inguinal hernia repair using the Lichtenstein procedure . CPIP after inguinal hernia repair remains a major clinical problem despite many efforts to address this problem. Recently, case volume and specialisation have been found correlated to significant improvement of outcomes in other fields of surgery; to date these important factors have not been reviewed extensively enough in the context of inguinal hernia surgery. A systematic literature review was performed to identify randomised controlled trials reporting on the incidence of CPIP after the Lichtenstein procedure and including the expertise of the surgeon. Surgical expertise was subdivided into expert and non-expert. In a total of 16 studies 3086 Lichtenstein procedures were included. In the expert group the incidence of CPIP varied between 6.9 and 11.7 % versus an incidence of 18.1 and 39.4 % in the non-expert group. Due to the heterogeneity between groups no statistical significance could be demonstrated. The results of this evaluation suggest that an association between surgical expertise and CPIP is highly likely warranting further analysis in a prospectively designed study.

  10. [F-18]2-fluoro-2-deoxyglucose (FDG) positron emission tomography after limb salvage surgery: post-surgical appearance, attenuation correction and local complications

    Energy Technology Data Exchange (ETDEWEB)

    Gelfand, Michael J.; Sharp, Susan E. [Cincinnati Children' s Hospital Medical Center, Department of Radiology, Nuclear Medicine Division, Cincinnati, OH (United States)

    2015-08-15

    Metal endoprostheses and internal fixation devices cause significant artifacts on CT after limb salvage surgery; positron emission tomography (PET) images should be evaluated for artifacts. (1) To describe [F-18]2-fluoro-2-deoxyglucose (FDG) PET uptake patterns after limb salvage surgery. (2) To determine whether metal endoprostheses and fixation hardware cause significant artifacts on CT attenuation-corrected PET that interfere with diagnostic use of PET/CT after limb salvage surgery. We reviewed 92 studies from 18 patients ages 5-21 years. Diagnoses were osteogenic sarcoma in 14, Ewing sarcoma in 3, and malignant peripheral nerve sheath tumor originating in bone in 1. Nine patients had distal femur/knee endoprostheses, five had lower-extremity bone allografts secured by large metal plates and four had upper-extremity limb salvage procedures. Maximum standardized uptake value was calculated at lower-extremity soft-tissue-endoprosthesis interfaces. In 15 patients with PET/CT imaging, the first PET/CT scan after limb salvage surgery was reviewed for metal artifacts on CT images and for artifacts at locations on PET corresponding to the CT metal artifacts. Increased FDG uptake was consistently present at soft-tissue interfaces with endoprostheses, allografts and internal fixation devices, with little or no FDG uptake at cemented endoprosthesis-bone interfaces. Maximum standardized uptake value at margins of femur/knee endoprostheses ranged from 1.4 to 5.7. In four patients with distal femur/knee endoprostheses, minimal artifact was noted on attenuation-corrected PET images, but image interpretation was not affected. In the other 11 patients who had CT attenuation correction, we detected no artifacts caused by the attenuation correction. CT attenuation correction did not cause artifacts that affected interpretation of attenuation-corrected PET images. (orig.)

  11. [F-18]2-fluoro-2-deoxyglucose (FDG) positron emission tomography after limb salvage surgery: post-surgical appearance, attenuation correction and local complications

    International Nuclear Information System (INIS)

    Gelfand, Michael J.; Sharp, Susan E.

    2015-01-01

    Metal endoprostheses and internal fixation devices cause significant artifacts on CT after limb salvage surgery; positron emission tomography (PET) images should be evaluated for artifacts. (1) To describe [F-18]2-fluoro-2-deoxyglucose (FDG) PET uptake patterns after limb salvage surgery. (2) To determine whether metal endoprostheses and fixation hardware cause significant artifacts on CT attenuation-corrected PET that interfere with diagnostic use of PET/CT after limb salvage surgery. We reviewed 92 studies from 18 patients ages 5-21 years. Diagnoses were osteogenic sarcoma in 14, Ewing sarcoma in 3, and malignant peripheral nerve sheath tumor originating in bone in 1. Nine patients had distal femur/knee endoprostheses, five had lower-extremity bone allografts secured by large metal plates and four had upper-extremity limb salvage procedures. Maximum standardized uptake value was calculated at lower-extremity soft-tissue-endoprosthesis interfaces. In 15 patients with PET/CT imaging, the first PET/CT scan after limb salvage surgery was reviewed for metal artifacts on CT images and for artifacts at locations on PET corresponding to the CT metal artifacts. Increased FDG uptake was consistently present at soft-tissue interfaces with endoprostheses, allografts and internal fixation devices, with little or no FDG uptake at cemented endoprosthesis-bone interfaces. Maximum standardized uptake value at margins of femur/knee endoprostheses ranged from 1.4 to 5.7. In four patients with distal femur/knee endoprostheses, minimal artifact was noted on attenuation-corrected PET images, but image interpretation was not affected. In the other 11 patients who had CT attenuation correction, we detected no artifacts caused by the attenuation correction. CT attenuation correction did not cause artifacts that affected interpretation of attenuation-corrected PET images. (orig.)

  12. Surgical correction of cryptotia combined with an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap.

    Science.gov (United States)

    Yu, Xiaobo; Yang, Qinghua; Jiang, Haiyue; Pan, Bo; Zhao, Yanyong; Lin, Lin

    2017-11-01

    Cryptotia is a common congenital ear deformity in Asian populations. In cryptotia, a portion of the upper ear is hidden and fixed in a pocket of the skin of the mastoid. Here we describe our method for cryptotia correction by using an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap. We developed a new method for correcting cryptotia by using an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap. Following ear release, the full-thickness skin rotation flap is rotated into the defect, and the donor site is covered with an ultra-delicate split-thickness skin graft raised in continuity with the flap. All patients exhibited satisfactory release of cryptotia. No cases involved partial or total flap necrosis, and post-operative outcomes using this new technique for cryptotia correction have been more than satisfactory. Our method of using an ultra-delicate split-thickness skin graft in continuity with a full-thickness skin rotation flap to correct cryptotia is simple and reliable. Copyright © 2017 British Association of Plastic, Reconstructive and Aesthetic Surgeons. Published by Elsevier Ltd. All rights reserved.

  13. Indications for surgical stabilization of rib fractures in patients without flail chest: surveyed opinions of members of the Chest Wall Injury Society.

    Science.gov (United States)

    Pieracci, Fredric M; Agarwal, Suresh; Doben, Andrew; Shiroff, Adam; Lottenberg, Larwence; Whitbeck, Sarah Ann; White, Thomas W

    2018-02-01

    There are currently no evidence-based indications for surgical stabilization of rib fractures (SSRF) in patients without flail chest. The purpose of this survey was to identify patients for whom there is relative equipoise (operative vs. non-operative) in order to assist in designing a randomized clinical trial. Members of the Chest Wall Injury Society were sent an online survey, in which 18 patient scenarios were presented. The baseline patient had ≥ three displaced, contiguous fractures and had no other contraindications for surgery. This default scenario was then varied based upon patient age, degree of traumatic brain injury (TBI), fracture series location, and number of abnormal pulmonary physiologic variables (oxygen requirement, respiratory rate, incentive spirometry ability, cough, and numeric pain score). Thirty respondents provided a total of 540 answers. Overall, the majority of responses were in favor of SSRF (n = 413, 84.1%). Furthermore, the vast majority of responses indicated that some degree of pulmonary compromise was necessary to recommend SSRF (n = 44, 90.4%), with ≥ two abnormal parameters being the most common threshold (n = 156, 31.8%). Decision to recommend SSRF varied significantly by number of abnormal clinical variables, age, and degree of TBI, but not by fracture series location. Patients aged 85 years old and those with moderate TBI were the least likely to be recommended for SSRF, regardless of abnormal pulmonary physiologic variables. The most appropriate cutoff for equipoise appeared to be a patient aged 21-79 years old, with no or mild TBI, ≥ two abnormal pulmonary parameters, and regardless of fracture location (44.8% consensus for SSRF). SSRF was recommended for most patients with non-flail, displaced rib fractures. However, this recommendation was contingent upon patient age, degree of TBI, and pulmonary clinical status. Results of this survey may be used to inform inclusion criteria for a future randomized

  14. Abortion - surgical

    Science.gov (United States)

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

  15. Surgical treatment for the subclavian steal syndrome. Surgical indication and selection of procedures by {sup 123}I-IMP-SPECT imaging and {sup 99m}Tc-HSA accumulation curve in upper extremities

    Energy Technology Data Exchange (ETDEWEB)

    Fujita, Toyohisa; Tokunaga, Hidemori; Akita, Nobuhisa; Nonaka, Masahiro [Saiseikai Chuwa Hospital, Sakurai, Nara (Japan)

    1998-03-01

    To select reasonable operative procedures in the respective patients, we have studied the cerebral blood flow, especially in the posterior circulation, by {sup 123}I-IMP-SPECT imaging, and the blood flow in the upper extremities by {sup 99m}Tc-HSA accumulation curve in 11 patients with subclavian steal syndrome. Although all patients presented distinct symptoms and signs of vertebrobasilar insufficiency, {sup 123}I-IMP-SPECT early image demonstrated no evident finding of decreased blood flow in the posterior circulation. However, in the delayed image 5 out of 11 patients revealed laterality of IMP uptake in cerebellar hemisphere. Four patients presented symptoms of the upper extremities including arm claudication, and all of them revealed {sup 99m}Tc-HSA accumulation curve indicated decreased blood flow in the affected side of arm and forearm. We performed transposition of vertebral artery to common carotid artery in 7 patients without evidence of decreased blood flow in the upper extremities by {sup 99m}Tc-HSA accumulation curve, common carotid-subclavian dacron graft bypass in 3 cases with evidence of decreased blood flow in the upper extremities, and arch aorta-common carotid dacron graft bypass for the innominate artery occlusion. When the ischemia in the anterior circulation had existed in patients with multiple cerebrovascular occlusive disease, we first corrected the anterior circulation, and then performed the revascularization for the posterior circulation mentioned above by staged operation, resulting in successful treatment of all patients. (K.H.)

  16. Combined Orthodontic and Surgical Approach in the Correction of a Class III Skeletal Malocclusion with Mandibular Prognathism and Vertical Maxillary Excess Using Bimaxillary Osteotomy.

    Science.gov (United States)

    Jose Cherackal, George; Thomas, Eapen; Prathap, Akhilesh

    2013-01-01

    For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment. Surgery is not a substitute for orthodontics in these patients. Instead, it must be properly coordinated with orthodontics and other dental treatments to achieve good overall results. Dramatic progress in recent years has made it possible for combined surgical orthodontic treatment to be carried out successfully for patients with a severe dentofacial problem of any type. This case report provides an overview of the current treatment methodology in managing a combination of asymmetrical mandibular prognathism and vertical maxillary excess.

  17. Combined Orthodontic and Surgical Approach in the Correction of a Class III Skeletal Malocclusion with Mandibular Prognathism and Vertical Maxillary Excess Using Bimaxillary Osteotomy

    Directory of Open Access Journals (Sweden)

    George Jose Cherackal

    2013-01-01

    Full Text Available For patients whose orthodontic problems are so severe that neither growth modification nor camouflage offers a solution, surgery to realign the jaws or reposition dentoalveolar segments is the only possible treatment. Surgery is not a substitute for orthodontics in these patients. Instead, it must be properly coordinated with orthodontics and other dental treatments to achieve good overall results. Dramatic progress in recent years has made it possible for combined surgical orthodontic treatment to be carried out successfully for patients with a severe dentofacial problem of any type. This case report provides an overview of the current treatment methodology in managing a combination of asymmetrical mandibular prognathism and vertical maxillary excess.

  18. Sagittal Plane Correction Using the Lateral Transpsoas Approach: A Biomechanical Study on the Effect of Cage Angle and Surgical Technique on Segmental Lordosis.

    Science.gov (United States)

    Melikian, Rojeh; Yoon, Sangwook Tim; Kim, Jin Young; Park, Kun Young; Yoon, Caroline; Hutton, William

    2016-09-01

    Cadaveric biomechanical study. To determine the degree of segmental correction that can be achieved through lateral transpsoas approach by varying cage angle and adding anterior longitudinal ligament (ALL) release and posterior element resection. Lordotic cage insertion through the lateral transpsoas approach is being used increasingly for restoration of sagittal alignment. However, the degree of correction achieved by varying cage angle and ALL release and posterior element resection is not well defined. Thirteen lumbar motion segments between L1 and L5 were dissected into single motion segments. Segmental angles and disk heights were measured under both 50 N and 500 N compressive loads under the following conditions: intact specimen, discectomy (collapsed disk simulation), insertion of parallel cage, 10° cage, 30° cage with ALL release, 30° cage with ALL release and spinous process (SP) resection, 30° cage with ALL release, SP resection, facetectomy, and compression with pedicle screws. Segmental lordosis was not increased by either parallel or 10° cages as compared with intact disks, and contributed small amounts of lordosis when compared with the collapsed disk condition. Placement of 30° cages with ALL release increased segmental lordosis by 10.5°. Adding SP resection increased lordosis to 12.4°. Facetectomy and compression with pedicle screws further increased lordosis to approximately 26°. No interventions resulted in a decrease in either anterior or posterior disk height. Insertion of a parallel or 10° cage has little effect on lordosis. A 30° cage insertion with ALL release resulted in a modest increase in lordosis (10.5°). The addition of SP resection and facetectomy was needed to obtain a larger amount of correction (26°). None of the cages, including the 30° lordotic cage, caused a decrease in posterior disk height suggesting hyperlordotic cages do not cause foraminal stenosis. N/A.

  19. How does sagittal imbalance affect the appropriateness of surgical indications and selection of procedure in the treatment of degenerative scoliosis? Findings from the RAND/UCLA Appropriate Use Criteria study.

    Science.gov (United States)

    Daubs, Michael D; Brara, Harsimran S; Raaen, Laura B; Chen, Peggy Guey-Chi; Anderson, Ashaunta T; Asch, Steven M; Nuckols, Teryl K

    2018-05-01

    Degenerative lumbar scoliosis (DLS) is often associated with sagittal imbalance, which may affect patients' health outcomes before and after surgery. The appropriateness of surgery and preferred operative approaches has not been examined in detail for patients with DLS and sagittal imbalance. The goals of this article were to describe what is currently known about the relationship between sagittal imbalance and health outcomes among patients with DLS and to determine how indications for surgery in patients with DLS differ when sagittal imbalance is present. This study included a literature review and an expert panel using the RAND/University of California at Los Angeles (UCLA) Appropriateness Method. To develop appropriate use criteria for DLS, researchers at the RAND Corporation recently employed the RAND/UCLA Appropriateness Method, which involves a systematic review of the literature and multidisciplinary expert panel process. Experts reviewed a synopsis of published literature and rated the appropriateness of five common operative approaches for 260 different clinical scenarios. In the present work, we updated the literature review and compared panelists' ratings in scenarios where imbalance was present versus absent. This work was funded by the Collaborative Spine Research Foundation, a group of surgical specialty societies and device manufacturers. On the basis of 13 eligible studies that examined sagittal imbalance and outcomes in patients with DLS, imbalance was associated with worse functional status in the absence of surgery and worse symptoms and complications postoperatively. Panelists' ratings demonstrated a consistent pattern across the diverse clinical scenarios. In general, when imbalance was present, surgery was more likely to be appropriate or necessary, including in some situations where surgery would otherwise be inappropriate. For patients with moderate to severe symptoms and imbalance, a deformity correction procedure was usually appropriate

  20. Case report: 122° kyphosis secondary to C5-L3 laminectomy and quadriplegia, surgical correction and 30-year follow-up.

    Science.gov (United States)

    Winter, R B; Akbarnia, B A

    2011-09-01

    The study design was a case report with 30-year follow-up. In 1980, there were no pedicle screws available, so it was a great challenge to achieve correction and fusion in a patient with no laminae, and who was quadriplegic. Such a case with such a long follow-up has not been previously reported. This is a single case report with an ultra-long follow-up. The patient underwent an anterior fusion from T3 to L4 via two incisions, and at a second stage, a posterior fusion from T3 to S1 using Luque rods and wires passed through the foramenae. After 2 years he underwent repair of two pseudarthroses with both anterior and posterior procedures. He achieved solid fusion following the pseudarthrosis repair. Although being a C7 quadriplegic all his life, he is totally independent in his activities of daily living, and is fully employed. Correction and fusion can be achieved even in the absence of laminae and pedicle screws.

  1. Comparison of resorbable poly-L-lactic acid-polyglycolic acid and internal Palmaz stents for the surgical correction of severe tracheomalacia.

    Science.gov (United States)

    Sewall, Gregory K; Warner, Thomas; Connor, Nadine P; Hartig, Gregory K

    2003-06-01

    Tracheomalacia (TM) is associated with expiratory airway collapse and potentially fatal respiratory distress. Internal and external tracheal stents and, recently, resorbable biopolymers have been used to treat this condition. In this study, the efficacy and biocompatibility of internal Palmaz stents and external poly-L-lactic acid-polyglycolic acid (PLPG) stents were compared in a model of severe TM induced in piglets. The tracheas were repaired with one of two stenting methods, and the animals survived for up to 16 weeks. Weight gain, adverse respiratory signs and symptoms, tracheal or lung histopathologic changes, and internal and external tracheal diameters were measured. The animals in the PLPG group uniformly were free of respiratory distress and tracheal stenosis or inflammation, whereas all animals in the Palmaz group developed respiratory distress as a result of pneumonia or tracheal stenosis caused by intraluminal granulation tissue. In conclusion, superior efficacy of external, resorbable PLPG stents was found relative to internal Palmaz stents for the surgical repair of severe TM.

  2. Right-ventricular and left-ventricular function parameters in patients with and without outflow tract patches as determined by radionuclide methods at least 10 years following surgical correction of Fallot's tetralogy in the adult individuals

    International Nuclear Information System (INIS)

    Seidel, P.

    1988-01-01

    During a period starting in 1983 and ending in April 1984 radionuclide ventriculography was performed in 26 patients subjected to surgical correction of Fallot's tetralogy after having reached adulthood. They were divided into two groups according to the surgical methods used. Patients showing no right-ventricular outflow patch were assigned to group I, while group II was made up of individuals that had received outflow tract patches of Dacron or Teflon for pressure reduction in the right ventricle. The parameters registered during radionuclide ventriculography, in which the tracer substance TC 99m was administered into a peripheral vein, included the endiastolic volume, endsystolic volume, stroke volume, global ejection fraction and cardiac index. For resting patients, these values were calculated using the first-pass technique, the determinations during exercise on the ergometer were based on equilibrium radionuclide ventriculography. It could be concluded from the results obtained here that non-invasive endocardial scintigraphy is a sensitive method that can be used both at rest and during exercise on the ergometer to detect function disorders of the right and left ventricles. (orig./MG) [de

  3. Peculiarities of changes in indices of immunological reactivity in experimental allergic alveolitis under adrenalin myocardial injury and their correction with thiotriazoline

    Directory of Open Access Journals (Sweden)

    Volodymyr Pyndus

    2015-10-01

      Abstract Allergic diseases cover more than 20% of people living on the earth, among who exogenous allergic alveolitis (AA occupies a prominent place. However, the frequency of this disease increases and there is a number of complications with not only medical but also socio-economic values. Today the question remains to be not studied that concerns changes of selected indicators of clinical and humoral immunity in the blood for experimental allergic alveoli (EAA and adrenaline myocardial injury (AMI and the possibility of their correction with antioxidants. The goal of study was to elucidate peculiarities of changes of immunological reactivity in the EAA in terms of AMI and set the effect of  thiotriazoline on them. The study of individual markers of cellular and humoral immunity showed a malfunction of the immune system in the formation of EAA and AMI and set monocristalline the effect of thiotriazolin on the level of T and B-lymphocytes and  CIC in blood.   Key words: experimental allergic alveolitis, adrenaline myocardial injury, thiotriazolin. Ключові слова: експериментальний алергічний альвеоліт, адреналінове пошкодження міокарда, тіотриазолін.

  4. "In situ preparation": new surgical procedure indicated for soft-tissue sarcoma of a lower limb in close proximity to major neurovascular structures.

    Science.gov (United States)

    Matsumoto, Seiichi; Kawaguchi, Noriyoshi; Manabe, Jun; Matsushita, Yasushi

    2002-02-01

    When soft-tissue sarcomas occur near neurovascular structures, preoperative images cannot always reveal the accurate relationship between the tumor and these structures. Therefore, in some patients, neurovascular structures are sacrificed unnecessarily. In other patients, neurovascular structures are preserved with an inappropriate margin, followed by local recurrence. The objective of this study was to evaluate a new surgical method, "in situ preparation" (ISP), which enables the preparation of neurovascular bundles and the intraoperative evaluation of the surgical margin without contamination by tumor cells. With this method, additional procedures, including pasteurization, alcohol soaking, and distilled water soaking of the preserved neurovascular bundle can also be performed to preserve the continuity of vessels. Between April 1992 and December 1998, 18 patients with soft-tissue sarcoma were operated on using ISP. The tumor and neurovascular structure were lifted en bloc from the surgical bed and separated from the field by the use of a vinyl sheet. The consistency of the neurovascular structures was preserved. The tissue block could be freely turned around and the neurovascular structure was separated from the block through the nearest approach. The margin between the tumor and neurovascular structure was evaluated, and an additional procedure, such as pasteurization, alcohol soaking or distilled water soaking, was performed, according to the safety of the surgical margin. Only one patient showed recurrence after ISP. Complications after ISP were arterial occlusion in two patients and nerve palsy in three patients. The main cause of these complications was the long period of pasteurization; modified additional procedures could prevent such complications. ISP is a useful method with which to ensure a safe surgical margin and good functional results.

  5. Bias correction of nutritional status estimates when reported age is used for calculating WHO indicators in children under five years of age.

    Science.gov (United States)

    Quezada, Amado D; García-Guerra, Armando; Escobar, Leticia

    2016-06-01

    To assess the performance of a simple correction method for nutritional status estimates in children under five years of age when exact age is not available from the data. The proposed method was based on the assumption of symmetry of age distributions within a given month of age and validated in a large population-based survey sample of Mexican preschool children. The main distributional assumption was consistent with the data. All prevalence estimates derived from the correction method showed no statistically significant bias. In contrast, failing to correct attained age resulted in an underestimation of stunting in general and an overestimation of overweight or obesity among the youngest. The proposed method performed remarkably well in terms of bias correction of estimates and could be easily applied in situations in which either birth or interview dates are not available from the data.

  6. Bias correction of nutritional status estimates when reported age is used for calculating WHO indicators in children under five years of age

    Directory of Open Access Journals (Sweden)

    Amado D Quezada

    2016-05-01

    Full Text Available Objective.To assess the performance of a simple correction method for nutritional status estimates in children under five years of age when exact age is not available from the data. Materials and methods. The proposed method was ba- sed on the assumption of symmetry of age distributions within a given month of age and validated in a large population-based survey sample of Mexican preschool children. Results. The main distributional assumption was consistent with the data. All prevalence estimates derived from the correction method showed no statistically significant bias. In contrast, failing to correct attained age resulted in an underestimation of stunting in general and an overestimation of overweight or obesity among the youngest. Conclusions. The proposed method performed remarkably well in terms of bias correction of estimates and could be easily applied in situations in which either birth or interview dates are not available from the data.

  7. NT-proBNP as Marker of Ventricular Dilatation and Pulmonary Regurgitation After Surgical Correction of Tetralogy of Fallot: A MRI Validation Study.

    Science.gov (United States)

    Paolino, Annalisa; Hussain, Tarique; Pavon, Antonio; Velasco, Maria Nieves; Uribe, Sergio; Ordoñez, Antonio; Valverde, Israel

    2017-02-01

    The goal of this study is to evaluate whether NT-proBNP plasma levels may help as a screening biomarker for monitoring right ventricular dilatation, pulmonary regurgitation and the onset of heart failure in patients with repaired Tetralogy of Fallot. Our single-centre observational prospective study involved 43 patients (15.1 years, SD = 8) with corrected Tetralogy of Fallot. Data collection included: clinical parameters (electrocardiogram, chest X-ray, NYHA scale, time since last surgery), biochemistry (NT-proBNP levels) and MRI values (ventricular volumetry, pulmonary flow assessment). Mean time since last surgery was 13.5 years (SD = 7.8). There was a statistically significant correlation between the NT-proBNP levels (187.4 pg/ml, SD = 154.9) and right ventricular dilatation for both the right ventricular end-diastolic volume (124.9 ml/m 2 , SD = 31.2) (Pearson = 0.19, p Tetralogy of Fallot, NT-proBNP levels correlate with right ventricular dilatation and the degree of pulmonary regurgitation. Ambulatory determination of NT-proBNP might be an easy, readily available and cost-effective alternative for MRI follow-up evaluation of these patients.

  8. Prevention of Surgical Fires: A Certification Course for Healthcare Providers.

    Science.gov (United States)

    Fisher, Marquessa

    2015-08-01

    An estimated 550 to 650 surgical fires occur annually in the United States. Surgical fires may have severe consequences, including burns, disfigurement, long-term medical care, or death. This article introduces a potential certification program for the prevention of surgical fires. A pilot study was conducted with a convenience sample of 10 anesthesia providers who participated in the education module. The overall objective was to educate surgical team members and to prepare them to become certified in surgical fire prevention. On completion of the education module, participants completed the 50-question certification examination. The mean pretest score was 66%; none of the participants had enough correct responses (85%) to be considered competent in surgical fire prevention. The mean post- test score was 92.80%, with all participants answering at least 85% of questions correct. A paired-samples t test showed a statistically significant increase in knowledge: t (df = 9) = 11.40; P = .001. Results of the pilot study indicate that this course can remediate gaps in knowledge of surgical fire prevention for providers. Their poor performance on the pretest suggests that many providers may not receive sufficient instruction in surgical fire prevention.

  9. SURGICAL ORTHODONTICS: LITERATURE REVIEW AND CASE REPORT

    OpenAIRE

    Piyush HEDA; Babita RAGHUWANSHI; Amit PRAKASH; Kishore SONAWANE

    2013-01-01

    Orthognathic surgery is a surgical procedure largely practiced throughout the world for the correction of various maxillofacial deformities. The procedure for correcting a particular deformity will be done after proper evaluation, which includes cephalometric, dental model analysis and photographs. The patient undergoes pre-surgical orthodontic correction for dental compensation, after which surgery is planned. During the last few decades, the profession has witnessed ...

  10. The influence of different error estimates in the detection of postoperative cognitive dysfunction using reliable change indices with correction for practice effects.

    Science.gov (United States)

    Lewis, Matthew S; Maruff, Paul; Silbert, Brendan S; Evered, Lis A; Scott, David A

    2007-02-01

    The reliable change index (RCI) expresses change relative to its associated error, and is useful in the identification of postoperative cognitive dysfunction (POCD). This paper examines four common RCIs that each account for error in different ways. Three rules incorporate a constant correction for practice effects and are contrasted with the standard RCI that had no correction for practice. These rules are applied to 160 patients undergoing coronary artery bypass graft (CABG) surgery who completed neuropsychological assessments preoperatively and 1 week postoperatively using error and reliability data from a comparable healthy nonsurgical control group. The rules all identify POCD in a similar proportion of patients, but the use of the within-subject standard deviation (WSD), expressing the effects of random error, as an error estimate is a theoretically appropriate denominator when a constant error correction, removing the effects of systematic error, is deducted from the numerator in a RCI.

  11. Surgical lighting

    NARCIS (Netherlands)

    Knulst, A.J.

    2017-01-01

    The surgical light is an important tool for surgeons to create and maintain good visibility on the surgical task. Chapter 1 gives background to the field of (surgical) lighting and related terminology. Although the surgical light has been developed strongly since its introduction a long time ago,

  12. Correction: Yu, Q., et al. Narrowband Bio-Indicator Monitoring of Temperate Forest Carbon Fluxes in Northeastern China. Remote Sens. 2014, 6, 8986-9013

    Directory of Open Access Journals (Sweden)

    Remote Sensing Editorial Office

    2015-01-01

    Full Text Available Due to a technical error at the Editorial Office, Figure 8 of manuscript [1] is missing in the published paper. The correct version of the figure is reproduced below. We apologize for any inconvenience caused to authors or readers of Remote Sensing.[...

  13. Total Pancreatectomy and Islet Auto-Transplantation in Children for Chronic Pancreatitis. Indication, Surgical Techniques, Post Operative Management and Long-Term Outcomes

    Science.gov (United States)

    Chinnakotla, Srinath; Bellin, Melena D.; Schwarzenberg, Sarah J.; Radosevich, David M.; Cook, Marie; Dunn, Ty B.; Beilman, Gregory J.; Freeman, Martin L.; Balamurugan, A.N.; Wilhelm, Josh; Bland, Barbara; Jimenez-Vega, Jose M; Hering, Bernhard J.; Vickers, Selwyn M.; Pruett, Timothy L.; Sutherland, David E.R.

    2014-01-01

    Objective Describe the surgical technique, complications and long term outcomes of total pancreatectomy and islet auto transplantation (TP-IAT) in a large series of pediatric patients. Summary Background Data Surgical management of childhood pancreatitis is not clear; partial resection or drainage procedures often provide transient pain relief, but long term recurrence is common due to the diffuse involvement of the pancreas. Total pancreatectomy (TP) removes the source of the pain, while islet auto transplantation (IAT) potentially can prevent or minimize TP-related diabetes. Methods Retrospective review of 75 children undergoing TP-IAT for chronic pancreatitis who had failed medical, endoscopic or surgical treatment between 1989–2012. Results Pancreatitis pain and the severity of pain statistically improved in 90% of patients after TP-IAT (p =Puestow (p=0.018), lower body surface area (p=0.048), IEQ per Kg Body Weight (p=0.001) and total IEQ (100,000) (0.004) were associated with insulin independence. By multivariate analysis, 3 factors were associated with insulin independence after TP-IAT:(1) male gender, (2) lower body surface area and the (3) higher total IEQ per kilogram body weight. Total IEQ (100,000) was the single factor most strongly associated with insulin independence (OR = 2.62; p value < 0.001). Conclusions TP-IAT provides sustained pain relief and improved quality of life. The β cell function is dependent on islet yield. TP-IAT is an effective therapy for children with painful pancreatitis that fail medical and or endoscopic management PMID:24509206

  14. When and why is surgical revascularization indicated for the treatment of moyamoya syndrome in patients with RASopathies? A systematic review of the literature and a single institute experience.

    Science.gov (United States)

    Scala, Marcello; Fiaschi, Pietro; Capra, Valeria; Garrè, Maria Luisa; Tortora, Domenico; Ravegnani, Marcello; Pavanello, Marco

    2018-07-01

    Moyamoya disease (MMD) is a cerebrovascular disorder characterized by the progressive occlusion of the supraclinoid internal carotid artery (ICA), resulting in the formation of an abnormal cerebral vascular network. When MMD occurs in association with an underlying medical condition, including some distinctive genetic disorders, it is named moyamoya syndrome (MMS). The discrimination between MMD and MMS has been validated by recent genetic researches and international reviews. Similarly to patients suffering from MMD, patients with MMS generally become symptomatic because of ischemic complications, which lead to hemiparesis, transient ischemic events, seizures, and sensory symptoms. RASopathies are a group of neurodevelopmental disorders that can be associated with MMS. We retrospectively reviewed 18 RASopathy patients with MMS treated at our institution from 2000 to 2015 (16 neurofibromatosis type 1, 1 Costello syndrome, and 1 Schimmelpenning syndrome). Here, we report clinical data, performed surgical procedures, and clinic-radiological outcome of these patients. Most of them received both indirect revascularization and medical therapy. At the moment, there are no univocal recommendations on which of these two treatment strategies is the treatment of choice in patients with RASopathies and MMS. We suggest that patients with a good overall prognosis (primarily depending on the distinctive underlying genetic disorder) and initial cerebrovascular disease could benefit from a prophylactic surgical revascularization, in order to prevent the cognitive impairment due to the progression of the vasculopathy.

  15. Impacted Mandibular Third Molars: A Retrospective Study of 1198 Cases to Assess Indications for Surgical Removal, and Correlation with Age, Sex and Type of Impaction-A Single Institutional Experience.

    Science.gov (United States)

    Patel, Shital; Mansuri, Saloni; Shaikh, Faizan; Shah, Taksh

    2017-03-01

    To study the incidence of mandibular third molar impaction in relation to type and side of impaction, age and sex of patients and indications for its surgical removal through data collected from a single institute over a period of 3 and half years. The records of 1198 patients who underwent the surgical removal of impacted mandibular third molars were reviewed retrospectively. Records were divided into groups according to sex, age, type and side of impaction. Radiographs were studied to determine angular position of impacted mandible third molar. We found that there was a high incidence of mesioangular lower third molar impaction (33.97 %), highest number of patients were found in 15-30 years of age group (48.33 %), a left side (56.93 %) was more commonly involved, female predominance (63.44 %) was observed and recurrent pericoronitis (33.81 %) was the most common indication. Awareness of the indications for surgical removal of impacted mandibular third molar to the patients will help to avoid future risk of complications and morbidity associated with the same. This will not only help in saving time and money but also prevents the psychological trauma associated with delayed treatment. Removal of only symptomatic IMTM seems to be the logical choice in view of financial constraint in developing countries like India but at the same time early removal offers freedom from future complications in selected cases. So surgeons should apply a meticulous approach in selecting the patients for SRIMTM.

  16. Surgical smoke.

    Science.gov (United States)

    Fan, Joe King-Man; Chan, Fion Siu-Yin; Chu, Kent-Man

    2009-10-01

    Surgical smoke is the gaseous by-product formed during surgical procedures. Most surgeons, operating theatre staff and administrators are unaware of its potential health risks. Surgical smoke is produced by various surgical instruments including those used in electrocautery, lasers, ultrasonic scalpels, high speed drills, burrs and saws. The potential risks include carbon monoxide toxicity to the patient undergoing a laparoscopic operation, pulmonary fibrosis induced by non-viable particles, and transmission of infectious diseases like human papilloma virus. Cytotoxicity and mutagenicity are other concerns. Minimisation of the production of surgical smoke and modification of any evacuation systems are possible solutions. In general, a surgical mask can provide more than 90% protection to exposure to surgical smoke; however, in most circumstances it cannot provide air-tight protection to the user. An at least N95 grade or equivalent respirator offers the best protection against surgical smoke, but whether such protection is necessary is currently unknown.

  17. Surgical correction of gynecomastia with minimal scarring.

    Science.gov (United States)

    Lee, Jun-Ho; Kim, Il-Kug; Kim, Tae-Gon; Kim, Yong-Ha

    2012-12-01

    Gynecomastia is a benign, excessive development of the male breast that occurs at an overall incidence of 32-36 %. The authors effectively removed peripheral fat tissues with power-assisted liposuction (PAL) and periareolar glandular tissues with a cartilage shaver in a series of patients. The small periareolar incisions were not easily recognized. Between February 2010 and April 2012, the charts of 15 patients (28 breasts) treated with PAL and a cartilage shaver were retrospectively reviewed. The mean volume of fat tissue removed with liposuction was 319 mL, and the mean volume of glandular tissue removed with the cartilage shaver was 70 mL. The mean follow-up period was 11.2 months. No infection, nipple-areola complex necrosis, nipple retraction, or saucer deformity was encountered in this series. Intraoperative bleeding occurred in one patient. Mild asymmetries developed in three patients. Use of PAL and a cartilage shaver for the treatment of gynecomastia allows for effective removal of both the fat and the glandular tissue of the breast through a minimal periareolar incision. This technique can achieve excellent aesthetic results with inconspicuous scarring. This journal requires that authors assign a level of evidence to each article. For a full description of these Evidence-Based Medicine ratings, please refer to the Table of Contents or the online Instructions to Authors www.springer.com/00266 .

  18. Noninvasive, near infrared spectroscopic-measured muscle pH and PO2 indicate tissue perfusion for cardiac surgical patients undergoing cardiopulmonary bypass

    Science.gov (United States)

    Soller, Babs R.; Idwasi, Patrick O.; Balaguer, Jorge; Levin, Steven; Simsir, Sinan A.; Vander Salm, Thomas J.; Collette, Helen; Heard, Stephen O.

    2003-01-01

    OBJECTIVE: To determine whether near infrared spectroscopic measurement of tissue pH and Po2 has sufficient accuracy to assess variation in tissue perfusion resulting from changes in blood pressure and metabolic demand during cardiopulmonary bypass. DESIGN: Prospective clinical study. SETTING: Academic medical center. SUBJECTS: Eighteen elective cardiac surgical patients. INTERVENTION: Cardiac surgery under cardiopulmonary bypass. MEASUREMENTS AND MAIN RESULTS: A near infrared spectroscopic fiber optic probe was placed over the hypothenar eminence. Reference Po2 and pH sensors were inserted in the abductor digiti minimi (V). Data were collected every 30 secs during surgery and for 6 hrs following cardiopulmonary bypass. Calibration equations developed from one third of the data were used with the remaining data to investigate sensitivity of the near infrared spectroscopic measurement to physiologic changes resulting from cardiopulmonary bypass. Near infrared spectroscopic and reference pH and Po2 measurements were compared for each subject using standard error of prediction. Near infrared spectroscopic pH and Po2 at baseline were compared with values during cardiopulmonary bypass just before rewarming commenced (hypotensive, hypothermic), after rewarming (hypotensive, normothermic) just before discontinuation of cardiopulmonary bypass, and at 6 hrs following cardiopulmonary bypass (normotensive, normothermic) using mixed-model analysis of variance. Near infrared spectroscopic pH and Po2 were well correlated with the invasive measurement of pH (R2 =.84) and Po2 (R 2 =.66) with an average standard error of prediction of 0.022 +/- 0.008 pH units and 6 +/- 3 mm Hg, respectively. The average difference between the invasive and near infrared spectroscopic measurement was near zero for both the pH and Po2 measurements. Near infrared spectroscopic Po2 significantly decreased 50% on initiation of cardiopulmonary bypass and remained depressed throughout the bypass and

  19. Nurses' 'worry' as predictor of deteriorating surgical ward patients: A prospective cohort study of the Dutch-Early-Nurse-Worry-Indicator-Score

    NARCIS (Netherlands)

    Douw, G.; Huisman-de Waal, G.J.; Zanten, A.R. van; Hoeven, J.G. van der; Schoonhoven, L.

    2016-01-01

    BACKGROUND: Nurses' 'worry' is used as a calling criterion in many Rapid Response Systems, however it is valued inconsistently. Furthermore, barriers to call the Rapid Response Team can cause delay in escalating care. The literature identifies nine indicators which trigger nurses to worry about a

  20. Frequency of CD4+CD25+Foxp3+ cells in peripheral blood in relation to urinary bladder cancer malignancy indicators before and after surgical removal.

    Science.gov (United States)

    Jóźwicki, Wojciech; Brożyna, Anna A; Siekiera, Jerzy; Slominski, Andrzej T

    2016-03-08

    Tumor cells communicate with stromal cells, including cancer-associated fibroblasts (CAFs) and tumor-associated macrophages (TAMs), to form microenvironment inhibiting immune responses. Regulatory T cells (Tregs, CD4+CD25+FoxP3+) stimulate immune tolerance and facilitate tumor progression. We analyzed the changes in Treg frequencies assessed using flow cytometry in the peripheral blood of patients with urothelial bladder cancer before and after tumor-removal. Changes in Treg frequency were investigated in relation to clinicopathomorphological indicators of tumor malignancy and expression of RCAS1 on CAFs and TAMs. Higher Treg frequencies were observed in early phase of tumor growth (pTa-pT2), in larger tumors, with more aggressive type of invasion, and with expression of RCAS1. The later phase of tumor development, accompanied by a nonclassic differentiations and pT3-pT4 advancement, had lower number of tumor infiltrating lymphocytes (TILs) and lower Treg frequency. Furthermore, in pT2-pT4 tumors, a decreased post-surgery Treg frequency was associated with poorer prognosis: patients with the lowest frequency of Tregs died first. These findings strongly suggest that the Treg frequencies at later phase of tumor growth, associated with a low anti-tumor response, represent a new and important prognostic indicator in urinary bladder cancer.

  1. Effects of resident duty hour reform on surgical and procedural patient safety indicators among hospitalized Veterans Health Administration and Medicare patients.

    Science.gov (United States)

    Rosen, Amy K; Loveland, Susan A; Romano, Patrick S; Itani, Kamal M F; Silber, Jeffrey H; Even-Shoshan, Orit O; Halenar, Michael J; Teng, Yun; Zhu, Jingsan; Volpp, Kevin G

    2009-07-01

    Improving patient safety was a strong motivation behind duty hour regulations implemented by Accreditation Council for Graduate Medical Education on July 1, 2003. We investigated whether rates of patient safety indicators (PSIs) changed after these reforms. Observational study of patients admitted to Veterans Health Administration (VA) (N = 826,047) and Medicare (N = 13,367,273) acute-care hospitals from July 1, 2000 to June 30, 2005. We examined changes in patient safety events in more versus less teaching-intensive hospitals before (2000-2003) and after (2003-2005) duty hour reform, using conditional logistic regression, adjusting for patient age, gender, comorbidities, secular trends, baseline severity, and hospital site. Ten PSIs were aggregated into 3 composite measures based on factor analyses: "Continuity of Care," "Technical Care," and "Other" composites. Continuity of Care composite rates showed no significant changes postreform in hospitals of different teaching intensity in either VA or Medicare. In the VA, there were no significant changes postreform for the technical care composite. In Medicare, the odds of a Technical Care PSI event in more versus less teaching-intensive hospitals in postreform year 1 were 1.12 (95% CI; 1.01-1.25); there were no significant relative changes in postreform year 2. Other composite rates increased in VA in postreform year 2 in more versus less teaching-intensive hospitals (odds ratio, 1.63; 95% CI; 1.10-2.41), but not in Medicare in either postreform year. Duty hour reform had no systematic impact on PSI rates. In the few cases where there were statistically significant increases in the relative odds of developing a PSI, the magnitude of the absolute increases were too small to be clinically meaningful.

  2. Population-specific use of the same tool-assisted alarm call between two wild orangutan populations (Pongo pygmaeus wurmbii indicates functional arbitrariness [corrected].

    Directory of Open Access Journals (Sweden)

    Adriano R Lameira

    Full Text Available Arbitrariness is an elementary feature of human language, yet seldom an object of comparative inquiry. While arbitrary signals for the same function are relatively frequent between animal populations across taxa, the same signal with arbitrary functions is rare and it remains unknown whether, in parallel with human speech, it may involve call production in animals. To investigate this question, we examined a particular orangutan alarm call - the kiss-squeak - and two variants - hand and leaf kiss-squeaks. In Tuanan (Central Kalimantan, Indonesia, the acoustic frequency of unaided kiss-squeaks is negatively related to body size. The modified variants are correlated with perceived threat and are hypothesized to increase the perceived body size of the sender, as the use of a hand or leaves lowers the kiss-squeak's acoustic frequency. We examined the use of these variants in the same context in another orangutan population of the same sub-species and with partially similar habitat at Cabang Panti (West Kalimantan, Indonesia. Identical analyses of data from this site provided similar results for unaided kiss-squeaks but dissimilar results for hand and leaf kiss-squeaks. Unaided kiss-squeaks at Cabang Panti were emitted as commonly and showed the same relationship to body size as in Tuanan. However, at Cabang Panti, hand kiss-squeaks were extremely rare, while leaf-use neither conveyed larger body size nor was related to perceived threat. These findings indicate functional discontinuity between the two sites and therefore imply functional arbitrariness of leaf kiss-squeaks. These results show for the first time the existence of animal signals involving call production with arbitrary function. Our findings are consistent with previous studies arguing that these orangutan call variants are socially learned and reconcile the role of gestures and calls within evolutionary theories based on common ancestry for speech and music.

  3. Uso de próteses na correção cirúrgica das hérnias hiatais Use of prostheses in surgical correction of hiatus hernia

    Directory of Open Access Journals (Sweden)

    Bruno Zilberstein

    2010-12-01

    of the diaphragmatic hiatus. METHODS: Fifteen patients were operated with mean age of 46 years using laparoscopic antireflux surgery, with Prolene® or Dacron® mesh reinforcement of the hiatal crura. The patients were operated under general anesthesia by laparoscopy using five trocars. The average time of surgery was 120 minutes. No deaths occurred. The mean postoperative time was 3.5 days. Patients returned to normal activities around the 10th postoperative day. The mean follow-up was five years. In only two patients, in which were used in a Dacron® mesh, and in another Prolene®, there was migration of the mesh to the esophageal lumen causing dysphagia. CONCLUSION: The mesh use in laparoscopic hiatoplasties is good alternative to close the diaphragmatic defect in large hiatal hernias, correction of reflux esophagitis associated with Barrett's esophagus or hiatal hernia/esophagitis recurrence after surgical correction.

  4. Essential fatty acid deficiency in surgical patients.

    Science.gov (United States)

    O'Neill, J A; Caldwell, M D; Meng, H C

    1977-01-01

    Parenteral nutrition may protect patients unable to eat from malnutrition almost indefinitely. If fat is not also given EFAD will occur. This outlines a prospective study of 28 surgical patients on total intravenous fat-free nutrition to determine the developmental course of EFAD and the response to therapy. Twenty-eight patients ranging from newborn to 66 years receiving parenteral nutrition without fat had regular determinations of the composition of total plasma fatty acids and the triene/tetraene ratio using gas liquid chromatography. Physical signs of EFAD were looked for also. Patients found to have evidence of EFAD were treated with 10% Intralipid. Topical safflower oil was used in three infants. Total plasma fatty acid composition was restudied following therapy. In general, infants on fat-free intravenous nutrition developed biochemical EFAD within two weeks, but dermatitis took longer to become evident. Older individuals took over four weeks to develop a diagnostic triene/tetraene ratio (greater than 0.4; range 0.4 to 3.75). Therapeutic correction of biochemical EFAD took 7 to 10 days but dermatitis took longer to correct. Cutaneous application of safflower oil alleviated the cutaneous manifestations but did not correct the triene/tetraene ratio of total plasma fatty acids. These studies indicate that surgical patients who are unable to eat for two to four weeks, depending upon age and expected fat stores, should receive fat as a part of their intravenous regimen. Images Fig. 7. PMID:404973

  5. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... misalignment of jaws and teeth. Surgery can improve chewing, speaking and breathing. While the patient's appearance may ... indicate the need for corrective jaw surgery: Difficulty chewing, or biting food Difficulty swallowing Chronic jaw or ...

  6. Surgical competence.

    Science.gov (United States)

    Patil, Nivritti G; Cheng, Stephen W K; Wong, John

    2003-08-01

    Recent high-profile cases have heightened the need for a formal structure to monitor achievement and maintenance of surgical competence. Logbooks, morbidity and mortality meetings, videos and direct observation of operations using a checklist, motion analysis devices, and virtual reality simulators are effective tools for teaching and evaluating surgical skills. As the operating theater is also a place for training, there must be protocols and guidelines, including mandatory standards for supervision, to ensure that patient care is not compromised. Patients appreciate frank communication and honesty from surgeons regarding their expertise and level of competence. To ensure that surgical competence is maintained and keeps pace with technologic advances, professional registration bodies have been promoting programs for recertification. They evaluate performance in practice, professional standing, and commitment to ongoing education.

  7. Publisher Correction

    DEFF Research Database (Denmark)

    Turcot, Valérie; Lu, Yingchang; Highland, Heather M

    2018-01-01

    In the published version of this paper, the name of author Emanuele Di Angelantonio was misspelled. This error has now been corrected in the HTML and PDF versions of the article.......In the published version of this paper, the name of author Emanuele Di Angelantonio was misspelled. This error has now been corrected in the HTML and PDF versions of the article....

  8. Author Correction

    DEFF Research Database (Denmark)

    Grundle, D S; Löscher, C R; Krahmann, G

    2018-01-01

    A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper.......A correction to this article has been published and is linked from the HTML and PDF versions of this paper. The error has not been fixed in the paper....

  9. A Modified Translaminar Osseous Channel-Assisted Percutaneous Endoscopic Lumbar Discectomy for Highly Migrated and Sequestrated Disc Herniations of the Upper Lumbar: Clinical Outcomes, Surgical Indications, and Technical Considerations

    Directory of Open Access Journals (Sweden)

    Zhijun Xin

    2017-01-01

    Full Text Available Objective is to describe a safe and effective percutaneous endoscopic approach for removal of highly migrated and sequestrated disc herniations of the upper lumbar spine and to report the results, surgical indications, and technical considerations of the new technique. Eleven patients who had highly migrated and sequestrated disc herniations in the upper lumbar were included in this study. A retrospective study was performed for all patients after translaminar osseous channel-assisted PELD was performed. Radiologic findings were investigated, and pre-and postoperative visual analog scale (VAS assessments for back and leg pain and Oswestry disability index (ODI evaluations were performed. Surgical outcomes were evaluated under modified MacNab criteria. All of the patients were followed for more than 1 year. The preoperative and postoperative radiologic findings revealed that the decompression of the herniated nucleus pulposus (HNP was complete. After surgery, the mean VAS scores for back and leg pain immediately improved from 8.64 (range, 7–10 and 8.00 (range, 6–10 to 2.91 (range, 2–4 and 2.27 (range, 1–3, respectively. The mean preoperative ODI was 65.58 (range, 52.2–86, which decreased to 7.51 (range, 1.8–18 at the 12-month postoperative follow-up. The MacNab scores at the final follow-up included nine excellent, one good, and one fair. The modified translaminar osseous channel-assisted PELD could be a safe and effective option for the treatment of highly migrated and sequestrated disc herniations of the upper lumbar.

  10. Biopsia de la arteria temporal: revisión de indicaciones y técnica quirúrgica para cirujanos plásticos Temporal artery biopsy: review of indications and surgical technique for plastic surgeons

    Directory of Open Access Journals (Sweden)

    A. Rodríguez Lorenzo

    2007-06-01

    Full Text Available La arteritis de células gigantes (ACG es una vasculitis que presenta complicaciones graves si no es diagnosticada y tratada precozmente con corticoides a altas dosis. La biopsia de la arteria temporal (BAT es la técnica diagnóstica estandarizada utilizada para confirmar la enfermedad. Se trata de una técnica sencilla y con poca morbilidad. No obstante, en la actualidad existe una controversia sobre su indicación en pacientes con sospecha clínica de arteritis sin síntomas craneales debido a la baja tasa de positividad de la biopsia. Presentamos en este trabajo una serie de 28 pacientes en los que se realizaron 30 BAT con el objetivo de revisar las indicaciones y describir la técnica quirúrgica utilizada.Giant cell arteritis is a vasculitis that presents serious complications if it is not diagnosed and treated prematurely with corticosteroids to high dose. The temporal artery biopsy is the gold estandar technique of diagnosis used to confirm the disease. It is a simple technique with little morbidity. Nevertheless, currently there is a controversy on its indication in patients with clinical suspicion of arteritis without craneal symptoms because of the downward rate of positiveness of the biopsy. We present in this work a serie of 28 patients in which 30 biopsies were carried out with the objective to review the indications and to describe the surgical technique utilized.

  11. Surgical treatment of gross posttraumatic deformations in thoracic spine

    Directory of Open Access Journals (Sweden)

    Aleksei E. Shul’ga

    2017-10-01

    Full Text Available Rigid severe post-traumatic thoracic spine deformities result from frequent, recent high-energy trauma in children with an increasing frequency due to a variety of reasons. These types of injuries are commonly followed by spinal cord anatomic injury; therefore, the treatment of these patients warrants special attention from the ethical viewpoint. Generally, the only indication for surgical intervention is spinal dysfunction. Considering this and the patients’ ordinary severe somatic state, surgical trauma should be minimized as much as possible. However, for adequate deformity correction, effective spine stabilization and restoration of liquorodynamics is necessary. Recent studies have reported the successful use of different methods of dorsal interventions (P/VCR in cases with unstable damages in children. Here, we present the case of a 15-year-old boy who underwent surgical treatment for coarse post-traumatic thoracic spine deformity with chronic fracture-dislocation of Th7 vertebra.

  12. A projective surgical navigation system for cancer resection

    Science.gov (United States)

    Gan, Qi; Shao, Pengfei; Wang, Dong; Ye, Jian; Zhang, Zeshu; Wang, Xinrui; Xu, Ronald

    2016-03-01

    Near infrared (NIR) fluorescence imaging technique can provide precise and real-time information about tumor location during a cancer resection surgery. However, many intraoperative fluorescence imaging systems are based on wearable devices or stand-alone displays, leading to distraction of the surgeons and suboptimal outcome. To overcome these limitations, we design a projective fluorescence imaging system for surgical navigation. The system consists of a LED excitation light source, a monochromatic CCD camera, a host computer, a mini projector and a CMOS camera. A software program is written by C++ to call OpenCV functions for calibrating and correcting fluorescence images captured by the CCD camera upon excitation illumination of the LED source. The images are projected back to the surgical field by the mini projector. Imaging performance of this projective navigation system is characterized in a tumor simulating phantom. Image-guided surgical resection is demonstrated in an ex-vivo chicken tissue model. In all the experiments, the projected images by the projector match well with the locations of fluorescence emission. Our experimental results indicate that the proposed projective navigation system can be a powerful tool for pre-operative surgical planning, intraoperative surgical guidance, and postoperative assessment of surgical outcome. We have integrated the optoelectronic elements into a compact and miniaturized system in preparation for further clinical validation.

  13. Surgical Instrument

    NARCIS (Netherlands)

    Dankelman, J.; Horeman, T.

    2009-01-01

    The present invention relates to a surgical instrument for minimall-invasive surgery, comprising a handle, a shaft and an actuating part, characterised by a gastight cover surrounding the shaft, wherein the cover is provided with a coupler that has a feed- through opening with a loskable seal,

  14. Surgical treatment of parastomal hernia

    International Nuclear Information System (INIS)

    Basti, Z.; Mayer, A.

    2013-01-01

    Stoma construction is among standard surgical skills and is performed for many indications. Every stoma means huge impact on quality of life for patients even with great improvement in surgical technique and ostomy devices. All patients are very sensitive to complication of stoma and the most frequent complication is parastomal hernia. Incidence reported in literature is very high and unacceptable, it is 30-70%. Surgical approach is very demanding on technical equipment and experiences of surgeon. Authors focus on each surgical approach for treating this complication weather it´s using mesh or laparoscopic or open approach. (author)

  15. Improvement in remote sensing of low vegetation cover in arid regions by correcting vegetation indices for soil ''noise''; Etude des propriétés spectrales des sols arides appliquée à l'amélioration des indices de végétation obtenus par télédétection

    Energy Technology Data Exchange (ETDEWEB)

    Escadafal, R. [Institut Francais de Recherche Scientifique pour le Developpement en Cooperation, Bondy (France); Huete, A.

    1991-05-23

    The variations of near-infrared red reflectance ratios of ten aridic soil samples were correlated with a ''redness index'' computed from red and green spectral bands. These variations have been shown to limit the performances of vegetation indices (NDVI and SAVI) in discriminating low vegetation covers. The redness index is used to adjust for this ''soil noise''. Dala simulated for vegetation densities of 5 to 15% cover showed that the sensitivity of the corrected vegetation indices was significantly improved. Specifically, the ''noise-corrected'' SAVI was able to assess vegetation amounts with an error four times smaller than the uncorrected NDVI. These promising results should lead to a significant improvement in assessing biomass in arid lands from remotely sensed data. (author) [French] Les variations du rapport de la réflectance dans les bandes rouge et infrarouge sont mises en relation avec un (( indice de coloration )) pouf une série de dix sols arides. Ces variations gZnent fortement la détection des faibles taux de couvert végétal avec les indices de végétation (NDVI et SAVI) calculés à partir de ces deux bandes. Il est proposé d’utiliser l’indice de coloration comme facteur de correction de ce (( bruit )) dû au sol. Une simulation de la reflectance des sols avec une couverture végétale variant de O à 15 % en évidence un doublement de la sensibilité des indices de végétation ainsi corrigés. En particulier, le SAVI corrigé permet d’estimer le taux de végétation avec une erreur quatre fois inférieure à celle du NDVI non corrigé. Ces premiers résultats devraient conduire à une amélioration sensible de la mesure de la biomasse végétale des régions arides par télédétection. (author)

  16. Acute surgical unit: The consultant experience

    Directory of Open Access Journals (Sweden)

    Patrick J Stokes

    2016-07-01

    Full Text Available Background Establishment of the Acute Surgical Unit (ASU has redefined the approach to emergency surgery in Australia with quantitative data showing improvement in patient outcomes. However, as qualitative data regarding the ASU remains scarce, we sought to determine the impact of the ASU on overall surgeon job satisfaction. Aims The aim of this paper was to specifically address the impact of the ASU on consultant surgeons overall job satisfaction. Methods We designed a 34 – item questionnaire with consultant general surgeons addressing important aspects of the ASU. Themes included on – call rostering and workload, academic pursuits, surgical training, work – life balance and overall job satisfaction. Results We received responses from 88 surgeons currently working on ASU units, responding correctly and in full to the survey. Overall, our surveyed cohort reported better on – call rostering, improved surgical training and higher levels of job satisfaction and overall work – life balance with ASU implementation. Conclusion Preliminary qualitative results indicate that the ASU may improve on – call rostering, work – life balance and overall job satisfaction.

  17. [Surgical therapy of gynecomastia].

    Science.gov (United States)

    Heckmann, A; Leclère, F M; Vogt, P M; Steiert, A

    2011-09-01

    Nowadays surgical intervention is an essential part of the treatment of idiopathic gynecomastia. Choosing the right method is crucial and is based on the current status in the clinical and histological evaluation. Before finalizing the process of choosing a specific method a prior interdisciplinary evaluation of the patient is necessary to ascertain clear indications for a surgical intervention. Liposuction is one of the methods which have become popular in recent years. The advantages are the possible combination with traditional techniques, such as subcutaneous mastectomy or periareolar mastopexy. The main indication is for gynecomastia stage IIa/b and is justifiable due to the reduction in surgical complications and scarring. Furthermore this technique provides an excellent aesthetical outcome for the patient. A total of 162 patients suffering from gynecomastia stages I-III (according to Simon) were surgically treated between 2000 and 2010 and these cases were retrospectively evaluated. The results showed a decline in the use of a T-shaped incision in combination with subcutaneous mastectomy with periareolar tightening compared to an increase in the use of subcutaneous mastectomy in combination with liposuction. The excised tissue should always be sent for histological examination to make sure no malignant cells were present.

  18. Publisher Correction

    DEFF Research Database (Denmark)

    Stokholm, Jakob; Blaser, Martin J.; Thorsen, Jonathan

    2018-01-01

    The originally published version of this Article contained an incorrect version of Figure 3 that was introduced following peer review and inadvertently not corrected during the production process. Both versions contain the same set of abundance data, but the incorrect version has the children...

  19. Publisher Correction

    DEFF Research Database (Denmark)

    Flachsbart, Friederike; Dose, Janina; Gentschew, Liljana

    2018-01-01

    The original version of this Article contained an error in the spelling of the author Robert Häsler, which was incorrectly given as Robert Häesler. This has now been corrected in both the PDF and HTML versions of the Article....

  20. Correction to

    DEFF Research Database (Denmark)

    Roehle, Robert; Wieske, Viktoria; Schuetz, Georg M

    2018-01-01

    The original version of this article, published on 19 March 2018, unfortunately contained a mistake. The following correction has therefore been made in the original: The names of the authors Philipp A. Kaufmann, Ronny Ralf Buechel and Bernhard A. Herzog were presented incorrectly....

  1. Surgical treatment for residual or recurrent strabismus

    Directory of Open Access Journals (Sweden)

    Tao Wang

    2014-12-01

    Full Text Available Although the surgical treatment is a relatively effective and predictable method for correcting residual or recurrent strabismus, such as posterior fixation sutures, medial rectus marginal myotomy, unilateral or bilateral rectus re-recession and resection, unilateral lateral rectus recession and adjustable suture, no standard protocol is established for the surgical style. Different surgical approaches have been recommended for correcting residual or recurrent strabismus. The choice of the surgical procedure depends on the former operation pattern and the surgical dosages applied on the patients, residual or recurrent angle of deviation and the operator''s preference and experience. This review attempts to outline recent publications and current opinion in the management of residual or recurrent esotropia and exotropia.

  2. Errors and complications in surgical treatment of non-stable equino-plano-valgus foot deformity in patients with cerebral palsy, with use of the calcaneus correcting osteotomy technique

    Directory of Open Access Journals (Sweden)

    Valery V. Umnov

    2017-03-01

    Full Text Available Aims. To examine the results of treatment for patients with a non-stable form of equino-plano-valgus foot deformity in cerebral palsy with the use of corrective osteotomy of the calcaneus. To further analyze the errors and complications that occurred in patients treated with this technique. Materials and methods. From 2006 to 2014, 64 patients (103 feet aged 3 to 17 years were operated using the described method of calcaneus correcting osteotomy. The equinus contracture was eliminated by transection of the gastrocnemius muscle tendon and extending achilloplastic surgery. The abnormal muscle tone was reduced either by administering the drug Dysport into the gastrocnemius muscle or by selective neurotomy of the tibial nerve. Results. The analysis revealed that there were good results for 75%, satisfactory results for 18%, and unacceptable results for 7% of patients. The unacceptable results of treatment were due to several technical and tactical errors, which were grouped and analyzed. Conclusion. The analysis of errors and complications of calcaneus corrective osteotomy for patients with cerebral palsy with a mobile form of talipes equinoplanovalgus will enable their future avoidance and improvement of the treatment quality.

  3. ERRORS AND COMPLICATIONS IN SURGICAL TREATMENT OF NON-STABLE EQUINO-PLANO-VALGUS FOOT DEFORMITY IN PATIENTS WITH CEREBRAL PALSY, WITH USE OF THE CALCANEUS CORRECTING OSTEOTOMY TECHNIQUE

    Directory of Open Access Journals (Sweden)

    Valery V. Umnov

    2017-03-01

    Full Text Available Aims. To examine the results of treatment for patients with a non-stable form of equino-plano-valgus foot deformity in cerebral palsy with the use of corrective osteotomy of the calcaneus. To further analyze the errors and complications that occurred in patients treated with this technique. Materials and methods. From 2006 to 2014, 64 patients (103 feet aged 3 to 17 years were operated using the described method of calcaneus correcting osteotomy. The equinus contracture was eliminated by transection of the gastrocnemius muscle tendon and extending achilloplastic surgery. The abnormal muscle tone was reduced either by administering the drug Dysport into the gastrocnemius muscle or by selective neurotomy of the tibial nerve. Results. The analysis revealed that there were good results for 75%, satisfactory results for 18%, and unacceptable results for 7% of patients. The unacceptable results of treatment were due to several technical and tactical errors, which were grouped and analyzed. Conclusion. The analysis of errors and complications of calcaneus corrective osteotomy for patients with cerebral palsy with a mobile form of talipes equinoplanovalgus will enable their future avoidance and improvement of the treatment quality.

  4. Innovation in prediction planning for anterior open bite correction.

    Science.gov (United States)

    Almuzian, Mohammed; Almukhtar, Anas; O'Neil, Michael; Benington, Philip; Al Anezi, Thamer; Ayoub, Ashraf

    2015-05-01

    This study applies recent advances in 3D virtual imaging for application in the prediction planning of dentofacial deformities. Stereo-photogrammetry has been used to create virtual and physical models, which are creatively combined in planning the surgical correction of anterior open bite. The application of these novel methods is demonstrated through the surgical correction of a case.

  5. [da Vinci surgical system].

    Science.gov (United States)

    Watanabe, Gou; Ishikawa, Norihiro

    2014-07-01

    The da Vinci surgical system was developed by Intuitive Surgical Inc. in the United States as an endoscopic surgical device to assist remote control surgeries. In 1998, the Da Vinci system was first used for cardiothoracic procedures. Currently a combination of robot-assisted internal thoracic artery harvest together with coronary artery bypass grafting (CABG) through a mini-incision (ThoraCAB) or totally endoscopic procedures including anastomoses under robotic assistance (TECAB) are being conducted for the treatment of coronary artery diseases. With the recent advances in catheter interventions, hybrid procedures combining catheter intervention with ThoraCAB or TECAB are anticipated in the future.On the other hand, with the decrease in number of coronary artery bypass surgeries, the share of valvular surgeries is expected to increase in the future. Among them, mitral valvuloplasty for mitral regurgitation is anticipated to be conducted mainly by low-invasive procedures, represented by minimally invasive cardiac surgery( MICS) and robot-assisted surgery. Apart from the intrinsic good surgical view, robotic-assisted systems offer additional advantages of the availability of an amplified view and the easy to observe the mitral valve in the physiological position. Thus, robotic surgical surgeries that make complicated procedures easier are expected to accomplish further developments in the future. Furthermore, while the number of surgeries for atrial septal defects has decreased dramatically following the widespread use of Amplatzer septal occluder, robotic surgery may become a good indication for cases in which the Amplatzer device is not indicated. In Japan, clinical trial of the da Vinci robotic system for heart surgeries has been completed. Statutory approval of the da Vinci system for mitral regurgitation and atrial septal defects is anticipated in the next few years.

  6. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ... out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment of jaws ...

  7. Radiografias em inclinação lateral como fator preditivo da correção cirúrgica na escoliose idiopática do adolescente Bending radiographs as a predictive factor in surgical correction of adolescent idiopathic scoliosis

    Directory of Open Access Journals (Sweden)

    Alberto Ofenhejm Gotfryd

    2011-10-01

    Full Text Available OBJETIVO: Avaliar a utilização de radiografias com inclinação lateral ativa em decúbito dorsal como fator preditivo da correção cirúrgica da curva torácica principal em pacientes com escoliose idiopática do adolescente (EIA. MÉTODOS: Foram avaliados, clínica e radiograficamente, 20 pacientes portadores de EIA tipo Lenke 1A e 1B operados por via posterior, utilizando nas montagens apenas parafusos pediculares. A flexibilidade das curvas foi calculada através de radiografias em inclinação lateral supina ativa. Os valores obtidos no pré-operatório para a curva torácica principal foram incluídos em uma equação matemática proposta por Cheung et al com a finalidade de predizer o resultado angular esperado após a correção cirúrgica. Após isto, foi realizado estudo estatístico de significância entre o valor predito e o real pós-operatório. RESULTADOS: Houve significância estatística para todos os casos estudados em relação ao valor predito pré-operatoriamente e os achados radiográficos do pós-operatório imediato (p OBJECTIVE: To evaluate the use of x-rays in dorsal decubitus, as a predictive factor for surgical correction of the main thoracic curve using pedicle screws, on patients with idiopathic adolescent scoliosis. METHOD: Twenty patients with idiopathic adolescent scoliosis of Lenke types 1A and 1B who were operated using a technique only involving pedicle screws by means of the posterior route were evaluated clinically and radiographically. The curve flexibility was calculated by means of active supine lateral oblique radiographs. The postoperative values for the main thoracic curve were included in a mathematical equation proposed by Cheung et al., with the aim of predicting the expected angular result from the surgical correction. The difference between the expected and actual postoperative results was then investigated regarding its statistical significance. RESULTS: There was statistical significance for

  8. [Indication for mitral valve interventions: Development of a quality indicator for external hospital quality assurance].

    Science.gov (United States)

    Köster, Christina; Schorbach, Lena; Wrede, Stephanie; Meyer, Sven; Kazmaier, Tonia; Szecsenyi, Joachim

    2017-11-01

    The indication for a mitral valve intervention is an important patient-relevant parameter for the assessment of process quality and the comparison of healthcare providers. In this article, we describe the development of a corresponding quality indicator for an external hospital quality assurance (QA) procedure in Germany. An expert panel was set up by the aQua Institute to assist with the development of a QA procedure for mitral valve interventions and the associated quality indicators. In a comprehensive, systematic literature and evidence research, the American and European guidelines were identified as the best evidence available. Especially the more current American guideline formed the basis on which a quality indicator dealing with the correct indication for a mitral valve intervention was developed. The developed quality indicator assesses the proportion of patients for whom an indication for a mitral valve intervention was determined in compliance with guideline recommendations. The indicator differentiates between surgical and catheter-based procedures. To determine whether or not the indication was correct, different medical parameters are included, such as, for example, type of mitral valve defect, etiology of the disease, severity of symptoms, valve morphology (e. g., mitral valve area), valve hemodynamics and comorbidity, which healthcare providers have to document. The documentation for the developed quality indicator is considerable. Nonetheless, its relevance is undeniable because it allows the user to determine whether a surgical or catheter-based mitral valve intervention was necessary and performed according to guideline recommendations. In the first year of its implementation, this indicator should be evaluated for further improvement and simplification of assessment. Copyright © 2017. Published by Elsevier GmbH.

  9. Electroweak corrections

    International Nuclear Information System (INIS)

    Beenakker, W.J.P.

    1989-01-01

    The prospect of high accuracy measurements investigating the weak interactions, which are expected to take place at the electron-positron storage ring LEP at CERN and the linear collider SCL at SLAC, offers the possibility to study also the weak quantum effects. In order to distinguish if the measured weak quantum effects lie within the margins set by the standard model and those bearing traces of new physics one had to go beyond the lowest order and also include electroweak radiative corrections (EWRC) in theoretical calculations. These higher-order corrections also can offer the possibility of getting information about two particles present in the Glashow-Salam-Weinberg model (GSW), but not discovered up till now, the top quark and the Higgs boson. In ch. 2 the GSW standard model of electroweak interactions is described. In ch. 3 some special techniques are described for determination of integrals which are responsible for numerical instabilities caused by large canceling terms encountered in the calculation of EWRC effects, and methods necessary to get hold of the extensive algebra typical for EWRC. In ch. 4 various aspects related to EWRC effects are discussed, in particular the dependence of the unknown model parameters which are the masses of the top quark and the Higgs boson. The processes which are discussed are production of heavy fermions from electron-positron annihilation and those of the fermionic decay of the Z gauge boson. (H.W.). 106 refs.; 30 figs.; 6 tabs.; schemes

  10. Evaluation of speech after correction of rhinophonia with pushback palatoplasty combined with pharyngeal flap.

    Science.gov (United States)

    Dixon, V L; Bzoch, K R; Habal, M B

    1979-07-01

    A comparison is made of the preoperative and postoperative speech evaluations of 15 selected subjects who had pharyngeal flap operations combined with palatal pushback. Postoperatively, 13 of the 15 patients (86 percent) showed no abnormal nasal emission and no evidence of significant hypernasality during word production. Gross substitution errors were also corrected by the surgical repair. While the number of patients is small, this study indicates equal effectiveness of the surgical technique described--regardless of the sex, the medical diagnosis, whether the procedure was primary or secondary, or the amount of postoperative time--providing there is good function of the muscles of the soft palate.

  11. Efficacy of anchoring the four-arm transvaginal mesh to the mid-urethra vs original surgery as a surgical correction for stress urine incontinence in coexisting anterior vaginal prolapse grades II and III: study protocol for a randomized controlled trial.

    Science.gov (United States)

    Fekete, Zoltán; Surányi, Andrea; Rénes, Lórand; Németh, Gábor; Kozinszky, Zoltan

    2017-12-28

    The prevalence of obesity with aging is escalating alarmingly; and pelvic organ prolapse (POP) and stress urinary incontinence (SUI) are now becoming a growing epidemic among the elderly. Synthetic transvaginal mesh has been employed with increasing popularity in the treatment of POP and is usually highly effective in controlling the principal symptoms of prolapse. However, studies have reported that mesh operations provide fairly unfavorable SUI cure rates. Therefore, additional anti-incontinence surgical strategies are increasingly being scrutinized to achieve better postoperative continence without any significant side-effects for patients with both POP and SUI. We hypothesize that the modification with the fixing of the mesh to the mid-urethra is superior to the original transvaginal mesh operation (TVM) with regard to anti-incontinence. One hundred and thirty patients diagnosed with POP-Q II-III and concomitant SUI requiring surgical treatment will be included in this prospective, randomized, double-blind, controlled clinical trial. Patients will be randomly allocated to receive either original TVM (TVM group, n = 65) or modified TVM surgery (mTVM group, n = 65). As the primary outcome parameter, we will evaluate the objective SUI and POP cure rates. Secondary endpoints include postoperative morbidity as assessed with the International Urogynaecological Association classification and subjective prolapse and incontinence cure rates reported by questionnaires. Recognizing the importance of an additional surgical procedure for anti-incontinence management, we aim to investigate whether a stabilizing suturing of the mesh to the mid-urethra delivers superior SUI correction compared to the original prosthesis surgery. ClinicalTrials.gov, NCT02935803. Registered on 20 May 2016.

  12. Surgical Management of Localized Scleroderma.

    Science.gov (United States)

    Lee, Jae Hyun; Lim, Soo Yeon; Lee, Jang Hyun; Ahn, Hee Chang

    2017-09-01

    Localized scleroderma is characterized by a thickening of the skin from excessive collagen deposits. It is not a fatal disease, but quality of life can be adversely affected due to changes in skin appearance, joint contractures, and, rarely, serious deformities of the face and extremities. We present six cases of localized scleroderma in face from our surgical practice. We reviewed six localized scleroderma cases that were initially treated with medication and then received follow-up surgery between April 2003 and February 2015. Six patients had facial lesions. These cases presented with linear dermal sclerosis on the forehead, oval subcutaneous and dermal depression in the cheek. En coup de sabre (n=4), and oval-shaped lesion of the face (n=2) were successfully treated. Surgical methods included resection with or without Z-plasty (n=3), fat graft (n=1), dermofat graft (n=1), and adipofascial free flap (n=1). Deformities of the affected parts were surgically corrected without reoccurrence. We retrospectively reviewed six cases of localized scleroderma that were successfully treated with surgery. And we propose an algorithm for selecting the best surgical approach for individual localized scleroderma cases. Although our cases were limited in number and long-term follow-up will be necessary, we suggest that surgical management should be considered as an option for treating scleroderma patients.

  13. Indications for spine surgery: validation of an administrative coding algorithm to classify degenerative diagnoses

    Science.gov (United States)

    Lurie, Jon D.; Tosteson, Anna N.A.; Deyo, Richard A.; Tosteson, Tor; Weinstein, James; Mirza, Sohail K.

    2014-01-01

    Study Design Retrospective analysis of Medicare claims linked to a multi-center clinical trial. Objective The Spine Patient Outcomes Research Trial (SPORT) provided a unique opportunity to examine the validity of a claims-based algorithm for grouping patients by surgical indication. SPORT enrolled patients for lumbar disc herniation, spinal stenosis, and degenerative spondylolisthesis. We compared the surgical indication derived from Medicare claims to that provided by SPORT surgeons, the “gold standard”. Summary of Background Data Administrative data are frequently used to report procedure rates, surgical safety outcomes, and costs in the management of spinal surgery. However, the accuracy of using diagnosis codes to classify patients by surgical indication has not been examined. Methods Medicare claims were link to beneficiaries enrolled in SPORT. The sensitivity and specificity of three claims-based approaches to group patients based on surgical indications were examined: 1) using the first listed diagnosis; 2) using all diagnoses independently; and 3) using a diagnosis hierarchy based on the support for fusion surgery. Results Medicare claims were obtained from 376 SPORT participants, including 21 with disc herniation, 183 with spinal stenosis, and 172 with degenerative spondylolisthesis. The hierarchical coding algorithm was the most accurate approach for classifying patients by surgical indication, with sensitivities of 76.2%, 88.1%, and 84.3% for disc herniation, spinal stenosis, and degenerative spondylolisthesis cohorts, respectively. The specificity was 98.3% for disc herniation, 83.2% for spinal stenosis, and 90.7% for degenerative spondylolisthesis. Misclassifications were primarily due to codes attributing more complex pathology to the case. Conclusion Standardized approaches for using claims data to accurately group patients by surgical indications has widespread interest. We found that a hierarchical coding approach correctly classified over 90

  14. A new plastic surgical technique for adult congenital webbed penis

    Science.gov (United States)

    Chen, Yue-bing; Ding, Xian-fan; Luo, Chong; Yu, Shi-cheng; Yu, Yan-lan; Chen, Bi-de; Zhang, Zhi-gen; Li, Gong-hui

    2012-01-01

    Objective: To introduce a novel surgical technique for correction of adult congenital webbed penis. Methods: From March 2010 to December 2011, 12 patients (age range: 14–23 years old) were diagnosed as having a webbed penis and underwent a new surgical procedure designed by us. Results: All cases were treated successfully without severe complication. The operation time ranged from 20 min to 1 h. The average bleeding volume was less than 50 ml. All patients achieved satisfactory cosmetic results after surgery. The penile curvature disappeared in all cases and all patients remained well after 1 to 3 months of follow-up. Conclusions: Adult webbed penis with complaints of discomfort or psychological pressure due to a poor profile should be indicators for surgery. Good corrective surgery should expose the glans and coronal sulcus, match the penile skin length to the penile shaft length dorsally and ventrally, and provide a normal penoscrotal junction. Our new technique is a safe and effective method for the correction of adult webbed penis, which produces satisfactory results. PMID:22949367

  15. Surgical options after Fontan failure

    DEFF Research Database (Denmark)

    van Melle, Joost P; Wolff, Djoeke; Hörer, Jürgen

    2016-01-01

    by the European Congenital Heart Surgeons Association among 22 member centres. Outcome of surgery to address failing Fontan was collected in 225 patients among which were patients with Fontan takedown (n=38; 17%), Fontan conversion (n=137; 61%) or HTX (n=50; 22%). RESULTS: The most prevalent indication...... for failing Fontan surgery was arrhythmia (43.6%), but indications differed across the surgical groups (p...OBJECTIVE: The objective of this European multicenter study was to report surgical outcomes of Fontan takedown, Fontan conversion and heart transplantation (HTX) for failing Fontan patients in terms of all-cause mortality and (re-)HTX. METHODS: A retrospective international study was conducted...

  16. [Corrected count].

    Science.gov (United States)

    1991-11-27

    The data of the 1991 census indicated that the population count of Brazil fell short of a former estimate by 3 million people. The population reached 150 million people with an annual increase of 2%, while projections in the previous decade expected an increase of 2.48% to 153 million people. This reduction indicates more widespread use of family planning (FP) and control of fertility among families of lower social status as more information is being provided to them. However, the Ministry of Health ordered an investigation of foreign family planning organizations because it was suspected that women were forced to undergo tubal ligation during vaccination campaigns. A strange alliance of left wing politicians and the Roman Catholic Church alleges a conspiracy of international FP organizations receiving foreign funds. The FP strategies of Bemfam and Pro-Pater offer women who have little alternative the opportunity to undergo tubal ligation or to receive oral contraceptives to control fertility. The ongoing government program of distributing booklets on FP is feeble and is not backed up by an education campaign. Charges of foreign interference are leveled while the government hypocritically ignores the grave problem of 4 million abortions a year. The population is expected to continue to grow until the year 2040 and then to stabilize at a low growth rate of .4%. In 1980, the number of children per woman was 4.4 whereas the 1991 census figures indicate this has dropped to 3.5. The excess population is associated with poverty and a forsaken caste in the interior. The population actually has decreased in the interior and in cities with 15,000 people. The phenomenon of the drop of fertility associated with rural exodus is contrasted with cities and villages where the population is 20% less than expected.

  17. Estudo randomizado de correção cirúrgica de fibrilação atrial permanente: resultados parciais Randomized study of surgical correction of permanent atrial fibrillation: preliminary results

    Directory of Open Access Journals (Sweden)

    Álvaro Albrecht

    2004-09-01

    .5% of sinus rhythm was seen detected at discharge and 84.6% at the end of follow-up. In the Control group 87.5% of the patients have atrial fibrillation at discharge and after follow-up atrial fibrillation remained at 56.3% of the patients. There was no difference in the NYHA class between the groups after follow-up (p=0.56 and Control group patients had more complications (p=0.017. CONCLUSION: These results show that both techniques, the Maze and Isolation of Pulmonary Veins, have advantages over simple correction of cardiac lesions when associated to atrial fibrillation.

  18. Surgical management of hyperthyroidism.

    Science.gov (United States)

    Quérat, C; Germain, N; Dumollard, J-M; Estour, B; Peoc'h, M; Prades, J-M

    2015-04-01

    Hyperthyroidism includes several clinical and histopathological situations. Surgery is commonly indicated after failure of medical treatment. The aim of this study was to analyze the indications and complications of surgery as well as endocrine results. Patients operated on for hyperthyroidism between 2004 and 2012 were included in a retrospective study. Total thyroidectomy was performed for Graves' disease, toxic multinodular goiter and amiodarone-associated thyrotoxicosis; patients with toxic nodule underwent hemithyroidectomy. Pathologic analysis assessed surgical specimens; postoperative complications and resolution of hyperthyroidism were noted. Two hundred patients from 15 to 83 years old were included. One hundred and eighty-eight underwent primary surgery and 12 were re-operated for recurrent goiter (6 with subtotal thyroidectomy for multinodular goiter 25 years previously; 6 with hemithyroidectomy for solitary nodule 15 years previously). Eighty-two patients suffered from toxic multinodular goiter, 78 from Graves' disease, 35 from solitary toxic nodules and 5 from amiodarone-associated thyrotoxicosis. Fourteen papillary carcinomas (including 11 papillary microcarcinomas) and 34 healthy parathyroid glands (17%) were identified in the pathological specimens. Postoperative complications comprised 4% permanent recurrent laryngeal nerve palsy (1 year follow-up), 9% hematoma requiring surgical revision, and 3% definitive hypocalcemia. Normalization of thyroid hormone levels was observed in 198 patients. Two recurrences occurred due to incomplete resection (1 case of Graves' disease and 1 intrathoracic toxic goiter that occurred respectively 18 and 5 months after resection). Postoperative complications were more frequent in multinodular goiter (23%) than in Graves' disease (13%) (ns: P>0.05). Surgical management of hyperthyroidism enables good endocrinal control if surgery is complete. Patients need to be fully informed of all possible postoperative complications

  19. Resultados imediatos e tardios da correção do aneurisma do ventrículo esquerdo Early and late results of surgical correction of left ventricle aneurysms

    Directory of Open Access Journals (Sweden)

    Jarbas J Dinkhuysen

    1993-09-01

    e de 34,3% no Grupo Ruim. Obtiveram alta hospitalar 286 (93,8% pacientes, dos quais 44,3% se encontram assintomáticos (Grupo Bom 60%, Grupo Regular 40%, Grupo Ruim 57,1%. Ocorreram 7,6% óbitos tardios, distribuídos no Grupo Bom 4,8%, Grupo Regular 7,4% e Grupo Ruim 23,8%. Analisando as curvas atuariais numa evolução até 8,5 anos, os autores concluem que a expectativa de vida para os portadores de aneurisma, de VE que se submetem a tratamento cirúrgico, com ou sem procedimentos associados, é de 85,5% com Fe = 0,58; 87,7% com Fe = 0,35 e 59,3% com Fe = 0,22.We revewed 305 cases with left ventricular aneurysms undertaken to surgery from January 84 to December 91 analising early results since the late follow-up that ranged from 8 months to 8.5 years, and included all patients discharged alive from hospital. There were 88.5% male, with age ranging from 33 to 78 years (46% of patients between 51 to 60 years. The most frequent clinical finding was chest pain (73.3%, followed byheartfailure (45.9%, arrhythmias (24.9%. Fifty four percent of the patients were in functional class 1,5.2% in II, 12.7% in III and 28.7% in class IV. Left ventricular angiogram showed aneurysms and diskinesis in all cases, and coronary angiography showed single vessel coronary artery disease (CAD in 20.9%, 2 vessel CAD in 45.9%, 3 vessel CAD in 25.9% and 4 or more vessels CAD in 7.2%. Patients were divided in groups according to left ventricular wall motion of the non aneurysmatic areas. There was 34.7% in the good group (mean wall motion = 0.58, 54.7% in the regular group (mean wall motion = 0.35 and 10.4% in the bad group (mean wall motion = 0.22. The used surgical technique included the observation of the beating heart under bypass auxiliary. This aided the differentation of fibrostic and contracting areas. This also allowed better preservation of the physiology of the myocardium during the procedure. In selected cases after opening the aneurysm and removing thrombus, coronaries were

  20. Surgical approach in patients with hyperparathyroidism in multiple endocrine neoplasia type 1: total versus partial parathyroidectomy

    Directory of Open Access Journals (Sweden)

    Francesco Tonelli

    2012-01-01

    Full Text Available Usually, primary hyperparathyroidism is the first endocrinopathy to be diagnosed in patients with multiple endocrine neoplasia type 1, and is also the most common one. The timing of the surgery and strategy in multiple endocrine neoplasia type 1/hyperparathyroidism are still under debate. The aims of surgery are to: 1 correct hypercalcemia, thus preventing persistent or recurrent hyperparathyroidism; 2 avoid persistent hypoparathyroidism; and 3 facilitate the surgical treatment of possible recurrences. Currently, two types of surgical approach are indicated: 1 subtotal parathyroidectomy with removal of at least 3-3 K glands; and 2 total parathyroidectomy with grafting of autologous parathyroid tissue. Transcervical thymectomy must be performed with both of these procedures. Unsuccessful surgical treatment of hyperparathyroidism is more frequently observed in multiple endocrine neoplasia type 1 than in sporadic hyperparathyroidism. The recurrence rate is strongly influenced by: 1 the lack of a pre-operative multiple endocrine neoplasia type 1 diagnosis; 2 the surgeon's experience; 3 the timing of surgery; 4 the possibility of performing intra-operative confirmation (histologic examination, rapid parathyroid hormone assay of the curative potential of the surgical procedure; and, 5 the surgical strategy. Persistent hyperparathyroidism seems to be more frequent after subtotal parathyroidectomy than after total parathyroidectomy with autologous graft of parathyroid tissue. Conversely, recurrent hyperparathyroidism has a similar frequency in the two surgical strategies. To plan further operations, it is very helpful to know all the available data about previous surgery and to undertake accurate identification of the site of recurrence.

  1. Surgical treatment of gynecomastia: complications and outcomes.

    Science.gov (United States)

    Li, Chun-Chang; Fu, Ju-Peng; Chang, Shun-Cheng; Chen, Tim-Mo; Chen, Shyi-Gen

    2012-11-01

    Gynecomastia is defined as the benign enlargement of the male breast. Multiple surgical options have been used to improve outcomes. The aim of this study was to analyze the surgical approaches to the treatment of gynecomastia and their outcomes over a 10-year period. All patients undergoing surgical correction of gynecomastia in our department between 2000 and 2010 were included for retrospective evaluation. The data were analyzed for etiology, stage of gynecomastia, surgical technique, complications, risk factors, and revision rate. The surgical result was evaluated with self-assessment questionnaires. A total of 41 patients with 75 operations were included. Techniques included subcutaneous mastectomy alone or with additional ultrasound-assisted liposuction (UAL) and isolated UAL. The surgical revision rate for all patients was 4.8%. The skin-sparing procedure gave good surgical results in grade IIb and grade III gynecomastia with low revision and complication rates. The self-assessment report revealed a good level of overall satisfaction and improvement in self-confidence (average scores 9.4 and 9.2, respectively, on a 10-point scale). The treatment of gynecomastia requires an individualized approach. Subcutaneous mastectomy combined with UAL could be used as the first choice for surgical treatment of grade II and III gynecomastia.

  2. Surgical management of contiguous multilevel thoracolumbar tuberculous spondylitis.

    Science.gov (United States)

    Qureshi, Muhammad Asad; Khalique, Ahmed Bilal; Afzal, Waseem; Pasha, Ibrahim Farooq; Aebi, Max

    2013-06-01

    Tuberculous spondylitis (TBS) is the most common form of extra-pulmonary tuberculosis. The mainstay of TBS management is anti-tuberculous chemotherapy. Most of the patients with TBS are treated conservatively; however in some patients surgery is indicated. Most common indications for surgery include neurological deficit, deformity, instability, large abscesses and necrotic tissue mass or inadequate response to anti-tuberculous chemotherapy. The most common form of TBS involves a single motion segment of spine (two adjoining vertebrae and their intervening disc). Sometimes TBS involves more than two adjoining vertebrae, when it is called multilevel TBS. Indications for correct surgical management of multilevel TBS is not clear from literature. We have retrospectively reviewed 87 patients operated in 10 years for multilevel TBS involving the thoracolumbar spine at our spine unit. Two types of surgeries were performed on these patients. In 57 patients, modified Hong Kong operation was performed with radical debridement, strut grafting and anterior instrumentation. In 30 patients this operation was combined with pedicle screw fixation with or without correction of kyphosis by osteotomy. Patients were followed up for correction of kyphosis, improvement in neurological deficit, pain and function. Complications were noted. On long-term follow-up (average 64 months), there was 9.34 % improvement in kyphosis angle in the modified Hong Kong group and 47.58 % improvement in the group with pedicle screw fixation and osteotomy in addition to anterior surgery (p debridement and anterior column reconstruction.

  3. Congenital completely buried penis in boys: anatomical basis and surgical technique.

    Science.gov (United States)

    Liu, Xing; He, Da-wei; Hua, Yi; Zhang, De-ying; Wei, Guang-hui

    2013-07-01

    WHAT'S KNOWN ON THE SUBJECT? AND WHAT DOES THE STUDY ADD?: Surgical correction of the congenital completely buried penis (CCBP) is a difficult challenge and there is no unanimous consensus about the surgical 'gold standard' and patient eligibility for surgery. In the present study, dysgenetic fundiform ligaments were found to be attached to the distal or middle shaft of the penis. This abnormality can be successfully corrected by releasing the fundiform ligament and mobilising the scrotal skin to cover the length of the penile shaft. The study shows that the paucity and traction of the penile skin and an abnormal fundiform ligament are important anatomical defects in CCBP. Dorsal curve and severe shortage of penile skin in erectile conditions are the main indications for surgical correction. To present our experience of anatomical findings for congenital completely buried penis (CCBP), which has no unanimous consensus regarding the 'gold standard' for surgical correction and patient eligibility, by providing our surgical technique and illustrations. Between February 2006 and February 2011, 22 children with a median (range) age of 4.2 (2.5-5.8) years, with CCBP underwent surgical correction by one surgeon. Toilet training and photographs of morning erections by parents were advised before surgery. The abnormal anatomical structure of buried penis during the operation was observed. The technique consisted of the release of the fundiform ligament, fixation of the subcutaneous penile skin at the base of the degloved penis, penoscrotal Z-plasty and mobilisation of the penile and scrotal skin to cover the penile shaft. In reflex erectile conditions, CCBP presents varying degrees of dorsal curve and shortage of penile skin. Dysgenetic fundiform ligaments were found to be attached to the distal or middle shaft of the penis in all patients. All wounds healed well and the cosmetic outcome was good at 6-month follow-up after the repair. The appearance of the dorsal curve in

  4. Surgical practice in a maximum security prison – unique and ...

    African Journals Online (AJOL)

    The practice of general surgery in a prison population differs considerably from that in a general surgical practice. We audited surgical consultations at the Mangaung Correctional Centre from December 2003 to April 2009. We found a high incidence of foreign object ingestion and anal pathology. Understanding the medical ...

  5. Surgical treatment of diplopia in Graves' Orbitopathy patients

    NARCIS (Netherlands)

    Jellema, H.M.

    2016-01-01

    This thesis addresses several aspects of the surgical treatment of diplopia in patients with Graves’ Orbitopathy (GO). We evaluated retrospectively the surgical outcome of different types of surgery on eye muscles to correct the diplopia. Each operated muscle seems to have its own dose-effect

  6. Surgical travellers: tapestry to Bayeux.

    Science.gov (United States)

    Hedley-Whyte, John; Milamed, Debra R

    2014-09-01

    The planning for surgery in war was revisited in 1937 when Ian Fraser was elected a member of the Surgical Travellers. At their 1938 Surgical Travellers meeting in Vienna, Ian and Eleanor Fraser were evicted from their hotel room by the Nazis. The 1939 meeting in Belfast discussed the organization of surgery and the conduct of Emergency Medical Service Hospitals in the United Kingdom; the vast majority were to be under civilian government and military control. From 1943 lengthy and informative organizational meetings were held at least monthly under the chairmanship of Sir Alexander Hood, KBE, Head of the RAMC. Surgical Consultants, now Major Generals, Brigadiers or Full Colonels in the British and U.S. Armies stationed in the UK, prepared for the invasion of Europe. The allocation of medical, surgical, nursing and auxiliary responsibilities was delineated. Liaison with the RAF and US Army Air Force was close as it was with the proposed leaders, Ulstermen Brooke and Montgomery. Montgomery chose Arthur Porritt as Surgeon in Chief to Supreme Headquarters Allied Expeditionary Force (SHAEF), and Eisenhower, General Albert W. Kenner. Just after D-Day, Porritt met Ian Fraser, who had waded in on Arromanches Beach. The triage and evacuation plans for Allied casualties had been controversial, particularly as regards Landing Ship Tanks (LSTs). The dispute with the Hood-selected surgeons on one side, against medical and surgical deployment of LSTs, and Admiral Ernest King and Winston Churchill on the other, favouring LST use for surgery and evacuation. King and Churchill were correct but total Allied air superiority allowed wide use of many of the Allies' Dakotas; 10,000 DC-3s were eventually in service. Supported by forty Allied combat planes to each Luftwaffe, the dispute about Landing Ship Tank use in about a fortnight became moot. The multifaceted role of the Princess Royal in the Emergency Medical Services of the United Kingdom and her close liaison with the Consultant

  7. American Pediatric Surgical Association

    Science.gov (United States)

    American Pediatric Surgical Association Search for: Login Resources + For Members For Professionals For Training Program Directors For Media For ... Surgical Outcomes Surveys & Results Publications Continuing Education + ExPERT Pediatric Surgery NaT Annual Meeting CME MOC Requirements Residents / ...

  8. Abortion - surgical - aftercare

    Science.gov (United States)

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

  9. Urogynecologic Surgical Mesh Implants

    Science.gov (United States)

    ... procedures performed to treat pelvic floor disorders with surgical mesh: Transvaginal mesh to treat POP Transabdominal mesh to treat ... address safety risks Final Order for Reclassification of Surgical Mesh for Transvaginal Pelvic Organ Prolapse Repair Final Order for Effective ...

  10. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Extensive education and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral ... Extensive education and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral ...

  11. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral and maxillofacial ... and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral and maxillofacial ...

  12. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral and maxillofacial surgeon to ... in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral and maxillofacial surgeon to ...

  13. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ...

  14. Corrective Jaw Surgery

    Science.gov (United States)

    ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ... Extractions and Other Oral Surgeries Extractions and Other Oral Surgeries Oral and maxillofacial surgeons surgically treat the soft ...

  15. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... education and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral and ... education and training in surgical procedures involving skin, muscle, bone and cartilage finely attune the oral and ...

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ... to find out more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures ...

  17. Permanent complete heart block following surgical correction of ...

    African Journals Online (AJOL)

    Conclusion: Permanent post-operative complete heart block occurred in 1.3% of patients undergoing VSD repair and 5.5% of those undergoing repair of conotruncal anomalies (Fallot's tetralogy). The dominant anatomic risk factor was a large perimembranous VSD as an isolated defect or as part of a conotruncal anomaly.

  18. surgically correctable adrenal-dependent hyper- tension: a report of ...

    African Journals Online (AJOL)

    DOfori-Adjei

    2007-06-01

    Jun 1, 2007 ... was delayed, no reason was immediately assigned to this. However, at subsequent outpatient reviews her surgeons noted that she had cushingoid facies and hypertension. Further tests requested con- firmed glycosuria, hyperglycaemia and an elevated morning plasma cortisol. Her parents had also no-.

  19. Early versus late surgical correction in congenital diaphragmatic hernia

    Directory of Open Access Journals (Sweden)

    Alexandra Yunes

    2017-11-01

    Full Text Available Resumen INTRODUCCIÓN El momento de la reparación quirúrgica en pacientes con hernia diafragmática congénita ha sido un tema controvertido a lo largo de los años, y aún no existe un acuerdo sobre si es preferible una reparación inmediata o una cirugía tardía con estabilización preoperatoria. MÉTODOS Para responder esta pregunta utilizamos Epistemonikos, la mayor base de datos de revisiones sistemáticas en salud, la cual es mantenida mediante búsquedas en múltiples fuentes de información, incluyendo MEDLINE, EMBASE, Cochrane, entre otras. Extrajimos los datos desde las revisiones identificadas, reanalizamos los datos de los estudios primarios, realizamos un metanálisis, preparamos tablas de resumen de los resultados utilizando el método GRADE. RESULTADOS Y CONCLUSIONES Identificamos cuatro revisiones sistemáticas que en conjunto incluyen 38 estudios primarios, de los cuales, dos son ensayos aleatorizados. Concluimos que no está claro si la reparación quirúrgica inmediata en hernia diafragmática congénita aumenta la mortalidad o disminuye los días de hospitalización en comparación a una reparación tardía porque la certeza de la evidencia es muy baja.

  20. An experimental model for the surgical correction of tracheomalacia.

    Science.gov (United States)

    Shaha, A R; Burnett, C; DiMaio, T; Jaffe, B M

    1991-10-01

    Tracheomalacia may result from large intrathoracic goiters. Due to the chronic compression, particularly within the confines of the thoracic inlet, the tracheal wall weakens, with disintegration of some of the cartilaginous rings. Tracheomalacia can cause acute airway distress, particularly during the post-operative period, and may occasionally result in death. The other major cause of tracheomalacia is related to either prolonged endotracheal intubation or over-inflation of the tracheostomy cuff. While various techniques such as internal stenting, external support devices, tracheostomy, and tracheal resection have been used based on individual circumstances, no one method appears to be perfect. To further study this difficult problem, an experimental model of tracheomalacia was created in eight dogs. Six to seven rings of the tracheal cartilages were dissected submucosally. More than half of the circumference of the tracheal rings was resected. The tracheal walls were reconstructed with polytetrafluoroethylene (PTFE) grafts. The grafts strengthened the tracheal wall without causing luminal constriction. Tracheostomy was not performed on any of the dogs. All dogs tolerated the procedure well and were extubated at the conclusion of the experiment. The dogs were followed for 4 to 6 months and then sacrificed so that the tracheal wall could be examined histologically. There was considerable fibrosis leading to stiff neotrachea. The results of this experimental technique for prosthetic reconstruction to counteract problems simulating tracheomalacia are very encouraging.

  1. SURGICAL ORTHODONTICS: LITERATURE REVIEW AND CASE REPORT

    Directory of Open Access Journals (Sweden)

    Piyush HEDA

    2013-03-01

    Full Text Available Orthognathic surgery is a surgical procedure largely practiced throughout the world for the correction of various maxillofacial deformities. The procedure for correcting a particular deformity will be done after proper evaluation, which includes cephalometric, dental model analysis and photographs. The patient undergoes pre-surgical orthodontic correction for dental compensation, after which surgery is planned. During the last few decades, the profession has witnessed intense interest for the treatment of facial deformities, being widely practiced throughout the world. Orthognathic surgery has become an acceptable treatment plan for patients with various maxillofacial deformities, giving pleasing results. The present study reports the successful treatment method of Class II division 1 malocclusion through orthognathic surgery.

  2. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... and Craniofacial Surgery Cleft Lip/Palate and Craniofacial Surgery A cleft lip may require one or more ... find out more. Corrective Jaw Surgery Corrective Jaw Surgery Orthognathic surgery is performed to correct the misalignment ...

  3. Trochleoplasty: Indications and Technique.

    Science.gov (United States)

    Nolan, John E; Schottel, Patrick C; Endres, Nathan K

    2018-05-09

    Trochlear dysplasia is a well-described risk factor for patellar instability. Trochleoplasty has emerged as a procedure within the surgical armamentarium for patellar instability, yet its role is unclear. A variety of trochleoplasty procedures have emerged. The purpose of this review is to clarify indications for trochleoplasty, outline the technical steps involved in performing common trochleoplasties and report the published outcomes and potential complications of these procedures. Patellar instability with severe trochlear dysplasia is the main indication for trochleoplasty. Three types of trochleoplasty have emerged: (1) lateral facet elevation; (2) sulcus deepening; and (3) recession wedge. Deepening and recession wedge trochleoplasties are the most commonly performed. Trochleoplasty is a surgical option for addressing patellar instability in patients with severe trochlear dysplasia. Deepening and recession wedge trochleoplasties that address Dejour B and D dysplastic trochleas are the most studied, with both short- and midterm outcomes reported. Long-term outcomes are lacking and comparative studies are needed.

  4. Medical and surgical treatment of primary divergent strabismus.

    Science.gov (United States)

    Noguera, H; Castiella Acha, J C; Anguiano Jimenez, M

    2014-11-01

    To evaluate the long-term effectiveness of different therapies applied in the past 30 years, both medical and surgical, and results, with the ultimate aim of determining which are the most appropriate criteria to indicate when and how to perform medical and surgical treatment in these patients. A retrospective randomized study was conducted on 198 patients with primary divergent strabismus first seen in our clinic (IOC) in the last 36 years (1976-2012), with a mean follow-up of 8.38 years. Demographic and clinical characteristics, as well as the various treatments performed, and motor and sensory outcome were collected. They were finally divided into 3 groups of 70, 71 and 56 patients, respectively, according to their first visit, in order to compare the therapies applied. Half (50%) of our patients debuted before 2 years of age (P50=24 months), and 26.3% had optimal binocular vision at the beginning of the study. Medical treatment was used as exclusive therapy in 29.3% of cases (occlusion therapy, applying negative lenses, botulinum toxin), and 70.7% required surgery (61.2% by double retro-insertion of lateral rectus, and 38.8% monolateral retro-resection). There was a recurrence in 26.7% of patients, and 40 re-interventions were performed (70% due to recurrence of divergent strabismus, 12.5% due to surgical over-correction, and 17.5% for other reasons). In the end, 61.1% of patients had perfect binocular vision (TNO=60"), and the proportion was higher in patients who showed proper control of their strabismus at the beginning (P=.003). However, no differences were found in the other variables studied. When the patients were divided into 3 groups (which are demographically comparable), an increased number of patients in Group 3 were found to be treated using negative lenses and botulinum toxin (P<.001 and P=.003). This group was found to have had a higher proportion of bilateral surgery (P=.032), seeking greater immediate postoperative over-correction, thus

  5. Aprotinina não influencia troponina I, NTproBNP e função renal em crianças operadas com circulação extracorpórea High-dose aprotinin does not affect troponin I, N-Terminal pro-B-type natriuretic peptid and renal function in children submitted to surgical correction with extracorporeal circulation

    Directory of Open Access Journals (Sweden)

    Cesar Augusto Ferreira

    2009-12-01

    Full Text Available OBJETIVO: Avaliar se o uso de aprotinina em altas doses hemostáticas pode influenciar as funções miocárdicas, renais e metabólicas em crianças operadas com circulação extracorpórea (CEC. MÉTODOS: Estudo prospectivo randomizado em crianças de 30 dias a 4 anos de idade, submetidas à correção de cardiopatia congênita acianogênica, com CEC e divididas em dois grupos, um denominado Controle (n=9 e o outro, Aprotinina (n=10. Neste, a droga foi administrada antes e durante a CEC. As disfunções miocárdicas e multiorgânicas foram analisadas por marcadores clínicos e bioquímicos. Foram consideradas significantes as diferenças com POBJECTIVE: To evaluate if the use of hemostatic high-dose aprotinin seems influence to myocardial, renal and metabolic functions in children submitted to surgical correction with extracorporeal circulation (ECC. Material and Methods A prospective randomized study was conducted on children aged 30 days to 4 years submitted to correction of acyanogenic congenital heart disease with ECC and divided into two groups: Control (n=9 and Aprotinin (n=10. In the Aprotinin Group the drug was administered before and during ECC and the myocardial and multiorgan dysfunctions were analyzed on the basis of clinical and biochemical markers. Differences were considered to be significant when P<0.05. RESULTS: The groups were similar regarding demographic and intraoperative variables, except for a greater hemodilution in the Aprotinin Group. The drug had no benefit regarding time of mechanical pulmonary ventilation, permanence in the pediatric postoperative intensive care unit (ICU and length of hospitalization, or regarding the use of inotropic drugs and renal function. The partial arterial oxygen pressure/inspired oxygen fraction ratio (PaO2/FiO2 was significantly reduced 24h after surgery in the Control Group. Blood loss was similar for both groups. Cardiac troponin I (cTnI, creatine kinase MB fraction (CKMB, serum

  6. Surgical therapeutic management of perforated peptic ulcer

    Directory of Open Access Journals (Sweden)

    Ana Karla de Sousa Almeida

    2016-03-01

    Full Text Available Perforated peptic ulcer is an emergency should be readily corrected by surgical approach to reduce potential damage and the risk of mortality associated with the extension frame. The option of handling most commonly used by surgeons is laparotomy, however, there is evidence pointing to approach laparoscopically like a viable, safe and with good results for their treatment. Therefore, it is appropriate to evaluate the data about each management and minimally invasive procedure, laparoscopy if overcomes the open surgical approach regarding the laparotomy regarding the treatment of patients with this condition.

  7. Estudo comparativo da ultrafiltração convencional e associação de ultrafiltração convencional e modificada na correção de cardiopatias congênitas com alto risco cirúrgico Comparative study of standard ultrafiltration and its association with modification for the correction of high surgical risk congenital heart diseases

    Directory of Open Access Journals (Sweden)

    Miguel Angel MALUF

    1999-07-01

    Full Text Available A necessidade de correção cirúrgica de má-formações cardíacas complexas, que requerem tempos prolongados de circulação extracorpórea (CEC aumentou a morbimortalidade devido a retenção hídrica e reação inflamatória sistêmica. O objetivo deste estudo é comparar a evolução pós-operatória imediata de pacientes submetidos a ultrafiltração convencional (UFC durante a CEC e ultrafiltração modificada (UFM após CEC. Quarenta e um pacientes submetidos a correção cirúrgica de cardiopatias congênitas foram divididos em 2 grupos: G1: 21 pacientes com idade de 15 dias a 36 meses (mediana: 11 meses e peso de 3,6 a 13,5 kg (M: 7,27 ± 3,07, operados entre 1996 e 1997, foram submetidos a UFC. G2: 20 pacientes com idade de 9 dias a 36 meses (mediana: 5,5 meses e peso entre 2,2 e 12 kg (M: 5,7 ± 2,5, operados entre 1997 e 1998, foram submetidos a UFC+UFM. Dentre as operações mais freqüentes temos: ventriculosseptoplastia, 15 (36,5% casos; operação de Jatene, 10 (24,3% casos; correção de defeito septal A-V total, 7 (17,0% casos etc. A análise estatística de idade, peso e complexidade cirúrgica mostrou semelhança entre os grupos. Houve 6 (28,5% óbitos no G1 e 4 (20% no G2, (p=0,71. O volume médio ultrafiltrado no G1 (UFC foi 143,3 ml e no G2 (UFC+UFM foi 227,0 ml, (pSurgical correction of complex cardiac malformations that require extended extracorporeal circulation (ECC increase morbidity/mortality due to water retention and systemic inflammatory reaction. The purpose of this study is to compare the immediate postoperative evolution of patients submitted to conventional ultrafiltration (CUF during ECC and modified ultrafiltration (MUF after ECC. Forty-one patients submitted to surgical correction of congenital cardiac disease were divided into 2 groups: G1 - 21 patients with ages from 15 days to 36 months (median 11 months and weighing from 3.6 kg (M: 7.27 ± 3.07, operated on between 1996 and 1997 were submitted to CUF

  8. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Oral and maxillofacial surgeons surgically treat the soft tissues of the face, mouth ... involving skin, muscle, bone and cartilage finely attune the oral and maxillofacial ...

  9. Empirical Productivity Indices and Indicators

    NARCIS (Netherlands)

    B.M. Balk (Bert)

    2016-01-01

    textabstractThe empirical measurement of productivity change (or difference) by means of indices and indicators starts with the ex post profit/loss accounts of a production unit. Key concepts are profit, leading to indicators, and profitability, leading to indices. The main task for the productivity

  10. Deriving DICOM surgical extensions from surgical workflows

    Science.gov (United States)

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

    2007-03-01

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

  11. Recognizing surgical patterns

    NARCIS (Netherlands)

    Bouarfa, L.

    2012-01-01

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

  12. Surgical medical record

    DEFF Research Database (Denmark)

    Bulow, S.

    2008-01-01

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

  13. Surgical treatment of cleft lip

    Directory of Open Access Journals (Sweden)

    Mateus Domingues Miachon

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

  14. Surgical therapeutic management of perforated peptic ulcer

    OpenAIRE

    Ana Karla de Sousa Almeida; Clara Rafael Silva Xavier; Lucas de Faria Barros Medeiros; Joanna de Andrade Cordeiro; Amália Cínthia Menezes Rêgo; Irami Araújo-Filho

    2016-01-01

    Perforated peptic ulcer is an emergency should be readily corrected by surgical approach to reduce potential damage and the risk of mortality associated with the extension frame. The option of handling most commonly used by surgeons is laparotomy, however, there is evidence pointing to approach laparoscopically like a viable, safe and with good results for their treatment. Therefore, it is appropriate to evaluate the data about each management and minimally invasive procedure, lap...

  15. NWS Corrections to Observations

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Form B-14 is the National Weather Service form entitled 'Notice of Corrections to Weather Records.' The forms are used to make corrections to observations on forms...

  16. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ... more surgeries depending on the extent of the repair needed. Click here to find out more. Corrective ...

  17. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Jaw Surgery Download Download the ebook for further information Corrective jaw, or orthognathic surgery is performed by ... your treatment. Correction of Common Dentofacial Deformities ​ ​ The information provided here is not intended as a substitute ...

  18. Anatomically corrected transposition of great vessels

    International Nuclear Information System (INIS)

    Ivanitskij, A.V.; Sarkisova, T.N.

    1989-01-01

    The paper is concerned with the description of rare congenital heart disease: anatomically corrected malposition of major vessels in a 9-mos 24 day old girl. The diagnosis of this disease was shown on the results of angiocardiography, concomitant congenital heart diseases were descibed. This abnormality is characterized by common atrioventricular and ventriculovascular joints and inversion position of the major vessels, it is always attended by congenital heart diseases. Surgical intervention is aimed at the elimination of concomitant heart dieseases

  19. Waste indicators

    Energy Technology Data Exchange (ETDEWEB)

    Dall, O.; Lassen, C.; Hansen, E. [Cowi A/S, Lyngby (Denmark)

    2003-07-01

    The Waste Indicator Project focuses on methods to evaluate the efficiency of waste management. The project proposes the use of three indicators for resource consumption, primary energy and landfill requirements, based on the life-cycle principles applied in the EDIP Project. Trial runs are made With the indicators on paper, glass packaging and aluminium, and two models are identified for mapping the Danish waste management, of which the least extensive focuses on real and potential savings. (au)

  20. Waste indicators

    International Nuclear Information System (INIS)

    Dall, O.; Lassen, C.; Hansen, E.

    2003-01-01

    The Waste Indicator Project focuses on methods to evaluate the efficiency of waste management. The project proposes the use of three indicators for resource consumption, primary energy and landfill requirements, based on the life-cycle principles applied in the EDIP Project. Trial runs are made With the indicators on paper, glass packaging and aluminium, and two models are identified for mapping the Danish waste management, of which the least extensive focuses on real and potential savings. (au)

  1. Surgical Treatment of Tattoo Complications.

    Science.gov (United States)

    Sepehri, Mitra; Jørgensen, Bo

    2017-01-01

    With a continuing increase in the number of tattoos performed worldwide, the need to treat tattoo complications is growing. Earlier treatments of chronic inflammatory tattoo reactions were dominated by a medical approach, or with no active intervention. In this chapter, we will address modern surgical approaches applied to situations when medical treatment is inefficient and lasers are not applicable. Dermatome shaving is positioned as first-line treatment of allergic tattoo reactions and also indicated in a number of other tattoo reactions, supplemented with excision in selected cases. The methods allow fundamental treatment with removal of the culprit pigment from the dermis. The different instruments, surgical methods, and treatment schedules are reviewed, and a guide to surgeons is presented. Postoperative treatments and the long-term outcomes are described in detail. An algorithm on specialist treatment and follow-up of tattoo reactions, which can be practiced in other countries, is presented. © 2017 S. Karger AG, Basel.

  2. Quality indicators

    DEFF Research Database (Denmark)

    Hjorth-Andersen, Christian

    1991-01-01

    In recent literature it has been suggested that consumers need have no knowledge of product quality as a number of quality indicators (or signals) may be used as substitutes. Very little attention has been paid to the empirical verification of these studies. The present paper is devoted...... to the issue of how well these indicators perform, using market data provided by consumer magazines from 3 countries. The results strongly indicate that price is a poor quality indicator. The paper also presents some evidence which suggests that seller reputation and easily observable characteristics are also...

  3. Right-ventricular and left-ventricular function parameters in patients with and without outflow tract patches as determined by radionuclide methods at least 10 years following surgical correction of Fallot's tetralogy in the adult individuals. Nuklearmedizinische Bestimmung der rechts- und linksventrikulaeren Funktionsparameter von Patienten ohne und mit Ausflusstraktpatch - mindestens 10 Jahre nach operativer Korrektur der Fallot'schen Tetralogie im Erwachsenenalter

    Energy Technology Data Exchange (ETDEWEB)

    Seidel, P.

    1988-12-15

    During a period starting in 1983 and ending in April 1984 radionuclide ventriculography was performed in 26 patients subjected to surgical correction of Fallot's tetralogy after having reached adulthood. They were divided into two groups according to the surgical methods used. Patients showing no right-ventricular outflow patch were assigned to group I, while group II was made up of individuals that had received outflow tract patches of Dacron or Teflon for pressure reduction in the right ventricle. The parameters registered during radionuclide ventriculography, in which the tracer substance TC 99m was administered into a peripheral vein, included the endiastolic volume, endsystolic volume, stroke volume, global ejection fraction and cardiac index. For resting patients, these values were calculated using the first-pass technique, the determinations during exercise on the ergometer were based on equilibrium radionuclide ventriculography. It could be concluded from the results obtained here that non-invasive endocardial scintigraphy is a sensitive method that can be used both at rest and during exercise on the ergometer to detect function disorders of the right and left ventricles. (orig./MG).

  4. General indicators

    International Nuclear Information System (INIS)

    2003-01-01

    This document summarizes the main 2002 energy indicators for France. A first table lists the evolution of general indicators between 1973 and 2002: energy bill, price of imported crude oil, energy independence, primary and final energy consumption. The main 2002 results are detailed separately for natural gas, petroleum and coal (consumption, imports, exports, production, stocks, prices). (J.S.)

  5. Surgical ethics: surgical virtue and more.

    Science.gov (United States)

    Vercler, Christian J

    2015-01-01

    The encounter between a patient and her surgeon is unique for several reasons. The surgeon inflicts pain upon a patient for the patient's own good. An operative intervention is irreducibly personal, such that the decisions about and performance of operations are inseparable from the idiosyncrasies of the individual surgeon. Furthermore, there is a chasm of knowledge between the patient and surgeon that is difficult to cross. Hence, training in the discipline of surgery includes the inculcation of certain virtues and practices to safeguard against abuses of this relationship and to make sure that the best interests of the patient are prioritized. The stories in this issue are evidence that in contemporary practice this is not quite enough, as surgeons reflect on instances they felt were ethically challenging. Common themes include the difficulty in communicating surgical uncertainty, patient-surgeon relationships, ethical issues in surgical training, and the impact of the technological imperative on caring for dying patients.

  6. [Diverticular disease of the large bowel - surgical treatment].

    Science.gov (United States)

    Levý, M; Herdegen, P; Sutoris, K; Simša, J

    2013-07-01

    Surgical treatment, despite the rapid development of the numerous modern miniinvasive intervention techniques, remains essential in the treatment of complicated diverticular disease. The aim of this work is to summarize indications for surgical treatment in both acute and elective patients suffering from diverticular disease of the large bowel. Review of the literature and recent findings concerning indications for surgical intervention in patients with diverticulosis of the colon. The article describes indications, types of procedures, techniques and postoperative care in patients undergoing surgical intervention for diverticular disease.

  7. Improving core surgical training in a major trauma centre.

    Science.gov (United States)

    Morris, Daniel L J; Bryson, David J; Ollivere, Ben J; Forward, Daren P

    2016-06-01

    English Major Trauma Centres (MTCs) were established in April 2012. Increased case volume and complexity has influenced trauma and orthopaedic (T&O) core surgical training in these centres. To determine if T&O core surgical training in MTCs meets Joint Committee on Surgical Training (JCST) quality indicators including performance of T&O operative procedures and consultant supervised session attendance. An audit cycle assessing the impact of a weekly departmental core surgical trainee rota. The rota included allocated timetabled sessions that optimised clinical and surgical learning opportunities. Intercollegiate Surgical Curriculum Programme (ISCP) records for T&O core surgical trainees at a single MTC were analysed for 8 months pre and post rota introduction. Outcome measures were electronic surgical logbook evidence of leading T&O operative procedures and consultant validated work-based assessments (WBAs). Nine core surgical trainees completed a 4 month MTC placement pre and post introduction of the core surgical trainee rota. Introduction of core surgical trainee rota significantly increased the mean number of T&O operative procedures led by a core surgical trainee during a 4 month MTC placement from 20.2 to 34.0 (pcore surgical trainee during a 4 month MTC placement was significantly increased (0.3 vs 2.4 [p=0.04]). Those of dynamic hip screw fixation (2.3 vs 3.6) and ankle fracture fixation (0.7 vs 1.6) were not. Introduction of a core surgical trainee rota significantly increased the mean number of consultant validated WBAs completed by a core surgical trainee during a 4 month MTC placement from 1.7 to 6.6 (pcore surgical trainee rota utilising a 'problem-based' model can significantly improve T&O core surgical training in MTCs. Copyright © 2016 Elsevier Ltd. All rights reserved.

  8. Surgical treatment of trochanteric fractures: Indications and early ...

    African Journals Online (AJOL)

    Pr KODO

    Road traffic accident was the main cause of fractures accounting for 42 cases. ... Infection occurred in seven patients, wound hematoma in eight and decubital ... under general anesthesia on a standard operating ... latter device arises while inserting the lower oblique ... preferred.13 The problem with the interlocking nail is.

  9. Performance Indicators For Quality In Surgical And Laboratory ...

    African Journals Online (AJOL)

    Methodology: Hospital records were reviewed and information recorded for planned and postponed operations, laboratory equipment, reagents, laboratory tests and quality assurance programmes. Results: In the year 2001 a total of 4332 non-emergency operations were planned, 3313 operations were performed and 1019 ...

  10. Solar Indices

    Data.gov (United States)

    National Oceanic and Atmospheric Administration, Department of Commerce — Collection includes a variety of indices related to solar activity contributed by a number of national and private solar observatories located worldwide. This...

  11. Surgical site infections

    African Journals Online (AJOL)

    Decrease the inflammatory response Vasodilatation leads to better perfusion and ... Must NOT be allowed to come in contact with brain, meninges, eyes or .... project (SCIP): Evolution of National Quality Measure. Surgical. Infection 2008 ...

  12. Surgical Critical Care Initiative

    Data.gov (United States)

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

  13. Ambulatory Surgical Measures - Facility

    Data.gov (United States)

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

  14. Surgical Management of Hemorrhoids

    Science.gov (United States)

    Agbo, S. P.

    2011-01-01

    Hemorrhoids are common human afflictions known since the dawn of history. Surgical management of this condition has made tremendous progress from complex ligation and excision procedures in the past to simpler techniques that allow the patient to return to normal life within a short period. Newer techniques try to improve on the post-operative complications of older ones. The surgical options for the management of hemorrhoids today are many. Capturing all in a single article may be difficult if not impossible. The aim of this study therefore is to present in a concise form some of the common surgical options in current literature, highlighting some important post operative complications. Current literature is searched using MEDLINE, EMBASE and the Cochrane library. The conclusion is that even though there are many surgical options in the management of hemorrhoids today, most employ the ligature and excision technique with newer ones having reduced post operative pain and bleeding. PMID:22413048

  15. Surgical site infections

    African Journals Online (AJOL)

    Surgical site infections (SSIs) are a worldwide problem that has ... deep tissue is found on clinical examination, re-opening, histopathological or radiological investigation ..... Esposito S, Immune system and SSI, Journal of Chemotherapy, 2001.

  16. Surgical management of pain

    African Journals Online (AJOL)

    If these therapies fail, and with a thorough multidisciplinary approach involving carefully ... Generally, surgical pain management is divided into neuro- modulative .... 9 suggested. It is important to be sure that the underlying instability or.

  17. [Simulation in surgical training].

    Science.gov (United States)

    Nabavi, A; Schipper, J

    2017-01-01

    Patient safety during operations hinges on the surgeon's skills and abilities. However, surgical training has come under a variety of restrictions. To acquire dexterity with decreasingly "simple" cases, within the legislative time constraints and increasing expectations for surgical results is the future challenge. Are there alternatives to traditional master-apprentice learning? A literature review and analysis of the development, implementation, and evaluation of surgical simulation are presented. Simulation, using a variety of methods, most important physical and virtual (computer-generated) models, provides a safe environment to practice basic and advanced skills without endangering patients. These environments have specific strengths and weaknesses. Simulations can only serve to decrease the slope of learning curves, but cannot be a substitute for the real situation. Thus, they have to be an integral part of a comprehensive training curriculum. Our surgical societies have to take up that challenge to ensure the training of future generations.

  18. Maxillary advancement for mandibular prognathism: indications and rationale.

    Science.gov (United States)

    Rosen, H M

    1991-05-01

    The surgical correction of mandibular prognathism has traditionally involved posterior repositioning of the mandibular body. This treatment approach corrects the skeletal disproportion at the expense of reducing facial skeletal volume and can unpredictably result in inadequately supported soft tissues with loss of skeletal definition. In an effort to avoid these sequelae of mandibular reduction, 18 patients diagnosed as having mandibular prognathism were treated with maxillary advancement surgery at the Le Fort I level. Mean patient SNB angle was 85.2 degrees, as compared with a normal 79 +/- 3 degrees. Maxillae were documented to be in normal position relative to both cranial base and Frankfort horizontal. The mean maxillary advancement was 6.9 mm, with a range of 4.5 to 8.8 mm. All patients required genioplasty to reduce vertical chin height and/or to laterally shift the chin. At the time of follow-up (mean 16.2 months), all patients retained cephalometric data suggestive of enlarged mandibles and excessive anterior facial divergence. However, maxillomandibular harmony and facial convexity had been restored without sacrificing skeletal volume. Treatment results demonstrated these faces to be skeletally well proportioned despite lower face protrusion that was beyond "normal." Postoperative appearances were characterized by a well-supported soft-tissue envelope and a highlighted skeletal foundation, creating angular, well-defined lower faces. These findings support the credibility of maxillary advancement as the procedure of choice in selected individuals with mandibular prognathism. Indications and an aesthetic rationale for this surgical approach are presented.

  19. The pregnant female surgical resident

    Directory of Open Access Journals (Sweden)

    Shifflette V

    2018-05-01

    with a child at home was the most difficult part. Conclusion: Our preliminary study shows that the programs surveyed were accommodating to the female surgical resident. Nevertheless, despite adequate support from their program and an overall positive experience, many residents indicated that they had a decline in their education and performance. Keywords: surgical resident, pregnant, medical education, maternity leave, graduate medical education

  20. Bilateral pharyngoceles (branchial cleft anomalies?) and endoscopic surgical considerations.

    Science.gov (United States)

    Chang, Christopher Y; Furdyna, Julia A

    2005-07-01

    A case report of bilateral pharyngoceles without a history of elevated intrapharyngeal pressures is used to support the hypothesis that pharyngoceles may be an adult manifestation of an internal branchial sinus anomaly. The development of a pharyngocele from a branchial sinus origin would suggest a predictable relationship to the hypoglossal, glossopharyngeal, and superior laryngeal nerves, which may influence the choice of surgical approach (open versus endoscopic) and the counseling of patients who are considering surgical correction.

  1. Developing Surgical Antimicrobial Prophylaxis Interventions Using Theoretical Domains Framework

    OpenAIRE

    Bonnar, Paul E; Senthinathan, Arrani; Nakamachi, Yoshiko; Backstein, David J; Steinberg, Marilyn; Morris, Andrew M

    2017-01-01

    Abstract Background Surgical site infections are common causes of healthcare-associated infections. Using surgical antimicrobial prophylaxis (SAP) is a complex process that can reduce these rates if performed correctly. While antimicrobial stewardship programs have developed guidelines for SAP, there has been less focus on understanding and modifying the behavioral and contextual factors required to optimize prophylaxis use. We performed chart reviews and workflow analyses to develop interven...

  2. THD Doppler procedure for hemorrhoids: the surgical technique.

    Science.gov (United States)

    Ratto, C

    2014-03-01

    Transanal hemorrhoidal dearterialization (THD) is an effective treatment for hemorrhoidal disease. The ligation of hemorrhoidal arteries (called "dearterialization") can provide a significant reduction of the arterial overflow to the hemorrhoidal piles. Plication of the redundant rectal mucosa/submucosa (called "mucopexy") can provide a repositioning of prolapsing tissue to the anatomical site. In this paper, the surgical technique and perioperative patient management are illustrated. Following adequate clinical assessment, patients undergo THD under general or spinal anesthesia, in either the lithotomy or the prone position. In all patients, distal Doppler-guided dearterialization is performed, providing the selective ligation of hemorrhoidal arteries identified by Doppler. In patients with hemorrhoidal/muco-hemorrhoidal prolapse, the mucopexy is performed with a continuous suture including the redundant and prolapsing mucosa and submucosa. The description of the surgical procedure is complemented by an accompanying video (see supplementary material). In long-term follow-up, there is resolution of symptoms in the vast majority of patients. The most common complication is transient tenesmus, which sometimes can result in rectal discomfort or pain. Rectal bleeding occurs in a very limited number of patients. Neither fecal incontinence nor chronic pain should occur. Anorectal physiology parameters should be unaltered, and anal sphincters should not be injured by following this procedure. When accurately performed and for the correct indications, THD is a safe procedure and one of the most effective treatments for hemorrhoidal disease.

  3. Corrective Jaw Surgery

    Medline Plus

    Full Text Available AAOMS - Oral and maxillofacial surgeons. The experts in face, mouth and jaw surgery.™ What We Do Who ... surgeons surgically treat the soft tissues of the face, mouth and gums to improve function, appearance and ...

  4. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... Oral and maxillofacial surgeons. The experts in face, mouth and jaw surgery.™ What We Do Who We ... surgically treat the soft tissues of the face, mouth and gums to improve function, appearance and oral ...

  5. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... best performed by a trained surgeon with specialized education and training. Click here to find out more. ... more. Facial Cosmetic Surgery Facial Cosmetic Surgery Extensive education and training in surgical procedures involving skin, muscle, ...

  6. Surgical Management of Chronic Pancreatitis.

    Science.gov (United States)

    Parekh, Dilip; Natarajan, Sathima

    2015-10-01

    Advances over the past decade have indicated that a complex interplay between environmental factors, genetic predisposition, alcohol abuse, and smoking lead towards the development of chronic pancreatitis. Chronic pancreatitis is a complex disorder that causes significant and chronic incapacity in patients and a substantial burden on the society. Major advances have been made in the etiology and pathogenesis of this disease and the role of genetic predisposition is increasingly coming to the fore. Advances in noninvasive diagnostic modalities now allow for better diagnosis of chronic pancreatitis at an early stage of the disease. The impact of these advances on surgical treatment is beginning to emerge, for example, patients with certain genetic predispositions may be better treated with total pancreatectomy versus lesser procedures. Considerable controversy remains with respect to the surgical management of chronic pancreatitis. Modern understanding of the neurobiology of pain in chronic pancreatitis suggests that a window of opportunity exists for effective treatment of the intractable pain after which central sensitization can lead to an irreversible pain syndrome in patients with chronic pancreatitis. Effective surgical procedures exist for chronic pancreatitis; however, the timing of surgery is unclear. For optimal treatment of patients with chronic pancreatitis, close collaboration between a multidisciplinary team including gastroenterologists, surgeons, and pain management physicians is needed.

  7. Análise comparativa da técnica da incisão em duplo círculo com as técnicas com incisão periareolar e transareolomamilar de correção cirúrgica da ginecomastia Comparative analysis of the double-circle incision and techniques with periareolar and transareolopapilar incision for the surgical correction of gynecomastia

    Directory of Open Access Journals (Sweden)

    André Alves Cardoso

    2007-09-01

    Full Text Available OBJETIVO: comparar a técnica da incisão em duplo círculo (DC com as técnicas de incisão periareolar (PA e transareolomamilar (TAM, na correção da ginecomastia. MÉTODOS: foram revisados os prontuários de 34 pacientes com ginecomastia submetidos à correção cirúrgica no Hospital das Clínicas de Goiânia de 1999 a 2004. Os pacientes foram divididos em três grupos, de acordo com a técnica cirúrgica utilizada. Comparamos as variáveis numéricas paramétricas usando o teste de Tukey. Para as variáveis nominais, foi utilizado o teste do chi2, ou o teste exato de Fisher, quando necessário. Considerou-se significante o pPURPOSE: to compare the double-circle (DC technique to other techniques, with periareolar (PA and transverse nipple-areolar (TNA incisions, for the surgical correction of gynecomastia. METHODS: we studied the medical files of 34 patients from the Federal University of Goiás, submitted to the surgical correction of gynecomastia, from 1999 to 2004. Patients were divided according to the surgical technique used. The parametric numeric variables were compared by Tukey test. The chi2 or the Fisher's exact test was used for nominal variables. It was considered significant a p value<0.05. RESULTS: the mean age of the patients was 27.9 (+12.5 years. There were 43 gynecomastias, 34 unilateral (79.1% and nine (20.9% bilateral. There were 19 breasts operated (44.2% using DC, 14 (33.6% using PA incision, and 10 (23.3%, TNA incision. The mean drain usage was five days for DC and one day for the others (p<0.01. The suction drain was used in 19 cases (100% of DC and two (22% in TNA. The other patients used drains of Penrose (p<0.01. The mean surgical time was significantly larger for DC (73 minutes than for PA (45 minutes and for TNA (48 minutes. DC was used mainly in voluminous gynecomastias (p=0.04. The complications consisted in three (33% hematomas in TNA (p<0.01 and one (5% in DC; one (11% infection in TNA; two (10% partial

  8. Surgical Treatment of Hepatocellular Carcinoma

    Science.gov (United States)

    Zamora-Valdes, Daniel; Taner, Timucin; Nagorney, David M.

    2017-01-01

    Hepatocellular carcinoma (HCC) is a major cause of cancer-related death worldwide. In select patients, surgical treatment in the form of either resection or transplantation offers a curative option. The aims of this review are to (1) review the current American Association for the Study of Liver Diseases/European Association for the Study of the Liver guidelines on the surgical management of HCC and (2) review the proposed changes to these guidelines and analyze the strength of evidence underlying these proposals. Three authors identified the most relevant publications in the literature on liver resection and transplantation for HCC and analyzed the strength of evidence according to the Grading of Recommendations Assessment, Development and Evaluation (GRADE) classification. In the United States, the liver allocation system provides priority for liver transplantation to patients with HCC within the Milan criteria. Current evidence suggests that liver transplantation may also be indicated in certain patient groups beyond Milan criteria, such as pediatric patients with large tumor burden or adult patients who are successfully downstaged. Patients with no underlying liver disease may also benefit from liver transplantation if the HCC is unresectable. In patients with no or minimal (compensated) liver disease and solitary HCC ≥2 cm, liver resection is warranted. If liver transplantation is not available or contraindicated, liver resection can be offered to patients with multinodular HCC, provided that the underlying liver disease is not decompensated. Many patients may benefit from surgical strategies adapted to local resources and policies (hepatitis B prevalence, organ availability, etc). Although current low-quality evidence shows better overall survival with aggressive surgical strategies, this approach is limited to select patients. Larger and well-designed prospective studies are needed to better define the benefits and limits of such approach. PMID:28975836

  9. [Quality of surgical continuing education in Germany].

    Science.gov (United States)

    Ansorg, J; Hassan, I; Fendrich, V; Polonius, M J; Rothmund, M; Langer, P

    2005-03-11

    One of the reasons for young doctors to leave the clinical work to go abroad or into non-clinical fields is insufficient quality of training under bad circumstances. Aim of the study was to evaluate the surgical training in Germany from the viewpoint of the residents. A questionnaire was prepared by residents and consultants and approved by the German surgical societies (Deutsche Gesellschaft fur Chirurgie und Berufsverband der Deutschen Chirurgen). It was sent to surgical residents between June 2003 and June 2004, published in "Der Chirurg BDC" and distributed among residents taking part in courses conducted by the BDC. It could be answered anonymously by email, mail or online. The questionnaire was sent back by 584 surgical residents (about 30 % of all). 58 % of the residents declared that they finished the training in the intended time (6 years). Rotation-systems as part of a structured residency program existed for 43 %. Standard surgical procedures were discussed or explained before the procedure in only 46 %. 61 % of the residents were not satisfied with the teaching assistance by their clinical teachers in the OR. Only 33 % had regular talks with the Chief about their progress in surgical training. 18 % of residents felt, that the hospital is interested in their progress in training. Indication-conferences took place in 52 % and mortality-conferences in only 20 % of programs. Regular seminars on recent issues took place in 62 %, and 61 % of residents did not get financial support to attend congresses. 36 % of residents had to use their holidays to attend congresses. Surgical training structures are not well established in about 50 % of the training hospitals from where we got answers to our survey. The training potential of daily surgical work is not used appropriately. It is therefore imperative to develop guidelines for surgical training, the use of log-books and rotation-programs.

  10. Post surgical complications from students' large animal surgical ...

    African Journals Online (AJOL)

    A retrospective study of post surgical complications was conducted on records of students' Large Animal Surgical Laboratories in the Faculty of Veterinary Medicine (F.V.M.), Ahmadu Bello University (A.B.U), Zaria from 1989 to 1993. Three hundred and eleven surgical complications were recorded from five surgical ...

  11. Corrections to primordial nucleosynthesis

    International Nuclear Information System (INIS)

    Dicus, D.A.; Kolb, E.W.; Gleeson, A.M.; Sudarshan, E.C.G.; Teplitz, V.L.; Turner, M.S.

    1982-01-01

    The changes in primordial nucleosynthesis resulting from small corrections to rates for weak processes that connect neutrons and protons are discussed. The weak rates are corrected by improved treatment of Coulomb and radiative corrections, and by inclusion of plasma effects. The calculations lead to a systematic decrease in the predicted 4 He abundance of about ΔY = 0.0025. The relative changes in other primoridal abundances are also 1 to 2%

  12. Operational indicators

    International Nuclear Information System (INIS)

    2010-01-01

    The chapter presents the operational indicators related to budget, travel costs and tickets, the evolution of the annual program for regulatory inspection, the scientific production, requested patents and the numbers related to the production of the services offered by the Institution

  13. [The rational application of Da Vinci surgical system in thyroidectomy].

    Science.gov (United States)

    He, Q Q

    2017-08-01

    Da Vinci surgical system is the most advanced minimally invasive surgical platform in the world, and this system has been widely used in cardiac surgery, urology surgery, gynecologic surgery and general surgery. Although the application of this system was relatively late in thyroid surgery, the number of thyroidectomy with Da Vinci surgical system is increasing quickly. Having reviewed recent studies and summarized clinical experience, compared with traditional open operation, the robotic thyroidectomy has the same surgical safety and effectiveness in selective patients with thyroid cancer. In this paper, several aspects on this novel operation were demonstrated, including surgical indications and contraindications, the approaches, surgical procedures and postoperative complications, in order to promote the rational application of Da Vinci surgical system in thyroidectomy.

  14. 3D Surgical Simulation

    Science.gov (United States)

    Cevidanes, Lucia; Tucker, Scott; Styner, Martin; Kim, Hyungmin; Chapuis, Jonas; Reyes, Mauricio; Proffit, William; Turvey, Timothy; Jaskolka, Michael

    2009-01-01

    This paper discusses the development of methods for computer-aided jaw surgery. Computer-aided jaw surgery allows us to incorporate the high level of precision necessary for transferring virtual plans into the operating room. We also present a complete computer-aided surgery (CAS) system developed in close collaboration with surgeons. Surgery planning and simulation include construction of 3D surface models from Cone-beam CT (CBCT), dynamic cephalometry, semi-automatic mirroring, interactive cutting of bone and bony segment repositioning. A virtual setup can be used to manufacture positioning splints for intra-operative guidance. The system provides further intra-operative assistance with the help of a computer display showing jaw positions and 3D positioning guides updated in real-time during the surgical procedure. The CAS system aids in dealing with complex cases with benefits for the patient, with surgical practice, and for orthodontic finishing. Advanced software tools for diagnosis and treatment planning allow preparation of detailed operative plans, osteotomy repositioning, bone reconstructions, surgical resident training and assessing the difficulties of the surgical procedures prior to the surgery. CAS has the potential to make the elaboration of the surgical plan a more flexible process, increase the level of detail and accuracy of the plan, yield higher operative precision and control, and enhance documentation of cases. Supported by NIDCR DE017727, and DE018962 PMID:20816308

  15. EPS Young Physicist Prize - CORRECTION

    CERN Multimedia

    2009-01-01

    The original text for the article 'Prizes aplenty in Krakow' in Bulletin 30-31 assigned the award of the EPS HEPP Young Physicist Prize to Maurizio Pierini. In fact he shared the prize with Niki Saoulidou of Fermilab, who was rewarded for her contribution to neutrino physics, as the article now correctly indicates. We apologise for not having named Niki Saoulidou in the original article.

  16. Use of castor oil polyurethane in an alternative technique for medial patella surgical correction in dogs Utilização do poliuretano de mamona em técnica alternativa de correção cirúrgica da luxação medial de patela em cães

    Directory of Open Access Journals (Sweden)

    Fabrício de Oliveira Frazilio

    2006-01-01

    Full Text Available PURPOSE: Comparative morphologic study of utilization of castor oil polymer in dogs joints, as an alternative technique to autogenous graft, in surgical correction of medial patella luxation. METHODS:Twelve adult dogs, of both sexes, were randomly allocated to two different groups of six animals each. Group I (biopolymer consisted of the deepening of the right femoral troclea, with the implantation of the biopolymer prothesis, and compared to group II (control which consisted of the conventional trocleoplastia technique with wedged cut of the left femoral troclea. The dogs were sacrified after 30 or 90 days and the anathomic peaces were analyzed macro and microscopically. Qui square and Wilcoxon tests were used for the statistic analyses of the results, considering probability of 5%. RESULTS: It was not observed bony integration on the castor oil polymer group. There was resorption of the graft along experimental period and absence of inflammatory cells in the studied periods. CONCLUSION: Castor oil polymer assisted cicatrisation process, was biocompatible without inflammation, and it can be used in joints as an alternative for bony filling.OBJETIVO: Estudo morfológico do implante da prótese de polímero de mamona em articulações de cães, como técnica alternativa ao enxerto ósseo autógeno na correção cirúrgica da luxação medial de patela. MÉTODOS: Doze cães adultos, de ambos os sexos, foram distribuídos aleatoriamente em dois grupos de 6 animais. No grupo I (poliuretano foi feito o aprofundamento da tróclea femoral direita com prótese de polímero de mamona, que foi comparado com o grupo II (controle sendo feita a trocleoplastia por ressecção em cunha da tróclea femoral esquerda. Os animais foram sacrificados após 30 e 90 dias e as peças anatômicas foram avaliadas macro e microscopicamente. O teste do quiquadrado e o teste não-paramétrico de Wilcoxon foram utilizados para a análise estatística dos resultados. Fixou

  17. Anxiety in veterinary surgical students

    DEFF Research Database (Denmark)

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

    2012-01-01

    The surgical educational environment is potentially stressful and this can negatively affect students' learning. The aim of this study was to investigate whether veterinary students' level of anxiety is higher in a surgical course than in a non-surgical course and if pre-surgical training...... in a Surgical Skills Lab (SSL) has an anxiety reducing effect. Investigations were carried out as a comparative study and a parallel group study. Potential participants were fourth-year veterinary students who attended a surgical course (Basic Surgical Skills) and a non-surgical course (Clinical Examination...... and 28 students from 2010). Our results show that anxiety levels in veterinary students are significantly higher in a surgical course than in a non-surgical course (p...

  18. Minimal debridement or simple wound closure as the only surgical treatment in war victims with low-velocity penetrating head injuries. Indications and management protocol based upon more than 8 years follow-up of 99 cases from Iran-Iraq conflict.

    Science.gov (United States)

    Amirjamshidi, Abbass; Abbassioun, Kazem; Rahmat, Hamid

    2003-08-01

    than five chips in other cases. The outcome was good (back to work) in 90 patients and poor (severely disabled) in 4. Five patients died because of severity of brain damage and meningitis. The effect of the different enumerated variables upon the outcome was measured using chi(2) and Fisher exact test, which was nonsignificant for all of the variables except for the orbitofacial entry point of injury (p = 0.00006). This study seems to indicate that not only is reoperation for retained bone or shell fragments unnecessary, but surgeons having modern neuroradiological instruments available to detect the proper explanation for changes in GCS of the patients may decide not to proceed with any surgical intervention in a good number of patients. As a result of the "no surgical treatment protocol," one can preserve cerebral tissue without exposing the patient to undue risk of seizures, infection, or death by leaving behind some or all the in-driven bone and shell fragments.

  19. Publisher Correction: Predicting unpredictability

    Science.gov (United States)

    Davis, Steven J.

    2018-06-01

    In this News & Views article originally published, the wrong graph was used for panel b of Fig. 1, and the numbers on the y axes of panels a and c were incorrect; the original and corrected Fig. 1 is shown below. This has now been corrected in all versions of the News & Views.

  20. SURGICAL SITE INFECTION: REVIEW

    Directory of Open Access Journals (Sweden)

    P. H. M. Bonai

    2016-07-01

    Full Text Available Nosocomial infection or nosocomial infection (NI is one of the factors that increase the cost of maintaining patients in the health system, even in processes that should safely occur, such as hospital patients and performing simple and routine surgical procedures surgical centers and clinics leading to complications resulting from these infections that prolong hospital stay and promote pain and suffering to the patient, resulting in the defense of the quality of services and influencing negatively the hospitals. Therefore, the aim of this study was to review the factors that result in surgical site infection, with the purpose of better understanding of the subject and the possibility of preventive actions to better treatment outcome of the patient.

  1. Correção cirúrgica da esotropia progressiva do alto míope pela técnica de Yamada: relato de dois casos Surgical correction of progressive high myopic esotropia by Yamada's technique: report of two cases

    Directory of Open Access Journals (Sweden)

    Fábio Ejzenbaum

    2005-08-01

    Full Text Available A "esotropia fixa progressiva" se apresenta como um quadro de esotropia progressiva, em adultos altos míopes, que aumenta até que os olhos fiquem fixos numa esotropia de grande ângulo, geralmente associada a hipotropia, e que tem fracos resultados cirúrgicos. O objetivo deste trabalho é descrever a abordagem cirúrgica de 2 pacientes com "esotropia fixa adquirida progressiva" que foram operados segundo a técnica de Yamada (hemitransposição dos retos lateral e superior, e obtiveram bom resultado pós-operatório."Progressive esotropia fixus" is a disease present in high myopic patients with a large angle esotropia associated with hypotropia with poor surgical results. This paper has the purpose to describe Yamada's surgical technique (hemitranspositions of the superior rectus and lateral rectus applied to 2 patients with good surgical results.

  2. Retained surgical sponge

    International Nuclear Information System (INIS)

    Koyama, Masashi; Kurono, Kenji; Iida, Akihiko; Suzuki, Hirochika; Hara, Masaki; Mizutani, Hirokazu; Ohba, Satoru; Mizutani, Masaru; Nakajima, Yoichiro.

    1993-01-01

    The CT, US, and MRI findings of confirmed retained surgical sponges were reviewed. The CT examinations in eight lesions demonstrated round or oval masses with heterogeneous internal structures. The US examinations in 5 lesions demonstrated low echogenic masses with high echogenic internal structures, which suggested retained surgical sponges. MR imagings in three lesions showed slightly high intensity comparable to that of muscles on T1-weighted images and high signal intensity on T2-weighted images, suggesting fluid collections of high protein concentration. (author)

  3. Minimally invasive corticotomy in orthodontics using a three-dimensional printed CAD/CAM surgical guide.

    Science.gov (United States)

    Cassetta, M; Giansanti, M; Di Mambro, A; Calasso, S; Barbato, E

    2016-09-01

    The aim of this prospective study was to evaluate the effectiveness of an innovative, minimally invasive, flapless corticotomy procedure in orthodontics. The STROBE guidelines were followed. Ten patients with severe dental crowding and a class I molar relationship were selected to receive orthodontic treatment with clear aligners and corticotomy-facilitated orthodontics. The mean age of these patients was 21 years (range 17-28, standard deviation 6.08 years); the male to female ratio was 2:1. The main outcome was a reduction in the total treatment time to correct dental crowding. The secondary outcomes were periodontal index changes, the degree of root resorption, and patient perceptions of the method used, assessed using the short-form Oral Health Impact Profile (OHIP-14). The occurrence of early surgical complications or unexpected events was also recorded. All patients completed the treatment to correct dental crowding. The average treatment time was reduced by two-thirds. The procedure did not significantly modify the periodontal indices or oral health-related quality of life. No early surgical complications or unexpected events were observed. In short, the results indicate that this new procedure is safe and accelerates tooth movement without periodontal complications or discomfort. However, the efficacy of this procedure must be confirmed in controlled clinical trials. Copyright © 2016 International Association of Oral and Maxillofacial Surgeons. Published by Elsevier Ltd. All rights reserved.

  4. Surgical Treatment of Acute Pancreatitis.

    Science.gov (United States)

    Werner, Jens; Uhl, Waldemar; Büchler, Markus W.

    2003-10-01

    Patients with predicted severe necrotizing pancreatitis as diagnosed by C-reactive protein (>150 mg/L) and/or contrast-enhanced computed tomography should be managed in the intensive care unit. Prophylactic broad-spectrum antibiotics reduce infection rates and survival in severe necrotizing pancreatitis. Endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy is a causative therapy for gallstone pancreatitis with impacted stones, biliary sepsis, or obstructive jaundice. Fine needle aspiration for bacteriology should be performed to differentiate between sterile and infected pancreatic necrosis in patients with sepsis syndrome. Infected pancreatic necrosis in patients with clinical signs and symptoms of sepsis is an indication for surgery. Patients with sterile pancreatic necrosis should be managed conservatively. Surgery in patients with sterile necrosis may be indicated in cases of persistent necrotizing pancreatitis and in the rare cases of "fulminant acute pancreatitis." Early surgery, within 14 days after onset of the disease, is not recommended in patients with necrotizing pancreatitis. The surgical approach should be organ-preserving (debridement/necrosectomy) and combined with a postoperative management concept that maximizes postoperative evacuation of retroperitoneal debris and exudate. Minimally invasive surgical procedures have to be regarded as an experimental approach and should be restricted to controlled trials. Cholecystectomy should be performed to avoid recurrence of gallstone-associated acute pancreatitis.

  5. Awareness and Use of Surgical Checklist among Theatre Users at Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria.

    Science.gov (United States)

    Ogunlusi, Johnson Dare; Yusuf, Moruf Babatunde; Ogunsuyi, Popoola Sunday; Wuraola, Obafemi K; Babalola, Waheed O; Oluwadiya, Kehinde Sunday; Ajogbasile, Oduwole Olayemi

    2017-01-01

    Surgical checklist was introduced by the World Health Organization to reduce the number of surgical deaths and complications. During a surgical conference on "safety in surgical practice," it was noticed that the awareness and the use of surgical checklist are poor in Nigerian hospitals. This study was aimed at determining the awareness and use of surgical checklist among the theater users in our hospital, factors militating against its implementation, and make recommendations. This is a prospective study at Ekiti State University Teaching Hospital, Ado-Ekiti; questionnaires were distributed to three groups of theater users - surgeons, anesthetists, and perioperative nurses. The responses were collated by the lead researcher, entered into Microsoft Excel spreadsheet, exported, and analyzed with SPSS. Eighty-five questionnaires were distributed, 70 were returned, and 4 were discarded due to poor filling. The studied 66 comprised 40, 12, and 14 surgeons, anesthetists, and perioperative nurses, respectively. Fifty-five (83.3%) of the responders indicated awareness of the checklist but only 12 (21.8%) correctly stated that the main objective is for patients' safety and for safe surgery. Major barriers to its use include lack of training 58.2%, lack of assertiveness of staff 58.2%, and that its delays operation list 47.2%. The study demonstrated high level of awareness of surgical checklist in our hospital; however, this awareness is based on wrong premises as it is not reflected in the true aim of the checklist. Majority of the responders would want to be trained on the use of checklist despite the highlighted barriers.

  6. Awareness and use of surgical checklist among theatre users at Ekiti State University Teaching Hospital, Ado-Ekiti, Nigeria

    Directory of Open Access Journals (Sweden)

    Johnson Dare Ogunlusi

    2017-01-01

    Full Text Available Background: Surgical checklist was introduced by the World Health Organization to reduce the number of surgical deaths and complications. During a surgical conference on “safety in surgical practice,” it was noticed that the awareness and the use of surgical checklist are poor in Nigerian hospitals. This study was aimed at determining the awareness and use of surgical checklist among the theater users in our hospital, factors militating against its implementation, and make recommendations. Methods: This is a prospective study at Ekiti State University Teaching Hospital, Ado-Ekiti; questionnaires were distributed to three groups of theater users – surgeons, anesthetists, and perioperative nurses. The responses were collated by the lead researcher, entered into Microsoft Excel spreadsheet, exported, and analyzed with SPSS. Results: Eighty-five questionnaires were distributed, 70 were returned, and 4 were discarded due to poor filling. The studied 66 comprised 40, 12, and 14 surgeons, anesthetists, and perioperative nurses, respectively. Fifty-five (83.3% of the responders indicated awareness of the checklist but only 12 (21.8% correctly stated that the main objective is for patients' safety and for safe surgery. Major barriers to its use include lack of training 58.2%, lack of assertiveness of staff 58.2%, and that its delays operation list 47.2%. Conclusion: The study demonstrated high level of awareness of surgical checklist in our hospital; however, this awareness is based on wrong premises as it is not reflected in the true aim of the checklist. Majority of the responders would want to be trained on the use of checklist despite the highlighted barriers.

  7. Class III Malocclusion Surgical-Orthodontic Treatment

    Directory of Open Access Journals (Sweden)

    Bruna Alves Furquim

    2014-01-01

    Full Text Available The aim of the present case report is to describe the orthodontic-surgical treatment of a 17-year-and-9-month-old female patient with a Class III malocclusion, poor facial esthetics, and mandibular and chin protrusion. She had significant anteroposterior and transverse discrepancies, a concave profile, and strained lip closure. Intraorally, she had a negative overjet of 5 mm and an overbite of 5 mm. The treatment objectives were to correct the malocclusion, and facial esthetic and also return the correct function. The surgical procedures included a Le Fort I osteotomy for expansion, advancement, impaction, and rotation of the maxilla to correct the occlusal plane inclination. There was 2 mm of impaction of the anterior portion of the maxilla and 5 mm of extrusion in the posterior region. A bilateral sagittal split osteotomy was performed in order to allow counterclockwise rotation of the mandible and anterior projection of the chin, accompanying the maxillary occlusal plane. Rigid internal fixation was used without any intermaxillary fixation. It was concluded that these procedures were very effective in producing a pleasing facial esthetic result, showing stability 7 years posttreatment.

  8. History of surgical treatments for hallux valgus.

    Science.gov (United States)

    Galois, Laurent

    2018-05-31

    In the nineteenth century, the prevalent understanding of the hallux valgus was that it was purely an enlargement of the soft tissue, first metatarsal head, or both, most commonly caused by ill-fitting footwear. Thus, treatment had varying results, with controversy over whether to remove the overlying bursa alone or in combination with an exostectomy of the medial head. Since 1871, when the surgical technique was first described, many surgical treatments for the correction of hallux valgus have been proposed. A number of these techniques have come into fashion, and others have fallen into oblivion. Progress in biomechanical knowledge, and improvements in materials and supports have allowed new techniques to be developed over the years. We have developed techniques that sacrifice the metatarsophalangeal joint (arthrodesis, arthroplasties), as well as conservative procedures, and one can distinguish those which only involve the soft tissues from those that are linked with a first ray osteotomy.

  9. Surgical infections with Mycoplasma

    DEFF Research Database (Denmark)

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

    1997-01-01

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

  10. Surgical manifestations of filariasis

    Directory of Open Access Journals (Sweden)

    Subrahmanyam M

    1978-01-01

    Full Text Available Surgical manifestations of filariasis as seen in 150 cases over a period of three years in the department of Surgery, Mahatma Gandhi Institute of Medical Sciences, Sevagram, Wardha are reviewed. The genital manifestations are more common than the elephantiasis in this endemic zone.

  11. Improving surgical weekend handover.

    Science.gov (United States)

    Culwick, Caroline; Devine, Chris; Coombs, Catherine

    2014-01-01

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

  12. [Surgical complications of colostomies].

    Science.gov (United States)

    Ben Ameur, Hazem; Affes, Nejmeddine; Rejab, Haitham; Abid, Bassem; Boujelbene, Salah; Mzali, Rafik; Beyrouti, Mohamed Issam

    2014-07-01

    The colostomy may be terminal or lateral, temporary or permanent. It may have psychological, medical or surgical complications. reporting the incidence of surgical complications of colostomies, their therapeutic management and trying to identify risk factors for their occurrence. A retrospective study for a period of 5 years in general surgery department, Habib Bourguiba hospital, Sfax, including all patients operated with confection of a colostomy. Were then studied patients reoperated for stoma complication. Among the 268 patients who have had a colostomy, 19 patients (7%) developed surgical stoma complications. They had a mean age of 59 years, a sex ratio of 5.3 and a 1-ASA score in 42% of cases. It was a prolapse in 9 cases (reconfection of the colostomy: 6 cases, restoration of digestive continuity: 3 cases), a necrosis in 5 cases (reconfection of the colostomy), a plicature in 2 cases (reconfection of the colostomy) a peristomal abscess in 2 cases (reconfection of the colostomy: 1 case, restoration of digestive continuity: 1 case) and a strangulated parastomal hernia in 1 case (herniorrhaphy). The elective incision and the perineal disease were risk factors for the occurrence of prolapse stomial. Surgical complications of colostomies remain a rare event. Prolapse is the most common complication, and it is mainly related to elective approach. Reoperation is often required especially in cases of early complications, with usually uneventful postoperative course.

  13. SELF CORRECTION WORKS BETTER THAN TEACHER CORRECTION IN EFL SETTING

    Directory of Open Access Journals (Sweden)

    Azizollah Dabaghi

    2012-11-01

    pre-test. In order to see whether there is a significant difference between the participants' attitudes toward correction before and after the treatment, an attitude questionnaire was administered to the experimental group and the subjects were asked to fill it. The result indicates that there is a significant difference betw

  14. A Novel Surgical Template Design in Staged Dental Implant Rehabilitations

    Directory of Open Access Journals (Sweden)

    Michael Patras

    2012-05-01

    Full Text Available Background: The philosophy of a gradual transition to an implant retained prosthesis in cases of full-mouth or extensive rehabilitation usually involves a staged treatment concept. In this therapeutic approach, the placement of implants may sometimes be divided into phases. During a subsequent surgical phase of treatment, the pre-existing implants can serve as anchors for the surgical template. Those modified surgical templates help in the precise transferring of restorative information into the surgical field and guide the optimal three-dimensional implant positioning. Methods: This article highlights the rationale of implant-retained surgical templates and illustrates them through the presentation of two clinical cases. The templates are duplicates of the provisional restorations and are secured to the existing implants through the utilization of implant mounts. Results: This template design in such staged procedures provided stability in the surgical field and enhanced the accuracy in implant positioning based upon the planned restoration, thus ensuring predictable treatment outcomes.Conclusions: Successful rehabilitation lies in the correct sequence of surgical and prosthetic procedures. Whenever a staged approach of implant placement is planned, the clinician can effectively use the initially placed implants as anchors for the surgical template during the second phase of implant surgery.

  15. Surgical virtual reality - highlights in developing a high performance surgical haptic device.

    Science.gov (United States)

    Custură-Crăciun, D; Cochior, D; Constantinoiu, S; Neagu, C

    2013-01-01

    Just like simulators are a standard in aviation and aerospace sciences, we expect for surgical simulators to soon become a standard in medical applications. These will correctly instruct future doctors in surgical techniques without there being a need for hands on patient instruction. Using virtual reality by digitally transposing surgical procedures changes surgery in are volutionary manner by offering possibilities for implementing new, much more efficient, learning methods, by allowing the practice of new surgical techniques and by improving surgeon abilities and skills. Perfecting haptic devices has opened the door to a series of opportunities in the fields of research,industry, nuclear science and medicine. Concepts purely theoretical at first, such as telerobotics, telepresence or telerepresentation,have become a practical reality as calculus techniques, telecommunications and haptic devices evolved,virtual reality taking a new leap. In the field of surgery barrier sand controversies still remain, regarding implementation and generalization of surgical virtual simulators. These obstacles remain connected to the high costs of this yet fully sufficiently developed technology, especially in the domain of haptic devices. Celsius.

  16. Correction of Neonatal Hypovolemia

    Directory of Open Access Journals (Sweden)

    V. V. Moskalev

    2007-01-01

    Full Text Available Objective: to evaluate the efficiency of hydroxyethyl starch solution (6% refortane, Berlin-Chemie versus fresh frozen plasma used to correct neonatal hypovolemia.Materials and methods. In 12 neonatal infants with hypoco-agulation, hypovolemia was corrected with fresh frozen plasma (10 ml/kg body weight. In 13 neonates, it was corrected with 6% refortane infusion in a dose of 10 ml/kg. Doppler echocardiography was used to study central hemodynamic parameters and Doppler study was employed to examine regional blood flow in the anterior cerebral and renal arteries.Results. Infusion of 6% refortane and fresh frozen plasma at a rate of 10 ml/hour during an hour was found to normalize the parameters of central hemodynamics and regional blood flow.Conclusion. Comparative analysis of the findings suggests that 6% refortane is the drug of choice in correcting neonatal hypovolemia. Fresh frozen plasma should be infused in hemostatic disorders. 

  17. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... surgery. It is important to understand that your treatment, which will probably include orthodontics before and after ... to realistically estimate the time required for your treatment. Correction of Common Dentofacial Deformities ​ ​ The information provided ...

  18. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... It can also invite bacteria that lead to gum disease. Click here to find out more. Who We ... It can also invite bacteria that lead to gum disease. Click here to find out more. Corrective Jaw ...

  19. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... is performed by an oral and maxillofacial surgeon (OMS) to correct a wide range of minor and ... when sleeping, including snoring) Your dentist, orthodontist and OMS will work together to determine whether you are ...

  20. The surgical treatment of acromegaly.

    Science.gov (United States)

    Buchfelder, Michael; Schlaffer, Sven-Martin

    2017-02-01

    Surgical extraction of as much tumour mass as possible is considered the first step of treatment in acromegaly in many centers. In this article the potential benefits, disadvantages and limitations of operative acromegaly treatment are reviewed. Pertinent literature was selected to provide a review covering current indications, techniques and results of operations for acromegaly. The rapid reduction of tumour volume is an asset of surgery. To date, in almost all patients, minimally invasive, transsphenoidal microscopic or endoscopic approaches are employed. Whether a curative approach is feasible or a debulking procedure is planned, can be anticipated on the basis of preoperative magnetic resonance imaging. The radicality of adenoma resection essentially depends on localization, size and invasive character of the tumour. The normalization rates of growth hormone and IGF-1 secretion, respectively, depend on tumour-related factors such as size, extension, the presence or absence of invasion and the magnitude of IGF-1 and growth hormone oversecretion. However, also surgeon-related factors such as experience and patient load of the centers have been shown to strongly affect surgical results and the rate of complications. As compared to most medical treatments, surgery is relatively cheap since the costs occur only once and not repeatedly. There are several new technical gadgets which aid in the surgical procedure: navigation and variants of intraoperative imaging. For the mentioned reasons, current algorithms of acromegaly management suggest an initial operation, unless the patients are unfit for surgery, refuse an operation or only an unsatisfactory resection is anticipated. A few suggestions are made when a re-operation could be considered.

  1. Disc degeneration: current surgical options

    Directory of Open Access Journals (Sweden)

    C Schizas

    2010-10-01

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

  2. Personalized recommendation with corrected similarity

    International Nuclear Information System (INIS)

    Zhu, Xuzhen; Tian, Hui; Cai, Shimin

    2014-01-01

    Personalized recommendation has attracted a surge of interdisciplinary research. Especially, similarity-based methods in applications of real recommendation systems have achieved great success. However, the computations of similarities are overestimated or underestimated, in particular because of the defective strategy of unidirectional similarity estimation. In this paper, we solve this drawback by leveraging mutual correction of forward and backward similarity estimations, and propose a new personalized recommendation index, i.e., corrected similarity based inference (CSI). Through extensive experiments on four benchmark datasets, the results show a greater improvement of CSI in comparison with these mainstream baselines. And a detailed analysis is presented to unveil and understand the origin of such difference between CSI and mainstream indices. (paper)

  3. ICT: isotope correction toolbox.

    Science.gov (United States)

    Jungreuthmayer, Christian; Neubauer, Stefan; Mairinger, Teresa; Zanghellini, Jürgen; Hann, Stephan

    2016-01-01

    Isotope tracer experiments are an invaluable technique to analyze and study the metabolism of biological systems. However, isotope labeling experiments are often affected by naturally abundant isotopes especially in cases where mass spectrometric methods make use of derivatization. The correction of these additive interferences--in particular for complex isotopic systems--is numerically challenging and still an emerging field of research. When positional information is generated via collision-induced dissociation, even more complex calculations for isotopic interference correction are necessary. So far, no freely available tools can handle tandem mass spectrometry data. We present isotope correction toolbox, a program that corrects tandem mass isotopomer data from tandem mass spectrometry experiments. Isotope correction toolbox is written in the multi-platform programming language Perl and, therefore, can be used on all commonly available computer platforms. Source code and documentation can be freely obtained under the Artistic License or the GNU General Public License from: https://github.com/jungreuc/isotope_correction_toolbox/ {christian.jungreuthmayer@boku.ac.at,juergen.zanghellini@boku.ac.at} Supplementary data are available at Bioinformatics online. © The Author 2015. Published by Oxford University Press. All rights reserved. For Permissions, please e-mail: journals.permissions@oup.com.

  4. Voluntary surgical contraception women of late reproductive age suffering from pelvic organ prolapse – features and benefits

    OpenAIRE

    Nigina Nasinova

    2014-01-01

    We have proposed the method of transvaginal Voluntary Surgical Contraception, conducted in conjunction with surgical treatment of descent and prolapse of the vaginal walls. Were studied the early and late results of the surgery in 50 women to which during the surgical treatment of genital prolapse simultaneously was carries out transvaginal occlusion of the fallopian tubes. Control groups consisted of 30 women to which in the first step before surgical correction of pelvic organ prolapse have...

  5. [Modern aspects of surgical treatment of myopia].

    Science.gov (United States)

    Beliaev, V S; Dushin, N V; Barashkov, V I; Frolov, M A; Gonchar, P A; Kravchinina, V V

    1997-01-01

    Problems in complex surgical treatment of myopia are discussed. Extensive clinical data and long follow-up of the patients permitted the authors to develop a well-based system of care which helps not only arrest the progress of myopia, but correct it within a rather wide range. The pathogenesis of tissue process in progressive myopia is discussed basing on the regularities revealed experimentally. The main modern operations on the cornea and sclera are described. Data on the inter-layer transplantation of the cornea, developed at the Chair of Ophthalmic Diseases of the Russian University of Peoples' Friendship are presented.

  6. Pattern of surgical periodontal treatment in a Nigerian Teaching Hospital: A 37 month review

    Directory of Open Access Journals (Sweden)

    Clement Chinedu Azodo

    2016-01-01

    Conclusion: Periodontal abscess and gingival enlargement constituted the main indications for surgical periodontal treatment while incision and drainage and gingivectomy were the main surgical periodontal treatments in this study.

  7. A Novel Surgical Pre-suturing Technique for the Management of ...

    African Journals Online (AJOL)

    cannot be protruded beyond lower incisor teeth because of a short lingual ... suggests that surgical interventions are absolutely safe at any age including ... Surgical procedures indicated for ankyloglossia are highly predictable but shows poor ...

  8. correction of tarsal ectropion following harmful eye medication in a

    African Journals Online (AJOL)

    Dr O Babalola

    Correction of Severe Traditional Medication-induced Lower Lid. Ectropion: A case report. BO Emmanuel. Rachel Eye Center, Abuja. SUMMARY. Introduction: The medical and surgical management of lower lid ectropion induced by the instillation of traditional eye medication in a middle-aged Nigerian woman is described .

  9. Clinical challenges late after correction of tetralogy of Fallot

    NARCIS (Netherlands)

    Bokma, J.P.

    2018-01-01

    This thesis focused on several clinical challenges which may occur late after surgical correction of tetralogy of Fallot. Among several other topics, three important clinical challenges were studied: (1) timing of pulmonary valve replacement, (2) risk stratification, (3) prevention and treatment of

  10. Scoliosis correction in children-anaesthetic challenge: A case report

    Directory of Open Access Journals (Sweden)

    Amarjeet D Patil, Sivashankar KR, Arpan Sashankar, Shikha A Malhotra

    2014-03-01

    Full Text Available Kyphoscoliosis is a challenging surgery to surgeons but even more challenging to anaesthesiologist to give anaesthesia and maintain it throughout the surgery and post operative pain relief and ventilation. Here we are describing the case of 3 years old male child weighing 9kg for surgical correction of spine deformity with instrumentation.

  11. Surgical extractions for periodontal disease in a Western Lowland gorilla.

    Science.gov (United States)

    Huff, John F

    2010-01-01

    This case report describes surgical exraction of multiple premolar and molar teeth in a Western Lowland gorilla. Postoperative photographs and radiographs indicated complete healing of the extraction sites. This case report includes a review of gorilla dental anatomy, oral disease in primates, pathogenesis of periodontal disease, predisposing factors to periodontal disease, and principles of surgical tooth extraction.

  12. Paediatric Abdominal Surgical Emergencies in a General Surgical ...

    African Journals Online (AJOL)

    ... organized for general surgeons undertaking paediatric surgical emergencies. More paediatric surgeons should be trained and more paediatric surgical units should established in the country. Key Words: Paediatric Abdominal Surgical Emergencies; Paediatric Surgeons, General Surgeons. Journal of College of Medicine ...

  13. Buried penis: classification surgical approach.

    Science.gov (United States)

    Hadidi, Ahmed T

    2014-02-01

    The purpose of this study was to describe morphological classification of congenital buried penis (BP) and present a versatile surgical approach for correction. Sixty-one patients referred with BP were classified into 3 grades according to morphological findings: Grade 1-29 patients with Longer Inner Prepuce (LIP) only, Grade II-20 patients who presented with LIP associated with indrawn penis that required division of the fundiform and suspensory ligaments, and Grade III-12 patients who had in addition to the above, excess supra-pubic fat. A ventral midline penile incision extending from the tip of prepuce down to the penoscrotal junction was used in all patients. The operation was tailored according to the BP Grade. All patients underwent circumcision. Mean follow up was 3 years (range 1 to 10). All 61 patients had an abnormally long inner prepuce (LIP). Forty-seven patients had a short penile shaft. Early improvement was noted in all cases. Satisfactory results were achieved in all 29 patients in grade I and in 27 patients in grades II and III. Five children (Grades II and III) required further surgery (9%). Congenital buried penis is a spectrum characterized by LIP and may include in addition; short penile shaft, abnormal attachment of fundiform, and suspensory ligaments and excess supra-pubic fat. Congenital Mega Prepuce (CMP) is a variant of Grade I BP, with LIP characterized by intermittent ballooning of the genital area. Copyright © 2014 Elsevier Inc. All rights reserved.

  14. [Surgical treatment of gynecomastia: an algorithm].

    Science.gov (United States)

    Wolter, A; Scholz, T; Diedrichson, J; Liebau, J

    2013-04-01

    Gynecomastia is a persistent benign uni- or bilateral enlargement of the male breast ranging from small to excessive findings with marked skin redundancy. In this paper we introduce an algorithm to facilitate the selection of the appropriate surgical technique according to the presented morphological aspects. The records of 118 patients (217 breasts) with gynecomastia from 01/2009 to 08/2012 were retrospectively reviewed. The authors conducted three different surgical techniques depending on four severity grades. The outcome parameters complication rate, patient satisfaction with the aesthetic result, nipple sensitivity and the need to re-operate were observed and related to the employed technique. In 167 (77%) breasts with moderate breast enlargement without skin redundancy (Grade I-IIa by Simon's classification) a subcutaneous semicircular periareolar mastectomy was performed in combination with water-jet assisted liposuction. In 40 (18%) breasts with skin redundancy (Grade IIb) a circumferential mastopexy was performed additionally. An inferior pedicled mammaplasty was used in 10 (5%) severe cases (Grade III). Complication rate was 4.1%. Surgical corrections were necessary in 17 breasts (7.8%). The patient survey revealed a high satisfaction level: 88% of the patients rated the aesthetic results as "very good" or "good", nipple sensitivity was rated as "very good" or "good" by 83%. Surgical treatment of gynecomastia should ensure minimal scarring while respecting the aesthetic unit. The selection of the appropriate surgical method depends on the severity grade, the presence of skin redundancy and the volume of the male breast glandular tissue. The presented algorithm rarely leads to complications, is simple to perform and shows a high satisfaction rate and a preservation of the nipple sensitivity. © Georg Thieme Verlag KG Stuttgart · New York.

  15. [Surgical approaches to tibial plateau fractures].

    Science.gov (United States)

    Krause, Matthias; Müller, Gunnar; Frosch, Karl-Heinz

    2018-06-06

    Intra-articular tibial plateau fractures can present a surgical challenge due to complex injury patterns and compromised soft tissue. The treatment goal is to spare the soft tissue and an anatomical reconstruction of the tibial articular surface. Depending on the course of the fracture, a fracture-specific access strategy is recommended to provide correct positioning of the plate osteosynthesis. While the anterolateral approach is used in the majority of lateral tibial plateau fractures, only one third of the joint surface is visible; however, posterolateral fragments require an individual approach, e. g. posterolateral or posteromedial. If necessary, osteotomy of the femoral epicondyles can improve joint access for reduction control. Injuries to the posterior columns should be anatomically reconstructed and biomechanically correctly addressed via posterior approaches. Bony posterior cruciate ligament tears can be refixed via a minimally invasive posteromedial approach.

  16. Reactive correction of a maxillary incisor in single-tooth crossbite following periodontal therapy.

    Science.gov (United States)

    Huang, Chih-Hao; Brunsvold, Michael A

    2005-05-01

    The reactive correction of a single tooth anterior crossbite following periodontal therapy is described. This case report provides new information regarding correction of a crossbite relationship and con- firms existing reports of tooth movement following periodontal therapy. A 39-year-old woman in good general health presented with a history of recurrent periodontal abscesses of a maxillary incisor. Probing depths of the abscessed tooth ranged from 5 to 12 mm, and class 1 mobility was noted. Radiographs revealed that the tooth had previously been treated endodontically. The patient's periodontal diagnosis was generalized chronic moderate to severe periodontitis. Treatment considerations were complicated by a single-tooth crossbite relationship of the involved incisor and clinical evidence that the periodontal abscess communicated with an apical infection. Treatment of the abscess consisted of cause-related therapy, bone grafting, and occlusal adjustment. Five months after surgical treatment, an edge-to-edge incisal relationship was observed, the first indicator of tooth movement. Further correction to a normal incisal relationship resulted 1 year after modification of the proximal contact. At this time, there was normal probing depth with only slight recession and mobility. Bone fill was radiographically noted. It appears that some cases of maxillary incisor crossbite that are complicated by periodontal disease may be corrected, without orthodontic appliances, following periodontal treatment.

  17. Surgical camps: the Ugandan experience

    African Journals Online (AJOL)

    . The planned visits were advertised locally and in the national media. Screening of the patients was done first by the local medical teams and later by the visiting surgical teams. The surgical teams were comprised of the following personnel:.

  18. Geological Corrections in Gravimetry

    Science.gov (United States)

    Mikuška, J.; Marušiak, I.

    2015-12-01

    Applying corrections for the known geology to gravity data can be traced back into the first quarter of the 20th century. Later on, mostly in areas with sedimentary cover, at local and regional scales, the correction known as gravity stripping has been in use since the mid 1960s, provided that there was enough geological information. Stripping at regional to global scales became possible after releasing the CRUST 2.0 and later CRUST 1.0 models in the years 2000 and 2013, respectively. Especially the later model provides quite a new view on the relevant geometries and on the topographic and crustal densities as well as on the crust/mantle density contrast. Thus, the isostatic corrections, which have been often used in the past, can now be replaced by procedures working with an independent information interpreted primarily from seismic studies. We have developed software for performing geological corrections in space domain, based on a-priori geometry and density grids which can be of either rectangular or spherical/ellipsoidal types with cells of the shapes of rectangles, tesseroids or triangles. It enables us to calculate the required gravitational effects not only in the form of surface maps or profiles but, for instance, also along vertical lines, which can shed some additional light on the nature of the geological correction. The software can work at a variety of scales and considers the input information to an optional distance from the calculation point up to the antipodes. Our main objective is to treat geological correction as an alternative to accounting for the topography with varying densities since the bottoms of the topographic masses, namely the geoid or ellipsoid, generally do not represent geological boundaries. As well we would like to call attention to the possible distortions of the corrected gravity anomalies. This work was supported by the Slovak Research and Development Agency under the contract APVV-0827-12.

  19. A novel osteogenic distraction device for the transversal correction of temporozygomatic hypoplasia.

    Science.gov (United States)

    Pagnoni, Mario; Fadda, Maria Teresa; Cascone, Piero; Iannetti, Giorgio

    2014-07-01

    Hemifacial microsomia (HFM) is a congenital disorder characterized by craniofacial malformation of one or both sides of the lower face. Since these anomalies are associated with soft-tissue deficiencies, corrective surgery is often difficult. Bone grafts have typically been used for augmentation, but distraction osteogenesis now offers an alternative for many craniofacial deficiencies, but there are few if any appropriate distraction devices and surgical procedures for the augmentation of craniofacial transversal dimensions. The aim of this study was to evaluate a technique for guided augmentation of craniofacial transversal dimensions through distraction osteogenesis. We tested the efficacy of a prototype distractor, developed in collaboration with Medartis, using cadavers and demonstrated its application for the correction of the transverse dimension of the temporozygomatic region in a patient with Goldenhar syndrome. CT scans showed a 4-mm transverse augmentation of the bony surface after 9 days and a 10-mm increase after 30 days. Upon removal of the distractor (60 days after the first surgery) CT indicated good bony fusion and a stable result in the transverse plane. Six months after removal of the distractor, 3D computed tomography confirmed the success of the transverse augmentation, as it appeared to be stable and reliable. Distraction osteogenesis, using our device, can be used to correct the transverse dimension of the temporozygomatic region in HFM patients. It should also be considered for the correction of residual postsurgical skeletal deficiency due to surgical relapse or deficient growth, and unsatisfactory skeletal contour. Copyright © 2013 European Association for Cranio-Maxillo-Facial Surgery. Published by Elsevier Ltd. All rights reserved.

  20. Correção cirúrgica do aneurisma de ventrículo esquerdo: comparação entre as técnicas de sutura linear e reconstrução geométrica Surgical correction of left ventricular aneurysm: comparison between linear suture and geometric reconstruction techniques

    Directory of Open Access Journals (Sweden)

    Cássio José SGARBI

    2000-12-01

    na evolução dos pacientes revascularizados.OBJECTIVE: To evaluate the evolution up to 15 years of patients who underwent surgical correction of left ventricular aneurysm and to compare the techniques of linear suture and geometric reconstruction. METHODS: We studied 213 patients, of which 166 (77.9% were men. The mean age was 53.1 years (SD=9.9 years. Of these, 145 (68% underwent repair using the linear suture technique and 68 (32% underwent the geometric reconstruction technique. The Kaplan - Meier method was used to evaluate late survival. We evaluated the presence of mural thrombus, in and out of hospital mortality and the possibility of myocardial revascularization in the same procedure. Statistical differences were measured using the Log Rank method for actuarial curves and the nonparametric test in the remaining data compared. RESULTS: Our survival curves after a follow up of 10 years demonstrated that patients submitted to the linear suture and LV geometric reconstruction had a survival of 47.19% (SEM=0.056 and 63,55% (SEM=0.068, respectively, which were not statistically significantly different (p= 0.56. The overall survival in the 2 groups together was 51.34% (SEM=0.0473 at 10 years and 35,77%(SEM=0.0684 at 15 years. The in hospital death was 9.5% for the linear suture and 16.6% for the geometric reconstruction (p=0.17. The removal of LV thrombus was 31.29% and 45.45%, respectively (p=0.07. Revascularization was performed in, 69% of the patients in the linear suture group and 85.3% in the geometric reconstruction group. Comparing patients who were revascularized with those who were not, there was a better survival at 10 years for the first group (p=0.008. CONCLUSIONS: There was no statistically significant difference in the survival of patients who underwent linear suture compared to geometric reconstruction of the LV for aneurysm repair. Our results demonstrated superior survival in those patients who could undergo revascularization in the same procedure.

  1. Improving surgical weekend handover

    OpenAIRE

    Culwick, Caroline; Devine, Chris; Coombs, Catherine

    2014-01-01

    Effective handovers are vital to patient safety and continuity of care, and this is recognised by several national bodies including the GMC. The existing model at Great Western Hospital (GWH) involved three general surgical teams and a urology team placing their printed patient lists, complete with weekend jobs, in a folder for the on-call team to collect at the weekend. We recognised a need to reduce time searching for patients, jobs and reviews, and to streamline weekend ward rounds. A unif...

  2. Acquiring minimally invasive surgical skills

    OpenAIRE

    Hiemstra, Ellen

    2012-01-01

    Many topics in surgical skills education have been implemented without a solid scientific basis. For that reason we have tried to find this scientific basis. We have focused on training and evaluation of minimally invasive surgical skills in a training setting and in practice in the operating room. This thesis has led to an enlarged insight in the organization of surgical skills training during residency training of surgical medical specialists.

  3. Robotic surgical training.

    Science.gov (United States)

    Ben-Or, Sharon; Nifong, L Wiley; Chitwood, W Randolph

    2013-01-01

    In July 2000, the da Vinci Surgical System (Intuitive Surgical, Inc) received Food and Drug Administration approval for intracardiac applications, and the first mitral valve repair was done at the East Carolina Heart Institute in May 2000. The system is now approved and used in many surgical specialties. With this disruptive technology and accepted use, surgeons and hospitals are seeking the most efficacious training pathway leading to safe use and responsible credentialing.One of the most important issues related to safe use is assembling the appropriate team of professionals involved with patient care. Moreover, proper patient selection and setting obtainable goals are also important.Creation and maintenance of a successful program are discussed in the article focusing on realistic goals. This begins with a partnership between surgeon leaders, hospital administrators, and industry support. Through this partnership, an appropriate training pathway and clinical pathway for success can be outlined. A timeline can then be created with periods of data analysis and adjustments as necessary. A successful program is attainable by following this pathway and attending to every detail along the journey.

  4. Acute and chronic pancreatitis: surgical management.

    Science.gov (United States)

    Dzakovic, Alexander; Superina, Riccardo

    2012-08-01

    Pancreatitis is becoming increasingly prevalent in children, posing new challenges to pediatric health care providers. Although some general adult treatment paradigms are applicable in the pediatric population, diagnostic workup and surgical management of acute and chronic pancreatitis have to be tailored to anatomic and pathophysiological entities peculiar to children. Nonbiliary causes of acute pancreatitis in children are generally managed nonoperatively with hydration, close biochemical and clinical observation, and early initiation of enteral feeds. Surgical intervention including cholecystectomy or endoscopic retrograde cholangiopancreatography is often required in acute biliary pancreatitis, whereas infected pancreatic necrosis remains a rare absolute indication for pancreatic debridement and drainage via open, laparoscopic, or interventional radiologic procedure. Chronic pancreatitis is characterized by painful irreversible changes of the parenchyma and ducts, which may result in or be caused by inadequate ductal drainage. A variety of surgical procedures providing drainage, denervation, resection, or a combination thereof are well established to relieve pain and preserve pancreatic function. Copyright © 2012. Published by Elsevier Inc.

  5. Surgical experts: born or made?

    Science.gov (United States)

    Sadideen, Hazim; Alvand, Abtin; Saadeddin, Munir; Kneebone, Roger

    2013-01-01

    The concept of surgical expertise and the processes involved in its development are topical, and there is a constant drive to identify reliable measures of expert performance in surgery. This review explores the notion of whether surgical experts are "born" or "made", with reference to educational theory and pertinent literature. Peer-reviewed publications, books, and online resources on surgical education, expertise and training were reviewed. Important themes and aspects of expertise acquisition were identified in order to better understand the concept of a surgical expert. The definition of surgical expertise and several important aspects of its development are highlighted. Innate talent plays an important role, but is insufficient on its own to produce a surgical expert. Multiple theories that explore motor skill acquisition and memory are relevant, and Ericsson's theory of the development of competence followed by deliberate self-practice has been especially influential. Psychomotor and non-technical skills are necessary for progression in the current climate in light of our training curricula; surgical experts are adaptive experts who excel in these. The literature suggests that surgical expertise is reached through practice; surgical experts are made, not born. A deeper understanding of the nature of expert performance and its development will ensure that surgical education training programmes are of the highest possible quality. Surgical educators should aim to develop an expertise-based approach, with expert performance as the benchmark. Copyright © 2013 Surgical Associates Ltd. Published by Elsevier Ltd. All rights reserved.

  6. Surgical navigation with QR codes

    Directory of Open Access Journals (Sweden)

    Katanacho Manuel

    2016-09-01

    Full Text Available The presented work is an alternative to established measurement systems in surgical navigation. The system is based on camera based tracking of QR code markers. The application uses a single video camera, integrated in a surgical lamp, that captures the QR markers attached to surgical instruments and to the patient.

  7. Nigerian Journal of Surgical Research

    African Journals Online (AJOL)

    The Nigerian Journal of Surgical Research is a publication of the Surgical Research Society with main office in Zaria, Nigeria. Zaria is home to Ahmadu Bello University (ABU), a premier university in Nigeria. The aim of The Nigerian Journal of Surgical Research is to cover developments and advances in the broad field of ...

  8. Work domain constraints for modelling surgical performance.

    Science.gov (United States)

    Morineau, Thierry; Riffaud, Laurent; Morandi, Xavier; Villain, Jonathan; Jannin, Pierre

    2015-10-01

    Three main approaches can be identified for modelling surgical performance: a competency-based approach, a task-based approach, both largely explored in the literature, and a less known work domain-based approach. The work domain-based approach first describes the work domain properties that constrain the agent's actions and shape the performance. This paper presents a work domain-based approach for modelling performance during cervical spine surgery, based on the idea that anatomical structures delineate the surgical performance. This model was evaluated through an analysis of junior and senior surgeons' actions. Twenty-four cervical spine surgeries performed by two junior and two senior surgeons were recorded in real time by an expert surgeon. According to a work domain-based model describing an optimal progression through anatomical structures, the degree of adjustment of each surgical procedure to a statistical polynomial function was assessed. Each surgical procedure showed a significant suitability with the model and regression coefficient values around 0.9. However, the surgeries performed by senior surgeons fitted this model significantly better than those performed by junior surgeons. Analysis of the relative frequencies of actions on anatomical structures showed that some specific anatomical structures discriminate senior from junior performances. The work domain-based modelling approach can provide an overall statistical indicator of surgical performance, but in particular, it can highlight specific points of interest among anatomical structures that the surgeons dwelled on according to their level of expertise.

  9. Surgical management of gynecomastia: 20 years' experience.

    Science.gov (United States)

    Lapid, O; Jolink, F

    2014-03-01

    Gynecomastia, breast hypertrophy in men, is a common finding. The diagnosis is clinical, and ancillary tests may be performed; however, there is no unanimity in the literature about their use or utility. The mainstay of management is conservative, with a minority of patients being operated on. The surgical treatment of gynecomastia is not restricted to one discipline and is performed by plastic, general, and pediatric surgeons. The aim of this study was to assess the experience treating gynecomastia in a university hospital and the practices of the different surgical disciplines in the diagnosis and surgical treatment of gynecomastia; this knowledge could be used for the formulation of guidelines and the allocation of health-care resources. a university medical center. A retrospective cohort study in which all records of patients operated on for gynecomastia over a 20-year period were retrieved. Data were obtained concerning patient demographics, responsible surgical discipline, the workup and etiology found, the surgical technique used, the occurrence of reoperations and revisions, and the use of pathological examination and its results. A total of 179 patients were treated. There was a difference between the patient groups operated on by the different disciplines regarding the indication, the workup, as well as in the operative techniques used. Plastic surgeons performed more bilateral operations than the other disciplines. Surgeons used more radiology and cytology testing. These results most probably represent differences in the population and pathologies treated. This is possibly due to a bias in the referrals by primary care physicians.

  10. Surgical managements of radiation enteritis

    Energy Technology Data Exchange (ETDEWEB)

    Tanaka, Tsuguo; Naito, Kazuyo; Noomi, Shinppachiro; Kurioka, Hideaki; Yamagishi, Hisakazu (Kyoto Prefectural Univ. of Medicine (Japan))

    1983-02-01

    Radiation injury to the digestive tract was surgically treated in 22 cases. Six of them died shortly after surgery. Major symptoms were ileus or perforative peritonitis in 20 of the 22 cases, and surgery was performed for ileal lesion in 18 cases, indicating the significance of lesions in the small intestine. Seven patients underwent resection of the injured portion of the intestinal tract and anastomotic reconstruction in one stage, but 3 of them died from rupture of sutures. It was highly probable that anastomosis was made using an injured portion of the intestine. Intraoperative judgement of intestinal injury is made by palpation and inspection. If judgement is difficult, an artificial anus should be constructed first, and anastomotic reconstruction should be done in the 2nd stage. Since delayed injury of this disease is an ischemic change due to vascular obliteration, conservative therapy never leads to complete recovery, but active resection and anastomosis seem to produce a satisfactory result.

  11. Surgical managements of radiation enteritis

    International Nuclear Information System (INIS)

    Tanaka, Tsuguo; Naito, Kazuyo; Noomi, Shinppachiro; Kurioka, Hideaki; Yamagishi, Hisakazu

    1983-01-01

    Radiation injury to the digestive tract was surgically treated in 22 cases. Six of them died shortly after surgery. Major symptoms were ileus or perforative peritonitis in 20 of the 22 cases, and surgery was performed for ileal lesion in 18 cases, indicating the significance of lesions in the small intestine. Seven patients underwent resection of the injured portion of the intestinal tract and anastomotic reconstruction in one stage, but 3 of them died from rupture of sutures. It was highly probable that anastomosis was made using an injured portion of the intestine. Intraoperative judgement of intestinal injury is made by palpation and inspection. If judgement is difficult, an artificial anus should be constructed first, and anastomotic reconstruction should be done in the 2nd stage. Since delayed injury of this disease is an ischemic change due to vascular obliteration, conservative therapy never leads to complete recovery, but active resection and anastomosis seem to produce a satisfactory result. (Chiba, N.)

  12. Neutron borehole logging correction technique

    International Nuclear Information System (INIS)

    Goldman, L.H.

    1978-01-01

    In accordance with an illustrative embodiment of the present invention, a method and apparatus is disclosed for logging earth formations traversed by a borehole in which an earth formation is irradiated with neutrons and gamma radiation produced thereby in the formation and in the borehole is detected. A sleeve or shield for capturing neutrons from the borehole and producing gamma radiation characteristic of that capture is provided to give an indication of the contribution of borehole capture events to the total detected gamma radiation. It is then possible to correct from those borehole effects the total detected gamma radiation and any earth formation parameters determined therefrom

  13. Robust Active Label Correction

    DEFF Research Database (Denmark)

    Kremer, Jan; Sha, Fei; Igel, Christian

    2018-01-01

    for the noisy data lead to different active label correction algorithms. If loss functions consider the label noise rates, these rates are estimated during learning, where importance weighting compensates for the sampling bias. We show empirically that viewing the true label as a latent variable and computing......Active label correction addresses the problem of learning from input data for which noisy labels are available (e.g., from imprecise measurements or crowd-sourcing) and each true label can be obtained at a significant cost (e.g., through additional measurements or human experts). To minimize......). To select labels for correction, we adopt the active learning strategy of maximizing the expected model change. We consider the change in regularized empirical risk functionals that use different pointwise loss functions for patterns with noisy and true labels, respectively. Different loss functions...

  14. Generalised Batho correction factor

    International Nuclear Information System (INIS)

    Siddon, R.L.

    1984-01-01

    There are various approximate algorithms available to calculate the radiation dose in the presence of a heterogeneous medium. The Webb and Fox product over layers formulation of the generalised Batho correction factor requires determination of the number of layers and the layer densities for each ray path. It has been shown that the Webb and Fox expression is inefficient for the heterogeneous medium which is expressed as regions of inhomogeneity rather than layers. The inefficiency of the layer formulation is identified as the repeated problem of determining for each ray path which inhomogeneity region corresponds to a particular layer. It has been shown that the formulation of the Batho correction factor as a product over inhomogeneity regions avoids that topological problem entirely. The formulation in terms of a product over regions simplifies the computer code and reduces the time required to calculate the Batho correction factor for the general heterogeneous medium. (U.K.)

  15. THE SECONDARY EXTINCTION CORRECTION

    Energy Technology Data Exchange (ETDEWEB)

    Zachariasen, W. H.

    1963-03-15

    It is shown that Darwin's formula for the secondary extinction correction, which has been universally accepted and extensively used, contains an appreciable error in the x-ray diffraction case. The correct formula is derived. As a first order correction for secondary extinction, Darwin showed that one should use an effective absorption coefficient mu + gQ where an unpolarized incident beam is presumed. The new derivation shows that the effective absorption coefficient is mu + 2gQ(1 + cos/sup 4/2 theta )/(1 plus or minus cos/sup 2/2 theta )/s up 2/, which gives mu + gQ at theta =0 deg and theta = 90 deg , but mu + 2gQ at theta = 45 deg . Darwin's theory remains valid when applied to neutron diffraction. (auth)

  16. Multi-perspective workflow modeling for online surgical situation models.

    Science.gov (United States)

    Franke, Stefan; Meixensberger, Jürgen; Neumuth, Thomas

    2015-04-01

    Surgical workflow management is expected to enable situation-aware adaptation and intelligent systems behavior in an integrated operating room (OR). The overall aim is to unburden the surgeon and OR staff from both manual maintenance and information seeking tasks. A major step toward intelligent systems behavior is a stable classification of the surgical situation from multiple perspectives based on performed low-level tasks. The present work proposes a method for the classification of surgical situations based on multi-perspective workflow modeling. A model network that interconnects different types of surgical process models is described. Various aspects of a surgical situation description were considered: low-level tasks, high-level tasks, patient status, and the use of medical devices. A study with sixty neurosurgical interventions was conducted to evaluate the performance of our approach and its robustness against incomplete workflow recognition input. A correct classification rate of over 90% was measured for high-level tasks and patient status. The device usage models for navigation and neurophysiology classified over 95% of the situations correctly, whereas the ultrasound usage was more difficult to predict. Overall, the classification rate decreased with an increasing level of input distortion. Autonomous adaptation of medical devices and intelligent systems behavior do not currently depend solely on low-level tasks. Instead, they require a more general type of understanding of the surgical condition. The integration of various surgical process models in a network provided a comprehensive representation of the interventions and allowed for the generation of extensive situation descriptions. Multi-perspective surgical workflow modeling and online situation models will be a significant pre-requisite for reliable and intelligent systems behavior. Hence, they will contribute to a cooperative OR environment. Copyright © 2015 Elsevier Inc. All rights reserved.

  17. Isolated cleft palate requires different surgical protocols depending on cleft type.

    Science.gov (United States)

    Elander, Anna; Persson, Christina; Lilja, Jan; Mark, Hans

    2017-08-01

    A staged protocol for isolated cleft palate (CPO), comprising the early repair of the soft palate at 6 months and delayed repair of the eventual cleft in the hard palate until 4 years, designed to improve maxillary growth, was introduced. CPO is frequently associated with additional congenital conditions. The study evaluates this surgical protocol for clefts in the soft palate (CPS) and for clefts in the hard and soft palate (CPH), with or without additional malformation, regarding primary and secondary surgical interventions needed for cleft closure and for correction of velopharyngeal insufficiency until 10 years of age. Of 94 consecutive children with CPO, divided into four groups with (+) or without (-) additional malformations (CPS + or CPS - and CPH + or CPH-), hard palate repair was required in 53%, performed with small local flaps in 21% and with bilateral mucoperiosteal flaps in 32%. The total incidence of soft palate re-repair was 2% and the fistula repair of the hard palate was 5%. The total incidence of secondary velopharyngeal surgery was 17% until 10 years, varying from 0% for CPS - and 15% for CPH-, to 28% for CPS + and 30% for CPH+. The described staged protocol for repair of CPO is found to be safe in terms of perioperative surgical results, with comparatively low need for secondary interventions. Furthermore, the study indicates that the presence of a cleft in the hard palate and/or additional conditions have a negative impact on the development of the velopharyngeal function.

  18. Bryant J. correction formula

    International Nuclear Information System (INIS)

    Tejera R, A.; Cortes P, A.; Becerril V, A.

    1990-03-01

    For the practical application of the method proposed by J. Bryant, the authors carried out a series of small corrections, related with the bottom, the dead time of the detectors and channels, with the resolution time of the coincidences, with the accidental coincidences, with the decay scheme and with the gamma efficiency of the beta detector beta and the beta efficiency beta of the gamma detector. The calculation of the correction formula is presented in the development of the present report, being presented 25 combinations of the probability of the first existent state at once of one disintegration and the second state at once of the following disintegration. (Author)

  19. Model Correction Factor Method

    DEFF Research Database (Denmark)

    Christensen, Claus; Randrup-Thomsen, Søren; Morsing Johannesen, Johannes

    1997-01-01

    The model correction factor method is proposed as an alternative to traditional polynomial based response surface techniques in structural reliability considering a computationally time consuming limit state procedure as a 'black box'. The class of polynomial functions is replaced by a limit...... of the model correction factor method, is that in simpler form not using gradient information on the original limit state function or only using this information once, a drastic reduction of the number of limit state evaluation is obtained together with good approximations on the reliability. Methods...

  20. Skin reduction technique for correction of lateral deviation of the erect straight penis.

    Science.gov (United States)

    Shaeer, Osama

    2014-07-01

    Lateral deviation of the erect straight penis (LDESP) refers to a penis that despite being straight in the erect state, points laterally, yet can be directed forward manually without the use of force. While LDESP should not impose a negative impact on sexual function, it may have a negative cosmetic impact. This work describes skin reduction technique (SRT) for correction of LDESP. Counseling was offered to males with LDESP after excluding other abnormalities. Surgery was performed in case of failed counseling. In the erect state, the degree and direction of LDESP were noted. Skin on the base of the penis on the contralateral side of LDESP was excised from the base of the penis and the edges approximated to correct LDESP. Further excision was repeated if needed. The incision was closed in two layers. Long-term efficacy of SRT was the main outcome measure. Out of 183 males with LDESP, 66.7% were not sexually active. Counseling relieved 91.8% of cases. Fifteen patients insisted on surgery, mostly from among the sexually active where the complaint was mutual from the patient and partner. SRT resulted in full correction of the angle of erection in 12 cases out of 15. Two had minimal recurrence, and one had major recurrence indicating re-SRT. LDESP is more common a complaint among those who have not experienced coital relationship, and is mostly relieved by counseling. However, sexually active males with this complaint are more difficult to relieve by counseling. A minority of patients may opt for surgical correction. SRT achieves a forward erection in such patients, is minimally invasive, and relatively safe, provided the angle of erection can be corrected manually without force. Shaeer O. Skin reduction technique for correction of lateral deviation of the erect straight penis. © 2014 International Society for Sexual Medicine.

  1. Corrective feedback via e-mail on the correct use of past tense ...

    African Journals Online (AJOL)

    panah

    2015-11-09

    Nov 9, 2015 ... Based on descriptive studies of teacher-student interaction (Lyster, 2002; Lyster, ... supplies the correct form, and clearly indicates that what the student is saying is incorrect. ..... Cognition and second language instruction.

  2. Surgical management of gynecomastia: experience of a general surgery center.

    Science.gov (United States)

    Longheu, A; Medas, F; Corrias, F; Farris, S; Tatti, A; Pisano, G; Erdas, E; Calò, P G

    2016-01-01

    Gynecomastia is a common finding in male population of all ages. The aim of our study was to present our experience and goals in surgical treatment of gynecomastia. Clinical records of patients affected by gynecomastia referred to our Department of Surgery between September 2008 and January 2015 were analyzed. 50 patients were included in this study. Gynecomastia was monolateral in 12 patients (24%) and bilateral in 38 (76%); idiopathic in 41 patients (82%) and secondary in 9 (18%). 39 patients (78%) underwent surgical operation under general anaesthesia, 11 (22%) under local anaesthesia. 3 patients (6%) presented recurrent disease. Webster technique was performed in 28 patients (56%), Davidson technique in 16 patients (32%); in 2 patients (4%) Pitanguy technique was performed and in 4 patients (8%) a mixed surgical technique was performed. Mean surgical time was 80.72±35.14 minutes, median postoperative stay was 1.46±0.88 days. 2 patients (4%) operated using Davidson technique developed a hematoma, 1 patient (2%) operated with the same technique developed hypertrophic scar. Several surgical techniques are described for surgical correction of gynecomastia. If performed by skilled general surgeons surgical treatment of gynecomastia is safe and permits to reach satisfactory aesthetic results.

  3. Feasibility of simultaneous correction of ametropia by varying gel refractive index with phaco-ersatz

    Science.gov (United States)

    Ho, Arthur; Erickson, Paul; Manns, Fabrice; Pham, Therese; Parel, Jean-Marie A.

    2001-06-01

    Recent developments in surgical procedures for restoring accommodation saw the availability of Phaco-ersatz as a feasible procedure returning near vision to the presbyopies. In Phaco-ersatz, the presbyopic crystalline lens is extracted and replaced by a flexible polymer gel in the intact lens capsule. The ability to simultaneously correct ametropia while restoring accommodation with this procedure is seen to be extremely attractive. One strategy by which this may be achieved within the Phaco-ersatz procedure is by making use of polymer gel of different refractive indices. We assessed the feasibility of simultaneously correcting ametropia while restoring accommodation using phaco-ersatz using this approach. Two model eyes (Gullstrand and Navarro) were used to evaluate this approach. Computation results using paraxial equations and ray tracing indicated that while this approach might be feasible for the hypermetrope, its usefulness for correcting myopia is limited due to significant reductions in the resultant amplitude of accommodation. A number of practical considerations may also influence the applicability of this approach.

  4. A proposed orbit and vertical dispersion correction system for PEP

    International Nuclear Information System (INIS)

    Close, E.; Cornacchia, M.; King, A.S.; Lee, M.J.

    1978-07-01

    The proposed arrangement of position monitors and dipole magnets for the closed orbit correction system in PEP is described. The computer code ALIGN, which simulates and corrects closed orbit displacements, has been used to study the most effective layout of monitors and correctors. The vertical dispersion function has been computed before and after closed orbit correction. The results indicate that the residual vertical dispersion after the orbit is corrected could exceed the tolerable values. A correction procedure for the vertical dispersion has been studied with the compute code CO-OP and this scheme of correction has been verified experimentally in SPEAR. 9 refs., 8 figs., 2 tabs

  5. Radical treatment of extensive nevoid hyperkeratosis of the areola and breast with surgical excision after mild response to topical agents: A case report

    Directory of Open Access Journals (Sweden)

    Ilaria Tocco-Tussardi, MD

    2016-01-01

    Conclusion: Indications for surgical treatment of NHNA can be: unsatisfying response to topical agents; young patients who want to restore the aesthetic appearance of the breast; and patients with concomitant indication for corrective surgery of the breast. Advantages are: predictable time of healing; predictable final result; radical excision of the affected tissue; and possibility of histologic analysis of the whole areola. In rare cases of lesions extending to the breast, preliminary treatment with topical agents can limit the extent of excision. Management and treatment should always be tailor-made for each individual case.

  6. Implementation of surgical quality improvement: auditing tool for surgical site infection prevention practices.

    Science.gov (United States)

    Hechenbleikner, Elizabeth M; Hobson, Deborah B; Bennett, Jennifer L; Wick, Elizabeth C

    2015-01-01

    Surgical site infections are a potentially preventable patient harm. Emerging evidence suggests that the implementation of evidence-based process measures for infection reduction is highly variable. The purpose of this work was to develop an auditing tool to assess compliance with infection-related process measures and establish a system for identifying and addressing defects in measure implementation. This was a retrospective cohort study using electronic medical records. We used the auditing tool to assess compliance with 10 process measures in a sample of colorectal surgery patients with and without postoperative infections at an academic medical center (January 2012 to March 2013). We investigated 59 patients with surgical site infections and 49 patients without surgical site infections. First, overall compliance rates for the 10 process measures were compared between patients with infection vs patients without infection to assess if compliance was lower among patients with surgical site infections. Then, because of the burden of data collection, the tool was used exclusively to evaluate quarterly compliance rates among patients with infection. The results were reviewed, and the key factors contributing to noncompliance were identified and addressed. Ninety percent of process measures had lower compliance rates among patients with infection. Detailed review of infection cases identified many defects that improved following the implementation of system-level changes: correct cefotetan redosing (education of anesthesia personnel), temperature at surgical incision >36.0°C (flags used to identify patients for preoperative warming), and the use of preoperative mechanical bowel preparation with oral antibiotics (laxative solutions and antibiotics distributed in clinic before surgery). Quarterly compliance improved for 80% of process measures by the end of the study period. This study was conducted on a small surgical cohort within a select subspecialty. The

  7. Patient Satisfaction of Surgical Treatment of Clitoral Phimosis and Labial Adhesions Caused by Lichen Sclerosus

    Directory of Open Access Journals (Sweden)

    Anne N. Flynn, MD

    2015-12-01

    Conclusions: This study shows high patient satisfaction and low complication risk associated with surgical correction of clitoral phimosis and lysis of vulvar adhesions for VGF caused by LS. Patients reported improvement in clitoral sensation and ability to achieve orgasm, as well as decreased dyspareunia. Surgical correction of vulvar scarring is a viable option to restore vulvar anatomy and sexual function in appropriate candidates with anogenital LS. Flynn AN, King M, Rieff M, Krapf J, and Goldstein AT. Patient satisfaction of surgical treatment of clitoral phimosis and labial adhesions caused by lichen sclerosus. Sex Med 2015;3:251–255.

  8. Orthodontic-orthognathic interventions in orthognathic surgical cases: "Paper surgery" and "model surgery" concepts in surgical orthodontics

    Directory of Open Access Journals (Sweden)

    Narayan H Gandedkar

    2016-01-01

    Full Text Available Thorough planning and execution is the key for successful treatment of dentofacial deformity involving surgical orthodontics. Presurgical planning (paper surgery and model surgery are the most essential prerequisites of orthognathic surgery, and orthodontist is the one who carries out this procedure by evaluating diagnostic aids such as crucial clinical findings and radiographic assessments. However, literature pertaining to step-by-step orthognathic surgical guidelines is limited. Hence, this article makes an attempt to provide an insight and nuances involved in the planning and execution. The diagnostic information revealed from clinical findings and radiographic assessments is integrated in the "paper surgery" to establish "surgical-plan." Furthermore, the "paper surgery" is emulated in "model surgery" such that surgical bite-wafers are created, which aid surgeon to preview the final outcome and make surgical movements that are deemed essential for the desired skeletal and dental outcomes. Skeletal complexities are corrected by performing "paper surgery" and an occlusion is set up during "model surgery" for the fabrication of surgical bite-wafers. Further, orthodontics is carried out for the proper settling and finishing of occlusion. Article describes the nuances involved in the treatment of Class III skeletal deformity individuals treated with orthognathic surgical approach and illustrates orthodontic-orthognathic step-by-step procedures from "treatment planning" to "execution" for successful management of aforementioned dentofacial deformity.

  9. Attenuation correction for SPECT

    International Nuclear Information System (INIS)

    Hosoba, Minoru

    1986-01-01

    Attenuation correction is required for the reconstruction of a quantitative SPECT image. A new method for detecting body contours, which are important for the correction of tissue attenuation, is presented. The effect of body contours, detected by the newly developed method, on the reconstructed images was evaluated using various techniques for attenuation correction. The count rates in the specified region of interest in the phantom image by the Radial Post Correction (RPC) method, the Weighted Back Projection (WBP) method, Chang's method were strongly affected by the accuracy of the contours, as compared to those by Sorenson's method. To evaluate the effect of non-uniform attenuators on the cardiac SPECT, computer simulation experiments were performed using two types of models, the uniform attenuator model (UAM) and the non-uniform attenuator model (NUAM). The RPC method showed the lowest relative percent error (%ERROR) in UAM (11 %). However, 20 to 30 percent increase in %ERROR was observed for NUAM reconstructed with the RPC, WBP, and Chang's methods. Introducing an average attenuation coefficient (0.12/cm for Tc-99m and 0.14/cm for Tl-201) in the RPC method decreased %ERROR to the levels for UAM. Finally, a comparison between images, which were obtained by 180 deg and 360 deg scans and reconstructed from the RPC method, showed that the degree of the distortion of the contour of the simulated ventricles in the 180 deg scan was 15 % higher than that in the 360 deg scan. (Namekawa, K.)

  10. Text Induced Spelling Correction

    NARCIS (Netherlands)

    Reynaert, M.W.C.

    2004-01-01

    We present TISC, a language-independent and context-sensitive spelling checking and correction system designed to facilitate the automatic removal of non-word spelling errors in large corpora. Its lexicon is derived from a very large corpus of raw text, without supervision, and contains word

  11. Ballistic deficit correction

    International Nuclear Information System (INIS)

    Duchene, G.; Moszynski, M.; Curien, D.

    1991-01-01

    The EUROGAM data-acquisition has to handle a large number of events/s. Typical in-beam experiments using heavy-ion fusion reactions assume the production of about 50 000 compound nuclei per second deexciting via particle and γ-ray emissions. The very powerful γ-ray detection of EUROGAM is expected to produce high-fold event rates as large as 10 4 events/s. Such high count rates introduce, in a common dead time mode, large dead times for the whole system associated with the processing of the pulse, its digitization and its readout (from the preamplifier pulse up to the readout of the information). In order to minimize the dead time the shaping time constant τ, usually about 3 μs for large volume Ge detectors has to be reduced. Smaller shaping times, however, will adversely affect the energy resolution due to ballistic deficit. One possible solution is to operate the linear amplifier, with a somewhat smaller shaping time constant (in the present case we choose τ = 1.5 μs), in combination with a ballistic deficit compensator. The ballistic deficit can be corrected in different ways using a Gated Integrator, a hardware correction or even a software correction. In this paper we present a comparative study of the software and hardware corrections as well as gated integration

  12. Correctness of concurrent processes

    NARCIS (Netherlands)

    E.R. Olderog (Ernst-Rüdiger)

    1989-01-01

    textabstractA new notion of correctness for concurrent processes is introduced and investigated. It is a relationship P sat S between process terms P built up from operators of CCS [Mi 80], CSP [Ho 85] and COSY [LTS 79] and logical formulas S specifying sets of finite communication sequences as in

  13. Error Correcting Codes -34 ...

    Indian Academy of Sciences (India)

    information and coding theory. A large scale relay computer had failed to deliver the expected results due to a hardware fault. Hamming, one of the active proponents of computer usage, was determined to find an efficient means by which computers could detect and correct their own faults. A mathematician by train-.

  14. Measured attenuation correction methods

    International Nuclear Information System (INIS)

    Ostertag, H.; Kuebler, W.K.; Doll, J.; Lorenz, W.J.

    1989-01-01

    Accurate attenuation correction is a prerequisite for the determination of exact local radioactivity concentrations in positron emission tomography. Attenuation correction factors range from 4-5 in brain studies to 50-100 in whole body measurements. This report gives an overview of the different methods of determining the attenuation correction factors by transmission measurements using an external positron emitting source. The long-lived generator nuclide 68 Ge/ 68 Ga is commonly used for this purpose. The additional patient dose from the transmission source is usually a small fraction of the dose due to the subsequent emission measurement. Ring-shaped transmission sources as well as rotating point or line sources are employed in modern positron tomographs. By masking a rotating line or point source, random and scattered events in the transmission scans can be effectively suppressed. The problems of measured attenuation correction are discussed: Transmission/emission mismatch, random and scattered event contamination, counting statistics, transmission/emission scatter compensation, transmission scan after administration of activity to the patient. By using a double masking technique simultaneous emission and transmission scans become feasible. (orig.)

  15. Corrective Jaw Surgery

    Medline Plus

    Full Text Available ... their surgery, orthognathic surgery is performed to correct functional problems. Jaw Surgery can have a dramatic effect on many aspects of life. Following are some of the conditions that may ... front, or side Facial injury Birth defects Receding lower jaw and ...

  16. Error Correcting Codes

    Indian Academy of Sciences (India)

    successful consumer products of all time - the Compact Disc. (CD) digital audio .... We can make ... only 2 t additional parity check symbols are required, to be able to correct t .... display information (contah'ling music related data and a table.

  17. Error Correcting Codes

    Indian Academy of Sciences (India)

    Science and Automation at ... the Reed-Solomon code contained 223 bytes of data, (a byte ... then you have a data storage system with error correction, that ..... practical codes, storing such a table is infeasible, as it is generally too large.

  18. Error Correcting Codes

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 2; Issue 3. Error Correcting Codes - Reed Solomon Codes. Priti Shankar. Series Article Volume 2 Issue 3 March ... Author Affiliations. Priti Shankar1. Department of Computer Science and Automation, Indian Institute of Science, Bangalore 560 012, India ...

  19. 10. Correctness of Programs

    Indian Academy of Sciences (India)

    Home; Journals; Resonance – Journal of Science Education; Volume 3; Issue 4. Algorithms - Correctness of Programs. R K Shyamasundar. Series Article Volume 3 ... Author Affiliations. R K Shyamasundar1. Computer Science Group, Tata Institute of Fundamental Research, Homi Bhabha Road, Mumbai 400 005, India.

  20. [Duane vertical surgical treatment].

    Science.gov (United States)

    Merino, M L; Gómez de Liaño, P; Merino, P; Franco, G

    2014-04-01

    We report 3 cases with a vertical incomitance in upgaze, narrowing of palpebral fissure, and pseudo-overaction of both inferior oblique muscles. Surgery consisted of an elevation of both lateral rectus muscles with an asymmetrical weakening. A satisfactory result was achieved in 2 cases, whereas a Lambda syndrome appeared in the other case. The surgical technique of upper-insertion with a recession of both lateral rectus muscles improved vertical incomitance in 2 of the 3 patients; however, a residual deviation remains in the majority of cases. Copyright © 2011 Sociedad Española de Oftalmología. Published by Elsevier Espana. All rights reserved.

  1. Open and Arthroscopic Surgical Treatment of Femoroacetabular Impingement

    Directory of Open Access Journals (Sweden)

    Benjamin D. Kuhns

    2015-12-01

    Full Text Available Femoroacetabular impingement (FAI is a common cause of hip pain, and when indicated, can be successfully managed through open surgery or hip arthroscopy. The goal of this review is to describe the different approaches to the surgical treatment of FAI. We present the indications, surgical technique, rehabilitation, and complications associated with (1 open hip dislocation, (2 reverse peri-acetabular osteotomy, (3 the direct anterior mini-open approach, and (4 arthroscopic surgery for femoroacetabular impingement.

  2. A Literature Review of Renal Surgical Anatomy and Surgical Strategies for Partial Nephrectomy.

    Science.gov (United States)

    Klatte, Tobias; Ficarra, Vincenzo; Gratzke, Christian; Kaouk, Jihad; Kutikov, Alexander; Macchi, Veronica; Mottrie, Alexandre; Porpiglia, Francesco; Porter, James; Rogers, Craig G; Russo, Paul; Thompson, R Houston; Uzzo, Robert G; Wood, Christopher G; Gill, Inderbir S

    2015-12-01

    A detailed understanding of renal surgical anatomy is necessary to optimize preoperative planning and operative technique and provide a basis for improved outcomes. To evaluate the literature regarding pertinent surgical anatomy of the kidney and related structures, nephrometry scoring systems, and current surgical strategies for partial nephrectomy (PN). A literature review was conducted. Surgical renal anatomy fundamentally impacts PN surgery. The renal artery divides into anterior and posterior divisions, from which approximately five segmental terminal arteries originate. The renal veins are not terminal. Variations in the vascular and lymphatic channels are common; thus, concurrent lymphadenectomy is not routinely indicated during PN for cT1 renal masses in the setting of clinically negative lymph nodes. Renal-protocol contrast-enhanced computed tomography or magnetic resonance imaging is used for standard imaging. Anatomy-based nephrometry scoring systems allow standardized academic reporting of tumor characteristics and predict PN outcomes (complications, remnant function, possibly histology). Anatomy-based novel surgical approaches may reduce ischemic time during PN; these include early unclamping, segmental clamping, tumor-specific clamping (zero ischemia), and unclamped PN. Cancer cure after PN relies on complete resection, which can be achieved by thin margins. Post-PN renal function is impacted by kidney quality, remnant quantity, and ischemia type and duration. Surgical renal anatomy underpins imaging, nephrometry scoring systems, and vascular control techniques that reduce global renal ischemia and may impact post-PN function. A contemporary ideal PN excises the tumor with a thin negative margin, delicately secures the tumor bed to maximize vascularized remnant parenchyma, and minimizes global ischemia to the renal remnant with minimal complications. In this report we review renal surgical anatomy. Renal mass imaging allows detailed delineation of the

  3. Ventilação elétrica: indicações e aspectos técnicos do implante cirúrgico do marca-passo de estimulação diafragmática Electric ventilation: indications for and technical aspects of diaphragm pacing stimulation surgical implantation

    Directory of Open Access Journals (Sweden)

    Miguel Lia Tedde

    2012-10-01

    was to highlight the indications for and some aspects of the surgical technique employed in the laparoscopic insertion of the DPS electrodes, as well as to describe five cases of tetraplegic patients submitted to the technique. METHODS: Patient selection involved transcutaneous phrenic nerve studies in order to determine whether the phrenic nerves were preserved. The surgical approach was traditional laparoscopy, with four ports. The initial step was electrical mapping in order to locate the "motor points" (the points at which stimulation would cause maximal contraction of the diaphragm. If the diaphragm mapping was successful, four electrodes were implanted into the abdominal surface of the diaphragm, two on each side, to stimulate the branches of the phrenic nerve. RESULTS: Of the five patients, three could breathe using DPS alone for more than 24 h, one could do so for more than 6 h, and one could not do so at all. CONCLUSIONS: Although a longer follow-up period is needed in order to reach definitive conclusions, the initial results have been promising. At this writing, most of our patients have been able to remain ventilator-free for long periods of time.

  4. Surgical management of gynecomastia--a 10-year analysis.

    Science.gov (United States)

    Handschin, A E; Bietry, D; Hüsler, R; Banic, A; Constantinescu, M

    2008-01-01

    Gynecomastia is defined as the benign enlargement of the male breast. Most studies on surgical treatment of gynecomastia show only small series and lack histopathology results. The aim of this study was to analyze the surgical approach in the treatment of gynecomastia and the related outcome over a 10-year period. All patients undergoing surgical gynecomastia corrections in our department between 1996 and 2006 were included for retrospective evaluation. The data were analyzed for etiology, stage of gynecomastia, surgical technique, complications, risk factors, and histological results. A total of 100 patients with 160 operations were included. Techniques included subcutaneous mastectomy alone or with additional hand-assisted liposuction, isolated liposuction, and formal breast reduction. Atypical histological findings were found in 3% of the patients (spindle-cell hemangioendothelioma, papilloma). The surgical revision rate among all patients was 7%. Body mass index and a weight of the resected specimen higher than 40 g were identified as significant risk factors for complications (p gynecomastia requires an individualized approach. Caution must be taken in performing large resections, which are associated with increased complication rates. Histological tissue analysis should be routinely performed in all true gynecomastia corrections, because histological results may reveal atypical cellular pathology.

  5. [Surgical assessment of complications after thyroid gland operations].

    Science.gov (United States)

    Dralle, H

    2015-01-01

    The extent, magnitude and technical equipment used for thyroid surgery has changed considerably in Germany during the last decade. The number of thyroidectomies due to benign goiter have decreased while the extent of thyroidectomy, nowadays preferentially total thyroidectomy, has increased. Due to an increased awareness of surgical complications the number of malpractice claims is increasing. In contrast to surgical databases the frequency of complications in malpractice claims reflects the individual impact of complications on the quality of life. In contrast to surgical databases unilateral and bilateral vocal fold palsy are therefore at the forefront of malpractice claims. As guidelines are often not applicable for the individual surgical expert review, the question arises which are the relevant criteria for the professional expert witness assessing the severity of the individual complication. While in surgical databases major complications after thyroidectomy, such as vocal fold palsy, hypoparathyroidism, hemorrhage and infections are equally frequent (1-3 %), in malpractice claims vocal fold palsy is significantly more frequent (50 %) compared to hypoparathyroidism (15 %), hemorrhage and infections (about 5 % each). To avoid bilateral nerve palsy intraoperative nerve monitoring has become of utmost importance for surgical strategy and malpractice suits alike. For surgical expert review documentation of individual risk-oriented indications, the surgical approach and postoperative management are highly important. Guidelines only define the treatment corridors of good clinical practice. Surgical expert reviews in malpractice suits concerning quality of care and causality between surgical management, complications and sequelae of complications are therefore highly dependent on the grounds and documentation of risk-oriented indications for thyroidectomy, intraoperative and postoperative surgical management.

  6. Surgical treatment of polymicrogyria-related epilepsy.

    Science.gov (United States)

    Cossu, Massimo; Pelliccia, Veronica; Gozzo, Francesca; Casaceli, Giuseppe; Francione, Stefano; Nobili, Lino; Mai, Roberto; Castana, Laura; Sartori, Ivana; Cardinale, Francesco; Lo Russo, Giorgio; Tassi, Laura

    2016-12-01

    The role of resective surgery in the treatment of polymicrogyria (PMG)-related focal epilepsy is uncertain. Our aim was to retrospectively evaluate the seizure outcome in a consecutive series of patients with PMG-related epilepsy who received, or did not receive, surgical treatment, and to outline the clinical characteristics of patients who underwent surgery. We evaluated 64 patients with epilepsy associated with magnetic resonance imaging (MRI)-documented PMG. After presurgical evaluation, 32 patients were excluded from surgical treatment and 32 were offered surgery, which was declined by 8 patients. Seizure outcome was assessed in the 40 nonsurgical and 24 surgical patients. Of 40 nonsurgical patients, 8 (20%) were seizure-free after a mean follow-up of 91.7 ± (standard deviation) 59.5 months. None of the eight patients who declined surgical treatment was seizure-free (mean follow-up: 74.3 ± 60.6 months). These seizure outcomes differ significantly (p = 0.000005 and p = 0.0003, respectively) from that of the 24 surgical patients, 18 of whom (66.7%) were Engel's class I postoperatively (mean follow-up: 66.5 ± 54.0 months). Of the eight patients excluded from surgery for seizure control at first visit, two had seizure recurrence at last contact. At last contact, antiepileptic drugs (AEDs) had been withdrawn in 6 of 24 surgical and in one of 40 nonsurgical cases (p = 0.0092). The present study indicates that, at least in a subset of adequately selected patients with PMG-related epilepsy, surgery may provide excellent seizure outcomes. Furthermore, it suggests that surgery is superior to AEDs for achieving seizure freedom in these cases. Wiley Periodicals, Inc. © 2016 International League Against Epilepsy.

  7. Surgical treatment analysis of idiopathic esophageal achalasia.

    Science.gov (United States)

    Aquino, José Luis Braga de; Said, Marcelo Manzano; Pereira, Douglas Rizzanti; Amaral, Paula Casals do; Lima, Juliana Carolina Alves; Leandro-Merhi, Vânia Aparecida

    2015-01-01

    Idiopathic esophageal achalasia is an inflammatory disease of unknown origin, characterized by aperistalsis of the esophageal body and failure of the lower esophageal sphincter in response to swallowing, with consequent dysphagia. To demonstrate the results of surgical therapy in these patients, evaluating the occurred local and systemic complications. Were studied retrospectively 32 patients, 22 of whom presented non-advanced stage of the disease (Stage I/II) and 10 with advanced disease (Stage III/IV). All of them had the clinical conditions to be submitted to surgery. The diagnoses were done by clinical, endoscopic, cardiological, radiological and esophageal manometry analysis. Pre-surgical evaluation was done with a questionnaire based on the most predisposing factors in the development of the disease and the surgical indication was based on the stage of the disease. The patients with non-advanced stages were submitted to cardiomyotomy with fundoplication, wherein in the post-surgical early assessment, only one (4,4%) presented pulmonary infection, but had a good outcome. In patients with advanced disease, seven were submitted to esophageal mucosectomy preserving the muscular layer, wherein one patient (14,2%) presented dehiscence of gastric cervical esophagus anastomosis as well as pulmonary infection; all of these complications were resolved with proper specific treatment; the other three patients with advanced stage were submitted to transmediastinal esophagectomy; two of them presented hydropneumothorax with good evolution, and one of them also presented fistula of the cervical esophagogastric anastomosis, but with spontaneous healing after conservative treatment and nutritional support. The two patients with fistula of the cervical anastomosis progressed to stenosis, with good results after endoscopic dilations. In the medium and long term assessment done in 23 patients, all of them reported improvement in life quality, with return to swallowing. The

  8. [Surgical treatment of gynecomastia].

    Science.gov (United States)

    Târcoveanu, E; Lupaşcu, C; Vasilescu, A; Moldovanu, R; Ichim, Mihaela; Georgescu, St; Niculescu, D; Dănilă, N; Dimofte, G; Anton, Raluca; Crumpei, Felicia; Florea, Niculina; Ungureanu, Cristina

    2008-01-01

    Gynecomastia describes a benign increase of the mammary gland in men. When medical treatment fails, the surgical procedure is the treatment of choice. There are two main surgical procedures: subdermal mastectomy and liposuction. To evaluate the results after surgical treatment (mastectomy) performed in a general surgery unit. We performed a retrospective study; all the patients operated for gynecomastia were reviewed. The clinical, imaging, biological, intraoperative and histological data were included into a MS Access database and statistical analyzed. From 1990-2007, 114 patients were admitted in the First Surgical Clinic Iaşi for gynecomastia. Only 12.6% from the patients were with bilateral gynecomastia. The mean age was 40.54 +/- 1.83 years old (range 12-84). Mean body mass was 26.72 +/- 0.46 kg/m2 (range 18.5-41), and about 20% from the patients had a BMI of over 30 kg/m2. We also noted that 46.5% were smokers. Simon classification was used for preoperative staging: 2.6% from the cases (N = 3) were included in stage I, 16.7% (N = 19) in stage IIa, 50% (N = 57) in stage IIb and 30.7% in stage III. The patients included in stages IIa and I are younger then the patients included in stage III (p = 0.024). Mastodynia was noted in 46 cases (40.4%). Ultrasound exam was performed in all the cases, and the larger diameter of the nodule measured was 3.75 +/- 0.18 cm (range 0.5-9.7). Only three cases were preoperatively treated with tamoxifen. Most of the cases were operated using general anesthesia (53.5%). Mastectomy was performed by peri-areolar (70.2%), elliptical (28.9%) or radial (0.9%) incisions. The subdermal mastectomy using peri-areolar approach was performed especially for the cases included in stages I, IIa and IIb--p gynecomastia in 6 cases; the other cases presented dilated ducts. We also noted intraductal papillary hyperplasia in 87 cases and chronic inflammation in 35 cases. The histological exam also revealed intraductal papilloma--9 cases, fibro

  9. Surgical Instrument Sets for Special Operations Expeditionary Surgical Teams.

    Science.gov (United States)

    Hale, Diane F; Sexton, Justin C; Benavides, Linda C; Benavides, Jerry M; Lundy, Jonathan B

    The deployment of surgical assets has been driven by mission demands throughout years of military operations in Iraq and Afghanistan. The transition to the highly expeditious Golden Hour Offset Surgical Transport Team (GHOST- T) now offers highly mobile surgical assets in nontraditional operating rooms; the content of the surgical instrument sets has also transformed to accommodate this change. The 102nd Forward Surgical Team (FST) was attached to Special Operations assigned to southern Afghanistan from June 2015 to March 2016. The focus was to decrease overall size and weight of FST instrument sets without decreasing surgical capability of the GHOST-T. Each instrument set was evaluated and modified to include essential instruments to perform damage control surgery. The overall number of main instrument sets was decreased from eight to four; simplified augmentation sets have been added, which expand the capabilities of any main set. The overall size was decreased by 40% and overall weight decreased by 58%. The cardiothoracic, thoracotomy, and emergency thoracotomy trays were condensed to thoracic set. The orthopedic and amputation sets were replaced with an augmentation set of a prepackaged orthopedic external fixator set). An augmentation set to the major or minor basic sets, specifically for vascular injuries, was created. Through the reorganization of conventional FST surgical instrument sets to maintain damage control capabilities and mobility, the 102nd GHOST-T reduced surgical equipment volume and weight, providing a lesson learned for future surgical teams operating in austere environments. 2017.

  10. Surgical Management of Laterognathia in Orthofacial Surgery.

    Science.gov (United States)

    García Y Sánchez, J M; Gómez Rodríguez, C L; Romero Flores, J

    2017-09-01

    Each year around the world, various surgical procedures are carried out with the goal of correcting laterognathia; both the intraoral vertical ramus osteotomy (IVRO) and bilateral sagittal split ramus osteotomy (OSB) have been the most used techniques in mandibular surgery. These techniques have advantages and disadvantages; for example the advantages of the OSB include: increased coefficient of friction between bony segments, for both the forward and the retroposition, as well as decrease in the time of intermaxillary fixation (IMF). Disadvantages include injury to the inferior alveolar nerve (IAN), hemorrhage, bad split, among others. The advantages of IVRO include decrease of possibility of injury to the IAN, ease of implementation of the technique, a lower incidence of hemorrhage and the short duration of the surgical procedure. Their disadvantages include: lower coefficient of friction between bony segments, requires a relatively long period of IMF. The combination between the techniques of mandibular osteotomy for the correction of minor 10 mm laterognathia is the ideal treatment, since it avoids potential recurrence. We describe two cases of patients with laterognathia greater than 6 mm associated with maxilla deformity, which were treated with combined osteotomies. At Maxillofacial Surgery Service, Specialty Hospital, National Medical Center XXI Century, we describe the advantages and disadvantages, pre and postoperative nosocomial, by comparing them with the reports of the literature. The combination of techniques in the correction of laterognathias greater than 4 mm (smaller than 10 mm) is the ideal treatment, eliminating problems of articular compression, recurrence and damage to the alveolar nerve.

  11. Differentiation of tuboovarian abscess from endometriosis: CT indicators

    International Nuclear Information System (INIS)

    Eo, Hong; Choi, Hyuck Jae; Kim, Sun Ho; Jung, Seong Il; Park, Byung Kwan; Kim, Seung Hyup

    2005-01-01

    To assess and compare CT findings of surgically confirmed cases of tuboovarian abscesses (TOA) and endometriosis in order to identify indicators which may be helpful in making correct preoperative diagnoses. Of the 35 consecutive patients with surgically confirmed TOA, CT images were available for 11 of those patients. As a comparative group, 36 patients with surgically confirmed endometriosis with CT images were selected. CT images of TOA were compared with those of endometriosis. A retrospective analysis of the CT images of both groups was performed without knowledge of the pathologic diagnosis. The analysis compared the thickness and enhancement pattern of the cyst wall, attenuation of the cyst content, size and shape of the cyst, and paraaortic lymphadenopathy. Mean thickness of the cyst wall was 6.2 ± 2.0 mm in TOA and 4.5 ± 2.4 mm in endometriosis. Multilayered appearance in both diseases was seen on enhanced CT in 91% (10/11) of TOA cases and in 25% (9/36) of endometriosis cases. Hounsefield units of the cyst contents were 20.0 ± 5.5 HU and 24.7 ± 10.0 HU for TOA and endometriosis, respectively. Mean diameter of the cysts was 7.5 ± 1.7 cm in TOA and 7.9 ± 3.1 in endometriosis. Shape of the cyst was multilocular in 82% (9/11) of TOA cases and in 75% (27/36) of endometriosis cases. Paraaortic lymphadenopathy was present in 73% (8/11) and 44% (16/36) for TOA and endometriosis, respectively. TOA should be suspected on CT when a multilocular cystic ovarian mass is observed, especially if the lesion has a thick wall and has a multilayered appearance, and is accompanied by paraaortic lymphadenopathy

  12. Differentiation of tuboovarian abscess from endometriosis: CT indicators

    Energy Technology Data Exchange (ETDEWEB)

    Eo, Hong; Choi, Hyuck Jae; Kim, Sun Ho; Jung, Seong Il; Park, Byung Kwan; Kim, Seung Hyup [Seoul National University College of Medicine, Seoul (Korea, Republic of)

    2005-10-15

    To assess and compare CT findings of surgically confirmed cases of tuboovarian abscesses (TOA) and endometriosis in order to identify indicators which may be helpful in making correct preoperative diagnoses. Of the 35 consecutive patients with surgically confirmed TOA, CT images were available for 11 of those patients. As a comparative group, 36 patients with surgically confirmed endometriosis with CT images were selected. CT images of TOA were compared with those of endometriosis. A retrospective analysis of the CT images of both groups was performed without knowledge of the pathologic diagnosis. The analysis compared the thickness and enhancement pattern of the cyst wall, attenuation of the cyst content, size and shape of the cyst, and paraaortic lymphadenopathy. Mean thickness of the cyst wall was 6.2 {+-} 2.0 mm in TOA and 4.5 {+-} 2.4 mm in endometriosis. Multilayered appearance in both diseases was seen on enhanced CT in 91% (10/11) of TOA cases and in 25% (9/36) of endometriosis cases. Hounsefield units of the cyst contents were 20.0 {+-} 5.5 HU and 24.7 {+-} 10.0 HU for TOA and endometriosis, respectively. Mean diameter of the cysts was 7.5 {+-} 1.7 cm in TOA and 7.9 {+-} 3.1 in endometriosis. Shape of the cyst was multilocular in 82% (9/11) of TOA cases and in 75% (27/36) of endometriosis cases. Paraaortic lymphadenopathy was present in 73% (8/11) and 44% (16/36) for TOA and endometriosis, respectively. TOA should be suspected on CT when a multilocular cystic ovarian mass is observed, especially if the lesion has a thick wall and has a multilayered appearance, and is accompanied by paraaortic lymphadenopathy.

  13. Nonperturbative QCD corrections to electroweak observables

    Energy Technology Data Exchange (ETDEWEB)

    Dru B Renner, Xu Feng, Karl Jansen, Marcus Petschlies

    2011-12-01

    Nonperturbative QCD corrections are important to many low-energy electroweak observables, for example the muon magnetic moment. However, hadronic corrections also play a significant role at much higher energies due to their impact on the running of standard model parameters, such as the electromagnetic coupling. Currently, these hadronic contributions are accounted for by a combination of experimental measurements and phenomenological modeling but ideally should be calculated from first principles. Recent developments indicate that many of the most important hadronic corrections may be feasibly calculated using lattice QCD methods. To illustrate this, we will examine the lattice computation of the leading-order QCD corrections to the muon magnetic moment, paying particular attention to a recently developed method but also reviewing the results from other calculations. We will then continue with several examples that demonstrate the potential impact of the new approach: the leading-order corrections to the electron and tau magnetic moments, the running of the electromagnetic coupling, and a class of the next-to-leading-order corrections for the muon magnetic moment. Along the way, we will mention applications to the Adler function, the determination of the strong coupling constant and QCD corrections to muonic-hydrogen.

  14. Nonperturbative QCD corrections to electroweak observables

    Energy Technology Data Exchange (ETDEWEB)

    Renner, Dru B. [Thomas Jefferson National Accelerator Facility, Newport News, VA (United States); Feng, Xu [High Energy Accelerator Research Organization (KEK), Tsukuba, Ibaraki (Japan); Jansen, Karl [Deutsches Elektronen-Synchrotron (DESY), Zeuthen (Germany); Petschlies, Marcus [The Cyprus Institute, Nicosia (Cyprus)

    2012-06-15

    Nonperturbative QCD corrections are important to many low-energy electroweak observables, for example the muon magnetic moment. However, hadronic corrections also play a significant role at much higher energies due to their impact on the running of standard model parameters, such as the electromagnetic coupling. Currently, these hadronic contributions are accounted for by a combination of experimental measurements, effective field theory techniques and phenomenological modeling but ideally should be calculated from first principles. Recent developments indicate that many of the most important hadronic corrections may be feasibly calculated using lattice QCD methods. To illustrate this, we examine the lattice computation of the leading-order QCD corrections to the muon magnetic moment, paying particular attention to a recently developed method but also reviewing the results from other calculations. We then continue with several examples that demonstrate the potential impact of the new approach: the leading-order corrections to the electron and tau magnetic moments, the running of the electromagnetic coupling, and a class of the next-to-leading-order corrections for the muon magnetic moment. Along the way, we mention applications to the Adler function, which can be used to determine the strong coupling constant, and QCD corrections to muonic-hydrogen.

  15. Inflationary power spectra with quantum holonomy corrections

    Energy Technology Data Exchange (ETDEWEB)

    Mielczarek, Jakub, E-mail: jakub.mielczarek@uj.edu.pl [Institute of Physics, Jagiellonian University, Reymonta 4, Cracow, 30-059 Poland (Poland)

    2014-03-01

    In this paper we study slow-roll inflation with holonomy corrections from loop quantum cosmology. It was previously shown that, in the Planck epoch, these corrections lead to such effects as singularity avoidance, metric signature change and a state of silence. Here, we consider holonomy corrections affecting the phase of cosmic inflation, which takes place away from the Planck epoch. Both tensor and scalar power spectra of primordial inflationary perturbations are computed up to the first order in slow-roll parameters and V/ρ{sub c}, where V is a potential of the scalar field and ρ{sub c} is a critical energy density (expected to be of the order of the Planck energy density). Possible normalizations of modes at short scales are discussed. In case the normalization is performed with use of the Wronskian condition applied to adiabatic vacuum, the tensor and scalar spectral indices are not quantum corrected in the leading order. However, by choosing an alternative method of normalization one can obtain quantum corrections in the leading order. Furthermore, we show that the holonomy-corrected equations of motion for tensor and scalar modes can be derived based on effective background metrics. This allows us to show that the classical Wronskian normalization condition is well defined for the cosmological perturbations with holonomy corrections.

  16. [High complication rate after surgical treatment of ankle fractures].

    Science.gov (United States)

    Bjørslev, Naja; Ebskov, Lars; Lind, Marianne; Mersø, Camilla

    2014-08-04

    The purpose of this study was to determine the quality and re-operation rate of the surgical treatment of ankle fractures at a large university hospital. X-rays and patient records of 137 patients surgically treated for ankle fractures were analyzed for: 1) correct classification according to Lauge-Hansen, 2) if congruity of the ankle joint was achieved, 3) selection and placement of the hardware, and 4) the surgeon's level of education. Totally 32 of 137 did not receive an optimal treatment, 11 were re-operated. There was no clear correlation between incorrect operation and the surgeon's level of education.

  17. Study of Serum Magnesium in Surgical Stress

    Directory of Open Access Journals (Sweden)

    Sandip D. Lambe

    2016-10-01

    Full Text Available Background: A deficiency of magnesium is of clinical importance in hospitalized patients. The prevalence of hypomagnesaemia is high in critically ill patients. Knowing the important role of magnesium in surgical cases, it is necessary to anticipate and diagnose magnesium deficiency prior to surgery and in the immediate postoperative period to correct it. Aims and Objectives: The aim of this study was to analyse serum magnesium levels in patients undergoing emergency surgical procedures, planned surgical procedures and normal healthy matched controls and to compare the serum magnesium levels in all the three groups. Materials and Methods: The study participants were divided into three groups: i Group I: patients undergoing emergency major surgery ii Group II: patients undergoing planned major surgery iii Group III: normal healthy controls. Serum Magnesium investigation was done by Xylidyl Blue Method using UV-1800/Shimadzu UV-Spectrophotometer. Results: The mean serum Magnesium in control group was found to be 2.16 ± 0.30 mg/dl. In patients undergoing planned surgery, pre-operative serum magnesium was normal (2.16 ± 0.22 mg/dl but decreased significantly on postoperative day 3 (1.63 ± 0.27 mg/dl and day 6 (1.97 ± 0.12 mg/dl and returned to normal level by post-operative day 9 (2.14 ± 0.14 mg/dl compared to controls. In patients undergoing emergency surgery, serum magnesium was decreased pre-operatively (1.90 ± 0.48 mg/dl.Further significant reduction was found at post-operative day 3 (1.38 ± 0.28 mg/dl, day 6 (1.59 ± 0.30 mg/dl and day 9 (1.88 ± 0.46 mg/dl compared to controls. Mean serum Magnesium overall in emergency surgery patients was reduced significantly compared to planned surgery patients. Conclusion: A transient fall in the serum Magnesium as compared to its pre-operative level was seen in every patient undergoing surgical procedure due to surgical stress. In patients undergoing emergency surgical procedure, the decrease was

  18. Visual performance in cataract patients with low levels of postoperative astigmatism: full correction versus spherical equivalent correction

    Directory of Open Access Journals (Sweden)

    Lehmann RP

    2012-03-01

    Full Text Available Robert P Lehmann1, Diane M Houtman21Lehmann Eye Center, Nacogdoches, TX, 2Alcon Research Ltd, Fort Worth, TX, USAPurpose: To evaluate whether visual performance could be improved in pseudophakic subjects by correcting low levels of postoperative astigmatism.Methods: An exploratory, noninterventional study was conducted using subjects who had been implanted with an aspheric intraocular lens and had 0.5–0.75 diopter postoperative astigmatism. Monocular visual performance using full correction was compared with visual performance using spherical equivalent correction. Testing consisted of high- and low-contrast visual acuity, contrast sensitivity, and reading acuity and speed using the Radner Reading Charts.Results: Thirty-eight of 40 subjects completed testing. Visual acuities at three contrast levels (100%, 25%, and 9% were significantly better using full correction than when using spherical equivalent correction (all P < 0.001. For contrast sensitivity testing under photopic, mesopic, and mesopic with glare conditions, only one out of twelve outcomes demonstrated a significant improvement with full correction compared with spherical equivalent correction (at six cycles per degree under mesopic without glare conditions, P = 0.046. Mean reading speed was numerically faster with full correction across all print sizes, reaching statistical significance at logarithm of the reading acuity determination (logRAD 0.2, 0.7, and 1.1 (P , 0.05. Statistically significant differences also favored full correction in logRAD score (P = 0.0376, corrected maximum reading speed (P < 0.001, and logarithm of the minimum angle of resolution/logRAD ratio (P < 0.001.Conclusions: In this study of pseudophakic subjects with low levels of postoperative astigmatism, full correction yielded significantly better reading performance and high- and low-contrast visual acuity than spherical equivalent correction, suggesting that cataractous patients may benefit from surgical

  19. Correction of refractive errors

    Directory of Open Access Journals (Sweden)

    Vladimir Pfeifer

    2005-10-01

    Full Text Available Background: Spectacles and contact lenses are the most frequently used, the safest and the cheapest way to correct refractive errors. The development of keratorefractive surgery has brought new opportunities for correction of refractive errors in patients who have the need to be less dependent of spectacles or contact lenses. Until recently, RK was the most commonly performed refractive procedure for nearsighted patients.Conclusions: The introduction of excimer laser in refractive surgery has given the new opportunities of remodelling the cornea. The laser energy can be delivered on the stromal surface like in PRK or deeper on the corneal stroma by means of lamellar surgery. In LASIK flap is created with microkeratome in LASEK with ethanol and in epi-LASIK the ultra thin flap is created mechanically.

  20. PS Booster Orbit Correction

    CERN Document Server

    Chanel, M; Rumolo, G; Tomás, R; CERN. Geneva. AB Department

    2008-01-01

    At the end of the 2007 run, orbit measurements were carried out in the 4 rings of the PS Booster (PSB) for different working points and beam energies. The aim of these measurements was to provide the necessary input data for a PSB realignment campaign during the 2007/2008 shutdown. Currently, only very few corrector magnets can be operated reliably in the PSB; therefore the orbit correction has to be achieved by displacing (horizontally and vertically) and/or tilting some of the defocusing quadrupoles (QDs). In this report we first describe the orbit measurements, followed by a detailed explanation of the orbit correction strategy. Results and conclusions are presented in the last section.