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Sample records for fast-track treatment results

  1. Maintaining Unity - Relatives in older patient's fast-track treatment programmes. A Grounded theory study

    DEFF Research Database (Denmark)

    Berthelsen, Connie Bøttcher; Lindhardt, Tove; Frederiksen, Kirsten

    2014-01-01

    over 70 years of age participated. The constant comparative method was the guiding principle for simultaneous data collection, data analysis and coding, while theoretically sampling and writing memos. FINDINGS: Maintaining Unity emerged as the relatives' pattern of behaviour through which they resolved...... to fit in with the patients' and health professionals' requirements. CONCLUSION: The substantive theory of Maintaining Unity offers knowledge of relatives' strong desire to provide compassionate and loving support for the older patients during fast-track treatment programmes....

  2. Multi-month prescriptions, fast-track refills, and community ART groups: results from a process evaluation in Malawi on using differentiated models of care to achieve national HIV treatment goals.

    Science.gov (United States)

    Prust, Margaret L; Banda, Clement K; Nyirenda, Rose; Chimbwandira, Frank; Kalua, Thokozani; Jahn, Andreas; Eliya, Michael; Callahan, Katie; Ehrenkranz, Peter; Prescott, Marta R; McCarthy, Elizabeth A; Tagar, Elya; Gunda, Andrews

    2017-07-21

    In order to facilitate scale-up of antiretroviral therapy (ART) in Malawi, innovative and pragmatic models have been developed to optimize the efficiency of HIV service delivery. In particular, three models of differentiated care have emerged for stable patients: adjusted appointment spacing through multi-month scripting (MMS); fast-track drug refills (FTRs) on alternating visits; and community ART groups (CAGs) where group members rotate in collecting medications at the facility for all members. This study aimed to assess the extent to which ART patients in Malawi are differentiated based on clinical stability and describe the characteristics and costs associated with the models of differentiated care offered. A mixed methods process evaluation was conducted from 30 purposefully selected ART facilities. Cross-sectional data for this evaluation was collected between February and May 2016. The following forms of data collection are reported here: structured surveys with 136 health care workers; reviews of 75,364 patient clinical records; 714 observations of visit time and flow; and 30 questionnaires on facility characteristics. Among ART patients, 77.5% (95% confidence interval [CI] 74.1-80.6) were eligible for differentiated models of care based on criteria for clinical stability from national guidelines. Across all facilities, 69% of patients were receiving MMS. In facilities offering FTRs and CAGs, 67% and 6% of patients were enrolled in the models, respectively. However, eligibility criteria were used inconsistently: 72.9% (95% CI 66.3-78.6) of eligible patients and 42.3% (95% CI 33.1-52.0) ineligible patients received MMS. Results indicated that patient travel and time costs were reduced by 67%, and the unit costs of ART service delivery through the MMS, FTR and CAG models were similar, representing a reduction of approximately 10% in the annual unit cost of providing care to stable patients that receive no model. MMS is being implemented nationally and has

  3. Postoperative Sleep Disturbances after Zolpidem Treatment in Fast-Track Hip and Knee Replacement

    DEFF Research Database (Denmark)

    Krenk, Lene; Jennum, Poul; Kehlet, Henrik

    2014-01-01

    architecture in an elderly population undergoing fast-track total hip and knee arthroplasty (THA/TKA) with length of stay spinal anesthesia and multimodal opioid-sparing postoperative analgesia were included...

  4. First results of the silicon telescope using an 'artificial retina' for fast track finding

    Energy Technology Data Exchange (ETDEWEB)

    Neri, N. [Istituto Nazionale di Fisica Nucleare - INFN, Sezione di Milano, Milano (Italy); Abba, A.; Caponio, F.; Geraci, A.; Grizzuti, M.; Lusardi, N. [INFN Milano and Politecnico di Milano, Milano (Italy); Citterio, M.; Coelli, S.; Fu, J.; Monti, M.; Petruzzo, M. [INFN Milano, Milano (Italy); Bedeschi, F.; Ninci, D.; Piucci, A.; Spinella, F.; Walsh, J. [INFN Pisa, Pisa (Italy); Cenci, R.; Marino, P.; Morello, M. J.; Stracka, S. [INFN Pisa and Scuola Normale Superiore di Pisa, Pisa (Italy); Punzi, G. [INFN Pisa and Universita di Pisa, Pisa (Italy); Tonelli, D. [CERN, Geneva (Switzerland); Ristori, L. [INFN Pisa, Pisa (Italy); Fermilab, Batavia, Illinois (United States)

    2015-07-01

    We present the first results of the prototype of a silicon tracker with trigger capabilities based on a novel approach for fast track finding. The working principle of the 'artificial retina' is inspired by the processing of visual images by the brain and it is based on extensive parallelization of data distribution and pattern recognition. The algorithm has been implemented in commercial FPGAs in three main logic modules: a switch for the routing of the detector hits, a pool of engines for the digital processing of the hits, and a block for the calculation of the track parameters. The architecture is fully pipelined and allows the reconstruction of real-time tracks with a latency less then 100 clock cycles, corresponding to 0.25 microsecond at 400 MHz clock. The silicon telescope consists of 8 layers of single-sided silicon strip detectors with 512 strips each. The detector size is about 10 cm x 10 cm and the strip pitch is 183 μm. The detectors are read out by the Beetle chip, a custom ASICs developed for LHCb, which provides the measurement of the hit position and pulse height of 128 channels. The 'artificial retina' algorithm has been implemented on custom data acquisition boards based on FPGAs Xilinx Kintex 7 lx160. The parameters of the tracks detected are finally transferred to host PC via USB 3.0. The boards manage the read-out ASICs and the sampling of the analog channels. The read-out is performed at 40 MHz on 4 channels for each ASIC that corresponds to a decoding of the telescope information at 1.1 MHz. We report on the first results of the fast tracking device and compare with simulations. (authors)

  5. Foinaven fast track flowlines

    Energy Technology Data Exchange (ETDEWEB)

    Taylor, L.H.; Mair, J.

    1996-12-31

    The decision by British Petroleum to develop offshore fields west of the Shetlands in water depths exceeding 500 meters within three and a half years of discovery posed a unique submarine pipeline installation challenge. This paper summarizes the salient features of a fast track program to install a diverless subsea pipeline system using rigid reeled pipe technology in an offshore frontier area.

  6. Fast track clinical pathway implications in esophagogastrectomy

    Institute of Scientific and Technical Information of China (English)

    Ke Jiang; Lin Cheng; Jian-Jun Wang; Jin-Song Li; Jun Nie

    2009-01-01

    AIM: To investigate the feasibility of fast track clinical pathway for esophageal tumor resections.METHODS: One hundred and fourteen patients with esophageal carcinoma who underwent esophagogastrectomy from January 2006 to October 2007 in our department were studied. Fast track clinical pathway included analgesia control, fluid infusion volume control, early ambulation and enteral nutrition.Nasogastric tube was removed 3 d after operation and chest tube was removed 4 d after operation as a routine, and full liquid diet 5 d after operation.RESULTS: Among 114 patients (84 men and 30 women), 26 patients underwent fast track surgery,including 17 patients over 65 years old and 9 under 65 ( P = 0.014); 18 patients who had preoperative complications could not bear fast track surgery ( P <0.001). No significant differences in tolerance of fast track surgery were attributed to differences in gender,differentiated degree or stage of tumor, pathological type of tumor, or operative incision. The median length of hospital stay was 7 d (5-28 d), 4% patients werereadmitted to hospital within 30 d of discharge. Three patients died and postoperative mortality was 2.6%.All 3 patients had no determinacy to fast track surgery approach.CONCLUSION: The major I ty of pat ients with esophageal carcinoma can tolerate fast track surgery.Patients younger than 65 or who have no preoperative diseases have the best results. Median length of hospital stay has been reduced to 7 d.

  7. Inhibiting Interference - a grounded theory of health professionals' pattern of behaviour related to the relatives of older patients in fast-track treatment programmes

    DEFF Research Database (Denmark)

    Berthelsen, Connie Bøttcher; Lindhardt, Tove; Frederiksen, Kirsten

    2014-01-01

    AIM: To generate a grounded theory explaining health professionals' pattern of behaviour and experience related to the relatives of older patients in fast-track treatment programmes during total joint replacement. BACKGROUND: Health professionals uphold standardised care for patients, and effect...... on quality is seen when relatives support patients during total joint replacement. Since health professionals often have problematic relationships with relatives, knowledge is needed of the health professionals' pattern of behaviour in relation to relatives of older patients in fast-track treatment programme....... DESIGN: Grounded theory according to Glaser's methodology was used to generate substantive theory of health professionals' pattern of behaviour. METHODS: Data were collected from 2010 to 2011 by 44 health professionals in orthopaedic wards at two Danish hospitals. Data from nonparticipant observations...

  8. Low manipulation prevalence following fast-track total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Jørgensen, Christoffer C.; Gromov, Kirill

    2015-01-01

    BACKGROUND AND PURPOSE: Postoperative joint stiffness following total knee arthroplasty (TKA) may compromise the outcome and necessitate manipulation. Previous studies have not been in a fast-track setting with optimized pain treatment, early mobilization, and short length of stay (LOS), which may...... have influenced the prevalence of joint stiffness and subsequent manipulation. We investigated the prevalence of manipulation following fast-track TKA and identified patients at risk of needing manipulation. PATIENTS AND METHODS: 3,145 consecutive unselected elective primary unilateral TKA patients...... operated in 6 departments with well-defined fast-track settings were included in the study. Demographic data, prevalence, type and timing of manipulation, and preoperative and postoperative ROM were recorded prospectively, ensuring complete 1-year follow-up. RESULTS: 70 manipulations were performed within...

  9. 急救绿色通道在严重创伤早期救治中的作用%Role of first-aid fast track in treatment of severe trauma patients

    Institute of Scientific and Technical Information of China (English)

    姚元章; 张宇; 孙士锦; 张连阳

    2008-01-01

    Objective To explore the effects and significance of first-aid fast track in the treatment of severe trauma. Methods A retrospective study was done on 60 trauma patients (fast track group)treated by means of first-aid fast track from January 2006 to November 2007 to observe the effect of first-aid fast track. Another 46 trauma patients treated from January 2004 to December 2005 were used as control group. Results There was no statistical difference in aspects of sex, age, injury mechanism, ISS and blood loss in both groups (P >0.05). Two patients died in the first track group, with mortality rate of 3% ;while five patients died in the control group, with mortality rate of 11% ( P < 0.05 ). Compared with the control group, there was shorter time in emergency room care, special examination and interval from admission to operating room in fast track group ( P < 0.05 ). Conclusion First-aid fast track can shorten the space and time in treatment of severe trauma, decrease the mortality rate, enhance success rate of treatment and hence guarantee chronergy and integrity of emergency trauma care.%目的 探讨绿色通道急救模式在严重创伤早期救治中的作用和意义. 方法 回顾性分析2006年1月-2007年11月以绿色通道急救模式救治60例创伤患者的效果,并与2004年1月-2005年12月收治的46例非绿色通道组患者的急救效果进行比较. 结果 两组患者性别、年龄、致伤机制、ISS及失血量等指标分布差异无统计学意义(P>0.05);绿色通道组60例患者死亡2例,死亡率为3%,对照组46例患者死亡5例,死亡率为11%(P<0.05).绿色通道组在急诊室处理时间、特殊检查时问、入院至手术室时间较对照组明显缩短(P<0.05). 结论 绿色通道急救模式缩短了严重创伤患者的救治空间和时间,显著降低了死亡率,提高了救治成功率,保证了创伤急救的"时效性和整体性".

  10. FAST TRACK PAPER: The creation of an asymmetric hydraulic fracture as a result of driving stress gradients

    Science.gov (United States)

    Fischer, T.; Hainzl, S.; Dahm, T.

    2009-10-01

    Hydraulic fracture stimulation is frequently performed in hydrocarbon reservoirs and geothermal systems to increase the permeability of the rock formation. These hydraulic fractures are often mapped by hypocentres of induced microearthquakes. In some cases microseismicity exhibits asymmetry relative to the injection well, which can be interpreted by unequal conditions for fracture growth at opposite sides of the well or by observation effects. Here we investigate the role of the lateral change of the minimum compressive stress. We use a simple model to describe the relation among the lateral stress gradient, the mean viscous pressure gradients in the fracture wings, the fracture geometry, and the net pressure in the fracture. Our model predicts a faster fracture growth in the direction of decreasing stress and a limited growth in the opposite direction. We derive a simple relationship to estimate the lateral stress gradient from the injection pressure and the shape of the seismic hypocentre cloud. The model is tested by microseismic data obtained during stimulation of a Canyon Sands gas field in West Texas. Using a maximum likelihood method we fit the parameters of the asymmetric fracture model to the space-time pattern of hypocentres. The estimated stress gradients per metre are in the range from 0.008 to 0.010 times the bottom-hole injection overpressure (8-10 kPam-1 assuming the net pressure of 1 MPa). Such large horizontal gradients in the order of the hydrostatic gradient could be caused by the inhomogeneous extraction of gas resulting in a lateral change of the effective normal stress acting normal to the fracture wall.

  11. Time-driven Activity-based Cost of Fast-Track Total Hip and Knee Arthroplasty.

    Science.gov (United States)

    Andreasen, Signe E; Holm, Henriette B; Jørgensen, Mira; Gromov, Kirill; Kjærsgaard-Andersen, Per; Husted, Henrik

    2017-06-01

    Fast-track total hip and knee arthroplasty (THA and TKA) has been shown to reduce the perioperative convalescence resulting in less postoperative morbidity, earlier fulfillment of functional milestones, and shorter hospital stay. As organizational optimization is also part of the fast-track methodology, the result could be a more cost-effective pathway altogether. As THA and TKA are potentially costly procedures and the numbers are increasing in an economical limited environment, the aim of this study is to present baseline detailed economical calculations of fast-track THA and TKA and compare this between 2 departments with different logistical set-ups. Prospective data collection was analyzed using the time-driven activity-based costing method (TDABC) on time consumed by different staff members involved in patient treatment in the perioperative period of fast-track THA and TKA in 2 Danish orthopedic departments with standardized fast-track settings, but different logistical set-ups. Length of stay was median 2 days in both departments. TDABC revealed minor differences in the perioperative settings between departments, but the total cost excluding the prosthesis was similar at USD 2511 and USD 2551, respectively. Fast-track THA and TKA results in similar cost despite differences in the organizational set-up. Compared to cost associated with longer more conventional published pathways, fast-track is cheaper, which on top of the favorable published clinical outcome adds to cost efficiency and the potential for economic savings. Detailed baseline TDABC calculations are provided for comparison and further optimization of cost-benefit effectiveness. Copyright © 2016 Elsevier Inc. All rights reserved.

  12. Fast track pathway for perforated appendicitis.

    Science.gov (United States)

    Frazee, Richard; Abernathy, Stephen; Davis, Matthew; Isbell, Travis; Regner, Justin; Smith, Randall

    2017-04-01

    Perforated appendicitis is associated with an increased morbidity and length of stay. "Fast track" protocols have demonstrated success in shortening hospitalization without increasing morbidity for a variety of surgical processes. This study evaluates a fast track pathway for perforated appendicitis. In 2013, a treatment pathway for perforated appendicitis was adopted by the Acute Care Surgery Service for patients having surgical management of perforated appendicitis. Interval appendectomy was excluded. Patients were treated initially with intravenous antibiotics and transitioned to oral antibiotics and dismissed when medically stable and tolerating oral intake. A retrospective review of patients managed on the fast track pathway was undertaken to analyze length of stay, morbidity, and readmissions. Thirty-four males and twenty-one females with an average age of 46.8 years underwent laparoscopic appendectomy for perforated appendicitis between January 2013 and December 2014. Pre-existing comorbidities included hypertension 42%, diabetes mellitus 11%, COPD 5% and heart disease 2%. No patient had conversion to open appendectomy. Average length of stay was 2.67 days and ranged from 1 to 12 days (median 2 days). Postoperative morbidity was 20% and included abscess (6 patients), prolonged ileus (3 patients), pneumonia (1 patient), and congestive heart failure (1 patient). Five patients were readmitted for abscess (3 patients), congestive heart failure (1 patient), and pneumonia (1 patient). A fast track pathway for perforated appendicitis produced shorter length of stay and acceptable postoperative morbidity and readmission. This offers the potential for significant cost savings over current national practice patterns. Copyright © 2016 Elsevier Inc. All rights reserved.

  13. Fast track surgery accelerates the recovery of postoperative insulin sensitivity

    Institute of Scientific and Technical Information of China (English)

    YANG Dong-jie; ZHANG Chang-hua; HE Yu-long; ZHANG Sheng; HE Wei-ling; CHEN Hua-yun; CAI Shi-rong; CHEN Chuang-qi; SONG Xin-ming; CUI Ji; MA Jin-ping

    2012-01-01

    Background Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity.This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection.Methods Controlled,randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up.Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups:a fast track group (35 cases) and a conventional care group (35 cases).All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia.Clinical parameters (complication rates,return of gastrointestinal function and postoperative length of stay),stress index and insulin sensitivity were evaluated in both groups perioperatively.Reaults Sixty-two patients finally completed the study,32 cases in the fast-track group and 30 cases in the conventional care group.Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group.We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation.Conclusion Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.

  14. Fast track surgery accelerates the recovery of postoperative insulin sensitivity.

    Science.gov (United States)

    Yang, Dong-jie; Zhang, Sheng; He, Wei-ling; Chen, Hua-yun; Cai, Shi-rong; Chen, Chuang-qi; Song, Xin-ming; Cui, Ji; Ma, Jin-Ping; Zhang, Chang-Hua; He, Yu-Long

    2012-09-01

    Few clinical studies or randomized clinical trial results have reported the impact of fast track surgery on postoperative insulin sensitivity. This study aimed to investigate the effects of fast track surgery on postoperative insulin sensitivity in patients undergoing elective open colorectal resection. Controlled, randomized clinical trial was conducted from November 2008 to January 2009 with one-month post-discharge follow-up. Seventy patients with colorectal carcinoma requiring colorectal resection were randomized into two groups: a fast track group (35 cases) and a conventional care group (35 cases). All included patients received elective open colorectal resection with combined tracheal intubation and general anesthesia. Clinical parameters (complication rates, return of gastrointestinal function and postoperative length of stay), stress index and insulin sensitivity were evaluated in both groups perioperatively. Sixty-two patients finally completed the study, 32 cases in the fast-track group and 30 cases in the conventional care group. Our findings revealed a significantly faster recovery of postoperative insulin sensitivity on postoperative day 7 in the fast-track group than that in the conventional care group. We also found a significantly shorter length of postoperative stay and a significantly faster return of gastrointestinal function in patients undergoing fast-track rehabilitation. Fast track surgery accelerates the recovery of postoperative insulin sensitivity in elective surgery for colorectal carcinoma with a shorter length of postoperative hospital stay.

  15. Time-driven Activity-based Cost of Fast-Track Total Hip and Knee Arthroplasty

    DEFF Research Database (Denmark)

    Andreasen, Signe E; Holm, Henriette B; Jørgensen, Mira

    2017-01-01

    this between 2 departments with different logistical set-ups. METHODS: Prospective data collection was analyzed using the time-driven activity-based costing method (TDABC) on time consumed by different staff members involved in patient treatment in the perioperative period of fast-track THA and TKA in 2 Danish...... orthopedic departments with standardized fast-track settings, but different logistical set-ups. RESULTS: Length of stay was median 2 days in both departments. TDABC revealed minor differences in the perioperative settings between departments, but the total cost excluding the prosthesis was similar at USD......-track methodology, the result could be a more cost-effective pathway altogether. As THA and TKA are potentially costly procedures and the numbers are increasing in an economical limited environment, the aim of this study is to present baseline detailed economical calculations of fast-track THA and TKA and compare...

  16. Postoperative morbidity after fast-track laparoscopic resection of rectal cancer

    DEFF Research Database (Denmark)

    Stottmeier, S; Harling, H; Wille-Jørgensen, Peer Anders;

    2012-01-01

    Aim: Analysis was carried out of the nature and chronological order of early complications after fast-track laparoscopic rectal surgery with a view to optimize the short-time outcome of rectal cancer surgery. Method: 102 consecutive patients who underwent elective fast-track laparoscopic rectal...... cancer surgery were analysed prospectively from the Danish Colorectal Cancer Database supplemented by data from the medical records. We studied in detail the nature and chronological order of postoperative morbidity and reason for prolonged stay (>5 days). Results: Twenty-five patients (25 per cent) had......: Postoperative morbidity remains a significant problem even in the fast-track era, even in experienced surgical hands. Our results suggest that besides improvement of surgical technique further improvement of outcome lies in early recognition and proper treatment of complications and the perioperative...

  17. Psychiatric Disorders and Psychopharmacologic Treatment as Risk Factors in Elective Fast-track Total Hip and Knee Arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer C; Knop, Joachim; Nordentoft, Merete;

    2015-01-01

    BACKGROUND: Psychiatric disorder (PsD) is rarely considered when evaluating perioperative risk factors. Studies on PsD are often limited by use of administrative coding, incomplete follow-up, and lack of preoperative data on psychopharmacological treatment. METHODS: A multicenter study with prosp...

  18. Delirium in fast-track colonic surgery

    DEFF Research Database (Denmark)

    Kurbegovic, Sorel; Andersen, Jens; Krenk, Lene

    2015-01-01

    BACKGROUND: Postoperative delirium (PD) is a common but serious problem after major surgery with a multifactorial pathogenesis including age, pain, opioid use, sleep disturbances and the surgical stress response. These factors have been minimised by the "fast-track methodology" previously...... demonstrated to enhance recovery and reduce morbidity. METHODS: Clinical symptoms of PD were routinely collected three times daily from preoperatively until discharge in a well-defined enhanced recovery program after colonic surgery in 247 consecutive patients. RESULTS: Total median length of hospital stay...... postoperative recovery program may decrease the risk and duration of PD after colonic surgery....

  19. Fast tracking of wind speed with a differential absorption LiDAR system: first results of an experimental campaign at Stromboli volcano

    Science.gov (United States)

    Parracino, Stefano; Santoro, Simone; Maio, Giovanni; Nuvoli, Marcello; Aiuppa, Alessandro; Fiorani, Luca

    2017-04-01

    Carbon dioxide (CO2) is considered a precursor gas of volcanic eruptions by volcanologists. Monitoring the anomalous release of this parameter, we can retrieve useful information for the mitigation of volcanic hazards, such as for air traffic security. From a dataset collected during the Stromboli volcano field campaign, an assessment of the wind speed, in both horizontal and vertical paths, performing a fast tracking of this parameter was retrieved. This was determined with a newly designed shot-per-shot differential absorption LiDAR system operated in the near-infrared spectral region due to the simultaneous reconstruction of CO2 concentrations and wind speeds, using the same sample of LiDAR returns. A correlation method was used for the wind speed retrieval in which the transport of the spatial inhomogeneities of the aerosol backscattering coefficient, along the optical path of the system, was analyzed.

  20. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B;

    2011-01-01

    Abstract Background and purpose Fast-track surgery has reduced the length of hospital stay (LOS), morbidity, and convalescence in primary hip and knee arthroplasty (TKA). We assessed whether patients undergoing revision TKA for non-septic indications might also benefit from fast-track surgery...

  1. Results of implementation of a fast track pathway for diagnosis of colorectal cancer Resultados de la implementación del circuito de diagnostico rápido de cáncer colorrectal

    Directory of Open Access Journals (Sweden)

    Helena Vallverdú Cartié

    2011-08-01

    Full Text Available Introduction: fast track pathways for diagnosis of cancer intend to decrease delays in diagnosis and treatment of cancer. It is recommended to initiate treatment in a period no longer than 30 days since admission in these circuits. Aims: to know the characteristics and fluency of our Fast Track Diagnostic Pathway (FTDP for Colorectal Cancer (CRC, with special attention to those patients selected for surgical treatment as a first choice. Material and method: all patients who entered the FTDP for CRC during a period of 2 years (2008-2009 were analyzed as well as the rest of patients also diagnosed with CRC but never seen in the FTDP. Results: of the 316 patients referred to the FTDP only 78 (24.7% were diagnosed as having some kind of cancer derived from the digestive system. At the end 61 patients (19.3% were diagnosed with CCR. The time interval from entry into the FTDP to the first hospital visit was 3 days (range 1-8, and the interval until colonoscopy was performed was 11.5 days (range 1-41. 14 (41.1% of those patients chosen for surgery were operated on in a period lesser than 30 days while 28 patients (82.3% underwent surgery before day 45 since admission into the circuit. Conclusions: though the functioning of the FTDP is acceptable, any increase in number of patients can generate delays. For this reason it is advisable to have a team to assure a good functioning of the FTDP. A proper follow-up of the whole process will possibly avoid unnecessary delays and it will improve coordination of the different phases of the fast track pathway and treatment. As the diagnostic outcome is poor it is mandatory to implement alternatives programs like screening of asymptomatic population, allowing an early detection of this condition.Introducción: los circuitos de diagnóstico rápido de cáncer (CDRC pretenden disminuir las demoras en el diagnóstico y tratamiento del cáncer colorrectal (CCR. Se recomienda el inicio del primer tratamiento en un plazo

  2. Fast-track surgery for breast cancer is possible

    DEFF Research Database (Denmark)

    Mertz, Birgitte G; Kroman, Niels; Williams, Helene

    2013-01-01

    INTRODUCTION: Breast cancer is common among Danish women with more than 4,100 new cases annually. In 2008 the concept of fast-track surgery was introduced at the Department of Breast Surgery at Rigshospitalet, Copenhagen. The aim of this study is to describe the new clinical pathway for breast...... to provide immediate advice and support. CONCLUSION: The results confirm that a short stay can be successfully carried out for breast cancer patients. Implementing the fast-track programme involved the introduction of a clear clinical pathway for the patients and more effective daily routines. Patients felt...... cancer patients after implementation of a fast-track surgery programme. MATERIAL AND METHODS: A clinical pathway of all involved disciplines was developed including anaesthetic, analgesics, nausea and vomiting, drain and wound management, discharge assessment and psychosocial support. RESULTS...

  3. Fast-track surgery for breast cancer is possible

    DEFF Research Database (Denmark)

    Mertz, Birgitte G; Kroman, Niels; Williams, Helene;

    2013-01-01

    INTRODUCTION: Breast cancer is common among Danish women with more than 4,100 new cases annually. In 2008 the concept of fast-track surgery was introduced at the Department of Breast Surgery at Rigshospitalet, Copenhagen. The aim of this study is to describe the new clinical pathway for breast...... to provide immediate advice and support. CONCLUSION: The results confirm that a short stay can be successfully carried out for breast cancer patients. Implementing the fast-track programme involved the introduction of a clear clinical pathway for the patients and more effective daily routines. Patients felt...... cancer patients after implementation of a fast-track surgery programme. MATERIAL AND METHODS: A clinical pathway of all involved disciplines was developed including anaesthetic, analgesics, nausea and vomiting, drain and wound management, discharge assessment and psychosocial support. RESULTS...

  4. Nursing in fast-track total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Specht, Kirsten; Kjaersgaard-Andersen, Per; Kehlet, Henrik

    2015-01-01

    AIM: To describe the increased activity in total hip arthroplasty (THA) and total knee arthroplasty (TKA) from 2002 to 2012 in a single orthopaedic department, the organisation of fast-track and its consequences for nursing care. METHODS: Retrospective, descriptive design. Data collection; from...... the hospital administrative database, local descriptions of fast-track, personal contact and discussion with staff. RESULTS: The number of operations increased threefold from 351 operations in 2002 to 1024 operations in 2012. In 2012, THA/TKA patients had a postoperative mean LOS of 2.6/2.8 days. Nurses had......, be considered a worthwhile investment to employ expert/highly qualified professional nurses in fast-track THA and TKA units....

  5. Short Hospital Stay after Laparoscopic Colorectal Surgery without Fast Track

    DEFF Research Database (Denmark)

    Burgdorf, Stefan K; Rosenberg, Jacob

    2012-01-01

    in our department resulted in shorter hospital stay without using fast track principles for peri- and postoperative care in patients not receiving a stoma during the operation. Consequently, we aimed to reduce hospitalisation without increasing cost in nursing staff per hospital bed. Length of stay......Purpose. Short hospital stay and equal or reduced complication rates have been demonstrated after fast track open colonic surgery. However, fast track principles of perioperative care can be difficult to implement and often require increased nursing staff because of more concentrated nursing tasks...... during the shorter hospital stay. Specific data on nursing requirements after laparoscopic surgery are lacking. The purpose of the study was to evaluate the effect of operative technique (open versus laparoscopic operation), but without changing nurse staffing or principles for peri- or postoperative...

  6. Low manipulation prevalence following fast-track total knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Jørgensen, Christoffer C.; Gromov, Kirill;

    2015-01-01

    Background and purpose - Postoperative joint stiffness following total knee arthroplasty (TKA) may compromise the outcome and necessitate manipulation. Previous studies have not been in a fast-track setting with optimized pain treatment, early mobilization, and short length of stay (LOS), which may...

  7. Fast-track hip and knee arthroplasty: clinical and organizational aspects

    DEFF Research Database (Denmark)

    Husted, Henrik

    2012-01-01

    Fast-track hip and knee arthroplasty aims at giving the patients the best available treatment at all times, being a dynamic entity. Fast-track combines evidence-based, clinical features with organizational optimization including a revision of traditions resulting in a streamlined pathway from......; patient-characteristics to predict outcome; and traditions which may be barriers in optimizing outcomes. Patients should be informed and motivated to be active participants and their expectations should be modulated in order to improve satisfaction. Also, organizational aspects need to be analyzed...... and optimized. New logistical approaches should be implemented; the ward ideally (re)structured to only admit arthroplasties; the staff educated to have a uniform approach; extensive preoperative information given including discharge criteria and intended length of stay. This thesis includes 9 papers...

  8. High patient satisfaction in 445 patients who underwent fast-track hip or knee replacement

    DEFF Research Database (Denmark)

    Specht, Kirsten; Kjaersgaard-Andersen, Per; Kehlet, Henrik;

    2015-01-01

    Background and purpose - Patient satisfaction is important in fast-track total hip and knee replacement (THR, TKR). We assessed: (1) how satisfied patients were with the treatment; (2) factors related to overall satisfaction; and (3) whether there was a difference between THR and TKR regarding...... length of stay (LOS) and patient satisfaction. Patients and methods - In this follow-up study, a consecutive series of 445 patients undergoing THR and TKR completed a questionnaire 2 weeks after discharge. LOS and short-term patient satisfaction with the fast-track management were measured. Patient...... satisfaction was measured using a numerical rating scale (NRS; 0-10). Results - For THR, the median satisfaction score was 9-10 and for TKR it was 8.5-10 in all parameters. Older THR patients had higher overall satisfaction. No association was found between overall satisfaction following THR or TKR and sex...

  9. Implementation of the scientific evidence into daily practice - example from fast-track colonic cancer surgery

    DEFF Research Database (Denmark)

    Hammer, J.; Harling, H.; Wille-Jorgensen, P.

    2008-01-01

    Objective To report the implementation and results of fast-track surgery for colonic cancer in the daily routine. Method A total of 131 consecutive patients scheduled for elective colonic cancer resections entered a fast-track perioperative course after thorough information. The regimen contained...

  10. Fast track treatment following cardiac surgery in patients with complex congenital heart disease%复杂先天性心脏病矫治术后的快速康复研究

    Institute of Scientific and Technical Information of China (English)

    曾敏; 李守军; 王旭; 阎军; 晏馥霞; 李霞

    2012-01-01

    目的 探索复杂先天性心脏病快速康复(fast track,FT)的可行性和安全性,探讨其相关影响因素.方法 回顾性分析2008年1月至2010年6月阜外心血管病医院小儿外科中心复杂先天性心脏病矫治术后患者865例的临床资料.病种包括:法洛四联症,肺动脉闭锁、右心室双出口,大动脉转位,肺静脉畸形引流,心内膜垫缺损,主动脉缩窄合并室间隔缺损等.分析先天性心脏病手术风险分级评估(risk adjustment forcongenital heart surgery 1,RACHS-1),病种类型、年龄、体质量等因素对FT的影响.结果 总体FT比率为42.65%.按年龄分组(0~6个月、6~12个月以及>12个月)3组FT比率分别为19.70%、40.20%、62.61%,3组间比较差异有统计学意义(P<0.05).FT组机械通气时间、重症监护病房住院时间比非FT组明显降低,差异有统计学意义[(6.51±4.06)h vs.(58.07±74.81)h,P<0.05;(2.05±1.06)d vs.(7.64±8.75)d,P<0.05].Logistic回归分析提示年龄、体质量、高RACHS-1分级是复杂先天性心脏病FT治疗影响因素.结论 部分复杂先天性心脏病矫治术后可行FT治疗,高RACHS-1风险分级、疾病类型、年龄<6个月是复杂先天性心脏病矫治术后FT的影响因素.%Objectives To access the feasibility and safety of fast track (FT) treatment in patients with complex congenital heart disease who received congenital cardiac surgery, and to discuss risk factors of FT treatment. Methods We retrospectively summarized the clinic data of 865 patients with complex congenital heart disease who underwent operations in Fuwai Hospital from January 2008 to June 2010. Patients with tetralogy of Fallot, pulmonary atresia, double outlet right ventricle transposition of the great arteries, total anomalous pulmonary venous connection, endocardial cushion defects and aortic coarctation combine with ventricular septal defect were all included in this study. The risk factors [risk adjustment for congenital

  11. Physical activity and return to work after fast-track total hip replacement with or without supervised rehabilitation. Results from a randomized controlled trial

    DEFF Research Database (Denmark)

    Mikkelsen, Lone Ramer; Mechlenburg, Inger; Søballe, Kjeld

    Background Total hip replacement (THR) results in pain reduction and functional improvements. However, it is suggested that these improvements are not followed by increases in physical activity level and return to usual activities postoperatively. Furthermore, it is unknown whether supervised...

  12. Fast-track rehabilitation program vs conventional care after colorectal resection: A randomized clinical trial

    Institute of Scientific and Technical Information of China (English)

    Gang Wang; Zhi-Wei Jiang; Jing Xu; Jian-Feng Gong; Yang Bao; Li-Fei Xie; Jie-Shou Li

    2011-01-01

    AIM: To compare the fast-track rehabilitation program and conventional care for patients after resection of colorectal cancer.METHODS: One hundred and six consecutive patients who underwent fast-track rehabilitation program were encouraged to have early oral feeding and movement for early discharge, while 104 consecutive patients underwent conventional care after resection of colorectal cancer. Their gastrointestinal functions, postoperative complications and hospital stay time were recorded.RESULTS: The restoration time of gastrointestinal functions in the patients was significantly faster after fasttrack rehabilitation program than after conventional care (2.1 d vs 3.2 d, P < 0.01). The percentage of patients who developed complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care (13.2% vs 26.9%, P < 0.05). Also,the percentage of patients who had general complications was significantly lower 30 d after fast-track rehabilitation program than after conventional care (6.6% vs 15.4%, P < 0.05). The postoperative hospital stay time of the patients was shorter after fast-track rehabilitation program than after conventional care (5 d vs 7 d, P <0.01). No significant difference was observed in the readmission rate 30 d after fast-track rehabilitation program and conventional care (3.8% vs 8.7%).CONCLUSION: The fast-track rehabilitation program can significantly decrease the complications and shorten the time of postoperative hospital stay of patients after resection colorectal cancer.

  13. Fast track for elderly patients: is it feasible for colorectal surgery?

    Science.gov (United States)

    Compagna, Rita; Aprea, Giovanni; De Rosa, Davide; Gentile, Maurizio; Cestaro, Giovanni; Vigliotti, Gabriele; Bianco, Tommaso; Massa, Guido; Amato, Maurizio; Massa, Salvatore; Amato, Bruno

    2014-01-01

    Fast-track program has been applied in several surgical fields. However, currently many surgical patients are elderly over 70 years of age, and discussion about the application of such protocols for elderly patients is inadequate. The present study was designed to consider the safety and feasibility of application of a fast-track program after colorectal surgery in elderly patients. A total of 76 elderly patients with colorectal cancer who underwent laparoscopic colorectal resection were randomly assigned to receive either the fast-track care program (n = 40) or the conventional perioperative care protocol (control group, n = 36). The fast track protocol included no preoperative mechanical bowel irrigation, immediate oral alimentation and earlier postoperative ambulation exercise. The length of postoperative hospital stay, the length of time to regain bowel function and the rate of postoperative complications were compared between the two groups. The length of time to regain bowel function, including the passage of flatus [32 (24-40) h vs 42 (32-52) h], and to start a liquid diet (13 [10-16] h v/s 43 [36-50] h) were significantly shorter in patients receiving the fast track care protocol compared with those receiving the conventional care protocol. A shorter duration of postoperative hospital stay was recorded in patients receiving the fast-track program than in those receiving conventional care [6 (5-7) days v/s 9.5 (7-12) days]. A reduced percentage of patients who developed general complications was also observed in the fast-track group (5.0% v/s 18%). Fast-track after laparoscopic colorectal surgery can be safely applied in carefully selected elderly patients older than age 70 years. The fast-track recovery program resulted in a more rapid postoperative recovery, earlier discharge from hospital and fewer general complications compared with a conventional postoperative protocol. Copyright © 2014 Surgical Associates Ltd. Published by Elsevier Ltd. All rights

  14. Successful integration of fast track projects into turnarounds

    Energy Technology Data Exchange (ETDEWEB)

    Williams, J. Patrick; Loureiro, Ramon C. [KBC Advanced Technologies, Surrey (United Kingdom)

    2012-07-01

    Fast track projects can provide quick wins and competitive advantage. However, in most cases the implementation of these projects requires a shutdown for installing the necessary tie-ins or integration into an upcoming turnaround (TA). Depending on the nature of the project and complexity of the TA, the integration can be seamless or result in cost or duration overruns and safety incidents. The risk of such overruns and safety incidents increases with the amount of project work to be integrated into the operations, maintenance and inspection schedules to be executed during the TA. The risk further increases with TA size and other factors. If not planned and scheduled properly and in a timely fashion, capital projects, in particular fast track projects trying to take advantage of an upcoming TA, can severely impact both TA performance, and the safety and reliability of the facility until the next opportunity for eliminating the defects introduced during the TA. Successful TAs are those delivered in a safe, on time, on budget manner, and with the quality standards needed for a leak-free start-up and a safe and reliable operation over the next run cycle. This paper discusses the key elements that are required to minimize the TA risks derived from the inclusion of fast track projects and how to establish the cut off criteria to either cancel or defer the project, or delay the TA in order to balance TA scope freeze and the case for compelling economics.(author)

  15. Social Security Administration Percentage of Fast-Track Receipts

    Data.gov (United States)

    Social Security Administration — The dataset provides the percentage of fast-track receipts by state during the reporting fiscal year. Fast-tracked cases consist of those cases identified as Quick...

  16. Cognitive dysfunction after fast-track hip and knee replacement

    DEFF Research Database (Denmark)

    Krenk, Lene; Kehlet, Henrik; Bæk Hansen, Torben

    2014-01-01

    to 2 weeks and 3 months postoperatively. LOS, pain, opioid use, inflammatory response, and sleep quality were recorded. The practice effect of repeated cognitive testing was gauged using data from a healthy community-dwelling control group (n = 161). RESULTS: Median LOS was 2 days (interquartile range...... this (23.6% of patients with early POCD had late onset vs 6.7% in non-POCD group; risk difference 16.9 (95% CI, -2.1% to 41.1%; P = 0.089). CONCLUSIONS: The incidence of POCD early after total hip and knee replacement seems to be lower after a fast-track approach than rates previously reported...

  17. Security market reaction to FDA fast track designations.

    Science.gov (United States)

    Anderson, Christopher W; Zhang, Ying

    2010-01-01

    Pharmaceutical firms can apply for the Food and Drug Administration to 'fast track' research and de velopment on new drugs, accelerating clinical trials and expediting regulatory review required prior to marketing to consumers. We investigate security market reaction to more than 100 fast track designations from 1998 to 2004. Fast track designation appears to enhance investor recognition of firm value. Specifically, fast track designation coincides with abnormal trading volume and excess daily stock returns for sponsoring firms. Institutional ownership and analyst attention also increase. Market response is more pronounced for firms that are smaller, do not yet market products, and have low institutional ownership.

  18. Fast-track knee arthroplasty – status and future challenges

    DEFF Research Database (Denmark)

    Kehlet, Henrik; Thienpont, Emmanuel

    2013-01-01

    Fast-track programs have been developed for different surgical procedures leading to higher patient satisfaction and lower morbidity. This concept has been extended to knee arthroplasty in recent years. The purpose of this narrative review was to discuss the different aspects of fast-track knee a...

  19. Fast Track Teaching: Beginning the Experiment in Accelerated Leadership Development

    Science.gov (United States)

    Churches, Richard; Hutchinson, Geraldine; Jones, Jeff

    2009-01-01

    This article provides an overview of the development of the Fast Track teaching programme and personalised nature of the training and support that has been delivered. Fast Track teacher promotion rates are compared to national statistics demonstrating significant progression for certain groups, particularly women. (Contains 3 tables and 3 figures.)

  20. Fast Track: A Language Arts Program for Middle School Gifted

    Science.gov (United States)

    Schneider, Jean

    2008-01-01

    "Fast Track" is a pseudonym for an accelerated, advanced language arts program for verbally gifted and high potential students in grades 6-8. The critical thinking model used for "Fast Track" was gleaned from Coalition of Essential Schools founder Ted Sizer's Habits of Mind: significance, evidence, connections, perspective, and supposition, as…

  1. Standardising fast-track surgical nursing care in Denmark

    DEFF Research Database (Denmark)

    Hjort Jakobsen, Dorthe; Rud, Kirsten; Kehlet, Henrik

    2014-01-01

    guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN...

  2. Convalescence after colonic resection with fast-track versus conventional care

    DEFF Research Database (Denmark)

    Hjort Jakobsen, D; Sonne, E; Basse, L;

    2004-01-01

    BACKGROUND: Multi-modal rehabilitation programmes may improve early postoperative body composition, pulmonary function, exercise capacity, and reduce hospital stay. So far, no data are available on convalescence after discharge. AIM: The objectives were to compare convalescence data (fatigue, sleep...... results in earlier resumption of normal activities with reduced fatigue and need for sleep postoperatively compared to conventional care, and without increased need for nursing care or visits to general practitioners. However, readmissions may occur more frequently....... vs. 8 days in the fast-track vs. conventional care group, respectively (p sleep were increased in the conventional care group when compared with the fast-track group (p

  3. Sleep disturbances after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Krenk, L; Jennum, P; Kehlet, H

    2012-01-01

    , and on the fourth postoperative night at home. Sleep staging was performed according to the American Academy of Sleep Medicine manual. Opioid use, pain, and inflammatory response (C-reactive protein) were also evaluated. RESULTS: /st>The mean LOS was 1.5 (1-2) days. The mean REM sleep time decreased from a mean...... on the fourth postoperative night. There was no association between opioid use, pain scores, and inflammatory response with a disturbed sleep pattern. CONCLUSIONS: /st>Despite ultra-short LOS and provision of spinal anaesthesia with multimodal opioid-sparing analgesia, REM sleep was almost eliminated......BACKGROUND: /st>Major surgery is followed by pronounced sleep disturbances after traditional perioperative care potentially leading to prolonged recovery. The aim was to evaluate the rapid eye movement (REM) sleep duration and sleep architecture before and after fast-track hip and knee replacement...

  4. Fast Tracking for the ATLAS LVL2 Trigger

    CERN Document Server

    Baines, J T M; Emeliyanov, D; Konstantinidis, N P; Parodi, F; Schiavi, C; Sutton, M; Computing In High Energy Physics

    2005-01-01

    We present a set of algorithms for fast track reconstruction at the second level (LVL2) trigger of ATLAS, using three-dimensional space points (= hits) from the silicon trackers. The strategy is to determine the position z_0 of the interesting pp interaction along the beam axis prior to any track reconstruction and then retain only groups of hits which point back to that z_0 and perform combinatorial tracking only inside those groups. We give results and discuss the advantages of this approach, which is generic enough to be applicable to other multi-collision experiments. We also make a qualitative comparison with a complementary approach which is based on Look-Up Tables (LUT) and is also used in ATLAS.

  5. Effect of an Emergency Department Fast Track on Press-Ganey Patient Satisfaction Scores

    Directory of Open Access Journals (Sweden)

    Hwang, Calvin E.

    2014-12-01

    Full Text Available Introduction: Mandated patient surveys have become an integral part of Medicare remuneration, putting hundreds of millions of dollars in funding at risk. The Centers for Medicare & Medicaid Services (CMS recently announced a patient experience survey for the emergency department (ED. Development of an ED Fast Track, where lower acuity patients are rapidly seen, has been shown to improve many of the metrics that CMS examines. This is the first study examining if ED Fast Track implementation affects Press-Ganey scores of patient satisfaction. Methods: We analyzed returned Press-Ganey questionnaires from all ESI 4 and 5 patients seen 11AM - 11PM, August-December 2011 (pre-fast track, and during the identical hours of fast track, August-December 2012. Raw ordinal scores were converted to continuous scores for paired student t-test analysis. We calculated an odds ratio with 100% satisfaction considered a positive response. Results: An academic ED with 52,000 annual visits had 140 pre-fast track and 85 fast track respondents. Implementation of a fast track significantly increased patient satisfaction with the following: wait times (68% satisfaction to 88%, OR 4.13, 95% CI [2.32-7.33], doctor courtesy (90% to 95%, OR 1.97, 95% CI [1.04-3.73], nurse courtesy (87% to 95%, OR 2.75, 95% CI [1.46-5.15], pain control (79% to 87%, OR 2.13, 95% CI [1.16-3.92], likelihood to recommend (81% to 90%, OR 2.62, 95% CI [1.42-4.83], staff caring (82% to 91%, OR 2.82, 95% CI [1.54-5.19], and staying informed about delays (66% to 83%, OR 3.00, 95% CI [1.65-5.44]. Conclusion: Implementation of an ED Fast Track more than doubled the odds of significant improvements in Press-Ganey patient satisfaction metrics and may play an important role in improving ED performance on CMS benchmarks. [West J Emerg Med. 2015;16(1:34–38.

  6. SMEs in Energy: Are they the parallel fast track for electrification of Africa?

    Energy Technology Data Exchange (ETDEWEB)

    Abdel-Rahman, Mohamed

    2010-09-15

    The African continent is suffering from a chronic energy shortage that hiders its development. The conventional wisdom is to put the Mega projects under focus. However, a parallel fast track for the energy as an SME business may bring faster results to the continent. To that end, this paper presents proposed steps to promote the concept within the continent.

  7. Serious renal and urological complications in fast-track primary total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Bjerregaard, Lars; Jørgensen, Christoffer Calov; Kehlet, Henrik

    2016-01-01

    BACKGROUND: Overall medical complications have been reduced after fast-track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited. METHODS: To describe the incidence and consequences of serious RU complications resulting in length o...

  8. Fast Track Open Partial Nephrectomy: Reduced Postoperative Length of Stay with a Goal-Directed Pathway Does Not Compromise Outcome

    Directory of Open Access Journals (Sweden)

    Bilal Chughtai

    2008-01-01

    Full Text Available Introduction. The aim of this study is to examine the feasibility of reducing postoperative hospital stay following open partial nephrectomy through the implementation of a goal directed clinical management pathway. Materials and Methods. A fast track clinical pathway for open partial nephrectomy was introduced in July 2006 at our institution. The pathway has daily goals and targets discharge for all patients on the 3rd postoperative day (POD. Defined goals are (1 ambulation and liquid diet on the evening of the operative day; (2 out of bed (OOB at least 4 times on POD 1; (3 removal of Foley catheter on the morning of POD 2; (4 removal of Jackson Pratt drain on the afternoon of POD 2; (4 discharge to home on POD 3. Patients and family are instructed in the fast track protocol preoperatively. Demographic data, tumor size, length of stay, and complications were captured in a prospective database, and compared to a control group managed consecutively immediately preceding the institution of the fast track clinical pathway. Results. Data on 33 consecutive patients managed on the fast track clinical pathway was compared to that of 25 control patients. Twenty two (61% out of 36 fast track patients and 4 (16% out of 25 control patients achieved discharge on POD 3. Overall, fast track patients had a shorter hospital stay than controls (median, 3 versus 4 days; P = .012. Age (median, 55 versus 57 years, tumor size (median, 2.5 versus 2.5 cm, readmission within 30 days (5.5% versus 5.1%, and complications (10.2% versus 13.8% were similar in the fast track patients and control, respectively. Conclusions. In the present series, a fast track clinical pathway after open partial nephrectomy reduced the postoperative length of hospital stay and did not appear to increase the postoperative complication rate.

  9. Fast tracking in paediatric cardiac anaesthesia : an update.

    Directory of Open Access Journals (Sweden)

    Lake Carol

    2002-01-01

    Full Text Available A care plan in which cardiac surgical patients progress quickly through the perioperative course to hospital discharge is often referred to as a Fast Track. Such care plans have been used extensively in adult cardiac patients but are also applicable to paediatric patients. Although no randomised controlled trials are available to document a reduction in hospital costs and avoidance of iatrogenic complications with paediatric fast tracks, many healthcare administrators encourage their use. Fast Track clinical guidelines usually include same day surgery, use of short- acting anaesthetic drugs, early extubation, effective pain management, and reduced intensive care unit stays. These protocols are certainly appropriate for simple procedures such as repair of atrial or ventricular septal defects or ligation of a patent ductus arteriosus. However, many paediatric cardiac anaesthesiologists consider that all paediatric patients without significant pulmonary or residual cardiac pathology can be managed using expedited postoperative protocols. Essential components in a "fast track" protocol include use of minimally invasive surgical techniques, modified ultrafiltration during cardiopulmonary bypass, transoesophageal echocardiography to evaluate the cardiac repair, and postoperative pain control. Using such techniques, 80-90% of paediatric patients can be extubated in the operating room or within 2-4 hours postoperatively. Despite the opinions of recognised experts, an appropriately sized and powered multicentre, controlled, randomised, prospective study is still needed to conclusively document the efficiency and effectiveness of the Fast Track in paediatric cardiac patients.

  10. Most patients regain prefracture basic mobility after hip fracture surgery in a fast-track programme

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Kehlet, Henrik

    2012-01-01

    Treatment of patients with hip fracture has improved over the past decade. Still, some patients do not regain independent mobility within their primary hospital stay even if they follow a multimodal fast-track surgical programme. The aim of the present article was to examine the validity of the p...... of the preliminary prefracture New Mobility Score (NMS), age and fracture type as independent predictors of in-hospital outcome after hip fracture surgery.......Treatment of patients with hip fracture has improved over the past decade. Still, some patients do not regain independent mobility within their primary hospital stay even if they follow a multimodal fast-track surgical programme. The aim of the present article was to examine the validity...

  11. Fast-track video-assisted thoracoscopic surgery

    DEFF Research Database (Denmark)

    Holbek, Bo Laksafoss; Petersen, René Horsleben; Kehlet, Henrik

    2016-01-01

    Objectives To provide a short overview of fast-track video-assisted thoracoscopic surgery (VATS) and to identify areas requiring further research. Design A literature search was made using key words including: fast-track, enhanced recovery, video-assisted thoracoscopic surgery, robot......-assisted thoracoscopic surgery (RATS), robotic, thoracotomy, single-incision, uniportal, natural orifice transluminal endoscopic surgery (NOTES), chest tube, air-leak, digital drainage, pain management, analgesia, perioperative management, anaesthesia and non-intubated. References from articles were screened for further...

  12. Fast track concept in the European fusion programme

    Energy Technology Data Exchange (ETDEWEB)

    Bolt, Harald [Max-Planck-Institute for Plasma Physics, Garching (Germany)

    2002-10-01

    Recently an expert meeting regarding a possible acceleration of the fusion programme with a view to energy production ('fast track') was held on the initiative of the EU Research Council. In the course of the discussions about the fast track programme, it has turned out that successful extraction of reactor grade heat and tritium from the blanket modules is essential in the ITER operation. In parallel with ITER, material development using a high intensity neutron source is essential to establish a database for licensing. The operation of a reactor combining DEMO and PROTO generations into a single step could be around 2030. (author)

  13. Most patients regain prefracture basic mobility after hip fracture surgery in a fast-track programme

    DEFF Research Database (Denmark)

    Kristensen, Morten Tange; Kehlet, Henrik

    2012-01-01

    Treatment of patients with hip fracture has improved over the past decade. Still, some patients do not regain independent mobility within their primary hospital stay even if they follow a multimodal fast-track surgical programme. The aim of the present article was to examine the validity...... of the preliminary prefracture New Mobility Score (NMS), age and fracture type as independent predictors of in-hospital outcome after hip fracture surgery....

  14. Setting up a fast-track insulin start clinic for type 2 diabetes.

    Science.gov (United States)

    Burden, Mary; Byard, Caroline; Gregory, Robert; Khulpateea, Anita; Burden, Andrew

    When people with established type 2 diabetes first need insulin therapy there is often a delay in accessing services. Since the report of the UK Prospective Diabetes Study was published it has been recognised that people with type 2 diabetes have a progressive disease and a need for increasing treatment. The authors set up a fast-track service to enable GPs and practice nurses to refer to a nurse-led service at the diabetes centre.

  15. Fast-track vs. delayed insertion of the levonorgestrel-releasing intrauterine system after early medical abortion - a randomized trial.

    Science.gov (United States)

    Korjamo, Riina; Mentula, Maarit; Heikinheimo, Oskari

    2017-08-05

    To compare levonorgestrel (LNG) 52-mg intrauterine system (IUS) expulsion rates with fast-track (≤3 days) or delayed (2-4 weeks) insertion following mifepristone and misoprostol medical abortion. In this pilot trial, we randomized 108 women at ≤63 days' gestation to fast-track (n=55) or delayed (n=53) insertion. Follow-up visits occurred at 2-4 weeks, 3 months and 1 year. We assessed total and partial expulsion at 3 months and 1 year, adverse effects and bleeding profiles. We had follow-up data at 3 months and 1 year for 41 (74.5%) and 37 (69.8%) women in the fast-track group and 31 (56.4%) and 28 (52.8%) women in the delayed group. By 3 months, expulsion occurred in six (12.5%) women after fast-track and one (2.3%) woman after delayed insertion [risk ratio (RR) 5.50, 95% confidence interval (CI) 0.69-43.90]; most (n=5) of these were partial expulsions in the fast-track group. By 1 year, expulsion had occurred in seven (14.6%) and five (11.5%) women in the fast-track and delayed groups, respectively (RR 1.28, 95% CI 0.44-3.75). We found no differences in rates of vacuum aspiration, residual tissue, infection and bleeding or bleeding patterns within 3 months of insertion. Fast-track insertion of the LNG 52-mg IUS after medical abortion is feasible but may result in higher expulsion rates compared to delayed insertion. Due to lack of statistical power and high lost-to-follow-up rates, we were unable to fully address this question. Fast-tract initiation of LNG 52-mg IUS contraception after medical abortion is feasible. It results in higher expulsion rates than delayed insertion but may improve postabortal intrauterine contraception uptake. Copyright © 2017 Elsevier Inc. All rights reserved.

  16. Effectiveness of fast-track rehabilitation vs conventional care in laparoscopic colorectal resection for elderly patients: a randomized trial.

    Science.gov (United States)

    Wang, Q; Suo, J; Jiang, J; Wang, C; Zhao, Y-Q; Cao, X

    2012-08-01

    The aim of the study was to evaluate the efficacy and safety of fast-track rehabilitation in elderly patients over 65 years of age, following laparoscopic surgery to remove colorectal cancer. A total of 78 elderly patients with colorectal cancer who underwent laparoscopic colorectal resection were randomly assigned to receive either the fast-track care programme (n = 40) or the conventional perioperative care protocol (control group, n = 38). Medical personnel conducting the study were blinded to patients' clinical outcomes prior to statistical analysis. The fast-track protocol included no preoperative mechanical bowel irrigation, immediate oral alimentation and earlier postoperative ambulation exercise. The length of postoperative hospital stay, the length of time to regain bowel function and the rate of postoperative complications were compared between the two groups. The length of time to regain bowel function, including the passage of flatus[31 (26-40) h vs 38 (32-51) h, P = 0.001], to the first bowel movement [55 (48-63) h vs 64 (48-71) h, P = 0.009] and to start a liquid diet (12 [11-16] h vs 47 [35-50] h, P = 0.000) were significantly shorter in patients receiving the fast-track care protocol compared with those receiving the conventional care protocol. A shorter duration of postoperative hospital stay was recorded in patients receiving the fast-track program than in those receiving conventional care (P = 0.0001). A reduced percentage of patients who developed general complications was also observed in the fast-track group (5.0%vs 21.1%, P = 0.045). This randomized controlled trial has shown that in the elderly undergoing laparoscopic colorectal surgery, the fast-track recovery programme resulted in a more rapid postoperative recovery, earlier discharge from hospital and fewer general complications compared with a conventional postoperative protocol. © 2011 The Authors. Colorectal Disease © 2011 The Association of Coloproctology of Great Britain and

  17. Delirium after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Krenk, Lene; Rasmussen, L S; Hansen, T B

    2012-01-01

    ). Twenty-two patients received general anaesthesia, and the rest had spinal anaesthesia. No patients developed PD (95% confidence interval 0.0-1.6%). CONCLUSIONS: /st>A fast-track set-up with multimodal opioid-sparing analgesia was associated with lack of PD after elective THA and TKA in elderly patients....

  18. Fast Track: Elementary School. What Works Clearinghouse Intervention Report

    Science.gov (United States)

    What Works Clearinghouse, 2014

    2014-01-01

    "Fast Track" is a comprehensive intervention designed to reduce conduct problems and promote academic, behavioral, and social improvement. The program's components include the "Promoting Alternative THinking Strategies" curriculum, parent groups, parent-child sharing time, child social skills training, home visiting, child…

  19. Fast-Track Cleanup at Closing DoD Installations

    Science.gov (United States)

    The Fast-Track Cleanup program strives to make parcels available for reuse as quickly as possible by the transfer of uncontaminated or remediated parcels, the lease of contaminated parcels where cleanup is underway, or the 'early transfer' of contaminated property undergoing cleanup.

  20. Readmissions after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Kristian Stahl; Kristensen, Billy B

    2010-01-01

    With the implementation of fast-track surgery with optimization of both logistical and clinical features, the postoperative convalescence has been reduced as functional milestones have been achieved earlier and consequently length of stay (LOS) in hospital has been reduced. However, it has been...

  1. Patient-reported outcome after fast-track knee arthroplasty

    DEFF Research Database (Denmark)

    Larsen, Kristian; Hansen, Torben B; Søballe, Kjeld;

    2012-01-01

    PURPOSE: The purpose of this study was to describe patient-related functional outcomes after fast-track total knee arthroplasty and unicompartmental knee arthroplasty. Furthermore, we wanted to assess physical areas where an additional need for rehabilitation could be identified, and finally, we...

  2. Subacute pain and function after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Andersen, Lasse Østergaard; Gaarn-Larsen, L; Kristensen, B B;

    2009-01-01

    In a well-defined fast-track setup for total hip and knee arthroplasty, with a multimodal analgesic regimen consisting of intra-operative local anaesthetic infiltration and oral celecoxib, gabapentin and paracetamol for 6 days postoperatively, we conducted a prospective, consecutive, observationa...... walking 1 month after surgery with a concomitant increase in the use of strong opioids. These results emphasise the need for improvement in analgesia after discharge following total knee arthroplasty, to facilitate rehabilitation....

  3. The role of pain for early rehabilitation in fast track surgery.

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten Tange; Myhrmann, Lis;

      Introduction: The purpose of this study was to investigate the relationship between early functional mobility and pain intensity on the first day after surgery and on the planned day of discharge in a well-defined fast-track programme after total knee arthroplasty (TKA) using the local injections...... the clinical pathway for fast track programs, including transfer and ambulation from day one, with further physiotherapy daily. Patients were discharged, according to the following discharge criteria: Independence in transfer and ambulation, able to walk with crutches, independence in toileting and dressing......, which was assessed together with pain intensity, measured by Visual Analog Scale (VAS), active range of knee extension-flexion, functional mobility using "Timed Up & Go" (TUG), walking distance and length of stay (LOS). Results: On POD 1, 84% of the patients were able to transfer and 89% to ambulate...

  4. Pathogenesis of morbidity after fast-track laparoscopic colonic cancer surgery

    DEFF Research Database (Denmark)

    Stottmeier, S; Harling, H; Wille-Jørgensen, P

    2011-01-01

    AIM: Analysis of the nature and time course of early complications after laparoscopic colonic surgery is required to allow rational strategies for their prevention and management. METHOD: One hundred and four consecutive patients who underwent elective fast-track laparoscopic colonic cancer surgery...... were analysed prospectively from the Danish Colorectal Cancer Database, supplemented by data from the medical records. We studied in detail the time course of morbidity and reasons for prolonged stay (> 3 days). RESULTS: Seventeen (16.3%) patients had one or more complications. Surgical complications...... occurred in 14 patients, of which four were preceded by medical complications. Three patients had only medical complications. Median length of stay was 3 days (range 1-44). CONCLUSION: Further improvement of outcomes after fast-track laparoscopic colonic surgery might be obtained by improved surgical...

  5. Research on Fast Track Surgery Application in Lung Cancer Surgery

    Directory of Open Access Journals (Sweden)

    Kaiyun YANG

    2010-02-01

    Full Text Available Background and objective Fast track surgery (FTS is a systematical method to accelerate the recovery of surgical patients by reducing the physical and mental trauma stress of them. The research is to investigate the feasibility of FTS application in lung cancer surgery. Methods A total of 80 cases of lung cancer patients with single leaf lobotomy resection were randomized into two groups. While the experimental group was treated with the conception of FTS, and the control group was treated with the traditional methods. The incident rate of post-operation pain degrees, telecasts, pleural effusion, the post-operation time stay in hospital time and the total cost during hospitalization in two groups were compared respectively. Results In FTS group: the VAS score of post-operation pain at 1 h, 6 h, 12 h, 24 h and 48 h all significantly decreased compared to the traditional therapy group. The incidence rate of telecast was 10.53%. The incidence rate of pleural effusion was 26.31%. The length of stay after operation was (4±1 d and the total cost was RMB 15 600±7 600. In the control group, the above values were 77.78%, 33.33%, 22.22%, (9±1 d, RMB 23 600±5 400, respectively. The post operation pain (VAS method of FTS group was remarkablely below the control group. There has significant difference of the incident rate of telecasts, stay time in hospital and the total cast in two groups (P < 0.05. No significant difference was observed in the incident rate of pleural effusion. Conclusion The new methods of FTS can apparently accelerates recovery after lung cancer resection, reduces complications, shorten timestay in hospital and cut down the total cost.

  6. Current Status of Fast-Track Recovery Pathways in Pancreatic Surgery

    Directory of Open Access Journals (Sweden)

    Efthymios Ypsilantis

    2009-11-01

    Full Text Available Context Pancreatic surgery is often associated with significant morbidity, thus requiring high level of peri-operative care and long hospital stay. Multi-modal “enhanced recovery” or “fast-track” pathways have recently been introduced, aiming to expedite patient recovery. Objective To evaluate the evidence underpinning the use of fast-track pathways in the peri-operative care of patients undergoing pancreatic cancer surgery. Results The available evidence is limited, consisting of three retrospective studies that report median length of hospital stay between 7 and 13 days. No significant difference has been noted in re-admission or 30-day mortality rates between fast-track patients and historical controls, but there is a trend for higher overall complication rate for the fast-track groups. Conclusion Implementation of an enhanced recovery pathway is feasible and can achieve shorter hospital stay and reduced costs, with no increase in re-admission or peri-operative mortality rates. There is, however, conflicting evidence on the physiological mechanisms that contribute to accelerated patient recovery. Certain safety issues associated with post-operative morbidity warrant rigorous evaluation in further prospective studies.

  7. Outcomes in smokers and alcohol users after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, C C; Kehlet, Henrik; Hansen, Torben Bæk

    2013-01-01

    and knee arthroplasty. RESULTS: In 3041 consecutive patients, 458 reported smoking and 216 drinking > 2 drinks a day, of which 66 did both. Smokers/alcohol users were younger than non-users (mean age: 64.3 vs. 68.0 years, P  4 days and smoking (odds ratio [95% confidence interval], P) (1.34 [0.92-1.95], 0......BACKGROUND: Smoking and alcohol use impair post-operative outcomes. However, no studies include fast-track surgery, which is a multimodal-enhanced recovery programme demonstrated to improve outcome. We hypothesised that outcome is similar in smokers and alcohol users as in non-users after fast......-track hip and knee arthroplasty. METHODS: Prospective questionnaires on co-morbidity and smoking/alcohol use were cross-referenced with the Danish National Health Registry to investigate relationship between smoking/alcohol use and length of stay of > 4 days and readmissions ≤ 90 days after fast-track hip...

  8. Standardising fast-track surgical nursing care in Denmark

    DEFF Research Database (Denmark)

    Hjort Jakobsen, Dorthe; Rud, Kirsten; Kehlet, Henrik;

    2014-01-01

    guidelines based on the principles of fast-track surgery-i.e. patient information, surgical stress reduction, effective analgesia, early mobilisation and rapid return to normal eating. Fast-track surgery was introduced systematically in Denmark by the establishment of the Unit of Perioperative Nursing (UPN......-track regimes in all surgical departments in Denmark. We recommend the workshop-practice method for implementation of new procedures in other areas of patient care.......Considerable variations in procedures, hospital stay and rates of recovery have been recorded within specific surgical procedures at Danish hospitals. The aim of this paper is to report on a national initiative in Denmark to improve the quality of surgical care by implementation of clinical...

  9. FAST TRACK SURGERY IN TOTAL KNEE ARTHROPLASTY - A REVIEW.

    OpenAIRE

    2015-01-01

    The number of orthopedic surgeons who are convinced in the need for significant changes in planned total knee arthroplasty (TKA) is increasing slowly and steadily. A new approach to pain control has been developed over the past 10-15 years, and the introduction of techniques to reduce perioperative stress, and the use of minimally invasive surgical techniques can help limit postoperative complications and shorten recovery time. This type of optimization is regarded as Fast-track Care program,...

  10. Readmissions after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B

    2010-01-01

    With the implementation of fast-track surgery with optimization of both logistical and clinical features, the postoperative convalescence has been reduced as functional milestones have been achieved earlier and consequently length of stay (LOS) in hospital has been reduced. However, it has been s...... speculated that a decrease in LOS may be associated with an increase in readmissions in general, including risk of dislocation after total hip arthroplasty (THA) or manipulation after total knee arthroplasty (TKA)....

  11. Serious renal and urological complications in fast-track primary total hip and knee arthroplasty; a detailed observational cohort study

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Jorgensen, Christoffer C; Kehlet, Henrik

    2016-01-01

    BACKGROUND: Overall medical complications have been reduced after fast-track total hip (THA) and knee arthroplasty (TKA), but data on specific renal and urological (RU) complications are limited. METHODS: To describe the incidence and consequences of serious RU complications resulting in length...... postoperatively. Seven complications . (0.08 %) were urological, mainly haematuria after bladder catheterisation, whereas 5 (0.06 were urosepsis/pyelonephritis. CONCLUSION: The overall incidence of serious RU complications after fast-track THA and TKA was 0.61 %. AKI occurred in 0.49% and was most often due...

  12. 限制性液体复苏联合绿色通道救治严重腹部创伤合并失血性休克的效果分析%Study on the therapeutic effect of limited fluid resuscitation associated with first-aid fast track in ;treatment of patients of traumatic hemorrhagic shock with severe abdominal trauma

    Institute of Scientific and Technical Information of China (English)

    陈发球; 陈锡林; 林惠文; 卢瑞梅; 陈荣健; 徐志锋

    2015-01-01

    目的:探讨限制性液体复苏联合绿色通道对严重腹部创伤合并失血性休克的救治效果。方法回顾性分析2006年5月至2013年5月江门市中心医院急诊收治的128例严重腹部创伤合并失血性休克患者临床资料,对比早期采用低压(A组)和正压(B组)液体复苏联合绿色通道手术治疗的救治效果,并与传统路径正压液体复苏(C组)的救治效果相比较。结果 A组死亡12例(12/64,18.75%),B组死亡12例(12/45,26.67%),C组死亡7例(7/19,36.84%);3组患者病死率比较差异有统计学意义(2=6.825,P=0.037)。A组患者的并发症发生率低于B组、C组(2=8.974,P=0.011),血浆凝血酶原时间(PT)最短(t=10.619,P=0.000)。结论限制性液体复苏联合绿色通道能降低严重腹部创伤合并失血性休克患者的病死率,提高存活率,并能降低存活患者并发症的发生率。%Objective To discuss the clinical effect of limited fluid resuscitation associated with first-aid fast track for severe abdominal trauma and hemorrhagic shock. Methods A retrospective anal-ysis was carried out on the therapeutic effect of one hundred and twenty-eight cases with severe abdomi-nal trauma and hemorrhagic shock, treated with limited fluid resuscitation or adequate fluid resuscitation by different operation paths. Results In limited fluid resuscitation associated with first-aid fast track group, both the mortality and the complication rate of survival patients were significantly lower than those with adequate fluid resuscitation group whether by traditional track or first-aid fast track ( 2=6.825, 8.974, P=0.037, 0.011). Furthermore, the prothrombin time (PT) was the shortest in the limited fluid resuscitation group (t=10.619, P=0.000). Conclusion Limited fluid resuscitation associated with first-aid fast track can reduce the mortality of severe abdominal trauma and hemorrhagic shock, improve the survival rate, and reduce postoperative complications of survival patients.

  13. "Fast-track" and "Minimally Invasive" Surgery for Gastric Cancer

    Institute of Scientific and Technical Information of China (English)

    Xin-Xin Liu; Hua-Feng Pan; Zhi-Wei Jiang; Shu Zhang; Zhi-Ming Wang; Ping Chen; Yan Zhao

    2016-01-01

    Background:Enhanced recovery after surgery (ERAS) protocols or fast-track (FT) programs enable a shorter hospital stay and lower complication rate.Minimally invasive surgery (MIS) is associated with a lesser trauma and a quicker recovery in many elective abdominal surgeries.However,little is known of the safety and effectiveness made by ERAS protocols combined with MIS for gastric cancer.The purpose of this study was to evaluate the safety and effectiveness made by FT programs and MIS in combination or alone.Methods:We summarized an 11-year experience on gastric cancer patients undergoing elective laparotomy or minimally invasive gastric resection in standard cares (SC) or FT programs during January 2004 to December 2014.A total of 984 patients were enrolled and assigned into four groups:open gastrectomies (OG) with SC (OG + SC group,n =167);OG with FT programs (OG + FT group,n =277);laparoscopic gastrectomies (LG) with FT programs (LG + FT group,n =248);and robot-assisted gastrectomies (RG) with FT programs (RG + FT group,n =292).Patients' data were collected to evaluate the clinical outcome.The primary end point was the length of postoperative hospital stay.Results:The OG + SC group showed the longest postoperative hospital stay (mean:12.3 days,median:11 days,interquartile range [IQR]:6-16 days),while OG + FT,LG + FT,and RG + FT groups recovered faster (mean:7.4,6.4,and 6.6 days,median:6,6,and 6 days,IQR:3-9,4-8,and 3-9 days,respectively,all P < 0.001).The postoperative rehabilitation parameters such as flatus time after surgery (4.7 ± 0.9,3.1 ± 0.8,3.0± 0.9,and 3.1 ± 0.9 days) followed the same manner.After 30 postoperative days' follow-up,the total incidence of complications was 9.6% in OG + SC group,10.1% in OG + FT group,8.1% in LG + FT group,and 10.3% in RG + FT group.The complications showed no significant differences between the four groups (all P > 0.05).Conclusions:ERAS protocols alone could significantly bring fast recovery after surgery

  14. A midsize tokamak as a fast track to burning plasmas

    Directory of Open Access Journals (Sweden)

    E. Mazzucato

    2011-03-01

    Full Text Available This paper describes the conceptual design of a midsize tokamak as a fast track to the investigation of burning plasmas. It is shown that it could reach large values of energy gain (≥ 10 with only a modest improvement in confinement over the scaling that was used for designing the International Thermonuclear Experimental Reactor (ITER. This can be achieved by operating in a low plasma recycling regime that experiments indicate can lead to improved plasma confinement. The possibility of reaching the necessary conditions of low recycling using a different magnetic divertor from those currently employed in present experiments is discussed.

  15. FAST TRACK SURGERY IN TOTAL KNEE ARTHROPLASTY - A REVIEW.

    Directory of Open Access Journals (Sweden)

    Pencho Kosev

    2015-08-01

    Full Text Available The number of orthopedic surgeons who are convinced in the need for significant changes in planned total knee arthroplasty (TKA is increasing slowly and steadily. A new approach to pain control has been developed over the past 10-15 years, and the introduction of techniques to reduce perioperative stress, and the use of minimally invasive surgical techniques can help limit postoperative complications and shorten recovery time. This type of optimization is regarded as Fast-track Care program, where improved healing process is particularly useful to comorbid patients.

  16. Early recovery after fast-track Oxford unicompartmental knee arthroplasty

    DEFF Research Database (Denmark)

    Munk, Stig; Dalsgaard, Jesper; Bjerggaard, Karin

    2012-01-01

    trauma. We investigated changes in leg-extension power (LEP) in the first month after MIS Oxford UKA and its relation to pain, knee motion, functional performance, and knee function. Patients and methods In 35 consecutive Oxford UKA patients, LEP was measured 1 week before and 1 month after surgery...... supervision in the first month after discharge. Interpretation Fast-track MIS Oxford UKA with discharge on the day after surgery is safe and leads to early recovery of knee motion and strength even when no physiotherapy is used....

  17. Delirium in the fast-track surgery setting

    DEFF Research Database (Denmark)

    Krenk, Lene; Rasmussen, Lars S; Kehlet, Henrik

    2012-01-01

    Postoperative delirium (PD) and postoperative cognitive dysfunction (POCD) are two separate syndromes of cognitive decline after major surgery, especially in the elderly. Pathogenesis is multifactorial with some common risk factors, and to reduce the risk, a multimodal approach is necessary....../knee arthroplasty (THA/TKA). The fast-track set-up seems to be associated with a lower frequency of PD and early POCD after THA/TKA. Thus, in a series of 225 patients ≥60 years, no cases of PD were seen and the incidence of POCD was reduced by more than 50% at 1 week postoperatively compared to previous studies...

  18. What Is Required to End the AIDS Epidemic as a Public Health Threat by 2030? The Cost and Impact of the Fast-Track Approach.

    Directory of Open Access Journals (Sweden)

    John Stover

    Full Text Available In 2011 a new Investment Framework was proposed that described how the scale-up of key HIV interventions could dramatically reduce new HIV infections and AIDS-related deaths in low and middle income countries by 2015. This framework included ambitious coverage goals for prevention and treatment services for 2015, resulting in a reduction of new HIV infections by more than half, in line with the goals of the declaration of the UN High Level Meeting in June 2011. However, the approach suggested a leveling in the number of new infections at about 1 million annually-far from the UNAIDS goal of ending AIDS by 2030. In response, UNAIDS has developed the Fast-Track approach that is intended to provide a roadmap to the actions required to achieve this goal. The Fast-Track approach is predicated on a rapid scale-up of focused, effective prevention and treatment services over the next 5 years and then maintaining a high level of programme implementation until 2030. Fast-Track aims to reduce new infections and AIDS-related deaths by 90% from 2010 to 2030 and proposes a set of biomedical, behavioral and enabling intervention targets for 2020 and 2030 to achieve that goal, including the rapid scale-up initiative for antiretroviral treatment known as 90-90-90. Compared to a counterfactual scenario of constant coverage for all services at early-2015 levels, the Fast-Track approach would avert 18 million HIV infections and 11 million deaths from 2016 to 2030 globally. This paper describes the analysis that produced these targets and the estimated resources needed to achieve them in low- and middle-income countries. It indicates that it is possible to achieve these goals with a significant push to achieve rapid scale-up of key interventions between now and 2020. The annual resources required from all sources would rise to US$7.4Bn in low-income countries, US$8.2Bn in lower middle-income countries and US$10.5Bn in upper-middle-income-countries by 2020 before

  19. Effect of fast-track cardiac anesthesia on myocardial oxidative damage, inflammation and nerve related peptides of patients undergoing cardiac operation

    Institute of Scientific and Technical Information of China (English)

    Xing-Tao Cai; Zhong-Jun Zhang; Wen-Bo Diao

    2016-01-01

    Objective:To study the effect of fast-track cardiac anesthesia on myocardial oxidative damage, inflammation and nerve related peptides of patients undergoing cardiac operation.Methods:Sixty patients with rheumatic heart disease undergoing heart valve surgery were randomly divided into the fast track group (n=30) and conventional group (n=30). Then myocardial injury indicators, mitochondrial oxidative stress indicators, inflammation indicators and nerve-related peptides of both groups were analyzed.Results: cTnI contents at T2-T4 points in time of both groups showed an increasing trend and the increasing trend of fast track group was weaker than that of conventional group; SOD contents as well as mitochondrial tristate respiratory function, respiratory control ratios and phosphorus oxygen ratios in myocardial tissue of fast track group were higher than those of conventional group, and MDA contents was lower than those of conventional group; plasma TNF-α, IL-6, IL-8, NSE, S100β and Aβcontents of fast track group were lower than those of conventional group.Conclusions:Fast-track cardiac anesthesia can protect myocardial cells, reduce mitochondrial oxidative stress, relieve inflammation and improve nerve function; it is an ideal anesthesia method for cardiac operation.

  20. A Fast-Track Referral System for Skin Lesions Suspicious of Melanoma

    DEFF Research Database (Denmark)

    Jarjis, Reem Dina; Hansen, Lone Bak; Matzen, Steen Henrik

    2016-01-01

    Introduction. To minimize delay between presentation, diagnosis, and treatment of cutaneous melanoma (CM), a national fast-track referral system (FTRS) was implemented in Denmark. The aim of this study was to analyze the referral patterns to our department of skin lesions suspicious of melanoma i...... melanocytic skin lesions will increase diagnostic accuracy, leading to larger capacity in secondary care for the required treatment of malignant skin lesions.......Introduction. To minimize delay between presentation, diagnosis, and treatment of cutaneous melanoma (CM), a national fast-track referral system (FTRS) was implemented in Denmark. The aim of this study was to analyze the referral patterns to our department of skin lesions suspicious of melanoma....... A total of 556 patients were registered as referred to the center in the FTRS for skin lesions suspicious of melanoma. Among these, a total of 312 patients (56.1%) were diagnosed with CM. Additionally, 41 (7.4%) of the referred patients were diagnosed with in situ melanoma.  Conclusion. In total, 353 (63...

  1. Acute chest pain fast track at the emergency department: who was misdiagnosed for acute coronary syndrome?

    Science.gov (United States)

    Prachanukool, Thidathit; Aramvanitch, Kasamon; Sawanyawisuth, Kittisak; Sitthichanbuncha, Yuwares

    2016-01-01

    Background Acute coronary syndrome (ACS) is a commonly treated disease in the emergency department (ED). Acute chest pain is a common presenting symptom of ACS. Acute chest pain fast track (ACPFT) is a triage to cover patients presenting with chest pain with the aims of early detection and treatment for ACS. This study aimed to assess the quality of the ACPFT with the aim of improving the quality of care for ACS patients. Methods This study was conducted at the ED in Mahidol University, Bangkok, Thailand. The inclusion criterion was patients presenting with acute chest pain at the ED. We retrospectively reviewed the medical records of all eligible patients. The primary outcomes of this study were to determine time from door to electrocardiogram and time from door to treatment (coronary angiogram with percutaneous coronary intervention or thrombolytic therapy in the case of ST elevation myocardial infarction). The outcome was compared between those who were in and not in the ACPFT. Results During the study period, there were 616 eligible patients who were divided into ACPFT (n=352 patients; 57.1%) and non-ACPFT (n=264 patients; 42.9%) groups. In the ACPFT group (n=352), 315 patients (89.5%) received an electrocardiogram within 10 minutes. The final diagnosis of ACS was made in 80 patients (22.7%) in the ACPFT group and 13 patients (4.9%) in the non-ACPFT group (P-value <0.01). After adjustment using multivariate logistic regression analysis, only epigastric pain was independently associated with being in the ACPFT group (adjusted odds ratio of 0.11; 95% confidence interval of 0.02, 0.56). Conclusion The ACPFT at the ED facilitated the prompt work-ups and intervention for ACS. PMID:27980438

  2. On fading probability density functions of fast-tracked and untracked free-space optical communication channels

    Science.gov (United States)

    Zhao, Zhijun; Liao, Rui

    2011-03-01

    Free-space optical (FSO) communication systems suffer from average power loss and instantaneous power fading due to the atmospheric turbulence. The channel fading probability density function (pdf) is of critical importance for FSO communication system design and evaluation. The performance and reliability of FSO communication systems can be greatly enhanced if fast-tacking devices are employed at the transmitter in order to compensate laser beam wander at the receiver aperture. The fast-tracking method is especially effective when communication distance is long. This paper studies the fading probability density functions of both fast-tracked and untracked FSO communication channels. Large-scale wave-optics simulations are conducted for both tracked and untracked lasers. In the simulations, the Kolmogorov spectrum is adopted, and it is assumed that the outer scale is infinitely large and the inner scale is negligibly small. The fading pdfs of both fast-tracked and untracked FSO channels are obtained from the simulations. Results show that the fast-tracked channel fading can be accurately modeled as gamma-distributed if receiver aperture size is smaller than the coherence radius. An analytical method is given for calculating the untracked fading pdfs of both point-like and finite-size receiver apertures from the fast-tracked fading pdf. For point-like apertures, the analytical method gives pdfs close to the well-known gamma-gamma pdfs if off-axis effects are omitted in the formulation. When off-axis effects are taken into consideration, the untracked pdfs obtained using the analytical method fit the simulation pdfs better than gamma-gamma distributions for point-like apertures, and closely fit the simulation pdfs for finite-size apertures where gamma-gamma pdfs deviate from those of the simulations significantly.

  3. Morbidity and mortality after bilateral simultaneous total knee arthroplasty in a fast-track setting

    Science.gov (United States)

    Gromov, Kirill; Troelsen, Anders; Stahl Otte, Kristian; Ørsnes, Thue; Husted, Henrik

    2016-01-01

    Background and purpose The safety aspects of bilateral simultaneous total knee arthroplasty (BSTKA) are still debated. In this retrospective single-center study, we investigated early morbidity and mortality following BSTKA in a modern fast-track setting. We also identified risk factors for re-admission within 90 days and for a length of stay (LOS) of more than 5 days. Patients and methods 284 patients were selected to receive BSTKA at our institution from 2008 through 2014 in a well-described, standardized fast-track setup (Husted 2012a, b). All re-admissions within 90 days were identified and mortality rates and time until death were recorded. Transfusion rates and numbers of transfusions were also recorded. Logistic regression analysis was used to identify risk factors for re-admission within 90 days, and also for a LOS of more than 5 days. Results 90-day mortality was 0%. 10% of the patients were re-admitted within 90 days. Median time to re-admission was 18 (3–75) days. 153 patients (54%) received postoperative blood transfusions. An ASA score of 3 was identified as an independent risk factor for re-admission within 90 days (OR = 5, 95% CI: 1.3–19) and for LOS of > 5 days (OR = 6, 95% CI: 1.6–21). Higher BMI was a weak risk factor for re-admission within 90 days. Interpretation BSTKA in selected patients without cardiopulmonary disease in a fast-track setting appears to be safe with respect to early postoperative morbidity and mortality. Surgeons should be aware that patients with an ASA score of 3 have an increased risk of re-admission and a prolonged length of stay, while patients with higher BMI have an increased risk of re-admission following BSTKA. PMID:26823094

  4. Avoiding ICU Admission by Using a Fast-Track Protocol Is Safe in Selected Adult-to-Adult Live Donor Liver Transplant Recipients

    Directory of Open Access Journals (Sweden)

    Juan Echeverri, MD

    2017-10-01

    Full Text Available Background. We evaluated patient characteristics of live donor liver transplant (LDLT recipients undergoing a fast-track protocol without intensive care unit (ICU admission versus LDLT patients receiving posttransplant ICU care. Methods. Of the 153 LDLT recipients, 46 patients were included in our fast-track protocol without ICU admission. Both, fast-tracked patients and ICU-admitted patients were compared regarding donor and patient characteristics, perioperative characteristics, and postoperative outcomes and complications. In a subgroup analysis, we compared fast-tracked patients with patients who were admitted in the ICU for less than 24 hours. Results. Fast-tracked versus ICU patients had a lower model for end-stage liver disease score (13 ± 4 vs 18 ± 7; P < 0.0001, lower preoperative bilirubin levels (51 ± 50 μmol/L vs 119.4 ± 137.3 μmol/L; P < 0.001, required fewer units of packed red blood cells (1.7 ± 1.78 vs 4.4 ± 4; P < 0.0001, and less fresh-frozen plasma (2.7 ± 2 vs 5.8 ± 5; P < 0.0001 during transplantation. Regarding postoperative outcomes, fast-tracked patients presented fewer bacterial infections within 30 days (6.5% [3] vs 29% [28]; P = 0.002, no episodes of pneumonia (0% vs 11.3% [11]; P = 0.02, and less biliary complications within the first year (6% [3] vs 26% [25]; P = 0.001. Also, fast-tracked patients had a shorter posttransplant hospital stay (10.8 ± 5 vs 21.3 ± 29; P = 0.002. In the subgroup analysis, fast-tracked vs ICU patients admitted for less than 24 hours had lower requirements of packed red blood cells (1.7 ± 1.78 vs 3.9 ± 4; P = 0.001 and fresh-frozen plasma (2.7 ± 2 vs 5.8 ± 4.5; P = 0.0001. Conclusions. Fast-track of selected patients after LDLT is safe and feasible. An objective score to perioperatively select LDLT recipients amenable to fast track is yet to be determined.

  5. A Fast Track approach to deal with the temporal dimension of crop water footprint

    Science.gov (United States)

    Tuninetti, Marta; Tamea, Stefania; Laio, Francesco; Ridolfi, Luca

    2017-07-01

    Population growth, socio-economic development and climate changes are placing increasing pressure on water resources. Crop water footprint is a key indicator in the quantification of such pressure. It is determined by crop evapotranspiration and crop yield, which can be highly variable in space and time. While the spatial variability of crop water footprint has been the objective of several investigations, the temporal variability remains poorly studied. In particular, some studies approached this issue by associating the time variability of crop water footprint only to yield changes, while considering evapotranspiration patterns as marginal. Validation of this Fast Track approach has yet to be provided. In this Letter we demonstrate its feasibility through a comprehensive validation, an assessment of its uncertainty, and an example of application. Our results show that the water footprint changes are mainly driven by yield trends, while evapotranspiration plays a minor role. The error due to considering constant evapotranspiration is three times smaller than the uncertainty of the model used to compute the crop water footprint. These results confirm the suitability of the Fast Track approach and enable a simple, yet appropriate, evaluation of time-varying crop water footprint.

  6. Role of patient characteristics for fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, C C; Kehlet, H; Søballe, Kjeld;

    2013-01-01

    with early mobilization and an LOS aim of 2-4 days remains unanswered.MethodA prospective study on patient characteristics and comorbidity in consecutive unselected patients undergoing fast-track THA and TKA was cross-referenced with the Danish National Health Registry and medical charts allowing complete 90......BACKGROUND: /st>Patient age and comorbidity have been found to increase the length of hospital stay (LOS), readmissions, and mortality after surgery, including in elective primary total hip arthroplasty (THA) and total knee arthroplasty (TKA). Whether the same applies in fast-track THA and TKA...... days follow-up. RESULTS: /st>A total of 3112 THA/TKAs were performed in 3020 patients. The mean age was 67 (range 18-97) years. The median LOS was 3 (inter-quartile range: 1) and the mean 3.0 days (range 1-34), with 91% having LOS ≤4 days. Age 76-80 [odds ratio (OR): 1.57; 95% confidence interval (CI...

  7. Fast-track program in laparoscopic liver surgery: Theory or fact?

    Science.gov (United States)

    Sánchez-Pérez, Belinda; Aranda-Narváez, José Manuel; Suárez-Muñoz, Miguel Angel; Eladel-Delfresno, Moises; Fernández-Aguilar, José Luis; Pérez-Daga, Jose Antonio; Pulido-Roa, Ysabel; Santoyo-Santoyo, Julio

    2012-11-27

    To analyze our results after the introduction of a fast-track (FT) program after laparoscopic liver surgery in our Hepatobiliarypancreatic Unit. All patients (43) undergoing laparoscopic liver surgery between March 2004 and March 2010 were included and divided into two consecutive groups: Control group (CG) from March 2004 until December 2006 with traditional perioperative cares (17 patients) and fast-track group (FTG) from January 2007 until March 2010 with FT program cares (26 patients). Primary endpoint was the influence of the program on the postoperative stay, the amount of re-admissions, morbidity and mortality. Secondarily we considered duration of surgery, use of drains, conversion to open surgery, intensive cares needs and transfusion. Both groups were homogeneous in age and sex. No differences in technique, time of surgery or conversion to open surgery were found, but more malignant diseases were operated in the FTG, and then transfusions were higher in FTG. Readmissions and morbidity were similar in both groups, without mortality. Postoperative stay was similar, with a median of 3 for CG vs 2.5 for FTG. However, the 80.8% of patients from FTG left the hospital within the first 3 d after surgery (58.8% for CG). The introduction of a FT program after laparoscopic liver surgery improves the recovery of patients without increasing complications or re-admissions, which leads to a reduction of the stay and costs.

  8. The role of pain for early rehabilitation in fast track total knee arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten Tange; Myhrmann, Lis;

    2010-01-01

    To investigate the relationship between early functional mobility and pain intensity in a fast track program after total knee arthroplasty (TKA).......To investigate the relationship between early functional mobility and pain intensity in a fast track program after total knee arthroplasty (TKA)....

  9. Hip dislocations after 2,734 elective unilateral fast-track total hip arthroplasties

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer C; Kjaersgaard-Andersen, Per; Solgaard, Søren

    2014-01-01

    characteristics from six Danish arthroplasty departments with similar fast-track approaches were cross-referenced with the Danish National Patient Registry for complete 90-day follow-up on readmissions, including emergency-room contacts. Complete patient files and postoperative radiographs were reviewed in case.......31-3.40)] but not hospital stay of fast-track total hip...

  10. Evidence Basis for Regional Anesthesia in Multidisciplinary Fast-Track Surgical Care Pathways

    DEFF Research Database (Denmark)

    Carli, Francesco; Kehlet, Henrik; Baldini, Gabriele

    2011-01-01

    of fast-track methodologies, were identified. The impact of epidural and paravertebral blockade, spinal analgesia, peripheral nerve blocks, and new regional anesthesia techniques on main procedure-specific postoperative outcomes is discussed. Finally, in the last section, implementations required......Fast-track programs have been developed with the aim to reduce perioperative surgical stress and facilitate patient's recovery after surgery. Potentially, regional anesthesia and analgesia techniques may offer physiological advantages to support fast-track methodologies in different type...... of surgeries. The aim of this article was to identify and discuss potential advantages offerred by regional anesthesia and analgesia techniques to fast-track programs. In the first section, the impact of regional anesthesia on the main elements of fast-track surgery is addressed. In the second section...

  11. Fast-track, ambulatory ultrasound-guided Tru-Cut liver biopsy is feasible and cost-efficient

    DEFF Research Database (Denmark)

    Huang, Chenxi; Lorentzen, Torben; Skjoldbye, Bjørn

    2015-01-01

    INTRODUCTION: Most institutions perform percutaneous liver biopsy with a post-biopsy patient observation period lasting up to eight hours, which is resource-demanding. This study aimed to evaluate the safety of liver biopsy performed in a fast-track set-up with an only one-hour post-biopsy...... observation time. METHODS: Patients referred to our institution underwent fast-track ultrasound-guided 18-gauge Tru-Cut liver biopsy procedures. Each single biopsy procedure was followed by a post-procedure observational period of one hour and an additional focused assessment with sonography for trauma before...... patient discharge. All patients underwent a clinical follow-up programme at revisit in order to register any delayed onset of major complications. RESULTS: Out of 200 completed biopsy procedures, two major complications were registered post biopsy and they were treated appropriately. All patients were...

  12. Thigh and knee circumference, knee-extension strength, and functional performance after fast-track total hip arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Kristensen, Morten Tange; Husted, Henrik;

    2011-01-01

    OBJECTIVE: To (1) quantify changes in knee-extension strength and functional-performance at discharge after fast-track total hip arthroplasty (THA) and (2) investigate whether these changes correlate to changes in thigh and knee circumference (ie, swelling) or pain. DESIGN: A prospective......, descriptive, hypothesis-generating study. SETTING: A special unit for fast-track hip and knee arthroplasty operations at a university hospital. PARTICIPANTS: Twenty-four patients (20 women and 4 men; ages 69 ± 6.1 years) scheduled for primary unilateral THA. METHODS: All patients were evaluated before surgery...... and on the day of hospital discharge. MAIN OUTCOME MEASURES: Knee-extension strength, thigh and knee joint circumference, hip pain, and functional performance (Timed Up & Go, 30-Second Chair Stand, and 10-Meter Walk tests). RESULTS: All investigated variables changed significantly from before to after surgery...

  13. Readmission rates after a planned hospital stay of 2 versus 3 days in fast-track colonic surgery

    DEFF Research Database (Denmark)

    Andersen, Jens; Hjort-Jakobsen, Dorthe; Christiansen, P. S.;

    2007-01-01

    with a planned hospital stay of 2 versus 3 days. METHODS: The study included 541 consecutive colonic resections from one surgical department with a structured care programme, including well defined discharge criteria, between April 1997 and December 2005. The planned hospital stay was increased from 2 to 3 days......BACKGROUND: Initial programmes of fast-track open colonic surgery with a planned 2-day postoperative hospital stay have had a high readmission rate (about 20 per cent). The aim of this large, consecutive series was to compare readmission rates after a fast-track open colonic surgery programme...... from August 2004. All patients were examined 8 and 30 days after surgery. RESULTS: Readmission rates fell from 20.1 per cent in 408 patients with a planned 2-day hospital stay (period 1) to 11.3 per cent in 133 patients with a planned 3-day hospital stay (period 2) (P

  14. Role of preoperative anemia for risk of transfusion and postoperative morbidity in fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jans, Øivind; Jørgensen, Christoffer; Kehlet, Henrik

    2014-01-01

    BACKGROUND: Preoperative anemia has been associated with increased risk of allogeneic blood transfusion and postoperative morbidity and mortality. The prevalence of preoperative anemia and its association with postoperative outcomes has not previously been reported in relation to fast......-track elective total hip arthroplasty (THA) and total knee arthroplasty (TKA). We aimed to evaluate the prevalence of preoperative anemia in elective fast-track THA and TKA and its association with risk of perioperative transfusion, prolonged length of hospital stay (LOS), and postoperative readmission. STUDY...... national databases and patient charts. Adjusted risk estimates for transfusion, prolonged LOS, and all-cause readmission according to preoperative anemia status were obtained by multivariate logistic regression. RESULTS: A total of 5.165 THA or TKA procedures were included with a mean patient age of 67...

  15. [Management and orientation of severely infected patients : relevance of a « Sepsis Fast-Track »].

    Science.gov (United States)

    Juillerat, André; Vivekanantham, Hari; Burger, Raphaël; Hausser, Joëlle; Fumeaux, Thierry

    2017-09-06

    Sepsis is a syndrome defined by a life-threatening organ dysfunction caused by a dysregulated host response to an infection. The early recognition of this syndrome in the emergency department (ED) can lead to a better prognosis, when associated with a standardized management focusing on identification of the infectious source, its treatment, and appropriate organ support. Therefore, the implementation of a « Sepsis Fast Track », by analogy with similar protocols regarding stroke or ST-elevated myocardial infarct, deserves interest. The aim of this article is to review the available evidences that support an implementation of such an initiative, and to identify the key elements that permit its integration in the ED setting of a secondary-care hospital.

  16. Effects of a nutritional intervention in a fast-track program for a colorectal cancer surgery: systematic review

    Directory of Open Access Journals (Sweden)

    Carmina Wanden-Berghe

    Full Text Available Background and aim: Preoperative nutritional status (NS has consequences on postoperative (POSTOP recovery. Our aim was to systematically review the nutritional interventions (NI in fast-track protocols for colorectal cancer surgery and assess morbidity-mortality and patient's recovery. Method: Systematic review of scientific literature after consulting bibliographic databases: Medline, The Cochrane Library, Scopus, Embase, Web of Science, Institute for Scientific Information, Latin American and Caribbean Health Sciences Literature, The Cumulative Index to Nursing and Allied Health Literature. MeSH Descriptors: "colorectal surgery", "fast-track", "perioperative care", "nutrition therapy" and "enhanced recovery programme". Filters: "humans", adult (19+ years and "clinical trial". Variables POSTOP outcomes: bowel recovery (BR, hospital stay (HS, complications and death. Results: Selected studies, 27, had good or excellent methodological quality. From 25 to 597 patients were included. Aged between 16-94 years, men were predominant in 66.6%. NS was evaluated in 13 studies; 7 by body mass index while one by subjective global assessment. One presented POSTOP data. Fast-track groups had solids, liquids or supplements (SS in prior 2-8 hours. SS were high in carbohydrates, immune-nutrients and non-residue. Free liquids, solids and SS intake was allowed in POSTOP. Half traditional groups fasted between 3-12 hours and resumed POSTOP food intake progressively. Conclusions: Fast-track groups had early BR (p < 0.01. Traditional groups had more infections episodes, deaths and a longer HS. Great variability between NI but had a common item; early intake. Although was seen patient's recovery. Future studies with detailed NI characteristics are need. Nutritional status must be assessed for a higher acknowledgement of NI impact.

  17. Acute chest pain fast track at the emergency department: who was misdiagnosed for acute coronary syndrome?

    Directory of Open Access Journals (Sweden)

    Prachanukool T

    2016-12-01

    Full Text Available Thidathit Prachanukool,1 Kasamon Aramvanitch,1 Kittisak Sawanyawisuth,2–4 Yuwares Sitthichanbuncha1 1Department of Emergency Medicine, Faculty of Medicine, Ramathibodi Hospital Mahidol University, Bangkok, 2Department of Medicine, Faculty of Medicine, 3Research Center in Back, Neck, Other Joint Pain and Human Performance (BNOJPH, 4Internal medicine research group, Faculty of Medicine, Khon Kean University, Khon Kaen, Thailand Background: Acute coronary syndrome (ACS is a commonly treated disease in the emergency department (ED. Acute chest pain is a common presenting symptom of ACS. Acute chest pain fast track (ACPFT is a triage to cover patients presenting with chest pain with the aims of early detection and treatment for ACS. This study aimed to assess the quality of the ACPFT with the aim of improving the quality of care for ACS patients. Methods: This study was conducted at the ED in Mahidol University, Bangkok, Thailand. The inclusion criterion was patients presenting with acute chest pain at the ED. We retrospectively reviewed the medical records of all eligible patients. The primary outcomes of this study were to determine time from door to electrocardiogram and time from door to treatment (coronary angiogram with percutaneous coronary intervention or thrombolytic therapy in the case of ST elevation myocardial infarction. The outcome was compared between those who were in and not in the ACPFT. Results: During the study period, there were 616 eligible patients who were divided into ACPFT (n=352 patients; 57.1% and non-ACPFT (n=264 patients; 42.9% groups. In the ACPFT group (n=352, 315 patients (89.5% received an electrocardiogram within 10 minutes. The final diagnosis of ACS was made in 80 patients (22.7% in the ACPFT group and 13 patients (4.9% in the non-ACPFT group (P-value <0.01. After adjustment using multivariate logistic regression analysis, only epigastric pain was independently associated with being in the ACPFT group (adjusted

  18. Influencing Factor of Postoperation Fast-track Recovery and in Hospital Cost after Lobctomy for Lung Cancer

    Directory of Open Access Journals (Sweden)

    Jianhua SU

    2014-07-01

    Full Text Available Background and objective It is unknown that the postoperation fast-track recovery and in hospital cost of the lobectomy in lung cancer, we explored the influencing factor of postoperative fast-track recovery and in hospital cost after undergoing lobectomy for lung cancer. Methods We retrospectively reviewed the medical records of all patients (n=176 who underwent lobectomy for lung cancer between January 2010 and November 2011 by a thoracic surgeon. Results The hospital costs of video-assisted thoracic surgery (VATS lobectomy (47,308.21 ¥ is significantly higher than open lobectomy (45,664.31 ¥(P=0.007. The hospital costs of body mass index (BMI ≥ 24 kg/m2 (51,186.99 ¥ is significantly higher than BMI < 24 kg/m2 (41,701.64 ¥(P=0.032. The hospital stay of VATS lobectomy (5.70 d is significantly less than open lobectomy (7.10 d(P<0.001. Conclusion These findings indicate that preoperative pulmonary rehabilitation and VATS lobectomy is contributed to fast-track recovery for patients who undergo lobectomy, but increase the hospital costs.

  19. Thromboembolic and major bleeding events in relation to perioperative bridging of vitamin K antagonists in 649 fast-track total hip and knee arthroplasties

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer C; Kehlet, Henrik

    2016-01-01

    - This was an observational cohort treatment study in consecutive primary unilateral total hip and knee arthroplasty patients between January 2010 and November 2013 in 8 Danish fast-track departments. Data were collected prospectively on preoperative comorbidity and anticoagulants in patients with preoperative vitamin K...

  20. Orchestrating care through the fast-track perspective: A qualitative content analysis of the provision of individualised nursing care in orthopaedic fast-track programmes.

    Science.gov (United States)

    Berthelsen, Connie Bøttcher; Frederiksen, Kirsten

    2017-02-01

    The lack of individualised care in orthopaedic regimes is often explained by the extended use of patient pathways and clinical guidelines. The aim of this study was to illuminate orthopaedic nurses' perceptions and experiences of providing individual nursing care for older patients in standardised fast-track programmes after total hip or knee replacement. Ten semi-structured interviews were conducted with orthopaedic nurses in orthopaedic wards at three Danish hospitals between April and June of 2015. Data were analysed using manifest and latent content analysis according to Graneheim and Lundman. The main theme of the overall interpretation was Orchestrating care through the fast-track perspective, accompanied by three sub-themes: Identifying and legitimising relevant individual care in the fast-track programme, Struggling to fit all patients in the fast-track programme and Justifying individualised care-related actions in the fast-track programme. The study concluded that, even though the nurses struggled to comply with the programme, they still found themselves compromising their nursing care and ethics to follow the standardised regime. There is a need to establish more specific inclusion criteria to maintain the effective elements in the programme and to facilitate nurses' opportunities to offer individual care, thereby ensuring that fragile patients have access to other possibilities. Copyright © 2016 Elsevier Ltd. All rights reserved.

  1. Does BMI influence hospital stay and morbidity after fast-track hip and knee arthroplasty?

    DEFF Research Database (Denmark)

    Husted, Henrik; Jørgensen, Christoffer C.; Gromov, Kirill;

    2016-01-01

    patients only) was associated with a LOS of >4 days (p = 0.001), but not with re-admission. No such relationship existed for TKA. Interpretation - A fast-track setting resulted in similar length of hospital stay and re-admission rates regardless of BMI, except for very obese and morbidly obese THA patients.......Background and purpose - Body mass index (BMI) outside the normal range possibly affects the perioperative morbidity and mortality following total hip arthroplasty (THA) and total knee arthroplasty (TKA) in traditional care programs. We determined perioperative morbidity and mortality....... Complete 90-day follow-up was achieved using national registries and review of medical records. Patients were grouped according to BMI as being underweight, of normal weight, overweight, obese, very obese, and morbidly obese. Results - Median length of stay (LOS) was 2 (IQR: 2-3) days in all BMI groups. 30...

  2. Evidence Basis for Regional Anesthesia in Multidisciplinary Fast-Track Surgical Care Pathways

    DEFF Research Database (Denmark)

    Carli, Francesco; Kehlet, Henrik; Baldini, Gabriele

    2011-01-01

    Fast-track programs have been developed with the aim to reduce perioperative surgical stress and facilitate patient's recovery after surgery. Potentially, regional anesthesia and analgesia techniques may offer physiological advantages to support fast-track methodologies in different type of surge......Fast-track programs have been developed with the aim to reduce perioperative surgical stress and facilitate patient's recovery after surgery. Potentially, regional anesthesia and analgesia techniques may offer physiological advantages to support fast-track methodologies in different type...... of surgeries. The aim of this article was to identify and discuss potential advantages offerred by regional anesthesia and analgesia techniques to fast-track programs. In the first section, the impact of regional anesthesia on the main elements of fast-track surgery is addressed. In the second section......, procedure-specific fast-track programs for colorectal, hernia, esophageal, cardiac, vascular, and orthopedic surgeries are presented. For each, regional anesthesia and analgesia techniques more frequently used are discussed. Furthermore, clinical studies, which included regional techniques as elements...

  3. Health preemption behind closed doors: trade agreements and fast-track authority.

    Science.gov (United States)

    Crosbie, Eric; Gonzalez, Mariaelena; Glantz, Stanton A

    2014-09-01

    Noncommunicable diseases result from consuming unhealthy products, including tobacco, which are promoted by transnational corporations. The tobacco industry uses preemption to block or reverse tobacco control policies. Preemption removes authority from jurisdictions where tobacco companies' influence is weak and transfers it to jurisdictions where they have an advantage. International trade agreements relocate decisions about tobacco control policy to venues where there is little opportunity for public scrutiny, participation, and debate. Tobacco companies are using these agreements to preempt domestic authority over tobacco policy. Other transnational corporations that profit by promoting unhealthy foods could do the same. "Fast-track authority," in which Congress cedes ongoing oversight authority to the President, further distances the public from the debate. With international agreements binding governments to prioritize trade over health, transparency and public oversight of the trade negotiation process is necessary to safeguard public health interests.

  4. Indirect Effects of the Fast Track Intervention on Conduct Disorder Symptoms and Callous-Unemotional Traits: Distinct Pathways Involving Discipline and Warmth.

    Science.gov (United States)

    Pasalich, Dave S; Witkiewitz, Katie; McMahon, Robert J; Pinderhughes, Ellen E

    2016-04-01

    Little is known about intervening processes that explain how prevention programs improve particular youth antisocial outcomes. We examined whether parental harsh discipline and warmth in childhood differentially account for Fast Track intervention effects on conduct disorder (CD) symptoms and callous-unemotional (CU) traits in early adolescence. Participants included 891 high-risk kindergarteners (69% male; 51% African American) from urban and rural United States communities who were randomized into either the Fast Track intervention (n = 445) or non-intervention control (n = 446) groups. The 10-year intervention included parent management training and other services (e.g., social skills training, universal classroom curriculum) targeting various risk factors for the development of conduct problems. Harsh discipline (Grades 1 to 3) and warmth (Grades 1 and 2) were measured using parent responses to vignettes and direct observations of parent-child interaction, respectively. Parents reported on children's CD symptoms in Grade 6 and CU traits in Grade 7. Results demonstrated indirect effects of the Fast Track intervention on reducing risk for youth antisocial outcomes. That is, Fast Track was associated with lower scores on harsh discipline, which in turn predicted decreased levels of CD symptoms. In addition, Fast Track was associated with higher scores on warmth, which in turn predicted reduced levels of CU traits. Our findings inform developmental and intervention models of youth antisocial behavior by providing evidence for the differential role of harsh discipline and warmth in accounting for indirect effects of Fast Track on CD symptoms versus CU traits, respectively.

  5. Fast-track surgery-an update on physiological care principles to enhance recovery

    DEFF Research Database (Denmark)

    Kehlet, Henrik

    2011-01-01

    INTRODUCTION: The concept of fast-track surgery (enhanced recovery programs) has been evolved and been documented to be successful by decreasing length of stay, morbidity and convalescence across procedures. FUTURE STRATEGIES: However, there are several possibilities for further improvement of mo...... of the components of fast-track surgery, where surgical stress, fluid and pain management are key factors. There is an urgent need for better design of studies, especially in minimal invasive surgery to achieve maximal outcome effects when integrated into the fast-track methodology....

  6. 42 CFR 422.626 - Fast-track appeals of service terminations to independent review entities (IREs).

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 3 2010-10-01 2010-10-01 false Fast-track appeals of service terminations to... Grievances, Organization Determinations and Appeals § 422.626 Fast-track appeals of service terminations to independent review entities (IREs). (a) Enrollee's right to a fast-track appeal of an MA...

  7. The risk of manipulation under anesthesia due to unsatisfactory knee flexion after fast-track total knee arthroplasty

    DEFF Research Database (Denmark)

    Wied, Christian; Thomsen, Morten G; Kallemose, Thomas

    2015-01-01

    BACKGROUND: Fast-track TKA has significantly shortened the time available for physiotherapists to optimize knee ROM before discharge. Safety aspects concerning knee stiffness and the need for manipulation in a fast-track setting need to be illuminated. The study aims were to analyze if fast-track...

  8. Post anesthesia recovery rate evaluated by using White fast tracking scoring system

    Directory of Open Access Journals (Sweden)

    Munevera Hadžimešić

    2013-12-01

    Full Text Available Introduction: Postponed recuperation from anesthesia can lead to different complications such as apnoea, aspiration of gastric content whit consequent development of aspiration pneumonia, laryngospasm, bradycardia, and hypoxia. Aim of this research was to determine infl uence of propofol, sevoflurane and isoflurane anesthesia on post anesthesia recovery rate.Methods: This was a prospective study; it included 90 patients hospitalized in period form October 2011 to may 2012 year, all patients included in the study underwent lumbar microdiscectomy surgery. Patients were randomly allocated to one of three groups: group 1: propofol maintained anesthesia, group 2: sevoflurane and group 3: isofl urane maintained anesthesia. Assessments of recovery rate were done 1, 5 and 10 minutes post extubation using White fast tracking scoring system.Results: Significant difference was observed only 1 minute after extubation (p=0,025 finding recovery rate to be superior in propofol group. Propofol group compared to inhaled anesthesia with sevoflurane group, shows significantly faster recovery from anesthesia only one minute after extubation (p=0,046. In comparison of propofol group and isofl urane anesthesia group, statistical significance was noticed one minute following extubation (p=0,008. Comparison of propofol group and inhaled anesthesia groups recovery rates were not significantly different at all times measured. When we were comparing sevoflurane and isoflurane anesthesia, recovery rates shoved no signifi cant statistical difference.Conclusions: Recovery rate evaluated by using White fast tracking scoring system was superior and with fewer complications in propofol maintained in comparison to sevoflurane and isoflurane maintained anesthesia only one minute post extubation, while after fifth and tenth minute difference was lost.

  9. Early Progressive Strength Training to Enhance Recovery After Fast-Track Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Jakobsen, Thomas Linding; Kehlet, Henrik; Husted, Henrik

    2014-01-01

    OBJECTIVE: To compare 7 weeks of supervised physical rehabilitation with or without progressive strength training (PST) commenced early after fast-track total knee arthroplasty (TKA) on functional performance. METHODS: In total, 82 patients with a unilateral primary TKA were randomized to 2...... was not superior to 7 weeks of supervised physical rehabilitation without PST in improving functional performance, measured as the maximal walking distance in 6 minutes, at the primary end point 8 weeks after fast-track TKA....

  10. Fall-related admissions after fast-track total hip and knee arthroplasty - cause of concern or consequence of success?

    Directory of Open Access Journals (Sweden)

    Jørgensen CC

    2013-11-01

    Full Text Available Christoffer C Jørgensen,1,2 Henrik Kehlet1,2 On behalf of the Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement Collaborative Group 1Section of Surgical Pathophysiology, Rigshospitalet, Copenhagen University, Copenhagen, Denmark; 2The Lundbeck Foundation Centre for Fast-track Hip and Knee Replacement, Copenhagen, Denmark Background: Total hip (THA and knee arthroplasty (TKA are common procedures in elderly persons, who are at potential increased risk of postoperative fall due to loss of muscle strength and impaired balance. Fast-track surgery with early mobilization and opioid-sparing analgesia have improved outcomes after these procedures, but early mobilization and short hospitalization length of stay (LOS could potentially increase the risk of falls after discharge. We investigated injuries, circumstances, and the timing of fall-related hospital admissions 90 days after fast-track THA and TKA. Methods: This was a prospective, descriptive multicenter study on fall-related hospital admissions, in 5145 elective fast-track THA and TKA patients, with complete 90-day follow up through the Danish National Patient registry and medical charts. Results: Of 83 (1.6% fall-related hospital admissions, 43 (51.8% were treated in the Emergency Room and 40 (48.2% were admitted to a regular ward. The median LOS after surgery was 3 days (interquartile range [IQR]: 2-3 in fallers versus (vs 2 days (IQR: 2-3 (P=0.022 in patients without falls. Injuries were classified as "none" or minor in 39.8%, moderate in 9.6%, and major in 50.6%. Most falls (54.8% occurred within 1 month of discharge. Falls due to physical activity (12.0% and extrinsic factors (14.5% occurred later than did surgery-related falls (73.5%, contributing to 40% of all falls >30 days after discharge. In multivariate analysis, age (odds ratio [OR]: 1.05; 95% confidence interval [CI]: 1.0-1.08 (P=0.001, living alone (OR: 2.09; 95% CI: 1.20-3.62 (P=0.009, and psychiatric disease (OR

  11. A prospective study to assess the implementation of a fast-track system to meet the two-week target for colorectal cancer in Somerset.

    Science.gov (United States)

    Davies, R. J.; Ewings, P.; Welbourn, R.; Collins, C.; Kennedy, R.; Royle, C.

    2002-01-01

    OBJECTIVE: This prospective study assesses the introduction of a fast-track referral system for patients with suspected colorectal cancer. PATIENTS AND METHODS: The referral system was initiated in Yeovil District Hospital and Taunton and Somerset Hospital using six screening criteria to select high-risk patients. Data on all high-risk patients from 1 November 1999 to 30 April 2000 was recorded prospectively. Patients with proven colorectal cancer diagnosed between 1 November 1998 and 30 April 1999 have been identified for comparison. RESULTS: There were 158 new cases of colorectal cancer in total (111 elective, 47 emergency). 59 cases of colorectal cancer were diagnosed from 433 fast-track referrals (53% of total elective cases). Median time from referral to diagnosis in the fast-track group was 11 days vs. 32.5 days for nonfast-track elective patients (P < 0.001). Median time from referral to diagnosis for all elective cases was 17 days vs. 38.5 days for patients presenting one year earlier (P < 0.001). 75% of fast-track patients were diagnosed with colorectal cancer within two weeks, compared with 17% of nonfast-track elective patients (P < 0.001). The proportion of emergency admissions was reduced from 40% to 30% (P=0.07) following the introduction of this system. CONCLUSION: Data from the first six months reveal that over half of the elective cases of colorectal cancer were diagnosed within the fast-track system. The median time from referral to diagnosis in these patients was within two weeks and there has been a significant reduction in the time to diagnosis associated with the introduction of this service.

  12. Comparison of remifentanil and low-dose fentanyl for fast-track cardiac anesthesia

    DEFF Research Database (Denmark)

    Khanykin, Boris; Siddiqi, Rizwan; Jensen, Per F

    2013-01-01

    BACKGROUND: Different anesthetic techniques have been used for fast tracking in cardiac anesthesia. Remifentanil, with its unique pharmacokinetic profile, could be an ideal drug for fast tracking. Possible limitations of remifentanil are rapid onset of postoperative pain after discontinuation...... of the drug infusion, which may increase the risk of an ischemic event. We conducted this randomized study to compare the efficacy of remifentanil versus low doses of fentanyl in fast-track cardiac anesthesia. It has been hypothesized that remifentanil would provide a safe anesthesia with no impact...... anesthesia. The study was designed as a prospective randomized study. The primary outcomes were changes in the cardiac index and creatine kinase MB fraction (CKMB), extubation times, mobilization times, and lengths of stay in the intensive care unit (ICU) and the hospital. Frequency of myocardial infarction...

  13. Evidence-based surgical care and the evolution of fast-track surgery

    DEFF Research Database (Denmark)

    Kehlet, H.; Wilmore, D.W.

    2008-01-01

    , randomized studies, and meta-analyses, the concept of the "fast-track methodology" has uniformly provided a major enhancement in recovery leading to decreased hospital stay and with an apparent reduction in medical morbidity but unaltered "surgery-specific" morbidity in a variety of procedures. However......BACKGROUND: Optimization of postoperative outcome requires the application of evidence-based principles of care carefully integrated into a multimodal rehabilitation program. OBJECTIVE: To assess, synthesize, and discuss implementation of "fast-track" recovery programs. DATA SOURCES: Medline MBASE...... (January 1966-May 2007) and the Cochrane library (January 1966-May 2007) were searched using the following keywords: fast-track, enhanced recovery, accelerated rehabilitation, and multimodal and perioperative care. In addition, the synthesis on the many specific interventions and organizational...

  14. Fertility and the fast-track: Continued childbearing among professionals in Sweden, 1991-2009

    Directory of Open Access Journals (Sweden)

    Maria Stanfors

    2014-08-01

    Full Text Available Background: During recent decades women have made considerable advances in education and the labor market, even in fast-track professions such as law, medicine, and academia. While women have entered high-status professions, the career paths of some jobs have changed little and are still inflexible, which implies that professional gains may be offset by familial losses. Objective: We investigate continued childbearing, focusing on the relationship between occupation and second and third births, among highly educated men and women in three high-status professions. Methods: We analyze the determinants of having a second or a third birth using longitudinal data from population registers in Sweden, 1991-2009. We use descriptive statistics and logistic models. Results: Net of demographic and socioeconomic controls, medical doctors are more likely to continue childbearing than lawyers and academics, irrespective of parity and gender. The patterns that emerge are independent of income. Public sector work is conducive to continued childbearing, especially for women. Conclusions: Although there are more opportunities to combine career and family in Sweden than in many other countries, this does not hold equally for all. The results indicate that working conditions and career structures contribute to making it easier for some groups than others to combine a professional career and children. Patterns that emerge reflect that women and men are not equally sensitive to career structures that imply a tradeoff between career and children at an early stage of the career. This puts policies promoting work and family for all into perspective.

  15. Post-discharge symptoms following fast-track colonic cancer surgery: a phenomenological hermeneutic study

    DEFF Research Database (Denmark)

    Krogsgaard, Marianne; Dreyer, Pia; Egerod, Ingrid

    2014-01-01

    OBJECTIVE: To obtain knowledge of patients' experiences of postoperative symptoms during the initial two weeks following fast-track colonic cancer surgery. METHOD: Semi-structured in-depth interviews with seven colonic cancer patients two weeks post hospital discharge. Analysis was performed using...... to report their unfamiliar symptoms during hospital nurse follow-up telephone call. While waiting for the final histology patients suffered loss of sleep and chaotic thinking, and experienced ambiguity of hoping for the best and expecting the worst. CONCLUSION: Although fast-track surgery programmes lead...

  16. Pivotal role of ATP in macrophages fast tracking wound repair and regeneration.

    Science.gov (United States)

    Kotwal, Girish J; Sarojini, Harshini; Chien, Sufan

    2015-09-01

    Chronic wounds occurring during aging or diabetes pose a significant burden to patients. The classical four-phase wound healing process has a 3-6 day lag before granulation starts to appear and it requires an intermediate step of activation of resident fibroblasts during the remodeling phase for production of collagen. This brief communication discusses published articles that demonstrate how the entire wound healing process can be fast tracked by intracellular ATP delivery, which triggers a novel pathway where alternatively activated macrophages play absolutely critical and central roles. This novel pathway involves an increase in proinflammatory cytokines (TNF, IL-1β, IL-6) and a chemokine (MCP-1) release. This is followed by activation of purinergic receptor (a family of plasma membrane receptors found in almost all mammalian cells), production of platelets and platelet microparticles, and activation of ATP-dependent chromatin remodeling enzymes. The end result is a massive influx and in situ proliferation of macrophages, increases in vascular endothelial growth factors that promote neovascularization, and most prominently, the direct production of collagen.

  17. Activity, Sleep and Cognition After Fast-Track Hip or Knee Arthroplasty

    DEFF Research Database (Denmark)

    Krenk, Lene; Jennum, Poul; Kehlet, Henrik

    2013-01-01

    Optimized perioperative care after total hip and knee arthroplasty (THA/TKA) has decreased length of stay (LOS) but data on activity, sleep and cognition after discharge are limited. We included 20 patients ≥60years undergoing THA/TKA, monitoring them for 3days preoperatively and 9days postoperat......Optimized perioperative care after total hip and knee arthroplasty (THA/TKA) has decreased length of stay (LOS) but data on activity, sleep and cognition after discharge are limited. We included 20 patients ≥60years undergoing THA/TKA, monitoring them for 3days preoperatively and 9days...... postoperatively with actigraphs for sleep and activity assessment. Pain scores were recorded daily. Cognition was evaluated by 2 cognitive tests. Results showed a mean age was 70.5years and mean LOS was 2.6days. Actigraphs showed increased daytime sleep and decreased motor activity postoperatively. Early...... postoperatively cognitive decline and increased pain returned to preoperative levels by postoperative day (POD) 5-9. Despite the small sample size the study illustrated that post-discharge activity is decreased and daytime sleep is increased after fast-track THA/TKA, while cognition and pain return...

  18. Evaluation of the influence of pulmonary hypertension in ultra-fast-track anesthesia technique in adult patients undergoing cardiac surgery

    Directory of Open Access Journals (Sweden)

    Paulo Sérgio da Silva

    2015-08-01

    Full Text Available Abstract Objective: To evaluate the influence of pulmonary hypertension in the ultra-fast-track anesthesia technique in adult cardiac surgery. Methods: A retrospective study. They were included 40 patients divided into two groups: GI (without pulmonary hypertension and GII (with pulmonary hypertension. Based on data obtained by transthoracic echocardiography. We considered as the absence of pulmonary hypertension: a pulmonary artery systolic pressure (sPAP 40 mmHg associated with additional echocardiographic signs of PH. It was established as influence of pulmonary hypertension: the impossibility of extubation in the operating room, the increase in the time interval for extubation and reintubation the first 24 hours postoperatively. Univariate and multivariate analyzes were performed when necessary. Considered significant a P value <0.05. Results: The GI was composed of 21 patients and GII for 19. All patients (100% were extubated in the operating room in a medium time interval of 17.58±8.06 min with a median of 18 min in GII and 17 min in GI. PH did not increase the time interval for extubation (P=0.397. It required reintubation of 2 patients in GII (5% of the total, without statistically significant as compared to GI (P=0.488. Conclusion: In this study, pulmonary hypertension did not influence on ultra-fast-track anesthesia in adult cardiac surgery.

  19. Private health insurance in Sweden: Fast-track lanes and the alleged attempts to stop them.

    Science.gov (United States)

    Lapidus, John

    2017-04-01

    According to the Health and Medical Services Act (1982:763), those who have the greatest need for healthcare shall be given priority. This is being challenged by the rapid emergence of private health insurance which increases the share of private funding and creates fast-track lanes where some people get faster access to healthcare than others. The Stop Law, implemented by a Social Democratic government in 2006, was generally regarded as a way to put an end to the fast-track lanes in Swedish healthcare. Based on a thorough examination of the law and its legislative history - official reports, propositions, comments on official reports - this article argues that the Stop Law was so full of exceptions and loopholes that it did not threaten the existence of fast-track lanes. The same goes for a similar Social Democratic proposal from 2016, which is also examined in the article. Further, the article analyses centre-right wing positions on fast-track lanes in Swedish healthcare. In summary, it is argued that politicians of all stripes have allowed the development to proceed in spite of unanimous support for the idea that Swedish healthcare shall be provided to all on equal terms. Copyright © 2017 Elsevier B.V. All rights reserved.

  20. Morbidity and mortality after bilateral simultaneous total knee arthroplasty in a fast-track setting

    DEFF Research Database (Denmark)

    Gromov, Kirill; Troelsen, Anders; Otte, Niels Kristian Stahl;

    2016-01-01

    Background and purpose - The safety aspects of bilateral simultaneous total knee arthroplasty (BSTKA) are still debated. In this retrospective single-center study, we investigated early morbidity and mortality following BSTKA in a modern fast-track setting. We also identified risk factors for re...

  1. Fast Track Initiative: Building a Global Compact for Education. Education Notes

    Science.gov (United States)

    Human Development Network Education, 2005

    2005-01-01

    This note series is intended to summarize lessons learned and key policy findings on the World Bank's work in education. "Fast Track Initiative" ("FTI") was launched in 2002 as a partnership between donor and developing countries to accelerate progress towards the Millennium Development Goal (MDG) of universal primary education. "FTI" is built on…

  2. The Effects of the Fast Track Preventive Intervention on the Development of Conduct Disorder across Childhood

    Science.gov (United States)

    Child Development, 2011

    2011-01-01

    The impact of the Fast Track intervention on externalizing disorders across childhood was examined. Eight hundred-ninety-one early-starting children (69% male; 51% African American) were randomly assigned by matched sets of schools to intervention or control conditions. The 10-year intervention addressed parent behavior-management, child social…

  3. Serious renal and urological complications in fast-track primary total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Jørgensen, Christoffer C; Kehlet, Henrik

    2016-01-01

    postoperatively. Seven complications . (0.08 %) were urological, mainly haematuria after bladder catheterisation, whereas 5 (0.06 were urosepsis/pyelonephritis. CONCLUSION: The overall incidence of serious RU complications after fast-track THA and TKA was 0.61 %. AKI occurred in 0.49% and was most often due...

  4. Fast Track Extubation In Adult Patients On Pump Open Heart Surgery At A Tertiary Care Hospital.

    Science.gov (United States)

    Akhtar, Mohammad Irfan; Sharif, Hasanat; Hamid, Mohammad; Samad, Khalid; Khan, Fazal Hameed

    2016-01-01

    Fast-track cardiac surgery programs have been established as the standard of cardiac surgical care. Studies have shown that early extubation in elective cardiac surgery patients, including coronary and non-coronary open-heart surgery patients does not increase perioperative morbidity and mortality. The objective of this observational study was to determine the success and failure profile of fast track extubation (FTE) practice in adult open-heart surgical patients. The study was conducted at cardiac operating room and Cardiac Intensive Care Unit (CICU) of a tertiary care hospital for a period of nine months, i.e., from Oct 2014 to June-2015. All on pump elective adult cardiac surgery patients including isolated CABG, isolated Valve replacements, combined procedures and aortic root replacements were enrolled in the study. Standardized anesthetic technique was adopted. Surgical and bypass techniques were tailored according to the procedure. Success of Fast track extubation was defined as extubation within 6 hours of arrival in CICU. A total of 290 patients were recruited. The average age of the patients was 56.3±10.5 years. There were 77.6% male and 22.4% female patients. Overall success rate was 51.9% and failure rate was 48.1%. The peri-operative renal insufficiency, cross clamp time and CICU stay (hours) were significantly lower in success group. Re-intubation rate was 0.74%. The perioperative parameters were significantly better in success group and the safety was also demonstrated in the patients who were fast tracked successfully. To implement the practice in its full capacity and benefit, a fast track protocol needs to be devised to standardize the current practices and to disseminate the strategy among junior anaesthesiologists, perfusionists and nursing staff.

  5. The yield of colorectal cancer among fast track patients with normocytic and microcytic anaemia.

    Science.gov (United States)

    Panagiotopoulou, I G; Fitzrol, D; Parker, R A; Kuzhively, J; Luscombe, N; Wells, A D; Menon, M; Bajwa, F M; Watson, M A

    2014-05-01

    We receive fast track referrals on the basis of iron deficiency anaemia (IDA) for patients with normocytic anaemia or for patients with no iron studies. This study examined the yield of colorectal cancer (CRC) among fast track patients to ascertain whether awaiting confirmation of IDA is necessary prior to performing bowel investigations. A review was undertaken of 321 and 930 consecutive fast track referrals from Centre A and Centre B respectively. Contingency tables were analysed using Fisher's exact test. Logistic regression analyses were performed to investigate significant predictors of CRC. Overall, 229 patients were included from Centre A and 689 from Centre B. The odds ratio for microcytic anaemia versus normocytic anaemia in the outcome of CRC was 1.3 (95% confidence interval [CI]: 0.5-3.9) for Centre A and 1.6 (95% CI: 0.8-3.3) for Centre B. In a logistic regression analysis (Centre B only), no significant difference in CRC rates was seen between microcytic and normocytic anaemia (adjusted odds ratio: 1.9, 95% CI: 0.9-3.9). There was no statistically significant difference in the yield of CRC between microcytic and normocytic anaemia (p=0.515, Fisher's exact test) in patients with anaemia only and no colorectal symptoms. Finally, CRC cases were seen in both microcytic and normocytic groups with or without low ferritin. There is no significant difference in the yield of CRC between fast track patients with microcytic and normocytic anaemia. This study provides insufficient evidence to support awaiting confirmation of IDA in fast track patients with normocytic anaemia prior to requesting bowel investigations.

  6. Traditional healers and the "Fast-Track" HIV response: is success possible without them?

    Science.gov (United States)

    Leclerc-Madlala, Suzanne; Green, Edward; Hallin, Mary

    2016-07-01

    The rapid scale-up of effective HIV prevention strategies is a central theme of the post-2015 health and development agenda. All major global HIV and AIDS funders have aligned their policies and plans to achieve sharp reductions in new HIV infections and reach epidemic control by 2030. In these "fast-track" plans, increased antiretroviral treatment coverage and the attainment of viral suppression are pivotal, and there is firm recognition of the need for countries to mobilise more domestic resources and build stronger community clinic systems. There is little in these bold plans, however, to suggest that the now 30-year-old call by the World Health Organization (WHO) and other organisations to establish systematic collaborations with the traditional health sector will finally be heeded. In the context of sub-Saharan Africa's HIV epidemic, a significant body of literature demonstrates the critical role that traditional healers can play in improving the success of health programmes, including those for HIV prevention. This paper provides a brief history of collaboration with traditional healers for HIV followed by a description of several successful collaborations and discussion of key elements for success. We argue that the traditional health sector is a major resource that has yet to be sufficiently mobilised against HIV. As we shift from a short-term HIV response to a longer-term and more sustainable response, there is an urgent need to accelerate efforts to leverage and partner with the hundreds of thousands of traditional health practitioners who are already providing health services in communities. Failure to better attune our work to the medical pluralism of communities affected by HIV will continue to hinder HIV programming success and help assure that ambitious post-2015 HIV prevention and control goals are not realised.

  7. Nurse practitioners’ attitudes to nutritional challenges dealing with the patients’ nutritional needs and ability to care for themselves in a fast track program

    DEFF Research Database (Denmark)

    Graarup, Jytte; Pedersen, Preben Ulrich; Bjerrum, Merete

    2014-01-01

    Background: Nutrition plays an important role to the success of fast track programs, but under nutrition are still reported. Nutritional care seems to be a low priority among nurses even though it is well-known that insufficient nutrition has severe consequences for the patients. The aim...... is to report to what extent a training program has made Nutritional Nurse Practitioners aware of the nutritional care for short-term hospitalized patients, and how they deal with patients’ nutritional needs and ability to provide self-care in the context of a fast track program. Methods: Deductive content...... analysis was used to analyse data from four focus group interviews. Sixteen Nutritional Nurse Practitioners from either medical or surgery wards participated. The Nutritional Nurse Practitioners were interviewed twice. The interviews were recorded and verbally transcribed. Results: In the Nutritional Nurse...

  8. Anti-HIV drug development on the fast track

    Institute of Scientific and Technical Information of China (English)

    2007-01-01

    @@ An international cooperation deal was made recently in Shanghai on developing a new anti-HIV drug based on the research results of CAS scientists and their preclinical studies,marking a breakthrough progress for China's research in the field.

  9. After colonic surgery: The lived experience of participating in a fast-track programme

    DEFF Research Database (Denmark)

    Norlyk, Annelise; Harder, Ingegerd

    2009-01-01

    Postoperative recovery can be accelerated and hospitalization reduced through fast-track programmes. However, documented knowledge is limited and primarily focusing on a medical perspective whereas the patients' perspective lacks documentation. This study describes the lived experience of partici......Postoperative recovery can be accelerated and hospitalization reduced through fast-track programmes. However, documented knowledge is limited and primarily focusing on a medical perspective whereas the patients' perspective lacks documentation. This study describes the lived experience......; but this role of being a good and cooperative patient had a built-in asymmetric power relationship favouring the professionals' expectations. The complexities of this power relationship were related to both patient factors and contextual factors, e.g. the daily regimen and hospital norms. Although patient...

  10. 投稿须知%Construction Technology for Fast-Track Concrete Pavement

    Institute of Scientific and Technical Information of China (English)

    2011-01-01

    In this paper, one of new contents: construction technology for fast-track concrete pavement is introduced in 《Technical Specification for Construction of Highway Cement Concrete Pavements》 (JTG F30) which is revised in 2010 in order to not only provide high-quality and long-lasting life, but also reduce the time of engineering in the new construction, reconstruction and resurfacing maintain of cement concrete pavements, to quickly and early open public traffic, and to reduce traffic interruptions.

  11. Liberal or restrictive fluid administration in fast-track colonic surgery

    DEFF Research Database (Denmark)

    Holte, K; Foss, N B; Andersen, J

    2007-01-01

    surgery were randomized to 'restrictive' (Group 1) or 'liberal' (Group 2) perioperative fluid administration. Fluid algorithms were based on fixed rates of crystalloid infusions and a standardized volume of colloid. Pulmonary function (spirometry) was the primary outcome measure, with secondary outcomes...... of exercise capacity (submaximal exercise test), orthostatic tolerance, cardiovascular hormonal responses, postoperative ileus (transit of radio-opaque markers), postoperative nocturnal hypoxaemia, and overall recovery within a well-defined multimodal, fast-track recovery programme. Hospital stay...

  12. Progressive strength training (10 RM) commenced immediately after fast-track total knee arthroplasty: is it feasible?

    DEFF Research Database (Denmark)

    Jakobsen, Thomas Linding; Husted, Henrik; Kehlet, Henrik;

    2012-01-01

    Purpose: To explore the feasibility of progressive strength training commenced immediately after total knee arthroplasty (TKA). Methods: A pilot study was conducted at an outpatient training facility. Fourteen patients with unilateral TKA were included from a fast-track orthopedic arthroplasty unit....... They received rehabilitation including progressive strength training of the operated leg (leg press and knee-extension), using relative loads of 10 repetition maximum with three training sessions per week for 2 weeks. Rehabilitation was commenced 1 or 2 days after TKA. At each training session, knee pain, knee...... joint effusion and training load were recorded. Isometric knee-extension strength and maximal walking speed were measured before the first and last session. Results: The training load increased progressively (p strength training exercises...

  13. 艾滋病合并外科急腹症患者的快速康复护理%Fast track nursing of patients with AIDS complicated with acute abdomen during perioperative period

    Institute of Scientific and Technical Information of China (English)

    李丹丹; 肖艳玲

    2016-01-01

    目的:探讨艾滋病合并外科急腹症患者的快速康复护理方法。方法:回顾性分析2012年7月至2015年7月42例艾滋病合并外科急腹症的患者的临床特点及护理对策。结果:38例患者围手术期经快速康复外科(fast track surgery,FTS)护理治疗(术前患者心理干预;避免胃管、尿管的置入;减少术中引流管留置、术中液体控制、体温控制;术后胃肠功能、肺功能的加速康复、疼痛的管理、切口的管理、管道的早期拔除),未出现院内感染及其他重大并发症,护理治疗效果满意,康复出院。4例因重度的免疫功能缺陷,术后出现难以控制的腹腔感染后继而多器官功能衰竭死亡。结论:快速康复护理治疗可减少艾滋病合并急腹症患者的术后并发症,降低围手术期病死率,促进患者术后早期康复。%Objective: To investigate the perioperative nursing methods on AIDS complicated with acute abdomen diseases. Methods: 42 cases of AIDS complicated with acute abdomen diseases from July 2012 to July 2015 were studied, the clinical features of patients and nursing treatment were analyzed.Results: 38 cases were healed without nosocomial infection and other serious complications by fast track nursing treatment (preoperative psychological intervention; avoid gastric tube, urine tube placement; reduce intraoperative drainage tube indwelling, intraoperative lfuid control, temperature control, accelerate postoperative gastrointestinal function, rehabilitate pulmonary function, pain management, postoperative incision management, early removal of pipeline). Four cases with severe immune function defects suffered uncontrollable abdominal postoperative infection and multiple organ failure which led to death.Conclusion: Fast track nursing can prevent postoperative complications, reduce perioperative mortality and promote the fast-tract recovery on patients with AIDS complicated with acute abdomen

  14. The impact of a fast track area on quality and effectiveness outcomes: a Middle Eastern emergency department perspective.

    LENUS (Irish Health Repository)

    Devkaran, Subashnie

    2009-01-01

    BACKGROUND: Emergency department (ED) overcrowding is a ubiquitous problem with serious public health implications. The fast track area is a novel method which aims to reduce waiting time, patient dissatisfaction and morbidity. |The study objective was to determine the impact of a fast track area (FTA) on both effectiveness measures (i.e. waiting times [WT] and length of stay [LOS]) and quality measures (i.e. LWBS rates and mortality rates) in non-urgent patients. The secondary objective was to assess if a FTA negatively impacted on urgent patients entering the ED. METHODS: The study took place in a 500 bed, urban, tertiary care hospital in Abu Dhabi, United Arab Emirates. This was a quasi-experimental, which examined the impact of a FTA on a pre-intervention control group (January 2005) (n = 4,779) versus a post-intervention study group (January 2006) (n = 5,706). RESULTS: Mean WTs of Canadian Triage Acuity Scale (CTAS) 4 patients decreased by 22 min (95% CI 21 min to 24 min, P < 0.001). Similarly, mean WTs of CTAS 5 patients decreased by 28 min (95% CI 19 min to 37 min, P < 0.001) post FTA. The mean WTs of urgent patients (CTAS 2\\/3) were also significantly reduced after the FTA was opened (P < 0.001). The LWBS rate was reduced from 4.7% to 0.7% (95% CI 3.37 to 4.64; P < 0.001). Opening a FTA had no significant impact on mortality rates (P = 0.88). CONCLUSION: The FTA improved ED effectiveness (WTs and LOS) and quality measures (LWBS rates) whereas mortality rate remained unchanged.

  15. Fast-track surgery protocol in elderly patients undergoing laparoscopic radical gastrectomy for gastric cancer: a randomized controlled trial

    Directory of Open Access Journals (Sweden)

    Liu G

    2016-06-01

    Full Text Available Guozheng Liu,1 Fengguo Jian,2 Xiuqin Wang,2 Lin Chen1 1Department of General Surgery, Chinese PLA General Hospital, Beijing, People’s Republic of China; 2Second Department of General Surgery, Changyi People’s Hospital, Shandong, People’s Republic of China Aim: To study the efficacy of the fast-track surgery (FTS program combined with laparoscopic radical gastrectomy for elderly gastric cancer (GC patients.Methods: Eighty-four elderly patients diagnosed with GC between September 2014 and August 2015 were recruited to participate in this study and were divided into four groups randomly based on the random number table as follows: FTS + laparoscopic group (Group A, n=21, FTS + laparotomy group (Group B, n=21, conventional perioperative care (CC + laparoscopic group (Group C, n=21, and CC + laparotomy group (Group D, n=21. Observation indicators include intrasurgery indicators, postoperative recovery indicators, nutritional status indicators, and systemic stress response indicators.Results: Preoperative and intraoperative baseline characteristics showed no significant differences between patients in each group (P>0.05. There were no significant differences between each group in nausea and vomiting, intestinal obstruction, urinary retention, incision infection, pulmonary infection, and urinary tract infection after operation (P>0.05. Time of first flatus and postoperative hospital stay time of FTS Group A were the shortest, and total medical cost of this group was the lowest. For all groups, serum albumin, prealbumin, and transferrin significantly decreased, while CRP and interleukin 6 were significantly increased postoperative day 1. From postoperative day 4–7, all indicators of the four groups gradually recovered, but compared with other three groups, those of Group A recovered fastest.Conclusion: FTS combined with laparoscopic surgery can promote faster postoperative recovery, improve early postoperative nutritional status, and more

  16. Multi-month prescriptions, fast-track refills, and community ART groups: results from a process evaluation in Malawi on using differentiated models of care to achieve national HIV treatment goals

    Directory of Open Access Journals (Sweden)

    Margaret L. Prust

    2017-07-01

    Conclusions: MMS is being implemented nationally and has already generated cost savings and efficiencies in Malawi for patients and the health system, but could be improved by more accurate patient differentiation. While expanding FTRs and CAGs may not offer significant further cost savings in Malawi, future studies should investigate if such alternative models lead to improvements in patient satisfaction or clinical outcomes that might justify their implementation.

  17. Impact of a Fast-track Esophagectomy Protocol on Esophageal Cancer Patient Outcomes and Hospital Charges

    DEFF Research Database (Denmark)

    Shewale, Jitesh B; Correa, Arlene M; Baker, Carla M

    2015-01-01

    OBJECTIVE: To evaluate the effects of a fast-track esophagectomy protocol (FTEP) on esophageal cancer patients' safety, length of hospital stay (LOS), and hospital charges. BACKGROUND: FTEP involved transferring patients to the telemetry unit instead of the surgical intensive care unit (SICU) after.......655; 95% confidence interval = 0.456, 0.942; P = 0.022). In addition, the median hospital charges associated with primary admission and readmission within 90 days for group B ($65,649) were lower than that for group A ($79,117; P

  18. Fast Track to the Cloud: Design Patterns for 12-Factor Earth Sciences Applications

    Science.gov (United States)

    Pawloski, Andrew; McLaughlin, Brett; Lynnes, Christopher

    2016-01-01

    As expanding service offerings and decreasing prices make the cloud increasingly attractive to Earth Science applications, there are nontrivial practical considerations which can hinder its meaningful use. In this talk, we will discuss architectural recommendations and lessons learned while working on EOSDIS' cloud efforts, particularly the NASA-compliant General Application Platform (NGAP) and its associated applications. Prominent in our findings is the importance of 12-factor design patterns and the powerful "wins" they enable in the cloud. We will share our strategies for "fast-tracking" applications to the cloud --whether they be legacy, planned for the future, or somewhere in between.

  19. Benefits of ultra-fast-track anesthesia in left ventricular assist device implantation: a retrospective, propensity score matched cohort study of a four-year single center experience.

    Science.gov (United States)

    Zayat, Rashad; Menon, Ares K; Goetzenich, Andreas; Schaelte, Gereon; Autschbach, Ruediger; Stoppe, Christian; Simon, Tim-Philipp; Tewarie, Lachmandath; Moza, Ajay

    2017-02-08

    The use of left ventricular assist devices (LVADs) has gained significant importance for treatment of end-stage heart failure. Fast-track procedures are well established in cardiac surgery, whereas knowledge of their benefits after LVAD implantation is sparse. We hypothesized that ultra-fast-track anesthesia (UFTA) with in-theater extubation or at a maximum of 4 h. after surgery is feasible in Interagency Registry for Mechanically Assisted Circulatory Support (INTERMACS) level 3 and 4 patients and might prevent postoperative complications. From March, 2010 to March, 2012, 53 LVADs (50 Heart Mate II and 3 Heart Ware) were implanted in patients in our department. UFTA was successfully performed (LVAD ultra ) in 13 patients. After propensity score matching, we compared the LVAD ultra group with a matched group (LVAD match ) receiving conventional anesthesia management. Patients in the LVAD ultra group had significantly lower incidences of pneumonia (p = 0.031), delirium (p = 0.031) and right ventricular failure (RVF) (p = 0.031). They showed a significantly higher cardiac index in the first 12 h. (p = 0.017); a significantly lower central venous pressure during the first 24 h. postoperatively (p = 0.005) and a significantly shorter intensive care unit (ICU) stay (p = 0.016). Kaplan-Meier analysis after four years of follow-up showed no significant difference in survival. In this pilot study, we demonstrated the feasibility of ultra-fast-track anesthesia in LVAD implantation in selected patients with INTERMACS level 3-4. Patients had a lower incidence of postoperative complications, better hemodynamic performance, shorter length of ICU stay and lower incidence of RVF after UFTA. Prospective randomized investigations should examine the preservation of right ventricular function in larger numbers and identify appropriate selection criteria.

  20. Fast track surgery, a strategy to improve operational efficiency in a high-complexity hospital in Latin America.

    Science.gov (United States)

    Betancur, Juan David Angel; Montaño, Liliana Marcela Betancur; Jaramillo, André Felipe Espinosa; Delgado, Carlos Enrique Yepes

    2015-01-01

    Fast Track surgery is designed to optimize time in low-complexity procedures, thus improving efficiency in care provision, and preserving patient safety. Before and after intervention study in a surgical setting, with failure mode and effects analysis, identification and prioritization of improvement opportunities, process measurement before the intervention, improvement implementation, practical application, process measurement after the intervention, and surgical time comparisons. With the Fast Track program, 19% of the operating room capacity available was freed per day; before surgical FastTrack implementation, 50% of the procedures started 23 minutes behind schedule. After the Fast Track program was implemented, procedures start 5 minutes ahead of schedule. Anesthesia induction time was reduced by 50%, and skin-to-skin surgical time dropped by 28%. The number of surgical procedures performed in the day increased by 33-50%. There were noincidents or adverse events. Fast Track surgery is a useful strategy for improving operating room efficiency and reducing surgical time. Procedures start on time, with increased timely care, patient and practitioner satisfaction, and lower service costs.

  1. The feasibility of a single-blinded fast-track pragmatic randomised controlled trial of a complex intervention for breathlessness in advanced disease

    Directory of Open Access Journals (Sweden)

    Booth Sara

    2009-07-01

    Full Text Available Abstract Background The Breathlessness Intervention Service is a novel service for patients with intractable breathlessness regardless of aetiology. It is being evaluated using the Medical Research Council's framework for the evaluation of complex interventions. This paper describes the feasibility results of Phase II: a single-blinded fast-track pragmatic randomised controlled trial. Methods A single-blinded fast-track pragmatic randomised controlled trial was conducted for patients with chronic obstructive pulmonary disease referred to the service. Patients were randomised to either receive the intervention immediately for an eight-week period, or receive the intervention after an eight-week period on a waiting list during which time they received standard care. Outcomes examined included: response rates to the trial; response rates to the individual questionnaires and items; comments relating to the trial functioning made during interviews with patients, carers, referrers and service providers; and, researcher fieldwork notes. Results 16 of the 20 eligible patients agreed to participate in a recruitment visit (16/20; 14 respondents went on to complete a recruitment visit/baseline interview. The majority of those who completed a recruitment visit/baseline interview completed the RCT protocol (13/14; 12 of their carers were recruited and completed the protocol. An unblinding rate of 6/25 respondents (patients and carers was identified. Missing data were minimal and only one patient was lost to follow up. The fast-track trial methodology proved feasible and acceptable. Two of the baseline/outcome measures proved unsuitable: the WHO performance scale and the Schedule for the Evaluation of Individual Quality of Life-Direct Weighting (SEIQoL-DW. Conclusion This study adds to the evidence that fast-track randomised controlled trials are feasible and acceptable in evaluations of palliative care interventions for patients with non-malignant conditions

  2. Postoperative morbidity and mortality in type-2 diabetics after fast-track primary total hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer C; Madsbad, Sten; Kehlet, Henrik

    2015-01-01

    BACKGROUND: Diabetes is a risk factor for postoperative morbidity, which includes total hip and knee arthroplasty. However, no previous studies have been done in a fast-track setting with optimized perioperative care, including spinal anesthesia, multimodal opioid-sparing analgesia, early...... mobilization, and discharge to home, which improved postoperative outcome. METHODS: We performed an observational cohort study using prospective data in primary total hip and total knee arthroplasty with a standardized fast-track approach. Eight hundred ninety type 2 diabetics were successfully propensity......-∞) and 115 (35-∞), respectively. Insulin-treated type 2 diabetes was associated with increased risk of specific "diabetes-related" morbidity (1.95 [1.13-3.35]; P = 0.016). CONCLUSIONS: Type 2 diabetes per se has limited influence on postoperative morbidity in fast-track total hip and knee arthroplasty....

  3. Room for improvement in the treatment of hip fractures in Denmark

    DEFF Research Database (Denmark)

    Egerod, Ingrid; Rud, Kirsten; Specht, Kirsten;

    2010-01-01

    INTRODUCTION: Treatment of hip fractures has evolved since the introduction of fast-track surgical programs in the late 1990s. The aim of our study was to describe the quality of treatment and care related to fast-track hip fracture surgery in Denmark by external audit of patient records. MATERIAL...... AND METHODS: This was a national multicenter audit of hospital charts from each hospital treating ≥ 50 hip fracture patients per year (n = 594). RESULTS: The study demonstrated significant variability in treatment and care of patients with hip fractures among the regions of Denmark. Pain management...

  4. First prototype of a silicon tracker using an artificial retina for fast track finding

    CERN Document Server

    Neri, N.; Caponio, F.; Citterio, M.; Coelli, S.; Fu, J.; Geraci, A.; Monti, M.; Petruzzo, M.; Bedeschi, F.; Marino, P.; Morello, M.J.; Piucci, A.; Punzi, G.; Spinella, F.; Stracka, S.; Walsh, J.; Ristori, L.; Tonelli, D.

    2014-01-01

    We report on the R\\&D for a first prototype of a silicon tracker based on an alternative approach for fast track finding. The working principle is inspired from neurobiology, in particular by the processing of visual images by the brain as it happens in nature. It is based on extensive parallelisation of data distribution and pattern recognition. In this work we present the design of a practical device that consists of a telescope based on single-sided silicon detectors; we describe the data acquisition system and the implementation of the track finding algorithms using available digital logic of commercial FPGA devices. Tracking performance and trigger capabilities of the device are discussed along with perspectives for future applications.

  5. Fast Track to the Cloud: Design Patterns for 12-Factor Earth Sciences Applications

    Science.gov (United States)

    Pawloski, A. W.; McLaughlin, B. D.; Plofchan, P.; Lynnes, C.

    2016-12-01

    As expanding service offerings and decreasing prices make the cloud increasingly attractive to Earth Science applications, there are nontrivial practical considerations which can hinder its meaningful use. Scientific organizations with large, existing software efforts often face the dilemma of investing in major re-architecting efforts or instead utilizing the cloud suboptimally (sometimes detrimentally). NASA's Earth Observing System Data and Information System (EOSDIS) has both sophisticated existing software infrastructure, as well as new initiatives, designed from their inception as cloud applications. In this talk, we will discuss architectural recommendations and lessons learned while working on EOSDIS' cloud efforts, particularly the NASA-compliant General Application Platform (NGAP) and its associated applications. Prominent in our findings is the importance of 12-factor design patterns and the powerful "wins" they enable in the cloud. We will share our strategies for fast-tracking applications to the cloud - whether they be legacy, planned for the future, or somewhere in between.

  6. Heart rate response during sleep in elderly patients after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Krenk, Lene; Sørensen, Gertrud Laura; Kehlet, Henrik

    2015-01-01

    Variability in heart rate response (HRR) can be used as a measure for autonomic nervous system function, which may influence sleep disturbances and the recovery phase after major surgery. The aim of this study was to evaluate autonomic function by assessment of HRR during sleep arousals...... in the postoperative period after fast-track hip and knee arthroplasty. Determination of autonomic function was gained from polysomnographic evaluation of 10 patients >60 years undergoing either hip or knee arthroplasty (mean age 69.9 years) evaluating HRR during the different sleep phases. Sleep monitoring took place...... in the patients' home preoperatively, during hospitalization on the first postoperative night, and on the fourth postoperative night at home. HRR was reduced (P sleep on the first postoperative night, and was still reduced on the fourth postoperative night compared...

  7. Design of a 300-Watt Isolated Power Supply for Ultra-Fast Tracking Converters

    DEFF Research Database (Denmark)

    Nguyen-Duy, Khiem; Ouyang, Ziwei; Petersen, Lars Press;

    2015-01-01

    that an overall circuit input-to-output parasitic capacitance of 10 pF in a 300 W prototype can be achieved. The circuit input-to-output capacitance per watt is therefore 30 times lower than that of existing approaches. A mathematical model of the inter-winding capacitance of the proposed transformer, circuit......This paper presents the design of a medium-powerrating isolated power supply for ultra-fast tracking converters and MOS-gate driver circuits in medium and high voltage applications. The key feature of the design is its very low circuit input-to-output parasitic capacitance, which maximizes its...... noise immunity from noise due to fast changes in voltage. The converter is a voltage-controlled current source, utilizing a transformer with extremely low inter-winding parasitic capacitance, which is achieved by separating the windings by a significant distance. Experimental measurements show...

  8. Postoperative anemia and early functional outcomes after fast-track hip arthroplasty

    DEFF Research Database (Denmark)

    Jans, Øivind; Bandholm, Thomas Quaade; Kurbegovic, Sorel

    2016-01-01

    BACKGROUND: Postoperative anemia is prevalent in fast-track hip arthroplasty (THA) where patients are mobilized and discharged early, but whether anemia impairs functional recovery after discharge has not been adequately evaluated previously. This study aimed to evaluate whether postoperative...... anemia influenced recovery of mobility and quality of life (Qol) during the first 2 weeks after discharge from THA. STUDY DESIGN AND METHODS: This was a prospective observational study in 122 THA patients more than 65 years of age. Mobility and Qol were assessed pre- and postoperatively by the 6-minute...... walk test (6MWT; primary outcome), the timed up-and-go test, and the FACT-anemia subscale. Twenty-four-hour mobility at home was assessed by activity monitoring on Days 1 to 6 after discharge. Hemoglobin (Hb) at discharge (HbD) and the Hb decrease from preoperatively (ΔHb) were compared to mobility...

  9. Fast tracking of a given heart rate profile in treadmill exercise.

    Science.gov (United States)

    Weng, Kaili; Turk, Basil; Dolores, Louis; Nguyen, Tuan N; Celler, Branko; Su, Steven; Nguyen, Hung T

    2010-01-01

    This paper investigates the application of a multi-loop PID controller in an automated treadmill exercise machine. The approach is to design a computer-controlled treadmill control system for the regulation of heart rate (HR) during treadmill exercise. A single-input and multiple-output (SIMO) controller was implemented to fast track a given heart rate profile in treadmill exercise. Two separate single-input and single-output (SISO) PID control systems are initially implemented to modify either the treadmill speed or its angle of inclination in order to achieve a desired HR. The purpose of this paper is to apply a SIMO control system by implementing a control algorithm which includes the two PID controllers working simultaneously to track the desired HR profile. The performance of the SIMO and SISO control systems are compared through the closed loop responses recorded during experimentation. This would also help future development of safe treadmill exercise system.

  10. Locational Sensitivity Investigation on PV Hosting Capacity and Fast Track PV Screening

    Energy Technology Data Exchange (ETDEWEB)

    Ding, Fei; Mather, Barry; Ainsworth, Nathan; Gotseff, Peter; Baker, Kyri

    2016-05-05

    A 15% PV penetration threshold is commonly used by utilities to define photovoltaic (PV) screening methods where PV penetration is defined as the ratio of total solar PV capacity on a line section to peak load. However, this method doesn't take into account PV locational impact or feeder characteristics that could strongly change the feeder's capability to host PVs. This paper investigates the impact of PV location and phase connection type on PV hosting capacity, and then proposes a fast-track PV screening approach that leverages various PV hosting capacity metric responding to different PV locations and types. The proposed study could help utilities to evaluate PV interconnection requests and also help increase the PV hosting capacity of distribution feeders without adverse impacts on system voltages.

  11. Physiotherapy Exercise After Fast-Track Total Hip and Knee Arthroplasty: Time for Reconsideration?

    DEFF Research Database (Denmark)

    Bandholm, Thomas; Kehlet, Henrik

    2012-01-01

    Bandholm T, Kehlet H. Physiotherapy exercise after fast-track total hip and knee arthroplasty: time for reconsideration? Major surgery, including total hip arthroplasty (THA) and total knee arthroplasty (TKA), is followed by a convalescence period, during which the loss of muscle strength......-track methodology or enhanced recovery programs. It is the nature of this methodology to systematically and scientifically optimize all perioperative care components, with the overall goal of enhancing recovery. This is also the case for the care component "physiotherapy exercise" after THA and TKA. The 2 latest...... meta-analyses on the effectiveness of physiotherapy exercise after THA and TKA generally conclude that physiotherapy exercise after THA and TKA either does not work or is not very effective. The reason for this may be that the "pill" of physiotherapy exercise typically offered after THA and TKA does...

  12. Perioperative role development: evaluating a fast-track approach to advanced scrub and/or dual role practitioner training.

    Science.gov (United States)

    Timpany, Michaela D; McAleavy, Janet

    2010-01-01

    This report describes the service evaluation of a newly developed fast-track advanced scrub practitioner (ASP)/dual role training programme. The evaluation examines whether the introduction of new policies and training based on risk assessment have strengthened quality assurance measures and controls which aim to ensure that staff work safely within their scope of practice. A further aim is to establish if the fast-track route is adequately meeting the training and development needs of staff within the organisation and supporting service requirements.

  13. Application of fast-track surgery concept in perioperative patients with biliary calculi and liver cirrhosis: a prospective study

    Directory of Open Access Journals (Sweden)

    WANG Hua

    2014-11-01

    Full Text Available ObjectiveTo investigate the advantage and safety of the concept of fast-track surgery (FTS applied in perioperative patients with biliary calculi and liver cirrhosis. MethodsFifty-two patients undergoing operation for biliary calculi and liver cirrhosis from January 2011 to September 2013 were included in this study. These patients were randomly divided into FTS group (n = 30 and control group (n = 22. Patients in the FTS group received perioperative care measures guided by FTS concept, while patients in the control group received traditional perioperative management measures. The intraoperative situation of patients, time to postoperative recovery of intestinal function, length of postoperative hospital stay, total medical expenses during hospitalization, and postoperative complications were compared between the two groups. Continuous data and categorical data were compared by t-test and χ2 test, respectively. ResultsAs compared with the control group, the FTS group had significantly time to postoperative recovery of intestinal function (t = 2.239, P = 0.045, a significantly shortened length of postoperative stay (t = 4.246, P = 0.038, and significantly reduced total medical expenses during hospitalization (t = 3.045, P = 0.033. No significant difference in postoperative complications was observed between the two groups (P>0.05. ConclusionThe concept of FTS can be safely and effectively applied in perioperative patients with biliary calculi and liver cirrhosis, which can accelerate rehabilitation without increasing the risk of surgery.

  14. A fast-track preliminary thermo-mechanical design of oil export pipelines from P-56 platform

    Energy Technology Data Exchange (ETDEWEB)

    Solano, Rafael F.; Mendonca, Salete M. de [PETROBRAS S.A., Rio de Janeiro, RJ (Brazil); Franco, Luciano D.; Walker, Alastair; El-Gebaly, Sherif H. [INTECSEA, Rio de Janeiro, RJ (Brazil)

    2009-12-19

    The oil export pipelines of Marlim Sul field Module 3, Campus Basin, offshore Brazil, will operate in high pressure and temperature conditions, and will be laid on seabed crossing ten previously laid pipelines along the routes. In terms of thermo-mechanical design, these conditions turn out to be great challenges. In order to obtain initial results and recommendations for detail design, a preliminary thermo-mechanical design of pipelines was carried out as a fast-track design before the bid. This way, PETROBRAS can assess and emphasize the susceptibility of these lines to lateral buckling and pipeline walking behavior. Therefore, PETROBRAS can present a preliminary mitigation strategy for lateral buckling showing solutions based on displacement controlled criteria and by introducing buckle initiation along the pipeline using distribution buoyancy. Besides that, axial displacements and loads at the pipeline ends can be furnished also in order to provide a basis for the detailed design. The work reported in this paper follows the SAFEBUCK JIP methodology and recommendation, which were used to determine the allowable strain and maximum allowable VAS (Virtual Anchor Spacing) considered in the buckling mitigation strategy. The paper presents also the formation of uncontrolled buckles on the seabed and the propensity for pipeline walking in its sections between buckles. The buckling mitigation strategy established in this preliminary design confirms that the oil pipeline specifications are adequate to maintain integrity during design life. (author)

  15. Quadriceps tendon rupture - treatment results

    Directory of Open Access Journals (Sweden)

    Popov Iva

    2013-01-01

    Full Text Available Introduction. Quadriceps tendon rupture is a rare but rather serious injury. If this injury is not promptly recognized and early operated, it may lead to disability. This research was aimed at pointing out the results and complications of the quadriceps tendon rupture surgical treatment. Material and Methods. This retrospective multicentric study was conducted in a group of 29 patients (mostly elderly men. Lysholm knee scoring scale was used to evaluate the surgical results. The post-operative results were compared in relation to the type of tendon rupture reconstructions (acute or chronic, various surgical techniques, type of injuries (unilateral or bilateral as well as the presence or absence of comorbid risk factors in the patients. Results. The average value of a Lysholm score was 87.6. Excellent and satisfactory Lysholm score results dominated in our sample of patients. Better post-operative results were recorded in the group of patients without risk factors, in case of a bilateral injury, and in case of an acute injury. The best result was obtained after performing the reconstruction using anchors, and the worst result came after using Codivilla technique. Discussion and Conclusion. Early diagnosis and surgical treatment are an absolute imperative in management of this injury. We have not proven that a certain surgical technique has an advantage over the others. A comorbid risk factor is related to a lower Lysholm score. Despite a few cases of complications, we can conclude that the surgical treatment yields satisfactory results.

  16. Postoperative Urinary Catheterization Thresholds of 500 versus 800 ml after Fast-track Total Hip and Knee Arthroplasty

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Hornum, Ulla; Troldborg, Charlotte

    2016-01-01

    BACKGROUND: No evidence-based threshold exists for postoperative urinary bladder catheterization. The authors hypothesized that a catheterization threshold of 800 ml was superior to 500 ml in reducing postoperative urinary catheterization and urological complications after fast-track total hip ar...

  17. Fast-track, ambulatory ultrasound-guided Tru-Cut liver biopsy is feasible and cost-efficient

    DEFF Research Database (Denmark)

    Huang, Chenxi; Lorentzen, Torben; Skjoldbye, Bjørn

    2015-01-01

    safely discharged from our institution. No fatality or long-term complications were found during this study. CONCLUSION: The fast-track approach reported herein is a feasible option when adequate patient information is given. Besides the obvious, positive effect on patient logistics and departmental...

  18. Introducing the fast track surgery principles can reduce length of stay after autologous breast reconstruction using free flaps

    DEFF Research Database (Denmark)

    Bonde, Christian; Khorasani, Hoda; Eriksen, Kirsten;

    2015-01-01

    INTRODUCTION: The concept of fast-track surgery (FTS) is a peri- and postoperative care concept developed to reduce length of hospital stay (LOS) and morbidity after surgery. FTS programmes have been reported from other surgical specialities, but there are few reports of FTS in plastic surgery...

  19. Serious renal and urological complications in fast-track primary total hip and knee arthroplasty; a detailed observational cohort study

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Jorgensen, Christoffer C; Kehlet, Henrik

    2016-01-01

    postoperatively. Seven complications . (0.08 %) were urological, mainly haematuria after bladder catheterisation, whereas 5 (0.06 were urosepsis/pyelonephritis. CONCLUSION: The overall incidence of serious RU complications after fast-track THA and TKA was 0.61 %. AKI occurred in 0.49% and was most often due...

  20. Six steps to fast-track insurance approval for bariatric surgery.

    Science.gov (United States)

    Frezza, Eldo E

    2006-05-01

    Most of the health-insurers approve bariatric surgery for patients according to the NIH standards, while others only approve the surgery if the patient has a BMI >50. Therefore, it is important for the physician to know and carefully follow the various criteria of different insurance companies. We suggest 6 steps to fast-track insurance approval: 1) a multidisciplinary team; 2) 6-month diet; 3) comprehensive medical evaluation; 4) flexibility and consistency; 5) analysis of each patient indication; 6) quality of cost-effectiveness and long-term monitoring and benefits. In the event that an insurance company rejects the request for surgery, a blueprint of an appeal letter is very important. The appeal letter should stress the indications and benefits of surgery for your patients. Insurance company criteria may differ from the NIH guidelines. Irrespective of this, the steps outlined will help speed the insurance approval process and reduce paperwork and confusion. Most often, rejections stem from letters that were not written clearly or that lacked one or more of the elements delineated above. If the surgeon follows the 6 steps described, he/she should meet less disappointment, as in our experience that went from 50% to 90% success because of better communication with insurance and more appropriate paperwork.

  1. Experience with "Fast track" postoperative care after deep brain stimulation surgery.

    Science.gov (United States)

    Martín, Nuria; Valero, Ricard; Hurtado, Paola; Gracia, Isabel; Fernández, Carla; Rumià, Jordi; Valldeoriola, Francesc; Carrero, Enrique J; Tercero, Francisco Javier; de Riva, Nicolás; Fàbregas, Neus

    A 24-h-stay in the post-anesthesia care unit (PACU) is a common postoperative procedure after deep brain stimulation surgery (DBS). We evaluated the impact of a fast-track (FT) postoperative care protocol. An analysis was performed on all patients who underwent DBS in 2 periods: 2006, overnight monitored care (OMC group), and 2007-2013, FT care (FT group). The study included 19 patients in OMC and 95 patients in FT. Intraoperative complications occurred in 26.3% patients in OMC vs. 35.8% in FT. Post-operatively, one patient in OMC developed hemiparesis, and agitation in 2 patients. In FT, two patients with intraoperative hemiparesis were transferred to the ICU. While on the ward, 3 patients from the FT developed hemiparesis, two of them 48h after the procedure. Thirty eight percent of FT had an MRI scan, while the remaining 62% and all patients of OMC had a CT-scan performed on their transfer to the ward. One patient in OMC had a subthalamic hematoma. Two patients in FT had a pallidal hematoma, and 3 a bleeding along the electrode. A FT discharge protocol is a safe postoperative care after DBS. There are a small percentage of complications after DBS, which mainly occur within the first 6h. Copyright © 2016 Sociedad Española de Neurocirugía. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Beyond trend analysis: How a modified breakpoint analysis enhances knowledge of agricultural production after Zimbabwe's fast track land reform

    Science.gov (United States)

    Hentze, Konrad; Thonfeld, Frank; Menz, Gunter

    2017-10-01

    In the discourse on land reform assessments, a significant lack of spatial and time-series data has been identified, especially with respect to Zimbabwe's ;Fast-Track Land Reform Programme; (FTLRP). At the same time, interest persists among land use change scientists to evaluate causes of land use change and therefore to increase the explanatory power of remote sensing products. This study recognizes these demands and aims to provide input on both levels: Evaluating the potential of satellite remote sensing time-series to answer questions which evolved after intensive land redistribution efforts in Zimbabwe; and investigating how time-series analysis of Normalized Difference Vegetation Index (NDVI) can be enhanced to provide information on land reform induced land use change. To achieve this, two time-series methods are applied to MODIS NDVI data: Seasonal Trend Analysis (STA) and Breakpoint Analysis for Additive Season and Trend (BFAST). In our first analysis, a link of agricultural productivity trends to different land tenure regimes shows that regional clustering of trends is more dominant than a relationship between tenure and trend with a slightly negative slope for all regimes. We demonstrate that clusters of strong negative and positive productivity trends are results of changing irrigation patterns. To locate emerging and fallow irrigation schemes in semi-arid Zimbabwe, a new multi-method approach is developed which allows to map changes from bimodal seasonal phenological patterns to unimodal and vice versa. With an enhanced breakpoint analysis through the combination of STA and BFAST, we are able to provide a technique that can be applied on large scale to map status and development of highly productive cropping systems, which are key for food production, national export and local employment. We therefore conclude that the combination of existing and accessible time-series analysis methods: is able to achieve both: overcoming demonstrated limitations of

  3. Comparison between two different selective spinal anesthesia techniques in ambulatory knee arthroscopy as fast-track anesthesia

    Science.gov (United States)

    Ali Hassan, Hossam Ibrahim Eldesuky

    2015-01-01

    Background: There were several studies using either low dose Bupivacaine as unilateral selective spinal anesthesia (SSA) or low dose lidocaine SSA for ambulatory knee arthroscopy. There were many concerns about high failure rate, complications, and different times to home readiness discharges. Aim of the Study: The study aimed to: (1) Compare the clinical efficacy and side effects of two different techniques of SSA in subarachnoid block for ambulatory knee arthroscopy (2) evaluate the possibility of a shorter stay in post-anesthesia care unit (PACU) or eligibility for fast tracking anesthesia (bypassing PACU) after SSA and numbers of patient bypassed PACU (3) compare the time to ambulate and time to home readiness. Patients and Methods: Prospective, randomized and open study was conducted, including 50 outpatients undergoing knee arthroscopy. Patients allocated into two groups: Bupivacaine group (group B); was injected with 3 mg bupivacaine and 10 ug fentanyl intrathecally in lateral decubitus position and remained for 20 min then supine position. Lidocaine group (group L) was injected with 20 mg lidocaine, plus 25 ug fentanyl intrathecally and immediately keeps in the supine position after injection. The quality and durations of motor and sensory block were compared between groups. Sensory block assessed by pin brick method and motor block assessed by Bromage scale. Time spent in PACU, the time to ambulate, and times to home-readiness were compared. Number of patients bypassed PACU was recorded. Side effects as pain, nausea, vomiting, postdural puncture headache, transient neurological symptoms, retention of urine and pruritus were evaluated and compared after SSA. Results: Bupivacaine group provided unilateral spinal anesthesia with significantly longer duration of both motor and sensory blocks than bilateral spinal of lidocaine group P 0.05. Group L patients did not stay in PACU, and all patients bypassed it P anesthesia than bupivacaine spinal with shorter time

  4. The Value of Fast-track Surgery without Nasogastric Decompression Tube in Choledochojejtmostomy%快速康复外科在胆肠吻合术后免胃肠减压中应用

    Institute of Scientific and Technical Information of China (English)

    吕洋; 夏宗保; 任辉明; 蔡崇元

    2012-01-01

    Objective:To explore the security and feasibility without routine nasogastric decompression in patients of choledochojejtmostomy fast-track surgery.Methods:In our hospitall from January 2010 to January 2007,seventy-five patients who received choledochojejtmostomy and were inserted nasogastric decompression tube were divided into conventional care group,and meanwhile other 40 ones without routine nasgastrie decompression tube as fast-track group. We compared their time to flatus,and the ratio of postoperative eomphcation including throat ache,nausea,atelectasis wound infection,pneumonia and anastomotic leak.The time to first passage of flatus and incidences of postoperative complications such as pharyngalgia,nausea,anastomotic fistulae,pulmonary infection,and surgical wound infection were recorded and compared between the two groups.Results:The time to first passage of flatus was significantly shorter in the as fast-track group than that of conventional care group (P0.05).The incidences of pharyngalgia,nausea and vomiting in the fast-track group were significantly lower than that of conventional care group (P0.05); 快速康复组肛门恢复排气时间显著提前(P<0.05),但传统治疗组病人诉咽喉疼痛、恶心呕吐明显较快速康复组增多(P<0.01).结论:快速康复外科不常规放置胃肠减压管用于胆肠吻合术后临床管理,可加速病人的康复.

  5. A fast-track anaemia clinic in the Emergency Department: feasibility and efficacy of intravenous iron administration for treating sub-acute iron deficiency anaemia

    Science.gov (United States)

    Quintana-Díaz, Manuel; Fabra-Cadenas, Sara; Gómez-Ramírez, Susana; Martínez-Virto, Ana; García-Erce, José A.; Muñoz, Manuel

    2016-01-01

    Background Clinically significant anaemia, requiring red blood cell transfusions, is frequently observed in Emergency Departments (ED). To optimise blood product use, we developed a clinical protocol for the management of iron-deficiency anaemia in a fast-track anaemia clinic within the ED. Materials and methods From November 2010 to January 2014, patients presenting with sub-acute, moderate-to-severe anaemia (haemoglobin [Hb] <11 g/dL) and confirmed or suspected iron deficiency were referred to the fast-track anaemia clinic. Those with absolute or functional iron deficiency were given intravenous (IV) ferric carboxymaltose 500–1,000 mg/week and were reassessed 4 weeks after receiving the total iron dose. The primary study outcome was the haematological response (Hb≥12 g/dL and/or Hb increment ≥2 g/dL). Changes in blood and iron parameters, transfusion rates and IV iron-related adverse drug effects were secondary outcomes. Results Two hundred and two anaemic patients with iron deficiency (150 women/52 men; mean age, 64 years) were managed in the fast-track anaemia clinic, and received a median IV iron dose of 1,500 mg (1,000–2,000 mg). Gastro-intestinal (44%) or gynaecological (26%) bleeding was the most frequent cause of the anaemia. At follow-up (183 patients), the mean Hb increment was 3.9±2.2 g/dL; 84% of patients were classified as responders and blood and iron parameters normalised in 90%. During follow-up, 35 (17%) patients needed transfusions (2 [range: 1–3] units per patient) because they had low Hb levels, symptoms of anaemia and/or were at risk. Eight mild and one moderate, self-limited adverse drug effects were witnessed. Discussion Our data support the feasibility of a clinical protocol for management of sub-acute anaemia with IV iron in the ED. IV iron was efficacious, safe and well tolerated. Early management of anaemia will improve the use of blood products in the ED. PMID:26674819

  6. Effect study of fast track surgery concept on patients with lumbar intervertebral disc herniation%快速康复外科理念对腰椎间盘突出症患者的影响

    Institute of Scientific and Technical Information of China (English)

    张学胜; 韩宝生

    2013-01-01

    Objective To investigate application effect of the fast track surgery concept on patients with lumbar intervertebral disc herniation. Methods The clinical data of one hundred and eight cases of patients with lumbar intervertebral disc herniation who were treated in the department of orthopedics in our hospital from February 2010 to February 2012 were collected, then they were divided into the control group and the observation group, patients in the control group were given the traditional operation method, patients in the observation group were given the fast track surgery concept on the basis of the treatments, in the end, the postoperative pain, postoperative hospitalization time and clinical efficacy were e-valuated. Results Pain visual analogue scale and postoperative hospitalization time in the observation group were lower than that in the control group, and the excellent good proportion of lumbar intervertebral disc herniation was also higher in the observation group than that in the control group (P < 0. 05). Conclusions The fast track surgery concept on patients with lumbar intervertebral disc herniation can improve pain degree, shorten the length of time and clinical efficacy is better, it is worthy of clinical application.%目的 探讨快速康复外科理念在腰椎间盘突出症患者中应用效果.方法 随机选择2010年2月-2012年2月在新疆昌吉州吉木萨尔县人民医院骨科住院治疗的108例腰椎间盘突出症患者为研究对象,应用随机数字表法将本研究入选患者分为对照组和治疗组,对照组患者给予传统的手术方式,而治疗组患者则应用FTS理念指导下行手术,比较对照组和治疗组患者的术后疼痛程度、术后住院时间和临床疗效.结果 治疗组患者术后出院时疼痛视觉模拟评分优于对照组的,术后住院时间明显缩短,临床疗效明显高于对照组的(P<0.05),但是两组患者出院时关节活动度没有差异(P>0.05).结论 快速康

  7. INVESTIGATING THE POTENTIALS OF FAST TRACK IN MITIGATING PROJECT ABANDONMENT: CASE STUDIES

    Directory of Open Access Journals (Sweden)

    Amir Hassin B.Baharuddin

    2011-12-01

    Full Text Available The construction industry plays a very role in the fixed capital formation of any economy. Thus, the activities of construction in any economy, mirrors its general performance; a healthy economy usually experiences an upward swing in construction activities and a depressed economy indicates the reverse. But, project abandonment has been posing a threat to so many countries in their march towards the achievement of the above economic independence and greater civilization, and Nigeria is no exception. We have road and other construction projects that have taken ages in building, whose completion date is only in the imagination of the gods. Governments succeed governments and waste many months reviewing contracts and on-going projects, and re-awarding contracts. The ritual has come to stay and public funds are sunk into projects whose viability, usefulness, and urgency remain doubtful; then they are abandonment. However, majority of project abandonment could be traced to longer project duration. This is because the longer the duration of a project the more additional costs to the project through variations, inflations, and other expenses associated with time (time related to expenses. Time consumed by project directly influence the cost incurred on a project. When these traditional costs are too much, they lead to the client’s budget for the project to be exceeded. And when clients can no longer entertain those additional costs, it becomes a subject of disputes, and eventually the project is abandoned. As such, there is the need for the construction industry participants to embrace an efficient and effective means of minimizing projects’ duration in order to minimize the occurrences of project abandonment; and Fast Track procurement method is one good project management tool that have been in used to meet these challenges of time and cost.

  8. Initial Impact of the Fast Track Prevention Trial for Conduct Problems: I. The High-Risk Sample

    OpenAIRE

    1999-01-01

    Fast Track is a multisite, multicomponent preventive intervention for young children at high risk for long-term antisocial behavior. Based on a comprehensive developmental model intervention included a universal-level classroom program plus social skills training, academic tutoring, parent training, and home visiting to improve competencies and reduce problems in a high-risk group of children selected in kindergarten. At the end of Grade 1, there were moderate positive effects on children's s...

  9. THE POLITICAL ECONOMY OF THE U.S.-MEXICO FREE TRADE AGREEMENT: ANALYSIS OF THE CONGRESSIONAL FAST TRACK VOTE

    OpenAIRE

    1993-01-01

    This paper presents an empirical analysis of the strategic forces shaping U.S.-Mexico trade relationships and the possibilities of extending the trade agreement to the rest of the Americas. The paper concludes that constituency interests, party loyalty, the proportion of a state's population of Hispanic origin, and the influence of textile-related employment in the state were significant explanatory factors in the Congressional Fast Track vote that occurred in May of 1991.

  10. Getting on the fast track, or how to get an MLIS through distance education, with a specialization in medical librarianship.

    Science.gov (United States)

    Detlefsen, Ellen G

    2004-01-01

    The article describes an innovation in MLIS education for medical librarianship, with an introduction to the FastTrack, the distance education program at the University of Pittsburgh's library and information science school, together with an overview of a model program linking the biomedical library at Vanderbilt University with the School of Information Sciences in Pittsburgh. Admissions requirements and specific curriculum for the distance education master's degree are detailed in an FAQ format.

  11. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients

    DEFF Research Database (Denmark)

    Husted, Henrik; Holm, Gitte; Jacobsen, Steffen

    2008-01-01

    BACKGROUND AND PURPOSE: Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction....... Epidemiological, physical, and perioperative parameters were registered and correlated to LOS and patient satisfaction. RESULTS: 92% of the patients were discharged directly to their homes within 5 days, and 41% were discharged within 3 days. Age, sex, marital status, co-morbidity, preoperative use of walking...... aids, pre- and postoperative hemoglobin levels, the need for blood transfusion, ASA score, and time between surgery and mobilization, were all found to influence postoperative outcome in general, and LOS and patient satisfaction in particular. INTERPRETATION: We identified several patient...

  12. Assessment of rehabilitation needs in colorectal cancer treatment: Results from a mixed audit and qualitative study in Denmark.

    Science.gov (United States)

    Wiedenbein, Liza; Kristiansen, Maria; Adamsen, Lis; Hjort, Dorte; Hendriksen, Carsten

    2016-06-01

    Background Systematic assessments of cancer patients' rehabilitation needs are a prerequisite for devising appropriate survivorship programs. Little is known about the fit between needs assessment outlined in national rehabilitation policies and clinical practice. This study aimed to explore clinical practices related to identification and documentation of rehabilitation needs among patients with colorectal cancer at Danish hospitals. Material and methods A retrospective clinical audit was conducted utilizing data from patient files randomly selected at surgical and oncology hospital departments treating colorectal cancer patients. Forty patients were included, 10 from each department. Semi-structured interviews were carried out among clinical nurse specialists. Audit data was analyzed using descriptive statistics, qualitative data using thematic analysis. Results Documentation of physical, psychological and social rehabilitation needs initially and at end of treatment was evident in 10% (n = 2) of surgical patient trajectories and 35% (n = 7) of oncology trajectories. Physical rehabilitation needs were documented among 90% (n = 36) of all patients. Referral to municipal rehabilitation services was documented among 5% (n = 2) of all patients. Assessments at surgical departments were shaped by the inherent continuous assessment of rehabilitation needs within standardized fast-track colorectal cancer surgery. In contrast, the implementation of locally developed assessment tools inspired by the distress thermometer (DT) in oncology departments was challenged by a lack of competencies and funding, impeding integration of data into patient files. Conclusion Consensus must be reached on how to ensure more systematic, comprehensive assessments of rehabilitation needs throughout clinical cancer care. Fast-track surgery ensures systematic documentation of physical needs, but the lack of inclusion of data collected by the DT in oncological departments

  13. Safeguarding Self-Governance: A Grounded Theory of Older Patients’ Pattern of Behavior in Relation to their Relatives in Fast-track Programs

    DEFF Research Database (Denmark)

    Berthelsen, Connie B.; Frederiksen, Kirsten; Lindhardt Damsgaard, Tove

    2014-01-01

    Abstract The aim of this study was to generate a grounded theory of older patients’ pattern of behavior in relation to their relatives’ involvement in fast-track programs during total joint replacement. Sixteen patients were recruited in orthopedic wards. Data collection included 11 interviews......-governance emerged in the analysis as the core category of our theory and pattern of behavior of the older patients in relation to their relatives. The older patients’ main concern was to complete the fast-track program while maintaining autonomy, which they resolved through four strategies of actions: embracing......, shielding, distancing, and masking. Keywords: Fast-track program, grounded theory, older patients, relatives, total joint replacement....

  14. Spouses’ involvement in older patients’ fast-track programmes during total hip replacement using case management intervention. A study protocol of the SICAM-trial

    DEFF Research Database (Denmark)

    Berthelsen, Connie Bøttcher; Kristensson, Jimmie

    2015-01-01

    Aim To present the protocol of a two-group quasi-experimental study of spouses’ involvement through case management (The SICAM-trial) in older patients’ fast-track programmes during total hip replacement. Background Patients in fast-track programmes are required to take an active part......-test measures (protocol approved in November 2012). Methods A total of 120 patients aged 65 years or older going through a fast-track programme for a total hip replacement and their spouses will be recruited from one Danish orthopaedic ward. We will initially include the control group for data collection...

  15. 快速康复外科在38例十二指肠球部溃疡穿孔患者中的应用分析%Application of fast track surgery in 38 cases with perforation of duodenal ulcer

    Institute of Scientific and Technical Information of China (English)

    高林; 黄建明; 钱雷敏

    2012-01-01

    Objective To reduce physiological and psychological trauma stress of patients with perforation of duodenal ulcer, and to achieve the goal of fast recovery by using a series of optimized measures based on evidence-based medicine during the perioperative management. Methods Seventy-six patients with perforation of duodenal ulcer were selected from January 2008 to December 2011, and randomly divided into fast track surgery group (FTS group, n = 38)and control group (n =38). Results After operation, the time of off -bed activity, food intake, first anal flatulence and defecation and hospital stay in the fast track surgery group were significantly shorter than those in the control group. Treatment cost was also less in FTS group, while the postoperative complications of the two groups showed no significant difference. Conclusion Compared with the conventional surgery treatment, fast track surgery occupies a dominant position in curing the patients with perforation of duodenal ulcer.%目的 采用一系列有循证医学依据的围术期处理的优化措施,以减少十二指肠球部溃疡穿孔患者的生理及心理的创伤应激,达到患者快速康复的目的.方法 选择2008年1月-2011年12月72例十二指肠球部溃疡穿孔患者,随机分为快速康复外科组(FTS组)和对照组,其中38例FTS组采用快速康复外科处理措施.结果 快速康复外科组患者术后下床活动时间、进食时间、首次肛门恢复排气排便时间、住院时间均短于对照组,痛苦程度和治疗费用均明显低于对照组,2组术后并发症发生率差异无统计学意义.结论 十二指肠球部溃疡穿孔患者采用快速康复外科处理措施,与常规处理比较,有着较为明显的优势.

  16. Surgery-induced changes and early recovery of hip-muscle strength, leg-press power, and functional performance after fast-track total hip arthroplasty

    DEFF Research Database (Denmark)

    Holm, Bente; Thorborg, Kristian; Husted, Henrik

    2013-01-01

    By measuring very early changes in muscle strength and functional performance after fast-track total hip arthroplasty (THA), post-operative rehabilitation, introduced soon after surgery, can be designed to specifically target identified deficits.......By measuring very early changes in muscle strength and functional performance after fast-track total hip arthroplasty (THA), post-operative rehabilitation, introduced soon after surgery, can be designed to specifically target identified deficits....

  17. 基于Gabor变换的快速跟踪算法%Fast tracking algorithm based on Gabor transformation

    Institute of Scientific and Technical Information of China (English)

    徐天阳; 吴小俊

    2016-01-01

    In order to enhance the speed and accuracy of object tracking, a fast tracking algorithm based on Gabor trans-formation is proposed. According to the good simulation capability of Gabor transformation to human visual receptive field, the proposed algorithm extracts features via multi-scale and multi-orientation Gabor filters, and then realizes track-ing by utilizing image matching between target model and candidates. At the feature extracting stage, a multi-channel model is used to fuse Gabor features. And at the output stage, convolution property in spatial-frequency domain is exploited to realize fast posterior distribution computation. Experimental results indicate that the proposed algorithm has good prop-erties in accuracy and speed, and outperforms state-of-the-art methods.%为了增强目标跟踪的速度和精度,提出了一种基于Gabor变换的快速跟踪算法。根据Gabor变换对人类视觉感受野良好的模拟能力,用多尺度多方向的Gabor滤波器对目标图像进行特征抽取,以此建立目标的表观模型,而后利用图像匹配的方法得到相邻帧目标位置的后验概率分布从而实现跟踪。其中在特征抽取级利用线性多通道模型将不同尺度和方向的Gabor特征融合起来,在输出级利用时频的卷积特性以FFT实现相邻帧目标位置后验概率的快速计算,充分考虑了跟踪的速度和精度。实验结果表明,该算法选用的Gabor特征对目标有准确的描述能力,以此建立的表观模型鲁棒性强;同时跟踪过程简单快速,在精度和速度上与其他前沿的跟踪算法相较有优越性。

  18. Orchestrating care through the fast-track perspective: Orthopaedic nurses’ perceptions and experiences of providing individualised nursing care in older patients’ standardised fast-track programmes after total hip or knee replacement

    DEFF Research Database (Denmark)

    Bøttcher Berthelsen, Connie; Frederiksen, Kirsten

    2017-01-01

    The lack of individualised care in orthopaedic regimes is often explained by the extended use of patient pathways and clinical guidelines. The aim of this study was to illuminate orthopaedic nurses' perceptions and experiences of providing individual nursing care for older patients in standardised...... fast-track programmes after total hip or knee replacement. Ten semi-structured interviews were conducted with orthopaedic nurses in orthopaedic wards at three Danish hospitals between April and June of 2015. Data were analysed using manifest and latent content analysis according to Graneheim...

  19. A "package solution" fast track program can reduce the diagnostic waiting time in head and neck cancer

    DEFF Research Database (Denmark)

    Sørensen, Jesper Roed; Johansen, Jørgen; Gano, Lars;

    2014-01-01

    In 2007, a fast track program for patients with suspicion of head and neck cancer (HNC) was introduced in Denmark to reduce unnecessary waiting time. The program was based on so called "package solutions" including pre-booked slots for outpatient evaluation, imaging, and diagnostic surgical...... the introduction, and the third interval represents the current situation. The median time from referral to first consultation was reduced from eight calendar days in group 1 to only one day in groups 2 and 3 (p ...

  20. Fast-track access to urologic care for patients with macroscopic haematuria is efficient and cost-effective

    DEFF Research Database (Denmark)

    Liedberg, Fredrik; Gerdtham, Ulf; Gralén, Katarina

    2016-01-01

    BACKGROUND: The delay between onset of macroscopic haematuria and diagnosis of bladder cancer is often long. METHODS: We evaluated timely diagnosis and health-care costs for patients with macroscopic haematuria given fast-track access to diagnostics. During a 15-month period, a telephone hotline......: In all 275 patients who called 'the Red Phone' hotline were investigated, and 47 of them (17%) were diagnosed with cancer and 36 of those had bladder cancer. Median time from patient-reported haematuria to diagnosis was 29 (interquartile range (IQR) 14-104) days and 50 (IQR 27-165) days...

  1. Fall-related admissions after fast-track total hip and knee arthroplasty - cause of concern or consequence of success?

    DEFF Research Database (Denmark)

    Jørgensen, Christoffer C; Kehlet, Henrik; Hansen, Torben Bæk

    2013-01-01

    Total hip (THA) and knee arthroplasty (TKA) are common procedures in elderly persons, who are at potential increased risk of postoperative fall due to loss of muscle strength and impaired balance. Fast-track surgery with early mobilization and opioid-sparing analgesia have improved outcomes after...... these procedures, but early mobilization and short hospitalization length of stay (LOS) could potentially increase the risk of falls after discharge. We investigated injuries, circumstances, and the timing of fall-related hospital admissions 90 days after fasttrack THA and TKA....

  2. A novel 4D fast track finding system using precise space and time information of the hit

    CERN Document Server

    Neri, Nicola

    2015-01-01

    We propose a novel fast track finding system capable of reconstructing four dimensional particle trajectories in real time using precise space and time information of the hits. Recent developments in silicon pixel detectors achieved 150 ps time resolution and intense R&D is in progress to improve the timing performance, aiming at 10 ps. The use of the precise space and time information allows the suppression of background hits not compatible with the time of passage of the particle and the determination of its time evolution. The fast track finding device that we are proposing is based on a massively parallel algorithm implemented in commercial field-programmable gate array using a pipelined architecture. We describe the algorithm and its implementation for a tracking system prototype based on 8 planes of silicon sensors used as a case study. According to simulations the suppression of noise hits is effective in reducing fake track combinations and improving real-time track reconstruction in presence of b...

  3. 快通道麻醉在小儿腹股沟区手术中的临床应用价值探讨%Clinical application value discussion of fast-track anesthesia in pediatric groin area surgery

    Institute of Scientific and Technical Information of China (English)

    何林

    2016-01-01

    Objective To evaluate the clinical value of fast-track anesthesia in pediatric surgery in the groin area.Methods This study for my children hospital in February 2012 120 routine surgery groin area in February 2015 - admitted, and randomly divided into control group (60 cases) and observation group (60 cases). The control group received conventional anesthesia, the observation group to take fast-track anesthesia.Results The group of children and mean arterial pressure after 30min 60min after extubation, heart rate, plasma glucagon, cortisol were significantly better than the control group (P<0.05).Conclusion The fast-track anesthesia in pediatric surgery in the groin area and promoting surgery, with a high clinical value.%目的:探讨快通道麻醉在小儿腹股沟区手术中的临床应用价值。方法本次研究对象为我院2012年2月至2015年2月收治的120例行腹股沟区手术的患儿,并随机分成对照组(60例)和观察组(60例)。对照组采取常规麻醉方法,观察组采取快通道麻醉方法。结果观察组患儿术后30min和拔管后60min的平均动脉压、心率、血浆胰高血糖素、血浆皮质醇均显著优于对照组(P <0.05)。结论快通道麻醉在小儿腹股沟区手术中有利于促进手术疗效,具有很高的临床应用价值。

  4. Predictors of length of stay and patient satisfaction after hip and knee replacement surgery: fast-track experience in 712 patients

    DEFF Research Database (Denmark)

    Husted, Henrik; Holm, Gitte; Jacobsen, Steffen

    2008-01-01

    after total hip and knee replacement surgery. PATIENTS AND METHODS: Between September 2003 and December 2005, 712 consecutive, unselected patients (440 women) with a mean age of 69 (31-91) years were admitted for hip and knee replacement surgery at our specialized fast-track joint replacement unit......BACKGROUND AND PURPOSE: Very few studies have focused on patient characteristics that influence length of stay (LOS) in fast-track total hip (THR) and knee arthroplasty (TKR). The aim of this prospective study was to identify patient characteristics associated with LOS and patient satisfaction...... characteristics that influence postoperative outcome, LOS, and patient satisfaction in our series of consecutive fast-track joint replacement patients, enabling further attention to be paid to certain aspects of surgery and rehabilitation....

  5. Cost-effectiveness of an integrated 'fast track' rehabilitation service for multi-trauma patients involving dedicated early rehabilitation intervention programs: design of a prospective, multi-centre, non-randomised clinical trial

    Directory of Open Access Journals (Sweden)

    Hemmen Bena

    2009-01-01

    Full Text Available Abstract Background In conventional multi-trauma care service (CTCS, patients are admitted to hospital via the accident & emergency room. After surgery they are transferred to the IC-unit followed by the general surgery ward. Ensuing treatment takes place in a hospital's outpatient clinic, a rehabilitation centre, a nursing home or the community. Typically, each of the CTCS partners may have its own more or less autonomous treatment perspective. Clinical evidence, however, suggests that an integrated multi-trauma rehabilitation approach ('Supported Fast-track multi-Trauma Rehabilitation Service': SFTRS, featuring: 1 earlier transfer to a specialised trauma rehabilitation unit; 2 earlier start of 'non-weight-bearing' training and multidisciplinary treatment; 3 well-documented treatment protocols; 4 early individual goal-setting; 5 co-ordination of treatment between trauma surgeon and physiatrist, and 6 shorter lengths-of-stay, may be more (cost-effective. This paper describes the design of a prospective cohort study evaluating the (cost- effectiveness of SFTRS relative to CTCS. Methods/design The study population includes multi-trauma patients, admitted to one of the participating hospitals, with an Injury Severity Scale score > = 16, complex multiple injuries in several extremities or complex pelvic and/or acetabulum fractures. In a prospective cohort study CTCS and SFTRS will be contrasted. The inclusion period is 19 months. The duration of follow-up is 12 months, with measurements taken at baseline, and at 3,6,9 and 12 months post-injury. Primary outcome measures are 'quality of life' (SF-36 and 'functional health status' (Functional Independence Measure. Secondary outcome measures are the Hospital Anxiety & Depression Scale, the Mini-Mental State Examination as an indicator of cognitive functioning, and the Canadian Occupational Performance Measure measuring the extent to which individual ADL treatment goals are met. Costs will be assessed

  6. A Comparative Study of Analog Voltage-mode Control Methods for Ultra-Fast Tracking Power Supplies

    DEFF Research Database (Denmark)

    Høyerby, Mikkel Christian Wendelboe; Andersen, Michael Andreas E.

    2007-01-01

    This paper presents a theoretical and experimental comparison of the standard PWM/PID voltage-mode control method for single-phase buck converters with two highperformance self-oscillating (a.k.a. sliding mode) control methods. The application considered is ultra-fast tracking power supplies...... (UFTPSs) for RF power amplifiers, where the switching converter needs to track a varying reference voltage precisely and quickly while maintaining low output impedance. The small-signal analyses performed on the different controllers show that the hysteretic-type controller can achieve the highest loop......-oscillating control is shown to reduce the worst-case UFTPS output impedance by a factor of 10....

  7. Program development: role of the clinical nurse specialist in implementing a fast-track postanesthesia care unit.

    Science.gov (United States)

    Harrington, Linda

    2005-01-01

    Advanced practice nurses are involved in many aspects of program development as part of their roles. This can involve such things as developing programs for staff and family education, organizing system-wide quality assurance programs, or implementing new care programs. One unique aspect of the advanced practice nurse's role is the ability to serve as a change agent and implement new models of care. Although all advanced practice nurses can be involved in program development, the role of the Clinical Nurse Specialist lends itself to devoting dedicated services for implementing programmatic change in the clinical setting. This article describes the role of the Clinical Nurse Specialist in implementing an evidence-based, fast-track postanesthesia care unit.

  8. The fast track to canonical Wnt signaling in MC3T3-E1 cells protected by substance P against serum deprivation-induced apoptosis.

    Science.gov (United States)

    Yang, Jianguo; Nie, Jiping; Fu, Su; Liu, Song; Wu, Jianqun; Cui, Liang; Zhang, Yongtao; Yu, Bin

    2017-01-01

    The canonical Wnt pathway is vital to bone physiology by increasing bone mass through elevated osteoblast survival. Although investigated extensively in stem cells, its role in osteoblastic MC3T3-E1 cells has not been completely determined. To explore how this pathway is regulated by different conditions, we assessed the anti-apoptotic effects of substance P on the canonical Wnt pathway in MC3T3-E1 cells by treating cells with serum deprivation or serum starving with "substance P," a neuropeptide demonstrated to promote bone growth and stimulate Wnt signaling. The results showed that serum deprivation both induced apoptosis and activated Wnt signal transduction while substance P further stimulated the Wnt pathway via the NK-1 receptor but protected the cells from apoptotic death. Fast-tracking of Wnt signaling by substance P was also noted. These results indicate that nutritional deprivation and substance P synergistically activated the canonical Wnt pathway, a finding that helps to reveal the role of Wnt signaling in bone physiology affected by nutritional deprivation and neuropeptide substance P.

  9. A stochastic frontier analysis of technical efficiency in smallholder maize production in Zimbabwe: The post-fast-track land reform outlook

    Directory of Open Access Journals (Sweden)

    Nelson Mango

    2015-12-01

    Full Text Available This article analyses the technical efficiency of maize production in Zimbabwe’s smallholder farming communities following the fast-track land reform of the year 2000 with a view of highlighting key entry points for policy. Using a randomly selected sample of 522 smallholder maize producers, a stochastic frontier production model was applied, using a linearised Cobb–Douglas production function to determine the production elasticity coefficients of inputs, technical efficiency and the determinants of efficiency. The study finds that maize output responds positively to increases in inorganic fertilisers, seed quantity, the use of labour and the area planted. The technical efficiency analysis suggests that about 90% of farmers in the sample are between 60 and 75% efficient, with an average efficiency in the sample of 65%. The significant determinants of technical efficiency were the gender of the household head, household size, frequency of extension visits, farm size and the farming region. The results imply that the average efficiency of maize production could be improved by 35% through better use of existing resources and technology. The results highlight the need for government and private sector assistance in improving efficiency by promoting access to productive resources and ensuring better and more reliable agricultural extension services.

  10. Tourniquet versus no tourniquet on knee-extension strength early after fast-track total knee arthroplasty; a randomized controlled trial

    DEFF Research Database (Denmark)

    Harsten, Andreas; Bandholm, Thomas Quaade; Kehlet, Henrik

    2015-01-01

    tourniquet during surgery was more effective than using a thigh tourniquet in preserving knee-extension strength 48h after fast-track TKA. METHODS: A total of 64 patients undergoing TKA were randomized (1:1) to the use of tourniquet (T-group) or no tourniquet (NT-group). In the T-group the tourniquet cuff...... pressure was based on the patient's systolic pressure and a margin of 100mmHg. It was inflated immediately before surgery and deflated as soon as surgery ended. The primary outcome was the change in knee-extension strength from pre-surgery to 48h after surgery (primary end point). Secondary outcomes were...... pain, nausea, length of hospital stay (LOS) and periarticular swelling. RESULTS: Knee-extension strength 48h after surgery was substantially reduced by about 90% in both groups, with no statistically significant difference between groups (mean difference 1.5N/kg, 95% CI 1.3-1.6). Among the secondary...

  11. Why "The Best Way of Learning to Coach the Game Is Playing the Game": Conceptualising "Fast-Tracked" High-Performance Coaching Pathways

    Science.gov (United States)

    Blackett, Alexander David; Evans, Adam; Piggott, David

    2017-01-01

    At the beginning of the 2013/2014 season in England and Wales, 90 head coaches of the 92 men's national professional football league clubs and 20 of the 22 men's professional rugby union clubs had tenure as a professional elite player in their respective sports. Moreover, Rynne [(2014). "'Fast track' and 'traditional path' coaches:…

  12. Expanding Support for Education in Fragile States: What Role for the Education for All-Fast Track Initiative? CREATE Pathways to Access. Research Monograph No. 30

    Science.gov (United States)

    Turrent, Victoria

    2009-01-01

    The new international aid architecture was established to improve the efficiency and effectiveness of development aid by emphasising country ownership, alignment with national priorities and the harmonisation of donor processes. These features are evident in the Education for All-Fast Track Initiative [EFA-FTI], a global partnership between donor…

  13. Admission of elderly medical patients to fast track or standard hospitalisation

    DEFF Research Database (Denmark)

    Strøm, Camilla; Rasmussen, Lars Simon; Rasmussen, Søren Wistisen

    2016-01-01

    INTRODUCTION: Emergency department-based short stay units (SSUs) are increasingly being introduced to provide accelerated care. The effects of treatment in SSUs for elderly medical patients are not well-studied. METHODS: The ELDER trial is a single-blinded, randomised parallel trial with 1......:1 allocation between hospitalisation in an SSU (intervention) and the Department of Internal Medicine (standard care). The study is conducted at Holbaek Hospital, Denmark. Elderly patients are screened for inclusion if an emergency physician assesses that treatment in an SSU is possible. Eligible participants...... are patients aged ≥ 75 years needing in-hospital treatment of an acute medical problem and who are stable upon admission. The primary outcome is 90-day all-cause mortality. Secondary outcomes include: length of stay in hospital, incidence of complications during hospitalisation, rate of unplanned readmissions...

  14. Examining Clinical Judgment in an Adaptive Intervention Design: The Fast Track Program

    Science.gov (United States)

    Bierman, Karen L.; Nix, Robert L.; Maples, Jerry J.; Murphy, Susan A.

    2006-01-01

    Although clinical judgment is often used in assessment and treatment planning, rarely has research examined its reliability, validity, or impact in practice settings. This study tailored the frequency of home visits in a prevention program for aggressive-disruptive children (n = 410; 56% minority) on the basis of 2 kinds of clinical judgment:…

  15. Evaluation of a fast-track programme for patients undergoing liver resection

    DEFF Research Database (Denmark)

    Schultz, Nicolai A.; Larsen, Peter Nørgaard; Klarskov, Birthe Michaelsen;

    2013-01-01

    removed early, and patients were mobilized and started eating and drinking from the day of surgery. An opioid-sparing multimodal pain treatment was given for the first week. Discharge criteria were: pain sufficiently controlled by oral analgesics alone, patient comfortable with discharge and no untreated...

  16. 快速康复外科护理干预对保肛术患者肠功能恢复的影响%Effect of fast track surgery nursing intervention on intestinal function recovery of patients with sphincter preserving sur-ge ry

    Institute of Scientific and Technical Information of China (English)

    郑丽君

    2015-01-01

    Objective To investigate the effect of postoperative fast track surgery nursing intervention on the recovery of intestinal functions in patients with sphincter preserving surgery .Methods 64 cases of patients with anal sphincter preservation for low rectal cancer were selected from May 2012 to May 2013 in Baishilong Community Health Center ,Shenzhen Longhua People′s Hospital ,and they were divided into treatment group (32 cases) and con‐trol group (32 cases) .Control group and treatment group received conventional surgical nursing and fast track sur‐gery nursing intervention ,respectively .The postoperative indicators of the two groups were analyzed and compared . Results The postoperative hospital stay ,first meal time ,first time out of bed ,first exhaust time ,first defecation time and time of removal of catheter and drainage tube of treatment group were significantly earlier of less than control group (P< 0 .05) .The ratio of urinary lactulose and mannitol (L/M ) and the level of postoperative blood glucose of treatment group were significantly lower than control group ,1 ,2 ,7 d after surgery ( P < 0 .05) .Conclusion Fast track surgery nursing intervention is beneficial to the recovery of intestinal function in patients with sphincter preser‐ving surgery ,which is worthy of clinical promotion .%目的:探讨快速康复外科护理干预对保肛术患者术后肠功能恢复的影响。方法将2012年5月至2013年5月在深圳市龙华人民医院白石龙社康中心行低位直肠癌保肛术的64例患者分为治疗组(32例)和对照组(32例),对照组给予常规外科治疗和护理,治疗组给予快速康复外科护理干预,对两组患者术后临床各项观察指标进行比较分析。结果治疗组术后住院时间、首次进食时间、首次下床时间、首次排气时间、首次排便时间、拔除尿管和拔除引流管时间均早于或小于对照组,差异有统计学意义(P<0.05

  17. Treatment results evaluation using the Index of Orthodontic Treatment Need

    Directory of Open Access Journals (Sweden)

    Thalca Hamid

    2009-12-01

    Full Text Available Background: The use of orthodontic indices were increasingly popular in the last few years. Index of Orthodontic Treatment Need (IOTN usually was used to assess the needs and demand of orthodontic treatment, eventhough, indices can be used for more than one purpose. Purpose: To determine whether the Index of Orthodontic Treatment Need (IOTN could be able to evaluate the treatment results as well. Method: Data was obtained by evaluating each of 202 study models from 17 Orthodontic Postgraduate students. The ‘before’ and ‘after’ treatment models were assessed, using the Index of Orthodontic Treatment Need. Result: Using the Wilcoxon Signed-Rank test, the assessment of Dental Health Component (DHC and Aesthetic Component (AC, before and after orthodontic treatment showed significantly differences from each others (p : 0,000 < α : 0.05. The Null hypothesis were rejected. The grade of DHC and AC were decreasing to a better score. Conclusion: The Index of Orthodontic Treatment Need (IOTN could be used to assess the orthodontic treatment outcomes, to evaluate before and after orthodontic treatment of the patients. The results of the treatment showed good improvements of dentofacial appearance of the patients which means the successful achievement of the clinical works programs.

  18. [Preliminary results of treatment with aflibercept].

    Science.gov (United States)

    Blăjan, Codruta; Nicula, D; Rusu, Ioana

    2014-01-01

    The paper presents the first results concerning the Aflibercept (Eylea) treatment, the last antiVEGF approved for treatment of the age related macular degeneration (AMD), neovascular form and for macular edema due to the central retinal vein occlusion. The treatment was applied to patients presenting AMD, ME and other diseases: myopic and idiopatic choroidal neovascularisation, central serous choroidopathy (CSC) or diabetic macular edema (DME). The results were good: improvement of the visual acuity, resolution of the intraretinal fluids and macular edema. Although we did not notice major side-effects, resistance or tachyphylaxis, we noticed some recurrences.

  19. School outcomes of aggressive-disruptive children: prediction from kindergarten risk factors and impact of the fast track prevention program.

    Science.gov (United States)

    Bierman, Karen L; Coie, John; Dodge, Kenneth; Greenberg, Mark; Lochman, John; McMohan, Robert; Pinderhughes, Ellen

    2013-01-01

    A multi-gate screening process identified 891 children with aggressive-disruptive behavior problems at school entry. Fast Track provided a multi-component preventive intervention in the context of a randomized-controlled design. In addition to psychosocial support and skill training for parents and children, the intervention included intensive reading tutoring in first grade, behavioral management consultation with teachers, and the provision of homework support (as needed) through tenth grade. This study examined the impact of the intervention, as well as the impact of the child's initial aggressive-disruptive behaviors and associated school readiness skills (cognitive ability, reading readiness, attention problems) on academic progress and educational placements during elementary school (Grades 1-4) and during the secondary school years (Grades 7-10), as well as high school graduation. Child behavior problems and skills at school entry predicted school difficulties (low grades, grade retention, placement in a self-contained classroom, behavior disorder classification, and failure to graduate). Disappointingly, intervention did not significantly improve these long-term school outcomes.

  20. Zebrafish Models of Prader-Willi Syndrome: Fast Track to Pharmacotherapeutics

    Directory of Open Access Journals (Sweden)

    Emma D. Spikol

    2016-03-01

    Full Text Available Prader-Willi syndrome (PWS is a rare genetic neurodevelopmental disorder characterized by an insatiable appetite, leading to chronic overeating and obesity. Additional features include short stature, intellectual disability, behavioral problems and incomplete sexual development. Although significant progress has been made in understanding the genetic basis of PWS, the mechanisms underlying the pathogenesis of the disorder remain poorly understood. Treatment for PWS consists mainly of palliative therapies; curative therapies are sorely needed. Zebrafish, Danio rerio, represent a promising way forward for elucidating physiological problems such as obesity and identifying new pharmacotherapeutic options for PWS. Over the last decade, an increased appreciation for the highly conserved biology among vertebrates and the ability to perform high-throughput drug screening has seen an explosion in the use of zebrafish for disease modeling and drug discovery. Here, we review recent advances in developing zebrafish models of human disease. Aspects of zebrafish genetics and physiology that are relevant to PWS will be discussed, and the advantages and disadvantages of zebrafish models will be contrasted with current animal models for this syndrome. Finally, we will present a paradigm for drug screening in zebrafish that is potentially the fastest route for identifying and delivering curative pharmacotherapies to PWS patients.

  1. A Voyage of Discovery or a Fast Track to Success: Men, Women and the MBA.

    Science.gov (United States)

    Simpson, Ruth

    2000-01-01

    Results of a study of the personal and career benefits of a Masters of Business Administration suggest that women (n=91) value the experience and appreciate the intrinsic benefits such as enhanced confidence and self-worth. Men (n=120) value the extrinsic benefits such as increased pay and status. (Contains 52 references.) (JOW)

  2. A Belated Green Revolution for Cannabis: Virtual Genetic Resources to Fast-Track Cultivar Development

    OpenAIRE

    Matthew Timothy Welling; Timothy Shapter; Terry James Rose; Lei Liu; Rhia Stanger; Graham John King

    2016-01-01

    Cannabis is a predominantly diecious phenotypically diverse domesticated genus with few if any extant natural populations. International narcotics conventions and associated legislation have constrained the establishment, characterization, and use of Cannabis genetic resource collections. This has resulted in the underutilization of genepool variability in cultivar development and has limited the inclusion of secondary genepools associated with genetic improvement strategies of the Green Revo...

  3. Why still in hospital after fast-track hip and knee arthroplasty?

    DEFF Research Database (Denmark)

    Husted, Henrik; Lunn, Troels H; Troelsen, Anders

    2011-01-01

    reasons for not allowing discharge were registered. Results Pain, dizziness, and general weakness were the main clinical reasons for being hospitalized at 24 and 48 hours postoperatively while nausea, vomiting, confusion, and sedation delayed discharge to a minimal extent. Waiting for blood transfusion...

  4. FAST TRACK COMMUNICATION: Variable thermal resistor based on self-powered Peltier effect

    Science.gov (United States)

    Min, Gao; Yatim, N. Md

    2008-11-01

    Heat flow through a thermoelectric material or device can be varied by an electrical resistor connected in parallel to it. This phenomenon is exploited to design a novel thermal component-variable thermal resistor. The theoretical background to this novel application is provided and an experimental result to demonstrate its feasibility is reported.

  5. A Voyage of Discovery or a Fast Track to Success: Men, Women and the MBA.

    Science.gov (United States)

    Simpson, Ruth

    2000-01-01

    Results of a study of the personal and career benefits of a Masters of Business Administration suggest that women (n=91) value the experience and appreciate the intrinsic benefits such as enhanced confidence and self-worth. Men (n=120) value the extrinsic benefits such as increased pay and status. (Contains 52 references.) (JOW)

  6. Fast Track Surgery Operating Room Management Application Value Analysis of New Ideas%手术室管理中快通道外科新理念的应用价值分析

    Institute of Scientific and Technical Information of China (English)

    廖晓玲

    2015-01-01

    目的:分析研究手术室管理中应用快通道外科新理念的价值与效果。方法选取2010年3月至2013年3月间在我院实施胃大部切除术的患者80例为研究对象进行回顾性分析,随机分为对照组和研究组,对照组手术室管理常规操作,研究组患者用快通道外科理念指导工作,对比管理效果。结果研究组肠鸣音的恢复、排气、住院时间、住院费用均低于对照组,护理配合度和护理满意度高于对照组,差异具有统计学意义(P<0.05);手术安全性无统计学意义(P>0.05);研究组术后并发症发生概率较低。结论在手术室管理中应用快通道外科新理念效果很好,能够提升手术室工作管理效率,提升手术效果,降低并发症发生率,提升患者满意度,可大力应用推广。%Objective Analysis of operating room management application fast track housing values and the effect of new ideas. Method Select a March 2010 March 2013 in our hospital's implementation gastrectomy for the study 80 patients were retrospectively analyzed, were randomly divided into control group and study group and the control group operating theater management practices, research application of fast-track surgery group concept to guide the work, compared to management effectiveness. Result Study group to restore bowel sounds, exhaust, duration of hospitalization, hospital costs were lower than the control group, with the degree of care and nursing satisfaction higher, the difference was statistically signiifcant (P0.05);study group lower risk of postoperative complications. Conclusion In the operating room management application new concept of fast track surgery with good results, can improve operating room management efifciency, improve surgical results and reduce the incidence of complications, improve patient satisfaction, can greatly promote the application.

  7. Relationship between self-reported pain sensitivity and pain after total knee arthroplasty: a prospective study of 71 patients 8 weeks after a standardized fast-track

    Directory of Open Access Journals (Sweden)

    Valeberg BT

    2016-09-01

    Full Text Available Berit T Valeberg,1 Lise H Høvik,2 Kari H Gjeilo3–6 1Faculty of Nursing, Oslo and Akershus University College of Applied Sciences, Oslo, 2Clinic of Anaesthesia and Intensive Care Medicine, St. Olavs Hospital, Trondheim University Hospital, 3Department of Cardiothoracic Surgery, 4Department of Cardiology, 5National Competence Centre for Complex Symptom Disorders, St. Olavs Hospital, Trondheim University Hospital, 6Department of Circulation and Medical Imaging, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway Background and purpose: This was a prospective cohort study assessing data from 71 adult patients undergoing total knee arthroplasty (TKA following a standardized fast-track program between January and July 2013. The objective was to examine the relationship between self-rated pain sensitivity, as measured by the Pain Sensitivity Questionnaire (PSQ, and postoperative pain after TKA. Methods: The baseline questionnaires, PSQ and Brief Pain Inventory, were given to the patients for self-administration at the presurgical evaluation (1–2 weeks prior to surgery. The follow-up questionnaire, Brief Pain Inventory, was administered at the first follow-up, 8 weeks after surgery. Results: A statistically significant association was found between average preoperative pain and average pain 8 weeks after surgery (P=0.001. The PSQ-minor was statistically significantly associated with average pain only for patients younger than 70 years (P=0.03. Interpretation: This is the first study to examine the relationship between pain sensitivity measured by PSQ and postoperative pain in patients after TKA. We found that a lower score on the PSQ-minor was statistically significantly associated with patients’ pain 8 weeks after TKA surgery, but only for younger patients. Further research is needed to explore whether the PSQ could be a useful screening tool for patients’ pain sensitivity in clinical settings. Keywords

  8. Fast track NTR systems assessment for NASA's first lunar outpost scenario

    Science.gov (United States)

    Borowski, Stanley K.; Alexander, Stephen W.

    1994-10-01

    Integrated systems and mission study results are presented which quantify the rationale and benefits for developing and using nuclear thermal rocket (NTR) technology for returning humans to the moon in the early 2000's. At present, the Exploration Program Office (ExPO) is considering chemical propulsion for its 'First Lunar Outpost' (FLO) mission, and NTR propulsion for the more demanding Mars missions to follow. The use of an NTR-based lunar transfer stage, capable of evolving to Mars mission applications, could result in an accelerated schedule, reduced cost approach to moon/Mars exploration. Lunar mission applications would also provide valuable operational experience and serve as a 'proving ground' for NTR engine and stage technologies. In terms of performance benefits, studies indicate that an expendable NTR stage powered by two 50 klbf engines can deliver approximately 96 metric tons (t) to trans-lunar injection (TLI) conditions for an initial mass in low earth orbit (IMLEO) of approximately 199 t compared to 250 t for a cryogenic chemical TLI stage. The NTR stage liquid hydrogen (LH2) tank has a 10 m diameter, 14.8 m length, and 68 t LH2 capacity. The NTR utilizes a 'graphite' fuel form consisting of coated UC2 particles in a graphite substrate, and has a specific impulse capability of approximately 870 s, and an engine thrust-to-weight ratio of approximately 4.8. The NTR stage and its piloted FLO lander has a total length of approximately 38 m and can be launched by a single Saturn V-derived heavy lift launch vehicle (HLLV) in the 200 to 250 t-class range. The paper summarizes NASA's First Lunar Outpost scenario, describes characteristics for representative engine/stage configurations, and examines the impact on engine selection and vehicle design resulting from a consideration of alternative NTR fuel forms and lunar mission profiles.

  9. Improving the ATLAS physics potential with the Fast Track Trigger System

    CERN Document Server

    Cavaliere, Viviana; The ATLAS collaboration

    2015-01-01

    The ATLAS Fast TracKer (FTK) is a custom electronics system that will operate at the full Level-1 accept rate, 100 kHz, to provide high quality tracks as input to the High-Level Trigger. The event reconstruction is performed in hardware, thanks to the massive parallelism of associative memories (AM) and FPGAs. We present the advantages for the physics goals of the ATLAS experiment and the recent results on the design, technological advancements and testing of some of the core components used in the processor.

  10. Low risk of thromboembolic complications after fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Kristian Stahl; Kristensen, Billy B;

    2010-01-01

    Pharmacological prophylaxis can reduce the risk of deep venous thrombosis (DVT), pulmonary embolism (PE), and death, and it is recommended 10–35 days after total hip arthroplasty (THA) and at least 10 days after total knee arthroplasty (TKA). However, early mobilization might also reduce the risk...... of DVT and thereby the need for prolonged prophylaxis, but this has not been considered in the previous literature. Here we report our results with short-duration pharmacological prophylaxis combined with early mobilization and reduced hospitalization....

  11.  MULTIMODAL ANALGESIA IN FAST TRACK HIP AND KNEE ARTHROPLASTY

    DEFF Research Database (Denmark)

    Holm, Bente; Bak, Mikkel; Kristensen, Billy Bjarne;

    scored mean nine out of possible ten points regarding their satisfaction with the entire stay including LOS. CONCLUSIONS: These results demonstrate, that LOS can be shortened without reducing the quality of the hospital stay. Further studies conducted as randomized controlled trials, including follow-up......  PURPOSE: The purpose of this project was to study the length of the hospital stay (LOS) in relation to a new multimodal pain strategy for patients undergoing elective hip and knee arthroplasty. Usual discharge criteria were used: independence in ambulation and transfers, independence in toileting...... underwent the "Timed Up & Go" test, a test for functional mobility. Patients were discharged according to criteria mentioned above and were asked to evaluate the quality of the hospital stay. EVALUATION: LOS was decreased for the THA patients from an already accelerated track of 3.8 days to 3.1 days...

  12. FAST TRACK COMMUNICATION: Production of antihydrogen at reduced magnetic field for anti-atom trapping

    Science.gov (United States)

    Andresen, G. B.; Bertsche, W.; Boston, A.; Bowe, P. D.; Cesar, C. L.; Chapman, S.; Charlton, M.; Chartier, M.; Deutsch, A.; Fajans, J.; Fujiwara, M. C.; Funakoshi, R.; Gill, D. R.; Gomberoff, K.; Hangst, J. S.; Hayano, R. S.; Hydomako, R.; Jenkins, M. J.; Jørgensen, L. V.; Kurchaninov, L.; Madsen, N.; Nolan, P.; Olchanski, K.; Olin, A.; Page, R. D.; Povilus, A.; Robicheaux, F.; Sarid, E.; Silveira, D. M.; Storey, J. W.; Thompson, R. I.; van der Werf, D. P.; Wurtele, J. S.; Yamazaki, Y.

    2008-01-01

    We have demonstrated production of antihydrogen in a 1 T solenoidal magnetic field. This field strength is significantly smaller than that used in the first generation experiments ATHENA (3 T) and ATRAP (5 T). The motivation for using a smaller magnetic field is to facilitate trapping of antihydrogen atoms in a neutral atom trap surrounding the production region. We report the results of measurements with the Antihydrogen Laser PHysics Apparatus (ALPHA) device, which can capture and cool antiprotons at 3 T, and then mix the antiprotons with positrons at 1 T. We infer antihydrogen production from the time structure of antiproton annihilations during mixing, using mixing with heated positrons as the null experiment, as demonstrated in ATHENA. Implications for antihydrogen trapping are discussed.

  13. Fast Tracking for the Second Level Trigger of the ATLAS Experiment Using Silicon Detectors Data

    CERN Document Server

    Schiavi, C; Parodi, F; Kostantinidis, N; Sutton, M; Baines, J T M; Emeliyanov, D; Drevermann, H; 2004 IEEE Nuclear Science Symposium And Medical Imaging Conference

    2005-01-01

    Online track reconstruction is an important ingredient for event selection at Large Hadron Collider (LHC) experiments. In the ATLAS experiment the first stage where this goal will be achievable is the software-based Second Level Trigger (LVL2). In this contribution we present an algorithm for fast pattern recognition and reconstruction of charged tracks and of the primary vertex in the framework of the High Level Trigger (HLT) of ATLAS. The pattern recognition makes extensive use of Monte Carlo Look Up Tables to quickly identify, in the innermost layers of the ATLAS silicon detectors, triplets of space points reconstructed from hits produced by the same track. The reconstruction strategy is compared, in the ATLAS LVL2 framework, with an alternative tracking algorithm, showing the complementarity of the two approaches. The algorithm’s performance is presented for different event topologies and luminosities, showing good tracking capabilities and uniform results with mean execution times which are compatible ...

  14. Knee Pain during Strength Training Shortly following Fast-Track Total Knee Arthroplasty

    DEFF Research Database (Denmark)

    Bandholm, Thomas; Thorborg, Kristian; Lunn, Troels Haxholdt

    2014-01-01

    BACKGROUND: Loading and contraction failure (muscular exhaustion) are strength training variables known to influence neural activation of the exercising muscle in healthy subjects, which may help reduce neural inhibition of the quadriceps muscle following total knee arthroplasty (TKA......). It is unknown how these exercise variables influence knee pain after TKA. OBJECTIVE: To investigate the effect of loading and contraction failure on knee pain during strength training, shortly following TKA. DESIGN: Cross-sectional study. SETTING: Consecutive sample of patients from the Copenhagen area, Denmark......), and ended with 1 single set to contraction failure (14 RM load). The individual loadings (kilograms) were determined during a familiarization session >72 hours prior. The patients rated their knee pain during each repetition, using a numerical rating scale (0-10). RESULTS: Two patients were lost to follow...

  15. Fast-track rehabilitation following video-assisted pulmonary sublobar wedge resection: A prospective randomized study

    Directory of Open Access Journals (Sweden)

    Christos Asteriou

    2016-01-01

    Full Text Available Background: Postoperative morbidity and inhospital length of stay are considered major determinants of total health care expenditure associated with thoracic operations. The aim of this study was to prospectively evaluate the role of video-assisted thoracic surgery (VATS compared to mini-muscle-sparing thoracotomy in facilitating early recovery and hospital discharge after pulmonary sublobar wedge resections. Patients and Methods: A total number of 120 patients undergoing elective pulmonary sublobar wedge resection were randomly assigned to VATS (n = 60 or mini-muscle-sparing thoracotomy (n = 60. The primary endpoint was time to hospital discharge. Postoperative complications, cardiopulmonary morbidity and 30-day mortality served as secondary endpoints. Results: Patients' baseline demographic and clinical data did not differ among study arms as well as the number of pulmonary segments resected and the morphology of the nodular lesions. Total hospital stay was significantly shorter in patients assigned to the thoracoscopic technique as opposed to those who were operated using the mini-muscle-sparing thoracotomy approach (4 ± 0.6 versus 4.4 ± 0.6 days respectively, P = 0.006. Multivariate analysis revealed that VATS approach was inversely associated with longer inhospital stay whereas the number of resected segments was positively associated with an increased duration of hospitalization. Patients in the VATS group were less likely to develop atelectasis (≥1 lobe compared to those who underwent thoracotomy (0% versus 6.7% respectively, P = 0.042. Kaplan-Meier analysis revealed similar 30-day mortality rates in both study arms (Log-rank P = 0.560. Conclusion: VATS was associated with shorter duration of hospitalization positively affecting the patients' quality of life and satisfaction. Significant suppression of the total cost of recovery after thoracoscopic pulmonary resections is expected.

  16. A Belated Green Revolution for Cannabis: Virtual Genetic Resources to Fast-Track Cultivar Development.

    Science.gov (United States)

    Welling, Matthew T; Shapter, Tim; Rose, Terry J; Liu, Lei; Stanger, Rhia; King, Graham J

    2016-01-01

    Cannabis is a predominantly diecious phenotypically diverse domesticated genus with few if any extant natural populations. International narcotics conventions and associated legislation have constrained the establishment, characterization, and use of Cannabis genetic resource collections. This has resulted in the underutilization of genepool variability in cultivar development and has limited the inclusion of secondary genepools associated with genetic improvement strategies of the Green Revolution. The structured screening of ex situ germplasm and the exploitation of locally-adapted intraspecific traits is expected to facilitate the genetic improvement of Cannabis. However, limited attempts have been made to establish the full extent of genetic resources available for pre-breeding. We present a thorough critical review of Cannabis ex situ genetic resources, and discuss recommendations for conservation, pre-breeding characterization, and genetic analysis that will underpin future cultivar development. We consider East Asian germplasm to be a priority for conservation based on the prolonged historical cultivation of Cannabis in this region over a range of latitudes, along with the apparent high levels of genetic diversity and relatively low representation in published genetic resource collections. Seed cryopreservation could improve conservation by reducing hybridization and genetic drift that may occur during Cannabis germplasm regeneration. Given the unique legal status of Cannabis, we propose the establishment of a global virtual core collection based on the collation of consistent and comprehensive provenance meta-data and the adoption of high-throughput DNA sequencing technologies. This would enable representative core collections to be used for systematic phenotyping, and so underpin breeding strategies for the genetic improvement of Cannabis.

  17. A Belated Green Revolution for Cannabis: Virtual Genetic Resources to Fast-track Cultivar Development

    Directory of Open Access Journals (Sweden)

    Matthew Timothy Welling

    2016-07-01

    Full Text Available Cannabis is a predominantly diecious phenotypically diverse domesticated genus with few if any extant natural populations. International narcotics conventions and associated legislation have constrained the establishment, characterization and use of Cannabis genetic resource collections. This has resulted in the underutilization of genepool variability in cultivar development and has limited the inclusion of secondary genepools associated with genetic improvement strategies of the Green Revolution. The structured screening of ex situ germplasm and the exploitation of locally-adapted intraspecific traits is expected to facilitate the genetic improvement of Cannabis. However, limited attempts have been made to establish the full extent of genetic resources available for pre-breeding. We present a thorough critical review of Cannabis ex situ genetic resources, and discuss recommendations for conservation, pre-breeding characterization and genetic analysis that will underpin future cultivar development. We consider East Asian germplasm to be a priority for conservation based on the prolonged historical cultivation of Cannabis in this region over a range of latitudes, along with the apparent high levels of genetic diversity and relatively low representation in published genetic resource collections. Seed cryopreservation could improve conservation by reducing hybridization and genetic drift that may occur during Cannabis germplasm regeneration. Given the unique legal status of Cannabis, we propose the establishment of a global virtual core collection based on the collation of consistent and comprehensive provenance meta-data and the adoption of high-throughput DNA sequencing technologies. This would enable representative core collections to be used for systematic phenotyping, and so underpin breeding strategies for the genetic improvement of Cannabis.

  18. Fast track program in liver resection: a PRISMA-compliant systematic review and meta-analysis.

    Science.gov (United States)

    Ahmed, Emad Ali; Montalti, Roberto; Nicolini, Daniele; Vincenzi, Paolo; Coletta, Martina; Vecchi, Andrea; Mocchegiani, Federico; Vivarelli, Marco

    2016-07-01

    FT program (FT) is a multimodal approach used to enhance postoperative rehabilitation and accelerate recovery. It was 1st described in open heart surgery, then modified and applied successfully in colorectal surgery. FT program was described in liver resection for the 1st time in 2008. Although the program has become widely accepted, it has not yet been considered the standard of care in liver surgery. we performed this systematic review and meta-analysis to evaluate the impact of using the FT program compared to the traditional care (TC), on the main clinical and surgical outcomes for patients who underwent elective liver resection. PubMed/Medline, Scopus, and Cochran databases were searched to identify eligible articles that compared FT with TC in elective liver resection to be included in this study. Subgroup meta-analysis between laparoscopic and open surgical approaches to liver resection was also conducted. Quality assessment was performed for all the included studies. Odds ratios (ORs) and mean differences (MDs) were considered as a summary measure of evaluating the association in this meta-analysis for dichotomous and continuous data, respectively. A 95% confidence interval (CI) was reported for both measures. I was used to assess the heterogeneity across studies. From 2008 to 2015, 3 randomized controlled trials (RCTs) and 5 cohort studies were identified, including 394 and 416 patients in the FT and TC groups, respectively. The length of hospital stay (LoS) was markedly shortened in both the open and laparoscopic approaches within the FT program (P < 0.00001). The reduced LoS was accompanied by accelerated functional recovery (P = 0.0008) and decreased hospital costs, with no increase in readmission, morbidity, or mortality rates. Moreover, significant results were found within the FT group such as reduced operative time (P = 0.03), lower intensive care unit admission rate (P < 0.00001), early bowel opening (P ≤ 0.00001), and rapid normal

  19. Research on nursing effect of fast track surgery used in colon cancer surgery in a primary hospital%快速康复外科护理应用于基层医院结肠癌手术患者的效果评价

    Institute of Scientific and Technical Information of China (English)

    赵华丽; 孙明侠

    2015-01-01

    目的 探讨基层医院应用快速康复外科护理结肠癌手术患者的护理效果.方法 将60例行结肠癌手术的患者应用随机数字表法随机分为快速康复组(A组)和常规护理组(B组)各30例.A组患者接受快速康复外科护理,B组患者给予常规护理,比较2组患者术后的肛门排气时间、进食时间、住院时间、住院费用以及术后并发症的发生情况、患者的满意度.结果 A组患者肛门排气时间(t=3.571)、进食时间(t=8.944)、住院时间(t=3.397)、住院费用(t=3.950)以及术后并发症的发生率均低于B组,A组患者满意度为96.67%(29/30),B组为83.33%(25/30),2组的满意度比较差异有统计学意义(x2=5.794).结论 在基层医院结肠癌围手术期患者中实施快速康复外科护理,可加快患者的康复,缩短了住院时间,减少住院费用,降低术后并发症的发生,减轻了护士的工作量,提高了患者的满意度.%Objective The study aimed to explore the application of fast track surgery in nursing of patients with colon cancer in a primary hospital.Methods The 60 colon cancer patients were identified with numbers to indicate randomization into the fast tract surgery group (group A) and the conventional treatment group (group B) with 30 cases in each group.Group A used the concept of fast track surgery (FST) perioperative nursing care,whereas traditional perioperative nursing care for colon cancer was used in group B.Patients in both groups were observed for postoperative time for passage of gas by anus,time for first food intake,length of stay in hospital,fee for hospitalization as well as incidence of postoperative complications,and comparative analysis was carried out.Results Time for passage of gas by anus(t value was 3.571),time for first food intake (t value was 8.944),length of stay in hospital (t value was 3.397),fee for hospitalization (t value was 3.950) as well as incidence of postoperative complication in group A were lower

  20. 合并呼吸功能不全病人围手术期快速康复治疗%Fast track surgery in patients with respiratory insufficiency

    Institute of Scientific and Technical Information of China (English)

    朱德祥; 任黎; 许剑民

    2011-01-01

    手术病人的快速康复治疗(fast track surgery)创新性地整合了围手术期一系列干预措施,这些干预措施在合并呼吸功能不全的手术病人中被证明具有良好效果,从而达到减少机体创伤应激反应,加快正常功能恢复和减少术后并发症的目的.%Fast track surgery in patients with respiratory insufficiency has been introduced as an integrated protocol to combine unimodal evidence-based perioperative intervention into a multi-modal effort to shorten stress and enhance recovery.

  1. Fast Tracks to Intelligence

    Science.gov (United States)

    Calvin, W. H.

    It is often assumed that the evolution of intelligence is inevitable, given the self-organizing seen in dissapative systems and the gradual shaping-up of Darwinism. While compound-interest reasoning suggests that small advantages will eventually triumph, eventually may be a very long time: there are few examples of rapid brain growth, suggesting that "smarter-is-better" is not a potent force for evolution.

  2. Implementing a Comprehensive Program for the Prevention of Conduct Problems in Rural Communities: The Fast Track Experience1

    Science.gov (United States)

    Bierman, Karen L.

    2012-01-01

    Childhood conduct problems are predictive of a number of serious long-term difficulties (e.g., school failure, delinquent behavior, and mental health problems), making the design of effective prevention programs a priority. The Fast Track Program is a demonstration project currently underway in four demographically diverse areas of the United States, testing the feasibility and effectiveness of a comprehensive, multicomponent prevention program targeting children at risk for conduct disorders. This paper describes some lessons learned about the implementation of this program in a rural area. Although there are many areas of commonality in terms of program needs, program design, and implementation issues in rural and urban sites, rural areas differ from urban areas along the dimensions of geographical dispersion and regionalism, and community stability and insularity. Rural programs must cover a broad geographical area and must be sensitive to the multiple, small and regional communities that constitute their service area. Small schools, homogeneous populations, traditional values, limited recreational, educational and mental health services, and politically conservative climates are all more likely to emerge as characteristics of rural rather than urban sites (Sherman, 1992). These characteristics may both pose particular challenges to the implementation of prevention programs in rural areas, as well as offer particular benefits. Three aspects of program implementation are described in detail: (a) community entry and program initiation in rural areas, (b) the adaptation of program components and service delivery to meet the needs of rural families and schools, and (c) issues in administrative organization of a broadly dispersed tricounty rural prevention program. PMID:9338956

  3. Results of the treatment for pancreatic carcinoma

    Energy Technology Data Exchange (ETDEWEB)

    Wakasugi, Hideyuki; Funakoshi, Akihiro; Iguchi, Haruo [National Hospital of Kyushu Cancer Center, Fukuoka (Japan)] [and others

    2000-07-01

    We evaluated results of the treatment for invasive ductal pancreatic carcinoma, which accounted for 90.6% of all pancreatic carcinomas. Three hundred thirty-six patients with this carcinoma (214 men and 122 women) were divided into two groups: one was admitted between 1978 and 1987, and the other, between 1988 and 1997. Investigation items were as follows: survival period (median), one-year survival rate, stage, diabetes, treatment. The latter group (193 cases in 1988-1997) lived slightly but significantly longer than the former group (143 cases in 1978-1987): median survival 125{yields}161.5 days, one-year survival rate 13.3{yields}18.7%. As a cause of the improvement, we obtained results that suggested the usefulness of radiotherapy: trialed cases of radiotherapy 44.0{yields}50.2%, median survival 146{yields}199.5 days, and one-year survival rate 9.5{yields}14.6%. In conclusion, results of the treatment for pancreatic carcinoma showed a slight but significant improvement. (author)

  4. [Results of the surgical treatment of thyrotoxicosis].

    Science.gov (United States)

    Uchikov, A; Nonchev, B; Danev, V; Murdzhev, K; Vladeva, S; Terzieva, D

    2006-01-01

    The aim of this study was to evaluate the results of the surgical treatment of patients with thyrotoxicosis in three surgical clinics in Plovdiv. PATIENTS AND MEDHOTS: We studied 90 patients, who underwent surgical treatment for thyrotoxicosis between 2000-2004. Of those 19 men (21%) and 71 women (79%); men:women = 1:3.74; mean age 38 +/- 8.3 years. The nosological distribution was as follows: Graves' disease--72 subjects (80.00%), solitary toxic adenoma--4 subjects (4.40%), toxic nodular goiter--14 subjects (15.60%). 77 subtotal thyroidectomies (85%) and 9 total thyroidectomies were performed. Patients with solitary toxic adenoma underwent lobectomy. Massive bleeding witch required revision and haemostasis was encountered in 1 patient. Transient laryngeal nerve injury occurred in 3 patients (3.33%), and temporary hypoparathyroidism in 6 subjects (6.67%), necessitating calcium supplementation. One year postoperatively, 49.35% (n = 38) of the patients who have undergone subtotal thyroidectomy were euthyroid, 45.45% (n = 35) developed hypothyroidism, and 5.2% (n = 4) relapsed. Our results indicate that surgery is safe and effective for patients with thyrotoxicosis referred for radical treatment. Because of the high rate of postoperative thyroid disfunction, assessment of the non-operative factors, witch influence the functional results, is recommended.

  5. Relatives in older patients' fast-track treatment programme during total hip or knee replacement. A grounded theory study

    DEFF Research Database (Denmark)

    Berthelsen, Connie Bøttcher

    was collected between 2010 and 2011 in the orthopaedic wards of two Copenhagen university hospitals, and guided by theoretical sampling. Study I: Seven relatives of patients over 70 years of age participated. Data consisted of 14 non-participant observations, 14 post-observational interviews, and five formal...... interviews. Maintaining Unity emerged as the relatives’ pattern of behaviour, through which they resolved their main concern; preventing the patients from feeling alone. The relatives resolved their main concern through three interchangeable behavioural modes: Protecting mode, by providing loving...

  6. 快速康复外科理念在初次行人工全膝关节置换术围术期临床应用%Application of fast-track surgery concept around perioperative total knee arthroplasty

    Institute of Scientific and Technical Information of China (English)

    何勇; 刘欣伟; 张敬东; 孙保飞; 韩文锋; 刘松波; 刘海立

    2016-01-01

    目的:探讨快速康复外科理念在初次行人工全膝关节置换术( TKA)围术期的临床应用效果。方法选取自2015年7月1日至2015年12月31日沈阳军区总医院骨科初次行人工TKA的60例患者,随机分为快速康复组和传统康复组,每组各30例患者。记录两组患者住院时间、住院费用、以及围术期并发症情况。采用疼痛视觉模拟评分( VAS)评估两组患者的疼痛程度,关节活动度( ROM)评估临床疗效。结果快速康复组住院时间短于传统康复组,差异有统计学意义(P<0.05);手术疗效优于传统康复组,差异有统计学意义(P<0.05);两组住院费用比较,差异无统计学意义( P>0.05)。结论将快速康复外科理念应用于初次行人工TKA围术期,能够加速患者早期康复,缩短患者平均住院时间,降低围术期不良反应的发生率,提高了临床疗效。%Objective To explore the clinical efficacy of the fast-track surgery concept around perioperative total knee ar-throplasty .Methods A retrospective study was performed on 60 cases of patients that received first artificial total knee ar-throplasty in the General Hospital of Shenyang Military Command from July 1 to December 31 ,2015 .Patients were randomly divided into the fast-track surgery group and the traditional rehabilitation group ,with 30 cases in each group .The length of stay,hospital costs and perioperative complications were recorded .Using visual analogue scale ( VAS) to assess the level of pain between the two groups and range of motion ( ROM) to assess the clinical efficacy .Results The hospitalized time in fast-track surgery group was significantly shorter than that in the traditional rehabilitation group ( P0.05 ) .Conclusion The appli-cation of fast-track surgery around perioperative total knee arthroplasty can be beneficial to patients with fast early rehabili -tation,reduce hospitalization time and improve

  7. The using experience of fast track surgery in laparoscopic commom bile duct exploration%快速康复外科在腹腔镜胆总管探查手术中的应用体会

    Institute of Scientific and Technical Information of China (English)

    罗洁; 王春华; 张伟; 李敏; 李毅

    2011-01-01

    目的:探讨快速康复外科(Fast Track Surgery)在腹腔镜胆总管探察手术(LCBDE)的应用效果.方法:遂宁市中心医院肝胆外科2009年6月~2011年2月对97例胆总管结石患者施行腹腔镜胆总管探察术,按治疗小组为单位分为两组:第一组(n=42)采用四孔法腹腔镜手术和传统方式进行围手术期处理,第二组(n=55)采用三孔法腹腔镜手术并运用快速康复外科理念指导围手术期处理.比较两组术后恶心、呕吐发生率,术后12小时疼痛程度,首次进食时间,下床活动时间,排气、排便时间,住院天数以及住院总费用.结果:97例手术均获成功,无严重术后并发症.两组术后恶心、呕吐发生率,术后12小时疼痛程度,首次进食时间,下床活动时间,排气、排便时间,住院天数以及住院总费用比较差别均有统计学意义(P<0.05).结论:快速康复外科理念能够减轻腹腔镜胆总管探察术后并发症,促进患者更快康复,降低住院费用,具有安全性和可操作性.%Objective: To evaluate the effects of Fast Track Surgery in laparoscopic commom bile duct exploration. Methods: During the period between June 2009 and February 2011,90 common duct stone patients were performed exploration surgery of LCBDE in the department of hepatobiliary surgery in Suining Central hospital. The patients were classified into two groups. 42 of them were classified to group one, which were subjected to 4 - holes Laparoscopic surgery with traditional ways of perioperative period. while 55 of them were classified to group two,which were subjected to 3 - holes Laparoscopic surgery and were treated under the guidance of Fast Track Surgery in perioperative period. After surgery, The incidence of nausea and vomits, ache level after 12 hours, first foodtake time, out -of - bed activity time, fart and defecate time, hospital day and hospital cost were compared between the two groups. Results: All the 97 surgeries were successful and no

  8. Application of fast-track anesthesia in the surgery for colorectal cancer in elderly patients%快通道麻醉在老年结直肠肿瘤手术中的应用

    Institute of Scientific and Technical Information of China (English)

    吴世贵; 刘吉生; 陈尔标

    2014-01-01

    Objective To discuss the clinical effects of fast-track anesthesia in the surgery for colorectal can-cer in elderly patients. Methods Ninety-two elderly patients with colorectal cancer undergoing laparoscopic surgery were randomly divided into observation group (n=46) and control group (n=46). The observation group was given fast-track anesthesia, and the control group was given general inhalation anesthesia. And then the Steward scores and neuroendocrine changes were compared between the two groups. Results There were more patients with Steward≥4 after operation in the observation group than that in the control group (P0.05). However, the plasma cortisol and glucose concentrations after the incision, in the end of surgery, and 1 h postoperative were significantly lower in the observation group than those in the control group (P0.05),而麻醉开始后观察组患者在切皮后、手术结束时以及术后1 h血浆皮质醇及血糖均显著低于对照组(P<0.05或P<0.01);观察组术后出现恶心、呕吐发生率显著低于对照组(P<0.01)。结论快通道麻醉能够使患者获得较快的术后苏醒,同时降低了麻醉及手术操作对患者神经内分泌系统功能的影响,减少了麻醉损伤,且术后恶心呕吐等不良反应发生率较低,值得推广应用。

  9. The impact of the Medicines Control Council backlog and fast-track review system on access to innovative and new generic and biosimilar medicines of public health importance in South Africa.

    Science.gov (United States)

    Leng, Henry Martin John; Pollock, Allyson M; Sanders, David

    2016-03-17

    The fast-track registration policy of the South African National Department of Health allows for rapid registration of new medicines of public health importance and of all medicines on the Essential Medicines List, most of which are generics. No limit is placed on the number of generic brands of a medicine that can be submitted for fast-track registration. This, together with resource constraints at the regulator, may delay access to important new medicines, new fixed-dose combinations of critical medicines or affordable versions of biological medicines (biosimilars). One reason for not limiting the number of fast-track generic applications was to promote price competition among generic brands. We found this not to be valid, since market share correlated poorly with price. Generic brands with high market share were, mostly, those that were registered first. We propose that the number of generic brands accepted for fast-tracking be limited to not more than seven per medicine.

  10. Laser treatment of stretch marks: preliminary results

    Science.gov (United States)

    Longo, Leonardo; Piccinetti, A. L.; Monache, G. D.; Botta, G.; Mancini, S.

    2000-06-01

    The best treatment of these stretch mark is still unknown. Some authors proposed the treatment with flash-lamp-pumped dye laser 585 nm, with fluence over 8 J/cm2. Reviewing our experiences on no-surgical effects of lasers in the various phases of the wound healing, including the re- epithelization, we would like to apply the no-surgical laser therapy treating the stretch marks of breast, abdomen and lumbo-sacral region. The goal is to inhibit the fibrous tissue metabolism, encouraging the destruction of the collagen fibers with inflammatory mechanism, and increasing the reconstitution of the superficial dermis layers. We treated five cases of stretch marks in women 22-35 years old, since May 1999, with a cycle of applications of double lasers, 511 and 577 nm, with energy of 20 Joule for spot, respecting the maximum thermal relaxation times of the skin. We waited two weeks interval between the applications. Results obtained after five applications are very positive, and we are encouraged to continue this experimentation.

  11. Development, effectiveness and cost-effectiveness of a new out-patient Breathlessness Support Service: study protocol of a phase III fast-track randomised controlled trial

    Directory of Open Access Journals (Sweden)

    Bausewein Claudia

    2012-09-01

    Full Text Available Abstract Background Breathlessness is a common and distressing symptom affecting many patients with advanced disease both from malignant and non-malignant origin. A combination of pharmacological and non-pharmacological measures is necessary to treat this symptom successfully. Breathlessness services in various compositions aim to provide comprehensive care for patients and their carers by a multiprofessional team but their effectiveness and cost-effectiveness have not yet been proven. The Breathlessness Support Service (BSS is a newly created multiprofessional and interdisciplinary outpatient service at a large university hospital in South East London. The aim of this study is to develop and evaluate the effectiveness and cost effectiveness of this multidisciplinary out–patient BSS for the palliation of breathlessness, in advanced malignant and non-malignant disease. Methods The BSS was modelled based on the results of qualitative and quantitative studies, and systematic literature reviews. A randomised controlled fast track trial (RCT comprising two groups: 1 intervention (immediate access to BSS in addition to standard care; 2 control group (standard best practice and access to BSS after a waiting time of six weeks. Patients are included if suffering from breathlessness on exertion or at rest due to advanced disease such as cancer, chronic obstructive pulmonary disease (COPD, chronic heart failure (CHF, interstitial lung disease (ILD or motor neurone disease (MND that is refractory to maximal optimised medical management. Both quantitative and qualitative outcomes are assessed in face to-face interviews at baseline, after 6 and 12 weeks. The primary outcome is patients' improvement of mastery of breathlessness after six weeks assessed on the Chronic Respiratory Disease Questionnaire (CRQ. Secondary outcomes for patients include breathlessness severity, symptom burden, palliative care needs, service use, and respiratory measures (spirometry

  12. Surgical Treatment Results of Acute Acromioclavicular Injuries

    Directory of Open Access Journals (Sweden)

    Mahmoud Jabalameli

    2010-02-01

    Full Text Available Background Different methods of surgical treatment for acromioclavicular(ACjoint injury were considered in the literature. The purpose of the study was to compare intra- articular AC repair technique with the extra-articular coracoclavicular repair technique for the patients with Rockwood type III and VAC joint injury when indicated.Methods: Nineteen consecutive patients with Rockwood type III and VAC joint injury  were treated with intra-articular (Group I - 12 cases and extra-articular (Group II - 7cases repair technique between 1380 - 1386, and the results reviewed. When the diagnosis was established, the mean age of the patients was 32.5 years (Range, 18 - 60; group I and II 31.8 years (Range, 18 - 60 and 34 years (Range, 22 - 58 respectively. The mean duration of postoperative follow - up was 24 months. The Constant shoulder scoring system was applied to obtain clinical results.   Results: Only in group I, the post-surgical complication was associated with fiber allergy, wound infection and pin site infection in two patients respectively. No pain was detected in fourteen cases. Four patients in group I had occasional mild pain during sport activity, while one case in this group reported severe pain during resting which prevented the patient from activity. Also, there was an ossification in thirteen patients particularly in group I. Clinical results showed the mean constant shoulder score was 93.4 in group I and 97.1 in group II.Conclusion: At the time of the follow - up, there was a clear difference between both groups regarding to postoperative pain and discomfort.Therefore, it seemed that potential cause of pain was due to postoperative complications. An interesting postoperative complication without interfere in the functional outcome was coracoclavicular space ossification in most cases. This was probably because of soft tissue injury during the operation.It seemed that surgical treatment of Rockwood type III and VAC joint injuries

  13. Treatment results in isolated humerus majus fractures

    Directory of Open Access Journals (Sweden)

    Hakan Serhat Yanık

    2012-09-01

    Full Text Available Introduction: The aim of this study is to evaluate the resultsof patients with the isolated greater tubercul fractures(GTF of humerus who conservatively or surgicallytreated.Materials and methods: 23 patients were admitted (11women, 12 men with GTF (54% dominant side of 24shoulder between 2008 and 2011. All of patient wereevaluated with MRI as preoperatively soft tissue injury.There was supraspinatus muscle tear together with GTFin 3 case and their shoulder were arthroscopically assistedrotator cuff repair. Osteosynthesis was performed in 3case with screw and fixation in 2 case with suture. GTF of16 shoulder were conservatively treated. Shoulder functionafter treatment were evaluated according to Constantscore (CS, Quick-DASH score (QDS and VAS score.Results: Three patients with screw fixation had CS 68,6points, QDS 12,8 points, VAS score 1,66. Two patientswith suture fixation had 67,5 CS points, 5,1 QDS pointsp,and 2 VAS score. Three patients with rotator cuff tear repairhad 82,6 CS points, 16,6 QDS points, and 2,33 VASscore. In patients with conservatively treated mean CSwas 63,9 points, QDS 26,1 points, VAS 2,96 points.Conclusions: In this study, conservative and surgicaltreatment results were satisfactory. In terms of pain theresults were excellent. In conclusion, GTFs are rare buttrouble-free with a good observation and sufficient rehabilitation.J Clin Exp Invest 2012; 3 (3: 378-382Key words: Humerus, fracture, greater, tubercul

  14. The Results of Surgical Treatment for Cyclotropia

    Directory of Open Access Journals (Sweden)

    Sibel Kocabeyoğlu

    2012-01-01

    Full Text Available Pur po se: To describe the effectiveness of oblique muscle surgery for cyclodeviations with vertical deviations. Ma te ri al and Met hod: Twenty-two eyes of 17 patients with cyclotropia were included in the study. All cases were examined pre- and postoperatively. Vertical and horizontal deviations, eye movements and oblique muscle functions were measured with prism cover test, while the degree of cyclotropia was evaluated with double Maddox rod and fundus photographs. Surgical techniques were anterior transposition of the inferior oblique muscle, inferior oblique recession, superior oblique tenotomy and superior oblique tucking. Re sults: There were 6 males and 11 females. The mean age of the patients was 17.4±9.7 years (range: 6-34 years and the mean follow-up time was 6.9±3.1 months (range: 3-12 months. Eight patients (47.1% presented with superior oblique palsy. Seven patients had a concomitant horizontal deviation; 29.4% of the patients had esotropia and 11.7% of the patients had exotropia. Eight eyes underwent anterior transposition of the inferior oblique muscle, 8 eyes underwent inferior oblique recession, 2 eyes underwent superior oblique tuck, and 4 eyes underwent superior oblique tenotomy. Anterior transposition of the inferior oblique muscle and inferior oblique recession were found as effective procedures in the treatment of vertical deviations and cyclotropia, but there was no statistically significant difference between the two procedures. Dis cus si on: Anterior transposition of the inferior oblique muscle and inferior oblique recession were found as effective procedures in the treatment of vertical deviations and cyclotropia. Anterior transposition of the inferior oblique muscle was found to be more effective than inferior oblique recession in the treatment of inferior oblique overaction. (Turk J Ophthalmol 2012; 42: 38-42

  15. Incidence of and risk factors for postoperative urinary retention in fast-track hip and knee arthroplasty

    DEFF Research Database (Denmark)

    Bjerregaard, Lars S; Bogø, Stina; Raaschou, Sofie

    2015-01-01

    , and preoperative international prostate symptom score (IPSS) were compared between catheterized and non-catheterized patients. RESULTS: The incidence of POUR was 40% (range between departments: 30-55%). Median bladder volume evacuated by catheterization was 0.6 (0.1-1.9) L. Spinal anesthesia increased the risk...... was 40%, with spinal anesthesia and increased IPSS in males as predictive factors. The large variation in perioperative bladder management and in bladder volumes evacuated by catheterization calls for randomized studies to define evidence-based principles for treatment of POUR in the future....

  16. 快速康复外科理念在妇科围手术期护理中的应用效果观察%Effect observation of fast track surgery applied in the gynecological perioperative nursing

    Institute of Scientific and Technical Information of China (English)

    安旭菁; 李明洁

    2015-01-01

    Objective:To explore the application effect of fast track surgery in gynecological surgery nursing.Methods:232 cases of patients with gynaecopathia were divided into the traditional nursing group and the rapid rehabilitation group.The postoperative taking food time,postoperative activity time out of bed,hospitalization time and nursing satisfaction of the two groups were compared.Results:The postoperative taking food time,postoperative activity time out of bed,hospitalization time and complications of the rapid rehabilitation group were less than those of the traditional nursing group,and the differences were statistically significant(P<0.05).The nursing satisfaction of the rapid rehabilitation group was significantly superior to that of the traditional nursing group(P<0.05).Conclusion:Fast track surgery could promote the recovery of patients with gynecological surgery,shorten the hospitalization time and avoid the postoperative complications.%目的:探讨快速康复外科理念在妇科手术护理中的应用效果。方法:将妇科病患者232例分为传统护理组和快速康复组,对比两组的术后进食时间、下床活动时间、住院时间及护理满意率。结果:快速康复组的术后进食时间、下床活动时间、住院时间、并发症发生率均低于传统护理组,差异有统计学意义(P<0.05)。快速康复组护理满意程度显著优于传统护理组(P<0.05)。结论:快速康复理念可促进妇科手术患者的恢复,缩短住院时间,避免术后并发症。

  17. Initial impact of the Fast Track prevention trial for conduct problems: I. The high-risk sample. Conduct Problems Prevention Research Group.

    Science.gov (United States)

    1999-10-01

    Fast Track is a multisite, multicomponent preventive intervention for young children at high risk for long-term antisocial behavior. Based on a comprehensive developmental model, intervention included a universal-level classroom program plus social skills training, academic tutoring, parent training, and home visiting to improve competencies and reduce problems in a high-risk group of children selected in kindergarten. At the end of Grade 1, there were moderate positive effects on children's social, emotional, and academic skills; peer interactions and social status; and conduct problems and special-education use. Parents reported less physical discipline and greater parenting satisfaction/ease of parenting and engaged in more appropriate/consistent discipline, warmth/positive involvement, and involvement with the school. Evidence of differential intervention effects across child gender, race, site, and cohort was minimal.

  18. Short-term impact of fast track surgery combined with minimally invasive surgery on elderly patients with colorectal cancer%快速康复外科联合微创手术在老年大肠癌患者中的短期效果分析

    Institute of Scientific and Technical Information of China (English)

    梁显军; 章周梁; 郭帅; 梁建华; 杨余沙

    2016-01-01

    Objective To analyze the short-term impact of fast track surgery (FTS) combined with minimally inva-sive surgery on elderly patients with colorectal cancer. Methods 200 patients with colorectal cancer received laparo-scopic surgery from July 2013 to July 2015 were selected and randomly divided into control group and FTS group. Patients in control group received conventional perioperative treatment and patients in FTS group received perioper-ative management according to fast track surgery. Status of intraoperative, postoperative recovery and the postopera-tive complication rate were compared between the two groups. Patients' quality of life were analyzed after two weeks of operation. Results Compared with the control group, the blood loss, operation time and number of lymph node dissection of patients in FTS group showed no significant difference ( > 0.05). Flatus time, ambulation time, start eating time, the infusion time and length of hospital stay in FTS group was significantly shorter than the control group, the difference was statistically significant ( 0.05)。加速康复组患者术后肛门排气时间、下地活动时间、开始进食时间、输液时间及住院时间明显短于对照组,差异均有统计学意义(<0.05),其总住院费用明显低于对照组(<0.05)。加速康复组术后咽痛、腹胀、肺部感染的发生率及并发症总发病率均明显低于对照组,差异均有统计学意义(<0.05)。加速康复组患者治疗满意为率96.0%(96/100)明显高于对照组82.0%(82/100),差异有统计学意义(<0.05)。欧洲癌症研究与治疗组织(EORTC)的生存质量核心问卷(QLQ- C30)调查结果显示加速康复组患者总体健康、情绪功能及社会功能评分明显高于对照组(<0.05),而恶心呕吐、疼痛、失眠、食欲减退和便秘评分明显低于对照组(<0.05)。结论快速康复治疗联合腹腔镜在老年大肠癌的治疗中安全有效

  19. Application of fast track surgery in patients undergoing surgery for rectal cancer%快速康复外科在直肠癌手术患者的应用

    Institute of Scientific and Technical Information of China (English)

    钱飞; 朱建伟; 于嘉伟; 孙乃志; 肖建佳; 陈澍周

    2015-01-01

    Objective To investigate the value of fast track surgery in the patients undergoing rectal cancer surgery .Methods Sixty patients with rectal cancer were randomized into two groups of A(treated with fast track surgery ,30 cases) and B(treated with conventional surgery ,30 cases) .The measures of fast track surgery included having liquid food and oral laxative ,but without enema one day before operation ,drinking a liquid with energy such as sugar water 250 ml ,not inserting indwelling gastric tube and urine catheter before surgery ,and having liquid food and restrictively infusing fluid of 2000‐2500 ml on the first postoperative day .The white blood cell counting one day after operation ,the first time of flatus passage ,postoperative hospital stay and complications were compared between two groups .Results Compared to group B ,the patients in group A had less white blood cell counting [(10.50 ± 1.56) × 109/L vs .(13.04 ± 2.53 ) × 109/L ]( P<0 .05 ) ,earlier passage of flatus [(2.5 ± 0.6) d vs .(3.8 ± 0.7 ) d ] ( P<0 .05 ) ,shorter hospital stay [(9.1 ± 2.9 ) d vs .(11.6 ± 3.5 ) d ] (P<0 .05) and lower incidence of complication (10.0% vs .30.0% )(P<0 .05) .Conclusion Fast track surgery in rectal cancer surgery can promote the recovery of bowel function ,reduce complications and hospital stay .%目的探讨快速康复外科在直肠癌手术中的应用价值。方法符合入组条件的60例直肠癌患者随机均分为快速康复组(A组)和传统治疗组(B组)。A组快速康复外科措施包括:(1)术前进流质1d,口服泻剂,不灌肠;(2)术前4h一次性口服能量液体,例如糖水250ml;(3)术前不留置胃管和导尿管;(4)术后第1天进流质后,限制性补液,补液量2000‐2500ml。比较术后第1天白细胞计数、术后首次排气时间、术后住院天数和并发症发生率等指标。结果与B组比较,A组术后第1天白细胞计数低[(10.50±1.56)×109/Lvs.(13

  20. Treatments for Infertility Resulting from Polycystic Ovary Syndrome (PCOS)

    Science.gov (United States)

    ... Information Clinical Trials Resources and Publications Treatments for Infertility Resulting from PCOS Skip sharing on social media ... reason for these problems. Before beginning treatment for infertility possibly related to PCOS, be sure that your ...

  1. 加速康复外科可能成为创伤救治的新模式%Fast-track surgery shall be the new mode for the trauma remedy

    Institute of Scientific and Technical Information of China (English)

    程黎阳

    2012-01-01

    Fast-track surgery (FTS) has been proved to be associated with a faster recovery, lower complication rates and a shorter stay in hospital for colorectal and other surgery which considered as a new principle to thoroughly change present surgical diagnose and treatment mode. But FTS is now mainly used in single, typical and elective surgery without severe malnutrition and organ dysfunction except for emergency, critical trauma and infection. Combining the literature and our re -search, the mechanism, significance and program for the application of FTS in trauma remedy are introduced in this article, as to discuss that FTS should be hoped to expand the theory and to become the new mode and standard of trauma remedy.%加速康复外科(FTS)在结直肠及其他外科手术中的应用,已被证明可显著加速术后康复进程,降低并发症的发生率,缩短术后住院时间,因而被认为是一种可能彻底改变目前外科诊疗模式的最新外科原则.但FTS当前的应用主要集中在择期结直肠手术中,尚未将其推广应用到急诊、严重创伤和感染等急危重症中.本文结合文献和作者研究,从应用机理、意义及方案等方面论述了FTS可望拓展创伤救治理论,树立创伤救治新模式和新标准的可能性.

  2. FastTrack to supercritical fluid chromatographic purification: Implementation of a walk-up analytical supercritical fluid chromatography/mass spectrometry screening system in the medicinal chemistry laboratory.

    Science.gov (United States)

    Aurigemma, Christine; Farrell, William

    2010-09-24

    Medicinal chemists often depend on analytical instrumentation for reaction monitoring and product confirmation at all stages of pharmaceutical discovery and development. To obtain pure compounds for biological assays, the removal of side products and final compounds through purification is often necessary. Prior to purification, chemists often utilize open-access analytical LC/MS instruments because mass confirmation is fast and reliable, and the chromatographic separation of most sample constituents is sufficient. Supercritical fluid chromatography (SFC) is often used as an orthogonal technique to HPLC or when isolation of the free base of a compound is desired. In laboratories where SFC is the predominant technique for analysis and purification of compounds, a reasonable approach for quickly determining suitable purification conditions is to screen the sample against different columns. This can be a bottleneck to the purification process. To commission SFC for open-access use, a walk-up analytical SFC/MS screening system was implemented in the medicinal chemistry laboratory. Each sample is automatically screened through six column/method conditions, and on-demand data processing occurs for the chromatographers after each screening method is complete. This paper highlights the "FastTrack" approach to expediting samples through purification.

  3. Evaluation of a point-of-care tuberculosis test-and-treat algorithm on early mortality in people with HIV accessing antiretroviral therapy (TB Fast Track study): study protocol for a cluster randomised controlled trial.

    Science.gov (United States)

    Fielding, Katherine L; Charalambous, Salome; Hoffmann, Christopher J; Johnson, Suzanne; Tlali, Mpho; Dorman, Susan E; Vassall, Anna; Churchyard, Gavin J; Grant, Alison D

    2015-03-28

    Early mortality for HIV-positive people starting antiretroviral therapy (ART) remains high in resource-limited settings, with tuberculosis the most important cause. Existing rapid diagnostic tests for tuberculosis lack sensitivity among HIV-positive people, and consequently, tuberculosis treatment is either delayed or started empirically (without bacteriological confirmation). We developed a management algorithm for ambulatory HIV-positive people, based on body mass index and point-of-care tests for haemoglobin and urine lipoarabinomannan (LAM), to identify those at high risk of tuberculosis and mortality. We designed a clinical trial to test whether implementation of this algorithm reduces six-month mortality among HIV-positive people with advanced immunosuppression. The TB Fast Track study is an open, pragmatic, cluster randomised superiority trial, with 24 primary health clinics randomised to implement the intervention or standard of care. Adults (aged ≥18 years) with a CD4 count of 150 cells/μL or less, who have not received any tuberculosis treatment in the last three months, or ART in the last six months, are eligible. In intervention clinics, the study algorithm is used to classify individuals as at high, medium or low probability of tuberculosis. Those classified as high probability start tuberculosis treatment immediately, followed by ART after two weeks. Medium-probability patients follow the South African guidelines for test-negative tuberculosis and are reviewed within a week, to be re-categorised as low or high probability. Low-probability patients start ART as soon as possible. The primary outcome is all-cause mortality at six months. Secondary outcomes include severe morbidity, time to ART start and cost-effectiveness. This trial will test whether a primary care-friendly management algorithm will enable nurses to identify HIV-positive patients at the highest risk of tuberculosis, to facilitate prompt treatment and reduce early mortality. There

  4. Meta analysis on the application of fast track surgery in gastrectomy for gastric cancer%快速康复外科在胃癌手术中应用的Meta分析

    Institute of Scientific and Technical Information of China (English)

    丁杰; 汪灏; 管文贤

    2015-01-01

    目的 系统评价快速康复外科(fast track surgery,FTS)在胃癌切除术中应用的安全性和有效性.方法 计算机检索1994年1月至2014年3月Pubmed、Medline、Cochrane library、Web ofscience数据库关于FTS在胃癌切除术中应用的随机对照实验(RCT)或临床对照实验(CCT),并辅用Google进行手工检索,对符合标准的文献采用RevMan 5.0软件进行Meta分析.结果 5组RCT和2组CCT纳入研究,共有636例患者,其中FTS组309例,对照组327例.Meta分析结果显示:FTS组较对照组术后肠道通气时间提前[WMD=-18.74,95% CI(-34.31,-3.17),P<0.05]、住院时间减少[WMD=-2.46,95% CI(-3.75,-1.17),P=0.000 2]、住院费用减少[SMD=-0.67,95% CI(-1.00,-0.34),P<0.000 1],但在手术时间、术中出血量、术中淋巴结清扫数目、导尿管拔除时间及并发症发生率方面相比差异均无统计学意义(均P>0.05).结论 FTS在胃癌切除术中应用能够促进术后肠道功能恢复、缩短住院时间和减少住院费用,从而加速患者康复出院.%Objective To review the safety and efficacy of fast track surgery in gastrectomy for gastric cancer.Methods The computer retrieved databases, including Pubmed, Medline, Cochrane library and Web of science, to collect randomized controlled trials (RCT) or controlled clinical trials (CCTS) on FTS was used in gastrectomy for gastric cancer between January 1994 and march 2014, and manual retrieval in Google.Using RevMan5.0 software analysis data that extract from collect literature.Results A total of five RCTs and two CCTs, involving 636 patients,were included, there were 309 cases in experimental group (FTS group) and 327 cases in control group.Meta-analysis showed: the FTS group had earlier postoperative flatus [WMD =-18.74, 95% CI (-34.31,-3.17), P < 0.05], shorter postoperative hospital stay [WMD =-2.46, 95% CI (-3.75,-1.17), P=0.000 2], and lower hospital charge [SMD =-0.67, 95% CI (-1.00,-0.34), P < 0.000 1].However

  5. Fast track, dynein-dependent nuclear targeting of human immunodeficiency virus Vpr protein; impaired trafficking in a clinical isolate

    Energy Technology Data Exchange (ETDEWEB)

    Caly, Leon [Department of Biochemistry and Molecular Biology, Monash University, Clayton, Vic. 3800 (Australia); Kassouf, Vicki T. [Centre for Virus Research, The Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW 2145 (Australia); Moseley, Gregory W. [Department of Biochemistry and Molecular Biology, Monash University, Clayton, Vic. 3800 (Australia); Diefenbach, Russell J.; Cunningham, Anthony L. [Centre for Virus Research, The Westmead Institute for Medical Research, The University of Sydney, Westmead, NSW 2145 (Australia); Jans, David A., E-mail: david.jans@monash.edu [Department of Biochemistry and Molecular Biology, Monash University, Clayton, Vic. 3800 (Australia)

    2016-02-12

    Nuclear import of the accessory protein Vpr is central to infection by human immunodeficiency virus (HIV). We previously identified the Vpr F72L mutation in a HIV-infected, long-term non-progressor, showing that it resulted in reduced Vpr nuclear accumulation and altered cytoplasmic localisation. Here we demonstrate for the first time that the effects of nuclear accumulation of the F72L mutation are due to impairment of microtubule-dependent-enhancement of Vpr nuclear import. We use high resolution imaging approaches including fluorescence recovery after photobleaching and other approaches to document interaction between Vpr and the dynein light chain protein, DYNLT1, and impaired interaction of the F72L mutant with DYNLT1. The results implicate MTs/DYNLT1 as drivers of Vpr nuclear import and HIV infection, with important therapeutic implications. - Highlights: • HIV-1 Vpr utilizes the microtubule network to traffic towards the nucleus. • Mechanism relies on interaction between Vpr and dynein light chain protein DYNLT1. • Long-term non-progressor derived mutation (F72L) impairs this interaction. • Key residues in the vicinity of F72 contribute to interaction with DYNLT1.

  6. FAST TRACK COMMUNICATION: Contrasting characteristics of sub-microsecond pulsed atmospheric air and atmospheric pressure helium-oxygen glow discharges

    Science.gov (United States)

    Walsh, J. L.; Liu, D. X.; Iza, F.; Rong, M. Z.; Kong, M. G.

    2010-01-01

    Glow discharges in air are often considered to be the ultimate low-temperature atmospheric pressure plasmas for numerous chamber-free applications. This is due to the ubiquitous presence of air and the perceived abundance of reactive oxygen and nitrogen species in air plasmas. In this paper, sub-microsecond pulsed atmospheric air plasmas are shown to produce a low concentration of excited oxygen atoms but an abundance of excited nitrogen species, UV photons and ozone molecules. This contrasts sharply with the efficient production of excited oxygen atoms in comparable helium-oxygen discharges. Relevant reaction chemistry analysed with a global model suggests that collisional excitation of O2 by helium metastables is significantly more efficient than electron dissociative excitation of O2, electron excitation of O and ion-ion recombination. These results suggest different practical uses of the two oxygen-containing atmospheric discharges, with air plasmas being well suited for nitrogen and UV based chemistry and He-O2 plasmas for excited atomic oxygen based chemistry.

  7. Fast Track to Accreditation: An Implementation Review of College of American Pathologists and International Organization for Standardization 15189 Accreditation.

    Science.gov (United States)

    AbdelWareth, Laila O; Pallinalakam, Fasila; Ibrahim, Faisal; Anderson, Peter; Liaqat, Muneezeh; Palmer, Bryson; Harris, Jonathan; Bashir, Saber; Alatoom, Adnan; Algora, Manuel; Alduaij, Ahmad; Mirza, Imran

    2017-08-31

    - This review examines challenges and opportunities in preparing laboratories in a startup phase for accreditation by both College of American Pathologists (CAP) and International Organization for Standardization (ISO) 15189 in an international setting as it relates to our experience at Cleveland Clinic Abu Dhabi Laboratory. It also discusses some of the strategies used in executing those projects and the added advantages in perusing both types of accreditations. - To share our experience with CAP and ISO 15189 accreditations in a startup international operation in relation to the challenges encountered and implementation strategy success factors. - MEDLINE (PubMed) database was used to review this topic as well as peer-reviewed articles and World Health Organization publications on the topic. - Accreditation is a perfect means toward building quality medical laboratories in a diverse workforce environment and improving patient safety. Further, it establishes a strong foundation on which any new operation can build a sustainable quality improvement culture. Accreditations by CAP and/or ISO are among the most reputable and well-established accreditation systems that clinical laboratories could aim for. As a result of both accreditations offering synergistic and complementing features, we recommend that any laboratory seeking excellence in quality and performance should consider exploring both. Key elements to success include having dedicated project management and change management support while preparing for accreditation. Laboratories seeking accreditation in early operational stages may face a number of challenges; however, significant opportunities will also be present to optimize various operational components from the beginning.

  8. Fast Track to Study Abroad

    Institute of Scientific and Technical Information of China (English)

    WANG HAIRONG

    2010-01-01

    @@ As the summer heat subsides, students are about to go back to school. Yang Guang, a tall and slender 16-year-old boy with a sunny smile, made an increasingly common decision. Rather than going to a first-rate public high school that prepares students for Chinese universities,Yang enrolled in a private international highschool in Beijing, which is dedicated to pre-paring students to go to overseas universi-ties.

  9. Still on the Fast Track

    Institute of Scientific and Technical Information of China (English)

    2009-01-01

    North China’s Inner Mongolia Autonomous Region’s development is progressing comparatively fast,though there is still a long way to go until it catches up with advances being made in other parts of China, officials said.

  10. Fast Track to Study Abroad

    Institute of Scientific and Technical Information of China (English)

    2010-01-01

    Young Chinese students get ready for their overseas education at international high schools As the summer heat subsides,students are about to go back to school.Yang Guang,a tall and slender 16-yearold boy with a sunny smile,made an increasingly common decision. Rather than going to a first-rate public high school that prepares students for Chinese universities, Yang enrolled in a private international high school in Beijing,which is dedicated to preparing students to go to overseas universities.

  11. Fast tracking using edge histograms

    Science.gov (United States)

    Rokita, Przemyslaw

    1997-04-01

    This paper proposes a new algorithm for tracking objects and objects boundaries. This algorithm was developed and applied in a system used for compositing computer generated images and real world video sequences, but can be applied in general in all tracking systems where accuracy and high processing speed are required. The algorithm is based on analysis of histograms obtained by summing along chosen axles pixels of edge segmented images. Edge segmentation is done by spatial convolution using gradient operator. The advantage of such an approach is that it can be performed in real-time using available on the market hardware convolution filters. After edge extraction and histograms computation, respective positions of maximums in edge intensity histograms, in current and previous frame, are compared and matched. Obtained this way information about displacement of histograms maximums, can be directly converted into information about changes of target boundaries positions along chosen axles.

  12. ATLAS FTK Fast Track Trigger

    CERN Document Server

    Iizawa, T; The ATLAS collaboration

    2014-01-01

    The Fast TracKer (FTK) will perform global track reconstruction after each Level-1 trigger accept signal to enable the software-based higher level trigger to have early access to tracking information. FTK is a dedicated processor based on a mixture of advanced technologies. Modern, powerful Field Programmable Gate Arrays (FPGAs) form an important part of the system architecture, and the large level of computing power required for pattern recognition is provided by incorporating standard-cell ASICs named Associative Memory (AM). Motivation and the architecture of the FTK system will be presented, and the status of hardware and simulation will be following.

  13. ATLAS FTK: Fast Track Trigger

    CERN Document Server

    Volpi, Guido; The ATLAS collaboration

    2015-01-01

    An overview of the ATLAS Fast Tracker processor is presented, reporting the design of the system, its expected performance, and the integration status. The next LHC runs, with a significant increase in instantaneous luminosity, will provide a big challenge to the trigger and data acquisition systems of all the experiments. An intensive use of the tracking information at the trigger level will be important to keep high efficiency in interesting events, despite the increase in multiple p-p collisions per bunch crossing (pile-up). In order to increase the use of tracks within the High Level Trigger (HLT), the ATLAS experiment planned the installation of an hardware processor dedicated to tracking: the Fast TracKer (FTK) processor. The FTK is designed to perform full scan track reconstruction at every Level-1 accept. To achieve this goal, the FTK uses a fully parallel architecture, with algorithms designed to exploit the computing power of custom VLSI chips, the Associative Memory, as well as modern FPGAs. The FT...

  14. Study on trauma remedy with fast track surgery%快速康复外科新理念下的创伤救治研究

    Institute of Scientific and Technical Information of China (English)

    程黎阳; 谢正勇

    2012-01-01

    研究已经证实:快速康复外科(FTS)能显著改善外科病人的预后,缩短住院时间,加速术后康复进程,减少并发症的发生率.但FTS目前主要还在择期胃肠手术中实施,在急诊创伤救治中的应用和研究近于空白.本文结合文献和作者研究,从应用机制、意义及方案等方面评述了FTS应用于创伤治疗的适用性、可行性、有效性和必要性,而这既是创伤救治的临床需求,也是FTS今后的研究方向,并有望由此拓展创伤的救治理论,树立创伤救治的新模式和新标准.%Fast track surgery( FTS ) has been proved to improve the prognosis of surgical patients, accelerate postoperative rehabilitation process, shorten the hospital stay, and reduce the complication incidence rate. FTS is mainly used in normal gastrointestinal surgery, however, none has been performed for emergency trauma at present. Combining the literature and our research,the mechanism,significance and project for the application of FTS in trauma remedy are introduced, and its adaptivity, feasibility, validity, and essentiality are discussed in this article. The application of FTS in trauma remedy,which is the clinical demand and direction of FTS study,should be hoped to expand the theory and to become the new mode and standard of trauma remedy.

  15. Evaluation surgical treatment results of scoliosis in patients with neurofibromatosis

    Directory of Open Access Journals (Sweden)

    Hojjat Hossein-Pourfeizi

    2014-08-01

    Full Text Available Introduction: Surgical treatment of spinal deformity resulting from neurofibromatosis (NF is a major challenge for orthopedic spine surgeons. There are several problems and complications including pseudoarthrosis and cure progress despite treatment. Progressive kyphoscoliosis is the most important spinal deformity. The present study aims to evaluate surgical treatment results in severe spinal involvement cases. Methods: This analytical a-descriptive study evaluated 20 patients with NF, severe scoliosis and kyphosis (up to 50° hospitalized and treated at our center during the past 10 years. The treatment failure rate and complications were studied. Results: In this study, 20 cases with NF and kyphoscoliosis with the mean age of 13.00 ± 7.18 years were studied. These case series were consisted of 13 (65% males and 7 (35% females. Overall treatment failure was 45%. However, it was 55% of failure happened in posterior fusion alone. Failure rate was reported 36% in the combined anterior and posterior fusion and mainly seen in younger than 8-years children. Surgical complications were found in 20% with pseudoarthrosis as the most common one. There were no infections and neurological complications. Statistically, there was a significant negative relation between age and curve progression in scoliosis and kyphosis during the 2 years follow-up period. There was not any significant difference between genders considering curvature progress. Conclusion: The combined anterior and posterior fusion is probably more effective treatment, especially at early ages when more aggressive treatment is required since it reduces the treatment failure possibility.

  16. Integrated thermal treatment system sudy: Phase 2, Results

    Energy Technology Data Exchange (ETDEWEB)

    Feizollahi, F.; Quapp, W.J.

    1995-08-01

    This report presents the second phase of a study on thermal treatment technologies. The study consists of a systematic assessment of nineteen thermal treatment alternatives for the contact-handled mixed low-level waste (MLLW) currently stored in the US Department of Energy complex. The treatment alternatives consist of widely varying technologies for safely destroying the hazardous organic components, reducing the volume, and preparing for final disposal of the MLLW. The alternatives considered in Phase 2 were innovative thermal treatments with nine types of primary processing units. Other variations in the study examined the effect of combustion gas, air pollution control system design, and stabilization technology for the treatment residues. The Phase 1 study, the results of which have been published as an interim report, examined ten initial thermal treatment alternatives. The Phase 2 systems were evaluated in essentially the same manner as the Phase 2 systems. The assumptions and methods were the same as for the Phase 1 study. The quantities, and physical and chemical compositions, of the input waste used in he Phase 2 systems differ from those in the Phase 1 systems, which were based on a preliminary waste input database developed at the onset of the Integrated Thermal Treatment System study. The inventory database used in the Phase 2 study incorporates the latest US Department of Energy information. All systems, both primary treatment systems and subsystem inputs, have now been evaluated using the same waste input (2,927 lb/hr).

  17. Psychogenic non-epileptic seizures and psychoanalytical treatment: results

    Directory of Open Access Journals (Sweden)

    Niraldo de Oliveira Santos

    2014-12-01

    Full Text Available Background: the occurrence of psychogenic non-epileptic seizures (PNES is estimated to be between 2 to 33 cases in every 100,000 inhabitants. The number of patients with PNES reaches 19% of those treated as epileptics. Patients with PNES are treated as if they had intractable epilepsy, with unsatisfactory results even after medication treatment is used to its maximum. The aim of this study is to present the effects of individual psychoanalytical treatment in patients with PNES, assessing its impact in the evolution of the clinical picture and its association with sex, time of disease, social, psychological and professional harm, as well as going through with treatment. Methods: The case base was composed of 37 patients with PNES. The diagnosis was reached with video-EEG monitoring. Psychoanalytical treatment was carried out through 12 months of weekly sessions timed for around 50-minutes each, in a total of 48 individual sessions. Results: This study found a high rate of success in the treatment of PNES patients. 29.7% (n=11 of patients had cessation or cure of symptoms and 51.4% (n=19 had a decrease in the number of episodes. There is an association between cessation or decrease in the number of episodes and sex (p<0.01, religion (p<0.01 and concluding treatment (p<0.01. Conclusion: Individual psychoanalytical treatment applied to patients with PNES is considered effective and can be an essential form of assistance for the reduction or cessation of episodes.

  18. Application of Fast Track Surgery Idea in Laparoscopic Cholecystectomy%加速康复外科理念在腹腔镜胆囊切除术中的应用

    Institute of Scientific and Technical Information of China (English)

    黄河; 王钢; 熊怡南

    2014-01-01

    [Objective] To observe the clinical efficacy of fast-track surgery (FTS) idea used in laparoscopic cholecystectomy .[Methods] Totally 106 patients undergoing laparoscopic cholecystectomy were chosen and randomly divided into FTS group( n=53) and conventional treatment group( n=53) .The postoperative first exhaust time ,eating time ,postoperative ambulation time ,the incidence of nausea ,vomiting and surgical com-plications ,length of stay ,hospitalization cost and other indicators were compared between two groups .[Re-sults]Compared with the control group ,the first exhaust time after operation was shortened ,and postopera-tive eating and ambulation time were ahead ,and the length of stay was shortened ,and the hospitalization cost was reduced in FTS group .There was no significant different in the incidence of postoperative nausea ,vomi-ting and operation complications between two groups .[Conclusion] FTS can be widely used in laparoscopic cholecystectomy .%[目的]探讨加速康复外科(FTS)理念在腹腔镜胆囊切除术中的应用效果。[方法]选取106例腹腔镜胆囊切除手术患者,随机分为快速康复组(FTS组)53例和常规治疗组(对照组)53例。比较两组术后的首次排气时间、进食时间、术后下床时间及恶心呕吐和手术并发症的发生率、住院时间、住院费用等指标。[结果]与对照组比较,FTS组术后首次排气时间缩短,术后进食和下床活动时间均提前,住院时间缩短,住院费用降低(P<0.01或 P<0.05)。两组术后恶心、呕吐发生率及手术并发症的发生率差异无统计学意义(P>0.05)。[结论]加速康复外科可广泛应用于腹腔镜胆囊切除。

  19. Results of open tibial fracture treatment using external fixation

    Directory of Open Access Journals (Sweden)

    Golubović Ivan

    2016-01-01

    Full Text Available Introduction. Open lower leg fractures are the most common open fractures of the locomotor system and their treatment is associated with a number of complications. Objective. The aim of the paper was to present the results of the treatment of 68 patients with open lower leg fractures, as well as the complications that accompany the treatment of these fractures. Methods. In the analyzed group, there were 45 (66.18% men and 23 (33.82% women. The majority of patients - 33 (48.53% of them - were injured in motor vehicle accidents, whereas 24 (35.29% patients sustained injuries due to falls from heights. In two (2.94% patients the cause of open tibial fractures was gunshot injuries. In the analyzed group, there were 18 (26.47% type I open fractures, 21 (30.88% type II open fractures, 19 (27.94% type IIIA open fractures, seven (10.29% type IIIB open fractures, and three (4.41% type IIIC open fractures. Results. The tibial shaft fracture healed without serious complications in 50 (73.53% patients, whereas in 18 (26.47% patients we observed some complications. Nonunion was found in 10 (14.71% patients, osteitis in four (5.88, malunion in two (2.94% patients. Milder complications such as soft tissue pin tract infection developed in 13 (19.12% patients, infection of the open fracture wound soft tissue was observed in four (5.88% patients. Conclusion. Basic principles in the treatment of open lower leg fractures in this study are thorough primary open fracture wound treatment followed by the delayed wound closure, stable fracture fixation using unilateral external skeletal device, proper antibiotic treatment and tetanus prophylaxis. The results correlate with similar studies. [Projekat Ministarstva nauke Republike Srbije, br. III 41017: Virtual Human Osteoarticular System and its Application in Preclinical and Clinical Practice

  20. Results of surgical treatment of atypical endometrial hyperplasia

    Directory of Open Access Journals (Sweden)

    O. A. Gornykh

    2014-01-01

    Full Text Available The results of surgical treatment in 132 patients with atypical endometrial hyperplasia have been studied. Post-operative diagnosis was: en- dometrial cancer – in 19 %, atypical hyperplasia – in 35 %, simple and complex hyperplasia – in 33 %, only atrophic endometrial changes – in 13 % of patients. The tumor was within the endometrium in 5 patients, the superficial invasion of the myometrium (1–2 mm were in 8 patients, invasion to half of the myometrium – in 9 patients, invasion of more than half of the myometrium – in 3 patients. The questions of tactics of treatment of atypical endometrial hyperplasia is under discussion.

  1. Esthesioneuroblastoma: clinical course, long-term results of treatment

    Directory of Open Access Journals (Sweden)

    T. D. Tabolinovskaya

    2016-01-01

    Full Text Available This rare tumor from a group of neuroendocrine neoplasms was studied. The material for the study was the data of 78 patients with esthesioneuroblastoma who had been treated and followed up at the N.N. Blokhin Russian Cancer Research Center in the period 1965 to 2014. Information on hospital statistics, clinical features, methods, and treatment results were presented. The possibilities of using the TNM classification for the nasal cavity, ethmoidal sinuses, and nasopharynx were assessed to determine the anatomic extent of primary tumor. The findings contribute to the solution of problems in the diagnosis and treatment of esthesioneuroblastoma at the present stage. 

  2. Surgery-induced changes and early recovery of hip-muscle strength, leg-press power, and functional performance after fast-track total hip arthroplasty: a prospective cohort study.

    Directory of Open Access Journals (Sweden)

    Bente Holm

    Full Text Available BACKGROUND: By measuring very early changes in muscle strength and functional performance after fast-track total hip arthroplasty (THA, post-operative rehabilitation, introduced soon after surgery, can be designed to specifically target identified deficits. OBJECTIVES: Firstly, to quantify changes (compared to pre-operative values in hip muscle strength, leg-press power, and functional performance in the first week after THA, and secondly, to explore relationships between the muscle strength changes, and changes in hip pain, systemic inflammation, and thigh swelling. DESIGN: Prospective, cohort study. SETTING: Convenience sample of patients receiving a THA at Copenhagen University Hospital, Hvidovre, Denmark, between March and December 2011. PARTICIPANTS: Thirty-five patients (65.9 ± 7.2 years undergoing THA. MAIN OUTCOME MEASURES: Hip muscle strength, leg-press power, performance-based function, and self-reported disability were determined prior to, and 2 and 8 days after, THA (Day 2 and 8, respectively. Hip pain, thigh swelling, and C-Reactive Protein were also determined. RESULTS: Five patients were lost to follow-up. Hip muscle strength and leg press power were substantially reduced at Day 2 (range of reductions: 41-58%, P<0.001, but less pronounced at Day 8 (range of reductions: 23-31%, P<0.017. Self-reported symptoms and function (HOOS: Pain, Symptoms, and ADL improved at Day 8 (P<0.014. Changes in hip pain, C-Reactive Protein, and thigh swelling were not related to the muscle strength and power losses. CONCLUSIONS: Hip muscle strength and leg-press power decreased substantially in the first week after THA - especially at Day 2 - with some recovery at Day 8. The muscle strength loss and power loss were not related to changes in hip pain, systemic inflammation, or thigh swelling. In contrast, self-reported symptoms and function improved. These data on surgery-induced changes in muscle strength may help design impairment-directed, post

  3. Endovascular treatment of penetrating aortic ulcers: mid-term results.

    Science.gov (United States)

    Dalainas, I; Nano, G; Medda, M; Bianchi, P; Casana, R; Ramponi, F; Stegher, S; Malacrida, G; Inglese, L; Tealdi, D G

    2007-07-01

    The aim of this study was to evaluate mid-term results of endovascular treatment of penetrating aortic ulcers. Between February 2000 and November 2006, 18 consecutive patients underwent endovascular treatment of the descending thoracic aorta (N=16) and abdominal infrarenal aorta (N=2) for penetrating aortic ulcer, in a single University Hospital. Data were prospectively collected and retrospectively analyzed. Mean follow-up was 41 months (range 4 to 77 months). Technical success was achieved in all patients. No perioperative deaths occurred. No conversion to open repair or secondary procedures were required. Two patients died in the follow-up period for reasons not related to penetrating aortic ulcers. One type II endoleak was observed. It was still present, unchanged, twelve months after the procedure. Endovascular treatment of penetrating aortic ulcers of the descending thoracic and infrarenal aorta were safe and effective in the mid-term in this small series of patients.

  4. Percutaneous Treatment of Splenic Cystic Echinococcosis: Results of 12 Cases

    Energy Technology Data Exchange (ETDEWEB)

    Akhan, Okan, E-mail: akhano@tr.net; Akkaya, Selçuk, E-mail: selcuk.akkaya85@gmail.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey); Dağoğlu, Merve Gülbiz, E-mail: drmgkartal@gmail.com [Istanbul University, Department of Radiology, Istanbul School of Medicine (Turkey); Akpınar, Burcu, E-mail: burcu-akpinar@yahoo.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey); Erbahçeci, Aysun, E-mail: aysunerbahceci@yahoo.com [Istanbul Bakirkoy Dr. Sadi Konuk Education and Research Hospital, Department of Radiology (Turkey); Çiftçi, Türkmen, E-mail: turkmenciftci@yahoo.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey); Köroğlu, Mert, E-mail: mertkoroglu@hotmail.com [Antalya Education and Research Hospital, Department of Radiology (Turkey); Akıncı, Devrim, E-mail: akincid@hotmail.com [Hacettepe University, Department of Radiology, School of Medicine (Turkey)

    2016-03-15

    PurposeCystic echinococcosis (CE) in the spleen is a rare disease even in endemic regions. The aim of this study was to examine the efficacy of percutaneous treatment for splenic CE.Materials and MethodsTwelve patients (four men, eight women) with splenic CE were included in this study. For percutaneous treatment, CE1 and CE3A splenic hydatid cysts were treated with either the PAIR (puncture, aspiration, injection, respiration) technique or the catheterization technique.ResultsEight of the hydatid cysts were treated with the PAIR technique and four were treated with catheterization. The volume of all cysts decreased significantly during the follow-up period. No complication occurred in seven of 12 patients. Abscess developed in four patients. Two patients underwent splenectomy due to cavity infection developed after percutaneous treatment, while the spleen was preserved in 10 of 12 patients. Total hospital stay was between 1 and 18 days. Hospital stay was longer and the rate of infection was higher in the catheterization group. Follow-up period was 5–117 months (mean, 44.8 months), with no recurrence observed.ConclusionThe advantages of the percutaneous treatment are its minimal invasive nature, short hospitalization duration, and its ability to preserve splenic tissue and function. As the catheterization technique is associated with higher abscess risk, we suggest that the PAIR procedure should be the first percutaneous treatment option for splenic CE.

  5. Results of the dental treatment in children with bruxism

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    Kirenia Pieri Silva

    2015-02-01

    Full Text Available Background: bruxism is a habit associated to stress and to occlusal disturbances which can be solved applying an odontological treatment. Objective: to evaluate the effectiveness of the odotological treatment in students from 5 to 11 years with bruxism. Methods: a study of cuasiexperimental intervention design of type before and after in all the children with bruxim (52, with ages of 5 to 11 elderly years, belonging to Health Area II. Cienfuegos. An oral exam to each child was made; parents and teachers were interviewed as well. Studied variables were: Age, sex, the bruxism's grade of affectation, psychological diagnosis and symptoms and the bruxism's signs. The results present itself in draw of numbers and percentages. Results: the bigger affectation predominated in the female sex from 6 to 11 elderly years and the psychological diagnosis of severe disorders. When examining the signs and symptoms of bruxism before the intervention, the more frequent were the dental squeaking and the dental squeezing. After applying the treatment, more than the half of the children improved his symptomatology in relation to the initial status, and an improvement of over the 70 % in the event of the muscular pain was achieved. Conclusion: the effectiveness of the dental treatment in the improvement of the signs and symptoms of the bruxism was demonstrated.

  6. Clinical Results of Hypomethylating Agents in AML Treatment

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    Marjan Cruijsen

    2014-12-01

    Full Text Available Epigenetic changes play an important role in the development of acute myeloid leukemia (AML. Unlike gene mutations, epigenetic changes are potentially reversible, which makes them attractive for therapeutic intervention. Agents that affect epigenetics are the DNA methyltransferase inhibitors, azacitidine and decitabine. Because of their relatively mild side effects, azacitidine and decitabine are particularly feasible for the treatment of older patients and patients with co-morbidities. Both drugs have remarkable activity against AML blasts with unfavorable cytogenetic characteristics. Recent phase 3 trials have shown the superiority of azacitidine and decitabine compared with conventional care for older AML patients (not eligible for intensive treatment. Results of treatment with modifications of the standard azacitidine (seven days 75 mg/m2 SC; every four weeks and decitabine (five days 20 mg/m2 IV; every four weeks schedules have been reported. Particularly, the results of the 10-day decitabine schedule are promising, revealing complete remission (CR rates around 45% (CR + CRi (i.e., CR with incomplete blood count recovery around 64% almost comparable with intensive chemotherapy. Application of hypomethylating agents to control AML at the cost of minimal toxicity is a very promising strategy to “bridge” older patients with co-morbidities to the potential curative treatment of allogeneic hematopoietic cell transplantation. In this article, we discuss the role of DNA methyltransferase inhibitors in AML.

  7. RESULTS OF SURGICAL TREATMENT OF HAGLUND’S DESEASE

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    A. A. Kardanov

    2013-01-01

    Full Text Available Objectives. The article presents the results assessment of open calcaneal excision compared to percutaneous excision of patients with Haglund’s disease. Materials and methods. Twenty-one patients (26 feet underwent the surgical treatment during the period from 2010 to 2012. The clinical diagnosis was confirmed by axial load radiography estimated with “Fowler-Philip” and “posterior pitch lines” methods. Eight feet were treated with open calcaneal excision and 18 feet - with percutaneous procedure. The mean duration of follow-up was 21,8 months. Clinical evaluation criteria were deformity and/or bursitis recurrence, tenderness, pain by wearing shoes, return to the sport training, patient satisfaction, presence/absence of major complications. Results. Good results were reported for 21 patients; fair results - for 4 patients; and poor results - for one patient. No significant differences in results depending on the method of intervention have been identified.

  8. Pirfenidone treatment in idiopathic pulmonary fibrosis: nationwide Danish results

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    Goran Nadir Salih

    2016-09-01

    Full Text Available Background: Pirfenidone was approved by the European Medicines Agency and introduced in most European countries in 2011 for treatment of idiopathic pulmonary fibrosis (IPF. Objective: To describe the national Danish experiences of pirfenidone treatment for IPF during 30 months with respect to target population, safety, adherence to the treatment and effect analysis in a well-characterised IPF population in a real-life setting. Methods: Retrospective data collection from medical records of all patients in Denmark with IPF from 2011 to 2014. Data included baseline demographics, high-resolution computed tomography (HRCT, histopathology, forced vital capacity (FVC and 6-min walk test (6MWT. Longitudinal data on FVC, walk test, adherence to the treatment and vital status were also collected. Results: Pirfenidone treatment was initiated in 113 patients. Mean age was 69.6±8.1 years (±SD, and 71% were male. Definite IPF diagnosis required thoracoscopic lung biopsy in 45 patients (39.8%. The remaining 68 cases had a definite (64 patients or possible usual interstitial pneumonia (four patients pattern on HRCT. Patients were followed for 0.1–33.8 months (median 9.4 months. Fifty-one patients (45.2% needed dose adjustment, 18 (16% patients discontinued therapy and 13 patients (11.5% died. The annual mean decline in FVC was 164 ml (SE 33.2. The decline in 6MWT was 18.2 m (SE 11.2. Nausea (44.2%, fatigue (38.9% and skin reactions (32.7% were frequent adverse events. Conclusion: Patients with IPF treated with pirfenidone experienced tolerable adverse events. Patients were maintained on treatment due to a careful follow-up and dose adjustment programme. The annual decline in physiological parameters and mortality rate was comparable to previous randomised controlled trials.

  9. Pirfenidone treatment in idiopathic pulmonary fibrosis: nationwide Danish results

    Science.gov (United States)

    Salih, Goran Nadir; Shaker, Saher Burhan; Madsen, Helle Dall; Bendstrup, Elisabeth

    2016-01-01

    Background Pirfenidone was approved by the European Medicines Agency and introduced in most European countries in 2011 for treatment of idiopathic pulmonary fibrosis (IPF). Objective To describe the national Danish experiences of pirfenidone treatment for IPF during 30 months with respect to target population, safety, adherence to the treatment and effect analysis in a well-characterised IPF population in a real-life setting. Methods Retrospective data collection from medical records of all patients in Denmark with IPF from 2011 to 2014. Data included baseline demographics, high-resolution computed tomography (HRCT), histopathology, forced vital capacity (FVC) and 6-min walk test (6MWT). Longitudinal data on FVC, walk test, adherence to the treatment and vital status were also collected. Results Pirfenidone treatment was initiated in 113 patients. Mean age was 69.6±8.1 years (±SD), and 71% were male. Definite IPF diagnosis required thoracoscopic lung biopsy in 45 patients (39.8%). The remaining 68 cases had a definite (64 patients) or possible usual interstitial pneumonia (four patients) pattern on HRCT. Patients were followed for 0.1–33.8 months (median 9.4 months). Fifty-one patients (45.2%) needed dose adjustment, 18 (16%) patients discontinued therapy and 13 patients (11.5%) died. The annual mean decline in FVC was 164 ml (SE 33.2). The decline in 6MWT was 18.2 m (SE 11.2). Nausea (44.2%), fatigue (38.9%) and skin reactions (32.7%) were frequent adverse events. Conclusion Patients with IPF treated with pirfenidone experienced tolerable adverse events. Patients were maintained on treatment due to a careful follow-up and dose adjustment programme. The annual decline in physiological parameters and mortality rate was comparable to previous randomised controlled trials. PMID:27616539

  10. Conservative treatment of the anal carcinoma. Retrospective results - radiotherapy

    Energy Technology Data Exchange (ETDEWEB)

    Dobrowsky, W.

    1987-09-01

    The results of primary radiotherapy in anal carcinoma are reported in a retrospective study. Fourteen patients have been treated by primary radiotherapy between 1970 and 1982. The three-year survival rate is 11/14 (corrected 11/12). Among eleven patients followed up, ten have a normal anal function. The importance of radio-oncology as a therapy of choice in conservative, function-preserving treatment of the anal carcinoma is discussed regarding the retrospective results as well as possible combinations of radiotherapy and chemotherapy.

  11. [Conservative treatment of anal cancer. Retrospective results--radiotherapy].

    Science.gov (United States)

    Dobrowsky, W

    1987-09-01

    The results of primary radiotherapy in anal carcinoma are reported in a retrospective study. Fourteen patients have been treated by primary radiotherapy between 1970 and 1982. The three-year survival rate is 11/14 (corrected: 11/12). Among eleven patients followed up, ten have a normal anal function. The importance of radio-oncology as a therapy of choice in conservative, function-preserving treatment of the anal carcinoma is discussed regarding the retrospective results as well as possible combinations of radiotherapy and chemotherapy.

  12. Chordoma. Report on treatment results in eighteen cases

    Energy Technology Data Exchange (ETDEWEB)

    Lybeert, M.L.M.; Meerwaldt, J.H.

    1986-01-15

    Eighteen patients with a proven histologic diagnosis of chordoma were treated between 1949 and 1982. Four patients received only surgery, 4 patients only radiation therapy, and 10 patients received surgery and postoperative radiation therapy to a varying dose. The results suggest that a higher radiation dose gives longer recurrence-free survival, and that the best long term results can be achieved by combining surgery - as radically as possible - with radiation therapy to a dose level of 60 to 65 Gy. In view of the number of marginal recurrences (2 out of the 14 patients who received radiation therapy), the importance of choosing the right treatment volume is stressed.

  13. THE RESULTS OF SURGICAL TREATMENT OF PATIENTS WITH ADRENAL TUMORS

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    A. A. Kostin

    2016-01-01

    Full Text Available Malignant adrenal tumors such as adrenocortical cancer (ACC and malignant pheochromocytoma (MPCC have a particularly aggressive course, leading to higher mortality in these patients, especially in the later stages of the disease. In this regard, there is a statistically significant difference in survival of patients, depending on the time of detection and initiation of treatment.Purpose. Analysis of the results of surgical treatment of patients with adrenal tumors.Patients and methods. 55 patients aged from 17 to 75 years (median 50 ± 13 years with primary tumor neoplasms of the adrenal gland underwent surgical treatment in the period from 1999 to 2014 in the Department of Onco-urology, P. Hertsen MORI. 18 adrenalectomy (32,7% completed laparoscopy, 36 (65,5% – open access, 1 (1,8% – videoassistance. Among them, retroperitoneal lymph node dissection with ipsilateral hand made in 14 (25.5%, combined operations with resection of adjacent organs – 7 (12,7%, thrombectomy with resection of the inferior Vena cava – 3 (5,5% cases. The median time was 100 ± 73 minutes in open surgical procedures – 183 ± 55 minutes, laparoscopic – 60 ± 30 minutes. The volume of blood loss – 300 ± 1136 ml. According to the routine morphological studies, 24 (43,6% patients the tumor were benign, the remaining 31 (56,4% – malignant.Results. Long-term results have been traced in 84% of patients in group with ACC. The observation time for patients varied from 2 to 167 months, with a median of 64.5 (IQR 22–111 months. Median survival without progression and 5-year overall and tumor survival was: I stage – 93 months and 67 ± 13%, II stage – 30 months and 75 ± 21%, III stage– 18 months and 67 ± 27%, IV stage – 10 months and 25 ± 21%. The observation time for patients with MPCC varies from 12 to 102 months, with a median of 60 (IQR 18–102 months. Median survival without progression was 26 (IQR 15 to 38 months, 5-year overall and tumor survival

  14. Upper cervical injuries: Clinical results using a new treatment algorithm

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    Andrei F Joaquim

    2015-01-01

    Full Text Available Introduction: Upper cervical injuries (UCI have a wide range of radiological and clinical presentation due to the unique complex bony, ligamentous and vascular anatomy. We recently proposed a rational approach in an attempt to unify prior classification system and guide treatment. In this paper, we evaluate the clinical results of our algorithm for UCI treatment. Materials and Methods: A prospective cohort series of patients with UCI was performed. The primary outcome was the AIS. Surgical treatment was proposed based on our protocol: Ligamentous injuries (abnormal misalignment, facet perched or locked, increase atlanto-dens interval were treated surgically. Bone fractures without ligamentous injuries were treated with a rigid cervical orthosis, with exception of fractures in the dens base with risk factors for non-union. Results: Twenty-three patients treated initially conservatively had some follow-up (mean of 171 days, range from 60 to 436 days. All of them were neurologically intact. None of the patients developed a new neurological deficit. Fifteen patients were initially surgically treated (mean of 140 days of follow-up, ranging from 60 to 270 days. In the surgical group, preoperatively, 11 (73.3% patients were AIS E, 2 (13.3% AIS C and 2 (13.3% AIS D. At the final follow-up, the American Spine Injury Association (ASIA score was: 13 (86.6% AIS E and 2 (13.3% AIS D. None of the patients had neurological worsening during the follow-up. Conclusions: This prospective cohort suggested that our UCI treatment algorithm can be safely used. Further prospective studies with longer follow-up are necessary to further establish its clinical validity and safety.

  15. Floating knee injuries: Results of treatment and outcomes

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    Mohammad Hadi Nouraei

    2013-01-01

    Full Text Available Background: Floating knee, referred to as ipsilateral fractures of the femur and tibia, is usually associated with several complications and mortality. This study was designed to present our experience with treatment of this injury throughout; age, sex, mechanism of injury, associated injuries, method and results of treatment, and complications of floating knee are discussed. Materials and Methods: This retrospective study was performed between January 2006 and December 2011. All patients with floating knee injuries who were admitted to the referral educational hospitals were included. The information about the 238 cases of floating knee injuries were gathered through the 254,620 trauma files and after excluding 18 patients who died within 6 months, the remaining files were studied and the target information was recorded. Results: The most frequent age group was 20-29 years (44.5%. The floating knee injuries were more common in males (85.5%. Type (D according to "the classification of Letts and Vincent" was observed in 38.9% cases. The most frequent mechanism of injury was car to motorcycles accidents (48.2%. The most common associated injury was pelvic fractures (86.8%. Open reduction and internal fixation was the common type of treatment (70%. The most common early and late complications were knee hemarthrosis in 31 cases (14% and knee osteoarthritis in 30 cases (13.6%, respectively. Death during the 5 years follow up was due to circulatory disruption, followed by deep vein thrombosis (61%. There was a significant relation between the age and outcomes as it worsens with age (P-value < 0.05. Conclusion: This study revealed that the complication rate associated with floating knee injuries remained high, regardless of the used treatment regimen and surgeons should focus on reducing complications while treating it.

  16. The results of surgical and nonsurgical treatment of mallet finger

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    Starčević Branislav

    2006-01-01

    Full Text Available Introduction: The injury of the hand tendon classified as mallet finger presents the loss of continuity of the united lateral band of the extensor apparatus above distal interphalangeal joint, which consequently leads to specific deformity of distal interphalangeal joint which is called mallet (hammer finger. Objective Our paper had several research Objectives: presentation of the existing Results of surgical and nonsurgical treatment of mallet finger deformities and comparison of our findings and other authors’ Results. Method: The study was retro-prospective, and analyzed 62 patients treated in the Clinical Center of Serbia in Belgrade (at the Institute of Orthopedic Surgery and Traumatology, and the Emergency Center in the period 1998 to 2003. The follow up of these patients lasted at least 8 months (from 8.3 months to 71.7 months. An average follow up was 28.7 months. The Objective parameters used in the study were as follows: sex, age, dominating hand, hand injury, finger injury, mode of treatment, complications, distal interphalangeal joint flexion and total movement of the distal interphalangeal joint. Collected data were analyzed by χ2-test and Student’s t-test. The confidence interval was p=0.05. Results: A total range of motion was 51.9±6.6 for nonsurgically treated patients, and 48.2±4.2 degrees for operated patients. Mean extension deficit of the distal interphalangeal joint was 6.5±3.3 for nonsurgical and 10.0±3.2 for operated patients. Conclusion: The Results confirmed that nonsurgical mode of treatment of mallet finger deformity was much more successful than surgical Method of treating the same deformity.

  17. Toxicity of solid residues resulting from wastewater treatment with nanomaterials.

    Science.gov (United States)

    Nogueira, Verónica; Lopes, Isabel; Rocha-Santos, Teresa; Gonçalves, Fernando; Pereira, Ruth

    2015-08-01

    Nanomaterials (NMs) are widely recommended for wastewater treatments due to their unique properties. Several studies report the different advantages of nanotechnology in the remediation of wastewaters, but limited research has been directed toward the fate and potential impacts of the solid residues (SRs) produced after the application of such technologies. The present work aimed at investigating the ecotoxicity of SRs resulting from the treatment of three effluents (OOMW, kraft pulp mill, and mining drainage) with two NMs (TiO2 and Fe2O3). The invertebrate Chironomus riparius was selected as test organism and exposed to the residues. The effect on percentage of survival and growth was assessed. Results showed that the SRs from the treatments nano-TiO2(1.0gL(-1))/H2O2(0.5M) and nano-Fe2O3(1.0gL(-1))/H2O2(1.0M) from OOMW and nano-Fe2O3(0.75gL(-1))/H2O2(0.01M) from kraft pulp mill effluent exhibited lethal toxicity to C. riparius. Only the exposure to SRs resulting from the treatment with nano-Fe2O3(0.75gL(-1))/H2O2(0.01M) applied to the kraft pulp mill effluent significantly affected the growth rate based on the head capsule width. In terms of growth rate, based on the body length, it decreased significantly after exposure to the SRs from the treatments nano-TiO2 (1.0gL(-1)) and nano-Fe2O3(0.75gL(-1))/H2O2(0.01M) of kraft paper mill effluent and nano-Fe2O3(1.0gL(-1))/H2O2(1.0M) of OOMW. According to our study the SRs can promote negative effects on C. riparius. However, the effects are dependent on the type of effluent treated as well as on the organic and inorganic compounds attached to the NMs. Copyright © 2015 Elsevier B.V. All rights reserved.

  18. Construction and operation effect of a multi-disciplinary healthcare team in Fast Track Surgery%快速康复外科多学科合作团队的建设及运行效果

    Institute of Scientific and Technical Information of China (English)

    李益萍; 徐琴鸿; 谢浩芬; 邱江锋; 费惠; 朱红; 黄长顺

    2015-01-01

    目的:探索多学科合作模式在快速康复外科实践中的效果。方法选择2011年1月—2013年12月,胃肠外科所有拟行腹腔镜胃癌根治术的患者500例。按随机数字表法分成研究组和对照组,每组250例,对照组按传统护理模式给予常规围术期护理,研究组组建多学科合作团队,通过周密设计多学科合作模式的快速康复流程,严格把握工作程序,进行有效质量控制,评价其术后康复效果,患者及医护人员满意度,观察多学科合作团队的应用效果。结果研究组患者满意度为97.05%,快速康复外科多学科合作组患者术后首次肛门排气时间为(2.13±0.69)d、首次下床时间为(1.33±1.13)d、术后胃管留置时间为(2.00±1.56)d、术后首次进食时间为(5.00±1.42)d、术后住院时间为(13.24±3.12)d,均优于对照组,差异有统计学意义(t 值分别为-16.8896,-25.0680,-14.7059,-14.1901,-5.6934;P <0.05)。结论快速康复外科多学科合作模式可促进患者术后快速康复,是临床行之有效的实践方法。%Objective To explore the implementation of multi-disciplinary healthcare teamwork in Fast Track Surgery( FTS). Methods A total of 500 patients,who would have laparoscopic radical resection of gastric cancer during January 2011 to December 2013,were averagely divided into control group( traditional nursing model and routine perioperative nursing) and experimental group ( multi-disciplinary healthcare teamwork)by random number table. The patients of experimental group received fast recovery process by careful design,strict work procedure,effective quality control and were assessed the effect of recovery,satisfaction of medical staffs and observed the application effect of multi-disciplinary healthcare teamwork. Results The satisfaction of experimental group for intervention was 97. 05% ,and the first time of fart(2. 13 ± 0. 69)d,first time to get

  19. Lamivudine treatment for decompensated cirrhosis resulting from chronic hepatitis B.

    Science.gov (United States)

    Villeneuve, J P; Condreay, L D; Willems, B; Pomier-Layrargues, G; Fenyves, D; Bilodeau, M; Leduc, R; Peltekian, K; Wong, F; Margulies, M; Heathcote, E J

    2000-01-01

    The prognosis of decompensated cirrhosis resulting from chronic hepatitis B is poor, and the benefits of treatment with interferon are outweighed by serious side effects and by the risk of fatal exacerbation of disease activity. Lamivudine rapidly reduces hepatitis B virus (HBV)-DNA in serum to undetectable levels. We have treated 35 patients with chronic hepatitis B and decompensated cirrhosis with lamivudine 100 mg or 150 mg orally once daily. Pretreatment, all were positive for HBV-DNA in serum. Ten had Child-Pugh class B and 25 had Child-Pugh class C liver disease. Seven patients underwent liver transplantation within 6 months of treatment initiation, 5 patients died within 6 months, and 23 patients were treated for at least 6 months (mean = 19 months). In a majority of these 23 cases, there was a slow but marked improvement in liver function, which was most apparent after 9 months of treatment, with a decrease in serum bilirubin from 67 +/- 13 to 30 +/- 4 micromol/L (P decompensated HBV cirrhosis, but the long-term benefits remain uncertain.

  20. Our Treatment Results of Circumscribed and Diffuse Choroidal Hemangiomas

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    Esra Savku

    2013-08-01

    Full Text Available Purpose: To discuss our treatment results of choroidal hemangiomas. Material and Method: The records of 39 cases of choroidal hemangioma followed up at our clinic between July 1999–October 2012 were reviewed retrospectively. Asymptomatic cases were followed up. Symptomatic cases with subretinal fluid and impaired vision received treatment. Results: Mean age of the 39 patients was 44 (12-80 years. Thirty-five of 39 cases had circumscribed choroidal hemangioma, and 4 cases had diffuse choroidal hemangioma. Sturge-Weber syndrome was present in 3 cases with diffuse choroidal hemangioma. Cases with circumscribed choroidal hemangioma and minimal subretinal fluid were treated with TTT in 11 cases, PDT in 12 cases, and PDT+TTT in 1 case. Cases with circumscribed choroidal hemangioma and excessive subretinal fluid were treated with Ru-106 plaque radiotherapy in 1 case, Ru-106 plaque radiotherapy+TTT in 1 case, EBRT in 3 cases, and TTT+EBRT in 1 case. One painful blind eye with neovascular glaucoma and complicated cataract was enucleated. Cases with diffuse choroidal hemangioma and excessive subretinal fluid were treated with Ru-106 plaque radiotherapy+TTT in 1 case and EBRT in 1 case. Ahmed glaucoma valve implantation and FAKO emulsification were applied to a case with neovascular glaucoma and complicated cataract. Complete resorption of subretinal fluid was achieved in 23 (72% of treated 32 cases. When mean initial tumor thickness was 2.6 mm (0.5-6, mean final tumor thickness was 1.4 mm (0-6. When mean initial visual acuity (LogMAR was 1.5 (0-3, mean final visual acuity was 1.1 (0-3. No recurrence was observed. Discussion: The amount of the subretinal fluid determines the method of treatment in circumscribed choroidal hemangioma. While TTT and PDT are effective treatment modalities for minimal subretinal fluid, plaque radiotherapy and EBRT are applied in cases with excessive subretinal fluid. Combination therapies may be necessary according to the

  1. Multistrain models predict sequential multidrug treatment strategies to result in less antimicrobial resistance than combination treatment

    DEFF Research Database (Denmark)

    Ahmad, Amais; Zachariasen, Camilla; Christiansen, Lasse Engbo;

    2016-01-01

    Background: Combination treatment is increasingly used to fight infections caused by bacteria resistant to two or more antimicrobials. While multiple studies have evaluated treatment strategies to minimize the emergence of resistant strains for single antimicrobial treatment, fewer studies have...... generated by a mathematical model of the competitive growth of multiple strains of Escherichia coli.Results: Simulation studies showed that sequential use of tetracycline and ampicillin reduced the level of double resistance, when compared to the combination treatment. The effect of the cycling frequency...... frequency did not play a role in suppressing the growth of resistant strains, but the specific order of the two antimicrobials did. Predictions made from the study could be used to redesign multidrug treatment strategies not only for intramuscular treatment in pigs, but also for other dosing routes....

  2. Varfarin in the complex treatment of antiphospholipid syndrome: preliminary results

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    T M Reshetnyak

    2003-01-01

    Full Text Available Objective. To assess efficacy and tolerance of varfarin in prophylaxis and therapy of thrombotic complications in patients with antiphospholipid syndrome (APS. Methods. 20 pts with APS (5 male and 15 female received varfarin during a year. 8 of them had primary APS (PAPS and 12 -systemic lupus erythematosus with APS (SLE+APS. 2 other pts (I with SLE+APS and I with PAPS received varfarin during the last 4 years. Nobody from 9 pts with PAPS received corticosteroids (CS. In SLE+APS pts CS dose varied from 4 to 20 mg/day and was not increased during follow up. During the study prothrombine time (PT was examined with thromboplastin ( manufactured by Renam having international sensitivity index 1,2 and international normalization relation (INR. Depending on treatment scheme APS pts were divided into 3 groups. Group 1 included 8 pts with INR<2,0, Group 2-7 with INR >3,0, group 3 - 7 pts with INR<2,0 receiving as additional treatment thrombo ASS 100 mg/day and vasonit from 600 to 1200 mg/day. Results. Two pts with INR = 1,8 had thrombosis recurrence (due to leg thrombophlebitis. There were no recurrences in other groups. 2 from 22 pts had "large" bleedings. "Small" bleedings episodes were noted in 7 from 22 pts. Largely that were subcutaneous bleedings (in 4 pts no more than 5 cm of size. Two pts receiving varfarin with INR 1,8 and 2,4 had renal colic. Conclusion. Our preliminary results prove the necessity of inclusion of varfarin in the treatment of pts with APS and thrombosis but intensive anticoagulant effect is not always desired.

  3. Comparison of Roth appliance and standard edgewise appliance treatment results.

    Science.gov (United States)

    Kattner, P F; Schneider, B J

    1993-01-01

    A retrospective comparison of Roth appliance and standard edgewise appliance treatment results was made using two indices. The first, the ideal tooth relationship index (ITRI), scored dental casts for the presence of ideal tooth contacts. The second judged posttreatment dental casts on the basis of criteria established by Andrews in his "Six Keys to Normal Occlusion." The sample consisted of 120 orthodontically treated cases completed by two practitioners who have used both the Roth and standard edgewise appliances. Thirty cases of each appliance type were collected from each practitioner. The overall posttreatment ITRI percentage scores showed no significant differences between the appliances. Practitioner differences existed for the anterior intraarch, anterior interarch, and posterior buccal interarch relationships. These differences were related to both treatment time and finishing arch wire size. The results of the Six Keys Analysis showed that the angulation and inclination of the maxillary posterior teeth were better with the Roth appliance. However, success in achieving some components of the six keys did not translate into an increased percentage of ideal tooth contacts as measured by the ITRI. Despite using the Roth appliance, experienced clinicians still found it difficult to achieve all six keys to normal occlusion.

  4. Results of Entecavir treatment in patients with chronic hepatitis B

    Directory of Open Access Journals (Sweden)

    Şükran Köse

    2013-12-01

    Full Text Available Objective: This study was designed to determine the efficacy and safety of Entecavir (ETV after 96 weeks treatment in patients with chronic viral hepatitis B (CHB. Methods: Thirty-eight patients were included into the study. The criteria for starting ETV treatment were as follows: elevated ALT levels >upper limit of normal (ULN two times, with HBV-DNA levels ≥5 log10 copies/ml (≥20000 IU/mL, in HBe Ag positive patients, ≥4log10 copies/ml (≥2000IU/mL in HBe Ag negative patients and liver damage was confirmed by histopathology (Knodell HAI ≥4 or fibrosis ≥1. Patients were followed up every 12 weeks by virological and biochemical tests. Results: Twenty-four of 38 patients (63.2% were male. Mean age of patients were 38.6 years, 14 of them were HBeAg positive (36.8%. At baseline, median ALT level was detected as 106.7 IU/ml, median HBV DNA levels were 4.8 x 107 copy/ml, and mean Knodell HAI score was nine. Eleven of 14 HBe Ag positive patients (78.6% were treatment-naïve. No resistance mutation was determined during treatment. Biochemical responses (BR at 48 th and 96th week were 100% and virologic response (VR were 57.1%, and 50%, respectively. Serological response (SR at 48th and 96 th weeks were 35.7% and 42.8% respectively. Fifteen (62.5% of 24 HBe Ag negative patients were treatment-naïve; two patients were detected to have lamivudine resistance mutation. At 48 th and 96 th week, BR was 95.8%, and 100%, respectively; and VR were 83.3% both. Conclusion:In our study, virologic response was significantly high after two years of therapy with Entecavir in HBe Ag negative patients. J Microbiol Infect Dis 2013;3(4: 176-180

  5. Treatment utilization and barriers to treatment: Results of a survey of dependent methamphetamine users

    Directory of Open Access Journals (Sweden)

    Lee Nicole K

    2011-02-01

    Full Text Available Abstract Background Australia has one of the highest rates of methamphetamine use in the world; however, treatment access for methamphetamine is comparatively low. This descriptive study aimed to identify patterns of treatment utilization and perceived barriers to accessing treatment among dependent methamphetamine users in the hope that such information will enable services to more appropriately respond to this group. Methods One hundred and twenty-six methamphetamine users who had a current or past history of methamphetamine dependence were interviewed about their experiences of, and perceived barriers to, treatment. Results Treatment utilization among methamphetamine users was reportedly low. One of the main reasons cited for not accessing treatment was that methamphetamine users did not perceive their drug use to be a problem (despite apparent levels of dependence. Self-detoxification with the use of other licit and illicit drugs was high among this group. Participants identified a lack of confidence in the ability of treatment services to address methamphetamine dependence and the 'opiate-centric' nature of treatment services as significant blocks to treatment entry. Suggestions for improvement by participants included operating specialist services for methamphetamine users, placing an emphasis on responsiveness and routinely involving case management services for this group. Discussion and Conclusions To improve service delivery, treatment services should reorient their services to better address the needs of methamphetamine users by making small changes such as specific opening times for methamphetamine users or using a dedicated space for methamphetamine treatment. Alternative options such as online treatments and specialist methamphetamine clinics should be considered for methamphetamine users.

  6. Results of the surgical treatment of calcaneo-navicular coalito.

    Science.gov (United States)

    Jerosch, J; Lindner, N; Finnen, D A

    1997-01-01

    We present the results after surgical treatment in 15 patients who suffered from calcaneo-navicular coalitio. A total of 20 operations were performed on 19 feet (3 T-arthrodesis, 5 simple resections, 9 resections with fat interposition, 3 resections with muscle interposition). At the time of follow-up, the patients were examined clinically and radiologically. In addition, different functional tests were performed (heel-tip test, balance test, single-leg high jump, single-leg jumping course). Ten of 17 patients who underwent radiographic study at the follow-up had a successful result. Patients who had a coalitio showed a tibial rotation (heel-tip test) of 11.5 degrees, and those patients without a coalitio had a tibia rotation of 20.3 degrees. Concerning the functional outcome, 12 of 17 patients had a successful result. The range of motion of the subtalar joint did not correlate with the functional capacity of the ankle. Seven of 20 patients subjectively judged the outcome as a failure. The worst results were found in patients with pre-existing degenerative changes at the time of resection.

  7. 加速康复外科联合单孔腹腔镜技术应用于直肠癌手术的临床研究%ingle-incision laparoscopic surgery combined with fast-track rehabilitation for rectal cancer

    Institute of Scientific and Technical Information of China (English)

    谢立飞; 江志伟; 鲍扬; 王刚; 黎介寿

    2012-01-01

    目的 加速康复外科(fast track surgery,FTS)理念以及单孔腹腔镜手术(single-incision laparoscopic surgery,SILS)可进一步减少创伤、加快患者术后康复.文中拟探讨FTS联合SILS应用于直肠癌患者围手术期的安全性.方法 择期行直肠癌手术患者40例分为2组,应用FTS理念联合传统腹腔镜手术22例作为FTS腔镜组,应用FTS理念联合SILS 18例作为FTS单孔组.比较2组病例平均手术时间、术中出血量、淋巴结清扫数目、手术切口长度、术后肛门通气时间、术后住院天数、术后并发症以及住院费用等指标.结果 2组病例的术后肛门通气时间及术后住院天数,差异无统计学意义(P>0.05),与相关文献报道的采用传统围手术期处理措施的腹腔镜手术相比较,术后住院时间缩短.FTS单孔组较FTS腔镜组手术切口长度明显缩短,手术时间延长,差异有统计学意义(P0.05).结论 FTS理念指导下的传统腹腔镜手术以及SILS均能加快肠功能恢复、缩短住院时间;相对于传统腹腔镜手术,SILS因其手术切口缩小而减轻了术后疼痛,加速了康复,因手术瘢痕减少和缩短,故不影响局部外观.%Objective Single-incision laparoscopic surgery (SILS) with fasMrack rehabilitation (FTR) can further reduce trauma and accelerate postoperative rehabilitation . This study aims to investigate the safety of SILS with FTR in the treatment of rectal cancer. Methods Forty patients with rectal cancer were randomly assigned to receive traditional laparoscopic surgery plus FTR (n = 22) and SILS plus FTR (n =18) , respectively. Comparisons were made between the two groups in the mean operation time , in-tra-operative blood loss, the number of lymphnodes excised , the length of incision , the time to first flatus , postoperative hospital stay , postoperative complications and medical cost . Results There were no significant differences in the first flatus time and postoperative hospital stay

  8. 快速康复外科理念在胃癌患者围术期营养支持中的应用%Application of the concept of fast track surgery in the perioperative nutritional support for patients with gastric cancer

    Institute of Scientific and Technical Information of China (English)

    吴翠干

    2013-01-01

    目的:探讨快速康复外科理念在胃癌患者围术期营养支持中的应用效果.方法:将66例胃癌手术患者随机分为观察组和对照组各33例,对照组采用胃癌手术围术期常规营养支持;观察组采用快速康复外科理念,主要包括术前给予流质饮食、不行灌肠,术后早期采用少量肠内营养直至肛门排气.观察两组患者术后胃肠道功能恢复情况、住院时间及并发症发生情况,比较两组患者入院时、术后第1天及术后第3天血清白蛋白及免疫球蛋白A水平.结果:观察组术后第1天及术后第3天血清白蛋白及免疫球蛋白A水平均明显高于对照组(P<0.05);术后肠鸣音恢复时间、肛门排气时间及术后住院时间均短于对照组(P<0.05).结论:将快速康复外科理念应用于胃癌患者围术期营养支持中,可促进患者肠道功能恢复,提高机体免疫力,缩短住院时间,治疗效果显著.%Objective: To investigate the application effect of the concept of fast track surgery in the perioperative nutritional support for patients with gastric cancer. Methods: 66 patients who would undergo gastric cancer surgery were randomly divided into the observation group and the control group (33 cases in each group). The conventional perioperative nutritional support was provided in the control group and the concept of fast track surgery was adopted in the observation group , including giving patients liquid diet before operation , giving no enema and giving early enteral nutrition till anal exsufflation . The recovery of gastrointestinal function , the length of hospitalization and inci -dence of complications were observed after operation , and the level of serum albumin and immunoglobulin A on admission , the first and the third day after operation were compared between the two groups . Results: The level of serum albumin and immunoglobulin A on the first and third day after operation was significantly higher in the observation

  9. Treatment results of incomplete chemoradiotherapy in locally advanced cervical cancer

    Directory of Open Access Journals (Sweden)

    Gao Y

    2013-04-01

    Full Text Available Ying Gao,1,* Fei Gao,2,* Zi Liu,1 Li-ping Song1 1Department of Radiotherapy Oncology, First Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, People’s Republic of China; 2Second Affiliated Hospital of Medical College of Xi’an Jiaotong University, Xi’an, People’s Republic of China *These authors contributed equally to this work Objective: Regimens that combine chemotherapy and radiotherapy increase toxicity and compromise a patient’s ability to adhere to the treatment plan. We evaluated the efficacy and safety of a partially completed chemoradiation regimen prescribed for locally advanced carcinoma of the cervix. Methods: Medical records of 156 patients with locally advanced cervical cancer stage IIB–IVA who received chemoradiation with cisplatin (40 mg/m2 and 5-fluorouracil (500 mg/m2 from October 2006 to October 2008 were collected. The treatment protocol called for two cycles of chemotherapy. External beam radiation therapy was administered using a 10-MeV electron beam. Local control, disease free survival, overall survival, and toxicities were evaluated. Results: With a median follow-up of 37.5 months, 89 patients (57% completed the planned protocol. Sixty seven patients (43% completed fewer than two cycles. The 3-year local control rate was significantly better in the patient group that completed the prescribed plan (92.1% compared to 80.6%; P = 0.033. No statistical significance was observed between the groups that completed or did not complete the two cycle protocol with regard to disease free survival (80.9% and 73.2%, respectively; P = 0.250, overall survival (84.3% and 79.1%; P = 0.405, and progression survival (3.4% and 3.0%; P = 0.892. Differences in acute hematologic toxicity and subcutaneous toxicity were observed between the two groups. Conclusions: Completion of two cycles of 5-fluorouracil and cisplatin with radiotherapy was effective, safe, and responsible for better local control

  10. Thermal plasma treatment of cell-phone waste : preliminary result

    Energy Technology Data Exchange (ETDEWEB)

    Ruj, B. [Central Mechanical Engineering Research Inst., Durgapur (India). Thermal Engineering Group; Chang, J.S.; Li, O.L. [McMaster Univ., Hamilton, ON (Canada). Dept. of Engineering Physics; Pietsch, G. [RWTH Aachen Univ., Aachen (Germany)

    2010-07-01

    The cell phone is an indispensable service facilitator, however, the disposal and recycling of cell phones is a major problem. While the potential life span of a mobile phone, excluding batteries, is over 10 years, most of the users upgrade their phones approximately four times during this period. Cell phone waste is significantly more hazardous than many other municipal wastes as it contains thousands of components made of toxic chemicals and metals like lead, cadmium, chromium, mercury, polyvinyl chlorides (PVC), brominated flame retardants, beryllium, antimony and phthalates. Cell phones also use many expensive rare metals. Since cell phones are made up of plastics, metals, ceramics, and trace other substances, primitive recycling or disposal of cell phone waste to landfills and incinerators creates irreversible environmental damage by polluting water and soil, and contaminating air. In order to minimize releases into the environment and threat to human health, the disposal of cell phones needs to be managed in an environmentally friendly way. This paper discussed a safer method of reducing the generation of syngas and hydrocarbons and metal recovery through the treatment of cell phone wastes by a thermal plasma. The presentation discussed the experiment, with particular reference to sample preparation; experimental set-up; and results four samples with different experimental conditions. It was concluded that the plasma treatment of cell phone waste in reduced condition generates gaseous components such as hydrogen, carbon monoxide, and hydrocarbons which are combustible. Therefore, this system is an energy recovery system that contributes to resource conservation and reduction of climate change gases. 5 refs., 2 tabs., 2 figs.

  11. Early diagnosis and retention in care of HIV-infected patients through rapid salivary testing: a test-and-treat fast track pilot study.

    Science.gov (United States)

    Parisi, Maria Rita; Soldini, Laura; Negri, Silvia; Vidoni, Gian Marino; Gianotti, Nicola; Nozza, Silvia; Schlusnus, Karin; Dorigatti, Fernanda; Lazzarin, Adriano

    2016-01-01

    Aim of this study was to evaluate the efficacy and the retention-in-care of individuals diagnosed during six years of salivary HIV testing (EASY-test project). Among those linked-to-care at the Infectious Diseases Department of San Raffaele Hospital (Milan, Italy), the proportion of patients engaged, retained in care and virologically suppressed after the antiretroviral treatment was 96%, 100% and 95.2%, respectively. Results from our study suggest that salivary HIV testing may help bring to light cases of HIV infection otherwise undiagnosed, and thus favour a more rapid and wider reduction of the HIV infection burden at the population level.

  12. Anesthesia management of patients with laparoscopic cholecystectomy based on fast track surgery%基于快速康复理念下腹腔镜胆囊切除手术患者的麻醉管理

    Institute of Scientific and Technical Information of China (English)

    薛官国

    2015-01-01

    目的:初步探讨基于快速康复理念下腹腔镜胆囊切除手术患者麻醉管理方案的作用。方法将38例拟行腹腔镜胆囊切除手术患者按随机数字法分为两组,各19例。试验组:采用联合麻醉,全身麻醉+硬膜外阻滞麻醉;对照组:常规全身麻醉,测定并比较两组患者行麻醉前、气腹成功时、手术开始15min时及术毕时的血糖、血清皮质醇浓度水平,并记录术后苏醒时间、排气时间及相关不良反应等指标。结果对照组患者在各时间点的血清皮质醇浓度水平较麻醉前均变化明显,且显著高于试验组患者同时间点的水平(P<0.05),各时间点的血糖变化类似于血清皮质醇浓度(P<0.05);相比对照组患者,试验组患者术后排气时间提前,住院时间缩短(P<0.05),且两组相关不良反应的差异有统计学意义(P<0.05)。结论快速康复理念指导下麻醉管理能够有效减轻腹腔镜胆囊切除手术患者的应激反应,加速快速康复。%Objective To investigate the effect of anesthesia management of patients with laparoscopic cholecystectomy(LC) based on fast track surgery(FTS). Methods A randomized controlled clinical trial was carried out, 38 patients were randomly divided into test group(n=19,epidural block anesthesia and general anesthesia) and control group (n=19,general anesthesia). The blood glucose(Glu)and serum cortisol were tested at the following four time pointsbefore anesthesia, at pneumoperitoneum, 15 min after surgery and completing operation. Awakening time, evacuation time post operation and adverse events were observed and compared. Results Compared with before anesthesia, serum cor-tisol and Glu were increased at various time point in control group (P<0.05), there were statistical differences in two groups (P<0.05). Awakening time and evacuation time post operation of test group were earlier than control group (P<0.05). There were

  13. Treatment strategies for extensive chronic SFA occlusions: indications and results.

    NARCIS (Netherlands)

    Lensvelt, M.M.A.; Reijnen, M.M.P.J.; Wallis de Vries, B.M.; Zeebregts, C.J.A.

    2012-01-01

    Treatment modalities for extensive chronic occlusive disease of the superficial femoral artery (SFA) have changed during the last decades. In this chapter we provide an overview of current treatment modalities for extensive chronic occlusive disease of the SFA. Although the autologous venous conduit

  14. Treatment strategies for extensive chronic SFA occlusions : indications and results

    NARCIS (Netherlands)

    Lensvelt, M. M. A.; Reijnen, M. M. P. J.; De Vries, B. M. Wallis; Zeebregts, C. J.

    2012-01-01

    Treatment modalities for extensive chronic occlusive disease of the superficial femoral artery (SFA) have changed during the last decades. In this chapter we provide an overview of current treatment modalities for extensive chronic occlusive disease of the SFA. Although the autologous venous conduit

  15. [Intermittent thrombolytic treatment. Results during severe, chronic arterial diseases].

    Science.gov (United States)

    Fiessinger, J N; Aiach, M; Lagneau, P; Cormier, J M; Housset, E

    1975-04-20

    38 patients with severe chronic arteritis of the lower limbs were treated with streptokinase intermittently. All had been refused for surgical operation. One patient died, 4 others had early interruption of treatment. Eleven of the 38 patients had efficient thrombolysis confirmed by arteriography. The facts confirm the possibility of thrombolysis during chronic arterial disease. The fact that the aggravation was recent was favourable factor in prognosis. The eleven patients improved, had severe aggravation of symptomes for less than 2 months. Thus thrombolytic treatment has a place of choice in the treatment of severe arterial disease where surgery is impossible, or dangerous, owing to the uncertain state of the vascular bed below the lesion. Efficacious, it permits reconstructive surgery in cases where it had been at first refused. The use of intermittent treatment, apart from advantages of confort and cost, seems to increase the efficacy of treatment.

  16. Endovascular treatment of popliteal artery aneurysm. Early and midterm results

    Directory of Open Access Journals (Sweden)

    Rodrigo Borges Domingues

    2015-02-01

    Full Text Available OBJECTIVE: to evaluate the efficacy of endovascular repair of popliteal artery aneurysms on maintaining patency of the stent in the short and medium term. METHODS: this was a retrospective, descriptive and analytical study, conducted at the Integrated Vascular Surgery Service at the Hospital da Beneficência Portuguesa de São Paulo. We followed-up 15 patients with popliteal aneurysm, totaling 18 limbs, treated with stent from May 2008 to December 2012. RESULTS: the mean follow-up was 14.8 months. During this period, 61.1% of the stents were patent. The average aneurysm diameter was 2.5cm, ranging from 1.1 to 4.5cm. The average length was 5cm, ranging from 1.5 to 10 cm. In eight cases (47.1%, the lesion crossed the joint line, and in four of these occlusion of the prosthesis occurred. In 66.7% of cases, treatment was elective and only 33.3% were symptomatic patients treated on an emergency basis. The stents used were Viabahn (Gore in 12 cases (66.7%, Fluency (Bard in three cases (16.7%, Multilayer (Cardiatis in two cases (11.1% and Hemobahn (Gore in one case (5.6%. In three cases, there was early occlusion (16.6%. During follow-up, 88.2% of patients maintained antiplatelet therapy. There was no leakage at ultrasound (endoleak. No fracture was observed in the stents. CONCLUSION: the results of this study are similar to other published series. Probably, with the development of new devices that support the mechanical characteristics found on the thighs, there will be improved performance and prognosis of endovascular restoration.

  17. Superficial urinary bladder tumors treatment results: A 10-year experience

    Directory of Open Access Journals (Sweden)

    Stanković Jablan

    2007-01-01

    Full Text Available Background/Aim. The most common urinary bladder tumors are superficial tumors. Due to their tension to relapse and progress towards deeper layers after surgical therapy, an adequate therapy significantly contributed to the improvement of the results of urinary bladder tumors treatment. Staging and gradus of the tumor, presence of the carcinoma in situ (CIS or relapses significantly influenced the choice of the therapy. The aim of this study was to ascertain the effectiveness of the intravesicelly applied BCG (Bacille Colmette - Guerin vaccine or chemiotherapy in the prevention of the relapses and further progression of superficial urinary bladder tumors. Methods. All of the diagnosed superficial tumors of bladder were removed by transurethral resection (TUR. After receiving the patohistological finding they were subjected to adjuvant therapy, immune BCG vaccine or chemiotherapy (epirubicin, doxorubicin, mitomycin-C. The third group did not accept adjuvant therapy, but had regularly scheduled cystoscopic controls. The appearance of relapses, progression of stage and grades of the tumor, as well as possible unwanted effects of adjuvant therapy were registered. Results. The applied immunotherapy (BCG influenced decreased tumor relapses (7% and statistically important difference between patients who had taken adjuvant chemotherapy (relapses 18.4% and those without this therapy was acknowledged. Grades of tumor did not show statistically significant difference on tumor relapse. A significantly longer period of time in the appearance of tumor relapse after BCG (29.33 months, had significant importance comparing to chemio (9.44 months or non-taken adjuvant therapy (9.84 months. Very small number of unwanted effects suggested an obligatory undertaking adjuvant therapy after TUR of superficial tumors. Conclusion. A significant decrease of relapses as well as avoidance of further progression of urinary bladder tumors, has introduced adjuvant therapy in

  18. Specialized treatment for Avoidant personality disorder (AvPD): Treatment rationales and preliminary results

    DEFF Research Database (Denmark)

    Simonsen, Sebastian

    and preliminary results from a specialized psychotherapy program developed for patients with AvPD treated at Stolpegaard Psychotherapy Centre, Capital Region of Denmark. Methods: Treatment consists of individual therapy based on Metacognitive Interpersonal Therapy (MIT) while group therapy is a modified form...

  19. Surgical treatment of cervical spine trauma: Our experience and results

    Science.gov (United States)

    Dobran, Mauro; Iacoangeli, Maurizio; Nocchi, Niccolò; Di Rienzo, Alessandro; di Somma, Lucia Giovanna Maria; Nasi, Davide; Colasanti, Roberto; Al-Fay, Mohuammad; Scerrati, Massimo

    2015-01-01

    Objective and Background: The objective of this study is to evaluate how the neurological outcome in patients operated for cervical spinal cord injury (SCI) is influenced by surgical timing, admission American Spinal Injury Association (ASIA) grading system, and age. Materials and Methods: From January 2004 to December 2011, we operated 110 patients with cervical SCI. Fifty-seven of them (44 males and 13 females) with preoperative neurological deficit, were included in this study with a complete follow-up. Age, sex, associated comorbidities (evaluated with Charlson comorbidity index [CCI]), mechanism of trauma, preoperative and follow-up ASIA score, time elapsed from injury to surgical treatment, preoperative cervical computed tomography scan or magnetic resonance imaging, type of fractures, and surgical procedure were evaluated for each patient. The patient population was divided into two groups related to the timing of surgery: Ultra-early surgery group (within 12 h from the trauma, 27 patients) and early surgery (within 12–72 h from the trauma, 30 patients). Statistical Analysis Used: The univariate analysis of data was carried out by the Chi-square test for discrete variables, the t-test for the continuous ones. Logistic regression was used for the multivariate analysis. Results: Neurological outcome was statistically better in ultra-early surgery group (<12 h) than in patient underwent surgery within 12–72 h (82.14% vs. 31%, multivariate analysis P = 0.005). The neurological improvement was also correlated with the age and the ASIA grade at admission in the univariate analysis (P = 0.006 and P = 0.017 respectively) and in the multivariate 1 (P = 0.037 and P = 0.006 respectively) while the CCI was correlated with the improvement only in the univariate analysis (P = 0.007). Conclusion: Nowadays, in patients with cervical SCI early surgery could be associated with improved outcome, most in case of young people with mild neurological impairment. PMID:26396608

  20. Integrated thermal treatment system study -- Phase 2 results. Revision 1

    Energy Technology Data Exchange (ETDEWEB)

    Feizollahi, F.; Quapp, W.J.

    1996-02-01

    This report presents the second phase of a study on thermal treatment technologies. The study consists of a systematic assessment of nineteen thermal treatment alternatives for the contact-handled mixed low-level waste (MLLW) currently stored in the US Department of Energy complex. The treatment alternatives consist of widely varying technologies for safely destroying the hazardous organic components, reducing the volume, and preparing for final disposal of the MLLW. The alternatives considered in Phase 2 were innovative thermal treatments with nine types of primary processing units. Other variations in the study examined the effect of combustion gas, air pollution control system design, and stabilization technology for the treatment residues. The Phase 1 study examined ten initial thermal treatment alternatives. The Phase 2 systems were evaluated in essentially the same manner as the Phase 1 systems. The alternatives evaluated were: rotary kiln, slagging kiln, plasma furnace, plasma gasification, molten salt oxidation, molten metal waste destruction, steam gasification, Joule-heated vitrification, thermal desorption and mediated electrochemical oxidation, and thermal desorption and supercritical water oxidation. The quantities, and physical and chemical compositions, of the input waste used in the Phase 2 systems differ from those in the Phase 1 systems, which were based on a preliminary waste input database developed at the onset of the Integrated Thermal Treatment System study. The inventory database used in the Phase 2 study incorporates the latest US Department of Energy information. All systems, both primary treatment systems and subsystem inputs, have now been evaluated using the same waste input (2,927 lb/hr). 28 refs., 88 figs., 41 tabs.

  1. Results of surgical treatment for juvenile myasthenia gravis.

    Science.gov (United States)

    Vázquez-Roque, F J; Hernández-Oliver, M O; Medrano Plana, Y; Castillo Vitlloch, A; Fuentes Herrera, L; Rivero-Valerón, D

    2017-04-01

    Radical or extended thymectomy is an effective treatment for myasthenia gravis in the adult population. There are few reports to demonstrate the effectiveness of this treatment in patients with juvenile myasthenia gravis. The main objective of this study was to show that extended transsternal thymectomy is a valid option for treating this disease in paediatric patients. Twenty-three patients with juvenile myasthenia gravis underwent this surgical treatment in the period between April 2003 and April 2014; mean age was 12.13 years and the sample was predominantly female. The main indication for surgery, in 22 patients, was the generalised form of the disease (Osserman stage II) together with no response to 6 months of medical treatment. The histological diagnosis was thymic hyperplasia in 22 patients and thymoma in one patient. There were no deaths and no major complications in the postoperative period. After a mean follow-up period of 58.87 months, 22 patients are taking no medication or need less medication to manage myasthenic symptoms. Extended (radical) transsternal thymectomy is a safe and effective surgical treatment for juvenile myasthenia gravis. Copyright © 2015 Sociedad Española de Neurología. Publicado por Elsevier España, S.L.U. All rights reserved.

  2. Stem cells show promising results for lymphoedema treatment

    DEFF Research Database (Denmark)

    Toyserkani, Navid Mohamadpour; Quaade, Marlene Louise; Sheikh, Søren Paludan

    2015-01-01

    Abstract Lymphoedema is a debilitating condition, manifesting in excess lymphatic fluid and swelling of subcutaneous tissues. Lymphoedema is as of yet still an incurable condition and current treatment modalities are not satisfactory. The capacity of mesenchymal stem cells to promote angiogenesis......, secrete growth factors, regulate the inflammatory process, and differentiate into multiple cell types make them a potential ideal therapy for lymphoedema. Adipose tissue is the richest and most accessible source of mesenchymal stem cells and they can be harvested, isolated, and used for therapy...... in a single stage procedure as an autologous treatment. The aim of this paper was to review all studies using mesenchymal stem cells for lymphoedema treatment with a special focus on the potential use of adipose-derived stem cells. A systematic search was performed and five preclinical and two clinical...

  3. Distal end radius fractures: evaluation of results of various treatments and assessment of treatment choice

    Directory of Open Access Journals (Sweden)

    Vargaonkar Gauresh

    2014-07-01

    Full Text Available 【Abstract】Objective:The rapid expansion of knowledge regarding the functional anatomy of hand and wrist, increasing functional demands of senior citizens and improved methodologies of achieving and maintaining anatomic restoration of distal radius fractures has generated a renewed interest in addressing these fractures in a more precise manner. The purpose of our study was to evaluate the difference in patients function among those treated by 1 closed reduction and Plaster of Paris cast, 2 distractor application, or 3 open reduction and internal fixation with a volar plate, and to assess the treatment choice for each particular fracture type. Methods: A prospective study was carried out on 60 patients with fractures of the distal end radius. Fractures were classified according to the AO classification into type A (extra-articular, type B (partial articular and type C (complete articular. After initial evaluation patients were taken up for either conservative or operative treatment and were followed up for two years. Results: Anatomical results were evaluated according to the Sarmiento’s modification of Lindstrom Criteria, which showed that excellent results were more frequent with open reduction and internal fixation using the plating technique. Clinical and functional results were evaluated according to the demerit point system of Gartland and Werley with Sarmiento modification, which was revealed to relate with the type of treatment techniques. Conclusion: There is no customized solution for all the fractures of the distal radius. The choice of treatment should be based on the fracture type, the patient’s characteristics, the patient’s demands and the treating surgeon’s experience and preference. Key words: Distal end radius fractures; Volar plate; Radial orthofix

  4. Distal end radius fractures: evaluation of results of various treatments and assessment of treatment choice

    Institute of Scientific and Technical Information of China (English)

    Vargaonkar Gauresh

    2014-01-01

    Objective:The rapid expansion of knowledge regarding the functional anatomy of hand and wrist,increasing functional demands of senior citizens and improved methodologies of achieving and maintaining anatomic restoration of distal radius fractures has generated a renewed interest in addressing these fractures in a more precise manner.The purpose of our study was to evaluate the difference in patients function among those treated by 1) closed reduction and Plaster of Paris cast,2) distractor application,or 3) open reduction and internal fixation with a volar plate,and to assess the treatment choice for each particular fracture type.Methods:A prospective study was carried out on 60 patients with fractures of the distal end radius.Fractures were classified according to the AO classification into type A (extra-articular),type B (partial articular) and type C (complete articular).After initial evaluation patients were taken up for either conservative or operative treatment and were followed up for two years.Results:Anatomical results were evaluated according to the Sarmiento's modification of Lindstrom Criteria,which showed that excellent results were more frequent with open reduction and internal fixation using the plating technique.Clinical and functional results were evaluated according to the demerit point system of Gartland and Werley with Sarmiento modification,which was revealed to relate with the type of treatment techniques.Conclusion:There is no customized solution for all the fractures of the distal radius.The choice of treatment should be based on the fracture type,the patient's characteristics,the patient's demands and the treating surgeon's experience and preference.

  5. CONGENITAL ABSENCE OF THE VAGINA - RESULTS OF CONSERVATIVE TREATMENT

    NARCIS (Netherlands)

    LAPPOHN, RE

    1995-01-01

    Objective: To assess the efficacy of a combination of Frank's mold therapy with intercourse as a treatment for congenital vaginal aplasia. Study design: From 1973-1993, thirty-three patients with congenital aplasia of vagina and uterus were seen by one gynecologist. Patients with a partner were inst

  6. Good result after surgical treatment of Pellegrini-Stieda syndrome.

    Science.gov (United States)

    Theivendran, Kanthan; Lever, Caroline J; Hart, William J

    2009-10-01

    Ossification of the femoral attachment of the medial collateral ligament (MCL) of the knee with associated pain and restricted movements is rare and is characteristic of the Pellegrini-Stieda (PS) syndrome. Although in mild cases conservative treatment is often successful, patients with more significant bone formation and persistent symptoms require surgical excision. We describe a case of PS syndrome with a description of the surgical technique consisting of excision of the bony lesion and reconstruction of the MCL by using the adductor magnus tendon.

  7. Non-invasive assessment of coronary artery disease with CT coronary angiography and SPECT: a novel dose-saving fast-track algorithm

    Energy Technology Data Exchange (ETDEWEB)

    Pazhenkottil, Aju P.; Herzog, Bernhard A.; Husmann, Lars; Buechel, Ronny R.; Burger, Irene A.; Valenta, Ines; Landmesser, Ulf; Wyss, Christophe A. [University Hospital Zurich, Cardiac Imaging, Zurich (Switzerland); Kaufmann, Philipp A. [University Hospital Zurich, Cardiac Imaging, Zurich (Switzerland); University of Zurich, Zurich Center for Integrative Human Physiology (ZIHP), Zurich (Switzerland)

    2010-03-15

    To validate a new low-dose and rapid stepwise individualized algorithm for non-invasive assessment of ischemic coronary artery disease by sequential use of prospectively ECG-triggered low-dose CT coronary angiography (CTCA) and low-dose single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI). Forty patients referred for elective invasive coronary angiography (CA) were prospectively enrolled to undergo a comprehensive non-invasive evaluation with low-dose CTCA and a dose-reduced stress/rest SPECT-MPI scan (using dedicated reconstruction algorithms for low count scans). The following algorithm was reviewed: CTCA first, followed by a stress-only MPI if a coronary stenosis ({>=} 50% diameter narrowing) or equivocal findings were observed. Only abnormal stress MPI scans were followed by rest MPI. The accuracy of the individualized algorithm to predict coronary revascularization and its mean effective radiation dose were assessed. CTCA documented CAD in 18 and equivocal findings in two patients, thus, requiring additional stress MPI scans. Of these, 16 were abnormal, therefore requiring a rest MPI scan, revealing ischemia in 15 patients. Sensitivity, specificity, negative and positive predictive value, and accuracy of the individualized algorithm for predicting coronary revascularization was 93.3%, 96.0%, 96.0%, 93.3% and 95.0% on a per-patient base. The mean effective radiation dose was significantly lower for the individualized (4.8 {+-} 3.4 mSv) versus the comprehensive method (8.1 {+-} 1.5 mSv) resulting in a total population radiation dose reduction of 132.6 mSv. This new individualized low-dose algorithm allows rapid and accurate prediction of invasive CA findings and of treatment decision with minimized radiation dose. (orig.)

  8. [The Helkimo index for assessing treatment results after mandibular fractures].

    Science.gov (United States)

    Härtel, J; Hellmuth, M; Hellmuth, K O

    1991-01-01

    Based on the Helkimo index we assessed the success of conservative and conservative-surgical forms of treatment for mandibular fractures in a total of 166 patients. The control group consisted of 50 probands. The Helkimo dysfunction index, which is based on various criteria, showed dysfunction in 81.9% of the patients with only slight functional impairment in 57.2% of these cases. 18.1% of the patients were clinically symptom-free. A comparison with the probands revealed no major differences in dysfunction between the two groups. Significant differences were observed only in the case of 2 isolated criteria (maximum mandibular protrusion, muscle pain). Severe dysfunction, however, was more common in the fracture patients. Based on the Helkimo occlusion index disorder were noted in 91.7% of the patients, while severe occlusion disorder were observed particularly in patients with combined mandibular body and condyle fractures (40.0%). In the control group a more favorable occlusion index was found to be due mainly to the greater number of present and/or occluding teeth. The Helkimo index, particularly the dysfunctionindex, is a very useful instrument for assessing the success of treatment measures in mandibular fracture cases. It should be more commonly used to improve the possibilites of objective comparisons between patients from different hospitals.

  9. Medulloblastoma in childhood: long-term results of treatment

    Energy Technology Data Exchange (ETDEWEB)

    Broadbent, V.A.; Barnes, N.D.; Wheeler, T.K.

    1981-07-01

    Thirty-one children under the age of 15 years with verified medulloblastoma were treated at Addenbrookes Hospital from 1940 to 1976. In addition to surgical treatment, all received high dose irradiation to the whole neuraxis. Nine were still alive in 1979, of whom eight were examined. All these patients showed some residual problems, but five were leading active lives and had only minor physical disability. There was evidence of disturbance in growth, with shortening of the spine in relation to the limbs, in all the children. The height centile was lower than expected from parental height in four and one was severely dwarfed. Growth hormone secretion in response to exercise was, however, normal in five of six patients tested. Three children also showed failure of growth of the jaw sufficiently severe to be a cosmetic problem. Frank mental retardation was present in three children. A raised resting TSH level was found in two children, one of whom had a multinodular goiter. Of the three children with severe problems, two had been treated when under two years of age. Long-term follow-up of children who survive medulloblastoma is clearly necessary and consideration should perhaps be given to revision of current treatment regimes in very young children.

  10. Waiting times for diagnosis and treatment of head and neck cancer in Denmark in 2010 compared to 1992 and 2002

    DEFF Research Database (Denmark)

    Lyhne, N M; Christensen, A; Alanin, M C

    2013-01-01

    BACKGROUND AND AIM: Significant tumour progression was observed during waiting time for treatment of head and neck cancer. To reduce waiting times, a Danish national policy of fast track accelerated clinical pathways was introduced in 2007. This study describes changes in waiting time and the pot......BACKGROUND AND AIM: Significant tumour progression was observed during waiting time for treatment of head and neck cancer. To reduce waiting times, a Danish national policy of fast track accelerated clinical pathways was introduced in 2007. This study describes changes in waiting time...... and the potential influence of fast track by comparing waiting times in 2010 to 2002 and 1992. METHODS: Charts of all new patients diagnosed with squamous cell carcinoma of the oral cavity, pharynx and larynx at the five Danish head and neck oncology centres from January to April 2010 (n=253) were reviewed...

  11. Favorable results with syringosubarachnoid shunts for treatment of syringomyelia.

    Science.gov (United States)

    Tator, C H; Meguro, K; Rowed, D W

    1982-04-01

    From 1969 to 1979, 20 patients with syringomyelia were treated with a syringosubarachnoid shunt. The principal indications for this procedure were: significant progressive neurological deterioration and absent or minimal tonsillar ectopia. There were 15 patients with idiopathic syringomyelia, four with posttraumatic syringomyelia, and one with syringomyelia secondary to spinal arachnoiditis. The operations were performed with an operating microscope, and attention was directed to preserving thearachnoid membrane to ensure proper placement of the distal end of the shunt in an intact subarachnoid space. In all cases, a silicone rubber ventricular catheter was inserted into the syrinx through a posterior midline myelotomy. The average follow-up period was 5 years. A favorable result was obtained in 15 of the 20 patients (75%), including an excellent result with improvement of neurological deficit in 11 patients and a good result with cessation of progression in four patients. In the remaining five patients the result was poor with further progression of neurological deficit. A short duration of preoperative symptoms was usually a favorable prognostic feature. Four patients with a history of less than 6 months all had excellent results. Thirteen patients had a syringosubarachnoid shunt only, and all had good or excellent results. Seven patients had other surgical procedures, before, accompanying, or after shunt placement, and two had favorable results. Thus, the syringosubarachnoid shunt is an effective therapeutic modality for many patients with syringomyelia, particularly if there is little or no tonsillar herniation.

  12. Results achieved in the treatment of patients with vestibular schwannoma.

    Science.gov (United States)

    Freigang, Bernd; Rudolf, Jan

    2004-01-01

    Personal experience gathered with the treatment of 264 vestibular schwannoma (VS) at the Magdeburg University ENT Hospital is analysed. ABR Audiometry is useful as a screening, even though it yielded false-negative values in 12.7% (n = 33) for intrameatal VS and 16.9% for all VS, despite accurate evaluation. Latency increases of Waves I, III and V and their intraaural comparison exhibited a statistically significant difference for the VS levels proposed by TOS. The mean of intrameatal VS too was found to have longer latencies compared with the normal-hearing ears of the patients. In the individual case, with threshold hearing normal, anamnestic findings as well as otoneurological evidence provide an early indication for enhanced MRI, CISS imaging, or individual 3D reconstruction of the pontocerebellar cisterna. Adopting intraoperative monitoring of the facial nerve and the cochlea as well as the Pars acustica by means of far-field and near-field electrodes, a good facial 'mobility' was achieved in 95.3%, and a useful audition (AAO-HNS Types A and B) in 60%. Monitoring is beneficial as it enhances the reliability and improves the subtle preparation during surgery. The power of hearing improved postoperatively within six months and remained at a good level over two years. From our perspective, otorhinolaryngologists are the right specialists to attend to VS.

  13. RESULTS OF SURGICAL TREATMENT IN THE CRANIOCERVICAL JUNCTION IN MUCOPOLYSACCHARIDOSIS

    Directory of Open Access Journals (Sweden)

    Luís Eduardo Carelli Teixeira da Silva

    2016-03-01

    Full Text Available ABSTRACT Objective: Evaluate the results after decompression and stabilization of craniocervical junction in patients with mucopolysaccharidosis (MPS. Method: Retrospective study of 10 patients with MPS through the analysis of medical records and additional tests. Result: All patients with mid-term and long-term follow-up achieved consolidation of the arthrodesis and 87.5% had neurological improvement of Nurick score. Conclusion: Early diagnosis and intervention in cases of stenosis and/or craniocervical instability of patients with MPS provide patients a good recovery of neurological function, despite the great technical difficulty and risk of complications.

  14. [Cranial acupuncture in the treatment of spasticity. Clinical results].

    Science.gov (United States)

    Gomirato, G; Grimaldi, L; Perfetti, C; Roccia, L

    1976-06-09

    Hospitals in communist China perfected a new acupuncture technique about 3 yrs ago, whereby needles are placed in the scalp to stimulate the cortical centres below. This method is particularly indicated in subjects with neurological damage. Results observed in 45 subjects with cerebral vasculopathy at the neurological clinic of Pisa University and the reflexotherapy service of the University of Turin were encouraging and suggest that clinical experimentation should be attempted on a wider scale.

  15. 快速康复外科护理应用于急腹症并发抑郁症患者的临床成效%Clinical effect of fast track surgery nursing for acute abdomen complicated with depression

    Institute of Scientific and Technical Information of China (English)

    古金花; 邹艳花; 陈小银

    2015-01-01

    our hospital in 2012 August to 2014 year in July in department of general surgery were set as the study group,the implementation of fast track surgery,nursing intervention.Two groups of patients in hospitalization day and intervention the end of 5D underwent brief depression rating scale(BPRS)assessment,two patients were also recorded after the group eating time,ambulation time,medical expenses,hospitalization time,complications rate. Results The study group the next activity time,postoperative eating time,hospitalization time was shorter than the control group(P 0.05)after the intervention,the study group;anxiety depression factor,lack of energy factor,thinking disorder factor and hostile factors were lower than the control group(P < 0.05),activated factor was higher than that in control group(P < 0.05). Conclusion For patients with acute abdomen complicated with depression,the concept of rapid rehabilitation surgery can promote the rehabilitation of patients with the disease prognosis,reduce the incidence of complications,and help to improve the emotional state of patients, promote the social function of the early return, achieved satisfactory clinical results.

  16. [Long term results after invasive treatment of critical limb ischemia].

    Science.gov (United States)

    Ruzsa, Zoltán; Kuti, Ferenc; Berta, Balázs; Tóth, Károly; Bánsághi, Zoltán; Vámosi, Zoltán; Hüttl, Kálmán

    2017-03-01

    Surgical tibial bypass for critical limb ischemia is associated with significant morbidity, mortality, and graft failure, whereas percutaneous angioplasty and stenting has promising results. The objective of this study was the investigation of the long term results of below-knee percutaneous angioplasty for restoring straight inline arterial flow in patients with critical limb ischemia. The clinical and angiographic data of 281 consecutive patients with critical limb ischemia treated by PTA between 2008 and 2011 was evaluated in a prospective register. The aim of the revascularization was to achieve a straight inline flow to the wound with balloon angioplasty. Stent implantation was done in the case of recoil and flow limiting dissection. Primary end points were clinical success (relief of resting pain, healing of ulceration, limb survival) and major adverse events (death, myocardial infarction, major unplanned amputation, need for surgical revascularization, or major bleeding). Secondary end points were the angiographic result of the intervention, procedural data and consumption of angioplasty equipment. The impact of diabetic leg syndrome and the result of the angioplasty on the limb salvage was also investigated. We have analysed the impact of major amputation on long term mortality. Mean age of patients was 72.5 ± 10.6 years and the follow-up period was 40.8 ± 9.7 months. Technical success was reached in 255 (90.7%) of the patient's: 255 limbs straight inline flow with good angiographic result was restored to at least one tibial vessel. Balloon angioplasty, stent implantation and rotational atherectomy was performed in 278 (98.9%), 74 (26.3%) and 2 patients (0.7%). From clinical end points the rest pain was ceased in 56.6%, the ulcer and the gangrena was healed in 73.5% and 46.5%. The long term limb survival was 73.5%; 65.8% in diabetic and 89.6% in non-diabetic leg syndrome (p = 0.001). The major adverse events at long-term follow-up occured in 122 (43

  17. The Immediate Results of Surgical Treatment of Bladder Cancer

    Directory of Open Access Journals (Sweden)

    Alexei L. Charyshkin

    2016-06-01

    Full Text Available The objective of this study was to evaluate the immediate results of the use of ureterointestinal anastomosis according to the Bricker technique at radical cystectomy (RC for bladder cancer (BC. Materials and Results: The study included 96 patients (11.5% women and 88.5% men with bladder cancer (BC, aged from 31 to 74 years (mean age 63.8±7.2, who underwent RC in the Lipetsk Regional Oncology Center, in the period from 2005 to 2014. Among the early postoperative complications, we identified dynamic ileus (16.7%, inflammatory complications of the surgical wound (12.5%, acute pyelonephritis (10.4%, and failure of ureterointestinal anastomosis (4.2%. The frequency of postoperative acute pyelonephritis corresponded to the findings of other authors. Two (2.1% patients died from early postoperative complications because of concomitant diseases (ischemic heart disease, myocardial infarction; thus, postoperative mortality in the early postoperative period was 4.2%. Chronic pyelonephritis with chronic renal failure detected in 15(15.6% patients after one year after surgery was the most frequent late postoperative complication. The stricture of ureterointestinal anastomosis in 9(9.4% patients has been eliminated through relaparotomy and resection of anastomosis. The development of urolithiasis in 12(12.5% patients after one year after surgery has required the implementation of contact lithotripsy and litholytic therapy.

  18. [Surgical treatment results of 52 cases of temporomandibular ankylosis].

    Science.gov (United States)

    Kimura-Fujikami, Takao

    2003-01-01

    We courried out a retrospective study of 52 surgical cases of temporomandibular joint ankylosis, fibrous types I and II in 19 patients (36.4%) and osseous type III-IV in 33 patients (63.6%). Forty two children and teenagers at the Hospital de Pediatria (1983-1985/1989-1998) and Hospital General La Raza (1985-1989) were included also, 10 adults including those operated on at the Hospital de Especialidades, CMN Siglo XXI (IMSS) from 1998 to 2001 were included. We used Dunn modified method en 37 cases (67%) and 17 patients were with Risdon operated on technique (33%). Etiology of ankylosis were direct trauma to jaw, which affected temporomandibular joint mainly in children, while in adults causes were more varied and included as osteomyelitis, middle ear infection, sequels of hemifacial microsomy, and trauma results were considered as good upon obtaining mouth opening of 35 mm without neo-ankylosis during 1-year postoperative control.

  19. Latest Results for Anti-Angiogenic Drugs in Cancer Treatment

    DEFF Research Database (Denmark)

    Frandsen, Sofie; Kopp, Sascha; Wehland, Markus;

    2016-01-01

    BACKGROUND: Angiogenesis is a mechanism, which tumors use to recruit oxygen and nutrients in order to maintain growth. The vascular endothelial growth factor family is the primary mediator of this process. For the last couple of decades, inhibition of angiogenesis has been the subject of extensiv...... mechanisms are necessary. Moreover, biomarker studies in future clinical investigations are important for the development of the next generation of anti-angiogenic drugs....... research, but so far anti-angiogenic drugs have only shown a modest effect. METHODS: This paper reviews four relevant anti-angiogenic drugs: bevacizumab, ramucirumab, nintedanib and sunitinib. The primary focus will be recent trials investigating the effects of the drugs in lung, breast...... and gastrointestinal cancers. Furthermore, there will be a discussion of unsolved problems, such as lack of biomarkers, drug resistance, and adverse events, for which a solution is necessary in order to improve the benefit of anti-angiogenic drugs in the future. RESULTS: Anti-angiogenic therapy is extensively used...

  20. [Pramipexole in Parkinson disease. Results of a treatment observation].

    Science.gov (United States)

    Reichmann, H; Brecht, H M; Kraus, P H; Lemke, M R

    2002-08-01

    Pramipexole is a novel, internationally available selective nonergot D2 dopamine agonist. The effectiveness, tolerability, and safety of pramipexole have been extensively proven in controlled trials in patients in the early and advanced stage of Parkinson's disease as monotherapy and in combination with L dopa. These trials indicated specific activity against tremor, anhedonia, and depression. Therefore, the present prospective, multicenter postmarketing surveillance study evaluated for the first time to what extent the results from the controlled pramipexole trials could be replicated under routine conditions in neurological practice and clinics. Modern scales were applied for the assessment of tremor and mood, i.e., the Short Parkinson's Evaluation Scale (SPES), the Tremor Impact Scale (TIS), and the German version of the Snaith-Hamilton Pleasure Scale (SHAPS-D). In 298 German Centers, 657 Parkinson's patients (365 men, 292 women) in advanced disease stages were treated with pramipexole in combination with levodopa. The average ages (+/- SD) were 67 (+/- 8.9) years for men and 69 (+/- 9.4) years for females. Motor functioning, especially tremor, motor complications, depression, and activities of daily living improved highly significantly (P pramipexole prescribed was 1.05 mg and thus was definitely lower than the average daily dosages of 2.35-2.66 mg used in controlled trials. This signifies that the option to adjust dosage according to effectiveness and tolerability under routine conditions yields a considerably lower incidence of adverse effects.

  1. [Morton metatarsalgia. Results of surgical treatment in 54 cases].

    Science.gov (United States)

    Assmus, H

    1994-04-01

    This syndrome, which involves nerve compression, is probably often overlooked and is, therefore, more frequent than supposed. It is characterized by pain of the forefoot, especially the 3rd and 4th toe, and is induced by pressure of the intermetatarsal space, or extension of the metatarsophalangeal joints. Results of the present study suggest that it can be successfully treated by surgery. Fifty-four patients--mostly women in midlife--had undergone operation by dorsal excision of the "neuroma" which had been performed under local anaesthesia in a bloodless field. Forty of the patients (74.1%) had recovered completely within an observation period of 1-6 years. Four (7.4%) demonstrated significant, and another 4, only slight improvement. In 6 cases (11.1%), surgery failed. The 6 unsuccessful cases had not exhibited any preoperative disturbance to the sensibility of the 4th toe. They showed, rather, symptoms of conversion disorder with depressive features, e.g. increased nocturnal suffering which is atypical for Morton's metatarsalgia. It is concluded that the accuracy of diagnosis according to strict criteria is decisive for surgical outcome.

  2. [Tendinosis calcarea--results of treatment with needling].

    Science.gov (United States)

    Gärtner, J

    1993-01-01

    In a prospective study, 33 patients with calcifying tendinitis had a needling in local anaesthesia performed under control of an image converter. There was at least a one year follow-up period. Resorption of the hydroxyapatite deposits was seen in 23 instances; 75% of all patients were free of symptoms or had considerably improved (Table 3). For better assessment of these results we embarked on an additional retrospective study observing the spontaneous evolution of 235 hydroxyapatite deposits for 3 years on average. On the x-ray, these deposits had a characteristic appearance and could be classified into one of three types: either sharply outlined and densely structured (type I), or with cloudy limitations and transparent in structure (type III). In addition we saw deposits combining the features of both of the above named types (type II) (Table 5, Fig. 6). Based on this classification, a clear correlation was revealed to exist between initial x-ray findings and the frequency of resorption after needling: with type I, complete resorption was seen in 33% of the cases, with type II in 71%, and with type III in 85% of the cases (Table 6). With type II, however, only half of the patients were free of symptoms. Surgical removal of the hydroxyapatite deposits became necessary in 3 patients because of persisting heavy pains. As complication we observed intraoperatively an incomplete tear of the rotator cuff, the relation of which to the needling remained unsure. In this context, the question is discussed whether calcifying tendinitis and rupture of the rotator cuff may represent two disease entities of identical origin.(ABSTRACT TRUNCATED AT 250 WORDS)

  3. Antiresorptive Treatment for Spaceflight Induced Bone Atrophy - Preliminary Results

    Science.gov (United States)

    LeBlanc, Adrian; Matsumoto, toshio; Jones, Jeff; Shapiro, Jay; Lang, Thomas; Shackelford, Linda C.; Smith, Scott M.; Evans, Harlan J.; Spector, Elisabeth R.; Ploutz-Snyder, Robert; Sibonga, Jean; Nakamura, Toshitaka; Kohri, Kenjiro; Ohshima, Hiroshi

    2011-01-01

    Detailed measurements from the Mir and ISS long duration missions have documented losses in bone mineral density (BMD) from critical skeletal sub-regions. The most important BMD losses are from the femoral hip, averaging about -1.6%/mo integral to -2.3%/mo trabecular. Importantly these studies have documented the wide range in individual BMD loss from -0.5 to -5%/mo. Associated elevated urinary Ca increases the risk of renal stone formation during flight, a serious impact to mission success. To date, countermeasures have not been satisfactory. The purpose of this study is to determine if the combined effect of anti-resorptive drugs plus the standard in-flight exercise regimen will have a measurable effect on preventing space flight induced bone loss (mass and strength) and reducing renal stone risk. To date, 4 crewmembers have completed the flight portion of the protocol in which crewmembers take a 70-mg alendronate tablet once a week before and during flight, starting 17 days before launch. Compared to previous ISS crewmembers (n=14) not taking alendronate, DXA measurements of the spine, femur neck and total hip were significantly improved from -0.8 +/- 0.5%/mo to 1.0 +/- 1.1%/mo, -1.1 +/- 0.5%/mo to -0.2 +/- 0.3%/mo, -1.1 +/- 0.5%/mo to 0.04 +/- 0.3%/mo respectively. QCT-determined trabecular BMD of the femur neck, trochanter and total hip were significantly improved from -2.7 +/- 1.9%/mo to -0.2 +/- 0.8%/mo, -2.2 +/- 0.9%/mo to -0.3 +/- 1.9%/mo and -2.3 +/- 1.0%/mo to -0.2 +/- 1.8%/mo respectively. Significance was calculated from a one-tailed t test. Resorption markers were unchanged, in contrast to measurements from previous ISS crewmembers that showed typical increases of 50-100% above baseline. Urinary Ca showed no increase compared to baseline levels, also distinct from the elevated levels of 50% or greater in previous crews. While these results are encouraging, the current n (4) is small, and the large SDs indicate that, while the means are improved, there

  4. Dexmedetomidine as an adjunct to anesthetic induction to attenuate hemodynamic response to endotracheal intubation in patients undergoing fast-track CABG

    Directory of Open Access Journals (Sweden)

    Menda Ferdi

    2010-01-01

    Full Text Available During induction of general anesthesia hypertension and tachycardia caused by tracheal intubation may lead to cardiac ischemia and arrhythmias. In this prospective, randomized study, dexmedetomidine has been used to attenuate the hemodynamic response to endotracheal intubation with low dose fentanyl and etomidate in patients undergoing myocardial revascularization receiving beta blocker treatment. Thirty patients undergoing myocardial revascularization received in a double blind manner, either a saline placebo or a dexmedetomidine infusion (1 µg/kg before the anesthesia induction. Heart rate (HR and blood pressure (BP were monitored at baseline, after placebo or dexmedetomidine infusion, after induction of general anesthesia, one, three and five minutes after endotracheal intubation. In the dexmedetomidine (DEX group systolic (SAP, diastolic (DAP and mean arterial pressures (MAP were lower at all times in comparison to baseline values; in the placebo (PLA group SAP, DAP and MAP decreased after the induction of general anesthesia and five minutes after the intubation compared to baseline values. This decrease was not significantly different between the groups. After the induction of general anesthesia, the drop in HR was higher in DEX group compared to PLA group. One minute after endotracheal intubation, HR significantly increased in PLA group while, it decreased in the DEX group. The incidence of tachycardia, hypotension and bradycardia was not different between the groups. The incidence of hypertension requiring treatment was significantly greater in the PLA group. It is concluded that dexmedetomidine can safely be used to attenuate the hemodynamic response to endotracheal intubation in patients undergoing myocardial revascularization receiving beta blockers.

  5. Comparative Evaluation of Pain, Stress, Neuropeptide Y, ACTH, and Cortisol Levels Between a Conventional Postoperative Care Protocol and a Fast-Track Recovery Program in Patients Undergoing Major Abdominal Surgery.

    Science.gov (United States)

    Kapritsou, Maria; Papathanassoglou, Elizabeth D; Bozas, Evangelos; Korkolis, Dimitrios P; Konstantinou, Evangelos A; Kaklamanos, Ioannis; Giannakopoulou, Margarita

    2017-03-01

    Fast-track (FT) postoperative protocol in oncological patients after major abdominal surgery reduces complications and length of postoperative stay compared to the conventional (CON) protocol. However, stress and pain responses have not been compared between the two protocols. To compare stress, pain, and related neuropeptidic responses (adrenocorticotropic hormone [ACTH], cortisol, and neuropeptide Y [NPY]) between FT and CON protocols. A clinical trial with repeated measurements was conducted (May 2012 to May 2014) with a sample of 63 hepatectomized or pancreatectomized patients randomized into two groups: FT ( n = 29) or CON ( n = 34). Demographic and clinical data were collected, and pain (Visual Analog Scale [VAS] and Behavioral Pain Scale [BPS]) and stress responses (3 self-report questions) assessed. NPY, ACTH, and cortisol plasma levels were measured at T1 = day of admission, T2 = day of surgery, and T3 = prior to discharge. ACTHT1 and ACTHT2 levels were positively correlated with self-reported stress levels (ρ = .43 and ρ = .45, respectively, p levels in the FT group were higher than those in the CON group at all time points ( p ≤ .004); this difference remained significant after adjusting for T1 levels through analysis of covariance for age, gender, and body mass index ( F = .003, F = .149, F = .015, respectively, p > .05). Neuropeptidic levels were higher in the FT group. Future research should evaluate this association further, as these biomarkers might serve as objective indicators of postoperative pain and stress.

  6. Effects of unplanned treatment interruptions on HIV treatment failure - results from TAHOD.

    Science.gov (United States)

    Jiamsakul, Awachana; Kerr, Stephen J; Ng, Oon Tek; Lee, Man Po; Chaiwarith, Romanee; Yunihastuti, Evy; Van Nguyen, Kinh; Pham, Thuy Thanh; Kiertiburanakul, Sasisopin; Ditangco, Rossana; Saphonn, Vonthanak; Sim, Benedict L H; Merati, Tuti Parwati; Wong, Wingwai; Kantipong, Pacharee; Zhang, Fujie; Choi, Jun Yong; Pujari, Sanjay; Kamarulzaman, Adeeba; Oka, Shinichi; Mustafa, Mahiran; Ratanasuwan, Winai; Petersen, Boondarika; Law, Matthew; Kumarasamy, Nagalingeswaran

    2016-05-01

    Treatment interruptions (TIs) of combination antiretroviral therapy (cART) are known to lead to unfavourable treatment outcomes but do still occur in resource-limited settings. We investigated the effects of TI associated with adverse events (AEs) and non-AE-related reasons, including their durations, on treatment failure after cART resumption in HIV-infected individuals in Asia. Patients initiating cART between 2006 and 2013 were included. TI was defined as stopping cART for >1 day. Treatment failure was defined as confirmed virological, immunological or clinical failure. Time to treatment failure during cART was analysed using Cox regression, not including periods off treatment. Covariables with P 30 days were associated with failure (31-180 days HR = 2.66, 95%CI (1.70-4.16); 181-365 days HR = 6.22, 95%CI (3.26-11.86); and >365 days HR = 9.10, 95% CI (4.27-19.38), all P < 0.001, compared to 0-14 days). Reasons for previous TI were not statistically significant (P = 0.158). Duration of interruptions of more than 30 days was the key factor associated with large increases in subsequent risk of treatment failure. If TI is unavoidable, its duration should be minimised to reduce the risk of failure after treatment resumption. © 2016 John Wiley & Sons Ltd.

  7. Coping and Self-Efficacy in Marijuana Treatment: Results from the Marijuana Treatment Project

    Science.gov (United States)

    Litt, Mark D.; Kadden, Ronald M.; Stephens, Robert S.

    2005-01-01

    This study examined whether a coping-skills-based treatment for marijuana dependence operated by encouraging the use of coping skills or via other mechanisms. Participants were 450 men and women treated in the multisite Marijuana Treatment Project who were randomly assigned to motivational enhancement therapy plus cognitive-behavioral (MET-CB)…

  8. Multistrain models predict sequential multidrug treatment strategies to result in less antimicrobial resistance than combination treatment

    DEFF Research Database (Denmark)

    Ahmad, Amais; Zachariasen, Camilla; Christiansen, Lasse Engbo

    2016-01-01

    Background: Combination treatment is increasingly used to fight infections caused by bacteria resistant to two or more antimicrobials. While multiple studies have evaluated treatment strategies to minimize the emergence of resistant strains for single antimicrobial treatment, fewer studies have...... frequency did not play a role in suppressing the growth of resistant strains, but the specific order of the two antimicrobials did. Predictions made from the study could be used to redesign multidrug treatment strategies not only for intramuscular treatment in pigs, but also for other dosing routes....... the sensitive fraction of the commensal flora.Growth parameters for competing bacterial strains were estimated from the combined in vitro pharmacodynamic effect of two antimicrobials using the relationship between concentration and net bacterial growth rate. Predictions of in vivo bacterial growth were...

  9. Early identification and delay to treatment in myocardial infarction and stroke: differences and similarities

    Directory of Open Access Journals (Sweden)

    Herlitz Johan

    2010-09-01

    Full Text Available Abstract Background The two major complications of atherosclerosis are acute myocardial infarction (AMI and acute ischemic stroke. Both are life-threatening conditions characterised by the abrupt cessation of blood flow to respective organs, resulting in an infarction. Depending on the extent of the infarction, loss of organ function varies considerably. In both conditions, it is possible to limit the extent of infarction with early intervention. In both conditions, minutes count. This article aims to describe differences and similarities with regard to the way patients, bystanders and health care providers act in the acute phase of the two diseases with the emphasis on the pre-hospital phase. Method A literature search was performed on the PubMed, Embase (Ovid SP and Cochrane Library databases. Results In both conditions, symptoms vary considerably. Patients appear to suspect AMI more frequently than stroke and, in the former, there is a gender gap (men suspect AMI more frequently than women. With regard to detection of AMI and stroke at dispatch centre and in Emergency Medical Service (EMS there is room for improvement in both conditions. The use of EMS appears to be higher in stroke but the overall delay to hospital admission is shorter in AMI. In both conditions, the fast track concept has been shown to influence the delay to treatment considerably. In terms of diagnostic evaluation by the EMS, more supported instruments are available in AMI than in stroke. Knowledge of the importance of early treatment has been reported to influence delays in both AMI and stroke. Conclusion Both in AMI and stroke minutes count and therefore the fast track concept has been introduced. Time to treatment still appears to be longer in stroke than in AMI. In the future improvement in the early detection as well as further shortening to start of treatment will be in focus in both conditions. A collaboration between cardiologists and neurologists and also between

  10. Multistrain models predict sequential multidrug treatment strategies to result in less antimicrobial resistance than combination treatment

    DEFF Research Database (Denmark)

    Ahmad, Amais; Zachariasen, Camilla; Christiansen, Lasse Engbo;

    2016-01-01

    considered combination treatments. The current study modeled bacterial growth in the intestine of pigs after intramuscular combination treatment (i.e. using two antibiotics simultaneously) and sequential treatments (i.e. alternating between two antibiotics) in order to identify the factors that favor...... the sensitive fraction of the commensal flora.Growth parameters for competing bacterial strains were estimated from the combined in vitro pharmacodynamic effect of two antimicrobials using the relationship between concentration and net bacterial growth rate. Predictions of in vivo bacterial growth were...

  11. 中西医结合快速康复技术在消化性溃疡穿孔中的应用效果%Applying integrated traditional Chinese and western medicine fast-track surgery on the perioperative period of neoplasty for peptic ulcer perforation

    Institute of Scientific and Technical Information of China (English)

    徐艳; 叶启乐; 温萍萍; 朱仁武; 顾叶春; 陈智椰; 蒋毅; 韩小超; 夏贝贝

    2016-01-01

    Objective To study the effects of integrated traditional Chinese and western medicine fast-track surgery ( FTS) in the perioperative period of neoplasty for peptic ulcer perforation. Methods From June 2012 to August 2014, 90 patients, who received open neoplasty caused by peptic ulcer perforation, were recruited and divided randomly into control group and experimental group. The patients of control group were treated with routine way in perioperative period, while the patients of experimental group were treated with integrated traditional Chinese and western medicine FTS. Meanwhile, the first flatus after operation, length of stay, times of clinic visit, readmission rate, re-operation rate, symptoms, postoperative complications, level of IL-6, CRP and ALB, and patient satisfaction were evaluated. Results The anus exhaust time, hospitalization time of patients in experimental group was shorter than that in control group (t= -5. 022,-7. 172;P0. 05). There was a significant difference in stress indicators and nutritional indicators between the two groups 5 days after operation (P0. 05). 术后第5天,两组应激指标和营养指标比较差异均有统计学意义(P<0. 05). 实验组患者满意41例,对照组16例,差异有统计学意义(Z= -2. 181,P<0. 05). 结论 中西医结合FTS技术在消化性溃疡穿孔的应用具有良好的安全性,可以有效促进患者术后康复、缓解患者症状、减轻应激反应以及增强营养支持,获得了患者更高的满意度.

  12. Application of Fast Track Surgery Concept in Perioperative Nursing of Elderly Patients with Total Hip Arthroplasty%快速康复外科理念在老年全髋关节置换术患者围术期中的应用

    Institute of Scientific and Technical Information of China (English)

    徐肖; 杨连香; 孙惠萍

    2012-01-01

    Objective To explore the effect of fast track surgery(FTS) concept on the perioperative nursing of elderly patients with total hip arthroplasty (THA). Methods From October 2009 to December 2011,69 THA patients in the hospital were divided into observational group (n = 33) and control group (n = 36). The control group adopted the conventional perioperative nursing, while the observational group was implemented with FTS concept based on the conventional perioperative nursing. Afterwards, pain de-grees(visual analog scale, VAS) , anxious status(Hamilton anxiety scale, HAMA) , and other physiological indicators of the two groups were compared at 1 d before operation and 7 d after operation. Results There was no significant difference in the HAMA and VAS scores, systolic blood pressure, diastolic blood pressure and heart rate between the two groups before operation (P>0. 05). However, the scores of HAMA and VAS, systolic blood pressure, diastolic blood pressure and heart rate were significantly lessened after operation(P0. 05). Conclusion FST concept in the perioperative nursing of elderly THA patients helps to reduce the perioperative anxiety, relieve the postoperative pain and improve the patients' blood pressure and heart rate and other physiological indicators, which is worth further clinical application.%目的 探讨快速康复外科(fast track surgery,FTS)理念在老年全髋关节置换术(total hip arthroplasty,THA)患者围术期护理中的应用效果.方法 按随机数字表法将2009年10月至2011年12月浙江省杭州市第一人民医院骨科收治的拟行THA的69例患者分为对照组36例和观察组33例,对照组采取常规围术期护理,观察组在对照组基础上将FST理念融入围术期护理,采用汉密尔顿焦虑量表(hamilton anxiety scale,HAMA)及疼痛视觉模拟评分法(visual analog scale,VAS)于术前1 d及术后7 d分别对患者进行测评,同时记录相关的生理指标.结果 两组患者术前的HAMA评分

  13. Retrospective Evaluation of Two Fast-track Strategies to Rule Out Acute Coronary Syndrome in a Real-life Chest Pain Population

    DEFF Research Database (Denmark)

    Schønemann-Lund, Martin; Schoos, Mikkel Malby; Iversen, Kasper

    2015-01-01

    BACKGROUND: The European Society of Cardiology (ESC) guideline on non-ST-elevation acute coronary syndrome (N-STE ACS) proposed a new ACS rule-out protocol. OBJECTIVES: To evaluate this new tool, which uses diagnostic levels of high-sensitivity troponin T (hs-TnT; > 14 ng/L) in a slightly modified......, and symptom status at 6-9 h. Protocol 2: a single blood sample of hs-TnT. The primary endpoint was a discharge diagnosis of ACS by blinded adjudication. Secondary endpoints were ACS re-admission days and 1-year mortality. RESULTS: Protocol 1 classified 434/534 (81%) patients, with 27.9% being ruled out...... predictive value of 94.1% (88.2-97.6%) and 90.8% (81.9-96.2%), respectively. Both protocols correctly ruled in 2/3 patients with ACS re-admission days and 55/56 1-year fatalities. CONCLUSION: The present study confirms the diagnostic value of a modified version of the ESC rule-out protocol (Protocol 1...

  14. Liver resection for hepatocellular carcinoma within a fast-track management:a propensity-score matched analysis between open and laparoscopic approach

    Institute of Scientific and Technical Information of China (English)

    Francesca Ratti; Federica Cipriani; Raffaella Reineke; Marco Catena; Michele Paganelli; Luigi Beretta; Luca Aldrighetti

    2016-01-01

    Aim: The study was designed to assess the implications of enhanced recovery after surgery (ERAS) approach in patients submitted to open liver resection for hepatocellular carcinoma (HCC) comparing their short term outcome with patients treated by laparoscopic approach, in a case-matched design.Methods: The open-group (n = 60) was matched in a ratio of 1:1 with patients undergoing laparoscopic liver resection for HCC (Lap-group,n= 60), with a matching achieved on a basis of propensity scores including 6 covariates representing patients characteristics and severity of the disease. Primary outcome analysis was performed in terms of ERAS-speciifc items and postoperative morbidity and mortality.Results: Overall morbidity and mortality were comparable between groups. Incidence of ascites was slightly higher in the open- compared with the Lap-group (respectively 11.7% and 13.3%), without statistical signiifcance. The need for introduction or increase of chronic diuretic therapy was signiifcantly higher in the open-compared with the Lap-group (16.7%vs. 11.7%,P = 0.046). Furthermore, ascites more frequently required percutaneous drainage in the open-compared with the Lap-group (5%vs. 1.7% respectively,P = 0.041).Conclusion: In patients who can’t beneift from minimally-invasive approach because of disease characteristics, ERAS management seems to be associated with an improved postoperative functional recovery and postoperative outcomes, comparable to those of the minimally invasive approach.

  15. Fast-Track, One-Step E. coli Detection: A Miniaturized Hydrogel Array Permits Specific Direct PCR and DNA Hybridization while Amplification.

    Science.gov (United States)

    Beyer, Antje; Pollok, Sibyll; Rudloff, Anne; Cialla-May, Dana; Weber, Karina; Popp, Jürgen

    2016-09-01

    A timesaving and convenient method for bacterial detection based on one-step, one-tube deoxyribonucleic acid (DNA) hybridization on hydrogel array while target gene amplification is described. The hydrogel array is generated by a fast one-pot synthesis, where N,N'-dimethylacrylamide/polyethyleneglycol(PEG1900 )-bisacrylamide mixture polymerizes via radical photoinitiation by visible light within 20 min concomitant with in situ capture probe immobilization. These DNA-functionalized hydrogel droplets arrayed on a planar glass surface are placed in the polymerase chain reaction (PCR) mixture during the thermal amplification cycles. The bacterial cells can be implemented in a direct PCR reaction, omitting the need for prior template DNA extraction. The resulting fluorescence signal is immediately detectable after the end of the PCR (1 h) following one short washing step by microscopy. Therefore a valid signal can be reached within 1.5 h including 10 min for pipetting and placement of the tubes and chips. The performance of this novel hydrogel DNA array was successfully proven with varying cell numbers down to a limit of 10(1) Escherichia coli cells.

  16. FAST TRACK COMMUNICATION: Effects of charge transfer interaction of graphene with electron donor and acceptor molecules examined using Raman spectroscopy and cognate techniques

    Science.gov (United States)

    Voggu, Rakesh; Das, Barun; Sekhar Rout, Chandra; Rao, C. N. R.

    2008-11-01

    The effects of the interaction of few-layer graphene with electron donor and acceptor molecules have been investigated by employing Raman spectroscopy, and the results compared with those from electrochemical doping. The G-band softens progressively with increasing concentration of tetrathiafulvalene (TTF) which is an electron donor, while the band stiffens with increasing concentration of tetracyanoethylene (TCNE) which is an electron acceptor. Interaction with both TTF and TCNE broadens the G-band. Hole and electron doping by electrochemical means, however, stiffen and sharpen the G-band. The 2D-band position is also affected by interaction with TTF and TCNE. More importantly, the intensity of the 2D-band decreases markedly with the concentration of either. The ratio of intensities of the 2D-band and G-band decreases with an increase in TTF or TCNE concentration, and provides a means for carrier titration in the charge transfer system. Unlike the intensity of the 2D-band, that of the D-band increases on interaction with TTF or TCNE. All of these effects occur due to molecular charge transfer, also evidenced by the occurrence of charge transfer bands in the electronic absorption spectra. The electrical resistivity of graphene varies in opposite directions on interaction with TTF and TCNE, the resistivity depending on the concentration of either compound.

  17. Fast Track Liver Resection: The Effect of a Comprehensive Care Package and Analgesia with Single Dose Intrathecal Morphine with Gabapentin or Continuous Epidural Analgesia

    Directory of Open Access Journals (Sweden)

    Jonathan B. Koea

    2009-01-01

    Full Text Available Background. A comprehensive care package for patients undergoing hepatectomy was developed with the aim of minimal physiological disturbance in the peri-operative period. Peri-operative analgesia with few gastrointestinal effects and reduced requirement for intravenous (IV fluid therapy was central to this plan. Methods. Data on 100 consecutive patients managed with continuous epidural infusion (n = 50; bupivicaine 0.125% and fentanyl 2 g/mL at 0.1 mL/kg/hr or intrathecal morphine (n = 50; 300 g in combination with oral gabapentin 1200 mg preoperatively and 400 mg bd postoperatively was compared. Results. The epidural and intrathecal morphine groups were equivalent in terms of patient demographics, procedures and complications. Patients receiving intrathecal morphine received less intra-operative IV fluids (median 1500 mL versus 2200 mL, =.06, less postoperative IV fluids (median 1200 mL versus 4300 mL, =.03 than patients receiving epidural infusion. Patients managed with intrathecal morphine established a normal dietary intake sooner (16 hours versus 20 hours, =.05 and had shorter hospital stays than those managed with epidural infusions (4.7 ± 0.9 days versus 6.8 ± 1.2 days, =.02. Conclusions. Single dose intrathecal morphine is a safe and effective means of providing peri-operative analgesia. Patients managed with intrathecal morphine have reduced peri-operative physiological disturbance and return home within a few days of hepatic resection.

  18. The influence of fast track surgery on stress and inflammatory response in breast cancer patient s treated with modified radical mastectomy%加速康复外科对乳腺癌改良根治术患者应激及炎症反应的影响

    Institute of Scientific and Technical Information of China (English)

    余红敏; 罗海平; 毛哲玉

    2015-01-01

    .Operation time,operative blood loss and hospitalization days were analyzed between the two groups,simultaneously ,the incidence of subcutaneous hydrops ,flap necrosis and upper limb edema were also de-tected.Results The concentration of serum PRA ,Ang-Ⅱ,ALD,cortisol,IL-6,IL-8 and TNF-αwere no significantly differences in two groups before operation and at 48 hours after surgery(P>0.05).The concentra-tions of serum PRA,Ang-Ⅱ,ALD,cortisol,IL-6,IL-8 and TNF-αof FTS group were significantly different between the preoperative and different time points (P0.05).The intraoperative blood loss in the FTS group(156.98 ±17.09)ml was not significantly less than that in the control group (158.57 ±16.92) ml(P=0.644).Hospitalization days were 8.37 ±1.89 and 10.37 ±2.05 in the FTS and the control group re-spectively ,with significant difference .The incidence of upper limb edema ,subcutaneous hydrops ,flap necrosis in FTS group were not less than control group .Conclusion Fast track surgery could attenuate stress and inflamma-tory response during ,and it is safe and effective in modified radical mastectomy .

  19. 42 CFR 483.372 - Medical treatment for injuries resulting from an emergency safety intervention.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 5 2010-10-01 2010-10-01 false Medical treatment for injuries resulting from an... Psychiatric Residential Treatment Facilities Providing Inpatient Psychiatric Services for Individuals Under Age 21 § 483.372 Medical treatment for injuries resulting from an emergency safety intervention....

  20. Behavioural treatment of trichotillomania : two-year follow-up results : predictors of treatment outcome

    NARCIS (Netherlands)

    Keijsers, G.P.J.; Minnen, A. van; Hoogduin, C.A.L.; Klaassen, B.N.W.; Hendriks, G.J.; Tanis-Jacobs, J.

    2006-01-01

    Post-treatment evaluation studies of behaviour therapy (BT) for trichotillomania (TTM) have shown that BT is successful in reducing symptoms in this impulse-control disorder. The present study was aimed at investigating gain maintenance at long-term follow-up. TTM-related symptoms and other symptom

  1. Study Finds Ebola Treatment ZMapp Holds Promise, Although Results Not Definitive

    Science.gov (United States)

    ... News Release Thursday, October 13, 2016 Study finds Ebola treatment ZMapp holds promise, although results not definitive ... emergency. A clinical trial to evaluate the experimental Ebola treatment ZMapp found it to be safe and ...

  2. FAST TRACK PAPER: Older crust underlies Iceland

    Science.gov (United States)

    Foulger, G. R.

    2006-05-01

    The oldest rocks outcropping in northwest Iceland are ~16 Myr old and in east Iceland ~13 Myr. The full plate spreading rate in this region during the Cenozoic has been ~2 cm a-1, and thus these rocks are expected to be separated by ~290 km. They are, however, ~500 km apart. The conclusion is inescapable that an expanse of older crust ~210 km wide underlies Iceland, submerged beneath younger lavas. This conclusion is independent of any considerations regarding spreading ridge migrations, jumps, the simultaneous existence of multiple active ridges, three-dimensionality, or subsidence of the lava pile. Such complexities bear on the distribution and age of the older crust, but not on its existence or its width. If it is entirely oceanic its maximum age is most likely 26-37 Ma. It is at least 150 km in north-south extent, but may taper and extend beneath south Iceland. Part of it might be continental-a southerly extension of the Jan Mayen microcontinent. This older crust contributes significantly to crustal thickness beneath Iceland and the ~40 km local thickness measured seismically is thus probably an overestimate of present-day steady-state crustal production at Iceland.

  3. An evolutionary fast-track to biocalcification.

    Science.gov (United States)

    Jackson, D J; Thiel, V; Wörheide, G

    2010-06-01

    The ability to construct mineralized shells, spicules, spines and skeletons is thought to be a key factor that fuelled the expansion of multicellular animal life during the early Cambrian. The genes and molecular mechanisms that control the process of biomineralization in disparate phyla are gradually being revealed, and it is broadly recognized that an insoluble matrix of proteins, carbohydrates and other organic molecules are required for the initiation, regulation and inhibition of crystal growth. Here, we show that Astrosclera willeyana, a living representative of the now largely extinct stromatoporid sponges (a polyphyletic grade of poriferan bauplan), has apparently bypassed the requirement to evolve many of these mineral-regulating matrix proteins by using the degraded remains of bacteria to seed CaCO(3) crystal growth. Because stromatoporid sponges formed extensive reefs during the Paelozoic and Mesozoic eras (fulfilling the role that stony corals play in modern coral reefs), and fossil evidence suggests that the same process of bacterial skeleton formation occurred in these stromatoporid ancestors, we infer that some ancient reef ecosystems might have been founded on this microbial-metazoan relationship.

  4. Fast-track revision knee arthroplasty

    DEFF Research Database (Denmark)

    Husted, Henrik; Otte, Niels Kristian Stahl; Kristensen, Billy B;

    2011-01-01

    excluding 1 patient, who was transferred to another hospital for logistical reasons (10 days). None of the patients died within 3 months, and 3 patients were re-admitted (2 for suspicion of DVT, which was not found, and 1 for joint mobilization). Patient satisfaction was high. Interpretation Patients...

  5. Clean Energy Cooperation Steering in Fast Track

    Institute of Scientific and Technical Information of China (English)

    Rose Yan

    2009-01-01

    @@ Cooperation, it is a win-win choice for China and the US. Cooperation has almost become the hottest buzz word in the energy sector globally. During the US President Obama's visit to China recently, China and the US made agreement on the climate change, energy and environment sectors and put forward specific measures for jointly promoting development in these fields, further heating the cooperation between China and the US in the clean energy sector.

  6. What is the fast track to future energy systems with lower CO2 emissions? Main findings and recommendations from Workshop on Future Energy Systems, Technical University of Denmark, 19 - 20 November 2008

    Energy Technology Data Exchange (ETDEWEB)

    Soenderberg Petersen, L.; Larsen, Hans (eds.)

    2009-04-15

    As part of the DTU Climate Change Technologies programme, DTU arranges a series of workshops and conferences on climate change technology focusing on assessment of and adaptation to climate changes as well as on mitigation of green house gasses (GHG). Each workshop target a specific problem area. This workshop focuses on the challenges for the future energy system from a Danish perspective as well as world wide with regard to both technology needs and policy measures with particular focus on identifying a fast track to energy systems with lower CO{sub 2} emissions. In the coming years, energy systems will be changed to consist of a combination of central units and smaller decentralized units - to a large extent based on renewable energy. At the same time there will be close links between the supply of energy and the individual end user of energy. These links will be based on extensive use of information and communication technology. This will allow end users to respond adequately to price signals and use the electricity for loading electric cars, laundry etc. while the electricity prices are low due to for example surplus of wind generated electricity. The workshop assessed the perspectives for a rapid development of energy systems with more renewable energy in order to reduce CO{sub 2} emissions. Furthermore, the workshop gives recommendations for the implementation of such energy systems. The recommendations are targeted at the research community, industry and public authorities. The recommendations include opportunities for synergy between the research community, the government and the energy industry as well as public authorities. This report presents summary and recommendations from the workshop. (au)

  7. The frequency of missed test results and associated treatment delays in a highly computerized health system

    OpenAIRE

    2007-01-01

    Abstract Background: Diagnostic errors associated with the failure to follow up on abnormal diagnostic studies ("missed results") are a potential cause of treatment delay and a threat to patient safety. Few data exist concerning the frequency of missed results and associated treatment delays within the Veterans Health Administration (VA). Objective: The primary objective of the current study was to assess the frequency of missed results and resulting treatment delays encountered by primary ca...

  8. Clinical effects of perioperative fast-track surgery program in patients with colorectal cancer%结直肠癌患者围手术期快速康复外科新理念治疗的效果观察

    Institute of Scientific and Technical Information of China (English)

    王钢; 黄河

    2011-01-01

    To observe the clinical effects of pcriopcrativc fast-track surgery (FTS) program in the patients with colorcctal cancer. Methods: Ninety-one patients with colorcctal cancer were randomly divided into FTS group (48 cases) and control group (43 cases). The patients in the FTS group received FTS program pcriopcrativcly, including psychological aid, cntcral nutrition and catharsis before operation, control of the volume of transfusion during the operation, small incision for operation, non-steroid analgesic treatment, early withdrawal of urc-thral catheter and gastric tube, and encouraging patients to be ambulatory early after operation. The patients in the control group received routine protocol pcriopcrativcly, including taking antibiotics orally, fasting, cleansing enema before operation, routine incision, large-volume transfusion, routine dainagc, opioid analgesic for pain, withdrawal of urinary catheter 3 days after operation. The duration from operation to the first flatus and defecation, the incidence of nausea and vomiting, rate of postoperative complications, postoperative nutritional state (scrum albumin level), and postoperative hospital stay, and hospitalization expenditure were compared between the two groups. Results:Compared to the control group, in the FTS group the duration from operation to the first passage of flatus and defecation was shortened, the incidence of complications after operation was reduced, the scrum albumin level was higher, the hospitalization time was shortened, and the hospitalization expenditure reduced. The rate of postoperative nausea and vomiting was simi-lcr between the two groups. Conclusions: FTS program can obviously increase the pcriopcrativc body constitution of the patients with colorcctal cancer, reduce the degree of operative trauma, decrease the incidence of complications, shorten hospital stay and lower hospitalization expenditure.%目的:观察结、直肠癌患者围手术期应用快速康复外科(FTS)新理念

  9. Treatment results and long-term stability of anterior open bite malocclusion.

    NARCIS (Netherlands)

    Remmers, D.; Hullenaar, RW Van't; Bronkhorst, E.M.; Berge, S.J.; Katsaros, C.

    2008-01-01

    OBJECTIVES: To evaluate treatment results and long-term stability of anterior open bite malocclusion and to identify predictive factors for both treatment results and their stability. DESIGN: Retrospective study. SETTING AND SAMPLE POPULATION: The Department of Orthodontics and Oral Biology at the R

  10. Redução do período de internação e de despesas no atendimento de portadores de cardiopatias congênitas submetidos à intervenção cirúrgica cardíaca no protocolo da via rápida The reduction in hospital stay and costs in the care of patients with congenital heart diseases undergoing fast-track cardiac surgery

    Directory of Open Access Journals (Sweden)

    Alfredo Manoel da Silva Fernandes

    2004-07-01

    Full Text Available OBJETIVO: Avaliar o atendimento de cardiopatas congênitos e cardiopatas isquêmicos submetidos à cirurgia cardíaca no protocolo de atendimento na via rápida (fast-track recovery em relação ao convencional. MÉTODOS: Avaliada a movimentação de 175 pacientes, 107 (61% homens e 68 (39% mulheres, idades entre 0,3-81 anos nas diferentes unidades hospitalares. RESULTADOS: A taxa de alta das diferentes unidades hospitalares por unidade de tempo, dos cardiopatas congênitos atendidos no protocolo da via rápida em relação ao convencional foi: a 11,3 vezes a taxa de alta quando assistidos no protocolo da via convencional, quanto ao tempo de permanência no centro cirúrgico; b 6,3 vezes quanto à duração da intervenção cirúrgica; c 6,8 vezes quanto à duração da anestesia; d 1,5 vezes quanto à duração da perfusão; e 2,8 vezes quanto à permanência na unidade de recuperação pós-operatória I; f 6,7 vezes quanto à permanência no hospital (período de tempo entre a data da internação e a data da alta; g 2,8 vezes quanto à permanência na unidade de internação pré-operatória; h 2,1 vezes quanto à permanência na unidade de internação após a alta da recuperação pós-operatória; i associada com redução de despesas pré e pós-operatórias. A diferença não foi significativa nos portadores de cardiopatia isquêmica. CONCLUSÃO: Verificou-se redução do período de internação e de despesas no atendimento dos pacientes submetidos à intervenção cirúrgica cardíaca no protocolo da via rápida.OBJECTIVE: To assess the care provided to patients with congenital heart diseases and ischemic heart diseases undergoing cardiac surgery according to the fast-track recovery protocol compared with those undergoing the conventional procedure. METHODS: The transfer of patients from one hospital unit to another was assessed for 175 patients, 107 (61% men and 68 (39% women, with ages ranging from 0.3 to 81 years. RESULTS: The

  11. An evaluation of culture results during treatment for tuberculosis as surrogate endpoints for treatment failure and relapse.

    Directory of Open Access Journals (Sweden)

    Patrick P J Phillips

    Full Text Available It is widely acknowledged that new regimens are urgently needed for the treatment of tuberculosis. The primary endpoint in the Phase III trials is a composite outcome of failure at the end of treatment or relapse after stopping treatment. Such trials are usually both long and expensive. Valid surrogate endpoints measured during or at the end of treatment could dramatically reduce both the time and cost of assessing the effectiveness of new regimens. The objective of this study was to evaluate sputum culture results on solid media during treatment as surrogate endpoints for poor outcome. Data were obtained from twelve randomised controlled trials conducted by the British Medical Research Council in the 1970s and 80s in East Africa and East Asia, consisting of 6974 participants and 49 different treatment regimens. The month two culture result was shown to be a poor surrogate in East Africa but a good surrogate in Hong Kong. In contrast, the month three culture was a good surrogate in trials conducted in East Africa but not in Hong Kong. As well as differences in location, ethnicity and probable strain of Mycobacteria tuberculosis, Hong Kong trials more often evaluated regimens with rifampicin throughout and intermittent regimens, and patients in East African trials more often presented with extensive cavitation and were slower to convert to culture negative during treatment. An endpoint that is a summary measure of the longitudinal profile of culture results over time or that is able to detect the presence of M. tuberculosis later in treatment is more likely to be a better endpoint for a phase II trial than a culture result at a single time point and may prove to be an acceptable surrogate. More data are needed before any endpoint can be used as a surrogate in a confirmatory phase III trial.

  12. The results of conservative and surgical treatments of styloiditis radii de Quervain

    OpenAIRE

    2004-01-01

    Though styloiditis radii de Quervain is a little disease condition, it sometimes necessitates surgery. in this research we examined the result of 147 patients who was admitted to the Department of Orthopaedics of Ev. Krankenhaus retrospectively. We compared corticosteroid which mentionted injection with conservative treatment. We prefer conservative methods instead of corticosteroid treatment which mentionted in the literature. Conservative treatment was necessary in 78,91% of cases. 31 of ou...

  13. Severe root resorption resulting from orthodontic treatment: Prevalence and risk factors

    Directory of Open Access Journals (Sweden)

    Caroline Pelagio Raick Maués

    2015-02-01

    Full Text Available OBJECTIVE: To assess the prevalence of severe external root resorption and its potential risk factors resulting from orthodontic treatment. METHODS: A randomly selected sample was used. It comprised conventional periapical radiographs taken in the same radiology center for maxillary and mandibular incisors before and after active orthodontic treatment of 129 patients, males and females, treated by means of the Standard Edgewise technique. Two examiners measured and defined root resorption according to the index proposed by Levander et al. The degree of external apical root resorption was registered defining resorption in four degrees of severity. To assess intra and inter-rater reproducibility, kappa coefficient was used. Chi-square test was used to assess the relationship between the amount of root resorption and patient's sex, dental arch (maxillary or mandibular, treatment with or without extractions, treatment duration, root apex stage (open or closed, root shape, as well as overjet and overbite at treatment onset. RESULTS: Maxillary central incisors had the highest percentage of severe root resorption, followed by maxillary lateral incisors and mandibular lateral incisors. Out of 959 teeth, 28 (2.9% presented severe root resorption. The following risk factors were observed: anterior maxillary teeth, overjet greater than or equal to 5 mm at treatment onset, treatment with extractions, prolonged therapy, and degree of apex formation at treatment onset. CONCLUSION: This study showed that care must be taken in orthodontic treatment involving extractions, great retraction of maxillary incisors, prolonged therapy, and/or completely formed apex at orthodontic treatment onset.

  14. Severe root resorption resulting from orthodontic treatment: Prevalence and risk factors

    Science.gov (United States)

    Maués, Caroline Pelagio Raick; do Nascimento, Rizomar Ramos; Vilella, Oswaldo de Vasconcellos

    2015-01-01

    OBJECTIVE: To assess the prevalence of severe external root resorption and its potential risk factors resulting from orthodontic treatment. METHODS: A randomly selected sample was used. It comprised conventional periapical radiographs taken in the same radiology center for maxillary and mandibular incisors before and after active orthodontic treatment of 129 patients, males and females, treated by means of the Standard Edgewise technique. Two examiners measured and defined root resorption according to the index proposed by Levander et al. The degree of external apical root resorption was registered defining resorption in four degrees of severity. To assess intra and inter-rater reproducibility, kappa coefficient was used. Chi-square test was used to assess the relationship between the amount of root resorption and patient's sex, dental arch (maxillary or mandibular), treatment with or without extractions, treatment duration, root apex stage (open or closed), root shape, as well as overjet and overbite at treatment onset. RESULTS: Maxillary central incisors had the highest percentage of severe root resorption, followed by maxillary lateral incisors and mandibular lateral incisors. Out of 959 teeth, 28 (2.9%) presented severe root resorption. The following risk factors were observed: anterior maxillary teeth, overjet greater than or equal to 5 mm at treatment onset, treatment with extractions, prolonged therapy, and degree of apex formation at treatment onset. CONCLUSION: This study showed that care must be taken in orthodontic treatment involving extractions, great retraction of maxillary incisors, prolonged therapy, and/or completely formed apex at orthodontic treatment onset. PMID:25741825

  15. "To whom do the results of this trial apply?" External validity of a randomized controlled trial involving 130 patients scheduled for primary total hip replacement

    DEFF Research Database (Denmark)

    Petersen, Mette K; Andersen, Karen Vestergaard; Andersen, Niels T

    2007-01-01

    , but they should at least allow patients and clinicians to judge to whom trial results can reasonably be applied. We assessed the external validity of an RCT investigating the efficacy of a fast-track program after total hip replacement. METHODS: 130 patients were identified as potential participants.18 patients...

  16. Results of Surgical Treatment of Chronic Patellar Tendinosis (Jumper's Knee): A Systematic Review of the Literature.

    Science.gov (United States)

    Brockmeyer, Matthias; Diehl, Nora; Schmitt, Cornelia; Kohn, Dieter M; Lorbach, Olaf

    2015-12-01

    To review the literature concerning surgical treatment options for chronic patellar tendinosis (jumper's knee), a common problem among athletes. When conservative treatment fails, surgical treatment is required. Systematic review of the literature concerning the results of current surgical treatment options for chronic patellar tendinosis. All articles of studies with an evidence level ≥IV from January 2000 until February 2015 presenting the surgical outcome after arthroscopic as well as open treatment of chronic patellar tendinosis were included. The literature research of the PubMed database was performed using the following key words: "patellar" and "tendinitis," "tendonitis," "tendinosis" or "tendinopathy"; "inferior patellar pole"; "jumper's knee"; "surgical treatment" and "open" or "arthroscopic patellar tenotomy." A systematic review of the literature was performed especially to point out the effectiveness of arthroscopic treatment of chronic patellar tendinosis. The results revealed good clinical results for arthroscopic as well as open treatment of chronic patellar tendinosis that is refractory to conservative treatment in athletes. An average success rate of 87% was found for the open treatment group and of 91% for the arthroscopic treatment group. However, after open surgery, the mean time of return to the preinjury level of activity is 8 to 12 months, with a certain number of patients/athletes who cannot return to the preinjury level of activity. Minimally invasive, arthroscopically assisted or all-arthroscopic procedures may lead to a significantly faster return to sporting activities and may, therefore, be the preferred method of surgical treatment. Level IV, systematic review of Level I-IV studies. Copyright © 2015 Arthroscopy Association of North America. Published by Elsevier Inc. All rights reserved.

  17. The extremely resorbed mandible : A comparative prospective study of 2-year results with 3 treatment strategies

    NARCIS (Netherlands)

    Stellingsma, Kees; Raghoebar, Gerry M.; Meijer, Henny J.A.; Stegenga, Boudewijn

    2004-01-01

    Purpose: The aim of this prospective clinical study was to compare the clinical and radiographic results of 3 modes of implant treatment in combination with an overdenture in patients with extremely resorbed mandibles. The 3 treatment strategies used were a transmandibular implant, augmentation of t

  18. Barriers to Mental Health Treatment: Results from the WHO World Mental Health (WMH) Surveys

    Science.gov (United States)

    Andrade, L. H.; Alonso, J.; Mneimneh, Z.; Wells, J. E.; Al-Hamzawi, A.; Borges, G.; Bromet, E.; Bruffaerts, R.; de Girolamo, G.; de Graaf, R.; Florescu, S.; Gureje, O.; Hinkov, H. R.; Hu, C.; Huang, Y.; Hwang, I.; Jin, R.; Karam, E. G.; Kovess-Masfety, V.; Levinson, D.; Matschinger, H.; O’Neill, S.; Posada-Villa, J.; Sagar, R.; Sampson, N. A.; Sasu, C.; Stein, D.; Takeshima, T.; Viana, M. C.; Xavier, M.; Kessler, R. C.

    2014-01-01

    Background To examine barriers to initiation and continuation of mental health treatment among individuals with common mental disorders. Methods Data are from the WHO World Mental Health (WMH) Surveys. Representative household samples were interviewed face-to-face in 24 countries. Reasons to initiate and continue treatment were examined in a subsample (n= 63,678) and analyzed at different levels of clinical severity. Results Among those with a DSM-IV disorder in the past twelve months, low perceived need was the most common reason for not initiating treatment and more common among moderate and mild than severe cases. Women and younger people with disorders were more likely to recognize a need for treatment. Desire to handle the problem on one’s own was the most common barrier among respondents with a disorder who perceived a need for treatment (63.8%). Attitudinal barriers were much more important than structural barriers both to initiating and continuing treatment. However, attitudinal barriers dominated for mild-moderate cases and structural barriers for severe cases. Perceived ineffectiveness of treatment was the most commonly reported reason for treatment dropout (39.3%) followed by negative experiences with treatment providers (26.9% of respondents with severe disorders). Conclusions Low perceived need and attitudinal barriers are the major barriers to seeking and staying in treatment among individuals with common mental disorders worldwide. Apart from targeting structural barriers, mainly in countries with poor resources, increasing population mental health literacy is an important endeavor worldwide. PMID:23931656

  19. [Remote results of surgical treatment of aging ptosis of face and neck tissues].

    Science.gov (United States)

    Ezrokhin, V M; Pavlovich, V A

    2008-01-01

    Remote results of surgical treatment of patients with aging ptosis of face and neck tissues during 15 years are presented. Results were good there where suggested incisions marking was carried out and for those face and neck skin regions which should be corrected. Unsatisfactory results were received in the cases when wounds edges were sewn by uninterrupted blanket sutures without skin deeper layers fixing.

  20. Interim results of the Ph-negative acute lymphoblastic leukemia treatment in adult patients (results of Russian research group of ALL treatment (RALL

    Directory of Open Access Journals (Sweden)

    E. N. Parovichnikova

    2015-01-01

    Full Text Available An interim analysis of long-term treatment results for 202 patients with acute lymphoblastic leukemia (ALL, aged 15–60 years, received therapy according protocol ALL-2009 was shown. The basic principle of ALL-2009 was non-aggressive, but continued cytostatic exposure, as well as the reproducibility in a regional hematology centers. Long-term treatment results of ALL-2009 are 2 times higher than the previously obtained in adult ALL patients within the Russian clinical multicenter studies of adult ALL. The 5‑year overall survival of patients younger than 30 years was 73.6 %, relapse-free survival (RFS – 71.5 %, compared with 52.7 % and 61.8 % in patients aged 30 years and older, respectively. In patients with B-precursor ALL with normal karyotype of blast cells significantly higher 5‑year RFS (82.1 % compared to patients with abnormal karyotype (58.8 % was registered. For T-ALL cytogenetic characteristics of blast cells had no prognostic significance. For patients with T-ALL important to perform autologous stem cell transplantation as a later consolidation, as this significantly reducerelapse rate (from 33 to 0 %.

  1. Interim results of the Ph-negative acute lymphoblastic leukemia treatment in adult patients (results of Russian research group of ALL treatment (RALL

    Directory of Open Access Journals (Sweden)

    E. N. Parovichnikova

    2014-01-01

    Full Text Available An interim analysis of long-term treatment results for 202 patients with acute lymphoblastic leukemia (ALL, aged 15–60 years, received therapy according protocol ALL-2009 was shown. The basic principle of ALL-2009 was non-aggressive, but continued cytostatic exposure, as well as the reproducibility in a regional hematology centers. Long-term treatment results of ALL-2009 are 2 times higher than the previously obtained in adult ALL patients within the Russian clinical multicenter studies of adult ALL. The 5‑year overall survival of patients younger than 30 years was 73.6 %, relapse-free survival (RFS – 71.5 %, compared with 52.7 % and 61.8 % in patients aged 30 years and older, respectively. In patients with B-precursor ALL with normal karyotype of blast cells significantly higher 5‑year RFS (82.1 % compared to patients with abnormal karyotype (58.8 % was registered. For T-ALL cytogenetic characteristics of blast cells had no prognostic significance. For patients with T-ALL important to perform autologous stem cell transplantation as a later consolidation, as this significantly reducerelapse rate (from 33 to 0 %.

  2. The comparative analysis of results of surgical treatment of myasthenia in the remote periods of disease

    Directory of Open Access Journals (Sweden)

    L. Zaslavsky

    2016-01-01

    Full Text Available Based on long-term follow-up to perform comparative analysis of long-term results of surgical treatment of myasthenia. A retrospective analysis of long-term results of surgical treatment of 146 patients with myasthenia has been carried out. We used the modified Keynes classification to estimate the severity of myasthenia and to summarize the data relating to therapy volume and treatment results. In dependence on the type of thymus lesion patients were divided into two groups. Thymus hyperplasia was verified at — 106 (72.6 % patients, tumor lesion of the thymus gland (thymoma — at 40 (27.4 % ones. The results were estimated in the following periods after thymectomy: 1—2 years, 3—4 years, 5—6 years, 7 — 9 years, 10—14 years, and over 15 years. Short- and longterm results of surgical treatment of myasthenia for the patients without tumor lesions of the thymus gland were significantly better. Positive effects of surgical treatment of myasthenia in patients with hyperplasia are observed after 1 year of surgery (p = 0.0023, and the best results are observed after 5 — 6 year of the disease, then after 7 — 9 year one notes some deterioration of state (p = 0.026. In the myasthenia patients with thymoma one notes the similar trends in dynamics of state, but in general, the results are significantly (p = 0.042 badly than in the group of the patients with hyperplasia. Starting from the first year after operation treatment the patients with myasthenia with thymus hyperplasia have statistically significant (p = 0.048 decrease of average doses of glucocorticoids, and anticholinesterase drugs. The statistically best treatment results were noted for the patients operated at the first year of the disease. Positive result of surgical treatment of myasthenia is noted both in the short- and long-term period and at thymomas. In the group of patients with thymoma one has noted significantly badly results in comparison with group of hyperplasia. It is

  3. The frequency of missed test results and associated treatment delays in a highly computerized health system

    Science.gov (United States)

    Wahls, Terry L; Cram, Peter M

    2007-01-01

    Background: Diagnostic errors associated with the failure to follow up on abnormal diagnostic studies ("missed results") are a potential cause of treatment delay and a threat to patient safety. Few data exist concerning the frequency of missed results and associated treatment delays within the Veterans Health Administration (VA). Objective: The primary objective of the current study was to assess the frequency of missed results and resulting treatment delays encountered by primary care providers in VA clinics. Methods: An anonymous on-line survey of primary care providers was conducted as part of the health systems ongoing quality improvement programs. We collected information from providers concerning their clinical effort (e.g., number of clinic sessions, number of patient visits per session), number of patients with missed abnormal test results, and the number and types of treatment delays providers encountered during the two week period prior to administration of our survey. Results: The survey was completed by 106 out of 198 providers (54 percent response rate). Respondents saw and average of 86 patients per 2 week period. Providers encountered 64 patients with missed results during the two week period leading up to the study and 52 patients with treatment delays. The most common missed results included imaging studies (29 percent), clinical laboratory (22 percent), anatomic pathology (9 percent), and other (40 percent). The most common diagnostic delays were cancer (34 percent), endocrine problems (26 percent), cardiac problems (16 percent), and others (24 percent). Conclusion: Missed results leading to clinically important treatment delays are an important and likely underappreciated source of diagnostic error. PMID:17519017

  4. The frequency of missed test results and associated treatment delays in a highly computerized health system

    Directory of Open Access Journals (Sweden)

    Wahls Terry L

    2007-05-01

    Full Text Available Abstract Background: Diagnostic errors associated with the failure to follow up on abnormal diagnostic studies ("missed results" are a potential cause of treatment delay and a threat to patient safety. Few data exist concerning the frequency of missed results and associated treatment delays within the Veterans Health Administration (VA. Objective: The primary objective of the current study was to assess the frequency of missed results and resulting treatment delays encountered by primary care providers in VA clinics. Methods: An anonymous on-line survey of primary care providers was conducted as part of the health systems ongoing quality improvement programs. We collected information from providers concerning their clinical effort (e.g., number of clinic sessions, number of patient visits per session, number of patients with missed abnormal test results, and the number and types of treatment delays providers encountered during the two week period prior to administration of our survey. Results: The survey was completed by 106 out of 198 providers (54 percent response rate. Respondents saw and average of 86 patients per 2 week period. Providers encountered 64 patients with missed results during the two week period leading up to the study and 52 patients with treatment delays. The most common missed results included imaging studies (29 percent, clinical laboratory (22 percent, anatomic pathology (9 percent, and other (40 percent. The most common diagnostic delays were cancer (34 percent, endocrine problems (26 percent, cardiac problems (16 percent, and others (24 percent. Conclusion: Missed results leading to clinically important treatment delays are an important and likely underappreciated source of diagnostic error.

  5. Results from a Community-Based Smoking Cessation Treatment Program for LGBT Smokers

    Science.gov (United States)

    Matthews, Alicia K.; Li, Chien-Ching; Kuhns, Lisa M.; Tasker, Timothy B.; Cesario, John A.

    2013-01-01

    Introduction. Little is known about lesbian, gay, bisexual, and transgender (LGBT) people's response to smoking cessation interventions. This descriptive study examined the benefits of a community-based, culturally tailored smoking cessation treatment program for LGBT smokers. Methods. A total of N = 198 LGBT individuals recruited from clinical practice and community outreach participated in group-based treatment. Sessions were based on the American Lung Association's “Freedom from Smoking Program” (ALA-FFS) and were tailored to LGBT smokers' needs. Seven-day smoking point prevalence abstinence served as the primary outcome. Results. Participants (M age = 40.5) were mostly White (70.4%) and male (60.5%) and had at least a college degree (58.4%). Forty-four percent scored in the moderate range on the Fagerström Test for Nicotine Dependence pretreatment, and 42.4% completed treatment (≥75% sessions). Higher educational attainment and use of nicotine replacement therapy (NRT) were associated with treatment completion. Self-reported quit rates were 32.3% at posttreatment assessment. Treatment attendance (OR = 2.45), use of NRT (OR = 4.24), and lower nicotine dependency (OR = 0.73) were positively associated with quitting smoking. Conclusions. Results suggest the benefits of offering LGBT smokers culturally tailored smoking cessation treatments. Future research could improve outcomes by encouraging treatment attendance and promoting NRT uptake. PMID:23840237

  6. Results from a Community-Based Smoking Cessation Treatment Program for LGBT Smokers

    Directory of Open Access Journals (Sweden)

    Alicia K. Matthews

    2013-01-01

    Full Text Available Introduction. Little is known about lesbian, gay, bisexual, and transgender (LGBT people’s response to smoking cessation interventions. This descriptive study examined the benefits of a community-based, culturally tailored smoking cessation treatment program for LGBT smokers. Methods. A total of N=198 LGBT individuals recruited from clinical practice and community outreach participated in group-based treatment. Sessions were based on the American Lung Association’s “Freedom from Smoking Program” (ALA-FFS and were tailored to LGBT smokers’ needs. Seven-day smoking point prevalence abstinence served as the primary outcome. Results. Participants (M age = 40.5 were mostly White (70.4% and male (60.5% and had at least a college degree (58.4%. Forty-four percent scored in the moderate range on the Fagerström Test for Nicotine Dependence pretreatment, and 42.4% completed treatment (≥75% sessions. Higher educational attainment and use of nicotine replacement therapy (NRT were associated with treatment completion. Self-reported quit rates were 32.3% at posttreatment assessment. Treatment attendance (OR = 2.45, use of NRT (OR = 4.24, and lower nicotine dependency (OR = 0.73 were positively associated with quitting smoking. Conclusions. Results suggest the benefits of offering LGBT smokers culturally tailored smoking cessation treatments. Future research could improve outcomes by encouraging treatment attendance and promoting NRT uptake.

  7. Treatment of complex PTSD: results of the ISTSS expert clinician survey on best practices.

    Science.gov (United States)

    Cloitre, Marylene; Courtois, Christine A; Charuvastra, Anthony; Carapezza, Richard; Stolbach, Bradley C; Green, Bonnie L

    2011-12-01

    This study provides a summary of the results of an expert opinion survey initiated by the International Society for Traumatic Stress Studies Complex Trauma Task Force regarding best practices for the treatment of complex posttraumatic stress disorder (PTSD). Ratings from a mail-in survey from 25 complex PTSD experts and 25 classic PTSD experts regarding the most appropriate treatment approaches and interventions for complex PTSD were examined for areas of consensus and disagreement. Experts agreed on several aspects of treatment, with 84% endorsing a phase-based or sequenced therapy as the most appropriate treatment approach with interventions tailored to specific symptom sets. First-line interventions matched to specific symptoms included emotion regulation strategies, narration of trauma memory, cognitive restructuring, anxiety and stress management, and interpersonal skills. Meditation and mindfulness interventions were frequently identified as an effective second-line approach for emotional, attentional, and behavioral (e.g., aggression) disturbances. Agreement was not obtained on either the expected course of improvement or on duration of treatment. The survey results provide a strong rationale for conducting research focusing on the relative merits of traditional trauma-focused therapies and sequenced multicomponent approaches applied to different patient populations with a range of symptom profiles. Sustained symptom monitoring during the course of treatment and during extended follow-up would advance knowledge about both the speed and durability of treatment effects. Copyright © 2011 International Society for Traumatic Stress Studies.

  8. [Results of surgical treatment for acromioclavicular dislocation using a modified Mitchell method].

    Science.gov (United States)

    Król, M; Jarco, K; Sleczkowski, M; Delimat, J; Szot, J

    2000-01-01

    The paper presents the results of surgical treatment in acromioclavicular dislocation (grade III according to Tossy) in 53 patients. Joint reconstruction was performed using Mitchell's modified method--acromioclavicular reconstruction was achieved by applying a with Dallos poliester fiber prosthesis. Clinically in 90.5% of the cases a good or excellent result was achieved.

  9. Enobosarm (GTx-024, S-22): a potential treatment for cachexia.

    Science.gov (United States)

    Srinath, Reshmi; Dobs, Adrian

    2014-02-01

    Muscle loss and wasting occurs with aging and in multiple disease states including cancer, heart failure, chronic obstructive pulmonary disease, end-stage liver disease, end-stage renal disease and HIV. Cachexia is defined as a multifactorial syndrome that is associated with anorexia, weight loss and increased catabolism, with increased morbidity and mortality. Currently no therapy is approved for the treatment or prevention of cachexia. Different treatment options have been suggested but many have proven to be ineffective or associated with adverse events. Nonsteroidal selective androgen receptor modulators (SARMs) are a new class of anabolic agents that bind the androgen receptor and exhibit tissue selectivity. Enobosarm (GTx-024, S-22) is a recently developed SARM, developed by GTx, Inc. (TN, USA), which has been tested in Phase I, II and III trials with promising results in terms of improving lean body mass and measurements of physical function and power. Enobosarm has received fast track designation by the US FDA and results from the Phase III trials POWER1 and POWER2 will help determine approval for use in the prevention and treatment of muscle wasting in patients with non-small-cell lung cancer. This article provides an introduction to enobosarm as a new therapeutic strategy for the prevention and treatment of cachexia. A review of the literature was performed using search terms 'cachexia', 'sarcopenia', 'SARM', 'enobosarm' and 'GTx-024' in September 2013 using multiple databases as well as online resources.

  10. Influence of parecoxib Na on anesthesia recovery period of patients under the fast track anesthesia with remifentanil%帕瑞昔布钠对瑞芬太尼快通道麻醉患者术后苏醒期影响的效果分析

    Institute of Scientific and Technical Information of China (English)

    周孝道; 龚红君; 马驰波

    2015-01-01

    (SPO2), ver-bal rating scale ( VRS) , sedation-agitation scale ( SAS) , ramsay sada-tion scale ( RSS ) and comfort score ( BCS ) were compared among three groups.Results The data of MAP, SAS and HR in group A and group B were significantly lower than those in group C, and the data of MAP, SAS and HR in group A were significantly lower than those in group B ( P<0.05).The data of RSS in group A was significantly lower than that in group B and RSS in group A and group B significantly higher than those in group C from T2 to T4 (P<0.05).The data of VRS in group A and group B were significantly lower than those in group C, and that in group A was signifi-cantly lower than group B each time point( P<0.05).Postoperative BCS in group A and group B were significantly higher than those in group C, and that in group A was significantly higher than group B( P<0.05).Conclusion Pre-operative use of parecoxib Na can significantly reduce the acute pain of the fast track anesthesia with remifentanil, effectively inhibiting hyperalgesia and reducing the patient's agitation.

  11. MASTICATION, PHONETICS AND ESTHETICS AS A FINAL RESULT OF PARTIAL OR COMPLETE DENTURE TREATMENT.

    Directory of Open Access Journals (Sweden)

    Kalina Georgieva

    2015-08-01

    Full Text Available Three target groups- dentists/ dental students, dental technicians and patients were asked to fill in an anonymous questionnaire about their satisfaction of the final results after prosthetic treatment with removable dentures using a scale from 1 to 5 (1- completely dissatisfied, 2-dissatisfied, 3-indifferent, 4-satisfied, 5-completely satisfied. The mean results (including colour, shape and size of artificial teeth, arrangement of front teeth, colour of artificial gums, phonetics, mastication, natural smile, enough space for tongue for all three groups of respondents were compared. Dental technicians (4,34 are more satisfied than dentists/dental students (3,62 and patients (3,53. A successful outcome of prosthetic treatment depends on one hand on the professional approach of the dental team and on the other hand on the patient’s motivation and cooperation. The predictive final results and realistic expectations lead to satisfaction of all participants in the treatment process.

  12. Clinical results after different operative treatment methods of radial head and neck fractures

    DEFF Research Database (Denmark)

    Zwingmann, J; Welzel, M; Dovi-Akue, D

    2013-01-01

    was placed on extracting data describing clinical efficacy and outcome by using the Mason classification and including elbow function scores. A total of 841 clinical studies were identified describing in total the clinical follow-up of 1264 patients. RESULTS: For type II radial head and neck fractures....... If a prosthesis was implanted, the primary implantation seems to be associated with a better outcome after type III (87%) and IV (82%) fractures compared to the results after a secondary implantation. DISCUSSION: Recommendations for surgical treatment of radial head and neck fractures according to the Mason...... the significant best treatment option seems to be ORIF with an overall success rate of 98% by using screws or biodegradable (polylactide) pins. ORIF with a success rate of 92% shows the best results in the treatment of type III fractures and seem to be better than resection and implantation of a prosthesis...

  13. Preemptive Treatment of Nausea and Vomiting of Pregnancy: Results of a Randomized Controlled Trial

    Directory of Open Access Journals (Sweden)

    Caroline Maltepe

    2013-01-01

    Full Text Available Objectives. To determine whether the initiation of treatment (preemptive treatment before the symptoms of nausea and vomiting of pregnancy (NVP versus when the symptoms begin can improve the outcome in patients at a high risk for recurrence of severe NVP. Study Design. Prospective, randomized controlled trial. Results. Preemptive therapy conferred a significant reduction in HG as compared to the previous pregnancy (P=0.047. In the preemptive arm, there were 2.5-fold fewer cases of moderate-severe cases of NVP than those in the control group (15.4% versus 39.13% in the first 3 weeks of NVP (P=0.05. In the preemptive group, significantly more women had their NVP resolved before giving birth (78.2% versus 50% (P<0.002. Conclusions. Preemptive treatment with antiemetics is superior to the treatment that starts only when the symptoms have already occurred in decreasing the risk of severe forms of NVP.

  14. Results of Shipboard Approval Tests of Ballast Water Treatment Systems in Freshwater

    Science.gov (United States)

    2014-11-01

    Results of Shipboard Approval Tests of Ballast Water Treatment Systems in Freshwater Distribution Statement A: Approved for public release...distribution is unlimited. November 2014 Report No. CG-D-05-15 Results of Shipboard Approval Tests of BWT Systems in Freshwater ii...London, CT 06320 Results of Shipboard Approval Tests of BWT Systems in Freshwater iii UNCLAS//Public | CG-926 R&DC | Cangelosi, et al

  15. [Remote results of the surgical treatment of dystopia of the kidneys in children].

    Science.gov (United States)

    Bairov, G A; Osipov, I Iu; Koval'chuk, V S; Kurbanov, T A

    1988-10-01

    An analysis of results of the surgical treatment of 61 patients aged from 1 to 14 years has been made. Follow-up examinations from 1 to 18 years after treatment was performed in 53 of the 61 patients. In sacral and iliac dystopia of the kidney good outcomes were obtained after combined reconstructive plastic operations consisting of nephropexy associated with ureterolysis, resection of accessory vessels, plasty of the pyeloureteral segment and resection of the kidney pole with abnormal blood supply. With pelvic and crossed dystopia nephrureterectomy is indicated. With the only dystopic kidney good remote results were obtained after a one-step radical correcting operation.

  16. Gout in a rheumatology clinic: results of EULAR/ACR guidelines-compliant treatment.

    Science.gov (United States)

    Slot, O

    2017-09-11

    Surveys of treatment results of gout in primary care have shown that less than 25% of patients reach the recommended treatment target (serum urate EULAR/ACR) guidelines-based treatment of gout in a rheumatology clinic. Data from consecutive new crystal-proven gout patients were analysed in a prospective observational study. The study included 100 patients: 88 males aged 62.1 ± 13.1 years (mean ± sd) and 12 females aged 74.1 ± 6.9 years. Disease duration was 8.6 ± 6.9 years, and the disease pattern was monoarticular, oligoarticular, polyarticular, and tophaceous in 18, 37, 25, and 20 patients, respectively. Overall, 42% had tried urate-lowering treatment (ULT) ever and 15% were on ULT at entry. ULT was initiated or intensified in a treat-to-target (T2T) approach in 93 patients, with flare prophylactic colchicine treatment in 90 patients. T2T was successfully reached in 85 patients after 4.7 ± 3.9 months and 82 patients reached a state of well-controlled disease (T2T reached for 3 months and no flares or anti-inflammatory treatment for 1 month) after 10.4 ± 5.6 months. Ten patients did not reach T2T owing to low compliance and five patients did not reach T2T owing to adverse effects or nephropathy. EULAR/ACR guidelines-compliant treatment in a rheumatology clinic with verified diagnosis, patient education, T2T with ULT, and flare prophylaxis led to successful treatment results in 85% of patients.

  17. Hand Robotics Rehabilitation: Feasibility and Preliminary Results of a Robotic Treatment in Patients with Hemiparesis

    Directory of Open Access Journals (Sweden)

    Patrizio Sale

    2012-01-01

    Full Text Available Background. No strongly clinical evidence about the use of hand robot-assisted therapy in stroke patients was demonstrated. This preliminary observer study was aimed at evaluating the efficacy of intensive robot-assisted therapy in hand function recovery, in the early phase after a stroke onset. Methods. Seven acute ischemic stroke patients at their first-ever stroke were enrolled. Treatment was performed using Amadeo robotic system (Tyromotion GmbH Graz, Austria. Each participant received, in addition to inpatients standard rehabilitative treatment, 20 sessions of robotic treatment for 4 consecutive weeks (5 days/week. Each session lasted for 40 minutes. The exercises were carried out as follows: passive modality (5 minutes, passive/plus modality (5 minutes, assisted therapy (10 minutes, and balloon (10 minutes. The following impairment and functional evaluations, Fugl-Meyer Scale (FM, Medical Research Council Scale for Muscle Strength (hand flexor and extensor muscles (MRC, Motricity Index (MI, and modified Ashworth Scale for wrist and hand muscles (AS, were performed at the beginning (T0, after 10 sessions (T1, and at the end of the treatment (T2. The strength hand flexion and extension performed by Robot were assessed at T0 and T2. The Barthel Index and COMP (performance and satisfaction subscale were assessed at T0 and T2. Results. Clinical improvements were found in all patients. No dropouts were recorded during the treatment and all subjects fulfilled the protocol. Evidence of a significant improvement was demonstrated by the Friedman test for the MRC (P<0.0123. Evidence of an improvement was demonstrated for AS, FM, and MI. Conclusions. This original rehabilitation treatment could contribute to increase the hand motor recovery in acute stroke patients. The simplicity of the treatment, the lack of side effects, and the first positive results in acute stroke patients support the recommendations to extend the clinical trial of this

  18. Results of the conservative treatment in clubfoot using the French method

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    Dana VASILESCU

    2014-03-01

    Full Text Available The idiopathic clubfoot represents a congenital deformation incorporating four distinct alterations: the equinus, varus, cavus and adduction of the forefoot to the hindfoot. The meaning given to the conservative treatment of clubfoot by French method is that of mobilization-manipulation and serial plaster immobilizations. We followed the results of the early conservative orthopedic treatment in the congenital clubfoot in 52 patients (74 feet under the age of 1 year. These cases were treated in the Department of Pediatric Orthopedics of the Rehabilitation Clinical Hospital of Cluj-Napoca for a period of 5 years. The degree of deformation used DiMeglio’s clinical criteria. The conservative treatment began since the presentation of the cases with mobilizations – manipulations and continued up to the age of one month. After the age of one month, serial plaster immobilizations followed. When the conservative treatment failed consecutive to five or six successive plasters, the correction already obtained was followed by surgery. The percentage of the favorable results after the conservative treatment can reach 82.44 %. The results are not so good in cases of arthrogryposis multiplex congenita, myelomeningocele etc.

  19. Primary care providers’ knowledge, beliefs and treatment practices for gout: results of a physician questionnaire

    Science.gov (United States)

    Mazor, Kathleen M.; Negron, Amarie; Ogarek, Jessica; Firneno, Cassandra; Yood, Robert A.

    2013-01-01

    Objective. We sought to examine primary care providers’ gout knowledge and reported treatment patterns in comparison with current treatment recommendations. Methods. We conducted a national survey of a random sample of US primary care physicians to assess their treatment of acute, intercritical and tophaceous gout using published European and American gout treatment recommendations and guidelines as a gold standard. Results. There were 838 respondents (response rate of 41%), most of whom worked in private practice (63%) with >16 years experience (52%). Inappropriate dosing of medications in the setting of renal disease and lack of prophylaxis when initiating urate-lowering therapy (ULT) accounted for much of the lack of compliance with treatment recommendations. Specifically for acute podagra, 53% reported avoidance of anti-inflammatory drugs in the setting of renal insufficiency, use of colchicine at a dose of ≤2.4 mg/day and no initiation of a ULT during an acute attack. For intercritical gout in the setting of renal disease, 3% would provide care consistent with the recommendations, including initiating a ULT at the appropriate dose with dosing titration to a serum urate level of ≤6 mg/dl and providing prophylaxis. For tophaceous gout, 17% reported care consistent with the recommendations, including ULT use with dosing titration to a serum urate level of ≤6 mg/dl and prophylaxis. Conclusion. Only half of primary care providers reported optimal treatment practices for the management of acute gout and gout, suggesting that care deficiencies are common. PMID:23620554

  20. Non-lethal heat treatment of cells results in reduction of tumor initiation and metastatic potential

    Energy Technology Data Exchange (ETDEWEB)

    Kim, Yoo-Shin; Lee, Tae Hoon; O' Neill, Brian E., E-mail: BEOneill@houstonmethodist.org

    2015-08-14

    Non-lethal hyperthermia is used clinically as adjuvant treatment to radiation, with mixed results. Denaturation of protein during hyperthermia treatment is expected to synergize with radiation damage to cause cell cycle arrest and apoptosis. Alternatively, hyperthermia is known to cause tissue level changes in blood flow, increasing the oxygenation and radiosensitivity of often hypoxic tumors. In this study, we elucidate a third possibility, that hyperthermia alters cellular adhesion and mechanotransduction, with particular impact on the cancer stem cell population. We demonstrate that cell heating results in a robust but temporary loss of cancer cell aggressiveness and metastatic potential in mouse models. In vitro, this heating results in a temporary loss in cell mobility, adhesion, and proliferation. Our hypothesis is that the loss of cellular adhesion results in suppression of cancer stem cells and loss of tumor virulence and metastatic potential. Our study suggests that the metastatic potential of cancer is particularly reduced by the effects of heat on cellular adhesion and mechanotransduction. If true, this could help explain both the successes and failures of clinical hyperthermia, and suggest ways to target treatments to those who would most benefit. - Highlights: • Non-lethal hyperthermia treatment of cancer cells is shown to cause a reduction in rates of tumor initiation and metastasis. • Dynamic imaging of cells during heat treatment shows temporary changes in cell shape, cell migration, and cell proliferation. • Loss of adhesion may lead to the observed effect, which may disproportionately impact the tumor initiating cell fraction. • Loss or suppression of the tumor initiating cell fraction results in the observed loss of metastatic potential in vivo. • This result may lead to new approaches to synergizing hyperthermia with surgery, radiation, and chemotherapy.

  1. Radiotherapy and hyperthermia for treatment of primary locally advanced cervix cancer: results in 378 patients.

    NARCIS (Netherlands)

    Franckena, M.; Lutgens, L.C.; Koper, P.C.; Kleynen, C.E.; Steen-Banasik, E.M. van der; Jobsen, J.J.; Leer, J.W.H.; Creutzberg, C.L.; Dielwart, M.F.; Norden, Y. Van; Canters, R.A.; Rhoon, G.C. van; Zee, J. van der

    2009-01-01

    PURPOSE: To report response rate, pelvic tumor control, survival, and late toxicity after treatment with combined radiotherapy and hyperthermia (RHT) for patients with locally advanced cervical carcinoma (LACC) and compare the results with other published series. METHODS AND MATERIALS: From 1996 to

  2. Acceptable results using plug for the treatment of complex anal fistulas

    DEFF Research Database (Denmark)

    Kleif, Jakob; Hagen, Kikke; Wille-Jørgensen, Peer

    2011-01-01

    The management of complex fistula-in-ano remains a surgical challenge. Previously published studies on the treatment of fistula-in-ano with the anal fistula plug (AFP) have reported a success rate reaching 35-87%. The aim of this study was to assess the results of the AFP procedure in a group...

  3. Biofeedback as complementary treatment in patients with epilepsy – an underestimated therapeutic option? Review, results, discussion

    Directory of Open Access Journals (Sweden)

    Uhlmann Carmen

    2016-12-01

    Full Text Available Background. Biofeedback methods represent side effect free complementary options in the treatment of epilepsy. In this paper we review the current status of these methods in terms of clinical study results and their evaluation by systematic review papers. Possible mechanisms of action in biofeedback methods are discussed.

  4. Long-term Results of the Posteromedial Release in the Treatment of Idiopathic Clubfoot

    NARCIS (Netherlands)

    van Gelder, Janke H.; van Ruiten, Alward G. P.; Visser, Jan D.; Maathuis, Patrick G. M.

    2010-01-01

    Background: Short-term follow-up studies show good results in foot function, after surgical treatment of idiopathic clubfeet. Long-term follow-up studies are rare and probably represent a mixture of experience of different treating orthopedic surgeons. The purpose of this study is to present the

  5. [Results of surgical treatment of cholelithiasis by laparotomic and minimally invasive accesses].

    Science.gov (United States)

    Aliev, Iu G; Chinikov, M A; Panteleeva, I S; Kurbanov, F S; Popovich, V K; Sushko, A N

    2014-01-01

    The article presents the results of surgical treatment of 1038 patients with cholelithiasis, acute and chronic calculous cholecystitis and complicated forms of the disease. Operations were performed with traditional laparotomic and minimally invasive approaches. Indications for choosing access, as well as the advantages and disadvantages of various options of surgery in patients with cholelithiasis are discussed.

  6. Treatment of simple bone cysts by topical infiltrations of methylprednisolone acetate: Technique and results

    Energy Technology Data Exchange (ETDEWEB)

    Carrata, A.; Garbagna, P.; Mapelli, S.; Zucchi, V.

    1983-02-01

    The authors report their experience in the percutaneous treatment of simple bone cysts by intra-cystic local infiltrations of methylprednisolone acetate. In particular, the method adopted, the evolution of the radiologic picture and the results, achieved are described. Sixty patients were successfully treated without complications or surgery.

  7. Long-term results and complications after treatment of bilateral fractures of the mandibular condyle

    NARCIS (Netherlands)

    Forouzanfar, T.; Lobbezoo, F.; Overgaauw, M.; de Groot, A.; Kommers, S.; van Selms, M.; van den Bergh, B.

    2013-01-01

    The purpose of this study was to investigate the long-term results of conservative treatment of bilateral condylar fractures and to study the influence of possible functional impairment on intensity of pain and associated disability. We studied 71 patients (mean (SD) age 33 (14) years) with conserva

  8. Treatment and follow up results of patients with monosymptomatic enuresis nocturna

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    Mehmet Sezai Oğraş

    2013-09-01

    Full Text Available Objective: To evaluate the treatment results of patientswith monosymptomatic enuresis nocturna.Methods: 97 patients with monosymptomatic enuresisnocturna were included. First, motivation and behavioraltreatment have been applied to the patients for 3 months.60-120 mcg desmopressin has been applied to 79 patientswho did not want to continue to the motivation andbehavioral treatment or who did not have benefit from motivationand behavioral treatment or whose disease haverelapsed. It is accepted as “full response” if the numberof wetting decreases 90-100%, “middle response” decreases50-90%, “failed response” decreases less than50%. Treatment and relapse rates were evaluated basedon the response to therapy at the time of controls.Results: Mean age of the patients was 7.75±1.96 (5-12years. 20 of 97 (21% patients who have taken motivationand behavioral treatment have been cured. Two (%10of these patients’ diseases have relapsed. Desmopressinhas been applied to79 patients who did not have benefitfrom motivation and behavioral treatment or whosediseases have relapsed. Full dryness has been providedin 36 (46% patients who have taken desmopressin andcame to the control visit. “Middle response” has been obtainedin 22 (28% patients. “Failed response” has beenobtained in 21 (26% patients. Relapse has been seen incase of quitting desmopressin in 35 (60% patients whohave benefit from desmopressin.Conclusion: Although, Desmopressin is the most preferredmethod in monosymptomatic enuresis nocturna,because of easy usage and fast response, relapse ratio ishigh following discontinuation of the drug.Key words: Monosymptomatic enuresis nocturna, desmopressin,treatment

  9. Endovascular Treatment of Malignant Superior Vena Cava Syndrome: Results and Predictive Factors of Clinical Efficacy

    Energy Technology Data Exchange (ETDEWEB)

    Fagedet, Dorothee, E-mail: DFagedet@chu-grenoble.fr [CHU de Grenoble, Clinique universitaire de medecine interne, Pole Pluridisciplinaire de Medecine (France); Thony, Frederic, E-mail: FThony@chu-grenoble.fr [CHU de Grenoble, Clinique universitaire de radiologie et imagerie medicale, Pole d' Imagerie (France); Timsit, Jean-Francois, E-mail: JFTimsit@chu-grenoble.fr [CHU de Grenoble, Clinique universitaire de reanimation, Pole Medecine Aiguee Communautaire (France); Rodiere, Mathieu, E-mail: MRodiere@chu-grenoble.fr [CHU de Grenoble, Clinique universitaire de radiologie et imagerie medicale, Pole d' Imagerie (France); Monnin-Bares, Valerie, E-mail: v-monnin@chu-montpellier.fr [CHRU Arnaud de Villeneuve, Imagerie Medicale Thoracique Cardiovasculaire (France); Ferretti, Gilbert R., E-mail: GFerretti@chu-grenoble.fr [CHU de Grenoble, Clinique universitaire de radiologie et imagerie medicale, Pole d' Imagerie (France); Vesin, Aurelien; Moro-Sibilot, Denis, E-mail: DMoro.pneumo@chu-grenoble.fr [University Grenoble 1 e Albert Bonniot Institute, Inserm U823 (France)

    2013-02-15

    To demonstrate the effectiveness of endovascular treatment (EVT) with self-expandable bare stents for malignant superior vena cava syndrome (SVCS) and to analyze predictive factors of EVT efficacy. Retrospective review of the 164 patients with malignant SVCS treated with EVT in our hospital from August 1992 to December 2007 and followed until February 2009. Endovascular treatment includes angioplasty before and after stent placement. We used self-expandable bare stents. We studied results of this treatment and looked for predictive factors of clinical efficacy, recurrence, and complications by statistical analysis. Endovascular treatment was clinically successful in 95% of cases, with an acceptable rate of early mortality (2.4%). Thrombosis of the superior vena cava was the only independent factor for EVT failure. The use of stents over 16 mm in diameter was a predictive factor for complications (P = 0.008). Twenty-one complications (12.8%) occurred during the follow-up period. Relapse occurred in 36 patients (21.9%), with effective restenting in 75% of cases. Recurrence of SVCS was significantly increased in cases of occlusion (P = 0.01), initial associated thrombosis (P = 0.006), or use of steel stents (P = 0.004). Long-term anticoagulant therapy did not influence the risk of recurrence or complications. In malignancy, EVT with self-expandable bare stents is an effective SVCS therapy. These results prompt us to propose treatment with stents earlier in the clinical course of patients with SVCS and to avoid dilatation greater than 16 mm.

  10. Preoperative lanreotide treatment improves outcome in patients with acromegaly resulting from invasive pituitary macroadenoma.

    Science.gov (United States)

    Li, Z-Q; Quan, Z; Tian, H-L; Cheng, M

    2012-01-01

    To investigate whether 3 months' preoperative treatment with lanreotide improved outcome in newly diagnosed patients with acromegaly resulting from invasive pituitary macroadenoma. After baseline evaluation, untreated patients were randomized to undergo direct transsphenoidal surgery or lanreotide treatment (30 mg via intramuscular injection every 2 weeks, increased to 30 mg/week at week 8 if growth hormone nadir > 2.5 μg/l), for 3 months prior to surgery. Tumour shrinkage following lanreotide treatment was analysed. Cure was evaluated at 3 months postsurgery by measuring growth hormone and insulinlike growth factor-1 (IGF-1) levels. Preoperative lanreotide treatment significantly reduced mean tumour size. Growth hormone and IGF-1 levels were lower in the pretreatment group than in the direct surgery group at 3 months postsurgery. According to combined growth hormone and IGF-1 levels, significantly more patients were cured by trans-sphenoidal surgery in the pretreatment group compared with the direct surgery group (11 of 24 and five of 25 patients, respectively). Lanreotide treatment for 3 months before trans-sphenoidal surgery effectively reduced tumour size, and improved surgical cure rate, in newly diagnosed patients with acromegaly resulting from invasive pituitary macroadenoma.

  11. Acceptable results using plug for the treatment of complex anal fistulas

    DEFF Research Database (Denmark)

    Kleif, Jakob; Hagen, Kikke; Wille-Jørgensen, Peer

    2011-01-01

    The management of complex fistula-in-ano remains a surgical challenge. Previously published studies on the treatment of fistula-in-ano with the anal fistula plug (AFP) have reported a success rate reaching 35-87%. The aim of this study was to assess the results of the AFP procedure in a group...... of Danish patients with complex fistulas, and to analyse if the results were compatible with previous international findings....

  12. [Results of the surgical treatment of acute thrombosis of the major arteries of the limbs].

    Science.gov (United States)

    Ovchinnikov, V A; Vereshchagin, N A; Shavin, V V; Parakhoniak, N V

    1984-08-01

    An analysis of the surgical treatment of acute arterial trombosis of the extremities in 86 patients is presented. The causes of thrombosis were mainly obliterating atherosclerosis, artery trauma and postembolic occlusion. Best results of reconstructive operations were obtained in patients with postembolic occlusion of the arteries and their posttraumatic trombosis, worst results - in obliterating atherosclerosis. Thrombendarterectomy and autovenous shunts and prostheses were found to be the mos effective reconstructive operations.

  13. Managing appearance changes resulting from cancer treatment: resilience in adolescent females.

    Science.gov (United States)

    Wallace, Melissa L; Harcourt, Diana; Rumsey, Nichola; Foot, Annabel

    2007-11-01

    Typically, adolescence is marked by cognitive and physical developments impacting on self-esteem, independence and sexual awareness, often resulting in increased appearance awareness and dissatisfaction. Adolescents with cancer have the additional burden of illness, treatments and resultant appearance changes. This study aimed to explore the impact of these changes on adolescents who have had cancer. In depth, semi-structured interviews were conducted with six females between 14 and 19 years who had completed treatment within the previous two years, and analysed using Interpretative Phenomenological Analysis (IPA). Concerns around an altered appearance were significant during treatment, serving as a constant reminder of 'difference' and a marker of illness. However, since treatment, participants expressed an apparent shift in views and expectations of their appearance, as well as the value placed on it -- expressing increased satisfaction with their own appearance and a decrease in its importance. While important to acknowledge the distress and challenges experienced by participants, results highlight the need for research and care to focus on positive experiences of patients, rather than simply maladjustment. Explanations for the findings are explored, including the temporary nature of many appearance changes and the life-threatening nature of cancer.

  14. Results of thrombolytic treatment with recombinant streptokinase in elderly and non elderly patients.

    Directory of Open Access Journals (Sweden)

    René Tomás Manso Fernández

    2005-04-01

    Full Text Available Fundament: The great advances of modern medicine in the last 30 years, have deepened on the treatment of acute myocardial infarct dynamically and efficiently, allowing at present to show good results not only in the decrease of the mortality rate but also in the improvement of the patientâ?Ts quality of life. Objective: To offer the precise results with recombinant sterptokinase in elder and non-elder patients with an acute myocardial infarct. Method: prospective observational study of 325 patients admitted with a diagnosis of an acute myocardial infarct at the ¨Dr. Gustavo Aldereguia Lima¨ Hospital. These patients received thrombolitic treatment with recombinant strptokinase (Heberkinase i a dose of 1 500 000 units, and treatment with 325 mg of acetil salicilic acid too. Results: The presence of the infarct was more frequent in males (68,31% mainly associated to the smoking habit, Hypertension, and cholesterolemia in patients less than 74 years of age and in those patients aged 75 or more, the infarct was associated to Hypertension and Diabetes. The most affected side of the heart was the anterior part(44,6%, and the thrombolitic treatment was developd in an average of 211, 76 minutes. Deaths increased with age. The most significant variables associated to mortality in the infarcted patients were the fact of being hemodinamically classified into a Killip-Kimball (K-K Grade III-IV and having had arrhythmia and cardiac rupture.

  15. Midterm results of endovascular treatment of iliac artery lesions: analysis of 59 cases

    Directory of Open Access Journals (Sweden)

    Leonardo Ghizoni Bez

    2013-06-01

    Full Text Available BACKGROUND: Endovascular treatment of peripheral arterial occlusive disease has become increasingly frequent in the past few years. Because it is a less invasive procedure, lower morbidity and mortality rates are associated with this form of treatment. OBJECTIVES: To describe the endovascular procedures performed in iliac arteries for the treatment of peripheral arterial occlusive disease. METHODS: This retrospective study assesses 59 cases of iliac artery angioplasty performed according to a specific protocol from January 2004 to February 2010. RESULTS: Mean age of patients was 62 years (minimum: 42, maximum: 89. Thirty seven were male (62.72% and 22 female (37.28%. The main indications for treatment were moderate to severe intermittent claudication in 30 cases (50.84% and rest pain or trophic lesions (critical ischemia in 29 cases (49.15%. Postoperative follow-up included ankle-brachial index measurements and a duplex ultrasound at 30 days, 3 months, 6 months, 12 months, and every 6 months thereafter. Minimum follow-up time was 3 months, and maximum, 72 months (6 years, with primary and secondary patency rates of 91.37 and 94.82%, respectively. CONCLUSIONS: The results of this case series, combined with literature review results, allow to conclude that the endovascular approach is an effective and safe option to treat peripheral arterial occlusive disease in iliac arteries.

  16. Using 'payment by results' to fund the treatment of dependent drug users--proceed with care!

    Science.gov (United States)

    Maynard, Alan; Street, Andrew; Hunter, Rachael

    2011-10-01

    The UK government is changing its system of payment for drug treatment services in order to reward the achievement of better patient outcomes. This is a model that may be taken up internationally. This 'payment by results' funding system will reward providers for achieving good outcomes in terms of whether clients are drug free, employed and/or not convicted of a criminal offence. Providers will also receive a payment based on health and wellbeing outcome measurement. The definition and measurement of success in achieving these outcomes is complex and challenging, as is the need to bridge treatment costs during the period in which outcomes are pursued. This experiment requires careful evaluation if the delivery of drug treatment is not to be jeopardized or fragmented.

  17. Result from arthroscopic surgical treatment of renewed tearing of the rotator cuff of the shoulder

    Directory of Open Access Journals (Sweden)

    Glaydson Gomes Godinho

    2015-02-01

    Full Text Available OBJECTIVES: To evaluate function among patients with postoperative recurrence of rotator cuff injuries that was treated arthroscopically (case series and compare this with function in patients without recurrence (control group; and to compare function among patients with recurrence of rotator cuff injuries that were greater than and smaller than 3 cm.METHODS: This was a retrospective evaluation of patients who underwent arthroscopic revision of rotator cuff injuries using the ASES, Constant & Murley and UCLA scores and a visual analog pain scale, in comparison with patients in a control group who underwent primary rotator cuff repair.RESULTS: The size of the rotator cuff injury recurrence had a statistically significant influence on the result from the arthroscopic surgical treatment. The functional scores showed worse results than those from the first procedure.CONCLUSION: Arthroscopic surgical treatment of renewed tearing of rotator cuff injuries showed worse functional scores than those from primary repair of the injury.

  18. [Short and long-term results of endovascular treatment of bifurcational coronary stenosis].

    Science.gov (United States)

    Shugushev, Z Kh; Movsesiants, M Iu; Maksimkin, D A; Baranovich, V Iu; Faĭbushevich, A G; Stefanov, S A; Tarichko, Iu V

    2010-01-01

    Short and long-term results of endovascular treatment of true bifurcational coronary stenosis were analyzed in 229 patients. 68 patients received a "provisional-T" stenting on the first stage of the study. On the next stage 40 patients received the same "provisional-T" stenting, a total bifurcational stenting was conducted in 37 patients. Only coated stents were used. Independent risk factors of "provisional-T" stenting conversion to total bifurcational stenting were revealed. There were no differences between "provisional-T" and total bifurcational stenting considering the short-term treatment results. Long-term results (12-18 months) were analyzed in 70 patients. There were no restenosis of the main artery, whereas restenosis of the lateral branch was noticed in 5.5 and 2.94%, respectively, in the groups of "provisional-T" and total bifurcational stenting. Late thrombosis was registered in 1 case from the group of total bifurcational stenting.

  19. FUNCTIONAL RESULTS OF SURGICAL TREATMENT FOR ISTHMIC SPONDYLOLISTHESIS USING ANTERIOR AND POSTERIOR EXPOSURES

    Directory of Open Access Journals (Sweden)

    V. V. Rudenko

    2013-01-01

    Full Text Available Objective - to compare results of spondylolisthesis treatment using different surgical technologies. Material and methods: 84 patients (aged from 19 till 67 with spondylolisthesis of 1-3 degree (H.W Meyerding were operated. Two methods of surgical exposures were used for decompression and stabilization. Anterior decompression and stabilization exposures from retroperitoneal access were used for the first group of patients. The second group was operated using posteriolateral interbody fusion with transpedicular screw fixation. The following results were estimated after operation: the level of patients’ postoperative adaptation period and the rate of neurological and orthopedic rehabilitation during the postoperative period. Conclusions. The obtained functional results show no difference for both groups where posterior and anterior exposures were used for spondylolisthesis surgical treatment of 1-3 degree.

  20. Desmoplastic small round cell tumor: Extra abdominal and abdominal presentations and the results of treatment

    Directory of Open Access Journals (Sweden)

    Biswas G

    2005-01-01

    Full Text Available BACKGROUND: Desmoplastic small round cell tumor (DSRCT is a rare malignant neoplasm of adolescent males. Current multimodality treatment prolongs life and rarely achieves cure. Aim: To review the presenting features, histopathology and outcome of 18 patients with DSRCT treated at a single institution. Setting and Design: This is a retrospective observational study of patients with DSRCT who presented at the Tata Memorial Hospital between January 1994 to January 2005. Materials and Methods: Eighteen patients of DSRCT seen during this period were evaluated for their clinical presentation, response to chemotherapy and other multimodality treatment and overall survival. The cohort of 18 patients included 11 males (61% and 7 females (39% with a mean age of 16 years (Range 1½ - 30 years. Majority (83% presented with abdomino-pelvic disease. The others, involving chest wall and extremities. There were 6 patients (33% with metastatic disease at presentation. Results:The treatment primarily included a multimodality approach using a combination of multiagent chemotherapy with adjuvant surgery and radiotherapy as applicable. A response rate of 39% (CR-1, PR-6, with chemotherapy was observed. The overall response rate after multimodality treatment was 39% (CR-5, PR-2. The overall survival was poor except in patients who had complete excision of the tumor. Conclusion: Abdomino-pelvic site was the commonest presentation, the disease can occur at other non-serosal surfaces also. Despite aggressive treatment the outcome was poor. However, complete surgical excision seems to provide a better survival.

  1. Characteristics and Treatment Results of 5 Patients with Fibrous Dysplasia and Review of the Literature

    Directory of Open Access Journals (Sweden)

    Nilufer Ozdemir Kutbay

    2015-01-01

    Full Text Available Aim. Fibrous dysplasia is a rare bone disease caused by missense mutation leading to abnormal fibroblast and osteoblast proliferation and increased bone resorption. FD can present in monostotic or polyostotic forms. About 3% of FD could be in association with McCune-Albright syndrome (MAS. Because FD is a rare disease, there is limited data in the literature about characteristics of disease and response to treatment. Methods. We present our five cases of FD with general properties and their responses to medical treatment. Results. Two of our patients had polyostotic and three had monostotic FD. One of the polyostotic patients had MAS. One of our patients had surgery for femur fractures, facial asymmetry, and findings of compression. Four patients were given pamidronate; one was given zoledronic acid as bisphosphonate treatment. Bone pain was relieved in all patients with medical treatment. Conclusion. There was a decrease in bone turnover markers to some degree with medical treatment but no radiological improvement was observed.

  2. Long-term Results of Treatment of Patients with Non-proliferative Diabetic Retinopathy Angioprotectors

    Directory of Open Access Journals (Sweden)

    I. V. Vorobyeva

    2017-01-01

    Full Text Available Purpose: Optimization of approaches to the treatment of early stages diabetic retinopathy based on modern diagnosis and monitoring of patients with type 2 diabetes.Patients and methods: It was examined 90 patients (180 eyes with type 2 diabetes with DR: women (74.4% and men (25.6%, age 63,7±2,3 years. All groups matched by sex and age: Group 1 — control (healthy individuals without diabetes; Group 2 — Patients with DR0 (30 patients, 60 eyes with type 2 diabetes without DR; 3 group — patients with DR I without DMO with type 2 diabetes (30 patients, 60 eyes. Patients 2 and 3 groups was treated with conservative treatment angioprotectors drug-Doxi-Hem® registered in Russia. The drug was administered in a dose of 500 mg three times a day for six months. Monitor patients for six months of receiving Doxi-Hem® preparation consisted of monthly conventional ophthalmic examination, including further analysis of BCVA (BCVA, light sensitivity of the macula (SM as a result of fundusmikroperimetrii MAIA, central retinal thickness (PZT based on the results of the optical coherence tomography (OCT. We take into account the compensation of diabetes on the level of glycated hemoglobin (HbA1C blood.Results: When monitoring patients with type 2 diabetes to optimize the treatment of established efficacy and safety of drug therapy Doxi-Hem® in the prevention and treatment of pre-clinical and early manifestations of DR (DR0, DR1, which is confirmed by reliable positive dynamics of visual functions (BCVA, p <0.05, before treatment 0,8±0,02, after treatment increased to 0,92±0,02, morphological reduction in retinal thickness (PZT, p <0.05; before treatment 272,3±5,8 mm, after treatment 241.5±15.8 um, increased sensitivity of the macula (CM, p <0.05, before treatment 22.2±1.5 dB, after treatment 27.0±3.2 dB. Required control the severity of type 2 diabetes on the target level of blood glycosylated hemoglobin (HbA1C.Conclusion: Optimization approaches to

  3. Hypopharyngeal squamous cell carcinoma--treatment results in 138 consecutively admitted patients

    Energy Technology Data Exchange (ETDEWEB)

    Johansen, L.V.; Grau, C.; Overgaard, J. [Danish Cancer Society, Aarhus (Denmark). Dept. of Experimental Clinical Oncology

    2000-07-01

    The aim of this study was to evaluate the results of the initial and salvage treatment for hypopharyngeal carcinoma. The study was conducted in 1963 to 1991 and included 138 patients (38 females and 100 males). Most of the tumours originated in the piriform sinus (86%). Tumour stage distribution was T1: 20%, T2: 27%, T3: 37% and T4: 17% and nodal stage distribution was N0: 45%, N1: 25%, N2: 10%, and N3: 20%. Primary treatment was delivered with curative intent in 124 out of 138 cases. Treatment failure was noted in 98 patients, with 55% recurrence in T-position, 39% in N-position, and 14% at distant metastases sites. Salvage surgery was successful in 9 out of 32 patients. The overall 5-year locoregional tumour control, cause-specific and overall survival rates were 20%, 25% and 19%, respectively. Univariate actuarial analysis showed that T- and N-stage, clinical stage, tumour size and well-differentiated tumours were significant prognostic parameters. A Cox multivariate analysis showed that only the T- and N-stages were independent prognostic factors. In conclusion, the prognosis for advanced hypopharyngeal carcinoma is extremely poor and the meagre results with conventional radiotherapy alone indicate that other treatment modalities should be introduced in the management of this disease.

  4. Self-perception of people who stutter regarding their experiences and results of stuttering treatments.

    Science.gov (United States)

    Andrade, Claudia Regina Furquim de; Cunha, Maria Claudia; Juste, Fabiola Staróbole; Ritto, Ana Paula; Almeida, Beatriz Paiva Bueno de

    2014-01-01

    To investigate the opinion about stuttering treatments in people who stutter, based on their answers to two open questions. The participants were 40 adults of both genders, with self-reported stuttering. During the first phase of the research, we contacted two Brazilian nongovernmental organizations: the Brazilian Stuttering Association (ABRAGAGUEIRA) and the Brazilian Fluency Institute (IBF). These associations agreed to participate and were responsible for sending the research questions to their members via electronic mail. The first contact with the participants elucidated the purpose and method of our research and, after obtaining informed consent from participants, the two questions were sent. The research questions involved their opinion about cure, treatments to which the participants had been submitted, and their outcome. After analysis, the answers obtained indicated that people who stutter believe in a cure for stuttering; that the ideal therapy would be the one that led to the disappearance of the symptoms; and the most frequently reported professional to treat the disorder is the speech-language pathologist. The results also indicated that although most of the participants had undergone speech-language treatment for stuttering, neither significant improvements were observed nor satisfaction was positive. The results indicate that the answers presented by the participants were not based on scientific knowledge about the disorder but on their wish that "something could happen" to make stuttering "disappear." Although in this study we did not investigate the type of treatment to which the patients were submitted, the results suggest that the factors that contribute to an effective treatment are contentious.

  5. Mid- and Long-Term Results of Endovascular Treatment in Thoracic Aorta Blunt Trauma

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    Luigi Irace

    2012-01-01

    Full Text Available Study Aim. Evaluation of results in blunt injury of the thoracic aorta (BAI endovascular treatment. Materials and Methods. Sixteen patients were treated for BAI. Thirteen patients had associated polytrauma, 4 of these had a serious hypotensive status and 4 had an hemothorax. In the remaining 3, two had a post-traumatic false aneurysm of the isthmus and 1 had a segmental dissection. In those 13 patients a periaortic hematoma was associated to hemothorax in 4. All patients were submitted to an endovascular treatment, in two cases the subclavian artery ostium was intentionally covered. Results. One patient died for disseminated intravascular coagulation. No paraplegia was recorded. No ischemic complications were observed. A type I endoleak was treated by an adjunctive cuff. During the followup (1–9 years 3 patients were lost. A good patency and no endoleaks were observed in all cases. One infolding and 1 migration of the endografts were corrected by an adjunctive cuff. Conclusion. The medium and long term results of the endovascular treatment of BAI are encouraging with a low incidence rate of mortality and complications. More suitable endo-suite and endografts could be a crucial point for the further improvement of these results.

  6. CLINICAL RESULTS FROM THE TREATMENT OF CHRONIC SKIN WOUNDS WITH PLATELET RICH PLASMA (PRP

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    Pencho Kossev

    2015-12-01

    Full Text Available PURPOSE: To show platelet rich plasma (PRP application of chronic skin wounds and to evaluate the results from the treatment. MATERIAL AND METHODS: A total of 14 patients with problematic skin wounds had been treated at the clinic for a period of five years (from May 2009 to December 2014 with the following patient sex ratio: male patients - 5 and female patients - 9. Average age - 48,5 (30-76. Patients with Type 2 Diabetes - 4, with decubitus ulcers - 6, traumatic - 8, with infection - 5. Based on a scheme developed by us, all cases were treated by administering platelet-rich plasma, derived by PRGF Endoret system. Follow-up period was within 4 - 6 months (4,5 on average. RESULTS: The results have been evaluated based on the following functional scoring systems - Total wound score, Total anatomic score and Total score (20. The baseline values at the very beginning of the follow-up period were as follows: Total wound score - 12 p.; Total anatomic score - 10 p., Total score - 17 p. By the end of the treatment period the score was 0 p., which means excellent results, i.e. complete healing of the wounds. CONCLUSION: We believe that the application of PRP may become optimal therapy in the treatment of difficult to heal wounds around joints, bone, subject tendons, plantar surface of the foot, etc., as it opens new perspectives in the field of human tissue regeneration.

  7. Prior doctor shopping resulting from differential treatment correlates with differences in current patient-provider relationships.

    Science.gov (United States)

    Gudzune, Kimberly A; Bennett, Wendy L; Cooper, Lisa A; Clark, Jeanne M; Bleich, Sara N

    2014-09-01

    To determine the prevalence of doctor shopping resulting from differential treatment and to examine associations between this shopping and current primary care relationships. In 2012, a national internet-based survey of 600 adults receiving primary care in the past year with a BMI ≥ 25 kg/m(2) was conducted. Our independent variable was "switching doctors because I felt treated differently because of my weight." Logistic regression models to examine the association of prior doctor shopping with characteristics of current primary care relationships: duration, trust in primary care provider (PCP), and perceived PCP weight-related judgment, adjusted for patient factors were used. Overall, 13% of adults with overweight/obesity reported previously doctor shopping resulting from differential treatment. Prior shoppers were more likely to report shorter durations of their current relationships [73% vs. 52%; p = 0.01] or perceive that their current PCP judged them because of their weight [74% vs. 11%; p shop resulting from perceived differential treatment. These prior negative experiences have no association with trust in current relationships, but our results suggest that patients may remain sensitive to provider weight bias. © 2014 The Obesity Society.

  8. Intravitreal bevacizumab treatment for choroidal neovascularization in pathologic myopia: 12-month results.

    Science.gov (United States)

    Gharbiya, Magda; Allievi, Francesca; Mazzeo, Luigi; Gabrieli, Corrado Balacco

    2009-01-01

    To evaluate the short-term efficacy and safety of intravitreal bevacizumab for the treatment of myopic choroidal neovascularization (CNV). Prospective, nonrandomized, interventional case series. Twenty eyes from 20 patients with CNV secondary to pathologic myopia participated in this prospective nonrandomized interventional case series. All patients were scheduled for three monthly intravitreal bevacizumab 1.25 mg injections. Early Treatment Diabetic Retinopathy Study best-corrected visual acuity (BCVA), foveal center thickness (FCT) on optical coherence tomography (OCT), and fluorescein angiographic findings were examined before and after treatment. Patients were followed up for 12 months. The mean BCVA (+/- standard deviation [SD]) at baseline was 24.8 (+/- 11.86) letters (Snellen equivalent: 20/80). At 12 months after treatment, the mean BCVA (+/- SD) improved significantly (P = .000001) to 43 (+/- 12.38) letters (Snellen equivalent: 20/35). At 12 month follow-up, BCVA improved 10 letters or more in 18 (90%) out of 20 treated eyes and improved 15 letters or more in 14 (70%) out of 20 treated eyes. No treated eyes experienced a worsening of BCVA from baseline. The mean FCT (+/- SD) at baseline was 223 (+/- 47.43) microns. At 12 months after treatment, the mean FCT (+/- SD) reduced to 206 (+/- 50.87) microns. This reduction in FCT after treatment was not statistically significant (P = .11). At 12 months follow-up, absence of fluorescein leakage from the CNV was demonstrated in 19 (95%) out of 20 treated eyes and persistent leakage in one eye (5%). None of the 19 eyes that had CNV closure experienced recurrence at 12-month follow-up. No ocular or systemic adverse effects from treatment were encountered. These results of intravitreal bevacizumab in myopic CNV are very promising with no apparent short-term safety concerns. At 12 months, treated eyes had a significant improvement in visual acuity (VA). OCT findings, as well, showed a trend consistent with the

  9. Intravitreal bevacizumab as primary treatment for retinal angiomatous proliferation: twelve-month results.

    Science.gov (United States)

    Gharbiya, Magda; Allievi, Francesca; Recupero, Vincenzo; Martini, Delia; Mazzeo, Luigi; Gabrieli, Corrado Balacco

    2009-06-01

    To evaluate the short-term efficacy and safety of intravitreal bevacizumab for the treatment of retinal angiomatous proliferation. Seventeen eyes from 16 patients with newly diagnosed retinal angiomatous proliferation underwent intravitreal injections of bevacizumab, 1.25 mg. The patients were scheduled for three monthly bevacizumab injections. Early Treatment of Diabetic Retinopathy Study (ETDRS) best-corrected visual acuity, central macular thickness on optical coherence tomography, and fluorescein angiographic findings were examined before and after treatment. Patients were followed-up for 12 months. The mean best-corrected visual acuity (+/- standard deviation [SD]) at baseline was 39.53 (+/-10.40) letters (Snellen equivalent: 20/42). At 12 months after treatment the mean best-corrected visual acuity (+/-SD) improved significantly (P = 0.0000001) to 47.88 (+/-11.78) letters (Snellen equivalent: 20/28). Best-corrected visual acuity improved 3 ETDRS lines or more in 3 (17.65%) of 17 treated eyes, 14 (82.35%) eyes were stable, and 15 (88.23%) eyes gained 1 or more ETDRS lines. The mean central macular thickness (+/-SD) at baseline was 297 (+/-60.72) microm. At 12 months after treatment, the mean central macular thickness (+/-SD) reduced significantly (P = 0.00001) to 237 (+/-28.80) microm. At the 12-month follow-up, absence of fluorescein leakage was demonstrated in 14 (82%) of 17 treated eyes. No ocular or systemic adverse effects from treatment were encountered. The 12-month results of intravitreal bevacizumab for retinal angiomatous proliferation are very promising with no apparent short-term safety concerns. Treated eyes had a significant functional and anatomical improvement. Further studies will be needed to better determine long-term efficacy and safety.

  10. The Results of Intraosseous Drilling and Decompression in the Treatment of Chronic Anterior Knee Pain

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    Saberi S

    2012-01-01

    Full Text Available Background: Anterior knee pain is one of the most common complaints of patients in orthopedic clinics. The first step in the treatment of this problem is conservative treatment which includes administration of anti-inflammatory drugs, exercise and changes in life style. Many patients respond well to these measures in about six months, but a small number of patients may not respond to the conservative treatment; therefore, surgical procedures such as Maquet osteotomy or lateral retinacular release may be needed in these cases. The aim of this study was to determine the efficacy of intraosseous drilling and decompression of patella in the treatment of chronic anterior knee pain.Methods : This study was performed as a case series on ten patients with chronic anterior knee pain attending the Orthopedic Clinic of Imam Khomeini Hospital, in Tehran, Iran in 2009-2010. Eight of the patients were male and the rest were female. The patients met the inclusion criteria and were followed up for at least 12 months after the surgery. Results : The mean age of the patients was 27.8±4.66 yr and their mean BMI was 22.5±1.71 kg/m2. The mean pain severity before the interventions was 8.2±0.78 based on VAS but it decreased to 2.5±1.26 post-surgically. An average reduction of 5.7 scores were noticed in pain severity depicting a significant reduction of pain (P<0.0001.Conclusion: It may be concluded that intraosseous drilling and decompression of patella is a safe and effective method in the treatment of chronic anterior knee pain not responding to conservative treatment.

  11. Squamous cell carcinoma of the oropharynx--an analysis of treatment results in 289 consecutive patients

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    Johansen, L.V.; Grau, C.; Overgaard, J. [Aarhus Univ. Hospital (Denmark). Dept. of Experimental Clinical Oncology

    2001-01-01

    In this retrospective study the results of primary and salvage treatment of oropharyngeal carcinoma were evaluated. A total of 289 consecutive patients (103 females and 186 males) were included in the study. Most tumours originated in the tonsil area (58%) and comprised stages I 8%, II 19%, III 46% and IV 28%. The primary treatment was delivered with curative intent in 276 cases (96%). Of these, 266 received primary radiotherapy. The median radiation dose was 62 Gy, given as laterally opposed fields to the primary tumour and bilateral neck. Eight patients were treated with primary surgery and two with chemotherapy as part of a curatively intended treatment programme including radiotherapy. Six patients received palliative treatment, and seven were not treated at all. Out of 276 tumours treated with curative intent, 173 reappeared; 72% recurred in T position, 38% in N position, and 12% at distant metastatic sites, some in combination. Salvage surgery was possible in 52 patients, and 24 treatments were successful. Salvage radiotherapy or cryotherapy was used in 22 patients and 4 were controlled. For the entire group, the 5-year locoregional tumour control, disease-specific survival and overall survival rates were 38%, 44% and 31%, respectively. For patients treated with curative intent, clinical T- and N-stage, stage, tumour size, gender, age, and pretreatment haemoglobin were significant prognostic parameters in a univariate analysis. The Cox multivariate analysis showed that T-stage, N-stage and gender were independent prognostic factors. It is concluded that T-stage, N-stage and gender are significant independent prognostic factors. The primary control of the carcinoma in the T-position is crucial for overall success, but salvage surgery is found to have a favourable success rate in patients suitable for relapse treatment.

  12. Results of Treatment with 2-Chlorodeoxyadenosine (2-CDA in Multiple Reactivations or Refractory Langerhans Cell Histiocytosis

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    Ghasem Miri-Aliabad

    2014-01-01

    Full Text Available Background: Langerhans cell histiocytosis (LCH is the most common type of histiocytosis and characterized by abnormal proliferation and excess accumulation of inflammatory and langerhans cells at various tissue sites. Clinical manifestations are variable, ranging from spontaneously regressing single bone lesion to multisystem disease, life-threatening and refractory to treatment. Conventional chemotherapy has been shown to be effective in treatment of majority of patients with LCH. However, treatment of refractory disease or multiple reactivations is difficult. The aim of this study is to assess the efficacy of 2-CDA in relapsed or refractory LCH. Materials and methods: Four patients with relapsed or refractory LCH that were treated with 2-chlorodeoxyadenosin (2-CDA enrolled in this study. All patients had received at least one prior chemotherapy regimen. The dose and schedule of 2-CDA was 6 mg/m²/day for 5 days every 3-4 weeks. Results: Median age at the time of treatment with 2-CDA was 9.7 years. Three patients had multisystem disease and one had multifocal bone lesions. All patients had multifocal bone lesions. None of them had risk organ involvement. Mean course of treatment with 2-CDA was 9.5. Radiologic evaluations revealed complete resolution of bone lesions in two (50% patients. In one (25% patient lesions regressed (partial response and in another (25% the disease remained stable. Drug related side effects were minimal. At the present time all patients are alive. Conclusion: Our study demonstrates that 2-CDA as a single agent is efficacious in treatment of multiple reactivations or refractory LCH and well-tolerated in children.

  13. Nonsurgical transurethral radiofrequency collagen denaturation: results at three years after treatment.

    Science.gov (United States)

    Elser, Denise M; Mitchell, Gretchen K; Miklos, John R; Nickell, Kevin G; Cline, Kevin; Winkler, Harvey; Wells, W Glen

    2011-01-01

    Objective. To assess treatment efficacy and quality of life in women with stress urinary incontinence 3 years after treatment with nonsurgical transurethral radiofrequency collagen denaturation. Methods. This prospective study included 139 women with stress urinary incontinence due to bladder outlet hypermobility. Radiofrequency collagen denaturation was performed using local anesthesia in an office setting. Assessments included incontinence quality of life (I-QOL) and urogenital distress inventory (UDI-6) instruments. Results. In total, 139 women were enrolled and 136 women were treated (mean age, 47 years). At 36 months, intent-to-treat analysis (n = 139) revealed significant improvements in quality of life. Mean I-QOL score improved 17 points from baseline (P = .0004), while mean UDI-6 score improved (decreased) 19 points (P = .0005). Conclusions. Transurethral collagen denaturation is a low-risk, office-based procedure that results in durable quality-of-life improvements in a significant proportion of women for as long as 3 years.

  14. Nonsurgical Transurethral Radiofrequency Collagen Denaturation: Results at Three Years after Treatment

    Directory of Open Access Journals (Sweden)

    Denise M. Elser

    2011-01-01

    Full Text Available Objective. To assess treatment efficacy and quality of life in women with stress urinary incontinence 3 years after treatment with nonsurgical transurethral radiofrequency collagen denaturation. Methods. This prospective study included 139 women with stress urinary incontinence due to bladder outlet hypermobility. Radiofrequency collagen denaturation was performed using local anesthesia in an office setting. Assessments included incontinence quality of life (I-QOL and urogenital distress inventory (UDI-6 instruments. Results. In total, 139 women were enrolled and 136 women were treated (mean age, 47 years. At 36 months, intent-to-treat analysis (n=139 revealed significant improvements in quality of life. Mean I-QOL score improved 17 points from baseline (P=.0004, while mean UDI-6 score improved (decreased 19 points (P=.0005. Conclusions. Transurethral collagen denaturation is a low-risk, office-based procedure that results in durable quality-of-life improvements in a significant proportion of women for as long as 3 years.

  15. DEWATERING TREATMENT SCALE-UP TESTING RESULTS OF HANFORD TANK WASTES

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    TEDESCHI AR

    2008-01-23

    This report documents CH2M HILL Hanford Group Inc. (CH2M HILL) 2007 dryer testing results in Richland, WA at the AMEC Nuclear Ltd., GeoMelt Division (AMEC) Horn Rapids Test Site. It provides a discussion of scope and results to qualify the dryer system as a viable unit-operation in the continuing evaluation of the bulk vitrification process. A 10,000 liter (L) dryer/mixer was tested for supplemental treatment of Hanford tank low-activity wastes, drying and mixing a simulated non-radioactive salt solution with glass forming minerals. Testing validated the full scale equipment for producing dried product similar to smaller scale tests, and qualified the dryer system for a subsequent integrated dryer/vitrification test using the same simulant and glass formers. The dryer system is planned for installation at the Hanford tank farms to dry/mix radioactive waste for final treatment evaluation of the supplemental bulk vitrification process.

  16. Monteggia-like lesions – treatment strategies and one-year results

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    Laun, Reinhold

    2015-12-01

    Full Text Available Introduction: The eponym “Monteggia fracture” includes various patterns of complex fracture-dislocations of the proximal ulna and radius, which are not well defined yet. They are frequently described as Monteggia-like lesions or Monteggia equivalent injuries. Until today, these injury patterns have been reported rarely. The objective of this retrospective study was to better define patterns of injury and to document the short-term results of treatment with current fixation techniques.Methods: Ten patients with a Monteggia-like lesion were included in this study and clinical and radiological follow-up examinations at an average of 12.3 months after the trauma were performed. For clinical follow-up the Mayo Modified Wrist Score, the Mayo Elbow Performance Score, the functional rating index of Broberg and Morrey, and the DASH score were utilized.Results: Osteosynthesis of the ulna was performed using a proximally contoured or precontoured LCP (locking compression plate in all patients. All patients had a fracture of the radial head. All patients with a Mason type III radial head fracture received a cemented bipolar radial head prosthesis. All Mason type II fractures were treated with open reduction and internal fixation using mini screws. In all Mason type I fractures the treatment of the radial head dislocation was by closed reduction. Associated coronoid fractures were stabilized with lag screws through the ulnar plate or with independent lag screws after reduction of the fracture. According to the aforementioned scoring systems good to excellent results could be achieved.Conclusions: Our findings demonstrate that good or excellent short-term results can be obtained if the injury is classified correctly and a standardized surgical treatment of all components of the injury is achieved. Further studies with larger patient populations and longer follow up periods are needed to evaluate long-term effectiveness of this treatment concept.

  17. Effects of Antibiotic Treatment on the Results of Nested PCRs for Scrub Typhus▿

    OpenAIRE

    Kim, Dong-Min; Byun, Joo Nam

    2008-01-01

    In order to determine the effects of antibiotic treatment on the results of nested PCRs for scrub typhus, we investigated the frequency of positive outcomes at various times after antibiotic administration in patients with scrub typhus. The rate of detection by nested PCR with blood buffy coat before antibiotic administration was 90.5%. However, this decreased to 60.5% within 3 days after administration of antibiotics such as doxycycline and rifampin and to 10% by the fourth day following ant...

  18. Surgery versus prolonged conservative treatment for sciatica: 5-year results of a randomised controlled trial

    OpenAIRE

    Lequin, Michiel B.; Verbaan, Dagmar; Jacobs, Wilco C. H.; Brand, Ronald; Gerrit J. Bouma; Vandertop, William P.; Peul, Wilco C; ,

    2013-01-01

    Objective This study describes the 5 years’ results of the Sciatica trial focused on pain, disability, (un)satisfactory recovery and predictors for unsatisfactory recovery. Design A randomised controlled trial. Setting Nine Dutch hospitals. Participants Five years’ follow-up data from 231 of 283 patients (82%) were collected. Intervention Early surgery or an intended 6 months of conservative treatment. Main outcome measures Scores from Roland disability questionnaire, visual analogue scale (V...

  19. Results of the spine-to-rib-cage distraction in the treatment of early onset scoliosis

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    Teli Marco

    2010-01-01

    Full Text Available Background: Growing rod systems have been used in the last 30 years for the treatment of early onset scoliosis (EOS with variable success rates. We report the results of treatment of EOS with a newly developed hybrid rod distraction system applied to the rib cage and spine with a nonfusion technique in a prospective multicenter clinical trial. Materials and Methods: A total of 22 patients affected by progressive EOS resistant to cast and/or brace treatment were enrolled from 2004 to 2005 after informed consent into a trial of surgical treatment with a single spine-to-rib growing rod instrumentation growing spine profiler (GSP. Curves> 60° Cobb in the frontal plane or bending < 50% were addressed with staged anterior annulotomy and fusion and posterior implantation of a GSP rod. Less severe and rigid curves were treated with posterior implantation of GSP only. The elongation of GSP was planned according to spinal growth. Patients were kept in a brace between elongations. Results: A total of 20 patients were available to follow-up with complete data. The mean follow up is 4.1 years. Mean age at time of initial surgery was 5 years (3-8. Nine patients had staged antero-posterior surgeries, 11 posterior only surgeries. Mean spinal growth was 1.9 cm (1.5-2.3 or 0.5 cm per year. Mean coronal Cobb′s angle correction was from 56° to 45°. Major complications affected 40% of patients and included rod failure in 6/20 and crankshaft in 5/20 (all in the anteroposterior surgery group. Conclusion: Treatment of EOS with spine-to-rib growing rod in the present form provides similar correction and complication rates to those published in the series considering traditional single or dual growing rod systems. Based on this, the authors recommend revision of the GSP design and a new clinical trial to test safety and efficacy.

  20. Biochemical changes in grape rootstocks resulted from humic acid treatments in relation to nematode infection

    Institute of Scientific and Technical Information of China (English)

    Hosny H Kesba; Hossam S El-Beltagi

    2012-01-01

    Objective: To investigate the effect of humic acid on nematode infected, resistant and susceptible grapes in relation to lipid peroxidation and antioxidant mechanisms on selected biochemical parameters known as proactive substances. Methods: The grape rootstocks, superior, superior/freedom and freedom were reacted differently to Meloidogyne incognita and Rotylenchulus reniformis according to rootstock progenitor. Two weeks after inoculation, two commercial products of humic acid were applied at the rate of (2, 4 mL or grams/plant) as soil drench. After 4 months, nematode soil populations were extracted and counted. A subsample of roots from each plant was stained and gall numbers, embedded stages per root were calculated, final population, nematode build up (Pf/Pi), average of eggs/eggmass were estimated. Subsamples of fresh root of each treatment were chemically analyzed. Results: Freedom reduced significantly the nematode criteria and build up. Humic acid granules appeared to be more suppressive to nematode build up on superior and the higher dose on superior/freedom than liquid treatments. On freedom, all treatments reduced significantly the nematode build up regardless to the material nature. The higher dose was more effective than the lower one. As a result of humic acid applications, the malondialdehyde (MDA) and H2O2 contents were significantly reduced after humic acid treatments while the antioxidant compounds glutathione (GSH), ascorbic acid (ASA) and total phenol contents were significantly increased when compared with check. Antioxidant defense enzymes ascorbate peroxidase (APX), superoxide dismutase (SOD), catalase (CAT) and polyphenol oxidase (PPO) showed significant increase in their specific activities in treated plants compared with nematode treated check. Conclusions: Humic acid treatments improve the yield of grape by increasing the contents of antioxidant compounds and the specific activities of antioxidant enzymes.

  1. Efficacy of physical activity in the adjunctive treatment of major depressive disorders: preliminary results

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    Velluti Claudio

    2007-07-01

    Full Text Available Abstract Background No controlled trials have evaluated the long term efficacy of exercise activity to improve the treatment of patients with Major Depressive Disorders. The aim of the present study was to confirm the efficacy of the adjunctive physical activity in the treatment of major depressive disorders, with a long term follow up (8 months. Methods Trial with randomized naturalistic control. Patients selected from the clinical activity registries of the Psychiatric Unit of the University of Cagliari, Italy. Inclusion criteria: female, between 40 and 60 years, diagnosis of Major Depressive Disorders (DSM-IV TR resistant to the ongoing treatment. Exclusion criteria: diagnosis of psychotic disorders; any contraindications to physical activity. 30 patients (71.4% of the eligible participated to the study. Cases: 10 randomized patients undergoing pharmacological treatment plus physical activity. Controls: 20 patients undergoing only pharmacological therapy. The following tools were collected from each patient by two different psychiatric physicians at baseline and 8 month after the beginning of exercise program: SCID-I, HAM-D, CGI (Clinical Global Impression, GAF. Results The patients that made physical activity had their HAM-D, GAF and CGI score improved from T0 to T8, all differences were statistically significant. In the control group HAM-D, GAF and CGI scores do not show any statistically significant differences between T0 and T8. Limits Small sample size limited to female in adult age; control group was not subject to any structured rehabilitation activity or placebo so it was impossible to evaluate if the improvement was due to a non specific therapeutic effect associated with taking part in a social activity. Conclusion Physical activity seems a good adjunctive treatment in the long term management of patients with MDD. Randomized placebo controlled trials are needed to confirm the results.

  2. Clinical Findings, Follow-up and Treatment Results in Patients with Ocular Rosacea

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    İlkay Kılıç Müftüoğlu

    2016-02-01

    Full Text Available Objectives: To report the clinical features, treatment options and complications in patients with ocular rosacea. Materials and Methods: The records of 48 eyes of 24 patients with ocular rosacea were retrospectively reviewed. Patients’ ocular signs and symptoms were scored between 1 and 4 points according to disease severity; tear film break-up time (BUT and Schirmer’s test results were recorded before and after the treatment. Preservative-free artificial tears, topical antibiotic eye drops/ointments, short-term topical corticosteroids, topical 0.05% cyclosporine and oral doxycycline treatment were applied as a standard therapy to all patients. Additional treatments were given as needed. Complications were recorded. Results: Twenty-four patients with a mean age of 48.5±35.4 (32-54 years were followed for a mean 15±9.4 (8-36 months. Ocular findings included meibomitis in 100% of cases, anterior blepharitis in 83% (40 eyes, punctate keratopathy in 67% (32 eyes, chalazia in 50% (24 eyes, corneal neovascularization in 50% (24 eyes and subepithelial infiltrates in 16.6% (8 eyes. Significant improvement of symptoms and clinical findings were achieved in all patients with treatment. The increases in Schirmer’s test and BUT were 3.3±1.5 and 4.5±2.8, respectively (p<0.05. Descemetocele and small corneal perforation occurred in 2 eyes; re-epithelialization was achieved in both eyes with tissue adhesive application (1 eye and additional amniotic membrane transplantation (1 eye. Four eyes of three patients showed significant regression of corneal neovascularization with topical bevacizumab therapy. Conclusion: Ocular rosacea may present with a variety of ophthalmic signs. It is possible to control the ophthalmic disease with appropriate therapeutic modalities including topical corticosteroids, topical cyclosporine and systemic doxycycline.

  3. Longterm results and their prognosis in surgical treatment of Grave's disease

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    I V Makarov

    2013-06-01

    Full Text Available This study focuses on improving the results of surgical treatment of patients with diffuse toxic goiter way jus tify the selection of thyroid residue and thyroid status in predicting longterm periods. The basis of the study is the immediate and longterm results of surgical treatment of 138 patients suffering from diffuse toxic goi ter. As a result of the research, with a modern point of clinical and statistical analysis proved the effective ness of fascial subtotal resection of the thyroid gland in patients with diffuse toxic goiter (Graves' disease. The dependence of disorders of the thyroid is remainded of its volume, autoimmune changes and limitations of the operation. The quality of life of patients in the late postoperative period is studied. The tactics of sur gical treatment of patients with diffuse toxic goiter, aimed at the prevention of postoperative recurrence of hyperthyroidism and hypothyroidism on the basis of prediction of the functional state of the thyroid residue in the longterm period, is proposed. Detected optimal sizes of thyroid balance after subtotal resection of the thyroid gland in patients with diffuse toxic goiter permit to objectify the technique of intervention.

  4. Sequential Salinomycin Treatment Results in Resistance Formation through Clonal Selection of Epithelial-Like Tumor Cells

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    Florian Kopp

    2014-12-01

    Full Text Available Acquiring therapy resistance is one of the major obstacles in the treatment of patients with cancer. The discovery of the cancer stem cell (CSC–specific drug salinomycin raised hope for improved treatment options by targeting therapy-refractory CSCs and mesenchymal cancer cells. However, the occurrence of an acquired salinomycin resistance in tumor cells remains elusive. To study the formation of salinomycin resistance, mesenchymal breast cancer cells were sequentially treated with salinomycin in an in vitro cell culture assay, and the resulting differences in gene expression and salinomycin susceptibility were analyzed. We demonstrated that long-term salinomycin treatment of mesenchymal cancer cells resulted in salinomycin-resistant cells with elevated levels of epithelial markers, such as E-cadherin and miR-200c, a decreased migratory capability, and a higher susceptibility to the classic chemotherapeutic drug doxorubicin. The formation of salinomycin resistance through the acquisition of epithelial traits was further validated by inducing mesenchymal-epithelial transition through an overexpression of miR-200c. The transition from a mesenchymal to a more epithelial-like phenotype of salinomycin-treated tumor cells was moreover confirmed in vivo, using syngeneic and, for the first time, transgenic mouse tumor models. These results suggest that the acquisition of salinomycin resistance through the clonal selection of epithelial-like cancer cells could become exploited for improved cancer therapies by antagonizing the tumor-progressive effects of epithelial-mesenchymal transition.

  5. Sequential Salinomycin Treatment Results in Resistance Formation through Clonal Selection of Epithelial-Like Tumor Cells.

    Science.gov (United States)

    Kopp, Florian; Hermawan, Adam; Oak, Prajakta Shirish; Ulaganathan, Vijay Kumar; Herrmann, Annika; Elnikhely, Nefertiti; Thakur, Chitra; Xiao, Zhiguang; Knyazev, Pjotr; Ataseven, Beyhan; Savai, Rajkumar; Wagner, Ernst; Roidl, Andreas

    2014-12-01

    Acquiring therapy resistance is one of the major obstacles in the treatment of patients with cancer. The discovery of the cancer stem cell (CSC)-specific drug salinomycin raised hope for improved treatment options by targeting therapy-refractory CSCs and mesenchymal cancer cells. However, the occurrence of an acquired salinomycin resistance in tumor cells remains elusive. To study the formation of salinomycin resistance, mesenchymal breast cancer cells were sequentially treated with salinomycin in an in vitro cell culture assay, and the resulting differences in gene expression and salinomycin susceptibility were analyzed. We demonstrated that long-term salinomycin treatment of mesenchymal cancer cells resulted in salinomycin-resistant cells with elevated levels of epithelial markers, such as E-cadherin and miR-200c, a decreased migratory capability, and a higher susceptibility to the classic chemotherapeutic drug doxorubicin. The formation of salinomycin resistance through the acquisition of epithelial traits was further validated by inducing mesenchymal-epithelial transition through an overexpression of miR-200c. The transition from a mesenchymal to a more epithelial-like phenotype of salinomycin-treated tumor cells was moreover confirmed in vivo, using syngeneic and, for the first time, transgenic mouse tumor models. These results suggest that the acquisition of salinomycin resistance through the clonal selection of epithelial-like cancer cells could become exploited for improved cancer therapies by antagonizing the tumor-progressive effects of epithelial-mesenchymal transition.

  6. Analysis of the results of treatment of patients with malignant tumors of the salivary glands

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    V. T. Vayradyan

    2016-01-01

    Full Text Available Objective: improve results of the treatment of patients with malignant salivary gland neoplasm (MSGN.Materials and methods. Analysis of 417 patients suffering from MSGN treated in the Federal State Budgetary Institution “N.N. Blokhin Russian Cancer Research Center” from 1988 to 2014. All the subjects were divided into 4 main groups according to the treatment assigned: group of the surgical treatment – 27.3 % (n = 114, group of the combined treatment (surgery and radiotherapy (RT – 54.0 % (n = 225, group of the complex treatment (surgery, radiotherapy and chemotherapy – 10.5 % (n = 44, group of conservative treatment (radiotherapy and/or chemotherapy – 8.2 % (n = 34.Results. Best 5-year disease-free survival (DFS was observed in patients with localization of the tumor process in the minor salivary glands (MSG, mucosal tunic (MT of mouth (73.2 ± 5.5% and parotid gland (62.3 ± 3.3 %, while the lowest survival rate was observed in tumors of sublingual salivary gland (0% (median was not achieved, p = 0.07. Depending on the morphological variants the best 5-year DFS was observed in groups of myoepithelial carcinoma, and acinar cell carcinoma: 81.3 ± 9.8 and 79.1 ± 8.4 %, respectively (median was not reached, p > 0.05; the worst survival rate was observed in patients with squamous cell carcinoma, carcinoma of the salivary ducts and adenocarcinoma: 45.7 ± 15.5; 50.3 ± 12.7 and 53.0 ± 5.5 %, respectively (median was not reached. In poorly differentiated tumors (G3 5-year DFS was lowest and was equal to 32.7 ± 4.1 %, while in G1 tumors – 83.6 ± 3.1% (p = 0.000001. In G3 tumors addition of radiotherapy to the surgery significantly reduces the incidence of local recurrence - from 51.4 % (surgical treatment alone down to 33.8 % (combined treatment (p = 0.08. There was a significant decrease in 5-year disease-free survival rate from 74.2 ± 2.6 % without any adverse pathological signs down to 37.9 ± 5.4% in the presence of these signs

  7. Cancer of the breast. Staging methods, primary treatment options and end results.

    Science.gov (United States)

    Donegan, W L

    1979-01-01

    A totally satisfying concept of treatment is not easy to formulate from the complex and often conflicting results of local therapeutic interventions for breast cancer. It seems evident that clinically occult cancer is often beyond the pale of both resection and irradiation at primary treatment, particularly when cancer is found in regional lymph nodes. Despite all combinations of local treatment, the ultimate risk of failure correlates more closely with the stage of the disease at the time of treatment than with the particular form of treatment. Thus the extent of disease must be considered the major, perhaps the ultimate determinant of prognosis. Because, under controlled conditions, several therapeutic alternatives have appeared to provide virtually identical end results in terms of survival and ultimate dissemination of the disease, the adequacy of control within the field of treatment may, in fact, be the most meaningful end result of local treatment. The experience that has accumulated with treatment of breast cancer supports the thesis that removal of the breast accomplishes all that can be achieved in terms of curing the disease, and wider treatment with surgery or irradiation serves only to improve the prospects for local control. Halsted demonstrated this principle with his radical mastectomy and it still seems to be the case. This fact provides further impetus for detecting and treating cancer while it is still localized to the breast. With these generalizations in mind some empirical observations can be added. An anatomic fact is that multiple microscopic foci of cancer that are not evident clinically are often present in the mammary parenchyma. Undisturbed, at least some, and perhaps eventually all, of these foci of cancer progress to become clinical cancers. Thorough removal of the entire breast (the entire mammary parenchyma) eliminates this particular hazard and, one may presume, terminates the disease if it is still limited to the breast. Removal of

  8. Results of Operative and Nonoperative Treatment of Rockwood Types III and V Acromioclavicular Joint Dislocation

    Science.gov (United States)

    Joukainen, Antti; Kröger, Heikki; Niemitukia, Lea; Mäkelä, E. Antero; Väätäinen, Urho

    2014-01-01

    Background: The optimal treatment of acute, complete dislocation of the acromioclavicular joint (ACJ) is still unresolved. Purpose: To determine the difference between operative and nonoperative treatment in acute Rockwood types III and V ACJ dislocation. Study Design: Randomized controlled trial; Level of evidence, 2. Methods: In the operative treatment group, the ACJ was reduced and fixed with 2 transarticular Kirschner wires and ACJ ligament suturing. The Kirschner wires were extracted after 6 weeks. Nonoperatively treated patients received a reduction splint for 4 weeks. At the 18- to 20-year follow-up, the Constant, University of California at Los Angeles Shoulder Rating Scale (UCLA), Larsen, and Simple Shoulder Test (SST) scores were obtained, and clinical and radiographic examinations of both shoulders were performed. Results: Twenty-five of 35 potential patients were examined at the 18- to 20-year follow-up. There were 11 patients with Rockwood type III and 14 with type V dislocations. Delayed surgical treatment for ACJ was used in 2 patients during follow-up: 1 in the operatively treated group and 1 in the nonoperatively treated group. Clinically, ACJs were statistically significantly less prominent or unstable in the operative group than in the nonoperative group (normal/prominent/unstable: 9/4/3 and 0/6/3, respectively; P = .02) and in the operative type III (P = .03) but not type V dislocation groups. In operatively and nonoperatively treated patients, the mean Constant scores were 83 and 85, UCLA scores 25 and 27, Larsen scores 11 and 11, and SST scores 11 and 12 at follow-up, respectively. There were no statistically significant differences in type III and type V dislocations. In the radiographic analysis, the ACJ was wider in the nonoperative than the operative group (8.3 vs 3.4 mm; P = .004), and in the type V dislocations (nonoperative vs operative: 8.5 vs 2.4 mm; P = .007). There was no statistically significant difference between study groups in

  9. 不置胃管在快速康复外科结直肠癌围术期有效性和安全性的Meta分析%Efficiency and safety of non-nasogastric tube on fast-track surgery patients with colorectal cancer:Meta- analysis and systematic review

    Institute of Scientific and Technical Information of China (English)

    彭淼; 李显蓉

    2015-01-01

    目的:探讨在快速康复外科护理干预措施中结直肠癌围术期不留置胃管的有效性和安全性。方法:计算机检索 PubMed、CBM、Cochrane Library、中国知网、万方数据库和维普数据库发表的快速康复外科中结直肠癌围术期不留置胃管临床效果的相关文献,采用RevMan5.3软件统计分析。结果:有8篇文献纳入分析,试验组409例,对照组438例。不置胃管缩短了术后肛门排气的时间(WMD -14.30,95%CI:-16.91~-11.69,P <0.01);缩短了患者术后住院时间(WMD -1.97,95%CI:-2.59~-1.34,P <0.01);降低肺部感染发生率,(RR 0.37,95%CI:0.19~0.73,P <0.01);咽喉部不适感降低(P <0.01),胃肠道并发症差异无统计学意义(P >0.05)。结论:结直肠手术中不常规留置胃管是安全可行的。%Objective To evaluate the efficiency and safety of non- nasogastric tube on fast-track surgery patients with colorectal cancer. Methods We searched PubMed, CBM, Cochrane Library, CNKI, Wanfang and Vip data. Controlled trials that met the criteria were selected. All reports were collected and analyzed by RevMan5.3. Results 8 reports were enrolled. The non-nasogastric tube group had a shorter anus exhausting time and lower morbidity of pulmonary and throat complications , and it also had a shorter postoperative length of hospital stays. Significant differences were found between the non-nasogastric tube group and the control group (P 0.05). Conclusion Current evidence shows that non-nasgastric tubes are recommended for the patients with colorectal cancer surgery.

  10. Burst fracture of the thoracolumbar spine: correlation between kyphosis and clinical result of the treatment

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    Rodrigo Arnold Tisot

    2015-06-01

    Full Text Available OBJECTIVE: To evaluate the correlation between kyphosis due to burst fractures of thoracic and lumbar spine and clinical outcome in patients undergoing conservative or surgical treatment.METHODS: A retrospective, cross-sectional study was conducted with 29 patients with thoracolumbar burst fractures treated by the Spine Group in a trauma reference hospital between the years 2002 and 2011. Patients were followed-up as outpatients for a minimum of 24 months. All cases were clinically evaluated by Oswestry and SF-36 quality of life questionnaires and the visual analogue scale (VAS of pain. They were also evaluated by X-ray examinations and CT scans of the lumbosacral spine at the time of hospitalization and subsequently as outpatients by Cobb method for measuring the degree of kyphosis.RESULTS: There was no statistically significant correlation between the degree of initial kyphosis and clinical outcome measured by VAS and by most of the SF-36 domains in both patients treated conservatively and the surgically treated. The Oswestry questionnaire showed benefits for patients who received conservative treatment (p=0.047 compared to those surgically treated (p=0.335. The analysis of difference between initial and final kyphosis and final kyphosis alone in relation to clinical outcome showed no statistical correlation in any of the scores used.CONCLUSION: The clinical outcome of treatment of the thoracic and lumbar burst fractures was not influenced by a greater or lesser degree of initial or residual kyphosis, regardless of the type of treatment.

  11. Analysis of structural transformation in wool fiber resulting from oxygen plasma treatment using vibrational spectroscopy

    Science.gov (United States)

    Barani, Hossein; Haji, Aminoddin

    2015-01-01

    The aim of this study was to investigate the influence of oxygen plasma procedure at different time treatments on wool fiber using the micro-Raman spectroscopy as a non-destructive vibrational spectroscopic technique and Fourier transform infrared spectroscopy. The amide I and III regions, Csbnd C skeletal vibration region, and Ssbnd S and Csbnd S bonds vibration regions were analyzed with the Raman microscope. The Fourier transform infrared spectroscope analysis was employed to find out the effect of oxygen plasma treatment on the cysteic acid residues content of the wool fiber sample. The results indicated that the α-helix structure was the highest component content of wool fiber. Moreover, the protein secondary structure of wool fibers was transformed from α-helical arrangement to the β-pleated sheet configuration during the oxygen plasma treatment. Also, the disulphide bonds content in the treated wool fiber reduced because they were fractured and oxidized during oxygen plasma treatment. The oxygen plasma treated samples presented higher cysteic acid compared to the untreated wool samples due to produce more cleavage of disulfide linkages.

  12. How does the inclusion of twins conceived via fertility treatments influence the results of twin studies?

    Science.gov (United States)

    Burt, S Alexandra; Klump, Kelly L

    2012-12-01

    Rates of twinning have risen dramatically over the last 30 years, from 1 in 53 births in 1980 to 1 in 30 births in 2009 (Martin et al. (January 2012). Three decades of twin births in the United States, 1980-2009. Atlanta, GA: Centers for Disease Control and Prevention, National Center for Health Statistics). This increase is largely attributable to increases in the use of fertility treatments (i.e., ovulation induction and in vitro fertilization) combined with delays in parenthood. Although this increase means that more twins are available for recruitment into twin studies, it also has potential consequences for the heritability estimates obtained in these studies. This study sought to evaluate this possibility, making use of the ongoing Michigan Twins Project (N = 7,261 families with twins aged 3-17 years), an arm of the Michigan State University Twin Registry. Results revealed that, on average, twins conceived via fertility treatments had lower rates of behavior problems than those conceived naturally, although these behavioral differences could be explained largely by demographic and socio-economic differences across the two types of twin families. Twin similarity did not meaningfully differ across fertility treatment status. We thus conclude that estimates of genetic and environmental influences obtained from twin studies over the last 10-15 years are more or less unaffected by the inclusion of twins conceived via fertility treatments in their samples.

  13. Internal structure changes in bleached black human hair resulting from chemical treatments: A Raman spectroscopic investigation

    Science.gov (United States)

    Kuzuhara, Akio

    2014-11-01

    In order to investigate in detail the influence of chemical treatments (reduction, hydrolyzed eggwhite protein (HEWP) treatment, and oxidation) on damaged hair keratin fibers, the structure of cross-sections at various depths of excessively bleached (damaged) black human hair resulting from a permanent waving process was directly analyzed using Raman spectroscopy. It was found that L-cysteine (CYS) largely reacted with the gauche-gauche-gauche (GGG) conformation of disulfide (-SS-) groups (while CYS did not react with the trans-gauche-trans (TGT) conformation). In particular, not only the GGG content, but also the cysteic acid content existing throughout the cortex region of the excessively bleached human hair remarkably decreased by performing the oxidation process after reduction. On the other hand, the GGG content of the excessively bleached black human hair increased, while the TGT content decreased by performing the oxidation process after reduction and then HEWP treatment processes. From these experiments, the authors concluded that some of the keratin associated protein (KAP), which has a rich -SS- content and cysteic acid content was eluted from the cortex region along with the disconnection of -SS- groups, thereby leading to the remarkable reduction in the reconnection of -SS- groups of the excessively bleached black human hair after the permanent waving process (the reduction and oxidation processes). Also, the authors concluded that the HEWP treatment process in the permanent waving process caused the reconstruction of the KAP, thereby contributing to the acceleration of the reconnection of -SS- groups during the oxidation process.

  14. Yttrium-90 radioembolization for the treatment of unresectable liver cancer: Results of a single center

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    Özhan Özgür

    2014-03-01

    Full Text Available Objective: To determine the effects of yttrium-90 (Y-90 resin microsphere radioembolization therapy on patients with unresectable liver cancer who do not benefit from chemotherapy. Methods: Fifty-five patients underwent radioembolization therapy included in the study whose had unresectable primary or metastatic liver cancer originating from the gastrointestinal tract. Three were excluded from the study after pre-evaluation angiography. Thirteen (23.6% of the remaining 52 patients had hepatocellular carcinoma and 39 (76.4% had metastatic liver cancer. Fifty-two patients underwent Y-90 radioembolization treatment. Each patient's response to the administered treatment was evaluated using the Response Evaluation Criteria in Solid Tumors (RECIST and the overall probability of survival was displayed graphically by the Kaplan-Meier method. Results: After Y-90 therapy, 47 patients were follow-up. While 57% of the patients responded to treatment as clinical benefit, the disease progressed in 43%. The median hepatic progression-free survival time of the patients was 3.4 months (95% confidence interval (ci:1.4-5.3 and the overall survival time was 11.3 months (95%, CI:8.7-14.03. Conclusion: This study emphasizes that Y-90 resin microsphere radioembolization treatment is effective in patients with unresectable liver cancer.

  15. Results of surgical treatment of developmental dysplasia of hip considering child’s age

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    Milašinović Sonja

    2011-01-01

    Full Text Available Introduction. Developmental dysplasia of the hip (DDH represents one of common diseases of the locomotor system. Late discovery and inadequate healing of this defect leads to serious disability in the best years of human life. Objective. The aim of this study was to analyze the quality of functional and anatomic restitution of the diseased hip, depending on the age of the patient at the time of surgery. Methods. Our retrospective study was developed on 78 children surgically treated for DDH. The examiners were distributed in three groups according to age in which they had been operated. The data were produced on the basis of full-scale medical documents for each patient. Results. We analyzed and compared anatomic and functional results of surgeries treating DDH in the group of examiners. On examination, we got data that the most prevalent were distorted gait, inequality of the legs and positive Trendelendburg’s sign in the group of children who had been operated in the oldest age. The patients who were surgically treated in older age had worse postoperative results in aspect value angle of flexion and abduction in treated hip, higher frequency in manifesting pain and asymmetric gait. Better corrective results on aspect of dimension of the colodiaphyseal and Hilgenrainer’s angle will be obtained if DDH treatment is conducted in younger age of patients. In 94.95%, the patients were treated with Salter innominate osteotomy of pelvis with osteotomy of the femur involving its shortening and reverse rotation. Preoperative treatment with Pavliks harness was provided in 44.02% children, with abduction of Hilgenrainer’s apparatus in 2.6%, with abductions “Niva” slips in 2.6% and preoperative extension in 28.2%. Conclusion. The surgical treatment of DDH in the observed patients done at the earlier age of growth resulted in the evidently better anatomical and functional results at postoperative observation.

  16. Short-term results of carotid stenting for the treatment of extracranial carotid occlusive disease

    Institute of Scientific and Technical Information of China (English)

    FU Wei-guo; ZHU Ting; CHEN Bin; JIANG Jun-hao; YANG Jue; SHI Zhen-yu

    2006-01-01

    @@ Carotid artery angioplasty and stenting (CAS) has been performed with increasing frequency for the treatment of extracranial carotid occlusive diseases (ECOD) in recent years. Its feasibility and safety are supported by the Stenting and Angioplasty with Protection in Patient at High Risk for Endarterectomy (SAPPHIRE) trial,1 which revealed a lower incidence of death, stroke and myocardial infarction compared with carotid endarterectomy (CEA) in high-risk patients. However, it is a pity that up to now, initial results of this endovascular procedure have yet been infrequently documented in China. This retrospective study was to analyze the short-term results of CAS to treat ECOD in a single medical center.

  17. RESULTS OF POSTERIOR MYECTOMY FOR THE TREATMENT OF CHILDREN WITH CHRONIC CONSTIPATION

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    Mehran PEYVASTEH

    2015-12-01

    Full Text Available Background and Objectives - The aim of this study was to evaluate the result of posterior myectomy in children with chronic constipation who underwent to this surgery. Methods - Forty eight children with chronic constipation who did not respond to diet, laxative, or enema were included. Children with abnormal barium enema showing transitional zone were excluded. Children with documented metabolic disease diabetes, and hypothyroidism were also excluded. All patients underwent posterior myectomy. Children were followed during 1 year after surgery regarding frequency of fecal evacuation, fecal consistency, straining during defecation, and diameter of feces. Data was analyzed using SPSS version 13.0 (Chicago, IL, USA. Results - Of 48 cases that underwent surgery, 21 were male and 27 were female. Age range was 1.5 to 11 years old. Mean duration of constipation before surgery was 22.79±17.08 (range 6-48 months. Mean duration of medical treatment was 14.90±10.31 (range= 6-48 months. Fecal consistency, feces diameter, number of bowel movements and straining during defecation were compared before and after surgery. The results were statistically significant ( P <0.001. Of all cases, 52% continued treatment of constipation after surgery for 1 year. Ganglion cells were absent in 32 cases. Ganglion cells were present in seven children. Proximal ganglion cell was found in nine cases Treatment response was not different between cases according to status of ganglion cell in biopsy. Conclusion - Fecal consistency, feces diameter, number of bowel movements, and straining for defecation were improved after posterior myectomy. Another study with more sample is required for better evaluation of treatment.

  18. Clinical Features, Presence of Human Herpesvirus-8 and Treatment Results in Classic Kaposi Sarcoma

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    Özlem Su

    2008-12-01

    Full Text Available Background and Design: Classic Kaposi sarcoma (KS occurs predominantly among the elderly, with Jews, Italians and Greeks. Classic KS has been seen relatively frequently in Turkey. Our aim was to evaluate the demographic, clinical features of Kaposi sarcoma and etiopathological role of human herpesvirus-8 (HHV-8. Treatment results of 18 classic Kaposi’s sarcoma were also concluded.Material and Method: Eighteen cases of classic Kaposi sarcoma diagnosed as clinically and histopathologically between January 2001 and August 2008 in our dermatology department were taken to this study. Demographic, clinical features and treatment results were reviewed retrospectively in all patients. HHV-8 was investigated in the lesional skin of 7 patients.Results: A male/female ratio of 2/1 was found. Mean age at diagnosis was 67.2 (37-94 years. Bilaterally lower extremities were involved in 15 patients (83.3%, the trunk was involved in 3 patients (16.6%. Plaques and nodules were the common type of lesions (66.6% and 55.5%. Nine patients had no symptoms (50%. Edema was the most common symptom (38.8%. A second primary malignancy was found in 2 patients (11.1%. HHV-8 was detected in 6 of the 7 patients(85.7%. Majority of the patients were treated with interferon alfa (subcutaneously and cryotherapy as a monotherapy or a combination therapy. Imiquimod was the second agent in combined treatment (27.7%. Conclusion: We suggest that interferon alfa and imiquimod can be used as first line therapy agents with their antiviral and immunmodulatuar features in the treatment of KKS. (Turkderm 2008; 42: 122-6

  19. Safety and efficacy of aneurysm treatment with WEB: results of the WEBCAST study.

    Science.gov (United States)

    Pierot, Laurent; Costalat, Vincent; Moret, Jacques; Szikora, Istvan; Klisch, Joachim; Herbreteau, Denis; Holtmannspötter, Markus; Weber, Werner; Januel, Anne-Christine; Liebig, Thomas; Sychra, Vojtech; Strasilla, Christoph; Cognard, Christophe; Bonafé, Alain; Molyneux, Andrew; Byrne, James V; Spelle, Laurent

    2016-05-01

    OBJECT WEB is an innovative intrasaccular treatment for intracranial aneurysms. Preliminary series have shown good safety and efficacy. The WEB Clinical Assessment of Intrasaccular Aneurysm Therapy (WEBCAST) trial is a prospective European trial evaluating the safety and efficacy of WEB in wide-neck bifurcation aneurysms. METHODS Patients with wide-neck bifurcation aneurysms for which WEB treatment was indicated were included in this multicentergood clinical practices study. Clinical data including adverse events and clinical status at 1 and 6 months were collected and independently analyzed by a medical monitor. Six-month follow-up digital subtraction angiography was also performed and independently analyzed by a core laboratory. Success was defined at 6 months as complete occlusion or stable neck remnant, no worsening in angiographic appearance from postprocedure, and no retreatment performed or planned. RESULTS Ten European neurointerventional centers enrolled 51 patients with 51 aneurysms. Treatment with WEB was achieved in 48 of 51 aneurysms (94.1%). Adjunctive implants (coils/stents) were used in 4 of 48 aneurysms (8.3%). Thromboembolic events were observed in 9 of 51 patients (17.6%), resulting in a permanent deficit (modified Rankin Scale [mRS] Score 1) in 1 patient (2.0%). Intraoperative rupture was not observed. Morbidity (mRS score > 2) and mortality were 2.0% (1 of 51 patients, related to rupture status on entry to study) and 0.0% at 1 month, respectively. Success was achieved at 6 months in 85.4% of patients treated with WEB: 23 of 41 patients (56.1%) had complete occlusion, 12 of 41 (29.3%) had a neck remnant, and 6 of 41 (14.6%) had an aneurysm remnant. CONCLUSIONS The WEBCAST study showed good procedural and short-term safety of aneurysm treatment with WEB and good 6-month anatomical results.

  20. Evaluation of the results from non-arthroplastic treatment (arthroscopy for shoulder arthrosis

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    Alberto Naoki Miyazaki

    2015-08-01

    Full Text Available ABSTRACTOBJECTIVES: To evaluate the functional results from patients with arthrosis who underwent an arthroscopic procedure, in an attempt to correlate these results with the patients' epidemiological profile, surgical technique used, possible complications and postoperative protocol. METHODS: Between 1998 and 2011, 31 patients (32 shoulders with shoulder arthrosis underwent arthroscopic treatment performed by the Shoulder and Elbow Group of the Department of Orthopedics and Traumatology of Santa Casa de São Paulo. Primary or secondary cases of shoulder arthrosis under the age of 70 years, in which the rotator cuff was intact, were included. Furthermore, cases in which, despite an indication for an arthroplastic procedure, an attempt to perform an alternative procedure had been chosen, were also included. The following were evaluated: sex, age, dominance, comorbidities, length of time with complaint, associated lesions, etiology, previous treatment, operation performed, postoperative protocol and pre and postoperative active ranges of motion. The functional evaluation was conducted using the UCLA criteria, before and after the operation. The joint cartilage alterations were classified in accordance with Outerbridge and the arthrosis by means of Walch. RESULTS: There were statistically significant mean differences in the values for elevation, lateral rotation and medial rotation from before to after the operation ( p< 0.001 and there was a tendency ( p= 0.057 toward poor results with greater length of time with complaints before the surgery. The total gain in UCLA score did not have any statistically significant relationship with any of the other variables analyzed. CONCLUSION: Arthroscopic treatment of glenohumeral arthrosis provided functional improvement of the glenohumeral joint, with significant gains in elevation and lateral and medial rotation, and improvements in function and pain. Greater length of time with complaints was a factor

  1. Results of surgical treatment of massive localized lymphedema in severely obese patients

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    Wilson Cintra Júnior

    2014-01-01

    Full Text Available OBJECTIVE: to evaluate the importance of treatment of deformities caused by massive localized lymphedema (MLL in the severely obese. METHODS: in a period of seven years, nine patients with morbid obesity and a mean age of 33 years underwent surgical resection of massive localized lymphedema with primary synthesis. This is a retrospective study on the surgical technique, complication rates and improved quality of life. RESULTS: all patients reported significant improvement after surgery, with greater range of motion, ambulation with ease and more effective hygiene. Histological analysis demonstrated the existence of a chronic inflammatory process marked by lymphomonocitary infiltrate and severe tissue edema. We observed foci of necrosis, formation of microabscesses, points of suppuration and local fibrosis organization, and pachydermia. The lymphatic vessels and some blood capillaries were increased, depicting a framework of linfangiectasias. CONCLUSION: surgical treatment of MLL proved to be important for improving patients' quality of life, functionally rehabilitating them and optimizing multidisciplinary follow-up of morbid obesity, with satisfactory surgical results and acceptable complication rates, demonstrating the importance of treatment and awareness about the disease.

  2. THE CLINICAL COURSE AND TREATMENT RESULTS OF LUNG METASTASES FROM BREAST CANCER

    Institute of Scientific and Technical Information of China (English)

    Xu Binghe; Zhou Jichang; Zhou Aiping; Wang Yan; Feng Fengyi; Sun yan

    1998-01-01

    Objective:To analyze the clinical course and treatment result of lung metastases from breast cancer. Method:122 cases with lung metastases from breast cancer were treated with chemotherapy or chemotherapy plus endocrine therapy, response was assessed according to WHO criteria and survival rate estimated using the life Table. Results: The median time from initial treatment of primary tumor to lung metastases was 22 months. Sites of common consecutive metastases were lung, liver and bone. The overall response rate was 48% with a CR rate of 15%. Compared to non- DDP- encompassing regimen, the CR rate was higher in DDP-based chemotherapy (7%versus 21%, P<0.05) with a longer median survival time (MST). The PR rate was higher in regimens containing anthracycline (48%) than in those without anthracycline (20%, P<0.01). The response rate was similar between chemotherapy and chemotherapy plus endocrine therapy (P>0.05). No difference in MST was observed between patients receiving anthracycline-and non-anthracyclineencompassing regimens. The 1-, 3-, 5-, and 10-year survival rate was 77%, 22 %, 11%, and 10%, respectively.Conclusion: Size of primary tumor, the length of diseasefree interval, the number of lung metastases may provide additional information for predicting patients survival after treatment of lung metastases. Combination chemotherapy, especially DDP-based chemotherapy may prolong survival time of patients with lung metastases from breast cancer.

  3. Results of kyphoplasty in the minimally invasive treatment of vertebral metastasis

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    Carlos Fernando Pereira da Silva Herrero

    2014-09-01

    Full Text Available OBJECTIVE: To evaluate the clinical and radiological outcome of minimally invasive surgical treatment of vertebral metastases using the technique of kyphoplasty. METHODS: This was a prospective observational study of patients with the diagnosis of spinal metastasis who underwent minimally invasive surgical treatment by filling the vertebral body with balloon kyphoplasty technique. Clinical evaluation included patient age at surgery, diagnosis of the tumor, biopsy results, data of the surgical procedure performed, visual pain scale (VAS and complications related to surgery. Radiological evaluation involved the study of radiographic procedures in the anteroposterior and lateral incidences, with the analysis of vertebral body kyphosis and the occurrence of extravasation of cement. RESULTS: 22 patients with spinal metastases who were treated by balloon kyphoplasty, 8 (36% males and 14 (64% females were studied. The average age was 56.05 years and the mean follow-up was 8.5 months. The mean preoperative VAS was 8.73, 1.73 in the initial postoperative period, and 1.92 in the late postoperative period. CONCLUSION: Kyphoplasty proved to be a safe and effective technique for symptomatic treatment of vertebral metastases.

  4. Factors that influence the urodynamic results of botulinum toxin in the treatment of neurogenic hyperactivity.

    Science.gov (United States)

    Gutiérrez-Martín, P; Vírseda-Chamorro, M; Salinas Casado, J; Gómez-Rodríguez, A; Esteban-Fuertes, M

    2015-05-01

    To determine the urodynamic efficacy and factors that influence the urodynamic results of treatment of neurogenic detrusor hyperactivity with intradetrusor injection of botulinum toxin type A (BTX-A) in patients with spinal cord injury (SCI). A retrospective study was conducted with a cohort of 70 patients composed of 40 men and 30 women with stable SCI (mean age, 39 ± 13.3 years) who underwent an intradetrusor injection of 300 IUs of BTX-A. A urodynamic study was conducted prior to the injection and 6 ± 4.3 months after the treatment. New urodynamic studies were subsequently performed up to an interval of 16 ± 12.2 months. The BTX-A significantly increased (p lesion age showed no influence in terms of the increase in bladder capacity. The indwelling urinary catheter (IUC) was the only statistically significant negative factor. The urodynamic effect of BTX-A is maintained for a considerable time interval. The IUC negatively influences the result of the treatment. Copyright © 2014 AEU. Publicado por Elsevier España, S.L.U. All rights reserved.

  5. Experience with cinacalcet in primary hyperparathyroidism: results after 1 year of treatment

    Science.gov (United States)

    García-Martín, Antonia; Luque-Pazos, Alessandra

    2013-01-01

    Objectives: To assess the characteristics of patients with primary hyperparathyroidism (PHPT) treated with cinacalcet and to evaluate its efficacy in reducing serum calcium and parathyroid hormone (PTH) concentrations after 1 year of treatment. Methods: The study included 20 patients with PHPT who had completed at least 12 months of treatment with cinacalcet (eight patients for refusal of parathyroidectomy, three for surgery not possible due to comorbidities and nine for progressive hypercalcemia prior to surgery). We recorded clinical and biochemical data at baseline, and after 3, 6 and 12 months of treatment. We also monitored adverse events. Cinacalcet was administered in increasing doses until normal serum calcium was reached or side effects preventing a further increase occurred. Results: After 3 months of treatment, serum calcium significantly decreased (11.73 ± 0.85 versus 10.71 ± 1.63 mg/dl, p < 0.001) and serum phosphorus significantly increased (2.41 ± 0.48 versus 2.63 ± 0.70 mg/dl, p = 0.004) while no significant change occurred in PTH (181.91 ± 102.37 versus 195.47 ± 111.71 pg/ml, p = 0.695). No further variation was observed after 6 months compared with 3 months of follow up. However, after 12 months of treatment, there was a significant decrease in PTH concentrations compared with baseline (181.91 ± 102.37 versus 152.47± 70.16 pg/ml, p = 0.028) as well as serum calcium (11.73 ± 0.85 versus 10.20± 0.95 mg/dl, p < 0.001); serum phosphorus significantly increased (2.41 ± 0.48 versus 2.71 ± 0.43 mg/dl, p = 0.01). Normocalcemia (S-Ca < 10.2 mg/dl) was achieved in 55% of patients. The medication was usually well tolerated (83.4%). Most common adverse events were nausea and vomiting, especially at the beginning of therapy. Conclusion: Cinacalcet rapidly reduced serum calcium in patients with PHPT and this reduction remained stable after 1 year of treatment. We also observed a decrease in PTH. Cinacalcet is an effective alternative in nonsurgical

  6. Nucleic Acids in Human Glioma Treatment: Innovative Approaches and Recent Results

    Directory of Open Access Journals (Sweden)

    S. Catuogno

    2012-01-01

    Full Text Available Gliomas are the most common primary central nervous system tumors with a dismal prognosis. Despite recent advances in surgery, radiotherapy, and chemotherapy, current treatment regimens have a modest survival benefit. A crucial challenge is to deliver drugs effectively to invasive glioma cells residing in a sanctuary within the central nervous system. New therapies are essential, and oligonucleotide-based approaches, including antisense, microRNAs, small interfering RNAs, and nucleic acid aptamers, may provide a viable strategy. Thanks to their unique characteristics (low size, good affinity for the target, no immunogenicity, chemical structures that can be easily modified to improve their in vivo applications, these molecules may represent a valid alternative to antibodies particularly to overcome challenges presented by the blood-brain barrier. Here we will discuss recent results on the use of oligonucleotides that will hopefully provide new effective treatment for gliomas.

  7. [The results of wet AMD treatment by intravitreal injections--preliminary report].

    Science.gov (United States)

    Okruszko, Anna; Borucka, Anna I; Ulińska, Magdalena; Szaflik, Jerzy

    2007-01-01

    Age-related macular degeneration (AMD) is the leading cause of irreversible, severe loss of vision in the developed countries. One of the modern methods of treatment in neovascular form of AMD are repeated intravitreal injections of ranibizumab (Lucentis). Ranibizumab is a recombinant, humanized, monoclonal antibody that neutralizes all biologically active forms of vascular endothelial growth factor A (VEGF-A). The aim of the study was to analyze the results of intravitreal ranibizumab injections in wet AMD patients. There were 57 patients enrolled in the study. 87% of them avoided any loss of visual acuity and 47.3% gained at least one line at visual acuity chart. Authors conclude that treatment with repeated intravitreal injections of ranibizumab is effective in neovascular form of AMD.

  8. Does occasional cannabis use impact anxiety and depression treatment outcomes?: Results from a randomized effectiveness trial.

    Science.gov (United States)

    Bricker, Jonathan B; Russo, Joan; Stein, Murray B; Sherbourne, Cathy; Craske, Michelle; Schraufnagel, Trevor J; Roy-Byrne, Peter

    2007-01-01

    This study investigated the extent to which occasional cannabis use moderated anxiety and depression outcomes in the Collaborative Care for Anxiety and Panic (CCAP) study, a combined cognitive-behavioral therapy (CBT) and pharmacotherapy randomized effectiveness trial. Participants were 232 adults from six university-based primary care outpatient clinics in three West Coast cities randomized to receive either the CCAP intervention or the usual care condition. Results showed significant (Pcannabis use status (monthly vs. less than monthly) for depressive symptoms, but not for panic disorder or social phobia symptoms (all P>.05). Monthly cannabis users' depressive symptoms improved in the CCAP intervention just as much as those who used cannabis less than monthly, whereas monthly users receiving usual care had significantly more depressive symptoms than those using less than monthly. A combined CBT and medication treatment intervention may be a promising approach for the treatment of depression among occasional cannabis users. (c) 2006 Wiley-Liss, Inc.

  9. RESULTS OF TREATMENT OF CERVICAL DISCOPATHY WITH PEEK INTERBODY CAGES AT THREE LEVELS WITHOUT PLATE FIXATION

    Directory of Open Access Journals (Sweden)

    Amado González Moga

    Full Text Available ABSTRACT Objective: To present the results of treatment of patients with cervical discopathy by anterior cervical approach, discectomy and placement of a PEEK interbody cage without anterior plate fixation. Methods: Retrospective, cross-sectional study from March 2013 to March 2015. Sixteen patients with radiculopathy or clinical signs of myelopathy were included; all patients underwent cervical surgery through anterior approach, discectomy, and placement of PEEK cages on three levels. Decompression levels were determined according to the correlation between preoperative radiological and clinical findings. Results: Sixteen patients predominantly male were included, with mean age of 50 years at the onset of the condition. Ten patients had involvement of C4-C5, C5-C6, C6-C7 levels, and six patients C3-C4, C4-C5 and C5-C6. Fourteen patients had cervicobrachialgia and two myelopathy. The preoperative visual analog scale average was 8/10 and the average postoperative value at 6 months was 3/10. At 6 months, there was no radiological evidence of recurrence. One patient had non-fatal complications. Conclusions: The treatment of cervical discopathy by anterior approach with interbody fusion with PEEK cage on three levels, with no plate fixation seemed to be safe and effective with better long-term results in terms of pain and myelopathy. The clinical results compare favorably with other similar series and, most importantly, the complications associated with anterior fixation plate are avoided.

  10. Extracapsular approach for arthroscopic treatment of femoroacetabular impingement: clinical and radiographic results and complications

    Directory of Open Access Journals (Sweden)

    Bruno Dutra Roos

    2015-08-01

    Full Text Available ABSTRACTOBJECTIVES: To evaluate the clinical and radiographic results and complications relating to patients undergoing arthroscopic treatment for femoroacetabular impingement by means of an extracapsular approach. METHODS: Between January 2011 and March 2012, 49 patients (50 hips underwent arthroscopic treatment for femoroacetabular impingement, performed by the hip surgery team of the Orthopedic Hospital of Passo Fundo, Rio Grande do Sul. Forty patients (41 hips fulfilled all the requirements for this study. The mean follow-up was 29.1 months. The patients were assessed clinically by means of the Harris Hip score, as modified by Byrd (MHHS, the Non-Arthritic Hip score (NAHS and the internal rotation of the hip. Their hips were also evaluated radiographically, with measurement of the CE angle, dimensions of the joint space, alpha angle, neck-head index, degree of arthrosis and presence of heterotopic ossification of the hip. RESULTS: Out of the 41 hips treated, 31 (75.6% presented good or excellent clinical results. There was a mean postoperative increase of 22.1 points for the MHHS, 21.5 for the NAHS and 16.4° for the internal rotation of the hip ( p< 0.001. Regarding the radiographic evaluation, correction to normal values was observed for the alpha angle and neck-head index, with a mean postoperative decrease of 32.9° and mean increase of 0.10, respectively ( p< 0.001. CONCLUSION: Arthroscopic treatment of femoroacetabular impingement by means of an extracapsular approach presented satisfactory clinical and radiographic results over a mean follow-up of 29.1 months, with few complications.

  11. Treatment for liver metastases from breast cancer: Results and prognostic factors

    Institute of Scientific and Technical Information of China (English)

    Xiao-Ping Li; Zhi-Qiang Meng; Wei-Jian Guo; Jie Li

    2005-01-01

    AIM: Liver metastases from breast cancer (BCLM) are associated with poor prognosis. Cytotoxic chemotherapy can result in regression of tumor lesions and a decrease in symptoms. Available data, in the literature, also suggest a subgroup of patients rraay berefit from surgery, but few talked about transcatheter arterial chemoembolization (TACE).We report the results of TACE and systemic chemotherapy for patients with liver metastases from breast cancer and evaluate the prognostic factors. METHODS: Forty-eight patients with liver metastases, from proved breast primary cancer were treated with TACEor systemic chemotherapy between January 1995 and December 2000. Treatment results were assessed according to WHO criteria, along with analysis of prognostic factors for survival using Cox regression model.RESULTS: The median follow-up was 28 mo (1-72 mo). Response rates were calculated for the TACE group and chemotherapy group, being 35.7% and 7.1%,respectively. The difference was significant. The one-, two- and three-year Survival rates for the TACE group were 63.04%, 30.35%, and 13.01%, and those for the systemic chemotherapy group were 33.88%, 11.29%, and 0%. According to univariate analysis, variables significantly associated with survival were the lymph node status of the primary cancer, the clinical stage of liver metastases, the Child-Pugh grade, loss of weight. Other factors such as age, the intervals between the primary to the metastases, the maximal diameter of the liver metastases, the number of liver metastases, extrahepatic metastasis showed no prognostic significances. These factors mentioned above such as the lymph node status of the primary cancer, the clinical stage of liver metastases, the Child-Pugh grade, loss of weight were also independent factors in multivariate analysis.CONCLUSION: TACE treatment of liver metastases from breast cancer may prolong survival in certain patients. This approach offers new promise for the curative treatment of the patients

  12. RESULTS FROM CLINICAL AND RADIOLOGICAL FOLLOW-UP, AFTER SURGICAL TREATMENT OF CHONDROBLASTOMA

    Science.gov (United States)

    Penna, Valter; Toller, Eduardo Areas; Ferreira, Adriano Jander; Dias, Dante Palloni Costa

    2015-01-01

    Objectives: To evaluate the long-term clinical and radiological results from patients who underwent surgical treatment of chondroblastoma, between 2003 and 2009, by the same surgical team, using the same operative technique. Methods: A retrospective study was conducted on 12 patients with histological diagnoses of chondroblastoma, who were attended between 2003 and 2009 at the Pius XII Foundation (Barretos Cancer Hospital, Barretos, State of São Paulo). These patients underwent surgical treatment with intralesional resection of the tumor, adjuvant electrocauterization and replacement with methyl methacrylate (11 cases) or an autologous graft from the iliac crest (one case). The preoperative evaluation included physical examination, plain radiographs of the site, magnetic resonance imaging, computed axial tomography and bone scintigraphy. The patients were assessed clinically and radiologically according to a predefined protocol, with a series of plain radiographs, and a functional assessment in accordance with the Enneking functional score. Results: The average age at the time of diagnosis was 14 years and 4 months. The most frequent location affected was the distal femoral epiphysis (75%), followed by the proximal tibial epiphysis (16.6%) and the calcaneus (8.4%). There was higher prevalence among the female patients than among the male patients (3:1). In three cases, preoperative biopsy was necessary. During the follow-up, there was no evidence of local tumor recurrence, and all the patients presented an excellent functional result from the surgical technique used, with Enneking scores ranging from 20 to 30. Conclusion: Surgical treatment of chondroblastoma, using intralesional resection, adjuvant electrocauterization and replacement with methyl methacrylate or bone graft produced good results. PMID:27027054

  13. Ethics on the dental treatment of patients with mental disability: results of a Netherlands - Belgium survey.

    Science.gov (United States)

    Marks, Luc; Adler, Naomi; Blom-Reukers, Helen; Elhorst, Jan H; Kraaijenhagen-Oostinga, Annelies; Vanobbergen, Jacques

    2012-11-01

    This study evaluates several ethical dilemmas of by dental practitioners treating persons with mental disabilities (PMD) by dentists in the Netherlands and Belgium. Ethical dental care for PMD is a hot topic. Worldwide different treatment strategies are used in the dental treatment of this patient group. In addition, cultural aspect seems to play an important role in the choices made. The latter can explain the difficulty in creating European and worldwide guidelines on this issue. A questionnaire was sent to dental practitioners interested in treating PMD persons both in the Netherlands and in Belgium including questions on the use of behaviour management techniques, use and attitude towards sedation and physical fixation and the cooperation with other health care personal. Behaviour management techniques and sedation are frequently used. Dentist of the Netherlands and Belgium in general reject the restraint of PMD persons. However, limited use of manual restraint in accordance with the carers and the close surrounding of the patient seems to be accepted. Dental practitioners are sometimes confronted with an emotional dilemma in treating PMD and the majority feels that it is a continuous challenge to obtain optimal result of the dental treatment.

  14. Metaplastic carcinoma of the breast: Treatment, results and prognostic factors based on international literature.

    Science.gov (United States)

    Sanguinetti, Alessandro; Lucchini, Roberta; Santoprete, Stefano; Farabi, Raffaele; Fioriti, Lorella; Bistoni, Giovanni; Triola, Roberta; Avenia, Nicola

    2014-01-01

    Metaplastic carcinoma of the breast (MCB) is a rare form of cancer containing mixture of epithelial and mesenchymal elements in variable combinations. Few and conflicting clinical data are available in the literature addressing optimal treatment modalities, prognosis and outcome. A retrospective study was conducted to review all patients with MCB diagnosed and treated at Breast Unit of Azienda Ospedaliera "Santa Maria" Terni - Italy between 2001/2010. The aim is to describe patient's clinic pathologic features and to analyze treatment results. Six female patients were studied. The median age was 48 years (range 14/58). The median tumor size was 9 cm. (range 3/18 cm.). Two cases (33%) were identified as purely epithelial and 4 (67%) as mixed epithelial and mesenchymal metaplasia. Hormone receptors were positive in only 2 patients. Modified radical mastectomy performed in 3 patients and 5 underwent axillary node dissection. Adjuvant chemotherapy was given to all patients and postoperative radiotherapy to 4. Four patients relapsed with median time of relapse of 12 months. MCB is an aggressive form of breast cancer associated with poor outcome, high incidence of local recurrence and pulmonary metastases. The disease tends to be estrogen/progesterone receptor negative. Tumor size has an important impact on outcome. The best treatment approach is yet to be defined.

  15. Preliminary results with a strip ionization chamber used as beam monitor for hadrontherapy treatments

    Science.gov (United States)

    Boriano, A.; Bourhaleb, F.; Cirio, R.; Cirrone, G. A. P.; Cuttone, G.; Donetti, M.; Garelli, E.; Giordanengo, S.; Luparia, A.; Marchette, F.; Peroni, C.; Raffaele, L.; Sabini, M. G.; Valastro, L.

    2006-01-01

    Preliminary results are presented from a test of a parallel plate ionization chamber with the anode segmented in strips (MOPI) to be used as a beam monitor for therapeutical treatments on the 62 MeV proton beam line of the INFN-LNS Superconducting Cyclotron. Ocular pathologies have been treated at the Catana facility since March 2002. The detector, placed downstream of the patient collimator, will allow the measurement of the relevant beam diagnostic parameters during treatment such as integrated beam fluence, for dose determination; the beam baricentre, width and asymmetry will be obtained from the fluence profile sampled with a resolution of about 100 Urn at a rate up to 1 kHz with no dead time. In this test, carried out at LNS, the detector has been exposed to different beam shapes and the integrated fluence derived by the measured beam profiles has been compared with that obtained with other dosimeters normally used for treatment. The skewness of the beam profile has been measured and shown to be suitable to on-line check variations of the beam shape.

  16. Does contraceptive treatment in wildlife result in side effects? A review of quantitative and anecdotal evidence.

    Science.gov (United States)

    Gray, Meeghan E; Cameron, Elissa Z

    2010-01-01

    The efficacy of contraceptive treatments has been extensively tested, and several formulations are effective at reducing fertility in a range of species. However, these formulations should minimally impact the behavior of individuals and populations before a contraceptive is used for population manipulation, but these effects have received less attention. Potential side effects have been identified theoretically and we reviewed published studies that have investigated side effects on behavior and physiology of individuals or population-level effects, which provided mixed results. Physiological side effects were most prevalent. Most studies reported a lack of secondary effects, but were usually based on qualitative data or anecdotes. A meta-analysis on quantitative studies of side effects showed that secondary effects consistently occur across all categories and all contraceptive types. This contrasts with the qualitative studies, suggesting that anecdotal reports are insufficient to investigate secondary impacts of contraceptive treatment. We conclude that more research is needed to address fundamental questions about secondary effects of contraceptive treatment and experiments are fundamental to conclusions. In addition, researchers are missing a vital opportunity to use contraceptives as an experimental tool to test the influence of reproduction, sex and fertility on the behavior of wildlife species.

  17. [Diagnosis and treatment of varicose veins: part 2: therapeutic procedures and results].

    Science.gov (United States)

    Nüllen, H; Noppeney, T

    2010-12-01

    This is the second of two articles on the diagnosis and treatment of varicose veins. Primary varicosis is a congenital degenerative disease of the peripheral venous system of the lower extremities. Treatment is carried out according to an individualized concept which takes the incurability and progression of the disease into consideration. Conservative treatment with compression bandages is an option for all forms of varicosis and the accompanying complications. Veins can be specifically ablated by sclerotherapy of varices. In addition to high ligation and stripping mini-phlebectomy and subfascial endoscopic perforator surgery (SEPS) can also be performed. The indications in cases of SEPS should be extremely limited because of possible severe complications. Radiofrequency ablation (RFO) and endovenous laser therapy (ELT) are also available as endovenous therapy options. Information in the literature on recurrence rates of the various procedures is extremely variable and the reasons for recurrent varicosis are the subject of controversy. The data relating to the results of RFO and ELT are relatively good and both procedures show a significant improvement in quality of life and the venous clinical severity score (VCSS).

  18. Results of surgical treatment versus chemoradiation therapy in oropharyngeal early tumors

    Directory of Open Access Journals (Sweden)

    Chedid, Helma Maria

    2009-03-01

    Full Text Available Introduction: The epidermoid carcinoma of the upper aerodigestive tract is diagnosed in approximately 40% of the cases of advanced clinical stages. Objective: To evaluate the disease-free interval in patients with clinical stages I and II epidermoid carcinoma who were submitted to surgery or chemoradiation. Method: Retrospective study of the records of 139 patients treated for oropharyngeal epidermoid carcinoma submitted to treatment with curative intent. Among those patients, 38 were classified with early tumors clinical stages I and II. Twenty-seven (71.1% underwent surgical treatment whereas eleven (28.9% were treated with chemoradiation. The mean age was 56.4 years; 31 cases (81.6% were in men and seven (18.4% were in women. Results: Among the eleven patients who were submitted to chemoradiation, 72.7% obtained locoregional control of the disease and their disease-free survival was of 42%. Among the 27 patients operated, 19 remained in Clinical Stages I and II in the histological report and six underwent postoperative radiation therapy. The disease-free interval for two years was of 70%. Conclusion: The patients submitted to the surgery had a better disease-free interval as compared to those submitted to chemoradiation treatment.

  19. Treatment Result in the Initial Stage of Kanazawa Mobile Embolectomy Team for Acute Ischemic Stroke

    Science.gov (United States)

    UCHIYAMA, Naoyuki; MISAKI, Kouichi; MOHRI, Masanao; KAMIDE, Tomoya; HIROTA, Yuichi; HIGASHI, Ryo; MINAMIDE, Hisato; KOHDA, Yukihiko; ASAHI, Takashi; SHOIN, Katsuo; IWATO, Masayuki; KITA, Daisuke; HAMADA, Yoshitaka; YOSHIDA, Yuya; NAKADA, Mitsutoshi

    2016-01-01

    Five recent multicenter randomized controlled trials (RCTs) have clearly shown the superiority of mechanical thrombectomy in large vessel occlusion acute ischemic stroke compared to systemic thrombolysis. Although 14 hospitals in Ishikawa prefecture have uninterrupted availability of systemic thrombolysis, mechanical thrombectomy is not available at all of these hospitals. Therefore, we established a Kanazawa mobile embolectomy team (KMET), which could travel to these hospitals and perform the acute reperfusion therapy. In this article, we report early treatment outcomes and validate the effectiveness of a network between affiliated hospitals and KMET. Between January 2014 and December 2015, 48 patients, aged 45–92 years (mean: 73.0 years), underwent acute reperfusion therapy provided by KMET in 10 affiliated hospitals of Kanazawa University Hospital. The pre-treatment NIHSS scores ranged from 5 to 39 (mean: 19.1). ASPECTS+W ranged from 1 to 11 (mean: 7.3). Successful revascularization, defined as thrombolysis in cerebral infarction (TICI) 2b or 3, was achieved in 38/48 cases (80%), and a good outcome, defined as modified Rankin Scale (mRS) score from 0 to 2 at 90 days after the treatment, was achieved in 24/48 cases (50%). There were two cases of intracranial bleeding (4%). Mean time from onset to recanalization was 297 min. These results, which are similar to those of five previous RCTs, suggest that a collaborative network between affiliated hospitals and KMET is effective for acute reperfusion therapy in local areas wherein experienced neuroendovascular specialists are insufficient. PMID:27725522

  20. Radiofrequency ablation of hepatic metastasis: Results of treatment in forty patients

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    Rath G

    2008-01-01

    Full Text Available Aim: To evaluate the local control of hepatic metastasis with radiofrequency ablation treatment. Materials and Methods: We did a retrospective analysis in 40 patients treated with radiofrequency ablation for hepatic metastasis. The tumors ablated included up to two metastatic liver lesions, with primaries in breast, gastrointestinal tract, cervix, etc. Radiofrequency ablation was performed under general anesthesia in all cases, using ultrasound guidance. Radionics Cool-Tip RF System was used to deliver the treatment. Results: The median age of patients treated was 49 years. There were 13 female and 27 male patients. The median tumor size ablated was 1.5 cm (0.75-4.0 cm. A total of 52 radiofrequency ablation cycles were delivered. Successful ablation was achieved in all patients with hepatic metastasis less than 3 cm in size. Pain was the most common complication seen (75%. One patients developed skin burns. At 2-year follow-up 7.5% of patients had locally recurrent disease. Conclusions: Radiofrequency ablation is a minimally invasive treatment modality. It can be useful in a select group of patients with solitary liver metastasis of less than 3 cm size.

  1. Treatment results of combined platelet-rich plasma and fat injection in patients with velopharyngeal insufficiency

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    Hamid Reza Fathi

    2013-10-01

    Full Text Available Background: Velopharyngeal insufficiency causes hypernasal vocal quality and can also result in audible nasal air emission and difficulty in producing pressure consonants. The resulting speech is often socially unacceptable and can be difficult to understand. Platelet-rich plasma is an autologous derivative of whole blood. Today, the importance of clinical use of Platelet-rich plasma in the plastic surgery is considered. This study was designed to evaluate the effectiveness of combined Platelet-rich plasma and fat injection in the treatment of velopharyngeal insufficiency. Methods: In this prospective clinicaltrial study, of 15 patients including 9 males and 6 females and aged 15-20 years with mild/ moderate velopharyngeal insufficiency who were injected with 5 mL of combined Platelet-rich plasma (1 mL and fat (4 mL in the front volume in the posterior pharyngeal wall in the pre-vertebral fascia under sedation. Speech samples were recorded by nasoendoscopy before the injection, and at 6 weeks and 6 months after the injection. Assessment of pathologic speech was done by speech therapist. Results: Velar displacement showed significantly increased at 6 weeks after the injection (P=0.049. Velopharyngeal gap disappeared in 60% of patients at 6 weeks after the injection (P=0.019. Lateral pharyngeal wall movement showed significantly increased in 73.3% of the patients at 6 months after the injection (P=0.04. After the treatment, aerodynamic assessment showed significantly decreased in nasal air escape during phonation and repeat the words (P<0.05. Assessment speech therapist showed significantly improve quality of phonation in these patients (P<0.05. Conclusion: It seems that, combined Platelet-rich plasma and fat injection lead to improve voice resonance and reduce nasal air escape in all treated cases. It can be a promising alternative to major procedures, such as velopharyngoplasties, for the treatment of mild/ moderate velopharyngeal insufficiency.

  2. Femtosecond laser for glaucoma treatment: the comparison between simulation and experimentation results on ocular tissue removal

    Science.gov (United States)

    Hou, Dong Xia; Ngoi, Bryan K. A.; Hoh, Sek Tien; Koh, Lee Huat K.; Deng, Yuan Zi

    2005-04-01

    In ophthalmology, the use of femtosecond lasers is receiving more attention than ever due to its extremely high intensity and ultra short pulse duration. It opens the highly beneficial possibilities for minimized side effects during surgery process, and one of the specific areas is laser surgery in glaucoma treatment. However, the sophisticated femtosecond laser-ocular tissue interaction mechanism hampers the clinical application of femtosecond laser to treat glaucoma. The potential contribution in this work lies in the fact, that this is the first time a modified moving breakdown theory is applied, which is appropriate for femtosecond time scale, to analyze femtosecond laser-ocular tissue interaction mechanism. Based on this theory, energy deposition and corresponding thermal increase are studied by both simulation and experimentation. A simulation model was developed using Matlab software, and the simulation result was validated through in-vitro laser-tissue interaction experiment using pig iris. By comparing the theoretical and experimental results, it is shown that femtosecond laser can obtain determined ocular tissue removal, and the thermal damage is evidently reduced. This result provides a promising potential for femtosecond laser in glaucoma treatment.

  3. Result of arthroscopic treatment of pigmented villonodular synovitis of the knee.

    Science.gov (United States)

    De Ponti, Alessandro; Sansone, Valerio; Malcherè, Marco

    2003-01-01

    We report 10 years' experience in arthroscopic treatment of pigmented villonodular synovitis (PVNS) of the knee in a series of patients affected by the localized or diffuse form of the disease. The purpose of the study is to critically examine the results of arthroscopic synovectomy in the knee affected by PVNS, to determine the safety and effectiveness of the procedure. Retrospective case analysis. The study population consists of 19 patients, with an average follow-up of 60 months (minimum, 12; maximum, 128). All patients underwent knee arthroscopy. The 3 standard portals were used; posteromedial and posterolateral portals were added if required. Four patients were affected by localized PVNS and were subject to partial synovectomy with excision of the pathologic tissue. The remaining 15 patients presented a diffuse form of PVNS; 7 of them underwent extended arthroscopic synovectomy and 8 underwent partial synovectomy. The diagnosis was confirmed by synovial biopsy. In the group affected by the localized form of PVNS, the arthroscopic local excision resulted in a complete and persistent regression of the pathology. Among the patients affected by the diffuse form of PVNS, clinical results were better and the recurrence rate was lower in the group treated with extended synovectomy. No relevant complications were encountered. In particular, no cases of infection, stiffness, or neurovascular lesions were seen. Arthroscopic synovectomy is an appropriate treatment for knee PVNS. Extended synovectomy must be performed in all cases of diffuse PVNS.

  4. RESULTS OF SURGICAL TREATMENT OF PAEDIATRIC DIAPHYSEAL FRACTURES OF LONG BONES USING INTRAMEDULLARY ELASTIC NAIL

    Directory of Open Access Journals (Sweden)

    Arun Kumar

    2015-12-01

    Full Text Available BACKGROUND Among the various methods of treating the long bone fractures in children less than 5yrs (POP cast and adolescents 16yrs (IMN, flexible intramedullary nail has gained importance because of its stability, not violating the physis and less complications and early rehabilitation. Irrespective of mode of treatment, goal shall be to achieve union at fracture site, control length and alignment, minimize the morbidity and complications for patient and their family. MATERIALS AND METHODS A prospective study was conducted on children of both sexes, between the age group of 5-15yrs with diaphyseal fractures of long bones, meeting the inclusion and exclusion criteria during the study period at RRMCH (September 2012 to September 2014. Totally, 30 cases were evaluated clinically and radiologically and followed up at 3, 6, 12, 24 weeks after surgery. Final outcome was assessed using Flynn’s criteria for Tens Scoring System. RESULTS Results of entire, 30 patients were followed up for an average of 6 months, was excellent in 19(63% cases and satisfactory in 11(37% cases and no poor outcome. CONCLUSION Based on this study and result, we found that intramedullary elastic nailing technique is an ideal method for treatment of pediatric femoral and tibial diaphyseal fractures.

  5. CLINICAL RESULTS FROM THE TREATMENT OF CHRONIC SKIN WOUNDS WITH PLATELET RICH PLASMA (PRP)

    OpenAIRE

    2015-01-01

    PURPOSE: To show platelet rich plasma (PRP) application of chronic skin wounds and to evaluate the results from the treatment. MATERIAL AND METHODS: A total of 14 patients with problematic skin wounds had been treated at the clinic for a period of five years (from May 2009 to December 2014) with the following patient sex ratio: male patients - 5 and female patients - 9. Average age - 48,5 (30-76). Patients with Type 2 Diabetes - 4, with decubitus ulcers - 6, traumatic - 8, with infection -...

  6. The Structural and Strength Changes Resulting from Modification of Heat Treatment of High Carbon Steel

    Directory of Open Access Journals (Sweden)

    Grygier D.

    2016-06-01

    Full Text Available Pearlitic steels containing from some 0,8 to 0,95% C belong to the group of unalloyed steels intended for cold drawing or rolling. One of the problems discussed in literature is cracking of pearlitic steel subjected to plastic working, caused by high brittleness of the lamellar precipitations of hard cementite. This issue is extremely important because it affects significantly reduce fatigue strength. The paper presents proposals to modify the process of heat treatment, results in getting a steel with spheroidal structure characterized by better plastic properties, in order to eliminate this problem.

  7. Results of treatment of acute liver failure patients with use of the prometheus FPSA system.

    Science.gov (United States)

    Grodzicki, M; Kotulski, M; Leonowicz, D; Zieniewicz, K; Krawczyk, M

    2009-10-01

    Herein we have presented the results of treatment of acute liver failure (ALF) patients with the use of the Prometheus FPSA dialysis system. To January 2009, we performed 278 FPSA procedures in 114 patients, including 52 experience and ALF. The patients who underwent the FPSA procedure consisted of 32 women and 20 men of overall mean age of 33 +/- 12 years. The causes of ALF were: Wilson's disease (n = 15), unknown origin ALF (n = 11), amanita phalloides intoxication (n = 7), paracetamol intoxication (n = 8), acute hepatitis B virus (HBV)/hepatitis C virus (HCV) infection (n = 7), liver insufficiency after parenchymal resection (n = 2) drug reaction with eosinophilia and systemic symptoms (DRESS) syndrome (n = 1), rabdomyolysis (n = 1), or primary nonfunction (PNF) after orthotopic liver transplantation (OLT) (n = 1). All procedures were performed using the Prometheus 4008H Fresenius Medical Care liver support system. The average number of treatments per patient was 2.41 and the average time for each FPSA treatment was 6.3 hours. The average heparin dose used during the procedure was 750 IU/h. After the whole treatment regimen, we observed significant improvements in the biochemical results. The average concentrations improved: serum ammonia (before 249.2 mug/dL versus after 109.7 mug/dL); serum bilirubin (before 21.53 mg/dL versus after 8.81 mg/dL), serum aspartate aminotransferase (AST; before 2456.4 U/L versus after 1068.8 U/L); serum alanine aminotransferase (ALT; before 2958.2 U/L versus after 1595.8 U/L); serum urea (before 58.5 mg/dL versus after 21.1 mg/dL); serum creatinine (before 2.9 mg/dL versus after 1.7 mg/dL); and pH value (before 7.11 versus after 7.32). After Prometheus treatment OLT was performed in 33 patients. Among the 28 who survived (53.8%), 22 underwent OLT and 6 did not have OLT. Among the 24 patients who died (46.2%), 13 were before OLT and 11 after OLT. The Prometheus 4008H Fresenius Medical Care Liver support system was useful method of

  8. Chronic antidepressant treatments resulted in altered expression of genes involved in inflammation in the rat hypothalamus.

    Science.gov (United States)

    Alboni, Silvia; Benatti, Cristina; Montanari, Claudia; Tascedda, Fabio; Brunello, Nicoletta

    2013-12-05

    To gain insight into the possible immune targets of antidepressant, we evaluated the expression of several inflammatory mediators in the hypothalamus of rats chronically (28 days) treated with the serotonin selective reuptake inhibitor fluoxetine (5mg/kg, i.p.) or the tricyclic compound imipramine (15 mg/kg, i.p.). We focused our attention on the hypothalamus as it plays a key role in determining many of the somatic symptoms experienced by depressed patients. This brain region, critical also for expression of motivated behaviours, participates in the control of the hypothalamic-pituitary-adrenal axis activity and in stress response as well as coordinates physiological functions such as sleep and food intake that have been found altered in a high percentage of depressed patients. Notably, hypothalamus is a key structure for brain cytokine expression and function as it integrates signals from the neuro, immune, endocrine systems. By means of quantitative Real Time PCR experiments we demonstrated that a chronic treatment with either fluoxetine or imipramine resulted in a reduction of IL-6 and IFN-γ mRNAs and increased IL-4 mRNA expression in the rat hypothalamus. Moreover, we demonstrated that hypothalamic expression of members of IL-18 system was differentially affected by chronic antidepressant treatments. Chronically administered fluoxetine decreased IL-8 and CX3CL1 hypothalamic expression, while a chronic treatment with imipramine decreased p11 mRNA. Our data suggest that a shift in the balance of the inflammation toward an anti-inflammatory state in the hypothalamus may represent a common mechanism of action of both the chronic treatments with fluoxetine and imipramine. © 2013 Published by Elsevier B.V.

  9. Results of the treatment of keratocystic odontogenic tumours using enucleation and treatment of the residual bony defect with Carnoy's solution.

    Science.gov (United States)

    Leung, Y Y; Lau, S L; Tsoi, K Y Y; Ma, H L; Ng, C L

    2016-09-01

    This retrospective study aimed to investigate the recurrence rate of keratocystic odontogenic tumours (KCOTs) treated by enucleation and the application of Carnoy's solution, and to assess the surgical morbidities associated with this treatment. KCOTs treated using a standard protocol of enucleation and the application of Carnoy's solution between 1990 and 2013 were evaluated. One hundred and five KCOTS in 105 patients (54 male, 51 female) were analysed. The mean follow-up period was 86.6 months (range 24-313 months). The recurrence rate was 11.4%. A postoperative inferior alveolar nerve neurosensory deficit occurred in 30.1% of the mandibular cases, with 16% of these being permanent. The postoperative infection and fracture rates were 1.9% and 0.9%, respectively. Younger age, multilocular KCOTs, larger tumour size, and longer antero-posterior lesion length on the radiograph were found to be risk factors for recurrence. It is concluded that enucleation and the application of Carnoy's solution to treat KCOTs results in a relatively low recurrence rate and a low rate of surgical morbidities.

  10. Treatment results of adjuvant radiotherapy and chemotherapy in breast cancer patients with positive axillary nodes

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    Shin, Hyun Soo [College of Medicine, Pochon CHA Univ, Sungnam (Korea, Republic of); Suh, Chang Ok [College of Medicine, Yonsei Univ, Seoul (Korea, Republic of)

    2000-12-01

    Between January 1983 and December 1988, 218 female patients with known breast cancer and positive axillary nodes were treated with adjuvant radiotherapy and chemotherapy following radical mastectomy. Treatment results were retrospectively analysed at the Department of Radiation Oncology, Yonsei Cancer Center, Yonsei University of College of Medicine. The patients were classified into 3 groups; group 1 included 80 patients treated with adjuvant chemotherapy alone; in group 2, 52 patients treated with radiotherapy alone; and in group 3, 86 patients treated with combined chemo-radiotherapy. The mean age was 44 years and ranged from 27 to 70. The median follow-up time was 51 months. Seven-year relapse free and overall survival rates were 56% and 67%; in group 1, 50% and 56%; in group 2, 51% and 65%; and in group 3, 62% and 75% respectively. This difference was not statistically significant(p<0.05). The loco-regional failure rates were 13% and distant failure rates were 33%. There was less risk of loco-regional failure in group 2 and 3 which included radiotherapy (.0<0.05). But there was no significant y difference in the rates of distant failure(p>0.05). By univariate analysis, the only significant prognostic factor affecting relapse-free survival was the percentage of positive axillary nodes; and the overall survival significantly correlated with the primary tumor size, the number or percentage of positive axillary nodes, and stage. But in multivariate analysis, the only significant prognostic factor was treatment modality. By univariate analysis of prognostic factors affecting the rates of overall failure and distant failure, the significant prognostic factors was the percentage of positive axillary nodes; and the risk of the loco-regional failure significantly correlated with the treatment modality. In conclusion, these results suggest a potential for decreasing the risk of loco-regional failure with the addition of postoperative radiotherapy to chemotherapy in the

  11. Long-term results of surgical treatment of pigmented villonodular synovitis of the knee.

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    Akinci, Orhan; Akalin, Yavuz; İncesu, Mustafa; Eren, Ahmet

    2011-01-01

    The aim of this study was to evaluate the long-term results of total synovectomy in pigmented villonodular synovitis of the knee (PVNS). Open total synovectomy was performed for 19 patients (9 men, 10 women; mean age: 42.8 years) with PVNS. Of these patients, 15 had diffuse and 4 localized PVNS. The patients were followed for an average of 80.2 months and the average time between the onset of complaints and surgery was 23 months. In 4 patients, PVNS was identified during total knee replacement (TKR) performed due to gonarthrosis. Radiotherapy was performed as an adjuvant treatment in one patient with recurrence. Puncture was performed in 11 patients due to effusion and 8 to 70 cc of fluid was aspirated. Diagnosis was made during the exposure for TKR in 4 patients, by a biopsy in 2 and based on joint puncture and MRI findings in the rest. Recurrence occurred in 5 patients. A second total synovectomy was performed in 4 patients. Radiotherapy was used for the remaining one patient. Two patients were operated three times. During the follow-up, TKR was performed in 7 of the 19 patients. None of the patients developed infection and hemarthrosis requiring puncture nor required amputation or arthrodesis. Three patients had a postoperative knee joint stiffness of 10 to 25 degrees. The patients were evaluated according to the Knee Society Score and 8 (42.2%) had perfect, 9 (47.3%) good and 2 (10.5%) bad results. PVNS is a disease with a high risk of recurrence. No individual or combined treatment method can offer a definitive solution. Open or arthroscopic radical synovectomy is still considered as the gold standard. If necessary, adjuvant intraarticular or extraarticular radiotherapy can be added to the treatment.

  12. First-year treatment costs among new initiators of topical prostaglandin analogs: pooled results

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    Jordana K Schmier

    2010-05-01

    Full Text Available Jordana K Schmier1, David W Covert21Managing Scientist, Exponent Inc., Alexandria, VA, USA; 2Associate Director, Health Economics, Alcon Research Ltd., Ft. Worth, TX, USAObjective: To estimate first-year treatment costs among new initiators of topical prostaglandin analogs in a managed care population.Research design and methods: A model was developed to estimate first-year medical costs. Model inputs were based on weighted results from three previous studies. Treatment patterns were derived from a claims database analysis. Published studies were used to estimate visit-related resource use. Costs were obtained from standard sources.Results: Across studies, 27,809 patients met study criteria, 44.2% of whom remained on their index therapy for 12 months. Adjunctive therapy was needed in 22.5%, 18.5%, and 11.9% of bimatoprost, latanoprost, and benzalkonium chloride (BAK-free travoprost patients, respectively. Median days to initiating adjunctive therapy were 64, 67, and 127 for bimatoprost, latanoprost, and BAK-free travoprost patients. Estimated first-year medical costs were $1,945, $1,803, and $1,730 for patients initiating therapy with bimatoprost, latanoprost, and BAK-free travoprost. Findings were consistent through sensitivity analysis.Conclusions: A BAK-free prostaglandin analog may permit longer duration of monotherapy and be associated with lower first-year treatment costs. Use of a claims database and the selection of new initiators of prostaglandin analogs limit the ability to project findings to all glaucoma patients.Keywords: costs and cost analysis, drug therapy, combination, glaucoma, prostaglandin analogs

  13. Systematic Review of Results of Kissing Stents in the Treatment of Aortoiliac Occlusive Disease.

    Science.gov (United States)

    Groot Jebbink, Erik; Holewijn, Suzanne; Slump, Cornelis H; Lardenoije, Jan-Willem; Reijnen, Michel M P J

    2017-07-01

    Endovascular treatment of aortoiliac occlusive disease (AIOD) involving the aortic bifurcation is challenging. The gold standard is open surgery with patency rates up to 90% at 5 years, but has considerable morbidity and mortality. The kissing stent (KS) technique was introduced as an alternative. The goal of this review is to give an overview of the current results and role of the KS technique in AIOD treatment. The Cochrane guidelines were used to assure a systematic method. A search query designed in the Scopus search interface was used to identify relevant studies. Abstracts from the search were screened against the inclusion and exclusion criteria. During full-text reading, methodological quality was scored using a critical review list tailored to the topic of AIOD. Thereafter, study data were extracted and pooled for further analysis. In total, 143 abstracts were retrieved using Scopus, 116 were rejected and 7 more were rejected after full-text screening. One study was included after cross referencing. Twenty-one studies presented 1,390 patients. Rutherford classification 1/2/3 was the indication in 76.2% of patients, and 48.4% of the lesions were classified as Trans-Atlantic Inter-Society Consensus C or D. The technical success rate was 98.7%, and the complication rate was 10.8%. Clinical improvement at 30 days was achieved in 89.9%. Primary patency at 12, 24, and 60 months was 89.3%, 78.6%, and 69.0%, respectively. KS treatment of AIOD yields acceptable mid-term results, with high technical success rates and mostly minor complications occur. The long-term patency cannot yet match that of open surgery, underlining the need for further research that provides insight into factors related to reocclusion. Copyright © 2017 Elsevier Inc. All rights reserved.

  14. [Treatment results of neuroblastoma in children in the Republic of Belarus].

    Science.gov (United States)

    Proleskovskaia, I V; Savich, T V; Mareĭko, Iu E; Savva, N N; Aleĭnikova, O V

    2009-01-01

    Our investigation was concerned with effectiveness of infantile neuroblastoma treatment in Belarus and dependence of prognosis on extent of radical surgery. The study involved 115 patients with morphologically confirmed diagnosis of primary tumor who were treated at the Center (1997-2007). Ten-year overall and relapse-free survival rates for favorable prognosis, stage I, II, III, were 1.00 and 0.94 +/- 0.04, respectively. They were significantly higher than those for intermediate (0.70 +/- 0.09 and 0.61 +/- 0.09) or high risk (0.32 +/- 0.08 and 0.27 +/- 0.08), respectively, (p < or = 0.01). The results for radical local surgery were better: 5-year relapse-free survival--0.82 +/- 0.09 as compared with subtotal excision (0.62 +/- 0.12) and biopsy (0.5 +/- 0.25) among patients older than 12 months. Autologous stem cell transplantation (ASCT) was followed by significant improvement: 6-year overall and relapse-free survival (stage IV) (0.5 +/- 0.12 and 0.38 +/- 0.12, respectively) as compared those without ASCT (0.12 +/- 0.08 and 0.1 +/- 0.08), respectively, (p < or = 0.01). The main cause of death after ASCT was relapse. Poor results following post-ASCT treatment of stage IV tumor should be improved by more effective detection and removal of tumor cell harvest.

  15. Photodynamic therapy with green light for the treatment of vulvar lichen sclerosus - Preliminary results.

    Science.gov (United States)

    Osiecka, B J; Jurczyszyn, K; Nockowski, P; Murawski, M; Ziółkowski, P

    2017-03-01

    The standard treatment for lichen sclerosus (LS) is symptomatic and is primarily based on the chronic use of corticosteroids, sometimes resulting in unsatisfactory effects. Therefore, other non-pharmacological methods are being sought, which are less aggravating for the patient. LS can be treated topically by using photodynamic therapy (PDT) based on 5-aminolevulinic acid (5-ALA). Unfortunately, therapy with the red light is often connected with severe local pain during the illumination. Green light can also be characterised by its ability to turn on photodynamic reactions in cells. The aim of this study was an evaluation into the efficacy and tolerance of 5-ALA-PDT with a green light (540nm±15nm) in 11 patients with chronic LS that were characterised by severe itching. The disease lasted from 1.5 to 4 years. All the patients were treated with three sessions of PDT. Following treatment with PDT, a significant improvement of local status, as well as a reduction of the main symptom (pruritus), were observed. No patient complained of severe pain during the sessions that would have required an interruption of irradiation or local application of analgesics. Our preliminary results of using green light in PDT for superficial skin non-oncological lesions are very promising but require further studies. Copyright © 2016 Elsevier B.V. All rights reserved.

  16. Treatment Results Of Diaphyseal Forearm Fractures With Dynamique Compression Plate A Retrospective study of 156 Cases.

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    Hassan BOUSSAKRI

    2016-03-01

    Full Text Available This retrospective study addresses a series of 156 cases of forearm fractures. These 156 cases were managed in the trauma-orthopedic department (B4 of Fez University Hospital, Morocco, from May 2008 till January 2013. The purpose of this study is to analyze epidemiological and clinical factors of diaphyseal forearm fractures and the results of their treatment with dynamic compression plate (DCP, as well as the complications and therapeutic errors of this surgical technique. The frequency of hospitalization in the trauma-orthopedic department was 3,96%. Ages ranged between 16 and 83, the average age was 32. 132 patients were male (85%. 90% were managed at the day of trauma. Traffic accidents were the most frequent cause in 52% patients. The fracture was in the left forearm in 65% of patients. 53% of fracture lines were in the middle third of the forearm. 38 fractures were open, and 30 were admitted for polytrauma. Osteosynthesis was performed with dynamic compression plate for all patients. In comparison with the literature, our series shows the predominance of young male patients, with traffic accidents being the cause. Osteosynthesis with dynamic compression plate remains the treatment of choice that provides satisfactory results if the accuracy in this technique was respected.

  17. Results of operative treatment for recalcitrant retrocalcaneal bursitis and midportion Achilles tendinopathy in athletes.

    Science.gov (United States)

    Lohrer, Heinz; Nauck, Tanja

    2014-08-01

    The results of operative treatment for recalcitrant midportion Achilles tendinopathy and recalcitrant retrocalcaneal bursitis were evaluated using the patient administered, disease specific, and validated VISA-A-G questionnaire. A cohort of 89 patients was prospectively followed. These patients underwent operations for sport induced midportion Achilles tendinopathy (39 procedures) or retrocalcaneal bursitis (55 procedures). Depending on the individual intraoperative findings the patients of either disease were treated with two respective operative modifications (tendon repair or no tendon repair). Preoperative and follow-up status (3, 6, and 12 months) were investigated using the VISA-A-G questionnaire. Preoperatively, the four groups scored from 37.0 ± 17.6 to 45.9 ± 15.2 (p = 0.376-0.993) on the VISA-A-G questionnaire. Six and 12 months postoperatively, the VISA-A-G scores improved significantly (p bursitis and midportion Achilles tendinopathy responded equally well to operative treatment. When repaired, additional tendon lesions did not influence this result. We demand to differentiate not only between midportion Achilles tendinopathy and retrocalcaneal bursitis but also to identify additional Achilles tendon lesions to specifically address these lesions during operative procedures.

  18. RESULTS OF THE USE OF PEEK CAGES IN THE TREATMENT OF BASILAR INVAGINATION BY GOEL TECHNIQUE

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    Luís Eduardo Carelli Teixeira da Silva

    2016-03-01

    Full Text Available ABSTRACT Objective: Analysis of the use of polyetheretherketone (PEEK cages for atlantoaxial facet realignment and distraction for treatment of basilar invagination by Goel technique. Method: Retrospective descriptive statistical analysis of the neurological status, pain, presence of subsidence and bone fusion with the use of PEEK cages in 8 atlantoaxial joints of 4 patients with basilar invagination. All patients were treated with atlantoaxial facet distraction and realignment and subsequent arthrodesis C1-C2 by the technique of Goel modified by the use of PEEK cage. Results: All patients showed improvement in Nurick neurological assessment scale and Visual Analogue Scale (VAS of pain. There were no cases of subsidence, migration, or damage to the vertebral artery during the insertion of the cage. All joints evolved with bone fusion, assessed by dynamic radiographs, and computed tomography. Two patients developed neuropathic pain in dermatome of C2 and one patient had unilateral vertebral artery injury during C2 instrumentation treated with insertion of pedicle screw to control the bleeding. Conclusion: The results of the treatment of basilar invagination by the Goel technique with the use of PEEK cages shown to be effective and safe although further studies are needed to confirm this use.

  19. Traumatic Cataract, Results of Surgical Treatment. Sancti Spíritus. 2005-2009.

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    Alina Abella Bonachea

    2012-04-01

    Full Text Available The traumatic cataract constitutes a challenge for the surgeon of the previous segment. It can be presented as a consequence of any type of ocular trauma or -penetrating traumatism with bigger frequency correlated to corneal injuries that they can implicate the iris. It was made a descriptive retrospective observacional study of all of the patients with this diagnosis who went to Oftalmology's consultation during the period of 1ro of January 2005 to September 30, 2009 at Sancti Spíritus's Hospital General, with the objective to describe the surgical treatment results of it with the implantation of intraocular lens and the most frequent complications of traumatic cataract. The population and sample was: 14 patients, totality. Datas were processed in tables and inferential statistics. In 85.7 % of patients were implanted intraocular lens, and it was used Blumenthal's surgical technique. The more frequent trans-operative complication was the losses of vitreous and the more frequent postoperative complications were the moderate corneal edema and the ocular hypertension. The election treatment is the surgical one, obtaining similar results than conventional surgery of cataract if the posterior segment is undamaged, in these cases the visual prognostic is very favorable.

  20. Treatment results in women with clinical stage I and pathologic stage II endometrial carcinoma.

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    Jobsen, J J; Schutter, E M; Meerwaldt, J H; Van Der Palen, J; Van Der Sijde, R; Ten Cate, L N

    2001-01-01

    The aim of this study is to report survival and results of therapy and possible prognostic factors in women with pathologic stage II endometrial carcinoma. Forty-two patients with pathologic stage II endometrial carcinoma were treated at the department of Radiation Oncology of the Medisch Spectrum Twente between 1987 and 1998. All patients received external radiotherapy following standard surgical procedures and no adjuvant systemic therapy was given. From the 42 patients 21 had a pathologic stage IIA and 21 stage IIB. The median follow-up was 62 months. The overall recurrence rate was 21.5% (9/42). Seven patients had distant metastasis, of which three also had locoregional recurrence, vaginal vault and/or pelvic. The presence of myometrial invasion (> (1/2)) and/or lymph-angioinvasion showed a significant relation with distant metastasis (P = 0.017). Stage IIB showed more recurrences, 33% (7/21). There was a significant different 5-year disease specific survival for stage IIA and IIB, respectively, 95% and 74% (P = 0.0311). Patients with a differentiation grade 3 and stage IIB showed a significantly poorer (P = 0.003) 5-year survival of 48.6% (P = 0.003). Results obtained in the present series of patients are in accordance with the literature. The present treatment policy seems justified, except for patients with pathologic stage IIB and grade 3, in which a more aggressive treatment should be considered.

  1. Surgical and conservative treatment of patients with congenital scoliosis: α search for long-term results

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    Weiss Hans-Rudolf

    2011-06-01

    Full Text Available Abstract Background In view of the limited data available on the conservative treatment of patients with congenital scoliosis (CS, early surgery is suggested in mild cases with formation failures. Patients with segmentation failures will not benefit from conservative treatment. The purpose of this review is to identify the mid- or long-term results of spinal fusion surgery in patients with congenital scoliosis. Methods Retrospective and prospective studies were included, reporting on the outcome of surgery in patients with congenital scoliosis. Studies concerning a small numbers of cases treated conservatively were included too. We analyzed mid-term (5 to 7 years and long-term results (7 years or more, both as regards the maintenance of the correction of scoliosis and the safety of instrumentation, the early and late complications of surgery and their effect on quality of life. Results A small number of studies of surgically treated patients were found, contained follow-up periods of 4-6 years that in the most cases, skeletal maturity was not yet reached, and few with follow-up of 36-44 years. The results of bracing in children with congenital scoliosis, mainly in cases with failure of formation, were also studied. Discussion Spinal surgery in patients with congenital scoliosis is regarded in short as a safe procedure and should be performed. On the other hand, early and late complications are also described, concerning not only intraoperative and immediate postoperative problems, but also the safety and efficacy of the spinal instrumentation and the possibility of developing neurological disorders and the long-term effect these may have on both lung function and the quality of life of children. Conclusions Few cases indicate the long-term results of surgical techniques, in the natural progression of scoliosis. Similarly, few cases have been reported on the influence of conservative treatment. In conclusion, patients with segmentation failures

  2. Surgical and conservative treatment of patients with congenital scoliosis: α search for long-term results

    Science.gov (United States)

    2011-01-01

    Background In view of the limited data available on the conservative treatment of patients with congenital scoliosis (CS), early surgery is suggested in mild cases with formation failures. Patients with segmentation failures will not benefit from conservative treatment. The purpose of this review is to identify the mid- or long-term results of spinal fusion surgery in patients with congenital scoliosis. Methods Retrospective and prospective studies were included, reporting on the outcome of surgery in patients with congenital scoliosis. Studies concerning a small numbers of cases treated conservatively were included too. We analyzed mid-term (5 to 7 years) and long-term results (7 years or more), both as regards the maintenance of the correction of scoliosis and the safety of instrumentation, the early and late complications of surgery and their effect on quality of life. Results A small number of studies of surgically treated patients were found, contained follow-up periods of 4-6 years that in the most cases, skeletal maturity was not yet reached, and few with follow-up of 36-44 years. The results of bracing in children with congenital scoliosis, mainly in cases with failure of formation, were also studied. Discussion Spinal surgery in patients with congenital scoliosis is regarded in short as a safe procedure and should be performed. On the other hand, early and late complications are also described, concerning not only intraoperative and immediate postoperative problems, but also the safety and efficacy of the spinal instrumentation and the possibility of developing neurological disorders and the long-term effect these may have on both lung function and the quality of life of children. Conclusions Few cases indicate the long-term results of surgical techniques, in the natural progression of scoliosis. Similarly, few cases have been reported on the influence of conservative treatment. In conclusion, patients with segmentation failures should be treated

  3. Changes in somatic disease incidents during opioid maintenance treatment: results from a Norwegian cohort study

    Science.gov (United States)

    Brekke, Mette; Gossop, Michael; Lindbaek, Morten; Reinertsen, Even; Thoresen, Magne; Waal, Helge

    2011-01-01

    Objectives To examine the effect of opioid maintenance treatment (OMT) on somatic morbidity in a cohort of OMT patients. Design Retrospective cohort study. Setting OMT programme in two Norwegian counties. Participants 200 OMT patients, participation rate 71.2%. Main outcome measures Incidence rates (IR) before, during and after OMT for acute/subacute hospital-treated somatic disease incidents (drug-related, non-drug-related, injuries) and rates for inpatient days and outpatient treatment contacts. Results IR for drug-related hospital treatment episodes were 76% lower during compared to before OMT (before versus during incidence rate ratio (IRR) 4.2 (95% CI 2.9 to 6.2), pOMT (after versus during IRR 11.1 (6.6 to 18.5), pOMT (before versus during IRR 0.7 (0.6 to 1.0), p=0.02) and 32% higher after compared to during OMT (IRR 1.4 (0.9 to 2.2), p=0.15), while injuries showed little change according to OMT status. Although patients with on-going drug-taking during OMT showed less reduction in drug-related hospital-treated incidents during treatment than patients not using illicit drugs, the quartile with most drug-taking showed a significant reduction (before versus during IRR 3.6 (2.4 to 5.3)). Patients who had experienced cessation of OMT showed a significant reduction in drug-related treatment episodes during OMT (before versus during IRR 1.7 (1.0 to 2.9)), although less than patients without OMT interruptions (before versus during IRR 6.1 (3.6 to 10.6)), and a significant increase after OMT cessation compared with during OMT (IRR 5.4 (3.0 to 9.7)). Conclusion Acute/subacute drug-related somatic morbidity is reduced during compared to before OMT. This was also found for patients with on-going drug-taking during OMT. However, acute drug-related health problems show an increase after OMT cessation, and this is a matter of concern. Further studies on somatic morbidity after OMT cessation should be carried out. PMID:22021771

  4. Results of surgical treatment of cervical cancer patients of childbearing age

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    V. S. Navruzova

    2015-01-01

    Full Text Available The world marked increase in the incidence of cervical cancer in young women, especially from 29 to 45 years old. Analysis showed that in patients with preserved ovarian function, not only the effectiveness of the treatment, but also the quality of life. It is associated with the acceleration, earlier puberty and the onset of sexual activity. In recent years more and more widely used radical surgery with preservation of the ovaries and the abduction of the radiation castration and preservation of reproductive function. In the National Cancer Research Centre of the Ministry of Health of the Republic of Uzbekistan analyzed the results of surgical treatment of 204 patients with cervical cancer younger. Age of patients from 23 to 45 years, that is, in the most hard-working, reproductive period. In our study patients met principally with exophytic – 82 (40.2 % and 68 (33.3 % еndophytic growth cervical tumors. Histological in 197 (96.6 % patients with squamous cervical cancer patients with 7 (3.4%. Adenocarcinoma of cervical cancer. Handard examination of the patient are further adapted to determine the level of sex hormones (estradiol, progesterone, determination of the tumor marter CA-125 levels of calcium and phosphate in the blood. 112 patients from the main group and the combined complex therapy surgical treatment with organ-component (conservation and ovarian transposition. The first group included 112 (55.1 % patients, who as part of combination therapy was performed and complex surgical treatment of ovarian transposition. The second group included 92 (44.9% patients who as part of combination therapy and complex surgery performed without ovarian transposition. Each group was divided into 3 subgroup included patients with stage process T1b–2aN0M0. Which performs the combined radiotherapy. The second subgroups included patients with stage process that runs systemic chemotherapy, surgery, combined radiotherapy. The third group included

  5. [CRITERIA OF ESTIMATION AND RESULTS OF TREATMENT OF IATROGENIC INJURIES OF URETERS IN ONCOLOGICAL PATIENTS].

    Science.gov (United States)

    Kononenko, O A; Stakhovskiy, E O; Vukalovych, P S; Voylenko, O A; Stakhovskiy, O E; Vitruk, Yu V; Chepurnatiy, M V

    2015-11-01

    Clinical analysis was conducted in 74 oncological patients, in whom 103 iatrogenic injuries of ureter (IIU) were revealed and for which they were treated in Scientific-nvestigative Department of Plastic and Reconstructive Oncourology. Restoration of renal and ureteric function were noted in terms up to 6 mo, in these terms were revealed all complications, caused by recurrence of obstruction. Late follow-up results of III were positive in 95.2% patients, unsatisfactory result was revealed in 3 (4.8%) patients, what have demanded conduction of surgical secondary correction of urodynamics. Quality of life after restoration operative treatment have improved in 31.70%patients in comparison of such before the operation.

  6. RESULTS OF TREATMENT OF ACUTE LUMBAR DISC HERNIATION WITH TRANSFORAMINAL NERVE ROOT BLOCK

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    EMILIANO NEVES VIALLE

    Full Text Available ABSTRACT Objective: To determine the efficacy of anesthetic transforaminal nerve root block in patients with sciatica secondary to lumbar disc herniation through a prospective observational study. Methods: The study included 176 patients from a private clinic undergoing transforaminal injection performed by a single spinal surgeon. The patients were assessed after two weeks, three months and six months regarding to the improvement of the pain radiating to the lower limbs. In case of persistent symptoms, patients could choose to perform a new nerve root block and maintenance of physical therapy or be submitted to conventional microdiscectomy. Results: By the end of six-month follow-up of the 176 patients, 116 had a favorable outcome (95 after one block and 21 after two blocks, and only 43 required surgery. Conclusion: The results of our study suggest a positive effect of transforaminal block for the treatment of sciatica in patients with lumbar disc herniation.

  7. Radiological assessment of surgical treatment results in children and adolescents with pectus excavatum: medium-term results of 75 cases

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    Sh.K. Khakimov

    2014-09-01

    Full Text Available Objective — Minimally invasive repair of pectus excavatum (PE has been established as the preferred technique for the repair of PE. Modified techniques of repair based on D. Nuss method for PE are promoted to improve the safety of the procedures. Purpose of this work was to analyzing the operative results with accounting of the toracometric parameters of pectus excavatum in children and adolescents. Methods — Toracometric parameters were the followings, as: sternum rotation, cardiac and pulmonary vein rotation angles, Haller and asymmetry indices in children and adolescents with PE. 48 (64% patients are operated by D. Nuss procedure and 27 (36% with modifications, due to severity of diagnostic parameters, which were exhibited the significance difference between pre- and postoperative indices, mainly, in patients who has a severe degree changes preoperatively. Results — The sternum rotation degree (in 75 patients was decreased till 0.4±0.02° (P=0.01, whereas was 20.7±0.46° preoperatively (P=0.001. Preoperatively, the mean of cardiac rotation angle significantly reduced, preoperative was 56.0±2.9° (P=0.001 (in 75 patients and after operative intervention made up 47.0±2.7° (P=0.001. Haller index also is decreased till 2.3±0.2, whereas was 3.9±0.2 preoperatively (P=0.002. The angle of the pulmonary vein rotation was preoperatively 51.0±3.4° (P=0.001 and after operation was increased till 53.0±1.8° (P=0.01. Conclusions — It has necessity apply the computer tomography investigation in patients with PE deformity. Also, it cannot miss the stage of the sterno-costal complex strength, its pliability and the gravity of the sternum rotation, which may lead to raise the share of good and excellent results.

  8. A prospective study of reversible dementias: Frequency, causes, clinical profile and results of treatment

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    Srikanth S

    2005-01-01

    Full Text Available Background: Dementia due to potentially reversible etiologies is an important group of dementias to be identified not only because of the number of such Patients encountered but also due to the potential for substantial improvement with treatment. Aims : To prospectively investigate the frequency and causes of dementias with potentially reversible etiologies; to examine the clinical features of this subgroup with a view to identifying a signature profile and to determine if this potential reversibility translates into actual reversibility with appropriate treatment. Setting and design : A prospective longitudinal study of patients with dementia presenting to the outpatient services of a tertiary referral hospital. Methods : All Patients above 40 years referred for evaluation of cognitive complaints were serially enrolled and underwent clinical examination, various laboratory tests and neuroimaging. Patients were followed-up for one year. Statistical analysis : One way analysis of variance for continuous variables followed by post hoc comparisons using Scheffe′s procedure. Results: A total of 129 patients met Diagnostic and Statistical Manual of Mental Disorders edition 4 (DSM IV criteria for dementia and qualified for inclusion into the study. Twenty-four patients (18%, all with moderately severe cognitive [mean mini mental state examination (MMSE score ± SD = 17.9 ± 4.8] and neuropsychiatric [mean neuropsychiatric inventory (NPI score ± SD = 30.7 ± 8.7] dysfunction were diagnosed to have reversible causes - neuroinfections in 11 patients, normal pressure hydrocephalus in 8 patients and vitamin B12 deficiency in 5 patients. The majority of these patients had gait and urinary dysfunction reminiscent of subcortical dementias. These reversible causes were clinically suspected in only 58% of patients. In 20/24 patients in whom follow up was possible mean MMSE score had improved to 22.2 and mean NPI score had improved to 8.0, following 6 months

  9. H02 WETLAND TREATMENT SYSTEM WATER CHEMISTRY SAMPLING AND RESULTS REPORT

    Energy Technology Data Exchange (ETDEWEB)

    Bach, M; Michael Serrato, M; Eric Nelson, E

    2008-02-15

    inorganic chemistry influence on pH. In addition, alternative methods to alleviate or mitigate the pH increase were evaluated. This study documents the results of sampling activities undertaken and conveys the analytical results along with suggestions for operation of the H-02 Wetland Treatment System. The water samples collected and the water quality data generated from this activity are for analytical purposes only, and as such, were not collected in support of compliance activities.

  10. Oncological results after surgical treatment of squamous cell cancer of the lateral wall of the oropharynx.

    Science.gov (United States)

    Díaz-Molina, Juan P; Rodrigo, Juan P; Alvarez-Marcos, Cesar; Llorente, José L; Costales, María; Suárez, Carlos

    2011-07-01

    The gold standard of treatment of cancer of the lateral wall of the oropharynx continues to be unclear, especially in advanced stages. In this study, we report our experience with surgical treatment of these cancers and describe the functional and oncological results of the procedures. Retrospective review. A total of 155 previously untreated patients with squamous cell carcinoma of the lateral wall of the oropharynx who underwent a surgical resection of the lesion at our department from January 1990 to January 2008 were included. Sixty-seven percent of these patients received postoperative radiotherapy. The records of these patients were reviewed to obtain measures such as local and regional control, disease-specific survival, and speech and swallowing function. Six patients had a stage I disease, 15 had a stage II disease, 31 had a stage III disease, 86 had a stage IVA, and 17 had stage IVB disease. The overall recurrence rate was 60%, and the local recurrence rate was 40%. The 5-year overall survival and disease-specific survival rates were 33% and 43%, respectively. Five-year disease-specific survival rates by stage were as follows: 100%, 59%, 57%, 31%, and 33% for stages I to IVB, respectively. Multivariate analysis showed two parameters that were independent predictors of a reduced disease-specific survival: cervical lymph node metastases pN2-3 (P = .027) and primary tumor classified as pT3-4 (P = .029). In 122 patients, a tracheotomy was performed, and it couldn't be sealed in 23% of them. Oral alimentation was successfully recovered in 93% of the patients. Surgical treatment of cancer of the lateral wall of the oropharynx provides acceptable oncological and functional results, especially in early and moderately advanced stages (stages I-III). In advanced stages (stage IV), we obtained good functional preservation rates but poor oncological outcomes. Consequently, these groups of patients could be considered for another treatment modality, such as

  11. Impact of smear microscopy results and observed therapy on tuberculosis treatment in Mombasa, Kenya.

    Science.gov (United States)

    Arentz, M; Narita, M; Sangaré, L; Kah, J F; Low, D; Mandaliya, K; Amukoye, E; Sitienei, J; Walson, J L

    2011-12-01

    Tuberculosis (TB) treatment center at Coast Provincial General Hospital in Mombasa, Kenya. To describe TB management practices in a facility in coastal Kenya and identify factors associated with poor treatment outcomes. Retrospective review of patient treatment records from January 2008 to June 2009. Treatment outcomes of patients were classified as treatment success (cure or treatment completion) or poor treatment outcome (treatment failure, death or default). Relative risk regression was used to determine the association between exposures of interest and poor treatment outcomes. Records were obtained from a total of 183 patients: 142 (78%) had pulmonary TB, 68 (37%) were human immunodeficiency virus (HIV) infected and 81 (44%) had acid-fast bacilli (AFB) positive smear micros- copy. Most treated individuals (86%) achieved a successful treatment outcome as defined by the World Health Organization. Of those with poor treatment outcomes, 64% defaulted, 32% died, and 4% failed treatment. Initial negative AFB smear and HIV co-infection were associated with poor treatment outcomes (RR 3.32, 95%CI 1.22-8.99 and RR 4.61, 95%CI 1.69- 12.59, respectively). Strategies to accelerate accurate diagnosis of smear-negative TB and increase patient retention during treatment, especially in HIV co-infected individuals, are needed to reduce poor treatment outcomes in Kenya.

  12. Treatment of intracranial aneurysms by flow diverter devices: Long-term results from a single center

    Energy Technology Data Exchange (ETDEWEB)

    Briganti, Francesco, E-mail: frabriga@unina.it [Unit of Interventional Neuroradiology, Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Napoli, Manuela, E-mail: napoli.manuela@gmail.com [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Leone, Giuseppe, E-mail: g.leonemd@gmail.com [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Marseglia, Mariano, E-mail: mariano-marseglia@libero.it [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Mariniello, Giuseppe, E-mail: giuseppe.mariniello@unina.it [Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Caranci, Ferdinando, E-mail: ferdinando.caranci@unina.it [Department of Advanced Biomedical Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy); Tortora, Fabio, E-mail: fabiotor@libero.it [Chair of Neuroradiology, “Magrassi Lanzara” Clinical-Surgical Department, Second University of Naples, Viale Colli Aminei 21, 80131 Naples (Italy); Maiuri, Francesco, E-mail: frmaiuri@unina.it [Division of Neurosurgery, Department of Neurosciences, Reproductive and Odontostomatological Sciences, “Federico II” University, Via S.Pansini 5., 80131 Naples (Italy)

    2014-09-15

    Highlights: • We report the long-term results (2–4 years) with Flow Diverter Devices (FDD) from a single-center. • We recommend the use of FDD for large-neck aneurysms of the ICA syphon. • We think that more sophisticate FDD will reduce the incidence of technical adverse events. - Abstract: Objectives: Flow-Diverter Devices (FDD) are a new generation stents designed for the treatment of the intracranial aneurysms. This article reports the long-term results (2–4 years) of this treatment from a single-center. Methods: From November 2008 to January 2012, 35 patients (29 females and 6 males; mean age 53.9 y) with 39 intracranial aneurysms were treated by FDD. Five patients (14.3%) had ruptured aneurysms and 30 (8